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Sample records for large trochanteral depressor

  1. Trochanteric bursitis

    Science.gov (United States)

    ... of the hip; Hip bursitis References Fredericson M, Lin C, Chew K. Greater trochanteric pain syndrome. In: ... Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, ...

  2. Trochanteric fractures

    International Nuclear Information System (INIS)

    Herrlin, K.; Stroemberg, T.; Lidgren, L.; Walloee, A.; Pettersson, H.; Lund Univ.

    1988-01-01

    Four hundred and thirty trochanteric factures operated upon with McLaughlin, Ender or Richard's osteosynthesis were divided into 6 different types based on their radiographic appearance before and immediately after reposition with special reference to the medial cortical support. A significant correlation was found between the fracture type and subsequent mechanical complications where types 1 and 2 gave less, and types 4 and 5 more complications. A comparison of the various osteosyntheses showed that Richard's had significantly fewer complications than either the Ender or McLaughlin types. For Richard's osteosynthesis alone no correlation to fracture type could be made because of the small number of complications in this group. (orig.)

  3. Trochanteric entry femoral nails yield better femoral version and lower revision rates-A large cohort multivariate regression analysis.

    Science.gov (United States)

    Yoon, Richard S; Gage, Mark J; Galos, David K; Donegan, Derek J; Liporace, Frank A

    2017-06-01

    Intramedullary nailing (IMN) has become the standard of care for the treatment of most femoral shaft fractures. Different IMN options include trochanteric and piriformis entry as well as retrograde nails, which may result in varying degrees of femoral rotation. The objective of this study was to analyze postoperative femoral version between three types of nails and to delineate any significant differences in femoral version (DFV) and revision rates. Over a 10-year period, 417 patients underwent IMN of a diaphyseal femur fracture (AO/OTA 32A-C). Of these patients, 316 met inclusion criteria and obtained postoperative computed tomography (CT) scanograms to calculate femoral version and were thus included in the study. In this study, our main outcome measure was the difference in femoral version (DFV) between the uninjured limb and the injured limb. The effect of the following variables on DFV and revision rates were determined via univariate, multivariate, and ordinal regression analyses: gender, age, BMI, ethnicity, mechanism of injury, operative side, open fracture, and table type/position. Statistical significance was set at pregression analysis revealed that a lower BMI was significantly associated with a lower DFV (p=0.006). Controlling for possible covariables, multivariate analysis yielded a significantly lower DFV for trochanteric entry nails than piriformis or retrograde nails (7.9±6.10 vs. 9.5±7.4 vs. 9.4±7.8°, pregression analysis. However, this is not to state that the other nail types exhibited abnormal DFV. Translation to the clinical impact of a few degrees of DFV is also unknown. Future studies to more in-depth study the intricacies of femoral version may lead to improved technology in addition to potentially improved clinical outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. [Trochanteric femoral fractures].

    Science.gov (United States)

    Douša, P; Čech, O; Weissinger, M; Džupa, V

    2013-01-01

    At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. Our department serves as a trauma centre for half of Prague and part of the Central Bohemia Region with a population of 1 150 000. Prague in particular has a high number of elderly citizens. Our experience is based on extensive clinical data obtained from the Register of Proximal Femoral Fractures established in 1997. During 14 years, 4280 patients, 3112 women and 1168 men, were admitted to our department for treatment of proximal femoral fractures. All patients were followed up until healing or development of complications. In the group under study, 82% were patients older than 70 years; 72% of those requiring surgery were in their seventies and eighties. Men were significantly younger than women (pfractures were 2.3-times more frequent in women than in men. In the category under 60 years, men significantly outnumbered women (pfractures were, on the average, eight years older than the patients with intertrochanteric fractures, which is a significant difference (pTrochanteric fractures accounted for 54.7% and femoral neck fractures for 45.3% of all fractures. The inter-annual increase was 5.9%, with more trochanteric than femoral neck fractures. There was a non-significant decrease in intertrochanteric (AO 31-A3) fractures. On the other hand, the number of pertrochanteric (AO 31-A1+2) fractures increased significantly (pfractures were treated with a proximal femoral nail; a short nail was used in 1260 and a long nail in 134 of them. A dynamic hip screw (DHS) was employed to treat 947 fractures. Distinguishing between pertrochanteric (21-A1

  5. Congenital Unilateral Hypoplasia of Depressor Anguli Oris

    Directory of Open Access Journals (Sweden)

    Seckin O. Ulualp

    2012-01-01

    Full Text Available Objectives. Asymmetric facial appearance may originate from abnormalities of facial musculature or facial innervation. We describe clinical features of congenital hypoplasia of depressor anguli oris muscle in a child. Material and Methods. Chart of a 10-month-old female referred to a tertiary care pediatric hospital for assessment of facial paralysis was reviewed. Data included relevant history and physical examination, diagnostic work up, and management. Results. The child presented with asymmetric movement of lower lip since birth. Asymmetry of lower lip was more pronounced when she smiled and cried. Rest of the face movement was symmetric. On examination, the face appeared symmetric at rest. The child had inward deviation of right lower lip when she smiled. Facial nerve function, as determined by frowning/forehead, wrinkling, eye closure, nasolabial fold depth, and tearing, was symmetric. Magnetic resonance imaging of the temporal bones and internal auditory canals were within normal limits. Echocardiogram did not show cardiac abnormality. Auditory brainstem response showed no abnormality. Conclusions. Congenital hypoplasia of depressor anguli oris is a rare anomaly that causes asymmetric crying face. Pediatricians and otolaryngologists need to be cognizant of cardiac, head and neck, and central nervous system anomalies associated with congenital unilateral hypoplasia of depressor anguli oris.

  6. Trochanteric bursitis: radiological findings

    International Nuclear Information System (INIS)

    Revilla, T.Y.; Manjon, P.; Lozaono, C.

    1997-01-01

    To describe the radiological findings associated with trochanteric bursitis. Six patients studied by means of plain radiography (n=6), CT(n=4) and MR(n=2). The conventional radiography study was normal in two patients and disclosed bone abnormalities in four. US showed a hypoechoic or anechoic collection in all the patients. Two patients presented areas suggestive of calcification, and septa were observed in one. CT disclosed the presence of well defined, low-attenuation, unenhanced collections. MR images identified collections with a signal intensity similar to that of water. Trochanteric bursitis is a relatively common cause of hip pain, and can involve any one of a number of etiologies. US is a good imaging technique for diagnosing this pathology. (Author) 10 refs

  7. Trochanteric reduction osteotomy as a treatment for refractory trochanteric bursitis

    NARCIS (Netherlands)

    Govaert, L. H. M.; van der Vis, H. M.; Marti, R. K.; Albers, G. H. R.

    2003-01-01

    We describe a new operative procedure for patients with chronic trochanteric bursitis. Between March 1994 and May 2000, a trochanteric reduction osteotomy was performed on ten patients (12 hips). All had received conservative treatment for at least one year. Previous surgical treatment with a

  8. Correlation of MRI findings with clinical findings of trochanteric pain syndrome

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    Blankenbaker, Donna G.; Ullrick, Steven R.; Davis, Kirkland W.; De Smet, Arthur A. [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); Haaland, Ben; Fine, Jason P. [University of Wisconsin School of Medicine and Public Health, Departments of Biostatistics and Medical Informatics and Statistics, Madison, WI (United States)

    2008-10-15

    Greater trochanter pain syndrome due to tendinopathy or bursitis is a common cause of hip pain. The previously reported magnetic resonance (MR) findings of trochanteric tendinopathy and bursitis are peritrochanteric fluid and abductor tendon abnormality. We have often noted peritrochanteric high T2 signal in patients without trochanteric symptoms. The purpose of this study was to determine whether the MR findings of peritrochanteric fluid or hip abductor tendon pathology correlate with trochanteric pain. We retrospectively reviewed 131 consecutive MR examinations of the pelvis (256 hips) for T2 peritrochanteric signal and abductor tendon abnormalities without knowledge of the clinical symptoms. Any T2 peritrochanteric abnormality was characterized by size as tiny, small, medium, or large; by morphology as feathery, crescentic, or round; and by location as bursal or intratendinous. The clinical symptoms of hip pain and trochanteric pain were compared to the MR findings on coronal, sagittal, and axial T2 sequences using chi-square or Fisher's exact test with significance assigned as p<0.05. Clinical symptoms of trochanteric pain syndrome were present in only 16 of the 256 hips. All 16 hips with trochanteric pain and 212 (88%) of 240 without trochanteric pain had peritrochanteric abnormalities (p=0.15). Eighty-eight percent of hips with trochanteric symptoms had gluteus tendinopathy while 50% of those without symptoms had such findings (p=0.004). Other than tendinopathy, there was no statistically significant difference between hips with or without trochanteric symptoms and the presence of peritrochanteric T2 abnormality, its size or shape, and the presence of gluteus medius or minimus partial thickness tears. Patients with trochanteric pain syndrome always have peritrochanteric T2 abnormalities and are significantly more likely to have abductor tendinopathy on magnetic resonance imaging (MRI). However, although the absence of peritrochanteric T2 MR abnormalities

  9. Correlation of MRI findings with clinical findings of trochanteric pain syndrome

    International Nuclear Information System (INIS)

    Blankenbaker, Donna G.; Ullrick, Steven R.; Davis, Kirkland W.; De Smet, Arthur A.; Haaland, Ben; Fine, Jason P.

    2008-01-01

    Greater trochanter pain syndrome due to tendinopathy or bursitis is a common cause of hip pain. The previously reported magnetic resonance (MR) findings of trochanteric tendinopathy and bursitis are peritrochanteric fluid and abductor tendon abnormality. We have often noted peritrochanteric high T2 signal in patients without trochanteric symptoms. The purpose of this study was to determine whether the MR findings of peritrochanteric fluid or hip abductor tendon pathology correlate with trochanteric pain. We retrospectively reviewed 131 consecutive MR examinations of the pelvis (256 hips) for T2 peritrochanteric signal and abductor tendon abnormalities without knowledge of the clinical symptoms. Any T2 peritrochanteric abnormality was characterized by size as tiny, small, medium, or large; by morphology as feathery, crescentic, or round; and by location as bursal or intratendinous. The clinical symptoms of hip pain and trochanteric pain were compared to the MR findings on coronal, sagittal, and axial T2 sequences using chi-square or Fisher's exact test with significance assigned as p<0.05. Clinical symptoms of trochanteric pain syndrome were present in only 16 of the 256 hips. All 16 hips with trochanteric pain and 212 (88%) of 240 without trochanteric pain had peritrochanteric abnormalities (p=0.15). Eighty-eight percent of hips with trochanteric symptoms had gluteus tendinopathy while 50% of those without symptoms had such findings (p=0.004). Other than tendinopathy, there was no statistically significant difference between hips with or without trochanteric symptoms and the presence of peritrochanteric T2 abnormality, its size or shape, and the presence of gluteus medius or minimus partial thickness tears. Patients with trochanteric pain syndrome always have peritrochanteric T2 abnormalities and are significantly more likely to have abductor tendinopathy on magnetic resonance imaging (MRI). However, although the absence of peritrochanteric T2 MR abnormalities

  10. Greater trochanteric pain syndrome diagnosis and treatment.

    Science.gov (United States)

    Mallow, Michael; Nazarian, Levon N

    2014-05-01

    Lateral hip pain, or greater trochanteric pain syndrome, is a commonly seen condition; in this article, the relevant anatomy, epidemiology, and evaluation strategies of greater trochanteric pain syndrome are reviewed. Specific attention is focused on imaging of this syndrome and treatment techniques, including ultrasound-guided interventions. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Tuberculous, trochanteric and ischial bursitis

    International Nuclear Information System (INIS)

    San Roman, R.; Manjon, P.; Revilla, Y.; Rodriguez, P.

    1998-01-01

    To analyze the radiological signs and clinical presentation of tuberculous bursitis arising in the ischial and trochanteric territories, given the limited available knowledge on these entities and in view of the growing prominence of extra pulmonary tuberculosis (TB) in the field of infectious diseases. We present seven cases dealt with in our hospital from the first medical consultation to the definitive diagnosis and treatment. Five of the patients presented greater trochanter involvement, while ischium was the site in the remaining two, in one of whom the bursitis extended toward pubis. The radiographic images revealed demineralization and/or erosion of the bone surface in six cases, soft tissue calcification in four, soft tissue mass in two, coccygeal involvement in one and avulsion of a bone fragment one. An ultrasound study was carried out in a of case soft tissue abscess and fistulography in a case of peri-ischial abscess reaching the cutaneous level. Images of the ischial and trochanteric tuberosities such as those described in the present report should lead to a suspicion of bursitis accompanied by local osteitis. One of the etiologies that should be considered, probably the most common one, is tuberculosis, given the serious consequences that poor initial management would have (if is often treated as pyogenic) and its growing incidence. (Author) 10 refs

  12. Septic trochanteric bursitis in an adolescent.

    Science.gov (United States)

    Makki, Daoud; Watson, Alex James

    2010-01-01

    Trochanteric bursitis, whether septic or inflammatory in origin, is a condition that affects middle-aged patients. Here we report the rare case of an adolescent with septic trochanteric bursitis (treated successfully with intravenous antibiotics), review the available literature on septic bursitis, illustrate the importance of prompt recognition and treatment of this condition in any age group, and describe the clinical presentation and the radiologic findings.

  13. Trochanteric bursitis: the last great misnomer.

    Science.gov (United States)

    Board, Tim N; Hughes, Simon J; Freemont, Anthony J

    2014-12-05

    Trochanteric bursitis has been used as a general term to describe pain around the greater trochanteric region of the hip. We hypothesised that trochanteric bursitis may not however have an inflammatory component and that accordingly, bursal inflammation has no role in lateral hip pain. This study was designed to test this hypothesis. Patients undergoing primary total hip replacement were enrolled in this prospective, case-controlled, blinded study. Twenty-five patients who met the criteria for diagnosis of trochanteric bursitis (group A) were matched with a control group of 25 patients (group B). Trochanteric bursal samples were harvested from all patients intraoperatively and sent for histological analysis for the presence of inflammation. The intraoperative appearance of the abductor tendon insertion was also noted. None of the samples showed any evidence of acute or chronic inflammatory changes. Intraoperatively, five patients (20%) in group A were noted to have thinning of the gluteus medius tendon but no macroscopic tendon tears were detected in any bursal samples. This study suggests that there is no inflammatory component to so-called trochanteric bursitis, which accordingly casts doubt on both the terminology and the existence of this condition as a separate clinical entity. Clinicians should search for an alternative cause of symptoms in such cases.

  14. Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture

    OpenAIRE

    Yun, Ho Hyun; Oh, Chi Hun; Yi, Ju Won

    2013-01-01

    We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nai...

  15. SURGICAL TREATMENT OF TROCHANTERIC FRACTURES BY GAMMA3 NAIL

    Directory of Open Access Journals (Sweden)

    Aleksandar Vukićević

    2010-09-01

    Full Text Available Fractures of the greater trochanter rank amongst severe injuries of bone tissue. They occur most frequently in patients over 65 years of age, nearly all of whom are diagnosed with osteoporosis. Non-surgical treatment does not prove to be satisfactory and results in high mortality rate. Surgical treatment is a method of fracture treatment of the trochanteric region, which enables early activation and thus prevents numerous complications in bedridden patients. Gamma3 nails are one of the most state-of-the-art implants for trochanteric fracture fixation. The implant is easy to embed, which does not require a large surgical team. This implant embedding requires the least invasive surgery and complications are rare.This paper describes 47 patients who received surgical treatment and is focused on the first nine months of 2009. The patients were treated at the Orthopaedics Ward of Health Centre Valjevo. They were in their seventies, average age: 72.21 years, with female sex prevailing (63.82%. The outcome was as follows: excellent in 65.96%, good in 17.02% and satisfactory in 4.25% of patients. Surface infections occurred in 6.38% of patients. One implant broke.We had one death outcome in the early post-surgical treatment.Surgical treatment of trochanteric fractures by Gamma3 implants proved very effective as it resulted in few complications and numerous excellent functional and anatomic outcomes. Thus we recommend it as an option when decision on treatment of this type of fractures is made.

  16. Real frequency of ordinary and atypical sub-trochanteric and diaphyseal fractures in France based on X-rays and medical file analysis.

    Science.gov (United States)

    Beaudouin-Bazire, Constance; Dalmas, Noémie; Bourgeois, Julie; Babinet, Antoine; Anract, Philippe; Chantelot, Christophe; Farizon, Frédéric; Chopin, Florence; Briot, Karine; Roux, Christian; Cortet, Bernard; Thomas, Thierry

    2013-03-01

    Atypical sub-trochanteric and femoral shaft fractures have been reported in patients treated with bisphosphonates. Their incidence has been determined from registered data analysis using international codes. Therefore, the aim of our study was to estimate the real frequency of typical and atypical sub-trochanteric or diaphyseal fractures, based on radiological and clinical data compared to registered data. In the registers of three large French University Hospitals, patients identified with International Classification of Diseases, 10th Revision diagnosis codes for sub-trochanteric or diaphyseal fracture were selected. Frequencies of ordinary and atypical fractures were calculated after both registered data, radiological and clinical files analysis. Among the 4592 patients hospitalized for a femoral fracture over 5 years, 574 were identified to have had a sub-trochanteric or femoral shaft fracture. 47.7% of the sub-trochanteric and femoral shaft fractures were misclassified, predominantly in the sub-trochanteric fractures subset. 12 patients had an atypical fracture (4% of the sub-trochanteric and femoral shaft fractures) and 11 fractures presented radiological features of atypical fractures, whereas clinical files analysis revealed they were pathological or traumatic fractures. Atypical fractures frequency is very low. Because of their low frequency and the unreliability of registered databases, the risk of atypical fractures is very difficult to estimate retrospectively. A prospective study is needed to clarify the risk factors associated with these fractures. Copyright © 2012 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  17. Greater trochanteric fracture with occult intertrochanteric extension.

    Science.gov (United States)

    Reiter, Michael; O'Brien, Seth D; Bui-Mansfield, Liem T; Alderete, Joseph

    2013-10-01

    Proximal femoral fractures are frequently encountered in the emergency department (ED). Prompt diagnosis is paramount as delay will exacerbate the already poor outcomes associated with these injuries. In cases where radiography is negative but clinical suspicion remains high, magnetic resonance imaging (MRI) is the study of choice as it has the capability to depict fractures which are occult on other imaging modalities. Awareness of a particular subset of proximal femoral fractures, namely greater trochanteric fractures, is vital for both radiologists and clinicians since it has been well documented that they invariably have an intertrochanteric component which may require surgical management. The detection of intertrochanteric or cervical extension of greater trochanteric fractures has been described utilizing MRI but is underestimated with both computed tomography (CT) and bone scan. Therefore, if MRI is unavailable or contraindicated, the diagnosis of an isolated greater trochanteric fracture should be met with caution. The importance of avoiding this potential pitfall is demonstrated in the following case of an elderly woman with hip pain and CT demonstrating an isolated greater trochanteric fracture who subsequently returned to the ED with a displaced intertrochanteric fracture.

  18. The art of trochanteric fracture reduction.

    Science.gov (United States)

    Biber, Roland; Berger, Johanna; Bail, Hermann Josef

    2016-12-01

    The name of Ender is primarily associated with the Ender nails, which were popular for trochanteric fracture fixation more than thirty years ago. However, Ender's concepts were not limited to the implant. Ender developed a unique classification system for trochanteric and subtrochanteric fractures, which provided the theory for closed reduction maneuvers that made the method so successful in his hands. While Ender's nails have become history in the meantime, his principles of fracture reduction can be readily applied on surgery with modern implants such as proximal femoral nails. This article reflects the classification and the principles published by Hans Georg Ender in some print work hardly available nowadays. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Bursectomy, Curettage, and Chemotherapy in Tuberculous Trochanteric Bursitis.

    Science.gov (United States)

    Ramos-Pascua, Luis R; Carro-Fernández, José A; Santos-Sánchez, José A; Casas Ramos, Paula; Díez-Romero, Luis J; Izquierdo-García, Francisco M

    2016-03-01

    We presented three patients with trochanteric tuberculosis and described the clinical and imaging findings of the infection. Histology revealed a necrotizing granulomatous bursitis and microbiology confirmed tuberculosis. All cases were successfully treated with bursectomy and curettage of the trochanteric lesion and antituberculous chemotherapy including isoniazid, pyrazinamide, rifampicin, and ethambutol.

  20. Subtrochanteric femoral fracture during trochanteric nailing for the treatment of femoral shaft fracture.

    Science.gov (United States)

    Yun, Ho Hyun; Oh, Chi Hun; Yi, Ju Won

    2013-09-01

    We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.

  1. Treatment of recent trochanteric fracture in adults.

    Science.gov (United States)

    Adam, P

    2014-02-01

    Recent trochanteric fracture is frequent in adults, and mainly affects elderly patients who risk loss of independence. Treatment is surgical, of various sorts. Open reduction internal fixation (ORIF) with intra- or extra-medullary implants is the most frequent attitude in these fractures, which usually heal easily. In elderly patients, arthroplasty is an alternative of choice for some authors. These different treatment modalities are presented, focusing on technical details. Possible technical difficulties and the means of dealing with them are considered. Published results help in choosing the treatment most suitable for a particular type of fracture in a particular patient. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  2. Anatomic variations found on dissection of depressor septi nasi muscles in cadavers.

    Science.gov (United States)

    Ebrahimi, Ali; Nejadsarvari, Nasrin; Motamedi, Mohammad Hosein Kalantar; Rezaee, Maryam; Koushki, Ehsan Shams

    2012-01-01

    To define variations of the depressor septi muscle in Iranians; to provide guidance for modification of this muscle during rhinoplasty in patients with an active muscle and short upper lip; and to correlate our findings with our clinical experience to develop the applied algorithms. This study was conducted by dissecting 82 depressor septi nasi muscles in 41 Iranian cadavers. Origin and insertion points of each muscle were studied. Three variations were found in muscle insertion points: periosteal, orbicularis oris, and floating. Forty-four percent of the muscles were inserted into the periosteum of the maxilla (n = 36); 39% of muscles were inserted into the orbicularis oris muscle (n = 32); and 17% were diminutive or floating (n = 14). Periosteal insertion was thicker and stronger than the other variations. In all cadavers, the origin of the muscle was medial crus of alar cartilage and caudal of the nasal septum. This cadaveric dissection showed that the percentage of depressor septi muscle insertions is not similar to that found in other surveys. In this study, periosteal insertion of the depressor septi muscle was the most common variation.

  3. Necrotizing fasciitis after internal fixation of fracture of femoral trochanteric ? ??

    OpenAIRE

    Santos, Leandro Em?lio Nascimento; Pires, Robinson Esteves Santos; Figueiredo, Leonardo Brand?o; Soares, Eduardo Augusto Marques

    2014-01-01

    Necrotizing fasciitis is a rare and potentially lethal soft tissue infection. We report a case of trochanteric femur fracture in a patient who underwent fracture fixation and developed necrotizing fasciitis. A literature review on the topic will be addressed.

  4. Trochanteric Stress Fracture in a Female Window Cleaner

    OpenAIRE

    Lee, Bong-Jin; Song, Jyewon

    2016-01-01

    Stress fractures may occur at various sites in the femur including the head, neck, shaft, supracondylar and condylar regions. To the best of our knowledge, stress fracture occurring in the trochanteric region has not been previously reported. We report here a case of trochanteric stress fracture in a 53-year-old female window cleaner treated with hip nailing without adverse consequences. Careful consideration of this entity is needed when evaluating patients who have repetitive jumping up and...

  5. Risk factors for trochanteric and femoral neck fracture.

    Science.gov (United States)

    Díaz, A R; Navas, P Z

    The differences between the two main types of fracture of proximal end of the femur, trochanteric and cervical fractures, are still a subject of study, and could be the key to a better understanding of its pathophysiology and prevention. The aim of this study is to determine whether epidemiological differences in the distribution of risk factors associated with hip fracture exist between these two entities. A descriptive cross-sectional study of 428 patients over the age of 65 admitted for trochanteric or cervical fractures in 2015, in which gender, age, previous diagnosis, external causes associated with fracture and place of the event were recorded. There were 220 patients with a cervical fracture (51.4%) and 208 patients with a trochanteric fracture (48.6%). The average age was higher in the trochanteric fracture, observing a constant increase with age only in women with trochanteric fractures. Cervical fracture showed a significant association with cerebrovascular disease (p=0.039) and trochanteric fracture with accidental falls (p=0.047) and presence of 5-9 previous diseases (p=0.014). A regression analysis maintained this association in the case of a cerebrovascular disease (OR 2.6, 95%CI 1.1-6.4) and the presence of 5-9 diseases (OR 1.5, 95%CI 1.1-2.3). Trochanteric fractures are associated with women patients of more advanced ages, 5-9 previous diseases and accidental falls. Cerebrovascular disease shows a higher prevalence in cervical fractures. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Assessment of trochanteric osteotomy fragment union after acetabular fracture surgery.

    Science.gov (United States)

    Dubina, Andrew G; Wickramaratne, Niluka; O'Toole, Robert V; Manson, Theodore T

    2017-02-01

    Trochanteric osteotomies are performed in conjunction with standard approaches to improve surgical exposure during open reduction and internal fixation (ORIF) of acetabular fractures. The literature on total hip arthroplasty reports nonunion rates as high as 30% associated with trochanteric osteotomies; however, few data exist regarding the outcomes of trochanteric osteotomies for acetabular fracture surgery. Our hypotheses were 1) patients receiving trochanteric osteotomies during ORIF of acetabular fractures have a low rate of nonunion of the osteotomy fragment, and 2) hip abduction precautions are not necessary with digastric type osteotomies. A retrospective review was conducted to identify patients with acetabular fractures between July 2002 and June 2010 (n=734 fractures) who required trochanteric osteotomies (n=64, 9% of fractures). Forty-seven met inclusion criteria of adequate follow-up (>56days). No excluded patient experienced a complication. Fractures were classified using the Letournel-Judet classification system. Only seven (20%) of 35 patients who received digastric osteotomies had hip abduction precautions applied during the postoperative period. All study patients were shown to have radiographic union at the trochanteric osteotomy site (100% union rate, n=47). Hip abduction precautions intended to protect the osteotomy site and reduce the risk of nonunion and fixation failure were infrequently applied to patients with digastric osteotomies (20%) in this cohort. Multiple protective factors against nonunion were present in this study population compared with previous arthroplasty studies from other institutions. Trochanteric osteotomies are not associated with a significant nonunion rate, and digastric osteotomies might be safely managed without hip abduction precautions. Copyright © 2016. Published by Elsevier Ltd.

  7. Extended trochanteric osteotomy: current concepts review.

    Science.gov (United States)

    Sambandam, Senthil Nathan; Duraisamy, Gopinath; Chandrasekharan, Jayadev; Mounasamy, Varatharaj

    2016-04-01

    Revision total hip arthroplasty is a technically demanding procedure which has gained importance for more than two decades. It was a nightmare for revision surgeons during its initial years of inception before the advent of extended trochanteric osteotomy (ETO). This technique gains access to the femoral medullary canal without compromising the bone stock and aids removal of primary implant and cement mantle without further damaging the parent bone. Like any other surgery, ETO does have certain limitations and complications as reported by various authors. Though it has been routinely used by revision surgeons, thorough knowledge of technical details of ETO is still lacking. So this review article is aimed at addressing the indications, surgical procedure, fixation technique, implant selection and complication of ETO which has been presented over a period of years by various authors. We searched in the most commonly used portals like MEDLINE (PubMed) and Google scholar using appropriate terminologies for the literature regarding the various preoperative, intraoperative and postoperative clinical scenarios in which revision surgeons utilized ETO. ETO is an important tool in the revision surgeon's armamentarium and can be used in variety of clinical scenarios and for various intraoperative needs and goals. Awareness about biomechanics of ETO, indications, implants selection, fixation techniques and complications is paramount for good intraoperative and postoperative outcome. ETO by posterior approach continues to be a work horse approach for most revision surgeons all over the world.

  8. Repair of femoral trochanteric osteotomy in the dog

    International Nuclear Information System (INIS)

    Whitelock, R.G.; Dyce, J.; Houlton, J.E.F.

    1997-01-01

    The records and radiographs of 24 dogs that underwent femoral trochanteric osteotomy repair were reviewed. Osteotomy repair was performed with either a pin and tension band wire or a lag screw technique. Significant clinical complications associated with the osteotomy were identified in one dog (4 per cent) six weeks after surgery, although abnormal radiographic changes were evident in 15 dogs (62 per cent). The method of repair did not influence healing and there were comparable radiographic complication rates. It is concluded that femoral trochanteric osteotomy is not associated with significant clinical problems, despite a high incidence of abnormal radiographic findings

  9. Avascular necrosis of the femoral head presenting as trochanteric bursitis.

    Science.gov (United States)

    Mandell, B F

    1990-01-01

    Five patients are described with avascular necrosis of the femoral head who presented with ipsilateral trochanteric bursitis, in the absence of clearcut hip joint disease. Avascular necrosis was indicated by magnetic resonance imaging. It is suggested that clinical trochanteric bursitis, especially when refractory to local corticosteroid treatment, may be the initial sign of hip disease. In the patient with risk factor(s) for avascular necrosis that diagnosis should be considered and evaluated with appropriate studies, such as magnetic resonance imaging, to prevent weight bearing at an early stage and permit possible surgical decompression in the hope of postponing or obviating the need for total hip replacement. PMID:2241294

  10. [Trochanteric bursitis due to tuberculosis in an immunocompetent young woman].

    Science.gov (United States)

    Soro Marín, Sandra; Sánchez Trenado, María Asunción; Mínguez Sánchez, María Dolores; Paulino Huertas, Marcos; García Morales, Paula Virginia; Salas Manzanedo, Verónica

    2012-01-01

    Soft tissue infection due to Mycobacterium tuberculosis can affect muscle, tendons, fascia, bursa and synovial tissue. Tuberculous trochanteric bursitis is a rare entity that usually affects immunocompromised patients. Manifestations usually occur insidiously, which delays diagnosis and treatment. We present the case of an immunocompetent young woman who came to our department for chronic left hip pain. The study confirms the diagnosis of tuberculous trochanteric bursitis. This case demonstrates the importance of considering a possible infectious origin of bursitis in immunocompetent patients. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  11. Electroacupuncture most effectively elicits depressor and bradycardic responses at 1 Hz in humans.

    Science.gov (United States)

    Nakahara, Hidehiro; Kawada, Toru; Ueda, Shin-ya; Kawai, Eriko; Yamamoto, Hiromi; Sugimachi, Masaru; Miyamoto, Tadayoshi

    2016-02-01

    Acupuncture stimulation is known to act on the autonomic nervous system and elicits depressor and bradycardic effects. However, previous studies on humans did not conduct quantitative analyses on optimal acupuncture conditions such as the stimulation frequency and duration to achieve maximum depressor and bradycardic effects. The aim of the present study was to investigate the effects of varying stimulation frequencies of electroacupuncture on time-dependent changes in blood pressure and heart rate in humans. Twelve healthy volunteers participated in the study. An acupuncture needle was inserted at the Ximen acupoint (PC4 according to WHO nomenclature), located at the anterior aspect of the forearm. An electrical stimulation was delivered through the acupuncture needle at an intensity of 1 V, pulse width of 5 ms, and stimulation frequencies of 0.5, 1, 5, and 10 Hz in a random order. The duration of electroacupuncture was 6 min, during which blood pressure and heart rate responses were monitored. Group-averaged data indicated that 1-Hz electroacupuncture decreased blood pressure and heart rate. Blood pressure was significantly decreased from the prestimulation baseline value of 86.6 ± 2.9 to 81.4 ± 2.3 mmHg during 4-6 min of 1-Hz electroacupuncture (mean ± SE, P < 0.01). Heart rate was also significantly decreased (from 66.2 ± 2.0 to 62.7 ± 1.7 beats/min, P < 0.01). These results provide fundamental evidence that bradycardiac and depressor responses are effectively produced by electrical acupuncture in humans.

  12. Trochanteric Soft Tissue Thickness and Hip Fracture in Older Men

    OpenAIRE

    Nielson, Carrie M.; Bouxsein, Mary L.; Freitas, Sinara S.; Ensrud, Kristine E.; Orwoll, Eric S.

    2009-01-01

    Background: Greater thickness of the tissue extending laterally from the greater trochanter has been associated with a lower risk of hip fracture in women. The effect of trochanteric soft tissue thickness on the risk of incident hip fracture has not been evaluated in men.

  13. [Clinical Results of Endoscopic Treatment of Greater Trochanteric Pain Syndrome].

    Science.gov (United States)

    Zeman, P; Rafi, M; Skala, P; Zeman, J; Matějka, J; Pavelka, T

    2017-01-01

    PURPOSE OF THE STUDY This retrospective study aims to present short-term clinical outcomes of endoscopic treatment of patients with greater trochanteric pain syndrome (GTPS). MATERIAL AND METHODS The evaluated study population was composed of a total of 19 patients (16 women, 3 men) with the mean age of 47 years (19-63 years). In twelve cases the right hip joint was affected, in the remaining seven cases it was the left side. The retrospective evaluation was carried out only in patients with greater trochanteric pain syndrome caused by independent chronic trochanteric bursitis without the presence of m. gluteus medius tear not responding to at least 3 months of conservative treatment. In patients from the followed-up study population, endoscopic trochanteric bursectomy was performed alone or in combination with iliotibial band release. The clinical results were evaluated preoperatively and with a minimum follow-up period of 1 year after the surgery (mean 16 months). The Visual Analogue Scale (VAS) for assessment of pain and WOMAC (Western Ontario MacMaster) score were used. In both the evaluated criteria (VAS and WOMAC score) preoperative and postoperative results were compared. Moreover, duration of surgery and presence of postoperative complications were assessed. Statistical evaluation of clinical results was carried out by an independent statistician. In order to compare the parameter of WOMAC score and VAS pre- and post-operatively the Mann-Whitney Exact Test was used. The statistical significance was set at 0.05. RESULTS The preoperative VAS score ranged 5-9 (mean 7.6) and the postoperative VAS ranged 0-5 (mean 2.3). The WOMAC score ranged 56.3-69.7 (mean 64.2) preoperatively and 79.8-98.3 (mean 89.7) postoperatively. When both the evaluated parameters of VAS and WOMAC score were compared in time, a statistically significant improvement (ppain syndrome yields statistically significant improvement of clinical results with the concurrent minimum incidence of

  14. Trochanteric Soft Tissue Thickness and Hip Fracture in Older Men

    Science.gov (United States)

    Nielson, Carrie M.; Bouxsein, Mary L.; Freitas, Sinara S.; Ensrud, Kristine E.; Orwoll, Eric S.

    2009-01-01

    Background: Greater thickness of the tissue extending laterally from the greater trochanter has been associated with a lower risk of hip fracture in women. The effect of trochanteric soft tissue thickness on the risk of incident hip fracture has not been evaluated in men. Methods: We measured trochanteric soft tissue thickness by dual-energy x-ray absorptiometry for all incident hip fracture cases (n = 70) and 222 randomly selected noncases in older men (≥65 yr) enrolled in the Osteoporotic Fractures in Men (MrOS) Study. Differences in tissue thickness between cases and controls were examined. Changes in fall force and factor-of-risk (the ratio of force from a sideways fall to femoral bone strength) associated with tissue thickness were determined. The relative risk for incident hip fracture per sd decrease in tissue thickness was calculated. Results: Mean trochanteric soft tissue thickness did not differ significantly between cases and noncases (29.1 ± 11.9 vs 31.0 ± 11.5 mm; P = 0.2). Although increased tissue thickness reduced both the estimates of fall force and the factor-of-risk, tissue thickness was not associated with the risk of hip fracture (age- and bone mineral density-adjusted relative risk per sd decrease in tissue thickness = 0.90; 95% confidence interval, 0.70–1.16). Conclusions: In this study of elderly community-dwelling men, we found no significant association between trochanteric soft tissue thickness and incident hip fracture. Trochanteric soft tissue thickness in these men was less than previously reported in older women and may explain the difference between these results and those reported in women. PMID:19017753

  15. [Trochanteric femoral fractures: anatomy, biomechanics and choice of implants].

    Science.gov (United States)

    Bonnaire, F; Lein, T; Bula, P

    2011-06-01

    The objective of any surgical care of a trochanteric femoral fracture should be the achievement of a stable osteosynthesis that allows early full weight-bearing mobilisation of the patient, because long-term immobilisation soon becomes a vital threat to the affected patients who are usually elderly with correlating comorbidities. The anatomical references of the proximal femur and the structure of the hip joint contain some specifics that play an essential role in the incurrence of a trochanteric femoral fracture and the planning of the osteosynthesis as well. With reposition and fracture stabilisation particular importance must be attached to the collo-diaphyseal and the antetorsion angle so that they do not interfere with the functional interaction of the hip and knee joint. Uncomplex trochanteric fractures ordinarily stabilise sufficiently after reposition so that even an extramedullary implant can ensure full weight-bearing stability. With evermore distal fracture course and intertrochanteric comminution zone, rotational instability and pivot transfer of the fracture area to lateral and caudal are followed by an increase of the dislocating forces. These kinds of fractures (A2 and A3 according to the AO/ASIF classification) profit from an intramedullary and rotationally stable osteosynthesis. Basically primary total hip arthroplasty is a potential option for surgical care of a trochanteric fracture in elderly patients with relevant coxarthrosis. However this procedure can only be recommended in cases of a stable uncomplex fracture. The more the medial interlocking of the proximal femur is destroyed the more difficult it will be to primarily implant a total hip prosthesis with good offset and without a varus and rotational failure in the fracture zone.The current studies in the main show disadvantages due to increased complications in these patients, so that in cases of an unstable trochanteric fracture a primary osteosynthesis should be performed followed by

  16. Cement technique for reducing post-operative bursitis after trochanteric fixation.

    Science.gov (United States)

    Derman, Peter B; Horneff, John G; Kamath, Atul F; Garino, Jonathan

    2013-02-01

    Post-operative trochanteric bursitis is a known complication secondary to the surgical approach in total hip arthroplasty. This phenomenon may be partially attributable to repetitive microtrauma generated when soft tissues rub against implanted hardware. Significant rates of post-operative trochanteric bursitis have been observed following procedures in which a trochanteric fixation device, such as a bolt-washer mechanism or a cable-grip/claw system, is used to secure the trochanteric fragment after trochanteric osteotomy. We present a simple technique for use with a bolt-washer system or grip plate in which trochanteric components are covered in bone wax followed by a layer of cement to decrease friction and to diminish the risk of post-operative bursitis.

  17. Intramedullary nails versus sliding hip screws for AO/OTA 31-A2 trochanteric fractures in adults: A meta-analysis.

    Science.gov (United States)

    Zhu, Qianzheng; Xu, Xiaodong; Yang, Xi; Chen, Xingzuo; Wang, Liqiang; Liu, Chenggang; Lin, Peng

    2017-07-01

    The optimum treatment with intramedullary nails (IMN) or sliding hip screws (SHS) for type 31-A2 trochanteric fractures remains controversial. Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) to compare IMN with SHS in AO/OTA 31-A2 trochanteric fractures. Databases including PubMed, Cochrane, and Embase were searched to identify RCTs published before December 2016, which compared IMN with SHS for intraoperative and postoperative outcomes in AO/OTA 31-A2 trochanteric fractures. A total of 909 patients from six RCTs were subjected to the meta-analysis. The results showed that the IMN group was associated with less operative blood loss, leg shortening, wound infections, length of hospital stay, and days to mobilization with walking aids and also yielded a higher Parker score as compared to the SHS group. No significant difference was seen in the other parameters including operative details, fracture fixation complications, postoperative complications, and 1 year mortality. IMN fixation was found to be the superior treatment of choice for 31-A2 trochanteric fractures as compared with SHS fixation in our meta-analysis. The adverse effects appeared comparable between the two groups. However, due to the variations in the included studies, more large-sample, measures-unified, and high-quality RCTs are needed to validate these conclusions. Copyright © 2017. Published by Elsevier Ltd.

  18. Arthroscopic bursectomy for recalcitrant trochanteric bursitis after hip arthroplasty.

    Science.gov (United States)

    Van Hofwegen, Christopher; Baker, Champ L; Savory, Carlton G; Baker, Champ L

    2013-01-01

    This study evaluated the use of arthroscopic bursectomy for pain relief in patients with trochanteric bursitis after hip arthroplasty. In this retrospective case series of 12 patients undergoing arthroscopic treatment of recalcitrant trochanteric bursitis after hip arthroplasty, outcomes were assessed via phone interview with a numeric pain rating scale from 1 to 10 and were compared with preoperative pain ratings. Patients were asked the percentage of time they had painless hip function and whether they would have the surgery again. At an average 36-month follow-up (range, 4-85 months), the average numeric pain scale rating improved from 9.3 to 3.3. At an average of 62% of the time, patients had painless use of the hip. Ten of 12 patients in the study felt the pain relief gained was substantial enough to warrant having procedure again. In these patients, arthroscopic bursectomy was a viable option for patients with recalcitrant bursitis after hip arthroplasty.

  19. Trochanteric impingement: is it a source of pain after THR?

    Directory of Open Access Journals (Sweden)

    Mark J. Isaacson, DO

    2015-09-01

    Full Text Available While uncommon, trochanteric-pelvic impingement may lead to significant lateral hip pain. We defined “impingement distance” as the radiographic distance from the medial aspect of the greater trochanter and the corresponding lateral edge of the acetabular bone or component and compared this to the contralateral normal hip. We present two painful total hip replacement (THR cases, each featuring a patient with severe lateral hip pain when walking and sitting. Both patients had diminished femoral offset and trochanteric-pelvic clearance, compared to the contralateral normal hip. The impingement distance was increased an average of 10 mm with the exchange to a longer femoral head. Both patients had immediate and complete pain relief with operative treatment to increase the impingement distance.

  20. Torsional malalignment, how much significant in the trochanteric fractures?

    Science.gov (United States)

    Kim, Tae Young; Lee, Yong Beom; Chang, Jun Dong; Lee, Sang Soo; Yoo, Jae Hyun; Chung, Kook Jin; Hwang, Ji Hyo

    2015-11-01

    The rotational alignment is definitely important in the long bones such as tibias and femurs. We also predict the importance of rotational alignment in the trochanteric fractures. So we measured torsional malalignment in trochanteric fracture and anlaysed their risk factors and their clinical significance. A total of 109 inpatients who had undergone internal fixation following trochanteric fracture and a postoperative pelvic CT scan between 2008 and 2013, with at least one year follow-up, were selected. Factors that affect torsional malalignment, such as age, gender, fracture stability, injured area, operative time, time of surgery after admission, and ASA status, were investigated. Factors that affect the patients' clinical results in malrotation, including ambulation time after surgery, postoperative complication rates, pain assessment of VAS one year postoperatively and Koval score, were also investigated. Of the 109 subjects, torsional malalignment was observed in 28 (25.7%) subjects with a mean torsional malalignment angle of 20.7° (range: -31.2° to 27.1°). Torsional malalignment risk factors were fracture stability (p=0.021) and operative time (p=0.043). In terms of the time to ambulation after surgery, the postoperative complication rates, and the VAS and Koval scores at one year postoperatively, no statistically significant difference was observed between the torsional malalignment patients and the non-deformity patients. In this study, 25.7% of the patients who had undergone internal fixation following trochanteric fracture experienced torsional malalignment. Major factors of the torsional malalignment were an unstable fracture and the consequent delay in the operative time. But the torsional malalignment was deemed to have no effect on clinical results. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Augmentation of proximal femoral nail in unstable trochanteric fractures

    Directory of Open Access Journals (Sweden)

    Gadegone Wasudeo M.

    2017-01-01

    Full Text Available Introduction: Biomechanically proximal femoral nail (PFN is a better choice of implant, still it is associated with screw breakage, cut out of screw through femoral head, Z effect, reverse Z effect, and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of prevention of postoperative complications and failure rates in unstable trochanteric fractures. Material and methods: We carried out a prospective study of 82 cases with unstable trochanteric femoral fractures from April 2010 to December 2015. Forty-two females and 40 males in the age group between 58 and 81 years were included in this study. There were 45 cases of AO 31 A2 (2.2, 2.3 and 37 cases of AO 31 A3 (3.1, 3.2, 3.3. Fractures were fixed by PFN with augmentation by an additional screw from trochanter to inferior quadrant of femoral head or cerclage wire to strengthen the lateral trochanteric wall. Results: The bone healing is observed in all the cases in the mean period of 14.2 weeks. Nine patients developed complications, including lateral migration of neck screws (n = 5, Z effect (n = 1, infection (n = 2, and breakage of distal interlocking bolt in one case. Removal of screws was required in five cases. Patients were followed up for a mean of 8.4 months. At the end of follow-up the Salvati and Wilson hip function was 32 (out of 40 in 88% of patients. Conclusion: The stabilization of lateral trochanteric wall with additional screw or cerclage wire increases the stability of construct.

  2. Medullary GABAergic mechanisms contribute to electroacupuncture modulation of cardiovascular depressor responses during gastric distention in rats

    Science.gov (United States)

    Guo, Zhi-Ling; Li, Min; Longhurst, John C.

    2013-01-01

    Electroacupuncture (EA) at P5–P6 acupoints overlying the median nerves typically reduces sympathoexcitatory blood pressure (BP) reflex responses in eucapnic rats. Gastric distention in hypercapnic acidotic rats, by activating both vagal and sympathetic afferents, decreases heart rate (HR) and BP through actions in the rostral ventrolateral medulla (rVLM) and nucleus ambiguus (NAmb), leading to sympathetic withdrawal and parasympathetic activation, respectively. A GABAA mechanism in the rVLM mediates the decreased sympathetic outflow. The present study investigated the hypothesis that EA modulates gastric distention-induced hemodynamic depressor and bradycardia responses through nuclei that process parasympathetic and sympathetic outflow. Anesthetized hypercapnic acidotic rats manifested repeatable decreases in BP and HR with gastric distention every 10 min. Bilateral EA at P5–P6 for 30 min reversed the hypotensive response from −26 ± 3 to −6 ± 1 mmHg and the bradycardia from −35 ± 11 to −10 ± 3 beats/min for a period that lasted more than 70 min. Immunohistochemistry and in situ hybridization to detect c-Fos protein and GAD 67 mRNA expression showed that GABAergic caudal ventral lateral medulla (cVLM) neurons were activated by EA. Glutamatergic antagonism of cVLM neurons with kynurenic acid reversed the actions of EA. Gabazine used to block GABAA receptors microinjected into the rVLM or cVLM reversed EA's action on both the reflex depressor and bradycardia responses. EA modulation of the decreased HR was inhibited by microinjection of gabazine into the NAmb. Thus, EA through GABAA receptor mechanisms in the rVLM, cVLM, and NAmb modulates gastric distention-induced reflex sympathoinhibition and vagal excitation. PMID:23302958

  3. Factors influencing period from surgery to discharge in patients with femoral trochanteric fractures

    Science.gov (United States)

    Shinoda, Soichiro; Mutsuzaki, Hirotaka; Watanabe, Arata; Morita, Hidetaka; Kamioka, Yumiko

    2017-01-01

    [Purpose] The purpose of this study was to investigate factors influencing the period from surgery to discharge in patients with femoral trochanteric fractures. [Subjects and Methods] Sixty patients with femoral trochanteric fractures were investigated retrospectively. Based on the mean period from surgery to discharge (85.6 ± 26.6 days), the patients were divided into two groups: an under-85-day group (range, 29–78 days) and an over-85-day group (87–128 days). Age, gender, fracture type, presence of lesser trochanteric displacement, discharge destination, and walking ability were investigated. The relationship between these factors and the period from surgery to discharge was analyzed with logistic regression analysis. [Results] Age and lesser trochanteric displacement were significantly higher in the over-85-day group, and walking ability before fracture and at discharge were significantly lower in the over-85-day group. Logistic regression analysis showed that lesser trochanteric displacement and age were predictors of the length from surgery to discharge. Lesser trochanteric displacement were observed in 87.5% of these. Immediate displacement after surgery occurred in 57.8% of lesser trochanteric fractures, while 26.3% displaced 1 to 3 weeks after surgery. [Conclusion] This study revealed that lesser trochanteric displacement, higher age, and lower walking ability before fracture and at discharge were associated with longer hospitalizations in patients with femoral trochanteric fractures. Lesser trochanteric displacement were observed in 87.5% of lesser trochanteric fractures. These displacements occurred within 3 weeks after surgery in 84.1% of cases. PMID:29200639

  4. Anatomical reconstruction of unstable trochanteric fractures through posterior approach

    Directory of Open Access Journals (Sweden)

    Partha Saha

    2015-01-01

    Full Text Available Objective Unstable intertrochanteric fractures continue to be a challenge for orthopedic surgeons due to the functional limitations it results in the postoperative period. Anatomical reconstruction of the posteromedial fragment becomes difficult through conventional lateral approach, leading to excessive fracture collapse and limping. Materials and Methods: prospective, nonrandomized study was done with 40 patients. They were operated in prone position through posterior approach. Cancellous screws or SS-wires were used to fix the greater or lesser trochanteric fragments and dynamic hip screw (DHS or dynamic condylar screw (DCS for the main two fragments. Bone grafts were used to pack cavities at the posterior trochanteric regions. Results: Fracture healing occurred earlier compared to conventional lateral approach without excessive fracture collapse in majority of cases (average time to achieve union was 13.8 weeks; range: 10–18 weeks. Good functional recovery was noted with 75% 'Good' or 'Excellent' Harris Hip Scores at 24 weeks. Conclusion: Anatomical reconstruction of unstable trochanteric fractures becomes easier through posterior approach with earlier and better functional recovery.

  5. The outcome of endoscopy for recalcitrant greater trochanteric pain syndrome.

    Science.gov (United States)

    Drummond, James; Fary, Camdon; Tran, Phong

    2016-11-01

    Greater trochanteric pain syndrome (GTPS), previously referred as trochanteric bursitis, is a debilitating condition characterised by chronic lateral hip pain. The syndrome is thought to relate to gluteal tendinopathy, with most cases responding to non-operative treatment. A number of open and endoscopic surgical techniques targeting the iliotibial band, trochanteric bursa and gluteal tendons have, however, been described for severe recalcitrant cases. We report the outcomes of one such endoscopic approach here. We retrospectively reviewed 49 patients (57 operations) who had undergone endoscopic longitudinal vertical iliotibial band release and trochanteric bursectomy. Inclusion criteria included diagnosed GTPS with a minimum of six months of non-operative treatment. Exclusion criteria included concomitant intra- or extra-articular hip pathology and previous hip surgery including total hip arthroplasty. Outcomes were assessed using the Visual Analogue Scale, Oxford hip Score and International Hip Outcome Tool (iHOT-33). The series included 42 females and 7 males with a mean age of 65.0 years (26.7-88.6). Mean follow-up time was 20.7 months (5.3-41.2). Eight patients had full thickness gluteal tendon tears, of which 7 were repaired. Adjuvant PRP was injected intraoperatively in 38 of 57 operations (67.2 %). At follow-up, overall mean Visual Analogue Scale values had decreased from 7.8 to 2.8 (p < 0.001), Oxford hip Scores had increased from 20.4 to 37.3 (p < 0.001) and iHOT-33 scores had increased from 23.8 to 70.2 (p < 0.001). Of the 57 operations performed, patients reported feeling very satisfied with the surgical outcome in 28 operations (49.1 %), satisfied in 17 operations (29.8 %) and less than satisfied in 12 operations (21.1 %). While the majority of patients with GTPS will improve with non-operative management, endoscopic iliotibial band release, trochanteric bursectomy and gluteal tendon repair is a safe and effective treatment for severe

  6. Posterior trochanteric osteotomy in acetabular fractures for 32 cases.

    Science.gov (United States)

    Niu, Yunfei; An, Xiaofei; Xu, Shuogui; Wu, Dajiang; Zhang, Chuncai; Li, Ming

    2014-11-01

    The aim of this study is to explore the method and clinical outcome of posterior trochanteric osteotomy in acetabular fractures. From January 2000 to January 2008, 32 cases of acetabular fractures involving the dome of acetabulum underwent posterior trochanteric osteotomy for a better exposure and internal fixation with acetabular tridimensional memory fixation system. 28 cases (16 men and 12 women, mean age 39.9 years, range 16-73 years) were followed up with an average of 48.9 months (range of 19-95 months) and four were lost during follow up. Of 28 cases, 19 were fresh fractures and 9 were old fractures. The reduction was evaluated with Matta criteria. Clinical evaluation was based on modified Merle d'Aubigne and Postel scoring. Motor strength of the abductors was evaluated according to the Medical Research Council grading system. Ectopic ossification was classified according to Brooker criteria. Anatomical reduction was achieved in 17 cases and satisfied reduction in 10 patients. Poor reduction happened in an old fracture. All acetabular fractures got a direct bone union and no displacement and deep infection occurred. All osteotomies healed within 3.5 months without any nonunion, proximal migration of the greater trochanter, loosing or broken of instrumentation, and deep infection. Two superficial infections were healed with a regular dressing. Two patients underwent removal of implants from greater trochanter because of irritation. The strength of the abductors was of Grade 3/5 in two patients, Grade 4/5 in five patients, and normal in the rest. Clinical scoring was excellent to good in 84 %. Ectopic ossification occurred in five patients, grade 1 in two patients, grade 2 in two, and grade 3 in one. But function of hip joint was not seriously affected. Posterior trochanteric osteotomy can provide an adequate exposure of the dome of acetabulum without the associated complications like nonunion, proximal replacement, and weak of the abductors which often occur

  7. Efficacy of Treatment of Trochanteric Bursitis: A Systematic Review

    Science.gov (United States)

    Lustenberger, David P; Ng, Vincent Y; Best, Thomas M; Ellis, Thomas J

    2013-01-01

    Objective Trochanteric bursitis (TB) is a self-limiting disorder in the majority of patients and typically responds to conservative measures. However, multiple courses of nonoperative treatment or surgical intervention may be necessary in refractory cases. The purpose of this systematic review was to evaluate the efficacy of the treatment of TB. Data Sources A literature search in the PubMed, MEDLINE, CINAHL, and ISI Web of Knowledge databases was performed for all English language studies up to April 2010. Terms combined in a Boolean search were greater trochanteric pain syndrome, trochanteric bursitis, trochanteric, bursitis, surgery, therapy, drug therapy, physical therapy, rehabilitation, injection, Z-plasty, Z-lengthening, aspiration, bursectomy, bursoscopy, osteotomy, and tendon repair. Study Selection All studies directly involving the treatment of TB were reviewed by 2 authors and selected for further analysis. Expert opinion and review articles were excluded, as well as case series with fewer than 5 patients. Twenty-four articles were identified. According to the system described by Wright et al, 2 studies, each with multiple arms, qualified as level I evidence, 1 as level II, 1 as level III, and the rest as level IV. More than 950 cases were included. Data Extraction The authors extracted data regarding the type of intervention, level of evidence, mean age of patients, patient gender, number of hips in the study, symptom duration before the study, mean number of injections before the study, prior hip surgeries, patient satisfaction, length of follow-up, baseline scores, and follow-up scores for the visual analog scale (VAS) and Harris Hip Scores (HHS). Data Synthesis Symptom resolution and the ability to return to activity ranged from 49% to 100% with corticosteroid injection as the primary treatment modality with and without multimodal conservative therapy. Two comparative studies (levels II and III) found low-energy shock-wave therapy (SWT) to be

  8. Time course of the hemodynamic responses to aortic depressor nerve stimulation in conscious spontaneously hypertensive rats

    Energy Technology Data Exchange (ETDEWEB)

    Durand, M.T.; Mota, A.L. [Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Barale, A.R. [Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Castania, J.A.; Fazan, R. Jr.; Salgado, H.C. [Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil)

    2012-03-16

    The time to reach the maximum response of arterial pressure, heart rate and vascular resistance (hindquarter and mesenteric) was measured in conscious male spontaneously hypertensive (SHR) and normotensive control rats (NCR; Wistar; 18-22 weeks) subjected to electrical stimulation of the aortic depressor nerve (ADN). The parameters of stimulation were 1 mA intensity and 2 ms pulse length applied for 5 s, using frequencies of 10, 30, and 90 Hz. The time to reach the hemodynamic responses at different frequencies of ADN stimulation was similar for SHR (N = 15) and NCR (N = 14); hypotension = NCR (4194 ± 336 to 3695 ± 463 ms) vs SHR (3475 ± 354 to 4494 ± 300 ms); bradycardia = NCR (1618 ± 152 to 1358 ± 185 ms) vs SHR (1911 ± 323 to 1852 ± 431 ms), and the fall in hindquarter vascular resistance = NCR (6054 ± 486 to 6550 ± 847 ms) vs SHR (4849 ± 918 to 4926 ± 646 ms); mesenteric = NCR (5574 ± 790 to 5752 ± 539 ms) vs SHR (5638 ± 648 to 6777 ± 624 ms). In addition, ADN stimulation produced baroreflex responses characterized by a faster cardiac effect followed by a vascular effect, which together contributed to the decrease in arterial pressure. Therefore, the results indicate that there is no alteration in the conduction of the electrical impulse after the site of baroreceptor mechanical transduction in the baroreflex pathway (central and/or efferent) in conscious SHR compared to NCR.

