Combination of Nasolabial V-Y Advancement Flap and Glabellar Subcutaneous Pedicled Flap for Reconstruction of Medial Canthal Defect

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Hiromichi Matsuda

2014-02-01

Full Text Available A 77-year-old woman presented with a 1-year history of a right medial canthal tumor, which was histopathologically diagnosed as a basal cell carcinoma. After removal of the tumor with a 4-mm safety margin, the defect occupied the areas superior and inferior to the medial canthal tendon. We first reconstructed the lower part of the defect using a nasolabial V-Y advancement flap to make an elliptic defect in the upper part. We then created a glabellar subcutaneous pedicled flap to match the residual upper elliptic defect with the major axis set along a relaxed skin tension line. The pedicled glabellar flap was passed through a subcutaneous tunnel to the upper residual defect. At 6 months postoperatively, the patient showed no tumor recurrence and a good cosmetic outcome.

Adjacent-segment disease after thoracic pedicle screw fixation.

Science.gov (United States)

Agarwal, Nitin; Heary, Robert F; Agarwal, Prateek

2018-03-01

OBJECTIVE Pedicle screw fixation is a technique widely used to treat conditions ranging from spine deformity to fracture stabilization. Pedicle screws have been used traditionally in the lumbar spine; however, they are now being used with increasing frequency in the thoracic spine as a more favorable alternative to hooks, wires, or cables. Although safety concerns, such as the incidence of adjacent-segment disease (ASD) after cervical and lumbar fusions, have been reported, such issues in the thoracic spine have yet to be addressed thoroughly. Here, the authors review the literature on ASD after thoracic pedicle screw fixation and report their own experience specifically involving the use of pedicle screws in the thoracic spine. METHODS Select references from online databases, such as PubMed (provided by the US National Library of Medicine at the National Institutes of Health), were used to survey the literature concerning ASD after thoracic pedicle screw fixation. To include the authors' experience at Rutgers New Jersey Medical School, a retrospective review of a prospectively maintained database was performed to determine the incidence of complications over a 13-year period in 123 consecutive adult patients who underwent thoracic pedicle screw fixation. Children, pregnant or lactating women, and prisoners were excluded from the review. By comparing preoperative and postoperative radiographic images, the occurrence of thoracic ASD and disease within the surgical construct was determined. RESULTS Definitive radiographic fusion was detected in 115 (93.5%) patients. Seven incidences of instrumentation failure and 8 lucencies surrounding the screws were observed. One patient was observed to have ASD of the thoracic spine. The mean follow-up duration was 50 months. CONCLUSIONS This long-term radiographic evaluation revealed the use of pedicle screws for thoracic fixation to be an effective stabilization modality. In particular, ASD seems to be less of a problem in the

Traumatic Fracture of Thin Pedicles Secondary to Extradural ...

African Journals Online (AJOL)

sequelae, secondary to local mass effect. Our objective is to report a technical case report, illustrating a traumatic spinal injury with multiple pedicle fractures, secondary to atrophic lumbar pedicles as well as the diagnostic workup and surgical management of this problem. Posterior lumbar decompression, resection of the ...

Does intraoperative navigation improve the accuracy of pedicle screw placement in the apical region of dystrophic scoliosis secondary to neurofibromatosis type I: comparison between O-arm navigation and free-hand technique.

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Jin, Mengran; Liu, Zhen; Liu, Xingyong; Yan, Huang; Han, Xiao; Qiu, Yong; Zhu, Zezhang

2016-06-01

To assess the accuracy of O-arm-navigation-based pedicle screw insertion in dystrophic scoliosis secondary to NF-1 and compare it with free-hand pedicle screw insertion technique. 32 patients with dystrophic NF-1-associated scoliosis were divided into two groups. A total of 92 pedicle screws were implanted in apical region (two vertebrae above and below the apex each) in 13 patients using O-arm-based navigation (O-arm group), and 121 screws were implanted in 19 patients using free-hand technique (free-hand group). The postoperative CT images were reviewed and analyzed for pedicle violation. The screw penetration was divided into four grades: grade 0 (ideal placement), grade 1 (penetration 4 mm). The accuracy rate of pedicle screw placement (grade 0, 1) was significantly higher in the O-arm group (79 %, 73/92) compared to 67 % (81/121) of the free-hand group (P = 0.045). Meanwhile, a significantly lower prevalence of grade 2-3 perforation was observed in the O-arm group (21 vs. 33 %, P arm navigation compared to free-hand technique (2 vs. 15 %, P arm navigation (58 vs. 42 %, P arm-based pedicle screw placement in dystrophic NF-1-associated scoliosis. O-arm navigation system does facilitate pedicle screw insertion in dystrophic NF-1-associated scoliosis, demonstrating superiorities in the safety and accuracy of pedicle screw placement in comparison with free-hand technique.

Versatility of the facial artery myomucosal island flap in neopharyngeal reconstruction

DEFF Research Database (Denmark)

Frisch, Thomas

2017-01-01

: Vitality of the flap was ascertained by fiber endoscopy. No donor-site morbidity was seen. Postoperatively, the patient had a minor stomal fistula with spontaneous healing. CONCLUSION: The pedicled FAMM island flap may be considered for smaller reconstructions of the upper hypopharynx. Accessibility, low...

History of Retractor Technologies for Percutaneous Pedicle Screw Fixation Systems.

Science.gov (United States)

Mobbs, Ralph J; Phan, Kevin

2016-02-01

Minimally invasive techniques aimed at minimizing surgery-associated risk and morbidity of spinal surgery have increased in popularity in recent years. Their potential advantages include reduced length of hospital stay, blood loss, and requirement for post-operative analgesia and earlier return to work. One such minimally invasive technique is the use of percutaneous pedicle screw fixation, which is paramount for promoting rigid and stable constructs and fusion in the context of trauma, tumors, deformity and degenerative disease. Percutaneous pedicle screw insertion can be an intimidating prospect for surgeons who have only been trained in open techniques. One of the ongoing challenges of this percutaneous system is to provide the surgeon with adequate access to the pedicle entry anatomy and adequate tactile or visual feedback concerning the position and anatomy of the rod and set-screw construct. This review article discusses the history and evolution of percutaneous pedicle screw retractor technologies and outlines the advances over the last decade in the rapidly expanding field of minimal access surgery for posterior pedicle screw based spinal stabilization. As indications for percutaneous pedicle screw techniques expand, the nuances of the minimally invasive surgery techniques and associated technologies will also multiply. It is important that experienced surgeons have access to tools that can improve access with a greater degree of ease, simplicity and safety. We here discuss the technical challenges of percutaneous pedicle screw retractor technologies and a variety of systems with a focus on the pros and cons of various retractor systems. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Comparison of Expansive Pedicle Screw and Polymethylmethacrylate-Augmented Pedicle Screw in Osteoporotic Sheep Lumbar Vertebrae: Biomechanical and Interfacial Evaluations

OpenAIRE

Liu, Da; Zhang, Yi; Zhang, Bo; Xie, Qing-yun; Wang, Cai-ru; Liu, Jin-biao; Liao, Dong-fa; Jiang, Kai; Lei, Wei; Pan, Xian-ming

2013-01-01

BACKGROUND: It was reported that expansive pedicle screw (EPS) and polymethylmethacrylate-augmented pedicle screw (PMMA-PS) could be used to increase screw stability in osteoporosis. However, there are no studies comparing the two kinds of screws in vivo. Thus, we aimed to compare biomechanical and interfacial performances of EPS and PMMA-PS in osteoporotic sheep spine. METHODOLOGY/PRINCIPAL FINDINGS: After successful induction of osteoporotic sheep, lumbar vertebrae in each sheep were random...

Accuracy of pedicle screw placement in patients with Marfan syndrome.

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Qiao, Jun; Zhu, Feng; Xu, Leilei; Liu, Zhen; Sun, Xu; Qian, Bangping; Jiang, Qing; Zhu, Zezhang; Qiu, Yong

2017-03-21

There is no study concerning safety and accuracy of pedicle screw placement in Marfan syndrome. The objective of this study is to investigate accuracy and safety of pedicle screw placement in scoliosis associated with Marfan syndrome. CT scanning was performed to analyze accuracy of pedicle screw placement. Pedicle perforations were classified as medial, lateral or anterior and categorized to four grades: ≤ 2 mm as Grade 1, 2.1-4.0 mm as Grade 2, 4.1-6.0 mm as Grade 3, ≥6.1 mm as Grade 4. Fully contained screws or with medial wall perforation ≤ 2 mm or with lateral wall perforation ≤ 6 mm and without injury of visceral organs were considered acceptable, otherwise were unacceptable. 976 pedicle screws were placed, 713 screws (73.1%) were fully contained within the cortical boundaries of the pedicle. 924 (94.7%) screws were considered as acceptable, and 52 (5.3%) as unacceptable. The perforation rate was higher using free-hand technique than O-arm navigation technique (30.8% VS. 11.4%, P Marfan syndrome is accuracy and safe. O-arm navigation was an effective modality to ensure the safety and accuracy of screw placement. Special attention should be paid when screws were placed at the lumber spine and the concave side of spine deformity to avoid the higher rate of complications.

Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading.

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Lindtner, Richard A; Schmid, Rene; Nydegger, Thomas; Konschake, Marko; Schmoelz, Werner

2018-03-01

Pedicle screw loosening is a common and significant complication after posterior spinal instrumentation, particularly in osteoporosis. Radiolucent carbon fiber-reinforced polyetheretherketone (CF/PEEK) pedicle screws have been developed recently to overcome drawbacks of conventional metallic screws, such as metal-induced imaging artifacts and interference with postoperative radiotherapy. Beyond radiolucency, CF/PEEK may also be advantageous over standard titanium in terms of pedicle screw loosening due to its unique material properties. However, screw anchorage and loosening of CF/PEEK pedicle screws have not been evaluated yet. The aim of this biomechanical study therefore was to evaluate whether the use of this alternative nonmetallic pedicle screw material affects screw loosening. The hypotheses tested were that (1) nonmetallic CF/PEEK pedicle screws resist an equal or higher number of load cycles until loosening than standard titanium screws and that (2) PMMA cement augmentation further increases the number of load cycles until loosening of CF/PEEK screws. In the first part of the study, left and right pedicles of ten cadaveric lumbar vertebrae (BMD 70.8 mg/cm 3  ± 14.5) were randomly instrumented with either CF/PEEK or standard titanium pedicle screws. In the second part, left and right pedicles of ten vertebrae (BMD 56.3 mg/cm 3  ± 15.8) were randomly instrumented with either PMMA-augmented or nonaugmented CF/PEEK pedicle screws. Each pedicle screw was subjected to cyclic cranio-caudal loading (initial load ranging from - 50 N to + 50 N) with stepwise increasing compressive loads (5 N every 100 cycles) until loosening or a maximum of 10,000 cycles. Angular screw motion ("screw toggling") within the vertebra was measured with a 3D motion analysis system every 100 cycles and by stress fluoroscopy every 500 cycles. The nonmetallic CF/PEEK pedicle screws resisted a similar number of load cycles until loosening as the contralateral standard

Current trends in pedicle screw stimulation techniques: lumbosacral, thoracic, and cervical levels.

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Isley, Michael R; Zhang, Xiao-Feng; Balzer, Jeffrey R; Leppanen, Ronald E

2012-06-01

Unequivocally, pedicle screw instrumentation has evolved as a primary construct for the treatment of both common and complex spinal disorders. However an inevitable and potentially major complication associated with this type of surgery is misplacement of a pedicle screw(s) which may result in neural and vascular complications, as well as impair the biomechanical stability of the spinal instrumentation resulting in loss of fixation. In light of these potential surgical complications, critical reviews of outcome data for treatment of chronic, low-back pain using pedicle screw instrumentation concluded that "pedicle screw fixation improves radiographically demonstrated fusion rates;" however the expense and complication rates for such constructs are considerable in light of the clinical benefit (Resnick et al. 2005a). Currently, neuromonitoring using free-run and evoked (triggered) electromyography (EMG) is widely used and advocated for safer and more accurate placement of pedicle screws during open instrumentation procedures, and more recently, guiding percutaneous placement (minimally invasive) where the pedicle cannot be easily inspected visually. The latter technique, evoked or triggered EMG when applied to pedicle screw instrumentation surgeries, has been referred to as the pedicle screw stimulation technique. As concluded in the Position Statement by the American Society of Neurophysiological Monitoring (ASNM), multimodality neuromonitoring using free-run EMG and the pedicle screw stimulation technique was considered a practice option and not yet a standard of care (Leppanen 2005). Subsequently, the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Joint Section on Disorders of the Spine and Peripheral Nerves published their "Guidelines for the Performance of Fusion Procedures for Degenerative Disease of the Lumbar Spine" (Heary 2005, Resnick et al. 2005a, Resnick et al. 2005b). It was concluded that the "primary

Ball tip method for thoracic pedicle screw placement in patients with adolescent idiopathic scoliosis

International Nuclear Information System (INIS)

Watanabe, Kota; Matsumoto, Morio; Iizuka, Shingo

2008-01-01

The purpose of this study was to evaluate the efficacy of ball tip method for thoracic pedicle screw placements in idiopathic scoliosis patients. 24 patients with adolescent idiopathic scoliosis were included in this study. Conventional method was performed in 12 patients. Ball tip method was performed in 12 patients. Accuracy of the pedicle screw placement was evaluated based on the postoperative CT. In the ball tip method, a probe which was consisted of ball tip with flexible shaft was used. After removing of cortical bone at a starting point, the probe was inserted manually or sometimes with gently tapping by hammer. During the maneuver, the probe will gradually progress into cancellous bone in the pedicle, without perforating cortical bone in the pedicle. Following expansion of the hole by a rigid gear shift probe, screw was placed in the pedicle. 65.1% of screws were located within pedicle in the conventional group and 86.5% in the ball tip group. 5.3% of screws were located out of pedicle within 2 mm in the conventional group and 8.2% in the ball tip group. 15.8% of screws were located out of pedicle beyond 2 mm and 1.8% in the ball tip group. The ball tip method enhanced the accuracy of thoracic pedicle screw placements in adolescent idiopathic scoliosis patients. The ball tip method may be effective for accurate pedicle screw placement in patients with adolescent idiopathic scoliosis. (author)

Cervical Fusion for Absent Pedicle Syndrome Manifesting with Myelopathy.

Science.gov (United States)

Goodwin, C Rory; Desai, Atman; Khattab, Mohamed H; Elder, Benjamin D; Bydon, Ali; Wolinsky, Jean-Paul

2016-02-01

Absent congenital pedicle syndrome is a posterior arch defect characterized by numerous congenital and mechanical abnormalities that result from disconnection of the anterior and posterior columns of the spinal canal. Absent congenital pedicle syndrome is a rare anomaly that is most commonly diagnosed incidentally, after evaluation of minor trauma, or after complaints of chronic neck pain. We report a case of absent congenital pedicle syndrome in a patient who presented with myelopathy and lower extremity weakness and review the literature on the surgical management of this entity. A 32-year-old woman with a history of systemic lupus erythematosus presented to the Neurosurgery Service with progressive weakness in her upper and lower extremities, clonus, and hyperreflexia. Magnetic resonance imaging revealed congenital absence of the pedicles of C2, C3, C4, C5, and C6 with a congenitally narrow canal at C4-5. The patient underwent a staged anterior and posterior cervical decompression and fusion. She was placed in a halo after surgery; at the 1-year follow-up, she was ambulatory with demonstrated improvement in weakness and fusion of her cervical spine. Absent congenital pedicle syndrome is rare, and most reported cases were treated conservatively. Surgical management is reserved for patients with myelopathy or instability. Copyright © 2016 Elsevier Inc. All rights reserved.

Pullout strength of misplaced pedicle screws in the thoracic and lumbar vertebrae - A cadaveric study

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Shyam K Saraf

2013-01-01

Full Text Available Background: The objective of this cadaveric study was to analyze the effects of iatrogenic pedicle perforations from screw misplacement on the mean pullout strength of lower thoracic and lumbar pedicle screws. We also investigated the effect of bone mineral density (BMD, diameter of pedicle screws, and the region of spine on the pullout strength of pedicle screws. Materials and Methods: Sixty fresh human cadaveric vertebrae (D10-L2 were harvested. Dual-energy X-ray absorptiometry (DEXA scan of vertebrae was done for BMD. Titanium pedicle screws of different diameters (5.2 and 6.2 mm were inserted in the thoracic and lumbar segments after dividing the specimens into three groups: a standard pedicle screw (no cortical perforation; b screw with medial cortical perforation; and c screw with lateral cortical perforation. Finally, pullout load of pedicle screws was recorded using INSTRON Universal Testing Machine. Results: Compared with standard placement, medially misplaced screws had 9.4% greater mean pullout strength and laterally misplaced screws had 47.3% lesser mean pullout strength. The pullout strength of the 6.2 mm pedicle screws was 33% greater than that of the 5.2 mm pedicle screws. The pullout load of pedicle screws in lumbar vertebra was 13.9% greater than that in the thoracic vertebra ( P = 0.105, but it was not statistically significant. There was no significant difference between pullout loads of vertebra with different BMD ( P = 0.901. Conclusion: The mean pullout strength was less with lateral misplaced pedicle screws while medial misplaced pedicle screw had more pullout strength. The pullout load of 6.2 mm screws was greater than that of 5.2 mm pedicle screws. No significant correlation was found between bone mineral densities and the pullout strength of vertebra. Similarly, the pullout load of screw placed in thoracic and lumbar vertebrae was not significantly different.

Pedicle measurement of the thoracolumbar spine: a cadaveric, radiographic, and CT scan study in Filipinos

International Nuclear Information System (INIS)

Molano, A.M.V.; Sison, A.B.; Fong, H.C.; Lim, N.T.; Sabile, K.

1994-01-01

With the popular usage of spinal pedicular screw fixation, it is essential to have a knowledge of the morphometry of the pedicles of the spine of particular populations. This study compared the direct pedicle measurements of ten cadavers in an institution, with their respective radiographic and computerized tomographic (CT) scan values, and also compared the effective pedicle diameter (EPD) with the conventional outer pedicle diameter (OPD) measurements. A compilation of pedicle values was also made in X-ray and CT scan plates of a Filipino population. A statistical analysis made on the 2,760 pedicle measurements taken from cadaveric T6-L5 vertebrae showed that direct measurements were significantly different from X-ray and CT scan values. The mean values of the EPD differed from those of the OPD, but not statistically significant. Comparison with previous foreign studies revealed significant differences in these pedicle dimensions. Pedicle measurements in a living Filipino population were found to be significantly different statistically between sexes. Accurate measurement of the pedicle diameters and lengths are indeed critical for the success of a spinal stabilization procedure using pedicular screws. (author). 8 refs.; 5 figs.; 1 tab

Unilateral Pedicle Stress Fracture in a Long-Term Hemodialysis Patient with Isthmic Spondylolisthesis

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Keishi Maruo

2015-01-01

Full Text Available Most unilateral pedicle stress fractures occur on the contralateral side of patients with unilateral spondylolysis. However, there are few reports of unilateral pedicle stress fractures in patients with bilateral spondylolysis and spondylolisthesis. We report a unique case of unilateral pedicle stress fracture in a long-term hemodialysis patient with isthmic spondylolisthesis. A 65-year-old man who had undergone hemodialysis presented with lower back pain that had persisted for several years. The patient experienced severe right lower extremity pain with no history of trauma. Computed tomography revealed unilateral pedicle fracture with bilateral L5 spondylolysis and spondylolisthesis with progression of scoliosis. The patient underwent Gill laminectomy of L5 with pedicle screw fixation at L4-S1 and interbody fusion at L5-S1. The patient’s leg pain ceased immediately, and he began walking without leg pain. In our present patient, development of scoliosis caused by destructive spondyloarthropathy may have contributed to a unilateral pedicle fracture.

Tapping insertional torque allows prediction for better pedicle screw fixation and optimal screw size selection.

Science.gov (United States)

Helgeson, Melvin D; Kang, Daniel G; Lehman, Ronald A; Dmitriev, Anton E; Luhmann, Scott J

2013-08-01

There is currently no reliable technique for intraoperative assessment of pedicle screw fixation strength and optimal screw size. Several studies have evaluated pedicle screw insertional torque (IT) and its direct correlation with pullout strength. However, there is limited clinical application with pedicle screw IT as it must be measured during screw placement and rarely causes the spine surgeon to change screw size. To date, no study has evaluated tapping IT, which precedes screw insertion, and its ability to predict pedicle screw pullout strength. The objective of this study was to investigate tapping IT and its ability to predict pedicle screw pullout strength and optimal screw size. In vitro human cadaveric biomechanical analysis. Twenty fresh-frozen human cadaveric thoracic vertebral levels were prepared and dual-energy radiographic absorptiometry scanned for bone mineral density (BMD). All specimens were osteoporotic with a mean BMD of 0.60 ± 0.07 g/cm(2). Five specimens (n=10) were used to perform a pilot study, as there were no previously established values for optimal tapping IT. Each pedicle during the pilot study was measured using a digital caliper as well as computed tomography measurements, and the optimal screw size was determined to be equal to or the first size smaller than the pedicle diameter. The optimal tap size was then selected as the tap diameter 1 mm smaller than the optimal screw size. During optimal tap size insertion, all peak tapping IT values were found to be between 2 in-lbs and 3 in-lbs. Therefore, the threshold tapping IT value for optimal pedicle screw and tap size was determined to be 2.5 in-lbs, and a comparison tapping IT value of 1.5 in-lbs was selected. Next, 15 test specimens (n=30) were measured with digital calipers, probed, tapped, and instrumented using a paired comparison between the two threshold tapping IT values (Group 1: 1.5 in-lbs; Group 2: 2.5 in-lbs), randomly assigned to the left or right pedicle on each

The application of data measurement before the pedicle vertebral arch fixed operation with spiral CT

International Nuclear Information System (INIS)

Yang Zenian; Luo Zhongyao; Chen Yong'an

2003-01-01

Objective: Authors carry out volume scans and 3D surface reconstruction. Then authors get the precise data of pedicle of vertebral arch, entering nail angle on horizontal direction, entering nail screw length, and the smallest horizontal diameter and entering nails' distance on pedicle of vertebral arch before the pedicle vertebral arch fixed operation. Method: Select the axial image of the widest pedicle of vertebral arch and it SSD image, measure the entering nail distance on the pedicle of vertebral arch, TSA, entering nail screw length, and the smallest horizontal diameter of the pedicle of vertebral arch. Result: The method helps to prepare the length, size and location of the nail and TSA for the pedicle of vertebral arch fixed operation, increase the operation success rate. Conclusion: This is a simple and reliable method to prepare the precise data of the nail length and size, TSA for the operation

Distally based sural neuro-fasciocutaneous perforator flap for foot and ankle reconstruction: Surgical modifications for flap pedicle and donor site closure without skin graft.

Science.gov (United States)

Chi, Zhenglin; Chen, Yiheng; Chu, Tinggang; Gao, Weiyang; Li, Zhijie; Yan, Hede; Song, Yonghuan

2018-02-01

The conventional procedure of the sural neuro-fasciocutaneous flap enables the supply of blood and venous drainage by increasing the width of the adipofascial tissue and preserving tiny venous return routes. Moreover, skin graft is a common method for donor site closure, which may lead to some complications and influence the aesthetic appearance. We report modifications for a distally based sural neuro-fasciocutaneous perforator flap and a relaying flap for donor site closure without skin graft. Twelve patients undergoing the modified flap for foot and ankle reconstruction were included in this study between 2014 and 2016. A peroneal-based perforator, a superficial vein, and the vascular axis of the sural nerve were included in the pedicle. A Z-shape skin incision was performed to explore the perforator vessels and a relaying island perforator flap was used to close the donor site. All flaps survived completely without necrosis. The area of the flaps ranged from 16 × 8 cm to 30 × 15 cm. The diameter width of the pedicle ranged from 1.0 to 2.0 cm. A relaying perforator island flap was used in 10 cases for donor site closure and no skin graft was performed. There were no serious donor site complications. All patients were satisfied with the aesthetic outcome postoperatively at the final follow-up. The distally based sural neuro-fasciocutaneous perforator flap is considered a reliable method for foot and ankle reconstruction. The modification for flap pedicle and donor site closure method without skin graft should be recommended. Copyright © 2017. Published by Elsevier Ltd.

Effects of lake trout refuges on lake whitefish and cisco in the Apostle Islands Region of Lake Superior

Science.gov (United States)

Zuccarino-Crowe , Chiara M.; Taylor, William W.; Hansen, Michael J.; Seider, Michael J.; Krueger, Charles C.

2016-01-01

Lake trout refuges in the Apostle Islands region of Lake Superior are analogous to the concept of marine protected areas. These refuges, established specifically for lake trout (Salvelinus namaycush) and closed to most forms of recreational and commercial fishing, were implicated as one of several management actions leading to successful rehabilitation of Lake Superior lake trout. To investigate the potential significance of Gull Island Shoal and Devils Island Shoal refuges for populations of not only lake trout but also other fish species, relative abundances of lake trout, lake whitefish (Coregonus clupeaformis), and cisco (Coregonus artedi) were compared between areas sampled inside versus outside of refuge boundaries. During 1982–2010, lake trout relative abundance was higher and increased faster inside the refuges, where lake trout fishing was prohibited, than outside the refuges. Over the same period, lake whitefish relative abundance increased faster inside than outside the refuges. Both evaluations provided clear evidence that refuges protected these species. In contrast, trends in relative abundance of cisco, a prey item of lake trout, did not differ significantly between areas inside and outside the refuges. This result did not suggest indirect or cascading refuge effects due to changes in predator levels. Overall, this study highlights the potential of species-specific refuges to benefit other fish species beyond those that were the refuges' original target. Improved understanding of refuge effects on multiple species of Great Lakes fishes can be valuable for developing rationales for refuge establishment and predicting associated fish community-level effects.

The biomechanical consequences of rod reduction on pedicle screws: should it be avoided?

Science.gov (United States)

Paik, Haines; Kang, Daniel G; Lehman, Ronald A; Gaume, Rachel E; Ambati, Divya V; Dmitriev, Anton E

2013-11-01

Rod contouring is frequently required to allow for appropriate alignment of pedicle screw-rod constructs. When residual mismatch is still present, a rod persuasion device is often used to achieve further rod reduction. Despite its popularity and widespread use, the biomechanical consequences of this technique have not been evaluated. To evaluate the biomechanical fixation strength of pedicle screws after attempted reduction of a rod-pedicle screw mismatch using a rod persuasion device. Fifteen 3-level, human cadaveric thoracic specimens were prepared and scanned for bone mineral density. Osteoporotic (n=6) and normal (n=9) specimens were instrumented with 5.0-mm-diameter pedicle screws; for each pair of comparison level tested, the bilateral screws were equal in length, and the screw length was determined by the thoracic level and size of the vertebra (35 to 45 mm). Titanium 5.5-mm rods were contoured and secured to the pedicle screws at the proximal and distal levels. For the middle segment, the rod on the right side was intentionally contoured to create a 5-mm residual gap between the inner bushing of the pedicle screw and the rod. A rod persuasion device was then used to engage the setscrew. The left side served as a control with perfect screw/rod alignment. After 30 minutes, constructs were disassembled and vertebrae individually potted. The implants were pulled in-line with the screw axis with peak pullout strength (POS) measured in Newton (N). For the proximal and distal segments, pedicle screws on the right side were taken out and reinserted through the same trajectory to simulate screw depth adjustment as an alternative to rod reduction. Pedicle screws reduced to the rod generated a 48% lower mean POS (495±379 N) relative to the controls (954±237 N) (p.05). In circumstances where a rod is not fully seated within the pedicle screw, the use of a rod persuasion device decreases the overall POS and work energy to failure of the screw or results in outright

L5 pedicle length is increased in subjects with spondylolysis: an anatomic study of 1072 cadavers.

Science.gov (United States)

Bajwa, Navkirat S; Toy, Jason O; Ahn, Nicholas U

2012-11-01

In spondylolisthesis, it is believed that as L5 slips on S1, the pedicle may become elongated in response to the instability in an attempt to bridge the defect. Whether patients with spondylolysis, which is largely developmental, also develop elongation of the pedicles is unknown. The purpose of this study is to evaluate and quantify the increase in L5 pedicle length in subjects with spondylolysis as compared with normal healthy subjects. Nine hundred fifty-two human cadaveric specimens without spondylolysis and 120 specimens with spondylolysis from the Hamann-Todd Osteological Collection were examined by a single examiner. Baseline data, including age, sex, and race of specimens, were collected. Digital calipers were used to measure the pedicle lengths at the L5 level. Linear regression analysis was performed to compare the L5 pedicle lengths in healthy patients and patients with spondylolysis. Linear regression showed a significant association of increased L5 pedicle length in subjects with spondylolysis. The average L5 pedicle length in subjects with spondylolysis was greater compared with subjects without spondylolysis. In spondylolytic specimens, pedicles start to elongate after the age of 40 years. The pedicle lengths increase progressively from 5.6 mm at 40 years to 6.7 mm at 80 years with a 1% to 3% increment every decade. The pedicle lengths showed little variation in specimens from healthy subjects. In spondylolytic specimens, there is progressive elongation of L5 pedicle length after the third decade. An increase in L5 pedicle length in all age groups compared with the specimens from healthy subjects suggests that pathologic changes occur in bony anatomy of L5 vertebrae as early as adolescence when the condition develops.

In vitro validation of a novel mechanical model for testing the anchorage capacity of pedicle screws using physiological load application.

Science.gov (United States)

Liebsch, Christian; Zimmermann, Julia; Graf, Nicolas; Schilling, Christoph; Wilke, Hans-Joachim; Kienle, Annette

2018-01-01

each case between 140N and 280N, while abrupt failures of the specimen were observed only in vitro. In the mechanical testing model, no translational motion was detected in the screw entry point, while in vitro, translational motions of up to 2.5mm in inferior direction were found, leading to a slight shift of the centre of rotation towards the screw tip. Translational motions of the screw tip of about 5mm in superior direction were observed both in vitro and in the mechanical testing model, while they were continuous in the mechanical testing model and rapidly increasing after screw loosening initiation in vitro. The overall pedicle screw loosening characteristics were qualitatively and quantitatively similar between the mechanical testing model and the human vertebral specimens as long as there was no translation of the screw at the screw entrance point. Therefore, the novel mechanical testing model represents a promising method for the standardized testing of pedicle screws regarding screw loosening for cases where the screw rotates around a point close to the screw entry point. Copyright © 2017 Elsevier Ltd. All rights reserved.

Pedicle marrow signal intensity changes in the lumbar spine: a manifestation of facet degenerative joint disease

International Nuclear Information System (INIS)

Morrison, J.L.; Kaplan, P.A.; Dussault, R.G.; Anderson, M.W.

2000-01-01

Objective. Signal intensity changes in lumbar pedicles, similar to those described in vertebral body endplates adjacent to degenerated discs, have been described as an ancillary sign of spondylolysis on MRI. The purpose of this study was to determine whether pedicle marrow signal intensity changes also occur in association with facet degenerative joint disease.Design. Eighty-nine lumbar spine MRI examinations without spondylolysis were reviewed for marrow signal intensity changes in pedicles and vertebral bodies as well as for facet degenerative joint disease.Results. Five percent (46/890) of lumbar pedicles in 23 patients had marrow signal intensity changes. Ninety-one percent (42/46) of the abnormal pedicles had adjacent degenerative joint disease of the facets, while only 21% (189/890) of normal pedicles had adjacent facet degenerative joint disease (p<0.001). Eighty-nine percent (41/46) of the pedicles with marrow signal intensity changes had adjacent degenerative disc disease.Conclusions. Pedicle marrow signal intensity changes are not a specific sign of spondylolysis; they are commonly seen with adjacent facet degenerative joint disease in the absence of spondylolysis. Pedicle marrow signal intensity changes are probably a response to abnormal stresses related to abnormal motion or loading caused by the degenerative changes in the spinal segment. (orig.)

Pedicle marrow signal intensity changes in the lumbar spine: a manifestation of facet degenerative joint disease

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Morrison, J.L.; Kaplan, P.A.; Dussault, R.G.; Anderson, M.W. [Dept. of Radiology, Univ. of Virginia Health System, Charlottesville, VA (United States)

2000-12-01

Objective. Signal intensity changes in lumbar pedicles, similar to those described in vertebral body endplates adjacent to degenerated discs, have been described as an ancillary sign of spondylolysis on MRI. The purpose of this study was to determine whether pedicle marrow signal intensity changes also occur in association with facet degenerative joint disease.Design. Eighty-nine lumbar spine MRI examinations without spondylolysis were reviewed for marrow signal intensity changes in pedicles and vertebral bodies as well as for facet degenerative joint disease.Results. Five percent (46/890) of lumbar pedicles in 23 patients had marrow signal intensity changes. Ninety-one percent (42/46) of the abnormal pedicles had adjacent degenerative joint disease of the facets, while only 21% (189/890) of normal pedicles had adjacent facet degenerative joint disease (p<0.001). Eighty-nine percent (41/46) of the pedicles with marrow signal intensity changes had adjacent degenerative disc disease.Conclusions. Pedicle marrow signal intensity changes are not a specific sign of spondylolysis; they are commonly seen with adjacent facet degenerative joint disease in the absence of spondylolysis. Pedicle marrow signal intensity changes are probably a response to abnormal stresses related to abnormal motion or loading caused by the degenerative changes in the spinal segment. (orig.)

Comparison of measurement results between cervical pedicle specimens and CT images

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Zhang Guangjian; Li Hua; Liu Haiyan; Gao Zhenping

2011-01-01

Objective: To compare the difference between the measurement results of the cervical pedicle specimens and CT image, and provide the basis for clinical cervical screw internal fixation operation. Methods: Twenty-seven Chinese adult cadaver cervical specimens including C3 to C7 vertebrae were measured by a digital calipers and CT image, containing pedicle height (PH, PH'), pedicle width(PW, PW'), total pedicle length (TL, TL') and two pedicle lengths(PL1, PL2; PL1', PL2'). The results of specimens and CT image were compared. Results: Different cervical vertebra in the same side of specimens or CT images, PW (PW'): C3, C4< C5, C6 (P<0.05), C5, C6< C7 (P<0.01); PH (PH'): there were no significant differences; TL, PL1, PL2 (TL', PL1', PL2'): there were no marked differences. In the same cervical vertebra of the specimens or CT images, PW (PW')< PH (PH') (P<0.01), PL1 (PL1') < PL2 (PL2') (P<0.01). Conclusion: The results of measurement by CT images are not markedly different from that of specimens. CT image measurement is available before cervical screw internal fixation operation. (authors)

Pedicle distraction increases intervertebral and spinal canal area in a cadaver and bone model

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Hughes Matthew

2018-01-01

Discussion: For each increase in pedicle distraction the area of the spinal and vertebral foramen increases. Pedicle distraction could potentially be used to alleviate spinal stenosis and root impingement. A potential osteotomy plane could be at the midpoint of the pedicle with minimal risk to nerve roots and soft tissue restrictions to prevent distraction.

OUTCOMES OF HILAR PEDICLE CONTROL USING SUTURE LIGATION DURING LAPAROSCOPIC SPLENECTOMY.

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Makgoka, M

2017-06-01

Laparoscopic splenectomy is a well described gold standard procedure for various indications. One of the key steps during laparoscopic splenectomy is the hilar pedicle vessels control, which can be challenging in most cases. Most centres around the world recommend the use Ligaclib or endovascular staplers as Methods of choice for hilar pedicle control but the issue is the cost and efficiency of the laparoscopic haemostatic devices. A descriptive retrospective study of patients who had laparoscopic splenectomy from 2013 to present. Hilar splenic vessel control was done with suture ligation. We looked at outcomes of patients offered this technique, complications of this technique, and describing the technique of hilar control in laparoscopic splenectomy. Total of 27 patients had laparoscopic splenectomy with splenic hilar pedicle control with suture ligation. Mean operative time, mean blood volume loss, length of hospital stay, postoperative complications conversion to laparotomy. Laparoscopic hilar pedicle control with suture ligation is safe and effective for the patient in our hospital setting.

Intra-operative computer navigation guided cervical pedicle screw insertion in thirty-three complex cervical spine deformities

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S Rajasekaran

2010-01-01

Full Text Available Background: Cervical pedicle screw fixation is challenging due to the small osseous morphometrics and the close proximity of neurovascular elements. Computer navigation has been reported to improve the accuracy of pedicle screw placement. There are very few studies assessing its efficacy in the presence of deformity. Also cervical pedicle screw insertion in children has not been described before. We evaluated the safety and accuracy of Iso-C 3D-navigated pedicle screws in the deformed cervical spine. Materials and Methods: Thirty-three patients including 15 children formed the study group. One hundred and forty-five cervical pedicle screws were inserted using Iso-C 3D-based computer navigation in patients undergoing cervical spine stabilization for craniovertebral junction anomalies, cervico-thoracic deformities and cervical instabilities due to trauma, post-surgery and degenerative disorders. The accuracy and containment of screw placement was assessed from postoperative computerized tomography scans. Results: One hundred and thirty (89.7% screws were well contained inside the pedicles. Nine (6.1% Type A and six (4.2% Type B pedicle breaches were observed. In 136 levels, the screws were inserted in the classical description of pedicle screw application and in nine deformed vertebra, the screws were inserted in a non-classical fashion, taking purchase of the best bone stock. None of them had a critical breach. No patient had any neurovascular complications. Conclusion: Iso-C navigation improves the safety and accuracy of pedicle screw insertion and is not only successful in achieving secure pedicle fixation but also in identifying the best available bone stock for three-column bone fixation in altered anatomy. The advantages conferred by cervical pedicle screws can be extended to the pediatric population also.

PEDICLE TONGUE FLAP SURGERY IN ORAL SUBMUCOUS FIBROSIS

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Muthubabu K

2016-09-01

Full Text Available BACKGROUND Oral submucous fibrosis is a disease of unknown aetiology and is a legacy of Indians. It has been variously treated both medically and surgically but neither has been found to be rewarding. Various groups have been studying the therapy schedules and aetiological association, but the conclusions have remained unclear. AIM The study aims to focus on newer surgical therapy stressing on the mechanics and use of pedicle tongue flap in the management of this condition. METHODS AND MATERIALS The study comprised of 40 patients from our outpatient department suffering from oral submucous fibrosis in the age group of 11 to 70 years. The contributory factors of oral submucous fibrosis and the symptoms of the disease were evaluated and the role of pedicle tongue flap surgery in the management of this disease which is a premalignant condition is discussed. RESULTS AND CONCLUSION Pedicle tongue flap surgery has given promising results in the treatment of trismus due to oral submucous fibrosis. After the surgery, none of our patients developed any malignant change.

Positioning of pedicle screws in adolescent idiopathic scoliosis using electromyography

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Bruno Moreira Gavassi

2015-06-01

Full Text Available OBJECTIVE: To analyze the occurrence of poor positioning of pedicle screws inserted with the aid of intraoperative electromyographic stimulation in the treatment of Adolescent Idiopathic Scoliosis (AIS.METHODS: This is a prospective observational study including all patients undergoing surgical treatment for AIS, between March and December 2013 at a single institution. All procedures were monitored by electromyography of the inserted pedicle screws. The position of the screws was evaluated by assessment of postoperative CT and classified according to the specific AIS classification system.RESULTS: Sixteen patients were included in the study, totalizing 281 instrumented pedicles (17.5 per patient. No patient had any neurological deficit or complaint after surgery. In the axial plane, 195 screws were found in ideal position (69.4% while in the sagittal plane, 226 screws were found in ideal position (80.4%. Considering both the axial and the sagittal planes, it was observed that 59.1% (166/281 of the screws did not violate any cortical wall.CONCLUSION: The use of pedicle screws proved to be a safe technique without causing neurological damage in AIS surgeries, even with the occurrence of poor positioning of some implants.

[A reverse vascular autograft finger island flap. A review of 15 cases and of the literature].

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Adani, R; Marcuzzi, A; Busa, R; Pancaldi, G; Bathia, A; Caroli, A

1995-01-01

The authors discuss the indications for homodigital island flap with a reverse vascular pedicle. This flap is based on the anastomoses between the radial and ulnar digital arteries. These anastomotic branches lie between the posterior wall of the tendon sheath and the periosteum to form an arch and are named the "digitopalmar arches". The vascularization of the reverse homodigital island flap is derived by using the middle transverse palmar arch. This flap was performed successfully in 14 patients involving 15 fingers to resurface amputation of the distal phalanx. In 6 cases the flap was used as an "artery" flap, and in 9 cases as a "sensitive" homodigital island flap. The pedicle in these cases was neurovascular also containing the digital nerve. The sensitivity of the flap was obtained by neurorraphy between the transposed digital nerve of the flap and the receiving digital nerve of the recipient finger. This technique achieves cover of the tactile pad in one operative stage and provides well vascularized skin allowing early mobilization. Sensation of the flap can be restored rapidly when neurorraphy of the transposed digital nerve is performed.

Accuracy of navigated pedicle screw insertion by a junior spine surgeon without spinal surgery experience

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Yamazaki, Hironori; Kotani, Toshiaki; Motegi, Hiroyuki; Nemoto, Tetsuharu; Koshi, Takana; Nagahara, Ken; Minami, Syohei

2010-01-01

The purpose of this study was to investigate pedicle screw placement accuracy during navigated surgery by a junior spine surgeon who had no spinal surgery experience. A junior spine surgeon with no spinal surgery experience implanted a total of 137 pedicle screws by using a navigation system. Postoperative computerized tomography was performed to evaluate screw placement, and the pedicle perforation rate was 2.2%. There were no neurologic or vascular complications related to the pedicle screws. The results demonstrated that pedicle screws can be placed safely and effectively by a junior spine surgeon who has no spinal surgery experience when instructed by a senior spine surgeon. The results of this study suggest that navigation can be used as a surgical training tool for junior spine surgeons. (author)

Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine.

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Guo, Fei; Dai, Jianhao; Zhang, Junxiang; Ma, Yichuan; Zhu, Guanghui; Shen, Junjie; Niu, Guoqi

2017-01-01

Pedicle screw fixation in the upper cervical spine is a difficult and high-risk procedure. The screw is difficult to place rapidly and accurately, and can lead to serious injury of spinal cord or vertebral artery. The aim of this study was to design an individualized 3D printing navigation template for pedicle screw fixation in the upper cervical spine. Using CT thin slices data, we employed computer software to design the navigation template for pedicle screw fixation in the upper cervical spine (atlas and axis). The upper cervical spine models and navigation templates were produced by 3D printer with equal proportion, two sets for each case. In one set (Test group), pedicle screws fixation were guided by the navigation template; in the second set (Control group), the screws were fixed under fluoroscopy. According to the degree of pedicle cortex perforation and whether the screw needed to be refitted, the fixation effects were divided into 3 types: Type I, screw is fully located within the vertebral pedicle; Type II, degree of pedicle cortex perforation is stability and no need to renovate; Type III, degree of pedicle cortex perforation is >1 mm or with the poor internal fixation stability and in need of renovation. Type I and Type II were acceptable placements; Type III placements were unacceptable. A total of 19 upper cervical spine and 19 navigation templates were printed, and 37 pedicle screws were fixed in each group. Type I screw-placements in the test group totaled 32; Type II totaled 3; and Type III totaled 2; with an acceptable rate of 94.60%. Type I screw placements in the control group totaled 23; Type II totaled 3; and Type III totaled 11, with an acceptable rate of 70.27%. The acceptability rate in test group was higher than the rate in control group. The operation time and fluoroscopic frequency for each screw were decreased, compared with control group. The individualized 3D printing navigation template for pedicle screw fixation is easy and safe

Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine.

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Fei Guo

Full Text Available Pedicle screw fixation in the upper cervical spine is a difficult and high-risk procedure. The screw is difficult to place rapidly and accurately, and can lead to serious injury of spinal cord or vertebral artery. The aim of this study was to design an individualized 3D printing navigation template for pedicle screw fixation in the upper cervical spine.Using CT thin slices data, we employed computer software to design the navigation template for pedicle screw fixation in the upper cervical spine (atlas and axis. The upper cervical spine models and navigation templates were produced by 3D printer with equal proportion, two sets for each case. In one set (Test group, pedicle screws fixation were guided by the navigation template; in the second set (Control group, the screws were fixed under fluoroscopy. According to the degree of pedicle cortex perforation and whether the screw needed to be refitted, the fixation effects were divided into 3 types: Type I, screw is fully located within the vertebral pedicle; Type II, degree of pedicle cortex perforation is 1 mm or with the poor internal fixation stability and in need of renovation. Type I and Type II were acceptable placements; Type III placements were unacceptable.A total of 19 upper cervical spine and 19 navigation templates were printed, and 37 pedicle screws were fixed in each group. Type I screw-placements in the test group totaled 32; Type II totaled 3; and Type III totaled 2; with an acceptable rate of 94.60%. Type I screw placements in the control group totaled 23; Type II totaled 3; and Type III totaled 11, with an acceptable rate of 70.27%. The acceptability rate in test group was higher than the rate in control group. The operation time and fluoroscopic frequency for each screw were decreased, compared with control group.The individualized 3D printing navigation template for pedicle screw fixation is easy and safe, with a high success rate in the upper cervical spine surgery.

Pull out Strength of Dual Outer Diameter Pedicle Screws Compared to Uncemented and Cemented Standard Pedicle Screws: A Biomechanical in vitro Study.

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Lorenz, Andrea; Leichtle, Carmen I; Frantz, Sandra; Bumann, Marte; Tsiflikas, Ilias; Shiozawa, Thomas; Leichtle, Ulf G

2017-05-01

To analyze the potential of the dual outer diameter screw and systematically evaluate the pull-out force of the dual outer diameter screw compared to the uncemented and cemented standard pedicle screws with special regard to the pedicle diameter and the vertebra level. Sixty vertebrae of five human spines (T 6 -L 5 ) were sorted into three study groups for pairwise comparison of the uncemented dual outer diameter screw, the uncemented standard screw, and the cemented standard screw, and randomized with respect to bone mineral density (BMD) and vertebra level. The vertebrae were instrumented, insertion torque was determined, and pull-out testing was performed using a material testing machine. Failure load was evaluated in pairwise comparison within each study group. The screw-to-pedicle diameter ratio was determined and the uncemented dual outer diameter and standard screws were compared for different ratios as well as vertebra levels. Significantly increased pull-out forces were measured for the cemented standard screw compared to the uncemented standard screw (+689 N, P dual outer diameter screw (+403 N, P dual outer diameter screw to the uncemented standard screw in the total study group, a distinct but not significant increase was measured (+149 N, P = 0.114). Further analysis of these two screws, however, revealed a significant increase of pull-out force for the dual outer diameter screw in the lumbar region (+247 N, P = 0.040), as well as for a screw-to-pedicle diameter ratio between 0.6 and 1 (+ 488 N, P = 0.028). For clinical application, cement augmentation remains the gold standard for increasing screw stability. According to our results, the use of a dual outer diameter screw is an interesting option to increase screw stability in the lumbar region without cement augmentation. For the thoracic region, however, the screw-to-pedicle diameter should be checked and attention should be paid to screw cut out, if the dual outer diameter screw is considered. �

A novel route for placing free flap pedicle from a palatal defect

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Rajeev B Ahuja

2014-01-01

Full Text Available One of the better options available to repair a large palatal defect is by employing a free flap. Almost all the times such free flaps are plumbed to facial vessels. The greatest challenge in such cases is the placement of the pedicle from palatal shelf to recipient vessels because there is no direct route available. As majority of large palatal fistulae are encountered in operated cleft palates there is a possibility of routing the pedicle through a cleft in the maxillary arch or via pyriform aperture. When such a possibility doesn′t exist the pedicle is routed behind the maxillary arch. We describe a novel technique of pedicle placement through a maxillary antrostomy, in this case report, where a large palatal fistula in a 16 year old boy was repaired employing a free radial artery forearm flap. The direct route provided by maxillary antrostomy is considered the most expeditious of all possibilities mentioned above.

Morphology of the atlas pedicle revisited: a morphometric CT-based study on 120 patients.

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Qian, Li-Xiong; Hao, Ding-Jun; He, Bao-Rong; Jiang, Yong-Hong

2013-05-01

To quantify the dimensions of the atlas pedicles and to analyze the relationship between extra medullary height (EMH) with intra medullary height (IMH) of the atlas pedicle. The images of the patients who had CT scanning and three-dimensional (3D) reconstruction involving atlantoaxial complex between June 2011 and April 2012 and meet our inclusion criteria were studied retrospectively. After reformatting the original images, the EMH and IMH of the atlas pedicles were measured. Extra medullary height and IMH were, respectively, 4.83 ± 1.13 and 1.29 ± 1.10 mm for males and 3.75 ± 0.93 and 0.60 ± 0.83 mm for females, with statistical difference (P atlas pedicles were measured by using CT images of the atlas, providing anatomic parameters for surgery. They showed a certain correlation but with a high variability. C1 pedicle screw fixation was well performed when the medullary canal was ≥1 mm, but the surgical procedure should be careful when it was between 0 and 1 mm, and avoided when there was no medullary canal in the atlas pedicle! So 3D CT reconstruction should be conducted to obtain data and establish individualized fixation strategy preoperatively.

[Polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws for the treatment of degenerative lumbar diseases with osteoporosis].

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Sun, H L; Li, C D; Yang, Z C; Yi, X D; Liu, H; Lu, H L; Li, H; Wang, Y

2016-12-18

To describe the application of polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws for the treatment of degenerative lumbar diseases with osteoporosis. Observation group included 14 cases of degenerative lumbar diseases with osteoporosis received polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws from November 2014 to July 2015, control group included 12 cases of degenerative lumbar diseases with osteoporosis received polymethylmethacrylate augmentation with traditional pedicle screws.The operation time, blood loss, number of pedicle screws and number of augmented pedicle screws in the two groups were compared. The bone cement leakage and pulmonary bone cement embolism in the two groups were also compared. The fusion rate and pedicle screws loosening by lumbar X ray and dynamic X ray were evaluated. The clinical results were assessed by visual analog scale (VAS) of pain on lumbar and lower limbers, lumbar Japanese Orthopaedic Association scores (JOA), Prolo functional scores and Oswestry disability (ODI) scores. Differences of operation time and blood loss in the two groups were not statistically significant. The average number of pedicle screws was 9.9±4.7 and the average number of augmented pedicle screws was 5.9±2.6 in observation group while the average number of pedicle screws was 7.1±2.8 and the average number of augmented pedicle screws was 3.0±1.9 in control group. The ratio of augmented pedicle screws was higher in observation group than in control group (0.69±0.30 vs.0.47±0.30,Pdegenerative lumbar diseases with osteoporosis was effective, with simple working processes and lower risk of bone cement leakage. The short-term clinical result was good.

Long-term follow-up and patient satisfaction after reduction mammoplasty: Superomedial versus inferior pedicle

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Mohamed Makboul

2016-01-01

Full Text Available Background: Surgery for hypertrophied breasts represents a challenge for plastic surgeons. The search for a good post-surgical cosmetic breast has led to the development of many techniques. Objectives for reduction mammoplasty are to achieve elevated, symmetrical breasts, a round shape, good projection, small cicatrices that are not very perceptible, and a lasting result. Patients and Methods: This study was carried out on sixty cases who had done reduction mammoplasty from January 2009 to December 2014. All patients were examined and were asked for late post-operative results and overall patients' satisfaction. Results: Long-term projection and contour of the breast were more satisfactory among patients who had superomedial pedicle with a statistically significant difference. No statistically significant difference was observed between patients underwent either superomedial or inferior pedicle reduction mammoplasty with regard to breast shape symmetry, nipple symmetry and sensation. The mean score for satisfaction was higher among patients who underwent superomedial pedicle rather than the inferior pedicle method. Conclusion: The superomedial pedicle shows better long-term cosmetic results.

Clinical accuracy of three-dimensional fluoroscopy (IsoC-3D)-assisted upper thoracic pedicle screw insertion

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Sugimoto, Yoshihisa; Ito, Yasuo; Shimokawa, Tetsuya; Shiozaki, Yasuyuki; Mazaki, Tetsuro; Tomioka, Masao; Tanaka, Masato

2010-01-01

Correct screw placement is especially difficult in the upper thoracic vertebrae. At the cervicothoracic junction (C7-T2), problems can arise because of the narrowness of the pedicle and the difficulty of using a lateral image intensifier there. Other upper thoracic vertebrae (T3-6) pose a problem for screw insertion also because of the narrower pedicle. We inserted 154 pedicle screws into 78 vertebrae (C7 to T6) in 38 patients. Screws were placed using intraoperative data acquisition by an isocentric C-arm fluoroscope (Siremobile Iso-C3D) and computer navigation. Out of 90 pedicle screws inserted into 45 vertebrae between C7 and T2, 87 of the 90 (96.7%) screws were classified as grade 1 (no perforation). Of 64 pedicle screws inserted into 33 vertebrae between T3 and T6, 61 of 64 (95.3%) screws were classified as grade 1. In this study, we reduced pedicle screw misplacement at the level of the C7 and upper thoracic (T1-6) vertebrae using the three-dimensional fluoroscopy navigation system. (author)

Age, growth, and maturity of round whitefish of the Apostle Islands and Isle Royale Regions, Lake Superior

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Bailey, Merryll M.

1963-01-01

The round whitefish has been of some commercial importance in the upper Great Lakes but production in Lake Superior has generally been small; the United States average was 26,600 pounds for 1929-59. This study is based on 1,173 fish collected in the Apostle Islands in 1958-60 and 103 collected at Isle Royale in 1958 and 1960. The average age of 6.0 years at Isle Royale was concluded to be significantly higher than the mean of 4.2 years in the Apostle Islands. The body-scale relation is a straight line with an intercept of 1.1 inches on the length axis. Weight of Apostle Islands round whitefish captured in several months increased as the 3.22 power of the length. Growth in length was relatively slow; nearly or fully 7 years were required to reach an acceptable commercial length of 14 inches in both the Apostle Islands and at Isle Royale. The calculated weights at the end of the seventh year were 12.6 ounces in the Apostle Islands and 13.8 ounces at Isle Royale. Minimum length at maturity of male round whitefish (7.0-7.4 inches) was less than that of females (8.5-8.9 inches). At age-group II, 11.1 percent of male round whitefish, but only 1.5 percent of the females were mature. All males were mature as age-group V and all females as age-group VI. Males dominated the younger age groups but females were more numerous in the older ones. Estimates of the number of eggs in 37 round whitefish ovaries yielded an average of 5,330 eggs for fish 10.5-17.4 inches long.

Diaphragmatic hernia repair using a rectus abdominis muscle pedicle flap in three dogs.

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Chantawong, P; Komin, K; Banlunara, W; Kalpravidh, M

2013-01-01

To report the clinical use of a pedicle flap from the rectus abdominis muscle to repair extensive diaphragmatic tears in dogs with diaphragmatic hernia. Three dogs with a combination of radial and circumferential diaphragmatic tears were studied. The circumferential tear was repaired by suturing the wound edge with the edge at the abdominal wall. A pedicle flap of the rectus abdominis muscle was used for repairing the radial tear. The dogs were examined radiographically for lung and diaphragm appearance and evidence of reherniation at 10 days, and at one, two, and four months after surgery, and fluoroscopically for paradoxical motion of the diaphragm at one and four months. The rectus abdominis muscle pedicle flap was successfully used in all three dogs. The animals recovered uneventfully without evidence of reherniation during the four follow-up months. Fluoroscopic examination revealed no paradoxical motion of the diaphragm. A rectus abdominis muscle pedicle flap can be used for repairing large diaphragmatic defects in dogs.

EFFECT OF PILOT HOLE TAPPING ON PULLOUT STRENGTH AND INSERTION TORQUE OF DUAL CORE PEDICLE SCREWS.

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Rosa, Rodrigo César; Silva, Patrícia; Falcai, Maurício José; Shimano, Antônio Carlos; Defino, Helton Luiz Aparecido

2010-01-01

To evaluate the influence of pilot hole tapping on pullout resistance and insertion torque of pedicle screws with a conical core. Mechanical tests using a universal testing machine were performed on pedicle screws with a conical core that were inserted into pedicles in the fifth lumbar vertebra of calves. The insertion torque was measured using a torque meter with a capacity of 10 Nm, which was considered to be the highest torque value. The pilot holes were prepared using a probe of external diameter 3.8 mm and tapping of the same dimensions and thread characteristics as the screw. Decreased insertion torque and pullout resistance were observed in the group with prior tapping of the pilot hole. Pilot hole tapping reduced the insertion torque and pullout resistance of pedicle screws with a conical core that had been inserted into the pedicle of the fifth lumbar vertebra of calves.

Tensor fascia lata flap versus tensor fascia lata perforator-based island flap for the coverage of extensive trochanteric pressure sores.

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Kim, Youn Hwan; Kim, Sang Wha; Kim, Jeong Tae; Kim, Chang Yeon

2013-06-01

Tensor fascia lata (TFL) musculocutaneous flaps often require a donor site graft when harvesting a large flap. However, a major drawback is that it also sacrifices the muscle. To overcome this disadvantage, we designed a TFL perforator-based island flap that was harvested from a site near the defect and involved transposition within 90 degrees without full isolation of the pedicles. We performed procedures on 17 musculocutaneous flaps and 23 perforator-based island flaps, and compared the outcomes of these surgeries. The overall complication rate was 27.5% (11 regions). There were 7 complications related to the musculocutaneous flaps and 4 complications related to the perforator flaps. Although there were no statistical differences between those groups, lower complication rates were associated with procedures involving perforator flaps. The TFL perforator procedure is a simple and fast operation that avoids sacrificing muscle. This decreases complication rates compared to true perforator flap techniques that require dissection around the perforator or pedicle.

Descending aortic injury by a thoracic pedicle screw during posterior reconstructive surgery: a case report.

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Watanabe, Kei; Yamazaki, Akiyoshi; Hirano, Toru; Izumi, Tomohiro; Sano, Atsuki; Morita, Osamu; Kikuchi, Ren; Ito, Takui

2010-09-15

Case report. To describe an iatrogenic aortic injury by pedicle screw instrumentation during posterior reconstructive surgery of spinal deformity. Iatrogenic major vascular injuries during anterior instrumentation procedures have been reported by several authors, but there have been few reports regarding iatrogenic major vascular injuries during posterior instrumentation procedures. A 57-year-old woman with thoracolumbar kyphosis due to osteoporotic T12 vertebral fracture underwent posterior correction and fusion (T10-L2), using segmental pedicle screw construct concomitant with T12 pedicle subtraction osteotomy. Postoperative routine plain radiographs and computed tomography myelography demonstrated a misplaced left T10 pedicle screw, which was in contact with the posteromedial aspect of the thoracic aorta, and suspected penetration of the aortic wall. The patient underwent removal of the pedicle screw, and repair of the penetrated aortic wall through a simultaneous anterior-posterior approach. The patient tolerated the procedure well without neurologic sequelae, and was discharged several days after removal of a left tube thoracostomy. Plain radiographs demonstrated solid fusion at the osteotomy site and no loosening of hardware. Preoperative neurologic symptoms improved completely at 18-months follow-up. Use of pedicle screw instrumentation has the potential to cause major vascular injury during posterior spinal surgery, and measures to prevent this complication must be taken. Timely diagnosis and treatment are essential to prevent both early and delayed complications and death.

Internal fixation and muscle pedicle bone grafting in femoral neck fractures

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Gupta A

2008-01-01

Full Text Available Background: The treatment of displaced intracapsular femoral neck fracture is still an unsolved problem. Non-union and avascular necrosis are the two main complications of this fracture, especially if patient presents late. Muscle pedicle bone grafting has been advocated to provide additional blood supply. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting. Materials and Methods: Open reduction and internal fixation with muscle pedicle grafting was done in 32 patients. The age of patients varied from 14-62 years (average age 45 years with male to female ratio of 13:3. Twenty-nine fractures were more than three weeks old. All the cases were treated by Meyers′ procedure. The fracture was internally fixed after open reduction and then a muscle pedicle graft was applied. It was supplemented by cancellous bone graft in seven cases. Fixation was done by parallel cancellous lag screws ( n = 19, crossed Garden′s screws ( n = 7, parallel Asnis screws ( n = 5 and Moore′s pin ( n = 1.Quadratus femoris muscle pedicle graft was used in 32 cases. In the initial 12 cases the graft was fixed with circumferential proline sutures, but later, to provide a secure fixation, the graft was fixed with a cancellous screw ( n = 20. Postoperative full weight bearing was deferred to an average of 10 weeks. Results: Union was achieved in 26/29 (89.65% cases which could be followed for an average period of 3.4 years, (2-8.5 years with good functional results and had the ability to squat and sit cross-legged. Results were based on hip rating system given by Salvatti and Wilson. The results were excellent in 15 cases, good in four cases, fair in four cases and poor in six cases. Complications were avascular necrosis ( n = 2, transient foot drop ( n = 2, coxa-vara ( n = 1 and temporary loss of scrotal sensation ( n = 1. Conclusion: Muscle pedicle bone grafting with

The Omental Pedicle Flap in Dogs Revised and Refined: A Cadaver Study.

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Doom, Marjan; Cornillie, Pieter; Simoens, Paul; Huyghe, Stephanie; de Rooster, Hilde

2016-08-01

To expand current knowledge on the canine omental vasculature and refine the existing lengthening technique of the canine omentum. Ex vivo study. Canine cadavers (n=20). In 10 canine cadavers the omental arteries were mapped using intravascular latex injection and these results were used to create an omental pedicle flap based on the splenic artery in 10 additional cadavers. The operating range of the flap was recorded with particular attention to the main regions of interest for omental transposition in dogs (axillary and inguinal regions). The superficial and deep omental leaves were each predominantly supplied by a left and a right marginal omental artery that anastomosed near the caudal omental border into a superficial and a deep omental arch, respectively. Anastomoses between arteries of the superficial and the deep omental leaves were weak and inconsistent, except for 1 anastomosis that was found in 8 of 10 dogs. By transposing the intact omentum, the right axilla could be reached in 3 dogs, both axillae in 1 dog, and both groins in all cadavers. In all cases, the omental pedicle reached to and beyond the axillary and inguinal regions. By unfolding the pedicle leaves, the width of the pedicle tip could be doubled. When lengthening the omentum is necessary to reach extra-abdominal structures, the omental pedicle flap based on the splenic artery appears to preserve the omental vascular supply. These observations warrant further clinical trials to evaluate this new omtental flap technique in vivo. © Copyright 2016 by The American College of Veterinary Surgeons.

[Comparison of pedicle and free tissue transfers in the German DRG system].

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Lotter, O; Stahl, S; Hohenstein, C; Schaller, H-E; Jaminet, P

2011-12-01

Diagnosis-Related Groups (DRGs) are a patient classification system grouping related types of patients to the resources they have consumed. In this analysis, we compared pedicle and free flaps in plastic and reconstructive surgery in the actual German DRG system. After grouping common flaps while systematically modifying the diagnosis, the operative procedure(s), and the receptor site, reimbursement and thresholds of length of stay were identified. The mean value of the average length of stay was higher in free flaps as compared to pedicle flaps (15 vs. 9 days) and the mean reimbursement in free flaps was almost twice as high as in pedicle flaps (8 936 € vs. 4 582 €). Regarding the diagnosis, third-grade open fractures in pedicle flaps and full-thickness burns in free flaps are in the vanguard of reimbursement. Higher DRG conformity is generally found with free flaps. Different possibilities in coding the procedures and the strong dependence on the underlying diagnosis lead to variations of remuneration and length of stay, which are not explainable and sometimes even seem paradoxical. Furthermore, mixed calculation creates DRGs that lose the ability to describe the real effort. © Georg Thieme Verlag KG Stuttgart · New York.

Utility of Glissonean Pedicle Transection for Surgical Treatment of Severe Liver Trauma

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Satoshi Koizumi

2017-04-01

Full Text Available The most common initial strategy for treatment of severe liver trauma is damage control in which hemostasis is achieved by perihepatic gauze packing and/or vascular embolization. However, we encounter patients in whom this strategy alone is not adequate. We have applied the principles of Glissonean pedicle transection, a technique that was originally devised to ensure safe and quick performance of planned hepatectomy for liver cancer, to 3 cases of severe liver trauma. We performed Glissonean pedicle ligation during damage control surgery in 2 patients and Glissonean pedicle transection during the definitive surgery in 1 patient. We describe the approaches and our experience with them, including operation times and outcomes. From our experience thus far, it seems that 8–12 h after the damage control procedure is appropriate for performing the definitive surgery. Although there are some problems posed by this strategy and cases to which it will not be applicable, the method seems to be particularly useful for cases of severe liver trauma in which the damage is extensive and involves the Glissonean pedicles near the hepatic hilus. We describe our 3 cases in detail and review our experience in light of the available literature.

Robot assisted navigated drilling for percutaneous pedicle screw placement: A preliminary animal study

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Hongwei Wang

2015-01-01

Conclusions: The preliminary study supports the view that computer assisted pedicle screw fixation using spinal robot is feasible and the robot can decrease the intraoperative fluoroscopy time during the minimally invasive pedicle screw fixation surgery. As spine robotic surgery is still in its infancy, further research in this field is worthwhile especially the accuracy of spine robot system should be improved.

Clinical evaluation of patients undergoing dynamic pedicle fixation in lumbar spine

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Felipe José Vieira Figueiredo

2015-06-01

Full Text Available OBJECTIVE: To evaluate the preliminary clinical results and complications in patients undergoing dynamic pedicle fixation of the spine in the treatment of a specific group of degenerative lumbar disease.METHODS: In this preliminary retrospective study, we selected 14 patients who underwent surgery from January 2006 to July 2010. We selected only patients with spondylolisthesis without spondylolysis (Grade 1 Meyerding. All patients underwent surgery at one level and the levels mostly addressed were: L3-L4, L4-L5 or L5-S1. The approach was the same in all patients (posterior median approach with preservation of the posterior elements. All patients underwent intense conservative treatment without clinical response and the same research algorithm preoperatively.RESULTS: Retrospective analysis of Oswestry questionnaire after selection and publication of results of 14 patients with Grade 1 spondylolisthesis who underwent dynamic pedicle stabilization in a total of 56 pedicle screws, being all in one level. There was no fracture of any screws, the mean hospital stay was a day and a half, no patient required blood transfusion and there were no cases of infection, with significant improvement in the Oswestry questionnaire.CONCLUSION: In this study, the dynamic pedicle stabilization method proved to be an excellent treatment option when surgical criteria are strictly adhered to. There was an improvement in Oswestry values, lower hospital stay and low rate of complications, consisting of an alternative in motion preservation surgery.

Isolated unilateral vertebral pedicle fracture caused by a back massage in an elderly patient: a case report and literature review.

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Guo, Zhiping; Chen, Wei; Su, Yanling; Yuan, Junhui; Zhang, Yingze

2013-11-01

The vertebral pedicle injuries are clinically common. However, the isolated vertebral pedicle fracture with intact vertebral bodies is a rare lesion. We reported a case of a 66-year-old man who experienced a pedicle fracture after a back massage. The patient sustained osteoporosis, long-existing low back pain and nerve compression symptoms without antecedent major trauma. Imaging findings demonstrated an isolated unilateral L5 vertebral pedicle fracture with intact vertebral bodies, spinal canal stenosis at the L4-5 levels, bulging annulus fibrosus at the L4-S1 levels, bilateral spondylolysis and an L5/S1 spondylolisthesis. The patient underwent L4-S1 decompressive laminectomy, L5/S1 discectomy and neurolysis, and reduction and fixation of the L5 vertebral pedicle fracture and L5/S1 spondylolisthesis using the pedicle nail system. At follow-ups, the patient showed good recovery without pain or numbness in the low back and bilateral lower extremities. This study raises the awareness of a complication of alternative medicine and the possibility of a pedicle fracture caused by a low-energy trauma.

