Correlação entre tempo para o tratamento cirúrgico e mortalidade em pacientes idosos com fratura da extremidade proximal do fêmur Correlation between time until surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur

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Gustavo Gonçalves Arliani

2011-04-01

Full Text Available OBJETIVO: O objetivo primário do estudo é analisar a possível associação entre o atraso para a realização do tratamento cirúrgico e mortalidade em pacientes idosos com fratura da extremidade proximal do fêmur. MÉTODOS: Foram estudados 269 pacientes com fraturas da extremidade proximal do fêmur (fraturas do colo do fêmur e fraturas intertrocanterianas, tratadas cirurgicamente no Hospital São Paulo - Unifesp-SP, no período de janeiro de 2003 a dezembro de 2007. Foram analisados e comparados com a literatura referente ao assunto os seguintes atributos: sexo, idade, tipo de fratura, classificação da mesma, lado acometido, síntese utilizada, mecanismo de trauma, tempo de internação, tempo para cirurgia, comorbidades associadas, hemograma de entrada, tipo de anestesia, necessidade de transfusão sanguínea, dia da semana e estação do ano da fratura. RESULTADOS: O estudo apresentou correlação entre maior número de comorbidades clínicas, maior tempo de internação e utilização de anestesia geral na cirurgia com maior mortalidade dos pacientes. CONCLUSÃO: Não houve associação entre tempo para realização da cirurgia e mortalidade.OBJECTIVE: The primary aim of this study was to analyze the possible association between delay in receiving surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur. METHODS: 269 patients with fractures at the proximal end of the femur (femur neck and intertrochanteric fractures who were treated surgically at Hospital São Paulo, UNIFESP, São Paulo, between January 2003 and December 2007, were studied. Sex, age, type of fracture, classification of the fracture, affected side, synthesis used, trauma mechanism, length of hospitalization, length of surgery, associated comorbidities, hemogram at admission, type of anesthesia, need for blood transfusion, day of the week and season of the year of the fracture were analyzed and compared with the literature

LA TERAPIA CELULAR EN EL TRATAMIENTO DE LA ISQUEMIA CRÍTICA DE EXTREMIDADES INFERIORES

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Gallardo Y

2006-07-01

Full Text Available ABSTRACT:Critical limb ischaemia is the final phase of the peripheral arterial disease. The treatment consists of the revascularización, but sometimes, the medical treatment is the only therapeutic option before the amputation. The cellular therapy allows the possibility of dealing with diseases with the use alive cells. This paper is a review about the utilization of adult staminal cells in patients with critical limb ischaemia.RESUMENLa isquemia crítica de la extremidad es la fase final de la enfermedad arterial periférica. El tratamiento consiste en la revascularización, pero en ocasiones, el tratamiento médico es la única opción terapéutica antes de la amputación. La terapia celular permite la posibilidad de tratar enfermedades con el uso de células vivas. En este artículo se efectúa una revisión del uso de células madre adultas en pacientes con isquemia crítica de la extremidad.

Tratamento dos desarranjos da articulação radio-ulnal distal pela técnica de Sauvé-Kapandji. Resultados preliminares Treatment of the distal radioulnar articulation disorders by the Sauvé-Kapandji technique

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Nilton Mazzer

2001-03-01

Full Text Available Foi realizado um estudo retrospectivo de 10 casos de desarranjo da articulação radio-ulnal distal tratados pela técnica de Sauvé-Kapandji. Os desarranjos eram resultantes de trauma (7, degeneração (2 e doença congênita (1 e as principais queixas pré-operatórias eram a dor, limitação da prono-supinação e deformidade. A idade média dos pacientes na época da operação era de 37,8 anos. Os pacientes foram submetidos a avaliação clínico-funcional e radiografica com um seguimento pós-operatório médio de 28,3 meses, particular atenção tendo sido dada a uma incidência radiográfica anteroposterior sob esforço de preensão manual. Todos os pacientes obtiveram melhora de suas queixas e o resultado final foi considerado satisfatório (excelente e bom em 8, e insatisfatório (regular 2. A artrodese da articulação radio-ulnal consolidou em 9 casos, independentemente do tipo de fixação empregado. O exame radiográfico sob esforço mostrou que todos os pacientes apresentavam deslocamento radial da ulna, mas isso aparentemente não interferiu com a função. Concluiu-se que a técnica de Sauvé-Kapandji é eficiente para o tratamento dos desarranjos da articulação radio-ulnal distal, pois ela não implica em perda funcional importante.A retrospective study of 10 cases of derrangement of the distal radioulnar joint treated with the technique of Sauvé-Kapandji was carried out. Derrangements resulted from trauma (7, degeneration (2 and congenital disease (1 and the main preoperative complaints were pain, limitation of pronation and supination and deformity. The patients' average age by the time of the operation was 37.8 years (range: 19 - 68 years. All were submitted to clinical, functional and radiographic evaluation at 28.3 months after the operation on average, particular attention being paid to an anteroposterior X-ray view with the hand in a moderate hand grip effort. All patients improved from their complaints and the final

Influência da vinculação em modelos numéricos de vigas mistas de aço e concreto em situação de incêndio

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R. Rigobello

Full Text Available Neste trabalho é discutida a influência da condição de vinculação de extremidade de vigas mistas de aço e concreto, sobre alvenaria, em situação de incêndio. O perfil de aço da viga é formado a frio, com seção transversal do tipo caixão. São consideradas situações de engastamento e rótula ideal para as extremidades da viga de interesse, em modelos numéricos elaborados por meio do código computacional ANSYS. Inicialmente, são realizadas análises numéricas de caráter térmico para a determinação do campo de temperaturas no perfil de aço e na laje, quando submetidos ao incêndio-padrão ISO 834. Em seguida, efetua-se o acoplamento termoestrutural para avaliação do desempenho do elemento em tempera- turas elevadas. Por fim, são apresentadas comparações de interesse entre situações de extremidades da viga considerando-as engastadas e rotuladas, bem como são determinados os redutores do esforço resistente em resposta ao tempo de exposição ao fogo.

Correlação entre a densidade mineral óssea e níveis séricos de cálcio, fósforo e fosfatase alcalina total em gatos após tirotoxicose experimental

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Fabiano Séllos Costa

2009-04-01

Full Text Available O hipertiroidismo é caracterizado por concentrações séricas excessivas dos hormônios tiroidianos, podendo causar efeitos sobre o tecido ósseo em humanos e animais. Para melhor caracterização dos efeitos da tirotoxicose no metabolismo ósseo, 16 gatos foram induzidos ao estado hipertiroideo. Os resultados demonstraram que, em alguns momentos experimentais, uma maior desmineralização óssea da extremidade distal do rádio promoveu elevação dos níveis séricos de fósforo e fosfatase alcalina total.

Avaliação eletromiográfica de músculos da cintura escapular e braço durante a realização de exercícios com extremidade fixa e carga axial Electromyographic assessment of scapular girdle and arm muscles during exercises with fixed boundary and axial load

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Daniel Pereira Cardoso de Brum

2008-10-01

Full Text Available O objetivo deste estudo foi comparar a atividade eletromiográfica de músculos da cintura escapular e braço entre os exercícios wall-press 90°, wall-press 45°, bench-press e push-up, realizados com a extremidade distal do segmento fixa sobre uma superfície estável e em esforço isométrico máximo. Participaram desta pesquisa 20 voluntários do sexo masculino, sedentários e sem história de trauma ou doenças na extremidade superior. A atividade elétrica da cabeça longa do músculo bíceps braquial, da porção anterior do músculo deltóide, da porção clavicular do músculo peitoral maior e do músculo serrátil anterior foi registrada por eletromiografia de superfície. O teste modelo estatístico ANOVA e o teste post-hoc de Tukey foram utilizados para determinar diferenças entre os valores de RMS de cada músculo e em cada exercício, normalizados pela contração isométrica voluntária máxima. Os resultados do presente estudo demonstram que o músculo bíceps braquial apresentou a menor atividade eletromiográfica em comparação com os demais músculos avaliados em todos os exercícios, enquanto a porção anterior do músculo deltóide e o serrátil anterior mostraram maior atividade eletromiográfica em relação aos demais músculos nos exercícios bench-press e push-up. Esses achados demonstram que não houve semelhança na atividade eletromiográfica dos músculos avaliados durante os exercícios, porém, houve coativação muscular, visto que os exercícios ativaram todos os músculos, mesmo que em diferentes níveis. Os exercícios estudados não são indicados para ativar o músculo bíceps braquial, mas os exercícios bench-press e push-up o são para ativar a porção anterior do músculo deltóide e o serrátil anterior; o wall-press 90° e o wall-press 45° são indicados para ativar a porção anterior do músculo trapézio.The objective of this study was to compare the electromyography activity of scapular and

Fratura extra-articular da extremidade medial da clavícula associada à luxação acromioclavicular tipo IV: relato de caso Extra-articular fracture of the medial end of the clavicle associated with type IV acromioclavicular dislocation: case report

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Mário Chaves Correa

2011-10-01

Full Text Available Ocorrendo isoladamente, as fraturas da clavícula e as luxações acromioclaviculares são lesões muito comuns. A combinação de uma luxação acromioclavicular e de uma fratura do terço lateral da clavícula não é rara. Entretanto, existem muito poucos casos descritos de luxações acromioclaviculares associadas a fraturas do terço médio da clavícula; aquelas associadas a fraturas do terço medial são ainda mais raras. Nós reportamos o caso de um indivíduo adulto do sexo masculino que sofreu uma luxação acromioclavicular (tipo IV associada a uma fratura extra-articular desviada da extremidade medial da clavícula (grupo 3 de Almann em um acidente ciclístico. O paciente foi tratado na fase aguda com redução aberta e fixação interna das duas lesões. Na avaliação clínica, 12 meses após a cirurgia, o paciente apresentava-se assintomático, com mobilidade ativa e passiva completa, força e resistência normais e simetria das cinturas escapulares. As radiografias e a tomografia computadorizada tridimensional mostravam subluxação posterossuperior persistente da articulação acromioclavicular e consolidação anatômica da fratura clavicular.Fractures of the clavicle and acromioclavicular dislocations are very common injuries when they occur separately. The combination of an acromioclavicular dislocation and a fracture of the lateral third of the clavicle is not rare. However, there are very few reported cases of acromioclavicular dislocations associated with fractures of the middle third of the clavicle; those associated with fractures of the medial third are even rarer. We report the case of an adult male who suffered an acromioclavicular dislocation (type IV associated with a displaced extra-articular fracture of the medial end of the clavicle (Almann group 3 in a cycling accident. The patient was treated during the acute phase with open reduction and internal fixation of the two lesions. At the clinical evaluation 12

Geología de la extremidad oriental de la zona sudportuguesa

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Simancas Cabrera, José Fernando

2013-01-01

Se ha efectuado un estudio de geología regional en la extremidad oriental de la zona Sudportuguesa estableciéndose nuevas unidades litoestratigráficas en los materiales del devonico superior y carbonífero inferior y en la cuenca del Viar. Se han estudiado los caracteres mineralógicos y geoquímicos del vulcanismo pretectónico del plutonismo sin-postectónico y del vulcanismo tardiherciano y se han establecido las deformaciones de plegamiento y la existencia de una notable cizalla frágil tardía ...

Tratamento da doença de Meige com droga agonista de receptores GABA

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Luiz Augusto Franco de Andrade

1985-09-01

Full Text Available A doença de Meige é distúrbio de movimento que consiste no aparecimento espontâneo de blefarospasmo associado a movimentos distônicos de musculatura orofacial. Associadamene podem ser encontrados torcicolo espasmódico, disfonia espástica e distonia de extremidades. Várias hipóteses foram formuladas para explicar esse distúrbio, tendo em vista a resposta a drogas com ação conhecida nos sistemas de neurotransmissores do cérebro. Algumas evidências apontam para um estado de preponderância dopaminérgica e, nesse sentido, justifica-se a estimulação da atividade GABA, sabendo-se que esse neurotrans-missor age sobre uma das alças de controle da produção de dopamina na substância negra. Por essa razão investigamos a ação de um agonista GABA, o baclofen, sobre a doença de Meige. Foram incluídos no protocolo 5 pacientes, 4 mulheres e um homem, com idade variando entre 50 e 63 anos e duração da doença variando entre 4 meses e 18 anos. Todos apresentavam blefaros-pasmo-distonia orofacial e, além disso três apresentavam disfonia espástica e um distonia de extremidades. A droga era iniciada em dose de 20mg/dia, aumentada em lOmg a cada três dias até ser obtida resposta ou surgirem efeitos colaterais. Um dos pacientes apresentou melhora marcada do blefaros-pasmo-distonia orofacial e outro melhora moderada dos mesmos sintomas, em avaliação 30 dias após estabilização da dose. Não houve melhora da disfonia espástica e ocorreu melhora moderada da distonia de extremidades. Não podemos afirmar que a melhora observada ao fim de um mês se mantenha, ou mesmo que melhora mais significativa fosse observada em avaliação feita mais tardiamente. Concluimos que o baclofen pode ser útil, pelo menos por algum tempo, na doença de Meige.

Evaluación de la fuerza explosiva de extensión de las extremidades inferiores en escolares

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Francisco José López Gallego

2016-01-01

Full Text Available Objetivo. El objetivo de esta investigación es evaluar la capacidad de fuerza explosiva de extensión de extremidades inferiores en escolares de educación primaria y analizar las diferencias que puedan existir tanto en capacidad de fuerza explosiva de extremidades inferiores como en composición corporal en función del sexo. Material y métodos. En este estudio han participado 90 estudiantes (54 niños y 36 niñas de educación primaria de un centro educativo urbano de la provincia de Jaén. La media de la edad de los sujetos es de 11,1 ± 0,7 años. Se ha realizado la valoración de la composición corporal y la evaluación de la capacidad de fuerza explosiva de extremidades inferiores mediante salto vertical. La evaluación de la composición corporal se llevó a cabo mediante la plataforma INBODY 230 (Microkaya, Spain. Para medir las variables de los saltos se utiliz ó una plataforma de fuerzas Quattro Jump (Kistler, Suiza y se realizaron los test de salto CMJ y ABK. Resultados y conclusiones. Los resultados obtenidos en las variables de los test de salto por los participantes se encuentran entre los valores de referencia para sujetos de su edad. Las chicas poseen mayores picos de potencia y de fuerza que los chicos, mientras que estos poseen mayores alturas de vuelo en los saltos. En la impedancia los chicos obtienen mayores porcentajes de músculo y las chicas mayor masa y mayores porcentajes de grasa.

Avaliação da espessura do esmalte proximal em segundos pré-molares superiores humanos e sua correlação com o diâmetro mésio-distal = Thickness valuation of adjacent enamel in second superior human pre molar teeth an their relationship with mesio distal diameter

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Fischer, Luís Henrique

2006-01-01

Full Text Available A determinação da espessura do esmalte proximal à altura do ponto de contato é de grande importância, visto que o desgaste desta região dental é freqüentemente utilizado na clínica ortodôntica com a finalidade de correção de discrepâncias dentais e estabilidade do tratamento. Com o intuito de determinar os valores do diâmetro mésio-distal e aferir os valores médios da espessura do esmalte nas faces proximais à altura do ponto de contato, foram avaliados 42 segundos pré-molares superiores. Os diâmetros mésio-distais foram mensurados com auxílio de um paquímetro digital, em seguida foram incluídos em resina e seccionados obtendo-se uma lâmina central de 0,7 mm de espessura, possibilitando a medição da espessura do esmalte em um perfilômetro de precisão milesimal. Com base nos dados obtidos, também foram analisadas as possíveis correlações entre a espessura do esmalte nas faces proximais e o diâmetro mésio-distal. Os resultados indicaram que o valor médio do diâmetro mésio-distal é de 6,85 mm para o segundo pré-molar superior e com espessura media do esmalte de 1,101 mm na mesial e 1,157 mm na distal. De acordo com os testes de Spearman e Pearson foram encontradas correlações estatisticamente significantes no lado direito entre a espessura do esmalte na face mesial e o diâmetro mésio-distal, entre a espessura na face distal e o diâmetro mésiodistal. No lado esquerdo foram encontradas correlações positivas entre a espessura do esmalte distal e o diâmetro mésio-distal. Em ambos os lados houve correlações estatisticamente significantes entre a espessura do esmalte mesial e a espessura do esmalte distal. Independente do lado, a espessura média do esmalte é maior na face distal que na mesial

Síndrome de Moebius associada a artrogripose: relato de caso e revisão da literatura

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Moreira,Ana Tereza Ramos; Teixeira,Sueli; Ruthes,Hilton Iran; Miranda,André Basso; Guerra,Daniel Roncaglio

2001-01-01

Os autores descrevem um caso de síndrome de Moebius associada a artogripose múltipla congênita, uma situação rara, sem relatos prévios na literatura latino-americana. A síndrome de Moebius é caracterizada por paralisia dos VII e VI pares cranianos, geralmente associada a outras anomalias ósseas e musculares, mais freqüentemente localizadas na parte distal das extremidades. A artrogripose múltipla congênita consiste de um grupo heterogêneo de alterações, sendo caracterizada por extrema rigidez...

LA TERAPIA CELULAR EN EL TRATAMIENTO DE LA ISQUEMIA CRÍTICA DE EXTREMIDADES INFERIORES

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Gallardo Y; Hermida G; Fonseca Legrand JL; Cuevas-Ruiz B

2006-01-01

ABSTRACT:Critical limb ischaemia is the final phase of the peripheral arterial disease. The treatment consists of the revascularización, but sometimes, the medical treatment is the only therapeutic option before the amputation. The cellular therapy allows the possibility of dealing with diseases with the use alive cells. This paper is a review about the utilization of adult staminal cells in patients with critical limb ischaemia.RESUMENLa isquemia crítica de la extremidad es la fase final de ...

FRACTURAS EN EXTREMIDADES "Cuando se convierten en un reto diagnòstico"

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Luis Gabriel Pèrez Amador

2013-05-01

Full Text Available El trauma en extremidades es un evento que se presenta a diario en los servicios de urgencias que en la mayoría de ocasiones es de fácil diagnostico imagenológico solo con la radiología convencional. La persistencia del dolor osteomuscular, sin mejoría con el manejo médico, es la situación que lleva a consultar de nuevo al médico para explorar su causa. Pacientes con dolor que incapacita o que persistente deben ser estudiados con otros métodos imagenológicos para descartar lesiones ocultas a los rayos X.

Enfrentamiento quirúrgigo en la reconstrucción funcional de la extremidad superior, en pacientes terapléjicos

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Dr. B. Manuel Méndez

2014-03-01

Full Text Available Los pacientes con lesión medular, hoy no tienen tratamiento, y cuando tienen lesiones altas (tetraplejia, quedan expuestos a una gran inhabilidad de función de sus extremidades superiores. Recuperar la funcionalidad de estas, aparece como una de las más grandes demandas de estos pacientes. Varias han sido las propuestas quirúrgicas en el tiempo para devolver la función de la extremidad superior. Actualmente, se privilegia hacer, en un acto quirúrgico, la reanimación de la función de pinza de la mano, la que se ve potenciada en forma significativa, si hay una buena función de la flexión y extensión del codo. De no existir extensión de codo, ésta debe ser reconstruida también. Las mediciones de los resultados se centran en evaluar la satisfacción y desempeño de actividades, que son identificadas por los pacientes como prioritarias. Nuestra experiencia de tres años en Teletón Santiago, nos muestran resultados alentadores con esta propuesta de tratamiento.

Compreendendo o trabalho da costureira: um enfoque para a postura sentada

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Dagmar Ambrosi

Full Text Available As trabalhadoras da indústria de confecção, principalmente no setor de costura, desenvolvem suas tarefas na postura sentada e a operação de máquinas de costura requer o uso repetitivo e coordenado do tronco, extremidades superiores e inferiores das operárias que trabalham em postura sentada prolongada. Visando verificar os desconfortos presentes no desenvolvimento do trabalho da costureira, foi realizada uma análise ergonômica em uma indústria da confecção na cidade de Santo André, Brasil. O estudo contou com observação da realização do trabalho real, aplicação de um questionário a fim de colher dados sobre o perfil dos trabalhadoras, conhecer suas relações de trabalho e sua situação de saúde.

Quem chega com velocidade maior?

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Francisco Catelli

2009-01-01

Full Text Available http://dx.doi.org/10.5007/2175-7941.2008v25n3p546 Apoiando uma das extremidades de uma haste no chão, e deixando- a cair, junto com uma esfera, colocada inicialmente a uma altura igual à extremidade livre da haste, quem chega com velocidade maior ao solo: a extremidade livre da haste ou a esfera? Neste trabalho são apresentadas diversas soluções, em níveis crescentes de complexidade. Conclui-se que questões como essa podem propiciar o desenvolvimento de atividades investigativas no ambiente da sala de aula e, eventualmente, despertar em alguns estudantes vocações para a carreira tecnológica.

Fratura segmentar da clavícula Segmental clavicle fracture

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Evander Azevedo Grossi

2011-01-01

Full Text Available O objetivo deste trabalho é apresentar um caso incomum de fratura segmentar da clavícula associada a fratura de arco costal ipsilateral. Apesar da clavícula ser muito superficial, podem ocorrer casos despercebidos das duas fraturas, pois geralmente estes pacientes sofrem politraumatismos. É descrito o caso de um paciente que apresentou fratura da diáfise e da extremidade lateral da clavícula que foi operado e obtido excelente resultado. Casos semelhantes foram revistos na literatura e discutida a conduta.The aim here was to present an unusual case of segmental clavicle fracture associated with ipsilateral rib fracture. Although the clavicle is very superficial, undetected cases of both types of fracture may occur, because these patients usually suffer multiple trauma. The case of a patient with a fracture of the diaphysis and lateral extremity of the clavicle is described: the patient was treated surgically and an excellent result was achieved. Similar cases in the literature are reviewed and their management is discussed.

Avaliação das metaloproteinases de matriz -2 e -9 em gatos com desmineralização óssea secundária à tirotoxicose induzida Evaluation of matrix metalloproteinases -2 and -9 in cats under bone demineralization secondary to induced thyrotoxicosis

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F.S. Costa

2008-10-01

Full Text Available Observou-se significativo aumento de atividade das formas ativas das metaloproteinases -2 e -9 em gatos com tirotoxicose induzida e desmineralização óssea. As formas pró e intermediária da metaloproteinase -2 elevaram-se com 14 dias de administração hormonal, porém, posteriormente, houve uma tendência de queda. Observou-se correlação negativa entre a forma ativa das metaloproteinases de matriz -2 e -9 e a densidade mineral óssea da extremidade distal do rádio. Os resultados sugerem aumento da degradação da matriz colágena secundária com a elevação dos hormônios tiroidianos.Significant increase of activity of active forms of matrix metalloproteinases -2 and -9 in cats under induced thyrotoxicosis and bone demineralization was observed. Pro and intermediated forms of matrix metalloproteinases -2 and -9 increased at 14 days of hormonal treatment, followed by decrease tendency. A negative correlation between active forms of matrix metalloproteinases -2 and -9 and bone mineral density of radius distal extremity was also observed. The results suggest an increase of collagen matrix degradation secondary to high levels of thyroid hormones.

A novel model of distal colon cancer in athymic mice Novo modelo de câncer de cólon distal em camundongos atímicos

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Denise Gonçalves Priolli

2012-06-01

Full Text Available PURPOSE: The present a novel adenocarcinoma model in athymic mice. METHODS: Seven athymic mice were used. Colon diversion and distal fistula were made. Adenocarcinoma cells were inoculated in the submucosa of fistula. Tumor growth was monitored daily. Scintigraphy with 99mTc-MIBI was performed to identify the tumor. RESULTS: The model of distal colon cancer is feasible. Tumor detection was possible by both, macroscopically and molecular imaging. All resections demonstrated poorly differentiated tumors. Colon obstruction occurred in one case, similarly to evolution in human tumors of distal colon. CONCLUSION: The proposed model of distal colon cancer is feasible, allows for easy monitoring of tumoral growth by both, macroscopically and molecular imaging, and is suitable for studying the evolution of tumor with implementation of cytotoxic therapy in vivo.OBJETIVO: Apresentar novo modelo de adenocarcinoma distal em camundongos atímicos. MÉTODOS: Foram utilizados sete camundongos atímicos. Desvio do cólon distal e fístula foram feitas. Células de adenocarcinoma foram inoculadas na submucosa da fístula. O crescimento do tumor foi monitorado diariamente. Cintilografia com 99mTc-MIBI foi realizada para identificar o tumor. RESULTADOS: O modelo de câncer de cólon distal é viável. Detecção do tumor foi possível macroscopicamente e por imagem molecular. Todas as ressecções demonstraram tumores pouco diferenciados. Obstrução do cólon ocorreu em um caso, de forma semelhante à evolução em tumores humanos do cólon distal. CONCLUSÃO: O modelo de câncer do cólon distal proposto é viável, permite a monitorização fácil do crescimento tumoral macroscopicamente e por imagem molecular, sendo adequado para o estudo da evolução de tumor com aplicação de terapia citotóxica in vivo.

Absorção de anticorpos do colostro em bezerros: II. Estudo no intestino delgado distal Colostral antibodies absorption in calves: II. Distal small intestine

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Rosana Bessi

2002-11-01

Full Text Available Com o objetivo de estudar a morfologia e determinar a localização da enzima fosfatase ácida na região distal do intestino delgado de bezerros, do nascimento ao fechamento intestinal, foram coletadas amostras de 15 animais machos em três idades: ao nascer sem que houvesse a ingestão de colostro; três horas após a ingestão da primeira refeição de colostro e aos três dias de idade. Observou-se, ao nascimento, a presença de um grande vacúolo, que dominava todo o citoplasma das células epiteliais do jejuno distal e íleo. Após a ingestão de colostro, verificou-se o acúmulo de material absorvido nesses vacúolos. Foi detectada a reação de fosfatase ácida nas células absortivas de bezerros recém-nascidos, antes e após a ingestão de colostro. Aos três dias de idade, uma nova população de células geralmente não vacuoladas, com sistema endocítico apical reduzido, foi observada recobrindo as vilosidades intestinais. Portanto, em bezerros a maturação do epitélio absortivo do intestino delgado distal pode iniciar-se com o aumento da atividade enzimática nos vacúolos absortivos, culminando com a rápida substituição das células fetais por células diferenciadas não pinocíticas, o que determinaria o término da transferência de anticorpos maternos.The localization of acid phosphatase at distal small intestine and its morphology were studied f0rom birth to intestinal closure from fifteen male dairy calves aged: unsuckled neonatal, three hours after colostrum ingestion and three days old. At birth, the presence of a large vacuole was found and it expanded all over the epithelial cells cytoplasm at distal jejunum and ileum. For colostrum fed calves, ingested material could be observed in the vacuole. The phosphatase acid reaction was detected in the absorptive cells of suckled and unsuckled newborn calves. Calves aged three days old, a new population of non-vacuolated cells and reduced apical endocytic system were found

Experiencia en reconstrucción de tercio distal de pierna con colgajo libre de músculo gracilis

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A. Conejero

2013-09-01

Full Text Available En los defectos de cobertura distales de la pierna con exposición ósea o articular, la transferencia de tejidos libres es frecuentemente la única opción viable. Se utilizan en el rescate de extremidades inferiores en riesgo por trauma, infección, ulceración, quemaduras y tumores. El colgajo libre de músculo gracilis está descrito en la literatura como una excelente alternativa. El objetivo de este estudio es describir las características de los pacientes y resultados de la utilización del colgajo libre de músculo gracilis en la reconstrucción del tercio distal de la pierna. Se trata de un estudio retrospectivo, observacional, de revisión de archivo clínico y fotográfico de 7 pacientes operados por los autores entre los años 2007-2010, 4 hombres y 3 mujeres con un promedio de edad de 38,5 años. El defecto de cobertura que motivó la cirugía (de hasta de 20 x 6 cm fue secundario a fractura expuesta (tipo III de Gustilo y a osteomielitis crónica. La cobertura del colgajo se hizo en todos los casos con injerto dermo-epidérmico. No hubo complicaciones menores ni mayores del sitio donante ni del receptor, con resultados funcionales y estéticos satisfactorios. El colgajo libre de músculo gracilis es una muy buena alternativa para la reconstrucción distal de pierna con defectos de cobertura en fracturas expuestas y osteomielitis o en úlceras crónicas. Tras el seguimiento, todos nuestros pacientes lograron una cobertura completa y estable en el tiempo.

Condiciones de trabajo relacionados con desórdenes musculoesqueléticos de la extremidad superior en residentes de odontología, Universidad El Bosque Bogotá, D.C. (Colombia

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Ana María Gutiérrez Strauss

2014-01-01

Full Text Available Objetivo: Examinar y describir las condiciones de trabajo dadas por la utilización prolongada de equipos e instrumental odontológico en estudiantes de postgrado y en docentes de cada especialidad. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal en estudiantes de posgrado y docentes de cada especialidad de la Facultad de Odontología. Se tomó el total de estudiantes matriculados en las siete especializaciones del programa de Odontología. La población estuvo conformada por 47 estudiantes y 22 docentes. Se adaptaron y aplicaron las guías del programa del Sistema de Vigilancia Epidemiológica para Desórdenes Musculoesqueléticos de la Extremidad Superior (DME-ES, la Guía de Priorización y la Guía Epidemiológica, Guía DEPARIS, Guía PME. Los datos fueron analizados con el programa STATA v9. Resultados: En los estudiantes se observó la mayor sintomatología en cuello (62% y hombros (47%. La especialidad de endodoncia es la que más presentó sintomatología en la extremidad superior, y la zona anatómica más destacada la mano (83.3 %. Las mujeres presentan mayor sintomatología en cuello (74.1 %, mientras que los hombres presenta mayor molestia en el resto de las zonas anatómicas de la extremidad superior, destacándose el hombro (62,5 %. Conclusión: Se adaptaron los instrumentos específicos y permitió conocer los riesgos de desórdenes musculoesquelético de la extremidad superior (DME-ES en la actividad laboral odontológica y realizar un material educativo para la promoción de la salud y prevención en riesgos profesionales en odontólogos.

Fratura extra-articular da extremidade medial da clavícula associada à luxação acromioclavicular tipo IV: relato de caso

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Correa, Mário Chaves; Gonçalves, Lucas Braga Jacques; Vilela, Jose Carlos Souza; Leonel, Igor Lima; Costa, Lincoln Paiva; Andrade, Ronaldo Percopi de

2011-01-01

Ocorrendo isoladamente, as fraturas da clavícula e as luxações acromioclaviculares são lesões muito comuns. A combinação de uma luxação acromioclavicular e de uma fratura do terço lateral da clavícula não é rara. Entretanto, existem muito poucos casos descritos de luxações acromioclaviculares associadas a fraturas do terço médio da clavícula; aquelas associadas a fraturas do terço medial são ainda mais raras. Nós reportamos o caso de um indivíduo adulto do sexo masculino que sofreu uma luxaçã...

Intersubjetividade ou Solipsismo? Aporias da Teoria do Agir Comunicativo de Jürgen Habermas

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João Paulo Bachur

Full Text Available RESUMO Este artigo argumenta que a intersubjetividade pretendida pela teoria do agir comunicativo é solapada pelo solipsismo monológico intrínseco às suas próprias premissas. O fio condutor do artigo é a reflexividade da linguagem (seção I. O problema da intersubjetividade surge na passagem da análise da esfera pública no século XVIII ao paradigma procedimental da democracia deliberativa (seção II. Entre essas extremidades institucionais, Habermas incrusta uma teoria anti-institucional da linguagem, apoiada na “situação ideal de fala” (seção III. A fim de assegurar o engajamento na busca pelo entendimento linguístico, os participantes em um discurso têm de agir de acordo com uma regra de sinceridade (seção IV, o que pressupõe um comprometimento moral prévio e, portanto, monológico, com a busca pelo consenso (seção V. Essas dificuldades comprometem o modelo deliberativo da democracia porque convertem o ideal da simetria discursiva no pressuposto empírico para a deliberação democrática (seção VI.

DISTAL MYOPATHIES

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Dimachkie, Mazen M.; Barohn, Richard J.

2014-01-01

Over a century ago, Gowers described two young patients in whom distal muscles weakness involved the hand, foot, sternocleidomastoid, and facial muscles in the other case the shoulder and distal leg musculature. Soon after, , similar distal myopathy cases were reported whereby the absence of sensory symptoms and of pathologic changes in the peripheral nerves and spinal cord at postmortem examination allowed differentiation from Charcot-Marie-Tooth disease. In 1951, Welander described autosomal dominant (AD) distal arm myopathy in a large Scandanavian cohort. Since then the number of well-characterized distal myopathies has continued to grow such that the distal myopathies have formed a clinically and genetically heterogeneous group of disorders. Affected kindred commonly manifest weakness that is limited to foot and toe muscles even in advanced stages of the disease, with variable mild proximal leg, distal arm, neck and laryngeal muscle involvement in selected individuals. An interesting consequence of the molecular characterization of the distal myopathies has been the recognition that mutation in a single gene can lead to more than one clinical disorder. For example, Myoshi myopathy (MM) and limb girdle muscular dystrophy (LGMD) type 2B are allelic disorders due to defects in the gene that encodes dysferlin. The six well described distal myopathy syndromes are shown in Table 1. Table 2 lists advances in our understanding of the myofibrillar myopathy group and Table 3 includes more recently delineated and less common distal myopathies. In the same manner, the first section of this review pertains to the more traditional six distal myopathies followed by discussion of the myofibrillar myopathies. In the third section, we review other clinically and genetically distinctive distal myopathy syndromes usually based upon single or smaller family cohorts. The fourth section considers other neuromuscular disorders that are important to recognize as they display prominent

Papel da lidocaína por via venosa no tratamento da dor na esclerodermia: relato de caso Papel de la lidocaína por vía venosa en el tratamiento del dolor en la esclerodermia: relato de un caso Intravenous lidocaine to treat scleroderma pain: case report

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Durval Campos Kraychete

2003-12-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: A esclerodermia ou esclerose sistêmica progressiva é uma doença sistêmica do tecido conjuntivo, de causa desconhecida, que costuma cursar com microangiopatia, isquemia de extremidades e dor intensa. O objetivo deste relato é descrever um caso do emprego de lidocaína por via venosa no tratamento da dor no curso de isquemia e enfatizar a possível ação antiinflamatória dos anestésicos locais nos pacientes com esclerodermia. RELATO DO CASO: Paciente do sexo feminino, 34 anos, auxiliar de enfermagem, portadora de esclerodermia há aproximadamente 8 anos, apresentava dor de elevada intensidade (escala numérica =10 nos membros superiores e inferiores, contínua, diária, acompanhada de alterações tróficas, da cor e da temperatura e pequenas úlceras nas extremidades. A paciente foi submetida a uma sessão semanal de lidocaína a 2% (400 mg sem vasoconstritor por via venosa durante 10 semanas com alívio da dor, do turgor, da elasticidade da pele e da perfusão periférica. CONCLUSÕES: O alívio da dor e de outros sintomas após a administração de lidocaína por via venosa sugere que os anestésicos locais podem modular a resposta inflamatória em vários estágios da esclerodermia.JUSTIFICATIVA Y OBJETIVOS: La esclerodermia o esclerosis sistémica progresiva es una enfermedad sistémica del tejido conjuntivo, de causa desconocida, que acostumbra acontecer con microangiopatía, isquemia de extremidades y dolor intenso. El objetivo de este relato es describir un caso del empleo de lidocaína por vía venosa en el tratamiento del dolor en el curso de isquemia y dar énfasis a una posible acción antiinflamatoria de los anestésicos locales en los pacientes con esclerodermia. RELATO DE CASO: Paciente del sexo femenino, 34 anos, auxiliar de enfermera, portadora de esclerodermia hace aproximadamente 8 años, presentaba dolor de elevada intensidad (escala numérica =10 en los miembros superiores e inferiores

Reabilitação das fraturas do rádio distal Rehabilitation of distal radius fractures

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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

Descrição histológica da via genital masculina e hermafrodita de escargots das espécies Achatina fulica e Achatina monochromatica

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Dulcinéa Gonçalves Teixeira

2008-12-01

Full Text Available O objetivo deste trabalho foi descrever a histologia da via genital masculina e hermafrodita dos escargots das espécies Achatina fulica e Achatina monochromatica. Foram usados 10 exemplares adultos de cada espécie para análise histológica. Após o processo seletivo, pesagem e tomada das medidas da concha, os espécimes foram sacrificados por congelamento em freezer, a -2ºC por aproximadamente 10min. Para a exposição dos órgãos reprodutores foi efetuada uma incisão longitudinal iniciada na extremidade cranial e, acompanhando a torção do corpo, até a extremidade caudal. Cada animal foi dissecado, sobre uma placa de Petri, sob imersão em formol a 10% para melhor preservação dos tecidos. Foram coletados fragmentos representativos de cada segmento do sistema reprodutor e observou-se que a estrutura histológica dos mesmos não apresentou diferenças notórias, com exceção do ovotestis do Achatina fulica, no qual se constatou um número maior de células pigmentadas no epitélio germinativo do que, nesse mesmo epitélio, no Achatina monochromatica.

A precisão experimental relacionada ao uso de bordaduras nas extremidades das fileiras em ensaios de milho The experimental precision related by using border plants at the ends of rows in corn trials

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Alberto Cargnelutti Filho

2003-08-01

Full Text Available Foram conduzidos quatro experimentos de competição de cultivares de milho, durante o ano agrícola de 2000/2001, e três no ano 2001/2002, na área experimental do Departamento de Fitotecnia da UFSM, Santa Maria, com o objetivo de verificar se o uso de bordadura nas extremidades das fileiras melhora a precisão experimental. Foi usado o delineamento em blocos ao acaso com três repetições, sendo os blocos espaçados entre si de um metro, e as parcelas constituídas por duas fileiras espaçadas de 0,8m com 5,0m de comprimento, com a área útil formada pelos quatro metros centrais. Para a variável rendimento de grãos de milho, procedeu-se a verificação das pressuposições do modelo, a análise da variância com teste F e a aplicação do teste Scott-Knott para as comparações entre as médias estimadas na área útil e na área total. A estatística diferença mínima significativa pelo teste de Tukey foi usada como principal indicador da precisão, cuja significância foi testada pelo teste F dos respectivos quadrados médios do erro. Todas as pressuposições do modelo matemático, nos sete experimentos, foram atendidas. Para o rendimento de grãos, o descarte dos resultados da bordadura nas extremidades das fileiras não altera a precisão experimental na comparação de cultivares.Seven experiments of corn cultivar competition were carried out to quantify the experimental precision improvement by evaluating border plants at the ends of rows of corn trials. The experiments were conducted during 2000 and 2001 grown seasons at the experimental area of the Fitotecnia Department, Federal University of Santa Maria, RS, Brazil. Each cultivar was replicated three times in plots of two rows of 5.0m separated by 0.80m following a randomized complete block design. The 0.5m of the ends of the same plot rows was considered as border plants and was separated evaluated. Data on grain yield of plot and total yield including border plants were used

Os jardins de Glaziou para a Quinta da Boa Vista, Rio de Janeiro / RJ

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Jeanne Trindade

2014-05-01

Full Text Available O projeto dos jardins da Quinta da Boa Vista foi apresentado ao Imperador D. Pedro II por Auguste François-Marie Glaziou em 1868 e as obras, efetivamente, iniciadas em 1872. Construídos para o deleite não só da família imperial, seus convidados e das pessoas que moravam no interior da propriedade, o acesso era aberto à população em geral aos domingos, talvez, numa tentativa de acalmar os ânimos revolucionários do povo, tal qual acontecera na Inglaterra nos séculos anteriores. Inspirado nos jardins paisagísticos franceses, aliado aos conhecimentos das matas nacionais, o projeto executado por Glaziou para a Quinta da Boa Vista produz grande impacto nos frequentadores devido aos contrastes proporcionados. A utilização maciça de vegetação arbórea — principalmente em suas extremidades — produz um distanciamento visual da cidade que pode promover uma evasão tanto da situação geográfica como de seus problemas, gerando uma sensação de conforto e bem-estar, característica de vários parques da época.

EDEMA HEMORRÁGICO AGUDO DA INFÂNCIA – CASO CLÍNICO

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Filipa Raposo

2016-07-01

Comentários: No caso clínico apresentado, a idade da criança, a associação a infecção das vias aéreas superiores, a distribuição e dimensões das lesões cutâneas, a apresentação aparatosa sem grande repercussão sobre o estado geral, a normalidade dos ECD e a curso auto-limitado sem sequelas, sugeriram o diagnóstico de EHAI. Os autores pretendem com este caso alertar para uma patologia rara, que deverá ser considerada como diagnóstico diferencial numa criança febril com exantema petequial/purpúrico e edemas das extremidades.

Correlação da espessura médio-intimal das carótidas primitivas proximal e distal

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Leonard Hermann Roelke

2013-09-01

Full Text Available FUNDAMENTO: O aumento da espessura do IMT (do inglês intima-media thickness das carótidas é utlizado como marcador precoce de aterosclerose e para avaliação do risco de eventos cardiovasculares. O ultrassom é utilizado na sua avaliação pela acessibilidade e baixo custo. São descritas medidas realizadas em diferentes regiões das carótidas. OBJETIVOS: Correlacionar o IMT nas regiões proximal e distal da carótida primitiva bilateral no intuito de orientar a sua utilização na prática clínica. MÉTODOS: O IMT foi medido nas porções proximais e distais da artéria carótida primitiva de 798 indivíduos (35-74 anos de ambos os sexos usando ultrassom de alta resolução. O coeficiente de correlação de Pearson foi usado para se estabelecer as associações. As análises foram feitas inicialmente para toda a amostra e nos subgrupos com IMT 0,90 mm em pelo menos um sítio de medida. A significância estatística foi considerada para p 0,90 mm, houve expressiva queda de correlações, que se situaram entre 0,20 e 0,40. CONCLUSÃO: Os dados sugerem que o espessamento médio-intimal é mais uniforme ao longo das carótidas em fases mais precoces do desenvolvimento e tende a adquirir desenvolvimento focal à medida que progride. Portanto, na avaliação clínica de pacientes, toda a extensão das carótidas comuns deve ser investigada bilateralmente para melhor utilizar os softwares disponíveis e concluir sobre a presença ou não de espessamento do complexo médio-intimal.

Diseño y desarrollo de una barra vibratoria: actividad neuromuscular durante el ejercicio con vibración de las extremidades superiores

OpenAIRE

Rodríguez Jiménez, Sergio

2015-01-01

[spa] El ejercicio con vibración (EJV) se ha convertido en la última década en una modalidad de ejercicio complementaria al entrenamiento. Las plataformas vibratorias son los dispositivos mas populares y practicos para transmitir la vibración por los pies a las extremidades inferiores mientras se realizan ejercicios estéticos y dinámicos. Otros tipos de dispositivos, tomo las mancuernas vibratorias y diversos sistemas de transmisión de la vibración por cable, se utilizan exclusivamente para t...

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.

Tratamento da pseudo-artrose do terço distal do rádio Treatment of nounion in the third distal of the radio

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Marco Aurélio Sertório Grecco

2005-01-01

Full Text Available Os autores apresentaram um estudo prospectivo de quatro pacientes portadores de pseudo-artrose no terço distal do rádio. Dois eram do sexo feminino e dois do masculino, com idade média de 42,5 anos. O diagnóstico de pseudo-artrose foi realizado em média com 5,3 meses após o trauma. Um paciente apresentava, como antecedente mórbido pessoal, epilepsia e osteoporose, outros dois relataram tabagismo e obesidade e o quarto, fratura exposta. O tratamento consistiu de osteossíntese interna e enxertia com osso autógeno. Todos foram submetidos à avaliação clínica pré e pós-operatória quanto à força de preensão palmar e arco de movimentos do punho. Houve 100% de consolidação das fraturas do terço distal do rádio em pseudo-artrose e retorno dos pacientes às atividades profissionais.The authors presented a prospective study of four patients presenting pseudarthrosis at the distal third of the radius. Two patients were females and two were males, aged between 29 and 51 years with a mean age of 42.5 year old. The diagnosis of pseudarthrosis was provided within an average of 5.3 months after trauma. One patient presented as personal morbid history, epilepsy and osteoporosis, two patients were smokers and obese, and the fourth had an open fracture. The treatment consisted of internal osteosynthesis and autogenous bone graft. All patients were submitted to pre- and post operative clinical evaluation for palmar holding force and movement arch of the wrist. 100% of the radius distal-third fractures in pseudarthrosis have been united, with all patients returning to their respective professional activities.

Mapeamento da safena interna com ecocolor Doppler no pré-operatório de cirurgia de revascularização mioc��rdica

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BARROS Fanilda Souto

1999-01-01

Full Text Available INTRODUÇÃO: O advento do ecocolor Doppler vascular tornou possível informar o estado anatômico e funcional da safena interna ao cirurgião cardiovascular, no pré-operatório da cirurgia de revascularização miocárdica, sem riscos para o paciente ou para o conduto venoso. O objetivo do estudo foi, juntamente com o cirurgião, avaliar a utilidade do mapeamento da safena interna no pré-operatório. CASUÍSTICA E MÉTODOS: Foram estudados, entre março de 1995 e maio de 1998, 208 extremidades inferiores de 104 pacientes selecionados para cirurgia de revascularização miocárdica. O critério utilizado para a seleção da safena foi a safena patente e o diâmetro maior ou igual a 3,0 mm, utilizando os aparelhos de ultra-sonografia ATL - HDI 3000 e Acuson-Sequóia 512. RESULTADOS: Dentre as 208 extremidades estudadas, 186 (89,4% das safenas preenchiam os critérios e a análise do cirurgião estava de acordo com a descrição do ecocolor Doppler. Dezessete (8,2% não preenchiam os critérios e, em 5 (2,4% ,o exame foi compatível com safenectomia radical. Das 17 safenas consideradas não apropriadas, 2 foram exploradas cirurgicamente, sendo a análise do cirurgião concordante com o ultra-som. CONCLUSÃO: Os autores concluem que o ecocolor Doppler, sendo um método diagnóstico não invasivo, pode ser útil no mapeamento da safena interna no pré-operatório de revascularização miocárdica devido à sua capacidade de identificar e selecionar com segurança o vaso a ser utilizado como conduto vascular, o que permite ao cirurgião cardíaco o planejamento cirúrgico.

Effects of constraint-induced movement therapy in children with hemiplegia: a single case experimental study Efeitos da terapia de restrição por movimento induzido em crianças com hemiplegia: desenho experimental de caso único

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Marina B. Brandão

2009-12-01

Full Text Available OBJECTIVE: To investigate the profile of changes in the use of the upper extremity in three children with hemiplegia submitted to an adapted protocol of constraint-induced movement therapy (CIMT. METHODS: A single-subject design (ABA was replicated in three children aged 8 to 11 years old. Baseline phases (A1 and (A2 and the intervention phase (B lasted 2 weeks each. During the intervention period, children wore a splint on the non-affected extremity for 10 hours a day and were submitted to 3 hours of therapy a day during 10 days. Training consisted of activities with the affected upper extremity, with gradually increasing complexity and verbal feedback. Hand function was classified according to the Manual Ability Classification System (MACS. Children were assessed four times every week with the Toddler Arm Use Test (TAUT and three adapted tasks from the Jebsen-Taylor Hand Function test (JTHF, and once a week with the Pediatric Motor Activity Log (PMAL and self-care scales of the Pediatric Evaluation of Disability Inventory (PEDI. Celeration Line, Two-Standard Deviation Band and visual analysis methods were used for data analyses. RESULTS: Significant improvements in the amount and quality of upper extremity use (PMAL, TAUT quality of use for children 2 and 3, and participation for child 1, as well as decreased time to complete JTHF tasks for children 2 and 3 were observed. No changes were observed in the PEDI self-care scales. CONCLUSION: CIMT effects were associated with improvements in manual dexterity, amount and quality of use of the affected upper extremity in children with hemiplegia.OBJETIVO: Investigar mudanças longitudinais no uso da extremidade superior em três crianças com hemiplegia submetidas a um protocolo adaptado de terapia de movimento induzido por restrição (CIMT. MÉTODOS: Um desenho experimental de caso único (ABA foi replicado em três crianças entre 8 e 11 anos de idade. Fases de baseline (A1 e (A2 e fase de

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.

Perfil histológico e inmunohistoquímico del desarrollo del mesenquima de la extremidad del embrión y feto

OpenAIRE

Gosálbez García, Javier

2016-01-01

El presente trabajo de tesis doctoral se centra en el estudio del mesémquima de la extremidad de embriones y fetos obtenidos de 50 muestras procedentes de abortos recogidas del archivo del Servicio de Anatomía Patológica del H.U.C.A. Tras la clasificación de las muestras según el tamaño y edad de gestación probable, el procesamiento de los tejidos se realizó según la técnica habitual de preparación de muestras para su estudio histológico con microscopio óptico. Las tinciones se realizaron ...

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

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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.

Corpo estranho intracardíaco: complicação da ventriculoauriculostomia

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Gilberto Machado de Almeida

1965-09-01

Full Text Available A ventriculoauriculostomia, apesar das complicações que pode determinar, continua a ser a técnica cirúrgica mais freqüentemente usada para o tratamento da hidrocefalia. Na literatura, existe referência a apenas três casos em que a extremidade inferior do sistema de derivação deslocou-se para o ventrículo direito. Nestes doentes o corpo estranho foi retirado ci-rùrgicamente. Apresentamos um caso operado segundo a técnica de Spitz-Holter, com embolização cardíaca pelo cateter jugular. O doente permanece há 22 meses com o corpo estranho no coração direito, porque a família não permitiu que fôsse realizada a cardiotomia.

Estudo radiográfico do posicionamento da falange distal e suas possíveis correlações com obesidade em equinos de patrulhamento da Polícia Militar do Estado de Minas Gerais

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V.F. Xavier

2014-06-01

Full Text Available Com o objetivo de se verificarem possíveis correlações entre a falange distal, o estojo córneo e a obesidade, 55 equinos de patrulhamento provenientes do Regimento de Cavalaria Alferes Tiradentes do Estado de Minas Gerais - RCAT tiveram seus dígitos torácicos radiografados. Posteriormente, os animais foram classificados quanto ao acúmulo de tecido adiposo regional por métodos subjetivos (escore corporal e escore de pescoço e objetivos (índice de massa corporal, circunferência do pescoço e determinação de espessura do tecido adiposo por meio de ultrassonografia na inserção da cauda e do abdômen. Na população estudada, o índice de massa corporal evidenciou que 52,6% dos equinos se encontravam acima do peso. A circunferência do pescoço a 50% de seu comprimento dorsal e a medida ultrassonográfica na inserção da cauda se mostraram os melhores métodos objetivos para quantificar o acúmulo de tecido adiposo. Foram identificadas particularidades radiográficas características da população estudada que diferem de parâmetros internacionais. Observaram-se correlações significantes entre sinais de obesidade e medidas radiográficas indicadoras de laminite, sugerindo associação entre essas duas condições na população estudada.

Avaliação da força de preensão e funcionalidade após fratura distal de rádio/Evaluation of strength and functionality after distal radius fracture

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Bruno Goto Kimura

2017-09-01

Full Text Available Esse estudo teve objetivo avaliar se existe diferença em relação a força de preensão e funcionalidade de pacientes com fratura distal de rádio em relação ao gênero e ao tipo de tratamento (conservador e cirúrgico. Os pacientes recrutados para este estudo foram divididos em dois grupos, grupo de homens (G1 e grupo de mulheres (G2. Todos os voluntários realizaram uma única avaliação da força de preensão palmar e a avaliação funcional pelos questionários Disability of the Arm, Shoulder and Hand (DASH e Patient Rated Wrist Evaluation (PRWE.Os valores de força de preensão foram significativamente (p<0,000 menores no grupo de mulheres 5,42 (±3,42 e no tratamento conservador 5,20 (±4,91 quando comparados aos homens 16,01 (±6,86 e ao tratamento cirúrgico 12,28 (±7,56. Enquanto que os valores de incapacidade, avaliados pelos questionários DASH e PRWE, foram maiores no grupo de mulheres e pacientes que realizaram tratamento conservador, porém não foram encontradas diferenças significativas. As fraturas distais de rádio se não reabilitadas precocemente podem comprometer a amplitude de movimento, a força muscular, a precisão, a destreza e controle dos movimentos. Neste caso, os questionários de funcionalidade são um parâmetro importante que refletem o desempenho do indivíduo durante a realização de atividades de vida diária, sendo que quanto pior os escores, pior o desempenho e autonomia desses pacientes. Nesse estudo, podemos concluir que o gênero e o tipo de tratamento influenciaram na diminuição da força de preensão e na maior incapacidade funcional na avaliação inicial após 45 dias da fratura. AbstractThis study had the objective of evaluating whether there is a difference in the grip strength and functionality of patients with distal radius fracture in relation to gender and type of treatment (conservative and surgical. The patients recruited for this study were divided into two groups, group of men (G1

ASPECTOS DA VARIAÇÃO AMBIENTAL EM UMA FLORESTA DE GALERIA EM ITUTINGA, MG, BRASIL

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Flavio Antonio Maës dos Santos

2003-09-01

Full Text Available Foi caracterizada a heterogeneidade ambiental em uma área de floresta de galeria (7,55 ha, em Itutinga, MG, Brasil, pelas variações das propriedades químicas e físicas do solo, da topografia e da abertura de dossel. As propriedades do solo e a topografia foram estudadas em 28 parcelas de 10 x 30 m utilizadas em um levantamento da comunidade arbóreo-arbustiva da área. Para a abertura do dossel utilizaram-se duas transecções de 50 m de largura, compostas por parcelas contíguas de 10 x 10 m, cruzando a floresta de lado a lado, perpendicularmente ao curso d’água. Fotos hemisféricas foram tomadas sobre estacas alternadas das extremidades das parcelas. Os dados de solo e topografia foram analisados por meio de uma PCA (Análise dos Componentes Principais e a abertura do dossel mediante gráficos de tendência e regressão linear. A variação mais importante em termos de solos e abertura do dossel se deu no sentido do distanciamento da borda da floresta e aproximação do curso d’água. Nesse sentido, a abertura do dossel diminuiu (b = -0,096; R2 = 0,34 e a umidade e acidez do solo aumentaram (Eixo 1 do PCA, autovalor = 9,713. Os maiores valores da abertura do dossel próximo à borda foram explicados pela entrada de luz lateral através da borda da floresta com o campo limpo circundante.

Avaliação do tratamento cirúrgico da doença de Dupuytren pela técnica da palma aberta modificada

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Thiago Almeida Guilhen

2014-01-01

Full Text Available Objetivo: avaliar o tratamento cirúrgico com o uso da técnica da palma aberta modificada para o tratamento das contraturas graves da doença de Dupuytren. Métodos: em quatro anos, foram submetidos ao tratamento cirúrgico 16 pacientes, que pertenciam aos estágios III e IV da classificação proposta por Tubiana et al. Foram feitas aferições do déficit de extensão das articulações metacarpofalangeanas e inferfalangeana proximal e distal nos períodos pré-operatório, pós-operatório (três meses e pós-operatório tardio (cinco a oito anos. Angulações maiores do que 30° nas articulações metacarpofalangeanas e 15° nas interfalangeanas proximais foram consideradas como recidiva cirúrgica. Resultados: obtivemos uma média de déficit de extensão de 6,3° ao nível da articulação metacarpofalangeana, 13,8° na interfalangeana proximal e 1,9° na interfalangeana distal. Conclusão: a técnica da palma aberta modificada é um método eficaz no tratamento cirúrgico das contraturas graves na doença de Dupuytren.

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.

Accuracy of chest radiography for positioning of the umbilical venous catheter

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Adriana F.M. Guimarães

2017-03-01

Full Text Available Objectives: To evaluate the accuracy of the simultaneous analysis of three radiographic anatomical landmarks – diaphragm, cardiac silhouette, and vertebral bodies – in determining the position of the umbilical venous catheter distal end using echocardiography as a reference standard. Methods: This was a cross-sectional, observational study, with the prospective inclusion of data from all neonates born in a public reference hospital, between April 2012 and September 2013, submitted to umbilical venous catheter insertion as part of their medical care. The position of the catheter distal end, determined by the simultaneous analysis of three radiographic anatomical landmarks, was compared with the anatomical position obtained by echocardiography; sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results: Of the 162 newborns assessed by echocardiography, only 44 (27.16% had the catheter in optimal position, in the thoracic portion of the inferior vena cava or at the junction of the inferior vena cava with the right atrium. The catheters were located in the left atrium and interatrial septum in 54 (33.33% newborns, in the right atrium in 26 (16.05%, intra-hepatic in 37 (22.84%, and intra-aortic in-one newborn (0.62%. The sensitivity, specificity and accuracy of the radiography to detect the catheter in the target area were 56%, 71%, and 67.28%, respectively. Conclusion: Anteroposterior radiography of the chest alone is not able to safely define the umbilical venous catheter position. Echocardiography allows direct visualization of the catheter tip in relation to vascular structures and, whenever possible, should be considered to identify the location of the umbilical venous catheter. Resumo: Objetivos: Avaliar a acurácia da análise simultânea dos três marcos anatômicos radiográficos – diafragma, silhueta cardíaca e corpos vertebrais, na determinação da posição da extremidade

[Distal clavicle fracture].

Science.gov (United States)

Seppel, G; Lenich, A; Imhoff, A B

2014-06-01

Reposition and fixation of unstable distal clavicle fractures with a low profile locking plate (Acumed, Hempshire, UK) in conjunction with a button/suture augmentation cerclage (DogBone/FibreTape, Arthrex, Naples, FL, USA). Unstable fractures of the distal clavicle (Jäger and Breitner IIA) in adults. Unstable fractures of the distal clavicle (Jäger and Breitner IV) in children. Distal clavicle fractures (Jäger and Breitner I, IIB or III) with marked dislocation, injury of nerves and vessels, or high functional demand. Patients in poor general condition. Fractures of the distal clavicle (Jäger and Breitner I, IIB or III) without marked dislocation or vertical instability. Local soft-tissue infection. Combination procedure: Initially the lateral part of the clavicle is exposed by a 4 cm skin incision. After reduction of the fracture, stabilization is performed with a low profile locking distal clavicle plate. Using a special guiding device, a transclavicular-transcoracoidal hole is drilled under arthroscopic view. Additional vertical stabilization is arthroscopically achieved by shuttling the DogBone/FibreTape cerclage from the lateral portal cranially through the clavicular plate. The two ends of the FibreTape cerclage are brought cranially via adjacent holes of the locking plate while the DogBone button is placed under the coracoid process. Thus, plate bridging is achieved. Finally reduction is performed and the cerclage is secured by surgical knotting. Use of an arm sling for 6 weeks. Due to the fact that the described technique is a relatively new procedure, long-term results are lacking. In the short term, patients postoperatively report high subjective satisfaction without persistent pain.