  9. Time course of the hemodynamic responses to aortic depressor nerve stimulation in conscious spontaneously hypertensive rats

    International Nuclear Information System (INIS)

    Durand, M.T.; Mota, A.L.; Barale, A.R.; Castania, J.A.; Fazan, R. Jr.; Salgado, H.C.

    2012-01-01

    The time to reach the maximum response of arterial pressure, heart rate and vascular resistance (hindquarter and mesenteric) was measured in conscious male spontaneously hypertensive (SHR) and normotensive control rats (NCR; Wistar; 18-22 weeks) subjected to electrical stimulation of the aortic depressor nerve (ADN). The parameters of stimulation were 1 mA intensity and 2 ms pulse length applied for 5 s, using frequencies of 10, 30, and 90 Hz. The time to reach the hemodynamic responses at different frequencies of ADN stimulation was similar for SHR (N = 15) and NCR (N = 14); hypotension = NCR (4194 ± 336 to 3695 ± 463 ms) vs SHR (3475 ± 354 to 4494 ± 300 ms); bradycardia = NCR (1618 ± 152 to 1358 ± 185 ms) vs SHR (1911 ± 323 to 1852 ± 431 ms), and the fall in hindquarter vascular resistance = NCR (6054 ± 486 to 6550 ± 847 ms) vs SHR (4849 ± 918 to 4926 ± 646 ms); mesenteric = NCR (5574 ± 790 to 5752 ± 539 ms) vs SHR (5638 ± 648 to 6777 ± 624 ms). In addition, ADN stimulation produced baroreflex responses characterized by a faster cardiac effect followed by a vascular effect, which together contributed to the decrease in arterial pressure. Therefore, the results indicate that there is no alteration in the conduction of the electrical impulse after the site of baroreceptor mechanical transduction in the baroreflex pathway (central and/or efferent) in conscious SHR compared to NCR

  10. The depressor response to intracerebroventricular hypotonic saline is sensitive to TRPV4 antagonist RN1734

    Directory of Open Access Journals (Sweden)

    Claire H Feetham

    2015-04-01

    Full Text Available Several reports have shown that the periventricular region of the brain, including the paraventricular nucleus (PVN, is critical to sensing and responding to changes in plasma osmolality. Further studies also implicate the transient receptor potential ion channel, type V4 (TRPV4 channel in this homeostatic behaviour. In previous work we have shown that TRPV4 ion channels couple to calcium-activated potassium channels in the PVN to decrease action potential firing frequency in response to hypotonicity. In the present study we investigated whether, similarly, intracerebroventricular (ICV application of hypotonic solutions modulated cardiovascular parameters, and if so whether this was sensitive to a TRPV4 channel inhibitor. We found that ICV injection of 270mOsmol artificial cerebrospinal fluid (ACSF decreased mean blood pressure, but not heart rate, compared to naïve mice or mice injected with 300mOsmol ACSF. This effect was abolished by treatment with the TRPV4 inhibitor RN1734. These data suggest that periventricular targets within the brain are capable of generating depressor action in response to TRPV4 ion channel activation. Potentially, in the future, the TRPV4 channel, or the TRPV4–KCa coupling mechanism, may serve as a therapeutic target for treatment of cardiovascular disease.

  11. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis.

    Science.gov (United States)

    Long, Suzanne S; Surrey, David E; Nazarian, Levon N

    2013-11-01

    Greater trochanteric pain syndrome is a common condition with clinical features of pain and tenderness at the lateral aspect of the hip. Diagnosing the origin of greater trochanteric pain is important because the treatment varies depending on the cause. We hypothesized that sonographic evaluation of sources for greater trochanteric pain syndrome would show that bursitis was not the most commonly encountered abnormality. We performed a retrospective review of musculoskeletal sonographic examinations performed at our institution over a 6-year period for greater trochanteric pain syndrome; completed a tabulation of the sonographic findings; and assessed the prevalence of trochanteric bursitis, gluteal tendon abnormalities, iliotibial band abnormalities, or a combination of findings. Prevalence of abnormal findings, associations of bursitis, gluteal tendinosis, gluteal tendon tears, and iliotibial band abnormalities were calculated. The final study population consisted of 877 unique patients: 602 women, 275 men; average age, 54 years; and age range, 15-87 years). Of the 877 patients with greater trochanteric pain, 700 (79.8%) did not have bursitis on ultrasound. A minority of patients (177, 20.2%) had trochanteric bursitis. Of the 877 patients with greater trochanteric pain, 438 (49.9%) had gluteal tendinosis, four (0.5%) had gluteal tendon tears, and 250 (28.5%) had a thickened iliotibial band. The cause of greater trochanteric pain syndrome is usually some combination of pathology involving the gluteus medius and gluteus minimus tendons as well as the iliotibial band. Bursitis is present in only the minority of patients. These findings have implications for treatment of this common condition.

  12. [DESIGN AND CLINICAL APPLICATION OF LESSER TROCHANTERIC REDUCTION FIXATION SYSTEM].

    Science.gov (United States)

    Guo, Xiaoze; Zhang, Ying; Xiao, Jin; Xie, Huibin; Yu, Jiefeng

    2015-02-01

    To design and produce a lesser trochanteric reduction fixation system and verify its value and effectiveness. A lesser trochanteric reduction fixation system was designed and produced according to the anatomical features of the lesser trochanteric fractures. Sixty-six patients with intertrochanteric fractures of Evans type III were included between January 2010 and July 2012. Of 66 patients, 32 were treated with dynamic hip screw (DHS) assisted with the lesser trochanteric reduction fixation system (study group), and 34 cases were treated with DHS only (control group). The 2 groups were comparable with no significant difference in gender, age, the reasons, and the types of the fractures (P > 0.05). The operation time, intraoperative blood loss, neck-shaft angle, bone healing time, ratio of successful fixations, and the functional evaluation of the hip joint after operation were compared between 2 groups. The study group had shorter operation time [(58.4 ± 5.3) minutes] and less intraoperative blood loss [(186.3 ± 6.6) mL than the control group [(78.5 ± 6.2)minutes and (246.2 ± 8.7) mL], showing significant differences (t = -14.040, P = 0.000; t = -31.145, P = 0.000). There was no significant difference in neck-shaft angle between study group [(138.6 ± 3.0)] and control group [(139.4 ± 2.9) degrees] (t = -1.044, P = 0.301). The wounds healed by first intention in both groups. The 30 and 31 patients were followed up 12 to 24 months (mean, 15 months) in the study group, and 13 to 25 months (mean, 16 months) in the control group, respectively. All fractures healed well in 2 groups. The study group had significantly shorter healing time [(8.8 ± 2.0) weeks] than the control group [(10.7 ± 3.4) weeks] (t = -2.871, P = 0.006). At 12 months after operation, coxa vara happened in 2 cases of the study group with a successful fixation ratio of 93.3% and in 10 cases of the control group with a successful fixation ratio of 67.7%, showing significant difference (Χ2 = 6

  13. The administration of intermittent parathyroid hormone affects functional recovery from trochanteric fractured neck of femur: a randomised prospective mixed method pilot study.

    Science.gov (United States)

    Chesser, T J S; Fox, R; Harding, K; Halliday, R; Barnfield, S; Willett, K; Lamb, S; Yau, C; Javaid, M K; Gray, A C; Young, J; Taylor, H; Shah, K; Greenwood, R

    2016-06-01

    We wished to assess the feasibility of a future randomised controlled trial of parathyroid hormone (PTH) supplements to aid healing of trochanteric fractures of the hip, by an open label prospective feasibility and pilot study with a nested qualitative sub study. This aimed to inform the design of a future powered study comparing the functional recovery after trochanteric hip fracture in patients undergoing standard care, versus those who undergo administration of subcutaneous injection of PTH for six weeks. We undertook a pilot study comparing the functional recovery after trochanteric hip fracture in patients 60 years or older, admitted with a trochanteric hip fracture, and potentially eligible to be randomised to either standard care or the administration of subcutaneous PTH for six weeks. Our desired outcomes were functional testing and measures to assess the feasibility and acceptability of the study. A total of 724 patients were screened, of whom 143 (20%) were eligible for recruitment. Of these, 123 were approached and 29 (4%) elected to take part. However, seven patients did not complete the study. Compliance with the injections was 11 out of 15 (73%) showing the intervention to be acceptable and feasible in this patient population. Only 4% of patients who met the inclusion criteria were both eligible and willing to consent to a study involving injections of PTH, so delivering this study on a large scale would carry challenges in recruitment and retention. Methodological and sample size planning would have to take this into account. PTH administration to patients to enhance fracture healing should still be considered experimental. Cite this article: Bone Joint J 2016;98-B:840-5. ©2016 Chesser et al.

  14. The role of trochanteric flip osteotomy in fixation of certain acetabular fractures

    Directory of Open Access Journals (Sweden)

    Sandeep Gupta

    2017-06-01

    Conclusion: Trochanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant complications compared with conventional way.

  15. Trochanteric bursitis after total hip arthroplasty: incidence and evaluation of response to treatment.

    Science.gov (United States)

    Farmer, Kevin W; Jones, Lynne C; Brownson, Kirstyn E; Khanuja, Harpal S; Hungerford, Marc W

    2010-02-01

    We examined the efficacy of corticosteroid injection as treatment for postarthroplasty trochanteric bursitis and the risk factors for failure of nonoperative treatment. There were 32 (4.6%) cases of postsurgical trochanteric bursitis in 689 primary total hip arthroplasties. Of the 25 hips with follow-up, 11 (45%) required multiple injections. Symptoms resolved in 20 (80%) but persisted in 5. We found no statistically significant differences between patients who did and did not develop trochanteric bursitis, or between those who did and did not respond to treatment. There was a trend toward younger age and greater limb-length discrepancy in nonresponders. In conclusion, (1) corticosteroid injection(s) for postoperative trochanteric bursitis is effective; and (2) nonoperative management may be more likely to fail in young patients and those with leg-length discrepancy. 2010 Elsevier Inc. All rights reserved.

  16. Effect of prophylactic trochanteric epiphyseodesis in older children with Perthes' disease.

    Science.gov (United States)

    Shah, Hitesh; Siddesh, Nandi D; Joseph, Benjamin; Nair, Sreekumaran N

    2009-12-01

    To evaluate the effect of prophylactic epiphyseodesis of the greater trochanter in Perthes' disease, 62 children with unilateral Perthes' disease who underwent trochanteric epiphyseodesis combined with varus osteotomy of the femur during the active stage of the disease (mean age at surgery: 8.4 y) and 20 controls were followed up until skeletal maturity. On radiographs taken at skeletal maturity, the articulo-trochanteric distance, the center-trochanteric distance, the length of the abductor lever arm, the neck-shaft angle, the radius of the femoral head, and the Reimer's migration index of normal and affected hips were measured. The shape of the femoral head was assessed according to the criteria of Mose. The range of hip motion, the strength of hip abduction, and limb lengths were measured and the Trendelenburg sign was elicited. The mean values of articulo-trochanteric distance and center-trochanteric distance were greater and the frequency of a positive Trendelenburg sign was less in children who had undergone trochanteric epiphyseodesis than in children who had no surgery (P<0.01). Trochanteric epiphyseodesis achieved optimal trochanteric growth arrest in 60% of operated children; the procedure was not effective in 30%, and in 10% of children there was overcorrection. Logistic regression analysis showed that the size of the femoral head at healing and the age at surgery were variables that significantly influenced the effectiveness of trochanteric growth arrest. At skeletal maturity, the mean shortening of the affected limb in operated children was 0.44 cm (SD 0.68 cm), whereas that of non-operated children was 0.86 cm (SD 0.78 cm) (P<0.05). The range of motion of the hip was excellent and there were no significant differences in the range of motion among children with optimal correction, under-correction, and overcorrection. A probability curve plotted on the basis of a logistic regression model suggests that effective trochanteric arrest may be achieved in a

  17. A study on management of extracapsular trochanteric fractures by proximal femoral nail

    Directory of Open Access Journals (Sweden)

    K Ramaprathap Reddy

    2016-01-01

    Full Text Available Background: Trochanteric fractures of femur like intertrochanteric and subtrochanteric fractures are a leading cause of hospital admissions in elderly people. Conservative methods of treatment results in malunion with shortening and limitation of hip movement as well as complications of prolonged immobilizations such as bed sores, deep vein thrombosis, and respiratory infections. This study is done to analyze the surgical management of trochanteric fractures of the femur using a proximal femoral nail (PFN. Methodology: This is a prospective study of 40 cases of trochanteric and subtrochanteric fractures admitted to Government General Hospital, Vijayawada, Andhra Pradesh. Cases were taken according to inclusion and exclusion criteria, i.e., patients with trochanteric fractures femur above the age of 20 years. Medically unsuitable, open fractures and patients not willing for surgery were excluded from the study. Results: Forty percentage of cases were admitted due to slip and fall and with a slight predominance of the right side. Out of 40 cases, 26 were trochanteric, and 14 were subtrochanteric. In trochanteric class, 37.5% were body and griffin Type 2, in subtrochanteric class 12.5% were sinsheimer Type 3a and 10% were 2b. Out of 30 remaining cases, 25 were trochanteric, and 05 were subtrochanteric. Good to excellent results are seen in 100% cases of trochanteric fractures and 90% cases in subtrochanteric fractures. Conclusion: From this sample study, we consider that PFN is an excellent implant for the treatment of pertrochanteric fractures. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate instrumentation, good image intensifier, and exactly performed osteosynthesis.

  18. Trochanteric bursitis--a frequent cause of 'hip' pain in rheumatoid arthritis.

    Science.gov (United States)

    Raman, D; Haslock, I

    1982-01-01

    One hundred consecutive patients with rheumatoid arthritis (RA) were examined for the presence of trochanteric bursitis. This condition was found in 15. Ten patients responded to a single local injection of corticosteroid and the remaining 5 to a second injection. Trochanteric bursitis is an underdiagnosed, easily remediable cause of pain in RA. Specific examination for in presence should be a routine in all patients with RA, especially those with hip pain. PMID:7149797

  19. Differential impact of some risk factors on trochanteric and cervical hip fractures.

    Science.gov (United States)

    Tal, Sari; Gurevich, Alexander; Sagiv, Shaul; Guller, Vladimir

    2015-04-01

    To investigate the potential distinct risk factors associated with trochanteric and cervical hip fractures. Elderly patients aged 65 years and older (n = 1161) were admitted to the orthopedic department with hip fractures during the years 2006-2011. Demographic and clinical data, as well as routine blood tests, were retrieved from the patient electronic medical records. Approximately 58% of patients had trochanteric fractures and 42% had cervical fractures. Women were more likely to have trochanteric fractures than men (P = 0.002). Female sex, frailty, falls, diabetes and subnormal calcium, as well as subnormal hemoglobin levels, were significant risk factors for trochanteric fractures (OR 1.39, P = 0.0202, OR 1.36, P = 0.0166, OR 1.49, P = 0.0015, OR 1.33, P = 0.0343, OR 0.68, P = 0.0054, OR 0.70, P = 0.0036, respectively). Patients with Parkinson's disease were at a lower risk for trochanteric fractures (OR 0.6, P = 0.007). As there are some differences between risk factors for trochanteric and cervical hip fractures, there is a need for further studies in order to understand the etiology of fractures and to be able to carry out effective preventive efforts. © 2014 Japan Geriatrics Society.

  20. Anatomy of the depressor septi nasi muscle: the basis for correction of deformities of the nose/lip junction.

    Science.gov (United States)

    Barbosa, Marcus Vinícius Jardini; Nahas, Fábio Xerfan; Ferreira, Lydia Masako

    2013-04-01

    The purpose of this study was to analyse the macroscopic aspect of the depressor septi nasi muscle in cadavers according to its relations with the nasolabial region, and to describe a surgical technique developed out of the knowledge gained from its study to take care of nasal tip drooping and gummy smile. Twenty fresh adult cadavers were studied. All of them were men. A transverse incision was done at the gingivo-labial sulcus, through the frenulum, to expose the orbicularis oris and the depressor nasi muscles. These muscles were isolated and their anatomical aspect, localisation, origin, and insertion were registered. Sixteen of the cadavers presented the muscle. From these, 14 were bilateral and two were unilateral. Four cadavers did not present the muscle. Muscular fibres were vertically disposed and presented oblique direction towards the midline, in a quadrangular shape. From the 16 cadavers of the subgroup in whom the muscle was present, 14 originated in the orbicularis oris and its insertion was in the maxilla. Two of the cadavers presented the origin and insertion at the maxilla. According to these findings, a surgical approach of the muscles was proposed to treat the gummy smile deformity during rhinoplasty and two clinical cases are presented. The depressor nasi muscles presented an anatomical variation. In most cases it is intimately related with the orbicularis oris and the maxilla, being a relatively thick structure. We suggest its treatment simultaneously during rhinoplasty for a better result of the nasal tip and it benefits the "tense nose" aspect and the smiling deformity.

  1. The trochanteric gamma nail versus the dynamic hip screw

    DEFF Research Database (Denmark)

    Ovesen, Ole; Andersen, Mikkel; Poulsen, Thomas

    2006-01-01

    In a prospective, randomized trial we compared the trochanteric gamma nail (TGN) and the dynamic hip screw (DHS) in the treatment of 146 intertrochanteric fractures. Follow-up was after four and 12 months. The operation time was significantly shorter in the DHS group. At discharge the need...... for walking aids was less in the DHS group. There were no differences in intraoperative blood loss, medical complications, mortality or length of hospital stay. Major fracture complications occurred twiceas often in the TGN group compared with the DHS group, however they were not statistically significant....... Any potential for the TGN leading to a less invasive procedure and a more rapid postoperative mobilisation could not be demonstrated. Compared with the TGN we prefer the DHS for most intertrochanteric fractures in a setting where the majority of these fractures are treated by younger doctors...

  2. [Treatment of trochanteric fractures of the femoral bone].

    Science.gov (United States)

    Wierer, I; Pospísil, M; Holubár, J; Volf, V

    1994-01-01

    The authors present the evaluation of some most often methods of treatment of trochanteric fractures of femur. They analyze the group of 235 patients in the years 1987 - 1991 treated for fractures by the McLaughlin technique and by Ender nailing. The first method was performed on 121 people and the technique of Ender nailing on 97 people. The results and complications of these methods of osteosynthesis are presented in the paper. The experiences of the authors confirm the advantage of Ender nailing in treating fractures of the oldest injured patients. The Ender nailing method of osteosynthesis is the more advantageous, because the operation takes less time and is easier for patients. After Ender nailing, the possibility of functional rehabilitation and walking on crutches is greater. McLaughlin osteosynthesis of these fractures proved the more advantageous in younger injured patients.

  3. Improving greater trochanteric reattachment with a novel cable plate system.

    Science.gov (United States)

    Baril, Yannick; Bourgeois, Yan; Brailovski, Vladimir; Duke, Kajsa; Laflamme, G Yves; Petit, Yvan

    2013-03-01

    Cable-grip systems are commonly used for greater trochanteric reattachment because they have provided the best fixation performance to date, even though they have a rather high complication rate. A novel reattachment system is proposed with the aim of improving fixation stability. It consists of a Y-shaped fixation plate combined with locking screws and superelastic cables to reduce cable loosening and limit greater trochanter movement. The novel system is compared with a commercially available reattachment system in terms of greater trochanter movement and cable tensions under different greater trochanteric abductor application angles. A factorial design of experiments was used including four independent variables: plate system, cable type, abductor application angle, and femur model. The test procedure included 50 cycles of simultaneous application of an abductor force on the greater trochanter and a hip force on the femoral head. The novel plate reduces the movements of a greater trochanter fragment within a single loading cycle up to 26%. Permanent degradation of the fixation (accumulated movement based on 50-cycle testing) is reduced up to 46%. The use of superelastic cables reduces tension loosening up to 24%. However this last improvement did not result in a significant reduction of the grater trochanter movement. The novel plate and cables present advantages over the commercially available greater trochanter reattachment system. The plate reduces movements generated by the hip abductor. The superelastic cables reduce cable loosening during cycling. Both of these positive effects could decrease the risks related to grater trochanter non-union. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

  4. Older Male Physicians Have Lower Risk of Trochanteric but Not Cervical Hip Fractures

    Directory of Open Access Journals (Sweden)

    Hsiu-Nien Shen

    2015-02-01

    Full Text Available Background: Osteoporosis is pathophysiologically related to trochanteric fractures, and this condition is more preventable by lifestyle modifications than cervical fractures. We investigated whether older physicians, who are health-conscious people, are at a lower risk of hip fractures because of fewer trochanteric fractures. Methods: Data regarding older (≥65 years physicians (n = 4303 and matched non-medical persons (control were retrieved from Taiwan’s National Health Insurance claims. All of the subjects were obtained from NHIRD with index dates from 1 January 2000 to 31 December 2008. Cox proportional hazard and competing risk regression models were established to estimate the hazard ratio (HR of hip fracture associated with older physicians. Results: The incidence rates of trochanteric fractures were lower in older physicians than in controls (1.73 and 3.07 per 1000 person-years, respectively, whereas the rates of cervical fractures were similar between the two groups (2.45 and 2.12 per 1000 person-years, respectively. Older physicians yielded 46% lower hazard of trochanteric fractures than controls (adjusted HR 0.54, 95% confidence interval 0.37–0.79; by contrast, hazards of cervical fractures were comparable between the two groups. The HRs estimated from the competing risk models remained unchanged. Conclusions: Our findings indicated that health risk awareness may pose a significant preventive effect on trochanteric hip fractures.

  5. Older Male Physicians Have Lower Risk of Trochanteric but Not Cervical Hip Fractures

    Science.gov (United States)

    Shen, Hsiu-Nien; Lin, Wei-Ting; Lu, Chin-Li; Li, Chung-Yi

    2015-01-01

    Background: Osteoporosis is pathophysiologically related to trochanteric fractures, and this condition is more preventable by lifestyle modifications than cervical fractures. We investigated whether older physicians, who are health-conscious people, are at a lower risk of hip fractures because of fewer trochanteric fractures. Methods: Data regarding older (≥65 years) physicians (n = 4303) and matched non-medical persons (control) were retrieved from Taiwan’s National Health Insurance claims. All of the subjects were obtained from NHIRD with index dates from 1 January 2000 to 31 December 2008. Cox proportional hazard and competing risk regression models were established to estimate the hazard ratio (HR) of hip fracture associated with older physicians. Results: The incidence rates of trochanteric fractures were lower in older physicians than in controls (1.73 and 3.07 per 1000 person-years, respectively), whereas the rates of cervical fractures were similar between the two groups (2.45 and 2.12 per 1000 person-years, respectively). Older physicians yielded 46% lower hazard of trochanteric fractures than controls (adjusted HR 0.54, 95% confidence interval 0.37–0.79); by contrast, hazards of cervical fractures were comparable between the two groups. The HRs estimated from the competing risk models remained unchanged. Conclusions: Our findings indicated that health risk awareness may pose a significant preventive effect on trochanteric hip fractures. PMID:25689999

  6. Dual head screw hip nailing for trochanteric fractures

    Science.gov (United States)

    Mavrogenis, Andreas F.; Igoumenou, Vasilios G.; Megaloikonomos, Panayiotis D.; Panagopoulos, George N.; Galanopoulos, Ioannis P.; Vottis, Christos Th.; Karamanis, Eirinaios; Koulouvaris, Panayiotis; Papagelopoulos, Panayiotis J.

    2017-01-01

    Introduction: There are limited information and inconclusive results for dual head screw intramedullary hip nails for trochanteric fractures. Therefore, we performed a prospective study to evaluate the healing of fractures, and survival, function, and complications of patients operated with this implant. Methods: We prospectively studied 79 patients (61 women and 18 men; mean age: 84.7 years; range: 65–96 years) with a low-energy trochanteric fracture, treated with a dual head screw intramedullary hip nail from 2013 to 2016. The mean follow-up was 2.1 years (range: 1–3 years); seven patients were lost to follow up. This left 72 patients for further analysis. We evaluated the healing of fractures, and survival, function, and complications of patients. Results: Fracture healing was evident in 70 patients (97.2%) at 2–3 months postoperatively. One patient experienced cut-out and z-effect phenomenon of the head screws. Another patient experienced a periprosthetic femoral diaphysis fracture at the distal tip of the nail. A third patient experienced an acute postoperative superficial skin infection that was treated successfully with wound dressing changes and a course of antibiotics. Sixteen patients (22.2%) deceased within 12 months postoperatively. In the remaining patients, the Harris Hip Score (HHS) at 12 months postoperatively was excellent in 16 (28.6%), good in 23 (41.1%), fair in 10 (17.8%), and poor in 7 patients (12.5%). The function declined after the patients’ fracture. Fair and poor results were related to age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3 fracture types. Conclusion: The dual head screw intramedullary hip nail is associated with high healing and low complication rates for intertrochanteric fractures. The function of the patients is good or excellent in most cases; however, it declines, especially for those patients with age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3 fracture types

  7. Dual head screw hip nailing for trochanteric fractures

    Directory of Open Access Journals (Sweden)

    Mavrogenis Andreas F.

    2017-01-01

    Full Text Available Introduction: There are limited information and inconclusive results for dual head screw intramedullary hip nails for trochanteric fractures. Therefore, we performed a prospective study to evaluate the healing of fractures, and survival, function, and complications of patients operated with this implant. Methods: We prospectively studied 79 patients (61 women and 18 men; mean age: 84.7 years; range: 65–96 years with a low-energy trochanteric fracture, treated with a dual head screw intramedullary hip nail from 2013 to 2016. The mean follow-up was 2.1 years (range: 1–3 years; seven patients were lost to follow up. This left 72 patients for further analysis. We evaluated the healing of fractures, and survival, function, and complications of patients. Results: Fracture healing was evident in 70 patients (97.2% at 2–3 months postoperatively. One patient experienced cut-out and z-effect phenomenon of the head screws. Another patient experienced a periprosthetic femoral diaphysis fracture at the distal tip of the nail. A third patient experienced an acute postoperative superficial skin infection that was treated successfully with wound dressing changes and a course of antibiotics. Sixteen patients (22.2% deceased within 12 months postoperatively. In the remaining patients, the Harris Hip Score (HHS at 12 months postoperatively was excellent in 16 (28.6%, good in 23 (41.1%, fair in 10 (17.8%, and poor in 7 patients (12.5%. The function declined after the patients’ fracture. Fair and poor results were related to age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3 fracture types. Conclusion: The dual head screw intramedullary hip nail is associated with high healing and low complication rates for intertrochanteric fractures. The function of the patients is good or excellent in most cases; however, it declines, especially for those patients with age > 85 years, poor pre-fracture level of function, and AO/OTA-31-A3

  8. Trans trochanteric approach with coronal osteotomy of the great trochanter

    Directory of Open Access Journals (Sweden)

    Steffann Francois

    2015-01-01

    Full Text Available Several surgical approaches could be used in hip arthroplasty or trauma surgery: anterior, anterolateral, lateral, posterior (with or without trochanterotomy, using or not an orthopedic reduction table. Subtrochanteric and extra-capsular trochanteric fractures (ECTF are usually treated by internal fixation with mandatory restrictions on weight bearing. Specific complications have been widely described. Mechanical failures are particularly high in unstable fractures. Hip fractures are a major public health issue with a mortality rate of 12%–23% at 1 year. An alternative option is to treat ECTF by total hip arthroplasty (THA to prevent decubitus complications, to help rapid recovery, and to permit immediate weight bearing as well as quick rehabilitation. However, specific risks of THA have to be considered such as dislocation or cardiovascular failure. The classical approach (anterior or posterior requires the opening of the joint and capsule, weakening hip stability and the repair of the great trochanter is sometimes hazardous. For 15 years, we have been treating unstable ECTF by THA with cementless stem, dual mobility cup (DMC, greater trochanter (GT reattachment, and a new surgical approach preserving capsule, going through the fracture and avoiding joint dislocation. Bombaci first described a similar approach in 2008; our trans fractural digastric approach (medial gluteus and lateral vastus is different. A coronal GT osteotomy is performed when there is no coronal fracture line. It allows easy access to the femoral neck and acetabulum. The THA is implanted without femoral internal rotation to avoid extra bone fragment displacement. With pre-operative planning, cup implantation is easy and stem positioning is adjusted referring to the top of the GT after trial reduction and preoperative planning. The longitudinal osteotomy and trochanteric fracture are repaired with wires and the digastric incision is closed. This variant of Bombaci

  9. A custom-made mouthpiece incorporating tongue depressors and elevators to reduce radiation-induced tongue mucositis during carbon-ion radiation therapy for head and neck cancer.

    Science.gov (United States)

    Ikawa, Hiroaki; Koto, Masashi; Ebner, Daniel K; Takagi, Ryo; Hayashi, Kazuhiko; Tsuji, Hiroshi; Kamada, Tadashi

    We introduce a custom-made mouthpiece for carbon-ion radiation therapy for head and neck malignancy. The mouthpiece incorporates either a tongue depressor or elevator depending on tumor location. The risk of tongue mucositis may be reduced without compromising therapeutic efficacy through mouthpiece shaping. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  10. Treatment of trochanteric fractures using the Gamma nail

    Directory of Open Access Journals (Sweden)

    Botnaru V.

    2015-02-01

    Full Text Available A retrospective study on 2 years and 4 months (April 2012 - August 2014 on 430 patients admitted with trochanteric fractures in our Clinic. The surgical indications depended on the patients age, degree of osteoporosis, level activity, associated pathologies and the anatomo-clinical particularity of the fractures. The fractures were operated with gamma nail. The surgery was done in the first 24-72 hours, patients were followed clinically and radiographically at 2, 4, 6 months postoperative. The age of the patients were between 28-95 years, female sex was predominant in 65% of case. It was reported a case of a fracture produced intraoperatory during progression of the nail, 11 bronhopulmonary complications, 5 phlebitis, 7 cases of hematoma after surgery, a case of pseudarthrosis with loosening of implant and 4 dead. There were no septic complications. Fractures consolidate within 12- 14 weeks. The results were appreciated according to fracture reduction, stability of implant, consolidation time and possibility of walking and weight bearing on operated limb.

  11. Traumatic subchondral fracture of the femoral head in a healed trochanteric fracture.

    Science.gov (United States)

    Lee, Sang Yang; Niikura, Takahiro; Iwakura, Takashi; Kurosaka, Masahiro

    2014-07-11

    An 82-year-old woman sustained a trochanteric fracture of the left femur after a fall. Fracture fixation was performed using proximal femoral nail antirotation (PFNA) II, and she was able to walk with a T-cane after 3 months. Eleven months following the operation, the patient presented with left hip pain after a fall. Radiographs showed a subchondral collapse of the femoral head located above the blade tip. The authors removed the PFNA-II and subsequently performed cemented bipolar hemiarthroplasty. Histological evaluation of the femoral head showed osteoporosis with no evidence of osteonecrosis. Repair tissue, granulation tissue and callus formation were seen at the collapsed subchondral area. Based on these findings, a traumatic subchondral fracture of the femoral head in a healed trochanteric fracture was diagnosed. A traumatic subchondral fracture of the femoral head may need to be considered as a possible diagnosis after internal fixation of the trochanteric fracture. 2014 BMJ Publishing Group Ltd.

  12. Unusual Presentation of Pseudoaneurysm with Trochanteric Fracture Femur with Associated Long-Term Antiepileptic Therapy

    Directory of Open Access Journals (Sweden)

    Nipun Rana

    2014-01-01

    Full Text Available Arterial injury following impalement due to a trochanteric hip fracture-fragment per se has been documented rarely. We report a case of pseudoaneurysm of profunda femoris artery at the first perforator branch in a 48-year-old male, with trochanteric hip fracture following a fall during an epileptic episode. Persistent recalcitrant pain, globular swelling in the groin, unexplained drop in the haemoglobin level, and color doppler ultrasonography findings were salient features to the diagnosis. Additionally, we collected all reported cases of pseudoaneurysm associated with hip fractures. We reviewed the literature regarding the incidence, treatment, and prognosis for the same. Acute vascular injury was probably caused by the spikes of fractured lesser trochanter which was found to be displaced superomedially. All trochanteric fractures especially those with displaced lesser trochanter fragment should be closely watched for the possibility of vascular injury. Early diagnosis and treatment in a staged manner can prevent the catastrophic vascular event and hence the limb.

  13. Restricted Mandibular Movement Attributed to Ossification of Mandibular Depressors and Medial Pterygoid Muscles in Patients With Fibrodysplasia Ossificans Progressiva: A Report of 3 Cases.

    Science.gov (United States)

    Okuno, Tetsuko; Suzuki, Hitoshi; Inoue, Akio; Kusukawa, Jingo

    2017-09-01

    Fibrodysplasia ossificans progressiva (FOP) is an extremely rare genetic condition characterized by congenital malformation and progressive heterotopic ossification (HO) caused by a recurrent single nucleotide substitution at position 617 in the ACVR1 gene. As the condition progresses, HO leads to joint ankylosis, breathing difficulties, and mouth-opening restriction, and it can shorten the patient's lifespan. This report describes 3 cases of FOP confirmed by genetic testing in patients with restricted mouth opening. Each patient presented a different onset and degree of jaw movement restriction. The anatomic ossification site of the mandibular joint was examined in each patient using reconstructed computed tomographic (CT) images and 3-dimensional reconstructed CT (3D-CT) images. A 29-year-old woman complained of jaw movement restriction since 13 years of age. 3D-CT image of the mandibular joint showed an osseous bridge, formed by the mandibular depressors that open the mouth, between the hyoid bone and the mentum of the mandible. A 39-year-old man presented with jaw movement restriction that developed at 3 years of age after a mouth injury. 3D-CT image of the jaw showed ankylosis of the jaw from ossification of the mandibular depressors that was worse than in patient 1. CT images showed no HO findings of the masticatory muscles. To the authors' knowledge, these are the first 2 case descriptions of the anatomic site of ankylosis involving HO of the mandibular depressors in the jaw resulting from FOP. In contrast, a 62-year-old bedridden woman with an interincisal distance longer than 10 mm (onset, 39 years of age) had no HO of the mandibular depressors and slight HO of the medial pterygoid muscle on the right and left sides. These findings suggest that restricted mouth opening varies according to the presence or absence of HO of the mandibular depressors. Copyright © 2017. Published by Elsevier Inc.

  14. Modulation of cardiopulmonary depressor reflex in nucleus ambiguus by electroacupuncture: roles of opioids and γ-aminobutyric acid.

    Science.gov (United States)

    Tjen-A-Looi, Stephanie C; Li, Peng; Li, Min; Longhurst, John C

    2012-04-01

    Stimulation of cardiopulmonary receptors with phenylbiguanide (PBG) elicits depressor cardiovascular reflex responses, including decreases in blood pressure and heart rate mediated in part by the brain stem parasympathetic cardiac neurons in the nucleus ambiguus (NAmb). The present study examined NAmb neurotransmitter mechanisms underlying the influence of electroacupuncture (EA) on the PBG-induced hypotension and bradycardia. We hypothesized that somatic stimulation during EA modulates PBG responses through opioid and γ-aminobutyric acid (GABA) modulation in the NAmb. Anesthetized and ventilated cats were studied during repeated stimulation with PBG or cardiac vagal afferents while low-frequency EA (2 Hz) was applied at P5-6 acupoints overlying the median nerve for 30 min and NAmb neuronal activity, heart rate, and blood pressure were recorded. Microinjection of kainic acid into the NAmb attenuated the PBG-induced bradycardia from -60 ± 11 to -36 ± 11 beats/min. Likewise, EA reduced the PBG-induced depressor and bradycardia reflex by 52 and 61%, respectively. Cardiac vagal afferent evoked preganglionic cellular activity in the NAmb was reduced by EA for about 60 min. Blockade of opioid or GABA(A) receptors using naloxone and gabazine reversed the EA-related modulation of the evoked cardiac vagal activity by 73 and 53%, respectively. Similarly, naloxone and gabazine reversed EA modulation of the negative chronotropic responses from -11 ± 5 to -23 ± 6 and -13 ± 4 to -24 ± 3 beats/min, respectively. Thus EA at P5-6 decreases PBG evoked hypotension and bradycardia as well as the NAmb PBG-sensitive preganglionic cardiac vagal outflow through opioid and GABA neurotransmitter systems.

  15. Proposal of new classification of femoral trochanteric fracture by three-dimensional computed tomography and relationship to usual plain X-ray classification.

    Science.gov (United States)

    Shoda, Etsuo; Kitada, Shimpei; Sasaki, Yu; Hirase, Hitoshi; Niikura, Takahiro; Lee, Sang Yang; Sakurai, Atsushi; Oe, Keisuke; Sasaki, Takeharu

    2017-01-01

    Classification of femoral trochanteric fractures is usually based on plain X-ray findings using the Evans, Jensen, or AO/OTA classification. However, complications such as nonunion and cut out of the lag screw or blade are seen even in stable fracture. This may be due to the difficulty of exact diagnosis of fracture pattern in plain X-ray. Computed tomography (CT) may provide more information about the fracture pattern, but such data are scarce. In the present study, it was performed to propose a classification system for femoral trochanteric fractures using three-dimensional CT (3D-CT) and investigate the relationship between this classification and conventional plain X-ray classification. Using three-dimensional (3D)-CT, fractures were classified as two, three, or four parts using combinations of the head, greater trochanter, lesser trochanter, and shaft. We identified five subgroups of three-part fractures according to the fracture pattern involving the greater and lesser trochanters. In total, 239 femoral trochanteric fractures (45 men, 194 women; average age, 84.4 years) treated in four hospitals were classified using our 3D-CT classification. The relationship between this 3D-CT classification and the AO/OTA, Evans, and Jensen X-ray classifications was investigated. In the 3D-CT classification, many fractures exhibited a large oblique fragment of the greater trochanter including the lesser trochanter. This fracture type was recognized as unstable in the 3D-CT classification but was often classified as stable in each X-ray classification. It is difficult to evaluate fracture patterns involving the greater trochanter, especially large oblique fragments including the lesser trochanter, using plain X-rays. The 3D-CT shows the fracture line very clearly, making it easy to classify the fracture pattern.

  16. Factors influencing period from surgery to discharge in patients with femoral trochanteric fractures

    OpenAIRE

    Shinoda, Soichiro; Mutsuzaki, Hirotaka; Watanabe, Arata; Morita, Hidetaka; Kamioka, Yumiko

    2017-01-01

    [Purpose] The purpose of this study was to investigate factors influencing the period from surgery to discharge in patients with femoral trochanteric fractures. [Subjects and Methods] Sixty patients with femoral trochanteric fractures were investigated retrospectively. Based on the mean period from surgery to discharge (85.6 ± 26.6 days), the patients were divided into two groups: an under-85-day group (range, 29–78 days) and an over-85-day group (87–128 days). Age, gender, fracture type, pre...

  17. MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Kong, Andrew; Van der Vliet, Andrew [Regional Imaging Border, Albury, NSW (Australia); Zadow, Steven [Dr Jones and Partners Medical Imaging, Adelaide, SA (Australia)

    2007-07-15

    Greater trochanteric pain syndrome is commonly due to gluteus minimus or medius injury rather than trochanteric bursitis. Gluteal tendinopathy most frequently occurs in late-middle aged females. In this pictorial review the pertinent MRI and US anatomy of the gluteal tendon insertions on the greater trochanter and the adjacent bursae are reviewed. The direct (peritendinitis, tendinosis, partial and complete tear) and indirect (bursal fluid, bony changes and fatty atrophy) MRI signs of gluteal tendon injury are illustrated. The key sonographic findings of gluteal tendinopathy are also discussed. (orig.)

  18. Circumferential wires as a supplement to intramedullary nailing in unstable trochanteric hip fractures

    DEFF Research Database (Denmark)

    Ban, Ilija; Birkelund, Lasse; Palm, Henrik

    2012-01-01

    Fixation of unstable trochanteric fractures is challenging. Application of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply to the under......Fixation of unstable trochanteric fractures is challenging. Application of a circumferential wire may facilitate bone contact and avoid postoperative fracture displacement. However, the use of circumferential wires remains controversial due to possible disturbance of the blood supply...... to the underlying bone. We evaluated the results of applied circumferential wires, concentrating mainly on complications and reoperations....

  19. Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients.

    Science.gov (United States)

    Norris, Rory; Bhattacharjee, Dhritiman; Parker, Martyn J

    2012-06-01

    A sliding hip screw (SHS) is currently the treatment of choice for trochanteric hip fractures, largely due to the low incidence of complications. An alternative treatment is the use of intramedullary proximal femoral nails. Unfortunately these implants have been associated with a risk of later fracture around the implant. The aim of this study was to see if any improvements have been made to the current intramedullary nails, to reduce the incidence of secondary fracture around the distal tip of the nail. We analysed data related to 13,568 patients from 89 studies, focusing on the incidence of post operative secondary femoral shaft fracture following the use of intramedullary nails in the fixation of trochanteric hip fractures. The overall reported incidence of secondary fracture around the nail was 1.7%. The incidence of fracture has reduced in the 3rd generation Gamma nails when compared to the older Gamma nail (1.7% versus 2.6%, p value 0.03). However, the incidence of secondary fracture in the 3rd generation Gamma nails is still significantly higher than the other brands of short nail (1.7% versus 0.7%, p value 0.0005). Long nails had a slight tendency towards a lower risk of fracture although the difference was not statistically significant (1.1% versus 1.7%, p value 0.28). There was a significantly lower risk of fracture for those nails with a biaxial fixation as opposed to uniaxial fixation (0.6% versus 1.9%, p value fracture around a proximal femoral nail is one of the most significant of fracture healing complications, and this study suggests that continuing design changes to this method of fixation has reduced the risk of this complication occurring. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Treatment of unstable trochanteric fractures : the balance between man and material

    NARCIS (Netherlands)

    I.B. Schipper (Inger)

    2003-01-01

    textabstractTreatment of unstable trochanteric fractures poses a challenge to surgeons in many ways. Accepting this challenge requires understanding of those parameters that determine the outcome. In operative fracture care at least four elements influence the outcome of treatment: the patient, the

  1. Perioperative lateral trochanteric wall fractures: sliding hip screw versus percutaneous compression plate for intertrochanteric hip fractures.

    Science.gov (United States)

    Langford, Joshua; Pillai, Gita; Ugliailoro, Anthony D; Yang, Edward

    2011-04-01

    This study was performed to determine the incidence of perioperative lateral wall fractures with a standard sliding hip screw (SHS) versus a percutaneous compression plate (PCCP) using identical meticulous closed reduction techniques in both groups. Retrospective analysis of a prospective trauma registry. Urban Level I trauma center. Over a 7-year period, 337 patients with intertrochanteric hip fractures were treated with either a SHS or a PCCP at our institution. The PCCP group (Group 1) consisted of 200 patients, of which 141 (71%) had adequate images to be included in the study. The SHS group (Group 2) consisted of 137 patients, of which 100 (73%) had adequate images to be included in the study. Closed reduction and plate application with either a standard sliding hip screw or a percutaneous compression plate for an Orthopaedic Trauma Association 31A1 or 31A2 intertrochanteric hip fracture. : Radiographic evidence of lateral trochanteric wall fracture as measured by intraoperative and perioperative radiographs. There was an overall lateral wall fracture incidence of 20% in the SHS group versus 1.4% in the PCCP group (P fracture types, there was a lateral wall fracture incidence of 29.8% in the SHS group versus 1.9% in the PCCP group (P trochanteric wall fracture compared with the SHS group. This difference became greater when just unstable intertrochanteric fractures were analyzed. An anatomic reduction, combined with a device (PCCP) that uses small-diameter defects in the lateral trochanteric wall, essentially eliminates perioperative lateral trochanteric wall fractures.

  2. Treatment of Unstable Trochanteric Femur Fractures: Proximal Femur Nail Versus Proximal Femur Locking Compression Plate.

    Science.gov (United States)

    Singh, Ashutosh Kumar; Narsaria, Nidi; G R, Arun; Srivastava, Vivek

    Unstable trochanteric femur fractures are common fractures that are difficult to manage. We conducted a prospective study to compare functional outcomes and complications of 2 different implant designs, proximal femur nail (PFN) and proximal femur locking compression plate (PFLCP), used in internal fixation of unstable trochanteric femur fractures. On hospital admission, 48 patients with unstable trochanteric fractures were randomly assigned (using a sealed envelope method) to treatment with either PFN (24 patients) or PFLCP (24 patients). Perioperative data and complications were recorded. All cases were followed up for 2 years. The groups did not differ significantly (P > .05) in operative time, reduction quality, complications, hospital length of stay, union rate, or time to union. Compared with the PFLCP group, the PFN group had shorter incisions and less blood loss. Regarding functional outcomes, there was no significant difference in mean Harris Hip Score (P = .48) or Palmer and Parker mobility score (P = .58). Both PFN and PFLCP are effective in internal fixation of unstable trochanteric femur fractures.

  3. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail.

    NARCIS (Netherlands)

    Schipper, I.B.; Steyerberg, E.W.; Castelein, R.M.; Heijden, F.H. van der; Hoed, P.T. den; Kerver, A.J.; Vugt, A.B. van

    2004-01-01

    The proximal femoral nail (PFN) is a recently introduced intramedullary system, designed to improve treatment of unstable trochanteric fractures of the hip. In a multicentre prospective clinical study, the intra-operative use, complications and outcome of treatment using the PFN (n = 211) were

  4. Elderly patient's mortality and morbidity following trochanteric fracture. A prospective study of 100 cases.

    Science.gov (United States)

    Mnif, H; Koubaa, M; Zrig, M; Trabelsi, R; Abid, A

    2009-11-01

    Trochanteric fractures are a major source of mortality, morbidity and functional impairment in the elderly. Morbidity is closely related to the degree of instability and comminution and is substantially influenced by the quality of reduction and internal fixation. Advanced age and associated co-morbidities are two decisive factors of mortality secondary to trochanteric fracture. This prospective study examined the epidemiological profile of trochanteric fractures and assessed mortality and morbidity with the aim of establishing management guidelines and improving prevention strategies. One hundred patients were included; 60% were male. Mean age was 76 years (range, 60-96 yrs). One, or more than one, co-morbidities were present in 68% of cases. The fractures were caused by a simple fall in 90% of cases. Fractures were classified according to the criteria of Ramadier and the ones of Ender. Sixty-five percent of these fractures were unstable. A dynamic hip screw was systematically used as the standard means of internal fixation. Anatomic and functional results were analyzed in 82 patients (18 had died within the first year following fracture occurrence). Mean follow-up period was 24 months (range, 12-36 months). Bone healing was achieved in 96% of cases. There were numerous postoperative complications (four cases of thromboembolism, fourteen immobility-related complications, two infections, six secondary displacement combined to loss of fixation, four non-unions, and nine malunions). At 2 years follow-up, 28 patients had died. Mortality was strongly correlated with older age (over 90 years), associated co-morbidity and fracture instability. Good functional outcomes (72%) correlated with younger age (60-74 years), fracture stability, adequate reduction and internal fixation. In stable trochanteric fractures, osteosynthesis by dynamic screw-plate is more effective than alternative techniques (blade-plate, nail-plate, Ender nail or even trochanteric nail). In unstable

  5. Fixation of Trochanteric Fragments in Cementless Bipolar Hemiarthroplasty of Unstable Intertrochanteric Fracture: Cerclage Wiring.

    Science.gov (United States)

    Lee, Young-Kyun; Park, Chan Ho; Koo, Kyung-Hoi

    2017-12-01

    Bipolar hemiarthroplasty (HA) is an option for the treatment of unstable intertrochanteric fracture in elderly patients. There is a raising concern regarding cable-grip related complications for the fixation of trochanteric fragments. Therefore, the aim of this study was to evaluate outcome of cementless HA with fixation for the trochanteric fragments using monofilament wires in unstable intertrochanteric fracture. We reviewed 92 cementless bipolar HAs using a grit-blasted long stem design for unstable intertrochanteric fractures in 91 elderly patients with a mean age of 81.7 years. During the arthroplasty, trochanteric fracture fragments were fixed using 1 or 2 vertical wires and transverse wires. We evaluated the clinical outcomes such as abductor power, ambulatory ability and wire-related complications, and radiologic outcomes including the union of the trochanteric fragment and subsidence of stem. Sixty-two patients were followed for a minimum of 2 years (mean, 59 months) postoperatively. The mean abductor power and Koval category was 4.1 (range, 3 to 5) and 4.6 (range, 1 to 6). The wire was broken in 3 hips (4.8%) and the nonunion of the greater trochanter occurred in 1 hips (1.6%). Two stems subsided by 3 mm and 8 mm, respectively, during postoperative 6 weeks, after which the subsidence was not progressive. Cerclage wiring of the trochanter using monofilament wire leads to acceptable outcome in cementless HA for senile patients with unstable intertrochanteric fracture. Cerclage wiring using a monofilament wire is recommended for the fixation of trochanteric fragments.

  6. Influence of Lateral Muscle Loading in the Proximal Femur after Fracture Stabilization with a Trochanteric Gamma Nail (TGN)

    Science.gov (United States)

    Sitthiseripratip, Kriskrai; Mahaisavariya, Banchong; Suwanprateeb, Jintamai; Bohez, Erik; Vander Sloten, Jos

    The purpose of this study was to investigate the influence of lateral muscle loading on the stress/strain distributions of the trochanteric Gamma nail (TGN) fixation within the healed, trochanteric and subtrochanteric femoral fractures by means of a finite element method. The effect of three muscle groups, the abductors (ABD), the vastus lateralis (VL) and the iliotibial band (ITB), were investigated. The analytical results showed that addition of lateral muscle forces, iliotibial band and vastus lateralis, produced compensation of forces and reduction of bending moments in the bone and in the trochanteric Gamma nail especially in the lateral aspect. The iliotibial band produced a higher impact as compared to the vastus lateralis. Therefore in the finite element analysis of the proximal femur with the trochanteric Gamma nail fracture fixation should include the lateral muscle forces to simulate load condition with maximal physiological relevance to the closed nailing technique.

  7. Study of the Effect of Sodium Sulfide as a Selective Depressor in the Separation of Chalcopyrite and Molybdenite

    Directory of Open Access Journals (Sweden)

    Huiqing Peng

    2017-03-01

    Full Text Available Two kinds of collectors, sodium butyl xanthate and kerosene, and a depressor, sodium sulfide, were used in this research. The study applied flotation tests, pulp potential measurements, contact angle measurements, adsorption calculations, and Fourier Transform Infrared Spectroscopy (FTIR analyses to demonstrate the correlation between reagents and minerals. For xanthate collectors, the best flotation responses of chalcopyrite and molybdenite were obtained at pH = 8, and, for kerosene, these were obtained at pH = 4. The flotation of molybdenite seemed to be less influenced by xanthate than by kerosene, while that of chalcopyrite showed the opposite. The optimum concentration of sodium sulfide for separation was 0.03 mol/L, which rejected 83% chalcopyrite and recovered 82% molybdenite in the single mineral flotation. Pulp potential measurements revealed that the dixanthogen and xanthate were decomposed and desorbed, respectively, from the mineral surface in a reducing environment. The contact angle measurement and adsorption calculation conformed to the flotation response, indicating that few functions of the xanthate and sodium sulfide on the molybdenite flotation were due to their low adsorption densities. The FTIR results further clarified that the xanthate ion was adsorbed on chalcopyrite by forming cuprous xanthate and dixanthogen; however, on molybdenite the adsorption product was only dixanthogen. After conditioning with sodium sulfide, the chalcopyrite surface became clean, but the molybdenite surface still retained slight peaks of dixanthogen. Meanwhile, the possible mechanism was expounded in this research.

  8. [Depressor anguli oris sign (DAO) in facial paresis. How to search it and release the smile (technical note)].

    Science.gov (United States)

    Labbé, D; Bénichou, L; Iodice, A; Giot, J-P

    2012-06-01

    After facial paralysis recovery, it is common to note a co-contraction between depressor anguli oris (DAO) muscle and zygomatic muscles. This DAO co-contraction will "obstruct" the patient's smile. The purpose of this technical note is to show how to find the DAO sign and how to free up the smile. TECHNICAL: This co-contraction between the zygomatic muscles and DAO research is placing a finger on marionette line, asking the patient to smile: we perceive a rope under the skin corresponding to the abnormal contraction and powerful DAO. A diagnostic test with lidocaine injection into the DAO can be performed to confirm the diagnosis. The treatment of pathological DAO's contraction can be by injection of botulinum toxin in the DAO, or by surgical myectomy. In all cases, a speech therapy complete the treatment. The DAO sign is a semiological entity easy to find. His treatment releases smile without negative effect on the facial expression as the DAO is especially useful in the expression of disgust. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  9. [The rotationally stable screw-anchor with trochanteric stabilizing plate (RoSA/TSP) : First results in unstable trochanteric femur fractures].