Osteonecrosis of femoral head: Treatment by core decompression and vascular pedicle grafting

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Babhulkar Sudhir

2009-01-01

Full Text Available Background: Femoral head-preserving core decompression and bone grafting have shown excellent result in preventing collapse. The use of vascularized grafts have shown better clinical results. The vascular pedicle bone graft is an easy to perform operation and does not require special equipment. We analyzed and report a series of patients of osteonecrosis of femoral head treated by core decompression and vascular pedicle grafting of part of iliac crest based on deep circumflex iliac vessels. Materials and Methods: The article comprises of the retrospective study of 31 patients of osteonecrosis of femoral head in stage II and III treated with core decompression and vascular pedicle grafting by using part of iliac crest with deep circumflex iliac vessels from January 1990 to December 2005. The young patients with a mean age 32 years (18-52 years with a minimum follow-up of five years were included for analysis. Sixteen patients had osteonecrosis following alcohol abuse, 12 patients following corticosteroid consumption, 3 patients had idiopathic osteonecrosis. Nine patients were stage IIB, and 22 patients were stage IIIC according to ARCO′s system. The core decompression and vascular pedicle grafting was performed by anterior approach by using part of iliac crest with deep circumflex iliac vessels. Results: Digital subtraction arteriography performed in 9 patients at the end of 12 weeks showed the patency of deep circumflex artery in all cases, and bone scan performed in 6 other patients showed high uptake in the grafted area of the femoral head proving the efficacy of the operative procedure. Out of 31 patients, only one patient progressed to collapse and total joint replacement was advised. At the final follow up period of 5-8 years, Harris Hip Score improved mean ± SD of 28.2 ± 6.4 ( p < 0.05. Forty-eight percent of patients had an improvement in Harris Hip Score of more that 28 points. Conclusion: The core decompression and vascular pedicle

Técnica de doble pedículo lateral en reconstrucción mamaria después de tumorectomía Double lateral pedicle technique in breast reconstruction after tumorectomy

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Orlando Rafael Expósito Reyes

2007-12-01

Full Text Available Los tumores mamarios aparecen cada vez con mayor frecuencia, e igualmente las secuelas poco estéticas de la cirugía de estos. Se presenta la técnica quirúrgica de doble pedículo externo (superior e inferior en la reconstrucción mamaria después de una tumorectomía por fibroadenoma gigante de la mama izquierda. Se planificó la intervención tomando como referencia la técnica de Skoog (pedículo lateral externo, por la localización, el área ocupada por la masa mamaria (3/4 partes de la mama y para conservar la irrigación del complejo areola-pezón. Para llenar el vacío dejado por el tumor, se utilizó un segundo pedículo inferolateral que se liberó, rotó y fijó a la fascia muscular, con sutura no absorbible, en el área del cuadrante superior interno, lo cual sirvió de relleno o apoyo al complejo areola-pezón y a su pedículo. Se obtuvo un resultado estético bueno, que satisfizo las expectativas de la paciente y de los médicos, al conservarse la mama y su forma.Breast tumors are more and more frequent, as well as the little aesthetic sequelae of their surgery. The external double pedicle surgical technique (upper and lower in breast reconstruction after a tumorectomy due to giant fibroadenoma of the left breast was presented. The operation was planned taking Skoog’s technique as a reference (external lateral pedicle by the localization, the area occupied by the breast mass (3/4 parts of the breast and to preserve the irrigation of the areola-nipple complex. To fill the gap left by the tumor, it was used a second inferolateral pedicle that was released, rotated and fixed to the muscle fascia with non-absorbable suture in the area of the upper internal quadrant that served as a filling or support to the areola-nipple complex and to its pedicle. A good aesthetic result that satisfied the patients and specialists’ expectations was obtained on conserving the breast and its form.

Spinal pedicle subtraction osteotomy for fixed sagittal imbalance patients

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Hyun, Seung-Jae; Kim, Yongjung J; Rhim, Seung-Chul

2013-01-01

In addressing spinal sagittal imbalance through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. Posterior column osteotomies such as the facetectomy or Ponte or Smith-Petersen osteotomy provide the least correction, but can be used at multiple levels with minimal blood loss and a lower operative risk. Pedicle subtraction osteotomies provide nearly 3 times the per-level correction of Ponte/Smith-Petersen osteotomies; however, they carry increased technical demands, longer operative time, and greater blood loss and associated significant morbidity, including neurological injury. The literature focusing on pedicle subtraction osteotomy for fixed sagittal imbalance patients is reviewed. The long-term overall outcomes, surgical tips to reduce the complications and suggestions for their proper application are also provided. PMID:24340276

Results of triple muscle (sartorius, tensor fascia latae and part of gluteus medius pedicle bone grafting in neglected femoral neck fracture in physiologically active patients

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Pankaj Kumar Mishra

2014-01-01

Full Text Available Background: Femoral neck fractures are notorious for complications like avascular necrosis and nonunion. In developing countries, various factors such as illiteracy, low socioeconomic status, ignorance are responsible for the delay in surgery. Neglected fracture neck femur always poses a formidable challenge. The purpose of this study was to evaluate the results of triple muscle pedicle bone grafting using sartorius, tensor fasciae latae and part of gluteus medius in neglected femoral neck fracture. Materials and Methods: This is a retrospective study with medical record of 50 patients, who were operated by open reduction, internal fixation along with muscle pedicle bone grafting by the anterior approach. After open reduction, two to three cancellous screws (6.5 mm were used for internal fixation in all cases. A bony chunk of the whole anterior superior iliac spine of 1 cm thickness, 1 cm width and 4.5 cm length, taken from the iliac crest comprised of muscle pedicle of sartorius, tensor fascia latae and part of gluteus medius. Then the graft with all three muscles mobilized and put in the trough made over the anterior or anterosuperior aspect of the femoral head. The graft was fixed with one or two 4.5 mm self-tapping cortical screw in anterior to posterior direction. Results: 14 patients were lost to followup. The results were based on 36 patients. We observed that in our series, there was union in 34, out of 36 (94.4% patients. All patients were within the age group of 15-51 years (average 38 years with displaced neglected femoral neck fracture of ≥30 days. Mean time taken for full clinicoradiological union was 14 weeks (range-10-24 weeks. Conclusion: Triple muscle pedicle bone grafting gives satisfactory results for neglected femoral neck fracture in physiologically active patients.

The feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus: a retrospective analysis of eleven patients.

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Zhang, Xin-Liang; Huang, Da-Geng; Wang, Xiao-Dong; Zhu, Jin-Wen; Li, Yi-Bing; He, Bao-Rong; Hao, Ding-Jun

2017-04-01

Ponticulus posticus is a common anatomic variation that can be mistaken for a broad posterior arch during C1 pedicle screw placement. When the atlas lateral mass screws are placed via the posterior arch, injury to the vertebral artery may result. To our knowledge, there are few clinical studies that have analyzed the feasibility of C1 pedicle screw fixation in patients with ponticulus posticus, in clinical practice. To evaluate the feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus. Between January 2008 and January 2012, 11 consecutive patients with atlantoaxial instability, and with a ponticulus posticus at C1, underwent posterior fusion surgery in our institution. According to preoperative computed tomography (CT) reconstruction, a complete ponticulus posticus was found unilaterally in nine patients and bilaterally in two. Postoperative CT reconstructive imaging was performed to assess whether C1 pedicle screw placement was successful. Patients were followed up at regular intervals and evaluated for symptoms of ponticulus posticus syndrome. Thirteen C1 pedicles (atlas vertebral artery groove), each with a complete ponticulus posticus, were successfully inserted with thirteen 3.5- or 4.0-mm diameter pedicle screws, without resection of the bony anomaly. No intraoperative complications (venous plexus, vertebral artery, or spinal cord injury) occurred. The mean follow-up period was 21 (range 14-30) months. Postoperative CT reconstructive images showed that all 13 pedicle screws were inserted in the C1 pedicles without destruction of the atlas pedicle cortical bone. In the follow-up period, none of the patients demonstrated clinical symptoms of ponticulus posticus syndrome or developed bone fusion. Three-dimensional CT imaging should be considered prior to C1 pedicle screw fixation in patients with ponticulus posticus, to avoid mistaking the ponticulus posticus for a widened dorsal arch of the atlas. If there is no ponticulus posticus

Safety of lumbar spine radiofrequency procedures in the presence of posterior pedicle screws: technical report of a cadaver study.

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Gazelka, Halena M; Welch, Tasha L; Nassr, Ahmad; Lamer, Tim J

2015-05-01

To determine whether the thermal energy associated with lumbar spine radiofrequency neurotomy (RFN) performed near titanium and stainless steel pedicle screws is conducted to the pedicle screws or adjacent tissues, or both, thus introducing potential for thermal damage to those tissues. Cadaver study. Cadaver laboratory equipped with fluoroscopy, surgical spine implements, and radiofrequency generator. No live human subject; a fresh frozen (and thawed) cadaver torso was used for the study. Titanium and stainless steel pedicle screws were placed in the lumbar spine of a fresh frozen cadaver torso with real-time fluoroscopic guidance. Conventional RFN cannula placement was performed at the level of pedicle screws and a control (nonsurgically altered) lumbar level. Neurotomy was performed with conventional radiofrequency lesioning parameters. Temperatures were recorded at multiple sites through thermistor probes. Direct contact of the radiofrequency cannula with the pedicle screws during conventional RFN produced a substantial increase in temperature in the surrounding soft tissues. A small increase in temperature occurred at the same sites at the control level. Titanium and stainless steel pedicle screws are capable of sustaining large increases in temperature when the radiofrequency probe comes in contact with the screw. These results are suggestive that pedicle screws could serve as a possible source of tissue heating and thermal injury during RFN. Wiley Periodicals, Inc.

Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis.

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Gong, Xu; Cui, Jianli; Jiang, Ziping; Lu, Laijin; Li, Xiucun

2018-03-01

Few clinical retrospective studies have reported the risk factors of pedicled flap necrosis in hand soft tissue reconstruction. The aim of this study was to identify non-technical risk factors associated with pedicled flap perioperative necrosis in hand soft tissue reconstruction via a multivariate logistic regression analysis. For patients with hand soft tissue reconstruction, we carefully reviewed hospital records and identified 163 patients who met the inclusion criteria. The characteristics of these patients, flap transfer procedures and postoperative complications were recorded. Eleven predictors were identified. The correlations between pedicled flap necrosis and risk factors were analysed using a logistic regression model. Of 163 skin flaps, 125 flaps survived completely without any complications. The pedicled flap necrosis rate in hands was 11.04%, which included partial flap necrosis (7.36%) and total flap necrosis (3.68%). Soft tissue defects in fingers were noted in 68.10% of all cases. The logistic regression analysis indicated that the soft tissue defect site (P = 0.046, odds ratio (OR) = 0.079, confidence interval (CI) (0.006, 0.959)), flap size (P = 0.020, OR = 1.024, CI (1.004, 1.045)) and postoperative wound infection (P < 0.001, OR = 17.407, CI (3.821, 79.303)) were statistically significant risk factors for pedicled flap necrosis of the hand. Soft tissue defect site, flap size and postoperative wound infection were risk factors associated with pedicled flap necrosis in hand soft tissue defect reconstruction. © 2017 Royal Australasian College of Surgeons.

Muscle-splitting approach to superior and inferior gluteal vessels: versatile source of recipient vessels for free-tissue transfer to sacral, gluteal, and ischial regions.

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Park, S

2000-07-01

The superior gluteal vessel has been reported as a recipient in free-tissue transfer for the coverage of complex soft-tissue defects in the lumbosacral region, where a suitable recipient vessel is difficult to find. The characteristics of proximity, vessel caliber, and constancy make the superior gluteal vessel preferable to previously reported recipient vessels. However, there are technical difficulties in microsurgery (e.g., short pedicle length and deep location) and muscle injury (transection of the muscle) associated with use of the superior gluteal vessel. The purpose of this article is to present a modification of an approach to the gluteal vessel to alleviate technical difficulties and minimize muscle injury. From August of 1997 to January of 1999, six patients received microvascular transfer of the latissimus dorsi muscle or myocutaneous flap to the sacral (4) and ischial (2) regions. The causes of defects were tumor (1), trauma (1), and pressure sores (4). A muscle-splitting approach was used on the superior gluteal vessel and was later applied to the inferior gluteal vessel. The gluteus maximus muscle was split as needed in the direction of its fibers, and the perforators were dissected down to the superior or inferior gluteal artery and vein deep into the muscle. The follow-up period ranged from 6 to 22 months, and all of the flaps survived with complete recovery of the lesion. The major drawbacks of using the superior and inferior gluteal vessels can be overcome with the muscle-splitting approach, which provides increased accessibility and additional length to the vascular pedicle while causing minimal injury to the muscle itself. It also proves to be an easy, safe, and reliable method of dissection. When free-tissue transfer to sacral, gluteal, and ischial regions is indicated, the muscle-splitting approach to the superior and inferior gluteal vessels is a recommended option in the selection of a recipient vessel.

Lumbar pedicle screw placement: Using only AP plane imaging

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Anil Sethi

2012-01-01

Conclusion: Placement of pedicle screws under fluoroscopic guidance using AP plane imaging alone with tactile guidance is safe, fast, and reliable. However, a good understanding of the radiographic landmarks is a prerequisite.

Reconstruction of trochanteric pressure sores with pedicled anterolateral thigh myocutaneous flaps.

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Wang, Chih-Hsin; Chen, Shih-Yi; Fu, Ju-Peng; Dai, Niann-Tzyy; Chen, Shao-Liang; Chen, Tim-Mo; Chen, Shyi-Gen

2011-05-01

To provide an alternative choice for covering trochanteric pressure sores, we report on a modified pedicle anterolateral thigh (ALT) myocutaneous flap based on the descending branch of the lateral circumflex femoral artery. From August 2007 to January 2010, 20 consecutive patients (10 men and 10 women) underwent 21 pedicled ALT myocutaneous flaps for reconstruction of trochanteric pressure sores. The flap was designed and elevated, resembling the ALT perforator flap including part of the vastus lateralis muscle but without skeletonisation of the perforators. The mean age of patients was 79.4 years (range: 46-103). The mean follow-up period was 13.9 months (range: 3-32). The flaps were 8-21 cm long and 5-11 cm wide. All flaps healed without major complications. All donor sites were closed primarily without skin grafting and showed good aesthetic results. No recurrence was observed. This modified design of pedicled ALT myocutaneous flap without skeletonisation of perforators is a reliable and easily harvested flap for reconstruction of trochanteric pressure sores with limited morbidity. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

Pedicle screw-rod fixation: a feasible treatment for dogs with severe degenerative lumbosacral stenosis.

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Tellegen, Anna R; Willems, Nicole; Tryfonidou, Marianna A; Meij, Björn P

2015-12-07

Degenerative lumbosacral stenosis is a common problem in large breed dogs. For severe degenerative lumbosacral stenosis, conservative treatment is often not effective and surgical intervention remains as the last treatment option. The objective of this retrospective study was to assess the middle to long term outcome of treatment of severe degenerative lumbosacral stenosis with pedicle screw-rod fixation with or without evidence of radiological discospondylitis. Twelve client-owned dogs with severe degenerative lumbosacral stenosis underwent pedicle screw-rod fixation of the lumbosacral junction. During long term follow-up, dogs were monitored by clinical evaluation, diagnostic imaging, force plate analysis, and by using questionnaires to owners. Clinical evaluation, force plate data, and responses to questionnaires completed by the owners showed resolution (n = 8) or improvement (n = 4) of clinical signs after pedicle screw-rod fixation in 12 dogs. There were no implant failures, however, no interbody vertebral bone fusion of the lumbosacral junction was observed in the follow-up period. Four dogs developed mild recurrent low back pain that could easily be controlled by pain medication and an altered exercise regime. Pedicle screw-rod fixation offers a surgical treatment option for large breed dogs with severe degenerative lumbosacral stenosis with or without evidence of radiological discospondylitis in which no other treatment is available. Pedicle screw-rod fixation alone does not result in interbody vertebral bone fusion between L7 and S1.

Omental pedicle transposition and suture repair of peripheral nerve ...

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Abu wael

This study aimed to compare the effectiveness of omental pedicle transposition and ... Assessment of the nerve regeneration was based on functional (motor and sensory), ..... peripheral nerve fibers regenerating after crush, multiple crush, and.

Use of a life-size three-dimensional-printed spine model for pedicle screw instrumentation training.

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Park, Hyun Jin; Wang, Chenyu; Choi, Kyung Ho; Kim, Hyong Nyun

2018-04-16

Training beginners of the pedicle screw instrumentation technique in the operating room is limited because of issues related to patient safety and surgical efficiency. Three-dimensional (3D) printing enables training or simulation surgery on a real-size replica of deformed spine, which is difficult to perform in the usual cadaver or surrogate plastic models. The purpose of this study was to evaluate the educational effect of using a real-size 3D-printed spine model for training beginners of the free-hand pedicle screw instrumentation technique. We asked whether the use of a 3D spine model can improve (1) screw instrumentation accuracy and (2) length of procedure. Twenty life-size 3D-printed lumbar spine models were made from 10 volunteers (two models for each volunteer). Two novice surgeons who had no experience of free-hand pedicle screw instrumentation technique were instructed by an experienced surgeon, and each surgeon inserted 10 pedicle screws for each lumbar spine model. Computed tomography scans of the spine models were obtained to evaluate screw instrumentation accuracy. The length of time in completing the procedure was recorded. The results of the latter 10 spine models were compared with those of the former 10 models to evaluate learning effect. A total of 37/200 screws (18.5%) perforated the pedicle cortex with a mean of 1.7 mm (range, 1.2-3.3 mm). However, the latter half of the models had significantly less violation than the former half (10/100 vs. 27/100, p 3D-printed spine model can be an excellent tool for training beginners of the free-hand pedicle screw instrumentation.

Are We Underestimating the Significance of Pedicle Screw Misplacement?

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Sarwahi, Vishal; Wendolowski, Stephen F; Gecelter, Rachel C; Amaral, Terry; Lo, Yungtai; Wollowick, Adam L; Thornhill, Beverly

2016-05-01

A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed. To evaluate the accuracy of pedicle screw placement using a novel classification system to determine potentially significant screw misplacement. The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. This demonstrates technical ability but does not represent the impact of screw misplacement on individual patients. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity. A retrospective review of charts, XRs and low-dose CT scans of 127 patients who underwent spinal fusion with pedicle screws for spinal deformity was performed. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). A total of 2724 screws were placed in 127 patients. A total of 2396 screws were placed accurately (87.96%). A total of 247 screws (9.07%) were BMP, 52 (1.91%) were IMP, and 29 (1.06%) were considered SAR. Per-patient analysis showed 23 (18.11%) of patients had all screws AP. Thirty-five (27.56%) had IMP and 18 (14.17%) had SAR. Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. Over 40% of patients had screws with either some/major concern. Overall reported screw misplacement is low, but it does not reflect the potential impact on patient morbidity. Per-patient analysis reveals more concerning numbers toward screw misplacement. With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. Better strategies need to be devised for evaluation of screw placement, including establishment of a national database of deformity surgery, use of intra-operative image guidance, and

Design of three-dimensional visualization based on the posterior lumbar pedicle screw fixation

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Kai XU

2011-09-01

Full Text Available Objective To establish a three-dimensional visualization model of posterior lumbar pedicle screw fixation.Methods A patient with lumbar intervertebral disc hernia and another patient with compression fracture of lumbar vertebra were involved in the present study.Both patients underwent multi-slice spiral CT scan before and after lumbar pedicle screw fixation.The degree of preoperative vertebral compression,vertebral morphology before and after surgery,postoperative pedicle screw position,and decompression effects were observed.The original data of the multi-slice spiral CT were inputted into the computer.The three-dimensional reconstructed images of the lumbar and implanted screws were obtained using the software Amira 4.1 to show the three-dimensional shape of the lumbar vertebrae before and after surgery and the location of the implanted screws.Results The morphology and structure of the lumbar vertebrae before and after surgery and of the implanted screws were reconstructed using the digital navigation platform.The reconstructed 3D images could be displayed in multicolor,transparent,or arbitrary combinations.In the 3D surface reconstruction images,the location and structure of the implanted screws could be clearly observed,and the decompression of the spinal cord or nerve roots and the severity of the fracture and the compression of lumbar vertebrae could be fully evaluated.The reconstructed images before operation revealed the position of the vertebral pedicles and provided reference for intraoperative localization.Conclusions The three-dimensional computerized reconstructions of lumbar pedicle screw fixation may be valuable in basic research,clinical experiment,and surgical planning.The software Amira is one of the bases of three-dimensional reconstruction.

A computed tomography morphometric study of occipital bone and C2 pedicle anatomy for occipital-cervical fusion.

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King, Nicolas K K; Rajendra, Tiruchelvarayan; Ng, Ivan; Ng, Wai Hoe

2014-01-01

Occipital-cervical fusion (OCF) has been used to treat instability of the occipito-cervical junction and to provide biomechanical stability after decompressive surgery. The specific areas that require detailed morphologic knowledge to prevent technical failures are the thickness of the occipital bone and diameter of the C2 pedicle, as the occipital midline bone and the C2 pedicle have structurally the strongest bone to provide the biomechanical purchase for cranio-cervical instrumentation. The aim of this study was to perform a quantitative morphometric analysis using computed tomography (CT) to determine the variability of the occipital bone thickness and C2 pedicle thickness to optimize screw placement for OCF in a South East Asian population. Thirty patients undergoing cranio-cervical junction instrumentation during the period 2008-2010 were included. The thickness of the occipital bone and the length and diameter of the C2 pedicle were measured based on CT. The thickest point on the occipital bone was in the midline with a maximum thickness below the external occipital protuberance of 16.2 mm (±3.0 mm), which was thicker than in the Western population. The average C2 pedicle diameter was 5.3 mm (±2.0 mm). This was smaller than Western population pedicle diameters. The average length of the both pedicles to the midpoint of the C2 vertebral body was 23.5 mm (±3.3 mm on the left and ±2.3 mm on the right). The results of this first study in the South East Asian population should help guide and improve the safety in occipito-cervical region instrumentation. Thus reducing the risk of technical failures and neuro-vascular injury.

Alternative radiation-free registration technique for image-guided pedicle screw placement in deformed cervico-thoracic segments.

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Kantelhardt, Sven R; Neulen, Axel; Keric, Naureen; Gutenberg, Angelika; Conrad, Jens; Giese, Alf

2017-10-01

Image-guided pedicle screw placement in the cervico-thoracic region is a commonly applied technique. In some patients with deformed cervico-thoracic segments, conventional or 3D fluoroscopy based registration of image-guidance might be difficult or impossible because of the anatomic/pathological conditions. Landmark based registration has been used as an alternative, mostly using separate registration of each vertebra. We here investigated a routine for landmark based registration of rigid spinal segments as single objects, using cranial image-guidance software. Landmark based registration of image-guidance was performed using cranial navigation software. After surgical exposure of the spinous processes, lamina and facet joints and fixation of a reference marker array, up to 26 predefined landmarks were acquired using a pointer. All pedicle screws were implanted using image guidance alone. Following image-guided screw placement all patients underwent postoperative CT scanning. Screw positions as well as intraoperative and clinical parameters were retrospectively analyzed. Thirteen patients received 73 pedicle screws at levels C6 to Th8. Registration of spinal segments, using the cranial image-guidance succeeded in all cases. Pedicle perforations were observed in 11.0%, severe perforations of >2 mm occurred in 5.4%. One patient developed a transient C8 syndrome and had to be revised for deviation of the C7 pedicle screw. No other pedicle screw-related complications were observed. In selected patients suffering from pathologies of the cervico-thoracic region, which impair intraoperative fluoroscopy or 3D C-arm imaging, landmark based registration of image-guidance using cranial software is a feasible, radiation-saving and a safe alternative.

Significance of magnetic resonance imaging signal change in the pedicle in the management of pediatric lumbar spondylolysis.

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Sakai, Toshinori; Sairyo, Koichi; Mima, Seiichi; Yasui, Natsuo

2010-06-15

Prospective study. To investigate the time course of signal changes in the adjacent pedicle in fresh pediatric lumbar spondylolysis. A recent study reported that high signal change (HSC) on T2-magnetic resonance image (MRI) in the pedicle adjacent to the pars interarticularis could be an indicator of early spondylolysis. In addition, the HSC-positive pars defects showed significant better bony healing than the HSC-negative pars defects. However, there has been no report on the time course and the duration of HSC. We prospectively investigated 10 boys and 5 girls with fresh lumbar spondylolysis showing HSC in the adjacent pedicle. Their mean age was 15.1 years, ranging from 10 to 17 years. Two patients had multilevel unilateral spondylolysis. Among 15 patients, HSC was found in 22 (12 unilateral and 5 bilateral) pedicles. At the first presentation, the diagnosis of spondylolysis was made based on the plain radiograph findings, multidetector computed tomograms (CTs), and MRI. Every month from the first presentation, follow-up MRIs were taken. When HSC disappeared, multidetector CT was taken to confirm bony healing of the pars defect. Bony healing of the pars was obtained in 21 out of 22 defects. The bony healing rate was 95.6%. In 19 pedicles of 12 patients, HSC gradually diminished by every month until it disappeared 3 months later, and radiologic osseous healing was confirmed by CT in all but 1 patient. In the 3 remaining pedicles of 3 patients, HSC took more than 4 months to disappear. In this study, HSC disappeared in most pedicles on the 3-month follow-up MRI. In patients who did not comply with treatment, HSC tended to last longer. These results led us to hypothesize that MRI at the third month during follow-up can indicate whether the conservative treatment is being successful or not.

Superior facet syndrome

International Nuclear Information System (INIS)

Kubo, Yoshichika; Igarashi, Seishi; Koyama, Tsunemaro

1985-01-01

Sciatica caused by root entrapment in the lateral recess was named superior facet syndrome by Epstein in 1972. Few reports on this subject based on large numbers of cases have been documented to date. Of the patients with sciatica, 32 patients were diagnosed to have root entrapment at the lateral recess L 5 or/and S 1 lumbar spine. Out of 32 patients, 20 patients were operated on and the lateral entrapment was recognized in all of surgical cases. Neuroradiological findings, especially of metrizamide CT (met. CT), were documented in detail. Thirty two patients were classified in three types according to radiological findings. They were congenital or developmental, degenerative, and combined type, respectively, Fourteen cases belonged to the congenital type, 13 to the degenerative and 5 to the combined type. Each group had the mean ages of 23.4, 53.8, and 36.8 years old, respectively. Of 32 cases the entrapment occured in 47 L 5 roots and 11 S 1 roots. There was no remarkable laterality. In operation the unroofing of the lateral recess were done and the sciatica subsided postoperatively in all of surgical cases. Met. CT revealed extreme medial protrusion of the superior articular joint in 18 of 24 cases(75%) and none filling of the root in the lateral recess in 21 of 24 cases (87.5%). In the degenerative type, met. CT showed some degenerative changes that were hypertrophy or deformity of the articular joints and spur formation of the vertebral body. In contrast to met. CT, metrizamide myelography revealed only slight changes, which were poor filling of the root before it turned out the pedicle of lateral compression of the root. In plain films or lumbar spine articular joints at Lsub(4/5) were formed in coronal plane in 69% of cases of the L 5 root entrapment. Met. CT using ReView technique was of great diagnostic value in superior facet syndrome. (author)

reduction mammoplasty using inferior pedicle in heavy breasts

African Journals Online (AJOL)

2011-09-09

Sep 9, 2011 ... sexual relationships. Reduction mammoplasty procedure provides weight and volume reduction of the breast as well as enhancement of the aesthetic appearance of the breasts. In this study, the inferior pedicle technique was used in reduction of thirty five patients over the last four years with macromastia.

Experimental study of pedicle screw stability on low BMD vertebrae

International Nuclear Information System (INIS)

Li Qi; Yang Huilin; Tang Tiansi; Wu Yiwei; Wang Yijin

2005-01-01

Objective: To conduct biomechanical study of different pedicle screws stability on spinal specimen, discuss the relationship between design parameter of screw, insertion torgue and BMD, establish the theoretical foundation for application of pedicle screw on osteoporotic patients. Methods: Six fixed lumbar cadavers were collected, the effects of design parameter, insertion torque and etc on fixation stability were determined under various BMD by using biomechanical ways. Results: According to in vitro study: (1) There was a significant difference among pullout strength of all screws (P 2 >U 1 >SF 1 >SF 2 >RF. Conclusions: There is a close correlated between type of screw, BMD and stability. The U-type screw displays the best fixation effect on specimen of low BMD. (authors)

The accuracy of the lateral vertebral notch-referred pedicle screw insertion technique in subaxial cervical spine: a human cadaver study.

Science.gov (United States)

Luo, Jiaquan; Wu, Chunyang; Huang, Zhongren; Pan, Zhimin; Li, Zhiyun; Zhong, Junlong; Chen, Yiwei; Han, Zhimin; Cao, Kai

2017-04-01

This is a cadaver specimen study to confirm new pedicle screw (PS) entry point and trajectory for subaxial cervical PS insertion. To assess the accuracy of the lateral vertebral notch-referred PS insertion technique in subaxial cervical spine in cadaver cervical spine. Reported morphometric landmarks used to guide the surgeon in PS insertion show significant variability. In the previous study, we proposed a new technique (as called "notch-referred" technique) primarily based on coronal multiplane reconstruction images (CMRI) and cortical integrity after PS insertion in cadavers. However, the PS position in cadaveric cervical segment was not confirmed radiologically. Therefore, the difference between the pedicle trajectory and the PS trajectory using the notch-referred technique needs to be illuminated. Twelve cadaveric cervical spines were conducted with PS insertion using the lateral vertebral notch-referred technique. The guideline for entry point and trajectory for each vertebra was established based on the morphometric data from our previous study. After 3.5-mm diameter screw insertion, each vertebra was dissected and inspected for pedicle trajectory by CT scan. The pedicle trajectory and PS trajectory were measured and compared in axial plane. The perforation rate was assessed radiologically and was graded from ideal to unacceptable: Grade 0 = screw in pedicle; Grade I = perforation of pedicle wall less than one-fourth of the screw diameter; Grade II = perforation more than one-fourth of the screw diameter but less than one-second; Grade III = perforation more than one-second outside of the screw diameter. In addition, pedicle width between the acceptable and unacceptable screws was compared. A total of 120 pedicle screws were inserted. The perforation rate of pedicle screws was 78.3% in grade 0 (excellent PS position), 10.0% in grade I (good PS position), 8.3% in grade II (fair PS position), and 3.3% in grade III (poor PS position). The

3D printing-assisted preoperative plan of pedicle screw placement for middle-upper thoracic trauma: a cohort study.

Science.gov (United States)

Xu, Wei; Zhang, Xuming; Ke, Tie; Cai, Hongru; Gao, Xiang

2017-08-11

This study aimed to evaluate the application of 3D printing in assisting preoperative plan of pedicle screw placement for treating middle-upper thoracic trauma. A preoperative plan was implemented in seven patients suffering from middle-upper thoracic (T3-T7) trauma between March 2013 and February 2016. In the 3D printing models, entry points of 56 pedicle screws (Magerl method) and 4 important parameters of the pedicle screws were measured, including optimal diameter (ϕ, mm), length (L, mm), inclined angle (α), head-tilting angle (+β), and tail-tilting angle (-β). In the surgery, bare-hands fixation of pedicle screws was performed using 3D printing models and the measured parameters as guidance. A total of seven patients were enrolled, including five men and two women, with the age of 21-62 years (mean age of 37.7 years). The position of the pedicle screw was evaluated postoperatively using a computerized tomography scan. Totally, 56 pedicle screws were placed, including 33 pieces of level 0, 18 pieces of level 1, 4 pieces of level 2 (pierced lateral wall), and 1 piece of level 3 (pierced lateral wall, no adverse consequences), with a fine rate of 91.0%. 3D printing technique is an intuitive and effective assistive technology to pedicle screw fixation for treating middle-upper thoracic vertebrae, which improve the accuracy of bare-hands screw placement and reduce empirical errors. The trial was approved by the Ethics Committee of the Fujian Provincial Hospital. It was registered on March 1st, 2013, and the registration number was K2013-03-001.

scrotal reconstruction with a pedicled gracilis muscle flap after

African Journals Online (AJOL)

nonviable tissue is removed and a granulation bed suitable for .... The pedicled or free greater omental flap as well as scrotal tissue ... Bien-keem Tan, Mohammed ZulfikarRasheed,. WofflesT.L.Wu ... Honda Hsu Chih Ming Lin, Tzong-Bon Sun,.

Evaluation of 99mTc-MDP bone imaging in monitoring the muscle-pedicle bone graft osteogenic activation

International Nuclear Information System (INIS)

Sang Shibiao; Wu Yiwei; Zhang Wei; Jiang Yimin; Chen Guangxiang; Dong Tianhua

2002-01-01

Nine mature and healthy dogs were divided into 4 groups randomly. The first group consists of 3 dogs, and the rest groups, 2 dogs. Self-control way was used. The left ilium was the experimental site, where the bone piece with sartorial muscle attached was cut from ilium. The right side served as control, where the graft bone from ilium was wrapped up with silica gel, then fixed subcutaneously. The pedicled bone pieces were retrieved in 2, 4, 6, 8 weeks after surgery, the size of graft bones from two sides were the same. Survival range, osteogenic formation of muscle-pedicle bone were examined by 99m Tc-MDP bone imaging and histological method to evaluate the clinical value of treatment of ischemic osteonecrosis of the femoral head with muscle-pedicle bone grafting. The results were as follows: 1. The part of bone attached by the sartorial survived, but osteonecrosis was observed at the location of 1.2-1.7 cm from attached point of muscle. 2. There were two forms observed in the course of osteogenic activation of muscle-pedicle bone. Under the reduction of mechanical stimulation and blood supply, bone marrow tissue was replaced by fibro-granulation tissue and new capillary in the survival part, while the survival bone of proximal part grew distally and gradually replace the dead bone of distal part. 3. Histological examination revealed that small amounts of fibro-granulation tissue and new capillary appeared in 2nd week, primary trabeculae appeared in 6th week, and in 8th week, some trabeculae recovered their normal appearance and osteogenic cell reduced remarkably. 4. Survival range of muscle-pedicle graft bone was directly proportional to the width of muscle pedicle. Therefore, radionuclide bone imaging and histological examination demonstrated that muscle-pedicle graft bone was a piece of bone with relatively poor blood supply, its effect is repairing necrosis and collapse of the femoral head is limited. 99m Tc-MDP bone imaging may be an effective and first

Comparative Analysis of Interval, Skipped, and Key-vertebral Pedicle Screw Strategies for Correction in Patients With Lenke Type 1 Adolescent Idiopathic Scoliosis.

Science.gov (United States)

Wang, Fei; Xu, Xi-Ming; Lu, Yanghu; Wei, Xian-Zhao; Zhu, Xiao-Dong; Li, Ming

2016-03-01

Pedicle screw constructs have become the mainstay for surgical correction in patients with spinal deformities. To reduce or avoid the risk of pedicle screw-based complications and to decrease the costs associated with pedicle screw instrumentation, some authors have introduced interval, skipped, and key-vertebral pedicle screw strategies for correction. However, there have been no comparisons of outcomes among these 3 pedicle screw-placement strategies.The aim of this study was to compare the correlative clinical outcomes of posterior correction and fusion with pedicle screw fixation using these 3 surgical strategies.Fifty-six consecutive patients with Lenke type 1 adolescent idiopathic scoliosis were included in this study. Twenty patients were treated with the interval pedicle screw strategy (IPSS), 20 with the skipped pedicle screw strategy (SPSS), and 16 with the key-vertebral pedicle screw strategy (KVPSS). Coronal and sagittal radiographs were analyzed before surgery, at 1 week after surgery, and at the last follow-up after surgery.There were no significant differences among the 3 groups regarding preoperative radiographic parameters. No significant difference was found between the IPSS and SPSS groups in correction of the main thoracic curve (70.8% vs 70.0%; P = 0.524). However, there were statistically significant differences between the IPSS and KVPSS groups (70.8% vs 64.9%) and between the SPSS and KVPSS groups (70.0% vs 64.9%) in correction of the main thoracic curve (P SPSS group was significantly higher than those in the IPSS (P SPSS and KVPSS groups (P SPSS, it can achieve a satisfactory clinical outcome and is more cost-effective.

Head and neck reconstruction with pedicled flaps in the free flap era.

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Mahieu, R; Colletti, G; Bonomo, P; Parrinello, G; Iavarone, A; Dolivet, G; Livi, L; Deganello, A

2016-12-01

Nowadays, the transposition of microvascular free flaps is the most popular method for management of head and neck defects. However, not all patients are suitable candidates for free flap reconstruction. In addition, not every defect requires a free flap transfer to achieve good functional results. The aim of this study was to assess whether pedicled flap reconstruction of head and neck defects is inferior to microvascular free flap reconstruction in terms of complications, functionality and prognosis. The records of consecutive patients who underwent free flap or pedicled flap reconstruction after head and neck cancer ablation from 2006 to 2015, from a single surgeon, in the AOUC Hospital, Florence Italy were analysed. A total of 93 patients, the majority with oral cancer (n = 59), were included, of which 64 were pedicled flap reconstructions (69%). The results showed no significant differences in terms of functional outcome, flap necrosis and complications in each type of reconstruction. Multivariate regression analysis of flap necrosis and functional impairments showed no associated factors. Multivariate regression analysis of complicated flap healing showed that only comorbidities remained an explaining factor (p = 0.019). Survival analysis and proportional hazard regression analysis regarding cancer relapse or distant metastasis, showed no significant differences in prognosis of patients concerning both types of reconstruction. In this retrospective, non-randomised study cohort, pedicled flaps were not significantly inferior to free flaps for reconstruction of head and neck defects, considering functionality, complications and prognosis. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

Use of omental pedicle flap for radiation induced chest wall ulcer. A case report

International Nuclear Information System (INIS)

Takamori, Shinzo; Hayashi, Akihiro; Nagamatsu, Yoshinori; Tsushimi, Mutsuo; Ono, Hirofumi; Ohtsuka, Shoji

1995-01-01

A 79-year-old female with breast carcinoma undergoing a classical Halsted radical mastectomy followed by irradiation (total; 180 Gy) 20 years before developed a left anterior chest wall ulcer. The ulcer was 10.0 x 8.0 cm in size with osteolysis of 3rd, 4th and 5th ribs, exposed pericardium, and parietal pleura with a pleuro-cutaneous fistula. After thorough debridement, an omental pedicle flap was transposed onto the chest wall defect and subsequently covered using a split-skin graft. The omental pedicle flap was 90% effective in covering the pericardial defect and resulted in a complete closure of the pleuro-cutaneous fistula. This report emphasises that an omental pedicle flap is effective in the treatment of radio-necrosis of the chest wall and also stresses the importance of judging the extent of debridement of radio-necrotic tissue. (author)

Use of omental pedicle flap for radiation induced chest wall ulcer. A case report

Energy Technology Data Exchange (ETDEWEB)

Takamori, Shinzo; Hayashi, Akihiro; Nagamatsu, Yoshinori; Tsushimi, Mutsuo; Ono, Hirofumi; Ohtsuka, Shoji [Kurume Univ., Fukuoka (Japan). School of Medicine

1995-12-01

A 79-year-old female with breast carcinoma undergoing a classical Halsted radical mastectomy followed by irradiation (total; 180 Gy) 20 years before developed a left anterior chest wall ulcer. The ulcer was 10.0 x 8.0 cm in size with osteolysis of 3rd, 4th and 5th ribs, exposed pericardium, and parietal pleura with a pleuro-cutaneous fistula. After thorough debridement, an omental pedicle flap was transposed onto the chest wall defect and subsequently covered using a split-skin graft. The omental pedicle flap was 90% effective in covering the pericardial defect and resulted in a complete closure of the pleuro-cutaneous fistula. This report emphasises that an omental pedicle flap is effective in the treatment of radio-necrosis of the chest wall and also stresses the importance of judging the extent of debridement of radio-necrotic tissue. (author).

Effectiveness of the Thoracic Pedicle Screw Placement Using the Virtual Surgical Training System: A Cadaver Study.

Science.gov (United States)

Hou, Yang; Lin, Yanping; Shi, Jiangang; Chen, Huajiang; Yuan, Wen

2018-03-14

The virtual simulation surgery has initially exhibited its promising potentials in neurosurgery training. To evaluate effectiveness of the Virtual Surgical Training System (VSTS) on novice residents placing thoracic pedicle screws in a cadaver study. A total of 10 inexperienced residents participated in this study and were randomly assigned to 2 groups. The group using VSTS to learn thoracic pedicle screw fixation was the simulation training (ST) group and the group receiving an introductory teaching session was the control group. Ten fresh adult spine specimens including 6 males and 4 females with a mean age of 58.5 yr (range: 33-72) were collected and randomly allocated to the 2 groups. After exposing anatomic structures of thoracic spine, the bilateral pedicle screw placement of T6-T12 was performed on each cadaver specimen. The postoperative computed tomography scan was performed on each spine specimen, and experienced observers independently reviewed the placement of the pedicle screws to assess the incidence of pedicle breach. The screw penetration rates of the ST group (7.14%) was significantly lower in comparison to the control group (30%, P < .05). Statistically significant difference in acceptable rates of screws also occurred between the ST (100%) and control (92.86%) group (P < .05). In addition, the average screw penetration distance in control group (2.37 mm ± 0.23 mm) was significantly greater than ST group (1.23 mm ± 0.56 mm, P < .05). The virtual reality surgical training of thoracic pedicle screw instrumentation effectively improves surgical performance of novice residents compared to those with traditional teaching method, and can help new beginners to master the surgical technique within shortest period of time.

Congenitally absent thoracic pedicle in a child with rhabdomyosarcoma

Energy Technology Data Exchange (ETDEWEB)

Kaufman, R A; Poznanski, A K; Hensinger, R N

1980-04-01

A case of congenital absence of a thoracic pedicle is reported in a 9 year old boy with embryonal rhabdomyosarcoma of the eyelid. In this clinical setting a surgical exploration was necessary in order to differentiate a developmental anomaly from an acquired metastatic deposit.

Post-traumatic arteriovenous fistula of the hepatic pedicle.

Science.gov (United States)

Ibn Majdoub Hassani, K; Mohsine, R; Belkouchi, A; Bensaid, Y

2010-10-01

Hepatico-portal fistula (HPF) is a rare condition, most often of post-traumatic or iatrogenic origin and occasionally secondary to a ruptured aneurysm of the hepatic artery into the portal vein. HPF in extrahepatic locations often results in portal hypertension (PHT). While Doppler ultrasound, CT angiography, and magnetic resonance angiography are usually demonstrative, arteriography remains indispensable to clarify the exact anatomical configuration. In the treatment of these arteriovenous (AV) fistulas, open surgical approaches have increasingly given way to radiological embolization techniques, especially in intrahepatic locations, but surgery remains indicated for AV fistulas of the hepatic pedicle where maintenance of hepatic arterial flow is a priority of treatment. We report a patient who had an AV fistula of the hepatic pedicle with resultant PHT presenting 5 years after open abdominal trauma. Treatment was surgical; the immediate and long-term postoperative course was uneventful with regression of PHT. Through analysis of this case and a review of the literature, we discuss the clinical, paraclinical, therapeutic, and prognostic features of this lesion. Copyright © 2010. Published by Elsevier Masson SAS.

Percutaneous augmentation of the superior pubic ramus with polymethyl methacrylate: treatment of acute traumatic and chronic insufficiency fractures

Energy Technology Data Exchange (ETDEWEB)

Beall, Douglas P. [University of Oklahoma, Clinical Radiology of Oklahoma, Oklahoma City, OK (United States); D' Souza, Sharon L. [University of Oklahoma, Oklahoma City, OK (United States); Costello, Richard F.; Stapp, Annette M. [Clinical Radiology of Oklahoma, Edmond, OK (United States); Prater, Scott D. [University of Oklahoma College of Medicine, Edmond, OK (United States); Van Zandt, Bryan L. [University of Oklahoma College of Medicine, Oklahoma City, OK (United States); Martin, Hal D. [Oklahoma Sports Science and Orthopaedics, Oklahoma City, OK (United States)

2007-10-15

The injection of polymethylmethacrylate (PMMA) is a minimally invasive image-guided procedure that is typically used to treat vertebral body fractures due to osteoporosis or neoplastic involvement. The injection of PMMA into various other locations including the sacrum, acetabulum, pedicles, femur and tibia has been reported previously, and these procedures have, overall, been highly effective at alleviating pain and discomfort. Although the injection of PMMA into the vertebral body is a very common procedure that has been performed for over 2 decades for the percutaneous treatment of vertebral body fractures, the percutaneous injection of PMMA has not been reported in the English literature as treatment for superior pubic ramus fractures. We report the percutaneous treatment of an acute superior pubic ramus fracture and of a chronic insufficiency fracture of the superior pubic ramus using a parasymphyseal approach to access the region of injury. (orig.)

Minimally invasive mini open split-muscular percutaneous pedicle screw fixation of the thoracolumbar spine

Directory of Open Access Journals (Sweden)

Murat Ulutaş

2015-03-01

Full Text Available We prospectively assessed the feasibility and safety of a new percutaneous pedicle screw (PPS fixation technique for instrumentation of the thoracic and lumbar spine in this study. All patients were operated in the prone position under general anesthesia. A 6 to 8 cm midline skin incision was made and wide sub-cutaneous dissection was performed. The paravertebral muscles were first dissected subperiosteally into the midline incision of the fascia for lumbar microdiscectomy with transforaminal lumbar interbody fusion cage implantation. After the secondary paramedian incisions on the fascia, the PPSs were inserted via cleavage of the multifidus muscles directly into the pedicles under fluoroscopy visualization. A total of 35 patients underwent surgery with this new surgical technique. The control group for operative time, blood loss and analgesic usage consisted of 35 randomly selected cases from our department. The control group underwent surgery via conventional pedicle screw instrumentation with paramedian fusion. All patients in the minimal invasive surgery series were ambulatory with minimal pain on the first postoperative day. The operation time and blood loss and the postoperative analgesic consumption were significantly less with this new technique. In conclusion, the minimal invasive mini open split-muscular percutaneous pedicle screw fixation technique is safe and feasible. It can be performed via a short midline skin incision and can also be combined with interbody fusion, causing minimal pain without severe muscle damage.

Lower abdominal wall reconstructions with pedicled rectus femoris flaps

International Nuclear Information System (INIS)

Arashiro, Ken; Nishizeki, Osamu; Ishida, Kunihiro

2003-01-01

During the past 10 years, seven pedicled rectus femoris muscle or musculocutaneous flaps were used to repair lower abdominal defects; three recalcitrant incisional hernias with previous radiotherapy, two long-standing wound infections after synthetic mesh reconstruction, one posttraumatic wall defect and one metastatic tumor. There were two flap complications, one skin paddle necrosis and one wound infection. There was no significant disability of the donor limb encountered. During the two-year and seven month average follow-up, there was no recurrence of the problems except for one minor fascial dehiscence in the patient with metastatic abdominal wall tumor. Easy approach, rapid harvest, relatively large and reliable overlying fascia lata, a single dominant neurovascular pedicle, easy primary closure of the donor site, and minimal donor site morbidity all make the rectus femoris flap a good alternative flap for lower abdominal wall reconstruction. It is especially useful in a condition where synthetic mesh would be unsuitable for defects with infection or recurrent incisional hernia after radiotherapy. (author)

Virtual surgery simulation versus traditional approaches in training of residents in cervical pedicle screw placement.

Science.gov (United States)

Hou, Yang; Shi, Jiangang; Lin, Yanping; Chen, Huajiang; Yuan, Wen

2018-06-01

The cervical screw placement is one of the most difficult procedures in spine surgery, which often needs a long period of repeated practices and could cause screw placement-related complications. We performed this cadaver study to investigate the effectiveness of virtual surgical training system (VSTS) on cervical pedicle screw instrumentation for residents. A total of ten novice residents were randomly assigned to two groups: the simulation training (ST) group (n = 5) and control group (n = 5). The ST group received a surgical training of cervical pedicle screw placement on VSTS and the control group was given an introductory teaching session before cadaver test. Ten fresh adult spine specimens including 6 males and 4 females were collected, and were randomly allocated to the two groups. The bilateral C3-C6 pedicle screw instrumentation was performed in the specimens of the two groups, respectively. After instrumentation, screw positions of the two groups were evaluated by image examinations. There was significantly statistical difference in screw penetration rates between the ST (10%) and control group (62.5%, P VSTS as an advanced training tool exhibited promising effects on improving performance of novice residents in cervical pedicle screw placement compared with the traditional teaching methods.

Image Guidance to Aid Pedicle Screw Fixation of a Lumbar Fracture-Dislocation Injury in a Toddler.

Science.gov (United States)

Houten, John K; Nahkla, Jonathan; Ghandi, Shashank

2017-09-01

Pedicle screw fixation of the lumbar spine in children age <2 years is particularly challenging, as successful cannulation of the small pedicle dimensions requires a high level of precision and there are no implants specifically designed for the infant spine. Image-guided navigation is commonly used in adult spinal surgery and may be particularly helpful for the placement of spinal screws in areas where the bony anatomy is small and/or anatomically complex, as in the upper cervical area. A 19-month-old female presented with a fracture-dislocation injury of L1-2. Intraoperative imaging using the O-arm multidimensional imaging system was networked to a workstation, and neuronavigation was used to place pedicle instrumentation with 3.5-mm-diameter polyaxial screws designed for posterior cervical fixation. At a 48-month follow-up, the patient was neurologically intact, demonstrated normal physical development, and was engaging in normal physical activity for her age. Radiographs obtained approximately 4 years postsurgery showed no evidence of loss for fixation. Image-guided placement of pedicle screws may be a useful aid in achieving accurate and safe fixation in the small dimensions of the infant spine. Copyright © 2017 Elsevier Inc. All rights reserved.

Probing and Tapping: Are We Inserting Pedicle Screws Correctly?

Science.gov (United States)

Prasad, Vishal; Mesfin, Addisu; Lee, Robert; Reigrut, Julie; Schmidt, John

2016-11-01

Although there are a significant number of research publications on the topic of bone morphology and the strength of bone, the clinical significance of a failed pedicle screw is often revision surgery and the potential for further postoperative complications; especially in elderly patients with osteoporotic bone. The purpose of this report is to quantify the mechanical strength of the foam-screw interface by assessing probe/pilot hole diameter and tap sizes using statistically relevant sample sizes under highly controlled test conditions. The study consisted of two experiments and used up to three different densities of reference-grade polyurethane foam (ASTM 1839), including 0.16, 0.24, and 0.32 g/cm 3 . All screws and rods were provided by K2M Inc. and screws were inserted to a depth of 25 mm. A series of pilot holes, 1.5, 2.2, 2.7, 3.2, 3.7, 4.2, 5.0, and 6.0 mm in diameter were drilled through the entire depth of the material. A 6.5 × 45-mm pedicle screw was inserted and axially pulled from the material (n = 720). A 3.0-mm pilot hole was drilled and tapped with: no tap, 3.5-, 4.5-, 5.5-, and 6.5-mm taps. A 6.5 × 45-mm pedicle screw was inserted and axially pulled from the material (n = 300). The size of the probe/pilot hole had a nonlinear, parabolic effect on pullout strength. This shape suggests an optimum-sized probe hole for a given size pedicle screw. Too large or too small of a probe hole causes a rapid falloff in pullout strength. The tap data demonstrated that not tapping and undertapping by two or three sizes did not significantly alter the pullout strength of the screws. The data showed an exponential falloff of pullout strength when as tap size increased to the diameter of the screw. In the current study, the data show that an ideal pilot hole size half the diameter of the screw is a starting point. Also, that if tapping was necessary, to use a tap two sizes smaller than the screw being implanted. A similar optimum pilot hole or tap size may be

A case of severe congenital kyphoscoliosis secondary to multiple bilateral thoracic pedicle aplasia

International Nuclear Information System (INIS)

Geoffray, Anne; Leloutre, Beatrice; Albertario, Marco; Bechard-Sevette, Nancy; Clement, Jean-Luc

2008-01-01

A 9-month-old boy with congenital kyphoscoliosis secondary to multiple bilateral thoracic pedicle aplasias is presented. This anomaly has rarely been described in the literature. Plain films showed absence of thoracic pedicles bilaterally from T2 to T9, which was better demonstrated on CT multiplanar and 3-D reformatted images. There were no neurological symptoms even though the deformity progressed rapidly. Congenital kyphosis or kyphoscoliosis is often related to spinal anomalies that are located on the anterior aspect of the vertebrae. However, posterior anomalies may also be responsible and should be recognized before neurological complications occur. (orig.)

The use of pedicled prepucial skin flap urethroplasty for proximal ...

African Journals Online (AJOL)

The use of pedicled prepucial skin flap urethroplasty for proximal bulbomembraneous urethral stricture in children: an easy alternative to transpubic urethroplasty. Harshjeet S. Bal, Jujju J. Kurian and Sudipta Sen. Objective Pediatric urethral strictures are not uncommon, and a myriad of treatment options is available.

Posterior Surgery for Adolescent Idiopathic Scoliosis With Pedicle Screws and Ultrahigh-Molecular Weight Polyethylene Tape: Achieving the Ideal Thoracic Kyphosis.

Science.gov (United States)

Imagama, Shiro; Ito, Zenya; Wakao, Norimitsu; Ando, Kei; Hirano, Kenichi; Tauchi, Ryoji; Muramoto, Akio; Matsui, Hiroki; Matsumoto, Tomohiro; Sakai, Yoshihito; Katayama, Yoshito; Matsuyama, Yukihiro; Ishiguro, Naoki

2016-10-01

Prospective clinical case series. To describe our surgical procedure and results for posterior correction and fusion with a hybrid approach using pedicle screws, hooks, and ultrahigh-molecular weight polyethylene tape with direct vertebral rotation (DVR) (the PSTH-DVR procedure) for treatment of adolescent idiopathic scoliosis (AIS) with satisfactory correction in the coronal and sagittal planes. Introduction of segmental pedicle screws in posterior surgery for AIS has facilitated good correction and fusion. However, procedures using only pedicle screws have risks during screw insertion, higher costs, and decreased postoperative thoracic kyphosis. We have obtained good outcomes compared with segmental pedicle screw fixation in surgery for AIS using a relatively simple operative procedure (PSTH-DVR) that uses fewer pedicle screws. The subjects were 30 consecutive patients with AIS who underwent the PSTH-DVR procedure and were followed for a minimum of 2 years. Preoperative flexibility, preoperative and postoperative Cobb angles, correction rates, loss of correction, thoracic kyphotic angles (T5-T12), coronal balance, sagittal balance, and shoulder balance were measured on plain radiographs. Rib hump, operation time, estimated blood loss, spinal cord monitoring findings, complications, and scoliosis research society (SRS)-22 scores were also examined. The mean preoperative curve of 58.0 degrees (range, 40-96 degrees) was corrected to a mean of 9.9 degrees postoperatively, and the correction rate was 83.6%. Fusion was obtained in all patients without loss of correction. In 10 cases with preoperative kyphosis angles (T5-T12) correction of deformity with PSTH-DVR is equivalent to that of all-pedicle screw constructs. The procedure gives favorable correction, is advantageous for kyphosis compared with segmental screw fixation, and uses the minimum number of pedicle screws. Therefore, the PSTH-DVR procedure may be useful for treatment of idiopathic scoliosis.

MIS Single-position Lateral and Oblique Lateral Lumbar Interbody Fusion and Bilateral Pedicle Screw Fixation: Feasibility and Perioperative Results.

Science.gov (United States)

Blizzard, Daniel J; Thomas, J Alex

2018-03-15

Retrospective review of prospectively collected data of the first 72 consecutive patients treated with single-position one- or two-level lateral (LLIF) or oblique lateral interbody fusion (OLLIF) with bilateral percutaneous pedicle screw and rod fixation by a single spine surgeon. To evaluate the clinical feasibility, accuracy, and efficiency of a single-position technique for LLIF and OLLIF with bilateral pedicle screw and rod fixation. Minimally-invasive lateral interbody approaches are performed in the lateral decubitus position. Subsequent repositioning prone for bilateral pedicle screw and rod fixation requires significant time and resources and does not facilitate increased lumbar lordosis. The first 72 consecutive patients (300 screws) treated with single-position LLIF or OLLIF and bilateral pedicle screws by a single surgeon between December 2013 and August 2016 were included in the study. Screw accuracy and fusion were graded using computed tomography and several timing parameters were recorded including retractor, fluoroscopy, and screw placement time. Complications including reoperation, infection, and postoperative radicular pain and weakness were recorded. Average screw placement time was 5.9 min/screw (standard deviation, SD: 1.5 min; range: 3-9.5 min). Average total operative time (interbody cage and pedicle screw placement) was 87.9 minutes (SD: 25.1 min; range: 49-195 min). Average fluoroscopy time was 15.0 s/screw (SD: 4.7 s; range: 6-25 s). The pedicle screw breach rate was 5.1% with 10/13 breaches measured as < 2 mm in magnitude. Fusion rate at 6-months postoperative was 87.5%. Two (2.8%) patients underwent reoperation for malpositioned pedicle screws with subsequent resolution of symptoms. The single-position, all-lateral technique was found to be feasible with accuracy, fluoroscopy usage, and complication rates comparable with the published literature. This technique eliminates the time and staffing associated with

Study on pedicle screw fixation of cervical spine assisted CT-based navigation system compared with the individual cervical peddle screws placement technique

International Nuclear Information System (INIS)

He Xishun; Yang Huilin; Zhu Ruofu; Tan Xiangqi; Wang Genlin; Tang Tiansi

2008-01-01

Objective: To explore a safe and effective method for placing the cervical pedicle screws. Methods: There were ten adult cadaver specimens of cervica spine (C 1 -C 7 ) with intact structures including ligament and perivertebral muscles. The spiral computed tomography scan (Elscint CT Twin flash) at the section of 1 mm and three-dimensional reconstruction of all 10 cervical specimens were taken. By CT scan, the parameters of the cervical pedicles were measure,Then taking randomly 5 cervical specimens, according to the CT measurements, an appropriate screw was inserted into pedicle individually. In the other 5 human cadaver cervical vertebraes, Φ3.5 mm screws were inserted into the C 2 -C 7 pedicles by assisted by CT-based navigation system. Cortical integrity of every sample was examined by anatomic dissection, the spiral computed tomography scan and arrows,and coronal reconstruction. Results: Sixty screws was inserted into pedicle individually, and the achievement ratio was 90%, the perfectness ratio was 75%, 60 screws was placed into pedicle assisted by CT-based navigation system, and the achievement ratio was 96.6%, the perfectness ratio was 90%. By chi-square test for statistical analysis, there were no statistical significance between the accuracy rate of two methods(P>0.05). However there was statistical significance between the perfectness ratio between two methods(P<0.05). Conclusion: Compared with the individual cervical peddle screws placement technique, the perfectness ratio of pedicle screw fixation of cervical spine assisted by CT-based navigation system is higher, but there are no significant difference in accuracy. (authors)

Pedicle Screw Fixation Study in Immature Porcine Spines to Improve Pullout Resistance during Animal Testing.

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Sophie Le Cann

Full Text Available The porcine model is frequently used during development and validation of new spinal devices, because of its likeness to the human spine. These spinal devices are frequently composed of pedicle screws with a reputation for stable fixation but which can suffer pullouts during preclinical implantation on young animals, leading to high morbidity. With a view to identifying the best choices to optimize pedicle screw fixation in the porcine model, this study evaluates ex vivo the impact of weight (age of the animal, the level of the vertebrae (lumbar or thoracic and the type of screw anchorage (mono- or bi-cortical on pedicle screw pullouts. Among the 80 pig vertebrae (90- and 140-day-old tested in this study, the average screw pullout forces ranged between 419.9N and 1341.2N. In addition, statistical differences were found between test groups, pointing out the influence of the three parameters stated above. We found that the the more caudally the screws are positioned (lumbar level, the greater their pullout resistance is, moreover, screw stability increases with the age, and finally, the screws implanted with a mono-cortical anchorage sustained lower pullout forces than those implanted with a bi-cortical anchorage. We conclude that the best anchorage can be obtained with older animals, using a lumbar fixation and long screws traversing the vertebra and inducing bi-cortical anchorage. In very young animals, pedicle screw fixations need to be bi-cortical and more numerous to prevent pullout.

Pedicle Screw Fixation Study in Immature Porcine Spines to Improve Pullout Resistance during Animal Testing.

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Le Cann, Sophie; Cachon, Thibaut; Viguier, Eric; Miladi, Lotfi; Odent, Thierry; Rossi, Jean-Marie; Chabrand, Patrick

2015-01-01

The porcine model is frequently used during development and validation of new spinal devices, because of its likeness to the human spine. These spinal devices are frequently composed of pedicle screws with a reputation for stable fixation but which can suffer pullouts during preclinical implantation on young animals, leading to high morbidity. With a view to identifying the best choices to optimize pedicle screw fixation in the porcine model, this study evaluates ex vivo the impact of weight (age) of the animal, the level of the vertebrae (lumbar or thoracic) and the type of screw anchorage (mono- or bi-cortical) on pedicle screw pullouts. Among the 80 pig vertebrae (90- and 140-day-old) tested in this study, the average screw pullout forces ranged between 419.9N and 1341.2N. In addition, statistical differences were found between test groups, pointing out the influence of the three parameters stated above. We found that the the more caudally the screws are positioned (lumbar level), the greater their pullout resistance is, moreover, screw stability increases with the age, and finally, the screws implanted with a mono-cortical anchorage sustained lower pullout forces than those implanted with a bi-cortical anchorage. We conclude that the best anchorage can be obtained with older animals, using a lumbar fixation and long screws traversing the vertebra and inducing bi-cortical anchorage. In very young animals, pedicle screw fixations need to be bi-cortical and more numerous to prevent pullout.

Stress analysis in a pedicle screw fixation system with flexible rods in the lumbar spine.

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Kim, Kyungsoo; Park, Won Man; Kim, Yoon Hyuk; Lee, SuKyoung

2010-01-01

Breakage of screws has been one of the most common complications in spinal fixation systems. However, no studies have examined the breakage risk of pedicle screw fixation systems that use flexible rods, even though flexible rods are currently being used for dynamic stabilization. In this study, the risk of breakage of screws for the rods with various flexibilities in pedicle screw fixation systems is investigated by calculating the von Mises stress as a breakage risk factor using finite element analysis. Three-dimensional finite element models of the lumbar spine with posterior one-level spinal fixations at L4-L5 using four types of rod (a straight rod, a 4 mm spring rod, a 3 mm spring rod, and a 2 mm spring rod) were developed. The von Mises stresses in both the pedicle screws and the rods were analysed under flexion, extension, lateral bending, and torsion moments of 10 Nm with a follower load of 400 N. The maximum von Mises stress, which was concentrated on the neck region of the pedicle screw, decreased as the flexibility of the rod increased. However, the ratio of the maximum stress in the rod to the yield stress increased substantially when a highly flexible rod was used. Thus, the level of rod flexibility should be considered carefully when using flexible rods for dynamic stabilization because the intersegmental motion facilitated by the flexible rod results in rod breakage.

Fatigue life prediction of pedicle screw for spinal surgery

Czech Academy of Sciences Publication Activity Database

Major, Štěpán; Kocour, Vladimír; Cyrus, P.

2016-01-01

Roč. 10, č. 35 (2016), s. 379-388 ISSN 1971-8993. [European Conference on Fracture. ECF21. Catania, 20.06.2015-20.06.2015] Institutional support: RVO:68378297 Keywords : pedicle-screw * titan alloy * fatigue life * finite element analysis Subject RIV: JK - Corrosion ; Surface Treatment of Materials http://www.fracturae.com/index.php/fis/article/view/IGF-ESIS.35.43

What is the Difference in Morphologic Features of the Thoracic Pedicle Between Patients With Adolescent Idiopathic Scoliosis and Healthy Subjects? A CT-based Case-control Study.

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Gao, Bo; Gao, Wenjie; Chen, Chong; Wang, Qinghua; Lin, Shaochun; Xu, Caixia; Huang, Dongsheng; Su, Peiqiang

2017-11-01

Describing the morphologic features of the thoracic pedicle in patients with adolescent idiopathic scoliosis is necessary for placement of pedicle screws. Previous studies showed inadequate reliability owing to small sample size and heterogeneity of the patients surveyed. To use CT scans (1) to describe the morphologic features of 2718 thoracic pedicles from 60 female patients with Lenke Type 1 adolescent idiopathic scoliosis and 60 age-, sex-, and height-matched controls; and (2) to classify the pedicles in three types based on pedicle width and analyze the distribution of each type. A total of 2718 pedicles from 60 female patients with Lenke Type 1 adolescent idiopathic scoliosis and 60 matched female controls were analyzed via CT. All patients surveyed were diagnosed with adolescent idiopathic scoliosis, Lenke Type 1, at the First Affiliated Hospital of Sun Yat-sen University, and all underwent pedicle screw fixation between January 2008 and December 2013 with preoperative radiographs and CT images on file. We routinely obtained CT scans before these procedures; all patients who underwent surgery during that period had CT scans, and all were available for analysis here. Control subjects had CT scans for other clinical indications and had no abnormal findings of the spine. The control subjects were chosen to match patients in terms of age (15 ± 2.6 years versus 15 ± 2.6 years) and sex. Height of the two groups also was matched (154 ± 9 cm versus 155 ± 10 cm; mean difference, -1.06 cm; 95% CI, -1.24 to -0.81 cm; p adolescent idiopathic scoliosis (22%; 293 of 1322) compared with controls (13%; 178 of 1396) (odds ratio [OR] = 0.51; 95% CI, 0.42-0.63; p adolescent idiopathic scoliosis, they commonly occurred on the concave side 34% (228 of 661) and on the AV-SC region (32%; 43 of 136). Pedicle width on the concave side was narrower than pedicle width on the convex side and pedicle width in healthy control subjects. The apical vertebra in the structural curve was

CT provides precise size assessment of implanted titanium alloy pedicle screws.

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Elliott, Michael J; Slakey, Joseph B

2014-05-01

After performing instrumented spinal fusion with pedicle screws, postoperative imaging using CT to assess screw position may be necessary. Stainless steel implants produce significant metal artifact on CT, and the degree of distortion is at least partially dependent on the cross-sectional area of the implanted device. If the same effect occurs with titanium alloy implants, ability to precisely measure proximity of screws to adjacent structures may be adversely affected as screw size increases. We therefore asked whether (1) CT provides precise measurements of true screw widths; and (2) precision degrades based on the size of the titanium implant imaged. CT scans performed on 20 patients after instrumented spinal fusion for scoliosis were reviewed. The sizes of 151 titanium alloy pedicle screws were measured and compared with known screw size. The amount of metal bloom artifact was determined for each of the four screw sizes. ANOVA with Tukey's post hoc test were performed to evaluate differences in scatter, and Spearman's rho coefficient was used to measure relationship between screw size and scatter. All screws measured larger than their known size, but even with larger 7-mm screws the size differential was less than 1 mm. The four different screw sizes produced scatter amounts that were different from each other (p titanium alloy pedicle screws produces minimal artifact, thus making this the preferred imaging modality to assess screw position after surgery. Although the amount of artifact increases with the volume of titanium present, the degree of distortion is minimal and is usually less than 1 mm.

Are computer numerical control (CNC)-manufactured patient-specific metal templates available for posterior thoracic pedicle screw insertion? Feasibility and accuracy evaluation.

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Kong, Xiangxue; Tang, Lei; Ye, Qiang; Huang, Wenhua; Li, Jianyi

2017-11-01

Accurate and safe posterior thoracic pedicle insertion (PTPI) remains a challenge. Patient-specific drill templates (PDTs) created by rapid prototyping (RP) can assist in posterior thoracic pedicle insertion, but pose biocompatibility risks. The aims of this study were to develop alternative PDTs with computer numerical control (CNC) and assess their feasibility and accuracy in assisting PTPI. Preoperative CT images of 31 cadaveric thoracic vertebras were obtained and then the optimal pedicle screw trajectories were planned. The PDTs with optimal screw trajectories were randomly assigned to be designed and manufactured by CNC or RP in each vertebra. With the guide of the CNC- or RP-manufactured PDTs, the appropriate screws were inserted into the pedicles. Postoperative CT scans were performed to analyze any deviations at entry point and midpoint of the pedicles. The CNC group was found to be significant manufacture-time-shortening, and cost-decreasing, when compared with the RP group (P  0.05). The screw positions were grade 0 in 90.3% and grade 1 in 9.7% of the cases in the CNC group and grade 0 in 93.5% and grade 1 in 6.5% of the cases in the RP group (P = 0.641). CNC-manufactured PDTs are viable for assisting in PTPI with good feasibility and accuracy.