Anestesia para cesariana em gestante com hipoplasia de aorta distal: relato de caso Anestesia para cesárea en embarazada con hipoplasia de aorta distal: relato de caso Anesthesia for cesarean section on a pregnant woman with hypoplasia of the distal aorta: case report

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Leonardo de Andrade Reis

2008-02-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Anomalias vasculares maternas, potencialmente graves para o feto, podem colocar em risco a perfusão uterina, suscitando cuidados ainda maiores por parte da equipe anestésica. O objetivo deste relato foi mostrar a conduta anestésica para operação cesariana em uma gestante com hipoplasia de aorta distal, logo abaixo da emergência das artérias renais, com estenose da artéria renal e ausência de artérias ilíacas. RELATO DO CASO: Paciente de 30 anos, 54 kg, na segunda gestação com uma cesariana anterior sem intercorrências. Durante a realização de ecografia gestacional na 12ª semana observou-se interrupção da aorta logo abaixo da saída das artérias renais. A paciente foi encaminhada para a realização de cineangiocoronariografia que mostrou hipoplasia da aorta distal abaixo das artérias renais, com ausência das artérias ilíacas. Durante a investigação clínica a paciente mostrou-se assintomática, com exceção de hipertensão arterial e claudicação aos grandes esforços. A paciente foi submetida à anestesia peridural contínua, com titulação da dose anestésica necessária à realização da cesariana. Inicialmente foram injetados 50 mg de bupivacaína a 0,5% sem vasoconstritor e 10 µg de sufentanil. Quinze minutos após, a anestesia foi complementada com mais 25 mg de bupivacaína a 0,5%, o que foi suficiente para atingir adequado nível de bloqueio. A cesariana transcorreu sem intercorrências e a criança nasceu em boas condições clínicas. CONCLUSÕES: O uso de anestesia peridural contínua com doses fracionadas demonstrou ser uma técnica anestésica segura para a realização desse procedimento por reduzir os riscos de hipotensão arterial materna inerente ao bloqueio espinal e também por minimizar a transferência placentária de fármacos, que ocorrem quando do emprego da anestesia geral. A titulação de fármacos através do cateter peridural possibilitou atingir nível anest

Morphology of beak and tongue of partrigde Rhynchotus rufescens Morfologia do bico e da língua de perdizes Rhynchotus rufescens

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Juliana Regina Rossi

2005-10-01

Full Text Available Twenty adult partridges Rhynchotus rufescens were used to study the morphology of the beak and the tongue. Lengths of the beak and of the tongue were evaluated, and histologic sections of the tongue were stained routinely with hematoxylin-eosin (HE, periodic acid-Schiff (PAS and Masson’s trichrome stain, later analyzed and described. The beak of the partridge of both sexes are curved, flat, hard and with a sharp extremity, with mean length of 4.90cm for the females and 4,80 for the males. The tongue is characterized by a triangular format with mean length of 1cm for both sexes, and its extremity is presented as a sharp format. Organization of the tongue tissue presents a stratified squamous epithelium with filiform papillae in all surface, mucous glands with ducts that project to the epithelium surface and a hyaline cartilage in the whole length of the tongue, which lays on the skeletal musculature that is guided in several directions.Vinte perdizes Rhynchotus rufescens foram utilizadas para estudar a morfologia do bico e da língua. Os comprimentos do bico e da língua foram avaliados, e secções histológicas foram coradas com Hematoxilina-Eosina (HE, ácido periódico de Schiff (PAS e tricromo de Masson, posteriormente analisadas e descritas. O bico da perdiz em ambos os sexos são curvos, duros e com uma extremidade pontiaguda tendo em média de 4,90cm de comprimento para as fêmeas e 4,80 para os machos. A língua é caracterizada por um formato triangular e possui em média 1cm de comprimento para ambos os sexos, sendo sua extremidade pontiaguda. A organização histológica da língua apresenta epitélio estratificado queratinizado com papilas filiformes em toda a superfície, glândulas mucosas com ductos que se projetam na superfície epitelial e cartilagem hialina em todo o comprimento, localizada sobre a musculatura esquelética, a qual é orientada em várias direções.

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

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.

Derivação ventriculoperitoneal com válvula no tratamento da hidrocefalia infantil

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José Jorge Facure

1972-03-01

Full Text Available Uma série de 95 crianças hidrocefálicas foram submetidas à derivação ventriculoperitoneal (DVP com válvula no período de dezembro de 1965 a novembro de 1969. Os resultados obtidos são analisados e comparados com os obtidos mediante derivação ventriculoatrial (DVA. Das crianças operadas, 54 estão vivas e com a hidrocefalia compensada, 9 faleceram, não sendo possível estabelecer as condições atuais das 32 restantes. Com a derivação para o peritônio foram evitadas as severas complicações vasculares e cardiopulmonares observadas com a derivação para a cvidade cardíaca. O número de revisões cirúrgicas é menor nos pacientes submetidos à DVP com válvula. Além disso, as infecções no sistema de drenagem ventriculoperitoneal provocam quadros menos graves e de mais fácil solução, que os observados na derivação ventriculoatrial. A análise das condições pré-operatórias, das complicações e dos resultados finais permitiram algumas conclusões: 1 o uso de válvula unidirecional, no sistema de derivação ventriculoperitoneal, dificulta a oclusão da extremidade distal do sistema de drenagem; 2 pode-se esperar bons resultados, sem necessidade de revisão cirúrgica, em cêrca de 42,35% das crianças hidrocefálicas submetidas à DVP com válvula; 3 as derivações ventriculoperitoneais com válvula, quando comparadas às derivações ventriculoatriais, considerando um grupo de crianças hidrocefálicas operadas nos mesmos Serviços, em condições semelhantes, com mesmo tempo de seguimento — foram as que proporcionaram melhores resultados; 4 os casos estudados permitem constatar, portanto, que a DVP com válvula, constitui atualmente a terapêutica cirúrgica mais apropriada da hidrocefalia infantil.

Optimización de la Energía Consumida por las Extremidades de un Robot Caminante

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Calderón López Hugo Enrique

2015-07-01

Full Text Available Resumen: Se presenta un método de optimización multi-objetivo, aplicado al funcionamiento de las cadenas cinemáticas abiertas, analizando el caso del movimiento de una extremidad de un robot caminante electro-hidráulico. Para demostrar la efectividad del método propuesto, se aplica en dos casos de estudio. El primer caso muestra el movimiento de la extremidad sin obstáculos en su espacio de trabajo, y en el segundo se incluye la evasión de un obstáculo. Se usan como criterios de optimización, la minimización del desplazamiento angular de los eslabones con mayor consumo de energía y la minimización del valor absoluto máximo de la aceleración angular de los eslabones. En ambos casos se determinó una trayectoria que disminuye el consumo de energía en más de un 25% respecto de otros métodos planteados en la literatura, a la vez que se mejora el comportamiento dinámico del sistema evitando variaciones en la velocidad y la aceleración durante la fase de trasferencia, además de aumentar la precisión y exactitud de la posición del pie. Abstract: It presents a method of multi-objective optimization, applied to energy consumption of open kinematic chains, analyzing the case of the movement of an extremity of a walking electro- hydraulic robot. To demonstrate the effectiveness of the proposed method, it is applied in two cases of displacement. The first case shows the movement of the extremity without obstacles in its workspace and the second includes the evasion of an obstacle. The minimization of angular displacement of the links with higher energy consumption and the minimization of the maximum absolute value of the angular acceleration of the links are used as optimization criteria. In both cases a trajectory that reduces energy consumption by more than 25% over the other methods proposed in the literature, at the same time the dynamic behavior of the system by avoiding variations in the speed and the acceleration is improved

Emprego experimental da placa de compósito poli-hidroxibutirado/hidroxiapatita na fixação femoral em gatos

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E.G.L. Alves

2010-10-01

Full Text Available Avaliou-se o compósito de poli-hidroxibutirado (PHB 70% e hidroxiapatita (HA 30% na forma de placas para fixação óssea em gatos. Foram usadas placas do compósito com 60mm de comprimento por 10mm de largura e espessura variando de 3mm no centro a 5mm nas extremidades, com seis orifícios. A placa do compósito foi empregada na fixação de osteotomia de fêmur em quatro gatos, totalizando seis intervenções. Verificou-se a ruptura de cinco placas (83,3% até o quarto dia e de uma placa (16,7% aos 21 dias, quando se observou um calo ósseo exuberante. O resultado da implantação da placa no gato mostrou que o compósito não possui resistência suficiente para ser empregado como placas de fixação de fêmur em gatos.

Edema agudo hemorrágico da infância: relato de três casos Acute hemorrhagic edema of infancy: report of three cases

OpenAIRE

Paulo Sergio Emerich; Patricia Almeida Prebianchi; Luciene Lage da Motta; Elton Almeida Lucas; Leonardo Mello Ferreira

2011-01-01

O Edema Agudo Hemorrágico da Infância é uma vasculite leucocitoclástica pouco frequente, que ocorre, quase exclusivamente, em crianças entre 4 meses e 2 anos de idade. Caracteriza-se, clinicamente, pela tríade febre, lesões purpúricas na face, pavilhões auriculares e extremidades e edema. Embora os achados cutâneos sejam dramáticos e de surgimento rápido, o prognóstico é favorável, com resolução espontânea dentro de 1 a 3 semanas. Descrevem-se três casos cujos achados clínicos e histopatológi...

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

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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.

Distal protection in cardiovascular medicine: current status.

Science.gov (United States)

Ali, Onn Akbar; Bhindi, Ravinay; McMahon, Aisling C; Brieger, David; Kritharides, Leonard; Lowe, Harry C

2006-08-01

Iatrogenic and spontaneous downstream microembolization of atheromatous material is increasingly recognized as a source of cardiovascular morbidity and mortality. Devising ways of reducing this distal embolization using a variety of mechanical means--distal protection--is currently under intense and diverse investigation. This review therefore summarizes the present status of distal protection. It examines the problem of distal embolization, describes the available distal protection devices, reviews those areas of cardiovascular medicine where distal protection devices are being investigated, and discusses potential future developments.

[New anterolateral approach of distal femur for treatment of distal femoral fractures].

Science.gov (United States)

Zhang, Bin; Dai, Min; Zou, Fan; Luo, Song; Li, Binhua; Qiu, Ping; Nie, Tao

2013-11-01

To assess the effectiveness of the new anterolateral approach of the distal femur for the treatment of distal femoral fractures. Between July 2007 and December 2009, 58 patients with distal femoral fractures were treated by new anterolateral approach of the distal femur in 28 patients (new approach group) and by conventional approach in 30 patients (conventional approach group). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, disease duration, complication, or preoperative intervention (P > 0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization days, and Hospital for Special Surgery (HSS) score of knee were recorded. Operation was successfully completed in all patients of 2 groups, and healing of incision by first intention was obtained; no vascular and nerves injuries occurred. The operation time and intraoperative fluoroscopy frequency of new approach group were significantly less than those of conventional approach group (P 0.05). All patients were followed up 12-36 months (mean, 19.8 months). Bone union was shown on X-ray films; the fracture healing time was (12.62 +/- 2.34) weeks in the new approach group and was (13.78 +/- 1.94) weeks in the conventional approach group, showing no significant difference (t=2.78, P=0.10). The knee HSS score at last follow-up was 94.4 +/- 4.2 in the new approach group, and was 89.2 +/- 6.0 in the conventional approach group, showing significant difference between 2 groups (t=3.85, P=0.00). New anterolateral approach of the distal femur for distal femoral fractures has the advantages of exposure plenitude, minimal tissue trauma, and early function rehabilitation training so as to enhance the function recovery of knee joint.

Aspectos epidemiológicos das lesões no pé e tornozelo do paciente diabético Epidemiological aspects of foot and ankle injury in the diabetic patient

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Ricardo Cardenuto Ferreira

2010-01-01

Full Text Available OBJETIVO: Identificar o perfil epidemiológico dos pacientes que procuram tratamento ortopédico das complicações nos pés e tornozelos relacionadas ao diabetes, além de correlacionar à sequência de eventos que culminam na amputação da extremidade. MÉTODO: analisamos os dados de prontuário de 300 pacientes no período compreendido entre março de 1997 a julho de 2006. RESULTADOS: A média de idade foi 61 anos, destes, duzentos e setenta e três pacientes (91% apresentavam diagnóstico de diabetes do tipo II, onde somente 49 (16,3% faziam controle regular da glicemia. Quatrocentos e cinco extremidades apresentavam problemas afetando a função do pé ou tornozelo, detacando-se: 102 extremidades (34% com lesões osteoarticulares relacionadas a neuroartropatia de Charcot; 181 extremidades (60,4% com ulceração crônica e 97 extremidades (32,4% com infecção. Após tempo médio de seguimento 14 pacientes (4,6% foram a óbito. CONCLUSÃO: A ulceração na planta dos pés foi a complicação mais frequente na nossa série de pacientes que, estavam na sétima década de vida, apresentavam diabetes do tipo II, faziam uso irregular de insulina e não realizavam controle adequado da glicemia. A perda da sensibilidade protetora nos pés, em associação com deformidade pré-existente, foi identificada como a principal causa das infecções secundárias culminando com a amputação da extremidade.OBJECTIVE: To identify the epidemiological profile of patients undergoing orthopedic treatment for complications of the feet and ankles due to diabetes, and to try to establish the sequence of events that led to amputation of the limb. METHOD: The medical records of 300 diabetic patients treated from March, 1997 to July, 2006 were systematically reviewed. RESULTS: The mean age of the patients was 61 years. Of these, two hundred and seventy three (91% were diagnosed with type II diabetes, but only 49 (16.3% had proper medical supervision and control of

Estudo morfoanatômico preliminar do caule e da folha de Acanthospermum australe (Loefl. Kuntze (Asteraceae-Heliantheae

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Lúcia R. Rocha Martins

Full Text Available Descrições morfoanatômicas preliminares do caule e da folha de Acanthospermum australe (Loefl. Kuntze foram realizadas a partir de material vegetal fresco e fixado. Secções transversais e paradérmicas, coradas com safranina/azul de astra e azul de toluidina foram analisadas ao microscópio. As superfícies do caule e da folha foram observadas através de microscopia eletrônica de varredura. A. australe apresenta, tanto no caule quanto na folha, tricomas tectores pluricelulares, unisseriados e de extremidades afiladas, e glandulares discóides, com pedúnculo curto unicelular, no qual se prendem cinco séries de células. A folha é anfiestomática e os estômatos são do tipo anomocítico, levemente proeminentes em relação ao nível das demais células epidérmicas. O caule apresenta crescimento secundário inicial, destacando-se os ductos secretores no parênquima cortical e medular.

PREDICCION DE LA ALTURA DE SALTO VERTICAL. IMPORTANCIA DEL IMPULSO MECÁNICO Y DE LA MASA MUSCULAR DE LAS EXTREMIDADES INFERIORES

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C. Ferragut

2010-09-01

Full Text Available

RESUMEN

El objetivo de este estudio ha sido determinar si es posible predecir la altura de vuelo en el salto vertical a partir de variables cinemáticas, dinamométricas y antropométricas, mediante un modelo de regresión múltiple lineal. Participaron en el estudio 53 sujetos, 21 hombres jugadores de voleibol de categorías nacionales (División de Honor y Primera División y 9 mujeres jugadoras de voleibol de División de Honor, así como 23 estudiantes de Educación Física, de los cuales 12 eran hombres y 11 mujeres. Inicialmente se determinó la altura de vuelo en saltos efectuados sin contramovimiento o "squat jumps" (SJ y en saltos precedidos por un contramovimiento o "countermovement jumps" (CMJ. Además, se determinó la fuerza isométrica máxima (FIM en posición de semisentadillla, con las rodillas flexionadas a 90º, 120º y 140º , simultáneamente se tomaron medidas de la actividad electromiográfica del vasto externo del cuádriceps. La masa muscular de las extremidades inferiores se midió mediante absociometría fotónica dual de rayos X (DEXA. El impulso positivo explicó por sí solo un 77% de la variabilidad en altura de vuelo. La variable anterior combinada con el porcentaje de masa corporal representado por la masa muscular de las extremidades inferiores permitió explicar un 82% de la variabilidad de la altura de vuelo en el CMJ. Al añadir a la ecuación anterior la masa muscular de las extremidades inferiores se pudo explicar un 98% de la variabilidad en altura de vuelo. En los saltos sin contramovimiento, también fue posible explicar un porcentaje similar de la variabilidad de la altura de vuelo utilizando las mismas variables.
PALABRAS CLAVE: Salto vertical, DEXA, masa muscular, fuerza

ABSTRACT

Aneurisma da artéria isquiática persistente: relato de caso de tratamento endovascular

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Dominique Rodas Costa

2018-03-01

Full Text Available Resumo A persistência da artéria isquiática é uma anomalia vascular congênita rara cuja principal complicação é a dilatação aneurismática. O quadro clínico pode incluir sintomas decorrentes da dilatação arterial e da isquemia, causada por trombose ou embolização distal. O tratamento dessa afecção rara conta com opções diversas que abrangem desde a ligadura do aneurisma até a correção endovascular. O presente relato descreve o caso de uma paciente do sexo feminino com queixa de tumoração pulsátil na região glútea. Foi encaminhada ao serviço de referência e realizou angiotomografia, que evidenciou persistência completa da artéria isquiática bilateralmente, com dilatação aneurismática à esquerda. A paciente foi submetida a tratamento endovascular do aneurisma, através de punção contralateral, com implante de dois stents revestidos com manutenção da perviedade distal da artéria. A manutenção da perviedade é particularmente importante nos casos da forma completa dessa variação anatômica. A paciente cursou com boa evolução.

Influência da Velocidade de Rotação do Rebite na Microestrutura e no Desempenho Mecânico de Juntas de Compósito Termofixo Rebitadas por Fricção

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Natascha Zocoller Borba

2016-03-01

Full Text Available Resumo A Rebitagem por Fricção tem se demonstrado como alternativa para união de perfis de compósito termofixo aplicados na construção civil, frente às necessidades atuais por tecnologias eficientes de união de estruturas multimateriais. Nesse processo, a extremidade de um rebite metálico é plastificada e forjada dentro de um componente polimérico, via calor friccional. Sua viabilidade técnica já foi demonstrada para juntas de Ti-6Al-4V/poliéster termofixo reforçado com fibra de vidro. Este artigo tem como objetivo complementar esse estudo através da análise do efeito da velocidade de rotação do rebite na temperatura do processo, microestrutura e propriedades mecânicas locais e globais das juntas. Foram fabricadas juntas com dois níveis de velocidade de rotação: 9000 rpm e 10000 rpm (os demais parâmetros foram mantidos constantes. Temperaturas do processo (655-765 °C superiores em 96% da temperatura de início de decomposição da matriz de poliéster (370 °C foram atingidas, desencadeando degradação polimérica acentuada na região de união. O aumento da velocidade de rotação e, portanto, do aporte térmico, não contribuiu estatisticamente para o aumento na profundidade de penetração e na largura da extremidade deformada do rebite. Porém, a extensão da área polimérica degradada aumentou em 47%, a qual resultou em redução proporcional de 50% da resistência à tração das juntas (de 4,0 ± 1,2 kN para 2,0 ± 0,7 kN. Adicionalmente, mapas de microdureza no rebite evidenciaram possíveis transformações de fase da liga que favoreceram seu endurecimento, com o aumento da velocidade de rotação. Contudo, nenhuma correlação pôde ser evidenciada entre a dureza e o desempenho mecânico das juntas sob tração, já que as amostras falharam majoritariamente por arrancamento completo do rebite da placa de compósito. Portanto, no desenvolvimento de juntas rebitadas por fricção de Ti-6Al-4V/ poli

Arthroplasty of the distal ulna distal in managing patients with post-traumatic disorders of the distal radioulnar joint: measurement of quality of life

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Marcio Aurélio Aita

2015-12-01

Full Text Available ABSTRACT OBJECTIVE: To measure the quality of life and clinical-functional results from patients diagnosed with osteoarthrosis of the distal radioulnar joint who underwent surgical treatment using the technique of total arthroplasty of the ulna, with a total or partial Ascension(r prosthesis of the distal ulna. METHODS: Ten patients were evaluated after 12 months of follow-up subsequent to total or partial arthroplasty of the distal ulna. All of them presented post-traumatic osteoarthrosis and/or chronic symptomatic instability of the distal radioulnar joint. The study was prospective. Seven patients had previously undergone wrist procedures (two cases with Darrach, three with Sauvé-Kapandji and two with ligament reconstruction of the fibrocartilage complex and three presented fractures of the distal ulna that evolved with pain, instability and osteoarthrosis of the distal radioulnar joint. The following were assessed: quality of life (DASH scale; percentage degree of palm grip strength (kgf and pronosupination range of motion in relation to the unaffected side; pain (VAS; return to work; subjective evaluation of radiography; and complications. RESULTS: The patients presented a mean range of motion of 174.5° (normal side: 180°. Quality of life was analyzed by applying the DASH questionnaire and the mean value found was 5.9. The mean pain score using the VAS was 2.3. The mean degree of palm grip strength (kgf was 50.7, which represented 90.7% of the strength on the unaffected side. The complication rate was 10%: this patient presented slight dorsal instability of the ulna and persistent pain, and did not return to work. This patient is still being followed up in the outpatient clinic and occupational therapy sector, with little improvement. He does not wish to undergo a new procedure. The mean length of follow-up was 16.8 months, with a minimum of 10 and maximum of 36 months. CONCLUSION: This concept is subject to the test of time

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.

Avaliação do comportamento fetal por meio da ultrassonografia de quarta dimensão: conhecimento atual e perspectivas futuras

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Hélio Antonio Guimarães Filho

2013-10-01

Full Text Available Durante as últimas décadas, o desenvolvimento da ultrassonografia em tempo real tem possibilitado a visibilização direta do feto no útero, bem como a avaliação de sua atividade. Com o advento da ultrassonografia tridimensional (3D no final dos anos 1980, iniciou-se uma nova era no diagnóstico por imagem em Obstetrícia, ampliando-se sobremaneira a possibilidade do estudo fetal. Recentemente, uma técnica que permitiu que a imagem 3D fosse transformada em um modo em tempo real foi introduzida e tem sido chamada de ultrassonografia em quarta dimensão (4D, a qual permite o monitoramento contínuo da face fetal e de outras áreas da superfície do feto, como, por exemplo, suas extremidades. Alguns estudos já se ocuparam em avaliar esta nova metodologia na observação do comportamento fetal durante diferentes estágios da gestação, na tentativa de melhor entender as relações entre a maturação do sistema nervoso central do feto e suas implicações em seu padrão de comportamento. No presente artigo, os autores realizam uma revisão sobre o uso atual da ultrassonografia 4D na avaliação do comportamento fetal, discorrendo sobre as perspectivas da técnica em espelhar, por meio da observação de padrões de movimentos e expressões faciais, o desenvolvimento neurológico do feto, destacando as potenciais aplicabilidades dessa tecnologia como nova área de pesquisa em medicina fetal.

Calcificación distrófica en úlceras de la extremidad inferior Dystrophic calcification in leg ulcers

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Daniel Chaverri Fierro

2011-09-01

Full Text Available La calcificación patológica entendida como depósito anormal de sales de calcio en los tejidos, es un proceso frecuente que ocurre en diversas situaciones patológicas bien conocidas como la hipercalcemia, la insuficiencia renal, el hiperparatiroidismo o en la patología valvular cardíaca. Sin embargo, este fenómeno, es todavía un gran desconocido en el campo de las heridas crónicas a juzgar por la escasa literatura existente al respecto. En este artículo se analiza en detalle este proceso y mostramos nuestra experiencia al respecto en el manejo de esta situación poco frecuente en el paciente con úlceras en la extremidad inferior.The pathological calcification known as an abnormal deposit of calcium salts into the tissues is a frequent process that we can find in several well known pathological situations as hypercalcaemia, renal insufficiency, hyperthyroidism or heart valve disease. However, this phenomenon is still a great unknown in the chronic wounds attending to the few existing literature. In this article we analyze this process in detail and we show our experience in this so infrequent situation in patients with chronic leg ulcers.

Morphometrical analysis of cleaning capacity using nickel-titanium rotary instrumentation associated with irrigating solutions in mesio-distal flattened root canals Análise morfológica da capacidade de limpeza promovida pela instrumentação rotatória, associada à soluções irrigantes, com limas de níquel-titânio em canais radiculares com achatamento mesio-distal

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Melissa Andréia Marchesan

2003-03-01

Full Text Available Variations in the internal anatomy of root canals may interfere with the success of root canal because tissue remnants may remain in the isthmus, re-entrances and ramifications of flattened root canals making instrumentation more difficult. Successful root canal treatment depends fundamentally on shaping, cleaning, disinfection and obturation. This study verified the quality of cleaning of ProFile .04 rotary technique associated with different irrigating solutions: 0.5% sodium hypochlorite, calcium hydroxide + Tergentol and 2% chlorhexidine in canals with mesio-distal flattening. Twelve human mandibular central incisors were randomly divided into 3 groups and instrumented up to ProFile 0.4 #35 file after cervical preparation, and processed histologically. After optical microscopic evaluation, statistical analysis showed that the percentage of cleaning of the three irrigating solutions was statistically different. Two-by-two comparisons classified the irrigating solutions in increasing order of cleaning: calcium hydroxide + Tergentol As variações da anatomia interna de cada canal radicular podem interferir no sucesso da terapêutica endodôntica devido ao fato de que em canais radiculares achatados, pode persistir remanescentes teciduais em istmos, reentrâncias e ramificações dificultando a execução das técnicas de instrumentação. O sucesso do tratamento dos canais radiculares depende fundamentalmente do preparo da forma, limpeza, desinfecção e obturação. Poucos trabalhos avaliaram a limpeza dos canais radiculares após a instrumentação rotatória. O presente trabalho verificou a qualidade de limpeza dos canais radiculares, por meio da microscopia óptica, promovida pela técnica de instrumentação rotatória associada ao hipoclorito de sódio 0,5%, HCT20 e clorexidina, em canais achatados no sentido mésio-distal. Doze incisivos centrais inferiores humanos foram divididos aleatoriamente em três grupos para que fossem

Estudo da ação dos fios de categute cromado e poliglecaprone 25, na ileocistoplastia em ratos, destacando a formação de cálculos

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Schauffert Marli Doroti

2000-01-01

Full Text Available Realizou-se um estudo da ação dos fios de categute cromado 6-0 e de poliglecaprone 25, 5-0, para determinar o fio ideal na ileocistoplastia em ratas. O maior objetivo, foi a profilaxia litiásica. Utilizaram-se 51 ratos de Wistar, que participaram de dois grupos experimentais: grupo do plano piloto (27 ratos, que foi o grupo categute (GC e grupo da tese do mestrado (24 ratos, que foi o grupo poliglecaprone (GP. Sob anestesia intraperitonial com pentobarbital sódico a 3%, todos os animais foram submetidos a ileocistoplastia, após laparotomia mediana longitudinal. Nos ratos do GC, a anastomose da bexiga urinária (aberta 0,5 cm sagitalmente no seu ápice, com a extremidade distal do segmento ileal ,era realizada por meio de pontos separados em plano único, com fio de categute cromado 6-0, e nas ratas do GP, com fio de poliglecaprone 25, 5-0. Seguiu-se a síntese da parede abdominal e recuperação anestésica. O estudo era realizado em 27, 42 e 57 dias nos animais do GC, que eram divididos em 3 subgrupos de 9 ratos. No GP, os animais eram analisados em 28 e 84 dias, por subgrupos de 12 animais. Transcorrido o tempo determinado para cada subgrupo, eram reoperados e observados os aspectos macroscópicos da cicatrização, aderências e formação de cálculos. A bexiga urinária ampliada pelo segmento ileal, era ressecada, aberta, lavada em solução salina isotônica, fixada no Líquido de Boüin, e processada , para histologia. A eutanásia era consumada com dose mínima letal anestésica. Os resultados apresentados, foram 29,6% de litíase, nas ratas do GC: 5,4% em 27dias; 10% em 42 dias e 14,25 em 57 dias do pós operatório (p.o.. Nas ratas do GP, não foram encontrados cálculos. Os estudos microscópicos, foram submetidos à análise estatística (a £ a 0,05, e utilizados para outro trabalho científico. Conclui-se: na ileocistoplastia com categute cromado 6-0, há 29,6% de cálculos, do 27o ao 57o dia p.o. e com o uso do fio de

Potassium secretion in mammalian distal colon

DEFF Research Database (Denmark)

Sørensen, Mads Vaarby

2009-01-01

Epithelial organs adjust the „inner milieu“ of the body and are crucial for all homeostatic processes. Epithelial transport of different solutes and water is regulated phenomena. The regulation processes include both long term hormonal regulation and short term local agonist mediated regulation....... 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......-sensitive tissue and participates in the regulation of Na+ excretion. In the distal nephron it was found that luminal nucleotides inhibit ENaC-mediated Na+ absorption. Here it was addressed whether luminal nucleotides regulate Na+ absorption and if so, which of the known luminal P2 receptors are involved. Using...

Relación entre la potencia muscular de extremidades inferiores y tronco con la velocidad de salida de la bola en el swing de drive en golf

OpenAIRE

Lorena Torres Ronda; Joan Solé Fortó; Lisímaco Vallejo Cuéllar; Xavier Balius Matas

2010-01-01

A pesar del interés emergente en el acondicionamiento físico en el golf, se han llevado a cabo pocos estudios para valorar la relación entre la potencia mecánica y el rendimiento en golf. El objetivo de este estudio fue valorar si existía una correlación entre la velocidad de salida de la bola del swing de drive y la potencia muscular de extremidades inferiores y tronco, en un grupo de 8 golfistas (16,8 ± 1,4 años; 2,2 ± 1,8 Handicap; 63,1 ± 6,4 kg.; 172,7 ± 7,5 cm). El test incluyó medicione...

Formas de preparo de figo-da-índia minimamente processado¹

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Kelly Magalhães Marques

2011-10-01

Full Text Available O trabalho teve como objetivo avaliar a influência da forma de preparo na conservação pós-colheita de figos-da-índia minimamente processados. Foram utilizados figos-da-índia maduros de polpa alaranjada, provenientes de pomar comercial da região de Valinhos-SP. Após a seleção, os frutos foram lavados e higienizados em solução com Sumaveg® a 200 mg 100g-1 de cloro livre, por 5 minutos. Em seguida, os frutos foram levados à câmara fria, a 12±2°C, onde permaneceram por 12 horas prévias ao processamento. O processamento constituiu na retirada da casca e das extremidades para a obtenção dos frutos inteiros. Para a obtenção das metades, foi realizado um corte no sentido longitudinal da fruta descascada e, para obtenção das rodelas, foram realizados cortes, a cada 2 cm, transversais à altura do fruto descascado. Os tratamentos assim obtidos foram acondicionados em contentores de tereftalato de polietileno transparente e com tampa, com capacidade de 1.000 mL (marca Neoform® N-94. As embalagens foram armazenadas em expositores refrigerados a 3°C, por um período de 16 dias, sendo as análises realizadas a cada 4 dias. O delineamento adotado foi o inteiramente casualizado, num esquema fatorial 3x5: três processamentos e cinco datas de amostragem (0;4;8;12 e 16 dias, com três repetições por tratamento. Avaliaram-se a perda de massa fresca, os teores de sólidos solúveis (SS, acidez titulável (AT, a relação (SS/AT, ácido ascórbico, além da análise sensorial dos produtos. Os frutos inteiros foram os preferidos quanto à intenção de compra e apresentaram melhores resultados quanto ao teor de sólidos solúveis, de acidez titulável, relação sólidos solúveis/acidez titulável e teor de ácido ascórbico. A maior perda de massa fresca foi verificada no processamento em rodelas.

Influência da idade e da posição ao longo do tronco na composição química da madeira de Eucalyptus grandis Hill ex. Maiden Influence of age and position along the trunk on the chemical composition of Eucalyptus grandis Hill ex. Maiden wood

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José de Castro Silva

2005-06-01

Full Text Available Este trabalho estudou a variação da composição química na madeira de Eucalyptus grandis de quatro diferentes idades (10, 14, 20 e 25 anos, proveniente de talhões comerciais. As amostras foram coletadas de tr��s discos, retirados da base e das extremidades das duas primeiras toras, de 3 m cada uma, de 16 árvores (quatro para cada idade, totalizando 48 discos. Os valores médios dos teores de holocelulose, lignina e extrativos foram de 69, 27 e 4%, respectivamente. Verificou-se que os teores de extrativos e lignina aumentaram com a idade, com maiores concentrações nos discos próximos da base; verificou-se, também, que o teor de holocelulose diminuiu com a idade, com maiores concentrações nos discos retirados nas regiões superiores do tronco.The objective of this work was to study the chemical composition variation of the Eucalyptus grandis wood, of four different ages (10,14,20 and 25 years, from commercial stands. The samples were removed from three disks taken from the base and top of the first two 3 m logs, from sixteen trees (four per age, totalizing fourty-eight discs. The mean values of holocellulose, lignin and extractive contents were 69, 27 and 4%, respectively. The extractive and lignin contents increased with age, with greater concentrations near the base; the holocellulose content also decreased with age with greater concentrations in discs removed from the upper parts of the trunk.

Estudos anatômicos e histológicos sôbre a subfamília Triatominae (Heteroptera, Reduviidae: Parte XXII. A estrutura da córnea de Triatoma Infestans

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Rudolf Barth

1965-01-01

Full Text Available Descreve-se a composição da córnea do ôlho de Triatoma infestans, chegando-se aos seguintes resultados: 1 - A faceta de um omatídeo consta de uma lente quitinosa central, incluída dentro de um prima hexagonal cuticular que, em virtude da sua construção, contribui decisivamente para o isolamento ótico da lente. 2 - A lente é formada (1 pela epicutícula superficial, muito fina, (2 pela exocutícula quase homogênea e (3 pela endocutícula lamelada. A exocutícula apresenta-se em forma de uma lente coletora, sem qualquer pigmento. A endocutícula, também sem pigmentos, compõe-se de numerosas (50 a 80 lamelas cuticulares, em forma de cones encaixados, um no outro, de modo que as extremidades dos cones se encontram no eixo ótico da lente. A lente corresponde à um cristal monaxial. 3 - A córnea é a continuação da cutícula da cabeça; as camadas desta, compostas de tiras quitinosas, coladas por proteínas entre si, desintegram0se em numerosas lamelas. 4 - As propriedades óticas das lentes correspondem às de um cilindro de lentes no sentido de EXNER (1891. 5 - Os omatídeos centrais do ôlho são homocêntrico, os periféricos heterocêntricos com eixo ótico curvado.

Avaliação de refluxo ultra-distal com pHmetria de múltiplos canais Ultra-distal reflux evaluation with multiple channel pHmonitoring

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Francisco Carlos Bernal da Costa Seguro

2011-03-01

Full Text Available RACIONAL: Displasia e adenocarcinoma esofágico surge em pacientes com esôfago de Barrett submetidos a tratamento cirúrgico (fundoplicatura com pHmetria esofágica sem evidência de acidez, o que sugere existir refluxo distal ao cateter de pHmetria convencional. OBJETIVO: Desenvolver metodologia para avaliar refluxo ultra-distal (1 cm acima da borda superior de esfíncter inferior do esôfago. MÉTODO: Foram selecionados 11 pacientes com esôfago de Barrett previamente submetidos à fundoplicatura à Nissen, sem sintomas de refluxo, com endoscopia e estudo contrastado de esôfago sem sinais de recidiva. Foi realizada manometria esofágica para avaliar a localização e a extensão do esfíncter esofágico inferior (EIE. Realizou-se então pHmetria esofágica com quatro canais: canal A a 5 cm acima da borda superior do EIE; canal B a 1 cm acima; canal C intraesfincteriano; canal D intragástrico. Avaliou-se o escore de DeMeester no canal A. Comparou-se o número de episódios de refluxo ácido, o número de episódios de refluxo prolongado e a fração de tempo com pHBACKGROUND: Esophageal adenocarcinoma and dysplasia in patients with Barrett's esophagus are seen after surgical treatment of GERD (fundoplication.Esophageal pH monitoring shows no evidence of acidity, suggesting distal reflux to the conventional catheter positioning. AIM: To develop methodology for assessing ultra-distal reflux (1 cm above the top edge of the lower esophageal sphincter. METHOD: Were selected 11 patients with Barrett's esophagus previously submitted to Nissen fundoplication, without reflux symptoms and with endoscopy and contrasted study of esophagus without signs of relapse. Esophageal manometry was used to evaluate the location and length of the lower sphincter of the esophagus (LES. After that, esophageal pH monitoring with four channels was done: channel A at 5 cm above the top edge of the LES; channel B at 1 cm above; channel C, intra-sphincteric; channel D

Combined open proximal and stent-graft distal repair for distal arch aneurysms: an alternative to total debranching.

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Zierer, Andreas; Sanchez, Luis A; Moon, Marc R

2009-07-01

We present herein a novel, combined, simultaneous open proximal and stent-graft distal repair for complex distal aortic arch aneurysms involving the descending aorta. In the first surgical step, the transverse arch is opened during selective antegrade cerebral perfusion, and a Dacron graft (DuPont, Wilmington, DE) is positioned down the descending aorta in an elephant trunk-like fashion with its proximal free margin sutured circumferentially to the aorta just distal to the left subclavian or left common carotid artery. With the graft serving as the new proximal landing zone, subsequent endovascular repair is performed antegrade during rewarming through the ascending aorta.

Distal clavicular osteolysis: MR evidence for subchondral fracture

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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.)

Distal clavicular osteolysis: MR evidence for subchondral fracture

International Nuclear Information System (INIS)

Kassarjian, Ara; Palmer, William E.; Llopis, Eva

2007-01-01

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.)

Maturação funcional da retina em bebês prematuros

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Adriana Berezovsky

2007-06-01

Full Text Available A retina humana ainda não está totalmente desenvolvida no nascimento. Só após o nascimento é que ocorrem mudanças anatômicas como o aumento na densidade de cones centrais e o alongamento do segmento externo dos fotorreceptores. As mudanças funcionais que ocorrem na retina com a maturação no primeiro ano de vida podem ser avaliadas pela técnica do eletrorretinograma de campo total, que representa a atividade somada da retina distal em resposta à luz. Abordaremos aspectos da maturação funcional da retina avaliada pelo eletrorretinograma em bebês prematuros.

Influência de idade e da posição radial nas dimensões das fibras e dos vasos da madeira de Eucalyptus grandis Hill ex. Maiden Influence of age and radial position on fiber and vessel dimensions of Eucalyptus grandis Hill ex. Maiden wood

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José de Castro Silva

2007-12-01

Full Text Available Objetivou-se neste trabalho avaliar a variação das dimensões das fibras e dos vasos da madeira de Eucalyptus grandis com quatro diferentes idades (10, 14, 20 e 25 anos, proveniente de talhões comerciais. A amostragem do material na árvore foi feita através da coleta de três discos, retirados da base e das extremidades das duas primeiras toras, ambas com o comprimento comercial de 3 m. De cada disco, retiraram-se cinco amostras, de dimensões 1,0 x 1,0 x 1,0 cm, tomadas de pontos eqüidistantes, correspondentes a 0; 25; 50; 75; e 100% da seção, no sentido radial medula-casca, fazendo-se a medição das fibras e dos vasos. Verificou-se, em todos os parâmetros, o efeito da idade e da variação radial, no sentido medula-casca, à exceção da largura e do diâmetro do lume das fibras; todos os demais parâmetros apresentaram correlação positiva.The objective of this work was to evaluate the variability of wood quantitative anatomical characteristics (fibers and vessels of Eucalyptus grandis of four different ages (10, 14, 20 and 25 years, obtained from commercial stands. Tree material sampling was collected from three disks in the bottom and top of the first two logs, both three m long. Five samples were collected from each disc at the pith-to-bark direction at 0, 25, 50, 75 and 100% of the radii. In all cases, age and pith-to-bark direction were observed to have a marked influence on all the assays, except for fiber lumen diameter and width; all the other parameters showed a positive correlation.

Closure of leak at the tip of the “J” after ileal pouch-anal anastomosis using a novel over-the-scope clipping system

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Lei Lian

2014-04-01

Full Text Available Objective: leaks from the body or the tip of the J-pouch can occur after restorative proctocolecotmy. Although it may follow an indolent clinical course, it often requires surgical repair or pouch revision. Here we describe a novel endoscopic approach to close the leak at the tip of the J pouch. Design: pouchoscopy was performed under sedation and endoscopic over-the-scope clipping system was used for the management of a leak from the tip of a J-pouch. Results: under sedation, a pouchoscopy was performed and the deep tip of “J” leak was detected with a guidewire, along with water-contrasted pouchogram. The contained cavity from the leak was cleaned with hydrogen peroxide and 50% dextrose. Debridement of the epithelialized mouth of the leak was performed with an endoscopic cytology brush. Then endoscopic over-the-scope clipping system was used and the leak defect was completely closed. There was no bleeding or perforation. The entire procedure took 25 min. The patient continued to do well and reported resolution of the low back pain symptom. Conclusion: we reported the first case in the literature that a leak from the tip of a J-pouch was endoscopically occluded using a novel over-the-scope clipping system. Resumo: Objetive: vazamentos do corpo da bolsa e da extremidade da bolsa ileal em J podem ocorrer após proctocolectomia restauradora. Embora possam apresentar um curso clínico indolente, muitas vezes requerem procedimentos abdominais. Desenho: endoscopia da bolsa ileal foi realizada sob sedação e clipagem endoscópica usando o sistema “over-the-scope” foi utilizada para fechar um vazamento na extremidade da bolsa ileal em “J”. Resultados: sob sedação, uma endoscopia de bolsa ileal foi realizada e a extremidade profunda do vazamento da bolsa ileal em “J” foi detectada com um fio-guia. A cavidade que continha o vazamento foi limpa com peróxido de hidrogênio e 50% de dextrose. Desbridamento da borda epitelizada do

Metodologia para estudo do volume e densidade absoluta da placenta humana de termo

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Del Nero Ulisses

2002-01-01

Full Text Available OBJETIVO: comparar duas metodologias para o cálculo do volume placentário em gestações normais de termo: a do princípio de Arquimedes e a do volume do cilindro, para estimar a densidade absoluta da placenta. Definir a metodologia mais adequada para o cálculo do volume e densidade placentários, que se relacione com o peso e classificação do recém-nascido. MÉTODOS: foram estudadas 50 placentas provenientes de gestações de termo sem complicações e calculados o volume e a densidade absoluta placentários: a pelo princípio de Arquimedes e b na suposição de que a placenta seria uma secção de cilindro com duas alturas diferentes do bolo placentário: com a altura média e com a altura da média aritmética do centro e extremidades. As densidades absolutas placentárias foram calculadas pelo quociente entre o peso ao ar da placenta e os diferentes volumes. RESULTADOS: a maioria das gestantes eram multíparas, idade média de 25,4 anos, volume placentário médio entre 547,8 e 610 cmsuperscript three e densidade média entre 0,94 e 1,14 g/cmsuperscript three, dependendo da metodologia empregada. CONCLUSÕES: a metodologia mais adequada para estimar o volume placentário no termo foi a do princípio de Arquimedes, pela melhor correlação com o peso dos recém-nascidos, o índice placentário e a classificação do peso dos recém-nascidos em relação à idade gestacional.

Rolling revisado: utilización del rolling para valorar y tratar la coordinación y control neuromuscular del core y extremidades en atletas

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Barbara J. Hoogenboom

2017-05-01

Full Text Available Rolling es un patrón de movimiento raramente utilizado por los fisioterapeutas para la evaluación e intervención de pacientes con función neurológica normal. El Rolling, como destreza motriz adulta, combina el uso de las extremidades superiores, core y extremidades inferiores con el movimiento coordinado en el paso de una postura a otra. El Rolling se lleva a cabo partiendo de la posición prona a posición supina y viceversa, aunque el método utilizado varía entre adultos. Desde la perspectiva de la habilidad de completar tareas o la simetría bilateral, el Rolling puede ser beneficioso para el uso de atletas que realizan deportes de rotación parcial tales como el golf, el lanzamiento, el tenis, y los deportes con torsión como la danza, la gimnasia, y el patinaje artístico. Además, cuando es usado como técnica de intervención, los patrones del Rolling tienen la capacidad de influir en disfunciones de la parte superior del cuerpo, core y parte inferior. Aplicando los principios de la facilitación neuromuscular propioceptiva (FNP, el terapeuta puede asistir a pacientes y clientes que son incapaces de completar un patrón de Rolling. Algunos ejemplos citados en el artículo incluyen separación/elongación, compresión, y contacto manual para facilitar el propio Rolling. Los autores defienden que el uso terapéutico de los patrones de desarrollo del Rolling con las técnicas derivadas de FNP es un distintivo en la rehabilitación de pacientes con disfunciones neurológicas que pueden ser también utilizados en la rehabilitación músculo-esquelética de forma creativa y efectiva. Se han obtenido los resultados preliminares de una exploración del mecanismo por el que el Rolling puede influir en la estabilidad y existen evidencias recientes disponibles. El propósito de este comentario clínico es describir las técnicas de análisis, evaluación y tratamiento de disfunción, usando casos ejemplos que incorporan el Rolling.

Unilateral maxillary molar distalization with zygoma-gear appliance.

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Kilkis, Dogan; Bayram, Mehmet; Celikoglu, Mevlut; Nur, Metin

2012-08-01

The aim of this study was to present the orthodontic treatment of a 15-year-old boy with a unilateral maxillary molar distalization system, called the zygoma-gear appliance. It consisted of a zygomatic anchorage miniplate, an inner bow, and a Sentalloy closed coil spring (GAC International, Bohemia, NY). A distalizing force of 350 g was used during the distalization period. The unilateral Class II malocclusion was corrected in 5 months with the zygoma-gear appliance. The maxillary left first molar showed distalization of 4 mm with an inclination of 3°. The maxillary premolars moved distally with the help of the transseptal fibers. In addition, there were slight decreases in overjet (-0.5 mm) and maxillary incisor inclination (-1°), indicating no anchorage loss from the zygoma-gear appliance. Preadjusted fixed appliances (0.022 × 0.028-in, MBT system; 3M Unitek, Monrovia, Calif) were placed in both arches to achieve leveling and alignment. After 14 months of unilateral distalization with the zygoma-gear appliance and fixed appliances, Class I molar and canine relationships were established with satisfactory interdigitation of the posterior teeth. Acceptable overjet and overbite were also achieved. This article shows that this new system, the zygoma-gear appliance, can be used for unilateral maxillary molar distalization without anchorage loss. Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Intra-Articular Osteotomy for Distal Humerus Malunion

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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.

Volar plating for distal radius fractures--do not trust the image intensifier when judging distal subchondral screw length.

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Park, Derek H; Goldie, Boyd S

2012-09-01

The use of the volar plate to treat distal radius fractures is increasing but despite the theoretical advantages of a volar approach there have been reports of extensor tendon ruptures due to prominent screw tips protruding past the dorsal cortex. The valley in the intermediate column between Lister tubercle and the sigmoid notch of the distal radius makes it difficult to rely on fluoroscopy to judge screw length. Our aim was to quantify the dimensions of this valley and to demonstrate the danger of relying on intraoperative image intensification fluoroscopy to determine lengths of distal screws. We measured the depth of this valley in the intermediate column of the distal radius in 33 patients with computed tomographic (9 patients) or magnetic resonance image (24 patients) scans of the wrist. There was a consistent valley in all images examined [average 1.8 mm (95% confidence interval, 1.6-2.0 mm)]. Thirty-nine percent of wrists had a valley depth of at least 2 mm. Standard lateral views or rotation of the forearm to obtain oblique views does not identify prominent screw tips; and whatever the rotation of the forearm, screw tips protruding beyond dorsal cortex may look as if it is within the bone when in fact it is out. When drilling we suggest noting the depth at which the drill bit just penetrates dorsal cortex and routinely downsize the distal screw length by 2 mm. We caution against relying on flourosocopy when judging the length of the distal subchondral screws.

COMPARATIVE ANATOMICAL STUDY AND INCIDENCE OF OS PERONEUM IN PERONEUS LONGUS TENDON AND ITS CLINICAL SIGNIFICANCE. Estudio anatómico comparativo e incidencia del os peroneum en el tendón de peroneo largo y su significación clínica

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Poonam Verma

2016-03-01

Full Text Available Introducción: El objetivo de nuestro estudio fue evaluar la tasa de incidencia del os peroneo (OP en el tendón del peroneo lateral largo (PLT y su importancia clínica. Métodos: La disección de 60 cadáveres embalsamados (56 hombres y 4 mujeres del grupo de mediana edad se hizo para tener acceso a la  tasa de incidencia del os peroneo en PLT. Resultados: En nuestro estudio se observó que la  tasa de incidencia del os peroneo fue de  86,6% (52  extremidades. La ubicación del os peroneo es también un tema de controversia. La mayoría de los autores afirman que se relaciona con el hueso cuboides y de vez en cuando se ve inferior al calcáneo distal a la articulación calcáneo-cuboidea. Pero en el presente estudio el os- peroneo estuvo en relación al hueso cuboides en 40 extremidades (76.9%  y distal a articulación calcaneocuboidea en el resto de las 12 extremidades (23.1%. Conclusión: Este estudio sugiere que existe una alta tasa de incidencia de un OP en cadaveres. Esto puede ser como consecuencia de la técnica utilizada para localizar el mismo. La importancia clínica ha sido mencionada en relación con la ubicación del os peroneo, que puede ser confundido con fracturas estiloides y de Jones. Introduction: The aim of our study was to assess the incidence rate of the os peroneum (OP in the peroneus longus tendon (PLT and its clinical significance. Methods: Dissection of 60 embalmed cadavers (56 male and 4 female of middle age group was done to access the incidence rate of os peroneum in peroneus longus tendon. Results: In our study the incidence rate of os peroneum was 86.6% (52 limbs. The location of os peroneum is also a subject of dispute. Most authors stated that it is related to the cuboid bone and occasionally it is seen inferior to the calcaneum distal to the calcaneocuboid joint. But in the present study os peroneum was in relation to cuboid bone in 40 limbs (76.9% and distal to calcaneocuboid joint in 12 limbs (23

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...

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

Preservação do baço na pancreatectomia distal por trauma

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Wilson Luiz Abrantes

Full Text Available OBJETIVOS: A esplenectomia simplifica a pancreatectomia distal no trauma mas tem o inconveniente de aumentar a vulnerabilidade do paciente às infecções. O objetivo é avaliar se a preservação do baço na referida cirurgia é exeqüível e segura. MÉTODOS: A preservação do baço foi feita em 52 pacientes (48% entre 108 submetidos à pancreatectomia distal. Quarenta e cinco (86,5% do sexo masculino e sete (13,5% do sexo feminino. Idade variou de seis a 42 anos com média de 22,1 anos. Trauma penetrante foi a causa da lesão em 35 (67% com 27 (77% por arma de fogo e oito (23% por arma branca. Contusão foi responsável pela lesão em 17 (33%. RESULTADOS: Não houve óbito. Fístula pancreática ocorreu em seis (11,5% pacientes; coleção subfrênica em seis (11,5%; pancreatite em dois (3,8%; abcesso de parede em quatro (8%; pneumonia em quatro (8%. Quarenta pacientes tiveram lesões associadas. O ISS médio foi de 19,3. O baço apresentava lesão em 13 pacientes. Sete foram submetidos à esplenorrafia e seis à ressecção parcial. Em 51 pacientes o baço foi conservado com os vasos esplênicos. Em um caso foi feita a ligadura proximal e distal dos vasos esplênicos (técnica Warschaw. Permanência hospitalar média de 12 dias. CONCLUSÃO: A pacreatectomia distal com preservação do baço mostrou ser segura nos pacientes estáveis, mesmo na presença de lesões associadas. A ausência de óbitos e a participação de cirurgiões em fase de treinamento confirmam sua segurança.

Posttraumatic osteolysis of the distal clavicula end

International Nuclear Information System (INIS)

Hermanns, P.H.; Beeger, R.; Koetter, D.; Hamburg Univ.

1981-01-01

Posttraumatic osteolysis of bone is rare. Its etiology is unknown. A case of posttraumatic osteolysis of the distal clavicle end is reported. Differentialdiagnostical and ethiological relations are discussed. The literature of posttraumatic osteolysis especially of distal clavicle osteolysis is reported. (orig.) [de

Pancreatectomia distal videolaparoscópica em pacientes com cistadenoma de pâncreas Laparoscopic distal pancreatectomy for pancreatic cystadenomas

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Marcel Autran C. Machado

2005-09-01

Full Text Available RACIONAL: O diagnóstico de tumores císticos do pâncreas vem aumentando nos últimos anos. Estes tumores acometem geralmente pacientes do sexo feminino e apresentam poucos sintomas. Sua remoção por videolaparoscopia está indicada em pacientes selecionadas, principalmente quando localizados na região distal do pâncreas. OBJETIVOS: É apresentada a experiência inicial de um grupo de cirurgiões na realização de pancreatectomia distal por videolaparoscopia em pacientes com cistadenoma pancreático. MATERIAL E MÉTODOS: Três pacientes do sexo feminino (idade média, 55 anos foram submetidas a ressecção pancreática por videolaparoscopia entre setembro de 2001 e dezembro de 2003. RESULTADOS: A ressecção pancreática por videolaparoscopia foi realizada com sucesso nas três doentes. O tempo cirúrgico variou de 4 a 6 horas. O sangramento operatório foi mínimo em todos os casos. A aplicação do grampeador endoscópico foi difícil em uma paciente devido à espessura do pâncreas. As três pacientes evoluíram bem, recebendo alta entre o 2º e o 5º dia pós-operatório. Duas apresentaram fístula pancreática com resolução após tratamento conservador. CONCLUSÃO: A pancreatectomia laparoscópica é factível, pode trazer benefícios aos pacientes portadores de neoplasia cística da porção distal do pâncreas, com pouca dor pós-operatória, curto tempo de permanência hospitalar, baixo índice de complicações e melhor resultado estético.BACKGROUND: Cystic neoplasms are an uncommon group among pancreatic tumors. These lesions are seen more frequently in recent surgical practice, probably because of advances in diagnostic and surgical techniques. Total tumor resection provides the best chance of cure and may remove the risk of malignant transformation of the cystadenomas, particularly of the mucinous type. Minimally invasive techniques have been revolutionary and provide clinical evidence of decreased morbidity and comparable

A STUDY OF SURGICAL MANAGEMENT OF DISTAL FEMORAL FRACTURES BY DISTAL FEMORAL LOCKING COMPRESSION PLATE OSTEOSYNTHESIS

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Dema Rajaiah

2016-08-01

Full Text Available AIMS AND OBJECTIVES To study the fractures of distal end of femur and the mechanism of injury in distal end femur fractures, the advantages and disadvantages of open reduction and internal fixation of distal end femur fractures by distal femoral locking compression plate osteosynthesis and to analyse the outcome in terms of range of Knee motion, time to union, and limb shortening. RESULTS The mean age of patient is 44 years, 85% are males, road traffic accidents account for majority (80%, right side involved in 70%, Muller’s type C fracture is common, good range of movements is seen 90% of cases and union occurred in 95% in 5 months. The results were assessed using Neer’s score, seven (35% patients had excellent results, eight (40% patients had good results, four (20% patients had fair results and one (5% patient had poor result. CONCLUSION From our study, we conclude that DF-LCP is a safe and reliable implant and has shown excellent to satisfactory results in majority of intra-articular fractures (AO type C. Fixation with locking compression plate showed more effectiveness in severely osteoporotic bones, shorter operative stay, faster recovery, faster union rates and excellent functional outcome.

Distal radioulnar joint injuries

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Binu P Thomas

2012-01-01

Full Text Available Distal radioulnar joint is a trochoid joint relatively new in evolution. Along with proximal radioulnar joint , forearm bones and interosseous membrane, it allows pronosupination and load transmission across the wrist. Injuries around distal radioulnar joint are not uncommon, and are usually associated with distal radius fractures,fractures of the ulnar styloid and with the eponymous Galeazzi or Essex_Lopresti fractures. The injury can be purely involving the soft tissue especially the triangular fibrocartilage or the radioulnar ligaments.The patients usually present with ulnar sided wrist pain, features of instability, or restriction of rotation. Difficulty in carrying loads in the hand is a major constraint for these patients. Thorough clinical examination to localize point of tenderness and appropriate provocative tests help in diagnosis. Radiology and MRI are extremely useful, while arthroscopy is the gold standard for evaluation. The treatment protocols are continuously evolving and range from conservative, arthroscopic to open surgical methods. Isolated dislocation are uncommon. Basal fractures of the ulnar styloid tend to make the joint unstable and may require operative intervention. Chronic instability requires reconstruction of the stabilizing ligaments to avoid onset of arthritis. Prosthetic replacement in arthritis is gaining acceptance in the management of arthritis.