    Science.gov (United States)

    Maier, K-J; Bücking, B; Horst, K; Andruszkow, H; Hildebrand, F; Knobe, M

    2017-12-01

    In unstable trochanteric fractures, the extramedullary rotationally stable screw-anchor (RoSA) combines the benefits of the load and rotational stability of the blade with the advantages of the screw (pull-out resistance, compression capability) in a single load carrier, and was designed to prevent femoral neck shortening by using an additional locked trochanteric stabilizing plate (TSP). The aim of the current prospective cohort study was the clinical evaluation of the RoSA/TSP system regarding the mechanical re-operation rate and the amount of postoperative femoral neck shortening. From September 2011 to January 2014 80 patients with unstable trochanteric fractures underwent internal extramedullary fixation with the RoSA/TSP (Königsee Implantate GmbH, Allendorf, Germany). Due to fracture stability and after induction of compression, additional long locked antitelescoping screws (AT, n = 1-4) were placed reaching the femoral head. Radiological (femoral neck shortening) and clinical re-examination of patients (n = 61) was performed 6-10 weeks and 6-10 months later. In the 61 re-examined patients (76 %) femoral neck shortening was very low with 2 mm 6-10 months after operation. Re-operations occurred in 8 % (n = 6) and in 4 % (n = 3) as prophylactic surgical intervention. Whereas one-third (4 %) of re-operations occurred due to iatrogenic surgical problems from the first operation two-thirds of patients (8 %) had a re-operation due to delay of bone union (3× nonunion, 3 planned removals of AT-screws to improve healing). The in-hospital mortality was 3 % (n = 2). The fixation of unstable trochanteric femur fractures using the RoSA/TSP in a first clinical setting led to a great primary stability, with significant advantages with regard to limited femoral neck shortening. However, the rigidity of the construct with its consequences regarding bone healing can be challenging for the surgeon. Nevertheless, in some cases of revision it could be beneficial

  10. Trochanteric Fixation With a Third-Generation Cable-Plate System: An Independent Experience.

    Science.gov (United States)

    Stewart, Andrew D; Abdelbary, Hesham; Beaulé, Paul E

    2017-09-01

    Greater trochanteric fracture/nonunion can be a devastating complication with significant functional impact after total hip arthroplasty, and their fixation remains a challenge because of the significant forces being transmitted as well as the poor bone quality often associated with these fractures. The objective of this study is to investigate the rates of reoperation and trochanteric nonunion using a third-generation cable-plate system at one center. Thirty-five patients, mean age 72.9 years (range 46-98 years) with 24 women and 11 men, underwent fixation of their fractured greater trochanter using a third-generation cable-plate system. The indications were: periprosthetic fracture (n = 17), complex primary arthroplasty (n = 5), and complex revision arthroplasty (n = 13). Primary outcomes included rates of reoperation and radiographic union. At a mean follow-up of 2.5 years, trochanteric union rate was 62.9% with nonunion rate of 31.4%, and fibrous union in 5.7%. In regard to quality of initial apposition, only 40% achieved a perfect bone on bone reduction. Ten patients (28.6%) had evidence of wire breakage. Five patients (14.3%) required reoperation and removal of the internal fixation because of lateral hip pain. Fixation of the trochanteric fractures remains a challenge with a relatively high reoperation rate. Poor bone quality and capacity to maintain a stable reduction continue to make this complication after total hip arthroplasty a difficult problem to solve. Copyright © 2017. Published by Elsevier Inc.

  11. Extent and Morbidity of Lateralization of a Trochanteric Fixation Nail Blade.

    Science.gov (United States)

    Sandifer, Phillip A; Hulick, Robert M; Graves, Matthew L; Spitler, Clay A; Russell, George V; Hydrick, Josie M; Jones, LaRita C; Bergin, Patrick F

    2017-09-01

    This study examined the incidence and risk factors associated with lateral helical blade migration and trochanteric pain with the trochanteric fixation nail. A retrospective review was performed of 141 cases of pertrochanteric femur fracture treated with a trochanteric fixation nail at a level I trauma center over a period of 42 months. Exclusion criteria included follow-up of less than 60 days, preexisting osteonecrosis of the femoral head, and prophylactic trochanteric fixation nail treatment. Patient demographics, operative findings, and radiographic findings were recorded. Medical records were reviewed to identify symptomatic hardware. Overall, 27 patients (19.1%) were symptomatic, and 3 (2.1%) required revision surgery for blade prominence. Of the patients, 42 (30%) had lateralization of greater than 1 cm, and 16 of these (38.1%) were symptomatic (Pfractures showing lateralization of greater than 1 cm. The quality of calcar reduction nearly reached statistical significance, and 44.8% of patients who had inadequate reduction had lateralization of greater than 1 cm compared with 26.4% of patients who had adequate reduction (P=.054). Lateralization of greater than 1 cm was directly associated with the presence of symptoms (Ptrochanteric pain (P=.007). Multivariate analysis showed that increasing tip-apex distance, inadequate calcar reduction, and greater fracture severity were predictive of excessive lateralization of greater than 1 cm. Nearly 20% of patients had lateral hip pain associated with cephalomedullary fixation. Final lateralization of the helical blade of greater than 1 cm was a very strong predictor of symptoms. During preoperative counseling, surgeons should caution patients about this relatively frequent and likely underreported complication. [Orthopedics. 2017; 40(5):e886-e891.]. Copyright 2017, SLACK Incorporated.

  12. Calcar femorale grafting in the hemiarthroplasty of the hip for unstable inter trochanteric fractures.

    Science.gov (United States)

    Thakkar, Chandrashekar J; Thakkar, Savyasachi; Kathalgere, Rajshekhar T; Kumar, Malhar N

    2015-01-01

    The sliding screw-plate devices and cephalo-medullary nail devices have performed well in stable inter-trochanteric fractures in patients with reasonably good quality of bone. However, their suboptimal performance in comminuted fractures in the presence of osteoporotic bone has prompted many surgeons to consider bipolar hemiarthroplasty as the primary modality of management of comminuted inter-trochanteric fractures in elderly patients. However, long term stability of the hemiarthroplasty implant also may be compromised due to the presence of postero-medial bone loss at the area of the calcar. We have presented a simple and effective technique of calcar grafting by harvesting cortical bone strut from the neck of the fractured femur. A total of 34 patients with inter-trochanteric fractures of the femur were treated with calcar grafting. The mean age was 79.2 years. The graft was harvested from the calcar region of the head and neck fragment of the femur and wedged between the medial femoral cortex and medial edge of the prosthesis. The mean followup period was 54.5 months. In 32 of 34 (94%) patients in our series, the calcar graft healed well without dislodgement. There was graft resorption in two patients associated with subsidence of the implant and loosening. Calcar grafting using this technique provides stability to the implant in the presence of comminution and incorporates well in the majority of patients. Donor site morbidity of graft harvesting is also avoided.

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

    Science.gov (United States)

    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.

  14. Depressor effect of the young leaves of Polygonum hydropiper Linn. in high-salt induced hypertensive mice.

    Science.gov (United States)

    Devarajan, Sankar; Yahiro, Eiji; Uehara, Yoshinari; Kuroda, Rieko; Hirano, Yoshio; Nagata, Kaori; Miura, Shinichiro; Saku, Keijiro; Urata, Hidenori

    2018-06-01

    A novel chymase inhibitor has been reported to have depressor effect in salt-induced hypertension. Therefore, we examined the hypothesis that chymase inhibitory dried young leaves of Polygonum hydropiper (PPH) or young leaves extract of Polygonum hydropiper (PHE) could reduce salt-induced hypertension. In this study, 8-wk old wild-type mice were allocated into three experiments and experiment I included groups, I- normal water drinking, II- high salt (2% NaCl) water (HSW) drinking, and III- HSW plus PPH (500 mg kg -1 , orally) for 12-wk. Blood pressure (BP) and heart rate (HR) were measured at baseline and weekly up to wk-12. In experiment II, mice were given HSW for 12-wk followed by 8-wk treatment with PPH plus HSW (62.5, 125, 250 and 500 mg kg -1 for groups I, II, III and IV, respectively). BP and HR were measured at baseline and monthly until wk-12, following weekly for 8-wk. Experiment III comprised of four groups of mice for 12-wk HSW and 8-wk treatment with PHE plus HSW (2.5, 5, 10 and 20 mg kg -1 for groups I-IV, respectively). BP and HR were measured at baseline and monthly up to wk-12, following weekly for 8-wk. Significant reduction in BP and HR were observed in mice treated with PPH (500 mg kg -1 ) compared to HSW control. PPH reduced BP and HR dose dependently in hypertensive mice and the higher dose showed maximum reduction. PHE at its maximum dose (20 mg kg -1 ) significantly suppressed BP and HR. Over all, we found that the young leaves of Polygonum hydropiper suppressed salt-induced hypertension. Copyright © 2018. Published by Elsevier Masson SAS.

  15. Tonic aortic depressor nerve stimulation does not impede baroreflex dynamic characteristics concomitantly mediated by the stimulated nerve.

    Science.gov (United States)

    Kawada, Toru; Turner, Michael J; Shimizu, Shuji; Kamiya, Atsunori; Shishido, Toshiaki; Sugimachi, Masaru

    2018-03-01

    Although electrical activation of the carotid sinus baroreflex (baroreflex activation therapy) is being explored as a device therapy for resistant hypertension, possible effects on baroreflex dynamic characteristics of interaction between electrical stimulation and pressure inputs are not fully elucidated. To examine whether the electrical stimulation of the baroreceptor afferent nerve impedes normal short-term arterial pressure (AP) regulation mediated by the stimulated nerve, we electrically stimulated the right aortic depressor nerve (ADN) while estimating the baroreflex dynamic characteristics by imposing pressure inputs to the isolated baroreceptor region of the right ADN in nine anesthetized rats. A Gaussian white noise signal with a mean of 120 mmHg and standard deviation of 20 mmHg was used for the pressure perturbation. A tonic ADN stimulation (2 or 5 Hz, 10 V, 0.1-ms pulse width) decreased mean sympathetic nerve activity (367.0 ± 70.9 vs. 247.3 ± 47.2 arbitrary units, P ADN stimulation did not affect the slope of dynamic gain in the neural arc transfer function from pressure perturbation to sympathetic nerve activity (16.9 ± 1.0 vs. 14.7 ± 1.6 dB/decade, not significant). These results indicate that electrical stimulation of the baroreceptor afferent nerve does not significantly impede the dynamic characteristics of the arterial baroreflex concomitantly mediated by the stimulated nerve. Short-term AP regulation by the arterial baroreflex may be preserved during the baroreflex activation therapy.

  16. A case of double depressor palsy followed by pursuit deficit due to sequential infarction in bilateral thalamus and right medial superior temporal area.

    Science.gov (United States)

    Kim, Su Jin; Yeom, Myeong In; Lee, Seung Uk

    2017-12-01

    We present a unique case of a patient who suffered two rare events affecting the supranuclear control, first of the vertical and second of the horizontal eye movements. The first event involved bilateral thalamic infarcts that resulted in double depressor palsy. The second event occurred 1 year later and it involved supranuclear control of horizontal eye movements creating pursuit deficit. A 47-year-old male presented with complaints of diplopia upon awakening. He had atrial fibrillation, mitral valve regurgitation, aortic valve regurgitation, and a history of spleen infarction 1 year ago. His right eye was hypertrophic and right eye downgaze was limited unilaterally of equal degree in adduction and abduction. The patient was diagnosed with double depressor palsy of the right eye. Magnetic resonance imaging (MRI) of the brain showed an old infarction of the left thalamus, and diffusion MRI showed acute infarction of the right thalamus. The patient's daily warfarin dose was 2 mg and it was increased to 5 mg with cilostazol 75 mg twice a day. Seven weeks later, the patient's ocular movement revealed near normal muscle action, and subjectively, the patient was diplopia free. At follow-up 12 months later, the patient revisited the hospital because of sudden onset of blurred vision on right gaze. He was observed to have smooth pursuit deficit to the right side, and orthophoric position of the eyes in primary gaze. MRI of the brain showed an acute infarction in the right medial superior temporal area. The patient experienced very rare abnormal eyeball movements twice. This case highlights the importance of evaluating vertical movement of the eyes and vascular supplies when patients present with depressor deficit and supports the theory of a supranuclear function in patients who present with pursuit deficit.

  17. Does a trochanteric lag screw improve fixation of vertically oriented femoral neck fractures? A biomechanical analysis in cadaveric bone.

    Science.gov (United States)

    Hawks, Michael A; Kim, Hyunchul; Strauss, Joseph E; Oliphant, Bryant W; Golden, Robert D; Hsieh, Adam H; Nascone, Jason W; O'Toole, Robert V

    2013-10-01

    We assessed the biomechanical performances of a trochanteric lag screw construct and a traditional inverted triangle construct in the treatment of simulated Pauwels type 3 femoral neck fractures. An inverted triangle construct (three 7.3-mm cannulated screws placed in inverted triangle orientation) and a trochanteric lag screw construct (two 7.3-mm cannulated screws placed across the superior portion of the femoral neck and one 4.5-mm lag screw placed perpendicular to the fracture in superolateral to inferomedial orientation) were tested in nine matched pairs of non-osteoporotic human cadaveric femora. We used a previously described vertically oriented femoral neck fracture model and testing protocol that incrementally loaded the constructs along the mechanical axis of the femur to 1400 N. Specimens that survived incremental loading underwent cyclic loading. Apparent construct stiffness, force at 3mm of displacement, and survival of incremental loading were recorded. The trochanteric lag screw group had a 70% increase in stiffness (261 N/mm [29 standard deviation] versus 153 N/mm [16 standard deviation]; P=0.026) and a 43% increase in force required for displacement (620 N versus 435 N; P=0.018) compared with the inverted triangle group. One trochanteric lag screw and no inverted triangle specimen survived incremental loading. A trochanteric lag screw construct applied to vertically oriented femoral neck fractures provides marked improvement in mechanical performance compared with the inverted triangle construct. © 2013.

  18. Hip fracture and anthropometric variations: dominance among trochanteric soft tissue thickness, body height and body weight during sideways fall.

    Science.gov (United States)

    Majumder, Santanu; Roychowdhury, Amit; Pal, Subrata

    2013-01-01

    Hip fracture depends on various anthropometric parameters such as trochanteric soft tissue thickness, body height and body weight. The objective was to evaluate the responses to the variations in anthropometric parameters during sideways fall, and to identify the most dominant parameter among them. Seven finite element models were developed having anthropometric variations in trochanteric soft tissue thickness (5-26 mm), body height (1.70-1.88 m), and body weight (63-93.37 kg). These were simulated for sideways fall with ANSYS-LS-DYNA® code. Significant effect of trochanteric soft tissue thickness variation was found on 'normalized peak impact force with respect to the body weight' (p=0.004, r²=0.808) and strain ratio (p=0.083, r²=0.829). But, variation in body height was found to be less significant on normalized peak impact force (p=0.478, r²=0.105) and strain ratio (p=0.292, r²=0.217). Same was true for the variation in body weight on normalized peak impact force (p=0.075, r²=0.456) and strain ratio (p=0.857, r²=0.007). The risk factor for fracture was also well correlated to the strain ratio for the inter-trochanteric zone (pfractures are clinically observed to happen. Trochanteric soft tissue thickness was found likely to be the most dominant parameter over body height and body weight, signifying that a slimmer elderly person, taller or shorter, with less trochanteric soft tissue thickness should be advised to take preventive measures against hip fracture under sideways fall. © 2013.

  19. Quantitative ultrasound parameters as well as bone mineral density are better predictors of trochanteric than cervical hip fractures in elderly women. Results from the EPIDOS study.

    Science.gov (United States)

    Schott, A M; Hans, D; Duboeuf, F; Dargent-Molina, P; Hajri, T; Bréart, G; Meunier, P J

    2005-12-01

    Hip fractures can be separated into cervical and trochanteric fractures. Trochanteric fractures have been associated with up to twice the short-term mortality of cervical fractures in the elderly. There is also evidence suggesting that the mechanisms are different. Evidence from the literature remains limited on the predictive power of bone mineral density (BMD) and quantitative ultrasounds (QUS) for both types of hip fractures. 5703 elderly women aged 75 years or more, who were recruited from the voting lists in the EPIDOS study, and had baseline calcaneal ultrasounds (QUS) and DXA measurements at the hip and the whole body, were analyzed in this paper. Among those, 192 hip fractures occurred during an average follow-up of 4 years, 108 cervical and 84 trochanteric fractures. Femoral neck, trochanteric and whole body BMD were able to predict trochanteric hip fracture (RR's and 95% CI were, respectively, 3.2 (2.4-4.2); 4.8 (3.5-6.6); and 2.8 (2.2-3.6)) more accurately than cervical fractures (respectively, 2.1 (1.7-2.7); 2.3 (1.8-3.0); 1.2 (1.0-1.6)). All ultrasound parameters, SOS, BUA, and stiffness index (SI) were significant predictors of trochanteric (RR's respectively 3.0 (2.2-4.1), 2.5(2.0-3.1), and 3.5(2.6-4.7)) but not cervical fractures. After adjustment for femoral neck or trochanteric BMD ultrasound parameters were still significant predictors of trochanteric fracture, and stiffness tended to be a better predictor of trochanteric fractures than either BUA or SOS with a relative risk of 2.25 (1.6-3.1). A significant decrease of all bone measurements, BMD and QUS, was highly predictive of trochanteric fractures, whereas a decrease of femoral neck and trochanteric BMD were only associated with a slight increase in cervical fracture risk and a low total body BMD or QUS parameters were not significant predictors of cervical fractures. In women who sustained a hip fracture, the decrease of BMD and QUS values increases the risk of trochanteric fracture as

  20. [Posterior partial trochanteric osteotomy for the treatment of the roof involved acetabular fractures].

    Science.gov (United States)

    Wang, Pan-Feng; Xu, Shuo-Gui; Zhang, Chun-Cai; Fu, Qing-Ge; Zhang, Yun-Tong; Liu, Xin-Wei; Niu, Yun-Fei; Tang, Yang

    2013-11-01

    To introduce a new trochanteric osteotomy,and evaluate the outcome of the procedure combined a posterior lateral approach in treating acetabular fractures which involving the roof. Between March 2007 and Novmber 2010,30 patients with displaced acetabular fractures involving the dome need trochanteric osteotomy were retrospectively reviewed. There were 21 males and 9 females,ranging in age from 18 to 70 years with an average of 35.2 years at the time of injury. According to Letournel-Judet classification, there were 10 posterior wall fractures,7 posterior column fractures,5 transverse fractures, 2 T-shape fractures, 1 transverse associated with posterior wall fracture, 3 posterior column and wall fractures and 2 bicolumn fractures. The standards of Matta,the modified Merle d'Aubigne-Postel, Medical Research Council were respectively used to evaluate the reduction result, function of hip joint and the strength of hip abduction. All patients were followed up with an average time of 25 months (18 to 40) and all osteotomy sites obtained bone union with an average time of 8.4 weeks (6 to 12). No bone non-union, bone block displaceing, internal fixation looseing and breaking,infection of deep part were found. Seventeen patients got anatomic reduction, 12 got satisfied reduction, and 1 got unsatisfied result according to the criteria of Matta. At final follow-up, function of hip joint obtained excellent results in 11 cases, good in 15, fair in 3 and poor in 1. The strength of the abductors of 3 patients were grade 4 and 27 patients were grade 5. Posterior partial great trochanteric osteotomy can enhance the exposure and provide a more accurate reduction and degrade the difficulty of acetabular fracture fixation without increasing the risk of complications. The method provide a new way for the treatment of the roof involved acetabular fractures.

  1. The role of trochanteric flip osteotomy in fixation of certain acetabular fractures.

    Science.gov (United States)

    Gupta, Sandeep; Singh, Jagdeep; Virk, Jagandeep Singh

    2017-06-01

    Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater trochanter has been used to enhance fracture visualization, especially the dome, in posterior and lateral exposures of the acetabulum. It also decreases the need for excessive muscle retraction. The purpose of the study was to investigate the outcome associated with trochanteric flip osteotomy in the management of certain acetabulum fractures. From January 2011 to December 2013, 25 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a Kocher-Langenbeck approach along with trochanteric flip osteotomy. At 3rd, 6th and 24th month follow-up, all patients had radiographic examination and underwent a final clinical evaluation based on the modified Merle d'Aubigne and Postel score. The strength of the abductors was assessed according to the Medical Research Council (MRC) grading system. Congruent reduction was achieved in all patients and all osteotomies healed within an average period of 3.8 months. All our patients were allowed full weight bearing at the end of 3 months and with no abductor lurch at the end of 6 months follow-up. There were no cases of avascular necrosis of femoral head. None of the patients had any neurovascular complication or infection by the end of the follow-up period. Trochanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant complications compared with conventional way. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  2. [Bilateral pathological sub-trochanteric fracture in a long-term biphosphonate user].

    Science.gov (United States)

    Kľoc, P; Tomčovčík, L; Kľoc, J

    2011-01-01

    The number of papers reporting the occurrence of specific pathological fractures in long-term biphosphonate users has recently increased. They refer to the forms of stress fracture probably resulting from an extreme decrease in bone turnover, which may involve sub-trochanteric or isolated transverse fractures, or short transverse fractures with a unicortical beak in an area of cortical hypertrophy. At the time of prodromal signs and symptoms, cortical bone at the site of impeding fracture appears rougher on radiographs. Gradually, an incomplete fracture develops, with a subsequent complete fracture often sustained without any mechanism of injury noted. The occurrence of such fractures is reported in the range of 2 to 8 years from the start of biphosphonate use. The fractures are often bilateral and, at the time the first occurs, it is often possible to diagnose contralateral pathological changes similar to those before the first fracture. The paper presents the case of a female patient who sustained a bilateral pathological sub-trochanteric fracture; the first fracture occurred after 5 and the other after 9 years of Rizendronat use. She was followed up for unilateral incomplete sub-trochanteric fracture from the fourth year of its use. In that period, magnetic resonance imaging showed a pathological finding in the contralateral extremity. She had already had prodromal signs manifested as lasting hip pain before the first fracture. Both fractures were surgically treated. Thirty-three months later she had to undergo repeat surgery for pseudoarthrosis at the site of the first fracture. The pseudoarthrosis healed without complications. However, in the second fracture non-union was still present at 7 months after surgery. The patient took Rizendronat during the whole treatment period and thereafter. In the discussion, certain aspects of long-term biphosphonate use are addressed, as well as some preventive, diagnostic and therapeutic procedures related to this rare

  3. PROXIMAL FEMURAL VALGUS SUBTROCHANTERIC OSTEOTOMY FOR NON UNION OF TROCHANTERIC FRACTURES.

    Science.gov (United States)

    Silva, Paulo; Coelho, Danilo Lopes; Curi, Calim; de Oliveira, Leandro Alves; de Moraes, Frederico Barra; do Amaral, Rogério Andrade; Rebello, Percival Rosa

    2012-01-01

    To evaluate valgus subtrochanteric osteotomy for the treatment of trochanteric non-union. A retrospective study of cases series. From 1998 September to 2009 January, seventeen (17) cases with a diagnosis of non-union of trochanteric fracture were re-operated by the hip group of the Ortophaedic And Traumatology service of the Hospital Geral de Goiania (HGG). The patients presented pain at the fracture site, a femoral varus angle of less than 120°, and non-union of the fracture in the 3(rd) months after the initial surgery. Patients with ages ranging from 30 to 73 years, with a maximum follow-up of 09 years and minimum of 09 years. The mean time from first surgery to osteotomy was six months. Bone union was observed in 16 patients, with a mean union time of 12 weeks after surgery. The mean hip varus angle was 105(0) (120(0) to 90(0)). After surgery, the mean hip valgus angle was 144(0) (155(0) to 135(0)). We had one unsuccessful case; a 78-year old patient who had osteogtomy, fixed with DHS of 150(0), with valgization to 154(0). After six months of follow-up without union of the fracture, it was decided to perform total cemented hip artroplasthy, without complications. Valgus subtrochanteric osteotomies can be indicated for the treatment of trochanteric treatment of pseudoarthroses, with good final results for bone union, avoiding the need for total hip artroplasthy and maintaining biological fixation, as well as reestablishing the mechanical and anatomical axis of the affected limb.

  4. Breakage of cephalomedullary nailing in operative treatment of trochanteric and subtrochanteric femoral fractures.

    Science.gov (United States)

    von Rüden, Christian; Hungerer, Sven; Augat, Peter; Trapp, Oliver; Bühren, Volker; Hierholzer, Christian

    2015-02-01

    Mechanical breakage of cephalomedullary nail osteosynthesis is a rare complication attributed to delayed fracture union or nonunion. This study presents a series of cases of breakage and secondary lag screw dislocation after cephalomedullary nailing. The aim of this study was to identify factors that contribute to cephalomedullary nail breakage. In a retrospective case series review between 02/2005 and 12/2013, we analyzed 453 patients with trochanteric and subtrochanteric fracture who had been treated by cephalomedullary nailing. Fractures were classified according to AO/OTA classification. 13 patients with cephalomedullary nail breakage were included (failure rate 2.9 %). Seven patients were women, and six men with a mean age of 72 years (range 35-94). Implant breakage occurred 6 months postoperatively (range 1-19 months). In ten cases, breakage was secondary to delayed or nonunion, which was thought to be mainly due to insufficient reduction of the fracture, and in two cases due to loss of the lag screw because of missing set screw. In one case, breakage was apparent during elective metal removal following complete fracture healing. Short-term outcome was evaluated 6 months after operative revision using Harris hip score in 11 out of 13 patients showing a mean score of 84 %. Complete radiological fracture healing has been found in 11 patients available for follow-up within 6 months after revision surgery. Breakage of cephalomedullary nail osteosynthesis of trochanteric fractures is a severe complication. The results of our study demonstrate that revision surgery provides good clinical and radiological short-term results. Predominately, failures of trochanteric fractures are related to lack of surgeon performance. Therefore, application of the implant requires accurate preoperative planning, advanced surgical experience to evaluate the patient and the fracture classification, and precise surgical technique including attention to detail and anatomical

  5. Comparison of femoral morphology and bone mineral density between femoral neck fractures and trochanteric fractures.

    Science.gov (United States)

    Maeda, Yuki; Sugano, Nobuhiko; Saito, Masanobu; Yonenobu, Kazuo

    2011-03-01

    Many studies that analyzed bone mineral density (BMD) and skeletal factors of hip fractures were based on uncalibrated radiographs or dual-energy xray absorptiometry (DXA). Spatial accuracy in measuring BMD and morphologic features of the femur with DXA is limited. This study investigated differences in BMD and morphologic features of the femur between two types of hip fractures using quantitative computed tomography (QCT). Forty patients with hip fractures with normal contralateral hips were selected for this study between 2003 and 2007 (trochanteric fracture, n=18; femoral neck fracture, n=22). Each patient underwent QCT of the bilateral femora using a calibration phantom. Using images of the intact contralateral femur, BMD measurements were made at the point of minimum femoral-neck cross-sectional area, middle of the intertrochanteric region, and center of the femoral head. QCT images also were used to measure morphologic features of the hip, including hip axis length, femoral neck axis length, neck-shaft angle, neck width, head offset, anteversion of the femoral neck, and cortical index at the femoral isthmus. No significant differences were found in trabecular BMD between groups in those three regions. Patients with trochanteric fractures showed a smaller neck shaft angle and smaller cortical index at the femoral canal isthmus compared with patients with femoral neck fractures. We conclude that severe osteoporosis with thinner cortical bone of the femoral diaphysis is seen more often in patients with trochanteric fracture than in patients with femoral neck fracture. Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

  6. Risks of subsequent contralateral fractures of the trochanteric region in elderly.

    Science.gov (United States)

    Pogliacomi, Francesco; Pellegrini, Andrea; Tacci, Fabrizio; Pedrini, Martina Francesca; Costantino, Cosimo; Pedrazzini, Alessio; Pedrazzi, Giuseppe; Lauretani, Fulvio; Vaienti, Enrico; Ceccarelli, Francesco

    2017-01-16

    Fractures in elderly are always a dramatic event and the healing is often not complete. In a context of bone fragility, repeated fractures are a growing problem in the industrialized world, in which the mean age of population is increasing. The aim of this study was to identify those general factors which may increase the risk of subsequent trochanteric fractures after an initial lesion. Three-hundred and thirty-one patients who underwent intramedullary fixation for trochanteric fractures between January 2012 and December 2013 were studied. Forty subjects yet alive (group 1), affected by a subsequent contralateral hip fracture, were compared with 202 patients (group 2) affected by isolated trochanteric fracture. Days of hospitalization before surgery, hospitalization, period of rehabilitation, type of discharge and comorbidities, that are reported in literature as possible risk factors for hip refracture, were analyzed. In addition, all patients were interviewed in order to assess if a therapy for osteoporosis was prescribed after the initial fracture and how their gait had been modified by fractures. Days of hospitalization before surgery, hospitalization, period of rehabilitation and type of discharge were not predictive factors for subsequent fractures, as well as diabetes mellitus, hypertension and cardiac diseases. The presence of neurologic and respiratory diseases were associated to a higher risk of refractures, as well as the absence of specific medical treatment for osteoporosis. Neurologic and respiratory comorbidities and the absence of osteoporosis medical treatment are the variables associated to a higher risk of contralateral fractures. Physicians can do more in terms of prevention and strategies must consider these risk factors.

  7. Trochanteric fracture-implant motion during healing - A radiostereometry (RSA) study.

    Science.gov (United States)

    Bojan, Alicja J; Jönsson, Anders; Granhed, Hans; Ekholm, Carl; Kärrholm, Johan

    2018-03-01

    Cut-out complication remains a major unsolved problem in the treatment of trochanteric hip fractures. A better understanding of the three-dimensional fracture-implant motions is needed to enable further development of clinical strategies and countermeasures. The aim of this clinical study was to characterise and quantify three-dimensional motions between the implant and the bone and between the lag screw and nail of the Gamma nail. Radiostereometry Analysis (RSA) analysis was applied in 20 patients with trochanteric hip fractures treated with an intramedullary nail. The following three-dimensional motions were measured postoperatively, at 1 week, 3, 6 and 12 months: translations of the tip of the lag screw in the femoral head, motions of the lag screw in the nail, femoral head motions relative to the nail and nail movements in the femoral shaft. Cranial migration of the tip of the lag screw dominated over the other two translation components in the femoral head. In all fractures the lag screw slid laterally in the nail and the femoral head moved both laterally and inferiorly towards the nail. All femoral heads translated posteriorly relative to the nail, and rotations occurred in both directions with median values close to zero. The nail tended to retrovert in the femoral shaft. Adverse fracture-implant motions were detected in stable trochanteric hip fractures treated with intramedullary nails with high resolution. Therefore, RSA method can be used to evaluate new implant designs and clinical strategies, which aim to reduce cut-out complications. Future RSA studies should aim at more unstable fractures as these are more likely to fail with cut-out. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. Hemi replacement arthroplasty for unstable inter-trochanteric fractures of femur.

    Science.gov (United States)

    Singh, Sudhir; Shrivastava, Chetan; Kumar, Sanjiv

    2014-10-01

    Unstable inter-trochanteric fracture in the geriatric population is a common injury and is associated with poor bone quality, excessive collapse, loss of fixation, and cut-out of the lag screw, are the common problems of attempts to fix these fractures. Present study is an attempt to evaluate the functional outcome of primary cemented bipolar hemiarthroplasty in unstable inter-trochanteric fractures in elderly patients. This prospective study included 25 cases with unstable inter-trochanteric fracture of femur between 60 -75 y of age in whom primary Cemented Bipolar hemi - arthroplasty was performed. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS), Lower Extremity Functional Scale (LEFS), Visual analogue scale (VAS) for evaluation of outcome. The mean HHS score was 78.86+8.13 by the end of one year. Similarly mean LEFS score was 34.36+7.01 by the end of one year, whereas the mean pain score on VAS Scale by the year end was 1.04+1.02. The changes in HHS, LEFS and VAS up to six months periods are much greater which starts showing a stable trend thereafter. Fair to good scores were observed in all the patients. We compared our results with those reported by other authors and our study gave quite comparable results. We also used lower extremity function status score (LEFS) for assessment of functional ability. The purpose of its use was that while Harris Hip Score (HHS) provides information on a multitude of factors, LEFS is more patient oriented and provides the correct information about the level of activities a patient can resume post-operatively and can be offered as a self assessment tool. No significant complication except for grade I pressure sores in four patients were seen in postoperative period but they all resolved with proper nursing care by six week follow up. No patient required revision surgery. The authors believe that primary cemented bipolar hemiarthroplasty for

  9. Spatial Differences in the Distribution of Bone Between Femoral Neck and Trochanteric Fractures.

    Science.gov (United States)

    Yu, Aihong; Carballido-Gamio, Julio; Wang, Ling; Lang, Thomas F; Su, Yongbin; Wu, Xinbao; Wang, Manyi; Wei, Jie; Yi, Chen; Cheng, Xiaoguang

    2017-08-01

    There is little knowledge about the spatial distribution differences in volumetric bone mineral density and cortical bone structure at the proximal femur between femoral neck fractures and trochanteric fractures. In this case-control study, a total of 93 women with fragility hip fractures, 72 with femoral neck fractures (mean ± SD age: 70.6 ± 12.7 years) and 21 with trochanteric fractures (75.6 ± 9.3 years), and 50 control subjects (63.7 ± 7.0 years) were included for the comparisons. Differences in the spatial distributions of volumetric bone mineral density, cortical bone thickness, cortical volumetric bone mineral density, and volumetric bone mineral density in a layer adjacent to the endosteal surface were investigated using voxel-based morphometry (VBM) and surface-based statistical parametric mapping (SPM). We compared these spatial distributions between controls and both types of fracture, and between the two types of fracture. Using VBM, we found spatially heterogeneous volumetric bone mineral density differences between control subjects and subjects with hip fracture that varied by fracture type. Interestingly, femoral neck fracture subjects, but not subjects with trochanteric fracture, showed significantly lower volumetric bone mineral density in the superior aspect of the femoral neck compared with controls. Using surface-based SPM, we found that compared with controls, both fracture types showed thinner cortices in regions in agreement with the type of fracture. Most outcomes of cortical and endocortical volumetric bone mineral density comparisons were consistent with VBM results. Our results suggest: 1) that the spatial distribution of trabecular volumetric bone mineral density might play a significant role in hip fracture; 2) that focal cortical bone thinning might be more relevant in femoral neck fractures; and 3) that areas of reduced cortical and endocortical volumetric bone mineral density might be more relevant for

  10. Avaliação dos efeitos depressores centrais do extrato etanólico das folhas de Synadenium umbellatum Pax. e de suas frações em camundongos albinos Evaluation of the central depressor effects of the ethanolic extract of the leaves of Synadenium umbellatum Pax. and its fractions in Swiss mice

    Directory of Open Access Journals (Sweden)

    Rodrigo Borges de Oliveira

    2008-09-01

    Full Text Available O Synadenium umbellatum Pax. (Euphorbiacea é uma planta nativa da África tropical conhecida como "cola-nota", "avelós", "cancerola", "milagrosa", dentre outros. A planta é utilizada pela população brasileira como detentora de propriedades antiinflamatória, analgésica, dentre outras. Foram avaliados os efeitos depressores sobre o sistema nervoso central (SNC do extrato etanólico das folhas de Synadenium umbellatum (EES e de suas frações - hexânica (FH, clorofórmica (FC e metanol/água (FM. Vários testes foram utilizados em camundongos machos albinos (Mus musculus, dentre eles, o sono induzido por barbitúrico, campo aberto e o teste do rota-rod. O EES foi testado nas doses de 25, 50 e 100 mg/kg, enquanto que a FH foi testada na dose de 10 mg/kg, a FC na dose de 20 mg/kg e a FM na dose de 25 mg/kg. O EES e as frações FH e FC, mas não a FM, apresentaram um possível efeito depressor sobre o SNC, visto que foram capazes de aumentar o tempo parado e diminuir o número de bolos fecais no campo aberto, além de potencializarem o sono induzido por barbitúrico. No teste do rota-rod, observou-se que o EES e as frações não foram capazes de causar incoordenação motora ou relaxamento muscular. Assim, conclui-se que o extrato etanólico e as frações FH e FC do Syandenium umbellatum Pax. possuem possível efeito depressor sobre o SNC.Synadenium umbellatum Pax. (Euphorbiacea is a native plant from tropical Africa known as "cola-nota", "avelós", "cancerola", "milagrosa", among others. The plant is used by Brazilian folks for having anti-inflammatory and analgesic properties, among others. It was evaluated the depressor effects over the central nervous system (CNS of the ethanolic extract of the leaves of Synadenium umbellatum (EES and its fractions - hexane (HF, chloroformic (CF and methanol/water fractions(MF. Several tests were used in Swiss mice (Mus musculus, among them, barbiturate-induced sleep, open field and rota-rod test. The

  11. Injuries of the trochanteric region: can analysis of radiographic indices help in prediction of recurrent osteoporotic hip fractures?

    Science.gov (United States)

    Pellegrini, Andrea; Tacci, Fabrizio; Leigheb, Massimiliano; Costantino, Cosimo; Pedrazzini, Alessio; Pedrazzi, Giuseppe; Vaienti, Enrico; Ceccarelli, Francesco; Pogliacomi, Francesco

    2017-10-18

    In a context of bone fragility, primitive and subsequent fractures are a growing problem in the industrialized countries where the mean age of the population is constantly increasing. Among the various factors that favor a fragility fracture, the most important is osteoporosis, a pathology that can be prevented through diagnostic screenings and treated by pharmacological and rehabilitative therapies. The aim of this study is to identify the subjects who are likely to have a higher risk of subsequent fractures of the trochanteric region through a retrospective radiographic evaluation of patients affected by low-energy trochanteric fractures and operated by intramedullary fixation between June 2013 and June 2015, so they can be targeted for prevention interventions. Three hundred and sixty-one patients yet alive were analyzed 2 years after surgery. Fifty-one (group 1), characterized by another contralateral trochanteric femoral fracture, were included. All subjects were retrospectively examined with the analysis of contralateral femur X-ray performed at the time of initial trauma in order to detect a condition of bone fragility and a predisposition to fractures by evaluating three radiographic indices (Singh index, Dorr's classification and Cortical Thickness Index). Patients of group 1 were compared to the other 310 patients (group 2) affected by isolated trochanteric fracture. Group 1 had all radiographic indices worse than group 2. The results observed suggest that orthopedists can use radiographic indices, in particular Cortical Thickness Index, as a valuable, simple and inexpensive screening tool for prevention of recurrent osteoporotic fractures.

  12. A Prospective Study to Evaluate the Management of Sub-trochanteric Femur Fractures with Long Proximal Femoral Nail

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    Kumar M

    2017-11-01

    Full Text Available INTRODUCTION: Sub-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to analyse the management and complications of sub-trochanteric fractures using long proximal femoral nail (PFN. MATERIALS AND METHODS: This was a prospective study of 50 patients with sub-trochanteric fractures of femur who were treated with long PFN at a tertiary care center from July 2012 to June 2016. The fractures were classified according to Seinsheimer classification. All patients were assessed functionally by Harris Hip Score. RESULTS: Average duration of union was 17.08 weeks (range 13 to 32 weeks, union was achieved in 92% cases. Closed reduction was achieved in 68% cases and open reduction was required in 32% cases. Various intraoperative complications were seen in 12% and delayed complications in 26% of cases. Good anatomical results were achieved in 86% of cases and 14% were fair. As per Harris Hip score, excellent results were noted in 28% cases, good in 56% cases and fair in 16% cases. CONCLUSION: The long PFN is a reliable implant for sub-trochanteric femur fractures, with high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the surgery is technically demanding.

  13. Gamma nail in the treatment of closed trochanteric fractures. Results and indications of 121 cases.

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    Kempf, I; Grosse, A; Taglang, G; Favreul, E

    2014-02-01

    The Gamma Nail is the latest advance in the treatment of trochanteric fractures based on intramedullary nailing principles during closed procedures. Its design is based on Küntscher's Y-nail and locking intramedullary (IM) nails. This paper reports the results from the first-ever series of 121 patients operated between 1988 and 1990. They were followed until bone union was achieved. The mean patient age was 75 years. Most patients were in poor general health and had unstable fractures. Anatomical preoperative reduction was achieved in 72% of cases. Fixation was good in 66% of cases and acceptable in 27% of cases. Intra-operative complications consisted of nine fractures without consequences. Of the treated patients, 83.4% resumed weight-bearing during the first week. There was one case of deep infection that resolved with treatment. The mortality rate was 12.3% at three months. We noted 7 alunions in varus, 3 in valgus, 2 in external rotation and 1 in internal rotation. There were no cases of non-union. In six cases, the screw had cut out of the femoral head. The drawbacks associated with surgical treatment methods for trochanteric fractures also apply to the Gamma nail. Nevertheless, one of its primary advantages is the possibility of using a closed procedure. When compared to Ender nailing, knee pain is absent and weight-bearing can be achieved in all patients, no matter the fracture type. Copyright © 2014. Published by Elsevier Masson SAS.

  14. Use of tranexamic acid in dynamic hip screw plate fixation for trochanteric fractures.

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    Baruah, Ranjit Kumar; Borah, Pranab Jyoti; Haque, Russel

    2016-12-01

    To evaluate perioperative blood loss and blood transfusion requirement in patients who underwent dynamic hip screw plate fixation for a stable trochanteric fracture with or without preoperative intravenous tranexamic acid (TXA). 49 men and 11 women (mean age, 56.5 years) who underwent open reduction and internal fixation with a dynamic hip screw plate for a stable trochanteric fracture by a single surgeon were equally randomised to receive either a single dose of intravenous TXA (15 mg/kg) 15 minutes prior to surgery or an equal volume of normal saline by slow infusion. Intra- and post-operative blood loss and the need for blood transfusion were assessed, as was any thromboembolic adverse event. The TXA and control groups were comparable in terms of age, gender, body mass index, blood pressure, pulse rate, time from injury to surgery, operating time, and preoperative haematological data. Blood loss was lower in the TXA than control group intraoperatively (320.3 vs. 403.33 ml, ptrochanteric fractures.

  15. Treatment options for unstable trochanteric fractures: Screw or helical proxima femoral nail.

    Science.gov (United States)

    Bajpai, Jeetendra; Maheshwari, Rajesh; Bajpai, Akansha; Saini, Sumit

    2015-01-01

    To compare treatment outcome of screw proximal femoral nail (PFN) system with that of a helical PFN. The study included 77 patients with closed unstable intertrochanteric fracture classified as AO 31A2&31A3, between June 2008 to August 2011. Inclusion criteria were: all mature skeletons above 50 years of age; closed unstable trochanteric fracture classified as AO 31A2&A3. Exclusion criteria were: immature skeleton, pathological fracture of any cause other than osteoporosis, inability to walk inde- pendently prior to injury. Patients were randomized to 2 treatment groups based on admission sequence. Forty patients were treated with screw PFN and thirty seven were treated with helical PFN. Both groups were similar in respect of time of surgery, blood loss and functional assessment and duration of hospitalization. In screw PFN group 2 patients had superficial wound infection, 1 patient had persistent hip pain and 1 patient had shortening>1 cm buttrochanteric fractures even in Indian patients where the bones are narrow and neck diameter is small. It is an implant of choice for osteoporotic and unstable trochanteric fractures.

  16. Dealing with sub-trochanteric fracture in a child with osteopetrosis : A case report.

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    Behera, P; Khurana, A; Saibaba, B; Aggarwal, S

    2016-12-01

    Osteopetrosis is a rare hereditary condition which may have autosomal recessive or autosomal dominant inheritance. Patients tend to present most commonly with fractures but involvement of cranial nerves and hematopoetic system is not uncommon. Patients with infantile and intermediate type tend to present more often with problems other than orthopaedic problems. While diagnosis can be made on the basis of radiographs, management needs to be customized for every patient. Non operative and operative management both have their advantages and disadvantages. We are here reporting a case of sub-trochanteric fracture in an eight-year-old child which was managed successfully with a dynamic hip screw (DHS). Surgery could be performed successfully by taking precautions during reduction, drilling and screw placement. At the latest follow up, which was after one and half years of surgery, the fracture had united well and the child faced no limitations of activities. Thus, open reduction and fixation with DHS can be considered as an effective management modality for pediatric sub-trochanteric fractures in osteopetrosis.

  17. Trans trochanteric approach with coronal osteotomy of the great trochanter: A new technique for extra-capsular trochanteric fracture patients treated by total hip arthroplasty (THA) in elderly.

    Science.gov (United States)

    Steffann, Francois; Prudhon, Jean-Louis; Puch, Jean-Marc; Ferreira, André; Descamps, Loys; Verdier, Régis; Caton, Jacques

    2015-06-05

    Several surgical approaches could be used in hip arthroplasty or trauma surgery: anterior, anterolateral, lateral, posterior (with or without trochanterotomy), using or not an orthopedic reduction table. Subtrochanteric and extra-capsular trochanteric fractures (ECTF) are usually treated by internal fixation with mandatory restrictions on weight bearing. Specific complications have been widely described. Mechanical failures are particularly high in unstable fractures. Hip fractures are a major public health issue with a mortality rate of 12%-23% at 1 year. An alternative option is to treat ECTF by total hip arthroplasty (THA) to prevent decubitus complications, to help rapid recovery, and to permit immediate weight bearing as well as quick rehabilitation. However, specific risks of THA have to be considered such as dislocation or cardiovascular failure. The classical approach (anterior or posterior) requires the opening of the joint and capsule, weakening hip stability and the repair of the great trochanter is sometimes hazardous. For 15 years, we have been treating unstable ECTF by THA with cementless stem, dual mobility cup (DMC), greater trochanter (GT) reattachment, and a new surgical approach preserving capsule, going through the fracture and avoiding joint dislocation. Bombaci first described a similar approach in 2008; our trans fractural digastric approach (medial gluteus and lateral vastus) is different. A coronal GT osteotomy is performed when there is no coronal fracture line. It allows easy access to the femoral neck and acetabulum. The THA is implanted without femoral internal rotation to avoid extra bone fragment displacement. With pre-operative planning, cup implantation is easy and stem positioning is adjusted referring to the top of the GT after trial reduction and preoperative planning. The longitudinal osteotomy and trochanteric fracture are repaired with wires and the digastric incision is closed. This variant of Bombaci approach could be use

  18. Causes and treatments of lag screw's cut out after intramedullary nailing osteosinthesis for trochanteric fractures.

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    Gazzotti, Gabriele; Matino, Giovanni; Tsatsis, Christos; Sacchetti, GianLuigi; Baudi, Paolo; Catani, Fabio

    2014-08-20

    Background. Superior cut-out of a lag screw remains a serious complication in the treatment of trochanteric or subtrochanteric fractures and it is related to many factors: the type of fracture, osteoporosis and the stability of fracture reduction. Little is known about the outcome after revision surgery for complications of the gamma nail. We assessed the outcome in patients who had revision surgery because of lag screw's cut out after gamma nailing for a trochanteric fracture.Material and Method. We present a study of 20 consecutive patients who underwent treatment after 20 cut-out of the lag screw fixation of a trochanteric fracture with Gamma Locking Nail from September 2004 to November 2010. In 16 patients hip prothesis was performed, in 1 the removal of the implant and in 3 the reosteosynthesis. We reviewed 13 patients: 10 total hip arthroplasty, 2 endoprothesis and 1 reosteosynthesis of nail and lag screw (mean follow up: 26 months, mean age: 73 years old), 7 patients died. Patients were reviewed retrospectively by an independent observer. Clinical evaluation was performed, Oxford score and Harris Hip score were measured. X-Ray examination was performed after a minimum of 12 months of follow up.Results. Mean Harris Hip Score mean was 67 and mean Oxford score was 32 in hip prothesis group (12 patients). We had several complications, Implant-related complications were: 2 ipometria > 2cm, 2 recurrent hip arthroplasty dislocations (1 reoperated), 4 persistent thigh pain. In only 4 patients none complications were observed. Another patient,  who had been subjected to reosteosinthesis, obtained better results (HHS:95, Oxford score:45) but with a 2 cm ipometria and occasional pain in the thigh.Conclusion. Cut out after gamma nail is consequent to biological or mechanical causes. Treatment of this complication is hip prosthesis (parzial or total hip arthroplasty), reosteosynthesis of the lag screw and/or the nail and the removal of the implant. Conversion to total

  19. UNSTABLE INTERTROCHANTERIC FRACTURE IN ELDERLY TREATED WITH CEMENTED BIPOLAR HEMIARTHROPLASTY AND TROCHANTERIC RECONSTRUCTION

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    Jagadeesh Kumar

    2015-06-01

    Full Text Available INTRODUCTION : Unstable inter - trochanteric fracture in the geriatric population is a common injury and is associated with poor bone quality, excessive collapse, loss of fixation, and cut - out of the lag screw, are the common problems of attempts to fix these fractures. Pr esent study is an attempt to evaluate the functional outcome of primary cemented bipolar hemiarthroplasty and trochanter reconstruction in these patients. MATERIALS AND METHOD S : This prospective study included 30 cases of elderly osteoporotic patients with mean age of 65.4 years who sustained comminuted inter - trochanteric femur fracture treated with cemented bipolar hemiarthroplasty& tension band wiring for greater trochanter rec onstruction. It is an essential technical step to avoid complication like abductor lurch gait. W e here describe a technique of reconstruction and fixation of greater trochanter using tension band wiring in figure of eight pattern. The patients were followe d up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS. RESULTS : The mean HHS score was was 85.6+SD 9.5 (range from 74 to 96. B y the end of one year. The main clinical measures were early post - opera tive full weight bearing, post - operative complication & functional outcome. The time to full weight bearing, the rate of post - operative complications & functional outcome was significantly better in cemented bipolar arthroplasty group . DISCUSSION : The chan ges in HHS up to six months periods are much greater which starts showing a stable trend thereafter. Fair to good scores were observed in all the patients. The purpose of its use was that while Harris Hip Score (HHS provides information on a multitude of factors. Superficial infection in 2 patients, anterior thigh pain in a patient, shortening less than 2cms in 2 patients, abductor lurch in a patient are the complications noted in post - operative period, but no patient required

  20. Interval hypoxic training in complex treatment of fractures of trochanteric area of the femur

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    Василь Михайлович Шимон

    2015-05-01

    Full Text Available The method of interval hypoxic training (IHT is used to increase physical endurance of athletes and for treatment of certain systemic diseases, due to the ability of IHT affect metabolism, homeostasis and the immune system. The aims of the article are improving the results of treatment and rehabilitation of patients with fractures of the trochanteric area of the femur by the method of interval hypoxic training and study its influence on bone metabolism.Materials and methods. 17 patients who were hospitalized in the clinic of general surgery UzhNU with fractures of the trochanteric area of the femur are examined in the period from 2012 to 2015.The first group consisted of 6 patients who from day-patient treatment is conducted IHT by gas mixture of 12 % oxygen. The second group consisted of 4 patients with thyrotoxicosis who are also receiving IHT by gas mixture of 12% oxygen.The control group consisted of 7 patients with fractures of the trochanteric area of the femur who refused from IHT.Results and its discussion. The best physical activity is observed in the first group. Starting physical activity is the lowest in the second group, but its development is faster. Slowly increase the duration of physical activity compared with the first two groups is observed in the control group.In the control study after 1 month it is noted that calcium level increased in all three groups. Increase in the second group is biggest. The level of phosphorus decreased in the first and the control group and increased in the second group.The levels of osteocalcin and alkaline phosphatase increased. Rates were higher and increase was substantial in the first two groups in comparison with the control group.Conclusions.• Intensive growth of length of one-time physical activity most notably in patients with thyrotoxicosis is observed in patients who are receiving IHT.• Improvement of the activity of bone metabolism is observed in patients after IHT

  1. Trochanteric fractures. Classification and mechanical stability in McLaughlin, Ender and Richard osteosynthesis

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    Herrlin, K.; Stroemberg, T.; Lidgren, L.; Walloee, A.; Pettersson, H.

    Four hundred and thirty trochanteric factures operated upon with McLaughlin, Ender or Richard's osteosynthesis were divided into 6 different types based on their radiographic appearance before and immediately after reposition with special reference to the medial cortical support. A significant correlation was found between the fracture type and subsequent mechanical complications where types 1 and 2 gave less, and types 4 and 5 more complications. A comparison of the various osteosyntheses showed that Richard's had significantly fewer complications than either the Ender or McLaughlin types. For Richard's osteosynthesis alone no correlation to fracture type could be made because of the small number of complications in this group.

  2. Femoral neck fractures after removal of hardware in healed trochanteric fractures.

    Science.gov (United States)

    Barquet, Antonio; Giannoudis, Peter V; Gelink, Andrés

    2017-12-01

    Hardware removal in healed trochanteric fractures (TF) in the absence of infection or significant mechanical complications is rarely indicated. However, in patients with persistent pain, prominent material and discomfort in the activities of daily living, the implant is eventually removed. Publications of ipsilateral femoral neck fracture after removal of implants from healed trochanteric fractures (FNFARIHTF) just because of pain or discomfort are rare. The purpose of this systematic review of the literature is to report on the eventual risk factors, the mechanisms, the clinical presentation, and frequency, and to pay special emphasis in their prevention. A comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of FNFARIHTF and series of TF with cases of FNFARIHTF due to pain or discomfort published between inception of journals to December 2016 were eligible for inclusion. Relevant information was divided in two parts. Part I included the analysis of cases of FNFARIHTF, with the objective of establishing the eventual risk factors, mechanisms and pathoanatomy, clinical presentation and diagnosis, treatment and prevention. Part II analyzed series of TF which included cases of FNFARIHTF for assessing the incidence of femoral neck fractures in this condition. Overall 24 publications with 45 cases of FNFARIHTF met the inclusion criteria. We found that the only prevalent factors for FNFARIHTF were: 1) preexisisting systemic osteoporosis, as most patients were older and elder females, with lower bone mineral density and bone mass; 2) local osteoporosis as a result of preloading by the fixation device in the femoral neck, leading to stress protection, reducing the strain at the neck, and increasing bone loss and weakness; and 3) the removal of hardware from the femoral neck, with reduction of the failure strength of the neck. The femoral neck fractures were spontaneous, i.e. not related to trauma or

  3. Giant trochanteric pressure sore: Use of a pedicled chimeric perforator flap for cover

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    Mehrotra Sandeep

    2009-01-01

    Full Text Available Pressure sores are increasing in frequency commensurate with an ageing population with multi-system disorders and trauma. Numerous classic options are described for providing stable wound cover. With the burgeoning knowledge on perforator anatomy, recent approaches focus on the use of perforator-based flaps in bedsore surgery. A giant neglected trochanteric pressure sore in a paraplegic is presented. Since conventional options of reconstruction appeared remote, the massive ulcer was successfully managed by a chimeric perforator-based flap. The combined muscle and fasciocutaneous flaps were raised as separate paddles based on the anterolateral thigh perforator branches and provided stable cover without complications. Perforators allow versatility in managing complex wounds without compromising on established principles.