Misdiagnosing absent pedicle of cervical spine in the acute trauma setting

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Fahad H. Abduljabbar

2015-09-01

Full Text Available Congenital absence of cervical spine pedicle can be easily misdiagnosed as facet dislocation on plain radiographs especially in the acute trauma setting. Additional imaging, including computed tomography (CT-scan with careful interpretation is required in order to not misdiagnose cervical posterior arch malformation with subsequent inappropriate management. A 39-year-old patient presented to the emergency unit of our university hospital after being trampled by a cow over her back and head followed by loss of consciousness, retrograde amnesia and neck pain. Her initial cervical CT-scan showed possible C5-C6 dislocation, then, it became clear that her problem was a misdiagnosed congenital cervical abnormality. Patient was treated symptomatically without consequences. The congenital absence of a cervical pedicle is a very unusual condition that is easily misdiagnosed. Diagnosis can be accurately confirmed with a CT-scan of the cervical spine. Symptomatic conservative treatment will result in resolution of the symptoms.

Ten-year experience of superior gluteal artery perforator flap for reconstruction of sacral defects in Tri-Service General Hospital

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Chin-Ta Lin

2014-01-01

Full Text Available Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old. Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients′ age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24. No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The

A great number of old vertebral fractures expressing instability are pedicle fractures. With the use of 64-line multi slice computerized tomography

International Nuclear Information System (INIS)

Kobayashi, Akihiko; Nishida, Kenki; Ogawa, Koichi; Takahashi, Yuichi; Nakahara, Masayuki; Hijikata, Yasukazu

2008-01-01

We examined old vertebral fractures expressing instability with the use of 64-line CT. From April 2006 to December 2006, CT photographic images of 15 unstable fractures were examined in detail. We confirmed gas or liquid in all vertebral bodies. In 5 cases (33%), vertebral body protruding into the canal was observed. Four cases (23%) had other vertebral fractures. In addition, 12 pedicle fractures (73%) were seen. We confirmed many pedicle fractures in vertebral fractures expressing instability. These results suggest that pedicle fracture is a risk factor for back pain associated with vertebral fracture. (author)

Colgajo de piel en isla con pedículo fasciocutáneo para cuello: caso clínico Island skin flap with fasciocutaneous pedicle for neck reconstruction: case report

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J.L. Ramón Vera

2009-06-01

Full Text Available Los defectos por falta de piel o las secuelas de quemaduras a nivel del cuello presentan gran dificultad de cobertura debido a la escasez de tejidos locales útiles para corregirlos, ya que debemos dar una solución a las graves alteraciones funcionales y estéticas que producen, con un mínimo de secuelas. Presentamos un caso clínico con graves secuelas de quemaduras en cuello que producían retracción importante y que fue resuelto con un colgajo de piel en isla con pedículo fasciosubcutáneo tomado de región subclavicular. Este colgajo presenta irrigación cutánea por medio de arterias cutáneas directas provenientes de la arteria mamaria interna y brinda la oportunidad de solucionar alteraciones a nivel del cuello con gran facilidad para su realización y con mínimas secuelas en la zona donante.Cutaneous defects or burn sequels at the neck level present difficult of covering, due to the poor local tissues, although we should give a solution to the serious functional and aesthetic alterations with minimal sequels. We present a clinical case with burn sequels of the neck that produced important retraction and that was solved whit an island fasciocutaneous pedicle flap from subclavicular region. This flap has skin irrigation supported by the cutaneous arteries coming from the internal mammary artery and gives us the opportunity to solve these alterations at the neck level in an easy way and with minimal sequels in the donor area.

Comparison of the Pullout Strength of Different Pedicle Screw Designs and Augmentation Techniques in an Osteoporotic Bone Model.

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Kiyak, Gorkem; Balikci, Tevfik; Heydar, Ahmed Majid; Bezer, Murat

2018-02-01

Mechanical study. To compare the pullout strength of different screw designs and augmentation techniques in an osteoporotic bone model. Adequate bone screw pullout strength is a common problem among osteoporotic patients. Various screw designs and augmentation techniques have been developed to improve the biomechanical characteristics of the bone-screw interface. Polyurethane blocks were used to mimic human osteoporotic cancellous bone, and six different screw designs were tested. Five standard and expandable screws without augmentation, eight expandable screws with polymethylmethacrylate (PMMA) or calcium phosphate augmentation, and distal cannulated screws with PMMA and calcium phosphate augmentation were tested. Mechanical tests were performed on 10 unused new screws of each group. Screws with or without augmentation were inserted in a block that was held in a fixture frame, and a longitudinal extraction force was applied to the screw head at a loading rate of 5 mm/min. Maximum load was recorded in a load displacement curve. The peak pullout force of all tested screws with or without augmentation was significantly greater than that of the standard pedicle screw. The greatest pullout force was observed with 40-mm expandable pedicle screws with four fins and PMMA augmentation. Augmented distal cannulated screws did not have a greater peak pullout force than nonaugmented expandable screws. PMMA augmentation provided a greater peak pullout force than calcium phosphate augmentation. Expandable pedicle screws had greater peak pullout forces than standard pedicle screws and had the advantage of augmentation with either PMMA or calcium phosphate cement. Although calcium phosphate cement is biodegradable, osteoconductive, and nonexothermic, PMMA provided a significantly greater peak pullout force. PMMA-augmented expandable 40-mm four-fin pedicle screws had the greatest peak pullout force.

Load-bearing evaluation of spinal posterior column by measuring surface strain from lumbar pedicles. An in vitro study.

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Sun, Peidong; Zhao, Weidong; Bi, Zhenyu; Wu, Changfu; Ouyang, Jun

2012-01-01

An understanding of the load transfer within spinal posterior column of lumbar spine is necessary to determine the influence of mechanical factors on potential mechanisms of the motion-sparing implant such as artificial intervertebral disc and the dynamic spine stabilization systems. In this study, a new method has been developed for evaluating the load bearing of spinal posterior column by the surface strain of spinal pedicle response to the loading of spinal segment. Six cadaveric lumbar spine segments were biomechanically evaluated between levels L1 and L5 in intact condition and the strain gauges were pasted to an inferior surface of L2 pedicles. Multidirectional flexibility testing used the Panjabi testing protocol; pure moments for the intact condition with overall spinal motion and unconstrained intact moments of ±8 Nm were used for flexion-extension and lateral bending testing. High correlation coefficient (0.967-0.998) indicated a good agreement between the load of spinal segment and the surface strain of pedicle in all loading directions. Principal compressive strain could be observed in flexion direction and tensile strain in extension direction, respectively. In conclusion, the new method seems to be effective for evaluating posterior spinal column loads using pedicles' surface strain data collected during biomechanical testing of spine segments.

CT study of vertebral metastasis: re-realization of the diagnostic role of the vertebral pedicle sign

International Nuclear Information System (INIS)

Meng Quanfei; Jiang Bo; Chen Yingming; Zhang Chaohui

2000-01-01

Objective: To investigate the essence of the vertebral pedicle sign of vertebral metastasis on plain film, and to explore the useful CT signs for the diagnosis and differential diagnosis of this tumor. Methods: The CT scans of the spine obtained in 48 patients with vertebral metastases, 19 patients with vertebral tuberculosis, and 11 with vertebral myeloma, were analyzed. The CT findings were correlated with the abnormalities seen on plain films in 34 of the 48 patients (66 vertebrae involved) with vertebral metastasis. Results: 66 vertebrae were involved in the group of metastasis. Of the 28 vertebrae whose vertebral body were completely destroyed, 15 were seen bilateral pedicles destruction; Of the 22 vertebrae with lateral destruction of the body, 16 were noticed unilateral pedicle destruction which located posterior to the involved side of the body. Of the 62 micro-metastatic foci, 56 were scattered in the vertebral body. In the 19 para-spinal soft-tissue masses of vertebral tuberculosis, 5 were noticed calcifications and 12 with postcontrast rings enhancement. The rates of vertebral pedicle destruction of vertebral metastasis and myeloma were not statistically different (X 2 = 0.03, P > 0.50). The locations of destruction of vertebral body in vertebral metastasis and myeloma had no statistical difference (X 2 = 3.52, P > 0.10), but they differed from that in tuberculosis (X 2 = 39.32, P < 0.001). The distribution of lesions within the vertebrae of metastasis and tuberculosis was similar, but was quite different from myeloma. Conclusion: The vertebral metastasis initially occurs in the vertebral body. The vertebral pedicle sign on plain film of vertebral metastasis is the outcome of the posterior invasion of the tumor in the vertebral body, which is of no differential significance for vertebral metastasis and myeloma. Para-spinal soft tissue mass, location of destruction of vertebral body, and the distribution of lesions within the vertebrae may help

Cost-Utility Analysis of Pedicle Screw Removal After Successful Posterior Instrumented Fusion in Thoracolumbar Burst Fractures.

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Lee, Han-Dong; Jeon, Chang-Hoon; Chung, Nam-Su; Seo, Young-Wook

2017-08-01

A cost-utility analysis (CUA). The aim of this study was to determine the cost-effectiveness of pedicle screw removal after posterior fusion in thoracolumbar burst fractures. Pedicle screw instrumentation is a standard fixation method for unstable thoracolumbar burst fracture. However, removal of the pedicle screw after successful fusion remains controversial because the clinical benefits remain unclear. CUA can help clinicians make appropriate decisions about optimal health care for pedicle screw removal after successful fusion in thoracolumbar burst fractures. We conducted a single-center, retrospective, longitudinal matched-cohort study of prospectively collected outcomes. In total, 88 consecutive patients who had undergone pedicle screw instrumentation for thoracolumbar burst fracture with successful fusion confirmed by computed tomography (CT) were used in this study. In total, 45 patients wanted to undergo implant removal surgery (R group), and 43 decided not to remove the implant (NR group). A CUA was conducted from the health care perspective. The direct costs of health care were obtained from the medical bill of each patient. Changes in health-related quality of life (HRQoL) scores, validated by Short Form 6D, were used to calculate quality-adjusted life-years (QALYs). Total costs and gained QALY were calculated at 1 year (1 year) and 2 years (2 years) compared with baseline. Results are expressed as an incremental cost-effectiveness ratio (ICER). Different discount rates (0%, 3%, and 5%) were applied to both cost and QALY for sensitivity analysis. Baseline patient variables were similar between the two groups (all P > 0.05). The additional benefits of implant removal (0.201 QALY at 2 years) were achieved with additional costs ($2541 at 2 years), equating to an ICER of $12,641/QALY. On the basis of the different discount rates, the robustness of our study's results was also determined. Implant removal after successful fusion in a thoracolumbar burst

[Longitudinal preputial pedicled flap urethroplasty for chordee of Donnahoo type IV].

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Zeng, Li; Shan, Wei; Yuan, Miao; Huang, Guizhen; Huang, Lugang

2012-11-01

To investigate the effectiveness of longitudinal preputial pedicled flap urethroplasty for chordee of Donnahoo IV type. Between June 1994 and October 2011, 30 patients with chordee (Donnahoo type IV) underwent longitudinal preputial pedicled flap urethroplasty. The patients' age ranged from 2 to 16 years (mean, 5.8 years). The morphology of the balanus-navicular fossa-external urethral orifice ranged normal; the penis length was 2.5-6.8 cm (mean, 4.3 cm); the penis bending angle was 35-70 degrees (mean, 40.1 degrees). Primary and secondary operation was 27 cases and 3 cases, respectively. The size of flap ranged from 1.5 cm x 1.3 cm to 4.0 cm x 2.0 cm. After correction, the penis length was 3.0-8.5 cm (mean, 6.6 cm); the penis bending angle was 0-10 degrees (mean, 1.2 degrees). All patients were followed up 6 months to 12 years (mean, 33 months). No recurrence, stabbing pain of the balanus, or foreign body sensation occurred during follow-up. Of them, 4 patients (13.33%) had urinary fistular, they had satisfactory results after the second operation; 2 patients (6.67%) had urethral stricture 1 month after operation, they also had satisfactory results after arethral dilatation. The other patients showed no scattering urinary flow and good direction without complication. Six patients had satisfactory sexual function after puberty without erection disorder, pain, or dyspareunia. Longitudinal preputial pedicled flap urethroplasty can achieve maximum utilization of prepuce and aesthetic and functional improvement with less complication, so it is a relatively ideal mean for treating chordee of Donnahoo type IV.

Peroneal island flap for wound coverage in complex injuries of the lower extremity

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Fazal A

2012-01-01

Full Text Available Akil Fazal1, Haroon-ur-Rashid1, Tahseen Cheema21Section of Orthopedics, Department of Surgery, Aga Khan University, Karachi, Pakistan; 2Department of Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, NM, USABackground: Complex injuries of the lower extremity pose a therapeutic challenge owing to limited availability of local soft tissue for coverage. One option in this region is the pedicled fasciocutaneous flap based on perforators of the peroneal artery. In this case series, we present our experience of the peroneal island pedicled flap for reconstruction of lower extremity wounds.Methods: Records of 18 cases of peroneal island flap admitted consecutively to the Section of Orthopedics at Aga Khan University Hospital from January 1996 to December of 2009 were studied and their outcomes determined.Results: The most common indication for coverage was open wounds due to a road traffic accident (n = 10, followed by burns (n = 3. The most common area exposed was the lower third of the leg followed by the middle third. The tibia was exposed in 11 patients. The flaps ranged in size from 35 cm2 to over 200 cm2. In 13 patients, the flaps healed uneventfully, while in the remaining five there was partial flap necrosis. In four of the latter patients, the residual wound healed with conservative measures only, but the fifth patient required further surgery to achieve acceptable coverage.Conclusion: The peroneal artery flap appears to be a simple, useful, and reliable flap in the armamentarium of the surgeon when planning soft tissue coverage of the lower extremity.Keywords: leg injuries, surgical flaps, lower extremity

Clinical study on the application of minimally invasive percutaneous pedicle screw fixation in single segment thoracolumbar fracture without neurological symptoms

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Jin-ping LIU

2016-04-01

Full Text Available Objective To discuss the clinical effects of minimally invasive percutaneous pedicle screw fixation in the treatment of single segment thoracolumbar fracture without neurological symptoms.  Methods From June 2012 to October 2014, 38 neurologically intact patients with thoracolumbar fracture underwent surgeries, including open pedicle screw fixation in 16 cases and percutaneous pedicle screw fixation in 22 cases. The incision length, operation time, intraoperative blood loss, postoperative drainage and postoperative complication were recorded and compared between 2 groups. Thoracolumbar orthophoric, lateral and flexion-extension X-ray was used to measure sagittal Cobb angle and height of injured anterior vertebral body before and after operation. Modified Macnab evaluation was used to assess the curative effects 3 months after operation. Results The success rate of operations in 38 patients was 100%. There were a total of 114 vertebral bodies fused and 228 pedicle screws implanted. Patients in the percutaneous pedicle screw group had smaller incision length [(10.55 ± 1.23 cm vs (18.50 ± 2.50 cm, P = 0.000], less intraoperative blood loss [(32.55 ± 7.22 ml vs (320.50 ± 15.48 ml, P = 0.000], shorter hospital stay [(6.55 ± 1.50 d vs (13.50 ± 2.52 d, P = 0.000], and without postoperative drainage. The follow-up after operation ranged from 3 to 6 months, with the average time of (4.65 ± 1.24 months. Cobb angle was reduced (P = 0.000 and height of injured anterior vertebral body were improved signifcantly (P = 0.000 3 months after surgery in both groups. The total effective rate was 14/16 in open surgery group, and 86.36% (19/22 in percutaneous pedicle screw group, however, the difference between 2 groups was not significant (P = 1.000. Conclusions Minimally invasive percutaneous pedicle screw fixation is a surgical method with less iatrogenic injury, less intraoperative blood loss and quick recovery for patients with thoracolumbar fracture

The transverse penile pedicled flap urethroplasty: description of a simplified technique for the dissection of the Fascio-cutaneous flap.

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Shittu, O B; Sotunmbi, P T

2015-06-01

Urethroplasty is often required for long urethral strictures or urethral strictures that have recurred after repeated urethral dilatations or urethrotomy. The transvers penile skin pedicled flap is very versatile for the reconstruction of long urethral stricture. However the meticulous sharp dissection required to develop it takes a long time to do and may be associated with button hole injuries to the vascular pedicle and the penile skin. We describe a simplified technique of raising the flap which does not require sharp dissection and is very quick to accomplish. Technique involves using a circumcising distal penile shaft skin incision to de-glove the penis by blunt dissection. The skin substitute, adequate to give appropriate urethra calibre is similarly dissected bluntly along with its vascular pedicle from the proximal penile skin. The techniques used to facilitate successful blunt dissection are described. In 9 adults with long, multiple urethral strictures, the average time to develop the flap was 15 minutes and complication have been limited to temporary urethro-cutaneous fistula at the ventral part of the circular skin closure. These fistulae closed on conservative treatment. No patient suffered button-hole injuries to either the vascular pedicle or the penile skin. This modification to the standard sharp dissection is very quick to accomplish. It also avoids the creation of button-hole injuries to either the vascular pedicle or the penile skin. It should make the use of this versatile flap more attractive in the reconstruction of long urethral strictures in those who may wish to use this option for reconstruction of long urethral strictures.

Use of next generation sequencing to detect biofilm bacteria in a patient with pedicle screw loosening after spine surgery

DEFF Research Database (Denmark)

Xu, Yijuan; Thomsen, Trine Rolighed; Lorenzen, Jan

2016-01-01

2. Center for Microbial Communities, Department of Biotechnology, Chemistry and Environmental Engineering, Aalborg University, Denmark 3. Otto-von-Guericke University Magdeburg, Department of Orthopedic Surgery, Magdeburg, Germany 4. Eifelklinik St. Brigida, Simmerath, Germany Aim: ”Hidden deep...... implant-related infection is believed to be linked to pedicle screw loosening after spine surgery. Low-grade bacterial infection can be hard to diagnose and may be undetected by conventional culture based methods. Next generation sequencing (NGS) could help to uncover hidden bacterial infections...... as a possible cause for implant loosening. This case report describes the use of NGS in the diagnostic work-up of a patient with pedicle screw loosening after spine surgery.” Method: ”A 60 y/o male had to undergo revision spine surgery for pedicle screw loosening and adjacent segment disease 3 years after...

Pedicle frozen autograft for limb sparing surgery in a dog with femoral osteosarcoma

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Aline Silva Gouvêa

Full Text Available ABSTRACT: Osteosarcoma (OSA is the most common bone tumor diagnosed in dogs and represents approximately 85% of canine skeletal tumors. The most commonly employed therapy is amputation of the limb followed by chemotherapy. However, preservation of the afflicted limb has been successful for patients with concomitant neurological or orthopedic conditions, which are contraindications to the complete amputation, or with owners reluctant to the possibility of amputation. For these reasons, the purpose of this study was to describe the technical procedures that allowed limb salvage through the use of pedicle frozen grafts in a dog with femoral OSA. Surgical procedures consisted of a femoral diaphyseal osteotomy with tearing of the soft tissues; thus, creating a bone pedicle that was frozen in liquid nitrogen according to the protocol outlined by TSUCHIYA et al. (2005. Limb function remained satisfactory for six months.

The accuracy and safety of fluoroscopically guided percutaneous pedicle screws in the lumbosacral junction and the lumbar spine: a review of 880 screws.

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Chiu, C K; Kwan, M K; Chan, C Y W; Schaefer, C; Hansen-Algenstaedt, N

2015-08-01

We undertook a retrospective study investigating the accuracy and safety of percutaneous pedicle screws placed under fluoroscopic guidance in the lumbosacral junction and lumbar spine. The CT scans of patients were chosen from two centres: European patients from University Medical Center Hamburg-Eppendorf, Germany, and Asian patients from the University of Malaya, Malaysia. Screw perforations were classified into grades 0, 1, 2 and 3. A total of 880 percutaneous pedicle screws from 203 patients were analysed: 614 screws from 144 European patients and 266 screws from 59 Asian patients. The mean age of the patients was 58.8 years (16 to 91) and there were 103 men and 100 women. The total rate of perforation was 9.9% (87 screws) with 7.4% grade 1, 2.0% grade 2 and 0.5% grade 3 perforations. The rate of perforation in Europeans was 10.4% and in Asians was 8.6%, with no significant difference between the two (p = 0.42). The rate of perforation was the highest in S1 (19.4%) followed by L5 (14.9%). The accuracy and safety of percutaneous pedicle screw placement are comparable to those cited in the literature for the open method of pedicle screw placement. Greater caution must be taken during the insertion of L5 and S1 percutaneous pedicle screws owing to their more angulated pedicles, the anatomical variations in their vertebral bodies and the morphology of the spinal canal at this location. ©2015 The British Editorial Society of Bone & Joint Surgery.

CpG island mapping by epigenome prediction.

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Christoph Bock

2007-06-01

Full Text Available CpG islands were originally identified by epigenetic and functional properties, namely, absence of DNA methylation and frequent promoter association. However, this concept was quickly replaced by simple DNA sequence criteria, which allowed for genome-wide annotation of CpG islands in the absence of large-scale epigenetic datasets. Although widely used, the current CpG island criteria incur significant disadvantages: (1 reliance on arbitrary threshold parameters that bear little biological justification, (2 failure to account for widespread heterogeneity among CpG islands, and (3 apparent lack of specificity when applied to the human genome. This study is driven by the idea that a quantitative score of "CpG island strength" that incorporates epigenetic and functional aspects can help resolve these issues. We construct an epigenome prediction pipeline that links the DNA sequence of CpG islands to their epigenetic states, including DNA methylation, histone modifications, and chromatin accessibility. By training support vector machines on epigenetic data for CpG islands on human Chromosomes 21 and 22, we identify informative DNA attributes that correlate with open versus compact chromatin structures. These DNA attributes are used to predict the epigenetic states of all CpG islands genome-wide. Combining predictions for multiple epigenetic features, we estimate the inherent CpG island strength for each CpG island in the human genome, i.e., its inherent tendency to exhibit an open and transcriptionally competent chromatin structure. We extensively validate our results on independent datasets, showing that the CpG island strength predictions are applicable and informative across different tissues and cell types, and we derive improved maps of predicted "bona fide" CpG islands. The mapping of CpG islands by epigenome prediction is conceptually superior to identifying CpG islands by widely used sequence criteria since it links CpG island detection to

CpG island mapping by epigenome prediction.

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Bock, Christoph; Walter, Jörn; Paulsen, Martina; Lengauer, Thomas

2007-06-01

CpG islands were originally identified by epigenetic and functional properties, namely, absence of DNA methylation and frequent promoter association. However, this concept was quickly replaced by simple DNA sequence criteria, which allowed for genome-wide annotation of CpG islands in the absence of large-scale epigenetic datasets. Although widely used, the current CpG island criteria incur significant disadvantages: (1) reliance on arbitrary threshold parameters that bear little biological justification, (2) failure to account for widespread heterogeneity among CpG islands, and (3) apparent lack of specificity when applied to the human genome. This study is driven by the idea that a quantitative score of "CpG island strength" that incorporates epigenetic and functional aspects can help resolve these issues. We construct an epigenome prediction pipeline that links the DNA sequence of CpG islands to their epigenetic states, including DNA methylation, histone modifications, and chromatin accessibility. By training support vector machines on epigenetic data for CpG islands on human Chromosomes 21 and 22, we identify informative DNA attributes that correlate with open versus compact chromatin structures. These DNA attributes are used to predict the epigenetic states of all CpG islands genome-wide. Combining predictions for multiple epigenetic features, we estimate the inherent CpG island strength for each CpG island in the human genome, i.e., its inherent tendency to exhibit an open and transcriptionally competent chromatin structure. We extensively validate our results on independent datasets, showing that the CpG island strength predictions are applicable and informative across different tissues and cell types, and we derive improved maps of predicted "bona fide" CpG islands. The mapping of CpG islands by epigenome prediction is conceptually superior to identifying CpG islands by widely used sequence criteria since it links CpG island detection to their characteristic

Correction Capability in the 3 Anatomic Planes of Different Pedicle Screw Designs in Scoliosis Instrumentation.

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Wang, Xiaoyu; Aubin, Carl-Eric; Coleman, John; Rawlinson, Jeremy

2017-05-01

Computer simulations to compare the correction capabilities of different pedicle screws in adolescent idiopathic scoliosis (AIS) instrumentations. To compare the correction and resulting bone-screw forces associated with different pedicle screws in scoliosis instrumentations. Pedicle screw fixation is widely used in surgical instrumentation for spinal deformity treatment. Screw design, correction philosophies, and surgical techniques are constantly evolving to achieve better control of the vertebrae and correction of the spinal deformity. Yet, there remains a lack of biomechanical studies that quantify the effects and advantages of different screw designs in terms of correction kinematics. The correction capabilities of fixed-angle, multiaxial, uniaxial, and saddle axial screws were kinematically analyzed, simulated, and compared. These simulations were based on the screw patterns and correction techniques proposed by 2 experienced surgeons for 2 AIS cases. Additional instrumentations were assessed to compare the correction and resulting bone-screw forces associated with each type of screw. The fixed-angle, uniaxial and saddle axial screws had similar kinematic behavior and performed better than multiaxial screws in the coronal and transverse planes (8% and 30% greater simulated corrections, respectively). Uniaxial and multiaxial screws were less effective than fixed-angle and saddle axial screws in transmitting compression/distraction to the anterior spine because of their sagittal plane mobility between the screw head and shank. Only the saddle axial screws allow vertebra angle in the sagittal plane to be independently adjusted. Pedicle screws of different designs performed differently for deformity corrections or for compensating screw placement variations in different anatomic planes. For a given AIS case, screw types should be determined based on the particular instrumentation objectives, the deformity's stiffness and characteristics so as to make the best of

Radiofrequency-activated PMMA-augmentation through cannulated pedicle screws: A cadaver study to determine the biomechanical benefits in the osteoporotic spine.

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Karius, T; Deborre, C; Wirtz, D C; Burger, C; Prescher, A; Fölsch, A; Kabir, K; Pflugmacher, R; Goost, H

2017-01-01

PMMA-augmentation of pedicle screws strengthens the bone-screw-interface reducing cut-out risk. Injection of fluid cement bears a higher risk of extravasation, with difficulty of application because of inconsistent viscosity and limited injection time. To test a new method of cement augmentation of pedicle screws using radiofrequency-activated PMMA, which is suspected to be easier to apply and have less extravasations. Twenty-seven fresh-frozen human cadaver lumbar spines were divided into 18 osteoporotic (BMD ≤ 0.8 g/cm2) and 9 non-osteoporotic (BMD > 0.8 g/cm2) vertebral bodies. Bipedicular cannulated pedicle screws were implanted into the vertebral bodies; right screws were augmented with ultra-high viscosity PMMA, whereas un-cemented left pedicle screws served as negative controls. Cement distribution was controlled with fluoroscopy and CT scans. Axial pullout forces of the screws were measured with a material testing machine, and results were analyzed statistically. Fluoroscopy and CT scans showed that in all cases an adequately big cement depot with homogenous form and no signs of extravasation was injected. Pullout forces showed significant differences (p < 0.001) between the augmented and non-augmented pedicle screws for bone densities below 0.8 g/cm2 (661.9 N ± 439) and over 0.8 g/cm2 (744.9 N ± 415). Pullout-forces were significantly increased in osteoporotic as well as in non-osteoporotic vertebral bodies without a significant difference between these groups using this standardized, simple procedure with increased control and less complications like extravasation.

A Novel Unscheduled Islanding Detection Method for Microgrid

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Li Hui

2018-01-01

Full Text Available Microgrid with its intelligent and flexible control characteristics conform to the trend of sustainable development of electricity, and when the microgrid in the unplanned island state, the successful detection of the island is a prerequisite, energy storage inverter as the key equipment in the microgrid system, island protection is one of the necessary functions. In this paper, an improved islanding detection method based on active frequency drift and q-axis reactive power perturbation is proposed. The method has the advantages of faster detection speed and minor influence on power quality, which makes the energy storage inverter with better output power quality when it works on grid-connected state, and can be detected the islanding state quickly from grid-connected mode to islanded mode. Finally, the validity and superiority of the improved island detection method are verified by simulation experiments.

Navigated pedicle screw placement using computed tomographic data in dorsolumbar fractures

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Saurabh Kapoor

2014-01-01

Conclusion: CT-based navigation is effective in improving accuracy of pedicle screw placement in traumatic injuries of dorsolumbar spine (T9-L5, however additional cost of procuring CT scan to the patient and cost of equipment is of significant concern in developing countries. Reduced radiation exposure and lowered ergonomic constraints around the operation table are its additional benefits.

Asymmetry of the Vertebral Body and Pedicles in the True Transverse Plane in Adolescent Idiopathic Scoliosis: A CT-Based Study.

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Brink, Rob C; Schlösser, Tom P C; Colo, Dino; Vincken, Koen L; van Stralen, Marijn; Hui, Steve C N; Chu, Winnie C W; Cheng, Jack C Y; Castelein, René M

2017-01-01

Cross-sectional. To quantify the asymmetry of the vertebral bodies and pedicles in the true transverse plane in adolescent idiopathic scoliosis (AIS) and to compare this with normal anatomy. There is an ongoing debate about the existence and magnitude of the vertebral body and pedicle asymmetry in AIS and whether this is an expression of a primary growth disturbance, or secondary to asymmetrical loading. Vertebral body asymmetry, defined as left-right overlap of the vertebral endplates (ie, 100%: perfect symmetry, 0%: complete asymmetry) was evaluated in the true transverse plane on CT scans of 77 AIS patients and 32 non-scoliotic controls. Additionally, the pedicle width, length, and angle and the length of the ideal screw trajectory were calculated. Scoliotic vertebrae were on average more asymmetric than controls (thoracic: AIS 96.0% vs. controls 96.4%; p = .005, lumbar: 95.8% vs. 97.2%; p transverse pedicle angle was greater (12.3° vs. 5.7°; p transverse plane in AIS and no uniform relation between the axial rotation and vertebral asymmetry could be observed in these moderate to severe patients, suggesting that asymmetrical vertebral growth does not initiate rotation, but rather follows it as a secondary phenomenon. Level 4. Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

A Novel Pedicle Screw with Mobile Connection: A Pilot Study

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Yasuaki Tokuhashi

2014-01-01

Full Text Available To prevent adjacent disc problems after spinal fusion, a pedicle screw with a mobile junction between the head and threaded shaft was newly developed. The threaded shaft of the screw has 10 degrees mobility in all directions, but its structure is to prevent abnormal translation and tilting. This screw was evaluated as follows: (1 endurance test: 106 times rotational stress was applied; (2 biological reactions: novel screws with a mobile head and conventional screws with a fixed head were inserted into the bilateral pedicles of the L3, L4, and L5 in two mini pigs with combination. Eight months after surgery, vertebral units with the screw rod constructs were collected. After CT scan, the soft and bony tissues around the screws were examined grossly and histologically. As a result, none of the screws broke during the endurance test stressing. The mean amount of abrasion wear was 0.0338 g. In the resected mini pig section, though zygapophyseal joints between fixed-head screws showed bony union, the amount of callus in the zygapophyseal joints connected with mobile-head screws was small, and joint space was confirmed by CT. No metalloses were noted around any of the screws. Novel screws were suggested to be highly durable and histologically safe.

Comparison of low density and high density pedicle screw instrumentation in Lenke 1 adolescent idiopathic scoliosis.

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Shen, Mingkui; Jiang, Honghui; Luo, Ming; Wang, Wengang; Li, Ning; Wang, Lulu; Xia, Lei

2017-08-02

The correlation between implant density and deformity correction has not yet led to a precise conclusion in adolescent idiopathic scoliosis (AIS). The aim of this study was to evaluate the effects of low density (LD) and high density (HD) pedicle screw instrumentation in terms of the clinical, radiological and Scoliosis Research Society (SRS)-22 outcomes in Lenke 1 AIS. We retrospectively reviewed 62 consecutive Lenke 1 AIS patients who underwent posterior spinal arthrodesis using all-pedicle screw instrumentation with a minimum follow-up of 24 months. The implant density was defined as the number of screws per spinal level fused. Patients were then divided into two groups according to the average implant density for the entire study. The LD group (n = 28) had fewer than 1.61 screws per level, while the HD group (n = 34) had more than 1.61 screws per level. The radiographs were analysed preoperatively, postoperatively and at final follow-up. The perioperative and SRS-22 outcomes were also assessed. Independent sample t tests were used between the two groups. Comparisons between the two groups showed no significant differences in the correction of the main thoracic curve and thoracic kyphosis, blood transfusion, hospital stay, and SRS-22 scores. Compared with the HD group, there was a decreased operating time (278.4 vs. 331.0 min, p = 0.004) and decreased blood loss (823.6 vs. 1010.9 ml, p = 0.048), pedicle screws needed (15.1 vs. 19.6, p density and high density pedicle screw instrumentation achieved satisfactory deformity correction in Lenke 1 AIS patients. However, the operating time and blood loss were reduced, and the implant costs were decreased with the use of low screw density constructs.

Woodland caribou persistence and extirpation in relic populations on Lake Superior

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Arthur T. Bergerud

2007-04-01

Full Text Available Extended: The hypothesis was proposed that woodland caribou (Rangifer tarandus caribou in North America had declined due to wolf predation and over-hunting rather than from a shortage of winter lichens (Bergerud, 1974. In 1974, two study areas were selected for testing: for the lichen hypothesis, we selected the Slate Islands in Lake Superior (36 km2, a closed canopy forest without terrestrial lichens, wolves, bears, or moose; for the predation hypothesis, we selected the nearby Pukaskwa National Park (PNP where terrestrial lichens, wolves, bears, and moose were present. Both areas were monitored from 1974 to 2003 (30 years. The living and dead caribou on the Slates were estimated by the ‘King census’ strip transect (mean length 108±9.3 km, extremes 22-190, total 3026 km and the Lincoln Index (mean tagged 45±3.6, extremes 15-78. The mean annual population on the Slate Islands based on the strip transects was 262±22 animals (extremes 104-606, or 7.3/km2 (29 years and from the Lincoln Index 303±64 (extremes 181-482, or 8.4/km2 (23 years. These are the highest densities in North America and have persisted at least since 1949 (56 years. Mountain maple (Acer spicatum interacted with caribou density creating a record in its age structure which corroborates persistence at relatively high density from c. 1930. The mean percentage of calves was 14.8±0.34% (20 years in the fall and 14.1±1.95% (19 years in late winter. The Slate Islands herd was regulated by the density dependent abundance of summer green foods and fall physical condition rather than density independent arboreal lichen availability and snow depths. Two wolves (1 wolf/150 caribou crossed to the islands in 1993-94 and reduced two calf cohorts (3 and 4.9 per cent calves while female adult survival declined from a mean of 82% to 71% and the population declined ≈100 animals. In PNP, caribou/moose/wolf populations were estimated by aerial surveys (in some years assisted by telemetry

Creation of a Bioengineered Skin Flap Scaffold with a Perfusable Vascular Pedicle.

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Jank, Bernhard J; Goverman, Jeremy; Guyette, Jacques P; Charest, Jon M; Randolph, Mark; Gaudette, Glenn R; Gershlak, Joshua R; Purschke, Martin; Javorsky, Emilia; Nazarian, Rosalynn M; Leonard, David A; Cetrulo, Curtis L; Austen, William G; Ott, Harald C

2017-07-01

Full-thickness skin loss is a challenging problem due to limited reconstructive options, demanding 75 million surgical procedures annually in the United States. Autologous skin grafting is the gold standard treatment, but results in donor-site morbidity and poor aesthetics. Numerous skin substitutes are available on the market to date, however, none truly functions as full-thickness skin due to lack of a vascular network. The creation of an autologous full-thickness skin analogue with a vascular pedicle would result in a paradigm shift in the management of wounds and in reconstruction of full-thickness skin defects. To create a clinically relevant foundation, we generated an acellular skin flap scaffold (SFS) with a perfusable vascular pedicle of clinically relevant size by perfusion decellularization of porcine fasciocutaneous flaps. We then analyzed the yielded SFS for mechanical properties, biocompatibility, and regenerative potential in vitro and in vivo. Furthermore, we assessed the immunological response using an in vivo model. Finally, we recellularized the vascular compartment of an SFS and reconnected it to a recipient's blood supply to test for perfusability. Perfusion decellularization removed all cellular components with preservation of native extracellular matrix composition and architecture. Biaxial testing revealed preserved mechanical properties. Immunologic response and biocompatibility assessed via implantation and compared with native xenogenic skin and commercially available dermal substitutes revealed rapid neovascularization and complete tissue integration. Composition of infiltrating immune cells showed no evidence of allorejection and resembled the inflammatory phase of wound healing. Implantation into full-thickness skin defects demonstrated good tissue integration and skin regeneration without cicatrization. We have developed a protocol for the generation of an SFS of clinically relevant size, containing a vascular pedicle, which can be

Unilateral pedicle screws asymmetric tethering: an innovative method to create idiopathic deformity

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Zhang Xuesong

2007-10-01

Full Text Available Abstract Objective To evaluate the feasibility of the method that unilateral pedicle screws asymmetric tethering in concave side in combination with convex rib resection for creating idiopathic deformity. Summary of background data Various methods are performed to create idiopathic deformity. Among these methods, posterior asmmetric tethering of the spine shows satisfying result, but some drawbacks related to the current posterior asymmetric tether were still evident. Materials and methods Unilateral pedicle screws asymmetric tethering was performed to 14 female goats (age: 5–8 week-old, weight: 6–8 kg in concave side in combination with convex rib resection. Dorsoventral and lateral plain radiographs were taken of each thoracic spine in the frontal and sagittal planes right after the surgery and later every 4 weeks. Results All animals ambulated freely after surgery. For technical reasons, 2 goats were excluded (one animal died for anesthetic during the surgery, and one animal was lost for instrumental fail due to postoperative infection. Radiography showed that 11 goats exhibited scoliosis with convex toward to the right side, and as the curve increased with time, only 1 goat showed nonprogressive. The initial scoliosis generated in the progressors after the procedures measured 29.0° on average (range 23.0°–38.5° and increased to 43.0° on average (range 36.0°–58.0° over 8 to 10 weeks. The average progression of 14.0° was measured. The curvature immediately after tethering surgery (the initial Cobb angle did have a highly significant correlation with the final curvature (p Conclusion Unilateral pedicle screws asymmetric tethering is a practical method to create experimental scoliosis, especially for those who would like to study the correction of this deformity.

The Pedicled LICAP Flap Combined with a Free Abdominal Flap In Autologous Breast Reconstructions

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Thomas Sjøberg, MD

2018-01-01

Conclusion:. In selected patients with insufficient abdominal flap tissue, a combination of a free abdominal flap and a pedicled LICAP flap is a valuable option to increase breast size and cosmetic outcome. Additional symmetrizing surgery might still be necessary.

Occurance of aldehyde-fuchsin and performic acid-victoria blue positive granules in the ovarian pedicle of Dysdercus koenigii F. (Pyrrhocridae: Heteroptera).

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Srivastava, R C; Srivastava, B P

1976-10-15

A cycle of activity of aldehyde-fuchsin and performic acid-Victoria blue positive granules was observed in the ovarian pedicle of Dysdercus koenigii during the first ovipositional cycle. The quantitative variation of these granules in the pedicle can also be correlated directly with the increase or decrease of the neurosecretory material in the A-type cells of the pars intercerebralis medialis region of the protocerebrum of the brian.

Clinical applications of the superior epigastric artery perforator (SEAP) flap: anatomical studies and preoperative perforator mapping with multidetector CT.

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Hamdi, Moustapha; Van Landuyt, Koenraad; Ulens, Sara; Van Hedent, Eddy; Roche, Nathalie; Monstrey, Stan

2009-09-01

Pedicled superior epigastric artery perforator (SEAP) flaps can be raised to cover challenging thoracic defects. We present an anatomical study based on multidetector computerized tomography (MDCT) scan findings of the SEA perforators in addition to the first reported clinical series of SEAP flaps in anterior chest wall reconstruction. (a) In the CT scan study, images of a group of 20 patients who underwent MDCT scan analysis were used to visualise bilaterally the location of musculocutaneous SEAP. X- and Y-axes were used as landmarks to localise the perforators. The X-axis is a horizontal line at the junction of sternum and xyphoid (JCX) and the Y-axis is at the midline. (b) In the clinical study, seven pedicled SEAP flaps were performed in another group of patients. MDCT images revealed totally 157 perforators with a mean of 7.85 perforators per patient. The dominant perforators (137 perforators) were mainly localised in an area between 1.5 and 6.5 cm from the X-axis on both sides and between 3 and 16 cm below the Y-axis. The calibre of these dominant perforators was judged as 'good' to 'very good' in 82.5% of the cases. The average dimension of the flap was 21.7x6.7 cm. All flaps were based on one perforator. Mean harvesting time was 110 min. There were no flap losses. Minor tip necrosis occurred in two flaps. One of them was treated with excision and primary closure. Our clinical experience indicates that the SEAP flap provides a novel and useful approach for reconstruction of anterior chest wall defects. CT-based imaging allows for anatomical assessment of the perforators of the superior epigastric artery (SEA).

Biomechanical comparative study of the stability of injectable pedicle screws with different lateral holes augmented with different volumes of polymethylmethacrylate in osteoporotic lumbar vertebrae.

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Liu, Da; Sheng, Jun; Luo, Yang; Huang, Chen; Wu, Hong-Hua; Zhou, Jiang-Jun; Zhang, Xiao-Jun; Zheng, Wei

2018-03-19

Polymethylmethacrylate (PMMA) is widely used for pedicle screw augmentation in osteoporosis. Until now, there had been no studies of the relationship between screw stability and the distribution and volume of PMMA. The objective of this study was to analyze the relationship between screw stability and the distribution pattern and injected volume of PMMA. This is a biomechanical comparison of injectable pedicle screws with different lateral holes augmented with different volumes of PMMA in cadaveric osteoporotic lumbar vertebrae. Forty-eight osteoporotic lumbar vertebrae were randomly divided into Groups A, B, and C with different pedicle screws (16 vertebrae in each group), and then each group was randomly divided into Subgroups 0, 1, 2, and 3 with different volumes of PMMA (four vertebra with eight pedicles in each subgroup). A pilot hole was prepared in advance using the same method in all samples. Type A and type B pedicle screws were directly inserted into vertebrae in Groups A and B, respectively, and then different volumes of PMMA (0, 1.0, 1.5, and 2.0 mL) were injected through the screws and into vertebrae in Subgroups 0, 1, 2, and 3. The pilot holes were filled with different volumes of PMMA (0, 1.0, 1.5, and 2.0 mL), and then the screws were inserted in Groups C0, C1, C2, and C3. Screw position and distribution of PMMA were evaluated radiographically, and axial pullout tests were performed to measure maximum axial pullout strength (F max ). Polymethylmethacrylate surrounded the anterior one-third of screws in the vertebral body in Groups A1, A2, and A3; the middle one-third of screws in the junction area of the vertebral body and the pedicle in Groups B1, B2, and B3; and the full length of screws evenly in both the vertebral body and the pedicle in Groups C1, C2, and C3. There was no malpositioning of screws or leakage of PMMA in any sample. Two-way analysis of variance revealed that two factors-distribution and volume of PMMA-significantly influenced

Multiaxial pedicle screw designs: static and dynamic mechanical testing.

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Stanford, Ralph Edward; Loefler, Andreas Herman; Stanford, Philip Mark; Walsh, William R

2004-02-15

Randomized investigation of multiaxial pedicle screw mechanical properties. Measure static yield and ultimate strengths, yield stiffness, and fatigue resistance according to an established model. Compare these measured properties with expected loads in vivo. Multiaxial pedicle screws provide surgical versatility, but the complexity of their design may reduce their strength and fatigue resistance. There is no published data on the mechanical properties of such screws. Screws were assembled according to a vertebrectomy model for destructive mechanical testing. Groups of five assemblies were tested in static tension and compression and subject to three cyclical loads. Modes of failure, yield, and ultimate strength, yield stiffness, and cycles to failure were determined for six designs of screw. Static compression yield loads ranged from 217.1 to 388.0 N and yield stiffness from 23.7 to 38.0 N/mm. Cycles to failure ranged from 42 x 10(3) to 4,719 x 10(3) at 75% of static ultimate load. There were significant differences between designs in all modes of testing. Failure occurred at the multiaxial link in static and cyclical compression. Bending yield strengths just exceeded loads expected in vivo. Multiaxial designs had lower static bending yield strength than fixed screw designs. Five out of six multiaxial screw designs achieved one million cycles at 200 N in compression bending. "Ball-in-cup" multiaxial locking mechanisms were vulnerable to fatigue failure. Smooth surfaces and thicker material appeared to be protective against fatigue failure.

Additive-manufactured patient-specific titanium templates for thoracic pedicle screw placement: novel design with reduced contact area.

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Takemoto, Mitsuru; Fujibayashi, Shunsuke; Ota, Eigo; Otsuki, Bungo; Kimura, Hiroaki; Sakamoto, Takeshi; Kawai, Toshiyuki; Futami, Tohru; Sasaki, Kiyoyuki; Matsushita, Tomiharu; Nakamura, Takashi; Neo, Masashi; Matsuda, Shuich

2016-06-01

Image-based navigational patient-specific templates (PSTs) for pedicle screw (PS) placement have been described. With recent advances in three-dimensional computer-aided designs and additive manufacturing technology, various PST designs have been reported, although the template designs were not optimized. We have developed a novel PST design that reduces the contact area without sacrificing stability. It avoids susceptibility to intervening soft tissue, template geometric inaccuracy, and difficulty during template fitting. Fourteen candidate locations on the posterior aspect of the vertebra were evaluated. Among them, locations that had high reproducibility on computed tomography (CT) images and facilitated accurate PS placement were selected for the final PST design. An additive manufacturing machine (EOSINT M270) fabricated the PSTs using commercially pure titanium powder. For the clinical study, 36 scoliosis patients and 4 patients with ossification of the posterior longitudinal ligament (OPLL) were treated with thoracic PSs using our newly developed PSTs. We intraoperatively and postoperatively evaluated the accuracy of the PS hole created by the PST. Based on the segmentation reproducibility and stability analyses, we selected seven small, round contact points for our PST: bilateral superior and inferior points on the transverse process base, bilateral inferior points on the laminar, and a superior point on the spinous process. Clinically, the success rates of PS placement using this PST design were 98.6 % (414/420) for scoliosis patients and 100 % (46/46) for OPLL patients. This study provides a useful design concept for the development and introduction of patient-specific navigational templates for placing PSs.

Use of the Composite Pedicled Pectoralis Minor Flap after Resection of Soft Tissue Sarcoma in Reconstruction of the Glenohumeral Joint

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Michiel A. J. van de Sande

2014-01-01

Full Text Available The surgical repair of an extensive anterior glenohumeral soft tissue defect is complicated by glenohumeral instability and subsequent significant functional deficit. This surgical note offers a relatively simple reconstruction of the anterior capsule and subscapularis muscle using a pectoralis minor pedicle flap. This reconstruction is supplemented with functional reconstruction of the anterior glenohumeral joint. A conventional deltopectoral approach is utilized and pectoralis minor is freed from its coracoid insertion, released, and mobilized without compromising the pedicle entering from the dorsum and inferior one-third of the muscle. The mobilized pectoralis minor vascular pedicle has sufficient length for the pectoralis minor to be transferred to provide coverage of the anterior shoulder joint even in full external rotation, providing anterior stability. To further improve glenohumeral stability and shoulder function, the pectoralis major muscle can be split with the clavicular part reinserted lateral to the bicipital groove onto the lesser tuberosity replacing subscapularis function while stabilising the glenohumeral joint.

Water resources of the Apostle Islands National Lakeshore, northern Wisconsin

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Rose, W.J.

1988-01-01

The Apostle Islands National Lakeshore consists of 21 islands, part of the Bayfield Peninsula, and the adjacent waters of Lake Superior. Selected water resources of the Apostle Islands National Lakeshore were assessed to aid the National Park Service in developing and managing the Lakeshore and to provide a data base against which future changes can be compared. This summary of water-resources data, collected by the U.S. Geological Survey during 1979-84, provides a qualitative description of selected hydrologic components of the Lakeshore.

Adynamic Graciloplasty With a Pedicled Gracilis Muscle Flap Wrapped Around Bulbar Urethra for Treatment of Male Acquired Urinary Incontinence.

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Guo, Hailin; Sa, Yinglong; Xu, Yuemin; Wang, Lin; Fei, Xiaofang

2016-05-01

To evaluate the efficacy of adynamic gracilis urethral myoplasty with a pedicled gracilis muscle flap wrapped around bulbar urethra for treatment of male acquired urinary incontinence. Twenty-four patients with acquired urinary incontinence (8 after radical prostatectomy, 7 after transurethral resection of the prostate, and 9 after posterior urethroplasty) were included in our study. Eighteen of these patients (75.0%) had mild to moderate urinary incontinence, and 6 (25.0%) had severe urinary incontinence. All patients received adynamic gracilis urethral myoplasty with a pedicled gracilis muscle flap wrapped around bulbar urethra and had a close follow-up. The mean postoperative maximum urethral pressure after the gracilis muscle wrapped around bulbar urethra was significantly higher than that of the preoperative measurements (P urethra can raise the urethral pressure. Adynamic graciloplasty with a pedicled gracilis muscle flap wrapped around bulbar urethra is a safe and effective surgical option in the treatment of male patients with mild to moderate incontinence, but is not suitable for severe incontinence. Copyright © 2016 Elsevier Inc. All rights reserved.

Superior facet syndrome. Findings on metrizamide CT myelography

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Kubo, Yoshichika; Igarashi, Seishi; Koyama, Tsunemaro

1985-02-01

Sciatica caused by root entrapment in the lateral recess was named superior facet syndrome by Epstein in 1972. Few reports on this subject based on large numbers of cases have been documented to date. Of the patients with sciatica, 32 patients were diagnosed to have root entrapment at the lateral recess L5 or/and S1 lumbar spine. Out of 32 patients, 20 patients were operated on and the lateral entrapment was recognized in all of surgical cases. Neuroradiological findings, especially of metrizamide CT (met. CT), were documented in detail. Thirty two patients were classified in three types according to radiological findings. They were congenital or developmental, degenerative, and combined type, respectively. Fourteen cases belonged to the congenital type, 13 to the degenerative and 5 to the combined type. Each group had the mean ages of 23.4, 53.8, and 36.8 years old, respectively. Of 32 cases the entrapment occured in 47 L5 roots and 11 S1 roots. There was no remarkable laterality. In operation the unroofing of the lateral recess were done and the sciatica subsided postoperatively in all of surgical cases. Met. CT revealed extreme medial protrusion of the superior articular joint in 18 of 24 cases(75%) and none filling of the root in the lateral recess in 21 of 24 cases (87.5%). In the degenerative type, met. CT showed some degenerative changes that were hypertrophy or deformity of the articular joints and spur formation of the vertebral body. In contrast to met. CT, metrizamide myelography revealed only slight changes, which were poor filling of the root before it turned out the pedicle of lateral compression of the root. In plain films or lumbar spine articular joints at Lsub(4/5) were formed in coronal plane in 69% of cases of the L5 root entrapment. Met. CT using ReView technique was of great diagnostic value in superior facet syndrome.

Infection of PTFE mesh 15 years following pedicled TRAM flap breast reconstruction: mechanism and aetiology.

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Elfaki, A; Gkorila, A; Khatib, M; Malata, C M

2018-01-01

The pedicled transverse rectus abdominis myocutaneous (TRAM) flap procedure is still widely used for breast reconstruction. The repair of the flap harvest site in the transverse rectus abdominis muscle and sheath is often assisted by the use of prosthetic meshes. This decreases the risk of abdominal wall weakness and herniation but, being a foreign body, it also carries the risk of infection. In this report, we describe the case of a 63-year-old patient who, whilst receiving chemotherapy for metastatic breast cancer, presented with an infected polytetrafluoroethylene mesh 15 years after pedicled TRAM flap immediate breast reconstruction. This necessitated mesh removal to treat the infection. Following a thorough review of the English literature, this is the longest recorded presentation of an abdominal prosthetic mesh infection. The mechanism and aetiology of such a late complication are discussed.

Closed reduction, internal fixation with quadratus femoris muscle pedicle bone grafting in displaced femoral neck fracture

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Chaudhuri Sibaji

2008-01-01

Full Text Available Background: Management of femoral neck fracture is still considered as an unsolved problem. It is more evident in displaced fractures where this fracture is considered as some sort of vascular insult to the head of the femur. We have used closed reduction, internal fixation and quadratus femoris muscle pedicle bone grafting in fresh displaced femoral neck fractures. Materials and Methods: From April 1996 to December 2004 we operated 73 consecutive patients of displaced femoral neck fracture in the age group of 24 to 81 years, mean age being 54.6 years. The patients were operated within one week of injury, the mean delay being 3.6 days. Closed reduction internal fixation along with quadratus femoris muscle pedicle bone grafting was done in all cases. They were followed up for an average period of 5.6 years (range 2-11 years. Results: Results were assessed according to modified Harris Hip Scoring system and found to be excellent in 53, good in 12, fair in six and poor in two patients. Bony union occurred in 68 cases, no patient developed avascular necrosis (AVN till date. Conclusion: For fresh displaced femoral neck fracture in physiologically active patients closed reduction, internal fixation and quadratus femoris muscle pedicle bone grafting is a suitable option to secure union and prevent development of AVN.

Blood flow autoregulation in pedicled flaps

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Bonde, Christian T; Holstein-Rathlou, Niels-Henrik; Elberg, Jens J

2009-01-01

was to evaluate if, and to what extent, a tissue flap could compensate a reduction in blood flow due to an acute constriction of the feed artery. Further, we wanted to examine the possible role of smooth muscle L-type calcium channels in the autoregulatory mechanism by pharmacological intervention with the L......, the flow in the pedicle was reduced and the flow was recorded. RESULTS: The flaps showed a strong autoregulatory response with complete compensation for flow reductions of up to 70-80%. Infusion of nimodipine caused a 28+/-10% increase in blood flow and removed the autoregulation. Papaverine caused...... a further increase in blood flow by 61+/-19%. The time control experiments proved that the experimental procedure was reproducible and stable over time. CONCLUSIONS: A tissue flap can nearly completely compensate for repeated flow reductions of up to 70-80%. This is due to a decrease in the peripheral...

Anatomy of vastus lateralis muscle flap.

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Tayfur, Volkan; Magden, Orhan; Edizer, Mete; Atabey, Atay

2010-11-01

A vastus lateralis muscle flap is used as a pedicled and free flap. In this study, the vastus lateralis muscles of 15 adult formalin-fixed cadavers (30 cases) were dissected. The dominant pedicle was found to be descending branch of the lateral circumflex femoral artery. The mean diameter of the artery was found to be 2.1 mm. This pedicle was located 119.4 mm distal to the pubic symphysis. The mean length of the major pedicle was found to be 56.8 mm when the dominant pedicle was chosen to nourish the flap. The dominant pedicle entered the muscle 155.8 and 213.7 mm from the greater trochanter and the anterior superior iliac spine, respectively. The muscle had proximal minor pedicles from the ascending and transverse branches of lateral circumflex femoral artery. These arteries had mean diameters of 1.8 and 2.0 mm, respectively. The distal minor branches were present in all of the dissections. The distal branch had a mean diameter of 1.8 mm. The origin of this distal branch was located 83.7 mm proximal to the intercondylar line. The motor nerve of the vastus lateralis was found to be originating from femoral nerve. The nerve entered the muscle 194.6 mm from the anterior superior iliac spine.

The Use of Tensor Fascia Lata Pedicled Flap in Reconstructing Full Thickness Abdominal Wall Defects and Groin Defects Following Tumor Ablation

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Rifaat, M.A.; Abdel Gawad, W.S.

2005-01-01

The tensor fascia lata is a versatile flap with many uses in reconstructive plastic surgery. As a pedicled flap its reach to the lower abdomen and groin made it an attractive option for reconstructing soft tissue defects after tumor ablation. However, debate exists on the safe dimension of the flap, as distal tip necrosis is common. Also, the adequacy of the fascia lata as a sole substitute for abdominal wall muscles has been disputable. The aim of the current study is to report our experience and clinical observations with this flap in reconstructing those challenging defects and to discuss the possible options to minimize the latter disputable issues. Patients and Methods: From April 2001 to April 2004, 12 pedicled TFL flaps were used to reconstruct 5 central abdominal wall full thickness defects and 6 groin soft tissue defects following tumor resection. ]n one case, bilateral flaps were used to reconstruct a large central abdominal wall defect. There were 4 males and 7 females. Their age ranged from 19 to 60. From the abdominal wall defects group, all repairs were enforced primarily with a prolene mesh except for one patient who was the first in this study. Patients presenting with groin defects required coverage of exposed vessels following tumor resection. All patients in the current study underwent immediate reconstruction. The resulting soft tissue defects in this study were due to resection of 4 abdominal wall desmoid tumors, a colonic carcinoma infiltrating the abdominal wall, 4 primary groin soft developed in a flap used to cover a groin defect. In the former 3 cases, The flap was simply transposed without complete islanding of the flap. In the latter case, a very large flap was harvested beyond the safe limits with its distal edge just above the knee. In addition, wound dehiscence of the flap occurred in 2 other cases from the groin group. Nevertheless, all the wounds healed spontaneously with repeated dressings. Out of the 5 cases that underwent

A multi-level rapid prototyping drill guide template reduces the perforation risk of pedicle screw placement in the lumbar and sacral spine.

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Merc, Matjaz; Drstvensek, Igor; Vogrin, Matjaz; Brajlih, Tomaz; Recnik, Gregor

2013-07-01

The method of free-hand pedicle screw placement is generally safe although it carries potential risks. For this reason, several highly accurate computer-assisted systems were developed and are currently on the market. However, these devices have certain disadvantages. We have developed a method of pedicle screw placement in the lumbar and sacral region using a multi-level drill guide template, created with the rapid prototyping technology and have validated it in a clinical study. The aim of the study was to manufacture and evaluate the accuracy of a multi-level drill guide template for lumbar and first sacral pedicle screw placement and to compare it with the free-hand technique under fluoroscopy supervision. In 2011 and 2012, a randomized clinical trial was performed on 20 patients. 54 screws were implanted in the trial group using templates and 54 in the control group using the fluoroscopy-supervised free-hand technique. Furthermore, applicability for the first sacral level was tested. Preoperative CT-scans were taken and templates were designed using the selective laser sintering method. Postoperative evaluation and statistical analysis of pedicle violation, displacement, screw length and deviation were performed for both groups. The incidence of cortex perforation was significantly reduced in the template group; likewise, the deviation and displacement level of screws in the sagittal plane. In both groups there was no significantly important difference in deviation and displacement level in the transversal plane as not in pedicle screw length. The results for the first sacral level resembled the main investigated group. The method significantly lowers the incidence of cortex perforation and is therefore potentially applicable in clinical practice, especially in some selected cases. The applied method, however, carries a potential for errors during manufacturing and practical usage and therefore still requires further improvements.

Minimal access direct spondylolysis repair using a pedicle screw-rod system: a case series

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Mohi Eldin Mohamed

2012-11-01

Full Text Available Abstract Introduction Symptomatic spondylolysis is always challenging to treat because the pars defect causing the instability needs to be stabilized while segmental fusion needs to be avoided. Direct repair of the pars defect is ideal in cases of spondylolysis in which posterior decompression is not necessary. We report clinical results using segmental pedicle-screw-rod fixation with bone grafting in patients with symptomatic spondylolysis, a modification of a technique first reported by Tokuhashi and Matsuzaki in 1996. We also describe the surgical technique, assess the fusion and analyze the outcomes of patients. Case presentation At Cairo University Hospital, eight out of twelve Egyptian patients’ acute pars fractures healed after conservative management. Of those, two young male patients underwent an operative procedure for chronic low back pain secondary to pars defect. Case one was a 25-year-old Egyptian man who presented with a one-year history of axial low back pain, not radiating to the lower limbs, after falling from height. Case two was a 29-year-old Egyptian man who presented with a one-year history of axial low back pain and a one-year history of mild claudication and infrequent radiation to the leg, never below the knee. Utilizing a standardized mini-access fluoroscopically-guided surgical protocol, fixation was established with two titanium pedicle screws place into both pedicles, at the same level as the pars defect, without violating the facet joint. The cleaned pars defect was grafted; a curved titanium rod was then passed under the base of the spinous process of the affected vertebra, bridging the loose fragment, and attached to the pedicle screw heads, to uplift the spinal process, followed by compression of the defect. The patients were discharged three days after the procedure, with successful fusion at one-year follow-up. No rod breakage or implant-related complications were reported. Conclusions Where there is no

Decision making in double-pedicled DIEP and SIEA abdominal free flap breast reconstructions: An algorithmic approach and comprehensive classification.

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Charles M Malata

2015-10-01

Full Text Available Introduction: The deep inferior epigastric artery perforator (DIEP free flap is the gold standard for autologous breast reconstruction. However, using a single vascular pedicle may not yield sufficient tissue in patients with midline scars or insufficient lower abdominal pannus. Double-pedicled free flaps overcome this problem using different vascular arrangements to harvest the entire lower abdominal flap. The literature is, however, sparse regarding technique selection. We therefore reviewed our experience in order to formulate an algorithm and comprehensive classification for this purpose. Methods: All patients undergoing unilateral double-pedicled abdominal perforator free flap breast reconstruction (AFFBR by a single surgeon (CMM over 40 months were reviewed from a prospectively collected database. Results: Of the 112 consecutive breast free flaps performed, 25 (22% utilised two vascular pedicles. The mean patient age was 45 years (range=27-54. All flaps but one (which used the thoracodorsal system were anastomosed to the internal mammary vessels using the rib-preservation technique. The surgical duration was 656 minutes (range=468-690 mins. The median flap weight was 618g (range=432-1275g and the mastectomy weight was 445g (range=220-896g. All flaps were successful and only three patients requested minor liposuction to reduce and reshape their reconstructed breasts.Conclusion: Bipedicled free abdominal perforator flaps, employed in a fifth of all our AFFBRs, are a reliable and safe option for unilateral breast reconstruction. They, however, necessitate clear indications to justify the additional technical complexity and surgical duration. Our algorithm and comprehensive classification facilitate technique selection for the anastomotic permutations and successful execution of these operations.

A case of incisional hernia repair using Composix mesh prosthesis after antethoracic pedicled jejunal flap reconstruction following an esophagectomy.

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Yasuda, Atsushi; Yasuda, Takushi; Kato, Hiroaki; Iwama, Mitsuru; Shiraishi, Osamu; Hiraki, Yoko; Tanaka, Yumiko; Shinkai, Masayuki; Imano, Motohiro; Kimura, Yutaka; Imamoto, Haruhiko

2017-12-01

An incisional hernia in a case of antethoracic pedicled jejunal flap esophageal reconstruction after esophagectomy is a very rare occurrence, and this hernia was distinctive in that the reconstructed jejunum had passed through the hernial orifice; a standard surgical treatment for such a presentation has not been established. Herein, we describe a case of repair using mesh prosthesis for an atypical and distinctive incisional hernia after antethoracic pedicled jejunal flap esophageal reconstruction. A 77-year-old woman with a history of subtotal esophagectomy who had undergone antethoracic pedicled jejunal flap reconstruction complained of epigastric prominence and discomfort without pain. On examination, she had an abdominal protrusion between the xiphoid process and the umbilicus that contained the small bowel. Computed tomography showed that the fenestration of the abdominal wall that was intentionally created for jejunum pull-up was dehisced in a region measuring 9 × 15 cm and the small intestine protruded through it into the subcutaneous space without strangulation. Because the hernial orifice was too large and the reconstructed jejunum was passing through the hernial orifice in this case, we applied a parastomal hernia repair method that was modified from the inguinal hernia repair using the Lichtenstein technique. After 3 years and 5 months following surgery, the patient has recovered without hernia recurrence or other complications. We consider this to be the first case of repair using Composix mesh prosthesis for repair of an atypical and distinctive incisional hernia after an antethoracic pedicled jejunal flap reconstruction. This method seems to be useful and could potentially be widely adopted as the surgical treatment for this condition.

[Clinical efficacy of unilateral percutaneous transfacet screws combined with contralateral pedicle screw versus bilateral pedicle screws fixation in the treatment of the degenerative lumbar disease].

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Hao, Rong-Xue; Zhou, Hui; Pan, Hao; Yue, Jun; Chen, Hui-Guo; Yang, He-Jie; Jia, Gao-Yong; Wang, Dong; Lin, Yan; Xu, Hua-Zi

2017-09-25

To investigate the surgical outcome of unilateral pedicle screw(UPS) after TLIF technique combined with contralateral percutaneous transfacet screw(PTS) fixation vs bilateral pedicle screws(BPS) fixation in treatment of degenerative lumbar disease. From January 2009 to June 2012, 46 patients with degenerative lumbar diseases, including 30 males and 16 females with an average age of 51.5 years old, who were divided into two groups according to different fixation methods. Twenty-two cases underwent UPS after TLIF technique combined with contralateral PTS fixation (group A), while the others underwent BPS fixation(group B). The relative data were analyzed, such as blood loss volume, operative time, fusion rate, ODI score, JOA score and so on. All the patients were followed up for 1 to 3 years with an average of 22 months. Except one case of each group was uncertainty fusion, the rest have obtained bony fusion, and the fusion rates in group A and B were 95.5% and 95.8%, respectively. No displacement and breakage of screw were found during follow-up. Operative time and blood loss volume in group A were better than of group B( P 0.05). Two approaches had similar clinical outcomes for degenerative lumbar disease with no severe instability. Compared with BPS fixation, the UPS after TLIF technique and contralateral PTS fixation has the advantages of less trauma, shorter operative time and less blood loss, and it is a safe and feasible surgical technique.

Navigation of Pedicle Screws in the Thoracic Spine with a New Electromagnetic Navigation System: A Human Cadaver Study

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Patrick Hahn

2015-01-01

Full Text Available Introduction. Posterior stabilization of the spine is a standard procedure in spinal surgery. In addition to the standard techniques, several new techniques have been developed. The objective of this cadaveric study was to examine the accuracy of a new electromagnetic navigation system for instrumentation of pedicle screws in the spine. Material and Method. Forty-eight pedicle screws were inserted in the thoracic spine of human cadavers using EMF navigation and instruments developed especially for electromagnetic navigation. The screw position was assessed postoperatively by a CT scan. Results. The screws were classified into 3 groups: grade 1 = ideal position; grade 2 = cortical penetration <2 mm; grade 3 = cortical penetration ≥2 mm. The initial evaluation of the system showed satisfied positioning for the thoracic spine; 37 of 48 screws (77.1%, 95% confidence interval [62.7%, 88%] were classified as group 1 or 2. Discussion. The screw placement was satisfactory. The initial results show that there is room for improvement with some changes needed. The ease of use and short setup times should be pointed out. Instrumentation is achieved without restricting the operator’s mobility during navigation. Conclusion. The results indicate a good placement technique for pedicle screws. Big advantages are the easy handling of the system.

Refinamientos en la reconstrucción del tercio superior auricular con la técnica de Davis: Estudio anatómico y serie clínica Refinements on reconstruction of auricular upper pole defects with Davi's technique: Anatomical study and clinical series

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S. Llanos

2009-06-01

que la técnica de Davis representa un efectivo método de reconstrucción del tercio superior auricular; los refinamientos a la técnica que comunicamos mejoran los resultados, dando un contorno más natural al área reconstruida.Acquired defects of the upper third of the ear constitute a surgical challenge. Several techniques have been described, and results are sometimes unfavorable. An anatomical study in 10 fresh cadavers shows the constant presence of a neurovascular pedicle penetrating the root of helix. Location and vessel diameters are shown. Based on that anatomical knowledge, a series of 10 consecutive cases treated by the senior author is presented. Etiology, surgical technique, complications and long-term results are analyzed. The author's technique introduces a refinement of the Davis' technique, which uses a pedicled chondrocutaneous rotation conchal flap, cutaneous based on the upper auricular branch of superficial temporal artery. An axial pedicled superiorly based retroauricular flap provides the coverage of the new superior helical rim, and the posterior aspect of the chondrocutaneous flap is then covered with a full thickness skin graft. In a second stage, a Z plasty on the root of helix brings it a natural shape All the anatomical dissections demonstrate the presence of a neurovascular pedicle penetrating the root of the helix. The clinical series is composed by 8 traumatic defects, 1 electrical burn and 1 benign skin tumor. All flaps survived and so demonstrated pedicle safety. Two retroauricular flaps presented vascular deficit, one of them with complete spontaneous restoration and the other one with small distal cutaneous necrosis. Two cases suffered partial skin graft loss. Some technical details were developed while the series went on, which are discussed. All 9 patients recovered auricular contour, which seems better for us using the above described refinements. As a conclusion, the Davis's technique represents an effective method to

Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension: technical note.