Dosimetric evaluation of a combination of brachytherapy applicators for uterine cervix cancer with involvement of the distal vagina; Avaliacao dosimetrica de uma combinacao de aplicadores para braquiterapia de tumores do colo uterino com acometimento da porcao distal da vagina

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Guimaraes, Roger Guilherme Rodrigues [Real e Benemerita Sociedade Portuguesa de Beneficencia, Sao Paulo, SP (Brazil). Servico de Radioterapia Estereotactica; Carvalho, Heloisa de Andrade; Stuart, Silvia Radwanski; Rubo, Rodrigo Augusto [Universidade de Sao Paulo (USP), SP (Brazil). Hospital das Clinicas. Servico de Radioterapia], e-mail: handrade@hcnet.usp.br; Seraide, Rodrigo Migotto [Centro de Oncologia Campinas, SP (Brazil)

2009-07-15

Objective: To evaluate an alternative brachytherapy technique for uterine cervix cancer involving the distal vagina, without increasing the risk of toxicity. Materials And Methods: Theoretical study comparing three different high-dose rate intracavitary brachytherapy applicators: intrauterine tandem and vaginal cylinder (TC); tandem/ring applicator combined with vaginal cylinder (TR+C); and a virtual applicator combining both the tandem/ring and vaginal cylinder in a single device (TRC). Prescribed doses were 7 Gy at point A, and 5 Gy on the surface or at a 5 mm depth of the vaginal mucosa. Doses delivered to the rectum, bladder and sigmoid colon were kept below the tolerance limits. Volumes covered by the isodoses, respectively, 50% (V50), 100% (V100), 150% (V150) and 200% (V200) were compared. Results: Both the combined TR+C and TRC presented a better dose distribution as compared with the TC applicator. The TR+C dose distribution was similar to the TRC dose, with V150 and V200 being about 50% higher for TR+C (within the cylinder). Conclusion: Combined TR+C in a two-time single application may represent an alternative therapy technique for patients affected by uterine cervix cancer involving the distal vagina. (author)

Contemporary Management of Primary Distal Urethral Cancer

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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

Distal technologies and type 1 diabetes management.

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Duke, Danny C; Barry, Samantha; Wagner, David V; Speight, Jane; Choudhary, Pratik; Harris, Michael A

2018-02-01

Type 1 diabetes requires intensive self-management to avoid acute and long-term health complications. In the past two decades, substantial advances in technology have enabled more effective and convenient self-management of type 1 diabetes. Although proximal technologies (eg, insulin pumps, continuous glucose monitors, closed-loop and artificial pancreas systems) have been the subject of frequent systematic and narrative reviews, distal technologies have received scant attention. Distal technologies refer to electronic systems designed to provide a service remotely and include heterogeneous systems such as telehealth, mobile health applications, game-based support, social platforms, and patient portals. In this Review, we summarise the empirical literature to provide current information about the effectiveness of available distal technologies to improve type 1 diabetes management. We also discuss privacy, ethics, and regulatory considerations, issues of global adoption, knowledge gaps in distal technology, and recommendations for future directions. Copyright © 2018 Elsevier Ltd. All rights reserved.

VULNERABILIDADE E VARIAÇÕES DE CURTO PRAZO DA PRAIA DE ITAIPU (NITERÓI-RJ EM RESPOSTA ÀS MUDANÇAS NAS CONDIÇÕES DE MAR

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Eduardo Macedo Rodrigues

2015-03-01

Full Text Available As praias da enseada de Itaipu na Região Oceânica de Niterói, estado do Rio de Janeiro (Brasil, vêm sendo intensamente modificadas devido ao rápido processo de urbanização dessa região, principalmente a partir da década de 1970 com a construção da ponte Presidente Costa e Silva (Rio-Niterói. A crescente ocupação desse litoral constitui-se no principal fator responsável pela degradação dos ecossistemas costeiros. A praia de Itaipu, apesar de ser a mais interna e, consequentemente a mais abrigada dentro da enseada de Itaipu, apresenta grande variabilidade na largura, em resposta as mudanças de curto prazo nas condições de mar. A faixa de areia da praia estreita-se de forma rápida em resposta a incidência de ondas de tempestades, restabelecendo-se logo a seguir quando do retorno às condições de tempo bom. As maiores variações foram constatadas na extremidade sul, devido à maior vulnerabilidade deste setor a incidência de ondas de tempestades. Os sedimentos da praia são constituídos predominantemente por areia quartzosa média, exceto em lâmina d’água de 5 m devido ao acúmulo de areia média com alto teor de carbonatos. Areia muito fina a fina aparece na profundidade de 7 metros, na área externa ao embasamento cristalino submerso.

Intra-articular osteotomy for distal humerus malunion

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Marti, René K.; Doornberg, Job

2009-01-01

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

Distal Communication by Chimpanzees (Pan troglodytes): Evidence for Common Ground?

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Leavens, David A; Reamer, Lisa A; Mareno, Mary Catherine; Russell, Jamie L; Wilson, Daniel; Schapiro, Steven J; Hopkins, William D

2015-01-01

van der Goot et al. (2014) proposed that distal, deictic communication indexed the appreciation of the psychological state of a common ground between a signaler and a receiver. In their study, great apes did not signal distally, which they construed as evidence for the human uniqueness of a sense of common ground. This study exposed 166 chimpanzees to food and an experimenter, at an angular displacement, to ask, "Do chimpanzees display distal communication?" Apes were categorized as (a) proximal or (b) distal signalers on each of four trials. The number of chimpanzees who communicated proximally did not statistically differ from the number who signaled distally. Therefore, contrary to the claim by van der Goot et al., apes do communicate distally. © 2015 The Authors. Child Development © 2015 Society for Research in Child Development, Inc.

Estudo da correlação de medidas radiográficas indicadoras de laminite em éguas da raça Mangalarga Marchador com e sem sinais de sobrepeso

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J.F. Magalhães

2014-08-01

Full Text Available A avaliação radiográfica do casco é essencial no diagnóstico e na avaliação da laminite em equinos, contudo poucos estudos têm sido feitos em raças nacionais. O objetivo deste trabalho foi realizar a morfometria de imagens radiográficas obtidas do dígito de éguas Mangalarga Marchador (MM, a fim de obter um perfil de medidas indicadoras de laminite nessa população e comparar grupos sem (escore corporal 5 e 6 e com (escore corporal 7 e 8 sinais de sobrepeso. Não houve diferença significativa entre os valores para as medidas dos dois grupos (P>0,05, mas verificou-se correlação positiva entre a distância entre os planos da linha coronária e do ápice do processo extensor (afundamento da falange distal e indicadores de deposição de gordura localizada no pescoço e na base da cauda. Os achados demonstram que a morfometria radiográfica do dígito dessa população de equinos Mangalarga Marchador difere da de raças estrangeiras. Além disso, nos animais estudados, éguas com escore corporal 7 e 8 não aparentaram estarem mais sujeitas à laminite, uma vez que não houve diferença entre a morfometria de éguas com escore inferior. Entretanto, as correlações positivas entre índices de obesidade e a distância de afundamento da falange distal indicam que éguas Mangalarga Marchador também estão sujeitas à ocorrência de laminite associada à obesidade.

18. Síndrome compartimental en una niña de 8 años secundario a canulación femoral para bypass cardiopulmonar

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R. Maseda Uriza

2010-01-01

La isquemia de las extremidades inferiores secundaria a canulación de vasos femorales es poco frecuente, pocos casos en la literatura publicados. Se produce secundario al edema producido por la isquemia. Debe ser sospechada y tratada de forma precoz pues puede provocar contractura isquémica, pérdida de funcionalidad, rabdomiólisis y daño cerebral secundario. El diagnóstico precoz es difícil en un paciente sedado e intubado, la pérdida de pulsos es un signo tardío, precede a la pérdida irreversible de la extremidad, se debe sospechar en cualquier paciente sometido a canulación femoral y medir presiones tisulares para confirmar diagnóstico y actuar en consecuencia.

Distal displacement of the maxilla and the upper first molar.

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Baumrind, S; Molthen, R; West, E E; Miller, D M

1979-06-01

Data from a sample of 198 Class II cases treated with various appliances which deliver distally directed forces to the maxilla were examined to determine the frequency of absolute distal displacement of the upper first molar and of the maxilla. Analysis revealed that such distal displacement is possible and that it is, in fact, a frequent finding following treatment. Long-range stability of distal displacement was not assessed.

Estudo do esvaziamento gástrico e da distribuição intragástrica de uma dieta sólida através da cintilografia: diferenças entre os sexos Scintigraphic study of gastric emptying and intragastric distribution of a solid meal: gender differences

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Sônia Letícia Silva LORENA

2000-04-01

Full Text Available Ainda existem controvérsias quanto a possíveis diferenças de esvaziamento gástrico entre os sexos. Os objetivos deste estudo são: confirmar se homens e mulheres realmente diferem no esvaziamento gástrico de uma dieta sólida e investigar se esta diferença está relacionada com diferentes padrões de distribuição da dieta entre os compartimentos proximal e distal do estômago. Dezoito voluntários assintomáticos (nove do sexo masculino, com idade média de 35 ± 9 anos e nove do sexo feminino, com idade média de 41 ± 11 anos foram estudados pela manhã, após ingestão da dieta sólida padronizada (omelete marcada com 185MBq de enxofre coloidal-99mTc. Imagens simultâneas do estômago nas projeções anterior e posterior foram adquiridas imediatamente após a ingestão da dieta e a cada 10 minutos, durante 120 minutos. Curvas de tempo versus contagem radioativa foram obtidas para o estômago total, proximal e distal. O T½ do esvaziamento gástrico foi maior para as mulheres (96,1 ± 17,2 minutos do que para os homens (79,9 ± 17,8 minutos; P = 0,02. A análise da distribuição intragástrica da dieta mostrou que não houve diferenças entre os sexos quanto ao esvaziamento gástrico proximal, mas as mulheres apresentaram maior retenção da dieta na porção distal do estômago (P = 0,04. Nossos resultados mostram que o esvaziamento gástrico de sólidos é mais lento nas mulheres não-menopausadas assintomáticas, do que nos homens de faixa etária semelhante, provavelmente devido a maior retenção da dieta na região distal do estômago. Este fato deve ser levado em conta nos estudos de esvaziamento gástrico pela cintilografia para evitar diagnósticos errôneos de gastroparesias nas pacientes do sexo feminino.Gender-related differences in gastric emptying are still controversial. The aims of this study were: to confirm the sex-related difference in gastric emptying of a solid meal and to investigate its association with

Distal splenorenal shunt with partial spleen resection

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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

Altura da lâmina, tempo e volume de enchimento de um equipamento de irrigação por pavio e determinação da uniformidade de distribuição de água em substratos

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Rhuanito Soranz Ferrarezi

2012-01-01

Full Text Available Os objetivos deste experimento foram realizar a avaliação da altura da lâmina de água, do tempo e volume de enchimento de um equipamento de irrigação por pavio usando calhas autocompensadoras e determinar a uniformidade de distribuição de água (UDA nesse equipamento utilizando substratos orgânicos comerciais (casca de pinus/CP e fibra de coco/FC. Dois módulos experimentais foram montados em delineamento experimental inteiramente casualizado com cinco repetições. Verificou-se grande variação das medidas de altura da lâmina de água (1,6 a 4,0 cm, mesmo com o equipamento nivelado. O tempo médio de enchimento foi de 6h22min para o Módulo 1 com CP e de 3h45min para o Módulo 2 com FC. O volume de enchimento foi variável, observando-se que as calhas das extremidades (n.° 1 e 5 apresentaram os menores volumes no Módulo 1, e as calhas do início (n.° 1 e 2 no Módulo 2. No Módulo 1, a umidade volumétrica (θ variou de 42% a 94%, e no Módulo 2, de 24% a 72%, com pontos isolados de secamento e/ou encharcamento. A altura da lâmina de água, o tempo e o volume de enchimento das calhas foram desuniformes nos dois módulos experimentais e nas cinco calhas autocompensadoras, indicando imperfeições no equipamento. A distribuição de água foi variável nos substratos em razão de suas características físico-hídricas e também da altura da lâmina de água nas calhas, apresentando maior umidade e uniformidade de distribuição de água na casca de pinus do que na fibra de coco.

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

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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.

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

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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.

Laparoscopic versus open distal pancreatectomy for pancreatic cancer.

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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

Reconstrução de ruptura crônica do tríceps distal sob a configuração de dupla fileira: nota técnica

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Alexandre Firmino Paniago

2015-10-01

Full Text Available resumo Rupturas do tríceps distal são incomuns e podem ser de difícil diagnóstico, especialmente as parciais. Métodos de imagem, como USG e RNM, devem ser usados para a confirmação diagnóstica e para definição da extensão da lesão. O tratamento de escolha para as rupturas completas do tríceps é o cirúrgico, diferentemente das parciais, que dependem de fatores como dor, déficit funcional e expectativas do paciente. Descrevemos o caso de um paciente com ruptura parcial do tríceps distal após queda ao solo. Não foi diagnosticado no momento do primeiro atendimento e evoluiu com dor e grande perda funcional. O procedimento cirúr gico foi feito após nove meses do trauma, com a reconstrução do tríceps por meio de reforço com o tendão do semitendíneo ipsilateral e fixação no olécrano sob a configuração de dupla fileira. O paciente permaneceu imobilizado com tipoia por uma semana e iniciou-se, a partir daí, o ganho de amplitude de movimento (ADM passiva. Após três semanas foi liberado para o ganho de ADM ativa. O fortalecimento muscular iniciou-se após 12 semanas. Após seis meses do procedimento cirúrgico o paciente apresenta-se sem dor, ADM completa, força de extensão do cotovelo grau V e hipertrofia do tríceps. A técnica descrita se mostrou útil para o tratamento de rupturas do tendão do tríceps distal.

Distribuição espacial de Calacarus Heveae feres na cultura da seringueira em Marinópolis - São Paulo

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Gustavo Luís Mamoré Martins

2012-04-01

Full Text Available O objetivo deste trabalho foi estudar a distribuição espacial de Calacarus heveae Feres (Acari: Eriophyidae na cultura da seringueira, tendo como base um monitoramento realizado com lupa de bolso. A área experimental, localizada em Marinópolis, São Paulo, com 1.000 plantas do clone RRIM 600, foi dividida em 100 parcelas de 10 plantas cada uma. Foram realizadas 16 coletas no período de dezembro de 2007 a junho de 2008. Nas coletas foram amostradas duas plantas por parcela, retirando-se de cada uma extremidade de ramo com 30 cm de comprimento. No laboratório, os ácaros foram avaliados com o uso de lupa de bolso de 20X de aumento, em seis folíolos por parcela, sendo três de cada ramo. A contagem dos ácaros foi realizada em duas áreas de 1 cm² na página superior dos folíolos, uma de cada lado da nervura principal. Os índices de dispersão estudados foram: razão variância/média (I, índice de Morisita (Id, coeficiente de Green (Cx e expoente k da distribuição binomial negativa. C. heveae apresenta distribuição agregada em área de cultivo de seringueira. A distribuição espacial do ácaro ajusta-se ao modelo de distribuição binomial negativa.

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

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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.

A FUNCTIONAL EVALUATION STUDY OF DISTAL FEMORAL FRACTURES FIXED WITH DISTAL FEMORAL LOCKING PLATE

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Manikumar C. J

2017-04-01

Full Text Available BACKGROUND Fractures of the distal femur present considerable challenges in management. Older patients especially women sustain fractures due to osteoporosis. Supracondylar fractures of femur have a bimodal distribution. They account for 6% of all femur fractures and 31% if hip fractures were excluded. Nearly, 50% of distal femur intra-articular fractures are open fractures. Before 1970, most supracondylar fractures were treated nonoperatively; however, difficulties were often encountered including persistent angulatory deformity, knee joint incongruity, loss of knee motion and delayed mobilisation. The trend of open reduction and internal fixation has become evident in recent years with good results being obtained with AO blade plate, dynamic condylar screw, intramedullary supracondylar nail and locking compression plate. Elderly patients and osteoporosis pose difficulty in treating intra-articular fractures of the lower end of femur. Loss of stable fixation is of great concern in these cases. Hence, locking compression plate use has an advantage in these patients. MATERIALS AND METHODS In this study, 20 patients with closed fracture of distal femur were studied. All the cases were treated at the Department of Orthopaedics, Rangaraya Medical College/Government General Hospital, Kakinada, Andhra Pradesh, between November 2013 and November 2015. The method used for fracture fixation was open reduction and internal fixation with distal femoral locking plate. The duration of follow up ranged from 3 months to 24 months. All the fractures in this series were posttraumatic. The patients were functionally evaluated with Neer’s scoring system. 1 RESULTS Twenty distal femoral fractures were treated with distal femoral locking plates. 15 patients were males and 5 patients were females. The median age was 47 years ranging from 28-70 years. 16 of the fractures were caused by road traffic accidents and 2 were due to fall, 2 were due to assault. 12 patients

Sintomas da injúria por frio em Heliconia spp

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GUSTAVO JONNAS S. M. BEZERRA

2008-07-01

Full Text Available As helicônias, entre as flores tropicais, têm se destacado no mercado internacional (Europa e Estados Unidos devido à beleza, diversidade de cores e formas e durabilidade. No entanto, para a comercialização a longas distâncias é necessário adotar formas de transporte que inibam o processo de senescência das flores e conservem a qualidade pós-colheita. O transporte de flores em temperaturas baixas é o mais utilizado, no entanto, em “flores tropicais” podem causar danos de injúria por frio. O objetivo deste trabalho foi descrever os sintomas causados pela injúria por frio em hastes florais de três genótipos de helicônia (H. bihai, H. wagneriana e H. caribaea x H. bihai cv. Carib Flame. As hastes florais de helicônia foram submetidas, por 72 horas, a três condições de temperatura: refrigerador expositor (2 ºC em caixa de papelão (embalagem padrão para transporte; refrigerador expositor (2 ºC sem caixa de papelão; e laboratório a 25 ºC e U.R. 60% (testemunha. O delineamento experimental utilizado foi o inteiramente casualizado, com três tratamentos e sete repetições na primeira avaliação e cinco repetições na segunda avaliação. Os sintomas da injúria por frio foram descritos a partir da comparação do aspecto visual das hastes florais submetidas a 2 °C com as testemunhas. A temperatura de 2 ºC, com ou sem a embalagem de transporte, provocou sintomas como: aspecto de queimadura no centro das brácteas, manchas escurecidas na área de inserção das brácteas na ráquis e murchamento das extremidades dos pecíolos das folhas e da base das inflorescências.

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

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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.

Traumatic Distal Ulnar Artery Thrombosis

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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.

Distinct subclassification of DRG neurons innervating the distal colon and glans penis/distal urethra based on the electrophysiological current signature.

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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.

Nonunions of the distal tibia treated by reamed intramedullary nailing

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Richmond, Jeffrey; Colleran, Kevin; Borens, Olivier; Kloen, Peter; Helfet, David L.

2004-01-01

The purpose of this study is to determine the efficacy of reamed intramedullary nailing in the treatment of nonunions of the distal one-fourth of the tibia. Nonunions of the distal tibia are particularly difficult to treat given the short distal segment, the proximity to the ankle joint, and the

Descompensación distal postoperatoria (D.D.P. en curvas lenke 1a tratadas con tornillos pediculares: una revisión de 63 casos Descompensação distal pós-operatória (DDP em curvaturas lenke 1a tratadas com parafusos pediculares: análise de 63 casos Postoperative distal decompensation (PDD in lenke 1a curvatures treated with pedicular screws: analysis of 63 cases

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Norberto Ventura

2012-06-01

Full Text Available OBJETIVO: Identificar los factores de riesgo de descompensación distal postoperatoria (D.D.P. y definir una estrategia quirúrgica segura en curvas tipo Lenke 1A tratadas con tornillos pediculares. MÉTODO: Estudio radiológico retrospectivo de 63 pacientes con escoliosis Lenke 1A, con un seguimiento mínimo de un año. Se evaluó, edad, sexo, grados Cobb, signo de Risser, relación de la vértebra distal instrumentada (V.D.I. con la vértebra distal de la curva (V.D., vértebra estable (V.E. y con la vértebra, cuya distancia a la línea central vertical al sacro (L.V.S. era superior a 10 mm "distancia vertebral" (D.V.. RESULTADOS: 8 casos (12,7% desarrollaron D.D.P. El signo de Risser fue 0 en 2 pacientes (25% y I en 2 pacientes (25%. Relación de V.D.I. con V.D.: 4 pacientes (50% mismo nivel (V.D. +0, 4 pacientes (50% un nivel caudal (V.D. (+1; relación V.D.I. con V.E.: 5 pacientes (62,5% 2 niveles cefálicos (V.E -2, 3 pacientes (37,5% 1 nivel cefálico (V. E.-1; relación V.D.I. con D.V.: 5 pacientes (62,5% un nivel cefálico D.V. (-1, 3 pacientes mismo nivel (D.V.+ 0. CONCLUSIONES: Riesgo de descompensación distal postoperatoria: V.D.I. mismo nivel V.D. (V.D. + 0, 2 niveles cefálicos V.E. (V.E.-2, 1 nivel cefálico D.V. (D.V. -1. Estrategia quirúrgica curvas Lenke 1A: V.D.I: 1/2 niveles caudales a V.D. (V.D. +1/+2, un nivel cefálico a V.E. (V.E -1, mismo nivel D.V. (D.V. +0.OBJETIVO: Identificar os fatores de risco de descompensação distal pós-operatória (DDP e definir estratégia cirúrgica de segurança em curvaturas de Lenke 1A, tratadas com parafusos pediculares. MÉTODO: Estudo radiológico retrospectivo de 63 pacientes com escoliose Lenke 1A, com acompanhamento mínimo de um ano. Os parâmetros avaliados foram idade, sexo, graus do ângulo de Cobb, sinal de Risser, relação da vértebra distal instrumentada (VDI com a vértebra distal da curvatura (VD, com a vértebra estável (VE e com a vértebra cuja distância da linha

Acropatia úlcero-mutilante familiar. Considerações a propósito de três casos Ulcero-mutilating familial acropathy

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Wilson Sanvito

1968-03-01

Full Text Available São apresentados três casos de acropatia úlcero-mutilante familial, também conhecida como doença de Thévenard e/ou neuropatía radicular sensitiva hereditária de Denny-Brown. Após ser salientado o caráter familial da moléstia e analisado o aspecto estereotipado das manifestações sensitivo-tróficas, é apresentada a árvore genealógica da família em estudo. Na patogenia da acropatia úlcero-mutilante familial, que é ainda obscura, é ressaltada sua possível identidade com as moléstias heredodegenerativas. Pelos dados da literatura a lesão siringomiélica é afastada pelos estudos anatomopatológicos. No diagnóstico diferencial é lembrada, principalmente em nosso meio, a neuroleprose, além de outras moléstias nas quais ocorre mal perfurante plantar. Finalmente, é lembrada a evolução da moléstia que se faz por surtos necrosantes sucessivos nas extremidades distais, e o tratamento, que é meramente sintomático.Three cases of ulcero-mutilating familial acropathy (also known as Thévenard's disease or heredo-sensitive radicular neuropathy of Denny-Brown are reported. The familial features of the disease are stressed and a genealogic study of the family is made. The similarity of sensitive-trophic lesions in all cases is noteworthy. The obscure pathogenesis has some features in common with heredodegenerative conditions. According to bibliographic references, syringomielia as a cause of the disease may be excluded by histopathologic data. Differential diagnosis must include leprosy and some other conditions where plantar ulcers are present. The disease is characterized by recurrent episodes of necrosis of the distal extremities. Treatment is only symptomatic.

Caracterização morfológica da semente e da plântula de bacurizinho (Rheedia acuminata (Ruiz et Pav. Plachon et Triana - Clusiaceae

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NASCIMENTO WALNICE MARIA OLIVEIRA DO

2002-01-01

Full Text Available O bacurizinho é uma espécie frutífera do gênero Rheedia, nativa da Amazônia, e raramente cultivada, pois seus frutos, embora comestíveis, apresentam polpa escassa. Os estudos com o bacurizinho visam a sua utilização como porta-enxerto, redutor de porte para outras espécies do gênero Rheedia e Garcinia que apresentam altura elevada, como o bacuripari (Rheedia macrophylla Planchon et Triana- Clusiaceae e o mangostão (Garcinia mangostana L.. Este trabalho teve como objetivo caracterizar, morfologicamente, a semente e a plântula dessa espécie. A semente é exalbuminosa, bitegumentada, com a testa de coloração marrom, apresentando vários feixes vasculares bem visíveis, distinguindo-se por sua coloração um pouco mais clara. O hilo é arredondado, de coloração escura, com pequena região mais clara ao centro, correspondendo no ponto de entrada de feixe vascular. A micrópila situa-se próxima ao hilo, sobre uma pequena protuberância triangular. O embrião é anômalo, hipocotilar e é representado unicamente por um longo eixo hipocótilo-radícula, sendo os cotilédones diminutos, aparecendo apenas na extremidade superior no lado oposto da micrópila. Durante a germinação, ocorre primeiramente a emergência de delgada raiz primária, no pólo oposto onde será originado o epicótilo. Essa raiz cresce aproximadamente 5-7cm e cessa, fenecendo posteriormente. Por ocasião da emergência do epicótilo, ocorre ao mesmo tempo a formação de uma raiz adventícia, na base do epicótilo, bem mais robusta que a anterior e que se constituirá no sistema radicular da planta. Precedendo a abertura do primeiro par de metáfilos, desenvolvem-se no epicótilo três pares de catafilos opostos e de coloração esverdeada. A germinação é hipógea e a plântula do tipo criptocotiledonar.

The role of imaging in diagnosing diseases of the distal radioulnar joint, triangular fibrocartilage complex, and distal ulna.

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Squires, Judy H; England, Eric; Mehta, Kaushal; Wissman, Robert D

2014-07-01

The purpose of this article is to review the anatomy, biomechanics, and multimodality imaging findings of common and uncommon distal radioulnar joint (DRUJ), triangular fibrocartilage complex, and distal ulna abnormalities. The DRUJ is a common site for acute and chronic injuries and is frequently imaged to evaluate chronic wrist pain, forearm dysfunction, and traumatic forearm injury. Given the complex anatomy of the wrist, the radiologist plays a vital role in the diagnosis of wrist pain and dysfunction.

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.

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

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

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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.

Laparoscopic distal pancreatectomy for adenocarcinoma: safe and reasonable?

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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

Distal finger replantation.

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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.

Edema agudo hemorrágico da infância: relato de três casos Acute hemorrhagic edema of infancy: report of three cases

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Paulo Sergio Emerich

2011-12-01

Full Text Available O Edema Agudo Hemorrágico da Infância é uma vasculite leucocitoclástica pouco frequente, que ocorre, quase exclusivamente, em crianças entre 4 meses e 2 anos de idade. Caracteriza-se, clinicamente, pela tríade febre, lesões purpúricas na face, pavilhões auriculares e extremidades e edema. Embora os achados cutâneos sejam dramáticos e de surgimento rápido, o prognóstico é favorável, com resolução espontânea dentro de 1 a 3 semanas. Descrevem-se três casos cujos achados clínicos e histopatológicos são característicos de edema agudo hemorrágico da infância.Acute Hemorrhagic Edema of Infancy is an infrequent leukocytoclastic vasculitis which occurs almost exclusively in children between 4 months and 2 years of age. It is clinically characterized by the triad fever, purpuric lesions on the face, auricular pinna and extremities, and edema. Although the cutaneous findings are dramatic and of rapid onset, the prognosis is favorable, with spontaneous resolution within 1 to 3 weeks. Three cases are described in which clinical and histopathological findings are characteristic of acute hemorrhagic edema of infancy.

Distal renal tubular acidosis and hepatic lipidosis in a cat.

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Brown, S A; Spyridakis, L K; Crowell, W A

1986-11-15

Clinical and laboratory evidence of hepatic failure was found in a chronically anorectic cat. Simultaneous blood and urine pH determinations established a diagnosis of distal renal tubular acidosis. The cat did not respond to treatment. Necropsy revealed distal tubular nephrosis and hepatic lipidosis. The finding of distal renal tubular acidosis in a cat with hepatic lipidosis emphasizes the importance of complete evaluation of acid-base disorders in patients.

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.

Costo-beneficio de la terapia en ambiente húmedo versus terapia tradicional: el caso de un paciente con úlcera en la extremidad inferior

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Blanca Lilia Reyes-Rocha

Full Text Available Actualmente, ha cobrado relevancia el uso de la terapia húmeda en la cura de las heridas crónicas; sin embargo, persiste el uso de la terapia tradicional como técnica para lograr la cicatrización de las mismas. El caso que presentamos tiene como propósito determinar el costo-beneficio del empleo de apósitos de cura en ambiente húmedo versus cura tradicional en un paciente con úlcera en la extremidad inferior. Los resultados muestran que el coste es mayor con la terapia en ambiente húmedo; sin embargo, el periodo de cicatrización de la herida es menor en comparación con el tiempo de cicatrización que conlleva la cura tradicional; esto redunda en un beneficio para el paciente al alcanzar su recuperación en un menor tiempo. Estos hallazgos permiten proponer hipótesis para estudios posteriores bajo otro diseño metodológico, a fin de generar evidencia científica que coadyuve en la mejora de los procesos de atención en beneficio de la población con este tipo de padecimiento.

Myxobolus platanus n. sp. (Myxosporea, Myxobolidae, a parasite of Mugil platanus Günther, 1880 (Osteichthyes, Mugilidae from Lagoa dos Patos, RS, Brazil Myxobolus platanus n. sp. (Myxosporea, Myxobolidae, parasita de Mugil platanus Günther, 1880 (Osteichthyes, Mugilidae da Lagoa dos Patos, RS

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J.C. Eiras

2007-08-01

Full Text Available Myxobolus platanus n. sp. infecting the spleen of Mugil platanus Günther, 1880 (Osteichthyes, Mugilidae from Lagoa dos Patos, Brazil is described The parasites formed round or slightly oval whitish plasmodia (about 0.05-0.1mm in diameter on the surface of the organ. The spores were round in frontal view and oval in lateral view, 10.7µm (10-11 long, 10.8µm (10-11 wide and 5µm thick, and presented four sutural marks along the sutural edge. The polar capsules, equal in size, were prominent, surpassing the mid-length of the spore, and were oval with the posterior extremity rounded, and converging with their anteriorly tapered ends. They were 7.7µm (7-8 long and 3.8µm (3.5-4 wide. A small intercapsular appendix was present. The polar filament formed five to six coils obliquely placed to the axis of the polar capsule. No mucous envelope or distinct iodinophilous vacuole were found.Descreve-se Myxobolus platanus n. sp. infectando o baço de Mugil platanus Günther, 1880 (Osteichthyes, Mugilidae da Lagoa dos Patos, Brasil. Os parasitas formavam plasmódios brancos redondos ou ligeiramente ovais (diâmetro de cerca de 0,05-0,1mm à superfície do órgão. Os esporos eram circulares em observação frontal e ovais em obervação lateral, medindo, em média, 10,7µm (10-11 de comprimento, 10,8µm (10-11 de largura e 5µm de espessura, e tinham quatro marcas suturais ao longo da linha de sutura. As cápsulas polares eram grandes e do mesmo tamanho ultrapassando a zona média do esporo. Eram de forma oval, tendo a extremidade posterior arredondada, e convergiam pelas extremidades anteriores afiladas, medindo 7,7µm (7-8 de comprimento por 3,8µm (3,5-4 de largura. Um pequeno apêndice intercapsular estava presente. O filamento polar formava cinco a seis dobras colocadas obliquamente em relação ao eixo da cápsula. Não havia envelope mucígeno nem vacúolo iodofílico.

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

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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.

Distally based superficial sural artery flap for soft tissue coverage in the distal 2/3 of leg and foot

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Kamath B

2005-01-01

Full Text Available Background: Skin coverage for defects in the lower 2/3 of leg, ankle region and posterior heel has always been a difficult challenge for reconstructive surgeon. Methods: We describe our experience with the distally based superficial sural artery flap coverage in 48 patients with moderate sized defects in these difficult areas. Results: One out of 48 flaps (in 48 patients was lost totally and 3 suffered marginal necrosis which did not require any secondary procedure. These complications could have been avoided by proper selection of cases and refining technical skills. Conclusion: This simple procedure could be an important and versatile tool for any reconstructive surgeon in providing skin coverage in the distal leg and proximal foot. Preservation of major arteries of the lower limb, minimal donor defect, relatively uninjured donor area in compound fracture or poly trauma involving distal leg are some of the advantages of the flap.

Metodologia para avaliação ultrassonográfica da biometria uterina na fêmea bovina

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Víctor Gómez-L

2017-07-01

Full Text Available Objetivou-se avaliar uma metodologia para mensurar a espessura endometrial e diâmetro dos cornos uterinos. Para o qual, os cornos uterinos foram divididos em três regiões. A partir do septo intercornual até o início a curvatura maior, foi considerada a primeira região. A partir da curvatura maior até o início do ápice do corno segunda região, e extremidade livre do corna a terceira região. Mensurou-se a espessura endometrial e o diâmetro dos cornos em animais in vivo e nos órgãos genitais dos mesmos post mortem. Foram utilizadas cinco vacas sexualmente maturas da raça Holandesa, criadas em manejo Losing-House. Os dados quantitativos foram analisados pela ANOVA e as médias comparadas pelos testes de Tukey ou pela análise não paramétrica comparando as médias pelo teste de Kruskall Wallis. Os valores médios não apresentaram diferenças para as características avaliadas no animal in vivo comparadas aos obtidos post mortem (P>0,05. Nas mensurações obtidas, a terceira região mostrou valores médios semelhantes para diâmetro (21,0±2,6 mm - 22,9±2,8 mm e espessura endometrial de ambos cornos (10,4±4,9 mm - 10,8±5,2 mm. De igual forma os valores obtidos para espessura e diâmetro de ambos cornos uterinos da terceira região mostrou-se semelhante aos valores obtidos na segunda e primeira região. Já os valores da segunda região diferiram dos obtidos na primeira região (P<0,05. Dessa forma, a obtenção de imagens ultrassonográficas em cortes transversais e a mensuração das biometrias uterinas a partir da bifurcação até a curvatura maior, mostra-se eficiente e representativa da espessura endometrial e diâmetro dos cornos uterinos como um tudo.

O esôfago curto e o refluxo distal são fatores de risco para o refluxo proximal? Short length of the esophagus and distal reflux are risk factors for proximal esophageal reflux?

Directory of Open Access Journals (Sweden)

Humberto Oliveira Serra

2010-12-01

Full Text Available RACIONAL: Não está claro se pacientes que apresentam refluxo gastroesofágico distal têm maior risco de apresentar também refluxo proximal. O senso comum sugere que um episódio de refluxo poderia chegar mais facilmente à faringe em pacientes que tivessem menor distância a percorrer entre o esfíncter inferior do esôfago e o superior. OBJETIVO: Investigar se o esôfago curto e a presença de refluxo esofágico distal são fatores de risco para refluxo proximal nos pacientes com sintomas respiratórios. MÉTODO: Cento e sete pacientes foram avaliados prospectivamente por meio de entrevista, esofagoscopia, manometria e pHmetria. Utilizaram-se o teste t de Student, o de correlação de Spearman, o do Qui-quadrado e odds-ratio. O nível de significância foi 0,05. RESULTADOS: Os sintomas que motivaram a investigação da doença do refluxo gastroesofágico foram: tosse 43 (40,2%; pigarro 25 (23,4%, globo faríngeo 23 (21,5% e rouquidão 16 (14,9%. No estudo endoscópico 22 apresentaram esofagite e 14 hérnia de hiato. Na avaliação manométrica 11 (10,8% apresentaram hipotonia do esfíncter inferior. A média do comprimento do esôfago foi 24,3 (± 1,9 cm, variando de 20 a 30 cm. Na avaliação pHmétrica 23 (21,5% apresentaram refluxo distal patológico e 12 (11,2% refluxo proximal. CONCLUSÕES: O comprimento do esôfago não esteve associado com a presença de refluxo proximal. Pacientes que apresentaram refluxo gatroesofágico distal, independente do comprimento do esôfago, tiveram risco aumentado de 4,6 vezes para apresentarem refluxo proximal.BACKGROUND: It is not clear whether patients suffering from distal esophageal reflux also present high risk to proximal esophageal reflux. Common sense suggests that reflux would more easily reach the pharynx in patients who have a smaller distance between the lower esophageal sphincter and the upper one and, thus, short esophagus. AIM: To Investigate if short esophageal length and presence of

The impact of splenectomy on outcomes after distal and total pancreatectomy

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Bramhall Simon

2007-06-01

Full Text Available Abstract Background Several authors advocate spleen preserving distal pancreatectomy, because of the increased complication rate after splenectomy. Methods Postoperative complications and survival after distal and total pancreatectomy, were recorded and retrospectively analyzed according to spleen preservation. Patients, who underwent distal and total pancreatectomy without histologically proven adenocarcinoma, or extrapancreatic disease, were included in the cohort which was divided into splenectomy and no splenectomy groups. Statistical analysis was performed using Fisher's test. Results The study group consisted of 62 patients who underwent distal and total pancreatectomy between 26/11/1987 to 6/1/2006. Splenectomy was performed in 35 out of 62 patients (56.5%, distal pancreatectomy was performed in 49 out of 62 patients (79%. Morbidity rate was 28.6% in splenectomy group and 14.8% in the no splenectomy group (p = 0.235, while 30 days mortality rate was 2.9%; one patient died in the splenectomy group (p = 1. Conclusion Spleen-preservation did not influence the outcomes after distal and total pancreatectomy in our series.

Two-wave propagation in in vitro swine distal ulna

Science.gov (United States)

Mano, Isao; Horii, Kaoru; Matsukawa, Mami; Otani, Takahiko

2015-07-01

Ultrasonic transmitted waves were obtained in an in vitro swine distal ulna specimen, which mimics a human distal radius, that consists of interconnected cortical bone and cancellous bone. The transmitted waveforms appeared similar to the fast waves, slow waves, and overlapping fast and slow waves measured in the specimen after removing the surface cortical bone (only cancellous bone). In addition, the circumferential waves in the cortical bone and water did not affect the fast and slow waves. This suggests that the fast-and-slow-wave phenomenon can be observed in an in vivo human distal radius.

MRI of fractures of the distal radius: comparison with conventional radiographs

International Nuclear Information System (INIS)

Spence, L.D.; Eustace, S.

1998-01-01

Objective. To compare the evaluation of fractures of the distal radius with MRI and conventional radiographs. To demonstrate the ability of MRI to detect unsuspected soft tissue derangement accompanying this common injury. Design and patients. Twenty-one consecutive inpatients admitted following fracture of the distal radius underwent preoperative evaluation with both conventional radiographs and MRI. In each case, analysis was made of both the osseous and soft tissue injury. MRI findings were compared with those identified on conventional radiographs and at subsequent surgical fixation. Results. Of 21 patients with fractures of the distal radius, 20 had extension to the radiocarpal articulation, 14 had distal radio-ulnar joint extension and 5 had avulsion of the ulnar styloid.Occult carpal bone fractures accompanying fracture of the distal radius were identified in two patients: one of the capitate and the other of the second metacarpal base. Ten patients (48%) had associated soft tissue injury: six patients had scapholunate ligament rupture, two patients had disruption of the triangular fibrocartilage, one patient had extensor carpi ulnaris tenosynovitis and one patient had a tear of a dorsal radiocarpal ligament. Of five patients with ulnar styloid avulsions, none had evidence of triangular fibrocartilage tears. Conclusion. MRI affords better evaluation of osseous injury accompanying distal radial fractures than conventional radiographs. Intra-articular soft tissue injury accompanies distal radial fractures in almost 50% of cases. Scapholunate ligament disruption commonly accompanies intra-articular fracture through the lunate facet of the distal radius. Fracture of the ulnar styloid is infrequently associated with tear of the triangular fibrocartilage. (orig.)

MRI of fractures of the distal radius: comparison with conventional radiographs

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Spence, L.D.; Eustace, S. [Medical Center, Boston, MA (United States). Dept. of Radiol.; Savenor, A.; Nwachuku, I.; Tilsley, J. [Department of Orthopedics, Boston Medical Center, Boston, MA 02118 (United States)

1998-05-01

Objective. To compare the evaluation of fractures of the distal radius with MRI and conventional radiographs. To demonstrate the ability of MRI to detect unsuspected soft tissue derangement accompanying this common injury. Design and patients. Twenty-one consecutive inpatients admitted following fracture of the distal radius underwent preoperative evaluation with both conventional radiographs and MRI. In each case, analysis was made of both the osseous and soft tissue injury. MRI findings were compared with those identified on conventional radiographs and at subsequent surgical fixation. Results. Of 21 patients with fractures of the distal radius, 20 had extension to the radiocarpal articulation, 14 had distal radio-ulnar joint extension and 5 had avulsion of the ulnar styloid.Occult carpal bone fractures accompanying fracture of the distal radius were identified in two patients: one of the capitate and the other of the second metacarpal base. Ten patients (48%) had associated soft tissue injury: six patients had scapholunate ligament rupture, two patients had disruption of the triangular fibrocartilage, one patient had extensor carpi ulnaris tenosynovitis and one patient had a tear of a dorsal radiocarpal ligament. Of five patients with ulnar styloid avulsions, none had evidence of triangular fibrocartilage tears. Conclusion. MRI affords better evaluation of osseous injury accompanying distal radial fractures than conventional radiographs. Intra-articular soft tissue injury accompanies distal radial fractures in almost 50% of cases. Scapholunate ligament disruption commonly accompanies intra-articular fracture through the lunate facet of the distal radius. Fracture of the ulnar styloid is infrequently associated with tear of the triangular fibrocartilage. (orig.) With 5 figs., 16 refs.

Young Children's Sibling Relationship Quality: Distal and Proximal Correlates

Science.gov (United States)

Kretschmer, Tina; Pike, Alison

2009-01-01

Background: Relationships within families are interdependent and related to distal environmental factors. Low socioeconomic status (SES) and high household chaos (distal factors) have been linked to less positive marital and parent-child relationships, but have not yet been examined with regard to young children's sibling relationships. The…

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; 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,

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

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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.)

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

International Nuclear Information System (INIS)

Oestreich, Alan E.

2015-01-01

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.)

Fishtail deformity - a delayed complication of distal humeral fractures in children

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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.)

Fishtail deformity - a delayed complication of distal humeral fractures in children

International Nuclear Information System (INIS)

Narayanan, Srikala; Shailam, Randheer; Nimkin, Katherine; Grottkau, Brian E.

2015-01-01

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.)

Spontaneous distal rupture of the plantar fascia.

Science.gov (United States)

Gitto, Salvatore; Draghi, Ferdinando

2018-07-01

Spontaneous ruptures of the plantar fascia are uncommon injuries. They typically occur at its calcaneal insertion and usually represent a complication of plantar fasciitis and local treatment with steroid injections. In contrast, distal ruptures commonly result from traumatic injuries. We describe the case of a spontaneous distal rupture of the plantar fascia in a 48-year-old woman with a low level of physical activity and no history of direct injury to the foot, plantar fasciitis, or steroid injections. © 2017 Wiley Periodicals, Inc.

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.

Fratura extra-articular da extremidade medial da clavícula associada à luxação acromioclavicular tipo IV: relato de caso Extra-articular fracture of the medial end of the clavicle associated with type IV acromioclavicular dislocation: case report

OpenAIRE

Mário Chaves Correa; Lucas Braga Jacques Gonçalves; Jose Carlos Souza Vilela; Igor Lima Leonel; Lincoln Paiva Costa; Ronaldo Percopi de Andrade

2011-01-01

Ocorrendo isoladamente, as fraturas da clavícula e as luxações acromioclaviculares são lesões muito comuns. A combinação de uma luxação acromioclavicular e de uma fratura do terço lateral da clavícula não é rara. Entretanto, existem muito poucos casos descritos de luxações acromioclaviculares associadas a fraturas do terço médio da clavícula; aquelas associadas a fraturas do terço medial são ainda mais raras. Nós reportamos o caso de um indivíduo adulto do sexo masculino que sofreu uma luxaçã...

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

Detecção do virus ‘HoBi’-like (BVDV-3 em bovino no semiárido do Estado da Paraíba

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Ana L.A. Marques

Full Text Available RESUMO: Objetivou-se descrever os aspectos clínicos e anatomopatológicos, e a identificação viral de um caso de infecção pelo vírus ‘Hobi’-like (BVDV-3 em bovino do semiárido paraibano, Nordeste do Brasil. Um bovino, fêmea, três meses de idade, foi levado ao Hospital Veterinário da UFCG apresentando salivação, dificuldade de apreensão do teto, falta de apetite, fezes escuras e em pouca quantidade. Diante da piora do quadro clínico optou-se por sua eutanásia in extremis, seguida da realização da necropsia e coleta de material para histopatologia. Histologicamente, nas mucosas do trato digestivo, havia edema, degeneração balonosa, necrose e infiltrado inflamatório, que foi observado na face dorsal da língua e no seu epitélio mais profundo. A imunohistoquímica de amostras de extremidade de pavilhão auricular demonstrou marcação antigênica positiva e pela RT-PCR foi possível detectar RNA viral do BVDV no soro sanguíneo, cujo efeito citopático em células epiteliais de rim bovino da linhagem “Madin Darby bovine kidney” (MDBK não foi observado. O sequenciamento do gene 5’NCR demonstrou que o vírus isolado estaria mais relacionado ao ‘Hobi’-like (BVDV-3. Após a confirmação do diagnóstico foram coletadas amostras de soro dos 23 animais do rebanho para sorologia por ELISA indireto, sendo constatada 69,6% (16/23 de soropositividade. A identificação deste novo caso de infecção por ‘Hobi’-like na Paraíba reafirma a necessidade de um monitoramento regular para BVDV na região para detecção precoce da infecção dos rebanhos e adoção de medidas eficazes de prevenção e controle.

Torsion of wandering spleen and distal pancreas

International Nuclear Information System (INIS)

Sheflin, J.R.; Lee, C.M.; Kretchmar, K.A.

1984-01-01

Wandering spleen is the term applied to the condition in which a long pedicle allows the spleen to lie in an abnormal location. Torsion of a wandering spleen is an unusual cause of an acute abdomen and is rarely diagnosed preoperatively. Associated torsion of the distal pancreas is even more uncommon. The authors describe a patient with torsion of a wandering spleen and distal pancreas, who was correctly diagnosed, and define the merits of the imaging methods used. The initial examination should be 99 /sup m/Tc-sulfur colloid liner-spleen scanning

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.)

Osteoblastoma-like osteosarcoma of the distal tibia

International Nuclear Information System (INIS)

Abramovici, Luigia; Steiner, German C.; Kenan, Samuel; Hytiroglou, Prodromos; Rafii, Mahvash

2002-01-01

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.)

Use of palatally inserted mini-screw for upper molar distalization: A case series

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Valliollah Arash

2015-09-01

Full Text Available  Abstract Reports have shown that molars can be distalized successfully with virtually no orthodontic anchorage loss with an intraosseous anchorage, even with fully erupted second molars. The purpose of this study was evaluating the effects of mini-screws as skeletal anchorage for upper molar distalization. In this case series, three patients needing maxillary first molar distalization, were selected. mini-screw was inserted in the anterior part of the palate. The screws were anchored to the first premolars by transpalatal arch and immediately loaded (150-160 g by 0.018-inch arch-wire and steel open-coil spring to distalize maxillary molars. The skeletal and dental changes were measured on cephalograms obtained before and after distalization. The amount of first molar distalization in the patients was 4 mm with 2°of tipping, 4 mm with 5°of tipping, and 3.5 mm with 2°of tipping respectively. Upper incisors and first premolars were stable during distalization.       

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.

Simultaneous bilateral distal biceps tendon repair: case report

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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.

Simultaneous bilateral distal biceps tendon repair: case report.

Science.gov (United States)

Storti, Thiago Medeiros; Paniago, Alexandre Firmino; Faria, Rafael Salomon Silva

2017-01-01

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.

Limited distal organelles and synaptic function in extensive monoaminergic innervation.

Science.gov (United States)

Tao, Juan; Bulgari, Dinara; Deitcher, David L; Levitan, Edwin S

2017-08-01

Organelles such as neuropeptide-containing dense-core vesicles (DCVs) and mitochondria travel down axons to supply synaptic boutons. DCV distribution among en passant boutons in small axonal arbors is mediated by circulation with bidirectional capture. However, it is not known how organelles are distributed in extensive arbors associated with mammalian dopamine neuron vulnerability, and with volume transmission and neuromodulation by monoamines and neuropeptides. Therefore, we studied presynaptic organelle distribution in Drosophila octopamine neurons that innervate ∼20 muscles with ∼1500 boutons. Unlike in smaller arbors, distal boutons in these arbors contain fewer DCVs and mitochondria, although active zones are present. Absence of vesicle circulation is evident by proximal nascent DCV delivery, limited impact of retrograde transport and older distal DCVs. Traffic studies show that DCV axonal transport and synaptic capture are not scaled for extensive innervation, thus limiting distal delivery. Activity-induced synaptic endocytosis and synaptic neuropeptide release are also reduced distally. We propose that limits in organelle transport and synaptic capture compromise distal synapse maintenance and function in extensive axonal arbors, thereby affecting development, plasticity and vulnerability to neurodegenerative disease. © 2017. Published by The Company of Biologists Ltd.

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.

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 ...

Distal antebrachial fractures in toy-breed dogs

International Nuclear Information System (INIS)

Muir, P.

1997-01-01

Antebrachial fractures account for approximately 17% of all canine fractures, with motor vehicle trauma cited as one of the primary causes. However, antebrachial fractures in toy-breed dogs are often sustained after apparently minimal trauma, such as jumping or falling, and are usually distal. The cause of antebrachial fractures in toy breeds is not well understood. Complications after treatment of distal antebrachial fractures in toy-breed dogs, including delayed union, nonunion, and malunion, are common and are potentially serious because they may necessitate limb amputation. This article reports on distal antebrachial fractures in 26 toy-breed dogs that wee presented to the University of California, Davis, Veterinary Medical Teaching Hospital from April 1987 to March 1996. The author found that (1) these fractures typically occur in growing or adolescent dogs; (2) the presence of complications of union is typically associated with prior treatment using intramedullary pinning or external coaptation; and (3) successful healing of this type of fracture is obtained via rigid stabilization with bone plating in combination with cancellous bone autograft

Ultrasound demonstration of distal biceps tendon bifurcation: normal and abnormal findings

International Nuclear Information System (INIS)

Tagliafico, Alberto; Capaccio, Enrico; Derchi, Lorenzo E.; Martinoli, Carlo; Michaud, Johan

2010-01-01

We demonstrate the US appearance of the distal biceps tendon bifurcation in normal cadavers and volunteers and in those affected by various disease processes. Three cadaveric specimens, 30 normal volunteers, and 75 patients were evaluated by means of US. Correlative MR imaging was obtained in normal volunteers and patients. In all cases US demonstrated the distal biceps tendon shaped by two separate tendons belonging to the short and long head of the biceps brachii muscle. Four patients had a complete rupture of the distal insertion of the biceps with retraction of the muscle belly. Four patients had partial tear of the distal biceps tendon with different US appearance. In two patients the partial tear involved the short head of the biceps brachii tendon, while in the other two patients, the long head was involved. Correlative MR imaging is also presented both in normal volunteers and patients. US changed the therapeutic management in the patients with partial tears involving the LH of the biceps. This is the first report in which ultrasound considers the distal biceps tendon bifurcation in detail. Isolated tears of one of these components can be identified by US. Knowledge of the distal biceps tendon bifurcation ultrasonographic anatomy and pathology has important diagnostic and therapeutic implications. (orig.)

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

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

Surgical treatment of distal biceps tendon rupture: a case report

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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.

Distal protection filter device efficacy with carotid artery stenting: comparison between a distal protection filter and a distal protection balloon.

Science.gov (United States)

Iko, Minoru; Tsutsumi, Masanori; Aikawa, Hiroshi; Matsumoto, Yoshihisa; Go, Yoshinori; Nii, Kouhei; Abe, Gorou; Ye, Iwae; Nomoto, Yasuyuki; Kazekawa, Kiyoshi

2013-01-01

This retrospective study aimed to compare the effectiveness of the embolization prevention mechanism of two types of embolic protection device (EPD)-a distal protection balloon (DPB) and a distal protection filter (DPF). Subjects were 164 patients scheduled to undergo carotid artery stenting: a DPB was used in 82 cases (DPB group) from April 2007 until June 2010, and a DPF was used in 82 cases (DPF group) from July 2010 to July 2011. Rates of positive findings on postoperative diffusion-weighted imaging (DWI) and stroke incidence were compared. Positive postoperative DWI results were found in 34 cases in the DPB group (41.4 %), but in only 22 cases in the DPF group (26.8 %), and there was only a small significant difference within the DPF group. In the DPB group, there was one case of transient ischemic attack (TIA) (1.2 %) and four cases of brain infarction (2 minor strokes, 2 major strokes; 4.9 %), compared to the DFP group with one case of TIA (1.2 %) and no cases of minor or major strokes. In this study, significantly lower rates of occurrence of DWI ischemic lesions and intraoperative embolization were associated with use of the DPF compared to the DPB.

Características das papilas o dorso da língua de cabras (Capra hircus: estudo por de microscopia eletrônica de varredura e luz

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Erika Toledo da Fonseca

2011-12-01

Full Text Available A morfologia das papilas linguais da cabra doméstica (Capra hircus foi estudada por Microscopia Eletrônica de Varredura (MEV e Microscopia de luz. Papilasfiiliformes, cônicas e lentiformes possuem função mecânica, enquanto que as papilas fungiformes e as valadas possuem função gustativa. As papilasfiiliformes estavam distribuídas por toda a extensão da língua, nas superfícies dorsal e lateral. Possuem um formato cônico com a extremidade pontiaguda direcionada caudalmente. Possuem vários processos secundários, de tamanhos diferentes, com a mesma orientação. A histologia revelou abundante tecido queratinizado. As papilas fungiformes foram observadas nas superfícies dorsal e lateral do ápice e do corpo da língua. Possuem formato semelhante a cogumelos, com epitélio corni[1]icado espesso e botões gustativos distribuídos na superfície. As papilas lentiformes se distribuíam na linha mediana da parte mais dorsal do toro, com projeções elevadas além da superfície da língua. Algumas apresentavam o formato de pirâmide e outras um formato mais achatado. As papilas valadas foram encontradas na superfície lateral da parte mais caudal do toro. Possuem formato arredondado, envolvido por um sulco pouco profundo. Possuem botões gustativos na parede lateral que se abrem no sulco. As papilas cônicas foram observadas no toro da língua e possuem formato alongado, com base larga e ponta romba. Embora as principais características morfológicas e estruturais do epitélio lingual sejam específicas da espécie, o tipo de alimentação e os hábitos alimentares podem influenciar na sua estrutura. Assim, o presente trabalho fornece uma descrição histológica e ultraestrutural da língua de cabras domésticas submetidas à alimentação baseada em gramíneas e ração.

Identification of distal silencing elements in the murine interferon-A11 gene promoter.

Science.gov (United States)

Roffet, P; Lopez, S; Navarro, S; Bandu, M T; Coulombel, C; Vignal, M; Doly, J; Vodjdani, G

1996-08-01

The murine interferon-A11 (Mu IFN-A11) gene is a member of the IFN-A multigenic family. In mouse L929 cells, the weak response of the gene's promoter to viral induction is due to a combination of both a point mutation in the virus responsive element (VRE) and the presence of negatively regulating sequences surrounding the VRE. In the distal part of the promoter, the negatively acting E1E2 sequence was delimited. This sequence displays an inhibitory effect in either orientation or position on the inducibility of a virus-responsive heterologous promoter. It selectively represses VRE-dependent transcription but is not able to reduce the transcriptional activity of a VRE-lacking promoter. In a transient transfection assay, an E1E2-containing DNA competitor was able to derepress the native Mu IFN-A11 promoter. Specific nuclear factors bind to this sequence; thus the binding of trans-regulators participates in the repression of the Mu IFN-A11 gene. The E1E2 sequence contains an IFN regulatory factor (IRF)-binding site. Recombinant IRF2 binds this sequence and anti-IRF2 antibodies supershift a major complex formed with nuclear extracts. The protein composing the complex is 50 kDa in size, indicating the presence of IRF2 or antigenically related proteins in the complex. The Mu IFN-A11 gene is the first example within the murine IFN-A family, in which a distal promoter element has been identified that can negatively modulate the transcriptional response to viral induction.

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

Distal Embolic Protection for Renal Arterial Interventions

International Nuclear Information System (INIS)

Dubel, Gregory J.; Murphy, Timothy P.

2008-01-01

Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices (DPDs) have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. Early experience with DPDs in the renal arteries in patients with suitable anatomy suggests retrieval of embolic materials in approximately 71% of cases and renal functional improvement/stabilization in 98% of cases. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices

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.

One-stage lingual augmented urethroplasty in repair of distal penile ...

African Journals Online (AJOL)

E. Elsayed

Abstract. Objectives: To evaluate the outcome of augmentation of shallow urethral plate by lingual graft in repair of distal penile hypospadias. Patients and methods: Between June 2008 and May 2011, the procedure was performed on 23 patients with mean age 2.3 years (range 1–3). All patients had distal penile ...

Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients

OpenAIRE

Gupta, Rakesh K.; Rohilla, Rajesh Kumar; Sangwan, Kapil; Singh, Vijendra; Walia, Saurav

2009-01-01

Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-...

Distal vertebral artery reconstruction when managing vertebrobasilar insufficiency

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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. 

Neglected Distal Humeral Epiphyseal Injury - Two Case Reports

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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.

Whole-exome sequencing as a diagnostic tool for distal renal tubular acidosis

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Paula Cristina Barros Pereira

2015-11-01

Full Text Available Objective: Distal renal tubular acidosis (dRTA is characterized by metabolic acidosis due to impaired renal acid excretion. The aim of this study was to demonstrate the genetic diagnosis of four children with dRTA through use of whole-exome sequencing. Methods: Two unrelated families were selected; a total of four children with dRTA and their parents, in order to perform whole-exome sequencing. Hearing was preserved in both children from the first family, but not in the second, wherein a twin pair had severe deafness. Whole-exome sequencing was performed in two pooled samples and findings were confirmed with Sanger sequencing method. Results: Two mutations were identified in the ATP6V0A4 and ATP6V1B1 genes. In the first family, a novel mutation in the exon 13 of the ATP6V0A4 gene with a single nucleotide change GAC → TAC (c.1232G>T was found, which caused a substitution of aspartic acid to tyrosine in position 411. In the second family, a homozygous recurrent mutation with one base-pair insertion (c.1149_1155insC in exon 12 of the ATP6V1B1 gene was detected. Conclusion: These results confirm the value of whole-exome sequencing for the study of rare and complex genetic nephropathies, allowing the identification of novel and recurrent mutations. Furthermore, for the first time the application of this molecular method in renal tubular diseases has been clearly demonstrated. Resumo: Objetivo: A acidose tubular renal distal (ATRd é caracterizada por acidose metabólica devido a excreção renal de ácido prejudicada. O objetivo deste artigo é apresentar o diagnóstico genético de quatro crianças com ATRd utilizando o sequenciamento total do exoma. Métodos: Selecionamos duas famílias não relacionadas, totalizando quatro crianças com ATRd e seus pais, para realizar o sequenciamento total do exoma. A audição foi preservada em ambas as crianças da família um, porém em nenhuma criança da família dois, na qual um par de gêmeas teve

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.