  4. Do intramedullary implants improve survival in elderly patients with trochanteric fractures? A retrospective study.

    Science.gov (United States)

    Vermesan, D; Prejbeanu, R; Poenaru, D V; Petrescu, H; Apostol, E; Inchingolo, F; Dipalma, G; Abbinante, A; Caprio, M; Potenza, M A; Cagiano, R; Malcangi, G; Inchingolo, A D; Haragus, H

    2015-01-01

    There is currently no consensus regarding superiority of the intramedullary fixation over the sliding hip screw. Regional variation remains high and not backed up by solid evidence. Given these premises we aimed to analyze weather implant preference can influence the postoperative survival. Secondary objectives were determining the trend for implant choice and confounding factors associated with intramedullary nails compared to sliding hip screws. Retrospective data was obtained from patient charts with the main diagnosis of extracapsular/ trochanteric fractures, corresponding to ICD S72.1 codes. Between 2008-2012, 441 patients underwent osteosynthesis with a dynamic hip screw and 155 with intramedullary nail respectively. The living status was determined by comparing the patient identification number against the national population evidence records. The lifetable shows similar survival for both implants over the 5 year period. The yearly mortality was 19.4% for the dynamic hip screw and 21.8% for the intramedullary implant respectively, even though the later were used predominantly in older patients. This age difference is significant according to both parametric and non-parametric tests whereas duration of hospital stay are similar. We found a clear increase in the proportion of intramedullary implants, for a total of 11.2% over the 5 year period. There is no difference for the one year mortality and overall survival between sliding screw plates and intramedullary constructs. A clear increase in the use of intramedullary implants for trochanteric fractures was observed. This is even more apparent for older ages, presumably due to an higher surgeon confidence with the biomechanical stability of the intramedullary constructs.

  5. A STUDY OF UNSTABLE INTERTROCHANTERIC FEMORAL FRACTURES TREATED BY TROCHANTERIC FEMORAL NAIL

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    Sreenivasa Neikar

    2017-11-01

    Full Text Available BACKGROUND Intertrochanteric fracture is one of the most common fracture of the hip especially in the elderly. The incidence of intertrochanteric fracture is rising because of the increase in number of elderly population along with superadded osteoporosis. MATERIALS AND METHODS Study included cases of unstable intertrochanteric fractures (AO and OTA Classification 31-A2 and 31-A3 fracture patterns that were operated with the short trochanteric femoral nail, which fitted into the inclusion criteria done in medical college hospital, Vijayanagara Institute of Medical Sciences, Bellary, from February 2015 to September 2016. RESULTS The age distribution was from 40 to 80 years. The largest group of patients were from 61 to 70 years. The average age was 60.5 years. The number of male patients in our series was 20 (66.7% and female was 10 (33.3%. Right side was affected in 11 cases (36.7% and left side in 19 cases (63.3%. Good reduction was achieved in 23 patients (76.7%. Acceptable reduction was achieved in 7 (23.3% patients due to severe comminution. In our study, 25 patients (83.33% had no complications. We encountered one intraoperative complication in the form of greater trochanter splintering, while inserting the nail. In our study, we encountered following postoperative complications. We noticed one case of delayed union, one case of Z effect and 2 cases of varus malunion. CONCLUSION We conclude that short trochanteric femoral nail provides good fixation for unstable intertrochanteric fractures if proper preoperative planning, good reduction and surgical technique are followed leading to high rate of bone union and minimal soft tissue damage especially for Asian patients with relatively small femora.

  6. Failure after osteosynthesis of trochanteric fractures. Where is the limit of osteoporosis?

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    Konstantinidis, L; Papaioannou, C; Blanke, P; Hirschmüller, A; Südkamp, N P; Helwig, P

    2013-10-01

    The aim of this study is to identify osteoporosis values, beyond which there is a high risk of osteosynthesis failure. Bone mineral density (BMD) of 30 cadaveric femora with a pertrochanteric fracture osteotomy was correlated to the risk of cut out after osteosynthesis on a biomechanical testing approach. For a BMD less than 250 mg/cm(3), there is a high risk of fixation failure after surgical treatment of pertrochanteric fractures. This value can be regarded as a reference value for future experimental and clinical studies. Despite continuous modification of intramedullary load carriers for the surgical stabilization of trochanteric fractures, cut out remains the most frequent complication. The aim of this experimental study was to identify threshold osteoporosis values, beyond which there is a high risk of osteosynthesis failure. Bone mineral density (BMD) of 30 cadaveric femora was recorded for the femoral head by QCT measurement. Subsequently, a standardized osteotomy mimicking an unstable trochanteric type fracture was stabilized by intramedullary nailing. The constructs were loaded axially at a force of 2,100 N up to 20,000 cycles. Cut out at the femoral head was documented by radiograph. Statistical evaluation of the cohort group was performed by calculation of relative risk in relation to the BMD values. In total, there were six cases of cut out after 10,000 cycles. The incidence of cut out for BMD less than 250 mg/cm(3) was 0.55 (5 of 9) and for BMD greater than 250 mg/cm(3), it was 0.05 (1 of 21). Therefore, the relative risk of cut out for BMD 250 mg/cm(3). After 20,000 cycles, an additional test caused one cut out (relative risk of cut out for a BMD fractures. Although this value is based on an experimental in vitro study design with all its associated limitations, it can be regarded as a reference value for future experimental and clinical studies.

  7. Trochanteric fragility fractures : Treatment using the cement-augmented proximal femoral nail antirotation.

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    Neuerburg, C; Mehaffey, S; Gosch, M; Böcker, W; Blauth, M; Kammerlander, C

    2016-06-01

    Use of standardized cement augmentation of the proximal femur nail antirotation (PFNA) for the treatment of trochanteric fragility fractures, which are associated with high morbidity and mortality, to achieve safer conditions for immediate full weight-bearing and mobilization, thus, improving preservation of function and independency of orthogeriatric patients. Trochanteric fragility fractures (type 31-A1-3). Ipsilateral arthritis of the hip, leakage of contrast agent into the hip joint, femoral neck fractures. Reduction of the fracture on a fracture table if possible, or minimally invasive open reduction of the proximal femur, i. e., using collinear forceps if necessary. Positioning of guidewires for adjustment of the PFNA and the spiral blade, respectively. Exclusion of leakage of contrast agent and subsequent injection of TRAUMACEM™ V(+) into the femoral head-neck fragment via a trauma needle kit introduced into the spiral blade. Dynamic or static locking of the PFNA at the diaphyseal level. Immediate mobilization of the patients with full weight-bearing and secondary prevention, such as osteoporosis management is necessary to avoid further fractures in the treatment of these patients. A total of 110 patients older than 65 years underwent the procedure. Of the 72 patients available for follow-up (average age 85.3 years), all fractures healed after an average of 15.3 months. No complications related with cement augmentation were observed. Approximately 60 % of patients achieved the mobility level prior to trauma.

  8. Presence of a nail in the medullary canal; is it enough to prevent femoral neck shortening in trochanteric fracture?

    Science.gov (United States)

    Song, Hyung Keun; Yoon, Han Kuk; Yang, Kyu Hyun

    2014-09-01

    Presence of a cephalomedullary nail (CMN) in the medullary canal has been thought as advantageous in the control of femoral neck shortening (FNS) and lag screw sliding in trochanteric fracture compared to extramedullary fixation system. However, researches on the factors that influence the degree of FNS after cephalomedullary nailing are lacking. We observed 95 patients (mean age, 75±2.8 years) with trochanteric fractures who were treated with a CMN, and evaluated the relationship between FNS and patient factors including age, gender, fracture type (AO/OTA), bone mineral density, medullary canal diameter, canal occupancy ratio (COR=nail size/canal diameter), and tip-apex distance using initial, immediate postoperative, and follow-up radiography. Univariate regression analyses revealed that the degree of FNS was significantly correlated with fracture type (A1 versus A3, pfracture type (pfracture.

  9. Comparison of cutout resistance of dynamic condylar screw and proximal femoral nail in reverse oblique trochanteric fractures: A biomechanical study

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    Gursimrat Singh Cheema

    2012-01-01

    Results: The bending moment of the PFN group was approximately 50% less than that of the DCS group (P<0.0001. The PFN group resisted more number of cycles than the DCS group (P=0.03 and showed lesser number of component failures as compared with the DCS group (P=0.003. Conclusions: The PFN is biomechanically superior to DCS for the fixation of reverse oblique trochanteric fractures of femur.

  10. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients

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    Shota Ikegami

    2009-10-01

    Full Text Available Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men with femoral neck fracture and 21 patients (17 women and 4 men with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX, as well as urine levels of C-terminal telopeptide of type I collagen (CTX and deoxypyridinoline (DPD, were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX, five weeks (serum NTX and DPD, and 2-3 weeks (CTX after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  11. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients.

    Science.gov (United States)

    Ikegami, Shota; Kamimura, Mikio; Nakagawa, Hiroyuki; Takahara, Kenji; Hashidate, Hiroyuki; Uchiyama, Shigeharu; Kato, Hiroyuki

    2009-10-10

    Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men) with femoral neck fracture and 21 patients (17 women and 4 men) with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP) was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX), as well as urine levels of C-terminal telopeptide of type I collagen (CTX) and deoxypyridinoline (DPD), were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX), five weeks (serum NTX and DPD), and 2-3 weeks (CTX) after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  12. Wiring Techniques for the Fixation of Trochanteric Fragments during Bipolar Hemiarthroplasty for Femoral Intertrochanteric Fracture: Clinical Study and Technical Note.

    Science.gov (United States)

    Lee, Joong-Myung; Cho, Yongsuk; Kim, Junhyun; Kim, Dong-Won

    2017-03-01

    Femoral intertrochanteric fractures are common in the elderly. Appropriate surgical fixation of trochanteric fracture fragments can restore normal anatomical structure and ambulation, and can aid in the recovery of biomechanical function of the hip. We evaluated clinical outcomes of bipolar hemiarthroplasty using a wiring technique for trochanteric fracture fragment fixation. From September 2006 to February 2015, a total of 260 cases underwent simultaneous bipolar hemiarthroplasty and wire fixation. A total of 65 patients (69 hips) with an average age of 78 years and more than one year of follow-up was included in the study. Using pre-, postoperative and follow-up radiograms, we evaluated wire fixation failure and also assessed changes in walking ability. Loosening or osteolysis around the stem was not observed; however, we did observe bone growth around the stem (54 cases), cortical hypertrophy (6 cases), a wide range of sclerotic lines but no stem subsidence (1 case), wire breakage (9 cases), and fracture fragment migration with no significant functional deficiency (2 cases). Our study showed that additional wiring for trochanteric fracture fragment fixation following bipolar hemiarthroplasty can help restore normal anatomy. The added stability results in faster rehabilitation, and good clinical and radiographic outcomes. We recommend this procedure in this type of fracture.

  13. A Prospective Study to Evaluate the Management of Sub-trochanteric Femur Fractures with Long Proximal Femoral Nail.

    Science.gov (United States)

    Kumar, M; Akshat, V; Kanwariya, A; Gandhi, M

    2017-11-01

    Introduction: Sub-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to analyse the management and complications of sub-trochanteric fractures using long proximal femoral nail (PFN). Materials and Methods: This was a prospective study of 50 patients with sub-trochanteric fractures of femur who were treated with long PFN at a tertiary care center from July 2012 to June 2016. The fractures were classified according to Seinsheimer classification. All patients were assessed functionally by Harris Hip Score. Results: Average duration of union was 17.08 weeks (range 13 to 32 weeks), union was achieved in 92% cases. Closed reduction was achieved in 68% cases and open reduction was required in 32% cases. Various intraoperative complications were seen in 12% and delayed complications in 26% of cases. Good anatomical results were achieved in 86% of cases and 14% were fair. As per Harris Hip score, excellent results were noted in 28% cases, good in 56% cases and fair in 16% cases. Conclusion: The long PFN is a reliable implant for subtrochanteric femur fractures, with high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the surgery is technically demanding.

  14. Differences in monthly variation, cause, and place of injury between femoral neck and trochanteric fractures: 6-year survey (2008–2013) in Kyoto prefecture, Japan

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    Horii, Motoyuki; Fujiwara, Hiroyoshi; Mikami, Yasuo; Ikeda, Takumi; Ueshima, Keiichiro; Ikoma, Kazuya; Shirai, Toshiharu; Nagae, Masateru; Oka, Yoshinobu; Sawada, Koshiro; Kuriyama, Nagato; Kubo, Toshikazu

    2016-01-01

    Summary Background The incidence of femoral neck and trochanteric fractures reportedly differ by age and regionality. We investigated differences in monthly variations of the occurrence of femoral neck and trochanteric fractures as well as place and cause of injury in the Kyoto prefecture over a 6-year period. Methods Fracture type (neck or trochanteric fracture), age, sex, place of injury, and cause of injury were surveyed among patients aged ≥ 65 years with hip fractures that occurred between 2008 and 2013 who were treated in 1 of 13 participating hospitals (5 in an urban area and 8 in a rural area). The proportion of sick beds in the participating hospitals was 24.7% (4,151/16,781). Monthly variations in the number of patients were investigated in urban and rural areas in addition to the entire Kyoto prefecture. Place of injury was classified as indoors or outdoors, and cause of injury was categorized as simple fall, accident, or uncertain. Results There were 2,826 patients with neck fractures (mean age, 82.1 years) and 3,305 patients with trochanteric fractures (mean age, 85.0 years). There were similarities in the monthly variation of the number of fractures in addition to the place and cause of injury between neck and trochanteric fractures. Indoors (approximately 74%) and simple falls (approximately 78%) were the primary place and cause of injury, respectively. The place of injury was not significantly different by fracture type with each age group. Significantly more patients with neck fracture had “uncertain” as the cause of injury than trochanteric fracture in all age groups. Conclusions Based on the results of the present study, the injury pattern might not have a great effect on the susceptibility difference between neck and trochanteric fractures. PMID:27252738

  15. Differences in monthly variation, cause, and place of injury between femoral neck and trochanteric fractures: 6-year survey (2008-2013) in Kyoto prefecture, Japan.

    Science.gov (United States)

    Horii, Motoyuki; Fujiwara, Hiroyoshi; Mikami, Yasuo; Ikeda, Takumi; Ueshima, Keiichiro; Ikoma, Kazuya; Shirai, Toshiharu; Nagae, Masateru; Oka, Yoshinobu; Sawada, Koshiro; Kuriyama, Nagato; Kubo, Toshikazu

    2016-01-01

    The incidence of femoral neck and trochanteric fractures reportedly differ by age and regionality. We investigated differences in monthly variations of the occurrence of femoral neck and trochanteric fractures as well as place and cause of injury in the Kyoto prefecture over a 6-year period. Fracture type (neck or trochanteric fracture), age, sex, place of injury, and cause of injury were surveyed among patients aged ≥ 65 years with hip fractures that occurred between 2008 and 2013 who were treated in 1 of 13 participating hospitals (5 in an urban area and 8 in a rural area). The proportion of sick beds in the participating hospitals was 24.7% (4,151/16,781). Monthly variations in the number of patients were investigated in urban and rural areas in addition to the entire Kyoto prefecture. Place of injury was classified as indoors or outdoors, and cause of injury was categorized as simple fall, accident, or uncertain. There were 2,826 patients with neck fractures (mean age, 82.1 years) and 3,305 patients with trochanteric fractures (mean age, 85.0 years). There were similarities in the monthly variation of the number of fractures in addition to the place and cause of injury between neck and trochanteric fractures. Indoors (approximately 74%) and simple falls (approximately 78%) were the primary place and cause of injury, respectively. The place of injury was not significantly different by fracture type with each age group. Significantly more patients with neck fracture had "uncertain" as the cause of injury than trochanteric fracture in all age groups. Based on the results of the present study, the injury pattern might not have a great effect on the susceptibility difference between neck and trochanteric fractures.

  16. Treatment of trochanteric fractures with the gamma3 nail - methodology and early results of a prospective consecutive monitored clinical case series.

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    A C, Unger; E, Wilde; B, Kienast; C, Jürgens; A P, Schulz

    2014-01-01

    There is only sparse data on clinical results and complications of the third-generation Gamma nailing system (Gamma3, Stryker). Therefore, we started a large multi-centre case series in 2008. The aim of this paper is to present the study design and early results of a single arm of a prospective, consecutive, monitored, post-market follow-up evaluation of Gamma3 nails. From September 2009 to January 2012, 154 consecutive patients with an average age of 80 ± 1.43 years (50-99 years) and a trochanteric femoral fracture were included in the local arm of the trial. All patients that fulfilled the inclusion criteria were treated with a Gamma3 nail. Preoperative variables included age, gender, fracture classification, walking ability (Merle d'Aubigné score), daily activity level (retrospective Zuckerman score), ASA rating of operative risk, waiting time for operation, use of walker or crutches and body mass index (BMI). Skin-to-skin time, fluoroscopy time, blood loss, intraoperative complications and device information were recorded for each patient. Follow-up postoperative assessment was undertaken at 4, 12 and 24 months. Hip range of motion, pain around the hip and the tight, walking ability (Merle d'Aubigné score, Sahlgrenska mobility score) and management of daily life (Zuckerman score) were used to evaluate the outcome. The descriptive data of age, gender, BMI, ASA classification, fracture type and skin-to-skin time is similar to other studies. Median fluoroscopy time was 62 seconds (range: 4-225 seconds) and significantly shorter in closed reductions. No intraoperative implant-related complication was recorded. A cut-out of the leg-screw during assessment period occurred in 2.6% patients (n = 4). At the 12-month assessment two (1.8%) non-unions were identified and two patients (1.8%) had broken the femoral shaft below the 180 mm nail after a fall. Analysis of the scores showed significantly declined mobility and activity in daily life four months after operation

  17. PRIMARY CEMENTED BIPOLAR HEMIARTHROPLASTY WITH TROCHANTERIC AND CALCAR RECONSTRUCTION IN UNSTABLE INTERTROCHANTERIC FRACTURES IN ELDERLY: A PROSPECTIVE STUDY

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    Pandu Ranga Vital

    2015-09-01

    Full Text Available INTRODUCTION : To avoid the complications and morbidity associated with attempted Osteosynthesis of the so called Unstable inter - trochanteric fractures in the elderly population, Primary Cemented Bipolar hemiarthroplasty been around for over three decades now. But, hardly any emphasis been given over the technical aspects to i mprove the functional outcome. Present study is one such, following reconstructive attempts ( O f primary cemented bipolar hemiarthroplasty with trochanter and calcar reconstruction in the elderly population to reduce the risk of unstable Hemiarthroplasty. MATERIALS AND METHODS: This prospective study included 20 cases of elderly patients with mean age of 73.5 years (Age range 66 to 82 yr who sustained multifragmentary/communited inter - trochanteric femur fracture treated with Primary cemented bipolar hemiar throplasty with trochanteric and calcar reconstruction to emphasize the importance of restoration soft tissue tension to reduce the risk of unstable Hemiarthroplasty. Essential Technical steps include Figure of eight / multiple wire loop technique of recons truction ( with or without K ‘wires of greater trochanter/ abductor mechanism and calcar reconstruction either by wiring Lesser trochanteric fragment and or insertion of cortical piece of bone graft (medially under the collar of the prosthesis harvested f rom head and neck fragment. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS. RESULTS: The mean HHS score was 85 (range 69 to 91 at the end of one year. The main clini cal measures were early post - operative full weight bearing, post - operative complication & functional outcome. The time to full weight bearing, the rate of post - operative complications & functional outcome was significantly better in cemented bipolar arthro plasty group. CONCLUSION: The authors strongly believe that primary cemented bipolar

  18. Bisphosphonate-associated atypical sub-trochanteric femur fractures: paired bone biopsy quantitative histomorphometry before and after teriparatide administration.

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    Miller, Paul D; McCarthy, Edward F

    2015-04-01

    Bisphosphonate-associated atypical sub-trochanteric femur fractures (ASFF) may be seen with long-term bisphosphonate use, though these fractures are also seen in patients never exposed to bisphosphonates. One theory for the mechanism of action whereby bisphosphonates may induce these ASFF is over-suppression of bone turnover. Bisphosphonates suppress bone turnover, but in bisphosphonate clinical trials, over-suppression defined whether by maintaining the biochemical markers of bone turnover below the defined reference range or by quantitative bone histomorphometry, has not been observed. We studied 15 clinic patients referred to The Colorado Center for Bone Research (CCBR) after they had a bisphosphonate-associated ASFF and performed quantitative bone histomorphometry both before and after 12 months of teriparatide (20µg SQ/day). All patients had been on long-term alendronate (mean = 7 years, range: 6-11 years) and had already had intramedullary rods placed when first seen (6 weeks to 7 months after rod placement). Alendronate had been discontinued in all patients at the time of their first clinic visit to CCBR. All of the fractures fulfilled The American Society for Bone and Mineral Research major radiological criteria for ASFF. Three key dynamic histomorphometric features show that 7 of the 15 patients had unmeasurable bone formation, mineralizing surface, and mineral apposition, while the other 8 patients had measurable dynamic parameters; although for all 15 patients, the mean values for all 3 dynamic parameters was far below the average for the published normal population. Administration of teriparatide was associated with an increase in all 3 dynamic histomorphometric parameters. Baseline bone turnover markers did not correlate with the baseline histomorphometry. While there is heterogeneity in the bone turnover in patients with bisphosphonate ASFF, there is a large portion in this uncontrolled series that had absent bone turnover at the standard biopsy site

  19. Evaluation of the health-related quality of life in elderly patients according to the type of hip fracture: femoral neck or trochanteric

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    Tânia Maria da Silva Mendonça

    2008-01-01

    Full Text Available OBJECTIVE: To evaluate the effect the type of hip fracture (femoral neck or trochanteric has on the Health-Related Quality of Life of elderly subjects. METHODS: Forty-five patients with hip fractures (mean 74.30 ± 7.12 years, 24 with a femoral neck fracture and 21 with a trochanteric fracture, completed the 36-item Short Form Health Survey (SF-36 at baseline and four months after fracture. The Health-Related Quality of Life scores were compared according to fracture type, undisplaced and displaced femoral neck fractures, and stable and unstable trochanteric fractures. RESULTS: Compared to baseline, all patients scored lower in the physical functioning, role limitation-physical, bodily pain and vitality categories four months after the fracture had occurred. The SF-36 scores for all the scales did not differ significantly between patients with femoral neck versus trochanteric fractures, or between patients with displaced versus undisplaced femoral neck fractures and stable versus unstable trochanteric fractures. CONCLUSIONS: The mental and physical quality of life of elderly patients with a hip fracture is severely impaired one month after fracture, with partial recovery by the end of the fourth month. The negative impact on the Health-Related Quality of Life did not differ significantly according to fracture type.

  20. High failure rate of trochanteric fracture osteosynthesis with proximal femoral locking compression plate.

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    Wirtz, C; Abbassi, F; Evangelopoulos, D S; Kohl, S; Siebenrock, K A; Krüger, A

    2013-06-01

    Stable reconstruction of proximal femoral (PF) fractures is especially challenging due to the peculiarity of the injury patterns and the high load-bearing requirement. Since its introduction in 2007, the PF-locking compression plate (LCP) 4.5/5.0 has improved osteosynthesis for intertrochanteric and subtrochanteric fractures of the femur. This study reports our early results with this implant. Between January 2008 and June 2010, 19 of 52 patients (12 males, 7 females; mean age 59 years, range 19-96 years) presenting with fractures of the trochanteric region were treated at the authors' level 1 trauma centre with open reduction and internal fixation using PF-LCP. Postoperatively, partial weight bearing was allowed for all 19 patients. Follow-up included a thorough clinical and radiological evaluation at 1.5, 3, 6, 12, 24, 36 and 48 months. Failure analysis was based on conventional radiological and clinical assessment regarding the type of fracture, postoperative repositioning, secondary fracture dislocation in relation to the fracture constellation and postoperative clinical function (Merle d'Aubigné score). In 18 patients surgery achieved adequate reduction and stable fixation without intra-operative complications. In one patient an ad latus displacement was observed on postoperative X-rays. At the third month follow-up four patients presented with secondary varus collapse and at the sixth month follow-up two patients had 'cut-outs' of the proximal fragment, with one patient having implant failure due to a broken proximal screw. Revision surgeries were performed in eight patients, one patient receiving a change of one screw, three patients undergoing reosteosynthesis with implantation of a condylar plate and one patient undergoing hardware removal with secondary implantation of a total hip prosthesis. Eight patients suffered from persistent trochanteric pain and three patients underwent hardware removal. Early results for PF-LCP osteosynthesis show major

  1. Outcomes of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

    Science.gov (United States)

    Gupta, Rakesh Kumar; Gupta, Vinay; Gupta, Navdeep

    2012-01-01

    Background: Dynamic hip screw (DHS) has been the standard treatment for stable trochanteric fracture patterns, but complications of lag screw cut out from a superior aspect, due to inadequate bone anchorage, occur frequently in elderly osteoporotic patients. Polymethylmethacrylate (PMMA) has been used as an augmentation tool to facilitate fixation stability in cadaveric femora for biomechanical studies and in pathological fractures. However, there are very few reports on the utilization of PMMA cement to prevent these complications in fresh intertrochanteric fractures. A prospective study was conducted to evaluate the outcome and efficacy of PMMA augmented DHS in elderly osteoporotic patients with intertrochanteric fractures. Materials and Methods: The study included 64 patients (AO type31-A2.1 in eight, A2.2 in 29, A2.3 in 17 patients, and 31-A3.1 in five, A3.2 in three, and A3.3 in two patients) with an average age of 72 years (60 – 94 years) of which 60 were available for final followup. PMMA augmentation of DHS was performed in all cases by injecting PMMA cement into the femoral head with a custommade gun designed by the authors. The clinical outcome was rated as per the Salvati and Wilson scoring system at the time of final followup of one year. Results were graded as excellent (score > 31), good (score 24 – 31), fair (score 16 – 23), and poor (score < 16). Results: Fracture united in all patients and the average time to union was 13.8 weeks (range 12 – 16 weeks). At an average followup of 18 months (range 12 – 24 months), no incidence of varus collapse or superior screw cut out was observed in any of the patients in spite of weightbearing ambulation from the early postoperative period. There was no incidence of avascular necrosis (AVN) or cement penetration into the joint in our series. Most of the patients were able to regain their prefracture mobility status with a mean hip pain score of 8.6. Conclusion: Cement augmentation of DHS appears to be an

  2. Outcomes of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

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    Rakesh Kumar Gupta

    2012-01-01

    Full Text Available Background: Dynamic hip screw (DHS has been the standard treatment for stable trochanteric fracture patterns, but complications of lag screw cut out from a superior aspect, due to inadequate bone anchorage, occur frequently in elderly osteoporotic patients. Polymethylmethacrylate (PMMA has been used as an augmentation tool to facilitate fixation stability in cadaveric femora for biomechanical studies and in pathological fractures. However, there are very few reports on the utilization of PMMA cement to prevent these complications in fresh intertrochanteric fractures. A prospective study was conducted to evaluate the outcome and efficacy of PMMA augmented DHS in elderly osteoporotic patients with intertrochanteric fractures. Materials and Methods: The study included 64 patients (AO type31-A2.1 in eight, A2.2 in 29, A2.3 in 17 patients, and 31-A3.1 in five, A3.2 in three, and A3.3 in two patients with an average age of 72 years (60 − 94 years of which 60 were available for final followup. PMMA augmentation of DHS was performed in all cases by injecting PMMA cement into the femoral head with a custommade gun designed by the authors. The clinical outcome was rated as per the Salvati and Wilson scoring system at the time of final followup of one year. Results were graded as excellent (score > 31, good (score 24 − 31, fair (score 16 − 23, and poor (score < 16. Results: Fracture united in all patients and the average time to union was 13.8 weeks (range 12 − 16 weeks. At an average followup of 18 months (range 12 − 24 months, no incidence of varus collapse or superior screw cut out was observed in any of the patients in spite of weightbearing ambulation from the early postoperative period. There was no incidence of avascular necrosis (AVN or cement penetration into the joint in our series. Most of the patients were able to regain their prefracture mobility status with a mean hip pain score of 8.6. Conclusion: Cement augmentation of DHS appears

  3. Cemented Hemiarthroplasty in Elderly Osteoporotic Unstable Trochanteric Fractures using Fracture Window

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    Thakur A

    2016-03-01

    Full Text Available Introduction: We would like to analyze the role of cemented hemiarthroplasty in elderly osteoporotic unstable intertrochanteric fractures through trochanteric fracture window. Materials and Methods: The study was conducted from July 2011 to July 2014. From a total of 265 consecutive patients with intertrochanteric fractures of 42 patients were selected according to inclusion criteria and results were analyzed prospectively. All patients were operated at tertiary care institute. Patients which matched the inclusion criteria were selected. 42 patients entered the study and all completed the study. Primary cemented hemiarthroplasty was done in all patients. Modified Harris Hip Score was used to assess all the patients. Results: 42 patients were included in the study with an average age of 80.7 years. Only AO/OTA type 31-A2.2 and 31-A2.3 were included, average HHS at final follow up of three years was 86.2. No revision or reoperation was done. Conclusion: In a selected cohort of patients primary prosthetic replacement in elderly osteoporotic unstable intertrochanteric fractures is good option and the surgical technique allowed us to perform it more easily.

  4. Prevention of excessive postoperative sliding of the short femoral nail in femoral trochanteric fractures.

    Science.gov (United States)

    Ito, Juji; Takakubo, Yuya; Sasaki, Kan; Sasaki, Junya; Owashi, Kazuya; Takagi, Michiaki

    2015-05-01

    Lag screw cut-out is one of the major postoperative complications on femoral trochanteric fractures. However, precise analyses of excessive sliding and lag screw cut-out were limited. The purpose of this study was to investigate the factors that induce this unfavorable event. From April 2010 to April 2013, 226 patients were operated in our institute using a short femoral nail. Among them, 177 patients (29 males and 148 females) with a mean age of 84 years (60-97 years), who were followed up >3 months, were included in this study. The postoperative sliding distance, fracture type (AO/OTA classification), tip-apex distance (TAD), reduction pattern in the postoperative X-ray (antero-posterior and lateral views), bone quality (canal flare and cortical indices), walking ability at the time of pre-injury and final follow-up, and complications were investigated retrospectively. The mean sliding distance was 3.7 mm, and one cut-out case (0.6 %) was observed. The sliding distance of the AO/OTA 31-A2 fractures was significantly longer than that of the A1 fractures (p fractures, an accurate reduction in the lateral view at surgery is important, particularly in unstable fractures.

  5. Complications and fixation techniques of trochanteric fractures with the TARGON(®) PF.

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    Takigawa, Naohide; Moriuchi, Hiromitsu; Abe, Muneki; Yasui, Kenji; Eshiro, Hisako; Kinoshita, Mitsuo

    2014-01-01

    The purpose of this study was to analyse clinical results of elderly patients with trochanteric fractures that were treated with use of TARGON(®) PF nail. Overall, 494 patients (113 males) were available for this study. On the basis of Jensen classification, there were 76 cases in type I, 164 cases in type II, 70 in type III, 129 in type IV and 55 in type V. (1) Sliding amount of lag screw in relation to the Jensen classification, (2) sliding amount of lag screw according to the Ikuta's classification that categorises the reduction in lateral view in three, Subtype A, Subtype N and Subtype P, (3) sliding amount of lag screw in correlation between Jensen classification and Ikuta's classification and (4) postoperative complications (9 cases; 1.7%) were assessed. Cut-out and back-out cases were seen in 6 cases (1.1%), and these severe complications were evaluated in details. In correlation between Jensen classification and Ikuta's classification, the excessive sliding of lag screw was prominent with the Subtype P, which was preoperatively in Jensen type III or V. Cut-out or back-out cases were caused either from (1) Subtype P that were preoperatively Jensen types III or V, or from (2) the fracture where there was bony defect anteriorly. Therefore, special care must be taken for these types. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Demystifying the Clinical Diagnosis of Greater Trochanteric Pain Syndrome in Women.

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    Ganderton, Charlotte; Semciw, Adam; Cook, Jill; Pizzari, Tania

    2017-06-01

    To evaluate the diagnostic accuracy of 10 clinical tests that can be used in the diagnosis of greater trochanteric pain syndrome (GTPS) in women, and to compare these clinical tests to magnetic resonance imaging (MRI) findings. Twenty-eight participants with GTPS (49.5 ± 22.0 years) and 18 asymptomatic participants (mean age ± standard deviation [SD], 52.5 ± 22.8 years) were included. A blinded physiotherapist performed 10 pain provocation tests potentially diagnostic for GTPS-palpation of the greater trochanter, resisted external derotation test, modified resisted external derotation test, standard and modified Ober's tests, Patrick's or FABER test, resisted hip abduction, single-leg stance test, and the resisted hip internal rotation test. A sample of 16 symptomatic and 17 asymptomatic women undertook a hip MRI scan. Gluteal tendons were evaluated and categorized as no pathology, mild tendinosis, moderate tendinosis/partial tear, or full-thickness tear. Clinical test analyses show high specificity, high positive predictive value, low to moderate sensitivity, and negative predictive value for most clinical tests. All symptomatic and 88% of asymptomatic participants had pathological gluteal tendon changes on MRI, from mild tendinosis to full-thickness tear. The study found the Patrick's or FABER test, palpation of the greater trochanter, resisted hip abduction, and the resisted external derotation test to have the highest diagnostic test accuracy for GTPS. Tendon pathology on MRI is seen in both symptomatic and asymptomatic women.

  7. Minimally invasive treatment of trochanteric fractures with intramedullary nails. Technique and results.

    Science.gov (United States)

    Todor, Adrian; Pojar, Adina; Lucaciu, Dan

    2013-01-01

    The aim of the study was to evaluate the results of minimally invasive treatment of trochanteric fractures with the use of intramedullary nails. From September 2010 to September 2012 we treated 21 patients with pertrochanteric fractures by a minimally invasive technique using the Gamma 3 (Stryker, Howmedica) nail. There were 13 females and 8 men with a mean age of 74.1 years, ranging from 58 to 88 years. Fractures were classified as being stable (AO type 31-A1) in 5 cases and unstable (AO type 31-A2 and A3) in the rest of 16 cases. Patients were reviewed at 6 weeks and 3 months postoperatively. Mean surgery time was 46.8 minutes and mean hospital stay was 14.9 days. No patients required blood transfusions. During the hospital stay all the patients were mobilized with weight bearing as tolerated. All patients were available for review at 6 weeks, and 2 were lost to the 3 months follow up. 16 patients regained the previous level of activity. This minimally invasive technique using a gamma nail device for pertrochanteric fractures gives reliable good results with excellent preservation of hip function.

  8. Case report: AVN of the femoral head five year follow-up of the combination of ipsilateral femoral neck and sub-trochanteric fracture.

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    Zhang, Wei; Zhu, Feng; Dong, Hanqing; Xu, Yaozeng

    2016-04-01

    To our knowledge, the type of combination of ipsilateral femoral neck and sub-trochanteric fracture is rare. And the long term follow-up is seldom been reported. A 60 year old woman suffered from a traffic accident. We gave her the intramedullary nail treatment for the combination of ipsilateral femoral neck and sub-trochanteric fracture, and the fracture indeed cured after one year and there is no clue of necrosis of the femoral head, but after 5 years, there is an evidence of necrosis of the femoral head. Combination of ipsilateral femoral neck and sub-trochanteric fracture should be kept in mind. Patients with this unusual fracture should be kept under surveillance for longer than might be thought currently to be necessary for there is a possibility of necrosis of the femoral head, even a nondisplaced femoral neck fracture.

  9. BMD T-score discriminates trochanteric fractures from unfractured controls, whereas geometry discriminates cervical fracture cases from unfractured controls of similar BMD.

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    Pulkkinen, P; Partanen, J; Jalovaara, P; Jämsä, T

    2010-07-01

    The ability of bone mineral density (BMD) to discriminate cervical and trochanteric hip fractures was studied. Since the majority of fractures occur among people who are not diagnosed as having osteoporosis, we also examined this population to elucidate whether geometrical risk factors can yield additional information on hip fracture risk beside BMD. The study showed that the T-score criterion was able to discriminate fracture patients from controls in the cases of trochanteric fractures, whereas geometrical measures may discriminate cervical fracture cases in patients with T-score >-2.5. Low bone mineral density (BMD) is a well-established risk factor for hip fracture. However, majority of fractures occur among people not diagnosed as having osteoporosis. We studied the ability of BMD to discriminate cervical and trochanteric hip fractures. Furthermore, we examined whether geometrical measures can yield additional information on the assessment of hip fracture risk in the fracture cases in subjects with T-score >-2.5. Study group consisted of postmenopausal females with non-pathologic cervical (n = 39) or trochanteric (n = 18) hip fracture (mean age 74.2 years) and 40 age-matched controls. BMD was measured at femoral neck, and femoral neck axis length, femoral neck and shaft cortex thicknesses (FNC and FSC), and femoral neck-shaft angle (NSA) were measured from radiographs. BMD T-score threshold of -2.5 was able to discriminate trochanteric fractures from controls (p trochanteric fractures occurred in individuals with T-score fractures. Twenty of these fractures (51.3%) occurred in individuals with BMD in osteoporotic range and 19 (48.7%) in individuals with T-score >-2.5. Within these non-osteoporotic cervical fracture patients (N = 19) and non-osteoporotic controls (N = 35), 83.3% were classified correctly based on a model including NSA and FNC (p trochanteric fractures could be discriminated based on a BMD T-score fracture cases would remain under-diagnosed if

  10. Outcomes of trochanteric femoral fractures treated with proximal femoral nail: an analysis of 100 consecutive cases.

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    Korkmaz, Mehmet Fatih; Erdem, Mehmet Nuri; Disli, Zeliha; Selcuk, Engin Burak; Karakaplan, Mustafa; Gogus, Abdullah

    2014-01-01

    In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between January 2002 and February 2007, and who were treated with a proximal femoral nail. One hundred consecutive cases were included in the study. A case documentation form was used to obtain intraoperative data including age, sex, mechanism of injury, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) classification and the American Society of Anesthesiologists' (ASA) physical status classification (ASA grade). Clinical and radiographic examinations were performed at the time of admission and at the 6th week; subsequent visits were organized on the 3rd month, 6th month, and 12th month, and in patients with longer follow-up and annually postoperatively. The Harris score of hip function was used, and any change in the position of the implants and the progress of the fracture union, which was determined radiologically, was noted. The mean age of the patients was 77.66 years (range: 37-98 years), and the sex distribution was 32 males and 68 females. Seventy-three fractures were reduced by closed means, whereas 27 needed limited open reduction. The mean follow-up time for the study group was 31.3 months (range: 12-75 months). Postoperative radiographs showed a near-anatomical fracture reduction in 78% of patients. The Harris hip score was negatively correlated with the ASA score and patient age. No cases of implant failure were observed. Three patients died before discharge (one due to pulmonary embolism, two due to cardiac arrest), and five patients died due to unrelated medical conditions within the first 3 months of the follow-up. Our study showed that proximal femoral nail is a reliable fixation with good fracture union, and it is not associated with major complications in any type of trochanteric femoral fracture.

  11. Kendrick's extrication device and unstable pelvic fractures: Should a trochanteric belt be added? A cadaveric study.

    Science.gov (United States)

    Reynard, Floran A; Flaris, Alexandros N; Simms, Eric R; Rouvière, Olivier; Roy, Pascal; Prat, Nicolas J; Damizet, Jean-Gabriel; Caillot, Jean-Louis; Voiglio, Eric J

    2016-03-01

    Pre-hospital pelvic stabilisation is advised to prevent exsanguination in patients with unstable pelvic fractures (UPFs). Kendrick's extrication device (KED) is commonly used to extricate patients from cars or crevasses. However the KED has not been tested for potential adverse effects in patients with pelvic fractures. The aim of this study was to examine the effect of the KED on pubic symphysis diastasis (SyD) with and without the use of a trochanteric belt (TB) during the extraction process following a MVC. Left-sided "open-book" UPFs were created in 18 human cadavers that were placed in seven different positions simulating pre-extraction and extraction positions using the KED with and without a TB in two different positions (through and over the thigh straps). The SyD was measured using anteroposterior radiographs. The effects of the KED with and without TB, on the SyD, were evaluated. The KED alone resulted in a non-significant increase of the SyD compared to baseline, whereas the addition of a TB to the KED resulted in a significant reduction of the SyD (p<0.001). The TB through the straps provided a significantly better reduction than the TB over the straps in the extracted position (p<0.05). Our study demonstrated that a TB in combination with the KED on UPFs is an effective way to achieve early reduction. The addition of the TB in combination with the KED could be considered for Pre-Hospital Trauma Life Support (PHTLS) training protocols. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Intramedullary femoral nailing through the trochanteric fossa versus greater trochanter tip : a randomized controlled study with in-depth functional outcome results

    NARCIS (Netherlands)

    Moein, C. M. Ansari; ten Duis, H. J.; Oey, P. L.; de Kort, G. A. P.; van der Meulen, W.; van der Werken, Chr

    2011-01-01

    In a level 1 university trauma center, an explorative randomized controlled study was performed to compare soft tissue damage and functional outcome after antegrade femoral nailing through a trochanteric fossa (also known as piriform fossa) entry point to a greater trochanter entry point in patients

  13. Plate fixation in periprosthetic femur fractures Vancouver type B1-Trochanteric hook plate or subtrochanterical bicortical locking?

    Science.gov (United States)

    Lenz, Mark; Stoffel, Karl; Kielstein, Heike; Mayo, Keith; Hofmann, Gunther O; Gueorguiev, Boyko

    2016-12-01

    Proximal plate fixation in periprosthetic femur fractures can be improved by plate anchorage in the greater trochanter (lateral tension band principle) or bicortical locking screw placement beside the prosthesis stem in an embracement configuration. Both concepts were compared in a biomechanical test using a femoral hook plate (hook) or a locking attachment plate (LAP). After bone mineral density (BMD) measurement in the greater trochanter, six pairs of fresh frozen human femora were assigned to two groups and instrumented with cemented hip endoprostheses. A transverse osteotomy was set distal to the tip of the prosthesis, simulating a Vancouver B1 fracture. Each pair was instrumented using a plate tensioner with either hook or LAP construct. Cyclic testing (2Hz) with physiologic profile and monotonically increasing load was performed until catastrophic failure. Plate stiffness was compared in a four-point-bending-test. Paired student's-t-test was used for statistical evaluation (pTrochanteric fixation is highly BMD dependent and may be restricted to major greater trochanteric involvement requiring stabilization. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Comparative study of the second and third generation of gamma nail for trochanteric fractures: review of 218 cases.

    Science.gov (United States)

    Mingo-Robinet, Juan; Torres-Torres, Miguel; Martínez-Cervell, Carmen; Alonso Del Olmo, Juan Antonio; Rivas Laso, Jose A; Aguado-Hernández, Hector; Burón-Alvarez, Isidro

    2015-03-01

    The aim of this study was to compare the complications of the trochanteric gamma nail (TGN) and the Gamma3 Nail (G3), focusing on cutout failure. Retrospective comparative cohort analysis. Level II Teaching Trauma Center academic trauma center. Two hundred eighteen trochanteric fractures with a mean follow-up of 15 months were included in the study. They were treated either with the TGN or the G3 between January 2005 and December 2010. Bivariate, stratified, and logistic regression analysis was conducted to determine the association between cutout and the independent variables. Proximal anterograde nailing with either the TGN or the G3. Patient age, sex, type of intramedullary device, stability fracture pattern, tip-apex distance (TAD), distraction at the fracture site, cervical angle, and cutout. The relative risk (RR) of cutout was 4.71 times higher in the group treated with G3 (P fractures compared with stable fractures was 3.07 (1.01-9.35). In unstable fractures, the RR of cutout was 8.78 times higher in patients with G3 (P 25 mm (P = 0.4). We have not found any relationship between cutout rate and TAD. Only the fracture pattern and the type of implant have shown to be associated with cutout risk. In our study, Gamma3 Nail has higher cutout rates than TGN in unstable fractures. Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.

  15. Clinical profiles and risk factors for outcomes in older patients with cervical and trochanteric hip fracture: similarities and differences

    Science.gov (United States)

    2012-01-01

    Background Data on clinical characteristics and outcomes in regard to hip fracture (HF) type are controversial. This study aimed to evaluate whether clinical and laboratory predictors of poorer outcomes differ by HF type. Methods Prospective evaluation of 761 consecutively admitted patients (mean age 82.3 ± 8.8 years; 74.9% women) with low-trauma non-pathological HF. Clinical characteristics and short-term outcomes were recorded. Haematological, renal, liver and thyroid status, C-reactive protein, cardiac troponin I, serum 25(OH) vitamin D, PTH, leptin, adiponectin and resistin were determined. Results The cervical compared to the tronchanteric HF group was younger, have higher mean haemoglobin, albumin, adiponectin and resistin and lower PTH levels (all P trochanteric HF only hyperparathyroidism; for post-operative myocardial injury dementia, smoking and renal impairment in the former group and coronary artery disease (CAD), hyperparathyroidism and hypoleptinaemia in the latter; for LOS > 20 days CAD, and age > 75 years and hyperparathyroidism, respectively. Need of institutionalisation was predicted by age > 75 years and dementia in both groups and also by hypovitaminosis D in the cervical and by hyperparathyroidism in the trochanteric HF. Conclusions Clinical characteristics and incidence of poorer short-term outcomes in the two main HF types are rather similar but risk factors for certain outcomes are site-specific reflecting differences in underlying mechanisms. PMID:22333003

  16. A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw.

    Science.gov (United States)

    Carulli, Christian; Piacentini, Federico; Paoli, Tommaso; Civinini, Roberto; Innocenti, Massimo

    2017-01-01

    Trochanteric fractures are frequent and generally associated with bone fragility. There is still debate on the best fixation device to treat stable or rather stable trochanteric fractures: we report our clinical and radiological results of fixation with Proximal Femoral Nail "antirotation" (PFNa) in a population of patients compared to a control group treated by Sliding Hip Screw (SHS). A prospective study was conducted in 71 consecutive patients treated by PFNa (group A), and 69 by a SHS (group B), with a mean age of 81.6 and 83.4 years respectively. Short Form 12 was administered to check postoperative results, and the following parameters were evaluated: range of motion, evaluation of pain, gait ability, X-rays, and Tip Apex Distance Index. A minimum follow-up was conducted in 128 patients: 66 subjects belonging to the PFNa group and 62 to the DHS group. All patients in the group A were able to reach partial or full weight-bearing on the operated leg before leaving the hospital. Forty-four patients (63.8%) of the group B were able to walk with partial weight-bearing before discharge. We recorded 17 complications with a final overall percentage of 17.2% on the overall study population with one single case of failure in both the two groups. A statistical significance (ptrochanteric fractures as well as DHS. The light superiority of PFNa may be principally related to its mechanical advantages.

  17. Posterior dislocation of a native hip joint associated with ipsilateral per-trochanteric fracture: A rare case report

    Directory of Open Access Journals (Sweden)

    Mazin Fageir

    2018-02-01

    Full Text Available We describe a case of traumatic posterior dislocation of a native hip joint associated with ipsilateral comminuted inter-trochanteric femoral fracture. In our case, closed reduction was attempted but proved unsuccessful. Taking into account the planned subsequent intra-medullary femoral nail, open reduction through a lateral incision was undertaken. Post-operatively, the planned mobility was for a non-weight bearing period of 6 weeks followed by a partial-weight bearing period of 6 weeks before progressing to full-weight bearing. Post-operatively, the patient completed a comprehensive course of physiotherapy. At five months, he was able to walk for five miles over the course of a weekend. At six months, the patient was looking at phased return to work as a fire fighter. Radiographs taken at the time demonstrated evidence of healing to his inter-trochanteric fracture. At ten months, the patient was back to normal duties at work as a fire fighter.

  18. Precise placement of lag screws in operative treatment of trochanteric femoral fractures with a new guide system.

    Science.gov (United States)

    Poyanli, Oguz S; Soylemez, Salih; Ozkut, Afsar T; Uygur, Esat; Kemah, Bahattin; Unal, Omer K

    2015-11-01

    We assessed the accuracy of a new guide system that we developed to place lag screws in the proper position with the minimum number of attempts for operative treatment of trochanteric femoral fractures. A total of 55 consecutive trochanteric femoral fractures were treated with a cephalomedullary nail. The first 27 consecutive patients were treated with the standard operation (group A), while the new guide system was used in the last 28 consecutive patients (group B). The numbers of attempts to place K wires and the duration of surgery were noted. Accuracy of lag screw placement was evaluated by measuring the angle of deviation from the central axis of the femoral head. Deviation values ranged from -11̊ to +15̊ for the 27 cases in group A, with a median absolute deviation of 8̊±6̊. That in the 28 cases after the introduction of the new guide system (group B) ranged from -5̊ to +6̊, with a median absolute deviation of 0.5̊±3̊ (Pfractures. The present study indicated that this new guide system and nail facilitate accurate placement of lag screws in the appropriate position with the minimum number of attempts. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Greater Trochanteric Pain Syndrome: Percutaneous Tendon Fenestration Versus Platelet-Rich Plasma Injection for Treatment of Gluteal Tendinosis.

    Science.gov (United States)

    Jacobson, Jon A; Yablon, Corrie M; Henning, P Troy; Kazmers, Irene S; Urquhart, Andrew; Hallstrom, Brian; Bedi, Asheesh; Parameswaran, Aishwarya

    2016-11-01

    The purpose of this study was to compare ultrasound-guided percutaneous tendon fenestration to platelet-rich plasma (PRP) injection for treatment of greater trochanteric pain syndrome. After Institutional Review Board approval was obtained, patients with symptoms of greater trochanteric pain syndrome and ultrasound findings of gluteal tendinosis or a partial tear (Pain scores were recorded at baseline, week 1, and week 2 after treatment. Retrospective clinic record review assessed patient symptoms. The study group consisted of 30 patients (24 female), of whom 50% were treated with fenestration and 50% were treated with PRP. The gluteus medius was treated in 73% and 67% in the fenestration and PRP groups, respectively. Tendinosis was present in all patients. In the fenestration group, mean pain scores were 32.4 at baseline, 16.8 at time point 1, and 15.2 at time point 2. In the PRP group, mean pain scores were 31.4 at baseline, 25.5 at time point 1, and 19.4 at time point 2. Retrospective follow-up showed significant pain score improvement from baseline to time points 1 and 2 (P.99). Our study shows that both ultrasound-guided tendon fenestration and PRP injection are effective for treatment of gluteal tendinosis, showing symptom improvement in both treatment groups. © 2016 by the American Institute of Ultrasound in Medicine.

  20. Mechanical properties of the compass depressors of the sea-urchin Paracentrotus lividus (Echinodermata, Echinoidea and the effects of enzymes, neurotransmitters and synthetic tensilin-like protein.

    Directory of Open Access Journals (Sweden)

    Iain C Wilkie

    Full Text Available The compass depressors (CDs of the sea-urchin lantern are ligaments consisting mainly of discontinuous collagen fibrils associated with a small population of myocytes. They are mutable collagenous structures, which can change their mechanical properties rapidly and reversibly under nervous control. The aims of this investigation were to characterise the baseline (i.e. unmanipulated static mechanical properties of the CDs of Paracentrotus lividus by means of creep tests and incremental force-extension tests, and to determine the effects on their mechanical behaviour of a range of agents. Under constant load the CDs exhibited a three-phase creep curve, the mean coefficient of viscosity being 561±365 MPa.s. The stress-strain curve showed toe, linear and yield regions; the mean strain at the toe-linear inflection was 0.86±0.61; the mean Young's modulus was 18.62±10.30 MPa; and the mean tensile strength was 8.14±5.73 MPa. Hyaluronidase from Streptomyces hyalurolyticus had no effect on creep behaviour, whilst chondroitinase ABC prolonged primary creep but had no effect on secondary creep or on any force-extension parameters; it thus appears that neither hyaluronic acid nor sulphated glycosaminoglycans have an interfibrillar load transfer function in the CD. Acetylcholine, the muscarinic agonists arecoline and methacholine, and the nicotinic agonists nicotine and 1-[1-(3,4-dimethyl-phenyl-ethyl]-piperazine produced an abrupt increase in CD viscosity; the CDs were not differentially sensitive to muscarinic or nicotinic agonists. CDs showed either no, or no consistent, response to adrenaline, L-glutamic acid, 5-hydroxytryptamine and γ-aminobutyric acid. Synthetic echinoid tensilin-like protein had a weak and inconsistent stiffening effect, indicating that, in contrast to holothurian tensilins, the echinoid molecule may not be involved in the regulation of collagenous tissue tensility. We compare in detail the mechanical behaviour of the CD with that

  1. Risk factors for cervical and trochanteric hip fractures in elderly women: a population-based 10-year follow-up study.

    Science.gov (United States)

    Jokinen, Heikki; Pulkkinen, Pasi; Korpelainen, Juha; Heikkinen, Jorma; Keinänen-Kiukaanniemi, Sirkka; Jämsä, Timo; Korpelainen, Raija

    2010-07-01

    We evaluated the contribution of lifestyle-related factors, calcaneal ultrasound, and radial bone mineral density (BMD) to cervical and trochanteric hip fractures in elderly women in a 10-year population-based cohort study. The study population consisted of 1,681 women (age range 70-73 years). Seventy-two percent (n = 1,222) of them participated in the baseline measurements. Calcaneal ultrasound was assessed with a quantitative ultrasound device. BMD measurements were performed at the distal and ultradistal radius by dual-energy X-ray absorptiometry. Forward stepwise logistic regression analysis was used to find the most predictive variables for hip fracture risk. During the follow-up, 53 of the women had hip fractures, including 32 cervical and 21 trochanteric ones. The fractured women were taller and thinner and had lower calcaneal ultrasound values than those without fractures. High body mass index (BMI) was a protective factor against any hip fractures, while low functional mobility was a risk factor of hip fractures. Specifically, high BMI protected against cervical hip fractures, while low physical activity was a significant predictor of these fractures. Similarly, high BMI protected against trochanteric fractures, whereas low functional mobility and high coffee consumption were significant predictors of trochanteric fractures. Cervical and trochanteric hip fractures seem to have different risk factors. Therefore, fracture type should be taken into account in clinical fracture risk assessment and preventative efforts, including patient counseling. However, the study is not conclusive due to the limited number of observed fractures during follow-up, and the results have to be confirmed in future studies.