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Mendel, Ehud; Nathoo, Narendra; Scharschmidt, Thomas; Schmidt, Carl; Boehmler, James; Mayerson, Joel L

2014-03-01

En bloc resection with negative tumor margins remains the principal treatment option for control or cure of primary pelvic chondrosarcomas, as current adjuvant therapies remain ineffective. Iliosacral chondrosarcomas with involvement of the sciatic notch are sufficiently challenging tumors. However, when there is concomitant lumbar extension requiring resection of the pedicles to maintain negative surgical margins, transpedicular screw fixation is not possible, making reconstruction of the lumbopelvic junction extremely challenging. A patient with an iliosacral chondrosarcoma with lumbar spine extension is presented in this report to illustrate a novel lumbopelvic spinal construct. Following combined external pelvectomy and hemisacrectomy with contralateral L3-5 hemilaminectomy and ipsilateral pediculotomy, bicortical transvertebral body screws were substituted for the missing pedicles, resulting in the creation of "false pedicles," which were further supplemented with an autologous vascularized fibular strut graft from the amputated lower limb and applied to the lateral aspect of the vertebral bodies. The creation of false pedicles allowed for a robust reconstruction of the lumbopelvic junction, including maintaining pelvic ring integrity with a "neo-pelvis", creating a functional load-bearing construct adequate for early mobilization and ambulation. The biomechanical dynamics of this unique construct are also discussed.

[Tibia reconstruction using cross-leg pedicled fibular flaps: report of two cases].

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Molski, M

2000-01-01

The paper presents the results of treatment of two children with cross-leg pedicle fibular flaps. A boy (10 years old) was operated because of an extensive defect of the proximal tibial shaft (15 cm) and soft tissue deficit due to osteosarcoma. He had been previously operated several times: tumor resection with chemiotherapy, bone reconstruction using allografts and two other procedures because of inflammatory complications. The second case was a 9-year old girl who underwent an extensive excision of congenital pseudoarthrosis of the tibia due to neurofibroma and reconstruction of the further fragment of the tibia. Vascularized fibula was nailed deep into the tibial shaft, beyond the previously implanted metal elements. This allowed to maintain a correct axis of the limb, a firm stabilization of the transplant and probably evoked a quick periosteal reaction of the tibia. Plaster of Paris was used to immobilize the limb. Postoperative course showed no complications. The flap pedicle was cut off after 3-4 weeks. Progressive bone healing followed by bony hypertrophy was observed after 8 weeks. The children were able to fully load the operated extremities and ambulate without crutches (the boys 12 months post-surgery and the girl 6 months post-surgery).

Localization and characterization of STRO-1 cells in the deer pedicle and regenerating antler.

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Hans J Rolf

2008-04-01

Full Text Available The annual regeneration of deer antlers is a unique developmental event in mammals, which as a rule possess only a very limited capacity to regenerate lost appendages. Studying antler regeneration can therefore provide a deeper insight into the mechanisms that prevent limb regeneration in humans and other mammals, and, with regard to medical treatments, may possibly even show ways how to overcome these limitations. Traditionally, antler regeneration has been characterized as a process involving the formation of a blastema from de-differentiated cells. More recently it has, however, been hypothesized that antler regeneration is a stem cell-based process. Thus far, direct evidence for the presence of stem cells in primary or regenerating antlers was lacking. Here we demonstrate the presence of cells positive for the mesenchymal stem cell marker STRO-1 in the chondrogenic growth zone and the perivascular tissue of the cartilaginous zone in primary and regenerating antlers as well as in the pedicle of fallow deer (Dama dama. In addition, cells positive for the stem cell/progenitor cell markers STRO-1, CD133 and CD271 (LNGFR were isolated from the growth zones of regenerating fallow deer antlers as well as the pedicle periosteum and cultivated for extended periods of time. We found evidence that STRO-1(+ cells isolated from the different locations are able to differentiate in vitro along the osteogenic and adipogenic lineages. Our results support the view that the annual process of antler regeneration might depend on the periodic activation of mesenchymal progenitor cells located in the pedicle periosteum. The findings of the present study indicate that not only limited tissue regeneration, but also extensive appendage regeneration in a postnatal mammal can occur as a stem cell-based process.

Anterior maxillary osteotomy: A technical note for superior repositioning: A bird wing segment

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V Sadesh Kannan

2014-01-01

Full Text Available Aim: The aim of this study is to evaluate the efficacy of a single piece bird wing osteotectomy segment during anterior maxillary osteotomy (AMO markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method thereby reducing the kinking effect to the palatal pedicle and gives good perfusion to the anterior segment. Materials and Methods: This study was conducted at Karpaga Vinayaga Institute of Dental Sciences composing of 20 patients in which male: female ratio was 8:12, with a mean age of 25-30 years. This bird wing segment technique is performed following presurgical orthodontics under the guidance of clinical assessment of the gummy smile with an incisal show when the lip is at repose (vertical maxillary excess, especially for the calculated amount of superior repositioning. It is calculated by subtracting 2 mm from the total amount of an incisor show when the lip is at repose. The normal incisal show when the lip is at repose is 2 mm. After conventional primary AMO cut was performed, the precise calculated. Results: All our cases were tested positive for pulp vitality, no relapse, and minimal edema and with no changes in the bite or dentoalveolar relation followed until 1 year postoperatively indicating a good perfusion to the anterior segment and all the patients were satisfied esthetically and free of complaints. Conclusion: This simple technique allows the precise amount of calculated bone removal in a single piece from the nasal floor markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method there by reducing the kinking effect to the palatal pedicle and maintains good perfusion.

Reconstruction of large upper eyelid defects with a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft.

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Toft, Peter B

2016-01-01

To review and present the results of a one-step method employing a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft for reconstruction of large upper eyelid defects after tumour surgery. This was a retrospective case-series of 8 patients who underwent reconstruction of the upper eyelid after tumour removal. The horizontal defect involved 50-75% of the lid (3 pts.), more than 75% (3 pts.), and more than 75% plus the lateral canthus (2 pts.). The posterior lamella was reconstructed with contralateral upper eyelid tarsal plate. The anterior lamella was reconstructed with a laterally based myocutaneous pedicle flap in 7 patients, leaving a raw surface under the brow which was covered with a free skin graft. In 1 patient with little skin left under the brow, the anterior lamella was reconstructed with a bi-pedicle orbicularis muscle flap together with a free skin graft. All patients healed without necrosis, did not suffer from lagophthalmos, achieved reasonable cosmesis, and did not need lubricants. In one patient, a contact lens was necessary for three weeks because of corneal erosion. One patient still needs a contact lens 3 months after excision to avoid eye discomfort. Large upper eyelid defects can be reconstructed with a free tarsal plate graft and a laterally based myocutaneous pedicle flap in combination with a free skin graft. Two-step procedures can probably be avoided in most cases.

Severe Gynecomastia: New Technique Using Superior Pedicle NAC Flap Through a Circumareolar Approach.

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Ibrahiem, Saad Mohamed Saad

2016-06-01

: Gynecomastia is defined as benign proliferation of glandular breast tissue in men. Gynecomastia causes considerable emotional discomfort because of limitation of everyday activity especially in young men. Surgical treatment of gynecomastia significantly contributes to an increase in social activity and an improvement of social acceptance and emotional comfort, and thus significantly improves satisfaction from personal life in men who underwent this intervention. Various surgical techniques were suggested to treat gynecomastia, but most of them end with visible scars especially in severe degree gynecomastia. The aim of many plastic surgeons is to advocate new techniques treating severe gynecomastia (grade II B and III according to Simon et al) with less visible scars. The author proposed a new technique combining both surgery and liposuction for treating grade II B and III gynecomastia using only circumareolar approach. This study evaluates aesthetic results after surgery and assessment of the incidence of early and late postoperative complications. The patient was marked preoperatively while standing. Under general anesthesia, ultrasound-assisted liposuction of the periglandular area and de-epithelialization of excess skin were performed. A superiorly based nipple areola complex flap was created based on the subdermal plexus. The excess glandular tissue was resected through the lower half of the circle of the de-epithelialized area. Closure of the wound was done after insertion of 14-French redivac. This treatment protocol was applied to 27 patients, 18 to 53 years of age, from February 2008 till now. Among these patients, 4 were classified as type IIB and 23 as type III. Follow-up ranged from 3 months to 4 years. Complications were the following: 1 hematoma, 1 wound dehiscence, 1 loss of nipple areola complex, 2 cases of hypertrophied scars, and 3 minor aesthetic problems near areolae. A new periareolar approach for correction of severe-grade gynecomastia

Analysis of MRI signal changes in the adjacent pedicle of adolescent patients with fresh lumbar spondylolysis.

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Goda, Yuichiro; Sakai, Toshinori; Sakamaki, Tadanori; Takata, Yoichiro; Higashino, Kosaku; Sairyo, Koichi

2014-09-01

The purpose of this study is to investigate a discrepancy between MRI and computed tomography (CT) findings in the spinal level distribution of spondylolysis. Recent advances in MRI have led to the early diagnosis of spondylolysis. Therefore, bony healing can be expected before the condition has a chance to worsen. In this study, we used MRI to examine the changes in spinal level signals in the pedicles adjacent to the pars interarticularis in adolescents with fresh lumbar spondylolysis. We then compared spinal level distribution of spondylolysis with that of previous results obtained by multidetector CT. The study included 98 adolescent patients (31 women and 67 men; mean age, 13.6 years; age range, 9-18 years) with fresh lumbar spondylolysis who showed MRI signal changes in the adjacent pedicle. An MRI signal change was defined as a high signal change on fat-suppressed imaging. MRI signal changes were detected in 150 adjacent pedicles of 101 vertebrae. Of these vertebrae, MRI signal changes in only 67 (66.3%) corresponded to L5, while changes in 34 (33.7%) corresponded to L3 or L4. In our follow-up study, the bone-healing rate with no vertebral defect was 100% at L3, 97.1% at L4, and 84.4% at L5. In addition, 11 of 34 (32.4%) vertebrae with signal changes at L3 or L4 occurred with L5 terminal-stage spondylolysis (no MRI signal change). MRI revealed a higher prevalence of L3 or L4 spondylolysis than observed with CT.

Indications, Outcomes, and Complications of Pedicled Propeller Perforator Flaps for Upper Body Defects: A Systematic Review

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Davide Lazzeri

2013-01-01

Full Text Available BackgroundThe aim of this investigation was to systematically review the current literature to provide the best data for indications, outcomes, survival, and complication rates of pedicled propeller perforator flaps for upper body defects.MethodsA comprehensive literature review for articles published from January 1991 to December 2011 was performed using the PubMed, Medline, and Cochrane Databases. Articles without available full-text, single case reports or papers with excessive missing data were excluded. Papers reporting pedicle-perforator (propeller flaps used for lower extremity reconstruction were excluded from meta-analysis.ResultsFrom the initial 1,736 studies our search yielded, 343 studies qualified for the second stage of selection. Of 117 full-text reports screened, 41 studies, met the definitive inclusion and exclusion criteria. Of the selected 41 articles, 26 were case series, original papers or retrospective reviews and were included, whereas 15 were case report papers and therefore were excluded. Two hundred ninety-five propeller flaps were reported to have been used in a total of 283 patients. Indications include repair of trauma-induced injuries, post-trauma revision surgery, cancer resection, chronic infection, pressure sores, and chronic ulcers with a major complication rate (3.3% comparable to that of free flaps. No specific exclusion criteria for the procedure were presented in the studies reviewed.ConclusionsPedicled propeller flaps are a versatile and safe reconstructive option that are easy and quick to raise and that provide unlimited clinical solutions because of the theoretical possibility of harvesting them based on any perforator chosen among those classified in the body.

"Two-step" technique with OsiriXTM to evaluate feasibility of C2 pedicle for surgical fixation

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Luis Miguel Sousa Marques

2016-01-01

Full Text Available Background: Surgical treatment of craniovertebral junction pathology has evolved considerably in recent decades with the implementation of short atlanto-axial fixation techniques, notwhithstanding increasing neurovascular risks. Also, there is strong evidence that fixation of C2 anatomical pedicle has the best biomechanical profile of the entire cervical spine. However, it is often difficult and misleading, to evaluate anatomical bony and vascular anomalies using the three orthogonal planes (axial, coronal, and sagittal of CT. Objectives: The authors describe an innovative and simple technique to evaluate the feasibility of C2 pedicle for surgical screw fixation using preoperative planning with the free DICOM (Digital Imaging and Communications in Medicine software OsiriX TM . Materials and Methods: The authors report the applicatin of this novel technique in 5 cases (3 traumatic, 1 Os Odontoideum, and 1 complex congenital malformation collected from our general case series of the Department in the last 5 years. Results: In this "proof of concept" study, the pre-operative analysis with the "two-step" tecnique was detrimental for choosing the surgical tecnique. Detailed post-operative analysis confirmed correct position of C2 screws without cortical breach. There were no complications or mortality reported. Conclusion: This "two-step" technique is an easy and reliable way to determine the feasibility of C2 pedicle for surgical fixation. The detailed tridimensional radiological preoperative evaluation of craniovertebral junction anatomy is critical to the sucess and safety of this surgeries, and can avoid, to certain degree, expensive intra-operative tridimensional imaging facilities.

The pedicle screw-rod system is an acceptable method of reconstructive surgery after resection of sacroiliac joint tumours

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Yi-Jun Zhou

2016-03-01

Full Text Available Hemipelvic resections for primary bone tumours require reconstruction to restore weight bearing along anatomic axes. However, reconstruction of the pelvic arch remains a major surgical challenge because of the high rate of associated complications. We used the pedicle screw-rod system to reconstruct the pelvis, and the purpose of this investigation was to assess the oncology, functional outcome and complication rate following this procedure. The purpose of this study was to investigate the operative indications and technique of the pedicle screw-rod system in reconstruction of the stability of the sacroiliac joint after resection of sacroiliac joint tumours. The average MSTS (Musculoskeletal Tumour Society score was 26.5 at either three months after surgery or at the latest follow-up. Seven patients had surgery-related complications, including wound dehiscence in one, infection in two, local necrosis in four (including infection in two, sciatic nerve palsy in one and pubic symphysis subluxation in one. There was no screw loosening or deep vein thrombosis occurring in this series. Using a pedicle screw-rod after resection of a sacroiliac joint tumour is an acceptable method of pelvic reconstruction because of its reduced risk of complications and satisfactory functional outcome, as well as its feasibility of reconstruction for type IV pelvis tumour resection without elaborate preoperative customisation. Level of evidence: Level IV, therapeutic study.

Use of Supplemental Short Pre-Contoured Accessory Rods and Cobalt Chrome Alloy Posterior Rods Reduces Primary Rod Strain and Range of Motion Across the Pedicle Subtraction Osteotomy Level

DEFF Research Database (Denmark)

Hallager, Dennis Winge; Gehrchen, Poul Martin; Dahl, Benny

2016-01-01

and rod strain is necessary to determine the biomechanical efficacy of these techniques. METHODS: Five specimens (T12-S1) underwent PSO at L3 with pedicle screw stabilization at L1-S1. Pedicle subtraction was adjusted to achieve a final lordosis of 70°. Flexion-extension (FE), lateral bending, and axial...

Outcomes of percutaneous pedicle screw fixation for spinal trauma and tumours.

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Mobbs, Ralph J; Park, Ashley; Maharaj, Monish; Phan, Kevin

2016-01-01

We investigated the clinical and radiological results of percutaneous pedicle screw fixation in the management of spinal trauma and metastatic tumours. A retrospective analysis was performed on a series of 14 patients who were operated on from March 2009 to November 2011 by a single surgeon (RJM). Following a radiological review (CT scan/MRI), six patients underwent short segment fixation, while the remaining underwent long segment fixation. All patients had routine follow-ups at 4, 6, 12months, and annually thereafter. Clinical examinations were conducted preoperatively and postoperatively, and the length of operation, blood loss, and postoperative pain relief were recorded. There was a single patient with an incision site complication. The mean blood loss was 269mL. All of the parameters demonstrated no significant differences between the trauma and the tumour groups (p=0.10). The neurological power scores improved for all patients, with the largest increase being from a score of 2 to 4. At follow-up, the majority of patients had returned to their previous activities and had reduced pain scores. One patient suffered high pain levels from other medical conditions that were not related to the operation. Minimally invasive pedicle screw fixation is a suitable option for patients with spinal tumours and fractures, with acceptable safety and efficacy in this small retrospective patient series. We have seen favourable results in our patients, who have experienced an increased quality of life following their surgery. Copyright © 2015 Elsevier Ltd. All rights reserved.

Comparative Analysis of Effect of Density, Insertion Angle and Reinsertion on Pull-Out Strength of Single and Two Pedicle Screw Constructs Using Synthetic Bone Model

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Krishnan, Venkatesh; Varghese, Vicky; Kumar, Gurunathan Saravana

2016-01-01

Study Design Biomechanical study. Purpose To determine the effect of density, insertion angle and reinsertion on pull-out strength of pedicle screw in single and two screw-rod configurations. Overview of Literature Pedicle screw pull-out studies have involved single screw construct, whereas two screws and rod constructs are always used in spine fusions. Extrapolation of results using the single screw construct may lead to using expensive implants or increasing the fusion levels specifically i...

Surgical treatment of gynecomastia with severe ptosis: periareolar incision and dermal double areolar pedicle technique.

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Cannistra, Claudio; Piedimonte, Andrea; Albonico, Fiorella

2009-11-01

Gynecomastia is a morphostructural impairment of the mammary region in men caused by parenchymal hypertrophy or a cutaneous distortion of breast skin covering or both. The clinical classification introduced by Simon et al. in 1973 ranks gynecomastia in three degrees. Each subtype can be treated with a specific technique. This article describes an alternative surgical procedure for treating gynecomastia with severe ptosis(type III and type IIIb of Simon's classification). Fifty-eight patients were treated for gynecomastia in our Plastic Surgery Unit from 1996 to 2004. The cutaneous excess of periareolar skin is evaluated by a pinching test. A circular periareolar mark is traced corresponding to the cutaneous excess that has to be removed.Initially, liposuction of adipous tissue on the periphery of the mammary region is performed through two cutaneous 3-mm incisions at the 3 o'clock and 9 o'clock positions around the areola. After this, the liposuction incisions are enlarged from 10 o'clock to 8 o'clock and from 2 o'clockto 4 o'clock to create access for the mastectomy. This dissection creates a double dermal areolar pedicle. The new areolar position is fixed with a Benelli round block suture. A resolution of the morphologic deformity without evident scars after hair growth and a correction of the breast deformity has been observed in the 6-month follow-ups conducted for all the patients. We observed that the vascular-nervous net under the areola at 12 o'clock and 6 o'clock is very important, more so than the lateral pedicle, and the conservation of a double vascular-nervous pedicle reduces significantly the risk of areolar necrosis, especially in cases of gynecomastia type III and in cases where there is a high degree of breast malformation such as the tuberous breast.

Pedicled Gastrocnemius Flap: Clinical Application in Limb Sparing Surgical Resection of Sarcoma Around the Knee Region and Popliteal Fossa

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EL-SHERBINY, M.

2008-01-01

To highlight on the versatility of superiorly based pedicled gastrocnemius muscle flap in the limb-sparing surgery for bone or soft tissue sarcoma around the knee and popliteal fossa. Patients and Methods: A total of 30 patients with localized bone or soft tissue sarcoma around the knee and popliteal fossa were treated with limb-salvage procedure. The study included 5 cases with bone sarcoma of the distal femur, 15 cases having bone sarcoma of proximal tibia and 10 cases having soft tissue sarcoma around the knee region and popliteal fossa. Routine preoperative staging studies were done for every patient and included local plain radiography, local MRI, isotopic bone scan and CT chest. Local MRA or angiography was done in selected cases. According to the Enneking staging system, 19 patients had stage IIB and 11 had stage IIA. Patients having bone sarcoma of the proximal tibia were subjected to wide resection, endo prosthetic reconstruction and reconstruction of the extensor mechanism by the medial gastrocnemius muscle flap. Patients having bone sarcoma of the distal femur were subjected to wide resection, endo prosthetic reconstruction and coverage of the prosthesis and re balance of the patellar tendon by the medial gas-trocnemius flap. Patients having soft tissue sarcoma were subjected to wide resection and soft tissue coverage with either medial or lateral myocutaneous gastrocnemius flap or muscle flap with grafting. Limb function was evaluated according to MSTS functional scores. Adjuvant chemotherapy or radiotherapy was given according to nationally agreed protocols. Results: There were 18 males and 12 females with a mean age of 29 years at the time of surgery (range 11-44 years). The mean follow-up period was 52 months (range 25-72 months). Resection with a negative bony and soft tissue margins could be achieved in all cases. A total of 30 flaps were used and included medial gastrocnemius muscle flaps in 21 cases (15 cases had proximal tibia endoprothesis, 5

The Use of Magnetic Resonance Imaging in Planning a Pedicled Perforator Flap for Pressure Sores in the Gluteal Region.

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Park, Sun-June; Lee, Kyeong-Tae; Jeon, Byung-Joon; Woo, Kyong-Je

2018-04-01

Pedicled perforator flaps (PPFs) have been widely used to treat pressure sores in the gluteal region. Selection of a reliable perforator is crucial for successful surgical treatment of pressure sores using PPFs. In this study, we evaluate the role of magnetic resonance imaging (MRI) in planning PPF reconstruction of pressure sores in the gluteal region. A retrospective chart review was performed in patients who had undergone these PPF reconstructions and who had received preoperative MRI. Preoperatively, the extent of infection and necrotic tissue was evaluated using MRI, and a reliable perforator was identified, considering the perforator location in relation to the defect, perforator size, and perforator courses. Intraoperatively, the targeted perforator was marked on the skin at the locations measured on the MRI images, and the marked location was confirmed using intraoperative handheld Doppler. Superior gluteal artery, inferior gluteal artery, or parasacral perforators were used for the PPFs. Surgical outcomes were evaluated. A total of 12 PPFs were performed in 12 patients. Superior gluteal artery perforator flaps were performed in 7 patients, inferior gluteal artery perforator flaps were performed in 3 patients, and parasacral perforator flaps were performed in 2 patients. We could identify a reliable perforator on MRI, and it was found at the predicted locations in all cases. There was only one case of partial flap necrosis. There was no recurrence of the pressure sores during the mean follow-up period of 6.7 months (range = 3-15 months). In selected patients with gluteal pressure sores, MRI is a suitable means for not only providing information about disease extent and comorbidities but also for evaluating perforators for PPF reconstructions.

The Use of Percutaneous Lumbar Fixation Screws for Bilateral Pedicle Fractures with an Associated Dislocation of a Lumbar Disc Prosthesis

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William D. Harrison

2013-01-01

Full Text Available Study Design. Case report. Objective. To identify a safe technique for salvage surgery following complications of total disc replacement. Summary of Background Data. Lumbar total disc replacement (TDR is considered by some as the gold standard for discogenic back pain. Revision techniques for TDR and their complications are in their infancy. This case describes a successful method of fixation for this complex presentation. Methods and Results. A 48-year-old male with lumbar degenerative disc disease and no comorbidities. Approximately two weeks postoperatively for a TDR, the patient represented with acute severe back pain and the TDR polyethylene inlay was identified as dislocated anteriorly. Subsequent revision surgery failed immediately as the polyethylene inlay redislocated intraoperatively. Further radiology identified bilateral pedicle fractures, previously unseen on the plain films. The salvage fusion of L5/S1 reutilized the anterior approach with an interbody fusion cage and bone graft. The patient was then turned intraoperatively and redraped. The percutaneous pedicle screws were used to fix L5 to the sacral body via the paracoccygeal corridor. Conclusion. The robust locking screw in the percutaneous screw allowed a complete fixation of the pedicle fractures. At 3-year followup, the patient has an excellent result and has returned to playing golf.

Clinical effects of posterior pedicle screw fixation on spinal deformity in growing period: a report of 360 cases

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Zheng-lei WANG

2011-08-01

Full Text Available Objective To observe the effect of a new kind of pedicle screw frame system with sliding terminus and locked middle segment on spinal deformity in growing period.Methods Three hundred and sixty patients in growing period were involved in the present study,and among them 82 were suffering from congenital scoliosis,218 idiopathic scoliosis and 60 kyphosis.All the patients were treated with the pedicle screw frame system with sliding terminus and locked middle segment.The treatment effects and postoperative complications were observed,and the Cobb angle before and after the operation was compared.Results The Cobb angle of 300 scoliosis patients was corrected from 53°±3° to 8°±2°,and the Cobb angle of 60 kyphosis patients was corrected from 60°±2° to 25°±3°,and the corrective effect was satisfactory.The correction rate of patients with Cobb angle ≤50° was 80%.Two hundred and ten patients were followed-up for 1 to 6 years,and the longitudinal growth of spine was 1.5-4.0cm.No severe complication,such as screw fracture,rod fracture or nerve injury,occurred.Conclusion The pedicle screw frame system with sliding terminus had a favorable three-dimensional correction effect,and the spine growth would not be restricted,and there was no stiffness,vertebral rotation,or distortion of shaft after operation.

Acute L5 pedicle fracture and contralateral spondylolysis in a 12-year-old boy: a case report

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Mary, Pierre; de Carvalho, Antonio; Pointe, Hubert Ducou le; Damsin, Jean-Paul; Filipe, Georges

2007-01-01

Acute unilateral L5 pedicle fracture associated with a pre-existing contralateral spondylolysis is a rare lesion. We report a case in a non-competitive 12-year-old boy. We present the clinical, radiological and specific management of this rare condition. The clinical and radiological draft of this patient was reviewed. The follow-up was 30 months after fracture healing. Some cases reported in the literature were analyzed and our clinical findings and therapeutic strategy was compared and discussed. Non-operative treatment was done including full-time bracing in a modified Boston brace incorporating one thigh for 3 months. Plain radiographs and computed tomographic (CT)-scan performed at 3 and 6 months showed progressive healing of the pedicle fracture and no modification of the contralateral isthmic spondylolytic lesion. At final follow-up, the patient was asymptomatic and resumed all his activities. In skeletally immature patients, we think that conservative treatment should be considered as a treatment option for this unusual injury. PMID:17520295

Pedicle distraction increases intervertebral and spinal canal area in a cadaver and bone model

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Hughes Matthew; Papadakos Nikolaos; Bishop Tim; Bernard Jason

2018-01-01

Introduction: Lumbar spinal stenosis is degenerative narrowing of the spinal canal and/or intervertebral foramen causing compression of the spinal cord and nerve roots. Traditional decompression techniques can often cause significant trauma and vertebral instability. This paper evaluates a method of increasing pedicle length to decompress the spinal and intervertebral foramen, which could be done minimally invasive. Methods: Three Sawbone (Sawbones Europe, Sweden) and 1 cadaveric lumbar sp...

The pedicled masseter muscle transfer for smile reconstruction in facial paralysis: repositioning the origin and insertion.

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Matic, Damir B; Yoo, John

2012-08-01

The pedicled masseter muscle transfer (PMMT) is introduced as a new reconstructive option for dynamic smile restoration in patients with facial paralysis. The masseter muscle is detached from both its origin and insertion and transferred to a new position to imitate the function of the native zygomaticus major muscle. Part one of this study consisted of cadaveric dissections of 4 heads (eight sides) in order to determine whether the masseter muscle could be (a) pedicled solely by its dominant neurovascular bundle and (b) repositioned directly over the native zygomaticus major. The second part of the study consisted of clinical assessments in three patients in order to confirm the applicability of this muscle transfer. Commissure excursion and vector of contraction following PMMT were compared to the non-paralyzed side. In all eight sides, the masseter muscles were successfully isolated on their pedicle and transposed on top of and in-line with the ipsilateral zygomaticus major. The mean length of the masseter and its angle from Frankfurt's horizontal line after transposition compared favorably to the native zygomaticus major muscle. In the clinical cases, the mean commissure movements of the paralyzed and normal sides were 7 mm and 12 mm respectively. The mean angles of commissural movement for the paralyzed and normal sides were 62° and 59° respectively. The PMMT can be used as a dynamic reconstruction for patients with permanent facial paralysis. As we gain experience with the PMMT, it may be possible to use it as a first-line option for patients not eligible for free micro-neurovascular reconstruction. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Evaluation of the Effect of Fixation Angle between Polyaxial Pedicle Screw Head and Rod on the Failure of Screw-Rod Connection

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Engin Çetin

2015-01-01

Full Text Available Introduction. Polyaxial screws had been only tested according to the ASTM standards (when they were perpendicularly positioned to the rod. In this study, effects of the pedicle screws angled fixation to the rod on the mechanical properties of fixation were investigated. Materials and Method. 30 vertically fixed screws and 30 screws fixed with angle were used in the study. Screws were used in three different diameters which were 6.5 mm, 7.0 mm, and 7.5 mm, in equal numbers. Axial pull-out and flexion moment tests were performed. Test results compared with each other using appropriate statistical methods. Results. In pull-out test, vertically fixed screws, in 6.5 mm and 7.0 mm diameter, had significantly higher maximum load values than angled fixed screws with the same diameters (P<0.01. Additionally, vertically fixed screws, in all diameters, had significantly greater stiffness according to corresponding size fixed with angle (P<0.005. Conclusion. Fixing the pedicle screw to the rod with angle significantly decreased the pull-out stiffness in all diameters. Similarly, pedicle screw instrumentation fixed with angle decreased the minimum sagittal angle between the rod and the screw in all diameters for flexion moment test but the differences were not significant.

The Pedicled Buccal Fat Pad: Anatomical Study of the New Flap for Skull Base Defect Reconstruction After Endoscopic Endonasal Transpterygoid Surgery

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Golbin, Denis A.; Lasunin, Nikolay V.; Cherekaev, Vasily A.; Polev, Georgiy A.

2016-01-01

Objectives To evaluate the efficacy and safety of using a buccal fat pad for endoscopic skull base defect reconstruction. Design Descriptive anatomical study with an illustrative case presentation. Setting Anatomical study was performed on 12 fresh human cadaver specimens with injected arteries (24 sides). Internal carotid artery was exposed in the coronal plane via the endoscopic transpterygoid approach. The pedicled buccal fat pad was used for reconstruction. Participants: 12 human cadaver head specimens; one patient operated using the proposed technique. Main outcome measures: Proximity of the buccal fat pad flap to the defect, compliance of the flap, comfort and safety of harvesting procedure, and compatibility with the Hadad–Bassagasteguy nasoseptal flap. Results: Harvesting procedure was performed using anterior transmaxillary corridor. The pedicled buccal fat pad flap can be used to pack the sphenoid sinus or cover the internal carotid artery from cavernous to upper parapharyngeal segment. Conclusion The buccal fat pad can be safely harvested through the same approach without external incisions and is compliant enough to conform to the skull base defect. The proposed pedicled flap can replace free abdominal fat in central skull base reconstruction. The volume of the buccal fat pad allows obliteration of the sphenoid sinus or upper parapharyngeal space. PMID:28180047

Hyperbaric oxygen therapy and surgical delay improve flap survival of reverse pedicle flaps for lower third leg and foot reconstruction

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Pradeoth Mukundan Korambayil

2015-06-01

Full Text Available Aim: The purpose of the study is to present a management protocol for various types of soft tissue defects of the distal third region of leg and foot treated with pedicle flaps, by including hyperbaric oxygen (HBO therapy in the treatment regimen with flap delay. Methods: We present a prospective study of 23 patients with various types of soft tissue defects of the foot, and lower third of leg managed in our institution from December 2012 to December 2013. All soft tissue defects were treated by a reverse pedicle flap. Twelve patients were managed with flap delay with HBO therapy and 11 patients with immediate flaps without HBO therapy. The postoperative period, hospital course, and follow-up were documented. Results: Of 12 patients with flap delay and HBO, 10 patients did not suffer any complications secondary to flap transfer. One patient had discoloration of the tip of the flap, which settled without the intervention, and 1 patient had recurrent abscess formation, which required debridement and closure. Of 11 patients with direct transfer, 6 patients presented with complications including flap congestion, partial flap loss, and tip necrosis, which required secondary intervention. Conclusion: HBO therapy is a useful adjunct in flap delay of the reverse pedicle flap for soft tissue reconstruction of the lower third of the leg and foot regions.

Safety and cost-effectiveness analysis of laparoscopic splenectomy by secondary pedicle division using monopolar electrocautery.

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Zhou, Jianyin; Liu, Pingguo; Yin, Zhenyu; Zhao, Yilin; Wang, Xiaomin

2013-09-01

The expense of laparoscopic splenectomy (LS) has limited its use in developing countries, while medical costs are increasing worldwide. In this study, we performed LS by secondary pedicle division using monopolar electrocautery to achieve cost savings. Over seven years, we performed 45 consecutive LSs by secondary pedicle division using monopolar electrocautery (n=17) or ultrasonic shears (n=28) at a single center. These were reviewed to assess outcome and cost. Mean operating time was 179.7min, 7 conversions to open operation (15.6%) were necessary. There were four postoperative complications (8.9%) and no deaths. Twenty-three of 28 (82.1%) patients with idiopathic thrombocytopenic purpura developed a long-term positive response; and mean operative cost was RMB6,577 (US$1,034), which was much lower than that of Endo-GIATM in published reports. Between the monopolar electrocautery and ultrasonic shears groups, there were no significant differences in demographic characteristics or intraoperative and postoperative details, but operative cost was significantly lower in the former (RMB4,416, US$696 vs. RMB7,889, US$1,243; pelectrocautery is safe, efficacious and economical.

A New Electromagnetic Navigation System for Pedicle Screws Placement: A Human Cadaver Study at the Lumbar Spine.

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Patrick Hahn

Full Text Available Technical developments for improving the safety and accuracy of pedicle screw placement play an increasingly important role in spine surgery. In addition to the standard techniques of free-hand placement and fluoroscopic navigation, the rate of complications is reduced by 3D fluoroscopy, cone-beam CT, intraoperative CT/MRI, and various other navigation techniques. Another important aspect that should be emphasized is the reduction of intraoperative radiation exposure for personnel and patient. The aim of this study was to investigate the accuracy of a new navigation system for the spine based on an electromagnetic field.Twenty pedicle screws were placed in the lumbar spine of human cadavers using EMF navigation. Navigation was based on data from a preoperative thin-slice CT scan. The cadavers were positioned on a special field generator and the system was matched using a patient tracker on the spinous process. Navigation was conducted using especially developed instruments that can be tracked in the electromagnetic field. Another thin-slice CT scan was made postoperatively to assess the result. The evaluation included the position of the screws in the direction of trajectory and any injury to the surrounding cortical bone. The results were classified in 5 groups: grade 1: ideal screw position in the center of the pedicle with no cortical bone injury; grade 2: acceptable screw position, cortical bone injury with cortical penetration ≤ 2 mm; grade 3: cortical bone injury with cortical penetration 2,1-4 mm, grad 4: cortical bone injury with cortical penetration 4,1-6 mm, grade 5: cortical bone injury with cortical penetration >6 mm.The initial evaluation of the system showed good accuracy for the lumbar spine (65% grade 1, 20% grade 2, 15% grade 3, 0% grade 4, 0% grade 5. A comparison of the initial results with other navigation techniques in literature (CT navigation, 2D fluoroscopic navigation shows that the accuracy of this system is

Cervical pedicle screw fixation at C6 and C7 A cadaveric study

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Ye Li

2015-01-01

Conclusion: The intersection of the horizontal line through the midpoint of the transverse process root and vertical line through the intersection of the posterolateral and posterior planes of the isthmus can be used as an entry point for C6 and C7 pedicle screw fixation. The screws should be inserted at 60 or 90° with the posterolateral isthmus in the horizontal plane and at 75° with the posterior isthmus in the sagittal plane. The LSC should not exceed 30 mm.

[CLINICAL APPLICATION OF THREE DIMENSIONAL PRINTED NAVIGATION TEMPLATES FOR TREATMENT OF OSTEONECROSIS OF FEMORAL HEAD WITH PEDICLED ILIAC BONE GRAFT].

Science.gov (United States)

Yu, Kaifu; Xu, Yongqing; Tan, Hongbo; He, Xiaoqing; Cai, Dixin; Zhou, Tianhua; Luo, Haotian; Duan, Jiazhang

2016-03-01

To investigate the feasibility and early effectiveness to treat osteonecrosis of the femoral head (ONFH) with pedicled iliac bone graft assisted by individual digital design and three dimensional (3D) printed navigation templates. Between February and June 2014, 15 patients (24 hips) with ONFH underwent pedicled iliac bone graft assisted by individual digital design and 3D printed navigation templates. There were 11 males (17 hips) and 4 females (7 hips) with a mean age of 38 years (range, 18-56 years) and a mean disease duration of 7.5 months (range, 1-24 months); the left hip was involved in 2 cases, the right hip in 4 cases, and both hips in 9 cases. There were 7 cases (12 hips) of steroid-induced ONFH, 5 cases (8 hips) of alcohol-induced ONFH, 1 case (1 hip) of traumatic ONFH, and 2 cases (3 hips) of idiopathic ONFH. The preoperative Harris score was 56.60 ± 6.97. According to Association Research Circulation Osseous (ARCO) staging system, 5 hips were classified as stage IIB, 8 hips as stage IIC, 6 hips as stage IIIB, and 5 hips as stage IIIC. The navigation templates were designed and printed to assist accurate location and debridement of necrosis area according to preoperative CT scanning at the beginning of pedicled iliac bone grafting procedure. The mean operation time was 135 minutes (range, 120-160 minutes), mean amount of bleeding was 255 mL (range, 200-300 mL). All the wounds healed primarily, no complication of deep vein thrombosis or infection was observed. All patients were followed up 12-16 months (mean, 14 months). The location of necrosis area was in accordance with preoperative design, which was removed completely without penetration of joint surface, pedicled iliac bone graft was performed at the right site according to postoperative imaging examination. Radiographically, graft fusion was achieved at 2.7 months (range, 2-3 months) in all patients. All the hips had no collapse during follow-up. Hip pain was relieved, and range of motion was

Metal Artifacts Reduction of Pedicle Screws on Spine Computed Tomography Images Using Variable Thresholding Technique

International Nuclear Information System (INIS)

Kaewlek, T.; Koolpiruck, D.; Thongvigitmanee, S.; Mongkolsuk, M.; Chiewvit, P.; Thammakittiphan, S.

2012-01-01

Metal artifacts are one of significant problems in computed tomography (CT). The streak lines and air gaps arise from metal implants of orthopedic patients, such as prosthesis, dental bucket, and pedicle screws that cause incorrect diagnosis and local treatment planning. A common technique to suppressed artifacts is by adjusting windows, but those artifacts still remain on the images. To improve the detail of spine CT images, the variable thresholding technique is proposed in this paper. Three medical cases of spine CT images categorized by the severity of artifacts (screws head, one full screw, and two full screws) were investigated. Metal regions were segmented by k-mean clustering, then transformed into a sinogram domain. The metal sinogram was identified by the variable thresholding method, and then replaced the new estimated values by linear interpolation. The modified sinogram was reconstructed by the filtered back- projection algorithm, and added the metal region back to the modified reconstructed image in order to reproduce the final image. The image quality of the proposed technique, the automatic thresholding (Kalender) technique, and window adjustment technique was compared in term of noise and signal to noise ratio (SNR). The propose method can reduce metal artifacts between pedicle screws. After processing by our proposed technique, noise in the modified images is reduced (screws head 121.15 to73.83, one full screw 160.88 to 94.04, and two full screws 199.73 to 110.05 from the initial image) and SNR is increased (screws head 0.87 to 1.88, one full screw 1.54 to 2.82, and two full screws 0.32 to 0.41 from the initial image). The variable thresholding technique can identify the suitable boundary for restoring the missing data. The efficiency of the metal artifacts reduction is indicated on the case of partial and full pedicle screws. Our technique can improve the detail of spine CT images better than automatic thresholding (Kalender) technique, and

Pedicle Screw Insertion Accuracy Using O-Arm, Robotic Guidance, or Freehand Technique: A Comparative Study.

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Laudato, Pietro Aniello; Pierzchala, Katarzyna; Schizas, Constantin

2018-03-15

A retrospective radiological study. The aim of this study was to evaluate the accuracy of pedicle screw insertion using O-Arm navigation, robotic assistance, or a freehand fluoroscopic technique. Pedicle screw insertion using either "O-Arm" navigation or robotic devices is gaining popularity. Although several studies are available evaluating each of those techniques separately, no direct comparison has been attempted. Eighty-four patients undergoing implantation of 569 lumbar and thoracic screws were divided into three groups. Eleven patients (64 screws) had screws inserted using robotic assistance, 25 patients (191 screws) using the O-arm, while 48 patients (314 screws) had screws inserted using lateral fluoroscopy in a freehand technique. A single experienced spine surgeon assisted by a spinal fellow performed all procedures. Screw placement accuracy was assessed by two independent observers on postoperative computed tomography (CTs) according to the A to D Rampersaud criteria. No statistically significant difference was noted between the three groups. About 70.4% of screws in the freehand group, 69.6% in the O arm group, and 78.8% in the robotic group were placed completely within the pedicle margins (grade A) (P > 0.05). About 6.4% of screws were considered misplaced (grades C&D) in the freehand group, 4.2% in the O-arm group, and 4.7% in the robotic group (P > 0.05). The spinal fellow inserted screws with the same accuracy as the senior surgeon (P > 0.05). The advent of new technologies does not appear to alter accuracy of screw placement in our setting. Under supervision, spinal fellows might perform equally well to experienced surgeons using new tools. The lack of difference in accuracy does not imply that the above-mentioned techniques have no added advantages. Other issues, such as surgeon/patient radiation, fiddle factor, teaching suitability, etc., outside the scope of our present study, need further assessment. 3.

A Universal Pedicle Screw and V-Rod System for Lumbar Isthmic Spondylolysis: A Retrospective Analysis of 21 Cases

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Chen, Xiong-sheng; Zhou, Sheng-yuan; Jia, Lian-shun; Gu, Xiao-min; Fang, Lei; Zhu, Wei

2013-01-01

Objective To investigate the surgical outcome of a universal pedicle screw-V rod system and isthmic bone grafting for isthmic spondylolysis. Methods Twenty-four patients with isthmic spondylolysis at L5 and grade 0–I spondylolisthesis (Meyerding classification) received isthmic bone graft and stabilization using the universal pedicle screw-V rod system. Back pain was evaluated using the visual analog scale (VAS) and time to bone healing, improvement in spondylolisthesis and intervertebral space height at L5/S1 and L4/L5 were assessed. Results Twenty-one patients were followed up for 24 months and included in the analysis. Back pain was markedly improved at 3 months postoperatively with a statistical difference in VAS scores compared with preoperative VAS scores (Pspondylolysis and reduces back pain, prevents anterior displacement of the diseased segment and maintains intervertebral space height, thus offering a promising alternative to current approaches for isthmic spondylolysis. PMID:23691090

Maniobra de movilización del pedículo mesentérico superior

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Alejandro García Gutiérrez

2003-12-01

Full Text Available Se realiza una investigación bibliográfica, con el fin de actualizar la base anátomo-embriológica y los objetivos de la maniobra de movilización del pedículo mesentérico superior en cirugía general y determinar la prioridad en su creación, basados en el análisis de los trabajos originales referidos a esta maniobra. Se concluyó que la prioridad en su empleo correspondió a los autores Petrov y Koundadzé de Rusia, quienes la emplearon para alargar la porción del intestino utilizada en las esofagoplastias, mientras que los autores norteamericanos Cattell y Braasch la realizaron para mejorar el acceso a las porciones 3ª y 4ª del duodeno y al ángulo duodeno-yeyunal, 10 años despuésA bibliographic investigation was made aimed at updating the anatomicoembriological base and the objectives of the mobilizing maneuver of the superior mesenteric pedicle in general surgery and at determining the priority in its creation, based on the analysis of the original papers referring to this maneuver. It was concluded that the priority in its use corresponded to the Russian authors Petrov and Koundadzé, who used it to enlarge the portion of the intestine utilized in the esophagoplasties, whereas the US authors Cattell and Broasch performed it to improve the access to the 3rd and 4th portions of the duodenum and to the duodeno-jejunal angle, 10 years later

[Effect evaluation of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion for lumbar degenerative diseases].

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Wang, Chong; Ying, Jin-He; Xie, Pan-Pan; Wu, Xiao-Guang

2016-07-25

To evaluate the clinical effects of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion(TLIF) in treating lumbar degenerative diseases. The clinical data of 24 patients with lumbar degenerative disease underwent unilateral pedicle screw fixation with transforaminal lumbar interbody fusion from March 2007 to October 2009, were retrospectively analyzed. There were 13 males and 11 females, aged from 34 to 68 years old with an average of 52 years. Postoperative pain and functional results were analyzed by the visual analogue scale(VAS) and Oswestry Disability Index(ODI). Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and general complications. All patients were followed up from 5 to 8 years with an average of 6.7 years. VAS scores of low back pain and leg pain decreased from preoperative 7.82±0.71, 8.42±1.24 to postoperative 1.87±0.81, 2.23±1.62, respectively( P degenerative diseases according to over 5 year follow up, however, its indications should be well considered. But the problems such as intervertebral space height of operated side loss and adjacent segment degeneration after unilateral pedicle screw fixation need further clinical study.

Versatility of Pedicled Tensor Fascia Lata Flap: A Useful and Reliable Technique for Reconstruction of Different Anatomical Districts

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Md. Sohaib Akhtar

2014-01-01

Full Text Available Aims and Objectives. The aim of this study was to evaluate the versatility of pedicled tensor fascia lata flap for reconstruction of various anatomical regions. Materials and Methods. In this retrospective study a total of 34 patients with defects over various anatomical regions were included. The defects were located over the trochanter (n=12, groin (n=8, perineum (n=6, lower anterior abdomen (n=6, gluteal region (n=1, and ischial region (n=1. The etiology of defects included trauma (n=12, infection (n=8, pressure sores (n=8, and malignancy (n=6. Reconstruction was performed using pedicled tensor fascia lata flaps. Patients were evaluated in terms of viability of the flap and donor site morbidity. The technical details of the operative procedure have also been outlined. Results. All the flaps survived well except 5 patients in which minor complications were noted and 1 who experienced complete flap loss. Of those with minor complications, 1 patient developed distal marginal necrosis and 1 developed infection which subsided within three days by dressings and antibiotics and in 2 patients partial loss of the skin graft occurred at the donor site out of which 1 required regrafting and another one healed completely with dressing and antibiotics. All the patients were followed up for an average period of 6 months, ranging from 1 to 12 months. Donor site morbidity was minimal. Conclusion. It was concluded that the pedicled tensor fascia lata flap is a versatile, reliable, easy, and less time consuming procedure for the coverage of defects around trochanter, groin, lower anterior abdomen, perineum, and ischial region.

Feasibility study of patient-specific surgical templates for the fixation of pedicle screws.

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Salako, F; Aubin, C-E; Fortin, C; Labelle, H

2002-01-01

Surgery for scoliosis, as well as other posterior spinal surgeries, frequently uses pedicle screws to fix an instrumentation on the spine. Misplacement of a screw can lead to intra- and post-operative complications. The objective of this study is to design patient-specific surgical templates to guide the drilling operation. From the CT-scan of a vertebra, the optimal drilling direction and limit angles are computed from an inverse projection of the pedicle limits. The first template design uses a surface-to-surface registration method and was constructed in a CAD system by subtracting the vertebra from a rectangular prism and a cylinder with the optimal orientation. This template and the vertebra were built using rapid prototyping. The second design uses a point-to-surface registration method and has 6 adjustable screws to adjust the orientation and length of the drilling support device. A mechanism was designed to hold it in place on the spinal process. A virtual prototype was build with CATIA software. During the operation, the surgeon places either template on patient's vertebra until a perfect match is obtained before drilling. The second design seems better than the first one because it can be reused on different vertebra and is less sensible to registration errors. The next step is to build the second design and make experimental and simulations tests to evaluate the benefits of this template during a scoliosis operation.

Drenaje suplementario del sistema venoso superficial en colgajos pediculados Supplementary drainage of superficial venous system in pedicled flaps

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A. Fernández García

2012-06-01

Full Text Available Los colgajos pediculados pueden sufrir edema y congestión debido a que su drenaje a trevés del sistema venoso superfical es imposible y el flujo hacia el sistema profundo a nivel del pedículo es precario. Esta situación suele evolucionar hacia la necrosis parcial o la pérdida total del colgajo en pocas horas. La apertura del sistema venoso superficial permite el drenaje adecuado de los tejidos transferidos y evita estas complicaciones. Este artículo analiza el papel de las anastomosis microquirúrgicas en el sistema venoso superficial de los colgajos pediculados. Esta técnica permite comunicar el sistema venoso superfical de los tejidos transferidos con el sistema venoso superficial del territorio que rodea al defecto. Presentamos los resultados obtenidos con esta técnica en colgajos de perforante en hélice, colgajos miocutáneos, colgajos neurocutáneos y colgajos fasciograsos volteados.The pedicled flaps can suffer edema and congestion due to the impossibility of drainage toward the superficial venous system and the precarious flow via the deep system at the level of the pedicle. The evolution of this situation is usually partial necrosis or total loss of the flap in a few hours. The opening of the venous superficial system achieves an appropriate drainage of the transfered tissues and avoids these complications. In this article we analyze the role of the microsurgical anastomosis at the level of the superficial venous system of pedicled flaps. This technique allows to communicate the superficial venous system of the transfered tissues with the superficial venous system of the territory around the defect. We report the results with this method in propeller perforator flaps, miocutaneous flaps, neurocutaneous flaps and adipofascial turn over flaps.

A universal pedicle screw and V-rod system for lumbar isthmic spondylolysis: a retrospective analysis of 21 cases.

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Xiong-sheng Chen

Full Text Available To investigate the surgical outcome of a universal pedicle screw-V rod system and isthmic bone grafting for isthmic spondylolysis.Twenty-four patients with isthmic spondylolysis at L5 and grade 0-I spondylolisthesis (Meyerding classification received isthmic bone graft and stabilization using the universal pedicle screw-V rod system. Back pain was evaluated using the visual analog scale (VAS and time to bone healing, improvement in spondylolisthesis and intervertebral space height at L5/S1 and L4/L5 were assessed.Twenty-one patients were followed up for 24 months and included in the analysis. Back pain was markedly improved at 3 months postoperatively with a statistical difference in VAS scores compared with preoperative VAS scores (P<0.001. The VAS scores were 0 to 3 at 6 months postoperatively in all patients and no back pain was reported in all patients except 2 patients who complained of back pain after prolonged sitting. X-ray examination showed a bone graft healing time of 3 to 12 months. Grade I spondylolisthesis improved to grade 0 in 4 patients and no noticeable change was observed in the remaining 17 cases. The intervertebral space height at L5/S1 was statistically increased (P<0.05 while no statistically significant change was seen at L4/L5. There was no statistically significant difference in the ROM of the intervertebral disks of L5/S1 and L4/5 before and after surgery.The universal pedicle screw-V rod system and isthmic bone grafting directly repairs isthmic spondylolysis and reduces back pain, prevents anterior displacement of the diseased segment and maintains intervertebral space height, thus offering a promising alternative to current approaches for isthmic spondylolysis.

One stage reconstruction of the floor of the mouth with a subcutaneous pedicled nasolabial flap

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El-Marakby, H.H.; Fouad, F.A.; Ali, H.H.

2012-01-01

Background: Nasolabial flaps have been recognised as versatile flaps for a variety of defects in the face, nose, lip and the oral cavity. Random pattern inferiorly based nasolabial flaps (NLF) have been utilised for covering small defects on the anterior floor of the mouth, but usually require a second stage procedure to divide the flap base. A subcutaneous pedicled inferiorly based nasolabial flap can provide a one stage repair of moderate sized defects of the floor of the mouth after de epithelialisation of the base of the flap. Aim: To evaluate the feasibility of a single stage reconstruction of intermediate sized defects in the oral cavity with an inferiorly based pedicled NLF. The study includes the indications of use of the flap, flap design, technique, and the complications rate. The incidence of secondary procedures and the final functional and the aesthetic results will also be evaluated. Materials and methods: A group of 20 patients presented with (T1-2) squamous cell carcinoma of the oral cavity have been treated at the Department of Surgery, National Cancer Institute, Cairo; in the period between January 2008 and September 2010. The pathology was confirmed with an incision biopsy and all metastatic work were carried out confirming that all patients were free from distant metastasis at presentation. Preoperative assessment also included assessment of the stage of the disease, the flap design and patient fitness for general anaesthesia. All patients underwent surgical excision combined with reconstruction of the defect with a subcutaneous inferiorly based pedicled NLF. The proximal part of the flap was routinely de epithelialised before it has been tunnelled through the cheek so a one stage procedure could only be required. Results: The mean age of the patients was 62.3±6 years, range (52-69 years). All patients were diagnosed with squamous cell carcinoma. The anterior floor of the mouth constituted 40% of the defects, the lateral floor of the mouth 20

Comparison of revision strategies for failed C2-posterior cervical pedicle screws: a biomechanical study.

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Mayer, Michael; Zenner, Juliane; Bogner, Robert; Hitzl, Wolfgang; Figl, Markus; von Keudell, Arvind; Stephan, Daniel; Penzkofer, Rainer; Augat, Peter; Korn, Gundobert; Resch, Herbert; Koller, Heiko

2013-01-01

With increasing usage within challenging biomechanical constructs, failures of C2 posterior cervical pedicle screws (C2-pCPSs) will occur. The purpose of the study was therefore to investigate the biomechanical characteristics of two revision techniques after the failure of C2-pCPSs. Twelve human C2 vertebrae were tested in vitro in a biomechanical study to compare two strategies for revision screws after failure of C2-pCPSs. C2 pedicles were instrumented using unicortical 3.5-mm CPS bilaterally (Synapse/Synthes, Switzerland). Insertion accuracy was verified by fluoroscopy. C2 vertebrae were potted and fixed in an electromechanical testing machine with the screw axis coaxial to the pullout direction. Pullout testing was conducted with load and displacement data taken continuously. The peak load to failure was measured in newtons (N) and is reported as the pullout resistance (POR). After pullout, two revision strategies were tested in each vertebra. In Group-1, revision was performed with 4.0-mm C2-pCPSs. In Group-2, revision was performed with C2-pedicle bone-plastic combined with the use of a 4-mm C2-pCPSs. For the statistical analysis, the POR between screws was compared using absolute values (N) and the POR of the revision techniques normalized to that of the primary procedures (%). The POR of primary 3.5-mm CPSs was 1,140.5 ± 539.6 N for Group-1 and 1,007.7 ± 362.5 N for Group-2; the difference was not significant. In the revision setting, the POR in Group-1 was 705.8 ± 449.1 N, representing a reduction of 38.1 ± 32.9 % compared with that of primary screw fixation. For Group-2, the POR was 875.3 ± 367.9 N, representing a reduction of 13.1 ± 23.4 %. A statistical analysis showed a significantly higher POR for Group-2 compared with Group-1 (p = 0.02). Although the statistics showed a significantly reduced POR for both revision strategies compared with primary fixation (p plastic, the POR can be significantly increased compared with the use of only an

[Anatomical study and clinical application of a leg flap pedicle-included with cutaneous nerve and its concomitant vessels].

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Liu, B; Hao, X; Goan, M

2000-05-01

To investigate the blood supply patterns and the clinical liability of a leg flap pedicle-included with cutaneous nerve and its concomitant vessels. Fresh cadaver legs with thirty-two in infants and two in adults were anatomically examined after the intravenous injection of the red Chlorinated Poly Vingl Choride (CPVC). Five patients with the soft tissue defects were selected for the treatment with the flap pedicle-included with the cutaneous nerve and its concomitant vessels. Four main cutaneous nerves were found in the leg after they perforated the deep fascia out. They were companioned with their concomitant vessels with different blood-supply pateeerns, which the upper part of the leg was in an axial pattern and the lower part was in a "chain-type anastomosing" pattern. Following the above-mentioned findings, five cases were successfully treated with this led flap. The leg flap should be designed along the cutaneous nerve and its concomitant vessels. When the flap is applied in the area of blood supply with "chain-type anastomosing" pattern, the deep fascia should also be included in the flap.

Asymmetry of the Vertebral Body and Pedicles in the True Transverse Plane in Adolescent Idiopathic Scoliosis : A CT-Based Study

NARCIS (Netherlands)

Brink, Rob C.; Schlösser, Tom P C; Colo, Dino; Vincken, Koen L.; van Stralen, Marijn; Hui, Steve C N; Chu, Winnie C W; Cheng, Jack C Y; Castelein, RM

2017-01-01

Study Design Cross-sectional. Objectives To quantify the asymmetry of the vertebral bodies and pedicles in the true transverse plane in adolescent idiopathic scoliosis (AIS) and to compare this with normal anatomy. Summary of background data There is an ongoing debate about the existence and

Surgical outcome of posterior decompression, posterolateral fusion and stabilization by pedicle screw and rod in thoracolumbar tuberculosis

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Md. Anowarul Islam

2017-05-01

Full Text Available Spinal tuberculosis causes severe complications like neurological and spinal deformity which may lead to respiratory distress, costo-pelvic impingement, paraplegia and consequent reduction in the quality and longevity of life. The aim of the present treatment is to avoid the consequence of neural complications and gain near-normal spine. Mechanical factor causes pathological fracture or dislocation of an affected vertebral body. Surgical decompression ensues further instability. Reconstruction of spinal column by pedicle screw and rod provide stability and prevents secondary neural damage and deformity thereby helps in early mobilization. Prospective study was done to evaluate the results in 20 cases of spinal tuberculosis in thoracolumbar region associated with neurological deficit. We operated our cases (12 males and 8 females by posterolateral decompression, fusion and stabilization by pedicle screw and rod along with antitubercular drug treatment. All patients were with neurological deficit, single level involvement and 10 to 30 degree of mild kyphosis. After surgery, kyphosis improved from 20.7 ± 5.5 degrees to 12.5 ± 3.9 degree. Bony fusion was in 65.0% cases. Neurological improvement and pain subsided in all the patients.

''The dermal internal brassiere flap,'' a new modification of inferior pedicle breast reduction technic.

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Temel, Metin; Karakaş, Ali O; Dokuyucu, Recep; Türkmen, Arif

2015-06-01

The inferior pedicle mammaplasty is particularly applied to large breasts with a long sternal notch to nipple distance. The present study reports modifications developed to solve the bottoming-out deformity, the lack of upper pole fullness and the wound healing problems seen at the reverse T-zone, known disadvantages of the inferior pedicle reduction mammaplasty, and evaluates postoperative sensation. A total of 110 patients with a mean age of 32 underwent the same technique. In this technique, two pairs of quadrangular and triangular flaps were planned from the skin of resection sites. The triangular dermal flaps and quadrangular flaps were suspended from the periosteum of the 2nd and 4th ribs, respectively. The distance from the nipple to inframammary fold was measured at the postoperative 1st month and 1st year. In the postoperative period, a nipple-inframammary fold distance increase of over 2 cm was determined as bottoming-out deformity. Sensation evaluations were performed by subjective and objective tests. The mean sternal notch to nipple distance was 35.00 cm. After operation, the mean distance between the sternal notch and the nipple was 20.00 cm. NAC examination revealed normal sensation in all patients. Whereas the preoperative mean areolar threshold value was 36.70 g/mm(2), the postoperative first-year mean areolar pressure threshold value was 35.50 g/mm(2) (p value was 25.30 g/mm(2), whereas the postoperative first-year mean nipple pressure threshold value was 26.00 g/mm(2) (p = 0.5471). The postoperative first-month mean sternal notch to nipple distance value of the patients was 20.00 cm, whereas the postoperative first-year mean sternal notch to nipple distance value of the patients was 20.00 cm, (p = 0.0648). The postoperative first-month mean nipple to submammary fold distance value of the patients was 10.50 cm, the postoperative first-year mean nipple to submammary fold distance value of the patients was 11.00 cm (p disadvantages of the inferior

[Effectiveness of posterior intrasegmental fixation with pedicle screw-lamina hook system in treatment of lumbar spondylolysis].

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Zhou, Zhongjie; Song, Yueming; Zeng, Jiancheng; Liu, Hao; Liu, Limin; Kong, Qingquan; Li, Tao; Gong, Quan

2013-03-01

To investigate the effectiveness of posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting for lumbar spondylolysis. Between January 2005 and October 2009, 22 patients with lumbar spondylolysis underwent posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting. There were 19 males and 3 females with an average age of 18.4 years (range, 12-26 years). The main symptom was low back pain with an average disease duration of 16 months (range, 8-56 months). The visual analogue scale (VAS) was 6.0 +/- 1.2 and Oswestry disability index (ODI) was 72.0% +/- 10.0% preoperatively. The X-ray films showed bilateral spondylolysis at L4 in 9 cases and at L5 in 13 cases. The range of motion (ROM) at upper and lower intervertebral spaces was (11.8 +/- 2.8) degrees and (14.1 +/- 1.9) degrees, respectively. All incisions healed by first intention. All patients were followed up 12-45 months (mean, 25 months). Low back pain was significantly alleviated after operation. The VAS score (0.3 +/- 0.5) and ODI (17.6% +/- 3.4%) were significantly decreased at last follow-up when compared with preoperative scores (P spondylolysis, having a high fusion rate, low complication rate, and maximum retention of lumbar ROM.

Pedicled Temporalis Muscle Flap for Craniofacial Reconstruction: A 35-Year Clinical Experience with 366 Flaps.

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Spanio di Spilimbergo, Stefano; Nordera, Paolo; Mardini, Samir; Castiglione, Giusy; Chim, Harvey; Pinna, Vittore; Brunello, Massimo; Cusino, Claudio; Roberto, Squaquara; Baciliero, Ugo

2017-02-01

In the past 130 years, the temporalis muscle flap has been used for a variety of different indications. In this age of microsurgery and perforator flaps, the temporalis muscle flap still has many useful applications for craniofacial reconstruction. Three hundred sixty-six temporalis muscle flaps were performed in a single center between 1978 and 2012. The authors divided the cases into two series-before and after 1994-because, after 1994, they started to perform free flap reconstructions, and indications for reconstruction with a temporalis muscle flap were changed RESULTS:: In the series after 1994, flaps were most commonly used for reconstruction of defects in the maxilla, mandible, and oropharynx, in addition to facial reanimation and filling of orbital defects. Complications included total flap necrosis (1.6 percent) and partial flap necrosis (10.7 percent). The rate of material extrusion at the donor site decreased after porous polyethylene was uniformly used for reconstruction from 17.1 to 7.9 percent. The pedicled temporalis muscle flap continues to have many applications in craniofacial reconstruction. With increasing use of free flaps, the authors' indications for the pedicled temporalis muscle flap are now restricted to (1) orbital filling for congenital or acquired anophthalmia; (2) filling of unilateral maxillectomy defects; and (3) facial reanimation in selected cases of facial nerve palsy. Therapeutic, IV.

Effectiveness of a refuge for Lake Trout in Western Lake Superior II: Simulation of future performance

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Akins, Andrea L; Hansen, Michael J.; Seider, Michael J.

2015-01-01

Historically, Lake Superior supported one of the largest and most diverse Lake Trout Salvelinus namaycush fisheries in the Laurentian Great Lakes, but Lake Trout stocks collapsed due to excessive fishery exploitation and predation by Sea Lampreys Petromyzon marinus. Lake Trout stocking, Sea Lamprey control, and fishery regulations, including a refuge encompassing Gull Island Shoal (Apostle Islands region), were used to enable recovery of Lake Trout stocks that used this historically important spawning shoal. Our objective was to determine whether future sustainability of Lake Trout stocks will depend on the presence of the Gull Island Shoal Refuge. We constructed a stochastic age-structured simulation model to assess the effect of maintaining the refuge as a harvest management tool versus removing the refuge. In general, median abundances of age-4, age-4 and older (age-4+), and age-8+ fish collapsed at lower instantaneous fishing mortality rates (F) when the refuge was removed than when the refuge was maintained. With the refuge in place, the F that resulted in collapse depended on the rate of movement into and out of the refuge. Too many fish stayed in the refuge when movement was low (0–2%), and too many fish became vulnerable to fishing when movement was high (≥22%); thus, the refuge was more effective at intermediate rates of movement (10–11%). With the refuge in place, extinction did not occur at any simulated level of F, whereas refuge removal led to extinction at all combinations of commercial F and recreational F. Our results indicate that the Lake Trout population would be sustained by the refuge at all simulated F-values, whereas removal of the refuge would risk population collapse at much lower F (0.700–0.744). Therefore, the Gull Island Shoal Refuge is needed to sustain the Lake Trout population in eastern Wisconsin waters of Lake Superior.

Treatment of degenerative lumbar spondylolisthesis by using minimally invasive transforaminal lumbar interbody fusion and percutaneous pedicle screw fixation

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Hao WU

2016-04-01

Full Text Available Objective To discuss clinical therapeutic effects of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF combined with percutaneous pedicle screw fixation for degenerative lumbar spondylolisthesis (DLS.  Methods A total of 32 DLS patients treated by MIS-TLIF and percutaneous pedicle screw fixation from January 2013 to September 2015 in Xuanwu Hospital, Capital Medical University were retrospectively reviewed. Visual Analogue Scale (VAS, Oswestry Disability Index (ODI and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36 scores were assessed and compared between preoperation and one week, 3 months after operation and in the last follow-up. Lumbar lordosis angle, coronal Cobb angle, coronal and sagittal body shifting, complication, the degree of spondylolisthesis (Meyerding classification and the rate of spondylolisthesis were measured according to preoperative and postoperative spinal X-ray examination. Fusion rate was evaluated according to X-rays or CT in the last follow-up, and MRI was used to assess the degree of decompression.  Results Thirty-two patients were under test with mean operation time 160 min, intraoperative blood loss 120 ml, postoperative hospital stay 7.22 d and follow-up 10.83 months. Decompression and fusion levels ranged from L2-S1 and interbody fusion was performed in 32 patients and 41 levels were fused. Compared with preoperation, the VAS and ODI scores were significantly increased at one week, 3 months after operation and in the last follow-up (P = 0.000, for all, while SF-36 score (P = 0.002, 0.000, 0.000, lumbar lordotic angle (P = 0.000, for all, coronal Cobb angle (P = 0.000, for all and slippage rate (P = 0.000, for all were significantly decreased. The fusion rate was 92.22%, and the improvement rate of ODI was (80.51 ± 6.02% in the last follow-up. There were 3 cases appeared complications, including one case of infection and 2 cases of cerebrospinal fluid (CSF fistula, and were

Surgical reconstruction with pedicle flap of advance after excision of facial melanoma in a dog - Case report

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Bruna Bristot Colombo

2016-06-01

Full Text Available ABSTRACT. Colombo B.B., Kuci C.C., Gehrcke M.I., de Souza L.P., Colodel M.M., Gerber J., Salbego F.Z., de Moraes A.N. & Oleskovicz N. [Surgical reconstruction with pedicle flap of advance after excision of facial melanoma in a dog - Case report.] Reconstrução cirúrgica com retalho pediculado de avanço após exérese de melanoma cutâneo facial em um cão - Relato de caso. Revista Brasileira de Medicina Veterinária, 38(2:128-132, 2016. Programa de Pós- -Graduação em Ciência Animal, Universidade do Estado de Santa Catarina, Av. Luís de Camões, 2090, Conta Dinheiro, Lages, SC 88520-000, Brasil. E-mail: brucolombo@hotmail.com The reconstructive surgery has been growing in veterinary medicine, whether in reconstruction tissue caused by trauma or even when there is an extensive tumor resection. This report aims to discuss about a female dog, assisted at the Teaching Hospital of an Educational Institution, which had an ulcerated nodule in the lateral portion of nasal flow plan, with suggestive diagnosis of malignant melanoma, concluded through cytology and referred for surgery. After resection of the tumor, the incision of skin and subcutaneous divulsion for production pedicle flap of advance. After surgery, it was applied with a padded bandage and gauze sheath on the face of the animal. During both the post-operative immediate period and in the following days the retail tissue showed rosy and healthy, with no sign of necrosis or dehiscence. The animal was observed until the day 30 after surgery, where there was local hair growth and good aesthetic appearance, which leads to the conclusion that the pedicle flap advance was an appropriate choice in this case, solving the matter about the animal’s health and looking from the owner’s point of view.