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.

Dental and skeletal changes after intraoral molar distalization with sectional jig assembly.

Science.gov (United States)

Gulati, S; Kharbanda, O P; Parkash, H

1998-09-01

The present study was conducted on 10 subjects to evaluate dental and skeletal changes after intraoral molar distalization. The maxillary molars were distalized with a sectional jig assembly. Sentalloy open coil springs were used to exert 150 gm of force for a period of 12 weeks. A modified Nance appliance was the main source of anchorage. The pre- and postdistalization records included dental study casts, clinical photographs, and cephalograms. A total of 665 readings recorded from lateral cephalograms and dental casts were subjected to statistical analysis. The mean distal movement of the first molar was 2.78 mm, which was highly significant (o < 0.001). It moved distally at the rate of 0.86 mm/month. There was clinically some distal tipping (3.50 degrees) and distopalatal rotation (2.40 degrees). These changes were statistically significant (p < 0.001). The second molars accompanied the first molars and moved distally by nearly the same amount. There was 1.00 mm increase in the overjet and 2.60 degrees mesial tip of second premolar. The changes in the facial skeleton and dentition bases were minimal and statistically not significant. However, there was clockwise rotation of the mandible of 1.30 degrees that was statistically significant. This was the result of molar extrusion (1.60 mm).

Social Support Contributes to Outcomes following Distal Radius Fractures

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Caitlin J. Symonette

2013-01-01

Full Text Available Background. Distal radius fractures are the most common fracture of the upper extremity and cause variable disability. This study examined the role of social support in patient-reported pain and disability at one year following distal radius fracture. Methods. The Medical Outcomes Study Social Support Survey was administered to a prospective cohort of 291 subjects with distal radius fractures at their baseline visit. Pearson correlations and stepwise linear regression models (F-to-remove 0.10 were used to identify whether social support contributes to wrist fracture outcomes. The primary outcome of pain and disability at one year was measured using the Patient Rated Wrist Evaluation. Results. Most injuries were low energy (67.5% and were treated nonoperatively (71.9%. Pearson correlation analysis revealed that higher reported social support correlated with improved Patient Rated Wrist Evaluation scores at 1 year, r(n=181=-0.22, P<0.05. Of the subscales within the Social Support Survey, emotional/informational support explained a significant proportion of the variance in 1-year Patient Rated Wrist Evaluation scores, R2=4.7%, F (1, 181 = 9.98, P<0.05. Conclusion. Lower emotional/informational social support at the time of distal radius fracture contributes a small but significant percentage to patient-reported pain and disability outcomes.

Proximal and distal alignment of normal canine femurs: A morphometric analysis.

Science.gov (United States)

Kara, Mehmet Erkut; Sevil-Kilimci, Figen; Dilek, Ömer Gürkan; Onar, Vedat

2018-05-01

Many researchers are interested in femoral conformation because most orthopaedic problems of the long bones occur in the femur and its joints. The neck-shaft (NSA) and the anteversion (AVA) angles are good predictors for understanding the orientation of the proximal end of the femur. The varus (aLDFA) and procurvatum (CDFA) angles have also been used to understand the orientation of the distal end of the femur. The purposes of this study were to investigate the relationship between the proximal and distal angles of the femur and to compare the distal femoral angles in male and female dogs in order to investigate the sexual dimorphism. The measurements of normal CDFAs, which have not been previously reported, may also provide a database of canine distal femoral morphology. A total of 75 cleaned healthy femora from different breeds or mixed breed of dogs were used. The three-dimensional images were reconstructed from computed tomographic images. The AVA, NSA, aLDFA and CDFA were measured on the 3D images. The correlation coefficients were calculated among the measured angles. The distal femoral angles were also compared between male and female femora. The 95% confidence intervals of the AVA and the NSA were calculated to be 24.22°-29.50° and 144.97°-147.50°, respectively. The 95% confidence intervals of the aLDFA and the CDFA for all studied dogs were 92.62°-94.08° and 89.09°-91.94°, respectively. The NSA showed no correlation with either the aLDFA or CDFA. There was a weak inverse correlation between the AVA and CDFA and a weak positive correlation between the AVA and aLDFA. The differences in the aLDFA and CDFA measurements between male and female dog were not significant. In conclusion, femoral version, regardless of the plane, might have little influence on distal femoral morphology in normal dogs. Besides this, there is no evidence of a sexual dimorphism in the varus and procurvatum angles of the dog distal femur. The data from this study may be used in

Emprego de fixador externo circular no tratamento de complicações de fraturas do rádio e ulna em cães de raças pequenas Use of circular external fixator in the treatment of fracture complications of radius and ulna in small breed dogs

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Sheila Canevese Rahal

2005-10-01

Full Text Available O objetivo deste estudo foi avaliar o método de Ilizarov no tratamento de complicações de fraturas do rádio e ulna em cães de raças pequenas. Um fixador de Ilizarov miniatura composto por anéis de alumínio e hastes de aço foi usado em três cães da raça poodle miniatura (casos 1, 2 e 3 e em um pinscher (caso 4. Os cães 1 e 4 apresentavam consolidação atrasada das porções médio-distal e distal, respectivamente, devido a prévio tratamento com tala externa. Foi aplicada uma montagem constituída por dois anéis proximais e um distal. Ambas as fraturas consolidaram, sendo que a do poodle apresentou leve desvio cranial das extremidades fraturadas. Os outros dois casos (2 e 3 consistiam de fraturas previamente tratadas por procedimento cirúrgico. O caso 2 apresentava rotação lateral do membro torácico e não-união do aspecto distal da diáfise radial com presença de pino intramedular e dois fios de cerclagem. O pino intramedular e um dos fios de cerclagem foram removidos e realizou-se a derrotação do foco da fratura. O aparelho foi montado como nos casos 1 e 4. A consolidação da fratura foi obtida com moderado desvio caudal do eixo ósseo. No caso 3, havia reabsorção óssea na diáfise do rádio e ulna devido ao emprego inadequado de fixador externo resina-pino. Empregou-se o transporte ósseo com o fixador de Ilizarov para induzir a regeneração óssea. Entretanto, este foi interrompido por falta de resposta. Manteve-se o fixador e o defeito ósseo foi tratado com enxerto esponjoso autólogo e biomateriais. A ulna ocupou parte do defeito segmentar do rádio. Foi possível concluir que o método de Ilizarov pode ser usado no tratamento de consolidação atrasada e não-união, mas o fixador externo circular é de difícil aplicação em cães de raças pequenas.The aim of this study was to evaluate the Ilizarov’s method for treating complications of radius and ulna fractures in small breed dogs. A miniature Ilizarov�

Modelado y Control de un Exoesqueleto para la Rehabilitación de Extremidad Inferior con dos grados de libertad

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Ricardo López

2014-07-01

Full Text Available Resumen: Los exoesqueletos mecánicos son robots acoplados a las extremidades del cuerpo humano enfocados en el incremento de su fuerza, velocidad y rendimiento principalmente. Las principales aplicaciones son en la milicia, en la industria y en la medicina. El exoesqueleto se puede utilizar para la rehabilitación de las extremidades cuando por causas de algún accidente o enfermedad se tiene una actividad muscular reducida o nula. En este artículo se presenta un exoesqueleto de dos grados de libertad para realizar ejercicios de rehabilitación para tobillo y rodilla. El diseño y fabricación del exoesqueleto está basado en la instrumentación de una ortesis del miembro inferior derecho. El Exoesqueleto utiliza sensores que estiman la fuerza producida por el humano y se encuentran incorporados en los actuadores de tipo SEA (Series Elastic Actuator que se utilizan para amplificar la fuerza humana. Además mediante sensores se estima la posición y velocidad angular de las articulaciones, que se utilizan para controlar el movimiento de la pierna. En el artículo se presentan: un estudio del modelo dinámico del exoesqueleto y de los actuadores acoplados por medio del método de perturbaciones singulares, el diseño de un control basado en la suma de fuerzas generadas por el humano y el exoesqueleto, el diseño y fabricación del prototipo experimental y sus actuadores. Se realizaron simulaciones que muestran el buen desempeño del controlador propuesto. Los resultados experimentales muestran que existe una amplificación de la fuerza generada por el portador y amplificada por la mecánica del exoesqueleto, ofreciendo una disminución en el esfuerzo del usuario para mantenerse de pie y realizar ejercicios de flexión y extensión de las articulaciones. De manera que la amplificación de la fuerza puede aumentarse o disminuirse según se necesite, permitiendo al usuario una mejora evolutiva hasta llegar a la rehabilitación completa. Abstract

Clinical study for pancreatic fistula after distal pancreatectomy with mesh reinforcement

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Akira Hayashibe

2018-05-01

Full Text Available Summary: Background: The purpose of this cohort study was to determine whether distal pancreatectomy with mesh reinforcement can reduce postoperative pancreatic fistula (POPF rates compared with bare stapler. Methods: In total, 51 patients underwent stapled distal pancreatectomy. Out of these, 22 patients (no mesh group underwent distal pancreatectomy with bare stapler and 29 patients (mesh group underwent distal pancreatectomy with mesh reinforced stapler. The risk factor for clinically relevant POPF (grades B and C after distal pancreatectomy was also evaluated. Results: Clinical characteristics were almost similar in both the groups. The days of the mean hospital stay and drainage tube insertion in the mesh group were significantly fewer than those in the no mesh group. The mean level of amylase in the discharge fluid in the mesh group was also significantly lower than that the in no mesh group. The rate of clinically relevant POPF (grades B and C in the mesh group was significantly lower than that in the no mesh group (p=0.016. Univariate analyses of risk factors for POPF (grades B and C revealed that only mesh reinforcement was associated with POPF (grades B and C. Moreover, on multivariate analyses of POPF risk factors with p value<0.2 in univariate analyses by logistic regression, mesh reinforcement was regarded as a significant factor for POPF(grades B and C. Conclusions: The distal pancreatectomy with mesh reinforced stapler was thought to be favorable for the prevention of clinically relevant POPF (grades B and C. Keywords: mesh reinforcement, pancreatic fistula, pancreatic surgery

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

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.

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....

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.

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.

Distal Oblique Bundle Reinforcement for Treatment of DRUJ Instability.

Science.gov (United States)

Brink, Peter R G; Hannemann, Pascal F W

2015-08-01

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 osteoarthritis, stabilization of the DRUJ may offer relief. To this end, several different techniques have been investigated over the past 90 years. Materials and Methods In this article we outline the procedure for a new technique using a tendon graft to reinforce the distal edge of the interosseous membrane. Description of Technique A percutaneous technique is used to harvest the palmaris longus tendon and to create a tunnel, just proximal to the sigmoid notch, through the ulna and radius in an oblique direction. By overdrilling the radial cortex, the knotted tendon can be pulled through the radius and ulna and the knot blocked at the second radial cortex, creating a strong connection between the radius and ulna at the site of the distal oblique bundle (DOB). The tendon is fixed in the ulna with a small interference screw in full supination, preventing subluxation of the ulna out of the sigmoid notch during rotation. Results Fourteen patients were treated with this novel technique between 2011 and October 2013. The QuickDASH score at 25 months postoperatively (range 16-38 months) showed an improvement of 32 points. Similarly, an improvement of 33 points (67-34 months) was found on the PRWHE. Only one recurrence of chronic, dynamic bidirectional instability in the DRUJ was observed. Conclusion This simple percutaneous tenodesis technique between radius and ulna at the position of the distal edge of the interosseous membrane shows promise in terms of both restoring stability and relieving complaints related to chronic subluxation in the DRUJ.

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...

Miyoshi-type distal muscular dystrophy. Clinical spectrum in 24 Dutch patients

NARCIS (Netherlands)

Linssen, W. H.; Notermans, N. C.; van der Graaf, Y.; Wokke, J. H.; van Doorn, P. A.; Höweler, C. J.; Busch, H. F.; de Jager, A. E.; de Visser, M.

1997-01-01

Miyoshi-type distal muscular dystrophy has now been found to be more frequent outside Japan than was previously thought. We studied 24 Dutch patients with Miyoshi-type distal muscular dystrophy and focused on its clinical expression and natural history, muscle CT-scans and muscle biopsy findings.

Miyoshi-type distal muscular dystrophy. Clinical spectrum in 24 Dutch patients

NARCIS (Netherlands)

W.H.J.P. Linssen (Wim); N.C. Notermans (Nicolette); Y. van der Graaf (Yolanda); J.H.J. Wokke (John); P.A. van Doorn (Pieter); C.J. Höweler (Chris); H.F.M. Busch (Herman); A.E.J. de Jager (Aeiko); M. de Visser (Marianne)

1997-01-01

textabstractMiyoshi-type distal muscular dystrophy has now been found to be more frequent outside Japan than was previously thought. We studied 24 Dutch patients with Miyoshi-type distal muscular dystrophy and focused on its clinical expression and natural history muscle CT-scans and muscle biopsy

Miyoshi-type distal muscular dystrophy - Clinical spectrum in 24 Dutch patients

NARCIS (Netherlands)

Linssen, WHJP; Notermans, NC; VanderGraaf, Y; Wokke, JHJ; VanDoorn, PA; Howeler, CJ; Busch, HFM; DeJager, AEJ; DeVisser, M

1997-01-01

Miyoshi-type distal muscular dystrophy has now been found to be more frequent outside Japan than was previously thought. We studied 24 Dutch patients with Miyoshi-type distal muscular dystrophy and focused on its clinical expression and natural history, muscle CT-scans and muscle biopsy findings.

HIV Distal Neuropathic Pain Is Associated with Smaller Ventral Posterior Cingulate Cortex.

Science.gov (United States)

Keltner, John R; Connolly, Colm G; Vaida, Florin; Jenkinson, Mark; Fennema-Notestine, Christine; Archibald, Sarah; Akkari, Cherine; Schlein, Alexandra; Lee, Jisu; Wang, Dongzhe; Kim, Sung; Li, Han; Rennels, Austin; Miller, David J; Kesidis, George; Franklin, Donald R; Sanders, Chelsea; Corkran, Stephanie; Grant, Igor; Brown, Gregory G; Atkinson, J Hampton; Ellis, Ronald J

2017-03-01

. Despite modern antiretroviral therapy, HIV-associated neuropathy is one of the most prevalent, disabling and treatment-resistant complications of HIV disease. The presence and intensity of distal neuropathic pain is not fully explained by the degree of peripheral nerve damage. A better understanding of brain structure in HIV distal neuropathic pain may help explain why some patients with HIV neuropathy report pain while the majority does not. Previously, we reported that more intense distal neuropathic pain was associated with smaller total cerebral cortical gray matter volumes. The objective of this study was to determine which parts of the cortex are smaller. . HIV positive individuals with and without distal neuropathic pain enrolled in the multisite (N = 233) CNS HIV Antiretroviral Treatment Effects (CHARTER) study underwent structural brain magnetic resonance imaging. Voxel-based morphometry was used to investigate regional brain volumes in these structural brain images. . Left ventral posterior cingulate cortex was smaller for HIV positive individuals with versus without distal neuropathic pain (peak P  = 0.017; peak t = 5.15; MNI coordinates x = -6, y = -54, z = 20). Regional brain volumes within cortical gray matter structures typically associated with pain processing were also smaller for HIV positive individuals having higher intensity ratings of distal neuropathic pain. . The posterior cingulate is thought to be involved in inhibiting the perception of painful stimuli. Mechanistically a smaller posterior cingulate cortex structure may be related to reduced anti-nociception contributing to increased distal neuropathic pain. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Effect of DA-9701 on Gastric Motor Function Assessed by Magnetic Resonance Imaging in Healthy Volunteers: A Randomized, Double-Blind, Placebo-Controlled Trial.

Science.gov (United States)

Min, Yang Won; Min, Byung-Hoon; Kim, Seonwoo; Choi, Dongil; Rhee, Poong-Lyul

2015-01-01

Improving gastric accommodation and gastric emptying is an attractive physiological treatment target in patients with functional dyspepsia (FD). We evaluated the effect of DA-9701, a new drug for FD, on gastric motor function after a meal in healthy volunteers using magnetic resonance imaging (MRI). Forty healthy volunteers were randomly allocated to receive either DA-9701 or placebo. After 5 days of treatment, subjects underwent gastric MRI (60 min before and 15, 30, 45, 60, 90, and 120 min after a liquid test meal). Gastric volume was measured through 3-dimensional reconstruction from MRI data. We analyzed 4 outcome variables including changes in total gastric volume (TGV), proximal TGV, and proximal to distal TGV ratio after a meal and gastric emptying rates after adjusting values at the pre-test meal. Changes in TGV and proximal TGV after a meal did not differ between the DA-9701 and placebo groups (difference between groups -25.9 mL, 95% confidence interval [CI] -54.0 to 2.3 mL, P = 0.070 and -2.9 mL, 95% CI -30.3 to 24.5 mL, P = 0.832, respectively). However, pre-treatment with DA-9701 increased postprandial proximal to distal TGV ratio more than placebo (difference between groups 0.93, 95% CI 0.08 to 1.79, P = 0.034). In addition, pre-treatment with DA-9701 significantly increased gastric emptying as compared with placebo (mean difference between groups 3.41%, 95% CI 0.54% to 6.29%, P = 0.021, by mixed model for repeated measures). Our results suggested that DA-9701 enhances gastric emptying and does not significantly affect gastric accommodation in healthy volunteers. Further studies to confirm whether DA-9701 enhances these gastric motor functions in patients with FD are warranted. ClinicalTrials.gov NCT02091635.

Effect of DA-9701 on Gastric Motor Function Assessed by Magnetic Resonance Imaging in Healthy Volunteers: A Randomized, Double-Blind, Placebo-Controlled Trial.

Directory of Open Access Journals (Sweden)

Yang Won Min

Full Text Available Improving gastric accommodation and gastric emptying is an attractive physiological treatment target in patients with functional dyspepsia (FD. We evaluated the effect of DA-9701, a new drug for FD, on gastric motor function after a meal in healthy volunteers using magnetic resonance imaging (MRI.Forty healthy volunteers were randomly allocated to receive either DA-9701 or placebo. After 5 days of treatment, subjects underwent gastric MRI (60 min before and 15, 30, 45, 60, 90, and 120 min after a liquid test meal. Gastric volume was measured through 3-dimensional reconstruction from MRI data. We analyzed 4 outcome variables including changes in total gastric volume (TGV, proximal TGV, and proximal to distal TGV ratio after a meal and gastric emptying rates after adjusting values at the pre-test meal.Changes in TGV and proximal TGV after a meal did not differ between the DA-9701 and placebo groups (difference between groups -25.9 mL, 95% confidence interval [CI] -54.0 to 2.3 mL, P = 0.070 and -2.9 mL, 95% CI -30.3 to 24.5 mL, P = 0.832, respectively. However, pre-treatment with DA-9701 increased postprandial proximal to distal TGV ratio more than placebo (difference between groups 0.93, 95% CI 0.08 to 1.79, P = 0.034. In addition, pre-treatment with DA-9701 significantly increased gastric emptying as compared with placebo (mean difference between groups 3.41%, 95% CI 0.54% to 6.29%, P = 0.021, by mixed model for repeated measures.Our results suggested that DA-9701 enhances gastric emptying and does not significantly affect gastric accommodation in healthy volunteers. Further studies to confirm whether DA-9701 enhances these gastric motor functions in patients with FD are warranted.ClinicalTrials.gov NCT02091635.

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...

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.

Complete mucosal healing of distal lesions induced by twice-daily budesonide 2-mg foam promoted clinical remission of mild-to-moderate ulcerative colitis with distal active inflammation: double-blind, randomized study.

Science.gov (United States)

Naganuma, Makoto; Aoyama, Nobuo; Tada, Tomohiro; Kobayashi, Kiyonori; Hirai, Fumihito; Watanabe, Kenji; Watanabe, Mamoru; Hibi, Toshifumi

2018-04-01

Budesonide foam is used for the topical treatment of distal ulcerative colitis. This phase III study was performed to confirm mucosal healing and other therapeutic effects of twice-daily budesonide 2-mg foam in patients with mild-to-moderate ulcerative colitis including left-sided colitis and pancolitis. This was a multicenter, randomized, placebo-controlled, double-blind trial. A total of 126 patients with mild-to-moderate ulcerative colitis with active inflammation in the distal colon were randomized to two groups receiving twice-daily budesonide 2 mg/25 ml foam or placebo foam. The primary endpoint was the percentage of complete mucosal healing of distal lesions (endoscopic subscore of 0) at week 6. Some patients continued the treatment through week 12. Drug efficacy and safety were evaluated. The percentages of both complete mucosal healing of distal lesions and clinical remission were significantly improved in the budesonide as compared with the placebo group (p = 0.0003 and p = 0.0035). Subgroup analysis showed similar efficacy of budesonide foam for complete mucosal healing of distal lesions and clinical remission regardless of disease type. The clinical remission percentage tended to be higher in patients achieving complete mucosal healing of distal lesions than in other patients. There were no safety concerns with budesonide foam. This study confirmed for the first time complete mucosal healing with twice-daily budesonide 2-mg foam in mild-to-moderate ulcerative colitis with distal active inflammation. The results also indicated that complete mucosal healing of distal lesions by budesonide foam promotes clinical remission of ulcerative colitis. Clinical trial registration no.: Japic CTI-142704.

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).

Distal vein patch as a form of autologus modification for infragenicular prosthetic bypass.

Science.gov (United States)

Totic, Dragan; Rustempasic, Nedzad; Djedovic, Muhamed; Solakovic, Sid; Vukas, Haris; Aslani, Ilijas; Krvavac, Alma; Rudalija, Dzejra; Ahmetasevic, Alen

2013-01-01

Preferred graft for infragenicular bypass is autologus vein. The problem is when there is not available autologus vein. Literature suggest that in these situations, prosthetic graft with some form of modification of distal anastomosis with autogenic tissue is valuable adjunctive. Frequently used modifications are Miller's cuff, Taylor's patch and St. Mary's boot. Recently, there are reports on "Distal vein patch" as a form of autologus modification which, due to its simplicity and patency rate, attracted attention. The aim of this study was to evaluate benefits of this novel modification by comparing its patencies with other autologus modification of distal anastomosis. Study was performed on 60 patients, diabetics, with critical limb ischemia (CLI). Patients were divided in two groups: Group with distal vein patch modification; and group with some other form modification - control group. Patients were followed at least 22 months. We examined patency of grafts by physical examination or using Color Doppler. For statistical purposes we used KIaplan Meier analysis and curve. Significance was determined by Mann-Whitney, Fisher's exact, Pearsons chi square or Student T test as appropriate. P value less than 0,05 was considered significant. Groups were fairly matched relative to demographics, risk factors, operative intervention and distal anastomosis site. There was not statistical difference in two year primary patency between distal vein patch and control group--50% vs 53% respectivly (X2 = 0,08; p = 0,773). Also, there was not statistically significant difference in extremity survival (77% vs 77%) and patient survival between groups (89% vs 93%; X2 = 2,458; p = 0,117). This study proved equivalent patencies of infragenicular prosthetic bypasses performed using distal vein patch technique as with any other modification of distal anastomosis.

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.

Left ventricular contractile function after distal protection in primary percutaneous coronary intervention Results from the Drug Elution and Distal Protection in ST-Elevation Myocardial Infarction trial

DEFF Research Database (Denmark)

Kofoed, K F; Kelbæk, H; Thuesen, L

2011-01-01

Coronary intervention (PCI) may result in an increased infarct size. We evaluated the effect of distal protection during PCI for ST-segment elevation myocardial infarction (STEMI) on myocardial function.......Coronary intervention (PCI) may result in an increased infarct size. We evaluated the effect of distal protection during PCI for ST-segment elevation myocardial infarction (STEMI) on myocardial function....

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.

Vertebral artery origin stent placement with distal protection: technical and clinical results.

Science.gov (United States)

Qureshi, A I; Kirmani, J F; Harris-Lane, P; Divani, A A; Ahmed, S; Ebrihimi, A; Al Kawi, A; Janjua, N

2006-05-01

To report the feasibility, safety, and 1-month results of performing stent placement for vertebral origin stenosis with the use of a distal protection device. Distal protection devices have been shown to reduce the number of cerebral emboli and subsequent ischemic events when used as adjuncts to percutaneous carotid intervention; however, one case of the use of a distal protection device for vertebral artery has been reported in the literature. We retrospectively determined rates of technical success and 1-month stroke or death associated with stent placement by using distal protection (Filter EX; Boston Scientific, Natick, Mass) in patients with symptomatic vertebral artery origin stenosis. Technical success was defined as successful deployment of distal protection device and stent at target lesion followed by successful retrieval of the device and a final residual stenosis of less than 30%. Other outcomes ascertained included any stroke, death, and semiquantitative assessment of particulate material retained by the filter device. The mean age of the 12 treated patients was 68 years (range, 52-88 years) and the group included 9 men and 3 women. The mean percentage of vertebral artery origin stenosis was 71 +/- 6%. Femoral and radial approaches were used in 9 and 3 cases, respectively. Technical success was achieved in 11 of the 12 patients in whom distal protection device placement was attempted. Postprocedure residual stenosis was 5 +/- 4%. Eight devices held macroscopically visible embolic debris (large and small amounts in 3 and 5 devices, respectively). No stroke or death was observed in the 1-month follow-up. The present study demonstrates the feasibility of performing stent placement for vertebral artery origin stenosis by using a distal protection device. Further studies are required to determine the effectiveness of this approach for vertebral artery origin atherosclerosis.

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.

Origem e distribuição anatômica do nervo isquiático de mão-pelada (Procyon cancrivorus

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Kleber F Pereira

2011-12-01

Full Text Available O nervo isquiático é considerado o maior nervo do corpo, pertence tanto ao plexo sacral quanto ao lombossacral em carnívoros, continuando até a extremidade distal do membro pélvico, recebe fiibras dos ramos ventrais do sexto e sétimo nervos lombares e do primeiro nervo sacral. O objetivo do presente estudo é descrever a distribuição do nervo isquiático em mão-pelada (Procyon cancrivorus e comparar com dados literários de animais domésticos e silvestres. Os animais são procedentes de coleta em rodovias, entre as cidades de Goiânia e Jataí, principalmente na BR 364 ou BR 060. (mortos por acidente e fiixados em solução aquosa, a 10% de formaldeído. Doados ao Museu de Anatomia Humana e Comparada da UFG (Universidade Federal de Goiás, Campus de Jataí, Proc.CAJ-287/2008. As dissecações e documentação fotográfiica permitiram observar a distribuição do nervo isquiático. O nervo isquiático de mão-pelada inerva o membro pélvico passando entre os músculos glúteo médio e profundo, emitindo ramos para a musculatura da região glútea e da coxa, respectivamente, para os músculos glúteo médio, glúteo bíceps, semimembranáceo, semitendíneo, bíceps femoral, gêmeos, quadrado femoral e adutor magno, emitindo nervo cutâneo lateral e caudal da sura para suprir a pele na superfiície lateral e caudal da perna, respectivamente. Próximo ao meio da coxa bifurca-se em nervo tibial e nervo fiibular comum. O conhecimento anatômico da origem e distribuição do nervo is quiático em mão pelada quando comparado com animais domésticos, silvestres e de fazenda, mostram um padrão de inervação semelhante entre os espécimes.

Robotic spleen-preserving distal pancreatectomy. A case report.

Science.gov (United States)

Vasilescu, C; Sgarbura, O; Tudor, S; Herlea, V; Popescu, I

2009-01-01

Distal pancreatectomy (DP) is the removal of the pancreatic tissue at the left side of the superior mesenteric vein and it is traditionally approached by an open or laparoscopic exposure. Preservation of the spleen is optional but appears to have a better immunological outcome. We present the case of a 53-year old patient with a 2.4/2.2 tumor located in the tail of the pancreas, with high tumour marker values for whom we decided to perform a robotic spleen-preserving distal pancreatectomy (RSPDP). The postoperative outcome was satisfactory. In conclusion, we recommend this type of approach for small pancreatic tail lesions.

Modified distal shoe appliance--fabrication and clinical performance.

Science.gov (United States)

Gujjar, Kumar Raghav; Indushekar, K R; Amith, H V; Sharma, Shefali Li

2012-01-01

When the primary second molar is prematurely lost, mesial movement and migration of the permanent first molar often occurs. This is one of the most difficult problems of the developing dentition confronted by pediatric dentists. Use of a space maintainer that will guide the permanent first molar into its normal position is indicated. In cases with bilateral premature loss of primary molars, the conventional design of distal shoe poses a variety of problems and, therefore, necessitates a customized design for the eruption guidance of permanent first molars. The purpose of this case report is to discuss an innovative design of a distal shoe appliance, which was used with good clinical results.

A Pitfall in Fixation of Distal Humeral Fractures with Pre-Contoured Locking Compression Plate

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Prakash Jayakumar

2015-04-01

Full Text Available Anatomically precontoured locking plates are intended to facilitate the fixation of articular fractures and particularly those associated with osteoporosis. Fractures of the distal humerus are relatively uncommon injuries where operative intervention can be exceptionally challenging. The distal humeral trochlea provides a very narrow anatomical window through which to pass a fixed-angle locking screw, which must also avoid the olecranon, coronoid, and radial fossae. We describe 3 patients (ages 27, 49, and 73 years with a bicolumnar fracture of the distal humerus where very short distal locking screws were used. Intra-articular screw placement was avoided but loss of fixation occurred in two patients and a third was treated with a prolonged period of immobilization. We postulate that fixed-angle screw trajectories may make it difficult for the surgeon to place screws of adequate length in this anatomically confined region, and may lead to insufficient distal fixation. Surgical tactics should include placement of as many screws as possible into the distal fragment, as long as possible, and that each screw pass through a plate without necessarily locking in.

Manifestações mucocutâneas da dengue Mucocutaneous manifestations of dengue

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Omar Lupi

2007-08-01

Full Text Available Dengue é doença viral sistêmica que ocorre de forma epidêmica em áreas tropicais e subtropicais da Ásia, Américas e África. O vírus da dengue pertence ao gênero Flavivirus e à família Flaviviridae (arbovírus do grupo B. Aedes aegypti é o principal vetor e verdadeiro reservatório. A febre na dengue clássica persiste por período de dois a cinco dias com cefaléia intensa, mialgia, artralgia e dor retro-orbital. Alterações cutâneas incluem diversos achados como erupção morbiliforme que pode ser pruriginosa e que gera descamação residual, algumas manifestações hemorrágicas discretas como epistaxe, petéquias e sangramento gengival. Extravasamento capilar de plasma é responsável pela hemoconcentração e trombocitopenia observadas e que caracterizam a dengue hemorrágica. Manifestações cutâneas da dengue hemorrágica incluem lesões hemorrágicas disseminadas como petéquias e equimoses, mas também instabilidade hemodinâmica com pulso filiforme, pressão arterial convergente, extremidades frias, confusão mental e choque.Dengue fever is a systemic viral disease that occurs epidemically in tropical and subtropical regions of Asia, Americas and Africa. The dengue virus belongs to the genus Flavivirus of the family Flaviviridae (group B arbovirus. Aedes aegypti is the major vector and the true reservoir for the virus. Classic dengue fever lasts for two-five days, with severe headache, intense myalgia, arthralgia and retro-orbital pain. Cutaneous alterations include several findings such as a diffuse morbilliform rash that may be pruritic and heals with desquamation, and minor bleeding phenomena such as epistaxis, petechiae, and gingival bleeding. Diffuse capillary leakage of plasma is responsible for the hemoconcentration and thrombocytopenia that characterize dengue hemorrhagic fever. Cutaneous manifestations of dengue hemorrhagic fever include many disseminated hemorrhagic lesions such as petechiae and ecchymoses, but

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 ...

Palladium catalyzed selective distal C-H olefination of biaryl systems.

Science.gov (United States)

Maity, Soham; Hoque, Ehtasimul; Dhawa, Uttam; Maiti, Debabrata

2016-11-29

Palladium catalyzed selective distal C-H activation with nitrile based templates has been of significant research interest in recent times. In this report, we disclose the distal C-H olefination of biphenyl systems with high regio- and stereo-selectivity and useful synthetic yields. The utility of this method has been demonstrated through its wide olefin scope, its operation at the gram scale and the easy removal/recovery of the directing group.

Increased T2 signal intensity in the distal clavicle: incidence and clinical implications

International Nuclear Information System (INIS)

Fiorella, D.; Helms, C.A.; Speer, K.P.

2000-01-01

Objective. The objectives of the current study were (1) to quantify the incidence of increased T2 signal in the distal clavicle and (2) to assess the clinical significance of this finding in patients with chronic acromioclavicular (AC) joint pain.Design and patients. Eight patients (five male and three female, 15-41 years of age) with disabling shoulder pain localized to the AC joint and marked increased T2 signal in the distal clavicle are presented. These eight patients underwent MR examination over a 25 month period (August 1996 to September 1998). The dictated reports of all shoulder MR examinations conducted over this same time period were reviewed retrospectively for the presence of signal abnormality in the distal cla-vicle. Clinical data and, in five patients, findings at shoulder arthroscopy or open surgery, were correlated with the results of MR imaging. One patient underwent arthroscopy on both shoulders.Results. The selected eight patients each presented clinically with disabling shoulder pain localized to the AC joint. One patient is presented twice, as both shoulders were symptomatic (n=9). Plain film examination (9/9) failed to indicate a structural cause of shoulder pain in any of the patients. MR examination demonstrated abnormally increased T2 signal in the distal clavicle in all nine cases and no other cause for AC joint pain. Three patients responded to a course of conservative therapy. Six experienced refractory pain despite conservative therapy. Resection of the distal clavicle was performed in five of the six cases. All patients who underwent resection of the distal clavicle experienced complete resolution of AC joint pain. A retrospective review of the dictated reports for all shoulder MR imaging examinations performed at out institution over a 25 month period (August 1996 to September 1998; n=761) demonstrated a 12.5% incidence of abnormally increased T2 signal in the distal clav-icle.Conclusions. Increased T2 signal in the distal clavicle

Increased T2 signal intensity in the distal clavicle: incidence and clinical implications

Energy Technology Data Exchange (ETDEWEB)

Fiorella, D.; Helms, C.A. [Dept. of Radiology, Duke Univ., Durham, NC (United States); Speer, K.P. [Dept. of Orthopedic Surgery, Duke Univ., Durham, NC (United States)

2000-12-01

Objective. The objectives of the current study were (1) to quantify the incidence of increased T2 signal in the distal clavicle and (2) to assess the clinical significance of this finding in patients with chronic acromioclavicular (AC) joint pain.Design and patients. Eight patients (five male and three female, 15-41 years of age) with disabling shoulder pain localized to the AC joint and marked increased T2 signal in the distal clavicle are presented. These eight patients underwent MR examination over a 25 month period (August 1996 to September 1998). The dictated reports of all shoulder MR examinations conducted over this same time period were reviewed retrospectively for the presence of signal abnormality in the distal cla-vicle. Clinical data and, in five patients, findings at shoulder arthroscopy or open surgery, were correlated with the results of MR imaging. One patient underwent arthroscopy on both shoulders.Results. The selected eight patients each presented clinically with disabling shoulder pain localized to the AC joint. One patient is presented twice, as both shoulders were symptomatic (n=9). Plain film examination (9/9) failed to indicate a structural cause of shoulder pain in any of the patients. MR examination demonstrated abnormally increased T2 signal in the distal clavicle in all nine cases and no other cause for AC joint pain. Three patients responded to a course of conservative therapy. Six experienced refractory pain despite conservative therapy. Resection of the distal clavicle was performed in five of the six cases. All patients who underwent resection of the distal clavicle experienced complete resolution of AC joint pain. A retrospective review of the dictated reports for all shoulder MR imaging examinations performed at out institution over a 25 month period (August 1996 to September 1998; n=761) demonstrated a 12.5% incidence of abnormally increased T2 signal in the distal clav-icle.Conclusions. Increased T2 signal in the distal clavicle

Análise da dureza de um novo material restaurador para ART: Glass Carbomer

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Célia Maria Condeixa de França LOPES

Full Text Available Resumo Objetivo Este estudo avaliou a microdureza de dois materiais ionoméricos – Glass Carbomer (GC-GCP Dental e Riva Light Cure (RL-SDI ‒ em combinação com quatro unidades fotopolimerizadoras (Carbo LED lamp, GCP-Dental; Demi LED curing light, Kerr; Poli Wireless, Kavo; Radii Plus, SDI. Material e método Foram confeccionados 80 corpos de prova seguindo a orientação dos fabricantes, sendo 40 para cada material ionomérico e, para cada 10 corpos de prova, uma das unidades fotopolimerizadoras foi utilizada. Após sete dias de armazenamento em água destilada e temperatura ambiente, os 80 corpos de prova foram submetidos ao teste de microdureza Vickers (microdurômetro HMV 2T. Cinco indentações foram realizadas em cada corpo de prova (centro, extremidades direita e esquerda, e superior e inferior. O ensaio foi realizado sob uma carga de 100 gramas, com tempo de penetração de dez segundos. Resultado Independentemente da unidade fotopolimerizadora, o Riva Light Cure (RL-SDI apresentou menor microdureza que o material Glass Carbomer (GC-GCP-Dental. A microdureza do Glass Carbomer (GC-GCP-Dental foi influenciada pelo tipo de unidade fotopolimerizadora utilizada como fonte de calor. A análise de variância e o Teste de Tuckey (p<0,05 mostraram que a interação dos fatores ‘material’ vs. ‘unidade fotopolimerizadora’ (p<0,001 e os fatores principais ‘material’ (p<0,001 e ‘unidade fotopolimerizadora’ (p=0,002 foram estatisticamente significantes. Conclusão O material ionomérico Glass Cabomer (GCP- Dental apresentou valor de microdureza significativamente superior quando comparado com o cimento de ionômero de vidro modificado por resina Riva Light Cure (SDI, independentemente da unidade fotopolimerizadora utilizada.

Distal triceps injuries (including snapping triceps): A systematic review of the literature.

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Shuttlewood, Kimberley; Beazley, James; Smith, Christopher D

2017-06-18

To review current literature on types of distal triceps injury and determine diagnosis and appropriate management. We performed a systematic review in PubMed, Cochrane and EMBASE using the terms distal triceps tears and snapping triceps on the 10 th January 2017. We excluded all animal, review, foreign language and repeat papers. We reviewed all papers for relevance and of the papers left we were able to establish the types of distal triceps injury, how these injuries are diagnosed and investigated and the types of management of these injuries including surgical. The results are then presented in a review paper format. Three hundred and seventy-nine papers were identified of which 65 were relevant to distal triceps injuries. After exclusion we had 47 appropriate papers. The papers highlighted 2 main distal triceps injuries: Distal triceps tears and snapping triceps. Triceps tear are more common in males than females occurring in the 4 th -5 th decade of life and often due to a direct trauma but are also strongly associated with weightlifting and American football. The tears are diagnosed by history and clinically with a palpable gap. Diagnosis can be confirmed with the use of ultrasound (US) and magnetic resonance imaging. Treatment depends on type of tear. Partial tears can be treated conservatively with bracing and physio whereas acute tears need repair either open or arthroscopic using suture anchor or bone tunnel techniques with similar success. Chronic tears often need augmenting with tendon allograft or autograft. Snapping triceps are also seen more in men than women but at a mean age of 32 years. They are characterized by a snapping sensation mostly medially and can be associated with ulna nerve subluxation and ulna nerve symptoms. US is the diagnostic modality of choice due to its dynamic nature and to differentiate between snapping triceps tendon or ulna nerve. Treatment is conservative initially with activity avoidance and if that fails surgical

Uniformidade de deposição da calda de pulverização de herbicidas em barra lateral protegida com diferentes combinações de pontas de pulverização Herbicide spray deposition uniformity from a protected lateral spray boom with different spray tip combinations

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A.C. Furlanetti

2001-12-01

Full Text Available O presente trabalho objetivou estudar a uniformidade de distribuição da calda de pulverização contendo herbicidas, em culturas perenes arbustivas, utilizando combinações de pontas de pulverização em barra lateral protegida, conduzida a pequena distância do alvo, na linha de culturas perenes arbustivas. Para isso, foi desenvolvido um programa computacional que permite simular a sobreposição do leque de pulverização, da porção protegida da barra e do leque formado pela ponta de pulverização do bico mais extremo da barra, de modo diferente dos demais programas. Após a seleção das melhores combinações de pontas de pulverização por meio de simulação dos padrões de deposição da pulverização das pontas individuais e dos coeficientes de variação menores que 10%, algumas dessas combinações foram testadas em campo, aplicando-se um herbicida sistêmico (glyphosate e outro com ação de contato (paraquat. Os resultados indicaram que o programa computacional desenvolvido pode constituir-se em um auxiliar valioso para a seleção das melhores combinações de pontas de pulverização. Em aplicações tanto do herbicida glyphosate quanto do paraquat, com volumes de calda mais reduzidos,abaixo de 100 L ha-1, destacaram-se como arranjos mais eficientes: a pontas TT110015 distanciadas de 52,5 cm entre si, combinadas com a ponta TK-0,5 na extremidade da barra a 50 cm do último bico, operando na velocidade de 5 km h-1 e pressão de 103 kPa (15 lbf pol-2, com distância de caminhamento do tronco da árvore de 20 cm ; b pontas SMCE2 distanciadas de 15 cm entre si, combinadas com a ponta TK-0,5 na extremidade da barra de 20 cm do último bico, operando na velocidade de 4 km h-1 e pressão de 414 kPa (60 lbf pol-2, com distância de caminhamento do tronco da árvore de 30 cm ; e c pontas TLX-2 distanciadas de 15 cm entre si, combinadas com a ponta TK-0,5 na extremidade da barra de 20 cm do último bico, operando à velocidade de 5 km

Nontraumatic osteonecrosis of the distal pole of the scaphoid

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Bhavuk Garg

2011-01-01

Full Text Available Post traumatic osteonecrosis of distal pole of scaphoid is very rare. We present a case of 34 years old male, drill operator by occupation with nontraumatic osteonecrosis of distal pole of the scaphoid. The patient was managed conservatively and was kept under regular follow-up every three months. The patient was also asked to change his profession. Two years later, the patient had no pain and had mild restriction of wrist movements (less than 15 degrees in either direction. The radiographs revealed normal density of the scaphoid suggesting revascularization.

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.)

MINIMUM INCISION PERCUTANEOUS PLATE OSTEOSYNTHESIS FOR DISTAL FIBULAR FRACTURES: A PROSPECTIVE STUDY

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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

Distal insertions of the semimembranosus tendon: MR imaging with anatomic correlation

Energy Technology Data Exchange (ETDEWEB)

Maeseneer, Michel de [Universitair Ziekenhuis Brussel, Department of Radiology, Jette, Brussels (Belgium); Vrije Universiteit Brussel, Department of Experimental Anatomy, Brussels (Belgium); Shahabpour, Maryam; Milants, Annemieke; Ridder, Filip de; Mey, Johan de [Universitair Ziekenhuis Brussel, Department of Radiology, Jette, Brussels (Belgium); Lenchik, Leon [Wake Forest University, Department of Radiology, Winston-Salem, NC (United States); Cattrysse, Erik [Vrije Universiteit Brussel, Department of Experimental Anatomy, Brussels (Belgium)

2014-06-15

The purpose of this study is to investigate the distal insertions of the semimembranosus tendon with MR imaging, correlated with findings in cadavers. Four fresh cadaveric specimens were studied with 3-T MR imaging. Sequences included proton density (PD) sequences (TE, 13; TR, 4957; FOV, 170 x 170; matrix, 424 x 413; NA, 2; slice thickness, 2.5 mm) in the axial, coronal, and sagittal planes and 3D fast field echo (FFE) sequences (TR 9.4; TE 6.9; FOV, 159 x 105; matrix, 200 x 211; NA, 2; slice thickness, 0.57 mm). One specimen was dissected and three specimens were sectioned with a bandsaw in the axial, coronal, and sagittal plane. The sections were photographed and correlated with MR images. To standardize the analysis, the semimembranosus muscle and tendon were assessed at seven levels for the axial sections, and at three levels for the coronal and sagittal sections. Anatomic dissection revealed six insertions of the distal semimembranosus tendon: direct arm, anterior arm, posterior oblique ligament extension, oblique popliteal ligament extension, distal tibial expansion (popliteus aponeurosis), and meniscal arm. Axial MR images showed five of six insertions: direct arm, anterior arm, oblique popliteal ligament extension, posterior oblique ligament extension, and distal tibial expansion. Sagittal MR images showed four of six insertions: direct arm, anterior arm, oblique popliteal ligament arm, and distal tibial expansion. Sagittal MR images were ideal for showing the direct arm insertion, but were less optimal than the axial images for showing the other insertions. The anterior arm was seen but volume averaging was present with the gracilis tendon. Coronal MR images optimally revealed the anterior arm, although magic angle artifact was present at its posterior aspect. The common semimembranosus tendon and meniscal arm were also well depicted. The division in anterior arm, direct arm, and oblique popliteal ligament arm was poorly seen on coronal images due to

Enclavado endomedular en fracturas del tercio distal de la tibia

OpenAIRE

Arroquy, Damian; Chahla, Jorge; Gomez Rodriguez, Gustavo; Cid Casteulani, Alberto; Svarzchtein, Santiago; Gomez, Diego; Pesciallo, Cesar

2015-01-01

Objetivo: Describir los resultados obtenidos con el enclavado endomedular acerrojado en pacientes con fractura del tercio distal de la tibia. Materiales y Métodos: Se incluyeron pacientes con fracturas desplazadas del tercio distal de la tibia, tratadas con clavo endomedular. La muestra incluyo 35 pacientes. El tiempo de seguimiento posoperatorio fue de 29.2 meses. Se evaluaron el tiempo de consolidacion, la consolidacion viciosa y las complicaciones. Los resultados funcionales se determinaro...

Robotic versus Laparoscopic Distal Pancreatectomy: A Meta-Analysis of Short-Term Outcomes.

Science.gov (United States)

Zhou, Jia-Yu; Xin, Chang; Mou, Yi-Ping; Xu, Xiao-Wu; Zhang, Miao-Zun; Zhou, Yu-Cheng; Lu, Chao; Chen, Rong-Gao

2016-01-01

To compare the safety and efficacy of robotic-assisted distal pancreatectomy (RADP) and laparoscopic distal pancreatectomy (LDP). A literature search of PubMed, EMBASE, and the Cochrane Library database up to June 30, 2015 was performed. The following key words were used: pancreas, distal pancreatectomy, pancreatic, laparoscopic, laparoscopy, robotic, and robotic-assisted. Fixed and random effects models were applied. Study quality was assessed using the Newcastle-Ottawa Scale. Seven non-randomized controlled trials involving 568 patients met the inclusion criteria. Compared with LDP, RADP was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, R0 resection rate, lymph nodes harvested, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups. RADP is a safe and feasible alternative to LDP with regard to short-term outcomes. Further studies on the long-term outcomes of these surgical techniques are required. To date, there is no consensus on whether laparoscopic or robotic-assisted distal pancreatectomy is more beneficial to the patient. This is the first meta-analysis to compare laparoscopic and robotic-assisted distal pancreatectomy. We found that robotic-assisted distal pancreatectomy was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.

Blowhole colostomy for the urgent management of distal large bowel obstruction.

Science.gov (United States)

Kasten, Kevin R; Midura, Emily F; Davis, Bradley R; Rafferty, Janice F; Paquette, Ian M

2014-05-01

Complete obstruction of the distal colon or rectum often presents as a surgical emergency. This study evaluated the efficacy of blowhole colostomy versus transverse loop colostomy for the emergent management of distal large intestinal obstruction. Retrospective chart review of all colostomy procedures (CPT 44320) performed for complete distal large bowel obstruction during the past 6 y in a university hospital practice was undertaken. Blowhole was compared with loop colostomy with a primary endpoint of successful colonic decompression. One hundred forty-one patients underwent colostomy creation during the study period. Of these, 61 were completed for acute obstruction of the distal colon or rectum (19 blowhole versus 42 loop colostomy). No differences between study groups were seen in age, gender, body mass index, malnutrition, American Society of Anesthesiology class, time to liquid or regular diet, 30-d or inhospital mortality, or rates of complications. Patients undergoing blowhole colostomy had significantly higher cecal diameters at diagnosis (9.14 versus 7.31 cm, P = 0.0035). Operative time was shorter in blowhole procedures (43 versus 51 min, P = 0.017). Postoperative length of stay was significantly shorter for blowhole colostomy (6 versus 8 d, P = 0.014). The primary endpoint of successful colonic decompression was met in all colostomy patients. Diverting blowhole colostomy is a safe, quick, and effective procedure for the urgent management of distal colonic obstruction associated with obstipation and massive distention. Copyright © 2014 Elsevier Inc. All rights reserved.

Osteoartropatia hipertrófica primária: relato de caso e revisão da literatura Primary hypertrophic osteoarthropathy: a case report and review of the literature

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Andréa de Almeida Peduti Batista

2003-06-01

Full Text Available Os autores relatam um caso de osteoartropatia hipertrófica do tipo primária em paciente de 29 anos de idade, com dores articulares e aumento de volume das extremidades há 15 anos. Ao exame físico apresentava baqueteamento dos dedos e unhas em "vidro de relógio". A osteoartropatia hipertrófica foi considerada como primária porque foram excluídas todas as causas da forma secundária. As principais alterações radiológicas foram: espessamento das camadas corticais dos ossos tubulares e reação periosteal contínua do tipo lamelar. Não foram notadas alterações dos espaços articulares.The authors report a case of primary hypertrophic osteoarthropathy in a 29-year-old male with swollen joints. Physical examination revealed also digital clubbing and convexity of the nails. All other causes of secondary forms of hypertrophic osteoarthropathy were excluded. The main radiological abnormalities found were bone cortical hypertrophy and periosteal proliferation. Abnormalities of the joint spaces were not observed.

Curvas de referência da Escala Motora Infantil de Alberta: percentis para descrição clínica e acompanhamento do desempenho motor ao longo do tempo

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Raquel Saccani

2012-02-01

Full Text Available OBJETIVOS: Comparar os dados de infantes brasileiros com a normativa canadense e estabelecer as curvas de referência e percentis do desenvolvimento motor da Escala Motora Infantil de Alberta segundo sexo. MÉTODOS: Participaram da pesquisa, 795 crianças com idade entre 0 e 18 meses provenientes de diferentes cidades de uma região do Brasil. Os participantes foram avaliados com a Escala Motora Infantil de Alberta, em uma sala silenciosa, por um experiente pesquisador. Foi realizada análise dos percentis (P5, P10, P25, P50, P75, P90 por faixa etária da escala e sexo. RESULTADOS: Não foram encontradas diferenças significativas (p > 0,05 entre meninos e meninas na maioria das diferentes faixas etárias. Apenas aos 14 meses, foi encontrada superioridade das meninas no escore total de desempenho motor (p = 0,015 e no percentil de desenvolvimento (0,021. Verificou-se, para ambos os sexos e para crianças típicas e atípicas, uma tendência de desenvolvimento motor alinear nas curvas desenvolvimentistas. Observou-se variação reduzida das aquisições motoras nos limites etários, nos dois primeiros meses de vida e a partir dos 15 meses. CONCLUSÕES: A Escala Motora Infantil de Alberta, embora seja um instrumento amplamente utilizado em clínica e pesquisa, possui restrições considerando a diferenciação comportamental até os 2 meses e depois dos 15 meses. Essa reduzida sensibilidade da escala nas extremidades etárias pode estar relacionada com o número e dificuldade dos itens motores avaliados nessas idades. Sugere-se a utilização de outros instrumentos de triagem para crianças acima dos 15 meses de idade.

Achados ultrassonográficos da glândula mamária de cabras naturalmente infectadas com o vírus da artrite encefalite caprina

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R.S. Vianna

Full Text Available RESUMO A artrite encefalite caprina é uma virose que está distribuída mundialmente nos rebanhos. Na forma mamária, é predominante a mastite crônica, que pode causar assimetria e endurecimento do úbere, mais conhecida como mastite endurativa crônica, levando à redução na produção leiteira. A ultrassonografia é um bom método de avaliação da glândula mamária, pois consiste em uma técnica não invasiva, rápida e de fácil aplicação. Este estudo objetivou avaliar as características ultrassonográficas (escala de cinza, ecogenicidade e homogeneidade do parênquima mamário de 20 cabras sororreagentes e 20 não sororreagentes para o vírus da artrite encefalite caprina. Observou-se que o diâmetro médio dos linfonodos retromamários de animais sororreagentes (0,72cm para o vírus da artrite encefalite caprina foi menor (P=0,02 que o dos animais não sororreagentes (0,93cm. Na análise entre as porções do úbere, os valores da escala de cinza do terço distal da porção caudal do parênquima mamário foram maiores nos animais sororreagentes (P0,05, exibindo em sua maioria padrões hipoecoicos e heterogêneos. Diante dos resultados, o presente estudo aponta indícios de que a artrite encefalite caprina pode causar alterações na escala de cinza mensuráveis pela ultrassonografia, a qual pode ser utilizada como método auxiliar eficiente e não invasivo no monitoramento e diagnóstico precoce da mastite endurativa.

Three-stage treatment protocol for recalcitrant distal femoral nonunion.

Science.gov (United States)

Ma, Ching-Hou; Chiu, Yen-Chun; Tu, Yuan-Kun; Yen, Cheng-Yo; Wu, Chin-Hsien

2017-04-01

In this study, we proposed a three-stage treatment protocol for recalcitrant distal femoral nonunion and aimed to analyze the clinical results. We retrospective reviewed 12 consecutive patients with recalcitrant distal femoral nonunion undergoing our three-stage treatment protocol from January 2010 to December 2014 in our institute. The three-stage treatment protocol comprised debridement of the nonunion site, lengthening to eliminate leg length discrepancy, deformity correction, stabilization with a locked plate, filling of the defect with cement spacer for inducing membrane formation, and bone reconstruction using a cancellous bone autograft (Masquelet technique) or free vascularized fibular bone graft. The bone union time, wound complication, lower limbs alignment, amount of lengthening, knee range of motion, and functional outcomes were evaluated. Osseous union with angular deformity lengthening was 5.88 cm (range 3.5-12 cm). Excellent or good outcomes were obtained in 9 patients. Although the current study involved only a small number of patients and the intervention comprised three stages, we believe that such a protocol may be a valuable alternative for the treatment of recalcitrant distal femoral nonunion.

Youngswick-Austin versus distal oblique osteotomy for the treatment of Hallux Rigidus.

Science.gov (United States)

Viladot, Antonio; Sodano, Luca; Marcellini, Lorenzo; Zamperetti, Marco; Hernandez, Elsa Sanchez; Perice, Ramon Viladot

2017-08-01

Hallux Rigidus is the most common degenerative joint pathology of the foot. Several procedures are described for the management of this deformity. In this prospective study we compared Youngswick-Austin and distal oblique osteotomy in the treatment of grade II Hallux Rigidus, in terms of clinical outcomes, efficacy and complications. Forty-six patients (50 feet) with moderate Hallux Rigidus (Regnauld grade II) were recruited and operated between March 2009 and December 2012. Surgical technique was Youngswick-Austin osteotomy (Group A) or distal oblique osteotomy (Group B). Mean follow-up was 42.7 ±12.2 (range, 24-70) months. Both groups achieved significant improvement of AOFAS score and first metatarsophalangeal joint range of motion (p value Austin and distal oblique osteotomies provides subjective patient improvement and increases the first metatarsophalangeal joint range of motion. The results of grade II Hallux Rigidus treatment were comparable when using a Youngswick-Austin or distal oblique osteotomy. Level II, prospective comparative study. Copyright © 2017 Elsevier Ltd. All rights reserved.

TRPV3, a thermosensitive channel is expressed in mouse distal colon epithelium

International Nuclear Information System (INIS)

Ueda, Takashi; Yamada, Takahiro; Ugawa, Shinya; Ishida, Yusuke; Shimada, Shoichi

2009-01-01

The thermo-transient receptor potential (thermoTRP) subfamily is composed of channels that are important in nociception and thermo-sensing. Here, we show a selective expression of TRPV3 channel in the distal colon throughout the gastrointestinal tract. Expression analyses clearly revealed that TRPV3 mRNA and proteins were expressed in the superficial epithelial cells of the distal colon, but not in those of the stomach, duodenum or proximal colon. In a subset of primary epithelial cells cultured from the distal colon, carvacrol, an agonist for TRPV3, elevated cytosolic Ca 2+ concentration in a concentration-dependent manner. This response was inhibited by ruthenium red, a TRPV channel antagonist. Organotypic culture supported that the carvacrol-responsive cells were present in superficial epithelial cells. Moreover, application of carvacrol evoked ATP release in primary colonic epithelial cells. We conclude that TRPV3 is present in absorptive cells in the distal colon and may be involved in a variety of cellular functions.