  2. Urban versus rural differences in the occurrence of hip fractures in Japan’s Kyoto prefecture during 2008–2010: a comparison of femoral neck and trochanteric fractures

    Science.gov (United States)

    2013-01-01

    Background To investigate the differences in the characteristics of femoral neck and trochanteric fractures between urban and rural areas of Kyoto Prefecture in Japan. Methods Fracture type (neck vs. trochanteric), age, sex, place where fracture occurred (indoors vs. outdoors), and cause of injury were surveyed among patients aged ≥65 years who sustained hip fractures between 2008 and 2010 and who were treated at 1 of 13 participating hospitals (5 urban, 8 rural). The ratio of sick beds to total number of beds at the participating hospitals was 19.6% (2,188/11,158) in the urban area and 34.9% (1,963/5,623) in the rural area. We also investigated the incidence of hip fracture in Tango medical district as a representative rural area. Results There were 1,346 neck (mean age, 82.4 years) and 1,606 trochanteric fractures (mean age, 85.0 years). The ratio of neck to trochanteric fractures was higher in the urban area than in the rural area in all age groups (65–74, 75–84, and ≥ 85 years). There were no apparent differences in place or cause of injury. The incidence of hip fracture in the women of Tango medical district was lower than the national average. Conclusions There was a difference in the ratio of neck to trochanteric fractures between urban and rural areas. This difference is estimated to be caused by the high and low incidence of neck fracture in urban and rural areas, respectively. PMID:24156244

  3. How evolution of the nailing system improves results and reduces orthopedic complications: more than 2000 cases of trochanteric fractures treated with the Gamma Nail System.

    Science.gov (United States)

    Pascarella, R; Fantasia, R; Maresca, A; Bettuzzi, C; Amendola, L; Violini, S; Cuoghi, F; Sangiovanni, P; Cerbasi, S; Boriani, S; Tigani, D S

    2016-04-01

    The incidence of trochanteric fractures has increased significantly during the last few decades, especially in elderly patients with osteoporosis. The dynamic/sliding hip screw and the cephalomedullary nail are the most commonly used fixation methods to treat trochanteric fractures. The improvements in the Gamma Nail System (GNS) associated with a correct surgical technique reduced the postoperative orthopedic complications. The purpose of this study was to compare the results of the different Gamma Nails. The present study is a retrospective analysis of 2144 patients treated with GNS between January 1997 and December 2011 for trochanteric fractures, classified according to AO classification method. The patients were divided into three groups according to the nailing system: 525 were treated with Standard Gamma Nail (SGN), 422 with Trochanteric Gamma Nail (TGN) and 1197 with Gamma3 Nail. The overall incidence of intra-operative complications was 1.21 %; the incidence of intra-operative complications for each group was 1.71 % for SGN group, 0.47 % for TGN group and 1.25 % for Gamma3 Nail group. The overall incidence of postoperative complications was 5.48 %, and the incidence for each group was 10.73 % for SGN group, 9.92 % for TGN group and 2.92 % for Gamma3 Nail group. The GNS is a safe device with a low rate of intra-operative complications. The evolution of this nail system reduces postoperative complications, thus improving the results at follow-up and confirming that the Gamma3 Nail is a safe and predictable device to fix trochanteric fracture.

  4. [Application of the anatomic plate and trapezoid plate in comminuted intertrochanteric fracture combined with trochanteric coronal position fracture: a controlled clinical trial].

    Science.gov (United States)

    Zhen, Ping; Liu, Xing-Yan; Gao, Ming-Xuan; Tian, Qi

    2010-05-01

    To investigate the therapeutic effect and operative characteristic of the anatomic plate and trapezoid plate for treament of the comminuted intertrochanteric fracture combined with trochanteric coronal position fracture. From Jan. 1998 to Mar. 2007, 57 patients suffered from comminuted intertrochanteric fracture combined with trochanteric coronal position fracture were randomly divided into two groups, 21 patients in trapezoid plate group were treated with the trapezoid compression plate, included 11 males and 10 females with an average age of 41.8 years; and 36 patients in anatomic plate group were treated with the anatomic plate, included 17 males and 19 females with an average age of 42.1 years. All of the 57 fractures were A3 type according to AO classification. The functions of hip joints were evaluated according to the Harris hip functional standard score. All 57 patients were followed-up for 5 months to 9 years and 3 months with an average of 4.8 years. The healing time of the fractures was from 8 to 20 weeks with an average of 12.8 weeks. The results of Harris scoring showed the pain scores of the anatomic plate group were higher than that of the trapezoid plate group (P 0.05). In unstable comminuted intertrochanteric fracture combined with trochanteric coronal position fracture, the lateral wall of trochanteric is often destroyed. The anatomic plate and the trapeziod compression plate can provide effective internal fixation, while many othere internal fixation methods were limited in this kind of fracture. As compared with the anatomic plate fixation, the trapezoid compression plate fixation of comminuted intertrochanteric fracture combined with trochanteric coronal position fracture have several advantages, such as fewer complications, faster union of fracture and earlier recovery of joint functions.

  5. Unstable intertrochanteric femur fractures in geriatric patients treated with the DLT trochanteric nail.

    Science.gov (United States)

    Temiz, Aytun; Durak, Aslihan; Atici, Teoman

    2015-07-01

    To evaluate clinical-functional and radiological results of geriatric patients with unstable intertrochanteric femur fracture treated with intramedullary nail. Thirty-two patients treated with intramedullary nail (DLT trochanteric nail) due to unstable intertrochanteric femur fractures were reviewed retrospectively. Fractures 31-A2 and 31-A3 (AO classification) were evaluated. Operation time, blood loss, and blood transfusion requirements, hospitalization period, time to fracture union were evaluated and perioperative and postoperative complications were recorded. According to the modified Baumgaertner criteria fracture reduction was analyzed radiologically, and nail tip-apex distance was measured. Femoral neck-shaft angle was also evaluated. Harris Hip Score for clinical evaluation and Kyo criteria for walking capacity were used. The mean age was 72 years (65-81), mean follow up time was 18.3 months (12-26). Nineteen patients had type 31-A2 and 13 had type 31-A3 fractures. Mean operation time was 36.3min (25-45), blood loss 185.9ml (100-250). Blood transfusion was required in 7 patients. The average hospitalization duration was 6 days (4-14) while the time to surgery from admission was 2.9 days (2-6). Radiologically, in 21 of the cases fracture reduction was well (65.6%), acceptable in 9 (28.1%), and poor in 2 (6.3%). In early postoperative period, the mean collo-diaphyseal angle was 129.1° (120-140°), mean tip-apex distance was 15.5mm (10-27). The mean Harris Hip Score was 63.4 (38-90). Two patients (6.3%) had excellent, 21 patients (65.6%) had good, 7 patients (21.8%) had moderate, and 2 patients (6.3%) had poor results. Walking capacity in the last follow-up in 20 of the cases (62.5%) was pre-fracture level. While complications were observed in seventeen patients (53.1%) (5 superficial wound infections, 5 fractures of the greater trochanter, 3 cases of secondary varus angulation and 4 cases of heterotopic ossification) none of them required additional surgery

  6. Outcomes of trochanteric femoral fractures treated with proximal femoral nail: an analysis of 100 consecutive cases

    Directory of Open Access Journals (Sweden)

    Korkmaz MF

    2014-04-01

    : 12–75 months. Postoperative radiographs showed a near-anatomical fracture reduction in 78% of patients. The Harris hip score was negatively correlated with the ASA score and patient age. No cases of implant failure were observed. Three patients died before discharge (one due to pulmonary embolism, two due to cardiac arrest, and five patients died due to unrelated medical conditions within the first 3 months of the follow-up. Conclusion: Our study showed that proximal femoral nail is a reliable fixation with good fracture union, and it is not associated with major complications in any type of trochanteric femoral fracture. Keywords: ASA, femoral fracture, Harris score, proximal femoral nail

  7. Avascular necrosis of the femoral head following trochanteric fractures in adults: a systematic review.

    Science.gov (United States)

    Barquet, Antonio; Mayora, Gabriel; Guimaraes, Joao Matheus; Suárez, Roberto; Giannoudis, Peter V

    2014-12-01

    Avascular necrosis of the femoral head (ANFH) following trochanteric fractures (TFx) is infrequent. The causal relationship between ANFH and TFx remains controversial. Although several major risk factors for ANFH have been proposed, most of them remain under discussion. In this study we undertook a systematic review of the literature to investigate the incidence of AVN, risk factors and outcomes following Tfx fixation. A comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of ANFH and series of TFx with or without cases of ANFH published between inception of journals to December 2013 were eligible for inclusion. Relevant information was divided in two sections. Part I: included the analysis of detailed case reports of ANFH, either published isolated or included in series of TFx, with the objective of establishing potential risk factors, clinical and radiological presentation, time to development, treatment and outcome of this complication. Part II: analyzed series of TFx, which included cases of ANFH with or without details of aetiology, treatment modalities and outcomes, with the objective of assessing the incidence of ANFH in TFx. Overall 80 articles with 192 cases of ANFH after TFx met the inclusion criteria. The most probable developmental pathway appears to be a disruption of the extra osseous arterial blood supply to the femoral head. Suggested risk factors included high-energy trauma with fracture comminution and displacement, and an atypical course of the fracture line, more proximal, at the base of the neck. Most cases were diagnosed within the first two years after fracture. The clinical and radiological features appear to be similar to those of idiopathic avascular necrosis of the femoral head. The incidence of AVFH with a minimum of 1-year follow-up was calculated 0.95%, and with a minimum 2-year follow-up it was 1.37%. Total hip replacement was the mainstay of treatment. The

  8. Internal fixation versus conservative treatment for elderly patients with a trochanteric hip fracture in conjunction with post-stroke hemiplegia.

    Science.gov (United States)

    Li, Kainan; Zheng, Yingjie

    2016-10-01

    To retrospectively evaluated Gamma nail internal fixation in the treatment of elderly patients with post-stroke hemiplegia experiencing trochanteric hip fracture. The patients were obtained consecutively from January 2005 to December 2010 with inclusion criteria. The total number was 138 and allocated to two groups: treated with the Gamma nail (n=72,group A) and continuous skin traction (n=66,group B). Preoperative variables including patient age, gender, duration of cerebrovascular accident, duration of hypertension, ASA risk score, Harris hip score and fracture type were recorded and compared. After treatment, time of patients activity on the bed, ambulation time, Harris hip score, mortality, complications were recorded and used to compare the outcomes. (1) Follow-up was undertaken from 3 to 10 years, with an average of 5.8 years. (2) No statistical difference in preoperative variables was found between the 2 groups. (3) two groups had statistical significance (P=0.000) in the time of patients activity on the bed and ambulation time and group A can activities on the bed and ambulates earlier. (4) There were significant differences between 2 groups in Harris hip score at 1 and 3 years and group A was significantly higher than group B. (5) there were statistically significant differences in mortality of 3 years, 5 years and 10 years and the group B was significantly higher than the group A. (6) There was a statistical significance in complications between 2 groups and group B was higher than group A. Major complications in group A were pain, lag screw cut out, implant infection and distal femoral fractures caused by fall after the surgery. On elderly patients with trochanteric hip fracture on the hemiplegic lower side, Gamma nail internal fixation treatment can achieve better effect, patients can be early activity, fewer complications, and less mortality. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Sliding hip screw versus the Targon PFT nail for trochanteric hip fractures: a randomised trial of 400 patients.

    Science.gov (United States)

    Parker, M J; Cawley, S

    2017-09-01

    To compare the outcomes for trochanteric fractures treated with a sliding hip screw (SHS) or a cephalomedullary nail. A total of 400 patients with a trochanteric hip fracture were randomised to receive a SHS or a cephalomedullary nail (Targon PFT). All surviving patients were followed up to one year from injury. Functional outcome was assessed by a research nurse blinded to the implant used. Recovery of mobility, as assessed by a mobility scale, was superior for those treated with the intramedullary nail compared with the SHS at eight weeks, three and nine months (p-values between 0.01 and 0.04), the difference at six and 12 months was not statistically significant (p = 0.15 and p = 0.18 respectively). The mean difference was around 0.4 points (0.3 to 0.5) on a nine point scale. Surgical time for the nail was four minutes less than that for the SHS (p Fracture healing complications were similar for the two groups. There were no statistically significant differences between implants for any other recorded outcomes including the need for post-operative blood transfusion, wound healing complications, general medical complications, hospital stay or mortality. This study confirms the findings of a previous study that both methods of treatment produce similar results, although intramedullary fixation does result in marginally improved regain of mobility in comparison with the SHS. Cite this article: Bone Joint J 2017;99-B:1210-15. ©2017 The British Editorial Society of Bone & Joint Surgery.

  10. Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review.

    Science.gov (United States)

    Dunn, John; Kusnezov, Nicholas; Bader, Julia; Waterman, Brian R; Orr, Justin; Belmont, Philip J

    2016-12-01

    Both long and short cephalomedullary nails (CMN) may be used to treat trochanteric femur fractures. The objective of this paper was to compare the clinical outcomes between long and short CMN in the treatment of trochanteric hip fractures. A literature search was performed, identifying 135 papers; 4 of which met inclusion and exclusion criteria. Papers included were those that compared cohorts of long and short nails for stable trochanteric femur fractures of level III evidence or superior. Data was pooled and analyzed, focusing on reoperation rate, secondary femoral shaft fracture rate, estimated blood loss, transfusion rate, operative time and length of stay. Included in the analysis were 1276 patients, with 438 short and 838 long CMN. The average age was 82.0 years for short CMN and 79.0 years for long CMN (P = 0.0002). The average follow up was 18 months, 46 % were male, and 71 % had an ASA (American Society of Anesthesiologists score) classification ≥3. The rate of reoperation was 5.0 % and 3.8 % for short and long CMN, respectively (P = 0.31). The rate of refracture was 1.6 % and 0.95 % for short and long CMN, respectively (P = 0.41). As compared to long nails, short nails had an average blood loss of 39 mL less (P = 0.0003), an 8.8 % decrease in transfusion rate (P = 0.07), and incurred 19 min less operative time (P trochanteric femur fractures, short CMN have a low reoperation rate while significantly decreasing operative time and estimated blood loss with the additional benefit of being cost effective. Level 3.

  11. New quantitative ultrasound techniques for bone analysis at the distal radius in hip fracture cases: differences between femoral neck and trochanteric fractures.

    Science.gov (United States)

    Horii, Motoyuki; Fujiwara, Hiroyoshi; Sakai, Ryo; Sawada, Koshiro; Mikami, Yasuo; Toyama, Syogo; Ozaki, Etsuko; Kuriyama, Nagato; Kurokawa, Masao; Kubo, Toshikazu

    2017-01-01

    Ample evidence on etiological and pathological differences between femoral neck and trochanteric fracture cases suggests the possibility of individualized treatment. There are many issues related to areal bone mineral density and other quantitative computed tomography parameters of the proximal femur. Although osteoporosis is a systemic problem, little has been reported regarding differences in bone structural parameters, including bone mineral density, between them in regions other than the proximal femur. Participants were consecutive female patients >50 years of age admitted to the Saiseikai Suita Hospital (Osaka prefecture, Japan) for their first hip fracture between January 2012 and September 2014. Cortical thickness (CoTh, mm), volumetric trabecular bone mineral density (TBD, mg/cm 3 ), and elastic modulus of trabecular bone (EMTb, GPa) were obtained as the new QUS parameters using the LD-100 system (Oyo Electric, Kyoto, Japan). The mean values of these parameters were compared between femoral neck and trochanteric fracture cases. In addition, correlations between age and each QUS parameter were investigated for each fracture type. A receiver operating characteristic (ROC) curve analysis was performed to examine the degree of effect each parameter on the fracture types. The area under the curve (AUC) for each parameter was compared to the AUC for age. There were 63 cases of femoral neck fracture (mean age, 78.2 years) and 37 cases of trochanteric fracture (mean age, 85.9 years). Mean TBD and EMTb were significantly higher for femoral neck fractures. There were significant negative correlations between QUS parameters and age for femoral neck fractures (P fractures were above those for trochanteric fractures for TBD and EMTb. AUCs were 0.72 for age, and 0.61, 0.65, and 0.65 for CoTh, TBD, and EMTb, respectively. The new QUS parameters indicated that TR fracture cases were more osteoporotic than were FN fracture cases, even at the distal radius. There might be

  12. Do PFNA devices and Intertan nails both have the same effects in the treatment of trochanteric fractures? A prospective clinical study.

    Science.gov (United States)

    Seyhan, Mustafa; Turkmen, Ismail; Unay, Koray; Ozkut, Afsar Timucin

    2015-11-01

    To clinically and radiologically compare third-generation intramedullary nails used in the treatment of trochanteric hip fractures and to determine their efficacy. Seventy-five of 88 patients admitted to our hospital with trochanteric fractures were enrolled in the study; 43 were treated with PFNA devices and 32 with Intertan nails. The amount of compression applied during the procedure, duration of the procedure, amount of subsequent shortening in the proximal femoral area, subsequent backup of proximal screws, and changes in the tip-apex and tip-cortex distances were compared between groups. The postoperative change in the varus angle of the proximal femur and times to mobilization, full weight bearing, and fracture union were also evaluated. On early postoperative radiographs, the tip-apex distance was ≤25 mm in 86 % of patients in the PFNA group and 96.9 % of those in the Intertan group. Twelve months postoperatively, the tip-apex distance did not differ between groups. No cut-out of the screws into the coxofemoral joint was observed. Fracture healing was achieved in all patients. At 12 months postoperatively, the rates of proximal screw backup, proximal femoral shortening, and decrease in the varus angle of the proximal femur were significantly higher in the PFNA group than in the Intertan group. Trochanteric fractures may be treated effectively with PFNA devices or Intertan nails. During the healing period, the rates of reverse displacement of the proximal screw, shortening of the proximal femur, and decrease in the varus angle of the proximal femur were significantly higher in the PFNA group than in the Intertan group. Surgical technique, implant positioning, and the choice of implant play roles in the successful treatment of trochanteric fractures. Level 1, prospective, prognostic study.

  13. Greater Trochanteric Fixation Using a Cable System for Partial Hip Arthroplasty: A Clinical and Finite Element Analysis

    Directory of Open Access Journals (Sweden)

    Fırat Ozan

    2014-01-01

    Full Text Available The aim of the study was to investigate the efficacy of greater trochanteric fixation using a multifilament cable to ensure abductor lever arm continuity in patients with a proximal femoral fracture undergoing partial hip arthroplasty. Mean age of the patients (12 men, 20 women was 84.12 years. Mean follow-up was 13.06 months. Fixation of the dislocated greater trochanter with or without a cable following load application was assessed by finite element analysis (FEA. Radiological evaluation was based on the distance between the fracture and the union site. Harris hip score was used to evaluate final results: outcomes were excellent in 7 patients (21.8%, good in 17 patients (53.1%, average in 5 patients (15.6%, and poor in 1 patient (9.3%. Mean abduction angle was 20.21°. Union was achieved in 14 patients (43.7%, fibrous union in 12 (37.5%, and no union in 6 (18.7%. FEA showed that the maximum total displacement of the greater trochanter decreased when the fractured bone was fixed with a cable. As the force applied to the cable increased, the displacement of the fractured trochanter decreased. This technique ensures continuity of the abductor lever arm in patients with a proximal femoral fracture who are undergoing partial hip arthroplasty surgery.

  14. Greater Trochanteric Fixation Using a Cable System for Partial Hip Arthroplasty: A Clinical and Finite Element Analysis

    Science.gov (United States)

    Ozan, Fırat; Koyuncu, Şemmi; Pekedis, Mahmut; Altay, Taşkın; Yıldız, Hasan; Toker, Gökhan

    2014-01-01

    The aim of the study was to investigate the efficacy of greater trochanteric fixation using a multifilament cable to ensure abductor lever arm continuity in patients with a proximal femoral fracture undergoing partial hip arthroplasty. Mean age of the patients (12 men, 20 women) was 84.12 years. Mean follow-up was 13.06 months. Fixation of the dislocated greater trochanter with or without a cable following load application was assessed by finite element analysis (FEA). Radiological evaluation was based on the distance between the fracture and the union site. Harris hip score was used to evaluate final results: outcomes were excellent in 7 patients (21.8%), good in 17 patients (53.1%), average in 5 patients (15.6%), and poor in 1 patient (9.3%). Mean abduction angle was 20.21°. Union was achieved in 14 patients (43.7%), fibrous union in 12 (37.5%), and no union in 6 (18.7%). FEA showed that the maximum total displacement of the greater trochanter decreased when the fractured bone was fixed with a cable. As the force applied to the cable increased, the displacement of the fractured trochanter decreased. This technique ensures continuity of the abductor lever arm in patients with a proximal femoral fracture who are undergoing partial hip arthroplasty surgery. PMID:25177703

  15. An in-vitro biomechanical study of different fixation techniques for the extended trochanteric osteotomy in revision THA.

    Science.gov (United States)

    Zhu, Zhonglin; Ding, Hui; Shao, Hongyi; Zhou, Yixin; Wang, Guangzhi

    2013-04-09

    The wire fixation and the cable grip fixation have been developed for the extended trochanteric osteotomy (ETO) in the revision of total hip arthroplasty (THA). Many studies reported the postoperative performance of the patients, but with little quantitative biomechanical comparison of the two fixation systems. An in-vitro testing approach was designed to record the loosening between the femoral bed and the greater trochanter after fixations. Ten cadaveric femurs were chosen in this study. Each femur underwent the THA, revision by ETO and fixations. The tension to the greater trochanter was from 0 to 500N in vertical and lateral direction, respectively. The translation and rotation of the greater trochanter with respect to the bony bed were captured by an optical tracking system. In the vertical tension tests, the overall translation of the greater trochanter was observed 0.4 mm in the cable fixations and 7.0 mm in the wire fixations. In the lateral tension tests, the overall motion of the greater trochanter was 2.0 mm and 1.2° in the cable fixations, while it was 6.2 mm and 5.3° in the wire fixations. The result was significantly different between the two fixation systems. The stability of the proximal femur after ETO using different fixations in the revision THA was investigated. The cable grip fixation was significantly more stable than the wire fixation.

  16. What is the optimal salvage procedure for cut-out after surgical fixation of trochanteric fractures with the PFNA or TFN?: A multicentre study.

    Science.gov (United States)

    Brunner, Alexander; Büttler, Markus; Lehmann, Uwe; Frei, Hans Curd; Kratter, Renato; Di Lazzaro, Marco; Scola, Alexander; Sermon, An; Attal, Rene

    2016-02-01

    To evaluate the outcome after different types of revision operations for blade 'cut-out' and 'cut-through' after fixation of trochanteric fractures with proximal femoral nail antirotation (PFNA) or a trochanter fixation nail (TFN). Twenty hospitals participated in this multicentre study. A total of 4109 patients were retrospectively screened for cut-out or cut-through complications after nailing of trochanteric fractures using PFNA or TFN. Fifty-seven patients (28 with 'cut-through' and 29 with 'cut-out') were included in the study. In the 'cut-through' group, 16 patients underwent a blade exchange, six patients had a blade exchange with bone cement augmentation, and six received total hip arthroplasty (THA). In the 'cut-out' group, three patients had a blade exchange, one had a blade exchange with augmentation, three underwent re-nailing of the fracture with a new PFNA, one had a girdlestone procedure and 21 had THA procedures. In the 'cut-through' group, eight patients who had a blade exchanges (50%) and two patients with blade exchange and augmentation (33%) required further revision operations. THA was the definite treatment in all 6 cases. In the 'cut-out' group, two patients (66%) who had blade exchanges and two (66%) who underwent re-nailing required additional revision operations during the subsequent course. One patient (4%) who had total hip arthroplasty needed revision surgery for acetabular replacement. Overall, a total of 81 revision procedures were performed. Based on the data from this study, we recommend THA as the only valid salvage procedure for 'cut-out' and 'cut-through' of helical blades after fixation of trochanteric fractures with the PFNA and TFN. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. [Curative effect analysis on proximal frmoral nail antirotation for the treatment of femoral intertrochanteric fracture and integrity of lateral trochanteric wall].

    Science.gov (United States)

    Wei, Jie; Qin, De-an; Guo, Xiu-sheng

    2015-06-01

    To explore clinical efficacy and key matters for the treatment of femoral intertrochanteric fracture and integrity of lateral trochanteric wall by proximal frmoral nail antirotation (PFNA). From June 2010 to December 2012,210 femoral intertrochanteric fracture patients treated with PFNA were retrospectively analyzed, including 76 males and 134 females aged from 46 to 96 years old with an average of 71 years old. All fracture were caused by injury and classified to type I (5 cases) type II (16 cases), type III (73 cases) and type IV (116 cases) according to Evans classification. The time of getting out of bed, postoperative complications and displacement of screw blade and fracture healing were observed, Baumgaertner criteria were used to evaluate quality of fracture reduction, Harris criteria were used to evaulate hip joint function. All incisions were healed at stage I, no complications occurred except incomplete of lateral trochanteric wall patients without reconstruction, other patients could get out of bed with crutches at one week and all patients discharged from hospital at 10 days after operation. One hundred and seventy-eight patients were followed up from 3 to 17 months with an average of 10 months. One case occurred unhealed fracture displacement caused by screw blade cutting, 2 cases occurred screw blade transfomed to proximal and out femoral head, other patients obtained fracture healing at 12 to 16 weeks after operation. According to Baumgaertner criteria, 130 cases obtained good results, 45 cases acceptable, and 3 poor; while 107 cases obtained excellent results, 65 good, 3 good and 3 poor according to Harris score. PFNA with mechanical advantage of intramedullary fixation has advantsges of stable fixation, shorter operation time, minimally invasive. Satisfied clinical effects could obtained by grasping fixation principle, dealing with negative factors in operation. Intraoperative reconstruction for integrity of lateral trochanteric wall could assure

  18. Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in the Norwegian Hip Fracture Register.

    Science.gov (United States)

    Matre, Kjell; Havelin, Leif Ivar; Gjertsen, Jan-Erik; Vinje, Tarjei; Espehaug, Birgitte; Fevang, Jonas Meling

    2013-06-01

    Intramedullary nailing is commonly recommended as the treatment of choice for transverse/reverse oblique trochanteric (AO/OTA type A3=intertrochanteric) and subtrochanteric fractures. However, only to a limited extent is this approach supported by superior results in well designed clinical trials, and the sliding hip screw (SHS) is still a frequently used implant for these fractures. The aim of the present study was to compare IM nails and SHS in the treatment of transverse/reverse oblique trochanteric and subtrochanteric fractures using data from the Norwegian Hip Fracture Register (NHFR). Data on 2716 operations for acute transverse/reverse oblique trochanteric or subtrochanteric fractures were collected from the NHFR from 2005 to 2010. Surgeons reported patient characteristics and details from initial surgery and reoperations, and patients answered questionnaires about pain, satisfaction, and quality of life (EQ-5D) 4, 12, and 36 months postoperatively. Reoperation rates were calculated using Kaplan-Meier analyses. Primary outcome measures were pain (Visual Analogue Scale (VAS)), satisfaction (VAS), quality of life (EQ-5D), and reoperation rates at one year. The treatment groups were similar regarding age, gender, ASA-class, cognitive impairment, and preoperative EQ-5Dindex score. At one year reoperation rates were 6.4% and 3.8% for SHS and IM nails, respectively (p=0.011). Patients treated with SHS also had slightly more pain (VAS 30 vs. 27, p=0.037) and were less satisfied (VAS 31 vs. 36, p=0.003) compared to patients treated with IM nail. There was no statistically significant difference in the EQ-5Dindex score, but the mobility was significantly better for the IM nail group. 12 months postoperatively patients with transverse/reverse oblique trochanteric and subtrochanteric fractures operated with a SHS had a higher reoperation rate compared to those operated with an IM nail. Small differences regarding pain, satisfaction, quality of life, and mobility were

  19. Lateral migration with telescoping of a trochanteric fixation nail in the treatment of an intertrochanteric hip fracture.

    Science.gov (United States)

    Liu, Wanjun; Wang, Junqiang; Weaver, Michael J; Vrahas, Mark S; Zhou, Dongsheng

    2014-01-01

    The trochanteric fixation nail (TFN) can be used to treat stable and unstable fractures of intertrochanteric hip fractures. We study the common lateral migration that occurs with telescoping of intertrochanteric hip fractures treated with TFN and identify the predictors and relationships to clinical outcomes. Patient demographic information, fracture type (Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) classification), radiographic data, and clinical data were collected. Lateral migration with telescoping was measured. Statistical analyses were performed to determine which variables predicted lateral migration with telescoping. Patient outcome scores were recorded using the Modified Harris Hip Score (MHHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL), and Visual Analog Scale for pain. Two hundred and twenty-three patients (67 males, 156 females) fitted the radiographic and follow-up (average 24.6 months) criteria. The average age was 77.2 years. The average lateral migration with telescoping was 4.8 mm. Twenty-one patients (9.4%) had excessive lateral migration with telescoping ( = 10 mm). The quality of calcar reduction (P = 0.01) and unstable fracture patterns (P = 0.006) were significant predictive factors of lateral migration with telescoping. The mean outcome scores (MHHS and HOS-ADL) were 80.1 points and 78.7 points, respectively. All subjects had no significant relationship to lateral migration with telescoping (P > 0.05). Of all the patients who developed lateral migration with telescoping, only one required removal of the blade for hip pain and all patients went on to uneventful union at an average time of 4.5 months. Lateral migration with telescoping is a common mechanical complication of intertrochanteric hip fracture treated with the TFN procedure. It was predicted by the quality of calcar reduction and fracture type. However, this did not affect stable fixation and fracture healing, so rarely leads to

  20. Anterior greater trochanteric muscle pedicle bone grafting: a viable graft option adjunct to hip osteotomy or fracture surgery.

    Science.gov (United States)

    Limpaphayom, Noppachart; Osateerakun, Phatcharapa; Wilairatana, Vajara; Prasongchin, Pairatch

    2017-05-12

    The objectives were to evaluate a technique, outcome and complications following anterior greater trochanteric with gluteus medius muscle pedicle bone graft (AMG) procedure in the treatment of adolescent and active adult hip disorders. 20 patients (20 hips) with a mean age of 22.7 ± 15.6 (range 10.0-63.5) years who had undergone AMG and been followed up more than 12 months postoperative were retrospectively enrolled in our study. The AMG procedure was performed in conjunction with subcapital osteotomy for slipped capital femoral epiphysis in 12 and open reduction for fracture/dislocation in 8 hips. At the most recent evaluation, patient functional status was rated by the Harris Hip Score (HHS) and radiographic changes were graded according to Tönnis criteria. Complications were defined as Tönnis grade >2 or hip requiring further surgery. Univariate analysis was used to explore factors associated with complications. Spearman's rank correlation coefficient was calculated between HHS and Tönnis grading. At mean follow-up of 4.4 ± 2.6 (range 1.1-9.5) years, mean HHS was 87.4. Tönnis grading was rated as 0 in 10 hips, 1 in 5 hips, 2 in 2 hips, and 3 in 3 hips. Avascular necrosis of the femoral head as a complication developed in 3 hips (15%). Clinical parameters including age at surgery, duration of follow-up and diagnosis were not significantly associated with postoperative complications. A negative correlation between HHS and Tönnis grade was shown by Spearman's rank correlation (rs = -0.49, p = 0.03). The AMG can be safely recommended as an adjunct bone graft procedure when performing anterior open reduction of adolescent and active adult hip disorders.

  1. Incidence of greater trochanteric pain syndrome in patients suspected for femoroacetabular impingement evaluated using magnetic resonance arthrography of the hip.

    Science.gov (United States)

    Pozzi, Grazia; Lanza, Ezio; Parra, Cleber Garcia; Merli, Ilaria; Sconfienza, Luca Maria; Zerbi, Alberto

    2017-03-01

    We evaluated the incidence of greater trochanter pain syndrome (GTPS) in patients who underwent magnetic resonance arthrography (MRA) of the hip for a suspected femoroacetabular impingement (FAI) syndrome. Hip MRA performed at our institution (3/2012-1/2014) were reviewed. The absence/presence of FAI (cam, pincer, and mixed) was noted. GTPS diagnosis was based on gluteus medius/minimus tendinopathy/tears, trochanteric bursitis, fascia lata thickening, and trochanter bone oedema/erosion. Subgroup analysis for age (under/over 40 years) and FAI type (cam, pincer, and mixed) was also performed. N = 189 patients were included (n = 125 males; age 39 ± 12 years). FAI was diagnosed in n = 133 (70, 4%): cam type, n = 85 (63, 9%); pincer type, n = 22 (16, 6%); and mixed type, n = 26 (19, 5%). N = 72 patients (38.1%) had tendinopathy, n = 14 (7.4%) had trochanter erosion, n = 31 (16.4%) had bursitis, n = 4 had bone oedema (2.1%), and n = 3 (1.6%) had fascia lata thickening, resulting in GTPS diagnosis in n = 74 patients (39.2%). The association of normal hip morphology/GTPS was significantly higher (P = 0.023) than that of FAI/GTPS. Under 40 years, GTPS incidence was higher in patients with normal hip and pincer-type FAI (P = 0.028). Over 40 years, no difference between patients with/without FAI (P = 0.119) was seen. GTPS was more frequently observed in patients with normal hip morphology than in patients with FAI, particularly in patients under 40.

  2. Low-dose external beam radiotherapy for greater trochanteric pain syndrome. Target volume definition and treatment outcome

    International Nuclear Information System (INIS)

    Kaltenborn, Alexander; Carl, Ulrich Martin; Hinsche, Tanja; Nitsche, Mirko; Hermann, Robert Michael

    2017-01-01

    Low-dose external beam radiotherapy (ED-EBRT) is frequently used in the therapy of refractory greater trochanteric pain syndrome (GTPS). As studies reporting treatment results are scarce, we retrospectively analyzed our own patient collectives. In all, 60 patients (74 hips) received LD-EBRT (6 x 0.5 Gy in 29 hips, 6 x 1 Gy in 45). The endpoint was the patient's reported subjective response to treatment. The influence of different patient and treatment characteristics on treatment outcome was investigated. At the end of LD-EBRT, 69% reported partial remission, 4% complete remission, no change 28%. A total of 3 months later (n = 52 hips), the results were 37, 33, and 30% and 18 months after LD-EBRT (n = 47) 21, 51, and 28%. In univariate analysis ''inclusion of the total femoral head into the PTV'' and ''night pain before LD-EBRT'' were correlated with symptom remission at the end of LD-EBRT, while ''initial increase in pain during LD-EBRT'' was significantly associated with treatment failure. In multivariable modeling ''initial increase in pain'' was identified as a risk factor for treatment failure (p = 0.007; odds ratio [OR] 0.209; 95% confidence interval [CI] 0.048-0.957), while ''night pain'' was an independent factor for remission (p = 0.038; OR 3.484; 95% CI 1.004-12.6). Three months after LD-EBRT ''night pain'' and ''inclusion of the complete femoral neck circumference into the PTV'' were predictive for remission. LD-EBRT represents a useful treatment option for patients suffering from GTPS. Three months after therapy two-thirds of the patients reported a partial or complete symptom remission. Especially patients who suffered from nocturnal pain seemed to benefit. Treatment appeared to be more effective when the entire circumference of the femoral neck was encompassed. (orig.) [de

  3. Use of the Gamma3™ nail in a teaching hospital for trochanteric fractures: mechanical complications, functional outcomes, and quality of life.

    Science.gov (United States)

    Buecking, Benjamin; Bliemel, Christopher; Struewer, Johannes; Eschbach, Daphne; Ruchholtz, Steffen; Müller, Thorben

    2012-11-23

    Trochanteric fractures are common fractures in the elderly. Due to characteristic demographic changes, the incidence of these injuries is rapidly increasing. Treatment of these fractures is associated with high rates of complications. In addition, the long-term results remain poor, with high morbidity, declines in function, and high mortality. Therefore, in this study, complication rates and patients' outcomes were evaluated after fixation of geriatric trochanteric fractures using the Gamma3™ nail. Patients aged 60 years old or older, with pertrochanteric and subtrochanteric femoral fractures, were included. Patients with polytrauma or pathological fractures were excluded. Age, sex, and fracture type were collected on admission. In addition, data were recorded concerning the surgeon (resident vs. consultant), time of operation, and local or systemic perioperative complications. Complications were also collected at the 6- and 12-month follow-ups after trauma. Barthel Index, IADL, and EQ-5D measurements were evaluated retrospectively on admission, as well as at discharge and during the follow-up. Ninety patients were prospectively included between April 2009 and September 2010. The patients' average age was 81 years old, and their average ASA score was 3. The incision/suture time was 53 min (95% CI 46-60 min). Hospital mortality was 4%, and overall mortality was 22% at the 12-month follow-up. Eight local complications occurred (4 haematomas, 1 deep infection, 1 cutting out, 1 irritation of the iliotibial tract, 1 periosteosynthetic fracture). The incidence of relevant systemic complications was 6%. Forty-two percent of the patients were operated on by residents in training, without significant differences in duration of surgery, complication rate, or mortality rate. The Barthel Index (82 to 71, p fracture levels during the follow-up period of 12 months. The results showed a relatively low complication rate using the Gamma3™ nail, even if the nailing was performed

  4. Effect of greater trochanteric epiphysiodesis after femoral varus osteotomy for lateral pillar classification B and B/C border Legg-Calvé-Perthes disease: A retrospective observational study.

    Science.gov (United States)

    Kwon, Keun-Sang; Wang, Sung Il; Lee, Ju-Hyung; Moon, Young Jae; Kim, Jung Ryul

    2017-08-01

    This is a retrospective observational study. Greater trochanteric epiphysiodesis (GTE) has been recommended to prevent Trendelenburg gait and limitation of the hip joint motion due to trochanteric overgrowth after femoral varus osteotomy (FVO) in Legg-Calvé-Perthes disease (LCPD). However, capital femoral physeal arrest frequently occurs in patients with severe disease (lateral pillar C), so GTE might not be as effective in these patients. The aim of this study was to compare trochanteric growth inhibition due to GTE after FVO between 2 age groups (8 years) in patients with lateral pillar B and B/C border LCPD and evaluate the effectiveness of GTE compared with the normal, unaffected hip.This study included 19 children with lateral pillar B and B/C border LCPD in 1 leg who underwent FVO followed by GTE. Of the 19 children, 9 underwent GTE before the age of 8 years and 10 underwent GTE after 8 years of age. On radiographs taken at the immediate postoperative period and at skeletal maturity, the articulo-trochanteric distance (ATD), center-trochanteric distance (CTD), and neck-shaft angle (NSA) were compared between the 2 age groups. The amount of correction was compared between groups. The contralateral, unaffected hip was used as a control for trochanteric growth. The patients were clinically evaluated with Iowa hip score at the final follow-up.There was no significant difference between the 2 age groups in terms of time to GTE, length of follow-up, or lateral pillar classification. In the affected hip, the amount of correction of the ATD, CTD, and NSA was significantly greater in patients  8 years. However, in the unaffected hip, the change in the ATD, CTD, and NSA did not differ significantly between the 2 groups.We suggest that FVO followed by GTE for lateral pillar B and B/C border LCPD in patients under the age of 8 years can affect growth of the greater trochanter. However, effective growth inhibition due to GTE was not achieved after 8 years of age.

  5. Fracture morphology of AO/OTA 31-A trochanteric fractures: A 3D CT study with an emphasis on coronal fragments.

    Science.gov (United States)

    Cho, Jae-Woo; Kent, William T; Yoon, Yong-Cheol; Kim, Youngwoo; Kim, Hyungon; Jha, Ashutosh; Durai, Senthil Kumar; Oh, Jong-Keon

    2017-02-01

    This study was designed to assess the incidence and morphology of coronal plane fragments in AO/OTA 31-A trochanteric fractures. 156 cases of AO/OTA 31-A trochanteric fractures were retrospectively evaluated. Lateral radiographs were analyzed for the presence of coronal plane fragments followed by analysis of 3D CT reconstructions in these fractures. The incidence of coronal fragments identified on the lateral radiograph and 3D CT reconstructions were both calculated. Coronal fragment morphology was described based upon the origin and exit points of fracture lines and the number of fragments. On plain radiographs, a coronal plane fracture was identified in 59 cases, an incidence of 37.8% (59/156). In comparison, 3D CT reconstructions identified coronal plane fractures in 138 cases for an incidence of 88.4% (138/156). 3D CT reconstructions identified coronal fracture fragments in 81.9% (50/61) of AO/OTA 31-A1 cases, 94.5% (69/73) of 31-A2 cases, and 86.3% (19/22) of 31-A3 cases. Incidence of coronal fractures identified on plain radiographs of 3 AO/OTA 31-A1,A2,A3 groups was lower when compared to the incidence of coronal fractures identified on 3D CT. Of the 138 cases that had coronal plane fracture, 82 cases (59.4%) had a single coronal fragment (GT fragment 35 cases, GLT fragment 19 cases, GLPC fragment 28 cases). The remaining 56 cases (40.5%) had two coronal fragments. There is a high incidence of coronal fragments in intertrochanteric femur fractures when analyzed with 3D CT reconstructions. Our study suggests that these coronal fragments are difficult to identify on plain radiographs. Knowledge of the incidence and morphology of coronal fragments helps to avoid potential intraoperative pitfalls. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Three-dimensional bone-implant movements in trochanteric hip fractures: Precision and accuracy of radiostereometric analysis in a phantom model.

    Science.gov (United States)

    Bojan, Alicja J; Bragdon, Charles; Jönsson, Anders; Ekholm, Carl; Kärrholm, Johan

    2015-05-01

    The accuracy and precision of RSA were evaluated in the experimental study of screw cut-out complication after fixation of trochanteric fractures. A plastic bone model of a two-part trochanteric fracture was constructed with a Gamma nail implant incorporating RSA markers. The femoral head fragment was attached to a separate rotational table and the femoral shaft was mounted on the micrometer. Three main motions were simulated: Femoral head translation and rotation along the axis of the lag screw and fracture fragment translation along anatomical axes. Accuracy and precision were determined according to ISO 16,087 and ASTM standard F2385-04. Translations along the lag screw axis were measured with a precision within  ±0.14 mm and an accuracy within ±0.03 mm. With simultaneous translations along all three anatomical axes, lowest precision was measured for the x-axis (±0.29, 0.07 mm, respectively), but improved when analyzed as a vector (±0.08, 0.03 mm). The precision and accuracy of femoral head rotations were within 0.5° and 0.18°, respectively. The resolution of the RSA method tested in this model was high, though it varied depending on the type of analyzed motion. This information is valuable when selecting and interpreting outcome parameters evaluating implant migration and osteosynthesis stability in future clinical RSA studies. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  7. The Trochanteric Localization is a Mediator of Slower Short-Term Functional Recovery in Overweight and Obese Elderly Women with Recent Hip Fracture: The BREAK Study.

    Science.gov (United States)

    Gonnelli, Stefano; Caffarelli, Carla; Rossi, Stefania; Siviero, Paola; Maggi, Stefania; Crepaldi, Gaetano; Nuti, Ranuccio

    2015-12-01

    The hypothesis tested in this study, carried out on elderly Italian women with recent hip fracture, was to assess the extent to which the effect of a condition of being overweight/obese on short-term functional recovery as evaluated by the "time to permitted load" could be explained by a mediator variable (type of hip fracture). We studied 727 women aged 60 years or over with a recent low trauma surgically treated hip fracture and for whom an information on post-surgery complications and on the time to permitted load was available. To assess for mediation, the statistical analyses were carried out following the procedure described by Baron and Kenny. In this study, 46 % of women with hip fracture presented a time to permitted load of ≥ 10 days. The women with a post-surgery time to permitted load of ≥ 10 days showed a significantly higher proportion of trochanteric fracture localization (72.1 vs 42 %), of total overweight/obesity (46.5 vs 36.8 %) and of post-surgery complications (38.8 vs 18.8 %). The mediating effect of hip fracture localization on the association between overweight/obesity and the time of permitted load was demonstrated and confirmed in a multivariate logistic regression model. This study, carried out using a "mediator" statistical analysis, suggests that in elderly women with hip fracture being overweight/obese is associated with a slower short-term functional recovery as evaluated by the time to permitted load and that this association is mediated by the trochanteric localization of hip fracture.

  8. Effects of trochanteric soft tissue thickness and hip impact velocity on hip fracture in sideways fall through 3D finite element simulations.

    Science.gov (United States)

    Majumder, Santanu; Roychowdhury, Amit; Pal, Subrata

    2008-09-18

    A major worldwide health problem is hip fracture due to sideways fall among the elderly population. The effects of sideways fall on the hip are required to be investigated thoroughly. The objectives of this study are to evaluate the responses to trochanteric soft tissue thickness (T) variations and hip impact velocity (V) variations during sideways fall based on a previously developed CT scan derived 3D non-linear and non-homogeneous finite element model of pelvis-femur-soft tissue complex with simplified biomechanical representation of the whole body. This study is also aimed at quantifying the effects [peak impact force (F(max)), time to F(max), acceleration and peak principal compressive strain (epsilon(max))] of these variations (T,V) on hip fracture. It was found that under constant impact energy, for 81% decrease in T (26-5mm), F(max) and epsilon(max) increased by 38% and 97%, respectively. Hence, decrease in T (as in slimmer persons) strongly correlated to risk for hip fracture (phi) and strain ratio (SR) by 0.972 and 0.988, respectively. Also under same T and body weight, for 75% decrease in V (4.79-1.2m/s), F(max) and epsilon(max) decreased by 70% and 86%, respectively. Hence, increase in V (as in taller persons) strongly correlated to phi and SR by 0.995 and 0.984, respectively. For both variations in T and V, inter-trochanteric fracture situations were well demonstrated by phi as well as by SR and strain contours, similar to clinically observed fractures. These quantifications would be helpful for effective design of person-specific hip protective devices.

  9. Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures - postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate.

    Science.gov (United States)

    Paulsson, Johnny; Stig, Josefine Corin; Olsson, Ola

    2017-08-24

    In treatment of unstable trochanteric fractures dynamic hip screw and Medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Different treatment protocols are used by two similar Swedish regional emergency care hospitals. Dynamic hip screw is used for fractures considered as stable within the respective treatment protocol, whereas one treatment protocol (Medoff sliding plate/dynamic hip screw) uses biaxial Medoff sliding plate for unstable pertrochanteric fractures and uniaxial Medoff sliding plate for subtrochanteric fractures, the second (intramedullary nail/dynamic hip screw) uses intramedullary nail for subtrochanteric fractures and for pertrochanteric fractures with intertrochanteric comminution or subtrochanteric extension. All orthopedic surgeries are registered in a regional database. All consecutive trochanteric fracture operations during 2011-2012 (n = 856) and subsequent technical reoperations (n = 40) were derived from the database. Reoperations were analysed and classified into the categories adjustment (percutaneous removal of the locking screw of the Medoff sliding plate or the intramedullary nail, followed by fracture healing) or minor, intermediate (reosteosynthesis) or major (hip joint replacement, Girdlestone or persistent nonunion) technical complications. The relative risk of intermediate or major technical complications was 4.2 (1.2-14) times higher in unstable pertrochanteric fractures and 4.6 (1.1-19) times higher in subtrochanteric fractures with treatment protocol: intramedullary nail/dynamic hip screw, compared to treatment protocol: Medoff sliding plate/dynamic hip screw. Overall rates of intermediate and major technical complications in unstable pertrochanteric and subtrochanteric fractures were with biaxial Medoff sliding plate 0.68%, with uniaxial Medoff sliding plate 1.4%, with dynamic hip screw 3.4% and with intramedullary nail 7.2%. The

  10. Functional and Aesthetic Outcome of Reconstruction of Large Oro-Facial Defects Involving the Lip after Tumor Resection

    International Nuclear Information System (INIS)

    Denewer, A.D.; Setie, A.E.; Hussein, O.A.; Aly, O.F.

    2006-01-01

    Background: Squamous cell carcinoma of the head and neck is a challenging disease to both surgeons and radiation oncologists due to proximity of many important anatomical structures. Surgery could be curative as these cancers usually metastasize very late by blood stream. Aim of the Work: This work addresses the oncologic, functional and aesthetic factors affecting reconstruction of large orofacial defects involving the lip following tumor resection. Patients and Methods: The study reviews the surgical outcome of one hundred and twelve patients with invasive tumors at. or extending to, the lip(s). treated at the Mansoura University - Surgical Oncology Department, from January 2000 to January 2005. Tumor stage were T 2 (43), T 3 (56) and T 4 (13). Nodal state was N 0 in 80, N 1 in 29 and N 2 in three cases. AJCC stage grouping was II (T 2 N 0 ) in 33 patients. stage III (T 3 N 0 orT 1-3 N 1 ) in 64 cases and stage IV (T 4 due to bone erosion or N 2 ) in 15 cases. The technique used for lip reconstruction was unilateral or bilateral myocutaneous depressor anguli oris flap (MCDAOF) for isolated lip defect (n=63). Bilateral myocutaneous depressor anguli oris (MCDAOF) plus local cervical rotational flap chin defects (n=3). pectorals major myocutaneous pedicled flap for cheek defects involving the lip together with a tongue flap for mucosal reconstruction (n=35). sternocleidomastoid clavicular myo-osseous flap for concomitant mandibular defects (n=] 2). Results: esthetic and functional results are evaluated regarding appearance, oral incompetence, disabling microstomia and eating difficulties. depressor anguli oris reconstruction allowed functioning static and dynamic oral function in all cases in contrast to the Pectorals major flap. there were 18 cases of oral incompetence (46.1%), nine cases of speech difficulty (23%) and five patients with poor cosmetic appearance within the second group total flap loss was not encountered, Partial nap loss affected thirteen

  11. Low-dose external beam radiotherapy for greater trochanteric pain syndrome. Target volume definition and treatment outcome

    Energy Technology Data Exchange (ETDEWEB)

    Kaltenborn, Alexander [Federal Armed Forces Hospital Westerstede, Department of Orthopedic and Trauma Surgery, Westerstede (Germany); Hannover Medical School, Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover (Germany); Carl, Ulrich Martin; Hinsche, Tanja [Center for Radiotherapy and Radiooncology Bremen and Westerstede, Westerstede (Germany); Nitsche, Mirko [Center for Radiotherapy and Radiooncology Bremen and Westerstede, Westerstede (Germany); University of Schleswig Holstein, Campus Kiel, Department of Radiotherapy, Karl-Lennert Cancer Center, Kiel (Germany); Hermann, Robert Michael [Center for Radiotherapy and Radiooncology Bremen and Westerstede, Westerstede (Germany); Hannover Medical School, Department of Radiotherapy and Special Oncology, Hannover (Germany)

    2017-04-15

    Low-dose external beam radiotherapy (ED-EBRT) is frequently used in the therapy of refractory greater trochanteric pain syndrome (GTPS). As studies reporting treatment results are scarce, we retrospectively analyzed our own patient collectives. In all, 60 patients (74 hips) received LD-EBRT (6 x 0.5 Gy in 29 hips, 6 x 1 Gy in 45). The endpoint was the patient's reported subjective response to treatment. The influence of different patient and treatment characteristics on treatment outcome was investigated. At the end of LD-EBRT, 69% reported partial remission, 4% complete remission, no change 28%. A total of 3 months later (n = 52 hips), the results were 37, 33, and 30% and 18 months after LD-EBRT (n = 47) 21, 51, and 28%. In univariate analysis ''inclusion of the total femoral head into the PTV'' and ''night pain before LD-EBRT'' were correlated with symptom remission at the end of LD-EBRT, while ''initial increase in pain during LD-EBRT'' was significantly associated with treatment failure. In multivariable modeling ''initial increase in pain'' was identified as a risk factor for treatment failure (p = 0.007; odds ratio [OR] 0.209; 95% confidence interval [CI] 0.048-0.957), while ''night pain'' was an independent factor for remission (p = 0.038; OR 3.484; 95% CI 1.004-12.6). Three months after LD-EBRT ''night pain'' and ''inclusion of the complete femoral neck circumference into the PTV'' were predictive for remission. LD-EBRT represents a useful treatment option for patients suffering from GTPS. Three months after therapy two-thirds of the patients reported a partial or complete symptom remission. Especially patients who suffered from nocturnal pain seemed to benefit. Treatment appeared to be more effective when the entire circumference of the femoral neck was encompassed. (orig.) [German] In der Behandlung des

  12. Prospective study of the reproducibility of X-rays and CT scans for assessing trochanteric fracture comminution in the elderly: a series of 110 cases.

    Science.gov (United States)

    Isida, Ronald; Bariatinsky, Varenka; Kern, Gregory; Dereudre, Gregoire; Demondion, Xavier; Chantelot, Christophe

    2015-10-01

    Trochanteric fractures are common but difficult to analyse in the elderly on plain X-rays. Fixation failures are related to the severity of the comminution, but comminution and the degree of instability are not easy to determine on standard X-rays. Use of computed tomography (CT) improves assessment of complex fractures, but this finding has not been confirmed versus intraoperative data. The primary objective of this prospective study was to determine the error rate when evaluating comminution on X-rays and CT scans. The secondary objectives were to determine whether CT data on comminution and stability were consistent with intraoperative findings and to define the fracture characteristics. Standard X-ray assessment underestimates the complexity of trochanteric fractures and is not very reproducible. Between January and December 2013, all proximal femur fractures in the trochanter area of patients aged 75 years or older (mean age 85) were analysed prospectively with standard X-rays and computed tomography (CT). One hundred and ten patients (88 women and 22 men) with trochanteric fractures were included in the study. Fracture stability was evaluated using the Müller AO classification; the other fracture characteristics were evaluated independently. A senior surgeon evaluated the anonymised X-rays. A radiologist specialised in musculoskeletal imaging interpreted the CT scan images. All patients underwent total hip arthroplasty (110 patients) and 104 fixations of the greater trochanter. The X-ray and CT findings were compared to the intraoperative findings (gold standard) to evaluate their reproducibility. The reproducibility of the X-ray evaluation was poor for comminution, with a kappa of 0.4, sensitivity of 44 % and a negative predictive value of 29 % but a positive predictive value and specificity of 100 %. The CT evaluation had a kappa of 0.94, sensitivity of 95 % and negative predictive value of 79 %. According to the AO classification, unstable fractures were

  13. A computational study on the effect of fracture intrusion distance in three- and four-part trochanteric fractures treated with Gamma nail and sliding hip screw.

    Science.gov (United States)

    Goffin, Jérôme M; Pankaj, Pankaj; Simpson, A Hamish

    2014-01-01

    Using finite element analysis, the behaviors of the Gamma nail and the sliding hip screw (SHS) were compared in an osteoporotic bone model for the fixation of three- and four-part trochanteric fractures (31-A2 in the AO classification, types IV and V in Evans' classification). The size of the medial fragment was varied based on clinical data, and the case of a fractured greater trochanter was also considered. Our results showed that for Evans' type V stabilized with a Gamma nail and for Evans' types IV and V with the SHS, cancellous bone around the lag screw is susceptible to yielding, thus indicating a risk of cut-out. The volume of bone susceptible to yielding increases with an increase in size of the medial fragment. Conversely, Evans' type IV with a Gamma nail was not predicted to cut out. Our findings suggest that future clinical trials investigating fixation of unstable proximal fractures should include the size of the medial fragment and the integrity of the greater trochanter as covariables and be powered to evaluate whether intramedullary devices are superior to SHSs for Evans' type IV fractures and inferior/equivalent for type V. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  14. Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures.