[Free tissue transfers with lengthening of vascular pedicle using interpositional vein grafts. About 10 cases].

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Yeo, S; Perrot, P; Duteille, F

2010-04-01

The realization of free flaps with lack of reliable vessels nearby the loss of substance is a difficult problem for plastic surgeons. We report 10 cases of free tissue transfers with a one-stage technique lengthening the vascular pedicle of the free flap with interpositional vein grafts. Taking into consideration the good results and the low rate of morbidity, the authors emphasize the use of this technique rather than a two-stage procedure. Copyright 2009 Elsevier Masson SAS. All rights reserved.

Pedicled rectus abdominis muscle and fascia flap sling the bulbar urethra for treatment for male-acquired urinary incontinence: report of ten cases.

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Xu, Yue-Min; Zhang, Xin-Ru; Xie, Hong; Song, Lu-Jie; Feng, Chao; Fei, Xiao-Fang

2014-03-01

Male urinary incontinence is relatively common complication of radical prostatectomy and of posterior urethroplasty following traumatic pelvic fracture. Here, we investigate the use of pedicled rectus abdominis muscle and fascia flap sling of the bulbar urethra for treatment for male-acquired urinary incontinence. Ten patients with acquired urinary incontinence were included in the study. Urinary incontinence was secondary to TURP in three patients and was secondary to posterior urethroplasty performed following traumatic pelvic fracture in seven patients. Pedicled rectus abdominalis muscle and fascial flaps, approximately 2.5 cm wide and 15 cm long, were isolated. The flaps were inserted into a perineal incision through a subcutaneous tunnel. The free end of the flap was sectioned to form two muscle strips, each 3 cm in length, and inserted into the space between bulbar urethra and corpus cavernosa. After adequate sling tension had been achieved, the two strips of muscle were anastomosed around the bulbar urethra using a 2-zero polyglactin suture. The patients were followed up for between 12 and 82 months (mean 42.8 months). Complete continence was achieved with good voiding in seven of the 10 patients. In other three patients achieved good voiding following catheter removal, but incontinence was only moderately improved. A pedicled rectus muscle fascial sling of the bulbar urethra is an effective and safe treatment for male patients with mild to moderate acquired urinary incontinence, but it may not be suitable for severe incontinence or for patients with weak rectus abdominalis muscles.

The pedicled omentoplasty and split skin graft (POSSG) for reconstruction of large chest wall defects. A validity study of 34 patients

NARCIS (Netherlands)

C.M.E. Contant; A.N. van Geel (Albert); B. van der Holt (Bronno); T. Wiggers (Theo)

1996-01-01

textabstractThe aim of this study was to evaluate retrospectively the results of pedicled omentoplasty and split skin graft (POSSG) in reconstructing (full thickness) chest wall defects, and to define its role as a palliative procedure for local symptom control. Thirty-four patients with recurrent

Sacral pressure sore reconstruction – the pedicled superior gluteal ...

African Journals Online (AJOL)

Pressure sore reconstruction has always been challenging. Immobile patients are prone to develop pressure sores from unre- lieved pressure on tissue over the sacral area, with shear, friction, moisture and malnutrition as contributing factors. Up to one-third of immobilised patients in long-term care facilities will develop.

Double elevator weakening for unilateral congenital superior oblique palsy with ipsilateral superior rectus contracture and lax superior oblique tendon.

Science.gov (United States)

Khan, Arif O

2012-06-01

In unilateral congenital superior oblique palsy, a large hypertropia is sometimes associated with ipsilateral contracture of the superior rectus muscle and apparent overaction of the contralateral superior oblique. Ipsilateral double elevator weakening is one surgical approach; however, this procedure could compromise supraduction. We report a series of three consecutive patients who underwent ipsilateral superior rectus and inferior oblique recessions for unilateral superior oblique palsy. Intraoperatively, all three patients were found to have a lax ipsilateral superior oblique tendon. Postoperatively, all three patients had satisfactory correction of the hypertropia and abnormal head position with minimal supraduction defect. This procedure seems to be an acceptable initial surgical option for treating congenital superior oblique muscle palsy with ipsilateral contracture of the superior rectus muscle, even when the ipsilateral superior oblique tendon is lax. Copyright © 2012 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

Clinical efficacy of bone cement injectable pedicle screw system combined with intervertebral fusion in treatment of lumbar spondylolysis and osteoporosis

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Peng-yi DAI

2016-10-01

Full Text Available Objective 　To observe the therapeutic effect of bone cement injectable pedicle screw system combined with intervertebral fusion for lumbar spondylolysis and osteoporosis. Methods 　The clinical data were analyzed retrospectively of 21 patients with lumbar spondylolysis and osteoporosis who received treatment of bone cement injectable pedicle screw system and intervertebral fusion from Aug. 2013 to Nov. 2015. The 21 patients (9 males and 12 females aged from 60 to 80 years (mean 64 years old; 6 of them presented degenerative spondylolysis, 15 with isthmic spondylolisthesis; 2 cases had I degree slippage, 13 had Ⅱdegree slippage, 6 had Ⅲdegree slippage, and all the cases were unisegmental slippage including 9 cases in L4 and 12 cases in L5. Bone mineral density of lumbar vertebrae (L2-L5 was measured with dual-energy X-ray absorptiometry, and T values conforming to the diagnostic criteria of osteoporosis were less than or equal to -2.5; All patients were operated with whole lamina resection for decompression, bone cement injectable pedicle screws system implantation, propped open reduction and fixation intervertebral fusion. The clinical outcomes were determined by the radiographic evaluation including intervertebral height, height of intervertebral foramen, slip distance, slip rate and slip angle, and Oswestry disability index (ODI on preoperative, 3 months after operation and the end of the time, and the interbody fusion were followed up. Results 　Cerebrospinal fluid leakage of incision was observed in two cases after operation, compression and dressing to incision, Trendelenburg position, dehydration and other treatments were taken, and the stitches of incisions were taken out on schedule. Slips in the 21 patients were reset to different extent, and lumbar physiological curvatures were recovered. The intervertebral height and height of intervertebral foramen were obviously higher 3 months after operation than that before operation (P0

Clinical and radiological results 6 years after treatment of traumatic thoracolumbar burst fractures with pedicle screw instrumentation and balloon assisted endplate reduction

NARCIS (Netherlands)

Verlaan, Jorrit Jan; Somers, Inne; Dhert, Wouter J A; Oner, F. Cumhur

2015-01-01

Background context  When used to fixate traumatic thoracolumbar burst fractures, pedicle screw constructs may fail in the presence of severe vertebral body comminution as the intervertebral disc can creep through the fractured endplates leading to insufficient anterior column support.

[Treatment of avascular necrosis of femoral head after femoral neck fracture with pedicled iliac bone graft].

Science.gov (United States)

Wang, Benjie; Zhao, Dewei; Guo, Lin; Yang, Lei; Li, Zhigang; Cui, Daping; Tian, Fengde; Liu, Baoyi

2011-05-01

To explore the effectiveness of pedicled iliac bone graft transposition for treatment of avascular necrosis of femoral head (ANFH) after femoral neck fracture. Between June 2002 and December 2006, 22 cases (22 hips, 16 left hips and 6 right hips) of ANFH after femoral neck fracture were treated with iliac bone graft pedicled with ascending branch of the lateral femoral circumflex vessels. There were 18 males and 4 females with an age range from 28 to 48 years (mean, 37.5 years). The time from injury to internal fixation was 2-31 days, and all fractures healed within 12 months after internal fixation. The ANFH was diagnosed at 15-40 months (mean, 22 months) after internal fixation. The ANFH duration was 3-11 months (mean, 8 months). According to Association Research Circulation Osseous (ARCO) staging system, 2 hips were classified as stage IIa, 3 hips as stage IIb, 3 hips as stage IIc, 3 hips as stage IIIa, 7 hips as stage IIIb, and 4 hips as stage IIIc. The preoperative Harris hip score (HHS) was 64.10 +/- 5.95. All incisions healed by first intention and the patients had no complication of lung embolism, sciatic nerve injury, lower limb deep venous thrombosis, and numbness and pain of donor site. All patients were followed up 2.5 to 6.3 years (mean, 4.8 years). The fracture healing time was 8-12 months, and no femoral neck fracture recurred. The HHS was 90.20 +/- 5.35 at last follow-up, showing significant difference when compared with the preoperative value (t = -18.447, P = 0.000). The hip function were excellent in 11 hips, good in 10 hips, fair in 1 hip, and the excellent and good rate was 95.5%. Four hips were radiographically progressed in ARCO staging, 18 hips remained stable with a stable rate of 81.8%. Pedicled iliac bone graft transposition is an ideal option for treatment of ANFH after internal fixation of femoral neck fracture for the advantages of femoral head revascularization, sufficient cancellous bone supply, and relatively simple procedure.

Modified frontolateral partial laryngectomy operation: combined muscle-pedicle hyoid bone and thyrohyoid membrane flap in laryngeal reconstruction

OpenAIRE

Ouyang, Dian; Liu, Tian-Run; Chen, Yan-Feng; Wang, Jian

2013-01-01

Objective Laryngeal reconstruction is needed to preserve laryngeal function in patients who have undergone extensive vertical or frontal partial laryngectomy. However, the procedure remains a difficult challenge. Several reconstruction techniques have been described, but these techniques pose risks of complications such as laryngeal stenosis. This study aimed to evaluate the postoperative course and functional outcomes of a new technique that combined a muscle-pedicle hyoid bone and a thyrohy...

Segmental vs non-segmental thoracic pedicle screws constructs in adolescent idiopathic scoliosis: is there any implant alloy effect?

Science.gov (United States)

Di Silvestre, Mario; Bakaloudis, Georgeous; Ruosi, Carlo; Pipola, Valerio; Colella, Gianluca; Greggi, Tiziana; Ruffilli, Alberto; Vommaro, Francesco

2017-10-01

The aim of this study is to understand how many anchor sites are necessary to obtain maximum posterior correction of idiopathic scoliotic curve and if the alloy of instrumentation, stainless steel or titanium, may have a role in the percent of scoliosis correction. We reviewed 143 consecutive patients, affected by AIS (Lenke 1-2), who underwent a posterior spinal fusion with pedicle screw-only instrumentation between 2002 and 2005. According to the implant density and alloy used we divided the cohort in four groups. All 143 patients were reviewed at an average follow-up of 7, 2 years, the overall final main thoracic curve correction averaged 61.4%, whereas the implant density within the major curve averaged 71%. A significant correlation was observed between final% MT correction and preoperative MT flexibility and implant density. When stainless steel instrumentation is used non-segmental pedicle screw constructs seem to be equally effective as segmental instrumentations in obtaining satisfactory results in patients with main thoracic AIS. When the implant alloy used is titanium one, an implant density of ≥60% should be guaranteed to achieve similar results.

Endoscopic combined “transseptal/transnasal” approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases

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Yasunori Fujimoto

2015-07-01

Full Text Available Objective The purpose of this study was to describe the endoscopic combined “transseptal/transnasal” approach with a pedicled nasoseptal flap for pituitary adenoma and skull base reconstruction, especially with respect to cerebrospinal fluid (CSF fistula.Method Ninety-one consecutive patients with pituitary adenomas were retrospectively reviewed. All patients underwent the endoscopic combined “transseptal/transnasal” approach by the single team including the otorhinolaryngologists and neurosurgeons. Postoperative complications related to the flap were analyzed.Results Intra- and postoperative CSF fistulae were observed in 36 (40% and 4 (4.4% patients, respectively. Among the 4 patients, lumbar drainage and bed rest healed the CSF fistula in 3 patients and reoperation for revision was necessary in one patient. Other flap-related complications included nasal bleeding in 3 patients (3.3%.Conclusion The endoscopic combined “transseptal/transnasal” approach is most suitable for a two-surgeon technique and a pedicled nasoseptal flap is a reliable technique for preventing postoperative CSF fistula in pituitary surgery.

Modified frontolateral partial laryngectomy operation: combined muscle-pedicle hyoid bone and thyrohyoid membrane flap in laryngeal reconstruction

International Nuclear Information System (INIS)

Ouyang, Dian; Liu, Tian-Run; Chen, Yan-Feng; Wang, Jian

2013-01-01

Laryngeal reconstruction is needed to preserve laryngeal function in patients who have undergone extensive vertical or frontal partial laryngectomy. However, the procedure remains a difficult challenge. Several reconstruction techniques have been described, but these techniques pose risks of complications such as laryngeal stenosis. This study aimed to evaluate the postoperative course and functional outcomes of a new technique that combined a muscle-pedicle hyoid bone and a thyrohyoid flap during laryngeal reconstruction after tumor resection. Four patients underwent extensive vertical partial or frontal partial laryngectomy for cancer. After tumor resection, laryngeal reconstruction was performed using the proposed technique. Postoperative recovery time, complications, and oncologic results were evaluated. The four patients were successfully treated with the proposed technique. No dyspnea, dysphagia, or death occurred during the postoperative course. Decannulation was performed after a median of 3 days. The average postoperative hospital stay was 7 days. Short-term postoperative functional recovery was normal. No laryngeal stenosis or tumor recurrence was observed in any of the four patients after a follow-up period of more than 24 months. The combination of the muscle-pedicle hyoid bone and the thyrohyoid flap is a reliable procedure for laryngeal reconstruction after extensive vertical partial or frontal partial laryngectomy

Clinical study on minimally invasive transforaminal lumbar interbody fusion combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis

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Hao WU

2016-04-01

Full Text Available Objective To discuss the operative essentials and therapeutic effects of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis (DLS.  Methods A total of 17 DLS patients without prior spinal diseases were treated by MIS-TLIF and percutaneous pedicle screw fixation from January 2013 to September 2015 in Xuanwu Hospital, Capital Medical University. The operation time, intraoperative blood loss, hospital stay, and postoperative complication were recorded in each patient. Visual Analogue Scale (VAS and Oswestry Disability Index (ODI were used to evaluate postoperative improvement of low back and leg pain, and clinical effects were assessed according to Medical Outcome Study 36-Item Short-Form Health Survey (SF-36. Coronal Cobb angle, sagittal lordosis angle and spinal deviation distances on coronal and sagittal plane were measured before operation, one week, 3 months after operation and in the last follow-up in spinal full-length X-ray examination. Fusion rate was calculated according to X-ray or CT scan, and the degree of decompression was evaluated by MRI.  Results Decompression and fusion levels ranged from T12-S1 vertebrae, and interbody fusion was performed in 17 patients and 56 levels were fused. Average operation time was 200 min (180-300 min, intraoperative blood loss was 320 ml (200-1000 ml and hospital stay was 8.21 d (5-12 d. All patients were followed-up for 12.13 months (5-24 months. Compared with preoperation, VAS (P = 0.000, for all and ODI scores (P = 0.000, for all decreased significantly, SF-36 score increased (P = 0.000, for all, coronal Cobb angle (P = 0.000, for all, sagittal lordosis angle (P = 0.000, for all, coronal and sagittal deviation (P = 0.000, for all decreased significantly one week and 3 months after operation and in the last follow-up. The improvement rate of ODI was (86.51 ± 6.02%, fusion rate of vertebral bodies

Ecological interactions in Aedes species on Reunion Island.

Science.gov (United States)

Bagny Beilhe, L; Delatte, H; Juliano, S A; Fontenille, D; Quilici, S

2013-12-01

Two invasive, container-breeding mosquito species, Aedes aegypti (Stegomyia aegypti) and Aedes albopictus (Stegomyia albopicta) (Diptera: Culicidae), have different distribution patterns on Reunion Island. Aedes albopictus occurs in all areas and Ae. aegypti colonizes only some restricted areas already occupied by Ae. albopictus. This study investigates the abiotic and biotic ecological mechanisms that determine the distribution of Aedes species on Reunion Island. Life history traits (duration of immature stages, survivorship, fecundity, estimated finite rate of increase) in Ae. aegypti and Ae. albopictus were compared at different temperatures. These fitness measures were characterized in both species in response to competitive interactions among larvae. Aedes aegypti was drastically affected by temperature, performing well only at around 25 °C, at which it achieved its highest survivorship and greatest estimated rate of increase. The narrow distribution of this species in the field on Reunion Island may thus relate to its poor ability to cope with unfavourable temperatures. Aedes aegypti was also more negatively affected by high population densities and to some extent by interactions with Ae. albopictus, particularly in the context of limited food supplies. Aedes albopictus exhibited better population performance across a range of environmental conditions. Its ecological plasticity and its superior competitive ability relative to its congener may further enhance its invasion success on Reunion Island. © 2012 The Royal Entomological Society.

Free-flap cover of complex defects around the knee using the descending genicular artery as the recipient pedicle.

Science.gov (United States)

Venkatramani, H; Sabapathy, S R; Nayak, S

2014-01-01

Selection of ideal recipient vessels is one of the most important factors determining success in free-flap reconstruction of the lower limb. At the knee, the choice of vessels has traditionally been either the common femoral or the popliteal vessels and their branches but these are often difficult to use or cannot be used. A series of 32 free flaps for cover of complex injuries of the knee involving the distal femur, the knee joint and the upper tibia were reconstructed using the descending genicular branch of the femoral artery in the adductor canal and its muscular branches to the vastus medialis as the recipient vessels. All but one flap survived with no major complications. The use of the descending genicular artery as the recipient vessel for reconstruction with free flaps around the knee has various advantages including: (i) it is mostly remote from the zone of trauma, (ii) it is constant in location, (iii) the recipient vessels are an excellent size match for end-to-end anastomosis, (iv) there is no need for changes of position of the patient when using most free flaps commonly used for knee reconstruction, (v) it is easy to harvest these simultaneously, (vi) secondary exposure of the underlying skeleton from all quadrants is unlikely to divide the flap pedicle as it is superior and (vii), perhaps most important of all, it obviates the need for exploration of the popliteal fossa. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Reconstruction of cervical scar contracture using axial thoracic flap based on the thoracic branch of the supraclavicular artery.

Science.gov (United States)

Ma, Xianjie; Li, Yang; Wang, Lu; Li, Weiyang; Dong, Liwei; Xia, Wei; Su, Yingjun

2014-09-01

Cervical scar contracture causes both physical and psychological distress for burn patients. Many pedicle flaps or skin grafting have been suggested for reconstruction of cervical scar contracture with variable results in the literature. The authors present the axial thoracic flap based on the thoracic branch of the supraclavicular artery (TBSA) for reconstruction of cervical scar contracture. Postburn scar contractures in anterior neck region of 66 patients had been reconstructed with the axial pattern thoracic flaps based on the TBSA, including 1 expanded and 10 nonexpanded pedicle flaps, and 9 expanded and 46 nonexpanded island pedicle flaps, during 1988 through 2012. After removing and releasing the cervical scar contracture, the flap was designed in the thoracic region. The axial artery of the flap is the TBSA bifurcating from the intersection point of sternocleidomastoid muscle and omohyoid muscle with several concomitant veins as the axial veins. The flap can be designed in a large area within the borders of the anterior border of the trapezius muscle superiorly, the middle part of the deltoid muscle laterally, the midsternal line medially, and the level 3 to 4 cm below nipples inferiorly. After incisions were made along the medial, inferior, and lateral border, dissection was performed toward the pedicle. Donor site was closed directly in expanded cases and with skin grafting in nonexpanded cases. Cervical scar contractures were repaired with good functional and cosmetic results in 64 cases among this cohort. Flap tip necrosis in other 2 cases, caused by postoperative hematoma, was repaired by skin grafting. The color and texture of all flaps were fitted with those of the surrounding skin. The donor sites all healed primarily. The flap sensation in the thoracic region regained in the early stage postoperatively and that in cervical area recovered completely after 6 months according to the report of the patients. With reliable blood supply based on the

Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures compared with open technique.

Science.gov (United States)

Paredes, Igor; Panero, Irene; Cepeda, Santiago; Castaño-Leon, Ana M; Jimenez-Roldan, Luis; Perez-Nuñez, Ángel; Alén, Jose A; Lagares, Alfonso

2018-06-14

This study aimed to compare the accuracy of screw placement between open pedicle screw fixation and percutaneous pedicle screw fixation (MIS) for the treatment of thoracolumbar spine fractures (TSF). Forty-nine patients with acute TSF who were treated with transpedicular screw fixation from January 2013 to December 2016 were retrospectively reviewed. The patients were divided into Open and MIS groups. Laminectomy was performed in either group if needed. The accuracy of the screw placement, the evolution of the Cobb sagital angle postoperatively and at 12-month follow up and the neurological status were recorded. AO type of fracture and TLICS score were also recorded. Mean age was 42 years old. Mean TLICS score was 6,29 and 5,96 for open and MIS groups respectively. Twenty five MIS and 24 open surgeries were performed, and 350 (175 in each group) screws were inserted (7,14 per patient). Twenty-four and 13 screws were considered ̈out ̈ in the open and MIS groups respectively (Odds ratio 1,98. 0,97-4,03 p=0,056). The Cobb sagittal angle went from 13,3o to 4,5o and from 14,9o to 8,2o in the Open and MIS groups respectively (both popen and MIS groups respectively. No neurological worsening was observed. For the treatment of acute thoracolumbar fractures, the MIS technique seems to achieve similar results to the open technique in relation to neurological improvement and deformity correction, while placing the screws more accurately.

Indications, Outcomes, and Complications of Pedicled Propeller Perforator Flaps for Upper Body Defects: A Systematic Review

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Davide Lazzeri

2013-01-01

Full Text Available Background The aim of this investigation was to systematically review the current literatureto provide the best data for indications, outcomes, survival, and complication rates ofpedicled propeller perforator flaps for upper body defects.Methods A comprehensive literature review for articles published from January 1991 toDecember 2011 was performed using the PubMed, Medline, and Cochrane Databases. Articleswithout available full-text, single case reports or papers with excessive missing data wereexcluded. Papers reporting pedicle-perforator (propeller flaps used for lower extremityreconstruction were excluded from meta-analysis.Results From the initial 1,736 studies our search yielded, 343 studies qualified for the secondstage of selection. Of 117 full-text reports screened, 41 studies, met the definitive inclusionand exclusion criteria. Of the selected 41 articles, 26 were case series, original papers orretrospective reviews and were included, whereas 15 were case report papers and thereforewere excluded. Two hundred ninety-five propeller flaps were reported to have been used ina total of 283 patients. Indications include repair of trauma-induced injuries, post-traumarevision surgery, cancer resection, chronic infection, pressure sores, and chronic ulcers with amajor complication rate (3.3% comparable to that of free flaps. No specific exclusion criteriafor the procedure were presented in the studies reviewed.Conclusions Pedicled propeller flaps are a versatile and safe reconstructive option that areeasy and quick to raise and that provide unlimited clinical solutions because of the theoreticalpossibility of harvesting them based on any perforator chosen among those classified in the body.

Substitution of the anterior cruciate ligament: a long-term histologic and biomechanical study with autogenous pedicled grafts of the iliotibial band in dogs

NARCIS (Netherlands)

Rens, van T.J.G.; Berg, van den A.F.; Huiskes, H.W.J.; Kuypers, W.

1986-01-01

This paper reports the experience with anterior cruciate ligament (ACL) substitution by standardized pedicled strips of the iliotibial band, fixed to the tibia and femur with a bone-peg fixation technique. Thirty-two young adult (± one year old) Labrador dogs were used for the experiments (58

Reconstruction of cica-contracture on the face and neck with skin flap and expanded skin flap pedicled by anterior branch of transverse cervical artery.

Science.gov (United States)

Chen, Baoguo; Song, Huifeng; Xu, Minghuo; Gao, Quanwen

2016-09-01

A high-quality flap is necessary for repairing faciocervical scar contractures. The supraclavicular region and chest wall are the preferred choices for reconstruction. The supraclavicular island flap (SIF) pedicled by the transverse cervical artery (TCA) has been reported. Compared to the traditional SIF flap, another type of flap pedicled by the anterior perforator of transverse cervical artery (ap-TCA) is more convenient for transfer to the faciocervical area. In this article, we use this type of perforator flap and expanded perforator flap to repair the faciocervical contracture. In this study, 10 cases (deformity caused by burn or trauma to the face and neck sites) with an average age of 32 years-old, were treated by ap-TCA flap and this type of expanded flap. In between, the flap was pre-expanded for approximately 3 months prior to transfer in 6 patients. Another 4 cases did not want the expander because of the long duration required for saline filling and potential complications of the expander. Bilateral prefabricated flaps were designed in two female cases. All 12 flaps in 10 patients were transferred tension-free to the defects and no flap was lost. The size of the flap ranged from 12 cm × 8 cm to 15 cm × 20 cm. All 12 flaps survived completely. The donor sites were closed directly in the above 6 patients where an expander had been used and reconstructed by split skin graft in 4 patients where no expander had been employed. Through a mean time of 6 months' follow-up, only one female patient was disappointed with the cicatrix that presented on the upper polar skin of both breasts, the other 9 patients were satisfied with both recipient function and appearance. The color and the texture matched well with the recipient area. The ap-TCA flap and expanded ap-TCA flap can be considered reliable options for faciocervical deformities as it can be easily elevated and it matches well with faciocervical area in color. With regards to the expanded flap, we

Reconstructive Surgery for Severe Penile Inadequacy: Phalloplasty with a Free Radial Forearm Flap or a Pedicled Anterolateral Thigh Flap

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N. Lumen

2008-01-01

Full Text Available Objectives. Severe penile inadequacy in adolescents is rare. Phallic reconstruction to treat this devastating condition is a major challenge to the reconstructive surgeon. Phallic reconstruction using the free radial forearm flap (RFF or the pedicled anterolateral thigh flap (ALTF has been routinely used in female-to-male transsexuals. Recently we started to use these techniques in the treatment of severe penile inadequacy. Methods. Eleven males (age 15 to 42 years were treated with a phallic reconstruction. The RFF is our method of choice; the ALTF is an alternative when a free flap is contraindicated or less desired by the patient. The RFF was used in 7 patients, the ALTF in 4 patients. Mean followup was 25 months (range: 4–49 months. Aesthetic and functional results were evaluated. Results. There were no complications related to the flap. Aesthetic results were judged as “good” in 9 patients and “moderate” in 2 patients. Sensitivity in the RFF was superior compared to the ALTF. Four patients developed urinary complications (stricture and/or fistula. Six patients underwent erectile implant surgery. In 2 patients the erectile implant had to be removed due to infection or erosion. Conclusion. In case of severe penile inadequacy due to whatever condition, a phalloplasty is the preferred treatment nowadays. The free radial forearm flap is still the method of choice. The anterolateral thigh flap can be a good alternative, especially when free flaps are contraindicated, but sensitivity is markedly inferior in these flaps.

Analysis of Island Land Use Change Based on Transfer Matrix'a Case Study of Dongtou Island in Zhejiang Province

Science.gov (United States)

Wang, Liang; Tao, Kunwang; Qian, Xinlin

2015-04-01

With the increasing developments of islands, the protection and management of island's natural resources are imperative. The core of islands' protection and management is to acquire the information of changes of the land use and land cover. What's more, the purpose of the islands' land use change information analysis is to plan the effective protection of land resource, achieve scientific management and sustainable utilization. Based on the improved calculation method of land use change and the computational model of change rate of the land use, an analysis of land use transfer matrix and transfer probability matrix is presented, and the method of land use change analysis based on the transfer matrix is proposed in this paper. And then the comparative analysis of all types of land use transfer is introduced. Taken the island of Dongtou in Zhejiang Province as the case, with the SPOT-5 satellite image in 2005 and the aerial image in 2011 as the data source, the current situation of land utilization of Dongtou Island and its land use change are analyzed. The experiment results show that, from 2005 to 2011, the greatest changes are the structures and water, followed by the forest land, grassland, cultivated land and others. The major change of structure and forest is the net change, while the major change of the water and grassland is the swap change. From the perspective of increment, the conversion from waters to structure has the most advantage, followed by water converted to grassland and road. To see from the loss, structures converted into roads and buildings have the most superiority transformation, followed by structures converted to grassland. The analysis of the case proves that the proposed process and method in this paper could achieve better results in the practical application. The experiment results also demonstrate that the proposed method could effectively obtain the dynamic change information of land use which is much helpful for land management and

Application of an expandable pedicle screw in the severe osteoporotic spine: a preliminary study.

Science.gov (United States)

Wu, Zi-xiang; Cui, Geng; Lei, Wei; Fan, Yong; Wan, Shi-yong; Ma, Zhen-sheng; Sang, Hong-xun

2010-12-01

To investigate the clinical abstract and radiographic outcome of multi-axial expandable pedicle screws (MEPS) in patients with osteoporosis. One hundred and twenty-five consecutive patients received MEPS from the UPASS spinal fixation system to obtain thoracolumbar or lumbosacral stabilization. All patients underwent bone mineral density (BMD) scans. The indications for use of the MEPS were spinal diseases with severe osteoporosis (degenerative diseases 46 cases, compression fractures 28 cases, lumbar tuberculosis 27 cases and revision spine surgery 24 cases). The pre-operative and three months post-operative functional evaluations were graded with JOA and VAS scoring system. One week, six months and 12 months after surgery, plain film and three-dimensional CT scans were obtained to evaluate the spinal fusion and fixation effectiveness of MEPS. The mean follow-up period was 18 months (ranged from 6 to 33 months). All patients suffered from severely osteoporosis with a decrease of 25.3% in BMD. The pre-operative JOA and VAS scores were 11.3±3.0 and 6.7±1.8 mm, respectively. Three months after operation, the JOA and VAS scores were 25.2±2.0 and 2.3±1.7 mm. The recovery rate was 78.1±11.5％ and the clinical results were satisfying. There were no instances of screw loosening or pullout of the MEPS and the screw-bone interface was excellent. The radiographic results showed that bone healing, both around the screws and inter-vertebral, was achieved. In osteoporosis spine surgery, excellent bone-screw interface and fixation strength can be achieved by using MEPS. MEPS are a novel approach to increase the pedicle screw fixation in osteoporotic and revision spine surgeries.

Spontaneus bilateral pedicle fracture 30 years after Harrington Instrumentation for idiopathic scoliosis: a case report

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Obid Peter

2012-01-01

Full Text Available Abstract Introduction Spontaneous fractures of the spine are a common entity. They usually occur in older people with osteoporosis. This case is presented on account of its rarity. To the best of the authors' knowledge only one case of an osteoporotic pedicle fracture after Harrington Instrumentation has been described before. Case presentation We report the case of a 46-year-old Caucasian woman who underwent surgery due to idiopathic scoliosis with a Harrington Instrumentation (T4 to L3 30 years ago. During the operation she was infected with hepatitis C while receiving erythrocyte concentrates and has suffered from liver cirrhosis since then. She presented with a sudden pain in her lower back and paraesthesia in both her legs but no other neurological symptoms. A computed tomography scan showed a bilateral pedicle fracture of L3 and an additional compression fracture of L4. In the first session we performed a dorsal stabilization with massive intraoperative bleeding and a postoperative failure of liver synthesis. In a second session an additional ventral augmentation was done. After the second operation she developed a hepatorenal syndrome. Both operations left the patient in a very critical state which led to a prolonged stay in the intensive care and rehabilitation unit. At her 12-month follow-up visit, she was free of complaints. Conclusion The un-physiological load of the spine after Harrington Instrumentation can lead to osteoporosis due to inactivity even in younger patients. Although these implants are not used anymore one should keep this possibility in mind when dealing with patients who have received Harrington rods in surgical procedures.

Adolescent idiopathic scoliosis: sagital plane and low density pedicle screws

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Rodrigo Augusto do Amaral

2014-03-01

Full Text Available OBJECTIVE: To examine the sagittal curves of patients treated with CD instrumentation using exclusively pedicle screws. METHODS: Image analysis of medical records of 27 patients (26 M and 1 F with a minimum follow-up of 6 months, who underwent surgical treatment in our service between January 2005 and December 2010. The curves were evaluated on coronal and sagittal planes, taking into account the potential correction of the technique. RESULTS: In the coronal plan the following curves were evaluated: proximal thoracic (TPx, main thoracic (TPp, and thoracolumbar; lumbar (TL, L, and the average flexibility was 52%, 52%, and 92% and the capacity of correction was 51%, 72%, and 64%, respectively. In the sagittal plane there was a mean increase in thoracic kyphosis (CT of 41% and an average reduction of lumbar lordosis (LL of 17%. Correlation analysis between variables showed Pearson coefficient of correlation of 0.053 and analysis of dispersion of R2 = <0.001. CONCLUSION: The method has shown satisfactory results with maintenance of kyphosis correction in patients with normal and hyper kyphotic deformities.

[Direct repair of adolescent lumbar spondylolysis using a pedicle screw-laminar hook system by paramedian approach].

Science.gov (United States)

Wang, Bin; Tang, Yong-hua; Tang, Hong-chao; Jin, Cai-yi

2011-08-01

To discuss the indication and clinical effect of direct repair of adolescent lumbar spondylolysis by screw-laminar hook system. From August 2003 to December 2008, 28 patients (13 males and 15 females,ranging in age from 15 and 26 years, averaged 21.6 years) with lumbar spondylolysis were treated with isthmic bone grafting and internal fixation with a pedicle screw-laminar hook system. Three patients had spondylolysis at L3, L4; 5 patients had spondylolysis at L4, L5; 8 patients had spondylolysis at L4; and 12 patients had spondylolysis at L5. All the patients had low back pain and lasted over 6 months. According to preoperative and postoperative plain radiograph, CT scan and Macnab criteria, the fusion rate and clinical effect of this technique were evaluated. All the patients were followed up with a mean period of 14.9 months, ranging from 9 to 24 months. All the patients had bony union according to the X-rays and CT scan. According to the calculation results of Macnab criteria, 22 patients got an excellent result, 5 good and 1 fair. The direct repair of adolescent lumbar spondylolysis with pedicle screw-laminar hook system can shorten length of operation,decrease blood loss, preserve more posterior structures of spine and avoid iatrogenic instability of spine. The postoperative immediate stability of vertebral segment is acquired and the mobility of adjacent intervertebral discs is reserved. The screw-laminar hook system for the treatment of adolescent spondylolisthesis can get satisfactory clinical results.

Novel free-hand T1 pedicle screw method: Review of 44 consecutive cases

Directory of Open Access Journals (Sweden)

Mark A Rivkin

2014-01-01

Full Text Available Summary of Background Data: Multilevel posterior cervical instrumented fusions are becoming more prevalent in current practice. Biomechanical characteristics of the cervicothoracic junction may necessitate extending the construct to upper thoracic segments. However, fixation in upper thoracic spine can be technically demanding owing to transitional anatomy while suboptimal placement facilitates vascular and neurologic complications. Thoracic instrumentation methods include free-hand, fluoroscopic guidance, and CT-based image guidance. However, fluoroscopy of upper thoracic spine is challenging secondary to vertebral geometry and patient positioning, while image-guided systems present substantial financial commitment and are not readily available at most centers. Additionally, imaging modalities increase radiation exposure to the patient and surgeon while potentially lengthening surgical time. Materials and Methods: Retrospective review of 44 consecutive patients undergoing a cervicothoracic fusion by a single surgeon using the novel free-hand T1 pedicle screw technique between June 2009 and November 2012. A starting point medial and cephalad to classic entry as well as new trajectory were utilized. No imaging modalities were employed during screw insertion. Postoperative CT scans were obtained on day 1. Screw accuracy was independently evaluated according to the Heary classification. Results: In total, 87 pedicle screws placed were at T1. Grade 1 placement occurred in 72 (82.8% screws, Grade 2 in 4 (4.6% screws and Grade 3 in 9 (10.3% screws. All Grade 2 and 3 breaches were <2 mm except one Grade 3 screw breaching 2-4 mm laterally. Only two screws (2.3% were noted to be Grade 4, both breaching medially by less than 2 mm. No new neurological deficits or returns to operating room took place postoperatively. Conclusions: This modification of the traditional starting point and trajectory at T1 is safe and effective. It attenuates additional bone

Persistent left superior vena cava with absent right superior vena cava: image findings

International Nuclear Information System (INIS)

Araujo Junior, Cyrillo Rodrigues de; Carvalho, Tarcisio Nunes; Fraguas Filho, Sergio Roberto; Costa, Marlos Augusto Bitencourt; Jacob, Beatriz Mahmud; Machado, Marcio Martins; Teixeira, Kim-Ir-Sen Santos; Ximenes, Carlos Alberto

2003-01-01

Persistent left superior vena cava absent right superior vena cava is a rare anomaly, with less than 150 cases reported in the literature. Congenitally persistent left superior vena cava is the most common variant of systemic venous return to the heart, resulting embryologically from failure of the left anterior cardinal vein to become obliterated. Its incidence varies from 0.3% in patients with otherwise normal heart to 4.3% in patients with congenital heart disease. In the majority of the patients, a right superior vena cava is present as well, but rarely the right anterior cardinal vein degenerates resulting in the absence of the normal right superior vena cava. The blood from the right side is carried by the persistent left superior vena cava to the right atrium through the coronary sinus. We report the case of a patient with a persistent left superior vena cava and absence of right superior vena cava identified by chance during a chest radiograph and computed tomography examination for investigation of chronic pulmonary obstructive disease. The patient had no congenital heart disease and the blood from the right side was drained by the persistent left superior vena cava into the right atrium through the coronary sinus. (author)

Urethrastriktur

DEFF Research Database (Denmark)

Honnens de Lichtenberg, M; Miskowiak, J

1990-01-01

wire netting seems promising but needs further investigation. Reconstructive operations in form of a free or pedicled skin island patch, skin tube graft, endourethral free split skin graft, multistaged urethroplasty, meatoplasty and excision of prostatomebraneous stricture are followed by cure in 50...

Outcome and safety analysis of 3D printed patient specific pedicle screw jigs for complex spinal deformities: A comparative study.

Science.gov (United States)

Garg, Bhavuk; Gupta, Manish; Singh, Menaka; Kalyanasundaram, Dinesh

2018-05-03

Spinal deformities are very challenging to treat and have a great risk of neurological complications due to hardware placement during corrective surgery. Various techniques have been introduced to ensure safe and accurate placement of pedicle screws. Patient-specific screw guides with pre-drawn and pre-validated trajectory seems to be an attractive option. We have focused on developing 3D printing technique for complex spinal deformities in India. This study also aimed to compare the placement of pedicle screw with 3D printing and free hand technique. This is a retrospective comparative clinical study at an academic institutional setting. A total of 20 patients were enrolled during the study, 10 were operated with the help of 3D printing (group 1) and 10 were operated with freehand technique (group 2). Group 1 included 6 congenital, 3 adolescent idiopathic scoliosis (AIS), one post tubercular kyphosis and Group 2 included 5 congenital, 4 AIS and one post tubercular kyphosis patient. Primary outcomes were measured in terms of screw violation and secondary outcome were measured in terms of Surgical time, Blood loss, Radiation exposure (no. of shoots required) and complications. MIMICS v18.0 Software was used for 3D reconstruction from CT scan images of all the patients. 3-Matic software was used to create drill guide. 3-D printer from Stratasys Mojo ABS P 430 model material cartilage (a thermoplastic material) was used for printing of vertebrae model and jigs. Two sample test of proportion was used to compare correctly and wrongly pedicle screw placement with 3D printing and freehand technique. T-test with equal variance was used for operating surgical time and blood loss. This work was carried out by collaboration of Orthopaedics Department, All India Institute of Medical Sciences (AIIMS), New Delhi and Biomedical Engineering Department, Indian Institute of Technology (IIT) Delhi. This project received the grant of USD 60000 from Department of Biotechnology (DBT

Veia cava superior esquerda anômala com ausência de veia cava superior direita: achados de imagem Persistent left superior vena cava with absent right superior vena cava: image findings

Directory of Open Access Journals (Sweden)

Cyrillo Rodrigues de Araújo Júnior

2003-10-01

Full Text Available A persistência da veia cava superior esquerda com ausência da veia cava superior direita é uma anomalia rara, com menos de 150 casos descritos na literatura. A não-obliteração e regressão da veia cardinal anterior esquerda durante o desenvolvimento embriológico promove uma variação sistêmica de retorno venoso ao coração, com persistência da veia cava superior esquerda. Sua incidência varia de 0,3% em pacientes sem alterações cardíacas congênitas concomitantes a 4,3% naqueles com cardiopatias. Na maioria das vezes coexiste a veia cava superior direita, porém se houver regressão e degeneração da veia cardinal anterior direita, implicará a sua ausência e a drenagem venosa para o coração será feita pela veia cava superior esquerda ao átrio direito, através do seio coronariano. Mostramos um caso de um paciente submetido a radiografia de tórax e tomografia computadorizada para avaliação de doença pulmonar obstrutiva crônica, tendo como achado a persistência da veia cava superior esquerda com ausência da direita, sem qualquer cardiopatia associada e com a drenagem cardíaca sendo feita, através do seio coronariano, para o átrio direito.Persistent left superior vena cava with absent right superior vena cava is a rare anomaly, with less than 150 cases reported in the literature. Congenitally persistent left superior vena cava is the most common variant of systemic venous return to the heart, resulting embryologically from failure of the left anterior cardinal vein to become obliterated. Its incidence varies from 0.3% in patients with otherwise normal heart to 4.3% in patients with congenital heart disease. In the majority of the patients, a right superior vena cava is present as well, but rarely the right anterior cardinal vein degenerates resulting in the absence of the normal right superior vena cava. The blood from the right side is carried by the persistent left superior vena cava to the right atrium through the

Heat Islands

Science.gov (United States)

EPA's Heat Island Effect Site provides information on heat islands, their impacts, mitigation strategies, related research, a directory of heat island reduction initiatives in U.S. communities, and EPA's Heat Island Reduction Program.

Biomechanical comparison between titanium and cobalt chromium rods used in a pedicle subtraction osteotomy model

Directory of Open Access Journals (Sweden)

Kalpit N. Shah

2018-03-01

Full Text Available Instrumentation failure is a common complication following complex spinal reconstruction and deformity correction. Rod fracture is the most frequent mode of hardware failure and often occurs at or near a 3-column osteotomy site. Titanium (Ti rods are commonly utilized for spinal fixations, however, theoretically stiffer materials, such as cobalt-chrome (CoCr rods are also available. Despite ongoing use in clinical practice, there is little biomechanical evidence that compares the construct ability to withstand fatigue stress for Ti and Co-Cr rods. Six models using 2 polyethylene blocks each were used to simulate a pedicle subtraction osteotomy. Within each block 6.0×45 mm polyaxial screws were placed and connected to another block using either two 6.0×100 mm Ti (3 models or CoCr rods (3 models. The rods were bent to 40° using a French bender and were secured to the screws to give a vertical height of 1.5 cm between the blocks. The blocks were fatigue tested with 700N at 4 Hz until failure. The average number of cycles to failure for the Ti rod models was 12840 while the CoCr rod models failed at a significantly higher, 58351 cycles (P=0.003. All Ti models experienced rod fracture as the mode of failure. Two out of the three CoCr models had rod fractures while the last sample failed via screw fracture at the screw-tulip junction. The risk of rod failure is substantial in the setting of long segment spinal arthrodesis and corrective osteotomy. Efforts to increase the mechanical strength of posterior constructs may reduce the occurrence of this complication. Utilizing CoCr rods in patients with pedicle subtraction osteotomy may reduce the rate of device failure during maturation of the posterior fusion mass and limit the need for supplemental anterior column support.

Pictorial Superiority Effect

Science.gov (United States)

Nelson, Douglas L.; And Others

1976-01-01

Pictures generally show superior recognition relative to their verbal labels. This experiment was designed to link this pictorial superiority effect to sensory or meaning codes associated with the two types of symbols. (Editor)

The Retrospective Analysis of Posterior Short-Segment Pedicle Instrumentation without Fusion for Thoracolumbar Burst Fracture with Neurological Deficit

Directory of Open Access Journals (Sweden)

Zhouming Deng

2014-01-01

Full Text Available This study aims to investigate the efficacy of posterior short-segment pedicle instrumentation without fusion in curing thoracolumbar burst fracture. All of the 53 patients were treated with short-segment pedicle instrumentation and laminectomy without fusion, and the restoration of retropulsed bone fragments was conducted by a novel custom-designed repositor (RRBF. The mean operation time and blood loss during surgery were analyzed; the radiological index and neurological status were compared before and after the operation. The mean operation time was 93 min (range: 62–110 min and the mean intraoperative blood loss was 452 mL in all cases. The average canal encroachment was 50.04% and 10.92% prior to the surgery and at last followup, respectively (P<0.01. The preoperative kyphotic angle was 17.2 degree (±6.87 degrees, whereas it decreased to 8.42 degree (±4.99 degrees at last followup (P<0.01. Besides, the mean vertebral body height increased from 40.15% (±9.40% before surgery to 72.34% (±12.32% at last followup (P<0.01. 45 patients showed 1-2 grades improvement in Frankel’s scale at last followup. This technique allows for satisfactory canal clearance and restoration of vertebral body height and kyphotic angle, and it may promote the recovery of neurological function. However, further research is still necessary to confirm the efficacy of this treatment.

Liposuction-assisted four pedicle-based breast reduction (LAFPBR): A new safer technique of breast reduction for elderly patients.

Science.gov (United States)

La Padula, Simone; Hersant, Barbara; Noel, Warren; Meningaud, Jean Paul

2018-05-01

As older people increasingly care for their body image and remain active longer, the demand for reduction mammaplasty is increasing in this population. Only a few studies of reduction mammaplasty have specifically focussed on the outcomes in elderly women. We developed a new breast reduction technique: the Liposuction-Assisted Four Pedicle-Based Breast Reduction (LAFPBR) that is especially indicated for elderly patients. The aim of this paper was to describe the LAFPBR technique and to determine whether it could be considered a safer option for elderly patients compared to the superomedial pedicle (SMP) technique. A retrospective study included sixty-two women aged 60 years and over who underwent bilateral breast reduction mammaplasty. Thirty-one patients underwent LAFPBR and 31 patients were operated using the SMP technique. Complications and patient satisfaction in both groups were analysed. Patient satisfaction was measured using a validated questionnaire: the client satisfaction questionnaire 8 (CSQ-8). The LAFPBR technique required less operating time, and avoided significant blood loss. Six minor complications were observed in SMP patients. No LAFPBR women developed a procedure-related complication. Patient satisfaction was high with a mean score of 29.65 in LAFPBR patients and 28.68 in SMP patients. The LAFPBR is an easy procedure that appears safer than SMP and results in a high satisfaction rate in elderly women. Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Island biogeography

DEFF Research Database (Denmark)

Whittaker, Robert James; Fernández-Palacios, José María; Matthews, Thomas J.

2017-01-01

Islands provide classic model biological systems. We review how growing appreciation of geoenvironmental dynamics of marine islands has led to advances in island biogeographic theory accommodating both evolutionary and ecological phenomena. Recognition of distinct island geodynamics permits gener...

Double Back Cut in Post-mastectomy Breast Skin (Fish-Shaped Skin Paddle) in Delayed Pedicled TRAM Flap Breast Reconstruction.

Science.gov (United States)

Berezovsky, Alexander Bogdanov; Pagkalos, Vasileios A; Shoham, Yaron; Krieger, Yuval; Silberstein, Eldad

2015-08-01

Breast reconstruction has become standard of care for female patients with breast cancer. The transverse rectus abdominis musculo-cutaneous flap (TRAMf) is the most common method of immediate or delayed autologous breast reconstruction following mastectomy. We share our experience with modified, double back cut of post-mastectomy skin in delayed pedicled TRAMf breast reconstruction, resulting in fish-shaped skin paddle. This sort of back cut is a simple, reliable way to obtain a natural, esthetically pleasant breast mound with inconspicuous hidden scars.

Tenarife Island, Canary Island Archipelago, Atlantic Ocean

Science.gov (United States)

1991-01-01

Tenarife Island is one of the most volcanically active of the Canary Island archipelago, Atlantic Ocean, just off the NW coast of Africa, (28.5N, 16.5W). The old central caldera, nearly filled in by successive volcanic activity culminating in two stratocones. From those two peaks, a line of smaller cinder cones extend to the point of the island. Extensive gullies dissect the west side of the island and some forests still remain on the east side.

Management of Anterior Abdominal Wall Defect Using a Pedicled Tensor Fascia Lata Flap: A Case Report

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K. D. Ojuka

2012-01-01

Full Text Available Degloving injuries to anterior abdominal wall are rare due to the mechanism of injury. Pedicled tensor fascia lata is known to be a versatile flap with ability to reach the lower anterior abdomen. A 34-year-old man who was involved in a road traffic accident presented with degloving injury and defect at the left inguinal region, sigmoid colon injury, and scrotal bruises. At investigation, he was found to have pelvic fracture. The management consisted of colostomy and tensor fascia lata to cover the defect at reversal. Though he developed burst abdomen on fifth postoperative day, the flap healed with no complications.

“The Lost Princess (putri duyung” of the Small Islands: Dugongs around Sulawesi in the Anthropocene

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Abigail M. Moore

2017-09-01

Full Text Available In the Spermonde as in the other main island groups around Sulawesi, seagrass and coral ecosystems are intimately linked ecologically and overlap extensively on the shallow water shelves surrounding most islands. One keystone species living in these shallow waters is the dugong (Dugong dugon. Officially fully protected under Indonesian Law (PP7/1999, published data on dugongs in the islands around Sulawesi are extremely limited. In this research, we collected, compiled and evaluated data and information (mostly unpublished on the distribution, exploitation and community perceptions of dugongs around Sulawesi, including the Togean, Banggai, Spermonde, Taka Bone Rate/Selayar, and Tanakeke Islands. Opportunities for dugong conservation, and potential benefits for coral reef ecosystems in a small island socio-ecological context, were considered. Once common within living memory, socio-economic data indicate that Sulawesi dugongs are now rare and under severe threat. Many fishing communities consider dugong meat superior to beef, and see it as a welcome change from fish, while certain body parts fetch a high price, as do dugong tears. In the Spermonde Islands, dugongs may already have been extirpated; the most recent reported sighting was in 1993 when the capture of an adult dugong by fishermen of Barranglompo Island resulted in an impromptu festival. All these Sulawesi small islands communities have dugong princess (putri duyung legends with potential as an entry-point to hearts and minds. Preventing further extirpations and striving to bring back the “lost princess” could be an iconic component of moving toward sustainability in small-island socio-ecological systems.

Undertapping of Lumbar Pedicle Screws Can Result in Tapping With a Pitch That Differs From That of the Screw, Which Decreases Screw Pullout Force.

Science.gov (United States)

Bohl, Daniel D; Basques, Bryce A; Golinvaux, Nicholas S; Toy, Jason O; Matheis, Erika A; Bucklen, Brandon S; Grauer, Jonathan N

2015-06-15

Survey of spine surgeons and biomechanical comparison of screw pullout forces. To investigate what may be a suboptimal practice regularly occurring in spine surgery. In order for a tap to function in its intended manner, the pitch of the tap should be the same as the pitch of the screw. Undertapping has been shown to increase the pullout force of pedicle screws compared with line-to-line tapping. However, given the way current commercial lumbar pedicle screw systems are designed, undertapping may result in a tap being used that has a different pitch from that of the screw (incongruent pitch). A survey asked participants questions to estimate the proportion of cases each participant performed in the prior year using various hole preparation techniques. Participant responses were interpreted in the context of manufacturing specifications of specific instrumentation systems. Screw pullout forces were compared between undertapping with incongruent pitch and undertapping with congruent pitch using 0.16 g/cm polyurethane foam block and 6.5-mm screws. Of the 3679 cases in which participants reported tapping, participants reported line-to-line tapping in 209 cases (5%), undertapping with incongruent pitch in 1156 cases (32%), and undertapping with congruent pitch in 2314 cases (63%). The mean pullout force for undertapping with incongruent pitch was 56 N (8%) less than the mean pullout force for undertapping with congruent pitch. This is equivalent to 13 lb. This study estimates that for about 1 out of every 3 surgical cases with tapping of lumbar pedicle screws in the United States, hole preparation is being performed by undertapping with incongruent pitch. This study also shows that undertapping with incongruent pitch results in a decrease in pullout force by 8% compared with undertapping with congruent pitch. Steps should be taken to correct this suboptimal practice. 3.

Mandible vertical height correction using lingual bone-split pedicle onlay graft technique

Directory of Open Access Journals (Sweden)

Coen Pramono D

2006-09-01

Full Text Available As edentulous mandible become atrophic, a denture bearing area will also be reduced. Difficulty in the removable prosthesis rehabilitation will be present as well. The purpose of this paper reports an innovative surgical technique to cope a problem of unstable complete lower denture due to bone atrophy and resulted of vertical height reduction of the anterior region of the mandible necessary for denture retention. Vertical advancement of the lower jaw using lingual bone split pedicle onlay graft technique in the anterior region of the mandible and followed by secondary epithelization vestibuloplasty in achieving the vertical height dimension. The surgery was achieved satisfactorily as the vertical dimension of the mandible anterior region had increased and the denture seated more stable comparing with the previous denture worn by the patient. It concluded that the surgery was achieved with a great result as the vertical height of the anterior region of the mandible had increased positively therefore lead the denture seated more stable.

Canary Islands

Science.gov (United States)

1992-01-01

This easterly looking view shows the seven major volcanic islands of the Canary Island chain (28.0N, 16.5W) and offers a unique view of the islands that have become a frequent vacation spot for Europeans. The northwest coastline of Africa, (Morocco and Western Sahara), is visible in the background. Frequently, these islands create an impact on local weather (cloud formations) and ocean currents (island wakes) as seen in this photo.

The use of Sural Island Musculo Fasciocutaneous Flap, in the ...

African Journals Online (AJOL)

2018-06-11

Jun 11, 2018 ... 4 weeks of surgery. Two patients ... allows others to remix, tweak, and build upon the work non-commercially, as long ... that the pedicle of the flap was not compressed with the ... to the 8th week after surgery [Figure 4].

Late Proximal Pedicle Hook Migration Into Spinal Canal After Posterior Correction Surgery of Scoliosis Causing Neurologic Deficit: "Proximal Junctional Scoliosis"? Case Series and a Review of the Literature

NARCIS (Netherlands)

Vereijken, I.M.P.; de Kleuver, M.

2013-01-01

Study Design: Case series. Objectives: We describe 4 patients with proximal pedicle hook migration as a late complication (greater than 12 months postoperatively) of posterior correction surgery in adolescent idiopathic scoliosis. We studied failure mechanisms and propose strategies for revision

Does connectivity exist for remnant boreal caribou (Rangifer tarandus caribou along the Lake Superior Coastal Range? Options for landscape restoration

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Christine C. Drake

2018-01-01

Full Text Available Genetic analysis can provide important information on the dynamic and spatial structure of groups of animals or populations. Little is known of the genetic population structure of caribou that inhabit the Lake Superior Coastal Range (LSCR and the level of gene flow between individuals within the range and beyond. From a landscape perspective, this range is spatially isolated and genetic connectivity within the range is presumed limited due to large water crossings on Lake Superior. This study aims to answer if animal movement can be discerned, using genetic population and relatedness analyses, within and beyond the LSCR. Faecal and hair samples collected between 2005 and 2015 in Pukaskwa National Park were analyzed for genetic markers and compared to 131 unique genotypes previously obtained from both within the LSCR and in the two next closest ranges. Animals from one nearshore island (i.e. Otter were more closely associated with offshore islands than other mainland caribou, likely a result of past movement and translocation rather than ongoing movement. Conversely, on another nearshore island (i.e. Pic, individuals assigned to a different genetic cluster and were related to animals further north outside the range, demonstrating some connectivity through the discontinuous distribution to the coast. Long-term population declines have been observed in the LSCR range despite genetic connectivity within the range and relatively low total habitat disturbance. Restoring connectivity of the LSCR so that it is not isolated from populations to the north is required for the recovery of the mainland portion of the coastal range. These genetic analyses provide some insights on where movements may occur and where landscape restoration efforts may best be directed to enhance connectivity.

Magnetic resonance imaging evaluation of meniscoid superior labrum: normal variant or superior labral tear

Directory of Open Access Journals (Sweden)

Marcelo Novelino Simão

Full Text Available Abstract Objective: The objective of this study was to determine the incidence of a "meniscoid" superior labrum. Materials and Methods: This was a retrospective analysis of 582 magnetic resonance imaging examinations of shoulders. Of those 582 examinations, 110 were excluded, for a variety of reasons, and the final analysis therefore included 472 cases. Consensus readings were performed by three musculoskeletal radiologists using specific criteria to diagnose meniscoid labra. Results: A meniscoid superior labrum was identified in 48 (10.2% of the 472 cases evaluated. Arthroscopic proof was available in 21 cases (43.8%. In 10 (47.6% of those 21 cases, the operative report did not include the mention a superior labral tear, thus suggesting the presence of a meniscoid labrum. In only one of those cases were there specific comments about a mobile superior labrum (i.e., meniscoid labrum. In the remaining 11 (52.4%, surgical correlation demonstrated superior labral tears. Conclusion: A meniscoid superior labrum is not an infrequent finding. Depending upon assumptions and the requirement of surgical proof, the prevalence of a meniscoid superior labrum in this study was between 2.1% (surgically proven and 4.8% (projected. However, superior labral tears are just as common and are often confused with meniscoid labra.

Pedicled Instep Flap and Tibial Nerve Reconstruction in a Cynomolgus Monkey [Macaca fascicularis

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Ruth Weiss

2016-01-01

Full Text Available A male cynomolgus monkey experienced extensive soft tissue trauma to the right caudal calf area. Some weeks after complete healing of the original wounds, the monkey developed a chronic pressure sore on plantar surface of the heel of its right foot. A loss of sensitivity in the sole of the foot was hypothesized. The skin defect was closed by a medial sensate pedicled instep flap followed by counter transplantation of a full thickness graft from the interdigital webspace. The integrity of the tibial nerve was revised and reconstructed by means of the turnover flap technique. Both procedures were successful. This is an uncommon case in an exotic veterinary patient as it demonstrates a reconstructive skin flap procedure for the treatment of a chronic, denervated wound in combination with the successful reconstruction of 2.5 cm gap in the tibial nerve.

Multidecadal shoreline changes of atoll islands in the Marshall Islands

Science.gov (United States)

Ford, M.

2012-12-01

Atoll islands are considered highly vulnerable to the impacts of continued sea level rise. One of the most commonly predicted outcomes of continued sea level rise is widespread and chronic shoreline erosion. Despite the widespread implications of predicted erosion, the decadal scale changes of atoll island shorelines are poorly resolved. The Marshall Islands is one of only four countries where the majority of inhabited land is comprised of reef and atoll islands. Consisting of 29 atolls and 5 mid-ocean reef islands, the Marshall Islands are considered highly vulnerable to the impacts of sea level rise. A detailed analysis of shoreline change on over 300 islands on 10 atolls was undertaken using historic aerial photos (1945-1978) and modern high resolution satellite imagery (2004-2012). Results highlight the complex and dynamic nature of atoll islands, with significant shifts in shoreline position observed over the period of analysis. Results suggest shoreline accretion is the dominant mode of change on the islands studied, often associated with a net increase in vegetated island area. However, considerable inter- and intra-atoll variability exists with regards to shoreline stability. Findings are discussed with respect to island morphodynamics and potential hazard mitigation and planning responses within atoll settings.

Soft Tissue Closure of Grafted Extraction Sockets in the Anterior Maxilla: A Modified Palatal Pedicle Connective Tissue Flap Technique.

Science.gov (United States)

El Chaar, Edgard; Oshman, Sarah; Cicero, Giuseppe; Castano, Alejandro; Dinoi, Cinzia; Soltani, Leila; Lee, Yoonjung Nicole

Localized ridge resorption, the consequence of socket collapse, following tooth extraction in the anterior maxilla can adversely affect esthetics, function, and future implant placement. Immediate grafting of extraction sockets may help preserve natural ridge contours, but a lack of available soft tissue can compromise the final esthetic outcome. The presented modified rotated palatal pedicle connective tissue flap is a useful technique for simultaneous soft tissue coverage and augmentation of grafted sockets to improve esthetic outcome. This article delineates its advantages through the presentation of a four-case series using this new technique.

Foundation Investigation for Ground Based Radar Project-Kwajalein Island, Marshall Islands

Science.gov (United States)

1990-04-01

iL_ COPY MISCELLANEOUS PAPER GL-90-5 i iFOUNDATION INVESTIGATION FOR GROUND BASED RADAR PROJECT--KWAJALEIN ISLAND, MARSHALL ISLANDS by Donald E...C!assification) Foundatioa Investigation for Ground Based Radar Project -- Kwajalein Island, Marshall Islands 12. PERSONAL AUTHOR(S) Yule, Donald E...investigation for the Ground Based Radar Project -- Kwajalein Island, Marshall Islands , are presented.- eophysical tests comprised of surface refrac- tion

Free tissue transfer versus pedicled flap reconstruction of head and neck malignancy defects.

LENUS (Irish Health Repository)

O'Neill, J P

2012-02-01

BACKGROUND: With the advent of microsurgery the pedicled flap is considered by many to be an outdated surgical option. AIMS: To explore the relationship between flap survival and pre-morbid risk factors, conduct a comparative analysis of flap and systemic morbidities and complete a cosmesis and functionality assessment for oral and oropharyngeal reconstruction patients. METHODS: 114 patients, over a 13-year period, who had a one-stage reconstructive procedure employing the pectoralis major myocutaneous flap (PMMF) or radial forearm-free flap (RFFF). RESULTS: Variables, including age, smoking and radiation exposure were not statistically significant predictors of flap survival probability. Atelectasis was a significant post-op finding of RFFF patients. Flap dehiscence of >50% was a significant morbidity of PMMF. No statistical difference in cosmetic deformity, diet and socialisation was noted. CONCLUSIONS: Pectoralis major myocutaneous flap remains an enduring and safe flap; however, the RFFF has markedly improved speech performance over the PMMF.

Percutaneous pedicle screw for unstable spine fractures in polytraumatized patients: A report of two cases

Directory of Open Access Journals (Sweden)

Boon Beng Tan

2012-01-01

Full Text Available Unstable spine fractures commonly occur in the setting of a polytraumatized patient. The aim of management is to balance the need for early operative stabilization and prevent additional trauma due to the surgery. Recent published literature has demonstrated the benefits of early stabilization of an unstable spine fracture particularly in patients with higher injury severity score (ISS. We report two cases of polytrauma with unstable spine fractures stabilized with a minimally invasive percutaneous pedicle screw instrumentation system as a form of damage control surgery. The patients had good recovery from the polytrauma injuries. These two cases illustrate the role of minimally invasive stabilization, its limitations and technical pitfalls in the management of unstable spine fractures in the polytrauma setting as a form of damage control surgery.

Island in an island – The suggestions for transportation improvement plan for Haidian Island, Haikou, Hainan

Directory of Open Access Journals (Sweden)

Sia Rosalind Juo Ling

2017-01-01

Full Text Available Haidian Island, which situated at the Northern part of Haikou City of Hainan Province, is an island within a city. Haidian Island is unique in term of it's development which centered around an university, the Hainan University, besides some others important landmarks, such as Haikou city hospital, Baishamen municipal park, Golf Driving Range etc. All commercials, residential, recreational activities etc are planned to serve Hainan University in particular. The study, taking ‘Haidian Island Area Development Control Plan’ as case study, would like to look into the importance of transportation and traffic planning. The study used observation, site investigation and traffic study methods to gather data needed. Firstly the study analyzed the current state of transportation system for Haidian Island in accordance to the Island Development Control plan and Haikou master plan and identified the problems. Then, the study made some recommendations for these problems. The study highlighted the important of non-motorized, cycling and walking as the main transportation system for an education-based island and as supportive to domestic tourism activities found. The transportation planning suggested by the study took ‘green and low-carbon’ approaches considered the role of University as the core activity in the island.

Tissue reactions induced by nylon cable tie used to clamp ovarian pedicles

Directory of Open Access Journals (Sweden)

Luiz Fernando Moraes Moreira

2018-03-01

Full Text Available The aim of this study was to evaluate the tissue reactions induced by nylon cable tie by using macroscopic and histological evaluations. Forty-five clinically healthy crossbreed female dogs, 31.11 ± 14.26 months old and with a body weight of 11.26 ± 4.7 kg, underwent ovariohysterectomy using a minimally invasive procedure. The dogs were randomly divided into three groups of 15 animals each and were evaluated preoperatively, and at 30 (G1, 60 (G2 and 90 days (G3 after surgery. The histological examination of the pedicles containing the nylon cable ties, collected from five animals in each group, showed a chronic inflammatory reaction with the presence of macrophages, giant cells and fibroplasia on the 30th postoperative day. Well-organized connective tissue and presence of lymphocytes and polymorphonuclear leukocytes were seen on the 60th postoperative day, and mature connective tissue and presence of macrophages and lymphocytes were seen at 90 days. Nylon cable ties induce an inflammatory reaction, which should be considered due to the risk of interference with surrounding structures.

Comparison between lamellar keratoplasties produced by conjunctival pedicle and free corneal autografts. Experimental study in the dog (Canis familiaris - LINNAEUS, 1758

Directory of Open Access Journals (Sweden)

José Luiz Laus

1996-03-01

Full Text Available A comparative study of conjunctival pedicle and corneal autografts, for experimental healing of superficial keratectomies in dogs (Canis familiaris was performed. It was carried out by using 24 animals, and the technical procedures were analysed according to clinical, histologic and scanning electron microscopy parameters, in early and late postoperative periods. The obtained results are believed to represent feasible methods of proteresis, applied to the healing ophthalmic surgery. There were few, irrelevant differences between the two tested techniques.

Comparison of pedicle screw-based dynamic stabilization and fusion surgery in the treatment of radiographic adjacent-segment degeneration: a retrospective analysis of single L5-S1 degenerative spondylosis covering 4 years.