Derivação ventriculoatrial no tratamento da hidrocefalia em crianças

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Gilberto Machado de Almeida

1969-03-01

Full Text Available Na última década, devido ao desenvolvimento das técnicas de derivação ventrículo-venosa, aumentou consideravelmente o interesse pelo tratamento cirúrgico da hidrocefalia. Entretanto, com o tempo, foram sendo observadas complicações que fizeram arrefecer o entusiasmo inicial de alguns cirurgiões. Julgamos oportuno, por isso, fazer uma avaliação dos resultados obtidos em uma série de 136 crianças hidrocefálicas operadas entre dezembro de 1958 e dezembro de 1965, e nas quais foi feita derivação ventrículo-atrial. Das crianças operadas, 72 estão vivas e com a hidrocefalia compensada e 30 faleceram, não sendo possível estabelecer as condições atuais das 34 restantes. A análise das condições pré-operatórias, das complicações e dos resultados finais permitiram algumas conclusões: 1 é pequena a ocorrência de manifestações clínicas de tromboembolismo pulmonar, no pós-operatório da ventrículo-atriostomia, justificando-se o uso destas derivações, enquanto não se desenvolverem formas mais eficazes de tratamento da hidrocefalia; 2 exames cardiológicos repetidos devem ser feitos em doentes submetidos às derivações ventrículo-atriais, a fim de permitir o diagnóstico precoce de sobrecarga do coração direito; 3 com enérgico tratamento das complicações infecciosas, progresso das técnicas de assepsia e seleção cuidadosa dos casos, os resultados tendem a melhorar; 4 o médico que trata hidrocefálicos deve prevenir os familiares a respeito da possível necessidade de novos atos cirúrgicos, devendo estar preparado para reintervir tantas vezes quantas forem necessárias; 5 não é justificada a conduta de trocar o catéter atrial sempre que a extremidade do mesmo atinge o nível da quarta vértebra torácica, como recomendam alguns cirurgiões; 6 não é justificada a afirmação de que uma criança submetida à ventrículo-atriostomia necessite permanecer sempre com a drenagem funcionando; 7 para avaliar o

Fractures of the Distal Tibia Treated with Polyaxial Locking Plating

OpenAIRE

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

2008-01-01

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 in...

Segmental reversal of distal small intestine in short bowel syndrome

DEFF Research Database (Denmark)

Grave, Pernille Kock; Thomsen, Sabrina Valentin; Clark, Pia Susanne

2018-01-01

were the influence on cell proliferation and mucosal architecture shown by histological analysis. Methods: Sixteen piglets underwent a 60% resection of the distal small intestine and were randomized into two groups. Group 1 short bowel syndrome alone (SBS) (n = 8) and group 2 with reversal of a distal...... small intestinal segment (SBS-RS) (n = 8). Body weight was measured daily and the pigs were euthanized after 1 month. Crypt depths, villus heights and muscle layers thicknesses were measured. For the evaluation of microvilli of the brush border of the epithelium and cell proliferation...... was found in the SBS group and increase in the thickness of the circular and longitudinal muscle layers in the SBS-RS group. In the distal ileal segment the longitudinal muscle layer thicknesses were increased in the SBS group. Otherwise, no significant changes were found. Conclusion: Reversal of a 20-cm...

Influência da adição de fibras de aço na tensão de aderência de barras de aço retilíneas

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D. L. Araújo

Full Text Available A aderência entre a barra de aço e o concreto permite que haja a compatibilização entre os dois materiais, validando o uso do concreto armado como material de construção. Quanto melhor a aderência, menores são as aberturas das fissuras e mais protegida fica a armadura. Assim, busca-se nessa pesquisa investigar a influência das fibras de aço na aderência aço-concreto. Para tanto, foram ensaiados trinta e três corpos de prova, com dimensões de 200 mm x 300 mm x 150 mm, dos quais foi arrancada uma barra de aço neles concretada. As variáveis analisadas foram o diâmetro da barra (10 mm, 12,5 mm, 16 mm e 20 mm, o comprimento aderente (cinco e dez vezes o diâmetro da barra e o volume de fibras de aço adicionadas ao concreto (1% e 2%. Foram utilizadas fibras de aço com ganchos nas extremidades, comprimento de 35 mm e relação de aspecto igual a 65. Dos ensaios de arrancamento foi determinada a forma e a força de ruptura em cada um dos modelos. Adicionalmente, foram feitas simulações computacionais dos ensaios realizados com barra de 10 mm de diâmetro. Tanto os resultados dos ensaios experimentais quanto da modelagem mostraram que as fibras estudadas exercem pequena influência na tensão de aderência entre a barra e o concreto. Por outro lado, quando a ruptura da aderência se dá pelo fendilhamento do cobrimento de concreto, a influência das fibras é significativa.

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

Resultados a médio prazo do tratamento cirúrgico da dissecção aguda de aorta tipo A com o emprego da prótese intraluminal Surgical treatment of type a aortic dissection using intraluminal prosthesis medium term follow up

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Jefferson Francisco de OLIVEIRA

2001-06-01

Full Text Available Introdução: O conceito de prótese intraluminal foi introduzido por CARREL, em 1912. Em 1978, DUREAU & ABLASA descreveram os primeiros casos de dissecção aguda de aorta tratados com o emprego da prótese intraluminal. Esta prótese foi utilizada nos anos 80 por vários grupos com bons resultados. Vários relatos de complicações (migração, embolias, estenoses, formação de pseudo-aneurismas fizeram com que os grupos cirúrgicos perdessem o entusiasmo por esta técnica. Objetivo: Avaliar a anastomose empregando a prótese intraluminal sem sutura no tratamento da dissecção aguda de aorta tipo A. Casuística e Métodos: Sessenta e quatro pacientes com diagnóstico de dissecção aguda de aorta do tipo A foram operados em nosso Serviço. Em todos os casos empregamos o anel intraluminal como técnica de sutura. A idade média dos pacientes era de 56,3 anos, sendo 57 (89% do sexo masculino. Todos os pacientes eram portadores de hipertensão arterial sistêmica. Em 26 pacientes utilizamos somente a anastomose intraluminal, com o anel proximal acima dos óstios coronários de modo a ressuspender a valva aórtica e o anel distal posicionado junto à origem do tronco braquiocefálico. O tempo médio de pinçamento da aorta nestes pacientes foi de 9 minutos e o tempo médio de CEC de 26 minutos. Somente em 1 caso houve rotura da ligadura sobre o anel proximal, quando realizamos uma operação radical (Bentall- DeBonno, mantendo o anel distal. Em 23 pacientes utilizamos a ressuspensão da valva aórtica e o preparo da raiz da aorta com duplo retalho de Dacron, empregando o anel intraluminal na anastomose distal. Abordamos o arco aórtico em 8 pacientes. A troca da valva aórtica foi necessária em apenas 6 pacientes. A mortalidade global foi de 10,3%, sendo que nos pacientes onde foi possível o tratamento com o duplo anel não houve nenhum óbito. Na avaliação pós-operatória destes pacientes foi realizado ecocardiograma e aortografia. N�

Robotic versus Laparoscopic Distal Pancreatectomy: A Meta-Analysis of Short-Term Outcomes.

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Jia-Yu Zhou

Full Text Available To compare the safety and efficacy of robotic-assisted distal pancreatectomy (RADP and laparoscopic distal pancreatectomy (LDP.A literature search of PubMed, EMBASE, and the Cochrane Library database up to June 30, 2015 was performed. The following key words were used: pancreas, distal pancreatectomy, pancreatic, laparoscopic, laparoscopy, robotic, and robotic-assisted. Fixed and random effects models were applied. Study quality was assessed using the Newcastle-Ottawa Scale.Seven non-randomized controlled trials involving 568 patients met the inclusion criteria. Compared with LDP, RADP was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, R0 resection rate, lymph nodes harvested, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.RADP is a safe and feasible alternative to LDP with regard to short-term outcomes. Further studies on the long-term outcomes of these surgical techniques are required.To date, there is no consensus on whether laparoscopic or robotic-assisted distal pancreatectomy is more beneficial to the patient. This is the first meta-analysis to compare laparoscopic and robotic-assisted distal pancreatectomy. We found that robotic-assisted distal pancreatectomy was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.

Pseudotumor of the distal common bile duct at endoscopic retrograde cholangiopancreatography

Science.gov (United States)

Tan, Justin H.; Coakley, Fergus V; Wang, Zhen J.; Poder, Liina; Webb, Emily; Yeh, Benjamin M.

2010-01-01

Background Prior studies have described a pseudocalculus appearance in the distal common bile duct as a normal variant at cholangiography. The objective of this study is to describe the occurrence of pseudotumor in the distal common bile duct at endoscopic retrograde cholangiopancreatography (ERCP). Methods Nine patients who underwent ERCP between May 2004 and July 2008 were identified as having a transient eccentric mural-based filling defect in the distal common bile duct. A single reader systematically reviewed all studies and recorded the imaging findings. Results The mean diameter of the filling defect was 9 mm (range, 5 to 11). Eight patients had resolution of the filling defect during the same ERCP or on a subsequent ERCP, and in 2 of these patients the inferior border of the filling defect was not well visualized. The other patient underwent surgical resection of a presumed tumor with no evidence of malignancy on surgical pathology. Conclusion An eccentric mural-based filling defect in the distal common bile duct can be artifactual in nature and may reflect transient contraction of the sphincter of Oddi. Recognition of this pseudotumor may help avoid unnecessary surgery. PMID:21724120

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...

Ofd1, a human disease gene, regulates the length and distal structure of centrioles.

Science.gov (United States)

Singla, Veena; Romaguera-Ros, Miriam; Garcia-Verdugo, Jose Manuel; Reiter, Jeremy F

2010-03-16

Centrosomes and their component centrioles represent the principal microtubule organizing centers of animal cells. Here, we show that the gene underlying orofaciodigital syndrome 1, Ofd1, is a component of the distal centriole that controls centriole length. In the absence of Ofd1, distal regions of centrioles, but not procentrioles, elongate abnormally. These long centrioles are structurally similar to normal centrioles but contain destabilized microtubules with abnormal posttranslational modifications. Ofd1 is also important for centriole distal appendage formation and centriolar recruitment of the intraflagellar transport protein Ift88. To model OFD1 syndrome in embryonic stem cells, we replaced the Ofd1 gene with missense alleles from human OFD1 patients. Distinct disease-associated mutations cause different degrees of excessive or decreased centriole elongation, all of which are associated with diminished ciliogenesis. Our results indicate that Ofd1 acts at the distal centriole to build distal appendages, recruit Ift88, and stabilize centriolar microtubules at a defined length. Copyright 2010 Elsevier Inc. All rights reserved.

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

Osteoid osteoma of the distal clavicle

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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.

Is distal motor and/or sensory demyelination a distinctive feature of anti-MAG neuropathy?

Science.gov (United States)

Lozeron, Pierre; Ribrag, Vincent; Adams, David; Brisset, Marion; Vignon, Marguerite; Baron, Marine; Malphettes, Marion; Theaudin, Marie; Arnulf, Bertrand; Kubis, Nathalie

2016-09-01

To report the frequency of the different patterns of sensory and motor electrophysiological demyelination distribution in patients with anti-MAG neuropathy in comparison with patients with IgM neuropathy without MAG reactivity (IgM-NP). Thirty-five anti-MAG patients at early disease stage (20.1 months) were compared to 23 patients with IgM-NP; 21 CIDP patients and 13 patients with CMT1a neuropathy were used as gold standard neuropathies with multifocal and homogeneous demyelination, respectively. In all groups, standard motor and sensory electrophysiological parameters, terminal latency index and modified F ratio were investigated. Motor electrophysiological demyelination was divided in four profiles: distal, homogeneous, proximal, and proximo-distal. Distal sensory and sensorimotor demyelination were evaluated. Anti-MAG neuropathy is a demyelinating neuropathy in 91 % of cases. In the upper limbs, reduced TLI is more frequent in anti-MAG neuropathy, compared to IgM-NP. But, predominant distal demyelination of the median nerve is encountered in only 43 % of anti-MAG neuropathy and is also common in IgM-NP (35 %). Homogeneous demyelination was the second most frequent pattern (31 %). Concordance of electrophysiological profiles across motor nerves trunks is low and median nerve is the main site of distal motor conduction slowing. Reduced sensory conduction velocities occurs in 14 % of patients without evidence of predominant distal slowing. Simultaneous sensory and motor distal slowing was more common in the median nerve of anti-MAG neuropathy than IgM-NP. Electrophysiological distal motor demyelination and sensory demyelination are not a distinctive feature of anti-MAG reactivity. In anti-MAG neuropathy it is mainly found in the median nerve suggesting a frequent nerve compression at wrist.

Osteosíntesis percutánea con placas volares bloqueadas en fracturas metafisarias distales de radio Descripción de la técnica y resultados preliminares. [Percutaneous volar locked plate fixation in metaphyseal fractures of distal radius: technical description and preliminary results].

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Natalia del Milagro Gutierrez Olivera

2016-05-01

Full Text Available Objetivo Evaluar resultados objetivos y subjetivos obtenidos luego de realizar osteosíntesis con placas en T bloqueadas volares, colocadas con técnica mínimamente invasiva, en fracturas del radio distal con extensión metafisaria. Material y Métodos Evaluación retrospectiva de seis pacientes adultos que presentaron fracturas inestables de radio distal, extra-articulares o articulares parciales, con extensión  metafisaria, tratadas quirúrgicamente con placas en T largas de compresión bloqueadas volares, mediante  técnica mínimamente invasiva, entre 2007 y  2012. Edad promedio 40,6 años. Todas las fracturas fueron cerradas, clasificadas como tipo 23A3 (n: 5 y 23B1 (n: 1 según el Sistema AO/ASIF. Se realizó reducción indirecta de la fractura, bajo visión radioscópica, a través de dos pequeñas incisiones se deslizó en forma percutánea una placa bloqueada volar en T. Se analizaron  parámetros radiológicos (angulación volar, inclinación radial y altura radial, el rango de movimiento y la fuerza. Los resultados subjetivos fueron evaluados usando la Escala de DASH y la Escala Visual Análoga. Resultados Tiempo de consolidaron promedio de 2,3 meses. Los resultados radiográficos no mostraron diferencias significativas entre el primer y el último control radiográfico al año de seguimiento. Flexión y extensión promedio 70° y 60°, pronación y supinación 79° y 80° respectivamente. Fuerza de prensión promedio 78,4%. El score de DASH 19,84 puntos y el EVA 1,5 puntos. Conclusión Las técnicas mínimamente invasivas reducen el daño quirúrgico y complicaciones. Son una opción en pacientes con daño severo de partes blandas, conminución metafisaria y trauma de alta energía. Pequeñas incisiones alejadas del sitio de fractura respetan los tejidos blandos y la biología ósea, contribuyendo a lograr la consolidación. La colocación de placas volares bloqueadas percutáneas es un procedimiento técnicamente demandante

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.)

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.)

Partial characterization of ribosomal operons of Lactobacillus delbrueckii UFV H2b20 Caracterização parcial de operons ribossomais de Lactobacillus delbrueckii UFV H2b20

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Juliana Teixeira de Magalhães

2005-06-01

Full Text Available Ribosomal operons are great tools for microbe community characterization and for microorganisms relationship study, particularly in the case of the acid lactic bacteria. The ribosomal operon of the probiotic strain Lactobacillus delbrueckii UFV H2b20 was partially characterized. A genomic library of this strain was constructed and the clones with partial ribosomal operon were sub-cloned using the shot-gun method for subsequent sequencing with the forward primer. The sequence analysis revealed that the 3' end of the rDNA 16S was following by the short spacer region 1 (16S-23S and that the 3' end of the rDNA 23S was following by the short spacer region 2 (23S-5S, which preceded the rDNA 5S. In the flanking region of the rDNA 5S gene of this operon rrn, a region encoding six tRNAs was detected.Operons ribossomais têm sido instrumentos importantes na caracterização de comunidades microbianas e no estudo de relacionamentos entre microrganismos, principalmente em bactérias do ácido láctico. Operons ribossomais da linhagem probiótica, Lactobacillus delbrueckii UFV H2b20, foram parcialmente caracterizados. Um banco genômico da linhagem foi construído e os clones, contendo parte do operon ribossomal, foram subclonados pelo método de "shot gun", para em seguida serem seqüenciados com primer "forward". As seqüências indicaram a presença da extremidade 3' do rDNA 16S seguida da região espaçadora curta 1 (16S-23S e a presença da extremidade 3' do rDNA 23S seguido da região espaçadora 2 (23S-5S, que por sua vez precedia o rDNA 5S. Adjacente ao gene rDNA 5S deste operon rrn uma região codificadora de 6 tRNAs foi detectada.

¿Es el ejercicio físico un factor determinante de las asimetrías funcionales en la extremidad inferior?

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Cristina Petisco Rodríguez

2016-09-01

Full Text Available El objetivo de este estudio ha sido analizar la asimetría entre pierna dominante y no dominante, por medio de test de salto unilateral horizontal y vertical, en una muestra de estudiantes universitarios con diferente patrón de práctica físico-deportiva semanal. La muestra está compuesta por 129 estudiantes universitarios divididos en grupos según el patrón de actividad física semanal: actividad física baja (GAFB; n = 44; 20,9 ± 2,6 años; 175,0 ± 8,1 cm; 71,2 ± 12,1 kg, actividad física media (GAFM; n = 46; 20,7 ± 1,9 años; 174,1 ± 7,0 cm; 68,9 ± 9,1 kg y actividad física alta (GAFA; n = 39; 20,7 ± 1,4 años; 174,8 ± 7,5 cm; 68,9 ± 9,1 kg. Todos realizaron test de salto unilaterales verticales: squat jump (SJ, countermovement jump (CMJ; y horizontales: triple hop test for distance (THD y cross-over hop test for distance (COHD. Los resultados reflejan diferencias en los valores de fuerza entre pierna dominante y no dominante para el GAFA, en las pruebas SJ (p < 0,01, CMJ (p < 0,05 y COHD (p < 0,01. No se observan diferencias significativas en el índice de asimetría en función del patrón de actividad física. En el GAFB existen mayor porcentaje de sujetos con alto riesgo de lesión en la extremidad inferior.

Imaging appearance of entrapped periosteum within a distal femoral Salter-Harris II fracture

International Nuclear Information System (INIS)

Chen, Johnathan; Abel, Mark F.; Fox, Michael G.

2015-01-01

Salter Harris II fractures of the distal femur are associated with a high incidence of complications, especially premature physeal closure. Many risk factors for this high rate of premature physeal closure have been proposed. More recently, entrapment of periosteum within the physis has been suggested as an additional predisposing factor for premature physeal closure. The radiographic diagnosis of entrapped soft tissues, including periosteum, can be suggested in the setting of a Salter-Harris II fracture when the fracture does not reduce and physeal widening >3 mm remains. We report a patient who sustained a distal femoral Salter-Harris II fracture following a valgus injury. The patient had persistent distal medial physeal widening >5 mm following attempted reduction. A subsequent MRI revealed a torn periosteum entrapped within the distal femoral physis. Following removal of the periosteum, the patient developed a leg length discrepancy which required physiodesis of the contralateral distal femur. We present this case to raise awareness of the importance of having a high index of suspicion of periosteal entrapment in the setting of Salter-Harris II fractures since most consider entrapped periosteum an indication for surgery. (orig.)

Alignment After Intramedullary Nailing of Distal Tibia Fractures Without Fibula Fixation.

Science.gov (United States)

De Giacomo, Anthony F; Tornetta, Paul

2016-10-01

To evaluate the efficacy of intramedullary nailing of distal tibia fractures using modern techniques, without fibula fixation, in obtaining and maintaining alignment. Retrospective case review. Level-I academic trauma center. One hundred thirty-two consecutive patients with distal tibia fractures. Intramedullary nail of distal tibia fracture, without fibula fixation, was performed in consecutive patients using modern reduction techniques. Malalignment and malunion were defined as >5 degrees of varus/valgus angulation or anterior/posterior angulation on the initial postoperative or final anteroposterior and lateral x-rays. There were 122 consecutive patients (86 men and 36 women) 16-93 years of age (average, 43 years) with 36 (30%) open and 85 (70%) closed fractures with complete follow-up. Mechanism of injury did not predict the presence or level of fibula fracture. Upon presentation, varus/valgus and procurvatum/recurvatum angulation was greatest when the fibula was fractured at the level of the tibia fracture (P = 0.001 and 0.028). The most common intraoperative reduction aids were nailing in relative extension, transfixion external fixation, and clamps at the fracture site. The OTA fracture type or level/presence of fibula fracture did not influence malalignment (P = 0.86 and 0.66), malunion (P = 0.81 and 0.79), or the change in alignment during union, which averaged 0.9 degrees. We found an overall low rate of both malalignment (2%) and malunion (3%) after intramedullary nailing of distal tibial shaft fracture without fibula fixation. We conclude that when modern nailing techniques are used, which allow for confirmation of reduction by visualization in fluoroscopy, from nail placement to distal interlocking, fibula fixation is not necessary to obtain or maintain alignment. Furthermore, standard 2 medial to lateral screws distally afford adequate stability to hold the reduction during union with a 0.9-degree difference in the initial postoperative and final

Hyperammonemia associated with distal renal tubular acidosis or urinary tract infection: a systematic review.

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Clericetti, Caterina M; Milani, Gregorio P; Lava, Sebastiano A G; Bianchetti, Mario G; Simonetti, Giacomo D; Giannini, Olivier

2018-03-01

Hyperammonemia usually results from an inborn error of metabolism or from an advanced liver disease. Individual case reports suggest that both distal renal tubular acidosis and urinary tract infection may also result in hyperammonemia. A systematic review of the literature on hyperammonemia secondary to distal renal tubular acidosis and urinary tract infection was conducted. We identified 39 reports on distal renal tubular acidosis or urinary tract infections in association with hyperammonemia published between 1980 and 2017. Hyperammonemia was detected in 13 children with distal renal tubular acidosis and in one adult patient with distal renal tubular acidosis secondary to primary hyperparathyroidism. In these patients a negative relationship was observed between circulating ammonia and bicarbonate levels (P urinary tract infection was complicated by acute hyperammonemia and symptoms and signs of acute neuronal dysfunction, such as an altered level of consciousness, convulsions and asterixis, often associated with signs of brain edema, such as anorexia and vomiting. Urea-splitting bacteria were isolated in 28 of the 31 cases. The urinary tract was anatomically or functionally abnormal in 30 of these patients. This study reveals that both altered distal renal tubular acidification and urinary tract infection may be associated with relevant hyperammonemia in both children and adults.

Heart defects and other features of the 22q11 distal deletion syndrome

DEFF Research Database (Denmark)

Fagerberg, Christina Ringmann; Graakjaer, Jesper; Heinl, Ulrike D

2013-01-01

patients with 22q11 distal deletions, of whom two have complex congenital heart malformation, thus broadening the phenotypic spectrum. We compare cardiac malformations reported in 22q11 distal deletion to those reported in the common 22q11 deletion syndrome. We also review the literature for patients...... with 22q11 distal deletions, and discuss the possible roles of haploinsufficiency of the MAPK1 gene. We find the most frequent features in 22q11 distal deletion to be developmental delay or learning disability, short stature, microcephalus, premature birth with low birth weight, and congenital heart...... malformation ranging from minor anomalies to complex malformations. Behavioral problems are also seen in a substantial portion of patients. The following dysmorphic features are relatively common: smooth philtrum, abnormally structured ears, cleft palate/bifid uvula, micro-/retrognathia, upslanting palpebral...

New Clasp Assembly for Distal Extension Removable Partial Dentures: The Reverse RPA Clasp.

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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.

Characterization of the distal promoter of the human pyruvate carboxylase gene in pancreatic beta cells.

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Ansaya Thonpho

Full Text Available Pyruvate carboxylase (PC is an enzyme that plays a crucial role in many biosynthetic pathways in various tissues including glucose-stimulated insulin secretion. In the present study, we identify promoter usage of the human PC gene in pancreatic beta cells. The data show that in the human, two alternative promoters, proximal and distal, are responsible for the production of multiple mRNA isoforms as in the rat and mouse. RT-PCR analysis performed with cDNA prepared from human liver and islets showed that the distal promoter, but not the proximal promoter, of the human PC gene is active in pancreatic beta cells. A 1108 bp fragment of the human PC distal promoter was cloned and analyzed. It contains no TATA box but possesses two CCAAT boxes, and other putative transcription factor binding sites, similar to those of the distal promoter of rat PC gene. To localize the positive regulatory region in the human PC distal promoter, 5'-truncated and the 25-bp and 15-bp internal deletion mutants of the human PC distal promoter were generated and used in transient transfections in INS-1 832/13 insulinoma and HEK293T (kidney cell lines. The results indicated that positions -340 to -315 of the human PC distal promoter serve as (an activator element(s for cell-specific transcription factor, while the CCAAT box at -71/-67, a binding site for nuclear factor Y (NF-Y, as well as a GC box at -54/-39 of the human PC distal promoter act as activator sequences for basal transcription.

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.

Minimally Invasive Surgical Approach to Distal Fibula Fractures: A Technique Tip

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Tyler A. Gonzalez

2017-01-01

Full Text Available Wound complications following ankle fracture surgery are a major concern. Through the use of minimally invasive surgical techniques some of these complications can be mitigated. Recent investigations have reported on percutaneous fixation of distal fibula fractures demonstrating similar radiographic and functional outcomes to traditional open approaches. The purpose of this manuscript is to describe in detail the minimally invasive surgical approach for distal fibula fractures.

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: ...

Renal denervation beyond the bifurcation: The effect of distal ablation placement on safety and blood pressure.

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Beeftink, Martine M A; Spiering, Wilko; De Jong, Mark R; Doevendans, Pieter A; Blankestijn, Peter J; Elvan, Arif; Heeg, Jan-Evert; Bots, Michiel L; Voskuil, Michiel

2017-04-01

Renal denervation may be more effective if performed distal in the renal artery because of smaller distances between the lumen and perivascular nerves. The authors reviewed the angiographic results of 97 patients and compared blood pressure reduction in relation to the location of the denervation. No significant differences in blood pressure reduction or complications were found between patient groups divided according to their spatial distribution of the ablations (proximal to the bifurcation in both arteries, distal to the bifurcation in one artery and distal in the other artery, or distal to the bifurcation in both arteries), but systolic ambulatory blood pressure reduction was significantly related to the number of distal ablations. No differences in adverse events were observed. In conclusion, we found no reason to believe that renal denervation distal to the bifurcation poses additional risks over the currently advised approach of proximal denervation, but improved efficacy remains to be conclusively established. ©2017 Wiley Periodicals, Inc.

Laparoscopic distal pancreatectomy for adenocarcinoma of the pancreas

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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

A radiographic study of the distal interphalangeal joint and navicular bursa of the horse

International Nuclear Information System (INIS)

Gibson, K.T.; McIlwraith, C.W.; Park, R.D.

1990-01-01

Radiographic contrast studies were used in 50 forelimbs from 13 live horses and 12 fresh adult cadavers to determine the frequency of communication between the navicular bursa and the distal interphalangeal joint. Injections of contrast medium were made into the dorsal aspect of the distal interphalangeal joint of one limb and into the navicular bursa of the other forelimb of each horse. In 25 limbs in which contrast medium was injected into the distal interphalangeal joint, no communication was demonstrated between the joint and the navicular bursa. In 20 of the 25 limbs in which injection was made into the navicular bursa, no communication between joint and bursa was seen. In five horses, contrast medium was visible in both the distal interphalangeal joint and the navicular bursa. However, in four of five horses the communication was clearly iatrogenic. In both limbs of one horse, contrast medium was seen to enter the digital flexor tendon sheath after injection into the navicular bursa.There is probably no naturally occurring communication between the navicular bursa and distal interphalangeal joint in the horse

Study on Oneself Developed to Apparatus Position of Measurement of BMD in the Distal Radius

International Nuclear Information System (INIS)

Han, Man Seok; Song, Jae Yong; Lee, Hyun Kuk; Yu, Se Jong; Kim, Yong Kyun

2009-01-01

The aim of this study was to evaluate the difference of bone mineral density according to distal radius rotation and to develop the supporting tool to measure rotation angles. CT scanning and the measurement of BMD by DXA of the appropriate position of the forearm were performed on 20 males. Twenty healthy volunteers without any history of operations, anomalies, or trauma were enrolled. The CT scan was used to evaluate the cross sectional structure and the rotation angle on the horizontal plane of the distal radius. The rotational angle was measured by the m-view program on the PACS monitor. The DXA was used in 20 dried radii of cadaveric specimens in pronation and supination with five and ten degrees, respectively, including a neutral position (zero degrees) to evaluate the changes of BMD according to the rotation. The mean rotation angle of the distal radius on CT was 7.4 degrees of supination in 16 cases (80%), 3.3 degrees of pronation in three cases (15%), and zero degree of neutral in one case (9%), respectively. The total average rotation angle in 20 people was 5.4 degrees of supination. In the cadaveric study, the BMD of the distal radius was different according to the rotational angles. The lowest BMD was obtained at 3.3 degrees of supination. In the case of the measurement of BMD in the distal radius with a neutral position, the rotational angle of the distal radius is close to supination. Pronation is needed for the constant measurement of BMD in the distal radius with the rotation angle measuring at the lowest BMD and about five degrees of pronation of the distal radius is recommended.

Bilateral en-masse distalization of maxillary posterior teeth with skeletal anchorage: a case report

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Saeed Noorollahian

Full Text Available ABSTRACT Objective: The aim of this study was to introduce a new method for bilateral distal movement of the entire maxillary posterior segment. Case report: A 17-year-old girl with Class I skeletal malocclusion (end-to-end molar relationships, deviated midline and space deficiency for left maxillary canine was referred for orthodontic treatment. She did not accept maxillary first premolars extraction. A modified Hyrax appliance (Dentaurum Ispringen, Germany was used for bilateral distalization of maxillary posterior teeth simultaneously. Expansion vector was set anteroposteriorly. Posterior legs of Hyrax were welded to first maxillary molar bands. All posterior teeth on each side consolidated with a segment of 0.017 × 0.025-in stainless steel wire from the buccal side. Anterior legs of Hyrax were bent into eyelet form and attached to the anterior palate with two mini-screws (2 × 10 mm (Jeil Medical Corporation Seoul, South Korea. Hyrax opening rate was 0.8 mm per month. Lateral cephalometric radiographs were used to evaluate the extent of distal movement. 3.5-mm distalization of posterior maxillary teeth was achieved in five months. Results: A nearly bodily distal movement without anchorage loss was obtained. Conclusion: The mini-screw-supported modified Hyrax appliance was found to be helpful for achieving en-masse distal movement of maxillary posterior teeth.

Synchronous Multicentric Giant Cell Tumour of Distal Radius and Sacrum with Pulmonary Metastases

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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.

Primary bone lymphoma of the distal tibia mimicking brodie's abscess

International Nuclear Information System (INIS)

Park, Jina; Lee, Seung Hun; Joo, Kyung Bin; Park, Chan Kum

2014-01-01

The 'penumbra sign' on an unenhanced T1-weighted image is a well-known characteristic of Brodie's abscess, and this sign is extremely helpful for discriminating subacute osteomyelitis from other bone lesions. We present a case of primary bone lymphoma of the distal tibia mimicking subacute osteomyelitis with Brodie's abscess in a 50-year-old woman. Initial radiographs and MRI showed a lesion in the distal tibia consistent with Brodie's abscess with the penumbra sign. Histopathological examination of the surgical biopsy specimen confirmed the presence of a diffuse large B-cell lymphoma involving the bone.

Pendulum and modified pendulum appliances for maxillary molar distalization in Class II malocclusion - a systematic review.

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Al-Thomali, Yousef; Basha, Sakeenabi; Mohamed, Roshan Noor

2017-08-01

The main purpose of the present systematic review was to evaluate the quantitative effects of the pendulum appliance and modified pendulum appliances for maxillary molar distalization in Class II malocclusion. Our systematic search included MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus and key journals and review articles; the date of the last search was 30 January 2017. We graded the methodological quality of the studies by means of the Quality Assessment Tool for Quantitative Studies, developed for the Effective Public Health Practice Project (EPHPP). In total, 203 studies were identified for screening, and 25 studies were eligible. The quality assessment rated four (16%) of the study as being of strong quality and 21 (84%) of these studies as being of moderate quality. The pendulum appliances showed mean molar distalization of 2-6.4 mm, distal tipping of molars from 6.67° to 14.50° and anchorage loss with mean premolar and incisor mesial movement of 1.63-3.6 mm and 0.9-6.5 mm, respectively. The bone anchored pendulum appliances (BAPAs) showed mean molar distalization of 4.8-6.4 mm, distal tipping of molars from 9° to 11.3° and mean premolar distalization of 2.7-5.4 mm. Pendulum and modified pendulum appliances are effective in molar distalization. Pendulum appliance with K-loop modification, implant supported pendulum appliance and BAPA significantly reduced anchorage loss of the anterior teeth and distal tipping of the molar teeth.

Doença vestibular periférica decorrente de osteoartropatia temporoioídea em um eqüino Peripheral vestibular disease associated with temporohyoid osteoarthropathy in a horse

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Alexandre Secorun Borges

2003-06-01

Full Text Available Um eqüino com 22 anos de idade apresentou síndrome vestibular periférica associada à paralisia de nervo facial esquerdo devido à osteoartropatia temporoioídea. O exame endoscópico das bolsas guturais mostrou alteração de contorno da bula timpânica esquerda e aumento de volume da extremidade proximal do osso estiloióide do mesmo lado.A 22-year-old gelding showed vestibular syndrome associated with left facial nerve paralysis due to temporohyoid osteoarthropathy and the diagnostic was confirmed by guttural pouch endoscopic examination. The exam revealed abnormal contour of the left tympanic bulla and an enlargement of the proximal part of the left stylohyoid bone.

A Comprehensive Reanalysis of the Distal Iliotibial Band: Quantitative Anatomy, Radiographic Markers, and Biomechanical Properties.

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Godin, Jonathan A; Chahla, Jorge; Moatshe, Gilbert; Kruckeberg, Bradley M; Muckenhirn, Kyle J; Vap, Alexander R; Geeslin, Andrew G; LaPrade, Robert F

2017-09-01

The qualitative anatomy of the distal iliotibial band (ITB) has previously been described. However, a comprehensive characterization of the quantitative anatomic, radiographic, and biomechanical properties of the Kaplan fibers of the deep distal ITB has not yet been established. It is paramount to delineate these characteristics to fully understand the distal ITB's contribution to rotational knee stability. Purpose/Hypothesis: There were 2 distinct purposes for this study: (1) to perform a quantitative anatomic and radiographic evaluation of the distal ITB's attachment sites and their relationships to pertinent osseous and soft tissue landmarks, and (2) to quantify the biomechanical properties of the deep (Kaplan) fibers of the distal ITB. It was hypothesized that the distal ITB has definable parameters concerning its anatomic attachments and consistent relationships to surgically pertinent landmarks with correlating plain radiographic findings. In addition, it was hypothesized that the biomechanical properties of the Kaplan fibers would support their role as important restraints against internal rotation. Descriptive laboratory study. Ten nonpaired, fresh-frozen human cadaveric knees (mean age, 61.1 years; range, 54-65 years) were dissected for anatomic and radiographic purposes. A coordinate measuring device quantified the attachment areas of the distal ITB to the distal femur, patella, and proximal tibia and their relationships to pertinent bony landmarks. A radiographic analysis was performed by inserting pins into the attachment sites of relevant anatomic structures to assess their location relative to pertinent bony landmarks with fluoroscopic guidance. A further biomechanical assessment of 10 cadaveric knees quantified the load to failure and stiffness of the Kaplan fibers' insertion on the distal femur after a preconditioning protocol. Two separate deep (Kaplan) fiber bundles were identified with attachments to 2 newly identified femoral bony prominences

Agrin mutations lead to a congenital myasthenic syndrome with distal muscle weakness and atrophy.

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Nicole, Sophie; Chaouch, Amina; Torbergsen, Torberg; Bauché, Stéphanie; de Bruyckere, Elodie; Fontenille, Marie-Joséphine; Horn, Morten A; van Ghelue, Marijke; Løseth, Sissel; Issop, Yasmin; Cox, Daniel; Müller, Juliane S; Evangelista, Teresinha; Stålberg, Erik; Ioos, Christine; Barois, Annie; Brochier, Guy; Sternberg, Damien; Fournier, Emmanuel; Hantaï, Daniel; Abicht, Angela; Dusl, Marina; Laval, Steven H; Griffin, Helen; Eymard, Bruno; Lochmüller, Hanns

2014-09-01

Congenital myasthenic syndromes are a clinically and genetically heterogeneous group of rare diseases resulting from impaired neuromuscular transmission. Their clinical hallmark is fatigable muscle weakness associated with a decremental muscle response to repetitive nerve stimulation and frequently related to postsynaptic defects. Distal myopathies form another clinically and genetically heterogeneous group of primary muscle disorders where weakness and atrophy are restricted to distal muscles, at least initially. In both congenital myasthenic syndromes and distal myopathies, a significant number of patients remain genetically undiagnosed. Here, we report five patients from three unrelated families with a strikingly homogenous clinical entity combining congenital myasthenia with distal muscle weakness and atrophy reminiscent of a distal myopathy. MRI and neurophysiological studies were compatible with mild myopathy restricted to distal limb muscles, but decrement (up to 72%) in response to 3 Hz repetitive nerve stimulation pointed towards a neuromuscular transmission defect. Post-exercise increment (up to 285%) was observed in the distal limb muscles in all cases suggesting presynaptic congenital myasthenic syndrome. Immunofluorescence and ultrastructural analyses of muscle end-plate regions showed synaptic remodelling with denervation-reinnervation events. We performed whole-exome sequencing in two kinships and Sanger sequencing in one isolated case and identified five new recessive mutations in the gene encoding agrin. This synaptic proteoglycan with critical function at the neuromuscular junction was previously found mutated in more typical forms of congenital myasthenic syndrome. In our patients, we found two missense mutations residing in the N-terminal agrin domain, which reduced acetylcholine receptors clustering activity of agrin in vitro. Our findings expand the spectrum of congenital myasthenic syndromes due to agrin mutations and show an unexpected

Factors associated with infection following open distal radius fractures.

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Glueck, Dane A; Charoglu, Constantine P; Lawton, Jeffrey N

2009-09-01

Open fractures are often classified according to a system described by Gustilo and Anderson. However, this system was applied to open long bone fractures, which may not predict the incidence of infection in open metaphyseal fractures of the upper extremity. Other studies have found that wound contamination and systemic illness were the best predictors of infections in open hand fractures. Our study assessed infection in open distal radius fractures and identifies factors that are associated with these infections. We hypothesize that contamination, rather than absolute wound size, is the best predictor of infection associated with open distal radius fractures. A review by CPT code yielded 42 patients with open distal radius fractures between 1997 and 2002 treated at a level one trauma center. Medical records and radiographic follow-up were reviewed to assess the time to irrigation and debridement, the number of debridements in initial treatment period, the method of operative stabilization, the Gustilo and Anderson type of fracture, the Swanson type of fracture, and description of wound contamination. Forty-two patients were followed up for an average of 15 months (range 4 to 68 months). Twenty-four fractures were classified as Gustilo and Anderson type I, ten were type II, and eight were type III, 30 were Swanson type I, and 12 were Swanson type II. Five of the 42 fractures were considered contaminated. Two were exposed to fecal contamination. The others were contaminated with tar, dirt/grass, and gravel, respectively. Three of 42 (7%) fractures developed infections. All three infected cases received a single irrigation and debridement. Two of five contaminated fractures (40%) developed a polymicrobial infection. Both were exposed to fecal contamination and, therefore, considered Swanson type II fractures. They were classified as Gustilo and Anderson type II and IIIB based solely upon the size of the wound. Both required multiple debridements and eventually wrist

Stress fracture as a complication of autogenous bone graft harvest from the distal tibia.

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Chou, Loretta B; Mann, Roger A; Coughlin, Michael J; McPeake, William T; Mizel, Mark S

2007-02-01

Autogenous bone graft from the distal tibia provides cancellous bone graft for foot and ankle operations, and it has osteogenic and osteoconductive properties. The site is in close proximity to the foot and ankle, and published retrospective studies show low morbidity from the procedure. One-hundred autografts were obtained from the distal tibia between 2000 and 2003. In four cases the distal tibial bone graft harvest resulted in a stress fracture. There were three women and one man. The average time of diagnosis of the stress fracture from the operation was 1.8 months. All stress fractures healed with a short course (average 2.4 months) of cast immobilization. This study demonstrated that a stress fracture from the donor site of autogenous bone graft of the distal tibia occurs and can be successfully treated nonoperatively.

Relationship between plate removal and Soong grading following surgery for fractured distal radius

NARCIS (Netherlands)

Selles, Caroline A.; Reerds, Sam T. H.; Roukema, Gert; van der Vlies, Kees H.; Cleffken, Berry I.; Schep, Niels W. L.

2018-01-01

The aim of this study was to determine the relationship between volar plate removal and the Soong classification following fixation for fractured distal radius. In this retrospective cohort study, all consecutive patients who had volar plate fixation for a distal radius fracture in 2011-2015 were

Laparoscopic Nephroureterectomy: Oncologic Outcomes and Management of Distal Ureter; Review of the Literature

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Andre Berger

2009-01-01

Full Text Available Introduction. Laparoscopic radical nephroureterectomy (LNU is being increasingly performed at several centers across the world. We review oncologic outcomes after LNU procedure and the techniques for the management of distal ureter. Materials and Methods. A comprehensive review of the literature was performed on the oncological outcomes and management of distal ureter associated with LNU for upper tract transitional cell carcinoma (TCC. Results and Discussion. LNU for upper tract TCC is performed pure laparoscopically (LNU or hand-assisted (HALNU. The management of the distal ureter is still debated. LNU appears to have superior perioperative outcomes when compared to open surgery. Intermediate term oncologic outcomes after LNU are comparable to open nephroureterectomy (ONU. Conclusions. Excision of the distal ureter and bladder cuff during nephroureterectomy remains controversial. Intermediate term oncologic outcomes for LNU compare well with ONU. Initial long-term oncologic outcomes are encouraging. Prospective randomized comparison between LNU and open surgery is needed to define the role of these modalities in the current context.

Distal ureteral calculi: the usefulness of transrectal ultrasound and comparison with intravenous urography

International Nuclear Information System (INIS)

Choi, Moon Hae; Yoon, Dae Young; Shim, Joo Eun; Kim, Ho Chul; Yi, Jeong Geun; Choi, Chul Sun; Bae, Sang Hoon; Kim, Ha Young

1996-01-01

To determine the usefulness of transrectal ultrasound (TRUS) and to compare TRUS with intravenous urography (IVU) in the evaluation of distal ureteral calculi. TRUS and IVU were performed in 24 patients with distal ureteral calculi. Using TRUS, we evaluated the presence and size of calculus, type of ureteral jet at the affected site and diameter of ureter proximal to calculus, and using IVU evaluated the presence and size of calculus, degree of ureteral obstruction, and degree of hydroureter. TRUS and IVU findings, were compared. In each patient, TRUS detected calculus of the distal ureter;in only 18 cases (75%), were the calculi demonstrated with IVU. In 18 cases where calculi were detected by both modalities, average calculus size was 4.5x3.0mm (longest and shortest dimensions) by IVU, and 6.1x3.7mm by TRUS. Between TRUS and IVU(p 0.05). TRUS appears to be a useful adjunctive method for the evaluation of distal ureteral calculus

Aspectos radiológicos da atresia brônquica: relato de três casos e revisão da literatura Radiological aspects of bronchial atresia: report of three cases and review of the literature

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Alexandre da Silva Neu

2003-01-01

Full Text Available A atresia brônquica é uma anomalia congênita rara que usualmente produz massa justa-hilar com hipertransparência distal à radiografia simples. A maioria dos pacientes é jovem e não apresenta sintomas. A tomografia computadorizada confirma o diagnóstico, permitindo o manejo conservador nos casos assintomáticos. Os autores relatam três casos de atresia brônquica. Um caso, de particular interesse, estava associado a volumosa broncocele em paciente do sexo feminino, de 45 anos de idade, que apresentou quadro sintomático de infecção respiratória. O diagnóstico foi estabelecido por meio dos achados da radiologia convencional, da tomografia computadorizada e da comparação com radiografias convencionais e tomografia linear prévios, que já demonstravam alterações. Realizou-se uma revisão sobre os achados clínicos e radiológicos dessa malformação.Bronchial atresia is a rare congenital abnormality that usually shows a juxta-hilar mass with distal radiolucency on conventional x-ray films. Most patients are young and have no symptoms. Computed tomography usually confirms the diagnosis, allowing conservative management of the asymptomatic cases. The authors report three cases of bronchial obstruction. One of the patients was of particular importance and interest, a 45-year-old female patient with symptoms of respiratory infection, due to the association with a bulky bronchocele. The diagnosis was made by analyzing the findings of conventional x-ray films and computed tomography, and the comparison with previous conventional x-ray films and linear tomography, which had already demonstrated abnormalities. A literature review on the clinical and radiological findings of this pulmonary malformation is presented.

Metaplasia intestinal especializada de esôfago distal na doença do refluxo gastroesofágico: prevalência e aspectos clínico-epidemiológicos Specialized intestinal metaplasia of distal esophagus in the gastroesophageal reflux disease: prevalence and clinical-demographic features

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Leiber C. Caum

2003-12-01

Full Text Available RACIONAL: A metaplasia intestinal especializada pode ser classificada, de acordo com os achados endoscópicos e histológicos, em Barrett longo, Barrett curto e metaplasia intestinal da cárdia. O esôfago de Barrett é doença adquirida que ocorre em aproximadamente 10% a 13% dos indivíduos com doença do refluxo gastroesofágico e representa uma condição pré-neoplásica. É caracterizado por substituição do epitélio escamoso estratificado pelo metaplásico colunar especializado, contendo células caliciformes. OBJETIVOS: Determinar, prospectivamente, a prevalência e as características clínico-epidemiológicas da metaplasia intestinal especializada de esôfago distal na doença do refluxo gastroesofágico. MÉTODOS: Entre abril e outubro de 2002, 402 pacientes com sintomas da doença do refluxo gastroesofágico foram avaliados através de questionário padronizado que abordava as variáveis demográficas e foram submetidos a exame endoscópico com biopsias 1 cm abaixo da junção escamocolunar, nos quatro quadrantes. RESULTADOS: Metaplasia intestinal especializada foi encontrada em 18,4% dos pacientes: 0,5% Barrett longo, 3,2% Barrett curto e 14,7% metaplasia intestinal da cárdia. Houve tendência de maior número de homens apresentando esôfago de Barrett e mulheres com metaplasia intestinal da cárdia. Todos com esôfago de Barrett eram da raça branca. Não houve relação entre a intensidade dos sintomas da doença do refluxo gastroesofágico e a presença de metaplasia intestinal especializada. O tempo de duração de sintomas superior a 5 anos foi uma tendência nos portadores de esôfago de Barrett. Este grupo também apresentou mais hérnia de hiato e esofagite mais intensa do que aqueles com metaplasia intestinal da cárdia. Não houve relação entre uso de tabaco ou álcool e metaplasia intestinal especializada. CONCLUSÕES: Esôfago de Barrett foi mais relacionado ao sexo masculino, com sintomas de longa cronicidade

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

Science.gov (United States)

Wismeijer, Daniel; Tawse-Smith, Andrew; Payne, Alan G T

2013-01-01

To compare the levels of patient satisfaction with either conventional mandibular bilateral distal extension partial dentures or those assisted by bilateral distal implants. Forty-eight participants who were dissatisfied with their existing conventional mandibular distal extension dentures opposing complete maxillary dentures were selected for a multicentre prospective study in New Zealand, Colombia and the Netherlands. A control group of 12 participants in New Zealand received conventional mandibular partial dentures. Three test groups involving 36 participants in New Zealand (12), Colombia (12) and the Netherlands (12) received bilateral distal implants in the second molar regions. After conventional loading, the test group participants initially had healing caps placed on the distal implants providing support only, followed after approximately 6 months by ball abutments (retentive anchors) for support and retention. Patient outcomes were determined with questionnaires completed at specific stages of the study for up to 3 years. Visual analogue scale, Likert and oral health impact questionnaires before and after treatment indicated improved results. There were significantly improved parameters of overall satisfaction, stability, chewing and appearance after 3 years (P removable partial dentures are a preferable treatment option for patients with complaints about their conventional distal extension partial dentures. © 2011 John Wiley & Sons A/S.

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.

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.

Deep pain thresholds in the distal limbs of healthy human subjects.

Science.gov (United States)

Rolke, R; Andrews Campbell, K; Magerl, W; Treede, R-D

2005-02-01

Pressure pain thresholds (PPTs) in distal limbs have been under-investigated despite their potential clinical importance. Therefore, we compared PPTs over nail bed, bony prominences, and muscle in distal parts of upper and lower limbs. We investigated 12 healthy subjects using three handheld devices: a spring-loaded, analogue pressure threshold meter (PTM) with two operating ranges, and an electronic Algometer. PPTs were determined with three series of ascending stimulus intensities with a ramp of about 50 kPa/s. PPTs were normally distributed in logarithmic space. PPTs over different tissues varied significantly (ANOVA, pAlgometer than with PTMs (ANOVA, ptesting over muscle. There was no significant right-left difference (ANOVA, p=0.33). In spite of considerable variability across subjects, reproducibility within subjects was high (correlation coefficients>0.90). For within-subject comparisons, threshold elevations beyond 33-43% would be abnormal (95% confidence intervals), whereas only deviations from the group mean by at least a factor of two would be abnormal with respect to absolute normative values. PPTs over distal muscles were comparable to published values on proximal limb and trunk muscles. These findings suggest that pressure pain testing over distal muscles may be a sensitive test for deep pain sensitivity and that the simple and less expensive devices are sufficient for testing this tissue type. Intra-individual site-to-site comparisons will be more sensitive than absolute normative values.

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

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.

Estimativa da degradação de fachadas com revestimento cerâmico: estudo de caso de edifícios de Brasília

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E. Bauer

2015-06-01

Full Text Available No contexto da temática da avaliação de desempenho, vida útil, degradação e diagnóstico de patologias, tem-se observado que os edifícios construídos em Brasília vêm apresentando elevados casos de manifestações patológicas nas fachadas. Esses fenômenos vêm sendo observados em edifícios nas mais diferentes idades, induzindo a questionamentos importantes na parte técnica, relacionados à compatibilidade dos materiais constituintes do sistema de revestimento, técnicas construtivas, degradação dos materiais e projeto. Neste sentido, o objetivo deste estudo consiste em apresentar uma metodologia de inspeção, identificação e quantificação das manifestações patológicas que ocorrem com maior frequência nas fachadas dos edifícios. A metodologia proposta consiste em uma sistematização do processo de inspeção, com identificação, mapeamento e quantificação das manifestações patológicas em uma amostra de 90 fachadas. Essa metodologia permite estabelecer índices de intensidade de ocorrência de danos em função da orientação solar e da idade, bem como permite determinar a intensidade de manifestação patológica em diferentes regiões das fachadas (paredes contínuas, aberturas, sacadas, cantos e extremidades, juntas, transição entre pavimentos e topo. A amostragem é tomada no contexto dos edifícios de Brasília com idade na faixa de 5 a 48 anos. Os resultados mostram elevado fator de dano de descolamento cerâmico e evidenciam que os valores mais elevados dos fatores de danos foram observados nas fachadas Norte e Oeste e ainda nas fachadas com idade acima de 10 anos. Os resultados mostram também que os danos ocorrem com maior frequência na região das paredes contínuas. Este estudo visa contribuir com a necessidade de sistematização da identificação, classificação e quantificação dos danos em fachadas com revestimento cerâmico.

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.

A PROSPECTIVE STUDY OF DISTAL TIBIAL FRACTURES BY MIPO (LCP

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Chandra Sekharam Naidu

2015-05-01

Full Text Available INTRODUCTION: D istal tibial fractures represent a significant challenge to most of the surgeons even today. They constitute 1 - 10% of all lower extremity fractures . 1 The difficulty in treating the fractures of distal tibial end is exemplif ied by orthopedists, who in the first half of twentieth century, believed these injuries were so severe and fraught with so many complications, that these fractures were deemed not amenable for surgical reconstruction . 2 Conservative treatment by POP cast l ead to prolonged immobilization, leading to ankle and knee stiffness affecting quality of life of the patient . 3 Operative treatment is indicated for most tibial fractures caused by high energy trauma. Operative treatment allows early motion, and avoids sho rtening and other complications associated with prolonged immobilization . 4 The fundamental goal of treatment of distal tibial fractures is restoration of normal or near normal alignment and articular congruity and finally to obtain a well healed fracture; pain free weight bearing ; and functional ROM of ankle joint. For the past decade, plating has been successful in treating complex fractures of the lower extremity especially distal tibia . 5 Conventional ORIF have been associated with complications like infe ction and delayed or non - union due to devitalisation of bony fragments and additional damage to the soft tissues . 6 To improve fracture healing, more “biological” methods have been developed in the last decade to lessen the surgical dissection, preserving b lood supply to bony fragments and containing at least partially the fracture haematoma . 7 Recently, the trend is towards use of a Locking compression plate for treatment of fractures of the distal part of the tibia 8 . Compared with a conventional plate, a Lo cking compression plate imparts a higher degree of stability and provides better protection against primary and secondary losses of reduction and minimization of bone

Endovascular treatment of ruptured distal posterior inferior ...

African Journals Online (AJOL)

2014-03-01

Mar 1, 2014 ... there are lots of reports regarding the interventional therapy of the artery aneurysms (including proximal and distal), all of which are considered to be safe and effective. All the incidences of interventional-related complications are below 10% and there is no report of injury of lower cranial nerves [11, 12].

Distal Regeneration Involves the Age Dependent Activity of Branchial Sac Stem Cells in the Ascidian Ciona intestinalis.

Science.gov (United States)

Jeffery, William R

2015-02-01

Tunicates have high capacities for regeneration but the underlying mechanisms and their relationship to life cycle progression are not well understood. Here we investigate the regeneration of distal structures in the ascidian tunicate Ciona intestinalis . Analysis of regenerative potential along the proximal-distal body axis indicated that distal organs, such as the siphons, their pigmented sensory organs, and the neural complex, could only be replaced from body fragments containing the branchial sac. Distal regeneration involves the formation of a blastema composed of cells that undergo cell proliferation prior to differentiation and cells that differentiate without cell proliferation. Both cell types originate in the branchial sac and appear in the blastema at different times after distal injury. Whereas the branchial sac stem cells are present in young animals, they are depleted in old animals that have lost their regeneration capacity. Thus Ciona adults contain a population of age-related stem cells located in the branchial sac that are a source of precursors for distal body regeneration.

Toward an integrated genetic model for vent-distal SEDEX deposits

Science.gov (United States)

Sangster, D. F.

2018-04-01

Although genetic models have been proposed for vent-proximal SEDEX deposits, an equivalent model for vent-distal deposits has not yet appeared. In view of this, it is the object of this paper to present a preliminary integrated vent-distal genetic model through exploration of four major components: (i) nature of the ore-forming fluid, (ii) role of density of the unconsolidated host sediments, (iii) dynamics of sulfate reduction and (iv) depositional environment. Two sub-groups of SEDEX Pb-Zn deposits, vent-proximal and vent-distal, are widely recognized today. Of the two, the latter is by far the largest in terms of metal content with each of the 13 largest containing in excess of 7.5 M (Zn+Pb) metal. In contrast, only one vent-proximal deposit (Sullivan) falls within this size range. Vent-proximal deposits are characteristically underlain by local networks of sulfide-filled veins (commonly regarded as feeder veins) surrounded by a discordant complex of host rock alteration. These attributes are missing in vent-distal deposits, which has led to the widespread view that vent-distal ore-forming fluids have migrated unknown distances away from their vent sites. Because of the characteristic fine grain size of ore minerals, critical fluid inclusion data are lacking for vent-distal ore-stage sulfides. Consequently, hypothetical fluids such as those which formed MVT deposits (120 °C, 20% NaCl equiv.) are considered to represent vent-distal fluids as well. Such high-salinity fluids are capable of carrying significant concentrations of Pb and Zn as chloride complexes while the relatively low temperatures preclude high Cu contents. Densities of such metalliferous brines result in bottom-hugging fluids that collect in shallow saucer-shaped depressions (collector basins). Lateral metal zoning in several deposits reveals the direction from which the brines came. Relative densities of the ore-forming fluid and sediment determine whether the ore-forming fluid stabilizes on top

Association between distal ulnar morphology and extensor carpi ulnaris tendon pathology

International Nuclear Information System (INIS)

Chang, Connie Y.; Huang, Ambrose J.; Bredella, Miriam A.; Kattapuram, Susan V.; Torriani, Martin

2014-01-01

The purpose of this study was to evaluate the association between distal ulnar morphology and extensor carpi ulnaris (ECU) tendon pathology. We retrospectively reviewed 71 adult wrist MRI studies with ECU tendon pathology (tenosynovitis, tendinopathy, or tear), and/or ECU subluxation. Subjects did not have a history of trauma, surgery, infection, or inflammatory arthritis. MRI studies from 46 subjects without ECU tendon pathology or subluxation were used as controls. The following morphological parameters of the distal ulna were measured independently by two readers: ulnar variance relative to radius, ulnar styloid process length, ECU groove depth and length. Subjects and controls were compared using Student's t test. Inter-observer agreement (ICC) was calculated. There was a significant correlation between negative ulnar variance and ECU tendon pathology (reader 1 [R1], P = 0.01; reader 2 [R2], P 0.64 for all parameters. Distal ulnar morphology may be associated with ECU tendon abnormalities. (orig.)

The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex.

Science.gov (United States)

Kasapinova, K; Kamiloski, V

2016-06-01

Our purpose was to determine the correlation of initial radiographic parameters of a distal radius fracture with an injury of the triangular fibrocartilage complex. In a prospective study, 85 patients with surgically treated distal radius fractures were included. Wrist arthroscopy was used to identify and classify triangular fibrocartilage complex lesions. The initial radial length and angulation, dorsal angulation, ulnar variance and distal radioulnar distance were measured. Wrist arthroscopy identified a triangular fibrocartilage complex lesion in 45 patients. Statistical analysis did not identify a correlation with any single radiographic parameter of the distal radius fractures with the associated triangular fibrocartilage complex injuries. The initial radiograph of a distal radius fracture does not predict a triangular fibrocartilage complex injury. III. © The Author(s) 2016.

Accuracy of specimen-specific nonlinear finite element analysis for evaluation of distal radius strength in cadaver material.