    Science.gov (United States)

    Makki, Daoud; Matar, Hosam E; Jacob, Nebu; Lipscombe, Stephen; Gudena, Ravindra

    2015-12-01

    Reverse oblique intertrochanteric fractures have unique mechanical characteristics and are often treated with intramedullary implants. We compared the outcomes of the reconstruction trochanteric antegrade nail (TAN) with the proximal femoral nail antirotation (PFNA). Between July 2008 and February 2014, we reviewed all patients with reverse oblique intertrochanteric fractures treated at our hospital. Patients with pathological fractures and those who were treated with other than TAN and PFNA nailing systems were excluded. Preoperative assessment included the Abbreviated mental test score (AMT), the ASA grade, pre-injury mobility and place of residence. Postoperative outcome measures included the type of implant used, time to fracture union, failures of fixation and revision surgeries. Fifty-eight patients were included and divided into two groups based on the treatment: 22 patients treated with TAN and 36 patients treated with PFNA systems. The two groups were well matched with regards to demographics and fracture type. The overall union rate was similar in both groups but the time to union was shorter in the TAN group. There were 8 implant failures in the PFNA (22.2%) group compare to none in the TAN group. Implant failure was associated with the severity of fracture (AO 31.A3.3) but was not related to fracture malreduction or screw position (Tip-apex-distance). Our study suggests that the use of reconstruction system with two screws such as TAN may be more suitable implant for reverse oblique intertrochanteric hip fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. [Thigh and leg musculo-cutaneous island flap for giant bilateral trochanteric and perineal pressure sores coverage: Extreme treatment in spinal cord injury].

    Science.gov (United States)

    André, A; Crouzet, C; De Boissezon, X; Grolleau, J-L

    2015-06-01

    Surgical treatment of perineal pressure sores could be done with various fascio-cutaneous or musculo-cutaneous flaps, which provide cover and filling of most of pressure sores after spinal cord injuries. In rare cases, classical solutions are overtaken, then it is necessary to use more complex techniques. We report a case of a made-to-measure lower limb flap for coverage of confluent perineal pressure sores. A 49-year-old paraplegic patient developed multiple pressure sores on left and right ischial tuberosity, inferior pubic bone and bilateral trochanters with hips dislocation. Surgical treatment involved a whole right thigh flap to cover and fill right side lesions, associated to a posterior right leg musculo-cutaneous island flap to cover and fill the left trochanteric pressure sore. The surgical procedure lasted 6.5 hours and required massive blood transfusion. Antibiotics were adapted to bacteriological samples. There were no postoperative complications; complete wound healing occurred after three weeks. A lower limb sacrifice for coverage of a giant perineal pressure sores is an extreme surgical solution, reserved to patients understanding the issues of this last chance procedure. A good knowledge of vascular anatomy is an essential prerequisite, and allows to shape made-to-measure flaps. The success of such a procedure is closely linked to the collaboration with the rehabilitation team (appropriate therapeutic education concerning transfers and positioning). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. PROSPECTIVE ASSESSMENT OF THE CLINICAL, RADIOGRAPHIC AND FUNCTIONAL EVOLUTION OF TREATMENT FOR UNSTABLE TROCHANTERIC FRACTURES OF THE FEMUR USING A CEPHALOMEDULLARY NAIL.

    Science.gov (United States)

    Borger, Richard Armelin; Borger, Frederico Araújo; Pires de Araújo, Rodrigo; Pereira, Thiago Ferreira Nunes; Queiroz, Roberto Dantas

    2011-01-01

    To assess the clinical, radiological and functional evolution of osteosynthesis using a cephalomedullary nail, in unstable trochanteric fractures of the femur, over a one-year postoperative follow-up. Fourteen men and 23 women of mean age 77.7 years were evaluated. Twenty-seven of them had fractures classified as AO/ASIF 31A2 and ten as 31A3. The patients were evaluated clinically, radiologically and functionally one week, two weeks, one month, two months, six months and one year after the operation. The clinical complications comprised five cases of death, one case of calcaneal ulcer, one case of acute arterial obstruction and two cases of deep vein thrombosis. The radiographic evaluation showed that the mean cervicodiaphyseal angle in the immediate postoperative period was 132.5°. The mean tip-apex index was 22.8 mm. After one year, the mean cervicodiaphyseal angle was 131.7°. Fracture consolidation was seen in all the patients six months after the operation, except in one case that presented cut-out. There were no cases of fracture below the implant. The functional evaluation using the Harris score after one year showed a mean of 69.3 points. The evaluation of walking progress showed that after one year, 40.6% of the patients had the same ability to walk that they had before the fracture. The visual analogue pain scale showed that a significant decrease in pain complaints occurred, going from 5.19 in the first week to 2.25 after 1 year. Osteosynthesis using a cephalomedullary nail resulted in low rates of clinical and mechanical complications and adequate functional outcomes.

  17. Femoral Medialization, Fixation Failures, and Functional Outcome in Trochanteric Hip Fractures Treated With Either a Sliding Hip Screw or an Intramedullary Nail From Within a Randomized Trial.

    Science.gov (United States)

    Bretherton, Christopher P; Parker, Martyn J

    2016-12-01

    The aim of this study was to determine if femoral medialization influences residual pain and mobility and to determine if fixation method or fracture pattern influences the tendency to medialize. This study used data from within a randomized controlled trial. Peterborough City Hospital, UK. Eight hundred forty-four patients presenting with a trochanteric hip fracture were randomized. Five hundred thirty-eight were available for 1-year follow-up. Fractures were classified according to OTA/AO classification as 31 A1, A2, and A3. Randomized to fixation with a Targon proximal femoral nail or sliding hip screw (SHS). Femoral medialization was calculated from follow-up x-rays at a minimum of 28 days post-fixation. Pain and mobility scores were assessed at 1 year by an independent blinded observer. Fixation failure and revision procedures were assessed at a minimum of 1 year from injury. Patients with >50% medialization had worse pain (P = 0.012) and mobility scores (P = 0.013) at 1 year. They also had more fracture healing complications (P = 0.021) and required more revision procedures (P = 0.014). Fractures treated with SHS were more likely to medialize >50% compared with intramedullary nail (P fractures were more likely to medialize, and A3 fractures were more likely to undergo >50% medialization (P fractures treated with SHS to undergo femoral medialization and correlates this with worse functional outcomes. It supports the use of intramedullary nails for A3 fractures, which have a significant tendency to medialize. Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.

  18. Treatment for Trochanteric Fracture of the Femur with Short Femoral Nail: A Comparison between the Asian Intramedullary Hip Screw (IMHS) and the Conventional IMHS.

    Science.gov (United States)

    Kawaji, Hidemi; Uematsu, Takuya; Oba, Ryosuke; Satake, Yoshihiko; Hoshikawa, Naoya; Takai, Shinro

    2016-01-01

    We usually use short femoral nails for the treatment of trochanteric fracture of the femur. In this retrospective study, we investigated and compared the clinical results of the conventional intramedullary hip screw (IMHS) and the Asian IMHS, which is a redesigned version of the former. The subjects were 42 patients; 21 treated with the Asian IMHS and 21 were treated with the conventional IMHS. From the clinical records, we retrospectively investigated the patients' age, sex, in-hospital waiting period for operation, operating time, intraoperative blood loss, walking ability before fracture and at discharge, and complication pertaining to the operation. The 21 patients (4 men and 17 women) receiving the Asian IMHS and the 21 patients (5 men and 16 women) receiving the conventional IMHS did not differ significantly in mean age, sex ratio, preoperative waiting period, mean postoperative hospital stay, mean operation time, or mean intraoperative blood loss. Among patients receiving the Asian IMHS, the complications of intraoperative fractures of the femur developed in 3 patients and breakage of the implant occurred in 1 patient. No complications occurred in patients receiving the conventional IMHS. Compared with the conventional IMHS, the Asian IMHS is smaller, has increased variations in the shaft/neck angle of the lag screw, and has a titanium-alloy construction, allowing magnetic resonance imaging. The intraoperative fracture may have occurred because of the configuration of the distal interlocking screw in the Asian IMHS. Breakage of the implant likely occurred because the nail was too small in diameter, and too short in length for the unstable AO 31-A3 fracture. If careful attention is paid to the configuration of its distal interlocking screw intraoperatively and a nail of appropriate size is selected, the Asian IMHS is better suited than the conventional IMHS for treating Japanese patients, who generally have a small physique, because of its many variations in

  19. The relationship of femoral neck shaft angle and adiposity to greater trochanteric pain syndrome in women. A case control morphology and anthropometric study

    Science.gov (United States)

    Fearon, AM; Stephens, S; Cook, JL; Smith, PN; Neeman, T; Cormick, W; Scarvell, JM

    2012-01-01

    Objective To evaluate if pelvic or hip width predisposed women to developing greater trochanteric pain syndrome (GTPS). Design Prospective case control study. Participants Four groups were included in the study: those gluteal tendon reconstructions (n=31, GTR), those with conservatively managed GTPS (n=29), those with hip osteoarthritis (n=20, OA) and 22 asymptomatic participants (ASC). Methods Anterior-posterior pelvic x-rays were evaluated for femoral neck shaft angle; acetabular index, and width at the lateral acetabulum, and the superior and lateral aspects of the greater trochanter. Body mass index, and waist, hip and greater trochanter girth were measured. Data were analysed using a one-way analysis of variance (ANOVA; posthoc Scheffe analysis), then multivariate analysis. Results The GTR group had a lower femoral neck shaft angle than the other groups (p=0.007). The OR (95% CI) of having a neck shaft angle of less than 134°, relative to the ASC group: GTR=3.33 (1.26 to 8.85); GTPS=1.4 (0.52 to 3.75); OA=0.85 (0.28 to 2.61). The OR of GTR relative to GTPS was 2.4 (1.01 to 5.6). No group difference was found for acetabular or greater trochanter width. Greater trochanter girth produced the only anthropometric group difference (mean (95% CI) in cm) GTR=103.8 (100.3 to 107.3), GTPS=105.9 (100.2 to 111.6), OA=100.3 (97.7 to 103.9), ASC=99.1 (94.7 to 103.5), (ANOVA: p=0.036). Multivariate analysis confirmed adiposity is associated with GTPS. Conclusion A lower neck shaft angle is a risk factor for, and adiposity is associated with, GTPS in women. PMID:22547561

  20. Subtrochanteric femoral fractures treated with the Long Gamma3® nail: A historical control case study versus Long trochanteric Gamma nail®.

    Science.gov (United States)

    Georgiannos, D; Lampridis, V; Bisbinas, I

    2015-10-01

    Gamma nail was developed for the treatment of subtrochanteric hip fractures. Despite its advantages over extramedullary devices, gamma nail has been historically related to significant complications (implant breakage, femoral fractures at the tip of the nail). There is limited data to determine if the rate of these complications was minimized by using a new design of the gamma nail. Therefore we performed a case control study between the long gamma3 nail (LG3N) and the long trochanteric gamma nail (LTGN) to assess if: (1) the complication rate in the treatment of subtrochanteric fractures using the LG3N was lower than the one using the LTGN; (2) the reoperation rate was lower after using the LG3N. The complication rate after fixation of subtrochanteric fracture of the femur is lower with LG3N than with the LTGN. This study prospectively recorded the intra- and postoperative complications of 75 patients with subtrochanteric fractures treated with the LG3N and compared them with those of a historical cohort of 83 patients treated with the LTGN. The two groups were matched regarding age, gender and fracture type. Patients with open, pathological, or impending fractures were excluded. Intraoperative complications in the LG3N group were lower (4 cases, 5.3%) compared with those in the LTGN group (9 cases, 10.8%; P=0.04). The major intraoperative complication encountered with the use of LTGN was fracture of the femur in 3 cases. We encountered in total 9 postoperative complications in LG3N (12%) and 20 in group LTGN (24%). The most frequent complication in both groups was the cut out of the lag screw (3 cases in LG3N and 7 cases in LTGN group). The overall reoperation rate was higher in LTGN group (20.4% vs 10.6%; P=0.03). As a result of the improvement of its mechanical characteristics, LG3N has proved a safe and efficient implant for the treatment of subtochanteric fractures. The new design seems superior to previous generation, giving promising outcomes, reduced

  1. Colgajo en hacha de tensor de fascia lata para úlceras por presión trocantereas Hatchet-Shaped fascia lata tensor flap for the treatment of trochanteric pressure sores

    Directory of Open Access Journals (Sweden)

    W. Calderón

    2010-12-01

    Full Text Available Las úlceras trocantéreas por presión representan un problema importante a nivel extra e intrahospitalario. Existen múltiples opciones terapéuticas, ya sean colgajos randomizados, musculocutáneos, fasciocutáneos o libres. Presentamos la técnica quirúrgica del colgajo en hacha de tensor de fascia lata para el tratamiento de esta patología. Consiste en el diseño de un colgajo en V con irrigación por su base superior, que contacta con la úlcera por uno de sus extremos, simulando la forma de un hacha. Resecamos la úlcera hasta obtener un lecho vital, resecando además el hueso prominente dicho hasta un plano en que se visualice tejido sano. Levantamos y rotamos el colgajo cubriendo el defecto. Finalmente se realiza el cierre primario en VY sin tensión. La zona donante permite un cierre primario sin tensión. Mantenemos drenajes durante 10 días. Este colgajo permite obtener una buena cobertura para úlceras trocantéreas por decúbito con un adecuado resultado cosmético. Recogemos una casuística de 17 úlceras tratadas mediante el colgajo descrito; como complicaciones se presentaron 3 seromas, resueltos con sistema de cierre con presión negativa externa e interna; 2 casos de dehiscencia de sutura y 2 hematomas resueltos en pabellón de cirugía. Creemos pertinente conocer este colgajo que debe estar siempre presente dentro de las posibilidades terapéuticas para pacientes con úlceras trocantereas por decúbito.The trochanteric pressure sore it´s an important intra and extrahospitalary problem. There are different therapeutic options for this pathology, for example random, musculocutaneous, fasciocutaneous or free flaps. We present the hatchet-shaped fascia lata tensor flap to treat this kind of lesions. We design a V flap with irrigation in the superior base, having one of the extreme in contact with the sore. The shape of the flap is a hatchet. It´s important to get a vital bed resecting affected tissues and prominent bone; then

  2. Rotationally Stable Screw-Anchor With Locked Trochanteric Stabilizing Plate Versus Proximal Femoral Nail Antirotation in the Treatment of AO/OTA 31A2.2 Fracture: A Biomechanical Evaluation.

    Science.gov (United States)

    Knobe, Matthias; Nagel, Philipp; Maier, Klaus-Jürgen; Gradl, Gertraud; Buecking, Benjamin; Sönmez, Tolga T; Modabber, Ali; Prescher, Andreas; Pape, Hans-Christoph

    2016-01-01

    Third-generation cephalomedullary nails currently represent the gold standard in the treatment of unstable trochanteric femur fractures. Recently, an extramedullary rotationally stable screw-anchor system (RoSA) has been developed. It was designed to combine the benefits of screw and blade and to improve stability using a locked trochanteric stabilizing plate (TSP). The purpose of this study was to compare the biomechanical behavior of RoSA/TSP and the proximal femoral nail antirotation (PFNA). Standardized AO/OTA 31A2.2 fractures were induced by an oscillating saw in 10 paired human specimens (n = 20; mean age = 85 years; range: 71-96 years). The fractures were stabilized by either the RoSA/TSP (Koenigsee Implants, Allendorf, Germany) or the PFNA (DePuy Synthes, Zuchwil, Switzerland). Femurs were positioned in 25 degrees of adduction and 10 degrees of posterior flexion and were cyclically loaded with axial sinusoidal pattern at 0.5 Hz, starting at 300 N, with stepwise increase by 300 N every 500 cycles until bone-implant failure occurred. After every load step, the samples were measured visually and radiographically. Femoral head migration was assessed. The stiffness at the load up to the clinically relevant load step of 1800 N (639 ± 378 N/mm (RoSA/TSP) vs. 673 ± 227 N/mm (PFNA); P = 0.542) was comparable, as was the failure load (3000 ± 787 N vs. 3780 ± 874 N; P = 0.059). Up to 1800 N, no femoral head rotation, head migration, or femoral neck shortening were observed either for RoSA/TSP or PFNA. Whereas failure of the PFNA subsumed fractures of the greater trochanter and the lateral wall, a posterior femoral neck fracture with a significantly increased femoral neck shortening (1.7 mm vs. 0 mm; P = 0.012) was the cause of failure with RoSA/TSP. This specific kind of failure was induced by a femoral neck weakening caused by the posterior TSP stabilizing screw. There was no significant difference in biomechanical properties between the RoSA/TSP and the PFNA for

  3. Large deviations

    CERN Document Server

    Varadhan, S R S

    2016-01-01

    The theory of large deviations deals with rates at which probabilities of certain events decay as a natural parameter in the problem varies. This book, which is based on a graduate course on large deviations at the Courant Institute, focuses on three concrete sets of examples: (i) diffusions with small noise and the exit problem, (ii) large time behavior of Markov processes and their connection to the Feynman-Kac formula and the related large deviation behavior of the number of distinct sites visited by a random walk, and (iii) interacting particle systems, their scaling limits, and large deviations from their expected limits. For the most part the examples are worked out in detail, and in the process the subject of large deviations is developed. The book will give the reader a flavor of how large deviation theory can help in problems that are not posed directly in terms of large deviations. The reader is assumed to have some familiarity with probability, Markov processes, and interacting particle systems.

  4. Avaliação do emprego da haste femoral curta na fratura trocantérica instável do fêmur Evaluating the use of a proximal femoral nail in unstable trochanteric fracture of the femur

    Directory of Open Access Journals (Sweden)

    João Antonio Matheus Guimarães

    2008-09-01

    , devido a uma redução inadequada em varo, ocorreu um cutout que necessitou de revisão cirúrgica. Outro caso de fratura do tipo 31A2, evoluiu para necrose avascular da cabeça femoral, após consolidação da fratura. Por fim, um caso de fratura do tipo 31A3, devido a redução inadequada no plano sagital, evoluiu para retarde de consolidação, com quebra da haste após 13 meses da cirurgia. CONCLUSÃO: A osteossíntese com haste proximal, como tratamento da fratura trocantérica instável do fêmur realizada em pacientes com idade superior a 60 anos, resultou na consolidação da maioria dos casos. As complicações foram distintas nos dois subgrupos estudados. A redução adequada da fratura antes da introdução da haste intramedular é fundamental para o sucesso do procedimento.OBJECTIVE: Identifying the rate of healing of unstable trochanteric fractures submitted to osteosynthesis with a proximal femoral nail (PFN® - AO/ASIF, in patients operated on between November 1999 and March 2004. METHODS: 45 patients were analyzed, ages ranging from 60 to 93, with unstable trochanteric fractures of the femur submitted to osteosynthesis with short PFN®, with indirect reduction in a traction device guided by radioscopy. The fractures were classified according to the AO/OTA classification. Bone quality was evaluated by the Singh index in the post-operative radiographic routine. The quality of the reduction achieved and the positioning of the implant were evaluated by post-operative anteroposterior and profile X-ray of the proximal femur, with analysis of the cervicodiaphyseal angle and the distance between the tip of the sliding nail and the center of the femoral head, the so-called "tip apex distance" (TAD. RESULTS: The mean age of patients studied was 80.8 years (60-93. Females prevailed, with 37 cases (82.2%. The right side was involved in 22 cases (48.89% and the left side, in 23 (51.1%. All fractures were unstable, 22 of them of the type 31A2 (48.8%, and 23, of the

  5. Do thoraco-lumbar spinal injuries classification systems exhibit lower inter- and intra-observer agreement than other fractures classifications?: A comparison using fractures of the trochanteric area of the proximal femur as contrast model.

    Science.gov (United States)

    Urrutia, Julio; Zamora, Tomas; Klaber, Ianiv; Carmona, Maximiliano; Palma, Joaquin; Campos, Mauricio; Yurac, Ratko

    2016-04-01

    It has been postulated that the complex patterns of spinal injuries have prevented adequate agreement using thoraco-lumbar spinal injuries (TLSI) classifications; however, limb fracture classifications have also shown variable agreements. This study compared agreement using two TLSI classifications with agreement using two classifications of fractures of the trochanteric area of the proximal femur (FTAPF). Six evaluators classified the radiographs and computed tomography scans of 70 patients with acute TLSI using the Denis and the new AO Spine thoraco-lumbar injury classifications. Additionally, six evaluators classified the radiographs of 70 patients with FTAPF using the Tronzo and the AO schemes. Six weeks later, all cases were presented in a random sequence for repeat assessment. The Kappa coefficient (κ) was used to determine agreement. Inter-observer agreement: For TLSI, using the AOSpine classification, the mean κ was 0.62 (0.57-0.66) considering fracture types, and 0.55 (0.52-0.57) considering sub-types; using the Denis classification, κ was 0.62 (0.59-0.65). For FTAPF, with the AO scheme, the mean κ was 0.58 (0.54-0.63) considering fracture types and 0.31 (0.28-0.33) considering sub-types; for the Tronzo classification, κ was 0.54 (0.50-0.57). Intra-observer agreement: For TLSI, using the AOSpine scheme, the mean κ was 0.77 (0.72-0.83) considering fracture types, and 0.71 (0.67-0.76) considering sub-types; for the Denis classification, κ was 0.76 (0.71-0.81). For FTAPF, with the AO scheme, the mean κ was 0.75 (0.69-0.81) considering fracture types and 0.45 (0.39-0.51) considering sub-types; for the Tronzo classification, κ was 0.64 (0.58-0.70). Using the main types of AO classifications, inter- and intra-observer agreement of TLSI were comparable to agreement evaluating FTAPF; including sub-types, inter- and intra-observer agreement evaluating TLSI were significantly better than assessing FTAPF. Inter- and intra-observer agreements using the Denis

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

    Science.gov (United States)

    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.

  7. Large deviations

    CERN Document Server

    Deuschel, Jean-Dominique; Deuschel, Jean-Dominique

    2001-01-01

    This is the second printing of the book first published in 1988. The first four chapters of the volume are based on lectures given by Stroock at MIT in 1987. They form an introduction to the basic ideas of the theory of large deviations and make a suitable package on which to base a semester-length course for advanced graduate students with a strong background in analysis and some probability theory. A large selection of exercises presents important material and many applications. The last two chapters present various non-uniform results (Chapter 5) and outline the analytic approach that allow

  8. A COMPARATIVE STUDY OF PROXIMAL FEMUR LOCKING COMPRESSION PLATE VERSUS PROXIMAL FEMORAL NAILING IN THE MANAGEMENT OF COMMINUTED TROCHANTERIC AND SUBTROCHANTERIC FRACTURE

    Directory of Open Access Journals (Sweden)

    Satish Koti

    2016-11-01

    Full Text Available BACKGROUND Fractures of proximal femur and hip are relatively common injuries in elderly individuals constituting 11.6% of total fractures. The latest implant for management of intertrochanteric fracture is Proximal Femoral Locking Compression Plate (PF-LCP. In this study, we compare the clinical outcome of fractures treated by proximal femoral nail with that of proximal femur locking compression plate. MATERIALS AND METHODS The present study consists of 24 elderly patients of peritrochanteric factures of femur satisfying the inclusion criteria who were treated with PF-LCP or PFN in Department of Orthopaedics, S.V.R.R.G.G.H, Tirupati, during a period between December 2013 to October 2015. RESULTS 24 cases were treated with PF-LCP or PFN in a randomised pattern who satisfied inclusion criteria. Intraoperative complication were found to be more with PF-LCP in contrast to PFN. Postoperative rehabilitation was easier with PFN though not statistically significant functional and anatomical outcomes were found to be better with PFN. CONCLUSION Both PFN and PF-LCP have good effectiveness in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in the elderly patients. Each has its own advantages and disadvantages. Further studies with large number of patients and long-term follow up is needed to determine the optimal implant for the internal fixation of comminuted pertrochanteric femoral fractures.

  9. Large ethics.

    Science.gov (United States)

    Chambers, David W

    2008-01-01

    This essay presents an alternative to the traditional view that ethics means judging individual behavior against standards of right and wrong. Instead, ethics is understood as creating ethical communities through the promises we make to each other. The "aim" of ethics is to demonstrate in our own behavior a credible willingness to work to create a mutually better world. The "game" of ethics then becomes searching for strategies that overlap with others' strategies so that we are all better for intending to act on a basis of reciprocal trust. This is a difficult process because we have partial, simultaneous, shifting, and inconsistent views of the world. But despite the reality that we each "frame" ethics in personal terms, it is still possible to create sufficient common understanding to prosper together. Large ethics does not make it a prerequisite for moral behavior that everyone adheres to a universally agreed set of ethical principles; all that is necessary is sufficient overlap in commitment to searching for better alternatives.

  10. Instantons and Large N

    Science.gov (United States)

    Mariño, Marcos

    2015-09-01

    Preface; Part I. Instantons: 1. Instantons in quantum mechanics; 2. Unstable vacua in quantum field theory; 3. Large order behavior and Borel summability; 4. Non-perturbative aspects of Yang-Mills theories; 5. Instantons and fermions; Part II. Large N: 6. Sigma models at large N; 7. The 1=N expansion in QCD; 8. Matrix models and matrix quantum mechanics at large N; 9. Large N QCD in two dimensions; 10. Instantons at large N; Appendix A. Harmonic analysis on S3; Appendix B. Heat kernel and zeta functions; Appendix C. Effective action for large N sigma models; References; Author index; Subject index.

  11. Large Neighborhood Search

    DEFF Research Database (Denmark)

    Pisinger, David; Røpke, Stefan

    2010-01-01

    Heuristics based on large neighborhood search have recently shown outstanding results in solving various transportation and scheduling problems. Large neighborhood search methods explore a complex neighborhood by use of heuristics. Using large neighborhoods makes it possible to find better...... candidate solutions in each iteration and hence traverse a more promising search path. Starting from the large neighborhood search method,we give an overview of very large scale neighborhood search methods and discuss recent variants and extensions like variable depth search and adaptive large neighborhood...

  12. Large scale electrolysers

    International Nuclear Information System (INIS)

    B Bello; M Junker

    2006-01-01

    Hydrogen production by water electrolysis represents nearly 4 % of the world hydrogen production. Future development of hydrogen vehicles will require large quantities of hydrogen. Installation of large scale hydrogen production plants will be needed. In this context, development of low cost large scale electrolysers that could use 'clean power' seems necessary. ALPHEA HYDROGEN, an European network and center of expertise on hydrogen and fuel cells, has performed for its members a study in 2005 to evaluate the potential of large scale electrolysers to produce hydrogen in the future. The different electrolysis technologies were compared. Then, a state of art of the electrolysis modules currently available was made. A review of the large scale electrolysis plants that have been installed in the world was also realized. The main projects related to large scale electrolysis were also listed. Economy of large scale electrolysers has been discussed. The influence of energy prices on the hydrogen production cost by large scale electrolysis was evaluated. (authors)

  13. Large Pelagics Intercept Survey

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Large Pelagics Intercept Survey (LPIS) is a dockside survey of private and charterboat captains who have just completed fishing trips directed at large pelagic...

  14. Large electrostatic accelerators

    International Nuclear Information System (INIS)

    Jones, C.M.

    1984-01-01

    The paper is divided into four parts: a discussion of the motivation for the construction of large electrostatic accelerators, a description and discussion of several large electrostatic accelerators which have been recently completed or are under construction, a description of several recent innovations which may be expected to improve the performance of large electrostatic accelerators in the future, and a description of an innovative new large electrostatic accelerator whose construction is scheduled to begin next year

  15. Large mass storage facility

    International Nuclear Information System (INIS)

    Peskin, A.M.

    1978-01-01

    The report of a committee to study the questions surrounding possible acquisition of a large mass-storage device is presented. The current computing environment at BNL and justification for an online large mass storage device are briefly discussed. Possible devices to meet the requirements of large mass storage are surveyed, including future devices. The future computing needs of BNL are prognosticated. 2 figures, 4 tables

  16. Large N Scalars

    DEFF Research Database (Denmark)

    Sannino, Francesco

    2016-01-01

    We construct effective Lagrangians, and corresponding counting schemes, valid to describe the dynamics of the lowest lying large N stable massive composite state emerging in strongly coupled theories. The large N counting rules can now be employed when computing quantum corrections via an effective...

  17. Large bowel resection

    Science.gov (United States)

    ... blockage in the intestine due to scar tissue Colon cancer Diverticular disease (disease of the large bowel) Other reasons for bowel resection are: Familial polyposis (polyps are growths on the lining of the colon or rectum) Injuries that damage the large bowel ...

  18. Adaptive Large Neighbourhood Search

    DEFF Research Database (Denmark)

    Røpke, Stefan

    Large neighborhood search is a metaheuristic that has gained popularity in recent years. The heuristic repeatedly moves from solution to solution by first partially destroying the solution and then repairing it. The best solution observed during this search is presented as the final solution....... This tutorial introduces the large neighborhood search metaheuristic and the variant adaptive large neighborhood search that dynamically tunes parameters of the heuristic while it is running. Both heuristics belong to a broader class of heuristics that are searching a solution space using very large...... neighborhoods. The tutorial also present applications of the adaptive large neighborhood search, mostly related to vehicle routing problems for which the heuristic has been extremely successful. We discuss how the heuristic can be parallelized and thereby take advantage of modern desktop computers...

  19. ERP inside Large Organizations

    Directory of Open Access Journals (Sweden)

    Constantin Daniel AVRAM

    2010-01-01

    Full Text Available Many large companies in Romania are still functioning without an ERP system. Instead they are using traditional application systems built around the strong boundaries of specific functions: finance, selling, HR, production. An ERP will offer lots of advantages among which the integration of functionalities and support for top management decisions. Although the total cost of ownership is not small and there are some risks when implementing an ERP inside large and very large organizations, having such a system is mandatory. Choosing the right product and vendor and using a correct risk management strategy, will ensure a successful implementation.

  20. Large Pelagics Telephone Survey

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Large Pelagics Telephone Survey (LPTS) collects fishing effort information directly from captains holding Highly Migratory Species (HMS) permits (required by...

  1. Large Customers (DR Sellers)

    Energy Technology Data Exchange (ETDEWEB)

    Kiliccot, Sila [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2011-10-25

    State of the large customers for demand response integration of solar and wind into electric grid; openADR; CAISO; DR as a pseudo generation; commercial and industrial DR strategies; California regulations

  2. Large Pelagics Biological Survey

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Large Pelagics Biological Survey (LPBS) collects additional length and weight information and body parts such as otoliths, caudal vertebrae, dorsal spines, and...

  3. Large Rotor Test Apparatus

    Data.gov (United States)

    Federal Laboratory Consortium — This test apparatus, when combined with the National Full-Scale Aerodynamics Complex, produces a thorough, full-scale test capability. The Large Rotor Test Apparatus...

  4. Large transverse momentum phenomena

    International Nuclear Information System (INIS)

    Brodsky, S.J.

    1977-09-01

    It is pointed out that it is particularly significant that the quantum numbers of the leading particles are strongly correlated with the quantum numbers of the incident hadrons indicating that the valence quarks themselves are transferred to large p/sub t/. The crucial question is how they get there. Various hadron reactions are discussed covering the structure of exclusive reactions, inclusive reactions, normalization of inclusive cross sections, charge correlations, and jet production at large transverse momentum. 46 references

  5. Large Retailers’ Financial Services

    OpenAIRE

    Risso, Mario

    2010-01-01

    Over the last few years, large retailers offering financial services have considerably grown in the financial services sector. Retailers are increasing the wideness and complexity of their offer of financial services. Large retail companies provide financial services to their customers following different strategic ways. The provision of financial services in the retailers offer is implemented in several different ways related to the strategies, the structures and the degree of financial know...

  6. Large momentum transfer phenomena

    International Nuclear Information System (INIS)

    Imachi, Masahiro; Otsuki, Shoichiro; Matsuoka, Takeo; Sawada, Shoji.

    1978-01-01

    The large momentum transfer phenomena in hadron reaction drastically differ from small momentum transfer phenomena, and are described in this paper. Brief review on the features of the large transverse momentum transfer reactions is described in relation with two-body reactions, single particle productions, particle ratios, two jet structure, two particle correlations, jet production cross section, and the component of momentum perpendicular to the plane defined by the incident protons and the triggered pions and transverse momentum relative to jet axis. In case of two-body process, the exponent N of the power law of the differential cross section is a value between 10 to 11.5 in the large momentum transfer region. The breaks of the exponential behaviors into the power ones are observed at the large momentum transfer region. The break would enable to estimate the order of a critical length. The large momentum transfer phenomena strongly suggest an important role of constituents of hadrons in the hard region. Hard rearrangement of constituents from different initial hadrons induces large momentum transfer reactions. Several rules to count constituents in the hard region have been proposed so far to explain the power behavior. Scale invariant quark interaction and hard reactions are explained, and a summary of the possible types of hard subprocess is presented. (Kato, T.)

  7. Large electrostatic accelerators

    Energy Technology Data Exchange (ETDEWEB)

    Jones, C.M.

    1984-01-01

    The increasing importance of energetic heavy ion beams in the study of atomic physics, nuclear physics, and materials science has partially or wholly motivated the construction of a new generation of large electrostatic accelerators designed to operate at terminal potentials of 20 MV or above. In this paper, the author briefly discusses the status of these new accelerators and also discusses several recent technological advances which may be expected to further improve their performance. The paper is divided into four parts: (1) a discussion of the motivation for the construction of large electrostatic accelerators, (2) a description and discussion of several large electrostatic accelerators which have been recently completed or are under construction, (3) a description of several recent innovations which may be expected to improve the performance of large electrostatic accelerators in the future, and (4) a description of an innovative new large electrostatic accelerator whose construction is scheduled to begin next year. Due to time and space constraints, discussion is restricted to consideration of only tandem accelerators.

  8. Large electrostatic accelerators

    International Nuclear Information System (INIS)

    Jones, C.M.

    1984-01-01

    The increasing importance of energetic heavy ion beams in the study of atomic physics, nuclear physics, and materials science has partially or wholly motivated the construction of a new generation of large electrostatic accelerators designed to operate at terminal potentials of 20 MV or above. In this paper, the author briefly discusses the status of these new accelerators and also discusses several recent technological advances which may be expected to further improve their performance. The paper is divided into four parts: (1) a discussion of the motivation for the construction of large electrostatic accelerators, (2) a description and discussion of several large electrostatic accelerators which have been recently completed or are under construction, (3) a description of several recent innovations which may be expected to improve the performance of large electrostatic accelerators in the future, and (4) a description of an innovative new large electrostatic accelerator whose construction is scheduled to begin next year. Due to time and space constraints, discussion is restricted to consideration of only tandem accelerators

  9. Large field radiotherapy

    International Nuclear Information System (INIS)

    Vanasek, J.; Chvojka, Z.; Zouhar, M.

    1984-01-01

    Calculations may prove that irradiation procedures, commonly used in radiotherapy and represented by large-capacity irradiation techniques, do not exceed certain limits of integral doses with favourable radiobiological action on the organism. On the other hand integral doses in supralethal whole-body irradiation, used in the therapy of acute leukemia, represent radiobiological values which without extreme and exceptional further interventions and teamwork are not compatible with life, and the radiotherapeutist cannot use such high doses without the backing of a large team. (author)

  10. Developing Large Web Applications

    CERN Document Server

    Loudon, Kyle

    2010-01-01

    How do you create a mission-critical site that provides exceptional performance while remaining flexible, adaptable, and reliable 24/7? Written by the manager of a UI group at Yahoo!, Developing Large Web Applications offers practical steps for building rock-solid applications that remain effective even as you add features, functions, and users. You'll learn how to develop large web applications with the extreme precision required for other types of software. Avoid common coding and maintenance headaches as small websites add more pages, more code, and more programmersGet comprehensive soluti

  11. Choice of large projects

    Energy Technology Data Exchange (ETDEWEB)

    Harris, R

    1978-08-01

    Conventional cost/benefit or project analysis has generally not taken into account circumstances in which the project under consideration is large enough that its introduction to the economy would have significant general equilibrium effects. In this paper, rules are examined that would indicate whether such large projects should be accepted or rejected. The rules utilize information yielded by before-project and after-project equilibrium prices and production data. Rules are developed for the undistorted ''first-best'' case, the case in which the fixed costs of the project are covered by distortionary taxation, and for the case of projects producing public goods. 34 references.

  12. LARGE SCALE GLAZED

    DEFF Research Database (Denmark)

    Bache, Anja Margrethe

    2010-01-01

    OF SELECTED EXISTING BUILDINGS IN AND AROUND COPENHAGEN COVERED WITH MOSAIC TILES, UNGLAZED OR GLAZED CLAY TILES. ITS BUILDINGS WHICH HAVE QUALITIES THAT I WOULD LIKE APPLIED, PERHAPS TRANSFORMED OR MOST PREFERABLY, INTERPRETED ANEW, FOR THE LARGE GLAZED CONCRETE PANELS I AM DEVELOPING. KEYWORDS: COLOR, LIGHT...

  13. Large hydropower generating units

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-07-01

    This document presents the Brazilian experience with the design, fabrication, construction, commissioning and operation of large scale and generation capacity unities. The experience had been acquired with the implementation of Itumbiara, Paulo Afonso IV, Tucurui, Itaipu and Xingo power plants, which are among the largest world unities.

  14. Large Data Set Mining

    NARCIS (Netherlands)

    Leemans, I.B.; Broomhall, Susan

    2017-01-01

    Digital emotion research has yet to make history. Until now large data set mining has not been a very active field of research in early modern emotion studies. This is indeed surprising since first, the early modern field has such rich, copyright-free, digitized data sets and second, emotion studies

  15. Representing Large Virtual Worlds

    NARCIS (Netherlands)

    Kol, T.R.

    2018-01-01

    The ubiquity of large virtual worlds and their growing complexity in computer graphics require efficient representations. This means that we need smart solutions for the underlying storage of these complex environments, but also for their visualization. How the virtual world is best stored and how

  16. The large hadron computer

    CERN Multimedia

    Hirstius, Andreas

    2008-01-01

    Plans for dealing with the torrent of data from the Large Hadron Collider's detectors have made the CERN particle-phycis lab, yet again, a pioneer in computing as well as physics. The author describes the challenges of processing and storing data in the age of petabyt science. (4 pages)

  17. LARGE BUILDING HVAC SIMULATION

    Science.gov (United States)

    The report discusses the monitoring and collection of data relating to indoor pressures and radon concentrations under several test conditions in a large school building in Bartow, Florida. The Florida Solar Energy Center (FSEC) used an integrated computational software, FSEC 3.0...

  18. Large Hadron Collider

    CERN Multimedia

    2007-01-01

    "In the spring 2008, the Large Hadron Collider (LHC) machine at CERN (the European Particle Physics laboratory) will be switched on for the first time. The huge machine is housed in a circular tunnel, 27 km long, excavated deep under the French-Swiss border near Geneva." (1,5 page)

  19. Migration of trochanteric cerclage cable debris to the knee joint

    Directory of Open Access Journals (Sweden)

    Kathleen M. Kollitz, BS

    2014-01-01

    Full Text Available Migrating orthopedic hardware has widely been reported in the literature. Most reported cases of migrating hardware involve smooth Kirschner wires or loosening/fracture of hardware involved with joint stabilization/fixation. It is unusual for hardware to migrate within the soft tissues. In some cases, smooth Kirschner wires have migrated within the thoracic cage—a proposed mechanism for this phenomenon is the negative intrathoracic pressure. While wires have also been reported to gain access to circulation, transporting them over larger distances, the majority of broken or retained wires remain local. We report a case of a 34-year-old man in whom numerous fragments of braided cable migrated from the hip to the knee.

  20. Surgical treatment of trochanteric fractures: Indications and early ...

    African Journals Online (AJOL)

    Pr KODO

    Road traffic accident was the main cause of fractures accounting for 42 cases. ... Infection occurred in seven patients, wound hematoma in eight and decubital ... under general anesthesia on a standard operating ... latter device arises while inserting the lower oblique ... preferred.13 The problem with the interlocking nail is.

  1. Large reservoirs: Chapter 17

    Science.gov (United States)

    Miranda, Leandro E.; Bettoli, Phillip William

    2010-01-01

    Large impoundments, defined as those with surface area of 200 ha or greater, are relatively new aquatic ecosystems in the global landscape. They represent important economic and environmental resources that provide benefits such as flood control, hydropower generation, navigation, water supply, commercial and recreational fisheries, and various other recreational and esthetic values. Construction of large impoundments was initially driven by economic needs, and ecological consequences received little consideration. However, in recent decades environmental issues have come to the forefront. In the closing decades of the 20th century societal values began to shift, especially in the developed world. Society is no longer willing to accept environmental damage as an inevitable consequence of human development, and it is now recognized that continued environmental degradation is unsustainable. Consequently, construction of large reservoirs has virtually stopped in North America. Nevertheless, in other parts of the world construction of large reservoirs continues. The emergence of systematic reservoir management in the early 20th century was guided by concepts developed for natural lakes (Miranda 1996). However, we now recognize that reservoirs are different and that reservoirs are not independent aquatic systems inasmuch as they are connected to upstream rivers and streams, the downstream river, other reservoirs in the basin, and the watershed. Reservoir systems exhibit longitudinal patterns both within and among reservoirs. Reservoirs are typically arranged sequentially as elements of an interacting network, filter water collected throughout their watersheds, and form a mosaic of predictable patterns. Traditional approaches to fisheries management such as stocking, regulating harvest, and in-lake habitat management do not always produce desired effects in reservoirs. As a result, managers may expend resources with little benefit to either fish or fishing. Some locally

  2. Resilin and chitinous cuticle form a composite structure for energy storage in jumping by froghopper insects

    Directory of Open Access Journals (Sweden)

    Shaw Stephen R

    2008-09-01

    Full Text Available Abstract Background Many insects jump by storing and releasing energy in elastic structures within their bodies. This allows them to release large amounts of energy in a very short time to jump at very high speeds. The fastest of the insect jumpers, the froghopper, uses a catapult-like elastic mechanism to achieve their jumping prowess in which energy, generated by the slow contraction of muscles, is released suddenly to power rapid and synchronous movements of the hind legs. How is this energy stored? Results The hind coxae of the froghopper are linked to the hinges of the ipsilateral hind wings by pleural arches, complex bow-shaped internal skeletal structures. They are built of chitinous cuticle and the rubber-like protein, resilin, which fluoresces bright blue when illuminated with ultra-violet light. The ventral and posterior end of this fluorescent region forms the thoracic part of the pivot with a hind coxa. No other structures in the thorax or hind legs show this blue fluorescence and it is not found in larvae which do not jump. Stimulating one trochanteral depressor muscle in a pattern that simulates its normal action, results in a distortion and forward movement of the posterior part of a pleural arch by 40 μm, but in natural jumping, the movement is at least 100 μm. Conclusion Calculations showed that the resilin itself could only store 1% to 2% of the energy required for jumping. The stiffer cuticular parts of the pleural arches could, however, easily meet all the energy storage needs. The composite structure therefore, combines the stiffness of the chitinous cuticle with the elasticity of resilin. Muscle contractions bend the chitinous cuticle with little deformation and therefore, store the energy needed for jumping, while the resilin rapidly returns its stored energy and thus restores the body to its original shape after a jump and allows repeated jumping.

  3. Large Hadron Collider manual

    CERN Document Server

    Lavender, Gemma

    2018-01-01

    What is the universe made of? How did it start? This Manual tells the story of how physicists are seeking answers to these questions using the world’s largest particle smasher – the Large Hadron Collider – at the CERN laboratory on the Franco-Swiss border. Beginning with the first tentative steps taken to build the machine, the digestible text, supported by color photographs of the hardware involved, along with annotated schematic diagrams of the physics experiments, covers the particle accelerator’s greatest discoveries – from both the perspective of the writer and the scientists who work there. The Large Hadron Collider Manual is a full, comprehensive guide to the most famous, record-breaking physics experiment in the world, which continues to capture the public imagination as it provides new insight into the fundamental laws of nature.

  4. [Large benign prostatic hiperplasia].

    Science.gov (United States)

    Soria-Fernández, Guillermo René; Jungfermann-Guzman, José René; Lomelín-Ramos, José Pedro; Jaspersen-Gastelum, Jorge; Rosas-Nava, Jesús Emmanuel

    2012-01-01

    the term prostatic hyperplasia is most frequently used to describe the benign prostatic growth, this being a widely prevalent disorder associated with age that affects most men as they age. The association between prostate growth and urinary obstruction in older adults is well documented. large benign prostatic hyperplasia is rare and few cases have been published and should be taken into account during the study of tumors of the pelvic cavity. we report the case of an 81-year-old who had significant symptoms relating to storage and bladder emptying, with no significant elevation of prostate specific antigen. this is a rare condition but it is still important to diagnose and treat as it may be related to severe obstructive uropathy and chronic renal failure. In our institution, cases of large prostatic hyperplasia that are solved by suprapubic adenomectomy are less than 3%.

  5. [Large vessel vasculitides].

    Science.gov (United States)

    Morović-Vergles, Jadranka; Puksić, Silva; Gracanin, Ana Gudelj

    2013-01-01

    Large vessel vasculitis includes Giant cell arteritis and Takayasu arteritis. Giant cell arteritis is the most common form of vasculitis affect patients aged 50 years or over. The diagnosis should be considered in older patients who present with new onset of headache, visual disturbance, polymyalgia rheumatica and/or fever unknown cause. Glucocorticoides remain the cornerstone of therapy. Takayasu arteritis is a chronic panarteritis of the aorta ant its major branches presenting commonly in young ages. Although all large arteries can be affected, the aorta, subclavian and carotid arteries are most commonly involved. The most common symptoms included upper extremity claudication, hypertension, pain over the carotid arteries (carotidynia), dizziness and visual disturbances. Early diagnosis and treatment has improved the outcome in patients with TA.

  6. Large tandem accelerators

    International Nuclear Information System (INIS)

    Jones, C.M.

    1976-01-01

    The increasing importance of energetic heavy ion beams in the study of atomic physics, nuclear physics, and materials science has partially or wholly motivated the construction of a new generation of tandem accelerators designed to operate at maximum terminal potentials in the range 14 to 30 MV. In addition, a number of older tandem accelerators are now being significantly upgraded to improve their heavy ion performance. Both of these developments have reemphasized the importance of negative heavy ion sources. The new large tandem accelerators are described, and the requirements placed on negative heavy ion source technology by these and other tandem accelerators used for the acceleration of heavy ions are discussed. First, a brief description is given of the large tandem accelerators which have been completed recently, are under construction, or are funded for construction, second, the motivation for construction of these accelerators is discussed, and last, criteria for negative ion sources for use with these accelerators are presented

  7. Large scale reflood test

    International Nuclear Information System (INIS)

    Hirano, Kemmei; Murao, Yoshio

    1980-01-01

    The large-scale reflood test with a view to ensuring the safety of light water reactors was started in fiscal 1976 based on the special account act for power source development promotion measures by the entrustment from the Science and Technology Agency. Thereafter, to establish the safety of PWRs in loss-of-coolant accidents by joint international efforts, the Japan-West Germany-U.S. research cooperation program was started in April, 1980. Thereupon, the large-scale reflood test is now included in this program. It consists of two tests using a cylindrical core testing apparatus for examining the overall system effect and a plate core testing apparatus for testing individual effects. Each apparatus is composed of the mock-ups of pressure vessel, primary loop, containment vessel and ECCS. The testing method, the test results and the research cooperation program are described. (J.P.N.)

  8. Large scale model testing

    International Nuclear Information System (INIS)

    Brumovsky, M.; Filip, R.; Polachova, H.; Stepanek, S.

    1989-01-01

    Fracture mechanics and fatigue calculations for WWER reactor pressure vessels were checked by large scale model testing performed using large testing machine ZZ 8000 (with a maximum load of 80 MN) at the SKODA WORKS. The results are described from testing the material resistance to fracture (non-ductile). The testing included the base materials and welded joints. The rated specimen thickness was 150 mm with defects of a depth between 15 and 100 mm. The results are also presented of nozzles of 850 mm inner diameter in a scale of 1:3; static, cyclic, and dynamic tests were performed without and with surface defects (15, 30 and 45 mm deep). During cyclic tests the crack growth rate in the elastic-plastic region was also determined. (author). 6 figs., 2 tabs., 5 refs

  9. Large mass storage facility

    Energy Technology Data Exchange (ETDEWEB)

    Peskin, Arnold M.

    1978-08-01

    This is the final report of a study group organized to investigate questions surrounding the acquisition of a large mass storage facility. The programatic justification for such a system at Brookhaven is reviewed. Several candidate commercial products are identified and discussed. A draft of a procurement specification is developed. Some thoughts on possible new directions for computing at Brookhaven are also offered, although this topic was addressed outside of the context of the group's deliberations. 2 figures, 3 tables.

  10. The Large Hadron Collider

    CERN Document Server

    Juettner Fernandes, Bonnie

    2014-01-01

    What really happened during the Big Bang? Why did matter form? Why do particles have mass? To answer these questions, scientists and engineers have worked together to build the largest and most powerful particle accelerator in the world: the Large Hadron Collider. Includes glossary, websites, and bibliography for further reading. Perfect for STEM connections. Aligns to the Common Core State Standards for Language Arts. Teachers' Notes available online.

  11. Large Right Pleural Effusion

    Directory of Open Access Journals (Sweden)

    Robert Rowe

    2016-09-01

    Full Text Available History of present illness: An 83-year-old male with a distant history of tuberculosis status post treatment and resection approximately fifty years prior presented with two days of worsening shortness of breath. He denied any chest pain, and reported his shortness of breath was worse with exertion and lying flat. Significant findings: Chest x-ray and bedside ultrasound revealed a large right pleural effusion, estimated to be greater than two and a half liters in size. Discussion: The incidence of pleural effusion is estimated to be at least 1.5 million cases annually in the United States.1 Erect posteroanterior and lateral chest radiography remains the mainstay for diagnosis of a pleural effusion; on upright chest radiography small effusions (>400cc will blunt the costophrenic angles, and as the size of an effusion grows it will begin to obscure the hemidiphragm.1 Large effusions will cause mediastinal shift away from the affected side (seen in effusions >1000cc.1 Lateral decubitus chest radiography can detect effusions greater than 50cc.1 Ultrasonography can help differentiate large pulmonary masses from effusions and can be instrumental in guiding thoracentesis.1 The patient above was comfortable at rest and was admitted for a non-emergent thoracentesis. The pulmonology team removed 2500cc of fluid, and unfortunately the patient subsequently developed re-expansion pulmonary edema and pneumothorax ex-vacuo. It is generally recommended that no more than 1500cc be removed to minimize the risk of re-expansion pulmonary edema.2

  12. Large litter sizes

    DEFF Research Database (Denmark)

    Sandøe, Peter; Rutherford, K.M.D.; Berg, Peer

    2012-01-01

    This paper presents some key results and conclusions from a review (Rutherford et al. 2011) undertaken regarding the ethical and welfare implications of breeding for large litter size in the domestic pig and about different ways of dealing with these implications. Focus is primarily on the direct...... possible to achieve a drop in relative piglet mortality and the related welfare problems. However, there will be a growing problem with the need to use foster or nurse sows which may have negative effects on both sows and piglets. This gives rise to new challenges for management....

  13. Large lithium loop experience

    International Nuclear Information System (INIS)

    Kolowith, R.; Owen, T.J.; Berg, J.D.; Atwood, J.M.

    1981-10-01

    An engineering design and operating experience of a large, isothermal, lithium-coolant test loop are presented. This liquid metal coolant loop is called the Experimental Lithium System (ELS) and has operated safely and reliably for over 6500 hours through September 1981. The loop is used for full-scale testing of components for the Fusion Materials Irradiation Test (FMIT) Facility. Main system parameters include coolant temperatures to 430 0 C and flow to 0.038 m 3 /s (600 gal/min). Performance of the main pump, vacuum system, and control system is discussed. Unique test capabilities of the ELS are also discussed

  14. Large coil test facility

    International Nuclear Information System (INIS)

    Nelms, L.W.; Thompson, P.B.

    1980-01-01

    Final design of the facility is nearing completion, and 20% of the construction has been accomplished. A large vacuum chamber, houses the test assembly which is coupled to appropriate cryogenic, electrical, instrumentation, diagnostc systems. Adequate assembly/disassembly areas, shop space, test control center, offices, and test support laboratories are located in the same building. Assembly and installation operations are accomplished with an overhead crane. The major subsystems are the vacuum system, the test stand assembly, the cryogenic system, the experimental electric power system, the instrumentation and control system, and the data aquisition system

  15. Large orbit neoclassical transport

    International Nuclear Information System (INIS)

    Lin, Z.; Tang, W.M.; Lee, W.W.

    1997-01-01

    Neoclassical transport in the presence of large ion orbits is investigated. The study is motivated by the recent experimental results that ion thermal transport levels in enhanced confinement tokamak plasmas fall below the open-quotes irreducible minimum levelclose quotes predicted by standard neoclassical theory. This apparent contradiction is resolved in the present analysis by relaxing the basic neoclassical assumption that the ions orbital excursions are much smaller than the local toroidal minor radius and the equilibrium scale lengths of the system. Analytical and simulation results are in agreement with trends from experiments. The development of a general formalism for neoclassical transport theory with finite orbit width is also discussed. copyright 1997 American Institute of Physics

  16. Large Superconducting Magnet Systems

    CERN Document Server

    Védrine, P.

    2014-07-17

    The increase of energy in accelerators over the past decades has led to the design of superconducting magnets for both accelerators and the associated detectors. The use of Nb−Ti superconducting materials allows an increase in the dipole field by up to 10 T compared with the maximum field of 2 T in a conventional magnet. The field bending of the particles in the detectors and generated by the magnets can also be increased. New materials, such as Nb$_{3}$Sn and high temperature superconductor (HTS) conductors, can open the way to higher fields, in the range 13–20 T. The latest generations of fusion machines producing hot plasma also use large superconducting magnet systems.

  17. Large Scale Solar Heating

    DEFF Research Database (Denmark)

    Heller, Alfred

    2001-01-01

    The main objective of the research was to evaluate large-scale solar heating connected to district heating (CSDHP), to build up a simulation tool and to demonstrate the application of the simulation tool for design studies and on a local energy planning case. The evaluation was mainly carried out...... model is designed and validated on the Marstal case. Applying the Danish Reference Year, a design tool is presented. The simulation tool is used for proposals for application of alternative designs, including high-performance solar collector types (trough solar collectors, vaccum pipe collectors......). Simulation programs are proposed as control supporting tool for daily operation and performance prediction of central solar heating plants. Finaly the CSHP technolgy is put into persepctive with respect to alternatives and a short discussion on the barries and breakthrough of the technology are given....