Science.gov (United States)

Han, Yu; Sun, Jianguang; Luo, Chenghan; Huang, Shilei; Li, Liren; Ji, Xiang; Duan, Xiaozong; Wang, Zhenqing; Pi, Guofu

2016-12-01

OBJECTIVE Pedicle screw-based dynamic spinal stabilization systems (PDSs) were devised to decrease, theoretically, the risk of long-term complications such as adjacent-segment degeneration (ASD) after lumbar fusion surgery. However, to date, there have been few studies that fully proved that a PDS can reduce the risk of ASD. The purpose of this study was to examine whether a PDS can influence the incidence of ASD and to discuss the surgical coping strategy for L5-S1 segmental spondylosis with preexisting L4-5 degeneration with no related symptoms or signs. METHODS This study retrospectively compared 62 cases of L5-S1 segmental spondylosis in patients who underwent posterior lumbar interbody fusion (n = 31) or K-Rod dynamic stabilization (n = 31) with a minimum of 4 years' follow-up. The authors measured the intervertebral heights and spinopelvic parameters on standing lateral radiographs and evaluated preexisting ASD on preoperative MR images using the modified Pfirrmann grading system. Radiographic ASD was evaluated according to the results of radiography during follow-up. RESULTS All 62 patients achieved remission of their neurological symptoms without surgical complications. The Kaplan-Meier curve and Cox proportional-hazards model showed no statistically significant differences between the 2 surgical groups in the incidence of radiographic ASD (p > 0.05). In contrast, the incidence of radiographic ASD was 8.75 times (95% CI 1.955-39.140; p = 0.005) higher in the patients with a preoperative modified Pfirrmann grade higher than 3 than it was in patients with a modified Pfirrmann grade of 3 or lower. In addition, no statistical significance was found for other risk factors such as age, sex, and spinopelvic parameters. CONCLUSIONS Pedicle screw-based dynamic spinal stabilization systems were not found to be superior to posterior lumbar interbody fusion in preventing radiographic ASD (L4-5) during the midterm follow-up. Preexisting ASD with a modified Pfirrmann

A novel planar vertical double-diffused metal-oxide-semiconductor field-effect transistor with inhomogeneous floating islands

International Nuclear Information System (INIS)

Ren Min; Li Ze-Hong; Liu Xiao-Long; Xie Jia-Xiong; Deng Guang-Min; Zhang Bo

2011-01-01

A novel planar vertical double-diffused metal-oxide-semiconductor (VDMOS) structure with an ultra-low specific on-resistance (R on,sp ), whose distinctive feature is the use of inhomogeneous floating p-islands in the n-drift region, is proposed. The theoretical limit of its R on,sp is deduced, the influence of structure parameters on the breakdown voltage (BV) and R on,sp are investigated, and the optimized results with BV of 83 V and R on,sp of 54 mΩ·mm 2 are obtained. Simulations show that the inhomogeneous-floating-islands metal-oxide-semiconductor field-effect transistor (MOSFET) has a superior 'R on,sp /BV' trade-off to the conventional VDMOS (a 38% reduction of R on,sp with the same BV) and the homogeneous-floating-islands MOSFET (a 10% reduction of R on,sp with the same BV). The inhomogeneous-floating-islands MOSFET also has a much better body-diode characteristic than the superjunction MOSFET. Its reverse recovery peak current, reverse recovery time and reverse recovery charge are about 50, 80 and 40% of those of the superjunction MOSFET, respectively. (interdisciplinary physics and related areas of science and technology)

Islands and non-islands in native and heritage Korean

Directory of Open Access Journals (Sweden)

Boyoung eKim

2016-02-01

Full Text Available To a large extent, island phenomena are cross-linguistically invariable, but English and Korean present some striking differences in this domain. English has wh-movement and Korean does not, and while both languages show sensitivity to wh-islands, only English has island effects for adjunct clauses. Given this complex set of differences, one might expect Korean/English bilinguals, and especially heritage Korean speakers (i.e. early bilinguals whose L2 became their dominant language during childhood to be different from native speakers, since heritage speakers have had more limited exposure to Korean, may have had incomplete acquisition and/or attrition, and may show significant transfer effects from the L2. Here we examine islands in heritage speakers of Korean in the U.S. Through a series of four formal acceptability experiments comparing these heritage speakers with native speakers residing in Korea, we show that the two groups are remarkably similar. Both show clear evidence for wh-islands and an equally clear lack of adjunct island effects. Given the very different linguistic environment that the heritage speakers have had since early childhood, this result lends support to the idea that island phenomena are largely immune to environmental influences and stem from deeper properties of the processor and/or grammar. Similarly, it casts some doubt on recent proposals that islands are learned from the input.

Class renormalization: islands around islands

International Nuclear Information System (INIS)

Meiss, J.D.

1986-01-01

An orbit of 'class' is one that rotates about a periodic orbit of one lower class with definite frequency. This contrasts to the 'level' of a periodic orbit which is the number of elements in its continued fraction expansion. Level renormalization is conventionally used to study the structure of quasi-periodic orbits. The scaling structure of periodic orbits encircling other periodic orbits in area preserving maps is discussed here. Fixed points corresponding to the accumulation of p/q bifurcations are found and scaling exponents determined. Fixed points for q > 2 correspond to self-similar islands around islands. Frequencies of the island boundary circles at the fixed points are obtained. Importance of this scaling for the motion of particles in stochastic regions is emphasized. (author)

Synthesis of hard magnetic Mn3Ga micro-islands by e-beam evaporation

Science.gov (United States)

Akdogan, O.

2018-05-01

The permanent magnet industry heavily depends on Nd-Fe-B and Sm-Co alloys because of their high-energy product and high room temperature coercivity. Main ingredient for having such superior magnetic properties compared to other known ferromagnetic materials is rare earth elements (Nd, Sm, Dy…). However recent worldwide reserve and export limitation problem of rare earths, shifted researchers' focus to rare earth free permanent magnets. Among many alternatives (FePt, Zr2Co11, FeNi …), Mn-based alloys are the most suitable due to abundance of the forming elements and trivial formation of the necessary hard phases. In this study, Mn3Ga micro islands have been prepared. Mn3Ga owes its hard magnetic properties to tetragonal D022 phase with magnetic anisotropy energy of 2 MJ/m3. Thin films and islands of Cr/MnGa/Cr layers have been deposited on Si/SiO2 wafers using combination of e-beam and thermal evaporation techniques. Cr has been used as buffer and cover layer to protect the sample from the substrate and prevent oxidation during annealing. Annealing under Ar/H2 forming gas has been performed at 350oC for 10 min. Nano thick islands of 25, 50 and 100 μm lateral size have been produced by photolithography technique. Room temperature coercivity of 7.5 kOe has been achieved on 100 μm micro islands of Mn3Ga. Produced micro islands could be a rare earth free alternative for magnetic memory and MEMS applications.

Synthesis of hard magnetic Mn3Ga micro-islands by e-beam evaporation

Directory of Open Access Journals (Sweden)

O. Akdogan

2018-05-01

Full Text Available The permanent magnet industry heavily depends on Nd-Fe-B and Sm-Co alloys because of their high-energy product and high room temperature coercivity. Main ingredient for having such superior magnetic properties compared to other known ferromagnetic materials is rare earth elements (Nd, Sm, Dy…. However recent worldwide reserve and export limitation problem of rare earths, shifted researchers’ focus to rare earth free permanent magnets. Among many alternatives (FePt, Zr2Co11, FeNi …, Mn-based alloys are the most suitable due to abundance of the forming elements and trivial formation of the necessary hard phases. In this study, Mn3Ga micro islands have been prepared. Mn3Ga owes its hard magnetic properties to tetragonal D022 phase with magnetic anisotropy energy of 2 MJ/m3. Thin films and islands of Cr/MnGa/Cr layers have been deposited on Si/SiO2 wafers using combination of e-beam and thermal evaporation techniques. Cr has been used as buffer and cover layer to protect the sample from the substrate and prevent oxidation during annealing. Annealing under Ar/H2 forming gas has been performed at 350oC for 10 min. Nano thick islands of 25, 50 and 100 μm lateral size have been produced by photolithography technique. Room temperature coercivity of 7.5 kOe has been achieved on 100 μm micro islands of Mn3Ga. Produced micro islands could be a rare earth free alternative for magnetic memory and MEMS applications.

[Clinical application of accurate placement of lumbar pedicle screws using three-dimensional printing navigational templates under Quadrant system].

Science.gov (United States)

Chen, Xuanhuang; Yu, Zhengxi; Wu, Changfu; Li, Xing; Chen, Xu; Zhang, Guodong; Zheng, Zugao; Lin, Haibin

2017-02-01

To explore the feasibility and the effectiveness of the accurate placement of lumbar pedicle screws using three-dimensional (3D) printing navigational templates in Quadrant minimally invasive system. The L 1-5 spines of 12 adult cadavers were scanned using CT. The 3D models of the lumbar spines were established. The screw trajectory was designed to pass through the central axis of the pedicle by using Mimics software. The navigational template was designed and 3D-printed according to the bony surface where the soft tissues could be removed. The placed screws were scanned using CT to create the 3D model again after operation. The 3D models of the designed trajectory and the placed screws were registered to evaluate the placed screws coincidence rate. Between November 2014 and November 2015, 31 patients with lumbar instability accepted surgery assisted with 3D-printing navigation module under Quadrant minimally invasive system. There were 14 males and 17 females, aged from 42 to 60 years, with an average of 45.2 years. The disease duration was 6-13 months (mean, 8.8 months). Single segment was involved in 15 cases, two segments in 13 cases, and three segments in 3 cases. Preoperative visual analogue scale (VAS) was 7.59±1.04; Oswestry disability index (ODI) was 76.21±5.82; and the Japanese Orthopaedic Association (JOA) score was 9.21±1.64. A total of 120 screws were placed in 12 cadavers specimens. The coincidence rate of placed screw was 100%. A total of 162 screws were implanted in 31 patients. The operation time was 65-147 minutes (mean, 102.23 minutes); the intraoperative blood loss was 50-116 mL (mean, 78.20 mL); and the intraoperative radiation exposure time was 8-54 seconds (mean, 42 seconds). At 3-7 days after operation, CT showed that the coincidence rate of the placed screws was 98.15% (159/162). At 4 weeks after operation, VAS, ODI, and JOA score were 2.24±0.80, 29.17±2.50, and 23.43±1.14 respectively, showing significant differences when compared

Tuppiap Qeqertaa (Tobias Island): a newly discovered island off northeast Greenland

DEFF Research Database (Denmark)

Bennike, O.; Mikkelsen, N.; Forsberg, René

2006-01-01

The small island of Tuppiap Qeqertaa, formerly known as Tobias circle divide or Tobias Island, is situated 80 km off the northeast Greenland coast. The island was discovered in 1993 and is approximately 2 km long and 1.5 km wide. Most of the island is covered by an ice cap that rises to 35 in abo...

Diomede Islands, Bering Straight

Science.gov (United States)

2008-01-01

The Diomede Islands consisting of the western island Big Diomede (also known as Imaqliq, Nunarbuk or Ratmanov Island), and the eastern island Little Diomede (also known as Krusenstern Island or Inaliq), are two rocky islands located in the middle of the Bering Strait between Russia and Alaska. The islands are separated by an international border and the International Date Line which is approximately 1.5 km from each island; you can look from Alaska into tomorrow in Russia. At the closest land approach between the United States, which controls Little Diomede, and Russia, which controls Big Diomede, they are 3 km apart. Little Diomede Island constitutes the Alaskan City of Diomede, while Big Diomede Island is Russia's easternmost point. The first European to reach the islands was the Russian explorer Semyon Dezhnev in 1648. The text of the 1867 treaty finalizing the sale of Alaska uses the islands to designate the border between the two nations. The image was acquired July 8, 2000, covers an area of 13.5 x 10.8 km, and is located at 65.8 degrees north latitude, 169 degrees west longitude. The U.S. science team is located at NASA's Jet Propulsion Laboratory, Pasadena, Calif. The Terra mission is part of NASA's Science Mission Directorate.

Sociodemographic Factors Influencing Island Food Consumption in the Pacific Islander Health Study

OpenAIRE

Baumhofer, Nicole Kau'i

2016-01-01

This dissertation explores the relationships between island food consumption, sociodemographic variables, and cardiovascular risk using data from the Pacific Islander Health Study (PIHS). Chapter 1 explores the associations between self-reported level of island food consumption and key covariates. Island food consumption was modeled using Poisson regression and adjusted for demographic, socioeconomic, and cultural characteristics. Increased Pacific Island cultural affinity was the strongest p...

Paradise Islands? Island States and Environmental Performance

Directory of Open Access Journals (Sweden)

Sverker C. Jagers

2016-03-01

Full Text Available Island states have been shown to outperform continental states on a number of large-scale coordination-related outcomes, such as levels of democracy and institutional quality. The argument developed and tested in this article contends that the same kind of logic may apply to islands’ environmental performance, too. However, the empirical analysis shows mixed results. Among the 105 environmental outcomes that we analyzed, being an island only has a positive impact on 20 of them. For example, island states tend to outcompete continental states with respect to several indicators related to water quality but not in aspects related to biodiversity, protected areas, or environmental regulations. In addition, the causal factors previously suggested to make islands outperform continental states in terms of coordination have weak explanatory power in predicting islands’ environmental performance. We conclude the paper by discussing how these interesting findings can be further explored.

Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging: A Spine Cadaveric Feasibility and Accuracy Study.

Science.gov (United States)

Elmi-Terander, Adrian; Skulason, Halldor; Söderman, Michael; Racadio, John; Homan, Robert; Babic, Drazenko; van der Vaart, Nijs; Nachabe, Rami

2016-11-01

A cadaveric laboratory study. The aim of this study was to assess the feasibility and accuracy of thoracic pedicle screw placement using augmented reality surgical navigation (ARSN). Recent advances in spinal navigation have shown improved accuracy in lumbosacral pedicle screw placement but limited benefits in the thoracic spine. 3D intraoperative imaging and instrument navigation may allow improved accuracy in pedicle screw placement, without the use of x-ray fluoroscopy, and thus opens the route to image-guided minimally invasive therapy in the thoracic spine. ARSN encompasses a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Two neurosurgeons placed 94 pedicle screws in the thoracic spine of four cadavers using ARSN on one side of the spine (47 screws) and free-hand technique on the contralateral side. X-ray fluoroscopy was not used for either technique. Four independent reviewers assessed the postoperative scans, using the Gertzbein grading. Morphometric measurements of the pedicles axial and sagittal widths and angles, as well as the vertebrae axial and sagittal rotations were performed to identify risk factors for breaches. ARSN was feasible and superior to free-hand technique with respect to overall accuracy (85% vs. 64%, P dimensions, except for vertebral body axial rotation, were risk factors for larger breaches when performed with the free-hand method. ARSN without fluoroscopy was feasible and demonstrated higher accuracy than free-hand technique for thoracic pedicle screw placement. N/A.

Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage.

Science.gov (United States)

Pee, Yong Hun; Park, Jong Dae; Choi, Young-Geun; Lee, Sang-Ho

2008-05-01

An anterior approach for debridement and fusion with autologous bone graft has been recommended as the gold standard for surgical treatment of pyogenic spondylodiscitis. The use of anterior foreign body implants at the site of active infection is still a challenging procedure for spine surgeons. Several authors have recently introduced anterior grafting with titanium mesh cages instead of autologous bone strut in the treatment of spondylodiscitis. The authors present their experience of anterior fusion with 3 types of cages followed by posterior pedicle screw fixation. They also compare their results with the use of autologous iliac bone strut. The authors retrospectively reviewed the cases of 60 patients with pyogenic spondylodiscitis treated by anterior debridement between January 2003 and April 2005. Fusion using either cages or iliac bone struts was performed during the same course of anesthesia followed by posterior fixation. Twenty-three patients underwent fusion with autologous iliac bone strut, and 37 patients underwent fusion with 1 of the 3 types of cages. The infections resolved in all patients, as noted by normalization of their erythrocyte sedimentation rates and C-reactive protein levels. Patients in both groups were evaluated in terms of their preoperative and postoperative clinical and imaging findings. Single-stage anterior debridement and cage fusion followed by posterior pedicle screw fixation can be effective in the treatment of pyogenic spondylodiscitis. There was no difference in clinical and imaging outcomes between the strut group and cage group except for the subsidence rate. The subsidence rate was higher in the strut group than in the cage group. The duration until subsidence was also shorter in the strut group than in the cage group.

Inferior Pedicle Reduction Mammoplasty with or without Tourniquet: A Comparative Study.

Science.gov (United States)

Demir, Canser Yilmaz; Sultanoglu, Yılmaz; Kocak, Omer Faruk; Ersoz, Muhammet Eren

2017-10-01

To compare the perioperative findings of inferior pedicle reduction mammoplasty (IPRM) performed with or without a tourniquet. This study was carried out in the plastic and reconstructive surgery department at a tertiary care center on a total of 42 consecutive women scheduled for IPRM. Patients in Group I (n = 21) underwent surgery using a tourniquet, whereas patients in Group II (n = 21) were operated on without a tourniquet. Levels of hemoglobin (Hb), hematocrit (Hct), Hct/Hb ratio, and platelet counts were noted preoperatively and on postoperative 24th and 48th h. Numbers of surgical pads and gauze sponges completely used and dripping with blood were recorded. Duration of operation, the amount of breast tissue excised on both sides, and fluid collected in hemovac drains on 48th h after operation were documented. In Group I, the operative time was significantly shorter (p usage is practical and safe, and it may also improve the cost-effectiveness of the procedure. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Localized Pigmented Villonodular Synovitis of the Hip: Sudden-Onset Pain Caused by Torsion of the Tumor Pedicle

Directory of Open Access Journals (Sweden)

Kiyokazu Fukui

2013-01-01

Full Text Available Pigmented villonodular synovitis is a rare, benign, but potentially locally aggressive disease that should be considered in younger patients who present with monoarticular joint symptoms and pathology. We present the case of a 33-year-old woman with a mass arising from her right hip joint that was examined using a multimodal radiological approach. Because her clinical presentation mimicked that of synovial osteochondromatosis of the hip, surgical dislocation was performed. Histopathological examination of the resected specimen confirmed the diagnosis of localized pigmented villonodular synovitis, with the mass consisting of proliferation of fibrohistiocytic cells, abundant hemosiderin, foamy histiocytes, and occasional giant cells. Because of the presence of tumor necrosis, we hypothesize that torsion of the tumor pedicle was the cause of acute presentation.

Tratamento da síndrome da veia cava superior Treatment of superior vena cava syndrome

Directory of Open Access Journals (Sweden)

Luís Marcelo Inaco Cirino

2005-12-01

Full Text Available A veia cava superior é formada pela união das duas veias inominadas, direita e esquerda, e localiza-se no mediastino médio, à direita da artéria aorta e anteriormente à traquéia. A síndrome da veia cava superior representa um conjunto de sinais (dilatação das veias do pescoço, pletora facial, edema de membros superiores, cianose e sintomas (cefaléia, dispnéia, tosse, edema de membro superior, ortopnéia e disfagia decorrentes da obstrução do fluxo sanguíneo através da veia cava superior em direção ao átrio direito. A obstrução pode ser causada por compressão extrínseca, invasão tumoral, trombose ou por dificuldade do retorno venoso ao coração secundária a doenças intra-atriais ou intraluminais. Aproximadamente 73% a 97% dos casos de síndrome da veia cava superior ocorrem durante a evolução de processos malignos intratorácicos. A maioria dos pacientes com a síndrome secundária a neoplasias malignas é tratada sem necessidade de cirurgia, através de radioterapia ou quimioterapia, ou através da colocação de stents endoluminais. Quando a síndrome é de etiologia benigna, o tratamento é feito através de medidas clínicas (anticoagulação, elevação da cabeça, etc. ou, em casos refratários, através de angioplastia, colocação de stents endoluminais e cirurgia.The superior vena cava is formed by the union of the right and left brachiocephalic veins. It is located in the middle mediastinum, to the right of the aorta and anterior to the trachea. Superior vena cava syndrome consists of a group of signs (dilation of the veins in the neck, facial swelling, edema of the upper limbs, and cyanosis and symptoms (headache, dyspnea, cough, orthopnea and dysphagia caused by the obstruction of blood flow through the superior vena cava to the right atrium. This obstruction can be caused by extrinsic compression, tumor invasion or thrombosis. Such obstruction may also occur as a result of insufficient venous return

A novel planar vertical double-diffused metal-oxide-semiconductor field-effect transistor with inhomogeneous floating islands

Institute of Scientific and Technical Information of China (English)

Ren Min; Li Ze-Hong; Liu Xiao-Long; Xie Jia-Xiong; Deng Guang-Min; Zhang Bo

2011-01-01

A novel planar vertical double-diffused metal-oxide-semiconductor (VDMOS) structure with an ultra-low specific on-resistance (Ron,sp),whose distinctive feature is the use of inhomogeneous floating p-islands in the n-drift region,is proposed.The theoretical limit of its Ron,sp is deduced,the influence of structure parameters on the breakdown voltage (BV) and Ron,sp are investigated,and the optimized results with BV of 83 V and Ron,sp of 54 mΩ.mm2 are obtained.Simulations show that the inhomogencous-floating-islands metal-oxide-semiconductor field-effect transistor (MOSFET)has a superior “Ron,sp/BV” trade-off to the conventional VDMOS (a 38％ reduction of Ron,sp with the same BV) and the homogeneous-floating-islands MOSFET (a 10％ reduction of Ron,sp with the same BV).The inhomogeneous-floatingislands MOSFET also has a much better body-diode characteristic than the superjunction MOSFET.Its reverse recovery peak current,reverse recovery time and reverse recovery charge are about 50,80 and 40％ of those of the superjunction MOSFET,respectively.

Kompetisi Stasiun Televisi Swasta Nasional Berdasarkan Superiority Direction dan Superiority Magnitude

Directory of Open Access Journals (Sweden)

Anastasia Winanti Riesardhy

2013-11-01

Full Text Available Abstract: Uses and gratification theory is employed particularly as the teoritical frame of the research to examine the extent to which ten national television stations compete to satisfy Indonesian audiences. In particular, two main concepts of that theory namely audiences “gratification sought and gratifications obtained, are broken down and counted based on superiority direction and superiority magnitude. In general, the findings show that those televisions have satisfied their audiences, although in terms of gratifications to dispersal motives, they haven’t satisfied as much as it was expected. Significant competition occurs between TRANSTV and TRANS7, RCTI and SCTV, and TVONE and METROTV. TVONE become the most satisfiyng television station. Abstrak: Teori Uses & Gratification menjadi dasar penelitian ini untuk mengukur bagaimana kompetisi yang terjadi di antara sepuluh stasiun televisi yang bersiaran secara nasional di Indonesia. Aplikasi dari teori tersebut dimunculkan dalam konsep kepuasan yang diharapkan dan kepuasan yang diperoleh ketika menonton acara televisi dan didasarkan pada penghitungan superiority direction dan superiority magnitude. Sepuluh stasiun televisi yang diteliti telah dapat memuaskan audiensnya, meskipun untuk kepuasan atas motif pengalihan masih belum dapat melampaui kepuasan yang diharapkan. Kompetisi yang signifikan terjadi antara TRANSTV dengan TRANS7, RCTI dengan SCTV serta TVONE dengan METROTV. TVONE menjadi stasiun televisi yang menduduki peringkat pertama dalam memberikan kepuasan tertinggi kepada audiens.

Information Superiority through Data Warehousing

National Research Council Canada - National Science Library

Warner, Neil

2001-01-01

.... A precursor to a knowledge edge is Information Superiority. Within most current Command Support Systems minimal integration and fusion of data is undertaken to provide the basis of information superiority...

Researching Pacific island livelihoods:

DEFF Research Database (Denmark)

Egelund Christensen, Andreas; Mertz, Ole

2010-01-01

on contemporary theories of nissology and conceptual analytical frameworks for island research. Through a review of selected case-study-based island literature on changing livelihoods coming out of the South Pacific, we wish to illustrate and discuss advantages of finding common grounds for small island studies....... The focus is on two dimensions of island livelihood, migration and natural resource management, both of which are significant contributors in making island livelihoods and shaping Pacific seascapes. We argue that there is still a substantial lack of studies targeting small island dynamics that are empirical...

78 FR 63860 - Amendment of Class D Airspace; Kwajalein Island, Marshall Islands, RMI

Science.gov (United States)

2013-10-25

...This action amends the Kwajalein Island Class D airspace description by amending the geographic coordinates for Bucholz Army Airfield (AAF), Kwajalein Island, Marshall Islands, RMI. The Bucholz AAF geographic coordinates information was updated in the Kwajalein Island Class E airspace descriptions in 2011, but was inadvertently overlooked in the Kwajalein Island Class D airspace description. This action ensures the safety of aircraft operating in the Kwajalein Island airspace area. This is an administrative action and does not affect the operating requirements of the airspace.

Stepping-stones to the Edge: Artistic Expressions of Islandness in an Ocean of Islands

Directory of Open Access Journals (Sweden)

Laurie Brinklow

2013-05-01

Full Text Available Since the earliest of times, islands have captured the artistic imagination—and, often, for the artist who finds his or her muse in being ‘islanded’, the smaller the island the better. Archipelagos offer an ideal setting for artists who take their inspiration from place: on small islands off islands they can experience an intensity of island living they might not otherwise have on a main island: boundedness and connection, isolation and community. This paper examines expressions of islandness by artists who live on islands off islands that are poles apart—‘archipelagos’ of the Canadian North Atlantic and the Great Southern Ocean. It draws upon interviews with those artists and writers to consider the nature of humans’ attachment and attraction to islands, exploring through the lens of phenomenology what Stratford et al. call the “entanglement between and among islands”.

Modeling the distribution of Norway rats (Rattus norvegicus on offshore islands in the Falkland Islands

Directory of Open Access Journals (Sweden)

Michael A. Tabak

2015-01-01

Full Text Available Non-native rats (Rattus spp. threaten native island species worldwide. Efforts to eradicate them from islands have increased in frequency and become more ambitious in recent years. However, the long-term success of some eradication efforts has been compromised by the ability of rats, particularly Norway rats (Rattus norvegicus which are good swimmers, to recolonize islands following eradications. In the Falkland Islands, an archipelago in the South Atlantic Ocean, the distance of 250 m between islands (once suggested as the minimum separation distance for an effective barrier to recolonization has shown to be insufficient. Norway rats are present on about half of the 503 islands in the Falklands. Bird diversity is lower on islands with rats and two vulnerable passerine species, Troglodytes cobbi (the only endemic Falkland Islands passerine and Cinclodes antarcticus, have greatly reduced abundances and/or are absent on islands with rats. We used logistic regression models to investigate the potential factors that may determine the presence of Norway rats on 158 islands in the Falkland Islands. Our models included island area, distance to the nearest rat-infested island, island location, and the history of island use by humans as driving variables. Models best supported by data included only distance to the nearest potential source of rats and island area, but the relative magnitude of the effect of distance and area on the presence of rats varied depending on whether islands were in the eastern or western sector of the archipelago. The human use of an island was not a significant parameter in any models. A very large fraction (72% of islands within 500 m of the nearest potential rat source had rats, but 97% of islands farther than 1,000 m away from potential rat sources were free of rats.

33 CFR 80.717 - Tybee Island, GA to St. Simons Island, GA.

Science.gov (United States)

2010-07-01

... Island. (j) An east-west line from the southernmost extremity of Sea Island across Goulds Inlet to St... Tybee Island 255° true across Tybee Inlet to the shore of Little Tybee Island south of the entrance to... shoreline across Cabretta Inlet. (g) A north-south line (longitude 81°16.9′ W.) drawn from the south...

Energy Transition Initiative: Island Energy Snapshot - U.S. Virgin Islands (Fact Sheet)

Energy Technology Data Exchange (ETDEWEB)

2015-03-01

This profile provides a snapshot of the energy landscape of the U.S. Virgin Islands (USVI) - St. Thomas, St. John, and St. Croix. The Virgin Islands archipelago makes up the northern portion of the Lesser Antilles and the western island group of the Leeward Islands, forming the border between the Atlantic Ocean and the Caribbean Sea.

Reconstruction of large upper eyelid defects with a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft

DEFF Research Database (Denmark)

Toft, Peter B

2016-01-01

skin graft. RESULTS: All patients healed without necrosis, did not suffer from lagophthalmos, achieved reasonable cosmesis, and did not need lubricants. In one patient, a contact lens was necessary for three weeks because of corneal erosion. One patient still needs a contact lens 3 months after...... excision to avoid eye discomfort. CONCLUSION: Large upper eyelid defects can be reconstructed with a free tarsal plate graft and a laterally based myocutaneous pedicle flap in combination with a free skin graft. Two-step procedures can probably be avoided in most cases....

46 CFR 7.70 - Folly Island, SC to Hilton Head Island, SC.

Science.gov (United States)

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Folly Island, SC to Hilton Head Island, SC. 7.70 Section... BOUNDARY LINES Atlantic Coast § 7.70 Folly Island, SC to Hilton Head Island, SC. (a) A line drawn from the...′ W. (Port Royal Sound Lighted Whistle Buoy “2PR”); thence to the easternmost extremity of Hilton Head...

Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging

Science.gov (United States)

Elmi-Terander, Adrian; Skulason, Halldor; Söderman, Michael; Racadio, John; Homan, Robert; Babic, Drazenko; van der Vaart, Nijs; Nachabe, Rami

2016-01-01

Study Design. A cadaveric laboratory study. Objective. The aim of this study was to assess the feasibility and accuracy of thoracic pedicle screw placement using augmented reality surgical navigation (ARSN). Summary of Background Data. Recent advances in spinal navigation have shown improved accuracy in lumbosacral pedicle screw placement but limited benefits in the thoracic spine. 3D intraoperative imaging and instrument navigation may allow improved accuracy in pedicle screw placement, without the use of x-ray fluoroscopy, and thus opens the route to image-guided minimally invasive therapy in the thoracic spine. Methods. ARSN encompasses a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Two neurosurgeons placed 94 pedicle screws in the thoracic spine of four cadavers using ARSN on one side of the spine (47 screws) and free-hand technique on the contralateral side. X-ray fluoroscopy was not used for either technique. Four independent reviewers assessed the postoperative scans, using the Gertzbein grading. Morphometric measurements of the pedicles axial and sagittal widths and angles, as well as the vertebrae axial and sagittal rotations were performed to identify risk factors for breaches. Results. ARSN was feasible and superior to free-hand technique with respect to overall accuracy (85% vs. 64%, P dimensions, except for vertebral body axial rotation, were risk factors for larger breaches when performed with the free-hand method. Conclusion. ARSN without fluoroscopy was feasible and demonstrated higher accuracy than free-hand technique for thoracic pedicle screw placement. Level of Evidence: N/A PMID:27513166

Postoperative Radiculopathy Caused by a Retained Fractured Pedicle Cannulation Probe and Its Mechanism of Extraction.

Science.gov (United States)

Yuk, Frank; Steinberger, Jeremy; Skovrlj, Branko; Mascitelli, Justin; Cho, Samuel K; Caridi, John M

2017-11-01

Spine surgery relies heavily on technology and surgical instrumentation. Improperly used instrumentation can be detrimental to the patient. Despite multiple checkpoints to ensure that foreign bodies are not retained in surgery, numerous case reports have described retained foreign bodies; however, none of these cases involve retained instrumentation after open spine surgery. Of the retained objects, 4 were sponges and one was a Jamshidi needle fragment. Although smaller objects are more commonly the culprits, surgical instruments can break off, remain stuck, and cause clinical sequelae. This case presents a retained fractured pedicle finder as the cause of right L5 radiculopathy. To our knowledge, this report is the first to describe an instrumentation-associated postoperative radiculopathy. Because of the strength with which the object was impacted, its extraction proved difficult. The technique of removal using a mallet and osteotome in 4 directions to loosen its hold in the vertebral body. Attempts and eventual successful removal are described. Copyright © 2017 Elsevier Inc. All rights reserved.

Burlington Northern Taconite Transshipment Facility, Duluth-Superior Harbor, Superior Wisconsin. Environmental Assessment Report.

Science.gov (United States)

1975-03-01

the Federal Government declared the Duluth- Superior area to be economically depressed . The reason given was the "consistant and chronic unemployment...include dogwood, sumac, arrowwood, blueberry, highbush cranberry , elderberry, wild grape, buttonbrush, snowberry and partridgeberry. Aquatic and...water for the proposed greenbelt areas and as dust sup- pression spray. 10.003 The depressed economy of the Duluth-Superior area would benefit by the

A Rare Case of Giant Basal Cell Carcinoma of the Abdominal Wall: Excision and Immediate Reconstruction with a Pedicled Deep Inferior Epigastric Artery Perforator (DIEP) Flap.

Science.gov (United States)

Di Lorenzo, Sara; Zabbia, Giovanni; Corradino, Bartolo; Tripoli, Massimiliano; Pirrello, Roberto; Cordova, Adriana

2017-12-04

BACKGROUND Basal cell carcinoma (BCC) greater than 5 cm in diameter is called giant basal cell carcinoma (GBCC), or super giant basal cell carcinoma if it has a diameter larger than 20 cm. Giant BCC only accounts for 0.5% of BCCs and super giant BCC is exceedingly rare. On account of their rarity, there are no established guidelines for GBCC treatment. CASE REPORT We describe a peculiar case of an 82-year-old woman with a GBCC carcinoma of the lower abdominal wall. The tumor was surgically removed with ipsilateral inguinal lymph nodes and the abdominal wall was reconstructed immediately with a pedicled deep inferior epigastric artery perforator (DIEP) flap. CONCLUSIONS Treatment of giant basal cell carcinoma is often difficult, especially in elderly patients with poor general health and multiple pathologies. The pedicled DIEP flap is rotated to cover the loss of substance without tension, and it is easy to harvest and transfer. This flap allowed a good result without local or systemic complication. We present this report as a reminder of the occasional occurrence of extremely aggressive BCCs. We believe that, especially for rare tumors like these, it is very useful for the entire scientific community to publish these cases and the therapeutic strategies used to treat them.

[Pedicle flap transfer combined with external fixator to treat leg open fracture with soft tissue defect].

Science.gov (United States)

Luo, Zhongchun; Lou, Hua; Jiang, Junwei; Song, Chunlin; Gong, Min; Wang, Yongcai

2008-08-01

To investigate the clinical results of treating leg open fracture with soft tissue defect by pedicle flap transfer in combination with external fixator. From May 2004 to June 2007, 12 cases of leg open fracture with soft tissue defect, 9 males and 3 females aged 18-75 years, were treated. Among them, 8 cases were caused by traffic accidents, 2 crush, 1 falling and 1 mechanical accident. According to the Gustilo Classification, there were 2 cases of type II, 5 of type IIIA and 5 of type IIIB. There were 2 cases of upper-tibia fracture, 3 of middle-tibia and 7 of middle-lower. The sizes of soft tissue defect ranged from 5 cm x 3 cm to 22 cm x 10 cm.The sizes of exposed bone ranged from 3 cm x 2 cm to 6 cm x 3 cm. The course of the disease was 1-12 hours. Fracture fixation was reached by external fixators or external fixators and limited internal fixation with Kirschner wire. The wounds with exposed tendons and bones were repaired by ipsilateral local rotation flap, sural neurocutaneous flap and saphenous nerve flap. The size of selected flap ranged from 5 cm x 4 cm to 18 cm x 12 cm. Granulation wounds were repaired by skin grafting or direct suture. All patients were followed up for 6 months to 2 years. All patients survived, among whom 2 with the wound edge infection and 1 with the distal necrosis were cured by changing the dressing, 8 with pin hole infection were treated by taking out the external fixator, 1 with nonunion received fracture healing after bone graft in comminuted fracture of lower tibia, 2 suffered delayed union in middle-lower tibia fracture. The ROM of ankle in 3 cases was mildly poor with surpass-joint fixation, with plantar extension of 0-10 degrees and plantar flexion of 10-30 degrees, while the others had plantar extension of 10-20 degrees and plantar flexion of 30-50 degrees. The method of pedicle flap transfer combined with external fixator is safe and effective for the leg open fracture with soft tissue defect.

Superior oblique luxation and trochlear luxation as new concepts in superior oblique muscle weakening surgery

NARCIS (Netherlands)

Mombaerts, I.; Koornneef, L.; Everhard-Halm, Y. S.; Hughes, D. S.; Maillette de Buy Wenniger-Prick, L. J.

1995-01-01

We used superior oblique luxation and trochlear luxation as new surgical procedures to treat acquired Brown's syndrome and superior oblique muscle overaction. We studied nine patients (11 eyes) who underwent trochlear surgery between 1988 and 1993. Four patients had acquired Brown's syndrome and

Rhode Island unemployment

OpenAIRE

Leonard Lardaro

2010-01-01

How can a state like Rhode Island have such a high unemployment rate? This question has been asked often over the past year, especially since at one point, Rhode Island found itself with the dubious distinction of having the highest unemployment rate in the United States. Following that extreme, Rhode Island seemed to settle into a niche where its rank was third nationally.

Combined anterior C2-C3 fusion and C2 pedicle screw fixation for the treatment of unstable hangman's fracture: a contrast to anterior approach only.

Science.gov (United States)

Xie, Ning; Khoo, Larry T; Yuan, Wen; Ye, Xiao-Jian; Chen, De-Yu; Xiao, Jian-Ru; Ni, Bin

2010-03-15

A retrospective clinical study was used to evaluate the effect of a new surgical treatment of the hangman's fractures. To determine the treatment efficacy of combined anterior C2-C3 reduction and fusion and posterior compressive C2 pedicle screw fixation for the management of unstable hangman's fractures. The classification of hangman's fractures as proposed by Levine-Edwards was used to classify and guide the treatment of these injuries. Most of these fractures respond to a variety of conservative therapies, but recently, earlier surgery has been increasingly advocated by authors from several countries for the rapid stabilization of these fractures. If surgery is indicated, an anterior approach using a C2-C3 reduction and fusion is preferred usually. Another well-accepted surgical method is the direct transpedicular osteosynthesis by the dorsal approach. However, there was rare report of the combined use of these 2 techniques. A group of 45 surgical patients were all diagnosed with radiograph, magnetic resonance imaging (MRI), and 3D CT scans. Initial and final radiographs were measured for anterior translation and angulation of the C2-C3 complex. Initial external skull traction with extension was used in all patients after admission to reduce the fracture. Then an anterior C2-C3 discectomy followed by an interbody fusion and locking plate fixation was performed. Intraoperative reduction was confirmed by fluoroscopic control. About 29 patients therefore received anterior surgeries only since satisfactory reduction was achieved during the procedure. For the 16 patients who had persistent large residual gaps after the anterior procedure, additional same stage posterior C2 compressive pedicle screws were placed. Clinical and radiologic comparisons were performed in these 2 groups. The follow-up ranged from 24 to 54 months, with an average 33.6 months. There was radiographic evidence of continuity of the fracture and the bone graft seen at 4.7 months on average. Neck

Coastal management strategy for small island: ecotourism potency development in Karimata Island, West Kalimantan

Science.gov (United States)

Rudiastuti, A. W.; Munawaroh; Setyawan, I. E.; Pramono, G. H.

2018-04-01

Sustainable coastal management is playing an important role in coastal resources conservation, particularly on small islands. Karimata archipelago has unique characteristics and great potential to be developed as a tourism object, one of which is Karimata Island as the largest island and also reserve area. The concept of ecotourism focuses on the ecology conservation, economic benefits, and social life. Ecotourism aims to build sustainable tourism that provides economically viable and social benefits to the community. This study aims to develop coastal management strategy based on ecotourism at Karimata Island. Spatial approaching through coastal type was done. Qualitative descriptive analysis and SWOT are used to develop sustainable management strategies for the coast of Karimata Island, where the opportunities and challenges to the development of coastal ecotourism Karimata Island also included. If this potential is optimally utilized, it can be relied as an economic opportunity for local communities. Structurally shaped coast, marine depositional coast and coast build by organism are several of coastal types found at Karimata Island. Coastal ecosystems inhabited Karimata Island are mangroves, coral reefs, and macro-algae. Karimata Island have not been optimally utilized for tourist destinations. The biggest obstacle encountered is the accessibility from Kalimantan or other island at Karimata islands. Several problems related to the utilization of coastal resources were found such as mangrove and coral reef damage, also regulation that less supportive. The results of this study are expected to provide an overview of solutions for the development of coastal tourism potentials in Karimata Island.

Selection of Fusion Levels Using the Fulcrum Bending Radiograph for the Management of Adolescent Idiopathic Scoliosis Patients with Alternate Level Pedicle Screw Strategy: Clinical Decision-making and Outcomes.

Science.gov (United States)

Samartzis, Dino; Leung, Yee; Shigematsu, Hideki; Natarajan, Deepa; Stokes, Oliver; Mak, Kin-Cheung; Yao, Guanfeng; Luk, Keith D K; Cheung, Kenneth M C

2015-01-01

Selecting fusion levels based on the Luk et al criteria for operative management of thoracic adolescent idiopathic scoliosis (AIS) with hook and hybrid systems yields acceptable curve correction and balance parameters; however, it is unknown whether utilizing a purely pedicle screw strategy is effective. Utilizing the fulcrum bending radiographic (FBR) to assess curve flexibility to select fusion levels, the following study assessed the efficacy of pedicle screw fixation with alternate level screw strategy (ALSS) for thoracic AIS. A retrospective study with prospective radiographic data collection/analyses (preoperative, postoperative 1-week and minimum 2-year follow-up) of 28 operative thoracic AIS patients undergoing ALSS was performed. Standing coronal/sagittal and FBR Cobb angles, FBR flexibility, fulcrum bending correction index (FBCI), trunkal shift, radiographic shoulder height (RSH), and list were assessed on x-rays. Fusion level selection was based on the Luk et al criteria and compared to conventional techniques. In the primary curve, the mean preoperative and postoperative 1 week and last follow-up standing coronal Cobb angles were 59.9, 17.2 and 20.0 degrees, respectively. Eighteen patients (64.3%) had distal levels saved (mean: 1.6 levels) in comparison to conventional techniques. Mean immediate and last follow-up FBCIs were 122.6% and 115.0%, respectively. Sagittal alignment did not statistically differ between any assessment intervals (p>0.05). A decrease in trunkal shift was noted from preoperative to last follow-up (p = 0.003). No statistically significant difference from preoperative to last follow-up was noted in RSH and list (p>0.05). No "add-on" of other vertebra or decompensation was noted and all patients achieved fusion. This is the first report to note that using the FBR for decision-making in selecting fusion levels in thoracic AIS patients undergoing management with pedicle screw constructs (e.g. ALSS) is a cost-effective strategy that

Self-sustained magnetic islands

Energy Technology Data Exchange (ETDEWEB)

Chatenet, J H; Luciani, J F [Ecole Polytechnique, 91 - Palaiseau (France); Garbet, X [Association Euratom-CEA, Centre d` Etudes de Cadarache, 13 - Saint-Paul-lez-Durance (France). Dept. de Recherches sur la Fusion Controlee

1996-06-01

Numerical simulations of a single magnetic island evolution are presented in the regime where the island width is smaller than an ion Larmor radius. It is shown that the island rotation is controlled by particle diffusion due to collisions or a background of microturbulence. As expected from the theory of a stationary island, there exist cases where linearly stable magnetic perturbation are nonlinearly self-sustained. This situation corresponds to large poloidal beta and temperature gradient. The drive is due to diamagnetic frequency effects. However, this situation is not generic, and islands can also decay. It is found that a magnetic island is self-sustained for a negative off-diagonal diffusion coefficient. This case occurs in a tokamak if the inward particle pinch is due to the temperature gradient. (author). 30 refs.

Self-sustained magnetic islands

International Nuclear Information System (INIS)

Chatenet, J.H.; Luciani, J.F.; Garbet, X.

1996-06-01

Numerical simulations of a single magnetic island evolution are presented in the regime where the island width is smaller than an ion Larmor radius. It is shown that the island rotation is controlled by particle diffusion due to collisions or a background of microturbulence. As expected from the theory of a stationary island, there exist cases where linearly stable magnetic perturbation are nonlinearly self-sustained. This situation corresponds to large poloidal beta and temperature gradient. The drive is due to diamagnetic frequency effects. However, this situation is not generic, and islands can also decay. It is found that a magnetic island is self-sustained for a negative off-diagonal diffusion coefficient. This case occurs in a tokamak if the inward particle pinch is due to the temperature gradient. (author)

[The shor-term clinical outcomes and safety of extreme lateral interbody fusion combined with percutaneous pedicle screw fixation for the treatment of degenerative lumbar disease].

Science.gov (United States)

Hu, Xu-Dong; Ma, Wei-Hu; Jiang, Wei-Yu; Ruan, Chao-Yue; Chen, Yun-Lin

2017-02-25

To evaluate the early efficacy and safety of extreme lateral interbody fusion (XLIF) combined with percutaneous pedicle screw fixation for lumbar degenerative disease. From January 2013 to June 2014, 13 patients with degenerative lumbar disease were treated with XLIF combined with percutaneous pedicle screw fixation, including 8 cases of lumbar instability, 5 cases of mild to moderate lumbar spondylolisthesis;there were 5 males and 8 females, aged from 56 to 73 years with an average of 62.1 years. All patients were single segment fusion. Operation time, perioperative bleeding and perioperative complications were recorded. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy. Interbody fusion rate was observed and the intervertebral foramen area changes were compared preoperation and postoperation by X-rays and CT scanning. The mean operation time and perioperative bleeding in the patients respectively was(62.8±5.2) min and(82.5±22.6) ml. One case occurred in the numbness of femoribus internus and 1 case occurred in the muscle weakness of hip flexion after operation, both of them recovered within 2 weeks. All the patients were followed up from 12 to 19 months with an average of 15.6 months. VAS was decreased from preoperative 7.31±0.75 to 2.31±0.75 at final follow-up( P degenerative disease.

Biomechanical evaluation of bending strength of spinal pedicle screws, including cylindrical, conical, dual core and double dual core designs using numerical simulations and mechanical tests.

Science.gov (United States)

Amaritsakul, Yongyut; Chao, Ching-Kong; Lin, Jinn

2014-09-01

Pedicle screws are used for treating several types of spinal injuries. Although several commercial versions are presently available, they are mostly either fully cylindrical or fully conical. In this study, the bending strengths of seven types of commercial pedicle screws and a newly designed double dual core screw were evaluated by finite element analyses and biomechanical tests. All the screws had an outer diameter of 7 mm, and the biomechanical test consisted of a cantilever bending test in which a vertical point load was applied using a level arm of 45 mm. The boundary and loading conditions of the biomechanical tests were applied to the model used for the finite element analyses. The results showed that only the conical screws with fixed outer diameter and the new double dual core screw could withstand 1,000,000 cycles of a 50-500 N cyclic load. The new screw, however, exhibited lower stiffness than the conical screw, indicating that it could afford patients more flexible movements. Moreover, the new screw produced a level of stability comparable to that of the conical screw, and it was also significantly stronger than the other screws. The finite element analysis further revealed that the point of maximum tensile stress in the screw model was comparable to the point at which fracture occurred during the fatigue test. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

Alternate superior Julia sets

International Nuclear Information System (INIS)

Yadav, Anju; Rani, Mamta

2015-01-01

Alternate Julia sets have been studied in Picard iterative procedures. The purpose of this paper is to study the quadratic and cubic maps using superior iterates to obtain Julia sets with different alternate structures. Analytically, graphically and computationally it has been shown that alternate superior Julia sets can be connected, disconnected and totally disconnected, and also fattier than the corresponding alternate Julia sets. A few examples have been studied by applying different type of alternate structures

Reliving Island Life: Staging Stories of the Blasket Islands

Directory of Open Access Journals (Sweden)

Daithí Kearney

2017-10-01

Full Text Available The Blasket Islands are located off the south-west coast of Ireland. No longer inhabited, the Great Blasket Island and its distinctive culture have been documented by a variety of writers and are celebrated today in an interpretative centre on the mainland and in performances by Siamsa Tíre, The National Folk Theatre of Ireland. “Siamsa” developed from local initiatives in North Kerry during the early 1960s and is located today in Tralee, Co. Kerry. It aims to present Irish folklore and folk culture through the medium of theatre involving music, song, dance and mime but invariably no dialogue. In this paper, I focus on the production Oiléan, based loosely on the stories of the Blasket Islanders, which was initially devised as part of the fiftieth anniversary commemoration of the departure of the last inhabitants of the islands in 2003.

46 CFR 7.85 - St. Simons Island, GA to Little Talbot Island, FL.

Science.gov (United States)

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false St. Simons Island, GA to Little Talbot Island, FL. 7.85... BOUNDARY LINES Atlantic Coast § 7.85 St. Simons Island, GA to Little Talbot Island, FL. (a) A line drawn from latitude 31°04.1′ N. longitude 81°16.7′ W. (St. Simons Lighted Whistle Buoy “ST S”) to latitude 30...

MORPHOMETRY OF THE PEDICLE OF FIRST SACRAL VERTEBRAE AND ITS APPLICATION IN POSTERIOR TRANSPEDICULAR SCREW FIXATION. Morfometría del pedículo de la primera vértebra sacra y su aplicación en la fijación posterior con tornillo transpedicular

Directory of Open Access Journals (Sweden)

Mangala M Pai

2016-03-01

Full Text Available Los objetivos del presente estudio fueron determinar los parámetros anatómicos del pedículo S1 en la población India del sur para comparar los datos con respecto a los géneros masculinos y femeninos. El estudio incluyó 50 sacros secos (25 hombres y 25 mujeres que se obtuvieron en el laboratorio de anatomía de nuestra institución. En el presente estudio se observa que la longitud media del pedículo S1 fue 49.9± 3,6 mm para los hombres y 46.3± 4,8 mm para las mujeres. La altura céfalo-caudal del pedículo S1 fue 27.2±4.0 mm y 23.9±3.7 mm para el varón y la hembra respectivamente. La anchura antero-posterior del pedículo S1 fue 7.5± 1,3 mm, 7.5± 1.7 mm en varones y mujeres, respectivamente. La distancia antero-posterior de S1, desde el promontorio sacro a la apófisis espinosa de S1 fue 52.9± 5.2 mm y 50.4± 6.8 mm en los géneros masculino y femenino respectivamente. El presente estudio demostró que la longitud y la altura de céfalo-caudal eran más altos (p0.05 en varones que en mujeres. Los datos de mujeres y varones con respecto a la anchura antero-posterior y la distancia antero-posterior de S1 no eran estadísticamente diferentes. El presente estudio ha proporcionado datos morfométricos importantes del pedículo de la primera vértebra sacra de la muestra anatómica de la población India del sur. El conocimiento de los diámetros del pedículo de S1 es crucial para la colocación segura de tornillos para la fijación transpedicular posterior. Objectives of the present study were to determine the anatomical parameters of the S1 pedicle in South Indian population and to compare the data, with respect to male and female genders. The stud­­y included 50 dry sacra (25 male and 25 female, which were obtained from the anatomy laboratory of our institution. It is observed in the present study that the mean S1 pedicle length was 49.9± 3.6 mm for male and 46.3± 4.8 mm for the female. The cephalocaudal heights of S1 pedicle

Adaptive radiation of island plants: Evidence from Aeonium (Crassulaceae) of the Canary Islands

DEFF Research Database (Denmark)

Jorgensen, T.H.; Olesen, J.M.

2001-01-01

evidence that such traits have been acquired through convergent evolution on islands comes from molecular phylogenies; however, direct evidence of their selective value rarely is obtained. The importance of hybridization in the evolution of island plants is also considered as part of a more general......The presence of diverse and species-rich plant lineages on oceanic islands is most often associated with adaptive radiation. Here we discuss the possible adaptive significance of some of the most prominent traits in island plants, including woodiness, monocarpy and sexual dimorphisms. Indirect...... discussion of the mechanisms governing radiations on islands. Most examples are from the Hawaiian and Canarian floras, and in particular from studies on the morphological, ecological and molecular diversification of the genus Aeonium, the largest plant radiation of the Canarian Islands....

Heron Island, Australia

Science.gov (United States)

2002-01-01

Heron Island is located at the sourthern end of Australia's 2,050 km-long Great Barrier Reef. Surrounded by coral reef and home to over 1000 species of fish, scuba divers and scientists alike are drawn to the island's resort and research station. The true-color image above was taken by Space Imaging's Ikonos satellite with a resolution of 4 meters per pixel-high enough to see individual boats tied up at the small marina. The narrow channel leading from the marina to the ocean was blasted and dredged decades ago, before the island became a national park. Since then the Australian government has implemented conservation measures, such as limiting the number of tourists and removing or recycling, instead of incinerating, all trash. One of the applications of remote sensing data from Ikonos is environmental monitoring, including studies of coral reef health. For more information about the island, read Heron Island. Image by Robert Simmon, based on data copyright Space Imaging

Formation and adjustment of typhoon-impacted reef islands interpreted from remote imagery: Nadikdik Atoll, Marshall Islands

Science.gov (United States)

Ford, Murray R.; Kench, Paul S.

2014-06-01

In 1905, a devastating typhoon hit Nadikdik Atoll (5°54‧ N and 172°09‧ E) in the southern Marshall Islands. Evidence suggests that large sections of reef islands on Nadikdik were overwashed and destroyed. Comparison of aerial photographs taken in 1945 and modern satellite imagery provides a unique record of the geomorphic adjustment of islands after the typhoon. Between 1945 and 2010 the vegetated area of islands on Nadikdik grew from 0.74 to 0.90 km2. Observed changes to Nadikdik reef islands manifested through a range of styles and were largely accretionary. Of note, the formation of a new island was tracked from an embryonic deposit to a fully vegetated and stable island over a 61 year period. Similarly, a number of previously discrete islands have agglomerated and formed a single larger island. These changes were rapid and indicate that reef island formation can occur quickly. Evidence suggests that despite the typhoon occurring over a century ago the geomorphic adjustment of islands is still on-going.

Bryophytes from Simeonof Island in the Shumagin Islands, southwestern Alaska

Science.gov (United States)

Schofield, W.B.; Talbot, S. S.; Talbot, S.L.

2004-01-01

Simeonof Island is located south of the Alaska Peninsula in the hyperoceanic sector of the middle boreal subzone. We examined the bryoflora of Simeonof Island to determine species composition in an area where no previous collections had been reported. This field study was conducted in sites selected to represent the spectrum of environmental variation within Simeonof Island. Data were analyzed using published reports to compare bryophyte distribution patterns at three levels, the Northern Hemisphere, North America, and Alaska. A total of 271 bryophytes were identified: 202 mosses and 69 liverworts. The annotated list of species for Simeonof Island expands the known range for many species and fills distribution gaps within Hulte??n's Western Pacific Coast district. Maps and notes on the distribution of 14 significant distribution records are presented. Compared with bryophyte distribution in the Northern Hemisphere, the bryoflora of Simeonof Island primarily includes taxa of boreal (55%), temperate (20%), arctic (10%), and cosmopolitan (8%) distribution; 6% of the moss flora are western North America endemics. A description of the bryophytes present in the vegetation and habitat types is provided as is a quantitative analysis of the most frequently occurring bryophytes in crowberry heath.

On the form of species–area relationships in habitat islands and true islands

DEFF Research Database (Denmark)

Matthews, Thomas J.; Guilhaumon, François; Triantis, Kostas A.

2016-01-01

and c vary between different island types. Location: Global. Methods: We used an information theoretic approach to compare the fit of 20 ISAR models to 207 habitat island datasets. Model performance was ranked according to pre-set criteria, including metrics of generality and efficiency. We also fitted......, and was the highest ranked model overall. In general, the more complex models performed badly. Average z-values were significantly lower for habitat island datasets than for true islands, and were higher for mountaintop and urban habitat islands than for other habitat island types. Average c-values were significantly...... multimodel comparisons demonstrated the nonlinear implementation of the power model to be the best overall model and thus to be a sensible choice for general use. As the z-value of the log–log power model varied in relation to ecological and geographical properties of the study systems, caution should...

Island formation without attractive interaction

NARCIS (Netherlands)

Jansen, A.P.J.

2008-01-01

We show that adsorbates on surfaces can form islands even if there are no attractive interactions. Instead, strong repulsion between adsorbates at short distances can lead to islands, because such islands increase the entropy of the adsorbates that are not part of the islands. We suggest that this

Superior Hiking Trail

Data.gov (United States)

Minnesota Department of Natural Resources — Superior Hiking Trail main trail, spurs, and camp spurs for completed trail throughout Cook, Lake, St. Louis and Carlton counties. These data were collected with...

Tales of island tails

NARCIS (Netherlands)

Groot, de Alma V.; Oost, Albert P.; Veeneklaas, Roos M.; Lammerts, Evert Jan; Duin, van Willem E.; Wesenbeeck, van Bregje K.

2016-01-01

The Frisian islands (Southern North Sea) have extensive island tails, i.e. the entire downdrift side of an island consisting of salt marshes, dunes, beaches and beach plains, and green beaches. Currently, large parts of these tails are ageing and losing dynamics, partly due to human influence.

Energy Self-Sufficient Island

International Nuclear Information System (INIS)

Bratic, S.; Krajacic, G.; Duic, N.; Cotar, A.; Jardas, D.

2011-01-01

In order to analyze energy self-sufficient island, example of a smaller island, connected to the power system of a bigger island with an undersea cable, was taken. Mounting substation 10/0,4 is situated on the island and for the moment it provides enough electricity using the medium voltage line. It is assumed that the island is situated on the north part of the Adriatic Sea. The most important problem that occurs on the island is the population drop that occurs for a significant number of years, therefore, life standard needs to be improved, and economic development needs to be encouraged immediately. Local authorities to stimulate sustainable development on the island through different projects, to breath in a new life to the island, open new jobs and attract new people to come live there. Because of the planned development and increase of the population, energy projects, planned as a support to sustainable development, and later achievement of the energy self-sufficiency, is described in this paper. Therefore, Rewisland methodology appliance is described taking into the account three possible scenarios of energy development. Each scenario is calculated until year 2030. Also, what is taken into the account is 100% usage of renewable sources of energy in 2030. Scenario PTV, PP, EE - This scenario includes installation of solar photovoltaic modules and solar thermal collectors on the buildings roofs, as well as well as implementation of energy efficiency on the island (replacement of the street light bulbs with LED lightning, replacement of the old windows and doors on the houses, as well as the installation of the thermal insulation). Scenario PV island - This scenario, similarly to the previous one, includes installation of solar photovoltaic modules and solar thermal collectors an the residential buildings, as well as the 2 MW photovoltaic power plant and ''Green Hotel'', a building that satisfies all of its energy needs completely from renewable energy sources

One million served: Rhode Island`s recycling facility

Energy Technology Data Exchange (ETDEWEB)

Malloy, M.G.

1997-11-01

Rhode Island`s landfill and adjacent materials recovery facility (MRF) in Johnston, both owned by the quasi-public Rhode Island Resource Recovery Corp. (RIRRC, Johnston), serve the entire state. The $12-million recycling facility was built in 1989 next to the state`s sole landfill, the Central Landfill, which accepts only in-state trash. The MRF is operated for RIRRC by New England CRInc. (Hampton, N.H.), a unit of Waste Management, Inc. (WMI, Oak Brook, Ill.). It handles a wide variety of materials, from the usual newspaper, cardboard, and mixed containers to new streams such as wood waste, scrap metal, aseptic packaging (milk and juice boxes), and even textiles. State municipalities are in the process of adding many of these new recyclable streams into their curbside collection programs, all of which feed the facility.

Immigrants, islandness and perceptions of quality-of-life on Prince Edward Island, Canada

Directory of Open Access Journals (Sweden)

Peter Kitchen

2014-11-01

Full Text Available This paper explores perceptions of immigrant quality-of-life (QOL and islandness in Charlottetown, Prince Edward Island, Canada, and compares these perceptions to those of Canadian-born residents of the same provincial capital. The study employed a mixed-methods approach, including a household telephone survey conducted in the summer of 2012 (n=302, focus group interviews with immigrants in late 2012 and observations on preliminary results by the staff of the PEI Association of Newcomers to Canada (PEIANC, the primary immigrant settlement service agency on the island. The analysis of the results suggests that immigrants have a high and undifferentiated assessment of their own QOL, sense of belonging and sense of place compared to Canadian-born islanders; immigrants are also critical of the quality of education and of the range of recreational and cultural events underway on the Island. While they express positive sentiments regarding life on the Island, immigrants still feel excluded from social and economic opportunities.

Fournier?s gangrene - delayed pedicle flap based upon the anterior abdominal wall

Directory of Open Access Journals (Sweden)

Ania Sliwinski

2014-06-01

Full Text Available Introduction Fournier’s gangrene is a poly-microbial necrotizing fasciitis that involves the perineum and/or external genitalia. Urgent surgical debridement is well recognized as essential acute treatment yet unique challenges arise for plastic surgical reconstruction to obtain a complete functional recovery. This case describes a successful delayed pedicle flap repair based upon the anterior abdominal wall. Case description A 24 year old man was admitted to ICU ten days after elective circumcision with Fournier’s gangrene. He underwent a number of surgical debridements, and was referred for plastic surgical management. He had penile reconstruction using a random pattern abdominal flap, which was performed as a three stage procedure including flap vascular delay technique. Discussion Perineal and penile skin loss can be significant and is difficult to repair. Various techniques have been used to reconstruct lost tissue: skin grafts, transposition of the testes and spermatic cords to the thigh, flaps, and other types of pediculated myocutaneous flaps. Muscle flap reconstruction provides an environment that allows for complete regeneration of the urethral epithelium but is bulky and unsightly. Skin grafts contract and may produce painful and dysfunctional reconstructions. This novel technique produces a functional, and aesthetic reconstruction. Conclusion Penile skin recovery following Fournier’s gangrene recovery is problematic. This case demonstrates the functionality of a delayed flap repair using the anterior abdominal wall.

Pathogenicity island mobility and gene content.

Energy Technology Data Exchange (ETDEWEB)

Williams, Kelly Porter

2013-10-01

Key goals towards national biosecurity include methods for analyzing pathogens, predicting their emergence, and developing countermeasures. These goals are served by studying bacterial genes that promote pathogenicity and the pathogenicity islands that mobilize them. Cyberinfrastructure promoting an island database advances this field and enables deeper bioinformatic analysis that may identify novel pathogenicity genes. New automated methods and rich visualizations were developed for identifying pathogenicity islands, based on the principle that islands occur sporadically among closely related strains. The chromosomally-ordered pan-genome organizes all genes from a clade of strains; gaps in this visualization indicate islands, and decorations of the gene matrix facilitate exploration of island gene functions. A %E2%80%9Clearned phyloblocks%E2%80%9D method was developed for automated island identification, that trains on the phylogenetic patterns of islands identified by other methods. Learned phyloblocks better defined termini of previously identified islands in multidrug-resistant Klebsiella pneumoniae ATCC BAA-2146, and found its only antibiotic resistance island.

First record of the mycoheterotrophic orchid Gastrodia fontinalis (Orchidaceae from Takeshima Island, the Ryukyu Islands, Japan

Directory of Open Access Journals (Sweden)

Kenji Suetsugu

2014-12-01

Full Text Available We found Gastrodia fontinalis T. P. Lin in a bamboo forest from Takeshima Island, which is the northernmost island of the Ryukyu Islands in Japan. This species is apparently rare and was previously considered to be an endemic Taiwanese species. Because there are a few minor differences between the original description and our specimens collected in Takeshima Island, here we report Gastrodia fontinalis from Takeshima Island as the first record outside of Taiwan, with a description of the specimens from Takeshima Island.

Renewable energy islands in Europe

Energy Technology Data Exchange (ETDEWEB)

Oestergaard, Iben [ed.

1998-12-31

This publication includes a compiled presentation of various aspects concerning the possible transformation of some European islands into renewable energy communities and these projects were presented by a selection of pioneer islands at the first European Seminar on Renewable Energy Islands, held on the Danish island of Samsoee, 29-30 June 1998. This issue has increased in importance with the presentation of the ambitious EU-White Paper: `Energy for the future: Renewable Sources of Energy` which was adopted in 1998. One of the key elements of the strategy for an accelerated implementation of renewable energy is to transform 100 localities within Europe into communities which are to be 100% self-sufficient with renewable energy before 2010. In line with this strategy, the Danish Government appointed the island of Samsoe towards the end of 1997 to be the first `official` Danish, renewable energy island. This is to serve as a demonstration project for other local communities, both in Denmark as well as in the rest Europe. Gothland, Madeira, Canary Islands, Cape Verde, Arki, Crete, Minorca and Orkney Islands were represented. Environmental advantages of wind, solar and wave power for distant island communities were indicated. Serious savings would be achieved by limitation of fossil fuel import and utilization of local resources. (EG)

Pullout characteristics of percutaneous pedicle screws with different cement augmentation methods in elderly spines: An in vitro biomechanical study.

Science.gov (United States)

Charles, Y P; Pelletier, H; Hydier, P; Schuller, S; Garnon, J; Sauleau, E A; Steib, J-P; Clavert, P

2015-05-01

Vertebroplasty prefilling or fenestrated pedicle screw augmentation can be used to enhance pullout resistance in elderly patients. It is not clear which method offers the most reliable fixation strength if axial pullout and a bending moment is applied. The purpose of this study is to validate a new in vitro model aimed to reproduce a cut out mechanism of lumbar pedicle screws, to compare fixation strength in elderly spines with different cement augmentation techniques and to analyze factors that might influence the failure pattern. Six human specimens (82-100 years) were instrumented percutaneously at L2, L3 and L4 by non-augmented screws, vertebroplasty augmentation and fenestrated screws. Cement distribution (2 ml PMMA) was analyzed on CT. Vertebral endplates and the rod were oriented at 45° to the horizontal plane. The vertebral body was held by resin in a cylinder, linked to an unconstrained pivot, on which traction (10 N/s) was applied until rupture. Load-displacement curves were compared to simultaneous video recordings. Median pullout forces were 488.5 N (195-500) for non-augmented screws, 643.5 N (270-1050) for vertebroplasty augmentation and 943.5 N (750-1084) for fenestrated screws. Cement augmentation through fenestrated screws led to significantly higher rupture forces compared to non-augmented screws (P=0.0039). The pullout force after vertebroplasty was variable and linked to cement distribution. A cement bolus around the distal screw tip led to pullout forces similar to non-augmented screws. A proximal cement bolus, as it was observed in fenestrated screws, led to higher pullout resistance. This cement distribution led to vertebral body fractures prior to screw pullout. The experimental setup tended to reproduce a pullout mechanism observed on radiographs, combining axial pullout and a bending moment. Cement augmentation with fenestrated screws increased pullout resistance significantly, whereas the fixation strength with the vertebroplasty

Barrier island habitat map and vegetation survey—Dauphin Island, Alabama, 2015

Science.gov (United States)

Enwright, Nicholas M.; Borchert, Sinéad M.; Day, Richard H.; Feher, Laura C.; Osland, Michael J.; Wang, Lei; Wang, Hongqing

2017-08-04

Barrier islands are dynamic environments due to their position at the land-sea interface. Storms, waves, tides, currents, and relative sea-level rise are powerful forces that shape barrier island geomorphology and habitats (for example, beach, dune, marsh, and forest). Hurricane Katrina in 2005 and the Deep Water Horizon oil spill in 2010 are two major events that have affected habitats and natural resources on Dauphin Island, Alabama. The latter event prompted a collaborative effort between the U.S. Geological Survey, the U.S. Army Corps of Engineers, and the State of Alabama funded by the National Fish and Wildlife Foundation to investigate viable, sustainable restoration options that protect and restore the natural resources of Dauphin Island, Alabama.In order to understand the feasibility and sustainability of various restoration scenarios, it is important to understand current conditions on Dauphin Island. To further this understanding, a detailed 19-class habitat map for Dauphin Island was produced from 1-foot aerial infrared photography collected on December 4, 2015, and lidar data collected in January 2015. We also conducted a ground survey of habitat types, vegetation community structure, and elevations in November and December 2015. These products provide baseline data regarding the ecological and general geomorphological attributes of the area, which can be compared with observations from other dates for tracking changes over time.

33 CFR 80.712 - Morris Island, SC to Hilton Head Island, SC.

Science.gov (United States)

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Morris Island, SC to Hilton Head..., SC to Hilton Head Island, SC. (a) A line drawn from the easternmost tip of Folley Island to the... easternmost extremity of Hilton Head at latitude 32°13.0′ N. longitude 80°40.1′ W. [CGD 77-118a, 42 FR 35784...

Island dynamics and Minoan expansion in the Aegean: the Kythera Island Project

Directory of Open Access Journals (Sweden)

Cyprian Broodbank

1999-11-01

Full Text Available In recent years archaeologists have become increasingly interested in the investigation of island societies. At a global level, discoveries in the Pacific, Caribbean, Mediterranean and elsewhere have greatly improved our understanding of the antiquity and dynamics of island life. Now archaeologists at the Institute, together with other colleagues, have embarked on a long-term interdisciplinary study of the island of Kythera in the Aegean.

Vegetation and checklist of Inaccessible Island, central South Atlantic Ocean, with notes on Nightingale Island

Directory of Open Access Journals (Sweden)

J. P. Roux

1992-10-01

Full Text Available The physiography and climate of Inaccessible and Nightingale Islands are briefly discussed. The vegetation and the major plant associations are described. Notes are given on the ecology and distribution of each taxon. Taxa newly recorded for Inaccessible Island include Agrostis goughensis, A.holgateana, A. wacei, Calamagrostis deschampsiiformis, Carex thouarsii var.  recurvata, Conyza albida, Elaphoglossum campylolepium and  Uncinia meridensis. One species, C.  albida, is alien to the Tristan group. Two native ferns Asplenium platybasis var.  subnudum and Blechnum australe were found on Nightingale Island for the first time, and the presence of introduced Malus domestica orchards was recorded. Two unidentified taxa were found that may represent new species:  Elaphoglossum sp. at Inaccessible Island and Apium sp. at both Inaccessible and Nightingale Islands. The total number of vascular plant species recorded at Inaccessible and Nightingale Islands now stands at 98 and 43, respectively, of which 26 (28% and seven (16% are introduced species. Only Airiplex plebeja and two species of Cotula occur at Nightingale Island but are absent from Inaccessible Island.