Science.gov (United States)

Matsuura, Yusuke; Kuniyoshi, Kazuki; Suzuki, Takane; Ogawa, Yasufumi; Sukegawa, Koji; Rokkaku, Tomoyuki; Takahashi, Kazuhisa

2014-11-01

Distal radius fracture, which often occurs in the setting of osteoporosis, can lead to permanent deformity and disability. Great effort has been directed toward developing noninvasive methods for evaluating the distal radius strength, with the goal of assessing fracture risk. The aim of this study was to evaluate distal radius strength using a finite element model and to gauge the accuracy of finite element model measurement using cadaver material. Ten wrists were obtained from cadavers with a mean age of 89.5 years at death. CT images of each wrist in an extended position were obtained. CT-based finite element models were prepared with Mechanical Finder software. Fracture on the models was simulated by applying a mechanical load to the palm in a direction parallel to the forearm axis, after which the fracture load and the site at which the fracture began were identified. For comparison, the wrists were fractured using a universal testing machine and the fracture load and the site of fracture were identified. The fracture load was 970.9 N in the finite element model group and 990.0 N in the actual measurement group. The site of the initial fracture was extra-articular to the distal radius in both groups. The finite element model was predictive for distal radius fracture when compared to the actual measurement. In this study, a finite element model for evaluation of distal radius strength was validated and can be used to predict fracture risk. We conclude that a finite element model is useful for the evaluation of distal radius strength. Knowing distal radius strength might avoid distal radius fracture because appropriate antiosteoporotic treatment can be initiated.

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.

Determination of bone mineral density at distal radius measured by single photon absorptiometry

International Nuclear Information System (INIS)

Tomomitsu, Tatsushi; Yanagimoto, Shinichi; Hitomi, Go; Murakami, Akihiko; Suemori, Shinji; Yokobayashi, Tsuneo; Ishii, Koshi; Hiji, Hiroo

1988-01-01

We have discussed the index of the bone mineral density (BMD) at the distal radius measured by single photon absorptiometry. Initially, the shape at the distal radius was evaluated using an X-ray photogram of the forearm and a calculation formula of the cross-sectional area at the distal radius was performed using an X-CT photogram of the forearm. A new index for the bone mineral density (modified BMD, mBMD), bone mineral content/cross-sectional area, at the distal radius was obtained for 154 young normal subjects (20 ∼ 44 yrs.). No significant differences in the mBMD values between young normal males and females, except for the group 20 ∼ 24 year-old group, were observed. Furthermore, a significantly decreased in the mBMD values with aging was observed in females between the ages of 20 ∼ 24 and 40 ∼ 44. However, no significant changes in the mBMD values were recognized in the men. Thus, it was shown that the new BMD index, mBMD, was useful for evaluating the changes of the bone mass. (author)

A simplified technique for a totally diverting transverse loop colostomy and distal irrigation.

Science.gov (United States)

Rose, D; Koniges, F; Frazier, T G

1985-12-01

This technique of totally diverting loop colostomy may be performed as an independent procedure or with exploratory laparotomy and surgical treatment on the distal part of the colon. Either a transverse or sigmoid loop colostomy can be used for diversion without the risk of fecal contamination of the peritoneal cavity, particularly when working with unprepared intestine. When distal irrigation is desired to purge the intestine of fecal material, either intraoperatively or as part of a subsequent intestinal preparation, it can easily be accomplished by placing an irrigating catheter distal to the staple line. In addition, the use of a small rubber suspension bar facilitates application of standard colostomy appliances for the stoma.

Three distal root canals in mandibular first molar with different canal configurations: Report of two cases and literature review

Directory of Open Access Journals (Sweden)

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.

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.

Osteomyelitis Caused by Candida glabrata in the Distal Phalanx

Directory of Open Access Journals (Sweden)

Shunichi Toki

2014-01-01

Full Text Available Osteomyelitis caused by Candida glabrata is rare and its optimal treatment is unknown. Here we report a case of osteomyelitis caused by C. glabrata in the distal phalanx in a 54-year-old woman. Despite partial resection of the nail and administering a 1-month course of antibiotics for paronychia, the local swelling remained and an osteolytic lesion was found. C. glabrata osteomyelitis of the distal phalanx was later diagnosed after curettage. Thereafter, the patient was treated with antifungal agents for 3 months. The infection eventually resolved, and radiological healing of the osteolytic lesion was achieved. Antifungal susceptibility testing should be performed in the case of osteomyelitis caused by nonalbicans Candida species, due to their resistance to fluconazole.

Optimal fit of chairside-fabricated distal shoe space maintainer.

Science.gov (United States)

Nouri, M R; Kennedy, D B

2013-10-01

Premature loss of a primary second molar may lead to space loss in the dental arch. This space loss tends to be more severe in unfavourable malocclusions. The distal shoe space maintainer (DSSM) may be beneficial in controlling the path of eruption of an unerupted permanent first molar from the primary into the early mixed dentition. This article describes the technique for achieving optimal fit of a chairside-fabricated band and DSSM in a single visit by contouring the distal shoe blade, and by extending it to the mesial surface of the permanent first molar. Upon the eruption of the permanent first molar DSSM may be modified to a reverse band-and-loop, or replaced by a lingual holding arch.

A Technique of Distal Clavicle Fracture Fixation Using The Tightrope Procedure

Directory of Open Access Journals (Sweden)

CJ Soh

2011-11-01

Full Text Available We present here a technique of fracture stabilization using the Tightrope procedure in a patient with a widely displaced Neer type IIB distal clavicle fracture. The Tightrope system, typically used for stabilization of acromioclavicular joint dislocation, has not been widely described for distal clavicle fractures. The patient achieved satisfactory results after surgery; we feel that this technique is appealing as it is simple, reproducible and avoids the complications associated with extensive metalwork. This technique may also appeal to the arthroscopic surgeon.

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...

Laparoscopic distal pancreatectomy: results of a prospective non-randomized study from a tertiary center.

Science.gov (United States)

Palanivelu, C; Shetty, R; Jani, K; Sendhilkumar, K; Rajan, P S; Maheshkumar, G S

2007-03-01

Though laparoscopic distal pancreatectomy for benign conditions was first described in the early 1990s, it has not become as popular as other laparoscopic surgeries. Published literature on this topic consists of several case reports and a handful of small series. We present our experience, which, to the best of our knowledge, is the largest series reported to date. Since 1998, 22 patients have undergone distal pancreatectomy at our institute. The technique of distal pancreatosplenectomy, as well as spleen-preserving distal pancreatectomy, is described. Four males and 18 females in the age range of 12-69 years underwent operation. Splenic preservation was possible in 7 patients. The tumor diameter ranged from 2.1 cm to 7.4 cm. The mean operating time was 215 min. The mean length of incision required for specimen retrieval was 3.4 cm. All patients were started on a liquid diet on the first postoperative day. The median hospital stay was 4 days. One patient developed a pancreatic fistula that was managed conservatively. At the end of an average follow-up of 4.6 years, no recurrence has been reported. Laparoscopic distal pancreatectomy is a safe procedure, with minimal morbidity, rapid recovery, and short hospital stay. In appropriate cases, splenic preservation is feasible.

[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

Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients.

Science.gov (United States)

Gupta, Rakesh K; Rohilla, Rajesh Kumar; Sangwan, Kapil; Singh, Vijendra; Walia, Saurav

2010-12-01

Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-mm limited-contact locking compression plate (LC-LCP) was used in 33 fractures, the metaphyseal LCP in 27 fractures and the distal medial tibial LCP in the remaining 20 fractures. Fibula fixation was performed in the majority of comminuted fractures (n = 41) to maintain the second column of the ankle so as to achieve indirect reduction and to prevent collapse of the fracture. There were two cases of delayed wound breakdown in fractures fixed with the 4.5-mm LC-LCP. Five patients required primary bone grafting and three patients required secondary bone grafting. All cases of delayed union (n = 7) and nonunion (n = 3) were observed in cases where plates were used in bridge mode. Minimally invasive plate osteosynthesis (MIPO) with LCP was observed to be a reliable method of stabilisation for these fractures. Peri-operative docking of fracture ends may be a good option in severely impacted fractures with gap. The precontoured distal medial tibial LCP was observed to be a better tolerated implant in comparison to the 4.5-mm LC-LCP or metaphyseal LCP with respect to complications of soft tissues, bone healing and functional outcome, though its contour needs to be modified.

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

Foco de criptas aberrantes e câncer da junção colorretal: análise da presença de lesões precoces microscópicas na periferia do câncer colorretal e correlação com a expressão da β-catenina e Ki-67

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Daniel Cury Ogata

Full Text Available OBJETIVO: Avaliar a presença de foco de criptas aberrantes (FCA em mucosa macroscopicamente normal, localizada na periferia de um câncer colorretal (CCR e correlacionar a progressão tumoral destes FCA para o CCR, por meio da expressão da β-catenina e o Ki-67. MÉTODOS: Utilizou-se 21 espécimes cirúrgicos contendo adenocarcinoma de junção retossigmóide. Foram coletadas amostras localizadas a 1 e 5 cm proximal e distal ao tumor, quando possível, bem como um fragmento da neoplasia. Os FCA foram selecionados. Subseqüentemente foi realizado estudo imunoistoquímico com os anticorpos β-catenina e o Ki-67. RESULTADOS: A expressão nuclear da β-catenina nos adenocarcinomas, revelou freqüência de 81%. O Ki-67 apresentou a mesma freqüência. Apesar disso o coeficiente Kappa revelou fraca concordância entre estes anticorpos. Foram observados 20 FCA, sendo que 13 destes focos localizavam-se nas proximidades do tumor. Nenhum dos FCA apresentou expressão da β-catenina nuclear, tampouco para o Ki-67. CONCLUSÃO: Nas áreas situadas a 1 cm da neoplasia colorretal, foi observada maior concentração de FCA em relação às áreas situadas a 5 cm do tumor. No entanto, não se observou correlação entre a expressão da β-catenina e ki-67 nos colonócitos das criptas aberrantes das áreas estudadas, com as células neoplásicas do adenocarcinoma.

Changes of nutritional status after distal gastrectomy in patients with gastric cancer.

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Katsube, Takao; Konnno, Soichi; Murayama, Minoru; Kuhara, Kotaro; Sagawa, Masano; Yoshimatsu, Kazuhiko; Shiozawa, Shunnichi; Shimakawa, Takeshi; Naritaka, Yoshihiko; Ogawa, Kenji

2008-01-01

In Japan, distal gastrectomy is the most common operation performed to treat gastric cancer. However, this procedure often leads to postoperative problems such as weight loss. We assessed the changes of nutritional status early after operation and the associations of the postoperative body weight (as a percentage of the preoperative weight) and background factors in patients who underwent distal gastrectomy. We measured the changes of nutritional indices (mean body weight, TSF, AMC and Alb) and nutrition intake on the day before operation (before operation), before postoperative resumption of oral intake (before oral intake), and on the fifth day of a soft rice porridge diet (after soft rice). Background factors included gender, age, preoperative BMI and preoperative exercise. Mean body weight, TSF, and AMC significantly decreased from before operation, to the day before oral intake and to the day after soft rice. The postoperative body weight was not associated with the gender, age, or preoperative BMI. The frequency of regular preoperative exercise was associated with the postoperative body weight. The total daily calorie intake was 1,664 kcal (before operation), 398 kcal (before oral intake), and 949 kcal (after soft rice). To conclude, nutritional status changes significantly after distal gastrectomy. Early nutrition intervention may be needed in patients who undergo distal gastrectomy for gastric cancer.

The anatomy and physiology of the suspensory apparatus of the distal phalanx.

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Pollitt, Christopher C

2010-04-01

The equine hoof capsule protects the softer, more sensitive, structures within. Failure of the connection between hoof and bone (suspensory apparatus of the distal phalanx or SADP) results in the crippling lameness of laminitis. Active basal cell proliferation occurs principally in tubular hoof and proximal and distal lamellae. The remaining lamellae are virtually non-proliferative and the hoof wall moves past the stationary distal phalanx, by controlled activation and inhibition of constituent proteases. The lamellar corium derives most of its blood supply from the branches of the terminal arch which perforate the distal phalanx. Valveless veins within the foot can be exploited clinically for retrograde venous therapy or contrast radiography (venography). The basement membrane (BM) forms the interface between the lamellar epidermis and the adjacent dermis and the plasma membrane of each lamellar basal cell is attached to the BM by numerous electron dense adhesion plaques or hemidesmosomes the ultimate attachment unit of the SADP. Laminitis destroys and dislocates the BM and its components and without an intact, functional BM, the structure and function of the lamellar epidermis is pathologically compromised. Transcription and activation of constituent proteases occurs in normal hoof lamellae but in increased amounts during laminitis. Copyright 2010 Elsevier Inc. All rights reserved.

Limb saving surgery for Ewing's sarcoma of the distal tibia: a case report.

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Mizoshiri, Naoki; Shirai, Toshiharu; Terauchi, Ryu; Tsuchida, Shinji; Mori, Yuki; Katsuyama, Yusei; Hayashi, Daichi; Oka, Yoshinobu; Kubo, Toshikazu

2018-05-02

Ewing's sarcoma is a primary malignant tumor of bone occurring mostly in childhood. Few effective reconstruction techniques are available after wide resection of Ewing's sarcoma at the distal end of the tibia. Reconstruction after wide resection is especially difficult in children, as it is necessary to consider the growth and activity of the lower limbs. A 12-year-old Japanese boy had presented with right lower leg pain at age 8 years. Imaging examination showed a bone tumor accompanied by a large extra-skeletal mass in the distal part of his tibia. The tumor was histologically diagnosed as Ewing's sarcoma. The patient received chemotherapy, followed by wide resection. Reconstruction consisted of a bone transport method involving external fixation of Taylor Spatial Frame. To prevent infection after surgery, the external fixation pin was coated with iodine. One year after surgery, the patient showed poor consolidation of bone, so iliac bone transplantation was performed on the extended bones and docking site of the distal tibia. After 20 months, tibia formation was good. Three years after surgery, there was no evidence of tumor recurrence or metastases; bone fusion was good, and he was able to run. The bone transport method is an effective surgical method of reconstruction after wide resection of a bone tumor at the distal end of the tibia, if a pin can be inserted into the distal bone fragment. Coating external fixation pins with iodine may prevent postoperative infection.

Minimally-invasive plate osteosynthesis in distal tibial fractures: Results and complications.

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Vidović, Dinko; Matejčić, Aljoša; Ivica, Mihovil; Jurišić, Darko; Elabjer, Esmat; Bakota, Bore

2015-11-01

Distal tibial or pilon fractures are usually the result of combined compressive and shear forces, and may result in instability of the metaphysis, with or without articular depression, and injury to the soft tissue. The complexity of injury, lack of muscle cover and poor vascularity make these fractures difficult to treat. Surgical treatment of distal tibial fractures includes several options: external fixation, IM nailing, ORIF and minimally-invasive plate osteosynthesis (MIPO). Management of distal tibial fractures with MIPO enables preservation of soft tissue and remaining blood supply. This is a report of a series of prospectively studied closed distal tibial and pilon fractures treated with MIPO. A total of 21 patients with closed distal tibial or pilon fractures were enrolled in the study between March 2008 and November 2013 and completed follow-up. Demographic characteristics, mechanism of injury, time required for union, ankle range of motion and complications were recorded. Fractures were classified according to the AO/OTA classification. Nineteen patients were initially managed with an ankle-spanning external fixator. When the status of the soft tissue had improved and swelling had subsided enough, a definitive internal fixation with MIPO was performed. Patients were invited for follow-up examinations at 3 and 6 weeks and then at intervals of 6 to 8 weeks until 12 months. Mean age of the patients was 40.1 years (range 19-67 years). Eighteen cases were the result of high-energy trauma and three were the result of low-energy trauma. According to the AO/OTA classification there were extraarticular and intraarticular fractures, but only simple articular patterns without depression or comminution. The average time for fracture union was 19.7 weeks (range 12-38 weeks). Mean range of motion was 10° of dorsiflexion (range 5-15°) and 28.3° of plantar flexion (range 20-35°). Three cases were metalwork-related complications. Two patients underwent plate removal

Median nerve fascicular anatomy as a basis for distal neural prostheses.

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Planitzer, Uwe; Steinke, Hanno; Meixensberger, Jürgen; Bechmann, Ingo; Hammer, Niels; Winkler, Dirk

2014-05-01

Functional electrical stimulation (FES) serves as a possible therapy to restore missing motor functions of peripheral nerves by means of cuff electrodes. FES is established for improving lower limb function. Transferring this method to the upper extremity is complex, due to a lack of anatomical data on the physiological configuration of nerve fascicles. Our study's aim was to provide an anatomical basis for FES of the median nerve in the distal forearm and hand. We investigated 21 distal median nerves from 12 body donors. The peripheral fascicles were traced back by removing the external and interfascicular epineurium and then assigned to 4 quadrants. A distinct motor and sensory distribution was observed. The fascicles innervating the thenar eminence and the first lumbrical muscle originated from the nerves' radial parts in 82%. The fascicle supplying the second lumbrical muscle originated from the ulnar side in 78%. No macroscopically visible plexus formation was observed for the distal median nerve in the forearm. The findings on the distribution of the motor branches of the median nerve and the missing plexus formation may likely serve as an anatomical basis for FES of the distal forearm. However, due to the considerable variability of the motor branches, cuff electrodes will need to be adapted individually in FES. Taking into account the sensory distribution of the median nerve, FES may also possibly be applied in the treatment of regional pain syndromes. Copyright © 2013 Elsevier GmbH. All rights reserved.

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)

early functional outcome of distal femoral fractures at kenyatta

African Journals Online (AJOL)

The leading cause was RTA, followed by falls from a height. ... Distal femoral fractures cause considerable morbidity .... as means and standard deviations. .... Anaesthesia. Spinal. 37 (80). General Anaesthesia (GA). 9 (20). Transfusion.

Distal renal tubular acidosis and amelogenesis imperfecta: A rare association

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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.

One-stage lengthening using a locked nailing technique for distal femoral shaft nonunions associated with shortening.

Science.gov (United States)

Wu, Chi-Chuan; Lee, Zhon-Liau

2004-02-01

To assess the effectiveness of a one-stage lengthening using a locked nail technique for the treatment of distal femoral shaft nonunions associated with shortening. Retrospective. University hospital. During a 6-year period, 36 distal femoral shaft nonunions associated with shortening (>1.5 cm) were treated by the one-stage lengthening technique. Indications for this technique were distal femoral shaft aseptic or quiescent infected nonunions, 1.5-5 cm shortening, and a fracture level suitable for the insertion of two distal locked screws. The surgical technique involved skeletal traction using the femoral condyle, local débridement, lengthening by lengthening was 2.5 cm (range 1.5-3.5 cm). One-stage lengthening using the locked nailing technique to treat distal femoral shaft nonunions associated with shortening can achieve a high success rate and low complication rate. The key to successful treatment is the patient's complete cooperation with strictly protected weight bearing until the fracture has healed.

Distal regeneration involves the age dependent activity of branchial sac stem cells in the ascidian Ciona intestinalis

Science.gov (United States)

2014-01-01

Abstract Tunicates have high capacities for regeneration but the underlying mechanisms and their relationship to life cycle progression are not well understood. Here we investigate the regeneration of distal structures in the ascidian tunicate Ciona intestinalis. Analysis of regenerative potential along the proximal−distal body axis indicated that distal organs, such as the siphons, their pigmented sensory organs, and the neural complex, could only be replaced from body fragments containing the branchial sac. Distal regeneration involves the formation of a blastema composed of cells that undergo cell proliferation prior to differentiation and cells that differentiate without cell proliferation. Both cell types originate in the branchial sac and appear in the blastema at different times after distal injury. Whereas the branchial sac stem cells are present in young animals, they are depleted in old animals that have lost their regeneration capacity. Thus Ciona adults contain a population of age‐related stem cells located in the branchial sac that are a source of precursors for distal body regeneration. PMID:25893097

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. ...

Mini replants: fingertip replant distal to the IP or DIP joint.

Science.gov (United States)

Dautel, G; Barbary, S

2007-01-01

Amputations through the distal interphalangeal joint or distal to this joint are frequent and they represent probably one of the best indications for replantation. Details on the vascular anatomy of the fingertip have to be perfectly known by the surgeon who will have to deal with these replantations. Factors such as age, mechanism of amputation and type of anastomosis will influence the overall success rate of the procedure. Return of a true static two points discrimination can be observed in children even in the absence of any neural repair.

Aneurisma sacular da artéria radial: a propósito de um caso clínico Sacular aneurysm of the radial artery: a case report

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Nádia Duarte

2011-06-01

Full Text Available Os aneurismas da artéria radial são raros e esporádicos, sendo que os pseudoaneurismas são mais frequentes do que os aneurismas verdadeiros e maioritariamente de configuração sacular. A etiologia é variada e diferenciam-se de outros diagnósticos pela pulsação e frémito. Raramente se complicam de ruptura, sendo a trombose e embolização as principais complicações. Dos casos publicados sobre aneurismas verdadeiros da artéria radial, apenas um está descrito como sendo secundário a lesão ocupacional repetitiva, sendo a maioria de causa idiopática. Os autores descrevem um caso de uma mulher de 63 anos, referenciada à consulta de Cirurgia Vascular por crescimento de massa pulsátil na tabaqueira anatómica da mão esquerda. O estudo por eco-doppler e angiografia, confirmaram o diagnóstico de aneurisma sacular da artéria radial, com 20 mm de maior eixo, arcada palmar permeável e sem sinais de embolização distal. Foi submetida a aneurismectomia parcial com laqueação dupla proximal e distal e endoaneurismorrafia. A cirurgia e pós-operatório decorreram sem complicações, nomeadamente complicações isquémicas. A propósito desde caso clínico, discute-se a abordagem diagnóstica e opções terapêuticas.Radial artery aneurysms are sporadic and rare, pseudoaneurysms are more common than true aneurysms, mainly in saccular configuration. The etiology is varied and difference from other diagnostics is done by the presence of pulse and thrill. Thrombosis and embolization are the main complications, while rupture is rare. From the reported cases of true aneurysms of the radial artery, only one is described as being secondary to repetitive occupational injury, the majority being idiopathic. The authors describe the case of a 63 year old woman, referred to a Vascular Surgery consultation because of a growing pulsatile mass in the anatomical snuffbox of the left hand. The Doppler and Angiography studies confirmed the diagnosis of

Relación entre la potencia muscular de extremidades inferiores y tronco con la velocidad de salida de la bola en el swing de drive en golf

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Lorena Torres Ronda

2010-09-01

Full Text Available A pesar del interés emergente en el acondicionamiento físico en el golf, se han llevado a cabo pocos estudios para valorar la relación entre la potencia mecánica y el rendimiento en golf. El objetivo de este estudio fue valorar si existía una correlación entre la velocidad de salida de la bola del swing de drive y la potencia muscular de extremidades inferiores y tronco, en un grupo de 8 golfistas (16,8 ± 1,4 años; 2,2 ± 1,8 Handicap; 63,1 ± 6,4 kg.; 172,7 ± 7,5 cm. El test incluyó mediciones de la velocidad de salida de la bola y tests de potencia mecánica (prensa de piernas horizontal, press de banca y rotaciones de tronco. Los resultados de este estudio indican que existe una correlación significativa entre la velocidad de salida de la bola y la potencia piernas (prensa de piernas horizontal: r2=,933; p=,000 y del tronco (press de banca: r2 = 0,66; p = ,014. La prensa de piernas se mostró como el predictor más representativo para la velocidad de salida de la bola (r2 = 0,934; p = ,000.

Repercussões da L-alanil-glutamina sobre as concentrações de lactato e lactato desidrogenase (LDH em pacientes com isquemia crítica dos membros inferiores submetidos a revascularização distal Repercussions of l-alanyl-glutamine upon the concentrations of lactate and lactate dehydrogenase (LDH in patients with critical ischemia of lower limbs subjected to distal revascularization

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Wellington Forte Alves

2003-06-01

Full Text Available OBJETIVO: Investigar efeitos da L-alanil-glutamina nas concentrações musculares de lactato, e nas concentrações sanguíneas de LDH, em pacientes com isquemia crítica dos membros inferiores submetidos à revascularização distal. MÉTODOS: Dezesseis adultos (12-homens/4-mulheres foram distribuídos em 2 grupos (1-controle/2-estudo. Três horas após injeção endovenosa de 250 ml de L-alanil-glutamina a 20% adicionados a 750 ml de soro fisiológico (Grupo 2, ou 1000 ml de solução salina (Grupo 1, iniciava-se a revascularização, sob raquianestesia. Amostras musculares e de sangue (arterial/venoso foram coletadas no início do procedimento (TI, no final (TF, e 10 e 20 minutos após isquemia (T1/T2. RESULTADOS: Observou-se redução significante (pPURPOSE: Investigate the repercussions of L-alanyl-glutamine in muscular tissue concentrations of lactate, and venous and arterial blood concentrations of LDH, in patients with critical ischemia of the lower limbs submitted to distal revascularization. METHODS: Sixteen adults (12 male/4 female were distributed in 2 groups (1-Control/2-Experiment. Three hours after the intravenous injection of 250 ml of a 20% solution of L-alanyl-glutamine added to 750 ml of saline solution (Group 2; or 1000 ml of saline solution (Group 1, distal bypass was carried out under spinal anesthesia. Muscle and blood samples (arterial/venous were collected at the beginning of the surgical procedure (TI, at the end (TF, and 10 and 20 minutes after re-establishment of blood flow. RESULTS: Significant reduction (p<0,05 of lactate concentration was observed in healthy muscle tissue in L-alanyl-glutamine treated patients in comparison to control group, at all times studied. There was a significant reduction (p <0,05 in venous concentrations of LDH in treated patients at all times studied (TI/TFV/T1V/T2V; and in arterial blood during reperfusion (T1A/T2A. CONCLUSIONS: 1. Decreased lactate concentrations in healthy skeletal

Rotation of intramedullary alignment rods affects distal femoral cutting plane in total knee arthroplasty.

Science.gov (United States)

Maderbacher, Günther; Matussek, Jan; Keshmiri, Armin; Greimel, Felix; Baier, Clemens; Grifka, Joachim; Maderbacher, Hermann

2018-02-17

Intramedullary rods are widely used to align the distal femoral cut in total knee arthroplasty. We hypothesised that both coronal (varus/valgus) and sagittal (extension/flexion) cutting plane are affected by rotational changes of intramedullary femoral alignment guides. Distal femoral cuts using intramedullary alignment rods were simulated by means of a computer-aided engineering software in 4°, 6°, 8°, 10°, and 12° of valgus in relation to the femoral anatomical axis and 4° extension, neutral, as well as 4°, 8°, and 12° of flexion in relation to the femoral mechanical axis. This reflects the different angles between anatomical and mechanical axis in coronal and sagittal planes. To assess the influence of rotation of the alignment guide on the effective distal femoral cutting plane, all combinations were simulated with the rod gradually aligned from 40° of external to 40° of internal rotation. Rotational changes of the distal femoral alignment guides affect both the coronal and sagittal cutting planes. When alignment rods are intruded neutrally with regards to sagittal alignment, external rotation causes flexion, while internal rotation causes extension of the sagittal cutting plane. Simultaneously the coronal effect (valgus) decreases resulting in an increased varus of the cutting plane. However, when alignment rods are intruded in extension or flexion partly contradictory effects are observed. Generally the effect increases with the degree of valgus preset, rotation and flexion. As incorrect rotation of intramedullary alignment guides for distal femoral cuts causes significant cutting errors, exact rotational alignment is crucial. Coronal cutting errors in the distal femoral plane might result in overall leg malalignment, asymmetric extension gaps and subsequent sagittal cutting errors.

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

Technical Aspects of Laparoscopic Distal Pancreatectomy for Benign and Malignant Disease: Review of the Literature

Science.gov (United States)

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 distal pancreatectomy should be attempted in case of benign disease. Spleen preservation can be achieved preferably by preserving the splenic vessels (Kimura technique), but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and left gastroepiploic artery (Warshaw technique). Several studies have suggested a higher rate of spleen preservation with laparoscopy. The radical antegrade modular pancreatosplenectomy has become mainstay for treating pancreatic cancer and can be performed laparoscopically as well. Evidence on the feasibility and safety of laparoscopic distal pancreatectomy for cancer is scarce. Despite the obvious advantages of laparoscopic surgery, postoperative morbidity remains relatively high, mainly because of the high incidence of pancreatic fistula. For decades, surgeons have tried to prevent these fistulas but to date no strategy has been confirmed to be effective in 2 consecutive randomized studies. Pragmatic multicenter studies focusing on technical aspects of laparoscopic distal pancreatectomy are lacking and should be encouraged. PMID:26240565

Technical Aspects of Laparoscopic Distal Pancreatectomy for Benign and Malignant Disease: Review of the Literature

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T. de Rooij

2015-01-01

Full Text Available 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 distal pancreatectomy should be attempted in case of benign disease. Spleen preservation can be achieved preferably by preserving the splenic vessels (Kimura technique, but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and left gastroepiploic artery (Warshaw technique. Several studies have suggested a higher rate of spleen preservation with laparoscopy. The radical antegrade modular pancreatosplenectomy has become mainstay for treating pancreatic cancer and can be performed laparoscopically as well. Evidence on the feasibility and safety of laparoscopic distal pancreatectomy for cancer is scarce. Despite the obvious advantages of laparoscopic surgery, postoperative morbidity remains relatively high, mainly because of the high incidence of pancreatic fistula. For decades, surgeons have tried to prevent these fistulas but to date no strategy has been confirmed to be effective in 2 consecutive randomized studies. Pragmatic multicenter studies focusing on technical aspects of laparoscopic distal pancreatectomy are lacking and should be encouraged.

Model-based aviation advice on distal volcanic ash clouds by assimilating aircraft in situ measurements

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G. Fu

2016-07-01

Full Text Available The forecast accuracy of distal volcanic ash clouds is important for providing valid aviation advice during volcanic ash eruption. However, because the distal part of volcanic ash plume is far from the volcano, the influence of eruption information on this part becomes rather indirect and uncertain, resulting in inaccurate volcanic ash forecasts in these distal areas. In our approach, we use real-life aircraft in situ observations, measured in the northwestern part of Germany during the 2010 Eyjafjallajökull eruption, in an ensemble-based data assimilation system combined with a volcanic ash transport model to investigate the potential improvement on the forecast accuracy with regard to the distal volcanic ash plume. We show that the error of the analyzed volcanic ash state can be significantly reduced through assimilating real-life in situ measurements. After a continuous assimilation, it is shown that the aviation advice for Germany, the Netherlands and Luxembourg can be significantly improved. We suggest that with suitable aircrafts measuring once per day across the distal volcanic ash plume, the description and prediction of volcanic ash clouds in these areas can be greatly improved.

Comparison of distal soft-tissue procedures combined with a distal chevron osteotomy for moderate to severe hallux valgus: first web-space versus transarticular approach.

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Park, Yu-Bok; Lee, Keun-Bae; Kim, Sung-Kyu; Seon, Jong-Keun; Lee, Jun-Young

2013-11-06

There are two surgical approaches for distal soft-tissue procedures for the correction of hallux valgus-the dorsal first web-space approach, and the medial transarticular approach. The purpose of this study was to compare the outcomes achieved after use of either of these approaches combined with a distal chevron osteotomy in patients with moderate to severe hallux valgus. One hundred and twenty-two female patients (122 feet) who underwent a distal chevron osteotomy as part of a distal soft-tissue procedure for the treatment of symptomatic unilateral moderate to severe hallux valgus constituted the study cohort. The 122 feet were randomly divided into two groups: namely, a dorsal first web-space approach (group D; sixty feet) and a medial transarticular approach (group M; sixty-two feet). The clinical and radiographic results of the two groups were compared at a mean follow-up time of thirty-eight months. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale hallux metatarsophalangeal-interphalangeal scores improved from a mean and standard deviation of 55.5 ± 12.8 points preoperatively to 93.5 ± 6.3 points at the final follow-up in group D and from 54.9 ± 12.6 points preoperatively to 93.6 ± 6.2 points at the final follow-up in group M. The mean hallux valgus angle in groups D and M was reduced from 32.2° ± 6.3° and 33.1° ± 8.4° preoperatively to 10.5° ± 5.5° and 9.9° ± 5.5°, respectively, at the time of final follow-up. The mean first intermetatarsal angle in groups D and M was reduced from 15.0° ± 2.8° and 15.3° ± 2.7° preoperatively to 6.5° ± 2.2° and 6.3° ± 2.4°, respectively, at the final follow-up. The clinical and radiographic outcomes were not significantly different between the two groups. The final clinical and radiographic outcomes between the two approaches for distal soft-tissue procedures were comparable and equally successful. Accordingly, the results of this study suggest that the medial transarticular

Acute distal biceps rupture in an adolescent weightlifter on chronic steroid suppression: a case report.

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Ding, David Y; LaMartina, Joey A; Zhang, Alan L; Pandya, Nirav K

2016-09-01

Distal biceps tendon ruptures are uncommon events in the adult population and exceedingly rare in the adolescent population. To the best of our knowledge, this is the first and only report of a distal biceps tendon rupture in an adolescent with a history of chronic corticosteroid suppression. We present a case of a 17-year-old male on chronic corticosteroid suppression who underwent a successful distal biceps tendon repair after an acute rupture following weightlifting. At the 1-year follow-up, the patient reports full range of motion and strength, and is able to return to his preinjury activity level with sports and weightlifting. Acute distal biceps ruptures are uncommon injuries in the pediatric population, but may occur in conjunction with chronic corticosteroid use. Anatomic repair, when possible, can restore function and strength. level IV, case report.

Fluxômetro hidrodinámico em cirurgia de revascularização do miocárdio Hidro-dynamic flowmeter in myocardial revascularization surgery

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Fábio Biscegli Jatene

1986-08-01

Full Text Available A avaliação do fluxo pelas pontes de veia safena na cirurgia de revascularização do miocárdio fornece uma informação segura do aporte sangüíneo ao miocárdio, bem como da perspectiva de perviabilidade destas anastomoses a longo prazo. Contudo, em nosso meio, a disponibilidade de fluxômetros eletrônicos, habitualmente utilizados, é, por vezes, difícil, sobretudo em função de seu custo e manutenção. O sistema desenvolvido consta de um conector para a linha arterial, com saída lateral, ligado a um tubo de Y. Uma das extremidades é conectada a um manómetro e a outra, à veia safena, ao término da anastomose distal. Como a saída lateral tem diâmetro conhecido, a queda da pressão, quando se liga o sistema para aveia safena, é proporcional ao fluxo. Uma tabela obtida por calibração prévia, permite conhecer, instantaneamente, o fluxo para a artéria tratada. Outra vantagem do sistema é a irrigação seletiva para a área tratada antes da realização da anastomose proximal, situação favorável quando existem áreas severamente isquémicas. Este sistema, em uso corrente em nosso Serviço, vem provando a sua eficiência, aliada à sua praticidade e ao custo irrelevante.Evaluation of blood flow in saphenous vein grafts during coronary surgery gives valuable information about myocardial perfusion and long-term by- pass patency as well. However, electronic flowmeter availability is a limiting factor because of costs and maintenance. A system was developed consisting of a connection to the arterial line, with a Y tube; one branch of the Y tube is connected to a manometer and the other one to the vein graft. Since the connection to the arterial line has a know diameter, pressure drop in the system is proportional to the flow in the graft. With previous calibration, a chart was constructed that allows instantaneous evaluation of the flow. Another advantage of the system is the selective perfusion of the area to be treated before

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 ...

Laparoscopic versus open distal pancreatectomy for pancreatic cancer

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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

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 ...

Intramedullary Venous Drainage System for Distal Fingertip Replantations.

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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.

Maxillary molar distalization with aligners in adult patients: a multicenter retrospective study

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Serena Ravera

2016-04-01

Full Text Available Abstract Background The aim of the present study was to test the hypothesis that bodily maxillary molar distalization was not achievable in aligner orthodontics. Methods Forty lateral cephalograms obtained from 20 non-growing subjects (9 male, 11 female; average age 29.73 years (group S, who underwent bilateral distalization of their maxillary dentition with Invisalign aligners (Align Technology, Inc., San José, CA, USA, were considered for the study. Skeletal class I or class II malocclusion and a bilateral end-to-end class II molar relationship were the main inclusion criteria. Cephalograms were taken at two time points: (T0 pretreatment and (T2 post-treatment. Treatment changes were evaluated between the time points using 39 variables by means of paired t test. The level of significance was set at P < 0.05. Reproducibility of measurements was assessed by the intraclass correlation coefficient (ICC. Results The mean treatment time was 24.3 ± 4.2 months. At the post-treatment point, the first molar moved distally 2.25 mm without significant tipping (P = 0.27 and vertical movements (P = 0.43. The second molar distalization was 2.52 mm without significant tipping (P = 0.056 and vertical movements (P = 0.25. No significant movements were detected on the lower arch. SN^GoGn and SPP^GoGn angles showed no significant differences between pre- and post-treatment cephalograms (P = 0.22 and P = 0.85, respectively. Conclusions Aligner therapy in association with composite attachments and class II elastics can distalize maxillary first molars by 2.25 mm without significant tipping and vertical movements of the crown. No changes to the facial height were revealed.

Arthroscopic resection of the distal clavicle in osteoarthritis of the acromioclavicular joint

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Tae-Soo Park

2016-01-01

Full Text Available Background: Symptomatic acromioclavicular joint (ACJ lesions are a common cause of shoulder complaints that can be treated successfully with both conservative and surgical methods. There are several operative techniques, including both open and arthroscopic surgery, for excising the distal end of the clavicle. Here, we present a new modified arthroscopic technique for painful osteoarthritis of the ACJ and evaluate its clinical outcomes. Our hypothesis was that 4- to 7-mm resection of the distal clavicle in an en bloc fashion would have several advantages, including no bony remnants, maintenance of stability of the ACJ, and reduced prevalence of heterotopic ossification, in addition to elimination of the pathologic portion of the distal clavicle. Materials and Methods: 20 shoulders of 20 consecutive patients with painful and isolated osteoarthritis of the ACJ who were treated by arthroscopic en bloc resection of the distal clavicle were included in the study. There were 10 males and 10 females with an average age of 56 years (range 42-70 years. The mean duration of followup was 6 years and 2 months (range 4-8 years 10 months. The results were evaluated using the University of California Los Angeles (UCLA shoulder rating score. Results: The overall UCLA score was 13.7 preoperatively, which improved to 33.4 postoperatively. All subscores were improved significantly ( P < 0.001. There were no specific complications at the latest followup. Conclusion: It is critical in this procedure to resect the distal clavicle evenly from superior to inferior in an en bloc fashion without any small bony remnants and to preserve the capsule and acromioclavicular ligament superoposteriorly. This arthroscopic procedure is a reliable and reproducible technique for painful osteoarthritis of the ACJ lesions in active patients engaged in overhead throwing sports and heavy labor.

Riesgos y daños a la salud derivados del uso de videoterminal

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Tamez González Silvia

2003-01-01

Full Text Available OBJETIVO: Evaluar la relación de daños a la salud con el uso de videoterminal, riesgos laborales y factores psicosociales en trabajadores de un diario informativo. MATERIAL Y MÉTODOS: En 1998 se estudió una muestra representativa (n=68 de una población de 218 trabajadores de un diario informativo de la Ciudad de México. Se presentan los resultados obtenidos a partir de una encuesta de autoaplicación, los cuales fueron comparados posteriormente con datos de exámenes clínicos. La hipótesis de esta investigación sustenta que, tanto el uso actual como la exposición acumulada de videoterminal, se asocian con mayor riesgo de presentar padecimientos visuales, músculo-esqueléticos y dermatológicos; trastornos mentales y psicosomáticos, y fatiga general. Los resultados fueron analizados en función de diferentes riesgos laborales: (riesgo visual, trabajo sedentario, uso de mouse, riesgo postural, calor excesivo y hacinamiento y factores psicosociales derivados de la organización del trabajo (demandas psicológicas, control sobre el trabajo y apoyo social. Para valorar su relación con los daños derivados del uso de videoterminal, se estimaron razones de prevalencias ajustadas por confusores potenciales (edad, sexo y escolaridad. RESULTADOS: Las mujeres presentaron prevalencias más elevadas de trastornos músculo-esqueléticos en la mayoría de los daños investigados, y las diferencias fueron significativas entre ambos sexos para dermatitis y eczema seborreico. El uso de videoterminal se asoció con mayor riesgo de fatiga neurovisual, trastornos músculo-esqueléticos en manos y extremidades superiores, dermatitis y eczema seborreico. De los riesgos laborales, los más asociados con trastornos fueron el uso de mouse y el riesgo postural. Los factores psicosociales se relacionaron principalmente con los padecimientos de naturaleza psicológica (trastornos mentales, psicosomáticos y fatiga general. CONCLUSIONES: Con el uso intensivo de

Autosomal dominant distal myopathy due to a novel ACTA1 mutation.

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Liewluck, Teerin; Sorenson, Eric J; Walkiewicz, Magdalena A; Rumilla, Kandelaria M; Milone, Margherita

2017-08-01

Mutations in skeletal muscle α-actin 1-encoding gene (ACTA1) cause autosomal dominant or recessive myopathies with marked clinical and pathological heterogeneity. Patients typically develop generalized or limb-girdle pattern of weakness, but recently a family with scapuloperoneal myopathy was reported. We describe a father and 2 children with childhood-to-juvenile onset distal myopathy, carrying a novel dominant ACTA1 variant, c.757G>C (p.Gly253Arg). Father had delayed motor development and developed significant proximal weakness later in life; he was initially misdiagnosed as having spinal muscular atrophy based on electromyographic findings. His children had predominant anterior distal leg and finger extensor involvement. Nemaline rods were abundant on the daughter's biopsy, absent on the father's initial biopsy, and extremely rare on the father's subsequent biopsy a decade later. The father's second biopsy also showed myofibrillar pathology and rare fibers with actin filament aggregates. The present family expands the spectrum of actinopathy to include a distal myopathy. Copyright © 2017 Elsevier B.V. All rights reserved.

Análise da medida de fluxo por tempo de trânsito da artéria torácica interna direita anastomosada para a artéria interventricular anterior comparada com a artéria torácica interna esquerda

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Rodrigo Milani

2014-04-01

Full Text Available Introdução: Avaliamos por meio da medida de fluxo por tempo de trânsito o desempenho das artérias torácicas direita e esquerda quando utilizadas como enxerto para revascularização da artéria interventricular anterior. Métodos: Cinquenta pacientes submetidos à operação para revascularização do miocárdio sem circulação extracorpórea foram divididos em dois grupos. No grupo A, os pacientes receberam enxerto de artéria torácica interna direita para o ramo interventricular anterior. No grupo B, os pacientes receberam enxerto de artéria torácica interna esquerda para o mesmo ramo. Ao término da operação, o fluxo foi avaliado por meio da medida de fluxo por tempo de trânsito. Resultados: No grupo A, idade média foi de 60,6±9,49 anos. A média de peso e altura do grupo foi de 80,4±10,32 Kg e 169,2±6,86 cm. A média de pontes por paciente neste grupo foi de 3,28±1,49. O fluxo médio e a resistência distal obtidos na artéria torácica interna direita foi de 42,1±23,4 ml/min e 2,8±0,9 respectivamente. No grupo B, a idade média foi de 59,8±9,7 anos. A média de peso e altura deste grupo foi de 77,7±14,2215,7 Kg e 166,0±8,2 cm. A média de pontes por paciente neste grupo foi de 3,08±0,82. O fluxo médio e a resistência distal observados neste grupo foi de 34,2±19,1ml⁄min e 2,0±0,7. Não houve óbitos nesta série. Conclusão: A artéria torácica interna direita apresentou um comportamento similar ao da artéria torácica interna esquerda quando anastomosada ao ramo interventricular anterior da coronária esquerda. Não houve diferença estatística entre a medida de fluxo obtida entre ambas as artérias.

Technical Aspects of Laparoscopic Distal Pancreatectomy for Benign and Malignant Disease: Review of the Literature

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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

Classification and treatment of distal radius fractures: a survey among orthopaedic trauma surgeons and residents

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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

Is nonoperative management of partial distal biceps tears really successful?

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Bauer, Tyler M; Wong, Justin C; Lazarus, Mark D

2018-04-01

The current treatment of partial distal biceps tears is a period of nonoperative management, followed by surgery, if symptoms persist. Little is known about the success rate and outcomes of nonoperative management of this illness. We identified 132 patients with partial distal biceps tears through an International Classification of Diseases, Ninth Revision code query of our institution's database. Patient records were reviewed to abstract demographic information and confirm partial tears of the distal biceps tendon based on clinical examination findings and confirmatory magnetic resonance imaging (MRI). Seventy-four patients completed an outcome survey. In our study, 55.7% of the contacted patients who tried a nonoperative course (34 of 61 patients) ultimately underwent surgery, and 13 patients underwent immediate surgery. High-need patients, as defined by occupation, were more likely to report that they recovered ideally if they underwent surgery, as compared with those who did not undergo surgery (odds ratio, 11.58; P = .0138). For low-need patients, the same analysis was not statistically significant (P = .139). There was no difference in satisfaction scores between patients who tried a nonoperative course before surgery and those who underwent immediate surgery (P = .854). An MRI-diagnosed tear of greater than 50% was a predictor of needing surgery (odds ratio, 3.0; P = .006). This study has identified clinically relevant information for the treatment of partial distal biceps tears, including the following: the failure rate of nonoperative treatment, the establishment of MRI percent tear as a predictor of failing nonoperative management, the benefit of surgery for the high-need occupational group, and the finding that nonoperative management does not negatively affect outcome if subsequent surgery is necessary. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Insight into the pathomorphology of the distal border of the equine navicular bone

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Martyna Frątczak

2017-01-01

Full Text Available Pathological changes of the equine navicular bone are found in a variety of forms in numerous old and also relatively young horses. Therefore, investigations on this small bone are of major practical significance. The current article presents a view of the alterations observed on the distal aspect of the bone and analyzes their origin and importance. As a result of pressure subjected by the deep digital flexor tendon and adaptive remodelling of the bone tissue, distal border of the navicular bone extends and becomes sharpened. Osseous distal border fragments may be a consequence of this phenomenon. However, the origin of fragments is also associated with the development of entheseophytes on the margins, which can result from stress induced by the distal impar sesamoid ligament. The authors are not unanimous about the clinical importance of fragments, but it seems that the most dangerous are large-sized ones, especially when occurring together with other lesions. An important issue is also the alterations of the nutrient foramina located on the distal border, due to the main role of this surface in blood supply. Changes in the size and shape of pathological synovial invaginations can be a sign of circulatory disturbances and abnormal turnover of the bone tissue. Some researchers link synovial invaginations to cases of lameness, but their importance is still enigmatic. Majority of studies focus on warmblood horses, and a lower interest in coldblood horses can be seen. Nonetheless, certain data are a strong argument that the breed and morphotype can affect the frequency of adverse changes.

Mini-implant-supported Molar Distalization

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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.

Treatment of unstable distal radius fractures with Ilizarov circular, nonbridging external fixator.

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Tyllianakis, Minos; Mylonas, Spyros; Saridis, Alkis; Kallivokas, Alkiviadis; Kouzelis, Antonis; Megas, Panagiotis

2010-03-01

Unstable distal radius fractures remain a challenge for the treating orthopaedic surgeon. We present a retrospective follow-up study (mean follow-up 12.5 months) of 20 patients with 21 unstable distal radius fractures that were reduced in a closed manner and stabilized with a nonbridging Ilizarov external fixator. Subsequent insertion of olive wires for interfragmentary compression was performed in cases with intra-articular fractures. According to the overall evaluation proposed by Gartland and Werley scoring system 12 wrists were classified as excellent, 6 as good, 2 as fair and 1 as poor. Grade II pin-tract infection in distal fracture fragment was detected in 3 wires from a total of 78 (3.8%) and in 4 half pins out of a total of 9 (44.4%). Pronation was the most frequently impaired movement. This was restricted in 4 patients (19%) in whom a radioulnar transfixing wire was applied. Symptoms of irritation of superficial sensory branch of the radial nerve occurred in 3 patients with an olive wire applied in a closed manner in the distal fragment. Ilizarov method yields functional results comparable to that of other methods whilst it avoids wrist immobilization, open reduction and reoperation for implant removal. The method is associated with a low rate of major complication and satisfactory functional outcome. Copyright 2009 Elsevier Ltd. All rights reserved.

Laparoscopic versus open distal pancreatectomy for pancreatic cancer

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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

Intramedullary nailing of proximal and distal one-third tibial shaft fractures with intraoperative two-pin external fixation.

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Wysocki, Robert W; Kapotas, James S; Virkus, Walter W

2009-04-01

Fractures of the proximal and distal one thirds of the tibial shaft have historically higher malunion rates than those of the midshaft. This retrospective case series evaluates the postoperative radiographic outcome of intramedullary nailing of proximal and distal one-third tibial shaft fractures using intraoperative two-pin external fixation, often referred to as traveling traction. Between 2000 and 2005, 15 consecutive patients with proximal third and 27 consecutive patients with distal third displaced extra-articular fractures of the tibia were treated with statically locked intramedullary nailing and supplementary intraoperative two-pin rectangular frame external fixation. The external fixation was removed once the proximal and distal locking screws were in place. The alignment of the fractures was determined using standard postoperative anteroposterior and lateral radiographs. Postoperatively, 14 of 15 patients with proximal fractures and 25 of 27 patients with distal fractures had less than 5 degrees of angular deformity in both the coronal and sagittal planes and less than 1 cm shortening. Statically locked intramedullary nailing with simultaneous intraoperative traveling traction external fixation as treatment for proximal and distal one-third extra-articular tibial shaft fractures is successful in achieving a high rate of acceptable postoperative alignment.

Single absorbable polydioxanone pin fixation for distal chevron bunion osteotomies.

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Deorio, J K; Ware, A W

2001-10-01

The distal chevron osteotomy is a well-established technique for correction of symptomatic mild to moderate metatarsus primus varus with hallux valgus deformity. Fixation of the osteotomy ranges from none to bone pegs, Kirschner wires, screws, or absorbable pins. We evaluated one surgeon's (J.K.D.) results of distal chevron osteotomy fixation with a single, nonpredrilled, 1.3-mm poly-p-dioxanone pin and analyzed any differences in patients with unilateral or bilateral symptomatic metatarsus primus varus with hallux valgus deformities. All osteotomies healed without evidence of infection, osteolysis, nonunion, or necrosis. Equal correction was achieved in unilateral and bilateral procedures. The technique is quick and easy, and adequate fixation is achieved.

Osteochondritis Dissecans in Crioulo Foals (Case Report OSTEOCONDRITE DISSECANTE EM POTROS DA RAÇA CRIOULA

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Márcio Nunes Correa

2008-12-01

Full Text Available The aim of this paper was to describe the manifestation of developmental orthopedic diseases, particularly Osteochondritis Dissecans (OCD, in Crioulo foals, considering the clinical sings, radiological study and the animal’s diet. Were evaluated three foals from Crioulo breed presenting volume increase in the knee, fore fetlock and hind fetlock joints. The foals were submitted to radiological examination of the affected joints, showing irregular images in the growing plates region and radiolucent areas in the distal portion of the radius e first phalanx, characterizing the presence of degenerative lesions of the articular cartilage.  The bromatological study of the pastures was made demonstrating imbalances in the calcium-phosphorus relation, being this one of the mains factors involved in the development of OCD lesions. The diagnosis was perform based on the clinical e radiological changes, besides the animal’s diet, age group and practiced exercise.

KEY WORDS: Crioulo,  DOD, equine, osteochondritis dissecans, orthopedics. Este estudo teve como objetivo descrever a manifestação de distúrbios ortopédicos do desenvolvimento, particularmente a osteocondrite dissecante (OCD, em potros da raça Crioula, levando em consideração os sinais clínicos, estudo radiológico e a dieta dos animais. Avaliaram-se três potros da raça Crioula que apresentaram aumento de volume nas articulações radiocárpicas, metacarpofalangeanas e metatarsofalangeanas. Estes foram submetidos a exame radiológico das regiões afetadas, demonstrando áreas de irregularidade nas placas de crescimento e áreas radioluscentes na porção distal do rádio e primeira falange, caracterizando a presença de lesões degenerativas da cartilagem articular. Desenvolveu-se estudo bromatológico das pastagens, verificando-se desequilíbrios na relação cálcio–fósforo, sendo este um dos principais fatores envolvidos no desenvolvimento de lesões de OCD. O diagn

A Misdiagnosis of Traumatic Hypersupination of the Distal Radioulnar Joint: A Case Report

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Vipin Asopa

2013-01-01

Full Text Available Traumatic hypersupination injury of the distal radioulnar joint is a rare injury, and occurs when sufficient supination force is applied to the joint so as to tear the volar radioulnar ligament, resulting in separation of the triangular fibrocartilage complex, and subluxation of the tendon of extensor carpi ulnaris. This allows the distal ulna to rotate such that the ulnar styloid comes to lie adjacent to the ulna notch of the radius. Treatment of this injury requires manipulation of the joint, under anaesthesia or sedation. We describe a case where posttraumatic radiological investigation of a patient with an anatomical variation of the wrist when in supination resembled a traumatic hypersupination injury of the distal radioulnar joint. A review of the literature has revealed this to be the first reported case of this type.

Dermal pocketing following distal finger replantation.

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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.

[Distal ureteral lithiasis. ESWL versus ambulatory URS].

Science.gov (United States)

Miján Ortiz, J L; Gutiérrez Tejero, F; López Carmona, F; Nogueras Ocaña, M; Arrabal Martín, M; Zuluaga Gómez, A

2001-11-01

To present the results achieved in the treatment of 1802 distal ureteral stones treated at the Lithotripsy Unit of the San Cecilio University Hospital over the last 10 years (1990-2000). Stones were treated by extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy (URS). ESWL was the initial treatment in 81% of the cases (1460 calculi) and URS in the remaining 19% (342 stones). URS was performed for complication or failed ESWL (102 stones) and ESWL was performed for failed URS, basically due to stone migration (24 stones). Ureterolithotomy was required on 7 occasions. Sedation-analgesia with fentanyl and midazolam was routinely used in URS. Sedation was required in only 55% of the ESWL procedures. Elective ESWL resolved 93% of the cases, a percentage which is similar to that achieved with URS as first treatment. The ESWL retreatment rate was 1.3. URS was successful in 98% of the cases of failed ESWL. There are two treatment modalities for stones in the distal ureter: ESWL and URS. We advocate the use of outpatient URS with sedation preferably in the female patient, impacted stones, obstructive uropathy, stones larger than 2 cm and radiotransparent stones.

Ionotropic GABA Receptors and Distal Retinal ON and OFF Responses

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E. Popova

2014-01-01

Full Text Available In the vertebrate retina, visual signals are segregated into parallel ON and OFF pathways, which provide information for light increments and decrements. The segregation is first evident at the level of the ON and OFF bipolar cells in distal retina. The activity of large populations of ON and OFF bipolar cells is reflected in the b- and d-waves of the diffuse electroretinogram (ERG. The role of gamma-aminobutyric acid (GABA, acting through ionotropic GABA receptors in shaping the ON and OFF responses in distal retina, is a matter of debate. This review summarized current knowledge about the types of the GABAergic neurons and ionotropic GABA receptors in the retina as well as the effects of GABA and specific GABAA and GABAC receptor antagonists on the activity of the ON and OFF bipolar cells in both nonmammalian and mammalian retina. Special emphasis is put on the effects on b- and d-waves of the ERG as a useful tool for assessment of the overall function of distal retinal ON and OFF channels. The role of GABAergic system in establishing the ON-OFF asymmetry concerning the time course and absolute and relative sensitivity of the ERG responses under different conditions of light adaptation in amphibian retina is also discussed.

Computer tomographic assessment of postoperative peripancreatic collections after distal pancreatectomy.

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Uchida, Yuichiro; Masui, Toshihiko; Sato, Asahi; Nagai, Kazuyuki; Anazawa, Takayuki; Takaori, Kyoichi; Uemoto, Shinji

2018-03-27

Peripancreatic collections occur frequently after distal pancreatectomy. However, the sequelae of peripancreatic collections vary from case to case, and their clinical impact is uncertain. In this study, the correlations between CT findings of peripancreatic collections and complications after distal pancreatectomy were investigated. Ninety-six consecutive patients who had undergone distal pancreatectomy between 2010 and 2015 were retrospectively investigated. The extent and heterogeneity of peripancreatic collections and background clinicopathological characteristics were analyzed. The extent of peripancreatic collections was calculated based on three-dimensional computed tomography images, and the degree of heterogeneity of peripancreatic collections was assessed based on the standard deviation of their density on computed tomography. Of 85 patients who underwent postoperative computed tomography imaging, a peripancreatic collection was detected in 77 (91%). Patients with either a large extent or a high degree of heterogeneity of peripancreatic collection had a significantly higher rate of clinically relevant pancreatic fistula than those without (odds ratio 5.95, 95% confidence interval 2.12-19.72, p = 0.001; odds ratio 8.0, 95% confidence interval 2.87-24.19, p = 0.0001, respectively). A large and heterogeneous peripancreatic collection was significantly associated with postoperative complications, especially clinically relevant postoperative pancreatic fistula. A small and homogenous peripancreatic collection could be safely observed.

Suture anchor tenodesis in repair of distal Achilles tendon injuries.

Science.gov (United States)

Kiliçoğlu, Onder; Türker, Mehmet; Yildız, Fatih; Akalan, Ekin; Temelli, Yener

2014-01-01

Distal Achilles tendon avulsions are in the form of either bony and nonbony avulsion of Achilles tendon from its calcaneal insertion. Four patients with distal Achilles tendon avulsions or ruptures which were treated with tendon to bone repair using suture anchors are presented here. Operated leg was immobilized in above-knee cast for 4 weeks while the patient walked non-weight-bearing. Then, cast was changed to below knee, and full weight-bearing was allowed. Patients underwent gait analysis minimum at first postoperative year. Mean American Orthopedics Foot Ankle Society ankle/hindfoot score of patients at last visit was 88.75 (range 85-100), and Achilles tendon total rupture score was 77.75 (range 58-87). Mean passive dorsiflexion of injured ankles (14° ± 5°) was lower than uninjured ankles (23° ± 9°). All the kinematic parameters of gait analysis were comparable to the uninjured side. Maximum plantar flexion power of injured ankle was 1.40 W/kg, and this was significantly lower than the contralateral side value 2.38 W/kg; (P = 0.0143). There were no visually altered gait or problems in daily life. Suture anchor tenodesis technique of distal Achilles tendon avulsions was successful in achieving durable osteotendinous repairs.