  18. Large Superconducting Magnet Systems

    Energy Technology Data Exchange (ETDEWEB)

    Védrine, P [Saclay (France)

    2014-07-01

    The increase of energy in accelerators over the past decades has led to the design of superconducting magnets for both accelerators and the associated detectors. The use of Nb−Ti superconducting materials allows an increase in the dipole field by up to 10 T compared with the maximum field of 2 T in a conventional magnet. The field bending of the particles in the detectors and generated by the magnets can also be increased. New materials, such as Nb3Sn and high temperature superconductor (HTS) conductors, can open the way to higher fields, in the range 13–20 T. The latest generations of fusion machines producing hot plasma also use large superconducting magnet systems.

  19. Avaliação da qualidade de vida em pacientes idosos um ano após o tratamento cirúrgico de fraturas transtrocanterianas do fêmur Functional outcomes and quality of life one year after surgical management of trochanteric fractures

    Directory of Open Access Journals (Sweden)

    Fernanda de Aquino Moraes Guimarães

    2011-01-01

    Full Text Available OBJETIVO: Avaliar o impacto que as fraturas transtrocanterianas produzem sobre a qualidade de vida de pacientes idosos, tratados cirurgicamente, durante o período de um ano de acompanhamento. MATERIAL E MÉTODO: Foram selecionados 73 idosos com fratura transtrocanterina, com idade igual ou superior a 65 anos de ambos os sexos. Foi aplicado questionário padronizado, para se obter informações quanto aos hábitos de vida, atividade física, funcionalidade, deambulação e estado cognitivo. Foram excluídos os óbitos ocorridos durante o estudo, pacientes que não deambulavam, com doenças neurológicas ou fraturas patológicas. RESULTADOS: A média de idade foi 80,17 ± 7,2, sendo 75% do sexo feminino. Ao comparar as somatórias das atividades de vida diária (p=0,04 e instrumentais da vida diária (p=0,004, obtidas na pré e pós-fratura, os pacientes tornaram-se mais dependentes pós-fratura. Atividades de vida diária que apresentaram piora pós-fratura foram: tomar banho (p=0,04, ir ao banheiro (p=0,02 e vestir-se (p=0,04. Todas as atividades instrumentais da vida diária apresentaram diferença significativa, apresentando maior dependência funcional pós-fratura, assim como aumento da necessidade de auxílio a deambulação (p=0,00002, idade avançada (p=0,01 e não realizar atividades domésticas (p=0,01. A baixa pontuação no teste Minimental estava associada com uma maior dependência para realizar as atividades da vida diária na pré-fratura (p=0,00002 e pós-fratura (p=0,01. CONCLUSÃO: Após um ano, as atividades de vida diária que dependiam dos membros inferiores pioraram significativamente, todas as atividades instrumentais de vida diária apresentaram piora significativa em mais de 50% dos pacientes e mais da metade dos pacientes que andavam sem apoio perderam esta capacidade.OBJECTIVE: Evaluate the impact that trochanteric hip fractures produce on life quality of elderly patients, treated surgically, during one year of

  20. Avaliação prospectiva da evolução clínica, radiográfica e funcional do tratamento das fraturas trocantéricas instáveis do fêmur com haste cefalomedular Prospective assessment of the clinical, radiographic and functional evolution of treatment for unstable trochanteric fractures of the femur using a cephalomedullary nail

    Directory of Open Access Journals (Sweden)

    Richard Armelin Borger

    2011-01-01

    Full Text Available OBJETIVO: Avaliar, durante um ano de seguimento pós-operatório, a evolução clínica, radiográfica e funcional das fraturas trocantéricas instáveis do fêmur submetidas à osteossíntese com haste cefalomedular. MÉTODOS: Foram avaliados 14 homens e 23 mulheres com idade média de 77,7 anos, 27 destes com fraturas AO/ASIF 31A2 e 10, 31A3. Os pacientes foram avaliados clinicamente, radiograficamente e funcionalmente com uma semana, duas semanas, um mês, dois meses, seis meses e um ano de pós-operatório. RESULTADOS: Nas complicações clínicas, verificaram-se cinco casos de óbito, um caso de úlcera de calcâneo, um caso de obstrução arterial aguda e dois casos de trombose venosa profunda. Na avaliação radiográfica, o ângulo cervicodiafisário médio no pós-operatório imediato foi de 132,5°. O índice ponta-ápice médio foi de 22,8mm. Após um ano, o ângulo cervicodiafisário médio foi de 131,7. A consolidação da fratura foi verificada em todos os pacientes após seis meses de pós-operatório, exceto em um caso que apresentou cut out. Não houve casos de fratura abaixo do implante. A avaliação funcional através do escore de Harris após um ano apresentou uma média de 69,3 pontos. A avaliação da progressão da marcha identificou que, após um ano, 40,6% dos pacientes apresentavam a mesma capacidade de deambulação prévia. Através da escala visual analógica de dor, identificamos diminuição importante das queixas álgicas, passando de 5,19 com uma semana para 2,25 após um ano. CONCLUSÃO: A osteossíntese com haste cefalomedular resultou em baixas complicações clínicas, mecânicas e resultados funcionais adequados.OBJECTIVE: To assess the clinical, radiological and functional evolution of osteosynthesis using a cephalomedullary nail, in unstable trochanteric fractures of the femur, over a one-year postoperative follow-up. METHODS: Fourteen men and 23 women of mean age 77.7 years were evaluated. Twenty -seven

  1. Large forging manufacturing process

    Science.gov (United States)

    Thamboo, Samuel V.; Yang, Ling

    2002-01-01

    A process for forging large components of Alloy 718 material so that the components do not exhibit abnormal grain growth includes the steps of: a) providing a billet with an average grain size between ASTM 0 and ASTM 3; b) heating the billet to a temperature of between 1750.degree. F. and 1800.degree. F.; c) upsetting the billet to obtain a component part with a minimum strain of 0.125 in at least selected areas of the part; d) reheating the component part to a temperature between 1750.degree. F. and 1800.degree. F.; e) upsetting the component part to a final configuration such that said selected areas receive no strains between 0.01 and 0.125; f) solution treating the component part at a temperature of between 1725.degree. F. and 1750.degree. F.; and g) aging the component part over predetermined times at different temperatures. A modified process achieves abnormal grain growth in selected areas of a component where desirable.

  2. Large scale tracking algorithms

    Energy Technology Data Exchange (ETDEWEB)

    Hansen, Ross L. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Love, Joshua Alan [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Melgaard, David Kennett [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Karelitz, David B. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Pitts, Todd Alan [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Zollweg, Joshua David [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Anderson, Dylan Z. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Nandy, Prabal [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Whitlow, Gary L. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Bender, Daniel A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Byrne, Raymond Harry [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2015-01-01

    Low signal-to-noise data processing algorithms for improved detection, tracking, discrimination and situational threat assessment are a key research challenge. As sensor technologies progress, the number of pixels will increase signi cantly. This will result in increased resolution, which could improve object discrimination, but unfortunately, will also result in a significant increase in the number of potential targets to track. Many tracking techniques, like multi-hypothesis trackers, suffer from a combinatorial explosion as the number of potential targets increase. As the resolution increases, the phenomenology applied towards detection algorithms also changes. For low resolution sensors, "blob" tracking is the norm. For higher resolution data, additional information may be employed in the detection and classfication steps. The most challenging scenarios are those where the targets cannot be fully resolved, yet must be tracked and distinguished for neighboring closely spaced objects. Tracking vehicles in an urban environment is an example of such a challenging scenario. This report evaluates several potential tracking algorithms for large-scale tracking in an urban environment.

  3. The large binocular telescope.

    Science.gov (United States)

    Hill, John M

    2010-06-01

    The Large Binocular Telescope (LBT) Observatory is a collaboration among institutions in Arizona, Germany, Italy, Indiana, Minnesota, Ohio, and Virginia. The telescope on Mount Graham in Southeastern Arizona uses two 8.4 m diameter primary mirrors mounted side by side. A unique feature of the LBT is that the light from the two Gregorian telescope sides can be combined to produce phased-array imaging of an extended field. This cophased imaging along with adaptive optics gives the telescope the diffraction-limited resolution of a 22.65 m aperture and a collecting area equivalent to an 11.8 m circular aperture. This paper describes the design, construction, and commissioning of this unique telescope. We report some sample astronomical results with the prime focus cameras. We comment on some of the technical challenges and solutions. The telescope uses two F/15 adaptive secondaries to correct atmospheric turbulence. The first of these adaptive mirrors has completed final system testing in Firenze, Italy, and is planned to be at the telescope by Spring 2010.

  4. Large Format Radiographic Imaging

    International Nuclear Information System (INIS)

    Rohrer, J. S.; Stewart, Lacey; Wilke, M. D.; King, N. S.; Baker A, S.; Lewis, Wilfred

    1999-01-01

    Radiographic imaging continues to be a key diagnostic in many areas at Los Alamos National Laboratory (LANL). Radiographic recording systems have taken on many form, from high repetition-rate, gated systems to film recording and storage phosphors. Some systems are designed for synchronization to an accelerator while others may be single shot or may record a frame sequence in a dynamic radiography experiment. While film recording remains a reliable standby in the radiographic community, there is growing interest in investigating electronic recording for many applications. The advantages of real time access to remote data acquisition are highly attractive. Cooled CCD camera systems are capable of providing greater sensitivity with improved signal-to-noise ratio. This paper begins with a review of performance characteristics of the Bechtel Nevada large format imaging system, a gated system capable of viewing scintillators up to 300 mm in diameter. We then examine configuration alternatives in lens coupled and fiber optically coupled electro-optical recording systems. Areas of investigation include tradeoffs between fiber optic and lens coupling, methods of image magnification, and spectral matching from scintillator to CCD camera. Key performance features discussed include field of view, resolution, sensitivity, dynamic range, and system noise characteristics

  5. Large Ventral Hernia

    Directory of Open Access Journals (Sweden)

    Meryl Abrams, MD

    2018-04-01

    Full Text Available History of present illness: A 46-year-old female presented to the emergency department (ED with diffuse abdominal pain and three days of poor oral intake associated with non-bilious, non-bloody vomiting. Initial vital signs consisted of a mild resting tachycardia of 111 with a temperature of 38.0 degrees Celsius (°C. On examination, the patient had a large pannus extending to the knees, which contained a hernia. She was tender in this region on examination. Laboratory values included normal serum chemistries and mild leukocytosis of 12.2. The patient reports that her abdomen had been enlarging over the previous 8 years but had not been painful until 3 days prior to presentation. The patient had no associated fever, chills, diarrhea, constipation, chest pain or shortness of breath. Significant findings: Computed tomography (CT scan with intravenous (IV contrast of the abdomen and pelvis demonstrated a large pannus containing a ventral hernia with abdominal contents extending below the knees (white circle, elongation of mesenteric vessels to accommodate abdominal contents outside of the abdomen (white arrow and air fluid levels (white arrow indicating a small bowel obstruction. Discussion: Hernias are a common chief complaint seen in the emergency department. The estimated lifetime risk of a spontaneous abdominal hernia is 5%.1 The most common type of hernia is inguinal while the next most common type of hernia is femoral, which are more common in women.1 Ventral hernias can be epigastric, incisional, or primary abdominal. An asymptomatic, reducible hernia can be followed up as outpatient with a general surgeon for elective repair.2 Hernias become problematic when they are either incarcerated or strangulated. A hernia is incarcerated when the hernia is irreducible and strangulated when its blood supply is compromised. A complicated hernia, especially strangulated, can have a mortality of greater than 50%.1 It is key to perform a thorough history

  6. Unification, small and large

    Energy Technology Data Exchange (ETDEWEB)

    Fritzsch, Harald

    1993-04-15

    Full text: Fruitful exchanges between particle physics, astrophysics and cosmology have become a common feature in the last decade. In January, Coral Gables near Miami was the stage for a 'Unified Symmetry in the Small and the Large' meeting. Coral Gables is a famous physics venue. In January 1964, the year that the quark model of hadrons emerged, Behram Kursunoglu initiated a series of particle physics meetings that continued for 20 years and formed a regular focus for this development. The final such meeting was in 1983, coinciding with both the 80th birthday of field theory pioneer Paul Dirac, who worked in Florida towards the end of his career, and the discovery of the W bosons at CERN. The resurrected Coral Gables meeting began with historical accounts of the emergence of Big Bang cosmology, by Robert Ralph and Herman Alpher, while Andrei Linde proposed our expanding universe as a small part of a stationary system, infinite both in space and in time. The observational status of Big Bang cosmology was reviewed by Bruce Partridge, John Mather and Martin Harwit, emphasizing the cosmic background radiation, where temperature is now measured by the COBE satellite detectors to 2.726 ± 0.01 OK. The tiny fluctuations observed by COBE pose problems for standard cold dark matter models. Edward ('Rocky') Kolb reported on new studies on the electroweak phase transition, based on an analogy with the physics of liquid crystals. Richard Holman discussed the fate of global symmetries at energies near the Planck (grand unification) energy, and Paul Steinhardt talked about tensorial and scalar metric fluctuations in the light of the COBE results. Anthony Tyson gave an impressive description of dark matter studies using gravitational lensing, now emerging as a unique tool for indirectly observing intervening dark matter. A neutrino mass of 10 electronvolts could account for observed dark matter distributions, but fails to provide the necessary seeds for galaxy formation. A

  7. Unification, small and large

    International Nuclear Information System (INIS)

    Fritzsch, Harald

    1993-01-01

    Full text: Fruitful exchanges between particle physics, astrophysics and cosmology have become a common feature in the last decade. In January, Coral Gables near Miami was the stage for a 'Unified Symmetry in the Small and the Large' meeting. Coral Gables is a famous physics venue. In January 1964, the year that the quark model of hadrons emerged, Behram Kursunoglu initiated a series of particle physics meetings that continued for 20 years and formed a regular focus for this development. The final such meeting was in 1983, coinciding with both the 80th birthday of field theory pioneer Paul Dirac, who worked in Florida towards the end of his career, and the discovery of the W bosons at CERN. The resurrected Coral Gables meeting began with historical accounts of the emergence of Big Bang cosmology, by Robert Ralph and Herman Alpher, while Andrei Linde proposed our expanding universe as a small part of a stationary system, infinite both in space and in time. The observational status of Big Bang cosmology was reviewed by Bruce Partridge, John Mather and Martin Harwit, emphasizing the cosmic background radiation, where temperature is now measured by the COBE satellite detectors to 2.726 ± 0.01 OK. The tiny fluctuations observed by COBE pose problems for standard cold dark matter models. Edward ('Rocky') Kolb reported on new studies on the electroweak phase transition, based on an analogy with the physics of liquid crystals. Richard Holman discussed the fate of global symmetries at energies near the Planck (grand unification) energy, and Paul Steinhardt talked about tensorial and scalar metric fluctuations in the light of the COBE results. Anthony Tyson gave an impressive description of dark matter studies using gravitational lensing, now emerging as a unique tool for indirectly observing intervening dark matter. A neutrino mass of 10 electronvolts could account for observed dark matter distributions, but fails to provide the necessary seeds for

  8. Laboratory for Large Data Research

    Data.gov (United States)

    Federal Laboratory Consortium — FUNCTION: The Laboratory for Large Data Research (LDR) addresses a critical need to rapidly prototype shared, unified access to large amounts of data across both the...

  9. Large-D gravity and low-D strings.

    Science.gov (United States)

    Emparan, Roberto; Grumiller, Daniel; Tanabe, Kentaro

    2013-06-21

    We show that in the limit of a large number of dimensions a wide class of nonextremal neutral black holes has a universal near-horizon limit. The limiting geometry is the two-dimensional black hole of string theory with a two-dimensional target space. Its conformal symmetry explains the properties of massless scalars found recently in the large-D limit. For black branes with string charges, the near-horizon geometry is that of the three-dimensional black strings of Horne and Horowitz. The analogies between the α' expansion in string theory and the large-D expansion in gravity suggest a possible effective string description of the large-D limit of black holes. We comment on applications to several subjects, in particular to the problem of critical collapse.

  10. Quenches in large superconducting magnets

    International Nuclear Information System (INIS)

    Eberhard, P.H.; Alston-Garnjost, M.; Green, M.A.; Lecomte, P.; Smits, R.G.; Taylor, J.D.; Vuillemin, V.

    1977-08-01

    The development of large high current density superconducting magnets requires an understanding of the quench process by which the magnet goes normal. A theory which describes the quench process in large superconducting magnets is presented and compared with experimental measurements. The use of a quench theory to improve the design of large high current density superconducting magnets is discussed

  11. Health impacts of large dams

    International Nuclear Information System (INIS)

    Lerer, L.B.

    1999-01-01

    Large dams have been criticized because of their negative environmental and social impacts. Public health interest largely has focused on vector-borne diseases, such as schistosomiasis, associated with reservoirs and irrigation projects. Large dams also influence health through changes in water and food security, increases in communicable diseases, and the social disruption caused by construction and involuntary resettlement. Communities living in close proximity to large dams often do not benefit from water transfer and electricity generation revenues. A comprehensive health component is required in environmental and social impact assessments for large dam projects

  12. Large deviations and idempotent probability

    CERN Document Server

    Puhalskii, Anatolii

    2001-01-01

    In the view of many probabilists, author Anatolii Puhalskii''s research results stand among the most significant achievements in the modern theory of large deviations. In fact, his work marked a turning point in the depth of our understanding of the connections between the large deviation principle (LDP) and well-known methods for establishing weak convergence results.Large Deviations and Idempotent Probability expounds upon the recent methodology of building large deviation theory along the lines of weak convergence theory. The author develops an idempotent (or maxitive) probability theory, introduces idempotent analogues of martingales (maxingales), Wiener and Poisson processes, and Ito differential equations, and studies their properties. The large deviation principle for stochastic processes is formulated as a certain type of convergence of stochastic processes to idempotent processes. The author calls this large deviation convergence.The approach to establishing large deviation convergence uses novel com...

  13. Large-scale grid management

    International Nuclear Information System (INIS)

    Langdal, Bjoern Inge; Eggen, Arnt Ove

    2003-01-01

    The network companies in the Norwegian electricity industry now have to establish a large-scale network management, a concept essentially characterized by (1) broader focus (Broad Band, Multi Utility,...) and (2) bigger units with large networks and more customers. Research done by SINTEF Energy Research shows so far that the approaches within large-scale network management may be structured according to three main challenges: centralization, decentralization and out sourcing. The article is part of a planned series

  14. Large-scale solar purchasing

    International Nuclear Information System (INIS)

    1999-01-01

    The principal objective of the project was to participate in the definition of a new IEA task concerning solar procurement (''the Task'') and to assess whether involvement in the task would be in the interest of the UK active solar heating industry. The project also aimed to assess the importance of large scale solar purchasing to UK active solar heating market development and to evaluate the level of interest in large scale solar purchasing amongst potential large scale purchasers (in particular housing associations and housing developers). A further aim of the project was to consider means of stimulating large scale active solar heating purchasing activity within the UK. (author)

  15. Physics with large extra dimensions

    Indian Academy of Sciences (India)

    can then be accounted by the existence of large internal dimensions, in the sub- ... strongly coupled heterotic theory with one large dimension is described by a weakly ..... one additional U(1) factor corresponding to an extra 'U(1)' D-brane is ...

  16. MPQS with three large primes

    NARCIS (Netherlands)

    Leyland, P.; Lenstra, A.K.; Dodson, B.; Muffett, A.; Wagstaff, S.; Fieker, C.; Kohel, D.R.

    2002-01-01

    We report the factorization of a 135-digit integer by the triple-large-prime variation of the multiple polynomial quadratic sieve. Previous workers [6][10] had suggested that using more than two large primes would be counterproductive, because of the greatly increased number of false reports from

  17. Querying Large Biological Network Datasets

    Science.gov (United States)

    Gulsoy, Gunhan

    2013-01-01

    New experimental methods has resulted in increasing amount of genetic interaction data to be generated every day. Biological networks are used to store genetic interaction data gathered. Increasing amount of data available requires fast large scale analysis methods. Therefore, we address the problem of querying large biological network datasets.…

  18. Large-scale data analytics

    CERN Document Server

    Gkoulalas-Divanis, Aris

    2014-01-01

    Provides cutting-edge research in large-scale data analytics from diverse scientific areas Surveys varied subject areas and reports on individual results of research in the field Shares many tips and insights into large-scale data analytics from authors and editors with long-term experience and specialization in the field

  19. Mobility and powering of large detectors. Moving large detectors

    International Nuclear Information System (INIS)

    Thompson, J.

    1977-01-01

    The possibility is considered of moving large lepton detectors at ISABELLE for readying new experiments, detector modifications, and detector repair. A large annex (approximately 25 m x 25 m) would be built adjacent to the Lepton Hall separated from the Lepton Hall by a wall of concrete 11 m high x 12 m wide (for clearance of the detector) and approximately 3 m thick (for radiation shielding). A large pad would support the detector, the door, the cryogenic support system and the counting house. In removing the detector from the beam hall, one would push the pad into the annex, add a dummy beam pipe, bake out the beam pipe, and restack and position the wall on a small pad at the door. The beam could then operate again while experimenters could work on the large detector in the annex. A consideration and rough price estimate of various questions and proposed solutions are given

  20. Measuring happiness in large population

    Science.gov (United States)

    Wenas, Annabelle; Sjahputri, Smita; Takwin, Bagus; Primaldhi, Alfindra; Muhamad, Roby

    2016-01-01

    The ability to know emotional states for large number of people is important, for example, to ensure the effectiveness of public policies. In this study, we propose a measure of happiness that can be used in large scale population that is based on the analysis of Indonesian language lexicons. Here, we incorporate human assessment of Indonesian words, then quantify happiness on large-scale of texts gathered from twitter conversations. We used two psychological constructs to measure happiness: valence and arousal. We found that Indonesian words have tendency towards positive emotions. We also identified several happiness patterns during days of the week, hours of the day, and selected conversation topics.

  1. Large Hadron Collider nears completion

    CERN Multimedia

    2008-01-01

    Installation of the final component of the Large Hadron Collider particle accelerator is under way along the Franco-Swiss border near Geneva, Switzerland. When completed this summer, the LHC will be the world's largest and most complex scientific instrument.

  2. Phenomenology of large Nc QCD

    International Nuclear Information System (INIS)

    Lebed, R.F.

    1999-01-01

    These lectures are designed to introduce the methods and results of large N c QCD in a presentation intended for nuclear and particle physicists alike. Beginning with definitions and motivations of the approach, we demonstrate that all quark and gluon Feynman diagrams are organized into classes based on powers of 1/N c . We then show that this result can be translated into definite statements about mesons and baryons containing arbitrary numbers of constituents. In the mesons, numerous well-known phenomenological properties follow as immediate consequences of simply counting powers of N c , while for the baryons, quantitative large N c analyses of masses and other properties are seen to agree with experiment, even when 'large' N c is set equal to its observed value of 3. Large N c reasoning is also used to explain some simple features of nuclear interactions. (author)

  3. Phenomenology of large Nc QCD

    International Nuclear Information System (INIS)

    Richard Lebed

    1998-01-01

    These lectures are designed to introduce the methods and results of large N c QCD in a presentation intended for nuclear and particle physicists alike. Beginning with definitions and motivations of the approach, they demonstrate that all quark and gluon Feynman diagrams are organized into classes based on powers of 1/N c . They then show that this result can be translated into definite statements about mesons and baryons containing arbitrary numbers of constituents. In the mesons, numerous well-known phenomenological properties follow as immediate consequences of simply counting powers of N c , while for the baryons, quantitative large N c analyses of masses and other properties are seen to agree with experiment, even when ''large'' N c is set equal to its observed value of 3. Large N c reasoning is also used to explain some simple features of nuclear interactions

  4. Community Detection for Large Graphs

    KAUST Repository

    Peng, Chengbin; Kolda, Tamara G.; Pinar, Ali; Zhang, Zhihua; Keyes, David E.

    2014-01-01

    Many real world networks have inherent community structures, including social networks, transportation networks, biological networks, etc. For large scale networks with millions or billions of nodes in real-world applications, accelerating current

  5. Physics with large extra dimensions

    Indian Academy of Sciences (India)

    Home; Journals; Pramana – Journal of Physics; Volume 62; Issue 2 ... The recent understanding of string theory opens the possibility that the string scale can be as ... by the existence of large internal dimensions, in the sub-millimeter region.

  6. Utility unbundling : large consumer's perspective

    International Nuclear Information System (INIS)

    Block, C.

    1997-01-01

    The perspectives of Sunoco as a large user of electric power on utility unbundling were presented. Sunoco's Sarnia refinery runs up an energy bill of over $60 million per year for electricity, natural gas (used both as a feedstock as well as a fuel), natural gas liquids and steam. As a large customer Sunoco advocates unbundling of all services, leaving only the 'pipes and wires' as true monopolies. In their view, regulation distorts the market place and prevents the lower prices that would result from competition as has been seen in the airline and telephone industries. Sunoco's expectation is that in the post-deregulated environment large and small consumers will have a choice of energy supplier, and large consumers will increasingly turn to co-generation as the most desirable way of meeting their power needs

  7. LSD: Large Survey Database framework

    Science.gov (United States)

    Juric, Mario

    2012-09-01

    The Large Survey Database (LSD) is a Python framework and DBMS for distributed storage, cross-matching and querying of large survey catalogs (>10^9 rows, >1 TB). The primary driver behind its development is the analysis of Pan-STARRS PS1 data. It is specifically optimized for fast queries and parallel sweeps of positionally and temporally indexed datasets. It transparently scales to more than >10^2 nodes, and can be made to function in "shared nothing" architectures.

  8. Large-scale solar heat

    Energy Technology Data Exchange (ETDEWEB)

    Tolonen, J.; Konttinen, P.; Lund, P. [Helsinki Univ. of Technology, Otaniemi (Finland). Dept. of Engineering Physics and Mathematics

    1998-12-31

    In this project a large domestic solar heating system was built and a solar district heating system was modelled and simulated. Objectives were to improve the performance and reduce costs of a large-scale solar heating system. As a result of the project the benefit/cost ratio can be increased by 40 % through dimensioning and optimising the system at the designing stage. (orig.)

  9. Optimization theory for large systems

    CERN Document Server

    Lasdon, Leon S

    2002-01-01

    Important text examines most significant algorithms for optimizing large systems and clarifying relations between optimization procedures. Much data appear as charts and graphs and will be highly valuable to readers in selecting a method and estimating computer time and cost in problem-solving. Initial chapter on linear and nonlinear programming presents all necessary background for subjects covered in rest of book. Second chapter illustrates how large-scale mathematical programs arise from real-world problems. Appendixes. List of Symbols.

  10. Hidden supersymmetry and large N

    International Nuclear Information System (INIS)

    Alfaro, J.

    1988-01-01

    In this paper we present a new method to deal with the leading order in the large-N expansion of a quantum field theory. The method uses explicitly the hidden supersymmetry that is present in the path-integral formulation of a stochastic process. In addition to this we derive a new relation that is valid in the leading order of the large-N expansion of the hermitian-matrix model for any spacetime dimension. (orig.)

  11. Large transverse momentum hadronic processes

    International Nuclear Information System (INIS)

    Darriulat, P.

    1977-01-01

    The possible relations between deep inelastic leptoproduction and large transverse momentum (psub(t)) processes in hadronic collisions are usually considered in the framework of the quark-parton picture. Experiments observing the structure of the final state in proton-proton collisions producing at least one large transverse momentum particle have led to the following conclusions: a large fraction of produced particles are uneffected by the large psub(t) process. The other products are correlated to the large psub(t) particle. Depending upon the sign of scalar product they can be separated into two groups of ''towards-movers'' and ''away-movers''. The experimental evidence are reviewed favouring such a picture and the properties are discussed of each of three groups (underlying normal event, towards-movers and away-movers). Some phenomenological interpretations are presented. The exact nature of away- and towards-movers must be further investigated. Their apparent jet structure has to be confirmed. Angular correlations between leading away and towards movers are very informative. Quantum number flow, both within the set of away and towards-movers, and between it and the underlying normal event, are predicted to behave very differently in different models

  12. The large-s field-reversed configuration experiment

    International Nuclear Information System (INIS)

    Hoffman, A.L.; Carey, L.N.; Crawford, E.A.; Harding, D.G.; DeHart, T.E.; McDonald, K.F.; McNeil, J.L.; Milroy, R.D.; Slough, J.T.; Maqueda, R.; Wurden, G.A.

    1993-01-01

    The Large-s Experiment (LSX) was built to study the formation and equilibrium properties of field-reversed configurations (FRCs) as the scale size increases. The dynamic, field-reversed theta-pinch method of FRC creation produces axial and azimuthal deformations and makes formation difficult, especially in large devices with large s (number of internal gyroradii) where it is difficult to achieve initial plasma uniformity. However, with the proper technique, these formation distortions can be minimized and are then observed to decay with time. This suggests that the basic stability and robustness of FRCs formed, and in some cases translated, in smaller devices may also characterize larger FRCs. Elaborate formation controls were included on LSX to provide the initial uniformity and symmetry necessary to minimize formation disturbances, and stable FRCs could be formed up to the design goal of s = 8. For x ≤ 4, the formation distortions decayed away completely, resulting in symmetric equilibrium FRCs with record confinement times up to 0.5 ms, agreeing with previous empirical scaling laws (τ∝sR). Above s = 4, reasonably long-lived (up to 0.3 ms) configurations could still be formed, but the initial formation distortions were so large that they never completely decayed away, and the equilibrium confinement was degraded from the empirical expectations. The LSX was only operational for 1 yr, and it is not known whether s = 4 represents a fundamental limit for good confinement in simple (no ion beam stabilization) FRCs or whether it simply reflects a limit of present formation technology. Ideally, s could be increased through flux buildup from neutral beams. Since the addition of kinetic or beam ions will probably be desirable for heating, sustainment, and further stabilization of magnetohydrodynamic modes at reactor-level s values, neutral beam injection is the next logical step in FRC development. 24 refs., 21 figs., 2 tabs

  13. Large aperture optical switching devices

    International Nuclear Information System (INIS)

    Goldhar, J.; Henesian, M.A.

    1983-01-01

    We have developed a new approach to constructing large aperture optical switches for next generation inertial confinement fusion lasers. A transparent plasma electrode formed in low pressure ionized gas acts as a conductive coating to allow the uniform charging of the optical faces of an electro-optic material. In this manner large electric fields can be applied longitudinally to large aperture, high aspect ratio Pockels cells. We propose a four-electrode geometry to create the necessary high conductivity plasma sheets, and have demonstrated fast (less than 10 nsec) switching in a 5x5 cm aperture KD*P Pockels cell with such a design. Detaid modelling of Pockels cell performance with plasma electrodes has been carried out for 15 and 30 cm aperture designs

  14. Assembling large, complex environmental metagenomes

    Energy Technology Data Exchange (ETDEWEB)

    Howe, A. C. [Michigan State Univ., East Lansing, MI (United States). Microbiology and Molecular Genetics, Plant Soil and Microbial Sciences; Jansson, J. [USDOE Joint Genome Institute (JGI), Walnut Creek, CA (United States); Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Earth Sciences Division; Malfatti, S. A. [USDOE Joint Genome Institute (JGI), Walnut Creek, CA (United States); Tringe, S. G. [USDOE Joint Genome Institute (JGI), Walnut Creek, CA (United States); Tiedje, J. M. [Michigan State Univ., East Lansing, MI (United States). Microbiology and Molecular Genetics, Plant Soil and Microbial Sciences; Brown, C. T. [Michigan State Univ., East Lansing, MI (United States). Microbiology and Molecular Genetics, Computer Science and Engineering

    2012-12-28

    The large volumes of sequencing data required to sample complex environments deeply pose new challenges to sequence analysis approaches. De novo metagenomic assembly effectively reduces the total amount of data to be analyzed but requires significant computational resources. We apply two pre-assembly filtering approaches, digital normalization and partitioning, to make large metagenome assemblies more computationaly tractable. Using a human gut mock community dataset, we demonstrate that these methods result in assemblies nearly identical to assemblies from unprocessed data. We then assemble two large soil metagenomes from matched Iowa corn and native prairie soils. The predicted functional content and phylogenetic origin of the assembled contigs indicate significant taxonomic differences despite similar function. The assembly strategies presented are generic and can be extended to any metagenome; full source code is freely available under a BSD license.

  15. Large scale structure and baryogenesis

    International Nuclear Information System (INIS)

    Kirilova, D.P.; Chizhov, M.V.

    2001-08-01

    We discuss a possible connection between the large scale structure formation and the baryogenesis in the universe. An update review of the observational indications for the presence of a very large scale 120h -1 Mpc in the distribution of the visible matter of the universe is provided. The possibility to generate a periodic distribution with the characteristic scale 120h -1 Mpc through a mechanism producing quasi-periodic baryon density perturbations during inflationary stage, is discussed. The evolution of the baryon charge density distribution is explored in the framework of a low temperature boson condensate baryogenesis scenario. Both the observed very large scale of a the visible matter distribution in the universe and the observed baryon asymmetry value could naturally appear as a result of the evolution of a complex scalar field condensate, formed at the inflationary stage. Moreover, for some model's parameters a natural separation of matter superclusters from antimatter ones can be achieved. (author)

  16. Large ceramics for fusion applications

    International Nuclear Information System (INIS)

    Hauth, W.E.; Stoddard, S.D.

    1979-01-01

    Prominent ceramic raw materials and products manufacturers were surveyed to determine the state of the art for alumina ceramic fabrication. This survey emphasized current capabilities and limitations for fabrication of large, high-density, high-purity, complex shapes. Some directions are suggested for future needs and development. Ceramic-to-ceramic sealing has applications for several technologies that require large and/or complex vacuum-tight ceramic shapes. Information is provided concerning the assembly of complex monolithic ceramic shapes by bonding of subassemblies at temperatures ranging from 450 to 1500 0 C. Future applications and fabrication techniques for various materials are presented

  17. Dijets at large rapidity intervals

    CERN Document Server

    Pope, B G

    2001-01-01

    Inclusive diet production at large pseudorapidity intervals ( Delta eta ) between the two jets has been suggested as a regime for observing BFKL dynamics. We have measured the dijet cross section for large Delta eta in pp collisions at square root s = 1800 and 630 GeV using the DOE detector. The partonic cross section increases strongly with the size of Delta eta . The observed growth is even stronger than expected on the basis of BFKL resummation in the leading logarithmic approximation. The growth of the partonic cross section can be accommodated with an effective BFKL intercept of alpha /sub BFKL/(20 GeV) = 1.65 +or- 0.07.

  18. Large Eddy Simulation of turbulence

    International Nuclear Information System (INIS)

    Poullet, P.; Sancandi, M.

    1994-12-01

    Results of Large Eddy Simulation of 3D isotropic homogeneous turbulent flows are presented. A computer code developed on Connexion Machine (CM5) has allowed to compare two turbulent viscosity models (Smagorinsky and structure function). The numerical scheme influence on the energy density spectrum is also studied [fr

  19. The Large Vector Multiplet Action

    OpenAIRE

    Ryb, Itai

    2007-01-01

    We discuss possible actions for the d=2, N=(2,2) large vector multiplet that gauges isometries of generalized Kahler geometries. We explore two scenarios that allow us to write kinetic and superpotential terms for the scalar field-strengths, and write kinetic terms for the spinor invariants that can introduce topological terms for the connections.

  20. Qatar - large capital investment planned

    International Nuclear Information System (INIS)

    Roberts, J.

    1996-01-01

    Large capital investments are planned throughout Qatar's energy industry over the next five years totalling $25 billion. This article describes the successful commissioning of Qatar's first liquefied natural gas (LNG) project on time and within budget. The second LNG plant is well underway and plans for a third are under negotiation. (UK)

  1. Large deviations and portfolio optimization

    Science.gov (United States)

    Sornette, Didier

    Risk control and optimal diversification constitute a major focus in the finance and insurance industries as well as, more or less consciously, in our everyday life. We present a discussion of the characterization of risks and of the optimization of portfolios that starts from a simple illustrative model and ends by a general functional integral formulation. A major item is that risk, usually thought of as one-dimensional in the conventional mean-variance approach, has to be addressed by the full distribution of losses. Furthermore, the time-horizon of the investment is shown to play a major role. We show the importance of accounting for large fluctuations and use the theory of Cramér for large deviations in this context. We first treat a simple model with a single risky asset that exemplifies the distinction between the average return and the typical return and the role of large deviations in multiplicative processes, and the different optimal strategies for the investors depending on their size. We then analyze the case of assets whose price variations are distributed according to exponential laws, a situation that is found to describe daily price variations reasonably well. Several portfolio optimization strategies are presented that aim at controlling large risks. We end by extending the standard mean-variance portfolio optimization theory, first within the quasi-Gaussian approximation and then using a general formulation for non-Gaussian correlated assets in terms of the formalism of functional integrals developed in the field theory of critical phenomena.

  2. Inconsistency in large pharmacogenomic studies

    DEFF Research Database (Denmark)

    Haibe-Kains, Benjamin; El-Hachem, Nehme; Birkbak, Nicolai Juul

    2013-01-01

    Two large-scale pharmacogenomic studies were published recently in this journal. Genomic data are well correlated between studies; however, the measured drug response data are highly discordant. Although the source of inconsistencies remains uncertain, it has potential implications for using...

  3. Strategic Management of Large Projects

    Institute of Scientific and Technical Information of China (English)

    WangYingluo; LiuYi; LiYuan

    2004-01-01

    The strategic management of large projects is both theoretically and practically important. Some scholars have advanced flexible strategy theory in China. The difference of strategic flexibility and flexible strategy is pointed out. The supporting system and characteristics of flexible strategy are analyzed. The changes of flexible strategy and integration of strategic management are discussed.

  4. Mass spectrometry of large molecules

    International Nuclear Information System (INIS)

    Facchetti, S.

    1985-01-01

    The lectures in this volume were given at a course on mass spectrometry of large molecules, organized within the framework of the Training and Education programme of the Joint Research Centre of the European Communities. Although first presented in 1983, most of the lectures have since been updated by their authors. (orig.)

  5. Large for Gestational Age (LGA)

    Science.gov (United States)

    ... mother Other risk factors for having large-for-gestational-age newborns include Maternal obesity Having had previous LGA babies Genetic abnormalities or syndromes (for example, Beckwith-Wiedemann syndrome or Sotos syndrome) Excessive weight gain during pregnancy (the fetus gets more calories as ...

  6. Large-scale pool fires

    Directory of Open Access Journals (Sweden)

    Steinhaus Thomas

    2007-01-01

    Full Text Available A review of research into the burning behavior of large pool fires and fuel spill fires is presented. The features which distinguish such fires from smaller pool fires are mainly associated with the fire dynamics at low source Froude numbers and the radiative interaction with the fire source. In hydrocarbon fires, higher soot levels at increased diameters result in radiation blockage effects around the perimeter of large fire plumes; this yields lower emissive powers and a drastic reduction in the radiative loss fraction; whilst there are simplifying factors with these phenomena, arising from the fact that soot yield can saturate, there are other complications deriving from the intermittency of the behavior, with luminous regions of efficient combustion appearing randomly in the outer surface of the fire according the turbulent fluctuations in the fire plume. Knowledge of the fluid flow instabilities, which lead to the formation of large eddies, is also key to understanding the behavior of large-scale fires. Here modeling tools can be effectively exploited in order to investigate the fluid flow phenomena, including RANS- and LES-based computational fluid dynamics codes. The latter are well-suited to representation of the turbulent motions, but a number of challenges remain with their practical application. Massively-parallel computational resources are likely to be necessary in order to be able to adequately address the complex coupled phenomena to the level of detail that is necessary.

  7. Active Learning in Large Classes

    DEFF Research Database (Denmark)

    Gørtz, Inge Li

    2011-01-01

    teaching large classes (more than 50 students), and describe how we successfully have in a second semester course in the Bachelor of Engineering (BEng) and Bachelor of Science Engineering (BSc Eng) program at the Technical University of Denmark (DTU). Approximately 200 students is attending...

  8. Adding large EM stack support

    KAUST Repository

    Holst, Glendon

    2016-12-01

    Serial section electron microscopy (SSEM) image stacks generated using high throughput microscopy techniques are an integral tool for investigating brain connectivity and cell morphology. FIB or 3View scanning electron microscopes easily generate gigabytes of data. In order to produce analyzable 3D dataset from the imaged volumes, efficient and reliable image segmentation is crucial. Classical manual approaches to segmentation are time consuming and labour intensive. Semiautomatic seeded watershed segmentation algorithms, such as those implemented by ilastik image processing software, are a very powerful alternative, substantially speeding up segmentation times. We have used ilastik effectively for small EM stacks – on a laptop, no less; however, ilastik was unable to carve the large EM stacks we needed to segment because its memory requirements grew too large – even for the biggest workstations we had available. For this reason, we refactored the carving module of ilastik to scale it up to large EM stacks on large workstations, and tested its efficiency. We modified the carving module, building on existing blockwise processing functionality to process data in manageable chunks that can fit within RAM (main memory). We review this refactoring work, highlighting the software architecture, design choices, modifications, and issues encountered.

  9. Protection of large capacitor banks

    International Nuclear Information System (INIS)

    Sprott, J.C.; Lovell, T.W.

    1982-06-01

    Large capacitor banks, as used in many pulsed plasma experiments, are subject to catastrophic failure in the event of a short in the output or in an individual capacitor. Methods are described for protecting such banks to minimize the damage and down-time caused by such a failure

  10. CERN's Large Hadron Collider project

    Science.gov (United States)

    Fearnley, Tom A.

    1997-03-01

    The paper gives a brief overview of CERN's Large Hadron Collider (LHC) project. After an outline of the physics motivation, we describe the LHC machine, interaction rates, experimental challenges, and some important physics channels to be studied. Finally we discuss the four experiments planned at the LHC: ATLAS, CMS, ALICE and LHC-B.

  11. CERN's Large Hadron Collider project

    International Nuclear Information System (INIS)

    Fearnley, Tom A.

    1997-01-01

    The paper gives a brief overview of CERN's Large Hadron Collider (LHC) project. After an outline of the physics motivation, we describe the LHC machine, interaction rates, experimental challenges, and some important physics channels to be studied. Finally we discuss the four experiments planned at the LHC: ATLAS, CMS, ALICE and LHC-B

  12. Large area CMOS image sensors

    International Nuclear Information System (INIS)

    Turchetta, R; Guerrini, N; Sedgwick, I

    2011-01-01

    CMOS image sensors, also known as CMOS Active Pixel Sensors (APS) or Monolithic Active Pixel Sensors (MAPS), are today the dominant imaging devices. They are omnipresent in our daily life, as image sensors in cellular phones, web cams, digital cameras, ... In these applications, the pixels can be very small, in the micron range, and the sensors themselves tend to be limited in size. However, many scientific applications, like particle or X-ray detection, require large format, often with large pixels, as well as other specific performance, like low noise, radiation hardness or very fast readout. The sensors are also required to be sensitive to a broad spectrum of radiation: photons from the silicon cut-off in the IR down to UV and X- and gamma-rays through the visible spectrum as well as charged particles. This requirement calls for modifications to the substrate to be introduced to provide optimized sensitivity. This paper will review existing CMOS image sensors, whose size can be as large as a single CMOS wafer, and analyse the technical requirements and specific challenges of large format CMOS image sensors.

  13. The large hadron collider project

    International Nuclear Information System (INIS)

    Maiani, L.

    1999-01-01

    Knowledge of the fundamental constituents of matter has greatly advanced, over the last decades. The standard theory of fundamental interactions presents us with a theoretically sound picture, which describes with great accuracy known physical phenomena on most diverse energy and distance scales. These range from 10 -16 cm, inside the nucleons, up to large-scale astrophysical bodies, including the early Universe at some nanosecond after the Big-Bang and temperatures of the order of 10 2 GeV. The picture is not yet completed, however, as we lack the observation of the Higgs boson, predicted in the 100-500 GeV range - a particle associated with the generation of particle masses and with the quantum fluctuations in the primordial Universe. In addition, the standard theory is expected to undergo a change of regime in the 10 3 GeV region, with the appearance of new families of particles, most likely associated with the onset of a new symmetry (supersymmetry). In 1994, the CERN Council approved the construction of the large hadron collider (LHC), a proton-proton collider of a new design to be installed in the existing LEP tunnel, with an energy of 7 TeV per beam and extremely large luminosity, of ∝10 34 cm -2 s -1 . Construction was started in 1996, with the additional support of the US, Japan, Russia, Canada and other European countries, making the LHC a really global project, the first one in particle physics. After a short review of the physics scenario, I report on the present status of the LHC construction. Special attention is given to technological problems such as the realization of the super-conducting dipoles, following an extensive R and D program with European industries. The construction of the large LHC detectors has required a vast R and D program by a large international community, to overcome the problems posed by the complexity of the collisions and by the large luminosity of the machine. (orig.)

  14. Degassing a large LHe cryopump

    International Nuclear Information System (INIS)

    Denhoy, B.S.; Batzer, T.H.; Call, W.R.

    1977-01-01

    A method has been developed and successfully tested to degas a large LHe cryopump. Use of this method inhibits the normally excessive pressure rise during the degassing cycle when the degassing rate exceeds the external pumping capabilities of the system. A small appendage pump, installed close to the main cryopump, absorbs all the gas, as it is desorbed from the main cryopump, with no rise in the system pressure. The appendage pump can then be isolated from the main vacuum system and degassed at high pressure. We pumped 15 to 20 x 10 3 Torr . 1 of H 2 on a 1.25 m 2 panel. During the degassing cycle the system pressure never rose above 1 x 10 -4 Torr. In large vacuum systems for future fusion machines that contain cryopump panels as well as cryogenic magnets, this method is a unique and very useful tool. It will allow the degassing of cryopumps without affecting the temperature equilibrium of cryogenic magnets

  15. Large-capacity current leads

    International Nuclear Information System (INIS)

    Ballarino, A.

    2008-01-01

    Feeding superconducting magnets with reliable low-loss devices is a key issue for any cryo-electrical system. Conventional or HTS current leads can be used, and cooling methods, materials, and geometries can be chosen to optimize the thermo-electrical performance of the system. The LHC magnets are powered via more than 3000 current leads transporting altogether about 3 MA of current. With thousands of leads, the LHC lead project represents today the largest project of its kind ever undertaken. Following a review of the LHC lead project, an overview of the choices that can be made for the optimization of large capacity current leads is presented. Examples are given of other leads for large scale magnet systems for which the use of HTS is being envisaged

  16. Large Aspect Ratio Tokamak Study

    International Nuclear Information System (INIS)

    Reid, R.L.; Holmes, J.A.; Houlberg, W.A.; Peng, Y.K.M.; Strickler, D.J.; Brown, T.G.; Wiseman, G.W.

    1980-06-01

    The Large Aspect Ratio Tokamak Study (LARTS) at Oak Ridge National Laboratory (ORNL) investigated the potential for producing a viable longburn tokamak reactor by enhancing the volt-second capability of the ohmic heating transformer through the use of high aspect ratio designs. The plasma physics, engineering, and economic implications of high aspect ratio tokamaks were assessed in the context of extended burn operation. Using a one-dimensional transport code plasma startup and burn parameters were addressed. The pulsed electrical power requirements for the poloidal field system, which have a major impact on reactor economics, were minimized by optimizing the startup and shutdown portions of the tokamak cycle. A representative large aspect ratio tokamak with an aspect ratio of 8 was found to achieve a burn time of 3.5 h at capital cost only approx. 25% greater than that of a moderate aspect ratio design tokamak

  17. Parametric instabilities in large plasmas

    International Nuclear Information System (INIS)

    Brambilla, Marco; Liberman, Bernardo.

    1979-01-01

    Parametric decay processes in large plasmas are considered as the linear stage of a three wave interaction (pump, sideband and beat wave) in which the amplitude of the externally excited pump is sufficiently large to neglect pump depletion to first order, yet sufficiently small to allow a linearized treatment of the pump propagation to zeroth order. The coupling coefficients are then obtained from an iterative solution of Vlasov equation, and a compact expression is derived, in which the multiple series over Bessel functions is explicitly summed. Even in the limit of a very long wavelength pump, the dispersion relation obtained in this way does not coincide with the one obtained using the well-known ''dipole'' approximation, unless both the sideband and beat wave are resonant modes of the plasma. An analysis of the origin of this discrepancy allows us to conclude that ''quasimodes'' (evanescent waves driven absolutely unstable by the pump) are more correctly described by the iterative approach

  18. Plasma diagnostics on large tokamaks

    International Nuclear Information System (INIS)

    Orlinskij, D.V.; Magyar, G.

    1988-01-01

    The main tasks of the large tokamaks which are under construction (T-15 and Tore Supra) and of those which have already been built (TFTR, JET, JT-60 and DIII-D) together with their design features which are relevant to plasma diagnostics are briefly discussed. The structural features and principal characteristics of the diagnostic systems being developed or already being used on these devices are also examined. The different diagnostic methods are described according to the physical quantities to be measured: electric and magnetic diagnostics, measurements of electron density, electron temperature, the ion components of the plasma, radiation loss measurements, spectroscopy of impurities, edge diagnostics and study of plasma stability. The main parameters of the various diagnostic systems used on the six large tokamaks are summarized in tables. (author). 351 refs, 44 figs, 22 tabs

  19. Foam rheology at large deformation

    Science.gov (United States)

    Géminard, J.-C.; Pastenes, J. C.; Melo, F.

    2018-04-01

    Large deformations are prone to cause irreversible changes in materials structure, generally leading to either material hardening or softening. Aqueous foam is a metastable disordered structure of densely packed gas bubbles. We report on the mechanical response of a foam layer subjected to quasistatic periodic shear at large amplitude. We observe that, upon increasing shear, the shear stress follows a universal curve that is nearly exponential and tends to an asymptotic stress value interpreted as the critical yield stress at which the foam structure is completely remodeled. Relevant trends of the foam mechanical response to cycling are mathematically reproduced through a simple law accounting for the amount of plastic deformation upon increasing stress. This view provides a natural interpretation to stress hardening in foams, demonstrating that plastic effects are present in this material even for minute deformation.

  20. Physics with large extra dimensions

    CERN Document Server

    Antoniadis, Ignatios

    2004-01-01

    The recent understanding of string theory opens the possibility that the string scale can be as low as a few TeV. The apparent weakness of gravitational interactions can then be accounted by the existence of large internal dimensions, in the submillimeter region. Furthermore, our world must be confined to live on a brane transverse to these large dimensions, with which it interacts only gravitationally. In my lecture, I describe briefly this scenario which gives a new theoretical framework for solving the gauge hierarchy problem and the unification of all interactions. I also discuss its main properties and implications for observations at both future particle colliders, and in non-accelerator gravity experiments. Such effects are for instance the production of Kaluza-Klein resonances, graviton emission in the bulk of extra dimensions, and a radical change of gravitational forces in the submillimeter range.

  1. Chunking of Large Multidimensional Arrays

    Energy Technology Data Exchange (ETDEWEB)

    Rotem, Doron; Otoo, Ekow J.; Seshadri, Sridhar

    2007-02-28

    Data intensive scientific computations as well on-lineanalytical processing applications as are done on very large datasetsthat are modeled as k-dimensional arrays. The storage organization ofsuch arrays on disks is done by partitioning the large global array intofixed size hyper-rectangular sub-arrays called chunks or tiles that formthe units of data transfer between disk and memory. Typical queriesinvolve the retrieval of sub-arrays in a manner that accesses all chunksthat overlap the query results. An important metric of the storageefficiency is the expected number of chunks retrieved over all suchqueries. The question that immediately arises is "what shapes of arraychunks give the minimum expected number of chunks over a query workload?"In this paper we develop two probabilistic mathematical models of theproblem and provide exact solutions using steepest descent and geometricprogramming methods. Experimental results, using synthetic workloads onreal life data sets, show that our chunking is much more efficient thanthe existing approximate solutions.

  2. Large Extremity Peripheral Nerve Repair

    Science.gov (United States)

    2016-12-01

    These antimicrobial peptides are implicated in the resistance of epithelial surfaces to microbial colonisation and have been shown to be upregulated...be equivalent to standard autograft repair in rodent models. Outcomes have now been validated in a large animal (swine) model with 5 cm ulnar nerve...Goals of the Project Task 1– Determine mechanical properties, seal strength and resistance to biodegradation of candidate photochemical nerve wrap

  3. Community Detection for Large Graphs

    KAUST Repository

    Peng, Chengbin

    2014-05-04

    Many real world networks have inherent community structures, including social networks, transportation networks, biological networks, etc. For large scale networks with millions or billions of nodes in real-world applications, accelerating current community detection algorithms is in demand, and we present two approaches to tackle this issue -A K-core based framework that can accelerate existing community detection algorithms significantly; -A parallel inference algorithm via stochastic block models that can distribute the workload.

  4. Large floating structures technological advances

    CERN Document Server

    Wang, BT

    2015-01-01

    This book surveys key projects that have seen the construction of large floating structures or have attained detailed conceptual designs. This compilation of key floating structures in a single volume captures the innovative features that mark the technological advances made in this field of engineering, and will provide a useful reference for ideas, analysis, design, and construction of these unique and emerging urban projects to offshore and marine engineers, urban planners, architects and students.

  5. Visualising large hierarchies with Flextree

    Science.gov (United States)

    Song, Hongzhi; Curran, Edwin P.; Sterritt, Roy

    2003-05-01

    One of the main tasks in Information Visualisation research is creating visual tools to facilitate human understanding of large and complex information spaces. Hierarchies, being a good mechanism in organising such information, are ubiquitous. Although much research effort has been spent on finding useful representations for hierarchies, visualising large hierarchies is still a difficult topic. One of the difficulties is how to show both tructure and node content information in one view. Another is how to achieve multiple foci in a focus+context visualisation. This paper describes a novel hierarchy visualisation technique called FlexTree to address these problems. It contains some important features that have not been exploited so far. In this visualisation, a profile or contour unique to the hierarchy being visualised can be gained in a histogram-like layout. A normalised view of a common attribute of all nodes can be acquired, and selection of this attribute is controllable by the user. Multiple foci are consistently accessible within a global context through interaction. Furthermore it can handle a large hierarchy that contains several thousand nodes in a PC environment. In addition results from an informal evaluation are also presented.

  6. The large sample size fallacy.

    Science.gov (United States)

    Lantz, Björn

    2013-06-01

    Significance in the statistical sense has little to do with significance in the common practical sense. Statistical significance is a necessary but not a sufficient condition for practical significance. Hence, results that are extremely statistically significant may be highly nonsignificant in practice. The degree of practical significance is generally determined by the size of the observed effect, not the p-value. The results of studies based on large samples are often characterized by extreme statistical significance despite small or even trivial effect sizes. Interpreting such results as significant in practice without further analysis is referred to as the large sample size fallacy in this article. The aim of this article is to explore the relevance of the large sample size fallacy in contemporary nursing research. Relatively few nursing articles display explicit measures of observed effect sizes or include a qualitative discussion of observed effect sizes. Statistical significance is often treated as an end in itself. Effect sizes should generally be calculated and presented along with p-values for statistically significant results, and observed effect sizes should be discussed qualitatively through direct and explicit comparisons with the effects in related literature. © 2012 Nordic College of Caring Science.