Marshall Islands

OpenAIRE

World Bank

2015-01-01

This note aims to build understanding of the existing disaster risk financing and insurance (DRFI) tools in use in The Marshall Islands and to identify gaps where potential engagement could further develop financial resilience. The likelihood that a hazardous event will have a significant impact on the Marshall Islands has risen with the increasing levels of population and assets in the urban ...

Superior versus inferior Ahmed glaucoma valve implantation.

Science.gov (United States)

Pakravan, Mohammad; Yazdani, Shahin; Shahabi, Camelia; Yaseri, Mehdi

2009-02-01

To compare the efficacy and safety of Ahmed glaucoma valve (AGV) (New World Medical Inc., Rancho Cucamonga, CA) implantation in the superior versus inferior quadrants. Prospective parallel cohort study. A total of 106 eyes of 106 patients with refractory glaucoma. Consecutive patients with refractory glaucoma underwent AGV implantation in the superior or inferior quadrants. Main outcome measures included intraocular pressure (IOP) and rate of complications. Other outcome measures included best corrected visual acuity (BCVA), number of glaucoma medications, and success rate (defined as at least 30% IOP reduction and 5glaucoma surgery, phthisis bulbi, or loss of light perception. Of a total of 106 eyes, 58 and 48 eyes underwent AGV implantation in the superior and inferior quadrants, respectively. Baseline characteristics were comparable in the study groups, except for preoperative IOP, which was higher in the superior group (P = 0.01). Patients were followed for a mean period of 10.6+/-8.49 months and 10.58+/-6.75 months in the superior and inferior groups, respectively (P = 0.477). BCVA was comparable between the groups at all postoperative visits (P>0.122). After 1 year, statistically significant but comparable IOP reduction from baseline (Pglaucoma medications was comparable after 1 year (1.3+/-1.2 vs. 1.9+/-0.8 for superior and inferior implants, respectively, P = 0.256). Success rates were also similar at 1 year: 27 eyes (81.8%) versus 20 eyes (95.2%) for superior and inferior implants, respectively (P = 0.227). However, the overall rate of complications, such as implant exposure necessitating removal, cosmetically unappealing appearance, and endophthalmitis, was higher in the inferior group: 12 eyes (25%) versus 3 eyes (5.2%) for superior and inferior groups, respectively, (P = 0.004). Superior and inferior AGV implants have similar intermediate efficacy in terms of IOP reduction, decrease in number of glaucoma medications, and preservation of vision. However

A man and his island: The island mirror in Michael Crummey’s Sweetland

Directory of Open Access Journals (Sweden)

Laurie Brinklow

2016-05-01

Full Text Available Between 1946 and 1975, dozens of islands and outports in the Canadian province of Newfoundland and Labrador were abandoned as part of a government resettlement policy. Families and communities were torn apart, and a culture and way of life that revolved around the fishery changed irrevocably. The practice, which continues to this day, has been well documented, particularly by artists and writers. Michael Crummey’s 2014 novel Sweetland is a recent iteration. The relationship between humans and place is complex: on an island, with compressed space and a very real boundary that is the ocean, emotional attachments to one’s place are often heightened and distilled. What happens when a person is displaced from his or her island; when bonds of attachment are severed and one’s mirrored double is destroyed? Sweetland offers a fictional lens through which we see an example of a mirrored relationship between an island protagonist and his island setting. Exploring themes of attachment to place, and what Barry Lopez calls a “storied” or “reciprocal” relationship with the land, this paper examines what happens to a man when confronted with leaving an island he knows as deeply as his own body and soul; and how the island reacts.

Extending the use of the gracilis muscle flap in perineal reconstruction surgery.

Science.gov (United States)

Goldie, Stephen J; Almasharqah, Riyadh; Fogg, Quentin A; Anderson, William

2016-08-01

Reconstruction of the perineum is required following oncological resections. Plastic surgical techniques can be used to restore the aesthetics and function of the perineum. The gracilis myocutaneous flap provides a substantial skin paddle, with minimal donor site morbidity. The flap is pedicled on a perforator from the medial circumflex femoral artery, giving it limited reach across the perineum. Tunnelling the flap under the adductor longus muscle may free up more of the arterial pedicle, increasing its reach. On three female cadavers, bilateral gracilis flaps were raised in the standard surgical manner, giving six flaps in total. With the flaps pedicled across the perineum, the distance from the tip of each flap was measured to the anterior superior iliac spine (ASIS). The flaps were then tunnelled under the adductor longus muscle. The distances to the ASIS were measured again. The average pedicle length was greater than 7 cm. Tunnelling the flap under the adductor longus muscle increased the reach by more than 4 cm on average. Cadaveric dissection has shown that tunnelling of the flap in a novel way increase its reach across the perineum. This additional flexibility improves its use clinically and is of benefit to plastic surgeons operating in perineal reconstruction. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Island development: Local governance under globalization

Directory of Open Access Journals (Sweden)

Huei-Min Tsai

2014-12-01

Full Text Available Issues surrounding island development have generated a growing volume of research. What does it mean to develop? How can island communities maintain control over development processes to the benefit of the local economy, rather than seeing economic flows enter and exit the island with little or a primarily negative impact? And how important is local knowledge for edifying local governance and enhancing potentials for innovation in island development? Island histories have repeatedly been forwarded as exemplars and ‘lessons’ for global learning on (unsustainability. To consider these issues, we have selected a number of papers from among the presentations given at the International Geographical Union’s Commission on Islands Conference, Island Development: Local Economy, Culture, Innovation and Sustainability, which took place in the Penghu Archipelago, Taiwan, 1–5 October 2013. These papers serve as examples of how the processes of globalization have penetrated the borders and changed the political and economic structures of islands. They also explore how island-based innovations in science, technology, culture, and formal or informal governance might contribute to sustainable island development.

Energy Transition Initiative, Island Energy Snapshot - British Virgin Islands (Fact Sheet)

Energy Technology Data Exchange (ETDEWEB)

2015-03-01

This profile provides a snapshot of the energy landscape of the British Virgin Islands (BVI), one of three sets of the Virgin Island territories in an archipelago making up the northern portion of the Lesser Antilles.

Absent right superior caval vein in situs solitus

DEFF Research Database (Denmark)

Lytzen, Rebekka; Sundberg, Karin; Vejlstrup, Niels

2015-01-01

Introduction In up to 0.07% of the general population, the right anterior cardinal vein obliterates and the left remains open, creating an absent right superior caval vein and a persistent left superior caval vein. Absent right superior caval vein is associated with additional congenital heart...... disease in about half the patients. We wished to study the consequences of absent right superior caval vein as an incidental finding on prenatal ultrasonic malformation screening. Material and methods This is a retrospective case series study of all foetuses diagnosed with absent right superior caval vein...... no postnatal complications. All children were found to have healthy hearts at follow-up. CONCLUSIONS: In all cases, the findings proved to be a benign condition with no clinical manifestations or complications. Although isolated absent right superior caval vein does not seem to affect the outcome, associated...

Demographic Ageing on Croatian Islands

Directory of Open Access Journals (Sweden)

Ivo Nejašmić

2013-08-01

Full Text Available This paper analyses the changes in the population structure of the Croatian islands by age, warns of the degree of ageing, provides spatial differentiation of this process and presents perspective of ageing at the level of settlement. Typing of population ageing is based on scores and has seven types. The total island population in 2011 belongs to the type 5 – very old population. Almost a half of the settlements (out of 303 have been affected by the highest levels of ageing (types 6 and 7. It was found that a quarter of island settlements will become “dead villages” in a foreseeable future; most of them are on small islands but also in the interior of larger islands. These are villages decaying in every respect, in which the way of life, as we know it, veins and goes out. The present ageing villagers are their last residents in most cases. Eve¬rything suggests that demographic recovery of the islands is not possible with the forces in situ. It is important to strike a balance between the needs and opportunities in order to successfully organize life on the islands, both small and large ones, and the fact is that there is a continuing disparity, which is especially profound in small islands. A sensitive and selective approach is needed to overcome the unfavourable demographic trends. Therefore it is necessary to respect the particularities of indi¬vidual islands and island groups in devising development strategy. Solutions to the problems must come of the local and wider community in synergy with relevant professional and scientific institutions. However, if the solutions are not found or measures do not give results, if the islands are left to desorganisation and senilisation, a part of the islands will become a wasteland. With regard to the value of this area whose wealth are people in the first place, this would be an intolerable civilization decline.

The Island Smart Energy System and Market

DEFF Research Database (Denmark)

Ma, Zheng; Billanes, Joy Dalmacio; Jørgensen, Bo Nørregaard

2017-01-01

developing island smart energy systems with the integration of renewable energy resources can increase the energy supply and address the global island energy issues. The island smart energy system operates either in a single-island or in multi-islands. However the island characteristics and influ...

Terrestrial bird population trends on Aguiguan (Goat Island), Mariana Islands

Science.gov (United States)

Amidon, Fred; Camp, Richard J.; Marshall, Ann P.; Pratt, Thane K.; Williams, Laura; Radley, Paul; Cruz, Justine B.

2014-01-01

The island of Aguiguan is part of the Mariana archipelago and currently supports populations of four endemic species, including one endemic genus, Cleptornis. Bird population trends since 1982 were recently assessed on the neighbouring islands of Saipan, Tinian, and Rota indicating declines in some native species. Point-transect surveys were conducted in 2008 by the U.S. Fish and Wildlife Service to assess population densities and trends on Aguiguan. Densities for six of the nine native birds—White-throated Ground-dove Gallicolumba xanthonura, Collared Kingfisher Todiramphus chloris, Rufous Fantail Rhipidura rufifrons, Golden White-eye Cleptornis marchei, Bridled White-eye Zosterops conspicillatus and Micronesian Starling Aplonis opaca—and the non-native bird—Island Collared-dove Streptopelia bitorquata—were significantly greater in 2008 than in 1982. No differences in densities were detected among the surveys for Mariana Fruit-dove Ptilinopus roseicapilla, and Micronesian MyzomelaMyzomela rubratra. Three federally and locally listed endangered birds—Nightingale Reed-warbler Acrocephalus luscinius, Mariana Swiftlet Collocalia bartschi, and Micronesian Megapode Megapodius laperous)—were either not detected during the point-transect counts, the surveys were not appropriate for the species, or the numbers of birds detected were too small to estimate densities. The factors behind the increasing trends for some species are unknown but may be related to increased forest cover on the island since 1982. With declining trends for some native species on neighbouring islands, the increasing and stable trends on Aguiguan is good news for forest bird populations in the region, as Aguiguan populations can help support conservation efforts on other islands in the archipelago.

Morphology study of thoracic transverse processes and its significance in pedicle-rib unit screw fixation.

Science.gov (United States)

Cui, Xin-gang; Cai, Jin-fang; Sun, Jian-min; Jiang, Zhen-song

2015-03-01

Thoracic transverse process is an important anatomic structure of the spine. Several anatomic studies have investigated the adjacent structures of the thoracic transverse process. But there is still a blank on the morphology of the thoracic transverse processes. The purpose of the cadaveric study is to investigate the morphology of thoracic transverse processes and to provide morphology basis for the pedicle-rib unit (extrapedicular) screw fixation method. Forty-five adult dehydrated skeletons (T1-T10) were included in this study. The length, width, thickness, and the tilt angle (upward and backward) of the thoracic transverse process were measured. The data were then analyzed statistically. On the basis of the morphometric study, 5 fresh cadavers were used to place screws from transverse processes to the vertebral body in the thoracic spine, and then observed by the naked eye and on computed tomography scans. The lengths of thoracic transverse processes were between 16.63±1.59 and 18.10±1.95 mm; the longest was at T7, and the shortest was at T10. The widths of thoracic transverse processes were between 11.68±0.80 and 12.87±1.48 mm; the widest was at T3, and the narrowest was at T7. The thicknesses of thoracic transverse processes were between 7.86±1.24 and 10.78±1.35 mm; the thickest was at T1, and the thinnest was at T7. The upward tilt angles of thoracic transverse processes were between 24.9±3.1 and 3.0±1.56 degrees; the maximal upward tilt angle was at T1, and the minimal upward tilt angle was at T7. The upward tilt angles of T1 and T2 were obviously different from the other thoracic transverse processes (Ptransverse processes gradually increased from 24.5±2.91 degrees at T1 to 64.5±5.12 degrees at T10. The backward tilt angles were significantly different between each other, except between T5 and T6. In the validation study, screws were all placed successfully from transverse processes to the vertebrae of thoracic spine. The length, width, and

The migration of doctors and nurses from South Pacific Island Nations.

Science.gov (United States)

Brown, Richard P C; Connell, John

2004-06-01

Little is known of the structure of the international migration of skilled health professionals. Accelerated migration of doctors and nurses from the Pacific island states of Fiji, Samoa and Tonga to the Pacific periphery is part of the globalization of health care. The findings from a recent survey of 251 doctors and nurses from the three island countries are reported here. Key determinants of both present migration status and future migration intentions were analyzed using econometric methods. Nurses' and doctors' propensities to migrate are influenced by both income and non-income factors, including ownership of businesses and houses. Migrants also tend to have more close relatives overseas, to have trained there, and so experienced superior working conditions. Migration propensities vary between countries, and between nurses and doctors within countries. Tongan nurses have a higher propensity to migrate, mainly because of greater relative earnings differentials, but are also more likely to return home. The role of kinship ties, relative income differentials and working conditions is evident in other developing country contexts. Remittances and return migration, alongside business investment, bring some benefits to compensate for the skill drain. National development policies should focus on encouraging return migration, alongside retention and recruitment, but are unlikely to prevent out migration.

Renewable technologies for generation systems in islands and their application to Cozumel Island, Mexico

OpenAIRE

Mendoza Vizcaino, Javier; Sumper, Andreas; Sudrià Andreu, Antoni; Ramirez, J.M.

2016-01-01

The electric generation systems on islands are based generally on fossil fuel. This fact and its supply make the electricity cost higher than in systems used in the continent. In this article, we present a review of the renewable energy generation systems on islands. To do it we analysed 77 islands from 45 different countries. This work will allow us to know how the implementation of renewable energy sources could help these islands in developing a renewable and sustainable energy sector, inc...

Digitalized design of extraforaminal lumbar interbody fusion: a computer-based simulation and cadaveric study.

Science.gov (United States)

Yang, Mingjie; Zeng, Cheng; Guo, Song; Pan, Jie; Han, Yingchao; Li, Zeqing; Li, Lijun; Tan, Jun

2014-01-01

This study aims to investigate the feasibility of a novel lumbar approach named extraforaminal lumbar interbody fusion (ELIF), a newly emerging minimally invasive technique for treating degenerative lumbar disorders, using a digitalized simulation and a cadaveric study. The ELIF surgical procedure was simulated using the Mimics surgical simulator and included dissection of the superior articular process, dilation of the vertebral foramen, and placement of pedicle screws and a cage. ELIF anatomical measures were documented using a digitalized technique and subsequently validated on fresh cadavers. The use of the Mimics allowed for the vivid simulation of ELIF surgical procedures, while the cadaveric study proved the feasibility of this novel approach. ELIF had a relatively lateral access approach that was located 8-9 cm lateral to the median line with an access depth of approximately 9 cm through the intermuscular space. Dissection of the superior articular processes could fully expose the target intervertebral discs and facilitate a more inclined placement of the pedicle screws and cage with robust enhancement. According to the computer-based simulation and cadaveric study, it is feasible to perform ELIF. Further research including biomechanical study is needed to prove ELIF has a superior ability to preserve the posterior tension bands of the spinal column, with similar effects on spinal decompression, fixation, and fusion, and if it can enhance post-fusion spinal stability and expedites postoperative recovery.

CRED Gridded Bathymetry near Laysan Island (100-006), Northwestern Hawaiian Islands

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — File 100-006b is a 60-m ASCII grid of depth data collected near Laysan Island in the Northwestern Hawaiian Islands as of May 2003. This grid has been produced as...

CRED Gridded Bathymetry near Lisianski Island (100-001), Northwestern Hawaiian Islands

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — File 100-001b is a 60-m ASCII grid of depth data collected near Lisianski Island in the Northwestern Hawaiian Islands as of May 2003. This grid has been produced as...

75 FR 61993 - Amendment of Class E Airspace; Kwajalein Island, Marshall Islands, RMI

Science.gov (United States)

2010-10-07

...This action removes the reference to the Kwajalein Tactacial Air Navigation (TACAN) System from the legal description of the Class E airspace areas for Kwajalein Island, Bucholz AAF, Marshall Islands, RMI. The U.S. Army notified the FAA that the Kwajalein TACAN was decommissioned. This action corrects the legal descriptions for the Class E airspace areas in the vicinity of the Marshall Islands.

Returning from the Horizon: Introducing Urban Island Studies

Directory of Open Access Journals (Sweden)

Xavier Barceló Pinya

2015-12-01

Full Text Available Island studies tends to focus on peripheral, isolated, and marginal aspects of island communities, while urban studies has showed scant awareness of islandness: Although many people research cities on islands, there is little tradition of researching island cities or urban archipelagos per se. Island cities (densely populated small islands and population centres of larger islands and archipelagos nevertheless play import cultural, economic, political, and environmental roles on local, regional, and global scales. Many major cities and ports have developed on small islands, and even villages can fulfil important urban functions on lightly populated islands. Island concepts are also deployed to metaphorically describe developments in urban space. The journal Urban Island Studies explores island and urban processes around the world, taking an island approach to urban research and an urban approach to island research.

Barrier island facies models and recognition criteria

Science.gov (United States)

Mulhern, J.; Johnson, C. L.

2017-12-01

Barrier island outcrops record transgressive shoreline motion at geologic timescales, providing integral clues to understanding how coastlines respond to rising sea levels. However, barrier island deposits are difficult to recognize. While significant progress has been made in understanding the modern coastal morphodynamics, this insight is not fully leveraged in existing barrier island facies models. Excellent outcrop exposures of the paralic Upper Cretaceous Straight Cliffs Formation of southern Utah provide an opportunity to revise facies models and recognition criteria for barrier island deposits. Preserved barrier islands are composed of three main architectural elements (shorefaces, tidal inlets, and tidal channels) which occur independently or in combination to create larger-scale barrier island deposits. Barrier island shorefaces record progradation, while barrier island tidal inlets record lateral migration, and barrier island tidal channels record aggradation within the tidal inlet. Four facies associations are used to describe and characterize these barrier island architectural elements. Barrier islands occur in association with backarrier fill and internally contain lower and upper shoreface, high-energy upper shoreface, and tidal channel facies. Barrier islands bound lagoons or estuaries, and are distinguished from other shoreface deposits by their internal facies and geometry, association with backbarrier facies, and position within transgressive successions. Tidal processes, in particular tidal inlet migration and reworking of the upper shoreface, also distinguish barrier island deposits. Existing barrier island models highlight the short term heterogeneous and dynamic nature of barrier island systems, yet overlook processes tied to geologic time scales, such as multi-directional motion, erosion, and reworking, and their expressions in preserved barrier island strata. This study uses characteristic outcrop expressions of barrier island successions to

Gridded multibeam bathymetry of Howland Island, Pacific Remote Island Areas, Central Pacific

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Gridded bathymetry at 40m resolution surrounding Howland Island, within the Pacific Remote Island Areas - Central Pacific Ocean. Bottom coverage was achieved in...

A short environmental report on 'De Las Gallinas island'

International Nuclear Information System (INIS)

Romero, Claudio; Gho, Carlos J.; Quiroga, Juan J.; De Nicola, Juan; Rico, Nestor; Isnardi, Edgardo; Malagamba, Eduardo

2003-01-01

of pastures and the very scarce presence of exotic invading weeds. The main results of this work are: The island shows an enormous potential in terms of conservation, with a particular structure of almost no anthropic intervention. Facing the lack of updated scientific studies on the island, as a first step it would be recommendable to make a systematic characterization of its area, allowing a detailed knowledge of its ecological issues. This task should be done prior to any decision on its way of management, so preventing any ecological impact. This area might be seen as a preferential site to perform studies on vegetation dynamics in the absence of major herbivores. De Las Gallinas might also be transformed in an excellent work field for the many undergraduate and graduate thesis of the Superior School of Biology, at the Regional University Center of Bariloche. A synergic association of the City of Bariloche and the University of Comahue should be foreseen. In the short term, a limited program of eradication of the few exotic species occurring at the island should be tackled. Moreover, the activities of underwater swimming should be moved to the Huemul Island, which is clearly more heavily anthropized. Last but not least, an emphatic recommendation is made to keep its present character of protected untouchable area, in order to preserve its present condition and its natural assets. (author)

Anatomic considerations for C2 pedicle screw placement: the use of computerized tomography measurements Consideraciones anatómicas de la cocalización de los tornillos pediculares en C2: uitlización de las medidas de la tomografia computadorizada Considerações anatômicas sobre a localização dos parafusos pediculares em C2: utilização das medidas da tomografia computadorizada

Directory of Open Access Journals (Sweden)

Adebukoa Onibokun

2009-03-01

Full Text Available OBJECTIVE: more detailed anatomical knowledge of the C2 pedicle is required to optimize and minimize the risk of screw placement. The aim of this study was to evaluate the linear and angular dimensions of the true C2 pedicle using axial CT. METHODS: ninety three patients (47 males, 46 females mean age 48 years who had cervical spinal CT imaging performed were evaluated for this study. Axial images of the C2 pedicle were selected and the following pedicle parameters were determined: pedicle width (PW, the mediolateral diameter of the pedicle isthmus, perpendicular to the pedicle axis and pedicle transverse angle (PTA, that is, the angle between the pedicle axis and the midline of the vertebral body. RESULTS: the overall mean pedicle width was 5.8 1.2mm. The mean pedicle width in males (6.01.3mm was greater than that in the female subjects (5.6 1.1mm. This difference was not found to be statistically significant (p=.6790. The overall mean pedicle transverse angle was 43.93.9 degrees. The mean PTA in males was 43.23.8 degrees, while that in females was 44.73.7 degrees. CONCLUSION: preoperative planning is absolutely mandatory, particularly in determining not only screw trajectory, but in analyzing individual patient anatomy and reception to a C2 pedicle screw.OBJETIVO: el conocimiento detallado de las características anatómicas del pedículo de C2 es necesario para minimizar los riesgos relacionados con la colocación de los tornillos. El objetivo del estudio fue evaluar las medidas lineares y angulares del eje axial verdadero del pedículo de C2 utilizando la tomografía computadorizada. MÉTODOS: fueron utilizadas tomografías computadorizadas axiales de 93 pacientes (47 del sexo masculino y 46 del sexo femenino con promedio de edad de 48 años. Las imágenes axiales del pedículo de C2 fueron seleccionadas para el estudio y los parámetros estudiados fueron: Ancho del pedículo (diámetro mediolateral del istmo del pedículo perpendicular al

Experimental Evaluation of PV Inverter Anti-Islanding with Grid Support Functions in Multi-Inverter Island Scenarios

Energy Technology Data Exchange (ETDEWEB)

Hoke, Anderson [National Renewable Energy Lab. (NREL), Golden, CO (United States); Nelson, Austin [National Renewable Energy Lab. (NREL), Golden, CO (United States); Miller, Brian [National Renewable Energy Lab. (NREL), Golden, CO (United States); Chakraborty, Sudipta [National Renewable Energy Lab. (NREL), Golden, CO (United States); Bell, Frances [SolarCity, San Mateo, CA (United States); McCarty, Michael [SolarCity, San Mateo, CA (United States)

2016-07-01

As PV and other DER systems are connected to the grid at increased penetration levels, island detection may become more challenging for two reasons: 1.) In islands containing many DERs, active inverter-based anti-islanding methods may have more difficulty detecting islands because each individual inverter's efforts to detect the island may be interfered with by the other inverters in the island. 2.) The increasing numbers of DERs are leading to new requirements that DERs ride through grid disturbances and even actively try to regulate grid voltage and frequency back towards nominal operating conditions. These new grid support requirements may directly or indirectly interfere with anti-islanding controls. This report describes a series of tests designed to examine the impacts of both grid support functions and multi-inverter islands on anti-islanding effectiveness. Crucially, the multi-inverter anti-islanding tests described in this report examine scenarios with multiple inverters connected to multiple different points on the grid. While this so-called 'solar subdivision' scenario has been examined to some extent through simulation, this is the first known work to test it using hardware inverters. This was accomplished through the use of power hardware-in-the-loop (PHIL) simulation, which allows the hardware inverters to be connected to a real-time transient simulation of an electric power system that can be easily reconfigured to test various distribution circuit scenarios. The anti-islanding test design was a modified version of the unintentional islanding test in IEEE Standard 1547.1, which creates a balanced, resonant island with the intent of creating a highly challenging condition for island detection. Three common, commercially available single-phase PV inverters from three different manufacturers were tested. The first part of this work examined each inverter individually using a series of pure hardware resistive-inductive-capacitive (RLC

Superior mesenteric artery syndrome causing growth retardation

Directory of Open Access Journals (Sweden)

Halil İbrahim Taşcı

2013-03-01

Full Text Available Superior mesenteric artery syndrome is a rare and lifethreateningclinical condition caused by the compressionof the third portion of the duodenum between the aortaand the superior mesenteric artery’s proximal part. Thiscompression may lead to chronic intermittent, acute totalor partial obstruction. Sudden weight-loss and the relateddecrease in the fat tissue are considered to be the etiologicalreason of acute stenosis. Weight-loss accompaniedby nausea, vomiting, anorexia, epigastric pain, andbloating are the leading complaints. Barium radiographs,computerized tomography, conventional angiography,tomographic and magnetic resonance angiography areused in the diagnosis. There are medical and surgical approachesto treatment. We hereby present the case ofa patient with superior mesenteric artery syndrome withdelayed diagnosis.Key words: superior mesenteric artery syndrome, nausea-vomiting, anorexia

Gridded multibeam bathymetry of Baker Island, Pacific Remote Island Areas, Central Pacific

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Gridded bathymetry at 40m resolution surrounding Baker Island, within the Pacific Remote Island Areas - Central Pacific Ocean. Bottom coverage was achieved in depths...

Vegetation assessment of forests of Pagan Island, Commonwealth of the Northern Mariana Islands

Science.gov (United States)

Pratt, Linda W.

2011-01-01

As part of the Marianas Expedition Wildlife Surveys-2010, the forest vegetation of the island of Pagan, Commonwealth of the Northern Mariana Islands (CNMI), was sampled with a series of systematic plots along 13 transects established for monitoring forest bird populations. Shrubland and grassland were also sampled in the northern half of the island. Data collected were woody plant density, tree diameter at breast height, woody plant density in height classes below 2 m, and ground cover measured with the point-intercept method. Coconut forests (Cocos nucifera) were generally found to have low native tree diversity, little regeneration of trees and shrubs in the forest understory, and little live ground cover. The sole exception was a coconut-dominated forest of the northeast side of the island that exhibited high native tree diversity and a large number of young native trees in the understory. Ironwood (Casuarina equisetifolia) forests on the northern half of the island were nearly monocultures with almost no trees other than ironwood in vegetation plots, few woody plants in the understory, and low ground cover dominated by native ferns. Mixed native forests of both northern and southern sections of the island had a diversity of native tree species in both the canopy and the sparse understory. Ground cover of native forests in the north had a mix of native and alien species, but that of the southern half of the island was dominated by native ferns and woody plants.

Minimally Invasive Transforaminal Lumbar Interbody Fusion with Percutaneous Bilateral Pedicle Screw Fixation for Lumbosacral Spine Degenerative Diseases. A retrospective database of 40 consecutive treated cases and literature review.

Science.gov (United States)

Millimaggi, Daniele Francesco; DI Norcia, Valerio; Luzzi, Sabino; Alfiero, Tommaso; Galzio, Renato Juan; Ricci, Alessandro

2017-04-12

To report our results about minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) with bilateral pedicle screw fixation, in patients with degenerative lumbosacral spine disease. To describe the indications, surgical technique and results of a consecutive series of 40 patients undergone MI-TLIF. Despite the limited number of clinical studies, published data suggest tremendous potential advantages of this technique. Forty patients with radiological findings of degenerative lumbosacral spine disease were undergone MI-TLIF between July 2012 and January 2015. Clinical outcomes were assessed by means of Oswestry Disability Index (ODI) and Health Survey Scoring (SF36) before surgery and at first year follow-up. Furthermore, the following parameters were retrospectively reviewed: age, sex, working activity, body mass index (BMI), type of degenerative disease, number of levels of fusion, operative time, blood loss, length of hospital stay. Average operative time was of 230 minutes, mean estimated blood loss 170 mL, average length of hospital stay 5 days. The ODI improved from a score of 59, preoperatively, to post-operative score of 20 at first year follow-up. Average SF36 score increased from 36 to 54 (Physical Health) and from 29 to 50 (Mental Health) at first year outcome evaluation. MI-TLIF with bilateral pedicle screw fixation is an excellent choice for selected patients suffering from symptomatic degenerative lumbosacral spine disease, especially secondary to recurrent disk herniations.

Island biogeography of marine organisms

Science.gov (United States)

Pinheiro, Hudson T.; Bernardi, Giacomo; Simon, Thiony; Joyeux, Jean-Christophe; Macieira, Raphael M.; Gasparini, João Luiz; Rocha, Claudia; Rocha, Luiz A.

2017-09-01

Studies on the distribution and evolution of organisms on oceanic islands have advanced towards a dynamic perspective, where terrestrial endemicity results from island geographical aspects and geological history intertwined with sea-level fluctuations. Diversification on these islands may follow neutral models, decreasing over time as niches are filled, or disequilibrium states and progression rules, where richness and endemism rise with the age of the archipelago owing to the splitting of ancestral lineages (cladogenesis). However, marine organisms have received comparatively little scientific attention. Therefore, island and seamount evolutionary processes in the aquatic environment remain unclear. Here we analyse the evolutionary history of reef fishes that are endemic to a volcanic ridge of seamounts and islands to understand their relations to island evolution and sea-level fluctuations. We also test how this evolutionary history fits island biogeography theory. We found that most endemic species have evolved recently (Pleistocene epoch), during a period of recurrent sea-level changes and intermittent connectivity caused by repeated aerial exposure of seamounts, a finding that is consistent with an ephemeral ecological speciation process. Similar to findings for terrestrial biodiversity, our data suggest that the marine speciation rate on islands is negatively correlated with immigration rate. However, because marine species disperse better than terrestrial species, most niches are filled by immigration: speciation increases with the random accumulation of species with low dispersal ability, with few opportunities for in situ cladogenesis and adaptive radiation. Moreover, we confirm that sea-level fluctuations and seamount location play a critical role in marine evolution, mainly by intermittently providing stepping stones for island colonization.

Nasal Unit Transplantation: A Cadaveric Anatomical Feasibility Study.

Science.gov (United States)

Dorafshar, Amir H; Mundinger, Gerhard S; Robinson, Brent; Tuffaha, Sami; Brandacher, Gerald; Byrne, Patrick; Walton, Robert L

2017-05-01

Background  The science and technical acumen in the field of vascularized composite allotransplantation has progressed rapidly over the past 15 years, and transplantation of specialized units of the face, such as the nose, appears possible. No study to date has evaluated the technical feasibility of isolated nasal unit transplantation (NUT). In this study, we explore the anatomy and technical specifics of NUT. Methods  In this study, four fresh cadaver heads were studied. Bilateral vascular pedicle dissections were performed in each cadaver. The facial artery was cannulated and injected with food dye under physiologic pressure in two cadavers, and with lead oxide mixture in two cadavers to evaluate perfusion territories supplied by each vascular pedicle. Results  The facial artery and vein were found to be adequate pedicles for NUT. Divergent courses of the vein and artery were consistently identified, which made for a bulky pedicle with necessary inclusion of large amounts of subcutaneous tissue. In all cases, the artery remained superficial, while the vein coursed in a deeper plane, and demonstrated consistent anastomoses with the superior transverse orbital arcade. While zinc oxide injection of the facial artery demonstrated filling of the nasal vasculature across the midline, dye perfusion studies suggested that unilateral arterial inflow may be insufficient to perfuse contralateral NUT components. Discrepancies in these two studies underscore the limitations of nondynamic assessment of nutritive perfusion. Conclusion  NUT based on the facial artery and facial vein is technically feasible. Angiosome evaluation suggests that bilateral pedicle anastomoses may be required to ensure optimal perfusion. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Interaction of bootstrap-current-driven magnetic islands

International Nuclear Information System (INIS)

Hegna, C.C.; Callen, J.D.

1991-10-01

The formation and interaction of fluctuating neoclassical pressure gradient driven magnetic islands is examined. The interaction of magnetic islands produces a stochastic region around the separatrices of the islands. This interaction causes the island pressure profile to be broadened, reducing the island bootstrap current and drive for the magnetic island. A model is presented that describes the magnetic topology as a bath of interacting magnetic islands with low to medium poloidal mode number (m congruent 3-30). The islands grow by the bootstrap current effect and damp due to the flattening of the pressure profile near the island separatrix caused by the interaction of the magnetic islands. The effect of this sporadic growth and decay of the islands (''magnetic bubbling'') is not normally addressed in theories of plasma transport due to magnetic fluctuations. The nature of the transport differs from statistical approaches to magnetic turbulence since the radial step size of the plasma transport is now given by the characteristic island width. This model suggests that tokamak experiments have relatively short-lived, coherent, long wavelength magnetic oscillations present in the steep pressure-gradient regions of the plasma. 42 refs

Some data on the avifauna of the Island of Roti, Lesser Sunda Islands, Indonesia

NARCIS (Netherlands)

Verheijen, J.A.J.

1976-01-01

INTRODUCTION For several years I had been looking for an opportunity to visit the island of Roti (Rotti, Roté, Loté). Junge (1954) mentions that only once an ornithological collection was made in the island, namely by Dr. H. F. C. ten Kate, an ethnologist who visited the island in 1891. Büttikofer

Islanded operation of distribution networks

Energy Technology Data Exchange (ETDEWEB)

NONE

2005-07-01

This report summarises the results of a study assessing the benefits and risks to distribution network of generator islanding and examining the technical, commercial and regulatory changes required to facilitate the operation of islanding. The background to the study is traced, and details are given of a literature review, the technical criteria for operating sections of the network in islanding mode, and the impact of islanding on trading. Case studies and a detailed implementation plan, data acquisition, and commercial incentives are discussed.

Islanded operation of distribution networks

International Nuclear Information System (INIS)

2005-01-01

This report summarises the results of a study assessing the benefits and risks to distribution network of generator islanding and examining the technical, commercial and regulatory changes required to facilitate the operation of islanding. The background to the study is traced, and details are given of a literature review, the technical criteria for operating sections of the network in islanding mode, and the impact of islanding on trading. Case studies and a detailed implementation plan, data acquisition, and commercial incentives are discussed

HYDROGEOLOGICAL RELATIONS ON KARSTIFIED ISLANDS - VIS ISLAND CASE STUDY

Directory of Open Access Journals (Sweden)

Josip Terzić

2004-12-01

Full Text Available An approach to the hydrogeological investigations on Adriatic islands is presented on the Island of Vis case study. Infiltration, accumulation and discharge of the groundwater occur in karstified rock mass. Hydrogeological relations are mostly a consequence of the geological setting, because of the complete hydrogeologic barrier in Komiža bay, and relative barrier in the area of karst poljes. Significant research was performed in the 1999 – 2000 period aimed of better understanding of hydrogeological relations. These investigations, as well as reinterpretation of some previously known data, included structural geology, hydrogeology, hydrology and hydrochemistry. Approximate rock mass hydraulic conductivity calculation is also shown, as well as level of its usability in such terrain. Based on all these methods, it is possible to conclude that on the Island of Vis there is no saline water present underneath the entire island. There is only a saline water wedge which is formed on the top of relatively impermeable base rock, some few tens of meters under recent sea level. With such a model, and taking in account the hydrological balance, it is possible to conclude that there is possibility of higher amount of groundwater exploitation then it is today (the paper is published in Croatian.

Strategic Environmental Assessment practices in European small islands: Insights from Azores and Orkney islands

Energy Technology Data Exchange (ETDEWEB)

Polido, Alexandra, E-mail: a.polido@campus.fct.unl.pt [CENSE, Center for Environmental and Sustainability Research, Departamento de Ciências e Engenharia do Ambiente, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Campus da Caparica, 2829-516 Caparica (Portugal); João, Elsa, E-mail: elsa.joao@strath.ac.uk [Department of Civil and Environmental Engineering, University of Strathclyde, Level 5, James Weir Building, 75 Montrose Street, Glasgow G1 1XJ, Scotland (United Kingdom); Ramos, Tomás B., E-mail: tabr@fct.unl.pt [CENSE, Center for Environmental and Sustainability Research, Departamento de Ciências e Engenharia do Ambiente, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Campus da Caparica, 2829-516 Caparica (Portugal)

2016-02-15

The literature concerning Strategic Environmental Assessment (SEA) often refers to the importance of context-specific approaches. However, there is a lack of systematised and consistent studies that enhance tailor-made SEA practices and procedures. Small islands are bounded units of study which may help explore SEA theory and practice in special territories. Small islands present particular features and unique values, such as, small size and population, geographic isolation, limited resources and vulnerable ecosystems. Hence, the main goal of this research was to profile SEA practices and procedures in European small islands and provide a background for future research aiming to improve context-specific SEA applications. To achieve this goal, an exploratory case study was developed using Azores (Portugal) and Orkney (Scotland) archipelagos. An analysis of the corresponding mainland was also carried out to contextualise both case studies. The data collection was achieved through a qualitative content analysis of 43 Environmental Reports. The research found that there is not an SEA context-specific approach used within these European small islands, including guidelines, assessment topics, assessment techniques, follow-up and stakeholders engagement. The debate concerning specific approaches to small islands must be re-focused on the enhancement of SEA capacity-building amongst different stakeholders (including decision-makers), on the development and implementation of collaborative approaches, and on the exchange of knowledge and experiences between small islands networks. - Highlights: • Reviewed the differences between the Portuguese and Scottish SEA system • Showed a low integration of SEA specific features in reports of European small islands • Provides background for future SEA research for small islands approaches.

Strategic Environmental Assessment practices in European small islands: Insights from Azores and Orkney islands

International Nuclear Information System (INIS)

Polido, Alexandra; João, Elsa; Ramos, Tomás B.

2016-01-01

The literature concerning Strategic Environmental Assessment (SEA) often refers to the importance of context-specific approaches. However, there is a lack of systematised and consistent studies that enhance tailor-made SEA practices and procedures. Small islands are bounded units of study which may help explore SEA theory and practice in special territories. Small islands present particular features and unique values, such as, small size and population, geographic isolation, limited resources and vulnerable ecosystems. Hence, the main goal of this research was to profile SEA practices and procedures in European small islands and provide a background for future research aiming to improve context-specific SEA applications. To achieve this goal, an exploratory case study was developed using Azores (Portugal) and Orkney (Scotland) archipelagos. An analysis of the corresponding mainland was also carried out to contextualise both case studies. The data collection was achieved through a qualitative content analysis of 43 Environmental Reports. The research found that there is not an SEA context-specific approach used within these European small islands, including guidelines, assessment topics, assessment techniques, follow-up and stakeholders engagement. The debate concerning specific approaches to small islands must be re-focused on the enhancement of SEA capacity-building amongst different stakeholders (including decision-makers), on the development and implementation of collaborative approaches, and on the exchange of knowledge and experiences between small islands networks. - Highlights: • Reviewed the differences between the Portuguese and Scottish SEA system • Showed a low integration of SEA specific features in reports of European small islands • Provides background for future SEA research for small islands approaches

Late Quaternary climate change shapes island biodiversity.

Science.gov (United States)

Weigelt, Patrick; Steinbauer, Manuel Jonas; Cabral, Juliano Sarmento; Kreft, Holger

2016-04-07

Island biogeographical models consider islands either as geologically static with biodiversity resulting from ecologically neutral immigration-extinction dynamics, or as geologically dynamic with biodiversity resulting from immigration-speciation-extinction dynamics influenced by changes in island characteristics over millions of years. Present climate and spatial arrangement of islands, however, are rather exceptional compared to most of the Late Quaternary, which is characterized by recurrent cooler and drier glacial periods. These climatic oscillations over short geological timescales strongly affected sea levels and caused massive changes in island area, isolation and connectivity, orders of magnitude faster than the geological processes of island formation, subsidence and erosion considered in island theory. Consequences of these oscillations for present biodiversity remain unassessed. Here we analyse the effects of present and Last Glacial Maximum (LGM) island area, isolation, elevation and climate on key components of angiosperm diversity on islands worldwide. We find that post-LGM changes in island characteristics, especially in area, have left a strong imprint on present diversity of endemic species. Specifically, the number and proportion of endemic species today is significantly higher on islands that were larger during the LGM. Native species richness, in turn, is mostly determined by present island characteristics. We conclude that an appreciation of Late Quaternary environmental change is essential to understand patterns of island endemism and its underlying evolutionary dynamics.

Effects of nonlinearity in the materials used for the semi-rigid pedicle screw systems on biomechanical behaviors of the lumbar spine after surgery

International Nuclear Information System (INIS)

Kim, Hyun; Lee, Sung-Jae; Lim, Do-Hyung; Oh, Hyun-Ju; Lee, Kwon-Yong

2011-01-01

Recently, various types of semi-rigid pedicle screw fixation systems have been developed for the surgical treatment of the lumbar spine. They were introduced to address the adverse issues commonly found in traditional rigid spinal fusion--abnormally large motion at the adjacent level and subsequent degeneration. The semi-rigid system uses more compliant materials (nitinol or polymers) and/or changes in rod design (coiled or twisted rods) as compared to the conventional rigid straight rods made of Ti alloys (E = 114 GPa, υ = 0.32). However, biomechanical studies on the semi-rigid pedicle screw systems were usually limited to linear modeling of the implant and anatomic elements, which may not be capable of reflecting realistic post-operative motions of the spine. In this study, we evaluated the effects of nonlinearity in materials used for semi-rigid pedicle screw fixation systems to evaluate the changes in biomechanical behaviors using finite element analysis. Changes in range of motion (ROM) and center of rotation (COR) were assessed at the operated and adjacent levels. Actual load-displacement results of the semi-rigid rod from mechanical test were carried out to reflect the nonlinearity of the implant. In addition, nonlinear material properties of various spinal ligaments studies were used for the finite element modeling. The post-operative models were constructed by modifying the previously validated intact model of the L1-S1 spine. Eight different post-operative models were made to address the effects of nonlinearity-with a traditional stiffness modulus rod (with linear ligaments, case 1; with nonlinear ligaments, case 5), with a rigid rod (with linear ligaments, case 2; with nonlinear ligaments, case 6), with a soft rod (with linear ligaments, case 3; with nonlinear ligaments, case 7), and with a nonlinear rod (with linear ligaments, case 4; with nonlinear ligaments, case 8). To simulate the load on the lumbar spine in a neutral posture, follower load (400 N

Virtually Impossible: Deleuze and Derrida on the Political Problem of Islands (and Island Studies

Directory of Open Access Journals (Sweden)

Stewart Williams

2012-11-01

Full Text Available It is commonplace to think of an island as a discreetly bounded unit. Selected writings on islands by the poststructuralist philosophers Gilles Deleuze and Jacques Derrida reveal the island variously to be both real and imaginary, mythological and scientific, but as most problematic when constituted in political terms as an indivisible, sovereign entity. These two thinkers’ more broadly developed concepts of the virtual and the impossible, respectively, are seen to disrupt any assumptions about the fixity and closure of the island polity. Instead they emphasize its actualization through processual relations that can be difficult yet dynamic and decisive in effecting the move from being to becoming-other. As the possibilities for instituting more ethical as well as different political relations open up, the question of island studies remaining in its currently coherent, familiar form is raised for consideration.

Bamboo Diversity in Sumba Island

Directory of Open Access Journals (Sweden)

KARSONO

2005-04-01

Full Text Available Bamboo is one of the economic plant which grow widely in the villages and have been used by the local people in the villages. Indonesia has about 10% of the world bamboo, 50% among them was endemic to Indonesia. According Widjaja (2001 Lesser Sunda Island which consists of Lombok, Sumbawa, Flores, Timor, Sumba and other small island eastern of Flores has 14 bamboo species, however, the information from the Sumba Island was lacking because of lacking data from this area except one species which was proposed by S. Soenarko in 1977 where the type specimens was collected by Iboet 443 in 1925. To fullfill data from the Sumba Island, an exploration to this area has been conducted on July 2003. The observation was done in West Sumba and East Sumba District, especially in two natioal parks at both districts. According to this inventory study in the Sumba Island, there were 10 bamboo species in Sumba Island, 1 species among them (Dinochloa sp. was a new species which has not been collected before, whereas the other species (Dinochloa kostermansiana has a new addition record from this area. The bamboo species in Sumba Island were Bambusa blumeana, Bambusa vulgaris, Dendocalamus asper, Dinochloa kostermansiana, Dinochloa sp., Gigantochloa atter, Nastus reholtumianus, Phyllostachys aurea, Schisotachyum brachycladum and Schizostachyum lima. From 10 recorded species, the genera Dinochloa and Nastus grow wild in the forest, whereas another species grow widly or cultivated in the garden. Furthermore, the genus Dinochloa was the only genus grow climbing. The endemic species found in Sumba Island was Nastus reholttumianus, whereas Dinochloa kostermansiana was also found in Flores Island.

Biological invasions on oceanic islands: Implications for island ecosystems and avifauna

Science.gov (United States)

Dean E. Pearson

2009-01-01

Biological invasions present a global threat to biodiversity, but oceanic islands are the systems hardest hit by invasions. Islands are generally depauperate in species richness, trophic complexity, and functional diversity relative to comparable mainland ecosystems. This situation results in low biotic resistance to invasion and many empty niches for invaders to...

Oak restoration trials: Santa Catalina Island

Science.gov (United States)

Lisa Stratton

2002-01-01

Two restoration trials involving four oak species have been implemented as part of a larger restoration program for Catalina Island. In 1997 the Catalina Island Conservancy began an active program of restoration after 50 years of ranching and farming activities on the island. The restoration program includes removing feral goats and pigs island-wide and converting 80...

Island history affects faunal composition: the treeshrews (Mammalia: Scandentia: Tupaiidae) from the Mentawai and Batu Islands, Indonesia

Science.gov (United States)

Sargis, Eric J.; Woodman, Neal; Morningstar, Natalie C.; Reese, Aspen T.; Olson, Link E.

2014-01-01

The Mentawai and Batu Island groups off the west coast of Sumatra have a complicated geological and biogeographical history. The Batu Islands have shared a connection with the Sumatran ‘mainland’ during periods of lowered sea level, whereas the Mentawai Islands, despite being a similar distance from Sumatra, have remained isolated from Sumatra, and probably from the Batu Islands as well. These contrasting historical relationships to Sumatra have influenced the compositions of the respective mammalian faunas of these island groups. Treeshrews (Scandentia, Tupaiidae) from these islands have, at various times in their history, been recognized as geographically circumscribed populations of a broadly distributed Tupaia glis, subspecies, or distinct species. We used multivariate analyses of measurements from the skull and hands to compare the island populations from Siberut (Mentawai Islands) and Tanahbala (Batu Islands) with the geographically adjacent species from the southern Mentawai Islands (T. chrysogaster) and Sumatra (T. ferruginea). Results from both the skull and manus of the Siberut population show that it is most similar to T. chrysogaster, whereas the Tanahbala population is more similar to T. ferruginea, confirming predictions based on island history. These results are further corroborated by mammae counts. Based on these lines of evidence, we include the Siberut population in T. chrysogaster and the Tanahbala population in T. ferruginea. Our conclusions expand the known distributions of both the Mentawai and Sumatran species. The larger geographical range of the endangered T. chrysogaster has conservation implications for this Mentawai endemic, so populations and habitat should be re-evaluated on each of the islands it inhabits. However, until such a re-evaluation is conducted, we recommend that the IUCN Red List status of this species be changed from ‘Endangered’ to ‘Data Deficient’.

Prostatic arterial supply: demonstration by multirow detector Angio CT and Catheter Angiography

Energy Technology Data Exchange (ETDEWEB)

Bilhim, Tiago [Departamento Universitario de Anatomia, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon (Portugal); Hospital Saint Louis, Interventional Radiology, Lisbon (Portugal); Pisco, Joao M. [Hospital Saint Louis, Interventional Radiology, Lisbon (Portugal); Universidade Nova de Lisboa, Departamento Universitario de Radiologia, Faculdade de Ciencias Medicas, Lisbon (Portugal); Furtado, Andrea; Casal, Diogo; Pais, Diogo; O' Neill, Joao E.G. [Departamento Universitario de Anatomia, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon (Portugal); Campos Pinheiro, Luis [Universidade Nova de Lisboa, Departamento Universitario de Urologia, Faculdade de Ciencias Medicas, Lisbon (Portugal)

2011-05-15

To evaluate the prostatic arterial supply with multidetector Angio CT and Digital Subtraction Angiography (DSA). DSA was performed in 21 male patients (7 of these also underwent Pelvic Angio CT); a further 4 patients only underwent Angio CT. Prostatic arteries were classified according to their origin, direction, number of pedicles, termination and anastomoses with surrounding arteries in 50 pelvic sides. The most frequent origin was the internal pudendal artery (n = 28; 56%) with the common gluteal-pudendal trunk the next commonest (n = 14; 28%). Less frequent origins were the obturator artery (n = 6; 12%) or the inferior gluteal artery (n = 2; 4%). Two separate vascular pedicles were found in 12 pelvic sides (24%). There were anastomoses with the termination of the internal pudendal artery in 24% of cases (n = 12), with the contra-lateral prostatic arteries in 6 cases (12%), and to the superior vesical artery in 4 cases (8%). Defining prostatic artery origin and direction is paramount to allow selective catheterisation. Angio CT is very useful as a pre-intervention tool. The number of independent vascular pedicles and the presence of anastomoses with surrounding arteries should be taken into account when planning prostatic arterial embolisation. (orig.)

Prostatic arterial supply: demonstration by multirow detector Angio CT and Catheter Angiography

International Nuclear Information System (INIS)

Bilhim, Tiago; Pisco, Joao M.; Furtado, Andrea; Casal, Diogo; Pais, Diogo; O'Neill, Joao E.G.; Campos Pinheiro, Luis

2011-01-01

To evaluate the prostatic arterial supply with multidetector Angio CT and Digital Subtraction Angiography (DSA). DSA was performed in 21 male patients (7 of these also underwent Pelvic Angio CT); a further 4 patients only underwent Angio CT. Prostatic arteries were classified according to their origin, direction, number of pedicles, termination and anastomoses with surrounding arteries in 50 pelvic sides. The most frequent origin was the internal pudendal artery (n = 28; 56%) with the common gluteal-pudendal trunk the next commonest (n = 14; 28%). Less frequent origins were the obturator artery (n = 6; 12%) or the inferior gluteal artery (n = 2; 4%). Two separate vascular pedicles were found in 12 pelvic sides (24%). There were anastomoses with the termination of the internal pudendal artery in 24% of cases (n = 12), with the contra-lateral prostatic arteries in 6 cases (12%), and to the superior vesical artery in 4 cases (8%). Defining prostatic artery origin and direction is paramount to allow selective catheterisation. Angio CT is very useful as a pre-intervention tool. The number of independent vascular pedicles and the presence of anastomoses with surrounding arteries should be taken into account when planning prostatic arterial embolisation. (orig.)

Sable Island: A heritage to preserve

Energy Technology Data Exchange (ETDEWEB)

Villeneuve, C.

1997-09-01

Sable Island is strategically located on the edge of the teeming fisheries of the Newfoundland Grand Banks and near one of the main sea routes between North America and Europe. It has been the bane of navigators from 1583 onward, with 250 ships running aground, the latest in 1947. Marine productivity around Sable Island is very high owing to the temperature differences between the currents and the adjacent underwater topography. Dolphins and whales abound in the area known as the `Gully`, and there are no fewer than 36 fish species present in the waters surrounding the Island. Approximately 35 per cent of the Island is covered by vegetation which is limited to species adapted to sandy soil containing little organic matter and few nutrients. Some plants, such as the American beachgrass, grow in dense colonies and help to stabilize the dunes. Bird diversity is limited to species adapted to open areas, ponds and the littoral. Some 324 species have been recorded on the Island, but only 25 are known to nest there. The Island is one of world`s most important breeding sites for grey seals where they can be observed in great numbers during mating, whelping and moulting season. Among the many introduced animals only the legendary horses of Sable Island remain to this day. Despite its remoteness and isolation, the Island faces many threats, one of the most worrysome being the erosion of the eastern extremity of the Island during severe winter storms. The Island benefits from its status as a Migratory Bird Sanctuary, and is legally protected under Sable Island Regulations of the Navigation Act.

Superiority in value and the repugnant conclusion

DEFF Research Database (Denmark)

Jensen, Karsten Klint

2007-01-01

superiority does not amount to a radical value difference at all. I then spell out the consequences of these results for different interpretations of Griffin's suggestion regarding population ethics. None of them comes out very successful, but perhaps they nevertheless retain some interest.......James Griffin has considered a weak form of superiority in value a possible remedy to the Repugnant Conclusion. In this paper, I demonstrate that, in a context where value is additive, this weaker form collapses into a stronger form of superiority. And in a context where value is non-additive, weak...

Islanded operation of distributed networks

Energy Technology Data Exchange (ETDEWEB)

NONE

2005-07-01

This report summarises the findings of a study to investigate the regulatory, commercial and technical risks and benefits associated with the operation of distributed generation to power an islanded section of distributed network. A review of published literature was carried out, and UK generators were identified who could operate as part of an island network under the existing technical, regulatory, and safety framework. Agreement on case studies for consideration with distributed network operators (DNOs) is discussed as well as the quantification of the risks, benefits and costs of islanding, and the production of a case implementation plan for each case study. Technical issues associated with operating sections of network in islanded mode are described, and impacts of islanding on trading and settlement, and technical and commercial modelling are explored.

Islanded operation of distributed networks

International Nuclear Information System (INIS)

2005-01-01

This report summarises the findings of a study to investigate the regulatory, commercial and technical risks and benefits associated with the operation of distributed generation to power an islanded section of distributed network. A review of published literature was carried out, and UK generators were identified who could operate as part of an island network under the existing technical, regulatory, and safety framework. Agreement on case studies for consideration with distributed network operators (DNOs) is discussed as well as the quantification of the risks, benefits and costs of islanding, and the production of a case implementation plan for each case study. Technical issues associated with operating sections of network in islanded mode are described, and impacts of islanding on trading and settlement, and technical and commercial modelling are explored

Coastal groundwater exchange on a small Pacific atoll island: Roi Namur, Republic of the Marshall Islands

Science.gov (United States)

Oberle, Ferdinand K. J.; Swarzenski, Peter W.; Storlazzi, Curt

2017-04-01

Atoll islands, most of which only average 1-2 meters above today's sea level, provide a tremendous natural laboratory in which to study and better understand the intensifying impacts of high rates of sea-level rise on tropical reef-lined islands globally due to their unique geologic structure and limited water supply. Groundwater resources of atolls are typically minimal due to the low elevation and small surface area of the islands and are also subject to recurring droughts, and more frequent, storm-driven seawater overwash events. Although groundwater is the principal means of freshwater storage on atoll islands and is a major factor in determining the overall sustainability of island communities, hydrological data on how an aquifer will response to changes in sea-level rise or storm-driven overwash remain limited. We here present high-resolution time series hydrogeological and geochemical data to determine the role of the atoll's carbonate geology, land use, and atmospheric and oceanographic forcing in driving coastal groundwater exchange on the island of Roi Namur on Kwajalein Atoll in the Republic of the Marshall Islands. This information can provide new estimates on the recovery and resilience of coastal groundwater resources on such islands to expected climate change-driven perturbations.

The coastline remote sensing survey for Zhao Shu Island in Xisha Islands based on WorldView-2

Science.gov (United States)

Li, Li; Zhong, Chang; Kong, Fanping

2014-11-01

Due to diastrophism, tide action and human activities, the coastline is always in flux. There are lots of coral islands in the south sea of China. Remote sensing survey for the coastline not only can reassert the necessity and importance of coral protection, but also can provide basic data and scientific basis for island ecologic protection, reasonable utilization of land resources. The study area named Zhao Shu Island lies in Jintong Islands of Xisha. It is a coral island which has people inhabited. Using WorldView-2 satellite remote sensing images as data sources we carry out three phases of coastline investigation and monitoring. The satellite data phases are 2002, 2010 and 2013. Firstly, affirm the bands valuable for color composition on the basis of spectral and correlation analysis. Then extract the coastline by a series of image process, such as image correction, fusion, waterline extraction and coastline revision. Finally determine the coastline types and length by artificial interpretation. The results show that the island length is gradually smaller, which means the island area is reducing. The beach bedrock coast in northern island was eroded seriously especially during the period between 2010 and 2013. In addition, the shoal head shape in the western island changed a lot.

Superior Hiking Trail Facilities

Data.gov (United States)

Minnesota Department of Natural Resources — Superior Hiking Trail main trail, spurs, and camp spurs for completed trail throughout Cook, Lake, St. Louis and Carlton counties. These data were collected with...

Late Quaternary climate change shapes island biodiversity

DEFF Research Database (Denmark)

Weigelt, Patrick; Steinbauer, Manuel; Cabral, Juliano

2016-01-01

Island biogeographical models consider islands either as geologically static with biodiversity resulting from ecologically neutral immigration–extinction dynamics1, or as geologically dynamic with biodiversity resulting from immigration–speciation–extinction dynamics influenced by changes in island...... sea levels3, 4 and caused massive changes in island area, isolation and connectivity5, orders of magnitude faster than the geological processes of island formation, subsidence and erosion considered in island theory2, 6. Consequences of these oscillations for present biodiversity remain unassessed5, 7...

Autumn monitoring of resident avifauna on Guana Island, British Virgin Islands

Science.gov (United States)

C.W. Boal; J.M. Wunderle Jr.; W.J. Arendt

2013-01-01

Although the Caribbean region is considered a biodiversity hotspot and a priority for ecological conservation efforts, little information exists on population trends of West Indian landbirds. We combined avian survey data collected from three studies spanning a 16-year period on a small island with a minimal human presence in the British Virgin Islands. Although...

The pacific island health care project.

Science.gov (United States)

Person, Donald Ames

2014-01-01

US Associated/Affiliated Pacific Islands (USAPI) include three freely associated states: Marshall Islands, Federated States of Micronesia, Palau, and three Territories: American Samoa, Guam, and Commonwealth of the Northern Mariana Islands. The Pacific Island Health Care Project (PIHCP) provides humanitarian medical referral/consultation/care to >500,000 indigenous people of these remote islands. In the mid-1990s, we developed a simple store-and-forward program to link the USAPI with Tripler Army Medical Center. This application allowed image attachment to email consultations. More than 8000 Pacific Islanders have benefited from the program. Three thousand Pacific Islanders prior to telemedicine (1990-1997) and since store-and-forward telemedicine (1997-present), the PIHCP has helped an additional 5000. Records post dynamically and are stored in an archival database. The PIHCP is the longest running telemedicine program in the world delivering humanitarian medical care. It has bridged the Developing World of the remote Pacific Islands with advanced medical and surgical care available at a major US military teaching hospital. (The opinions expressed here are those of the author and not that of the Army, Department of Defense, or the US Government.).

The Pacific Island Health Care Project

Directory of Open Access Journals (Sweden)

Donald Ames Person

2014-10-01

Full Text Available Introduction/BackgroundUS Associated/Affiliated Pacific Islands (USAPI include 3 Freely Associated States: Marshall Islands, Federated States of Micronesia, Palau and 3 Territories: American Samoa, Guam, and Commonwealth of the Northern Mariana Islands. ObjectiveThe Pacific Island Health Care Project (PIHCP provides humanitarian medical referral/consultation/care to >500,000 indigenous people of these remote islands. Methods In the mid-1990s, we developed a simple store-and-forward program to link the USAPI with Tripler Army Medical Center (TAMC. This application allowed image attachment to email consultations. ResultsMore than 8000 Pacific Islanders have benefited from the program. 3000 Pacific Islanders prior to telemedicine (1990-1997 and since store-and-forward telemedicine (1997-present, the PIHCP has helped an additional 5000. Records post dynamically and are stored in an archival database. Conclusion The PIHCP is the longest running telemedicine program in the world delivering humanitarian medical care. It has bridged the Developing World of the remote Pacific islands with advanced medical and surgical care available at a major US military teaching hospital.(The opinions expressed here are those of the author and not that of the Army, Department of Defense, or the US Government.

Physically Based Modeling of Delta Island Consumptive Use: Fabian Tract and Staten Island, California

Directory of Open Access Journals (Sweden)

Lucas J. Siegfried

2014-12-01

Full Text Available doi: http://dx.doi.org/10.15447/sfews.2014v12iss4art2Water use estimation is central to managing most water problems. To better understand water use in California’s Sacramento–San Joaquin Delta, a collaborative, integrated approach was used to predict Delta island diversion, consumption, and return of water on a more detailed temporal and spatial resolution. Fabian Tract and Staten Island were selected for this pilot study based on available data and island accessibility. Historical diversion and return location data, water rights claims, LiDAR digital elevation model data, and Google Earth were used to predict island diversion and return locations, which were tested and improved through ground-truthing. Soil and land-use characteristics as well as weather data were incorporated with the Integrated Water Flow Model Demand Calculator to estimate water use and runoff returns from input agricultural lands. For modeling, the islands were divided into grid cells forming subregions, representing fields, levees, ditches, and roads. The subregions were joined hydrographically to form diversion and return watersheds related to return and diversion locations. Diversions and returns were limited by physical capacities. Differences between initial model and measured results point to the importance of seepage into deeply subsided islands. The capabilities of the models presented far exceeded current knowledge of agricultural practices within the Delta, demonstrating the need for more data collection to enable improvements upon current Delta Island Consumptive Use estimates.

Population Size and Decadal Trends of Three Penguin Species Nesting at Signy Island, South Orkney Islands.

Science.gov (United States)

Dunn, Michael J; Jackson, Jennifer A; Adlard, Stacey; Lynnes, Amanda S; Briggs, Dirk R; Fox, Derren; Waluda, Claire M

2016-01-01

We report long-term changes in population size of three species of sympatrically breeding pygoscelid penguins: Adélie (Pygoscelis adeliae), chinstrap (Pygoscelis antarctica) and gentoo (Pygoscelis papua ellsworthii) over a 38 year period at Signy Island, South Orkney Islands, based on annual counts from selected colonies and decadal all-island systematic counts of occupied nests. Comparing total numbers of breeding pairs over the whole island from 1978/79 to 2015/16 revealed varying fortunes: gentoo penguin pairs increased by 255%, (3.5% per annum), chinstrap penguins declined by 68% (-3.6% per annum) and Adélie penguins declined by 42% (-1.5% per annum). The chinstrap population has declined steadily over the last four decades. In contrast, Adélie and gentoo penguins have experienced phases of population increase and decline. Annual surveys of selected chinstrap and Adélie colonies produced similar trends from those revealed by island-wide surveys, allowing total island population trends to be inferred relatively well. However, while the annual colony counts of chinstrap and Adélie penguins showed a trend consistent in direction with the results from all-island surveys, the magnitude of estimated population change was markedly different between colony wide and all island counts. Annual population patterns suggest that pair numbers in the study areas partly reflect immigration and emigration of nesting birds between different parts of the island. Breeding success for all three species remained broadly stable over time in the annually monitored colonies. Breeding success rates in gentoo and chinstrap penguins were strongly correlated, despite the differing trends in population size. This study shows the importance of effective, standardised monitoring to accurately determine long-term population trajectories. Our results indicate significant declines in the Adélie and chinstrap penguin populations at Signy Island over the last five decades, and a gradual

A roadmap for island biology

DEFF Research Database (Denmark)

Patino, Jairo; Whittaker, Robert J.; Borges, Paulo A.V.

2017-01-01

Aims: The 50th anniversary of the publication of the seminal book, The Theory of Island Biogeography, by Robert H. MacArthur and Edward O. Wilson, is a timely moment to review and identify key research foci that could advance island biology. Here, we take a collaborative horizon-scanning approach...... to identify 50 fundamental questions for the continued development of the field. Location: Worldwide. Methods: We adapted a well-established methodology of horizon scanning to identify priority research questions in island biology, and initiated it during the Island Biology 2016 conference held in the Azores......); global change (5); conservation and management policies (5); and invasive alien species (4). Main conclusions: Collectively, this cross-disciplinary set of topics covering the 50 fundamental questions has the potential to stimulate and guide future research in island biology. By covering fields ranging...

Pediatrics in the Marshall Islands

International Nuclear Information System (INIS)

Dungy, C.I.; Morgan, B.C.; Adams, W.H.

1984-01-01

The delivery of health care to children living on isolated island communities presents unique challenges to health professionals. An evolved method of providing longitudinal services to infants and children residing on islands of the Marshall Island chain - a central Pacific portion of the Micronesian archipelago - is presented. The difficulties associated with provision of comprehensive health care in a vast ocean area are discussed

Genetically depauperate in the continent but rich in oceanic islands: Cistus monspeliensis (Cistaceae in the Canary Islands.

Directory of Open Access Journals (Sweden)

Mario Fernández-Mazuecos

Full Text Available BACKGROUND: Population genetic theory holds that oceanic island populations are expected to have lower levels of genetic variation than their mainland counterparts, due to founder effect after island colonization from the continent. Cistus monspeliensis (Cistaceae is distributed in both the Canary Islands and the Mediterranean region. Numerous phylogenetic results obtained in the last years allow performing further phylogeographic analyses in Cistus. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed sequences from multiple plastid DNA regions in 47 populations of Cistus monspeliensis from the Canary Islands (21 populations and the Mediterranean basin (26 populations. The time-calibrated phylogeny and phylogeographic analyses yielded the following results: (1 a single, ancestral haplotype is distributed across the Mediterranean, whereas 10 haplotypes in the Canary Islands; (2 four haplotype lineages are present in the Canarian Islands; (3 multiple colonization events across the archipelago are inferred; (4 the earliest split of intraspecific lineages occurred in the Early to Middle Pleistocene (<930,000 years BP. CONCLUSIONS/SIGNIFICANCE: The contrasting pattern of cpDNA variation is best explained by genetic bottlenecks in the Mediterranean during Quaternary glaciations, while the Canarian archipelago acted as a refugium of high levels of genetic diversity. Active colonization across the Canarian islands is supported not only by the distribution of C. monspeliensis in five of the seven islands, but also by our phylogeographic reconstruction in which unrelated haplotypes are present on the same island. Widespread distribution of thermophilous habitats on every island, as those found throughout the Mediterranean, has likely been responsible for the successful colonization of C. monspeliensis, despite the absence of a long-distance dispersal mechanism. This is the first example of a plant species with higher genetic variation among oceanic island

The CT appearance of the superior intercostal veins

International Nuclear Information System (INIS)

Lund, G.

1982-01-01

The CT appearance of the superior intercostal veins is described. The veins are more frequently seen on the right side. The right superior intercostal vein should not be misinterpreted as a paraspinal mass when it is large or bulges into the contour of the right lung. A case of stenosis of the left brachiocephalic vein is shown, where the left superior intercostal vein serves as a collateral. (orig.)

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.

Issues and Tensions in Island Heritage Management: A Case Study of Motuihe Island, New Zealand

Directory of Open Access Journals (Sweden)

David Bade

2010-05-01

Full Text Available This paper draws on a New Zealand case study, Motuihe Island, to examine the challenges of conserving cultural heritage in places renowned for natural heritage values. In keeping with the broader trend toward the ecological restoration of islands close to Auckland, Motuihe Island is undergoing conversion into an ecosystem of native flora and fauna. Issues and tensions relating to the management of natural and cultural heritage will be discussed and influencing aspects investigated: the nature/culture dualism, the effect of New Zealand’s history and identity, and the influence of islandness on heritage management.

Status of the Island Night Lizard and Two Non-Native Lizards on Outlying Landing Field San Nicolas Island, California

Science.gov (United States)

Fellers, Gary M.; Drost, Charles A.; Murphey, Thomas G.