Distal radius fractures result in alterations in scapular kinematics: a three-dimensional motion analysis.

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Ayhan, Cigdem; Turgut, Elif; Baltaci, Gul

2015-03-01

Scapular motion is closely integrated with arm motion. Injury to a distal segment requires compensatory changes in the proximal segments leading to alterations in scapular motion. Since the effects of distal injuries on scapular kinematics remain unknown, in the present study we investigated the influences on scapular motion in patients with distal injuries. Sixteen subjects with a history of distal radius fracture and 20 asymptomatic healthy subjects (controls) participated in the study. Three-dimensional scapular and humeral kinematic data were collected on all 3 planes of shoulder elevation: frontal, sagittal, and scapular. All testing was performed in a single session; therefore, the sensors remained attached to the participants for all testing. The position and orientation data of the scapula at 30°, 60°, 90°, and 120° humerothoracic elevation and 120°, 90°, 60°, and 30° lowering were used for statistical comparisons. Independent samples t-test was used to compare the scapular internal/external rotation, upward/downward rotation, and anterior/posterior tilt between the affected side of subjects with a distal radius fracture and the dominant side of asymptomatic subjects at the same stage of humerothoracic elevation. Scapular internal rotation was significantly increased at 30° elevation (P=0.01), 90° elevation (P=0.03), and 30° lowering (P=0.03), and upward rotation was increased at 30° and 60° elevation (Pplane elevation. Scapular upward rotation and anterior tilt were significantly increased during 30° lowering on both the scapular (P=0.002 and 0.02, respectively) and sagittal planes (P=0.01 and 0.02. respectively). Patients with distal radius fractures exhibit altered scapular kinematics, which may further contribute to the development of secondary musculoskeletal pathologies. Copyright © 2014 Elsevier Ltd. All rights reserved.

Increased Variability and Asymmetric Expansion of the Hippocampal Spatial Representation in a Distal Cue-Dependent Memory Task.

Science.gov (United States)

Park, Seong-Beom; Lee, Inah

2016-08-01

Place cells in the hippocampus fire at specific positions in space, and distal cues in the environment play critical roles in determining the spatial firing patterns of place cells. Many studies have shown that place fields are influenced by distal cues in foraging animals. However, it is largely unknown whether distal-cue-dependent changes in place fields appear in different ways in a memory task if distal cues bear direct significance to achieving goals. We investigated this possibility in this study. Rats were trained to choose different spatial positions in a radial arm in association with distal cue configurations formed by visual cue sets attached to movable curtains around the apparatus. The animals were initially trained to associate readily discernible distal cue configurations (0° vs. 80° angular separation between distal cue sets) with different food-well positions and then later experienced ambiguous cue configurations (14° and 66°) intermixed with the original cue configurations. Rats showed no difficulty in transferring the associated memory formed for the original cue configurations when similar cue configurations were presented. Place field positions remained at the same locations across different cue configurations, whereas stability and coherence of spatial firing patterns were significantly disrupted when ambiguous cue configurations were introduced. Furthermore, the spatial representation was extended backward and skewed more negatively at the population level when processing ambiguous cue configurations, compared with when processing the original cue configurations only. This effect was more salient for large cue-separation conditions than for small cue-separation conditions. No significant rate remapping was observed across distal cue configurations. These findings suggest that place cells in the hippocampus dynamically change their detailed firing characteristics in response to a modified cue environment and that some of the firing

Modified distal shoe appliance for premature loss of multiple deciduous molars: a case report.

Science.gov (United States)

Bhat, Prasanna Kumar; K, Navin H; Idris, Mohammed; Christopher, Pradeep; Rai, Niharika

2014-08-01

Preservation of the primary dentition until the normal time of exfoliation is one of the most important factor involved in preventive and interceptive dentistry. The premature loss of second primary molar before the eruption of permanent first molar can create a significant arch space/tooth size discrepancy. Distal shoe space maintainer is a valuable part of the Paediatric Dentist's armamentarium in those cases where the second primary molar is prematurely lost and it helps to guide the first permanent molar into place. Conventional design poses various limitations in cases of premature loss of multiple deciduous molars. Thus, it is required to modify the conventional designs according to the needs of the patient. This case report describes an innovative modification of distal shoe appliance in cases of premature loss of multiple deciduous molars. In the present case, modification of distal shoe space maintainer was advocated because of inadequate abutments caused due to multiple loss of deciduous molars. Bilateral design of distal shoe was planned for unilateral loss of deciduous molars.

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

African Journals Online (AJOL)

This study reports the surgical management for this rare case and the treatment ... car accident and presented closed femoral shaft fracture associated with a ... to fix the distal femur fracture, enhancing the construction stability [Figures 4 and 5].

Spontaneous rupture of the distal iliopsoas tendon: clinical and imaging findings, with anatomic correlations

Energy Technology Data Exchange (ETDEWEB)

Lecouvet, Frederic E.; Vande Berg, Bruno C.; Malghem, Jacques [Universite Catholique de Louvain, Department of Radiology and Medical Imaging, Saint Luc University Hospital, Brussels (Belgium); Demondion, Xavier [Centre Hospitalier Universitaire de Lille, Department of Bone Radiology and Laboratory of Anatomy, Lille (France); Leemrijse, Thibaut [Universite Catholique de Louvain, Department of Orthopedic Surgery, Saint Luc University Hospital, Brussels (Belgium); Devogelaer, Jean-Pierre [Universite Catholique de Louvain, Department of Rheumatology, Saint Luc University Hospital, Brussels (Belgium)

2005-11-01

We report the clinical and imaging findings in two elderly female patients with spontaneous rupture of the distal iliopsoas tendon from the lesser trochanter of the femur. We emphasize the key contribution of magnetic resonance (MR) imaging to this diagnosis and provide an anatomic correlation. Spontaneous rupture of the distal iliopsoas tendon should be kept in mind in the differential diagnosis of acute groin pain in the elderly. MR imaging enables positive diagnosis, by showing mass effect on the anterior aspect of the hip joint, proximal muscle thickening, and abnormal signal intensity, and by demonstrating interruption of the psoas tendon, whereas the distal insertion of the lateral portion of the iliacus muscle remains muscular and is preserved. (orig.)

A unique physeal injury of the distal phalanx.

Science.gov (United States)

Berber, Onur; Singh, Bijayendra

2015-01-01

An unusual Salter-Harris Type 1 fracture variant of the distal phalanx of the index finger is described. The epiphysis was dislocated, sitting dorsally over the middle phalanx head with the articular surface facing dorsal. Reduction could only be achieved through an open procedure. The reduction was stable without supplemental fixation.

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 ...

Retrograde nailing for distal femur fractures in the elderly

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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.

Percutaneous Screw Fixation of Distal Tibia Fractures – Functional Results in Sixteen Patients

OpenAIRE

Kaftandziev, Igor; Trpeski, Simon; Arsovski, Oliver; Spasov, Marko

2014-01-01

INTRODUCTION: An important feature of distal tibia fractures is the relevance of the soft tissue coverage. In order to maintain good functional outcome, several operative techniques have been established. Among them, percutaneous screw fixation has the advantage of causing less biological damage of the soft tissues with lower rates of complications. MATERIAL AND METHODS: We reviewed 16 patients with distal tibia fracture. Operative treatment consisted of indirect reduction and percutaneou...

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.

Osteossíntese de fratura diafisária do úmero com placa em ponte: apresentação e descrição da técnica Osteosynthesis of the humeral shaft fractures, with bridge plate

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Bruno Livani

2004-06-01

Full Text Available Os autores descrevem o método cirúrgico inédito para o tratamento das fraturas da diáfise do úmero, com placa colocada por técnica minimamente invasiva. Após estudos anatômicos, foram identificadas três acessos cirúrgicos pelos quais se pode introduzir uma placa na face anterior do úmero, sem risco de lesão vásculo nervosa. O acesso proximal se faz entre os múculos deltóide, lateralmente, e bíceps braquial, medialmente. Nas fraturas do terço médio o acesso distal é feito entre os músculos bíceps braquial e braquial com a placa introduzida de proximal para distal. Nas fraturas distais do úmero o acesso proximal é o mesmo, mas o acesso distal é o descrito por Kocher, com a placa introduzida de distal para proximal e fixada na face anterior da coluna lateral do úmero. O método aqui apresentado vem sendo utilizado desde junho de 2001, principalmente nos pacientes politraumatizados e polifraturados, por ser rápida, segura e por permitir que o paciente possa ser operado em decúbito dorsal horizontal. Além disso, não há necessidade de intensificador de imagem, ou mesmo aparelho de radiografia. Até o momento não foram observadas complicações vásculo nervosas nos 22 pacientes tratados.The authors describe for the first time ever a minimally invasive plate osteosythesis for the treatment of the humeral shatf fractures. After anatomic human cadaver's studies, it was identified three surgical approaches for plate percutaneous insertion on the anterior surface of the humerus without vascular and nervous injury. The proximal approach is between the biceps and deltoid muscles. The distal approach for medial third fractures is between the biceps brachialis and brachialis muscles. The plate is inserted from the proximal to distal direction. For distal fractures, the proximal approach is the same described by Krocher, with the plate inserted from distal to proximal and fixed on the anterior surface of the lateral column of the

Furosemide/Fludrocortisone Test and Clinical Parameters to Diagnose Incomplete Distal Renal Tubular Acidosis in Kidney Stone Formers.

Science.gov (United States)

Dhayat, Nasser A; Gradwell, Michael W; Pathare, Ganesh; Anderegg, Manuel; Schneider, Lisa; Luethi, David; Mattmann, Cedric; Moe, Orson W; Vogt, Bruno; Fuster, Daniel G

2017-09-07

Incomplete distal renal tubular acidosis is a well known cause of calcareous nephrolithiasis but the prevalence is unknown, mostly due to lack of accepted diagnostic tests and criteria. The ammonium chloride test is considered as gold standard for the diagnosis of incomplete distal renal tubular acidosis, but the furosemide/fludrocortisone test was recently proposed as an alternative. Because of the lack of rigorous comparative studies, the validity of the furosemide/fludrocortisone test in stone formers remains unknown. In addition, the performance of conventional, nonprovocative parameters in predicting incomplete distal renal tubular acidosis has not been studied. We conducted a prospective study in an unselected cohort of 170 stone formers that underwent sequential ammonium chloride and furosemide/fludrocortisone testing. Using the ammonium chloride test as gold standard, the prevalence of incomplete distal renal tubular acidosis was 8%. Sensitivity and specificity of the furosemide/fludrocortisone test were 77% and 85%, respectively, yielding a positive predictive value of 30% and a negative predictive value of 98%. Testing of several nonprovocative clinical parameters in the prediction of incomplete distal renal tubular acidosis revealed fasting morning urinary pH and plasma potassium as the most discriminative parameters. The combination of a fasting morning urinary threshold pH 3.8 mEq/L yielded a negative predictive value of 98% with a sensitivity of 85% and a specificity of 77% for the diagnosis of incomplete distal renal tubular acidosis. The furosemide/fludrocortisone test can be used for incomplete distal renal tubular acidosis screening in stone formers, but an abnormal furosemide/fludrocortisone test result needs confirmation by ammonium chloride testing. Our data furthermore indicate that incomplete distal renal tubular acidosis can reliably be excluded in stone formers by use of nonprovocative clinical parameters. Copyright © 2017 by the American

Comparison of blood loss between using non central part cutting knee prosthesis and distal central part cutting.

Science.gov (United States)

Malairungsakul, Anan

2014-12-01

Patients who undergo knee replacement surgery may need to receive a blood transfusion due to blood loss during the operation. Therefore it was important to improve the design of knee implant operative procedures in an attempt to reduce the rate of blood loss. The present study aimed to compare the blood loss between two types of knee replacement surgery. This is a retrospective study in which 78 patients received cemented knee replacements in Phayao Hospital between October 2010 and March 2012. There were two types of surgical procedure: 1) using an implant position covering the end of the femoral bone without cutting into the central part of the distal femoral, 2) using an implant position covering the end of the femoral bone cutting the central part of the distal femoral. Blood loss, blood transfusion, hemoglobin and hematocrit were recorded preoperatively, immediately postsurgery and 48 hours after surgery. Findings revealed that the knee replacement surgery using the implant position covering the end of the femoral bone without cutting the central part of the distal femoral significantly lowered the rate of blood loss when compared to using the implant position covering the end of the femoral bone with central cutting of the distal femor. The average blood loss during the operation without cutting at the central part of distal femoral was 49.50 ± 11.11 mL; whereas the operation cutting the central part of the distal femoral was 58.50 ± 11.69 mL. As regards blood loss, the knee replacement surgery using the implant position covering the end ofthefemoral bone without cutting the central part of distal femor was better than using the implant position covering the end of the femoral bone cutting at the central part of the distal femor.

78 kDa receptor for Man6P-independent lysosomal enzyme targeting: Biosynthetic transport from endoplasmic reticulum to 'high-density vesicles'

International Nuclear Information System (INIS)

Gonzalez-Noriega, Alfonso; Ortega Cuellar, Daniel D.; Michalak, Colette

2006-01-01

Recent work has shown that the cation-independent mannose 6-phosphate and the 78 kDa receptors for lysosomal enzyme targeting are located in different cell compartments. While the mannose 6-phosphate receptor is enriched in the Percoll fractions that contain Golgi apparatus, most of the 78 kDa receptor is localized in a heavy fraction at the bottom of the Percoll gradient. This report presents the biosynthetic transport of the 78 kDa receptor. Newly synthesized 78 kDa receptor was transported to Golgi from endoplasmic reticulum with a half life of 5 min. From the Golgi apparatus, the receptor takes two routes; about 15-25% is transported to the plasma membrane, and the rest migrates to late endosomes, subsequently to prelysosomes and finally to the dense vesicles. The 78 kDa receptor starts appearing at the dense vesicles 120 min after biosynthesis and reaches a maximum of 40-50% of the total receptor. Treatment of cells with NH 4 Cl causes depletion of the receptor from the dense vesicles and prelysosomes and corresponding augmentation in endosomes and plasma membrane. These results suggest that the 78 kDa receptor cycles between compartments and that the dense vesicles seem to represent the most distal compartment in the biosynthetic pathway of this receptor

Model-based aviation advice on distal volcanic ash clouds by assimilating aircraft in situ measurements

NARCIS (Netherlands)

Fu, G.; Heemink, A.; Lu, S.; Segers, A.; Weber, K.; Lin, H.X.

2016-01-01

The forecast accuracy of distal volcanic ash clouds is important for providing valid aviation advice during volcanic ash eruption. However, because the distal part of volcanic ash plume is far from the volcano, the influence of eruption information on this part becomes rather indirect and uncertain,

Differences in Ureteroscopic Stone Treatment and Outcomes for Distal, Mid-, Proximal, or Multiple Ureteral Locations

DEFF Research Database (Denmark)

Perez Castro, Enrique; Osther, Palle J S; Jinga, Viorel

2014-01-01

Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones.......Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones....

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; Eygendaal, Denise; Verbeek, Diederik O. F.; Beeres, Frank J. P.; Thomas, George; Ponsen, Kornelis J.; van den Bekerom, Michel P. J.; Schep, Niels; Kloen, Peter; Haverlag, Robert

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

Congenital Deficiency of Distal Ulna and Dislocation of the Radial Head Treated by Single Bone Forearm Procedure

Directory of Open Access Journals (Sweden)

Paragjyoti Gogoi

2014-01-01

Full Text Available Congenital deficiency of part of distal ulna affecting the distal radio-ulnar joint is a rare disorder. It is even rarer to find the association of proximal radio-ulnar joint dislocation along with distal ulnar deficiency. This type of congenital forearm anomaly is difficult to treat. Conversion to a single bone forearm in the expense of pronation-supination movement is a viable option. By doing so the elbow and wrist can be stabilized; however movement is possible in only one plane. We are describing here a girl of 8 years having proximal radio-ulnar joint dislocation along with deficiency of distal ulna treated by converting into a single bone forearm.

The boomerang flap in managing injuries of the dorsum of the distal phalanx.

Science.gov (United States)

Chen, S L; Chou, T D; Chen, S G; Cheng, T Y; Chen, T M; Wang, H J

2000-09-01

Finding an appropriate soft-tissue grafting material to close a wound located over the dorsum of a finger, especially the distal phalanx, can be a difficult task. The boomerang flap mobilized from the dorsum of the proximal phalanx of an adjacent digit can be useful when applied as an island pedicle skin flap. The vascular supply to the skin flap is derived from the retrograde perfusion of the dorsal digital artery. Mobilization and lengthening of the vascular pedicle are achieved by dividing the distal end of the dorsal metacarpal artery at the bifurcation and incorporating two adjacent dorsal digital arteries into one. The boomerang flap was used in seven individuals with injuries involving the dorsal aspect of the distal phalanx over the past year. Skin defects in all patients were combined with bone,joint, or tendon exposure. The authors found that the flap was reliable and technically simple to design and execute. This one-step procedure preserves the proper palmar digital artery to the fingertip and has proven valuable for the coverage of wide and distal defects because it has the advantages of an extended skin paddle and a lengthened vascular pedicle. When conventional local flaps are inadequate, the boomerang flap should be considered for its reliability and low associated morbidity.

Distrofia simpático-reflexa

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Lotito Ana P. N.

2004-01-01

Full Text Available OBJETIVO: Descrever as características clínicas, laboratoriais e terapêuticas de oito crianças com distrofia simpático-reflexa. DESCRIÇÃO: Foram analisados retrospectivamente oito casos de distrofia simpático-reflexa. O diagnóstico foi baseado na presença de dor no segmento distal de um membro, edema local, alterações vasomotoras e de sensibilidade. Dentre os oito pacientes com distrofia simpático-reflexa, dois eram portadores de lúpus eritematoso sistêmico, um de artrite idiopática juvenil e um de trombastenia de Glanzmann. Quatro eram meninas, e a média de idade foi de 11,5 anos. Os membros inferiores foram acometidos na maioria dos pacientes (7/8, e as características clínicas mais marcantes foram dor, edema e alterações vasomotoras da extremidade afetada (7/8, incapacitação funcional (7/8 e alterações de sensibilidade (3/8. A velocidade de hemossedimentação esteve alterada em três pacientes, e a cintilografia músculo-esquelética em cinco. Todos os pacientes receberam antiinflamatórios não-hormonais e fisioterapia, com melhora clínica observada em sete pacientes em até 6 meses de tratamento. Três pacientes foram submetidos à acupuntura, com boa resposta. Um paciente teve curso de difícil controle, tendo recebido antidepressivos tricíclicos e apresentando melhora após mais de 1 ano de tratamento. COMENTÁRIOS: A distrofia simpático-reflexa é uma doença que deve ser incluída no diagnóstico diferencial das dores em membros na infância, para que se estabeleça o diagnóstico precocemente, evitando-se, assim, prejuízo funcional a médio e longo prazo.

Preoperative risk factors for conversion and learning curve of minimally invasive distal pancreatectomy.

Science.gov (United States)

Hua, Yongfei; Javed, Ammar A; Burkhart, Richard A; Makary, Martin A; Weiss, Matthew J; Wolfgang, Christopher L; He, Jin

2017-11-01

Although laparoscopic distal pancreatectomy is considered a standard approach, 10% to 40% of these are converted. The preoperative risk factors for conversion are not well described. The aim of this study was to identify risk factors associated with conversion. Clinicopathological variables of 211 consecutive patients who underwent laparoscopic distal pancreatectomy between January 2007 and December 2015 at Johns Hopkins were analyzed to identify factors associated with conversion. Furthermore, the learning curve for laparoscopic distal pancreatectomy was studied. On univariate analysis of diabetes mellitus, preoperative diagnosis of malignant disease, multiorgan resection, surgeons' years and case experience were significantly associated with conversion (all P pancreatectomy with a preoperative diagnosis of malignant disease or possible multiorgan resection are at a higher risk of conversion. Surgeon experience of performing >15 procedures significantly reduces the risk of conversion. Copyright © 2017 Elsevier Inc. All rights reserved.

The fibrocartilaginous sesamoid: a cause of size and signal variation in the normal distal posterior tibial tendon

Energy Technology Data Exchange (ETDEWEB)

Delfaut, E.M.; Bieganski, A.; Cotten, A. [Department of Skeletal Radiology, Roger Salengro Hospital, CHRU of Lille, Bd du Professeur Jules Leclercq, 59037, Lille Cedex (France); Demondion, X. [Department of Skeletal Radiology, Roger Salengro Hospital, CHRU of Lille, Bd du Professeur Jules Leclercq, 59037, Lille Cedex (France); Department of Anatomy, Faculty of Medicine, Place de Verdun, 59037, Lille Cedex (France); Cotten, H. [Pathology Laboratory, 128 Bd de la Liberte, 59000, Lille Cedex (France); Mestdagh, H. [Department of Orthopaedic Surgery, Roger Salengro Hospital, CHRU of Lille, Bd du Professeur Jules Leclercq, 59037, Lille Cedex (France)

2003-12-01

The aim of this study was to investigate the presence of fibrocartilage within the distal posterior tibial tendon (PTT) before its division correlating with size and signal variation on MR images through a radio-anatomic and pathologic study. Eight fresh cadaveric feet underwent MR imaging were cut into 4-mm slices in the axial plane. The PTT specimens were harvested at the tendon distal portion before its division and sent to pathology. Thirty-three asymptomatic subjects underwent axial double-echo turbo-spin-echo MR imaging. Proximal and distal PTT signal and diameter were evaluated. In cadavers, every PTT flared distally. Intratendinous fibrocartilage and ossified sesamoid were found in, respectively, 87.5 and 12.5% of the cases. Distal PTT flaring was demonstrated in 100% of the asymptomatic subjects (mean diameter 8 mm). An intratendinous high signal intensity on proton-density-weighted images and sesamoid bone were evidenced in, respectively, 36 and 33% of the cases. Proximally, PTT presented a 4-mm mean diameter and was hypointense in 100% of the cases. Only one accessory navicular bone was detected. Laterally off-centered increased intratendinous signal intensity as well as PTT distal widening with otherwise normal MR imaging features are related to an intratendinous fibrocartilage. (orig.)

Termografia infravermelha em tempo real como método de avaliação da viabilidade do baço em modelo de esplenectomia parcial em porcos

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Hugo Daniel Welter Ribeiro

Full Text Available OBJETIVO: Determinar se a termografia infravermelha é capaz de detectar com precisão a perda de perfusão tecidual em áreas de parênquima esplênico. MÉTODOS: Cinco porcos Landrace pesando entre 12 a 15 kg, após medicação pré-anestésica intramuscular e anestesia por infusão endovenosa, foram submetidos a quatro etapas de ligaduras sequenciais, dos vasos arteriais para o pólo inferior do baço: 1-vasos do ligamento esplênico; 2-ramo da artéria esplênica para o pólo inferior; 3-ramo arterial para o pólo inferior na face visceral do órgão; 4-parênquima esplênico dividindo o órgão. As imagens foram captadas por câmera Therma CAM SC500 instalada a 50 centímetros da superfície do órgão. As temperaturas foram medidas na região proximal (vascularizada e na região distal (isquêmica, em três áreas circulares distintas de cada região através do software SAT Report, antes e após cada etapa de ligaduras, constituindo cinco grupos de medidas: tempo 0 = antes da etapa 1; tempo 1 = após etapa 1; tempo 2 = após etapa 2; tempo 3 = após etapa 3; tempo 4 = após etapa 4. RESULTADOS: Houve manutenção da temperatura da região proximal (vascularização preservada durante todos os tempos de desvascularização. A temperatura da região distal (desvascularizada iniciou queda a partir da primeira ligadura e tornou-se estatisticamente menor que a da região proximal a partir da ligadura 3 (Etapa 3. Houve diferença estatisticamente significativa entre as temperaturas proximais e distais do órgão na medida em que foram sendo realizadas as ligaduras vasculares. CONCLUSÃO: A termografia infravermelha foi capaz de distinguir com precisão áreas de parênquima esplênico com vascularização preservada de áreas isquêmicas e pode contribuir para a avaliação da viabilidade de órgãos sólidos.

Is Bone Grafting Necessary in the Treatment of Malunited Distal Radius Fractures?

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Disseldorp, Dominique J. G.; Poeze, Martijn; Hannemann, Pascal F. W.; Brink, Peter R. G.

2015-01-01

Background Open wedge osteotomy with bone grafting and plate fixation is the standard procedure for the correction of malunited distal radius fractures. Bone grafts are used to increase structural stability and to enhance new bone formation. However, bone grafts are also associated with donor site morbidity, delayed union at bone–graft interfaces, size mismatch between graft and osteotomy defect, and additional operation time. Purpose The goal of this study was to assess bone healing and secondary fracture displacement in the treatment of malunited distal radius fractures without the use of bone grafting. Methods Between January 1993 and December 2013, 132 corrective osteotomies and plate fixations without bone grafting were performed for malunited distal radius fractures. The minimum follow-up time was 12 months. Primary study outcomes were time to complete bone healing and secondary fracture displacement. Preoperative and postoperative radiographs during follow-up were compared with each other, as well as with radiographs of the uninjured side. Results All 132 osteotomies healed. In two cases (1.5%), healing took more than 4 months, but reinterventions were not necessary. No cases of secondary fracture displacement or hardware failure were observed. Significant improvements in all radiographic parameters were shown after corrective osteotomy and plate fixation. Conclusion This study shows that bone grafts are not required for bone healing and prevention of secondary fracture displacement after corrective osteotomy and plate fixation of malunited distal radius fractures. Level of evidence Therapeutic, level IV, case series with no comparison group PMID:26261748

Postoperative Course and Complications after Pull-through Vaginoplasty for Distal Vaginal Atresia.

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Mansouri, Roshanak; Dietrich, Jennifer E

2015-12-01

To report the usual postoperative course and complications after pull-through vaginoplasty for isolated distal vaginal atresia. Retrospective chart review at Texas Children's Hospital of all patients who were diagnosed with isolated distal vaginal atresia and underwent pull-through vaginoplasty during the study time frame. None. Postoperative complications such as vaginal stenosis or infection and postoperative vaginal diameter. Sixteen patients were identified and charts were reviewed. Patients were initially evaluated by pelvic magnetic resonance imaging and found to have distended hematometrocolpos with distal vaginal atresia. All patients underwent pull-through vaginoplasty with similar operative techniques. The average distance from the perineum to the level of the obstruction was 1.84 ± 1.2 cm. Two patients, both with obstructions at greater than 3 cm, experienced stricture formation postoperatively. Four patients (25%) experienced postoperative vaginitis. One patient (6.25%) experienced a postoperative urinary tract infection. Two groups (3 cm or less versus greater than 3 cm) were compared, and the presence of stricture was statistically different based on mean centimeters from perineum prior to pull-through vaginoplasty (P = .038). Distal vaginal atresia is managed with pull-through vaginoplasty. Atresias that extend greater than 3 cm from the perineum are at increased risk for vaginal stricture formation and should be followed to monitor for their formation. Other complications are infrequent and minor. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Utility of 64-row MDCT in assessment of neonates with congenital EA and distal TEF

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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.

Clinical outcomes for 14 consecutive patients with solid pseudopapillary neoplasms who underwent laparoscopic distal pancreatectomy.

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Nakamura, Yoshiharu; Matsushita, Akira; Katsuno, Akira; Yamahatsu, Kazuya; Sumiyoshi, Hiroki; Mizuguchi, Yoshiaki; Uchida, Eiji

2016-02-01

The postoperative results of laparoscopic distal pancreatectomy for solid pseudopapillary neoplasm of the pancreas (SPN), including the effects of spleen-preserving resection, are still to be elucidated. Of the 139 patients who underwent laparoscopic pancreatectomy for non-cancerous tumors, 14 consecutive patients (average age, 29.6 years; 1 man, 13 women) with solitary SPN who underwent laparoscopic distal pancreatectomy between March 2004 and June 2015 were enrolled. The tumors had a mean diameter of 4.8 cm. Laparoscopic spleen-preserving distal pancreatectomy was performed in eight patients (spleen-preserving group), including two cases involving pancreatic tail preservation, and laparoscopic spleno-distal pancreatectomy was performed in six patients (standard resection group). The median operating time was 317 min, and the median blood loss was 50 mL. Postoperatively, grade B pancreatic fistulas appeared in two patients (14.3%) but resolved with conservative treatment. No patients had postoperative complications, other than pancreatic fistulas, or required reoperation. The median postoperative hospital stay was 11 days, and the postoperative mortality was zero.None of the patients had positive surgical margins or lymph nodes with metastasis. The median follow-up period did not significantly differ between the two groups (20 vs 39 months, P = 0.1368). All of the patients are alive and free from recurrent tumors without major late-phase complications. Laparoscopic distal pancreatectomy might be a suitable treatment for patients with SPN. A spleen-preserving operation is preferable for younger patients with SPN, and this study demonstrated the non-inferiority of the procedure compared to spleno-distal pancreatectomy. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

Nonoperative treatment of distal biceps brachii musculotendinous partial rupture: a report of two cases.

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López-Zabala, I; Fernández-Valencia, J A

2013-01-01

Musculotendinous ruptures of the distal biceps brachii are extremely rare injuries whose clinical presentation is similar to distal biceps avulsion. We describe two cases of patients who suffered a distal biceps brachii musculotendinous partial rupture. The first patient was playing soccer as goalkeeper and experienced sudden pain while throwing the ball overhead with his left arm. The second patient experienced sudden pain while weightlifting with his right arm. The mechanism of injury was the same in the two cases, as both involved glenohumeral elevation with elbow extension and forearm supination. Neither of these two patients underwent surgical repair or rehabilitation, and both had perfect scores of 100 on the Mayo Clinic Performance Index for the Elbow at one-year followup.

[Lithiasis of the distal ureter: ESWL or URS].

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González Enguita, C; Sánchez Gómez, J; Rodríguez-Miñon Cifuentes, J L; Cabrera Pérez, J; Calahorra Fernández, F J; García Cardoso, J; García de la Peña, E; Vela Navarrete, R

1998-10-01

A nephritic colic is the clinical picture that evidences the presence of ureteral stones, the natural evolution being their spontaneous passing. Stones in the distal ureter are self-eliminated in about 71-80% cases. The adoption of a "watchful wait" involves an uncertain occupational and medical evolution since, although in some cases the stones will pass with no problems, in other instances they can result in severe, life threatening situations for the patient's health (intractable pain, anuria or sepsis). When a decision is made to treat the condition, there are two choices available: "in situ" SWEL (extracorporeal lithotrity), or URS (ureterorenoscopy), long-standing conflicting techniques each with its own advantages and disadvantages, which should now be considered complementary. SWEL's major disadvantage is the number of repetitions required and the long wait, sometimes even months, until the last fragment is passed. The greater strength of URS is that it can be resolutive in just one episode (95% cases), thus avoiding the obstruction problems that can arise after SWEL. In the Lithiasis-Lithotrity Unit of FJD, SWEL is the first therapeutical option for the treatment of stones in the distal ureter. SWEL and URS are equally likely to be performed although SWEL is the initial choice for efficiency reasons that are explained. We achieve 93.6% positive results with a 1.82% re-SWEL rate (retreatment), 0.60 coefficient of efficiency (EQ) and 0.69 modified coefficient of efficiency (EQM) (Chart). No serious complications were recorded. Morbidity is variable with little clinical significance. Distal ureter lithiasis can be treated with either URS and SWEL, both considered "different and complementary". The choice in each particular case and within each hospital will depend on availability of means to perform one or the other, equipment's efficiency, skill of the urologist, patient's preference and cost of each treatment.

Distal Stressors and Depression among Homeless Men

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Coohey, Carol; Easton, Scott D.

2016-01-01

Depression is a common problem among homeless men that may interfere with functional tasks, such as securing stable housing, obtaining employment, and accessing health services. Previous research on depression among homeless men has largely focused on current psychosocial resources, substance abuse, and past victimization. Guided by Ensel and Lin’s life course stress process model, the authors examined whether distal stressors, including victimization and exposure to parent problems in childh...

Vascularização temporária de membros isquêmicos por meio de shunt arteriomedular: trabalho experimental Temporary vascularization on ischemic limbs through arterial-medullar shunt: an experimental work

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Ronaldo André Poerschke

2012-03-01

Full Text Available CONTEXTO: Os autores idealizaram um shunt temporário entre a artéria femoral e o canal medular de ossos longos para manter a viabilidade dos membros agudamente isquêmicos, enquanto não é possível estabelecer um tratamento definitivo. OBJETIVO: Avaliar a perviedade de shunts temporários arteriomedulares e a perfusão dos membros, durante duas horas em cães de experimentação, que tiveram a artéria femoral ligada. MÉTODOS: Alocaram-se aleatoriamente dois grupos, com três cães no Grupo Controle e seis no Grupo Intervenção. Os controles tiveram a artéria femoral comum direita ligada. O Grupo Intervenção, além da ligadura da artéria, recebeu um shunt. Após duas horas, realizou-se a medida de pH dos membros isquêmicos; avaliação do fluxo arterial por meio de um sonar Doppler; avaliação da coloração do sangramento na extremidade distal do membro e foram retirados em bloco torácico os pulmões para análise anatomopatológica. RESULTADOS: A média do pH do sangue capilar das extremidades do membros no Grupo Controle foi de 6,97 (±0,39; no Grupo Intervenção o pH foi de 7,25 (±0,46, com pBACKGROUND: The authors idealized a temporary shunt between the femoral artery and the medullar canal on long bones to keep the viability of acutely ischemic limbs, while waiting for a definitive treatment. OBJECTIVE: To assess the flow on temporary shunts between the femoral artery and the marrow canal of the tibia during two hours in experimental dogs, which had the femoral artery interrupted. METHODS: Two groups with three dogs on the Control Group and six on the Intervention Group were allocated at random. The controls had the right femoral common artery interrupted. The Intervention Group received a shunt between the iliac external artery and the medullar canal of the right tibia in addition. After two hours, the measure of the pH, blood coloration, blood flow in sonar Doppler on the ischemic limbs were performed. The lungs were

Functional anatomy of the distal radioulnar joint in health and disease.

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Lees, V C

2013-04-01

The distal radioulnar joint (DRUJ) is critical to the function of the forearm as a mechanical unit. This paper is concerned with the concepts and observations that have changed understanding of the function of the DRUJ, notably with respect to the biomechanics of this joint. The DRUJ has been shown to be important in acting to distribute load and removal of the ulna head leads to the biomechanical equivalent of a one-bone forearm. The soft tissues with topographical relations to the distal forearm and DRUJ have also been investigated in our experimental series with findings including the description of a clinical disorder termed subluxation-related ulna neuropathy syndrome.

Anomalous pancreatic ductal system allowing distal bowel gas with duodenal atresia

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Shruti Sevak

2017-11-01

Bypass of the atretic duodenal segment through an anomalous pancreatic ductal system is a rare anomaly described in the literature in only a handful of cases. This case report highlights the importance of considering duodenal atresia and pancreaticobiliary enteric bypass in the differential diagnosis of neonates presenting with partial duodenal obstruction. On ultrasound, the presence of gas in the biliary tree or pancreatic duct should alert the physician to the possibility of duodenal atresia with congenital pancreaticobiliary duct anomalies that allow for bypass of enteric contents, including air, into more distal bowel, thereby creating a gas pattern aptly described as double bubble with distal gas.

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

African Journals Online (AJOL)

2017-03-06

Mar 6, 2017 ... How to cite this article: Dumani A, Yilmaz S, Yoldas O, Kuden C. Evaluation ... Niger J. Clin Pract 2017;20:307-12. This is an open access article distributed ... in oval-shaped distal canals of mandibular molars was inadequate.

Detection of Lateglacial distal tephra layers in the Netherlands

NARCIS (Netherlands)

Davies, S.M.; Hoek, W.Z.; Bohncke, S.J.P.; Lowe, J.; Pyne O'Donnle, S.; Turney, C.S.M.

2005-01-01

Three distal tephra layers or cryptotephras have been detected within a sedimentary sequence from the Netherlands that spans the last glacial-interglacial transition. Geochemical analyses identify one as the Vedde Ash, which represents the southernmost discovery of this mid-Younger Dryas tephra so

DIAGNOSTICS AND TREATMENT OF DISTAL RADIOULNAR JOINT INJURIES

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A. V. Skoroglyadov

2010-01-01

Full Text Available We present the experience of treatment of 169 patients with distal radioulnar joint injuries, operated in specialized hand surgery department of the Clinic of traumatology and orthopedics of Russian State Medical University on the base of Moscow city clinical hospital № 4. We have carried out the following operations: closed osteoclasia of the distal epimetaphys fractures, osteotomy of the radius with the external fixator application in 97 (57,4% patients, percutaneous 2 Kirschner wires fixation of the ulna head to the radius after reposition of dislocation - 38 (22,5% patients, lavsanoplasty of DRUJ ligaments - 12 (7,1%, fixation of the ulna head to the radius by pin - 7 (4,1%, open reposition of dislocation of the ulna head and K-wire fixation - 8 (4,8%, osteotomy of synostosis of forearm bones, W. Darrach and Sauve-Kapandji operations - 7 (4,1%. Complications were observed in 13 (7,7% cases. Postponed results (1 year after operation were studied in 110 patients. We got good results in 95 (86,4% cases, satisfactory - in 12 (10,9% cases, unsatisfactory - in 3 (2,7% cases.

An In Vitro Study of the Number of Distal Roots and Canals in mandibular First Molars in Iranian Population.

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Razmi, Hasan; Shokouhinejad, Noushin; Hooshyar, Mohsen

2008-01-01

The purpose of this study was to evaluate the number of distal roots and canals in mandibular first molars and their internal anatomy radiographically within Iranian population. A total of 310 distal roots of mandibular first molars were incorporated in this study and evaluated in terms of number of roots and number and types of canals. Root canal systems were studied in vitro by means of radiography and based on Vertucci's classifications. It was shown that 4.5% of the teeth in this study had two distal roots, of which, 100% indicated type I for both distobuccal and distolingual roots. Among all the teeth, 43.2% had two canals, 24.2% two apical foramina, and 38.7% two orifices in their distal roots. According to Vertucci's classification 54.9% of the teeth were type I, 19% type II, 1.9% type III, 14.2% type IV, 4.2% type V, 1% type VI, 0.3% type VII and 0% type VIII. In as many as 43.2% of all teeth assessed in this study, bicanaled distal roots were observed, dentists are always recommended to search for the second canal in distal roots of mandibular first molars. In case the second canal in the distal root is missed, failure of endodontic treatment will be anticipated. A rectangular type access cavity design allows better visualization and negotiation of the probable second canals within the distal roots of mandibular first molars.

Subclinical ischemic events in patients undergoing carotid artery stent placement: comparison of proximal and distal protection techniques.

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Aytac, Emrah; Gürkaş, Erdem; Akpinar, Cetin Kursad; Saleem, Muhammad A; Qureshi, Adnan I

2017-10-01

To determine the relative effectiveness of proximal and distal protection in prevention of cerebral ischemic events during carotid artery stent (CAS) placement using diffusion-weighted MRI (DW-MRI). We analyzed data from patients who had undergone DW-MRI before and within 24 hours of CAS for symptomatic internal carotid artery (ICA) stenosis (with last ischemic events within 3 months). The study was performed prospectively; patients were not randomized, and were treated either with a proximal balloon occlusion system (Mo.Ma; Invatec, Roncadelle, Italy) or filter-type distal protection device (Spider device; ev3, Plymouth, Minnesota, USA). Of the 45 patients (mean age±SD: 66.9±9.8 years; 73.3% were men) who underwent CAS, 19 had proximal protection and 26 distal protection. New ischemic lesions were detected in 26/45 patients on DW-MRI scans obtained within 24 hours after CAS. The proportion of patients with new lesions on DW-MRI at 24 hours was not different between the two groups (47.4% vs 65.4% for proximal and distal protection, respectively). The mean number of new ischemic lesions on post-CAS DW-MRI was non-significantly higher in patients who underwent CAS with distal protection (2.80±3.54 for proximal protection vs 4.96±5.11 for distal protection; p=0.12). The proportion of patients with new lesions >1 cm did not differ between the two groups (5.3% for proximal protection vs 11.5% for distal protection; p=0.62). There was no difference in the rates of ischemic stroke between patients who underwent CAS treatment using proximal and distal protection (5.3% vs 7.7%; p=1.000). We found a relatively high rate of new ischemic lesions in patients undergoing CAS with cerebral protection. There was no difference in the proportion of patients with new lesions between patients treated using distal protection and those treated using proximal protection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

The feasibility and advantages of billroth-I reconstruction in distal gastric cancers following resection.

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Ganesh, M S; Reddy, K G; Venkata Subbareddy, D S

2012-01-01

Gastric carcinomas are common malignancies in southern India and distal stomach remains the commonest site in low socio economic groups. Surgery still remains an important modality of treatment to achieve local control and also relieve obstructive symptoms. In this study we investigated the feasibility of performing a gastrectomy and billroth-1 type of anastomosis in a rural cancer center setting, with parameters like adequacy of margins, ease of anastomosis and its functional results were analysed. Eight patients presenting to a rurally based cancer center underwent a distal gastrectomy and billroth-1 type of anastomosis for continuity restoration. All the patients had adequate proximal and distal marg. The surgical time varied between-hrs. The anastomosis was constructed without any tension on bowel ends in all patients. The average time to start oral feeds varied between- None of the patients showed symptoms of bile reflux nor dumping. The average hospital stay varied between. Billroth-1 anastomosis is a physiologically more natural way of restoring continuity following a gastrectomy and it is a procedure which would be technically more simpler and decrease per and post operative complications and allow speedier post operative recovery following surgery on distal gastric cancers.

Influência do tamanho e da rigidez dos objetos nos ajustes proximais e distais do alcance de lactentes Influence of object size and rigidity on proximal and distal adjustments to infant reaching

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NACF Rocha

2006-09-01

Full Text Available CONTEXTUALIZAÇÃO: Estudos têm identificado que as propriedades dos objetos induzem os ajustes no alcance; no entanto, poucos investigaram a influência específica do tamanho e rigidez dos objetos em lactentes jovens. OBJETIVO: Verificar se lactentes de 4 a 6 meses realizam ajustes proximais e distais ao alcançarem objetos de diferentes tamanhos e rigidez. MÉTODOS: Nove lactentes saudáveis foram posicionados em uma cadeira inclinada a 50º. Quatro objetos foram apresentados, um rígido grande (RG, um rígido pequeno (RP, um maleável grande (MG e um maleável pequeno (MP, por um período de 1 minuto cada. Em um total de 384 alcances, foram analisados os ajustes proximais (alcance uni e bimanual e distais (orientação da mão horizontal, vertical e oblíqua; mão aberta, fechada e semi-aberta e o sucesso do alcance dos objetos. RESULTADOS: Constatou-se ajuste bimanual para o objeto RG e unimanual para os demais. A orientação da mão oblíqua foi predominante no toque dos objetos, enquanto para a preensão dos mesmos, a predominância foi a vertical, principalmente para o objeto RG. A orientação horizontal não foi observada na preensão do objeto RG. A mão semi-aberta foi mais freqüente no início do alcance para todos os objetos, enquanto no toque do objeto RG a mão aberta foi predominante. O sucesso do alcance foi maior para os objetos maleáveis (MG, MP do que para os rígidos (RG e RP. CONCLUSÃO: Lactentes jovens estudados são capazes de planejar e ajustar seus movimentos baseados na percepção das propriedades físicas dos objetos, o que sugere interação percepção-ação.BACKGROUND: Studies have identified that object properties lead to adjustments to reaching. However, few have investigated the specific influence of object size and rigidity among young infants. OBJECTIVE: To verify whether four to six-month-old infants make proximal and distal adjustments when reaching for objects of different sizes and rigidity. METHOD

Tratamento cirúrgico do câncer da porção distal do têrço inferior do reto pela ressecção anterior ultrabaixa e interesfinctérica com anastomose coloanal por videolaparoscopia Surgical treatment of ultra-low rectal cancer by laparoscopic coloanal anastomosis and intersphincteric resection

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José Reinan Ramos

2009-09-01

Full Text Available OBJETIVO: Identificar as complicações pós-operatórias, a duração da internação hospitalar, os resultados funcionais clínicos, e os resultados oncológicos num seguimento médio de 2,5 anos nos pacientes com câncer do reto distal submetidosà ressecção anterior ultrabaixa e interesfinctérica com anastomose coloanal por videolaparoscopia. CASUÍSTICA E MÉTODOS: De um total de 491 pacientes operados pelo acesso videolaparoscópico, foram selecionados para esse estudo prospectivo 13 doentes , nove do sexo feminino,com câncer da porção distal do reto inferior entre os 172 pacientes com câncer do reto.Nenhum tumor T4 ou com resposta completa à quimiorradioterapia foi selecionado. A quimiorradioterapia neo-adjuvante foi aplicada em 8 doentes. RESULTADOS: A taxa de complicaçãos pós-operatória foi de 23,1%., sendo de 7,7% o índice de fístula anastomótica. A mortalide foi nula. A alta hospitalar ocorreu até o 7° dia de pós-operatório para 8 pacientes (61,5%, 4 dos quais no quinto dia.. O número médio de linfonodos por peça foi 13. A margem distal média foi de 1,5 cm. A margem circunferencial foi positiva em um caso (7,7%. Evacuação fracionada foi relatada por 11 pacientes (91% e incontinência fecal por 5 pacientes (41%. Onze pacientes (84% estão satisfeitos com a operação. Um paciente continua ileostomizado (7,7%. Em um seguimento médio de 30 meses ocorreu uma recidiva local (7,7% e dois casos de metástase pulmonar (15,4 %. As três pacientes faleceram da doença. Dez pacientes (77% estão sem doença. CONCLUSÕES: Apesar da pequena casuística, a analise permitiu as seguintes conclusões: a A técnica empregada mostrou ser viável e segura, pois apresentou baixo índice de complicação pós-operatória e mortalidade nula; b O emprego dessa técnica permitiu período de internação hospitalar pós-operatório curto; c Apesar dos resultados funcionais com avaliação clínica regular, evitou-se a colostomia

Esophagojejunal Anastomosis Fistula, Distal Esophageal Stenosis, and Metalic Stent Migration after Total Gastrectomy

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Nadim Al Hajjar

2015-01-01

Full Text Available Esophagojejunal anastomosis fistula is the main complication after a total gastrectomy. To avoid a complex procedure on friable inflamed perianastomotic tissues, a coated self-expandable stent is mounted at the site of the anastomotic leak. A complication of stenting procedure is that it might lead to distal esophageal stenosis. However, another frequently encountered complication of stenting is stent migration, which is treated nonsurgically. When the migrated stent creates life threatening complications, surgical removal is indicated. We present a case of a 67-year-old male patient who was treated at our facility for a gastric adenocarcinoma which developed, postoperatively, an esophagojejunostomy fistula, a distal esophageal stenosis, and a metallic coated self-expandable stent migration. To our knowledge, this is the first reported case of an esophagojejunostomy fistula combined with a distal esophageal stenosis as well as with a metallic coated self-expandable stent migration.

Fracture heuristics: surgical decision for approaches to distal radius fractures. A surgeon's perspective.

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Wichlas, Florian; Tsitsilonis, Serafim; Kopf, Sebastian; Krapohl, Björn Dirk; Manegold, Sebastian

2017-01-01

Introduction: The aim of the present study is to develop a heuristic that could replace the surgeon's analysis for the decision on the operative approach of distal radius fractures based on simple fracture characteristics. Patients and methods: Five hundred distal radius fractures operated between 2011 and 2014 were analyzed for the surgeon's decision on the approach used. The 500 distal radius fractures were treated with open reduction and internal fixation through palmar, dorsal, and dorsopalmar approaches with 2.4 mm locking plates or underwent percutaneous fixation. The parameters that should replace the surgeon's analysis were the fractured palmar cortex, and the frontal and the sagittal split of the articular surface of the distal radius. Results: The palmar approach was used for 422 (84.4%) fractures, the dorsal approach for 39 (7.8%), and the combined dorsopalmar approach for 30 (6.0%). Nine (1.8%) fractures were treated percutaneously. The correlation between the fractured palmar cortex and the used palmar approach was moderate (r=0.464; p<0.0001). The correlation between the frontal split and the dorsal approach, including the dorsopalmar approach, was strong (r=0.715; p<0.0001). The sagittal split had only a weak correlation for the dorsal and dorsopalmar approach (r=0.300; p<0.0001). Discussion: The study shows that the surgical decision on the preferred approach is dictated through two simple factors, even in the case of complex fractures. Conclusion: When the palmar cortex is displaced in distal radius fractures, a palmar approach should be used. When there is a displaced frontal split of the articular surface, a dorsal approach should be used. When both are present, a dorsopalmar approach should be used. These two simple parameters could replace the surgeon's analysis for the surgical approach.

Partial tears of the distal biceps tendon: MR appearance and associated clinical findings

Energy Technology Data Exchange (ETDEWEB)

Williams, B.D.; Schweitzer, M.E.; Weishaupt, D.; Miller, L.S. [Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology; Lerman, J. [Lerman Imaging, Brooklyn, NY (United States); Rubenstein, D.L. [Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (United States); Rosenberg, Z.S. [Dept. of Diagnostic Radiology, New York Univ. Medical Center, NY (United States)

2001-10-01

Purpose: To describe the magnetic resonance (MR) appearance and associated clinical findings of partial distal biceps tendon tears. Design: Twenty elbow MR images at 1.5 T, performed over a 7 year period, were reviewed for an appearance of partial tears in the distal biceps. These images were assessed by two musculoskeletal radiologists for the extent of: (a) abnormal signal intensity within the tendon, and the presence of (b) bicipitoradial bursitis, and (c) bony microavulsive injury of the radial tuberosity. Medical records for nine of the 20 cases were reviewed for the clinical findings of ecchymosis, trauma, sensation of a ''pop'', loss of function, and acuity of onset. Results: Twenty partial distal biceps tendon tears were seen. All displayed an abnormally increased signal in the distal biceps tendon. Three of 20 (15%) showed a 25% to 50% tear, ten of 20 (50%) showed a 50% tear, and seven of 20 (35%) showed a 75% to 90% tear. Bicipitoradial bursitis was seen in 11 of 20 (55%) cases. Bony microavulsive injury of the radial tuberosity was observed in 10 of 20 (50%). Of the nine cases reviewed for associated clinical findings, surprisingly, only three (33%) experienced an acute traumatic episode with an abrupt onset of pain. An insidious onset was reported in four of nine (44%). Sensation of a ''pop'' was recorded in only two of nine (22%) cases. Ecchymosis and loss of function were not seen in any of the cases. Finally, surgical conformation was obtained for three cases. Conclusion: Partial distal biceps tendon tears have a characteristic MR appearance, demonstrate little functional deficit, and may be attritional in their etiology due to the observation of a low number of patients reporting trauma or an acute onset. (orig.)

Partial tears of the distal biceps tendon: MR appearance and associated clinical findings

International Nuclear Information System (INIS)

Williams, B.D.; Schweitzer, M.E.; Weishaupt, D.; Miller, L.S.; Rubenstein, D.L.; Rosenberg, Z.S.

2001-01-01

Purpose: To describe the magnetic resonance (MR) appearance and associated clinical findings of partial distal biceps tendon tears. Design: Twenty elbow MR images at 1.5 T, performed over a 7 year period, were reviewed for an appearance of partial tears in the distal biceps. These images were assessed by two musculoskeletal radiologists for the extent of: (a) abnormal signal intensity within the tendon, and the presence of (b) bicipitoradial bursitis, and (c) bony microavulsive injury of the radial tuberosity. Medical records for nine of the 20 cases were reviewed for the clinical findings of ecchymosis, trauma, sensation of a ''pop'', loss of function, and acuity of onset. Results: Twenty partial distal biceps tendon tears were seen. All displayed an abnormally increased signal in the distal biceps tendon. Three of 20 (15%) showed a 25% to 50% tear, ten of 20 (50%) showed a 50% tear, and seven of 20 (35%) showed a 75% to 90% tear. Bicipitoradial bursitis was seen in 11 of 20 (55%) cases. Bony microavulsive injury of the radial tuberosity was observed in 10 of 20 (50%). Of the nine cases reviewed for associated clinical findings, surprisingly, only three (33%) experienced an acute traumatic episode with an abrupt onset of pain. An insidious onset was reported in four of nine (44%). Sensation of a ''pop'' was recorded in only two of nine (22%) cases. Ecchymosis and loss of function were not seen in any of the cases. Finally, surgical conformation was obtained for three cases. Conclusion: Partial distal biceps tendon tears have a characteristic MR appearance, demonstrate little functional deficit, and may be attritional in their etiology due to the observation of a low number of patients reporting trauma or an acute onset. (orig.)

Radiographic anatomy of the distal dural SAC

International Nuclear Information System (INIS)

Larsen, J.L.; Olsen, K.O.

1991-01-01

A radio-anatomical study was performed of the distal dural sac (DS) in 121 patients subjected to myelography. In 83.4% the termination of the DS was located from the upper half of the S1-segment to the lower half of the S2-segment. In the remaining patients the dural terminations were more distally located. The average location of the DS-termination was higher than that found in a previous anatomic study. The inference is that in patients with low-back pain and sciatica, the DS tends to terminate at a higher spinal level than in a non-selected anatomic material. The caudal reduction in sagittal diameter of the DS was less than that of the frontal diameter of the sac. The linear diminution in cross-sectional area of the DS from the level of L3 towards the lumbosacral junction was not correlated with the degree of caudal extension of the DS into the sacrum. Thus the length of the DS and its transverse diameters are independent of each other. These results supported the view that the location of the termination of the DS (and hence that of the spinal cord) is not related to stenosis of the central spinal canal. (orig.)

Skeletal developmental patterns in the acromial process and distal clavicle as observed by MRI

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Kothary, Pratik [Tufts University School of Medicine, Boston, MA (United States); Rosenberg, Zehava Sadka [NYU Hospital for Joint Disease, Radiology Department, New York, NY (United States)

2014-10-17

To provide an MRI timeline of normal skeletal developmental patterns in the acromial process and distal clavicle in children up to 18 years of age. Retrospective review of all shoulder MRIs obtained at our institution between January 2003 and March 2012, in children up to age 18, was performed. When available, radiographs and CT scans for these children were also reviewed. The following variables of the distal acromion and clavicle, with attention to morphology and MRI signal, were assessed: (1) Chondro-osseous junction and (2) Development and fusion of the secondary ossification centers. Ninety-eight children with 116 MR studies were identified from the data search. Of these, 13 patients were excluded and the final cohort included 85 children with 102 MRI studies. Forty-one of these patients also had shoulder radiographs. The cartilaginous precursors of the distal clavicle and acromion conformed to the final shape of these structures. The chondro-osseous interphases became progressively more lobulated and notched in the distal acromion and clavicle respectively. Appearance and fusion of the secondary ossification centers was significantly earlier in our study than previously reported. Acromial secondary ossification centers began forming at age 10 and clavicular ones, while uncommon, began forming at age 11. Fusion of acromial primary and secondary ossification centers began at age 14 and was generally complete after age 16. Based on MR imaging the development and fusion of the acromion and distal clavicle in children occur earlier than previously reported. They follow a sequential pattern and can serve as a blueprint for evaluating imaging studies of pediatric shoulders. (orig.)

Fluxo de informação na perspectiva do ambiente em rede / Information flow in the network environment

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Cibele Roberta Sugahara

2013-05-01

Full Text Available No campo da Ciência da Informação estudar o fluxo de informação na perspectiva do espaço social em rede requer um olhar atento para a circulação da informação considerando as práticas para troca de informação entre contatos diretos e intermediários. Esse estudo discute a troca de informação no ambiente da rede Arranjo Produtivo Local Têxtil (APL Americana/SP. Para tanto, utiliza-se o método da Análise de Redes Sociais (ARS visando identificar o papel que cada elo desempenha junto à estrutura social da rede. Os resultados indicam que o fluxo da informação na rede APL Têxtil apresenta maior intensidade principalmente por elos com pequeno número de interações. Isso permite o alcance da informação às extremidades da rede e troca de informação com alto grau de novidade. O ambiente em rede propicia interação entre seus integrantes, podendo ocorrer de acordo com interesses específicos, que são reconhecidos ou postos em questão por seus pares.

Observations on the morphology of Pomacea lineata (Spix, 1827 (Mollusca, Ampullariidae Observações sobre a morfologia de Pomacea lineata (Spix, 1827 (Mollusca, Ampullaridae

Directory of Open Access Journals (Sweden)

Silvana Carvalho Thiengo

1987-12-01

-tipo. Concha com espessura moderada, globosa, castanha, com faixas espirais castanhas-escuras; ápice pouco elevado, 4-5 giros arredondados crescendo rapidamente em diâmetro, separados por suturas profundas. Abertura grande oval; lábio externo simples; umbigo pequeno e profundo; opérculo concêntrico, córneo. Razão: largura da concha/comprimento da concha = 0.74 - 0.83 (média 0.78; comprimento da espira/comprimento da concha = 0.10 - 0.18 (média 0.13; comprimento da abertura/comprimento da concha = 0.70 - 0.77 (média 0.73. Animal com sifão bem desenvolvido. A rádula é tenioglossa (2.1.1.1.2 e tem em média 35 fileiras transversais de dentes. A forma e a disposição dos dentes radulares são semelhantes ao padrão dos ampularídeos. Rim de cor castanha apresentando uma invaginação acentuada na parede direita. Ureter alongado e transversal ao eixo principal do rim. Testículo constituído por uma massa cor creme, ocupando as três primeiras voltas da espira. Espermiduto estreito e uniforme, correndo para a base da espira. Vesícula seminal esbranquiçada levemente achatada dorso-ventralmente. Próstata cilíndrica e compacta com coloração semelhante à do testículo. Pênis em forma de chicote com canal espermático fechado e de contorno circular. Bolsa do pênis ovalada, envolvendo-o completamente. Bainha do pênis alongada tendo sua largura diminuída gradualmente da base para a extremidade; sua superfície interna apresenta um canal mediano em sua metade proximal e duas glândulas, uma mediana e outra apical. Ovário constituído por túbulos ramificados branco-amarelados situados superficilamente sobre a glândula digestiva. Oviduto estreito correndo pelo eixo columelar até a base da espira. Receptáculo seminal tubular com parede espessa e extremidade proximal alargada. Glândula de albume volumosa e rosada envolvendo o receptáculo seminal e a glândula da casca em espiral. Vestígio do aparelho copulador masculino (pênis e sua bainha presente em todas as

[Short-term efficacy of da Vinci robotic surgical system on rectal cancer in 101 patients].