2008-01-01

More than 900 individually marked island night lizards (Xantusia riversiana) were captured on San Nicolas Island, California, between 1984 and 2007 as part of an ongoing study to monitor the status of this threatened species. Our data suggest that at least a few lizards are probably more than 20 years old, and one lizard would be 31.5 years old if it grew at an average rate for the population. Ages of 20 and 30 years seem reasonable given the remarkably slow growth during capture intervals of more than a decade for five of the lizards which we estimated to be 20 or more years old. Like other lizards, island night lizard growth rates vary by size, with larger lizards growing more slowly. In general, growth rates were somewhat greater on San Nicolas Island (compared with Santa Barbara Island), and this increase was sustained through all of the intermediate size classes. The higher growth rate may account for the somewhat larger lizards present on San Nicolas Island, although we cannot discount the possibility that night lizards on San Nicolas are merely living longer. The high percentage of small lizards in the Eucalyptus habitat might seem to reflect a healthy population in that habitat, but the high proportion of small lizards appears to be caused by good reproduction in the 1900s and substantially poorer reproduction in subsequent years. The Eucalyptus habitat has dried quite a bit in recent years. Night lizards in the Haplopappus/Grassland habitat have shown an increase in the proportion of larger lizards since 2000. There has also been an increase in the proportion of large lizards in the Rock Cobble habitat at Redeye Beach. However, there are has been some change in habitat with more elephant seals occupying the same area just above the high tide as do the night lizards. Southern alligator lizards and side-blotched lizards are both non-native on San Nicolas Island. Neither lizard causes obvious harm to island night lizards, and management time and effort should

Vulnerability assessment of small islands to tourism: The case of the Marine Tourism Park of the Gili Matra Islands, Indonesia

Directory of Open Access Journals (Sweden)

Fery Kurniawan

2016-04-01

Full Text Available The Indonesian government is currently directing its focus of development on the optimum uses of marine and coastal ecosystem services including the marine and coastal tourism. One of the main locus of coastal and marine tourism is the small islands tourism such as Gili Matra Islands among others. Small islands tourism is one of the favourite touristic activities because the destination provides beauty, exotism, aesthetic and a diversity of natural habitats including the warm, clear and attractive water. Tourism is being considered as a development instrument in order to boost a country’s economy and has become part of the global industry. However, tourism is also one of the actors that is responsible for environmental depletion, due to the constructions of buildings and tourism activities. This paper aims to study the level of vulnerability in small islands to tourism as a basis of integrated small islands management in Indonesian conservation area. The group of islands in this study consists of three islands namely Gili Ayer Island, Gili Meno Island and Gili Trawangan Island (known as Gili Matra Islands that were observed using Small Islands Vulnerability Index (SIVI. The results indicate that Gili Matra Islands have a vulnerability status from low into moderate, ranging from 2.25 to 2.75. Gili Ayer Island has the highest vulnerability with SIVI of 2.75 (Moderate, followed by Gili Meno Island with SIVI of 2.50 (Low and Gili Trawangan Island with SIVI of 2.25 (Low. The driving factor of vulnerability is the intensive utilization of marine tourism activities. Tourism is the sole stress to Gili Matra Island’s ecosystem due to its direct damaging impact and reducing its environmental quality. The vulnerability index which was built from the coastline, coral reef, live coral reef, and development area was applicable to assess the small island’s vulnerability in Indonesia, especially for coral island.

Dendrochronology of Strain-Relaxed Islands

International Nuclear Information System (INIS)

Merdzhanova, T.; Kiravittaya, S.; Rastelli, A.; Stoffel, M.; Denker, U.; Schmidt, O.G.

2006-01-01

We report on the observation and study of tree-ring structures below dislocated SiGe islands (superdomes) grown on Si(001) substrates. Analogous to the study of tree rings (dendrochronology), these footprints enable us to gain unambiguous information on the growth and evolution of superdomes and their neighboring islands. The temperature dependence of the critical volume for dislocation introduction is measured and related to the composition of the islands. We show clearly that island coalescence is the dominant pathway towards dislocation nucleation at low temperatures, while at higher temperatures anomalous coarsening is effective and leads to the formation of a depletion region around superdomes

Dendrochronology of strain-relaxed islands.

Science.gov (United States)

Merdzhanova, T; Kiravittaya, S; Rastelli, A; Stoffel, M; Denker, U; Schmidt, O G

2006-06-09

We report on the observation and study of tree-ring structures below dislocated SiGe islands (superdomes) grown on Si(001) substrates. Analogous to the study of tree rings (dendrochronology), these footprints enable us to gain unambiguous information on the growth and evolution of superdomes and their neighboring islands. The temperature dependence of the critical volume for dislocation introduction is measured and related to the composition of the islands. We show clearly that island coalescence is the dominant pathway towards dislocation nucleation at low temperatures, while at higher temperatures anomalous coarsening is effective and leads to the formation of a depletion region around superdomes.

Age, growth and sex composition of the American smelt Osmerus mordax(Mitchill), of western Lake Superior

Science.gov (United States)

Bailey, Merryll M.

1964-01-01

This study is based on 4,561 smelt collected in Chequamegon Bay, the Apostle Islands, the Brule River, and Superior Harbor, all in western Lake Superior. Commercial production in the Great Lakes (U.S. and Canada combined) reached a peak of nearly 16 million pounds in 1960. Production in Lake Superior has generally been small but increased during the 1950's to reach 948,000 pounds in 1960. All O-group and spring I-group smelt had scales with sufficient sculpturing to permit detection of the first annulus. Annulus formation began after 6 June in 1960. In 1961, all smelt had completed the annulus by 24 August. The body-scale relation is a straight line with an intercept of -0.9 inch on the axis of fish length. The weight of western Lake Superior smelt increased as the 2.952 power of the length. A large range of length in each age group and resulting overlap of age-groups II-VI made length a poor index of age. Female smelt grew faster than males after the second year and dominated strongly in age-groups IV-VII. Both sexes made their best annual growth in length (3.3 inches) during their second year of life; the largest weight increments (0.74 ounce, males; 0.85 ounce, females) came in the third year. Best production from a commercial pound net in 1961 occurred when the sex ratios of spawning smelt were nearest 50:50. Spawning male smelt were consistently shorter than females and the average lengths of both sexes decreased as the spawning season progressed. Shortest mature smelt of each sex were 5.0 to 5.2 inches but the males are probably the first to reach 100 percent maturity. All year-old smelt were immature. Among 2-year-old fish, 40.7 per cent of the males and 17.7 percent of the females had reached maturity. All smelt more than 2 years old were mature. Ovaries of 10 smelt contained an average of 31,338 eggs for fish 7.3 to 8.8 inches long.

75 FR 28542 - Superior Resource Advisory Committee

Science.gov (United States)

2010-05-21

... Self-Determination Act (Pub. L. 110-343) and in compliance with the Federal Advisory Committee Act. The purpose of the meeting is to orient the new Superior Resource Advisory Committee members on their roles... following business will be conducted: Overview of the roles and responsibilities of the Superior Resource...

The Limacidae of the Canary Islands

NARCIS (Netherlands)

Regteren Altena, van C.O.

1950-01-01

CONTENTS Introduction............... 3 Systematic survey of the Limacidae of the central and western Canary Islands 5 Biogeographical notes on the Limacidae of the Canary Islands . . . . 21 Alphabetical list of the persons who collected or observed Limacidae in the Canary Islands.............. 31

Enhancement of micro-grid performance during islanding mode using storage batteries and new fuzzy logic pitch angle controller

International Nuclear Information System (INIS)

Kamel, Rashad M.; Chaouachi, A.; Nagasaka, Ken

2011-01-01

Research highlights: → Novel fuzzy pitch angle controller is proposed for smoothing wind fluctuation. → Storage batteries are used for performance improve of MG in islanding mode. → Those new techniques are compared with conventional PI pitch angle controller. -- Abstract: Power system deregulation, shortage of transmission capacities and needing to reduce green house gas have led to increase interesting in distributed generations (DGs) especially renewable sources. This study developed a complete model able to analysis and simulates in details the transient dynamic performance of the Micro-Grid (MG) during and subsequent islanding process. Wind speed fluctuations cause high fluctuations in output power of wind turbine which lead to fluctuations of frequency and voltages of the MG during the islanding mode. In this paper a new fuzzy logic pitch angle controller is proposed to smooth the output power of wind turbine to reduce MG frequency and voltage fluctuations during the islanding mode. The proposed fuzzy logic pitch controller is compared with the conventional PI pitch angle controller which usually used for wind turbine power control. Results proved the effectiveness of the proposed fuzzy controller in improvement of the MG performance. Also, this paper proposed using storage batteries technique to reduce the frequency deviation and fluctuations originated from wind power solar power fluctuations. Results indicate that the storage batteries technique is superior than fuzzy logic pitch controller in reducing frequency deviation, but with more expensive than the fuzzy controller. All models and controllers are built using Matlab (registered) Simulink (registered) environment.

Genomic island excisions in Bordetella petrii

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Levillain Erwan

2009-07-01

Full Text Available Abstract Background Among the members of the genus Bordetella B. petrii is unique, since it is the only species isolated from the environment, while the pathogenic Bordetellae are obligately associated with host organisms. Another feature distinguishing B. petrii from the other sequenced Bordetellae is the presence of a large number of mobile genetic elements including several large genomic regions with typical characteristics of genomic islands collectively known as integrative and conjugative elements (ICEs. These elements mainly encode accessory metabolic factors enabling this bacterium to grow on a large repertoire of aromatic compounds. Results During in vitro culture of Bordetella petrii colony variants appear frequently. We show that this variability can be attributed to the presence of a large number of metastable mobile genetic elements on its chromosome. In fact, the genome sequence of B. petrii revealed the presence of at least seven large genomic islands mostly encoding accessory metabolic functions involved in the degradation of aromatic compounds and detoxification of heavy metals. Four of these islands (termed GI1 to GI3 and GI6 are highly related to ICEclc of Pseudomonas knackmussii sp. strain B13. Here we present first data about the molecular characterization of these islands. We defined the exact borders of each island and we show that during standard culture of the bacteria these islands get excised from the chromosome. For all but one of these islands (GI5 we could detect circular intermediates. For the clc-like elements GI1 to GI3 of B. petrii we provide evidence that tandem insertion of these islands which all encode highly related integrases and attachment sites may also lead to incorporation of genomic DNA which originally was not part of the island and to the formation of huge composite islands. By integration of a tetracycline resistance cassette into GI3 we found this island to be rather unstable and to be lost from

Superiority of Bessel function over Zernicke polynomial as base ...

Indian Academy of Sciences (India)

Abstract. Here we describe the superiority of Bessel function as base function for radial expan- sion over Zernicke polynomial in the tomographic reconstruction technique. The causes for the superiority have been described in detail. The superiority has been shown both with simulated data for Kadomtsev's model for ...

CRED Gridded Bathymetry of Necker Island (100-021) in the Northwestern Hawaiian Islands

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — File 100-021b is a 60-m ASCII grid of depth data collected near Necker Island in the Northwestern Hawaiian Islands as of May 2003. This grid has been produced as...

Bathymetry of Lake Superior

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Bathymetry of Lake Superior has been compiled as a component of a NOAA project to rescue Great Lakes lake floor geological and geophysical data and make it more...

Digitalized design of extraforaminal lumbar interbody fusion: a computer-based simulation and cadaveric study.

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Mingjie Yang

Full Text Available PURPOSE: This study aims to investigate the feasibility of a novel lumbar approach named extraforaminal lumbar interbody fusion (ELIF, a newly emerging minimally invasive technique for treating degenerative lumbar disorders, using a digitalized simulation and a cadaveric study. METHODS: The ELIF surgical procedure was simulated using the Mimics surgical simulator and included dissection of the superior articular process, dilation of the vertebral foramen, and placement of pedicle screws and a cage. ELIF anatomical measures were documented using a digitalized technique and subsequently validated on fresh cadavers. RESULTS: The use of the Mimics allowed for the vivid simulation of ELIF surgical procedures, while the cadaveric study proved the feasibility of this novel approach. ELIF had a relatively lateral access approach that was located 8-9 cm lateral to the median line with an access depth of approximately 9 cm through the intermuscular space. Dissection of the superior articular processes could fully expose the target intervertebral discs and facilitate a more inclined placement of the pedicle screws and cage with robust enhancement. CONCLUSIONS: According to the computer-based simulation and cadaveric study, it is feasible to perform ELIF. Further research including biomechanical study is needed to prove ELIF has a superior ability to preserve the posterior tension bands of the spinal column, with similar effects on spinal decompression, fixation, and fusion, and if it can enhance post-fusion spinal stability and expedites postoperative recovery.

Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

Energy Technology Data Exchange (ETDEWEB)

Hudyana, Hendrah; Maes, Alex [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Hospital Leuven, Department of Morphology and Medical Imaging, Leuven (Belgium); Vandenberghe, Thierry; Fidlers, Luc [AZ Groeninge, Department of Neurosurgery, Kortrijk (Belgium); Sathekge, Mike [University of Pretoria, Department of Nuclear Medicine, Pretoria (South Africa); Nicolai, Daniel [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); Wiele, Christophe van de [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Ghent, Department of Radiology and Nuclear Medicine, Ghent (Belgium)

2016-02-15

The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found. The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac

Colonialism and Sanctity in the Mariana Islands: the soldiers of Gideon (1676-1690

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Alexandre Coello de la Rosa

2010-04-01

Full Text Available In this article I analyze the conquest and conversion of the Marianas (1676- 1690 as a discursive reality that turned the islands in a violent theater wherein the chamorros were defined as ruthless warriors (warrior’s ethos, and the Jesuits, on the contrary, as victims of the betrayals and retaliations of their newly converted «children» (martyr’s ethos. The hagiographers elevated their Jesuit martyrs to the category of «moral heroes», turning their deeds into a strong element of cohesion and identity for the missionaries preaching in the archipelago. In addition, the superiors wrote informaciones or memorials in which they stood out the behaviour of the military «heroes» of the colonization. We refer to José de Quiroga y Losada, captain and major sergeant of the garrison, and to the «loyal Indian» don Ignacio de Hineti, Indian sergeant and a «good Christian», whose military expeditions were directed to deal with the «anomaly» of the chamorros’ resistance. After the Second Great War (1683-86, the Jesuits clearly adopted the political and religious leadership in the islands, becoming the founders of a real «missionary state» wherein their martyrs acted as moral referents of the subjugated territories.

The geology of the Falkland Islands

OpenAIRE

Aldiss, D.T.; Edwards, E.J.

1999-01-01

This report is complementary to the 1:250 000 scale geological map of the Falkland Islands compiled in 1998. The report and map are products of the Falkland Islands Geological Mapping Project (1996-1998). Geological observation and research in the Islands date from 1764. The Islands were visited during two pioneering scientific cruises in the 19th century. Subsequently, many scientists visited en route to the Antarctic or Patagonia. Geological affinities to other parts of the sout...

The Solomon Islands tsunami of 6 February 2013 field survey in the Santa Cruz Islands

Science.gov (United States)

Fritz, H. M.; Papantoniou, A.; Biukoto, L.; Albert, G.

2013-12-01

On February 6, 2013 at 01:12:27 UTC (local time: UTC+11), a magnitude Mw 8.0 earthquake occurred 70 km to the west of Ndendo Island (Santa Cruz Island) in the Solomon Islands. The under-thrusting earthquake near a 90° bend, where the Australian plate subducts beneath the Pacific plate generated a locally focused tsunami in the Coral Sea and the South Pacific Ocean. The tsunami claimed the lives of 10 people and injured 15, destroyed 588 houses and partially damaged 478 houses, affecting 4,509 people in 1,066 households corresponding to an estimated 37% of the population of Santa Cruz Island. A multi-disciplinary international tsunami survey team (ITST) was deployed within days of the event to document flow depths, runup heights, inundation distances, sediment and coral boulder depositions, land level changes, damage patterns at various scales, performance of the man-made infrastructure and impact on the natural environment. The 19 to 23 February 2013 ITST covered 30 locations on 4 Islands: Ndendo (Santa Cruz), Tomotu Noi (Lord Howe), Nea Tomotu (Trevanion, Malo) and Tinakula. The reconnaissance completely circling Ndendo and Tinakula logged 240 km by small boat and additionally covered 20 km of Ndendo's hard hit western coastline by vehicle. The collected survey data includes more than 80 tsunami runup and flow depth measurements. The tsunami impact peaked at Manoputi on Ndendo's densely populated west coast with maximum tsunami height exceeding 11 m and local flow depths above ground exceeding 7 m. A fast tide-like positive amplitude of 1 m was recorded at Lata wharf inside Graciosa Bay on Ndendo Island and misleadingly reported in the media as representative tsunami height. The stark contrast between the field observations on exposed coastlines and the Lata tide gauge recording highlights the importance of rapid tsunami reconnaissance surveys. Inundation distance and damage more than 500 m inland were recorded at Lata airport on Ndendo Island. Landslides were

Forces in the development of remote islands in Japan : A case study of local energy enterprises in Tsushima Island

OpenAIRE

Matsumura, Yuko; Miyoshi, Emako

2018-01-01

Japan, one of the most famous islander nations in the world, has promoted the development of its remote islands for over 60 years after the Second World War. The target islands and projects for fostering development have been steadily expanded. However, the country is facing serious socio-economic challenges such as aging and recession, resulting in less available funding for preferential treatment to remote islands. Thus, the framework for boosting island development should be reconsidered, ...

Population Size and Decadal Trends of Three Penguin Species Nesting at Signy Island, South Orkney Islands.

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Michael J Dunn

Full Text Available We report long-term changes in population size of three species of sympatrically breeding pygoscelid penguins: Adélie (Pygoscelis adeliae, chinstrap (Pygoscelis antarctica and gentoo (Pygoscelis papua ellsworthii over a 38 year period at Signy Island, South Orkney Islands, based on annual counts from selected colonies and decadal all-island systematic counts of occupied nests. Comparing total numbers of breeding pairs over the whole island from 1978/79 to 2015/16 revealed varying fortunes: gentoo penguin pairs increased by 255%, (3.5% per annum, chinstrap penguins declined by 68% (-3.6% per annum and Adélie penguins declined by 42% (-1.5% per annum. The chinstrap population has declined steadily over the last four decades. In contrast, Adélie and gentoo penguins have experienced phases of population increase and decline. Annual surveys of selected chinstrap and Adélie colonies produced similar trends from those revealed by island-wide surveys, allowing total island population trends to be inferred relatively well. However, while the annual colony counts of chinstrap and Adélie penguins showed a trend consistent in direction with the results from all-island surveys, the magnitude of estimated population change was markedly different between colony wide and all island counts. Annual population patterns suggest that pair numbers in the study areas partly reflect immigration and emigration of nesting birds between different parts of the island. Breeding success for all three species remained broadly stable over time in the annually monitored colonies. Breeding success rates in gentoo and chinstrap penguins were strongly correlated, despite the differing trends in population size. This study shows the importance of effective, standardised monitoring to accurately determine long-term population trajectories. Our results indicate significant declines in the Adélie and chinstrap penguin populations at Signy Island over the last five decades, and a

CRED Gridded Bathymetry of Nihoa Island (100-025) in the Northwestern Hawaiian Islands

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — File 100-025b is a 60-m ASCII grid of depth data collected near Nihoa Island in the Northwestern Hawaiian Islands as of May 2003. This grid has been produced as part...

Equilibrium theory of island biogeography: A review

Science.gov (United States)

Angela D. Yu; Simon A. Lei

2001-01-01

The topography, climatic pattern, location, and origin of islands generate unique patterns of species distribution. The equilibrium theory of island biogeography creates a general framework in which the study of taxon distribution and broad island trends may be conducted. Critical components of the equilibrium theory include the species-area relationship, island-...

Prosopomorphic vessels from Moesia Superior

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Nikolić Snežana

2008-01-01

Full Text Available The prosopomorphic vessels from Moesia Superior had the form of beakers varying in outline but similar in size. They were wheel-thrown, mould-made or manufactured by using a combination of wheel-throwing and mould-made appliqués. Given that face vessels are considerably scarcer than other kinds of pottery, more than fifty finds from Moesia Superior make an enviable collection. In this and other provinces face vessels have been recovered from military camps, civilian settlements and necropolises, which suggests that they served more than one purpose. It is generally accepted that the faces-masks gave a protective role to the vessels, be it to protect the deceased or the family, their house and possessions. More than forty of all known finds from Moesia Superior come from Viminacium, a half of that number from necropolises. Although tangible evidence is lacking, there must have been several local workshops producing face vessels. The number and technological characteristics of the discovered vessels suggest that one of the workshops is likely to have been at Viminacium, an important pottery-making centre in the second and third centuries.

The Development of the Picture-Superiority Effect

Science.gov (United States)

Whitehouse, Andrew J. O.; Maybery, Murray T.; Durkin, Kevin

2006-01-01

When pictures and words are presented serially in an explicit memory task, recall of the pictures is superior. While this effect is well established in the adult population, little is known of the development of this picture-superiority effect in typical development. This task was administered to 80 participants from middle childhood to…

Nearshore coastal bathymetry data collected in 2016 from West Ship Island to Horn Island, Gulf Islands National Seashore, Mississippi

Science.gov (United States)

DeWitt, Nancy T.; Stalk, Chelsea A.; Fredericks, Jake J.; Flocks, James G.; Kelso, Kyle W.; Farmer, Andrew S.; Tuten, Thomas M.; Buster, Noreen A.

2018-04-13

The U.S. Geological Survey (USGS) St. Petersburg Coastal and Marine Science Center, in cooperation with the U.S. Army Corps of Engineers, Mobile District, conducted bathymetric surveys of the nearshore waters surrounding Ship and Horn Islands, Gulf Islands National Seashore, Mississippi. The objective of this study was to establish base-level elevation conditions around West Ship, East Ship, and Horn Islands and their associated active littoral system prior to restoration activities. These activities include the closure of Camille Cut and the placement of sediment in the littoral zone of East Ship Island. These surveys can be compared with future surveys to monitor sediment migration patterns post-restoration and can also be measured against historic bathymetric datasets to further our understanding of island evolution.The USGS collected 667 line-kilometers (km) of single-beam bathymetry data and 844 line-km of interferometric swath bathymetry data in July 2016 under Field Activity Number 2016-347-FA. Data are provided in three datums: (1) the International Terrestrial Reference Frame of 2000 (ellipsoid height); (2) the North American Datum of 1983 (NAD83) CORS96 realization and the North American Vertical Datum of 1988 with respect to the GEOID12B model (orthometric height); and (3) NAD83 (CORS96) and Mean Lower Low Water (tidal datum). Data products, including x,y,zpoint datasets, trackline shapefiles, digital and handwritten Field Activity Collection Systems logs, 50-meter digital elevation model, and formal Federal Geographic Data Committee metadata, are available for download.

Checklist of marine fishes of the Zunan Islands, located between the Izu and Ogasawara (Bonin) islands, Japan, with zoogeographical comments

OpenAIRE

Kuriiwa, Kaoru; Arihara, Hisashi; Chiba, Satoru; Kato, Shoichi; Senou, Hiroshi; Matsuura, Keiichi

2014-01-01

The Zunan Islands are located 360–650 km south of Tokyo, and consist of four uninhabited volcanoes: the Bayonnaise Rocks, the Smith Rocks, Torishima Island and the Sofugan Rock. Although all of the elements of the Zunan Islands are tiny islets and rocks, they form a series of stepping stones for shallow water fishes between the Izu Islands in the north and the Ogasawara (Bonin) Islands in the south. We report here the first comprehensive survey of marine fishes in the Zunan Islands. A total o...

Ecology and Evolution: Islands of Change.

Science.gov (United States)

Benz, Richard

This book was designed for middle and junior high school science classes and focuses on island biogeography, ecology, and evolution. Sections include: (1) "Galapagos: Frame of Reference"; (2) "Ecology and Islands"; and (3) "Evolution." Nineteen standards-based activities use the Galapagos Islands as a running theme…

Tools for sustainability assessment in island socio-ecological systems: an application to the Canary Islands

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Isabel Banos-González

2016-05-01

Full Text Available An integral dynamic model, in combination with other methods (indicators, policy and scenario analysis, is presented as a tool for sustainability assessment in island socio-ecological systems (SES. The Fuerteventura sustainability model (FSM, tested for the 1996-2011, allows a better understanding of the dynamic interactions between sustainability indicators and other factors of this island. The FSM was first applied to analyse the vulnerability of this island to climate change for the 2012-2025 period; results point to the need for urgent measures to mitigate its effects on some of the analysed indicators. A set of policy measures was then assessed from the behaviour of nine indicators and their sustainability thresholds. Finally, the FSM facilitated the development of a dynamic model of the island of El Hierro, extrapolating the features common to both SES. We propose this to be a useful tool for the quantitative sustainability assessment and the management of real island socio-ecological systems

The Idea of the Archipelago: Contemplating Island Relations

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Elaine Stratford

2013-05-01

Full Text Available Creative, innovative, and timely research on islands and island futures is warranted and pressing, not least because island(ers are poorly served by established tropes of them as subordinate to continents or mainlands. Opportunities exist to provide a more thoroughgoing account of island life and island relations, and the seven papers in this special issue address that task. In works that consider islands in the Timor Sea, the Caribbean, the Pacific, Atlantic and Southern Oceans, and that span several different disciplinary frames—archival-historical, critical theoretical, literary, cultural, geopolitical, sociological and artistic—these papers evidence both the diversity of approach to thinking with the archipelago, and numerous points in common. Among the latter is an understanding that island relations are built on connection, assemblage, mobility, and multiplicity, and a commitment to critically examine the ways in which these entanglements affect and give effect to island life. The models of island relationality brought to light by this collective focus on the archipelago reveal new and diverse connections of island peoples with their physical and cultural environments, and with the world beyond; create spaces for growing resilience, association and engagement; and invite further study.

Pedicle subtraction osteotomy in elderly patients with degenerative sagittal imbalance.

Science.gov (United States)

Cho, Kyu-Jung; Kim, Ki-Tack; Kim, Whoan-Jeang; Lee, Sang-Hoon; Jung, Jae-Hoon; Kim, Young-Tae; Park, Hae-Bong

2013-11-15

Retrospective, radiographical analysis. To evaluate pedicle subtraction osteotomy (PSO) as a means of correcting severe degenerative sagittal imbalance in elderly patients. PSO in patients with degenerative sagittal imbalance is likely to cause more complications than in patients with iatrogenic flatback deformity. This study analyzed 34 patients who underwent fusion to the sacrum, with a minimum 2-year follow-up. Age of the patients were in the range from 58 to 73 with the mean at 65.5 years. PSO was performed at one segment in all cases, consisting of L3 (n = 26), L4 (n = 4), L2 (n = 3), and L1 (n = 1). The average number of levels fused was 8.15. Ten patients had structural interbody fusion at the lumbosacral junction. Applying PSO at one segment, the mean correction of the lordotic angle at the osteotomy site was 33.3°, of which the loss of correction (LOC) was 4.0° at the last visit. The correction of lumbar lordosis was 33.7° and the LOC was 8.5°. The sagittal C7 plumb was 215.9 mm before surgery, corrected to 35.1 mm after surgery, and changed to 95.9 mm by the last visit. The correction of the sagittal C7 plumb was 119.9 mm and the LOC was 60.9 mm. There was substantial LOC in lumbar lordosis and sagittal C7 plumb. In 10 patients with addition of posterior lumbar interbody fusion, the LOC of lumbar lordosis was 7.4°, which was less than 9° in those without it. PSO for the correction of degenerative sagittal imbalance in elderly patients resulted in correction of sagittal alignment with a significant LOC of lumbar lordosis and sagittal C7 plumb. The LOC of lumbar lordosis occurred at both the osteotomy and non-osteotomy site. The addition of anterior column support is helpful to maintain correction and reduce complications. N/A.

seal Arctocephaius tropicaiis at Gough Island

African Journals Online (AJOL)

Population increase in the Amsterdam Island fur seal Arctocephaius tropicaiis at Gough Island. M.N. Bester. Mammal Research Institute, University of Pretoria, Pretoria. Population size of Arctocephalus tropicalis on Gough Island was determined by direct censuses of parts of the coast duro ing the summers of 1974 - 1976 ...

Simple method for calculating island widths

International Nuclear Information System (INIS)

Cary, J.R.; Hanson, J.D.; Carreras, B.A.; Lynch, V.E.

1989-01-01

A simple method for calculating magnetic island widths has been developed. This method uses only information obtained from integrating along the closed field line at the island center. Thus, this method is computationally less intensive than the usual method of producing surfaces of section of sufficient detail to locate and resolve the island separatrix. This method has been implemented numerically and used to analyze the buss work islands of ATF. In this case the method proves to be accurate to at least within 30%. 7 refs

Recommendations for a barrier island breach management plan for Fire Island National Seashore, including the Otis Pike High Dune Wilderness Area, Long Island, New York

Science.gov (United States)

Williams, S. Jeffress; Foley, Mary K.

2007-01-01

The U.S Army Corps of Engineers, New York District is developing engineering plans, including economic costs and benefits, for storm damage reduction along an 83 mile stretch of the coastal barrier islands and beaches on the south shore of Long Island, NY from Fire Island Inlet east to the Montauk Point headland. The plan, expected to include various alternatives for storm protection and erosion mitigation, is referred to as the Fire Island to Montauk Point Reformulation Plan (FIMP). These plans are expected to follow the Corps of Engineers’ Environmental Operating Principles striving for long term environmental sustainability and balance between environmental protection and protection of human health and property. Fire Island National Seashore (FIIS), a 19,579 acre unit of the National Park System includes a 32 mile long coastal barrier island located within the FIMP project area. A seven-mile section of the park, Otis Pike Fire Island High Dune Wilderness Area, is also a designated Federal Wilderness Area. The FIIS includes not only the barrier island and sand dunes, but also several islands, sand flats and wetlands landward of the barrier, submerged parts of Great South Bay shoreface, extending approximately 4,000 feet into the bay with the inner shelf region extending approximately 1,000 feet seaward of the Fire Island shoreline. The Fire Island barrier islands, a sand-starved system dominated by highly dynamic processes, are struggling to maintain their integrity in the face of sea-level rise and storms. Adding to the dilemma is that development on the barriers and the mainland has increased greatly during the past 50 years. As such, managers and decision makers in federal agencies, state agencies and local governments are challenged to balance tradeoffs between protection of lives and property, public access and long term conservation of natural habitats and processes and the plants and animals that depend on these habitats. National Park Service (NPS

Postoperative quality-of-life assessment in patients with spine metastases treated with long-segment pedicle-screw fixation.

Science.gov (United States)

Bernard, Florian; Lemée, Jean-Michel; Lucas, Olivier; Menei, Philippe

2017-06-01

OBJECTIVE In recent decades, progress in the medical management of cancer has been significant, resulting in considerable extension of survival for patients with metastatic disease. This has, in turn, led to increased attention to the optimal surgical management of bone lesions, including metastases to the spine. In addition, there has been a shift in focus toward improving quality of life and reducing hospital stay for these patients, and many minimally invasive techniques have been introduced with the aim of reducing the morbidity associated with more traditional open approaches. The goal of this study was to assess the efficacy of long-segment percutaneous pedicle screw stabilization for the treatment of instability associated with thoracolumbar spine metastases in neurologically intact patients. METHODS This study was a retrospective review of data from a prospective database. The authors analyzed cases in which long-segment percutaneous pedicle screw fixation was performed for the palliative treatment of thoracolumbar spinal instability due to spinal metastases in neurologically intact patients. All of the patients included in the study underwent surgery between January 2014 and May 2015 at the authors' institution. Postoperative radiation therapy was planned within 10 days following the stabilization in all cases. Clinical and radiological follow-up assessments were planned for 3 days, 3 weeks, 6 weeks, 3 months, 6 months, and 1 year after surgery. Outcome was assessed by means of standard postoperative evaluation and oncological and spinal quality of life measures (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Version 3.0 [EORTC QLQ-C30] and Oswestry Disability Index [ODI], respectively). Moreover, 5 patients were given an activity monitoring device for recording the distance walked daily; preoperative and postoperative daily distances were compared. RESULTS Data from 17 cases were analyzed. There were no

Mosquito Surveys Carried out On Green Island, Orchid Island, and Penghu Island, Taiwan, in 2003

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Hwa-Jen Teng

2005-02-01

Full Text Available Field surveys of mosquitoes were carried out on Green, Orchid, and Penghu Islands in 2003 to ascertain the status of mosquito vectors. Eighteen species of mosquitoes were collected, including three species of Anopheles, four species of Aedes, eight species of Culex, two species of Armigeres, and one species of Malaya. Seventeen previously recorded species were not collected in this study but 11 species collected had not previously been recorded. Ten newly recorded species, An. maculatus, An. takasagoensis, Ae. alcasidi, Ae. lineatopennis, Ae. vexans vexans, Ar. omissus, Cx. vishnui, Cx. halifaxii, Cx. hayashii, and Cx. neomimulus, were collected on Green Island and one previously unrecorded species, Ar. subalbatus, was collected on Orchid Island. Potential vectors An. maculatus and An. sinensis, malaria vectors in Korea and Mainland China, Ae. albopictus, a vector of dengue in Taiwan and West Nile virus in the USA, Cx. vishnui and Cx. tritaeniorhynchus, Japanese encephalitis vectors in Taiwan, Ae. vexans vexans, an eastern equine encephalitis vector in the USA, and Cx. quinquefasciatus, a vector of filariasis in Taiwan and West Nile virus in the USA, were among the mosquito species collected.

Superior semicircular canal dehiscence in relation to the superior petrosal sinus: a potential cause of pulsatile tinnitus

International Nuclear Information System (INIS)

Liu, Z.; Bi, W.; Li, J.; Li, Q.; Dong, C.; Zhao, P.; Lv, H.; Wang, Z.

2015-01-01

Aim: To examine the association between superior semicircular canal dehiscence (SSCD) and pulsatile tinnitus (PT). Materials and methods: Two SSCD groups included 408 unilateral persistent PT patients, and 511 controls undergoing head and neck dual-phase contrast-enhanced computed tomography (DP-CECT) for reasons other than PT. The prevalence of type I (no the superior petrosal sinus running through the dehiscence) and type II (superior semicircular canal dehiscence in relation to the superior petrosal sinus) SSCD was analysed using chi-square test. Results: SSCD was identified in 5.1% (21/408) of PT ears, significantly different from 2% (8/408) of non-PT ears and 0.7% (7/1022) of controls. There was no significant difference in SSCD prevalence between non-PT ears in the PT group and controls. In the PT group, 15/21 ears were type II SSCD; 6/21 ears were type I. Fifteen combined non-PT and control ears with SSCD included two type II and 13 type I SSCD. The prevalence of type II SSCD in PT ears was significantly higher than that of non-PT ears in both groups, and the prevalence of type I SSCD in PT ears was similar to that of non-PT ears in both groups. Conclusion: Compared with type I SSCD, there may be a causal relationship between type II SSCD and PT. -- Highlights: •The prevalence of type II SSCD in PT ears was significantly higher than that in non-PT ears in both the PT group and controls. •The prevalence of type I SSCD was similar among the PT ears and non-PT ears. •The superior petrosal sinus running through the dehiscence may be essential for SSCD to induce PT. •Venous phase CT images with bone window settings is the modality method to differentiate type II from type I SSCD

Intersectional gene flow between insular endemics of Ilex (Aquifoliaceae) on the Bonin Islands and the Ryukyu Islands.

Science.gov (United States)

Setoguchi, H; Watanabe, I

2000-06-01

Hybridization and introgression play important roles in plant evolution, and their occurrence on the oceanic islands provides good examples of plant speciation and diversification. Restriction fragment length polymorphisms (RFLPs) and trnL (UAA) 3'exon-trnF (GAA) intergenic spacer (IGS) sequences of chloroplast DNA (cpDNA), and the sequences of internal transcribed spacer (ITS) of nuclear ribosomal DNA were examined to investigate the occurrence of gene transfer in Ilex species on the Bonin Islands and the Ryukyu Islands in Japan. A gene phylogeny for the plastid genome is in agreement with the morphologically based taxonomy, whereas the nuclear genome phylogeny clusters putatively unrelated endemics both on the Bonin and the Ryukyu Islands. Intersectional hybridization and nuclear gene flow were independently observed in insular endemics of Ilex on both sets of islands without evidence of plastid introgression. Gene flow observed in these island systems can be explained by ecological features of insular endemics, i.e., limits of distribution range or sympatric distribution in a small land area.

Seed islands driven by turbulence and NTM dynamics

Science.gov (United States)

Muraglia, M.; Agullo, O.; Poye, A.; Benkadda, S.; Horton, W.; Dubuit, N.; Garbet, X.; Sen, A.

2014-10-01

Magnetic reconnection is an issue for tokamak plasmas. Growing magnetic islands expel energetic particles from the plasma core leading to high energy fluxes in the SOL and may cause damage to the plasma facing components. The islands grow from seeds from the bootstrap current effects that oppose the negative delta-prime producing nonlinear island growth. Experimentally, the onset of NTM is quantified in terms of the beta parameter and the sawtooth period. Indeed, in experiments, (3;2) NTM magnetic islands are often triggered by sawtooth precursors. However (2;1) magnetic islands can appear without noticeable MHD event and the seed islands origin for the NTM growth is still an open question. Macroscale MHD instabilities (magnetic islands) coexist with micro-scale turbulent fluctuations and zonal flows which impact island dynamics. Nonlinear simulations show that the nonlinear beating of the fastest growing small-scale ballooning interchange modes on a low order rational surface drive a magnetic islands located on the same surface. The island size is found to be controlled by the turbulence level and modifies the NTM threshold and dynamics.

Introduced mammals on Western Indian Ocean islands

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James C. Russell

2016-04-01

Full Text Available The diversity of introduced mammals and their introduction history varies greatly across the Western Indian Ocean (WIO islands, from ancient introductions in the past millennia on islands off the East coast of Africa where extant terrestrial native mammal communities exist, to very recent invasions in the past decades on islands in the Mascarene archipelago. We compile the distribution of 16 introduced mammal taxa on 28 island groups comprising almost 2000 islands. Through an exhaustive literature review and expert consultation process we recorded all mammal eradications, and species recoveries which could be attributed to introduced mammal eradication or control. All island groups have been invaded by mammals, and invasive cats and rats in particular are ubiquitous, but cultural contingency has also led to regional invasions by other mammals such as lemurs, civets and tenrecs. Mammal eradications have been attempted on 45 islands in the WIO, the majority in the Seychelles and Mauritius, and where successful have resulted in spectacular recovery of species and ecosystems. Invasive mammalian predator eradication or control in association with habitat management has led to improved conservation prospects for at least 24 species, and IUCN red-list down-listing of eight species, in the Mascarene Islands. Future island conservation prioritisation in the region will need to take account of global climate change and predicted sea-level rises and coastal inundation. Greater investment and prioritisation in island conservation in the region is warranted, given its high biodiversity values and the extent of invasions.

Vancouver Island gas supply

International Nuclear Information System (INIS)

Des Brisay, C.

2005-01-01

Terasen Gas is pursuing alternatives for the supply of additional natural gas capacity to Vancouver Island. Its subsidiary, Terasen Gas (Vancouver Island) Inc. (TGVI), is responding to the need for delivery of increased gas supply and, is supporting plans for new gas-fired power generation on Vancouver Island. TGVI's proposal for new natural gas capacity involves a combination of compression and pipeline loops as well as the addition of a storage facility for liquefied natural gas (LNG) at Mt. Hayes to help manage price volatility. This presentation outlined the objectives and components of the resource planning process, including demand forecast scenarios and the preferred infrastructure options. tabs., figs

Agenesia de cava superior associada a bloqueio atrioventricular de 3º grau Agenesis of the right superior vena cava associated with total heart block

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Gustavo J. Ventura Couto

2008-03-01

Full Text Available A persistência de veia cava superior esquerda com ausência da veia cava superior é uma anomalia rara, principalmente quando associada a bloqueio atrioventricular de 3º grau. Relatamos o caso de uma paciente, na qual durante implante de marca-passo definitivo, para a correção de bloqueio atrioventricular total, foi detectada presença de veia cava superior esquerda com suspeição de ausência de veia cava superior, o que levou ao emprego de técnica diferenciada para fixação do eletrodo ventricular. Para confirmação da provável agenesia, foram realizados diversos exames complementares de imagem, demonstrando-se a dificuldade no diagnóstico da síndrome aqui descrita.The superior left vena cava with the absent superior vena cava is a rare abnormality, especially when associated with total heart block. We report a case of a patient in which the presence of superior left vena cava and the absence of the superior vena cava was detected during the implantation of a pacemaker for the correction of a total heart block, which led us to use a different technique for the fixation of the ventricular electrode. To confirm the supposed absence, several image exams were made showing the difficulty on the diagnosis of the described syndrome.

Wind energy potential on Malaysian Resort Islands: a case study of Tioman, Redang and Perhentian Island

International Nuclear Information System (INIS)

Kamaruzzaman Sopian

2000-01-01

Wind data collected at three east coast islands of Peninsular Malaysia namely Tioman, Redang and Perhentian Island were analyzed for the wind energy potential. The results were presented as Weibull distribution and preliminary analysis indicate that the site at Redang Island have the greatest potential with a mean power density of 85.1 w/m 2 at 10 meters above sea level. (Author)

Writing superiority in cued recall

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Carina eFueller

2013-10-01

Full Text Available In list learning paradigms with free recall, written recall has been found to be less susceptible to intrusions of related concepts than spoken recall when the list items had been visually presented. This effect has been ascribed to the use of stored orthographic representations from the study phase during written recall (Kellogg, 2001. In other memory retrieval paradigms, either better recall for modality-congruent items or an input-independent writing superiority effect have been found (Grabowski, 2005. In a series of four experiments using a paired associate (PA learning paradigm we tested (a whether output modality effects on verbal recall can be replicated in a paradigm that does not involve the rejection of semantically related intrusion words, (b whether a possible superiority for written recall was due to a slower response onset for writing as compared to speaking in immediate recall, and (c whether the performance in PA word recall was correlated with performance in an additional episodic memory task. We found better written recall in the first half of the recall phase, irrespective of the modality in which the material was presented upon encoding. An explanation based on longer response latencies for writing and hence more time for retrieval could be ruled out by showing that the effect persisted in delayed response versions of the task. Although there was some evidence that stored additional episodic information may contribute to the successful retrieval of associate words, this evidence was only found in the immediate response experiments and hence is most likely independent from the observed output modality effect. In sum, our results from a PA learning paradigm suggest that superior performance for written versus spoken recall cannot be (solely explained in terms of additional access to stored orthographic representations from the encoding phase. Our findings rather suggest a general writing-superiority effect at the time of memory

Modeling the Response of Human Altered Natural Barrier Island Dynamics Along Assateague Island National Seashore to Climate Change

Science.gov (United States)

Carroll, A.; McNamara, D.; Schupp, C.

2009-12-01

Assateague Island National Seashore comprises a long barrier island located off the coasts of Maryland and Virginia. Geological evidence suggests that over recent centuries Assateague Island has steadily transgressed up the continental shelf in response to rising sea level. More recently, the natural barrier island dynamics governing Assateague’s evolution have been altered by human activity in three ways: the construction of a jetty and the subsequent interruption of alongshore sediment transport on the north end of Assateague and both the ongoing and abandoned maintenance of a continuous dune system along portions of Assateague with the concomitant modification to overwash dynamics. It is unclear how these varied human alterations to the natural barrier island dynamics will influence the response of Assateague to climate change induced shifts in forcing such as increased rates of sea level rise and changing storm patterns. We use LIDAR detected morphological data of Assateague Island as initial conditions in an alongshore extended model for barrier island dynamics including beach erosion, island overwash and inlet cutting during storms, and beach accretion, tidal delta growth and dune and vegetation growth between storms to explore the response of the various human altered segments of Assateague Island to forcing changes. Traditional models exploring barrier island evolution contain only cross-shore dynamics therefore lacking important alongshore-spatial dynamics in aeolian and surf zone sediment transport. Results show that including alongshore dynamics alter the steady state of Assateague relative to simulations that only include cross-shore dynamics. Results will also be presented exploring the potential for regime shifts in steady state behavior under various scenarios for the rate of sea level rise and storm climate and varying management strategies.

Terrestrial radiation measurements in Marshall Islands

International Nuclear Information System (INIS)

Gudiksen, P.H.

1978-01-01

With the prospect of habitation in the near future, radiological surveys were undertaken of Enewetak and Bikini Atolls to provide a basis for determining whether or not the atolls can be safely reinhabited. The surveys included all of the forty islands within Enewetak Atoll, but only the two principal islands, Bikini and Eneu Islands, of Bikini Atoll. These atolls were former U.S. nuclear weapons test sites in the Pacific. Integral parts of the surveys were the measurements of the distributions of radioactivity in the soil and the resulting gamma ray exposure rates for external dose estimation. Numerous soil samples were collected from both atolls for analysis by Ge (Li) gamma spectrometry and by wet chemistry techniques. At Enewetak Atoll the gamma exposure rates were measured by TLDs and a helicopter-borne array of Nal detectors, while at Bikini Atoll portable Nal detectors, pressurized ion-chambers, and TLDs were utilized. The predominant species measured in the soil samples collected from both atolls were 90 Sr, 239,240 Pu, 137 Cs and 60 Co with the latter two nuclides being the primary contributors to the gamma-ray exposure rates. The geographical distribution of the exposure rates measured on both atolls, was highly variable ranging from less than 1 μR/h on islands that had not been impacted radiologically by the testing program, to over 100 μR/h near weapon detonation sites. Thus, within Enewetak Atoll, the highest soil activities and gamma-ray exposure rates were measured on the northern islands, where the weapons testing had been most intense. Bikini Island exhibited contamination levels that were considerably higher than those on Eneu Island. Generally, the highest activity levels were observed within the island interiors or in proximity to ground zero sites, and could usually be related to the surrounding vegetation density. The island of Yvonne, within Enewetak Atoll, is the most severely contaminated land area. Particles containing as much as several

Globally threatened vertebrates on islands with invasive species.

Science.gov (United States)

Spatz, Dena R; Zilliacus, Kelly M; Holmes, Nick D; Butchart, Stuart H M; Genovesi, Piero; Ceballos, Gerardo; Tershy, Bernie R; Croll, Donald A

2017-10-01

Global biodiversity loss is disproportionately rapid on islands, where invasive species are a major driver of extinctions. To inform conservation planning aimed at preventing extinctions, we identify the distribution and biogeographic patterns of highly threatened terrestrial vertebrates (classified by the International Union for Conservation of Nature) and invasive vertebrates on ~465,000 islands worldwide by conducting a comprehensive literature review and interviews with more than 500 experts. We found that 1189 highly threatened vertebrate species (319 amphibians, 282 reptiles, 296 birds, and 292 mammals) breed on 1288 islands. These taxa represent only 5% of Earth's terrestrial vertebrates and 41% of all highly threatened terrestrial vertebrates, which occur in vertebrates was available for 1030 islands (80% of islands with highly threatened vertebrates). Invasive vertebrates were absent from 24% of these islands, where biosecurity to prevent invasions is a critical management tool. On the 76% of islands where invasive vertebrates were present, management could benefit 39% of Earth's highly threatened vertebrates. Invasive mammals occurred in 97% of these islands, with Rattus sp. as the most common invasive vertebrate (78%; 609 islands). Our results provide an important baseline for identifying islands for invasive species eradication and other island conservation actions that reduce biodiversity loss.

North Aegean island landscapes as ecomuseums: the case of Lesvos Island

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Evangelos Pavlis

2017-05-01

Full Text Available The main advantage of the Aegean islands, in generating national, regional, or international competitiveness, compared to the areas on the continental mainland, is their natural and cultural assets, their cultural landscapes. Consequently, the organized utilization of cultural heritage, rich biodiversity, and the unique Aegean landscape, could make the islands attractive as places to live or work and help them fulfill their sustainability goals. Ecomuseums are ‘in situ’ museums, aimed at local communities and managed by them, aiming at the interpretation, protection, utilization, and promotion of natural and cultural assets of a place, and at the economic revival of marginal regions through the combinational development of small-scale tourism, local manufacturing, and primary production sectors. They could function as laboratories of sustainable development. The island of Lesvos has been selected as a case study for such a potential ecomuseum.

Frog size on continental islands of the coast of Rio de Janeiro and the generality of the Island Rule.

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Raoni Rebouças

Full Text Available Island Rule postulated that individuals on islands tend to dwarfism when individuals from mainland populations are large and to gigantism when mainland populations present small individuals. There has been much discussion about this rule, but only few studies were carried out aiming to reveal this pattern for anurans. Our study focused on measuring the size of individuals on islands and to find a possible pattern of size modification for insular anurans. Individuals were collected on continental islands, measured and compared to mainland populations. We selected four species with different natural history aspects during these analyses. Island parameters were compared to size of individuals in order to find an explanation to size modification. Three of the four species presented size shifting on islands. Ololygon trapicheiroi and Adenomera marmorata showed dwarfism, Boana albomarginata showed gigantism and in Thoropa miliaris there was no evident size modification. Allometric analysis also revealed differential modification, which might be a result of different selective pressures on islands in respect of mainland populations. Regression model explained most of the size modification in B. albomarginata, but not for the other species. Our results indicate that previous assumptions, usually proposed for mammals from older islands, do not fit to the anurans studied here. We support the assumption that size modification on islands are population-specific. Hence, in B. albomarginata some factor associated to competition, living area and isolation time might likely be responsible for gigantism on islands.

Spatial and temporal controls of atoll island inundation: implications for urbanized atolls in the Marshall Islands.

Science.gov (United States)

Ford, M.; Becker, J. M.; Merrifield, M. A.

2012-12-01

Atoll islands are highly vulnerable to a range of inundation hazards. The impacts of such hazards are expected to be magnified as a result of continued sea-level rise. Both recent and historic inundation events provide unique insights into the requisite conditions necessary to initiate island inundation. A number of recent and historic inundation events are presented in order to examine the oceanographic and meteorological conditions driving inundation of a densely populated, urbanized atoll in the central Pacific. Analysis of inundation events suggests that a number of key drivers contribute to the spatial and temporal extent of island inundation, with unique degrees of predictability and resultant impact signatures apparent on island geomorphology and local anthropogenic activities. Results indicate three distinct drivers of inundation hazards exist. Firstly, tropical storms and typhoons elevate sea level through inverse barometric setup, wind setup and a range of wave driven processes and have caused considerable impact on atolls within the Marshall Islands. Secondly, super-elevated sea level conditions resulting from the combination of seasonal high tides and quasi-cyclical La Nina conditions drive inundation of low-lying lagoon facing coastal areas. Thirdly, long period swell conditions, typically generated by distant storms, can elevate reef-flat water levels through wave setup and infragravity wave oscillations. Such wave conditions can over wash the ocean-facing island ridge, often inundating large sections of the island. Reef-flat wave conditions are tidally modulated, with inundation events typically occurring around high tide. However, the two most recent destructive swell-driven inundation events have occurred while tide levels were significantly lower than spring tide levels, suggesting high water levels are not a necessary prerequisite for wave-driven inundation. The different modes of inundation are discussed and grounded within recent and historic

Chronic Liver Disease and Asian Americans/Pacific Islanders

Science.gov (United States)

... Cancer Asian/Pacific Islander Women Non-Hispanic White Women Asian/Pacific Islander/ Non-Hispanic White Ratio All Sites ... Cancer Asian/Pacific Islander Women Non-Hispanic White Women Asian/Pacific Islander/ Non-Hispanic White Ratio Liver & IBD* ...

Motor mechanisms of vertical fusion in individuals with superior oblique paresis.

Science.gov (United States)

Mudgil, Ananth V; Walker, Mark; Steffen, Heimo; Guyton, David L; Zee, David S

2002-06-01

We wanted to determine the mechanisms of motor vertical fusion in patients with superior oblique paresis and to correlate these mechanisms with surgical outcomes. Ten patients with superior oblique paresis underwent 3-axis, bilateral, scleral search coil eye movement recordings. Eye movements associated with fusion were analyzed. Six patients had decompensated congenital superior oblique paresis and 4 had acquired superior oblique paresis. All patients with acquired superior oblique paresis relied predominantly on the vertical rectus muscles for motor fusion. Patients with congenital superior oblique paresis were less uniform in their mechanisms for motor fusion: 2 patients used predominantly the oblique muscles, 2 patients used predominantly the vertical recti, and 2 patients used predominantly the superior oblique in the hyperdeviated eye and the superior rectus in the hypodeviated eye. The last 2 patients developed the largest changes in torsional eye alignment relative to changes in vertical eye alignment and were the only patients to develop symptomatic surgical overcorrections. There are 3 different mechanisms for vertical fusion in individuals with superior oblique paresis, with the predominant mechanism being the vertical recti. A subset of patients with superior oblique paresis uses predominantly the superior oblique muscle in the hyperdeviated paretic eye and the superior rectus muscle in the fellow eye for fusion. This results in intorsion of both eyes, causing a large change in torsional alignment. The consequent cyclodisparity, in addition to the existing vertical deviation, may make fusion difficult. The differing patterns of vertical fusional vergence may have implications for surgical treatment.

Design of a Fractional Order Frequency PID Controller for an Islanded Microgrid: A Multi-Objective Extremal Optimization Method

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Huan Wang

2017-10-01

Full Text Available Fractional order proportional-integral-derivative(FOPID controllers have attracted increasing attentions recently due to their better control performance than the traditional integer-order proportional-integral-derivative (PID controllers. However, there are only few studies concerning the fractional order control of microgrids based on evolutionary algorithms. From the perspective of multi-objective optimization, this paper presents an effective FOPID based frequency controller design method called MOEO-FOPID for an islanded microgrid by using a Multi-objective extremal optimization (MOEO algorithm to minimize frequency deviation and controller output signal simultaneously in order to improve finally the efficient operation of distributed generations and energy storage devices. Its superiority to nondominated sorting genetic algorithm-II (NSGA-II based FOPID/PID controllers and other recently reported single-objective evolutionary algorithms such as Kriging-based surrogate modeling and real-coded population extremal optimization-based FOPID controllers is demonstrated by the simulation studies on a typical islanded microgrid in terms of the control performance including frequency deviation, deficit grid power, controller output signal and robustness.

Solid waste management on small islands. The case of Green Island, Taiwan

Energy Technology Data Exchange (ETDEWEB)

Chen, M.C.; Ruijs, A.; Wesseler, J. [Environmental Economics and Natural Resources Group, Wageningen University, P.O. Box 8130, 6700 EW Wageningen (Netherlands)

2005-09-01

Municipalities of small islands have limited capacities for waste disposal. In the case of Green Island, Taiwan, continuing with business as usual would only allow the disposal of waste on the island for another 8 years. Three alternatives for solid waste management (SWM) are compared. The cost-effective solution is the one, which is the most expensive in the short run: continuing business as usual and introducing an incineration plant in the year 2010. The results indicate furthermore that deviations from optimal timing of investment only slightly change average annual costs. In the long run, the municipality can hardly avoid transporting waste to the mainland. By investing in an incineration plant, they can buy additional time to investigate alternative SWM strategies.

[Finite element analysis of stress changes of posterior spinal pedicle screw infixation].

Science.gov (United States)

Yan, Jia-Zhi; Wu, Zhi-Hong; Xu, Ri-Xin; Wang, Xue-Song; Xing, Ze-Jun; Zhao, Yu; Zhang, Jian-Guo; Shen, Jian-Xiong; Wang, Yi-Peng; Qiu, Gui-Xing

2009-01-06

To evaluate the mechanical response of L3-L4 segment after posterior interfixation with a transpedicle screw system. Spiral CT machine was used to conduct continuous parallel scan on the L3-L4 section of a 40-year-old healthy male Chinese. The image data thus obtained were introduced into MIMICS software to reconstruct the 2-D data into volume data and obtain 3-D models of every element.. Pro/3-D model construction software system was used to simulate the 3-D entity of L3-L4 fixed by screw robs through spinal pedicle via posterior approach that was introduced into the finite element software ABAQUS to construct a 3-D finite element model. The stress changes on the vertebrae and screw under the axial pressure of 0.5 mPa was analyzed. Under the evenly distributed pressure the displacement of the L4 model was 0.00125815 mm, with an error of only 0.8167% from the datum displacement. The convergence of the model was good. The stress of the fixed vertebral body, intervertebral disc, and internal fixators changed significantly. The stress concentration zone of the intervertebral disc turned from the posterolateral side to anterolateral side. The stress produced by the fixed vertebral bodies decreased significantly. Obvious stress concentration existed in the upper and lower sides of the base of screw and the fixed screw at the upper vertebral body bore greater stress than the lower vertebral body. Integration of computer aided device and finite element analysis can successfully stimulate the internal fixation of L3-IA visa posterior approach and observe the mechanic changes in the vertebral column more directly.

An algorythmic approach to restoration of the fronto-naso-periorbital skin defects using the forehead flaps.

Science.gov (United States)

Tan, Onder

2010-01-01

The classic forehead flaps, which are designed vertically, two-staged and exteriorised pedicled peninsular flaps, are still a reconstructive option for nasal and periorbital defects. However, some drawbacks such as conspicuous donor-site scar, multi-staged procedure, rather short pedicle, hairy appearance (in narrow foreheads), and inability to use the forehead flap when the donor site is involved are often encountered during surgery. To avoid these issues, three unusual designs of the forehead flap are presented, and also a new algorithm is proposed to guide surgeons in their solutions. Nineteen patients (10 women and nine men) were managed with 21 forehead flaps to restore the nasal, medial canthal and frontal defects caused by skin tumours. The flaps were applied as interpolation island, V-Y island, and transverse peninsular designs in 12, four and three patients, respectively. All donor sites were closed primarily except one, where a split thickness skin graft was used. The average follow-up was 14 months. All flaps survived (totally) but in one partial necrosis developed. Aesthetic and functional recoveries were acceptable in all patients. Based on the algorithm presented, the forehead flaps with their superb anatomic characteristics including rich vascular supply and pliable skin can be safely used in either classic or extraordinary fashion for small to medium sized defects of the nasoorbital and frontal regions.

CRED Gridded Bathymetry near Lisianski Island and Pioneer Bank (100-002), Northwestern Hawaiian Islands

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — File 100-002b is a 60-m ASCII grid of depth data collected near Lisianski Island and Pioneer Bank in the Northwestern Hawaiian Islands as of May 2003. This grid has...

Revisiting the Metaphor of the Island: Challenging "World Culture" from an Island Misunderstood

Science.gov (United States)

Rappleye, Jeremy

2015-01-01

This article revisits the newly "discovered" island that world culture theorists have repeatedly utilised to explain their theoretical stance, conceptual preferences and methodological approach. Yet, it seeks to (re)connect world culture with the real world by replacing their imagined atoll with a real one--the island-nation of Japan. In…

Marketing at Superior: Theory meets application in the field

International Nuclear Information System (INIS)

Jeffrey, S.

1992-01-01

The field marketing practices of Superior Propane in rural Ontario are illustrated. In the Smithville area, Superior's customer base consists of agricultural, industrial, commercial, and residential customers, plus a large market for auto propane. A 6,900 ft 2 showroom presents a representative selection of the wide range of appliances using propane. Superior's Smithville branch is one of the top five in Canada, in terms of volume. To expand business beyond its traditional branch structures, Superior has an Independent Partners Program which is aimed at all phases of business including independent sales agents, conversions, propane fuel stops, appliance installations, and building contractors. In Keswick, located in the summer resort region on the south shore of Lake Simcoe, Superior's base load is 40% commercial and 20% each agricultural, residential, and automotive. A new 4,100 ft 2 showroom was recently constructed with separate display units for each appliance. The new building has brought increases in auto propane and appliance sales. The different branches of Superior Propane are able to tailor their marketing programs according to local needs by choosing the appropriate programs from those available at head office. 5 figs

A new species of iguana Brachylophus Cuvier 1829 (Sauria: Iguania: Iguanidae) from Gau Island, Fiji Islands.

Science.gov (United States)

Fisher, Robert N; Niukula, Jone; Watling, Dick; Harlow, Peter S

2017-06-06

The south Pacific iguanas (Brachylophus) currently have three recognized living species in Fiji.  Recent surveys have uncovered more specific variation (morphological and genetic) within the genus and have better defined the geographic ranges of the named species.  One of these recent discoveries is a strikingly different iguana from all other island populations in Fiji which is restricted to Gau Island of the Lomaiviti Province.  Gau is the fifth largest island in Fiji and maintains excellent upland forests in the higher elevations.  We describe this population from Gau Island as a new species, Brachylophus gau sp. nov., in recognition of its type locality.

A new species of iguana Brachylophus Cuvier 1829 (Sauria: Iguania: Iguanidae) from Gau Island, Fiji Islands

Science.gov (United States)

Fisher, Robert N.; Niukula, Jone; Watling, Dick; Harlow, Peter S.

2017-01-01

The south Pacific iguanas (Brachylophus) currently have three recognized living species in Fiji.  Recent surveys have uncovered more specific variation (morphological and genetic) within the genus and have better defined the geographic ranges of the named species.  One of these recent discoveries is a strikingly different iguana from all other island populations in Fiji which is restricted to Gau Island of the Lomaiviti Province.  Gau is the fifth largest island in Fiji and maintains excellent upland forests in the higher elevations.  We describe this population from Gau Island as a new species, Brachylophus gau sp. nov., in recognition of its type locality.

Island forming processes in the Okavango Delta, Botswana

Science.gov (United States)

McCarthy, T. S.; Humphries, M. S.; Mahomed, I.; Le Roux, P.; Verhagen, B. Th.

2012-12-01

The Okavango Delta in Botswana is a large (40,000 km2) alluvial fan that is characterised by the presence of numerous tree-covered islands. Thought to originate from the mound-building activities of termites or through fluvial processes associated with development of scroll bars and inverted channels, islands have been shown to play an important role in the structure and functioning of the Delta through the creation of habitat diversity, focusing of nutrients, and disposal of toxic salts. This study investigates the processes responsible for the maintenance and growth of two such islands in the seasonal swamps. Transpiration by vegetation is shown to result in substantial increases in groundwater salinity beneath the islands, contributing to their growth through chemical precipitation. Detailed chemical analyses revealed that the precipitation of magnesian calcite and silica within the island soils contributes 30-40% of the total island volume. Isotopic analyses of carbonate samples show that vegetation plays an important role in providing carbon for carbonate precipitation. Variations in δ13C carbonate values appear to reflect the relative proportion of C3 to C4 plants on the island, with C4 species becoming more dominant toward island centres in response to increases in groundwater salinity. The study suggests that continued island growth is also related to the deposition of aerosols and the accumulation of dust preferentially on islands and possibly to ongoing termite activity. Tall trees that characterise the island margins trap dust carried from the floodplains, resulting particularly in the lateral growth of islands. Islands in the Okavango are considered to be the product of long-term aggradation processes, with the two islands studied estimated to be in the order of tens of thousands of years old.

Elastic energies of coherent germanium islands on silicon

International Nuclear Information System (INIS)

Vanderbilt, D.; Wickham, L.K.

1991-01-01

Motivated by recent observations of coherent Ge island formation during growth of Ge on Si (100), the authors of this paper have carried out a theoretical study of the elastic energies associated with the evolution of a uniform strained overlayer as it segregates into coherent islands. In the context of a two-dimensional model, the authors have explored the conditions under which coherent islands may be energetically favored over both uniform epitaxial films and dislocated islands. The authors find that if the interface energy (for dislocated islands) is more than about 15% of the surface energy, then there is a range of island sizes for which the coherent island structure is preferred

Modified cup flap for volar oblique fingertip amputations

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Ahmadli, A.

2016-02-01

Full Text Available We describe a modified volar “V-Y cup” flap for volar fingertip defects that do not exceed more than half of the distal phalanx for better aesthetic and functional outcome. In seven cases out of eight, the flap was elevated with a subdermal pedicle, whereas in one case, the flap was elevated as an island on the bilateral neurovascular bundle. The fingertips have been evaluated for sensibility using standard tests, hook nail deformity and patient satisfaction. Seven flaps have survived completely. The flap with skeletonized bilateral digital neurovascular bundle has shown signs of venous insufficiency on the 5 postoperative day with consecutive necrosis. Suturing the distal edges of the flap in a “cupping” fashion provided a normal pulp contour. The modified flap can be used for defects as mentioned above. Subdermally dissected pedicle-based flap is safe and easy to elevate. The aesthetic and functional outcomes have been reported to be satisfactory.

Mechanisms causing size differences of the land hermit crab Coenobita rugosus among eco-islands in Southern Taiwan.

Directory of Open Access Journals (Sweden)

Chia-Hsuan Hsu

Full Text Available Numerous environmental factors can influence body size. Comparing populations in different ecological contexts is one potential approach to elucidating the most critical of such factors. In the current study, we found that the body size of the land hermit crab Coenobita rugosus was significantly larger on Dongsha Island in the South China Sea than on other eco-islands around Southern Taiwan. We hypothesized that this could be due to differences in (1 shell resources, (2 parasite impact, (3 competition, (4 predation, and (5 food. We found no supporting evidence for the first three hypotheses; the shells used by the hermit crabs on Dongsha were in poorer condition than were those used elsewhere, extremely few individuals in the region had ectoparasites, and the density of hermit crabs varied considerably among localities within each island. However, significantly higher percentages of C. rugosus reached age 3 years on Dongsha than at Siziwan bay in Taiwan. Two growth rate indices inferred from size structures suggested faster growth on Dongsha than at Siziwan. The condition index (i.e., the body mass/shield length ratio of C. rugosus was also greater on Dongsha than at Siziwan. Therefore, Dongsha hermit crabs seem to have superior diet and growth performance. Seagrass debris accumulation at the shore of Dongsha was considerable, whereas none was observed at Siziwan or on the other islands, where dicot leaves were the dominant food item for the vegetarian hermit crabs. We then experimentally evaluated the possible role of seagrass as food for C. rugosus. The crabs on Dongsha preferred seagrass to dicot leaves, and their growth increment was faster when they fed on seagrass than when they fed on dicot leaves; no such differences were found in the Siziwan hermit crabs. The aforementioned results are compatible with the food hypothesis explaining the size differences among the islands. The predator hypothesis could explain the greater life span but

Shape and coarsening dynamics of strained islands

DEFF Research Database (Denmark)

Schifani, Guido; Frisch, Thomas; Argentina, Mederic

2016-01-01

and numerically the formation of an equilibrium island using a two-dimensional continuous model. We have found that these equilibrium island-like solutions have a maximum height h_{0} and they sit on top of a flat wetting layer with a thickness h_{w}. We then consider two islands, and we report that they undergo...... and leads to the shrinkage of the smallest island. Once its height becomes smaller than a minimal equilibrium height h_{0}^{*}, its mass spreads over the entire system. Our results pave the way for a future analysis of coarsening of an assembly of islands....

Observer-Based Load Frequency Control for Island Microgrid with Photovoltaic Power

Directory of Open Access Journals (Sweden)

Chaoxu Mu

2017-01-01

Full Text Available As renewable energy is widely integrated into the power system, the stochastic and intermittent power generation from renewable energy may cause system frequency deviating from the prescribed level, especially for a microgrid. In this paper, the load frequency control (LFC of an island microgrid with photovoltaic (PV power and electric vehicles (EVs is investigated, where the EVs can be treated as distributed energy storages. Considering the disturbances from load change and PV power, an observer-based integral sliding mode (OISM controller is designed to regulate the frequency back to the prescribed value, where the neural network observer is used to online estimate the PV power. Simulation studies on a benchmark microgrid system are presented to illustrate the effectiveness of OISM controller, and comparative results also demonstrate that the proposed method has a superior performance for stabilizing the frequency over the PID control.

Review of islanding detection methods for distributed generation

DEFF Research Database (Denmark)

Chen, Zhe; Mahat, Pukar; Bak-Jensen, Birgitte

2008-01-01

This paper presents an overview of power system islanding and islanding detection techniques. Islanding detection techniques, for a distribution system with distributed generation (DG), can broadly be divided into remote and local techniques. A remote islanding detection technique is associated...

Effect of island shape on dielectrophoretic assembly of metal nanoparticle chains in a conductive-island-based microelectrode system