Science.gov (United States)

Zeng, Dong-Zhu; Shi, Yan; Lei, Xiao; Tang, Bo; Hao, Ying-Xue; Luo, Hua-Xing; Lan, Yuan-Zhi; Yu, Pei-Wu

2013-05-01

To investigate the feasibility and safety of da Vinci robotic surgical system in rectal cancer radical operation, and to summarize its short-term efficacy and clinical experience. Data of 101 cases undergoing da Vinci robotic surgical system for rectal cancer radical operation from March 2010 to September 2012 were retrospectively analyzed. Evaluation was focused on operative procedure, complication, recovery and pathology. All the 101 cases underwent operation successfully and safely without conversion to open procedure. Rectal cancer radical operation with da Vinci robotic surgical system included 73 low anterior resections and 28 abdominoperineal resections. The average operative time was (210.3±47.2) min. The average blood lose was (60.5±28.7) ml without transfusion. Lymphadenectomy harvest was 17.3±5.4. Passage of first flatus was (2.7±0.7) d. Distal margin was (5.3±2.3) cm without residual cancer cells. The complication rate was 6.9%, including anastomotic leakage(n=2), perineum incision infection(n=2), pulmonary infection (n=2), urinary retention (n=1). There was no postoperative death. The mean follow-up time was(12.9±8.0) months. No local recurrence was found except 2 cases with distant metastasis. Application of da Vinci robotic surgical system in rectal cancer radical operation is safe and patients recover quickly The short-term efficacy is satisfactory.

Sphincter preservation in distal CT2N0 rectal cancer after preoperative chemoradiotherapy

International Nuclear Information System (INIS)

Wasserberg, Nir; Kundel, Yulia; Purim, Ofer; Keidar, Andrei; Kashtan, Hanoch; Sadot, Eran; Fenig, Eyal; Brenner, Baruch

2014-01-01

Preoperative chemoradiotherapy is usually not indicated for cT2N0 rectal cancer. Abdominoperineal resection is the standard treatment for distal rectal tumors. The aim of the study was to evaluate the actual sphincter-preservation rate in patients with distal cT2N0 rectal cancer given neoadjuvant chemoradiotherapy. Data were retrospectively collected for all patients who were diagnosed with distal cT2N0 rectal cancer at a tertiary medical center in 2000–2008 and received chemoradiotherapy followed by surgery (5–7 weeks later). Thirty-three patients (22 male) of median age 65 years (range, 32–88) were identified. Tumor distance from the anal verge ranged from 0 to 5 cm. R0 resection with sphincter preservation was accomplished in 22 patients (66%), with a 22% pathological complete response rate. Median follow-up time was 62 months (range 7–120). There were no local failures. Crude disease-free and overall survival were 82% and 86%, respectively. Factors associated with sphincter preservation were tumor location (OR = 0.58, p = 0.02, 95% CI = 0.37-0.91) and pathological downstaging (OR = 7.8, p = 0.02, 95% CI = 1.35-45.85). Chemoradiotherapy was well tolerated. High rates of sphincter preservation can be achieved after preoperative chemoradiotherapy for distal cT2N0 rectal cancer, with tolerable toxicity, without compromising oncological outcome

The effect of functional limitations and fatigue on the quality of life in people with multiple sclerosis O efeito das limitações funcionais e da fadiga na qualidade de vida de indivíduos com esclerose múltipla

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Leandro Alberto Calazans Nogueira

2009-09-01

Full Text Available The purpose of this study was to determine the effect of functional limitations and fatigue on the quality of life (QoL in people with multiple sclerosis (MS. A descriptive case series study at Lagoa Hospital - Rio de Janeiro, Brazil was carried. The main outcome measurements were demographic variables, QoL (SF-36 v.1, disability (EDSS, motor function of the upper limb (Box & Blocks test, Tone (Modified Ashworth Scale, gait (Hauser ambulatory index and fatigue (Fatigue Severity Scale. Sixty one patients fulfilled the study criteria. The mean age of patients was 39 years and 74% of patients were female. The most of cases presented mild disability (EDSSO objetivo do estudo foi determinar o efeito das limitações funcionais e da fadiga na qualidade de vida (qv de indivíduos com esclerose múltipla (em. foi conduzido um estudo descritivo de série de casos no Hospital da Lagoa - Rio de Janeiro, Brasil. As principais medidas utilizadas foram as variáveis demográficas, QV (SF-36 v.1, incapacidade (EDSS, função motora da extremidade superior (Teste da Caixa e Blocos, Tônus (Escala Modificada de Ashworth, marcha (Índice Ambulatorial de Hauser e fadiga (Escala de Severidade de Fadiga. Sessenta e um pacientes preencheram os critérios do estudo. A média de idade foi de 39 anos e 74% dos pacientes eram do gênero feminino. A maioria dos casos apresentou incapacidade leve (EDSS<3,5. Foi encontrada uma diminuição em todas dimensões da QV. Foi observada uma associação entre a função física e as variáveis EDSS, fadiga, tônus dos membros inferiores e marcha. Marcha, incapacidade, hipertonia dos membros inferiores e fadiga afetam negativamente a QV de indivíduos com EM.

Radial nerve palsy in mid/distal humeral fractures: is early exploration effective?

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Keighley, Geffrey; Hermans, Deborah; Lawton, Vidya; Duckworth, David

2018-03-01

Radial nerve palsies are a common complication with displaced distal humeral fractures. This case series examines the outcomes of early operative exploration and decompression of the nerve with fracture fixation with the view that this provides a solid construct for optimisation of nerve recovery. A total of 10 consecutive patients with a displaced distal humeral fracture and an acute radial nerve palsy were treated by the senior author by open reduction and internal fixation of the distal humerus and exploration and decompression of the radial nerve. Motor function and sensation of the radial nerve was assessed in the post-operative period every 2 months or until full recovery of the radial nerve function had occurred. All patients (100%) had recovery of motor and sensation function of their upper limb in the radial nerve distribution over a 12-month period. Recovery times ranged between 4 and 32 weeks, with the median time to recovery occurring at 26 weeks and the average time to full recovery being 22.9 weeks. Wrist extension recovered by an average of 3 months (range 2-26 weeks) and then finger extension started to recover 2-6 weeks after this. Disability of the arm, shoulder and hand scores ranged from 0 to 11.8 at greater than 1 year post-operatively. Our study demonstrated that early operative exploration of the radial nerve when performing an open stabilization of displaced distal humeral fractures resulted in a 100% recovery of the radial nerve. © 2017 Royal Australasian College of Surgeons.

Minimally invasive locked plating of distal tibia fractures is safe and effective.

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Ronga, Mario; Longo, Umile Giuseppe; Maffulli, Nicola

2010-04-01

Distal tibial fractures are difficult to manage. Limited soft tissue and poor vascularity impose limitations for traditional plating techniques that require large exposures. The nature of the limitations for traditional plating techniques is intrinsic to the large exposure required to approach distal tibia, a bone characterized by limited soft tissue coverage and poor vascularity. The locking plate (LP) is a new device for treatment of fractures. We assessed the bone union rate, deformity, leg-length discrepancy, ankle range of motion, return to preinjury activities, infection, and complication rate in 21 selected patients who underwent minimally invasive osteosynthesis of closed distal tibia fractures with an LP. According to the AO classification, there were 12 Type A, 5 Type B, and 4 Type C fractures. The minimum followup was 2 years (average, 2.8 years; range, 2-4 years). Two patients were lost to followup. Union was achieved in all but one patient by the 24th postoperative week. Four patients had angular deformity less than 7 degrees . No patient had a leg-length discrepancy more than 1.1 cm. Five patients had ankle range of motion less than 20 degrees compared with the contralateral side. Sixteen patients had not returned to their preinjury sporting or leisure activities. Three patients developed a delayed infection. We judge the LP a reasonable device for treating distal tibia fractures. The level of physical activities appears permanently reduced in most patients. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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.

MRI diagnosis of trapped periosteum following incomplete closed reduction of distal tibial Salter-Harris II fracture

International Nuclear Information System (INIS)

Raman, Subha; Wallace, E.C.

2011-01-01

Irreducible fracture of the distal tibial physis due to interposed soft tissue including periosteum is well documented in the orthopedic literature but is uncommon. This condition has been associated with subsequent growth disturbance and requires open reduction. There are very few prior reports of MRI depiction of soft tissue interposition and none of periosteal interposition in the distal tibial physis. This is a relatively common location of physeal injury and related growth disturbance. We present a case of periosteum trapped in the distal tibial physis, diagnosed on MRI, in a Salter-Harris II fracture and its management implications. (orig.)

A case of distal extrahepatic cholangiocarcinoma with two positive resection margins.

Science.gov (United States)

Warner, Wayne A; Ramcharan, Wesley; Harnanan, Dave; Umakanthan, Srikanth; Maharaj, Ravi

2016-11-01

Cholangiocarcinoma is an uncommon primary malignancy of the biliary tract that is challenging to diagnose and treat effectively due to its relatively silent and late clinical presentation. The present study reports a case of a 60-year-old male with distal extrahepatic cholangiocarcinoma with a 3-week history of painless obstructive jaundice symptoms and subjective weight loss. Imaging revealed an obstructing lesion in the common bile duct, just distal to the entrance of the cystic duct. Pathology revealed moderately differentiated cholangiocarcinoma with two positive proximal resection margins. The two positive resection margins presented a challenge during surgery and points to an urgent need for further studies to better illuminate diagnostic and therapeutic options for patients with similar clinicopathological presentation.

Scoping the proximal and distal dimensions of climate change on health and wellbeing.

Science.gov (United States)

Morris, George Paterson; Reis, Stefan; Beck, Sheila Anne; Fleming, Lora Elderkin; Adger, William Neil; Benton, Timothy Guy; Depledge, Michael Harold

2017-12-05

The impacts of climate on health and wellbeing occur in time and space and through a range of indirect, complicated mechanisms. This diversity of pathways has major implications for national public health planning and influence on interventions that might help to mitigate and adapt to rapidly changing environmental conditions, nationally and internationally. This paper draws upon evidence from public health and adverse impact studies across climate science, hydrology, agriculture, public health, and the social sciences. It presents a conceptual model to support decision-making by recognizing both the proximal and distal pathways from climate-induced environmental change to national health and wellbeing. The proximal and distal pathways associated with food security, migration and mobility illustrate the diverse climate change influences in different geographic locations over different timescales. We argue that greater realization and articulation of proximal and distal pathways should radically alter how climate change is addressed as a national and international public health challenge.

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

International Nuclear Information System (INIS)

Foley, P. T.; Kavnoudias, H.; Cameron, P. U.; Czarnecki, C.; Paul, E.; Lyon, S. M.

2015-01-01

PurposeTo compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels.Materials and MethodsPatients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population.ResultsOf the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age, grade of injury or residual splenic volume.ConclusionIgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Energy Technology Data Exchange (ETDEWEB)

Foley, P. T., E-mail: pfoley@doctors.org.uk [The Canberra Hospital, Department of Medical Imaging (Australia); Kavnoudias, H., E-mail: h.kavnoudias@alfred.org.au [The Alfred Hospital, Radiology Research Unit, Radiology Department (Australia); Cameron, P. U., E-mail: paul.cameron@unimelb.edu.au [The Alfred Hospital, Infectious Diseases Unit (Australia); Czarnecki, C., E-mail: caroline.czarnecki@gmail.com [Royal Melbourne Hospital, Radiology Department (Australia); Paul, E., E-mail: eldho.paul@monash.edu [Monash University, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Alfred Hospital (Australia); Lyon, S. M., E-mail: lyonsey@optusnet.com.au [Melbourne Endovascular (Australia)

2015-10-15

PurposeTo compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels.Materials and MethodsPatients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population.ResultsOf the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age, grade of injury or residual splenic volume.ConclusionIgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Science.gov (United States)

Foley, P T; Kavnoudias, H; Cameron, P U; Czarnecki, C; Paul, E; Lyon, S M

2015-10-01

To compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels. Patients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population. Of the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation-a difference that could not be attributed to differences in age, grade of injury or residual splenic volume. IgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

Distribution of skeletal muscle involvement in autosomal recessive distal muscular dystrophy

International Nuclear Information System (INIS)

Mizusawa, Hidehiro; Nakanishi, Takao; Kobayashi, Fumie.

1987-01-01

Distribution of skeletal muscle involvement in 5 cases with autosomal recessive distal muscular dystrophy was studied clinically and by computed tomography (CT). Manual muscle test showed muscle involvement with a predilection for flexors in the lower leg and adductors in the thigh. Flexion and extension of the thigh and the lower leg was impaired to similar degree. In progressed cases, neck flexors and trunk muscles were also affected mildly. CT disclosed more clearly the preferential involvement of flexors in the lower leg, and involvement of both hamstrings · adductors group and extensors group of the thigh to similar degree. However, m. popliteus was curiously well preserved. In addition, there was a stage showing high density and hypertrophy of m. sartorius, m. gracilis, m. adductor, m. biceps femoris, m. semimenbranosus, m. semitendinosus or m. rectus femoris, which in thought to be compensatory hypertrophy. M. gluteus minimus in the pelvic girdle and m. dorsi proprii in the trunk were also liable to be affected. The CT findings are regarded as characteristic features noted clearly before muscle weakness and atrophy become apparent clinically. CT is very useful for distinguishing distal muscular dystrophy from rimmed vacuolar distal myopathy in which m. quadriceps femoris and flexors of the lower leg are usually well preserved without compensatory hypertrophy on CT. (author)

The distally-based island ulnar artery perforator flap for wrist defects

Directory of Open Access Journals (Sweden)

Karki Durga

2007-01-01

Full Text Available Background: Reconstruction of soft tissue defects around the wrist with exposed tendons, joints, nerves and bone represents a challenge to plastic surgeons, and such defects necessitate flap coverage to preserve hand functions and to protect its vital structures. We evaluated the use of a distally-based island ulnar artery perforator flap in patients with volar soft tissue defects around the wrist. Materials and Methods: Between June 2004 and June 2006, seven patients of soft tissue defects on the volar aspect of the wrist underwent distally-based island ulnar artery perforator flap. Out of seven patients, five were male and two patients were female. This flap was used in the reconstruction of the post road traffic accident defects in four patients and post electric burn defects in three patients. Flap was raised on one or two perforators and was rotated to 180°. Results: All flaps survived completely. Donor sites were closed primarily without donor site morbidity. Conclusion: The distally-based island Ulnar artery perforator flap is convenient, reliable, easy to manage and is a single-stage technique for reconstructing soft tissue defects of the volar aspect of the wrist. Early use of this flap allows preservation of vital structures, decreases morbidity and allows for early rehabilitation.

Prevention of distal extension cantilever fracture in mandibular overdentures.

Science.gov (United States)

Quirynen, Thomas; Quirynen, Marc; Duyck, Joke

2015-09-01

Fractures of distal bar extensions, supporting a mandibular overdenture, do occur with significant functional and economic consequences for the patient. This study therefore aims to evaluate the effect of different bar cross-sectional shapes and surfaces, bar extension lengths and the placement of a support rib under the distal bar extension on fracture resistance. The 2nd moment area and static strength were calculated for 11 frequently used bar designs using finite element analysis (FEA). For two specific designs (Ackermann round Ø 1.8mm and Dolder-Y macro, the former with and without a support rib) additional physical static and fatigue strength tests were included. The FEA static strength data corresponded well to the 2nd moment area (a similar ranking when maximum allowed force was considered). The application of a rib support (Ackermann Ø 1.8mm) and limitations of the bar extension length (6mm for the Ackermann Ø 1.8mm, 8mm for the Dolder-Y macro) allowed the bars to exceed 5 × 10(6) cycles of 120 and 250N, respectively, before fracture. The region of highest stresses in FEA corresponded well with the locations of the fractures observed in static- and fatigue-testing. With some simple guidelines/modifications, the number of bar extension fractures can be reduced significantly. This study focusses on distal bar extensions which improve the positioning of an implant supported overdenture. By combining laboratory testing and finite element simulations we aim to: (1) explain why fractures occur (dependent on physical characteristics of the bar), and (2) give clinical guidelines on how to prevent such fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

Miniscrew-assisted mandibular molar distalization in a patient with skeletal class-III malocclusion: A clinical case report

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Seyed Mohammadreza Safavi

2013-01-01

Full Text Available In nongrowing patients with mild skeletal Class-III malocclusion, premolar extraction or molar distalization in the lower arch can be done as a part of camouflage treatment. Temporary anchorage devices are widely used for this purpose because they do not produce undesirable reciprocal effects and do not depend on the patient′s cooperation. However, most reported cases in this regard have used interradicular miniscrews in the mandibular arch and these have a risk of failure as they can loosen due to collision with adjacent roots. This article showcases mandibular molar distalization utilizing miniscrews, inserted at the retromolar area to correct a Class-III problem. A 24-year-old girl with a mild skeletal Class-III malocclusion and dental Class-III molar and canine relationship bilaterally was referred for orthodontic treatment. The treatment plan included distalization of the lower molars bilaterally followed by full fixed appliance therapy, after third molar extractions. For the lower molar distalization, the miniscrews were inserted at the retromolar pad. At the end of 21 months, a Class-I molar and canine relationship, normal overjet and overbite were obtained. The average amount of distalization of mandibular first molar was 3.2 mm at the crown level. In conclusion, placing miniscrews at the retromolar pad area for lower molar distalization was found to be a simple and effective method for correcting anterior cross bite and mandibular anterior crowding or protrusion, without the need for patient compliance.

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

Robotic versus laparoscopic distal pancreatectomy: A propensity score-matched study.

Science.gov (United States)

Liu, Rong; Liu, Qu; Zhao, Zhi-Ming; Tan, Xiang-Long; Gao, Yuan-Xing; Zhao, Guo-Dong

2017-09-01

Robotic distal pancreatectomy (RDP) is considered a safe and feasible alternative to laparoscopic distal pancreatectomy (LDP). However, previous studies have some limitations including small sample size and selection bias. This study aimed to evaluate whether the robotic approach has advantages over laparoscopic surgery in distal pancreatectomy. Demographics and perioperative outcomes among patients undergoing RDP (n = 102) and LDP (n = 102) between January 2011 and December 2015 were reviewed. A 1:1 propensity score matched analysis was performed between both groups. Both groups displayed no significant differences in perioperative outcomes including operative time, blood loss, transfusion rate, and rates of overall morbidities and pancreatic fistula. Robotic approach reduced the rate of conversion to laparotomy (2.9% vs 9.8%, P = 0.045), especially in patients with large tumors (0% vs 22.2%, P = 0.042). RDP improved spleen (SP) and splenic vessels preservation (SVP) rates in patients with moderate tumors (60.0% vs 35.5%, P = 0.047; 37.1% vs 12.9%, P = 0.025), especially in patients without malignancy (95.5% vs 52.4%, P = 0.001; 59.1% vs 19.0%, P = 0.007). RDP also reduced postoperative hospital stay (PHS) significantly (7.67% vs 8.58, P = 0.032). RDP is associated with less rate of conversion to laparotomy, shorter PHS, and improved SP and SVP rates in selected patients than LDP. © 2017 Wiley Periodicals, Inc.

Total elbow arthroplasty for the treatment of distal humeral fractures.

Science.gov (United States)

Gallucci, G L; Larrondo Calderón, W; Boretto, J G; Castellaro Lantermo, J A; Terán, J; de Carli, P

2016-01-01

To report the clinical-functional outcomes of the treatment of humeral distal fractures with a total elbow prosthesis. This retrospective study was performed in two surgical centres. A total of 23patients were included, with a mean age of 79years, and of which 21 were women. The inclusion criteria were: patients with humeral distal fractures, operated on using a Coonrad-Morrey prosthesis, and with a follow-up of more than one year. According to AO classification, 15fractures were type C3, 7 C2 and 1 A2. All patients were operated on without de-insertion of the extensor mechanism. The mean follow-up was 40 months. Flexor-extension was 123-17°, with a total mobility arc of 106° (80% of the contralateral side). Pain, according to a visual analogue scale was 1. The Mayo Elbow Performance Index (MEPI) was 83 points. Excellent results were obtained in 8 patients, good in 13, medium in 1, and poor in 1. The mean DASH (disability) score was 24 points. Treatment of humeral distal fractures with total elbow arthroplasty could be a good treatment option, but indications must be limited to patients with complex fractures, poor bone quality, with osteoporosis and low functional demands. In younger patients, the use is limited to serious cases where there is no other treatment option. Level of Evidence IV. Copyright © 2016 SECOT. Published by Elsevier Espana. All rights reserved.

Importance of early audiologic assessment in distal renal tubular acidosis

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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

Spatial information is preferentially processed by the distal part of CA3: implication for memory retrieval.

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Flasbeck, Vera; Atucha, Erika; Nakamura, Nozomu H; Yoshida, Motoharu; Sauvage, Magdalena M

2018-07-16

For the past decades, CA3 was considered as a single functional entity. However, strong differences between the proximal (close to the dentate gyrus) and the distal (close to CA2) parts of CA3 in terms of connectivity patterns, gene expression and electrophysiological properties suggest that it is not the case. We recently showed that proximal CA3 (together with distal CA1) preferentially deals with non-spatial information [1]. In contrast to proximal CA3, distal CA3 mainly receives and predominantly projects to spatially tuned areas. Here, we tested if distal CA3 preferentially processes spatial information, which would suggest a segregation of the spatial information along the proximodistal axis of CA3. We used a high-resolution imaging technique based on the detection of the expression of the immediate-early gene Arc, commonly used to map activity in the medial temporal lobe. We showed that distal CA3 is strongly recruited in a newly designed delayed nonmatching-to-location task with high memory demands in rats, while proximal CA3 is not. These results indicate a functional segregation of CA3 that mirrors the one reported in CA1, and suggest the existence of a distal CA3- proximal CA1 spatial subnetwork. These findings bring further evidence for the existence of 'specialized' spatial and non-spatial subnetworks segregated along the proximodistal axis of the hippocampus and put forward the 'segregated' view of information processing in the hippocampus as a reasonable alternative to the well-accepted 'integrated' view, according to which spatial and non-spatial information are systematically integrated in the hippocampus to form episodic memory. Copyright © 2018. Published by Elsevier B.V.

Toward endoscopes with no distal optics: video-rate scanning microscopy through a fiber bundle.

Science.gov (United States)

Andresen, Esben Ravn; Bouwmans, Géraud; Monneret, Serge; Rigneault, Hervé

2013-03-01

We report a step toward scanning endomicroscopy without distal optics. The focusing of the beam at the distal end of a fiber bundle is achieved by imposing a parabolic phase profile across the exit face with the aid of a spatial light modulator. We achieve video-rate images by galvanometric scanning of the phase tilt at the proximal end. The approach is made possible by the bundle, designed to have very low coupling between cores.

The prevalence of an excessive prepuce and the effects of distal circumcision on premature ejaculation

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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.

Ecologia alimentar e conectividade genética de Chaetodon Striatus em um gradiente geográfico

OpenAIRE

Liedke, Ana Maria Rubini

2013-01-01

Resumo: Conhecer a ecologia alimentar de uma espécie é um aspecto importante para compreender sua biologia. A relação entre disponibilidade, qualidade do alimento e estado fisiológico reflete na distribuição e abundância de uma dada espécie, e terá influência direta no comportamento alimentar e tipo de presas. A relação entre plasticidade alimentar e fluxo gênico pode levar as populações das extremidades da distribuição a se diferenciarem e possivelmente se adaptarem aos recursos disponíveis....

Proximal versus distal control of two-joint planar reaching movements in the presence of neuromuscular noise.

Science.gov (United States)

Nguyen, Hung P; Dingwell, Jonathan B

2012-06-01

Determining how the human nervous system contends with neuro-motor noise is vital to understanding how humans achieve accurate goal-directed movements. Experimentally, people learning skilled tasks tend to reduce variability in distal joint movements more than in proximal joint movements. This suggests that they might be imposing greater control over distal joints than proximal joints. However, the reasons for this remain unclear, largely because it is not experimentally possible to directly manipulate either the noise or the control at each joint independently. Therefore, this study used a 2 degree-of-freedom torque driven arm model to determine how different combinations of noise and/or control independently applied at each joint affected the reaching accuracy and the total work required to make the movement. Signal-dependent noise was simultaneously and independently added to the shoulder and elbow torques to induce endpoint errors during planar reaching. Feedback control was then applied, independently and jointly, at each joint to reduce endpoint error due to the added neuromuscular noise. Movement direction and the inertia distribution along the arm were varied to quantify how these biomechanical variations affected the system performance. Endpoint error and total net work were computed as dependent measures. When each joint was independently subjected to noise in the absence of control, endpoint errors were more sensitive to distal (elbow) noise than to proximal (shoulder) noise for nearly all combinations of reaching direction and inertia ratio. The effects of distal noise on endpoint errors were more pronounced when inertia was distributed more toward the forearm. In contrast, the total net work decreased as mass was shifted to the upper arm for reaching movements in all directions. When noise was present at both joints and joint control was implemented, controlling the distal joint alone reduced endpoint errors more than controlling the proximal joint

Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study

NARCIS (Netherlands)

van Hilst, Jony; de Rooij, Thijs; Klompmaker, Sjors; Rawashdeh, Majd; Aleotti, Francesca; Al-Sarireh, Bilal; Alseidi, Adnan; Ateeb, Zeeshan; Balzano, Gianpaolo; Berrevoet, Frederik; Björnsson, Bergthor; Boggi, Ugo; Busch, Olivier R.; Butturini, Giovanni; Casadei, Riccardo; del Chiaro, Marco; Chikhladze, Sophia; Cipriani, Federica; van Dam, Ronald; Damoli, Isacco; van Dieren, Susan; Dokmak, Safi; Edwin, Bjørn; van Eijck, Casper; Fabre, Jean-Marie; Falconi, Massimo; Farges, Olivier; Fernández-Cruz, Laureano; Forgione, Antonello; Frigerio, Isabella; Fuks, David; Gavazzi, Francesca; Gayet, Brice; Giardino, Alessandro; Bas Groot, Koerkamp; Hackert, Thilo; Hassenpflug, Matthias; Kabir, Irfan; Keck, Tobias; Khatkov, Igor; Kusar, Masa; Lombardo, Carlo; Marchegiani, Giovanni; Marshall, Ryne; Menon, Krish V.; Montorsi, Marco; Orville, Marion; de Pastena, Matteo; Pietrabissa, Andrea; Poves, Ignaci; Primrose, John; Pugliese, Raffaele; Ricci, Claudio; Roberts, Keith; Røsok, Bård; Sahakyan, Mushegh A.; Sánchez-Cabús, Santiago; Sandström, Per; Scovel, Lauren; Solaini, Leonardo; Soonawalla, Zahir; Souche, F. Régis; Sutcliffe, Robert P.; Tiberio, Guido A.; Tomazic, Aleš; Troisi, Roberto; Wellner, Ulrich; White, Steven; Wittel, Uwe A.; Zerbi, Alessandro; Bassi, Claudio; Besselink, Marc G.; Abu Hilal, Mohammed

2017-01-01

The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC). Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent

Periosteal osteoblastoma of the distal femur

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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.)

Mid-term functional outcome after the internal fixation of distal radius fractures

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Phadnis Joideep

2012-01-01

Full Text Available Abstract Background Distal radius fracture is a common injury with a variety of operative and non-operative management options. There remains debate as to the optimal treatment for a given patient and fracture. Despite the popularity of volar locking plate fixation, there are few large cohort or long term follow up studies to justify this modality. Our aim was to report the functional outcome of a large number of patients at a significant follow up time after fixation of their distal radius with a volar locking plate. Methods 180 patients with 183 fractures and a mean age of 62.4 years were followed up retrospectively at a mean of 30 months (Standard deviation = 10.4. Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand (DASH and modified MAYO wrist scores. Statistical analysis was performed to identify possible variables affecting outcome and radiographs were assessed to determine time to fracture union. Results The median DASH score was 2.3 and median MAYO score was 90 for the whole group. Overall, 133 patients (74% had a good or excellent DASH and MAYO score. Statistical analysis showed that no specific variable including gender, age, fracture type, post-operative immobilisation or surgeon grade significantly affected outcome. Complications occurred in 27 patients (15% and in 11 patients were major (6%. Conclusion This single centre large population series demonstrates good to excellent results in the majority of patients after volar locking plate fixation of the distal radius, with complication rates comparable to other non-operative and operative treatment modalities. On this basis we recommend this mode of fixation for distal radius fractures requiting operative intervention.

Radiologic examination and measurement of the wrist and distal radio-ulnar joint

International Nuclear Information System (INIS)

Toernvall, A.H.; Ekenstam, F. af; Hagert, C.G.; Irstam, L.; Sahlgrenska Sjukhuset, Goeteborg; Uppsala Univ.

1986-01-01

Following fractures of the distal radius, a relatively high incidence of complications is caused by malalignment in the distal radio-ulnar (DRU) joint; recent anatomic and clinical investigations have shown a congruity of that joint to be of significant importance for restoring the function of the wrist. The radius forms a moderately arched bone, which moves around the ulna in pronation and supination. Biomechanically, the ulna may be regarded as the pillar around which the radius moves. In an anatomic investigation of 5 arm specimens, we have shown that the maximum cartilage contact in the DRU joint between the ulna head and the distal radius occurs in the neutral rotation position. A proposed routine examination method of the wrist and forearm includes a true antero-posterior and a lateral projection of the radius and the ulna, performed with the forearm and wrist in a neutral rotation, a neutral wrist deviation and with the elbow angled 90 degrees. Such an examination implies a standardized and reproducible method. In a radioanatomic investigation, a series of 50 healthy wrists and forearms were examined. A simple measuring technique is presented, applicable to the DRU joint and wrist favouring the ulna as the bone through which a reproducible long axis of the forearm/wrist may be drawn. It is suggested that the length of the radius should be judged relative to the ulna. Ulnar head inclination and radio-ulnar angle are new concepts, being major characteristics of the DRU joint. These angles of the right and left wrist were equal and no difference was found between the sexes. Minor alterations of the distal radius may be revealed when estimating these angles. (orig.)

Post-traumatic and stress-induced osteolysis of the distal clavicle: MR imaging findings in 17 patients

International Nuclear Information System (INIS)

Puente, R. de la; Boutin, R.D.; Theodorou, D.J.; Hooper, A.; Resnick, D.; Schweitzer, M.

1999-01-01

Objective. To describe the MR imaging findings in patients with osteolysis of the distal clavicle and to compare the MR imaging appearance of clavicular osteolysis following acute injury with that related to chronic stress. Design and patients. MR imaging examinations were reviewed in 17 patients (14 men, 3 women; ages 16-55 years) with the diagnosis of post-traumatic or stress-induced osteolysis of the clavicle. A history of a single direct injury was present in seven patients and a history of weight-lifting, participation in sports, or repetitive microtrauma was present in 10 patients. Results. MR imaging showed edema in the distal clavicle in 17 patients and, of these, eight also had edema in the acromion. The edema was most evident in STIR and fat-suppressed T2-weighted pulse sequences. Other findings about the acromioclavicular (AC) joint were prominence of the joint capsule in 14, joint fluid in eight, cortical irregularity in 12, and bone fragmentation in six patients. No differences in the MR imaging features of post-traumatic and stress-induced osteolysis of the distal clavicle were observed. Conclusion. Post-traumatic and stress-induced osteolysis of the distal clavicle have similar appearances on MR imaging, the most common and conspicuous MR imaging feature being increased T2 signal intensity in the distal clavicle. (orig.)

Post-traumatic and stress-induced osteolysis of the distal clavicle: MR imaging findings in 17 patients

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Puente, R. de la [Department of Radiology, University of California San Diego and Veterans Affairs Medical Center, San Diego, CA (United States)]|[Servicio de Radioloxia, CXH Cristal Pinor, Ourense (Spain); Boutin, R.D. [Department of Radiology, University of California San Diego and Veterans Affairs Medical Center, San Diego, CA (United States)]|[Department of Radiology, Veterans Affairs Medical Center, San Diego, CA (United States); Theodorou, D.J.; Hooper, A.; Resnick, D. [Department of Radiology, University of California San Diego and Veterans Affairs Medical Center, San Diego, CA (United States); Schweitzer, M. [Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA (United States)

1999-04-01

Objective. To describe the MR imaging findings in patients with osteolysis of the distal clavicle and to compare the MR imaging appearance of clavicular osteolysis following acute injury with that related to chronic stress. Design and patients. MR imaging examinations were reviewed in 17 patients (14 men, 3 women; ages 16-55 years) with the diagnosis of post-traumatic or stress-induced osteolysis of the clavicle. A history of a single direct injury was present in seven patients and a history of weight-lifting, participation in sports, or repetitive microtrauma was present in 10 patients. Results. MR imaging showed edema in the distal clavicle in 17 patients and, of these, eight also had edema in the acromion. The edema was most evident in STIR and fat-suppressed T2-weighted pulse sequences. Other findings about the acromioclavicular (AC) joint were prominence of the joint capsule in 14, joint fluid in eight, cortical irregularity in 12, and bone fragmentation in six patients. No differences in the MR imaging features of post-traumatic and stress-induced osteolysis of the distal clavicle were observed. Conclusion. Post-traumatic and stress-induced osteolysis of the distal clavicle have similar appearances on MR imaging, the most common and conspicuous MR imaging feature being increased T2 signal intensity in the distal clavicle. (orig.) With 5 figs., 1 tab., 19 refs.

Distal posterior cerebral artery aneurysms: Retrospective review of characteristics and endovascular treatment

International Nuclear Information System (INIS)

Baek, Jin Wook; Jeong, Bae Woong; Seung, Won Bae

2016-01-01

The objective of this study was to review the clinical outcome after treatment of distal posterior cerebral artery (PCA) aneurysms via endovascular approach. Eleven patients with 11 distal PCA aneurysms who were treated via endovascular approach in Inje University Busan Paik Hospital and Kosin University Gospel Hospital from December 2002 to December 2013 were retrospectively reviewed. Among the 11 patients, there were 3 males (27.3%) and 8 females (72.7%). The mean age was 56.6 years (range 44 -72 years) and the mean aneurysm size was 8.45 mm (3 - 30 mm). Four (36.4%) aneurysms were located in the P2 segment, 6 (54.5%) in the P3 segment and 1 (9.1%) in the P1/2 junction. Seven (63.6%) aneurysms were treated with preservation of the parent artery; and the remaining 4 (36.4%) aneurysms were treated with parent artery occlusion. After treatment, the overall complication rate was 27% with the morbidity rate of 9.1% and the mortality rate of 18%. Endovascular treatment of distal PCA aneurysm might be used to minimize neurologic deficit, considering the diverse and rich collaterals of posterior cerebral artery

Distal posterior cerebral artery aneurysms: Retrospective review of characteristics and endovascular treatment

Energy Technology Data Exchange (ETDEWEB)

Baek, Jin Wook [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Jeong, Bae Woong [Dept. of Diagnostic Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan (Korea, Republic of); Seung, Won Bae [Dept. of Neurosurgery, Kosin University College of Medicine, Gospel Hospital, Busan (Korea, Republic of)

2016-04-15

The objective of this study was to review the clinical outcome after treatment of distal posterior cerebral artery (PCA) aneurysms via endovascular approach. Eleven patients with 11 distal PCA aneurysms who were treated via endovascular approach in Inje University Busan Paik Hospital and Kosin University Gospel Hospital from December 2002 to December 2013 were retrospectively reviewed. Among the 11 patients, there were 3 males (27.3%) and 8 females (72.7%). The mean age was 56.6 years (range 44 -72 years) and the mean aneurysm size was 8.45 mm (3 - 30 mm). Four (36.4%) aneurysms were located in the P2 segment, 6 (54.5%) in the P3 segment and 1 (9.1%) in the P1/2 junction. Seven (63.6%) aneurysms were treated with preservation of the parent artery; and the remaining 4 (36.4%) aneurysms were treated with parent artery occlusion. After treatment, the overall complication rate was 27% with the morbidity rate of 9.1% and the mortality rate of 18%. Endovascular treatment of distal PCA aneurysm might be used to minimize neurologic deficit, considering the diverse and rich collaterals of posterior cerebral artery.

The reliability of AO classification for distal radius fracture, using CT findings

International Nuclear Information System (INIS)

Nakanishi, Yasuaki; Ono, Hiroshi; Furuta, Kazuhiko; Fujitani, Ryoutarou; Ota, Hiroyoshi

2006-01-01

The purpose of this study was to assess the reliability of the AO (Association for the Study of Internal Fixation) classification of distal radius fracture, using plain radiographs and 2 cross-sectional computed tomographic (CT) surface images. Five observers independently classified 32 distal radius fractures into 9 groups under AO classification. We established 4 methods for observation. First, using only two-directional radiographs; second, four-directional radiographs; third, CT (axial view) with four-directional radiographs; and fourth, CT (axial and sagittal views) with four-directional radiographs. Kappa statistics were used to establish the relative level of agreement between the observers. Interobserver reliability was poor in both first and second methods in which only plain radiographs were used (κ=0.30 and 0.23, respectively). Furthermore, reliability did not increase in the third method with the addition of 1 CT surface image (κ=0.29). In the fourth method, with the addition of 2 cross-sectional CT surface images, the reliability increased to a moderate level (κ=0.44). Interobserver reliability of the AO system of the classification of distal radius fractures was observed on using 2 cross-sectional CT surface images with four-directional radiographs. (author)

The distal semimembranosus complex: normal MR anatomy, variants, biomechanics and pathology

International Nuclear Information System (INIS)

Beltran, Javier; Jbara, Marlena; Maimon, Ron; Matityahu, Amir; Hwang, Ki; Padron, Mario; Mota, Javier; Beltran, Luis; Sundaram, Murali

2003-01-01

To describe the normal MR anatomy and variations of the distal semimembranosus tendinous arms and the posterior oblique ligament as seen in the three orthogonal planes, to review the biomechanics of this complex and to illustrate pathologic examples. The distal semimembranosus tendon divides into five tendinous arms named the anterior, direct, capsular, inferior and the oblique popliteal ligament. These arms intertwine with the branches of the posterior oblique ligament in the posterior medial aspect of the knee, providing stability. This tendon-ligamentous complex also acts synergistically with the popliteus muscle and actively pulls the posterior horn of the medial meniscus during knee flexion. Pathologic conditions involving this complex include complete and partial tears, insertional tendinosis, avulsion fractures and bursitis. (orig.)

The distal semimembranosus complex: normal MR anatomy, variants, biomechanics and pathology

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Beltran, Javier; Jbara, Marlena; Maimon, Ron [Department of Radiology, Maimonides Medical Center, 4802 Tenth Avenue, NY 11219, Brooklyn (United States); Matityahu, Amir; Hwang, Ki [Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, NY (United States); Padron, Mario [Department of Radiology, Clinica CEMTRO, Madrid (Spain); Mota, Javier [Department of Radiology, Instituto Clinica Corachan, Barcelona (Spain); Beltran, Luis [New York Medical College, Valhalla, NY (United States); Sundaram, Murali [Department of Radiology, Mayo Clinic, Rochester, MN (United States)

2003-08-01

To describe the normal MR anatomy and variations of the distal semimembranosus tendinous arms and the posterior oblique ligament as seen in the three orthogonal planes, to review the biomechanics of this complex and to illustrate pathologic examples. The distal semimembranosus tendon divides into five tendinous arms named the anterior, direct, capsular, inferior and the oblique popliteal ligament. These arms intertwine with the branches of the posterior oblique ligament in the posterior medial aspect of the knee, providing stability. This tendon-ligamentous complex also acts synergistically with the popliteus muscle and actively pulls the posterior horn of the medial meniscus during knee flexion. Pathologic conditions involving this complex include complete and partial tears, insertional tendinosis, avulsion fractures and bursitis. (orig.)

Surgical Treatment of Carpal Tunnel Syndrome through a Minimal Incision on the Distal Wrist Crease: An Anatomical and Clinical Study

Directory of Open Access Journals (Sweden)

Hye Mi Yoo

2015-05-01

Full Text Available BackgroundAn anatomical analysis of the transverse carpal ligament (TCL and the surrounding structures might help in identifying effective measures to minimize complications. Here, we present a surgical technique based on an anatomical study that was successfully applied in clinical settings.MethodsUsing 13 hands from 8 formalin-fixed cadavers, we measured the TCL length and thickness, correlation between the distal wrist crease and the proximal end of the TCL, and distance between the distal end of the TCL and the palmar arch; the TCL cross sections and the thickest parts were also examined. Clinically, fasciotomy was performed on the relevant parts of 15 hands from 13 patients by making a minimally invasive incision on the distal wrist crease. Postoperatively, a two-point discrimination check was conducted in which the sensations of the first, second, and third fingertips and the palmar cutaneous branch injuries were monitored (average duration, 7 months.ResultsIn the 13 cadaveric hands, the distal wrist crease and the proximal end of the TCL were placed in the same location. The average length of the TCL and the distance from the distal TCL to the superficial palmar arch were 35.30±2.59 mm and 9.50±2.13 mm, respectively. The thickest part of the TCL was a region 25 mm distal to the distal wrist crease (average thickness, 4.00±0.57 mm. The 13 surgeries performed in the clinical settings yielded satisfactory results.ConclusionsThis peri-TCL anatomical study confirmed the safety of fasciotomy with a minimally invasive incision of the distal wrist crease. The clinical application of the technique indicated that the minimally invasive incision of the distal wrist crease was efficacious in the treatment of the carpal tunnel syndrome.

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.

Age-related vessel calcification at distal extremities is a risk factor of osteoporosis

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Ling Qin

2014-01-01

Full Text Available We conducted a cohort study to investigate if the vessel calcifications (VCs found in the distal extremities are an index of low bone mass at multiskeletal sites. A total of 332 healthy women aged 41–80 years were recruited for bone mineral content (BMC and bone mineral density measurement using peripheral quantitative computed tomography (pQCT and dual-energy X-ray absorptiometry (DXA. Seven percent of the women showed VC at both upper and lower distal extremities based on pQCT images. Women who had VC were then compared with their age-matched non-VC counterparts. Results showed that peripheral VC was mainly formed at distal lower extremities, and the prevalence of VC increased with advancing age, with 0%, 5.6%, 9.3%, and up to 34.5% in the age groups of 41–50 years, 51–60 years, 61–70 years, and 71–80 years, respectively. Compared with the control group, the VC group showed a significantly higher body mass index (25.2 vs. 23.2, p < 0.01, lower BMC at the spine (27.4 g vs. 31.3 g, p < 0.05, and lower BMC (1.8 g vs. 2.0 g, p < 0.05 and bone mineral density (0.57 g/cm2 vs. 0.66 g/cm2, p < 0.05 at the hip as measured by DXA. The diagnosis of VC in the distal extremities by pQCT increased the diagnosis sensitivity of osteoporosis by 50%. The significance of our findings imply that in clinical settings using pQCT for bone assessment and identification of patients with VC in the distal extremities, patients should also be referred for central DXA measurement at the femoral neck for diagnosis of osteoporosis as well as further assessment of vascular disorders.

Sphincter of Oddi botulinum toxin injection to prevent pancreatic fistula after distal pancreatectomy.

Science.gov (United States)

Hackert, Thilo; Klaiber, Ulla; Hinz, Ulf; Kehayova, Tzveta; Probst, Pascal; Knebel, Phillip; Diener, Markus K; Schneider, Lutz; Strobel, Oliver; Michalski, Christoph W; Ulrich, Alexis; Sauer, Peter; Büchler, Markus W

2017-05-01

Postoperative pancreatic fistula represents the most important complication after distal pancreatectomy. The aim of this study was to evaluate the use of a preoperative endoscopic injection of botulinum toxin into the sphincter of Oddi to prevent postoperative pancreatic fistula (German Clinical Trials Register number: DRKS00007885). This was an investigator-initiated, prospective clinical phase I/II trial with an exploratory study design. We included patients who underwent preoperative endoscopic sphincter botulinum toxin injection (100 units of Botox). End points were the feasibility, safety, and postoperative outcomes, including postoperative pancreatic fistula within 30 days after distal pancreatectomy. Botulinum toxin patients were compared with a control collective of patients undergoing distal pancreatectomy without botulinum toxin injection by case-control matching in a 1:1 ratio. Between February 2015 and February 2016, 29 patients were included. All patients underwent successful sphincter of Oddi botulinum toxin injection within a median of 6 (range 0-10) days before operation. One patient had an asymptomatic, self-limiting (48 hours) increase in serum amylase and lipase after injection. Distal pancreatectomy was performed in 24/29 patients; 5 patients were not resectable. Of the patients receiving botulinum toxin, 7 (29%) had increased amylase levels in drainage fluid on postoperative day 3 (the International Study Group of Pancreatic Surgery definition of postoperative pancreatic fistula grade A) without symptoms or need for reintervention. Importantly, no clinically relevant fistulas (International Study Group of Pancreatic Surgery grades B/C) were observed in botulinum toxin patients compared to 33% postoperative pancreatic fistula grade B/C in case-control patients (P botulinum toxin injection is a novel and safe approach to decrease the incidence of clinically relevant postoperative pancreatic fistula after distal pancreatectomy. The results of

A COMPARATIVE STUDY OF CONSERVATIVE MANAGEMENT VS. EXTERNAL FIXATION OF COMMINUTED DISTAL RADIUS FRACTURES

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Sanjeev Kumar Kare

2016-12-01

Full Text Available BACKGROUND Fracture of the distal radius (‘broken wrist’ is a common clinical problem. It can be treated conservatively usually involving wrist immobilisation in a plaster cast or surgically. A key method of surgical fixation is external fixation. MATERIALS AND METHODS A prospective study was carried out on 66 patients admitted between June 2014 to May 2016 for evaluation of conservative and surgical management of distal radius fractures. RESULTS Excellent, fair or good result was noticed in around 85% of cases managed conservatively and in above 90% of cases managed by external fixator. CONCLUSION There is some evidence to support the use of external fixation for dorsally displaced fractures of the distal radius in adults. Though, there is insufficient evidence to confirm a better functional outcome, external fixation reduces redisplacement gives improved anatomical results and most of the excess surgically-related complications are minor.

Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: Long-term oncologic outcomes after standard resection.

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Sahakyan, Mushegh A; Kim, Song Cheol; Kleive, Dyre; Kazaryan, Airazat M; Song, Ki Byung; Ignjatovic, Dejan; Buanes, Trond; Røsok, Bård I; Labori, Knut Jørgen; Edwin, Bjørn

2017-10-01

Surgical resection is the only curative option in patients with pancreatic ductal adenocarcinoma. Little is known about the oncologic outcomes of laparoscopic distal pancreatectomy. This bi-institutional study aimed to examine the long-term oncologic results of standard laparoscopic distal pancreatectomy in a large cohort of patients with pancreatic ductal adenocarcinoma. From January 2002 to March 2016, 207 patients underwent standard laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma at Oslo University Hospital-Rikshospitalet (Oslo, Norway) and Asan Medical Centre (Seoul, Republic of Korea). After the exclusion criteria were applied (distant metastases at operation, conversion to an open operation, loss to follow-up), 186 patients were eligible for the analysis. Perioperative and oncologic variables were analyzed for association with recurrence and survival. Median overall and recurrence-free survivals were 32 and 16 months, while 5-year overall and recurrence-free survival rates were estimated to be 38.2% and 35.9%, respectively. Ninety-six (52%) patients developed recurrence: 56 (30%) extrapancreatic, 27 (15%) locoregional, and 13 (7%) combined locoregional and extrapancreatic. Thirty-seven (19.9%) patients had early recurrence (within 6 months of operation). In the multivariable analysis, tumor size >3 cm and no adjuvant chemotherapy were associated with early recurrence (P = .017 and P = .015, respectively). The Cox regression model showed that tumor size >3 cm and lymphovascular invasion were independent predictors of decreased recurrence-free and overall survival. Standard laparoscopic distal pancreatectomy is associated with satisfactory long-term oncologic outcomes in patients with pancreatic ductal adenocarcinoma. Several risk factors, such as tumor size >3 cm, no adjuvant chemotherapy, and lymphovascular invasion, are linked to poor prognosis after standard laparoscopic distal pancreatectomy. Copyright © 2017 Elsevier Inc

Reprodutibilidade da atividade eletromiográfica em usuários de próteses totais durante simulação de atividades de vida diária = Reliability of EMG activity in complete denture users during simulation of activities of daily living

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Baldisserotto, Simone Michielon

2010-01-01

Full Text Available da atividade eletromiográfica dos músculos mastigatórios (m. temporal e m. masseter, posturais do pescoço (mm. esternocleidomastoideo e trapézio, posturais do tronco (mm. reto abdominal e paravertebrais e de força das extremidades inferiores (mm. reto femoral e gastrocnemius medial durante simulação de atividades de vida diária (AVDs. Metodologia: A amostra foi constituída por dez mulheres saudáveis, usuárias de prótese total bimaxilar, com idade média de 58,2 anos. Foram realizados três testes AVDs: levantar/sentar da cadeira (TCAD, levantar/deitar na cama (TCAM e pegar/largar sacolas (TSAC. A reprodutibilidade dos valores EMG foi analisada por teste-reteste. Para cada teste AVD foram estimados coeficiente de correlação intraclasse (CCIC e intervalo de confiança de 95% com estratificação por músculo, condição com e sem prótese (suporte oclusal e movimento durante o teste, considerando três repetições por sujeito para avaliar consistência. Resultados: Todos os grupos musculares apresentaram ativação durante os testes simulando AVDs. O método utilizado mostrou reprodutibilidade satisfatória com CCICs considerados moderados a altos. Os maiores valores de CCIC foram estimados para os m. esternocleidomastoideo (0,82 a 0,97 e m. paravertebrais (0,86 a 0,99. Conclusão: Os resultados sugerem que o método de EMG cinesiológico descrito apresentou reprodutibilidade satisfatória nesta amostra

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)

Laparoscopic Transvesical Resection of an En Bloc Bladder Cuff and Distal Ureter during Nephroureterectomy

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Stilianos Giannakopoulos

2012-01-01

Full Text Available Objective. The most appropriate technique for excising the distal ureter and bladder cuff during laparoscopic nephroureterectomy is still debated. We report our experience with a pure laparoscopic transvesical method that duplicates the long-standing open transvesical approach. Materials and Methods. Seven men and three women diagnosed with upper tract transitional cell carcinoma were treated with this procedure. Three intravesical ports were inserted, and pneumovesicum was established at 12 mmHg. Transvesical laparoscopic circumferential detachment of the bladder cuff and en bloc mobilization of the last centimeters of the distal ureter were performed, followed by the closure of the bladder defect. Subsequently, a nephrectomy was performed either laparoscopically or using an open flank approach. Results. The median age was 68.5 years. The procedure was completed uneventfully in all cases. The median operating time for distal ureter excision was 82.5 minutes (range 55–120. No complications directly related to the pneumovesicum method were recorded. The median follow-up period was 31 months (range 12–55. During the follow-up period, two patients (20% died from the disease, and a bladder tumor developed in three cases (30%. Conclusion. The laparoscopic transvesical resection of the en bloc bladder cuff and distal ureter is a reliable, effective, and oncologically safe technique, at least in the midterm.

The influence of distal-end heat treatment on deflection of nickel-titanium archwire.

Science.gov (United States)

Silva, Marcelo Faria da; Pinzan-Vercelino, Célia Regina Maia; Gurgel, Júlio de Araújo

2016-01-01

The aim of this in vitro study was to evaluate the deflection-force behavior of nickel-titanium (NiTi) orthodontic wires adjacent to the portion submitted to heat treatment. A total of 106 segments of NiTi wires (0.019 x 0.025-in) and heat-activated NiTi wires (0.016 x 0.022-in) from four commercial brands were tested. The segments were obtained from 80 archwires. For the experimental group, the distal portion of each segmented archwire was subjected to heat treatment (n = 40), while the other distal portion of the same archwire was used as a heating-free control group (n = 40). Deflection tests were performed in a temperature-controlled universal testing machine. Unpaired Student's t-tests were applied to determine if there were differences between the experimental and control groups for each commercial brand and size of wire. Statistical significance was set at p wire. Heat treatment applied to the distal ends of rectangular NiTi archwires does not permanently change the elastic properties of the adjacent portions.

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.

[Intramedullary nailing of the distal tibia illustrated with the Expert(TM) tibia nail].

Science.gov (United States)

El Attal, R; Hansen, M; Rosenberger, R; Smekal, V; Rommens, P M; Blauth, M

2011-12-01

Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare and to maintain joint mobility. Good bony healing in closed and open fractures. Closed and open fractures of the tibia and complete lower leg fractures distal to the isthmus (AO 42), extraarticular fractures of the distal tibia (AO 43 A1/A2/A3), segmental fractures of the tibia with a fracture in the distal tibia, and certain intraarticular fractures of the distal tibia without impression of the joint line with the use of additional implants (AO 43 C1) Patient in reduced general condition (e.g., bed ridden), flexion of the knee of less than 90°, patients with knee arthroplasty of the affected leg, infection in the area of the nail's insertion, infection of the tibial cavity, complex articular fractures of the proximal or distal tibia with joint depression. Closed reduction of the fracture preferably on a fracture table or using a distractor or an external fixation frame. If necessary, use pointed reduction clamps or sterile drapery. In some cases, additional implants like percutaneous small fragment screws, poller screws or k-wires are helpful. Open reduction is rarely necessary and must be avoided. Opening of the proximal tibia in line with the medullary canal. Canulated insertion of the Expert(TM) tibia nail (ETN; Synthes GmbH, Oberdorf, Switzerland) with reaming of the medullary canal. Control of axis, length, and rotation. Distal interlocking with the radiolucent drill and proximal interlocking with the targeting device. Immediate mobilization of ankle and knee joint. Mobilization with 20 kg weight-bearing with crutches. X-ray control 6 weeks postoperatively and increased weight-bearing depending on the fracture status. In cases with simple fractures, good bony contact, or transverse fracture pattern, full weight-bearing at the end of week 6 is targeted. Between July 2004 and May 2005, 180 patients were included in a

Closed treatment of overriding distal radial fractures without reduction in children.

Science.gov (United States)

Crawford, Scott N; Lee, Lorrin S K; Izuka, Byron H

2012-02-01

Traditionally, distal radial fractures with marked displacement and angulation have been treated with closed or open reduction techniques. Reduction maneuvers generally require analgesia and sedation, which increase hospital time, cost, patient risk, and the surgeon's time. In our study, a treatment protocol for pediatric distal radial fractures was used in which the fracture was left shortened in an overriding position and a cast was applied without an attempt at anatomic fracture reduction. Consecutive patients three to ten years of age presenting between 2004 and 2009 with a closed overriding fracture of the distal radial metaphysis were followed prospectively. Our protocol consisted of no analgesia, no sedation, and a short arm fiberglass cast gently molded to correct only angulation. Patients were followed for at least one year. All parents or guardians were given a questionnaire assessing their satisfaction with the treatment. Financial analysis was performed with use of Current Procedural Terminology codes and the average total cost of care. Fifty-one children with an average age of 6.9 years were included in the study. Initial radial shortening averaged 5.0 mm. Initial sagittal and coronal angulation averaged 4.0° and 3.2°, respectively. The average duration of casting was forty-two days. Residual sagittal and coronal angulation at the time of final follow-up averaged 2.2° and 0.8°, respectively. All fifty-one patients achieved clinical and radiographic union with a full range of wrist motion. All parents and guardians answered the questionnaire and were satisfied with the treatment. Cost analysis demonstrated that closed reduction with the patient under conscious sedation or general anesthesia is nearly five to six times more expensive than the treatment used in this study. Adding percutaneous pin fixation increases costs nearly ninefold. This treatment protocol presents an alternative approach to overriding distal radial fractures in children and

[Distal radius fractures--retrospective quality control after conservative and operative therapy].

Science.gov (United States)

Sommer, C; Brendebach, L; Meier, R; Leutenegger, A

2001-01-01

The distal radius fracture is the most frequent fracture in the adult patient. The wide spectrum of different types of fracture and the coexisting factors make the choice for the optimal treatment difficult. As an interne quality control we retrospectively evaluated all patients with distal radius fractures treated in 1995 at our institution. The study included 69 adult patients with 71 distal radius fractures. After on average 26 months 58 patients with 59 fractures were clinically and radiologically evaluated. The patients were asked to give supplementary information about their follow-up treatment as well as any remaining physical difficulties and limitations in the daily life. All x-rays of the broken radius were carefully analysed and compared with the opposite side. The final results were evaluated according to the "Demerit Point System". Patients were treated with five different therapeutical methods. 76.3% of the patients showed a very good/good final result. In 56.7% of the cases secondary fracture dislocation occurred; the dislocation-rate of fractures treated with percutaneous k-wires was 93.3%! A clear correlation between secondary displacement and final results was found. A main factor for an optimal outcome is the anatomic restoration of length and axis of the distal radius as well as of joint congruency, also moderate angular deformities are well tolerated. Our collective showed an unexpected high rate of secondary displacement, especially in the k-wire group. The reasons for this unsatisfactory event are manifold: too optimistic indication, insufficient follow-up examination in the first four to six weeks, inconsequent change to a more stable fixation method in case of a secondary dislocation. The results of this retrospective evaluation had a major impact on our concept of treatment. The dorso-radial double-plate technique combined with bone graft will be more used in the future especially in younger patients. The new standardised concept is the

"Osteoporosis and orthopods" incidences of osteoporosis in distal radius fracture from low energy trauma.

LENUS (Irish Health Repository)

Bahari, Syah