  7. Large nuclear steam turbine plants

    International Nuclear Information System (INIS)

    Urushidani, Haruo; Moriya, Shin-ichi; Tsuji, Kunio; Fujita, Isao; Ebata, Sakae; Nagai, Yoji.

    1986-01-01

    The technical development of the large capacity steam turbines for ABWR plants was partially completed, and that in progress is expected to be completed soon. In this report, the outline of those new technologies is described. As the technologies for increasing the capacity and heightening the efficiency, 52 in long blades and moisture separating heaters are explained. Besides, in the large bore butterfly valves developed for making the layout compact, the effect of thermal efficiency rise due to the reduction of pressure loss can be expected. As the new technology on the system side, the simplification of the turbine system and the effect of heightening the thermal efficiency by high pressure and low pressure drain pumping-up method based on the recent improvement of feed water quality are discussed. As for nuclear steam turbines, the actual records of performance of 1100 MW class, the largest output at present, have been obtained, and as a next large capacity machine, the development of a steam turbine of 1300 MWe class for an ABWR plant is in progress. It can be expected that by the introduction of those new technologies, the plants having high economical efficiency are realized. (Kako, I.)

  8. Perturbation theory in large order

    International Nuclear Information System (INIS)

    Bender, C.M.

    1978-01-01

    For many quantum mechanical models, the behavior of perturbation theory in large order is strikingly simple. For example, in the quantum anharmonic oscillator, which is defined by -y'' + (x 2 /4 + ex 4 /4 - E) y = 0, y ( +- infinity) = 0, the perturbation coefficients, A/sub n/, in the expansion for the ground-state energy, E(ground state) approx. EPSILON/sub n = 0//sup infinity/ A/sub n/epsilon/sup n/, simplify dramatically as n → infinity: A/sub n/ approx. (6/π 3 )/sup 1/2/(-3)/sup n/GAMMA(n + 1/2). Methods of applied mathematics are used to investigate the nature of perturbation theory in quantum mechanics and show that its large-order behavior is determined by the semiclassical content of the theory. In quantum field theory the perturbation coefficients are computed by summing Feynman graphs. A statistical procedure in a simple lambda phi 4 model for summing the set of all graphs as the number of vertices → infinity is presented. Finally, the connection between the large-order behavior of perturbation theory in quantum electrodynamics and the value of α, the charge on the electron, is discussed. 7 figures

  9. Foreshock occurrence before large earthquakes

    Science.gov (United States)

    Reasenberg, P.A.

    1999-01-01

    Rates of foreshock occurrence involving shallow M ??? 6 and M ??? 7 mainshocks and M ??? 5 foreshocks were measured in two worldwide catalogs over ???20-year intervals. The overall rates observed are similar to ones measured in previous worldwide and regional studies when they are normalized for the ranges of magnitude difference they each span. The observed worldwide rates were compared to a generic model of earthquake clustering based on patterns of small and moderate aftershocks in California. The aftershock model was extended to the case of moderate foreshocks preceding large mainshocks. Overall, the observed worldwide foreshock rates exceed the extended California generic model by a factor of ???2. Significant differences in foreshock rate were found among subsets of earthquakes defined by their focal mechanism and tectonic region, with the rate before thrust events higher and the rate before strike-slip events lower than the worldwide average. Among the thrust events, a large majority, composed of events located in shallow subduction zones, had a high foreshock rate, while a minority, located in continental thrust belts, had a low rate. These differences may explain why previous surveys have found low foreshock rates among thrust events in California (especially southern California), while the worldwide observations suggests the opposite: California, lacking an active subduction zone in most of its territory, and including a region of mountain-building thrusts in the south, reflects the low rate apparently typical for continental thrusts, while the worldwide observations, dominated by shallow subduction zone events, are foreshock-rich. If this is so, then the California generic model may significantly underestimate the conditional probability for a very large (M ??? 8) earthquake following a potential (M ??? 7) foreshock in Cascadia. The magnitude differences among the identified foreshock-mainshock pairs in the Harvard catalog are consistent with a uniform

  10. Large number discrimination by mosquitofish.

    Directory of Open Access Journals (Sweden)

    Christian Agrillo

    Full Text Available BACKGROUND: Recent studies have demonstrated that fish display rudimentary numerical abilities similar to those observed in mammals and birds. The mechanisms underlying the discrimination of small quantities (<4 were recently investigated while, to date, no study has examined the discrimination of large numerosities in fish. METHODOLOGY/PRINCIPAL FINDINGS: Subjects were trained to discriminate between two sets of small geometric figures using social reinforcement. In the first experiment mosquitofish were required to discriminate 4 from 8 objects with or without experimental control of the continuous variables that co-vary with number (area, space, density, total luminance. Results showed that fish can use the sole numerical information to compare quantities but that they preferentially use cumulative surface area as a proxy of the number when this information is available. A second experiment investigated the influence of the total number of elements to discriminate large quantities. Fish proved to be able to discriminate up to 100 vs. 200 objects, without showing any significant decrease in accuracy compared with the 4 vs. 8 discrimination. The third experiment investigated the influence of the ratio between the numerosities. Performance was found to decrease when decreasing the numerical distance. Fish were able to discriminate numbers when ratios were 1:2 or 2:3 but not when the ratio was 3:4. The performance of a sample of undergraduate students, tested non-verbally using the same sets of stimuli, largely overlapped that of fish. CONCLUSIONS/SIGNIFICANCE: Fish are able to use pure numerical information when discriminating between quantities larger than 4 units. As observed in human and non-human primates, the numerical system of fish appears to have virtually no upper limit while the numerical ratio has a clear effect on performance. These similarities further reinforce the view of a common origin of non-verbal numerical systems in all

  11. Radiosurgery for Large Brain Metastases

    International Nuclear Information System (INIS)

    Han, Jung Ho; Kim, Dong Gyu; Chung, Hyun-Tai; Paek, Sun Ha; Park, Chul-Kee; Jung, Hee-Won

    2012-01-01

    Purpose: To determine the efficacy and safety of radiosurgery in patients with large brain metastases treated with radiosurgery. Patients and Methods: Eighty patients with large brain metastases (>14 cm 3 ) were treated with radiosurgery between 1998 and 2009. The mean age was 59 ± 11 years, and 49 (61.3%) were men. Neurologic symptoms were identified in 77 patients (96.3%), and 30 (37.5%) exhibited a dependent functional status. The primary disease was under control in 36 patients (45.0%), and 44 (55.0%) had a single lesion. The mean tumor volume was 22.4 ± 8.8 cm 3 , and the mean marginal dose prescribed was 13.8 ± 2.2 Gy. Results: The median survival time from radiosurgery was 7.9 months (95% confidence interval [CI], 5.343–10.46), and the 1-year survival rate was 39.2%. Functional improvement within 1–4 months or the maintenance of the initial independent status was observed in 48 (60.0%) and 20 (25.0%) patients after radiosurgery, respectively. Control of the primary disease, a marginal dose of ≥11 Gy, and a tumor volume ≥26 cm 3 were significantly associated with overall survival (hazard ratio, 0.479; p = .018; 95% CI, 0.261–0.880; hazard ratio, 0.350; p = .004; 95% CI, 0.171–0.718; hazard ratio, 2.307; p = .006; 95% CI, 1.274–4.180, respectively). Unacceptable radiation-related toxicities (Radiation Toxicity Oncology Group central nervous system toxicity Grade 3, 4, and 5 in 7, 6, and 2 patients, respectively) developed in 15 patients (18.8%). Conclusion: Radiosurgery seems to have a comparable efficacy with surgery for large brain metastases. However, the rate of radiation-related toxicities after radiosurgery should be considered when deciding on a treatment modality.

  12. Large-bore pipe decontamination

    International Nuclear Information System (INIS)

    Ebadian, M.A.

    1998-01-01

    The decontamination and decommissioning (D and D) of 1200 buildings within the US Department of Energy-Office of Environmental Management (DOE-EM) Complex will require the disposition of miles of pipe. The disposition of large-bore pipe, in particular, presents difficulties in the area of decontamination and characterization. The pipe is potentially contaminated internally as well as externally. This situation requires a system capable of decontaminating and characterizing both the inside and outside of the pipe. Current decontamination and characterization systems are not designed for application to this geometry, making the direct disposal of piping systems necessary in many cases. The pipe often creates voids in the disposal cell, which requires the pipe to be cut in half or filled with a grout material. These methods are labor intensive and costly to perform on large volumes of pipe. Direct disposal does not take advantage of recycling, which could provide monetary dividends. To facilitate the decontamination and characterization of large-bore piping and thereby reduce the volume of piping required for disposal, a detailed analysis will be conducted to document the pipe remediation problem set; determine potential technologies to solve this remediation problem set; design and laboratory test potential decontamination and characterization technologies; fabricate a prototype system; provide a cost-benefit analysis of the proposed system; and transfer the technology to industry. This report summarizes the activities performed during fiscal year 1997 and describes the planned activities for fiscal year 1998. Accomplishments for FY97 include the development of the applicable and relevant and appropriate regulations, the screening of decontamination and characterization technologies, and the selection and initial design of the decontamination system

  13. The IEA Large Coil Task

    International Nuclear Information System (INIS)

    Beard, D.S.; Klose, W.; Shimamoto, S.; Vecsey, G.

    1988-01-01

    A multinational program of cooperative research, development, demonstrations, and exchanges of information on superconducting magnets for fusion was initiated in 1977 under an IEA agreement. The first major step in the development of TF magnets was called the Large Coil Task. Participants in LCT were the U.S. DOE, EURATOM, JAERI, and the Departement Federal de l'Interieur of Switzerland. The goals of LCT were to obtain experimental data, to demonstrate reliable operation of large superconducting coils, and to prove design principles and fabrication techniques being considered for the toroidal magnets of thermonuclear reactors. These goals were to be accomplished through coordinated but largely independent design, development, and construction of six test coils, followed by collaborative testing in a compact toroidal test array at fields of 8 T and higher. Under the terms of the IEA Agreement, the United States built and operated the test facility at Oak Ridge and provided three test coils. The other participants provided one coil each. Information on design and manufacturing and all test data were shared by all. The LCT team of each participant included a government laboratory and industrial partners or contractors. The last coil was completed in 1985, and the test assembly was completed in October of that year. Over the next 23 months, the six-coil array was cooled down and extensive testing was performed. Results were gratifying, as tests achieved design-point performance and well beyond. (Each coil reached a peak field of 9 T.) Experiments elucidated coil behavior, delineated limits of operability, and demonstrated coil safety. (orig./KP)

  14. Large block test status report

    International Nuclear Information System (INIS)

    Wilder, D.G.; Lin, W.; Blair, S.C.

    1997-01-01

    This report is intended to serve as a status report, which essentially transmits the data that have been collected to date on the Large Block Test (LBT). The analyses of data will be performed during FY98, and then a complete report will be prepared. This status report includes introductory material that is not needed merely to transmit data but is available at this time and therefore included. As such, this status report will serve as the template for the future report, and the information is thus preserved

  15. Large volume cryogenic silicon detectors

    International Nuclear Information System (INIS)

    Braggio, C.; Boscardin, M.; Bressi, G.; Carugno, G.; Corti, D.; Galeazzi, G.; Zorzi, N.

    2009-01-01

    We present preliminary measurements for the development of a large volume silicon detector to detect low energy and low rate energy depositions. The tested detector is a one cm-thick silicon PIN diode with an active volume of 31 cm 3 , cooled to the liquid helium temperature to obtain depletion from thermally-generated free carriers. A thorough study has been done to show that effects of charge trapping during drift disappears at a bias field value of the order of 100V/cm.

  16. Large volume cryogenic silicon detectors

    Energy Technology Data Exchange (ETDEWEB)

    Braggio, C. [Dipartimento di Fisica, Universita di Padova, via Marzolo 8, 35131 Padova (Italy); Boscardin, M. [Fondazione Bruno Kessler (FBK), via Sommarive 18, I-38100 Povo (Italy); Bressi, G. [INFN sez. di Pavia, via Bassi 6, 27100 Pavia (Italy); Carugno, G.; Corti, D. [INFN sez. di Padova, via Marzolo 8, 35131 Padova (Italy); Galeazzi, G. [INFN lab. naz. Legnaro, viale dell' Universita 2, 35020 Legnaro (Italy); Zorzi, N. [Fondazione Bruno Kessler (FBK), via Sommarive 18, I-38100 Povo (Italy)

    2009-12-15

    We present preliminary measurements for the development of a large volume silicon detector to detect low energy and low rate energy depositions. The tested detector is a one cm-thick silicon PIN diode with an active volume of 31 cm{sup 3}, cooled to the liquid helium temperature to obtain depletion from thermally-generated free carriers. A thorough study has been done to show that effects of charge trapping during drift disappears at a bias field value of the order of 100V/cm.

  17. Large area and flexible electronics

    CERN Document Server

    Caironi, Mario

    2015-01-01

    From materials to applications, this ready reference covers the entire value chain from fundamentals via processing right up to devices, presenting different approaches to large-area electronics, thus enabling readers to compare materials, properties and performance.Divided into two parts, the first focuses on the materials used for the electronic functionality, covering organic and inorganic semiconductors, including vacuum and solution-processed metal-oxide semiconductors, nanomembranes and nanocrystals, as well as conductors and insulators. The second part reviews the devices and applicatio

  18. Japanese large-scale interferometers

    CERN Document Server

    Kuroda, K; Miyoki, S; Ishizuka, H; Taylor, C T; Yamamoto, K; Miyakawa, O; Fujimoto, M K; Kawamura, S; Takahashi, R; Yamazaki, T; Arai, K; Tatsumi, D; Ueda, A; Fukushima, M; Sato, S; Shintomi, T; Yamamoto, A; Suzuki, T; Saitô, Y; Haruyama, T; Sato, N; Higashi, Y; Uchiyama, T; Tomaru, T; Tsubono, K; Ando, M; Takamori, A; Numata, K; Ueda, K I; Yoneda, H; Nakagawa, K; Musha, M; Mio, N; Moriwaki, S; Somiya, K; Araya, A; Kanda, N; Telada, S; Sasaki, M; Tagoshi, H; Nakamura, T; Tanaka, T; Ohara, K

    2002-01-01

    The objective of the TAMA 300 interferometer was to develop advanced technologies for kilometre scale interferometers and to observe gravitational wave events in nearby galaxies. It was designed as a power-recycled Fabry-Perot-Michelson interferometer and was intended as a step towards a final interferometer in Japan. The present successful status of TAMA is presented. TAMA forms a basis for LCGT (large-scale cryogenic gravitational wave telescope), a 3 km scale cryogenic interferometer to be built in the Kamioka mine in Japan, implementing cryogenic mirror techniques. The plan of LCGT is schematically described along with its associated R and D.

  19. Large spin systematics in CFT

    Energy Technology Data Exchange (ETDEWEB)

    Alday, Luis F.; Bissi, Agnese; Łukowski, Tomasz [Mathematical Institute, University of Oxford,Andrew Wiles Building, Radcliffe Observatory Quarter,Woodstock Road, Oxford, OX2 6GG (United Kingdom)

    2015-11-16

    Using conformal field theory (CFT) arguments we derive an infinite number of constraints on the large spin expansion of the anomalous dimensions and structure constants of higher spin operators. These arguments rely only on analyticity, unitarity, crossing-symmetry and the structure of the conformal partial wave expansion. We obtain results for both, perturbative CFT to all order in the perturbation parameter, as well as non-perturbatively. For the case of conformal gauge theories this provides a proof of the reciprocity principle to all orders in perturbation theory and provides a new “reciprocity' principle for structure constants. We argue that these results extend also to non-conformal theories.

  20. Large spin systematics in CFT

    International Nuclear Information System (INIS)

    Alday, Luis F.; Bissi, Agnese; Łukowski, Tomasz

    2015-01-01

    Using conformal field theory (CFT) arguments we derive an infinite number of constraints on the large spin expansion of the anomalous dimensions and structure constants of higher spin operators. These arguments rely only on analyticity, unitarity, crossing-symmetry and the structure of the conformal partial wave expansion. We obtain results for both, perturbative CFT to all order in the perturbation parameter, as well as non-perturbatively. For the case of conformal gauge theories this provides a proof of the reciprocity principle to all orders in perturbation theory and provides a new “reciprocity' principle for structure constants. We argue that these results extend also to non-conformal theories.

  1. Quick Mining of Isomorphic Exact Large Patterns from Large Graphs

    KAUST Repository

    Almasri, Islam

    2014-12-01

    The applications of the sub graph isomorphism search are growing with the growing number of areas that model their systems using graphs or networks. Specifically, many biological systems, such as protein interaction networks, molecular structures and protein contact maps, are modeled as graphs. The sub graph isomorphism search is concerned with finding all sub graphs that are isomorphic to a relevant query graph, the existence of such sub graphs can reflect on the characteristics of the modeled system. The most computationally expensive step in the search for isomorphic sub graphs is the backtracking algorithm that traverses the nodes of the target graph. In this paper, we propose a pruning approach that is inspired by the minimum remaining value heuristic that achieves greater scalability over large query and target graphs. Our testing on various biological networks shows that performance enhancement of our approach over existing state-of-the-art approaches varies between 6x and 53x. © 2014 IEEE.

  2. Quick Mining of Isomorphic Exact Large Patterns from Large Graphs

    KAUST Repository

    Almasri, Islam; Gao, Xin; Fedoroff, Nina V.

    2014-01-01

    The applications of the sub graph isomorphism search are growing with the growing number of areas that model their systems using graphs or networks. Specifically, many biological systems, such as protein interaction networks, molecular structures and protein contact maps, are modeled as graphs. The sub graph isomorphism search is concerned with finding all sub graphs that are isomorphic to a relevant query graph, the existence of such sub graphs can reflect on the characteristics of the modeled system. The most computationally expensive step in the search for isomorphic sub graphs is the backtracking algorithm that traverses the nodes of the target graph. In this paper, we propose a pruning approach that is inspired by the minimum remaining value heuristic that achieves greater scalability over large query and target graphs. Our testing on various biological networks shows that performance enhancement of our approach over existing state-of-the-art approaches varies between 6x and 53x. © 2014 IEEE.

  3. Quantum chromodynamics at large distances

    International Nuclear Information System (INIS)

    Arbuzov, B.A.

    1987-01-01

    Properties of QCD at large distances are considered in the framework of traditional quantum field theory. An investigation of asymptotic behaviour of lower Green functions in QCD is the starting point of the approach. The recent works are reviewed which confirm the singular infrared behaviour of gluon propagator M 2 /(k 2 ) 2 at least under some gauge conditions. A special covariant gauge comes out to be the most suitable for description of infrared region due to absence of ghost contributions to infrared asymptotics of Green functions. Solutions of Schwinger-Dyson equation for quark propagator are obtained in this special gauge and are shown to possess desirable properties: spontaneous breaking of chiral invariance and nonperturbative character. The infrared asymptotics of lower Green functions are used for calculation of vacuum expectation values of gluon and quark fields. These vacuum expectation values are obtained in a good agreement with the corresponding phenomenological values which are needed in the method of sum rules in QCD, that confirms adequacy of the infrared region description. The consideration of a behaviour of QCD at large distances leads to the conclusion that at contemporary stage of theory development one may consider two possibilities. The first one is the well-known confinement hypothesis and the second one is called incomplete confinement and stipulates for open color to be observable. Possible manifestations of incomplete confinement are discussed

  4. Large scale cluster computing workshop

    International Nuclear Information System (INIS)

    Dane Skow; Alan Silverman

    2002-01-01

    Recent revolutions in computer hardware and software technologies have paved the way for the large-scale deployment of clusters of commodity computers to address problems heretofore the domain of tightly coupled SMP processors. Near term projects within High Energy Physics and other computing communities will deploy clusters of scale 1000s of processors and be used by 100s to 1000s of independent users. This will expand the reach in both dimensions by an order of magnitude from the current successful production facilities. The goals of this workshop were: (1) to determine what tools exist which can scale up to the cluster sizes foreseen for the next generation of HENP experiments (several thousand nodes) and by implication to identify areas where some investment of money or effort is likely to be needed. (2) To compare and record experimences gained with such tools. (3) To produce a practical guide to all stages of planning, installing, building and operating a large computing cluster in HENP. (4) To identify and connect groups with similar interest within HENP and the larger clustering community

  5. Nonlinear electrokinetics at large voltages

    Energy Technology Data Exchange (ETDEWEB)

    Bazant, Martin Z [Department of Chemical Engineering and Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge, MA 02139 (United States); Sabri Kilic, Mustafa; Ajdari, Armand [Department of Mathematics, Massachusetts Institute of Technology, Cambridge, MA 02139 (United States); Storey, Brian D [Franklin W Olin College of Engineering, Needham, MA 02492 (United States)], E-mail: bazant@mit.edu

    2009-07-15

    The classical theory of electrokinetic phenomena assumes a dilute solution of point-like ions in chemical equilibrium with a surface whose double-layer voltage is of order the thermal voltage, k{sub B}T/e=25 mV. In nonlinear 'induced-charge' electrokinetic phenomena, such as ac electro-osmosis, several volts {approx}100k{sub B}T/e are applied to the double layer, and the theory breaks down and cannot explain many observed features. We argue that, under such a large voltage, counterions 'condense' near the surface, even for dilute bulk solutions. Based on simple models, we predict that the double-layer capacitance decreases and the electro-osmotic mobility saturates at large voltages, due to steric repulsion and increased viscosity of the condensed layer, respectively. The former suffices to explain observed high-frequency flow reversal in ac electro-osmosis; the latter leads to a salt concentration dependence of induced-charge flows comparable to experiments, although a complete theory is still lacking.

  6. Large shaft development test plan

    International Nuclear Information System (INIS)

    Krug, A.D.

    1984-03-01

    This test plan proposes the conduct of a large shaft development test at the Hanford site in support of the repository development program. The purpose and objective of the test plan is to obtain the information necessary to establish feasibility and to predict the performance of the drilling system used to drill large diameter shafts. The test plan is based upon drilling a 20 ft diameter shaft to a depth of 1,000 feet. The test plan specifies series of tests to evaluate the performance of the downhole assembly, the performance of the rig, and the ability of the system to cope with geologic hazards. The quality of the hole produced will also be determined. This test plan is considered to be preliminary in that it was prepared as input for the decision to determine if development testing is required in this area. Should the decision be made to proceed with development testing, this test plan shall be updated and revised. 6 refs., 2 figs., 3 tabs

  7. How Large Asexual Populations Adapt

    Science.gov (United States)

    Desai, Michael

    2007-03-01

    We often think of beneficial mutations as being rare, and of adaptation as a sequence of selected substitutions: a beneficial mutation occurs, spreads through a population in a selective sweep, then later another beneficial mutation occurs, and so on. This simple picture is the basis for much of our intuition about adaptive evolution, and underlies a number of practical techniques for analyzing sequence data. Yet many large and mostly asexual populations -- including a wide variety of unicellular organisms and viruses -- live in a very different world. In these populations, beneficial mutations are common, and frequently interfere or cooperate with one another as they all attempt to sweep simultaneously. This radically changes the way these populations adapt: rather than an orderly sequence of selective sweeps, evolution is a constant swarm of competing and interfering mutations. I will describe some aspects of these dynamics, including why large asexual populations cannot evolve very quickly and the character of the diversity they maintain. I will explain how this changes our expectations of sequence data, how sex can help a population adapt, and the potential role of ``mutator'' phenotypes with abnormally high mutation rates. Finally, I will discuss comparisons of these predictions with evolution experiments in laboratory yeast populations.

  8. Creating Large Scale Database Servers

    International Nuclear Information System (INIS)

    Becla, Jacek

    2001-01-01

    The BaBar experiment at the Stanford Linear Accelerator Center (SLAC) is designed to perform a high precision investigation of the decays of the B-meson produced from electron-positron interactions. The experiment, started in May 1999, will generate approximately 300TB/year of data for 10 years. All of the data will reside in Objectivity databases accessible via the Advanced Multi-threaded Server (AMS). To date, over 70TB of data have been placed in Objectivity/DB, making it one of the largest databases in the world. Providing access to such a large quantity of data through a database server is a daunting task. A full-scale testbed environment had to be developed to tune various software parameters and a fundamental change had to occur in the AMS architecture to allow it to scale past several hundred terabytes of data. Additionally, several protocol extensions had to be implemented to provide practical access to large quantities of data. This paper will describe the design of the database and the changes that we needed to make in the AMS for scalability reasons and how the lessons we learned would be applicable to virtually any kind of database server seeking to operate in the Petabyte region

  9. Creating Large Scale Database Servers

    Energy Technology Data Exchange (ETDEWEB)

    Becla, Jacek

    2001-12-14

    The BaBar experiment at the Stanford Linear Accelerator Center (SLAC) is designed to perform a high precision investigation of the decays of the B-meson produced from electron-positron interactions. The experiment, started in May 1999, will generate approximately 300TB/year of data for 10 years. All of the data will reside in Objectivity databases accessible via the Advanced Multi-threaded Server (AMS). To date, over 70TB of data have been placed in Objectivity/DB, making it one of the largest databases in the world. Providing access to such a large quantity of data through a database server is a daunting task. A full-scale testbed environment had to be developed to tune various software parameters and a fundamental change had to occur in the AMS architecture to allow it to scale past several hundred terabytes of data. Additionally, several protocol extensions had to be implemented to provide practical access to large quantities of data. This paper will describe the design of the database and the changes that we needed to make in the AMS for scalability reasons and how the lessons we learned would be applicable to virtually any kind of database server seeking to operate in the Petabyte region.

  10. Histotripsy Liquefaction of Large Hematomas.

    Science.gov (United States)

    Khokhlova, Tatiana D; Monsky, Wayne L; Haider, Yasser A; Maxwell, Adam D; Wang, Yak-Nam; Matula, Thomas J

    2016-07-01

    Intra- and extra-muscular hematomas result from repetitive injury as well as sharp and blunt limb trauma. The clinical consequences can be serious, including debilitating pain and functional deficit. There are currently no short-term treatment options for large hematomas, only lengthy conservative treatment. The goal of this work was to evaluate the feasibility of a high intensity focused ultrasound (HIFU)-based technique, termed histotripsy, for rapid (within a clinically relevant timeframe of 15-20 min) liquefaction of large volume (up to 20 mL) extra-vascular hematomas for subsequent fine-needle aspiration. Experiments were performed using in vitro extravascular hematoma phantoms-fresh bovine blood poured into 50 mL molds and allowed to clot. The resulting phantoms were treated by boiling histotripsy (BH), cavitation histotripsy (CH) or a combination in a degassed water tank under ultrasound guidance. Two different transducers operating at 1 MHz and 1.5 MHz with f-number = 1 were used. The liquefied lysate was aspirated and analyzed by histology and sized in a Coulter Counter. The peak instantaneous power to achieve BH was lower than (at 1.5 MHz) or equal to (at 1 MHz) that which was required to initiate CH. Under the same exposure duration, BH-induced cavities were one and a half to two times larger than the CH-induced cavities, but the CH-induced cavities were more regularly shaped, facilitating easier aspiration. The lysates contained a small amount of debris larger than 70 μm, and 99% of particulates were smaller than 10 μm. A combination treatment of BH (for initial debulking) and CH (for liquefaction of small residual fragments) yielded 20 mL of lysate within 17.5 minutes of treatment and was found to be most optimal for liquefaction of large extravascular hematomas. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  11. Book review: Large igneous provinces

    Science.gov (United States)

    du Bray, Edward A.

    2015-01-01

    This book presents a comprehensive compilation of all aspects of large igneous provinces (LIPs). Published in 2014, the book is now the definitive source of information on the petrogenesis of this type of globally important, voluminous magmatic activity. In the first few pages, LIPs are characterized as magmatic provinces with areal extents >0.1 Mkm2 that are dominated by mafic magmas emplaced or erupted in intraplate settings during relatively short (1–5 m.y.) time intervals. Given these parameters, particularly areal extent, LIPs clearly represent significant contributions to global geologic evolution through time. This point is underscored, also in the introductory chapter, by a series of figures that aptly characterize the global time-space distribution of LIPs; an accompanying, particularly useful table identifies individual LIPs, quantifies their basic characteristics, and enumerates pertinent references. Accordingly, this compilation is a welcome addition to the geologic literature.

  12. Large errors and severe conditions

    CERN Document Server

    Smith, D L; Van Wormer, L A

    2002-01-01

    Physical parameters that can assume real-number values over a continuous range are generally represented by inherently positive random variables. However, if the uncertainties in these parameters are significant (large errors), conventional means of representing and manipulating the associated variables can lead to erroneous results. Instead, all analyses involving them must be conducted in a probabilistic framework. Several issues must be considered: First, non-linear functional relations between primary and derived variables may lead to significant 'error amplification' (severe conditions). Second, the commonly used normal (Gaussian) probability distribution must be replaced by a more appropriate function that avoids the occurrence of negative sampling results. Third, both primary random variables and those derived through well-defined functions must be dealt with entirely in terms of their probability distributions. Parameter 'values' and 'errors' should be interpreted as specific moments of these probabil...

  13. Large shaft development test plan

    International Nuclear Information System (INIS)

    Krug, A.D.

    1984-03-01

    This test plan proposes the conduct of shaft liner tests as part of the large shaft development test proposed for the Hanford Site in support of the repository development program. The objectives of these tests are to develop techniques for measuring liner alignment (straightness), both construction assembly alignment and downhole cumulative alignment, and to assess the alignment information as a real time feedback to aid the installation procedure. The test plan is based upon installing a 16 foot ID shaft liner into a 20 foot diameter shaft to a depth of 1000 feet. This test plan is considered to be preliminary in that it was prepared as input for the decision to determine if development testing is required in this area. Should the decision be made to proceed with development testing, this test plan shall be updated and revised. 6 refs., 2 figs

  14. Large scale biomimetic membrane arrays

    DEFF Research Database (Denmark)

    Hansen, Jesper Søndergaard; Perry, Mark; Vogel, Jörg

    2009-01-01

    To establish planar biomimetic membranes across large scale partition aperture arrays, we created a disposable single-use horizontal chamber design that supports combined optical-electrical measurements. Functional lipid bilayers could easily and efficiently be established across CO2 laser micro......-structured 8 x 8 aperture partition arrays with average aperture diameters of 301 +/- 5 mu m. We addressed the electro-physical properties of the lipid bilayers established across the micro-structured scaffold arrays by controllable reconstitution of biotechnological and physiological relevant membrane...... peptides and proteins. Next, we tested the scalability of the biomimetic membrane design by establishing lipid bilayers in rectangular 24 x 24 and hexagonal 24 x 27 aperture arrays, respectively. The results presented show that the design is suitable for further developments of sensitive biosensor assays...

  15. Model of large pool fires

    Energy Technology Data Exchange (ETDEWEB)

    Fay, J.A. [Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139 (United States)]. E-mail: jfay@mit.edu

    2006-08-21

    A two zone entrainment model of pool fires is proposed to depict the fluid flow and flame properties of the fire. Consisting of combustion and plume zones, it provides a consistent scheme for developing non-dimensional scaling parameters for correlating and extrapolating pool fire visible flame length, flame tilt, surface emissive power, and fuel evaporation rate. The model is extended to include grey gas thermal radiation from soot particles in the flame zone, accounting for emission and absorption in both optically thin and thick regions. A model of convective heat transfer from the combustion zone to the liquid fuel pool, and from a water substrate to cryogenic fuel pools spreading on water, provides evaporation rates for both adiabatic and non-adiabatic fires. The model is tested against field measurements of large scale pool fires, principally of LNG, and is generally in agreement with experimental values of all variables.

  16. Model of large pool fires

    International Nuclear Information System (INIS)

    Fay, J.A.

    2006-01-01

    A two zone entrainment model of pool fires is proposed to depict the fluid flow and flame properties of the fire. Consisting of combustion and plume zones, it provides a consistent scheme for developing non-dimensional scaling parameters for correlating and extrapolating pool fire visible flame length, flame tilt, surface emissive power, and fuel evaporation rate. The model is extended to include grey gas thermal radiation from soot particles in the flame zone, accounting for emission and absorption in both optically thin and thick regions. A model of convective heat transfer from the combustion zone to the liquid fuel pool, and from a water substrate to cryogenic fuel pools spreading on water, provides evaporation rates for both adiabatic and non-adiabatic fires. The model is tested against field measurements of large scale pool fires, principally of LNG, and is generally in agreement with experimental values of all variables

  17. Large-scale solar heating

    Energy Technology Data Exchange (ETDEWEB)

    Tolonen, J.; Konttinen, P.; Lund, P. [Helsinki Univ. of Technology, Otaniemi (Finland). Advanced Energy Systems

    1998-10-01

    Solar heating market is growing in many European countries and annually installed collector area has exceeded one million square meters. There are dozens of collector manufacturers and hundreds of firms making solar heating installations in Europe. One tendency in solar heating is towards larger systems. These can be roof integrated, consisting of some tens or hundreds of square meters of collectors, or they can be larger centralized solar district heating plants consisting of a few thousand square meters of collectors. The increase of size can reduce the specific investments of solar heating systems, because e.g. the costs of some components (controllers, pumps, and pipes), planning and installation can be smaller in larger systems. The solar heat output can also be higher in large systems, because more advanced technique is economically viable

  18. Large aspect ratio tokamak study

    International Nuclear Information System (INIS)

    Reid, R.L.; Holmes, J.A.; Houlberg, W.A.; Peng, Y.K.M.; Strickler, D.J.; Brown, T.G.; Sardella, C.; Wiseman, G.W.

    1979-01-01

    The Large Aspect Ratio Tokamak Study (LARTS) investigated the potential for producing a viable long burn tokamak reactor through enhanced volt-second capability of the ohmic heating transformer by employing high aspect ratio designs. The plasma physics, engineering, and economic implications of high aspect ratio tokamaks were accessed in the context of extended burn operation. Plasma startup and burn parameters were addressed using a one-dimensional transport code. The pulsed electrical power requirements for the poloidal field system, which have a major impact on reactor economics, were minimized by optimizing the field in the ohmic heating coil and the wave shape of the ohmic heating discharge. A high aspect ratio reference reactor was chosen and configured

  19. LARGE BLOCK TEST STATUS REPORT

    International Nuclear Information System (INIS)

    D.G. WILDER, W. LIN, S.C. BLAIR, T. BUSCHECK, R.C. CARLSON, K. LEE, A. MEIKE, A.L. RAMIREZ, J.L. WAGONER, AND J. WANG

    1997-01-01

    This report is intended to serve as a status report, which essentially transmits the data that have been collected to date on the Large Block Test (LBT). The analyses of data will be performed during FY98, and then a complete report will be prepared. This status report includes introductory material that is not needed merely to transmit data but is available at this time and therefore included. As such, this status report will serve as the template for the future report, and the information is thus preserved. The United States Department of Energy (DOE) is investigatinq the suitability of Yucca Mountain (YM) as a potential site for the nation's first high-level nuclear waste repository. As shown in Fig. 1-1, the site is located about 120 km northwest of Las Vegas, Nevada, in an area of uninhabited desert

  20. Large Aperture Electrostatic Dust Detector

    International Nuclear Information System (INIS)

    Skinner, C.H.; Hensley, R.; Roquemore, A.L.

    2007-01-01

    Diagnosis and management of dust inventories generated in next-step magnetic fusion devices is necessary for their safe operation. A novel electrostatic dust detector, based on a fine grid of interlocking circuit traces biased to 30 or 50 v has been developed for the detection of dust particles on remote surfaces in air and vacuum environments. Impinging dust particles create a temporary short circuit and the resulting current pulse is recorded by counting electronics. Up to 90% of the particles are ejected from the grid or vaporized suggesting the device may be useful for controlling dust inventories. We report measurements of the sensitivity of a large area (5x5 cm) detector to microgram quantities of dust particles and review its applications to contemporary tokamaks and ITER.

  1. Conference on Large Scale Optimization

    CERN Document Server

    Hearn, D; Pardalos, P

    1994-01-01

    On February 15-17, 1993, a conference on Large Scale Optimization, hosted by the Center for Applied Optimization, was held at the University of Florida. The con­ ference was supported by the National Science Foundation, the U. S. Army Research Office, and the University of Florida, with endorsements from SIAM, MPS, ORSA and IMACS. Forty one invited speakers presented papers on mathematical program­ ming and optimal control topics with an emphasis on algorithm development, real world applications and numerical results. Participants from Canada, Japan, Sweden, The Netherlands, Germany, Belgium, Greece, and Denmark gave the meeting an important international component. At­ tendees also included representatives from IBM, American Airlines, US Air, United Parcel Serice, AT & T Bell Labs, Thinking Machines, Army High Performance Com­ puting Research Center, and Argonne National Laboratory. In addition, the NSF sponsored attendance of thirteen graduate students from universities in the United States and abro...

  2. Large scale nuclear structure studies

    International Nuclear Information System (INIS)

    Faessler, A.

    1985-01-01

    Results of large scale nuclear structure studies are reported. The starting point is the Hartree-Fock-Bogoliubov solution with angular momentum and proton and neutron number projection after variation. This model for number and spin projected two-quasiparticle excitations with realistic forces yields in sd-shell nuclei similar good results as the 'exact' shell-model calculations. Here the authors present results for a pf-shell nucleus 46 Ti and results for the A=130 mass region where they studied 58 different nuclei with the same single-particle energies and the same effective force derived from a meson exchange potential. They carried out a Hartree-Fock-Bogoliubov variation after mean field projection in realistic model spaces. In this way, they determine for each yrast state the optimal mean Hartree-Fock-Bogoliubov field. They apply this method to 130 Ce and 128 Ba using the same effective nucleon-nucleon interaction. (Auth.)

  3. Analysis of large urban fires

    International Nuclear Information System (INIS)

    Kang, S.W.; Reitter, T.A.; Takata, A.N.

    1984-11-01

    Fires in urban areas caused by a nuclear burst are analyzed as a first step towards determining their smoke-generation chacteristics, which may have grave implications for global-scale climatic consequences. A chain of events and their component processes which would follow a nuclear attack are described. A numerical code is currently being developed to calculate ultimately the smoke production rate for a given attack scenario. Available models for most of the processes are incorporated into the code. Sample calculations of urban fire-development history performed in the code for an idealized uniform city are presented. Preliminary results indicate the importance of the wind, thermal radiation transmission, fuel distributions, and ignition thresholds on the urban fire spread characteristics. Future plans are to improve the existing models and develop new ones to characterize smoke production from large urban fires. 21 references, 18 figures

  4. Large-scale river regulation

    International Nuclear Information System (INIS)

    Petts, G.

    1994-01-01

    Recent concern over human impacts on the environment has tended to focus on climatic change, desertification, destruction of tropical rain forests, and pollution. Yet large-scale water projects such as dams, reservoirs, and inter-basin transfers are among the most dramatic and extensive ways in which our environment has been, and continues to be, transformed by human action. Water running to the sea is perceived as a lost resource, floods are viewed as major hazards, and wetlands are seen as wastelands. River regulation, involving the redistribution of water in time and space, is a key concept in socio-economic development. To achieve water and food security, to develop drylands, and to prevent desertification and drought are primary aims for many countries. A second key concept is ecological sustainability. Yet the ecology of rivers and their floodplains is dependent on the natural hydrological regime, and its related biochemical and geomorphological dynamics. (Author)

  5. Large-order perturbation theory

    International Nuclear Information System (INIS)

    Wu, T.T.

    1982-01-01

    The original motivation for studying the asymptotic behavior of the coefficients of perturbation series came from quantum field theory. An overview is given of some of the attempts to understand quantum field theory beyond finite-order perturbation series. At least is the case of the Thirring model and probably in general, the full content of a relativistic quantum field theory cannot be recovered from its perturbation series. This difficulty, however, does not occur in quantum mechanics, and the anharmonic oscillator is used to illustrate the methods used in large-order perturbation theory. Two completely different methods are discussed, the first one using the WKB approximation, and a second one involving the statistical analysis of Feynman diagrams. The first one is well developed and gives detailed information about the desired asymptotic behavior, while the second one is still in its infancy and gives instead information about the distribution of vertices of the Feynman diagrams

  6. Great expectations: large wind turbines

    International Nuclear Information System (INIS)

    De Vries, E.

    2001-01-01

    This article focuses on wind turbine product development, and traces the background to wind turbines from the first generation 1.5 MW machines in 1995-6, plans for the second generation 3-5 MW class turbines to meet the expected boom in offshore wind projects, to the anticipated installation of a 4.5 MW turbine, and offshore wind projects planned for 2000-2002. The switch by the market leader Vestas to variable speed operation in 2000, the new product development and marketing strategy taken by the German Pro + Pro consultancy in their design of a 1.5 MW variable speed pitch control concept, the possible limiting of the size of turbines due to logistical difficulties, opportunities offered by air ships for large turbines, and the commissioning of offshore wind farms are discussed. Details of some 2-5 MW offshore wind turbine design specifications are tabulated

  7. Perspectives on large linear colliders

    International Nuclear Information System (INIS)

    Richter, B.

    1987-11-01

    Three main items in the design of large linear colliders are presented. The first is the interrelation of energy and luminosity requirements. These two items impose severe constraints on the accelerator builder who must design a machine to meet the needs of experimentl high energy physics rather than designing a machine for its own sake. An introduction is also given for linear collider design, concentrating on what goes on at the collision point, for still another constraint comes here from the beam-beam interaction which further restricts the choices available to the accelerator builder. The author also gives his impressions of the state of the technology available for building these kinds of machines within the next decade. The paper concludes with a brief recommendation for how we can all get on with the work faster, and hope to realize these machines sooner by working together. 10 refs., 9 figs

  8. Joint studies on large CANDU

    International Nuclear Information System (INIS)

    Lee, Ikhwan; Yu, S. K. W.

    1994-01-01

    from economic, safety and strategic viewpoints. A large number of research and development programs are now in place at AECL and KAERI that will permit substantial improvements to be realized in the next generation of CANDU okabts, Furthermore, opportunities exist for engineered improvements based on the research and development in advancing the generic CANDU Technology. Final Large CANDU joint study report with technical deliverables will be issued 1994 October. Phase 2 R and D program of the joint studies will be determined this year and implemented in next year. CANDU neutron economy permits versatility in choices of fuel cycles. This allows a utility to choose fuel cycle options for lower fuelling cost, better security of supply, and ultimately for much lower spent-fuel volume, than with PWR's alone. To meet Korea's strategic requirements, CANDU should be an integral part of the electricity supply mix.

  9. Large Volcanic Rises on Venus

    Science.gov (United States)

    Smrekar, Suzanne E.; Kiefer, Walter S.; Stofan, Ellen R.

    1997-01-01

    Large volcanic rises on Venus have been interpreted as hotspots, or the surface manifestation of mantle upwelling, on the basis of their broad topographic rises, abundant volcanism, and large positive gravity anomalies. Hotspots offer an important opportunity to study the behavior of the lithosphere in response to mantle forces. In addition to the four previously known hotspots, Atla, Bell, Beta, and western Eistla Regiones, five new probable hotspots, Dione, central Eistla, eastern Eistla, Imdr, and Themis, have been identified in the Magellan radar, gravity and topography data. These nine regions exhibit a wider range of volcano-tectonic characteristics than previously recognized for venusian hotspots, and have been classified as rift-dominated (Atla, Beta), coronae-dominated (central and eastern Eistla, Themis), or volcano-dominated (Bell, Dione, western Eistla, Imdr). The apparent depths of compensation for these regions ranges from 65 to 260 km. New estimates of the elastic thickness, using the 90 deg and order spherical harmonic field, are 15-40 km at Bell Regio, and 25 km at western Eistla Regio. Phillips et al. find a value of 30 km at Atla Regio. Numerous models of lithospheric and mantle behavior have been proposed to interpret the gravity and topography signature of the hotspots, with most studies focusing on Atla or Beta Regiones. Convective models with Earth-like parameters result in estimates of the thickness of the thermal lithosphere of approximately 100 km. Models of stagnant lid convection or thermal thinning infer the thickness of the thermal lithosphere to be 300 km or more. Without additional constraints, any of the model fits are equally valid. The thinner thermal lithosphere estimates are most consistent with the volcanic and tectonic characteristics of the hotspots. Estimates of the thermal gradient based on estimates of the elastic thickness also support a relatively thin lithosphere (Phillips et al.). The advantage of larger estimates of

  10. Reviving large-scale projects

    International Nuclear Information System (INIS)

    Desiront, A.

    2003-01-01

    For the past decade, most large-scale hydro development projects in northern Quebec have been put on hold due to land disputes with First Nations. Hydroelectric projects have recently been revived following an agreement signed with Aboriginal communities in the province who recognized the need to find new sources of revenue for future generations. Many Cree are working on the project to harness the waters of the Eastmain River located in the middle of their territory. The work involves building an 890 foot long dam, 30 dikes enclosing a 603 square-km reservoir, a spillway, and a power house with 3 generating units with a total capacity of 480 MW of power for start-up in 2007. The project will require the use of 2,400 workers in total. The Cree Construction and Development Company is working on relations between Quebec's 14,000 Crees and the James Bay Energy Corporation, the subsidiary of Hydro-Quebec which is developing the project. Approximately 10 per cent of the $735-million project has been designated for the environmental component. Inspectors ensure that the project complies fully with environmental protection guidelines. Total development costs for Eastmain-1 are in the order of $2 billion of which $735 million will cover work on site and the remainder will cover generating units, transportation and financial charges. Under the treaty known as the Peace of the Braves, signed in February 2002, the Quebec government and Hydro-Quebec will pay the Cree $70 million annually for 50 years for the right to exploit hydro, mining and forest resources within their territory. The project comes at a time when electricity export volumes to the New England states are down due to growth in Quebec's domestic demand. Hydropower is a renewable and non-polluting source of energy that is one of the most acceptable forms of energy where the Kyoto Protocol is concerned. It was emphasized that large-scale hydro-electric projects are needed to provide sufficient energy to meet both

  11. Large Scale Glazed Concrete Panels

    DEFF Research Database (Denmark)

    Bache, Anja Margrethe

    2010-01-01

    Today, there is a lot of focus on concrete surface’s aesthitic potential, both globally and locally. World famous architects such as Herzog De Meuron, Zaha Hadid, Richard Meyer and David Chippenfield challenge the exposure of concrete in their architecture. At home, this trend can be seen...... in the crinkly façade of DR-Byen (the domicile of the Danish Broadcasting Company) by architect Jean Nouvel and Zaha Hadid’s Ordrupgård’s black curved smooth concrete surfaces. Furthermore, one can point to initiatives such as “Synlig beton” (visible concrete) that can be seen on the website www.......synligbeton.dk and spæncom’s aesthetic relief effects by the designer Line Kramhøft (www.spaencom.com). It is my hope that the research-development project “Lasting large scale glazed concrete formwork,” I am working on at DTU, department of Architectural Engineering will be able to complement these. It is a project where I...

  12. The Large Hadron Collider project

    CERN Document Server

    Maiani, Luciano

    1999-01-01

    Knowledge of the fundamental constituents of matter has greatly advanced, over the last decades. The standard theory of fundamental interactions presents us with a theoretically sound picture, which describes with great accuracy known physical phenomena on most diverse energy and distance scales. These range from 10/sup -16/ cm, inside the nucleons, up to large-scale astrophysical bodies, including the early Universe at some nanosecond after the Big-Bang and temperatures of the order of 10/sup 2/ GeV. The picture is not yet completed, however, as we lack the observation of the Higgs boson, predicted in the 100-500 GeV range-a particle associated with the generation of particle masses and with the quantum fluctuations in the primordial Universe. In addition, the standard theory is expected to undergo a change of regime in the 10/sup 3/ GeV region, with the appearance of new families of particles, most likely associated with the onset of a new symmetry (supersymmetry). In 1994, the CERN Council approved the con...

  13. MALIGNANCY IN LARGE COLORECTAL LESIONS

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Oliveira dos SANTOS

    2014-09-01

    Full Text Available Context The size of colorectal lesions, besides a risk factor for malignancy, is a predictor for deeper invasion Objectives To evaluate the malignancy of colorectal lesions ≥20 mm. Methods Between 2007 and 2011, 76 neoplasms ≥20 mm in 70 patients were analyzed Results The mean age of the patients was 67.4 years, and 41 were women. Mean lesion size was 24.7 mm ± 6.2 mm (range: 20 to 50 mm. Half of the neoplasms were polypoid and the other half were non-polypoid. Forty-two (55.3% lesions were located in the left colon, and 34 in the right colon. There was a high prevalence of III L (39.5% and IV (53.9% pit patterns. There were 72 adenomas and 4 adenocarcinomas. Malignancy was observed in 5.3% of the lesions. Thirty-three lesions presented advanced histology (adenomas with high-grade dysplasia or early adenocarcinoma, with no difference in morphology and site. Only one lesion (1.3% invaded the submucosa. Lesions larger than 30 mm had advanced histology (P = 0.001. The primary treatment was endoscopic resection, and invasive carcinoma was referred to surgery. Recurrence rate was 10.6%. Conclusions Large colorectal neoplasms showed a low rate of malignancy. Endoscopic treatment is an effective therapy for these lesions.

  14. Large-area photonic crystals

    Science.gov (United States)

    Ruhl, Tilmann; Spahn, Peter; Hellmann, Gotz P.; Winkler, Holger

    2004-09-01

    Materials with a periodically modulated refractive index, with periods on the scale of light wavelengths, are currently attracting much attention because of their unique optical properties which are caused by Bragg scattering of the visible light. In nature, 3d structures of this kind are found in the form of opals in which monodisperse silica spheres with submicron diameters form a face-centered-cubic (fcc) lattice. Artificial opals, with the same colloidal-crystalline fcc structure, have meanwhile been prepared by crystallizing spherical colloidal particles via sedimentation or drying of dispersions. In this report, colloidal crystalline films are introduced that were produced by a novel technique based on shear flow in the melts of specially designed submicroscopic silica-polymer core-shell hybrid spheres: when the melt of these spheres flows between the plates of a press, the spheres crystallize along the plates, layer by layer, and the silica cores assume the hexagonal order corresponding to the (111) plane of the fcc lattice. This process is fast and yields large-area films, thin or thick. To enhance the refractive index contrast in these films, the colloidal crystalline structure was inverted by etching out the silica cores with hydrofluoric acid. This type of an inverse opal, in which the fcc lattice is formed by mesopores, is referred to as a polymer-air photonic crystal.

  15. Shutdown problems in large tokamaks

    International Nuclear Information System (INIS)

    Weldon, D.M.

    1978-01-01

    Some of the problems connected with a normal shutdown at the end of the burn phase (soft shutdown) and with a shutdown caused by disruptive instability (hard shutdown) have been considered. For a soft shutdown a cursory literature search was undertaken and methods for controlling the thermal wall loading were listed. Because shutdown computer codes are not widespread, some of the differences between start-up codes and shutdown codes were discussed along with program changes needed to change a start-up code to a shutdown code. For a hard shutdown, the major problems are large induced voltages in the ohmic-heating and equilibrium-field coils and high first wall erosion. A literature search of plasma-wall interactions was carried out. Phenomena that occur at the plasma-wall interface can be quite complicated. For example, material evaporated from the wall can form a virtual limiter or shield protecting the wall from major damage. Thermal gradients that occur during the interaction can produce currents whose associated magnetic field also helps shield the wall

  16. Large scale cross hole testing

    International Nuclear Information System (INIS)

    Ball, J.K.; Black, J.H.; Doe, T.

    1991-05-01

    As part of the Site Characterisation and Validation programme the results of the large scale cross hole testing have been used to document hydraulic connections across the SCV block, to test conceptual models of fracture zones and obtain hydrogeological properties of the major hydrogeological features. The SCV block is highly heterogeneous. This heterogeneity is not smoothed out even over scales of hundreds of meters. Results of the interpretation validate the hypothesis of the major fracture zones, A, B and H; not much evidence of minor fracture zones is found. The uncertainty in the flow path, through the fractured rock, causes sever problems in interpretation. Derived values of hydraulic conductivity were found to be in a narrow range of two to three orders of magnitude. Test design did not allow fracture zones to be tested individually. This could be improved by testing the high hydraulic conductivity regions specifically. The Piezomac and single hole equipment worked well. Few, if any, of the tests ran long enough to approach equilibrium. Many observation boreholes showed no response. This could either be because there is no hydraulic connection, or there is a connection but a response is not seen within the time scale of the pumping test. The fractional dimension analysis yielded credible results, and the sinusoidal testing procedure provided an effective means of identifying the dominant hydraulic connections. (10 refs.) (au)

  17. Mapping change in large networks.

    Directory of Open Access Journals (Sweden)

    Martin Rosvall

    2010-01-01

    Full Text Available Change is a fundamental ingredient of interaction patterns in biology, technology, the economy, and science itself: Interactions within and between organisms change; transportation patterns by air, land, and sea all change; the global financial flow changes; and the frontiers of scientific research change. Networks and clustering methods have become important tools to comprehend instances of these large-scale structures, but without methods to distinguish between real trends and noisy data, these approaches are not useful for studying how networks change. Only if we can assign significance to the partitioning of single networks can we distinguish meaningful structural changes from random fluctuations. Here we show that bootstrap resampling accompanied by significance clustering provides a solution to this problem. To connect changing structures with the changing function of networks, we highlight and summarize the significant structural changes with alluvial diagrams and realize de Solla Price's vision of mapping change in science: studying the citation pattern between about 7000 scientific journals over the past decade, we find that neuroscience has transformed from an interdisciplinary specialty to a mature and stand-alone discipline.

  18. Tipping device for large components

    International Nuclear Information System (INIS)

    Guigon, J.P.; Beraudier, D.

    1984-01-01

    For large components machining as components of a pressurized water reactor, it is necessary to have means allowing to present them in a position determined with regard to the machine tool used. The aim of the invention is a tipping device which consists of a base resting on the ground, a support-table mounted on this base, moving in rotation with the aid of at least a pivot joint of which axis is horizontal and parallel to the table and a gear pivot allowing to get a very good precision for the orientation of the piece and a very good stability whatever the orientation may be. The output shaft pinion of the base meshes with a gear wheel segment fixed to the table structure. Safety straps fasten the table structure to the base, as they are secured by horizontal pins. The toe pins run in straight slot holes incorporated in base jaws. The table rotation may be controlled by a spring-loaded braking mechanism which acts on the pivot axis and can be released by a hydraulic jack. The hydraulic pressure is used to prevent motor operation, unless the brakes have been released [fr

  19. Natural Selection in Large Populations

    Science.gov (United States)

    Desai, Michael

    2011-03-01

    I will discuss theoretical and experimental approaches to the evolutionary dynamics and population genetics of natural selection in large populations. In these populations, many mutations are often present simultaneously, and because recombination is limited, selection cannot act on them all independently. Rather, it can only affect whole combinations of mutations linked together on the same chromosome. Methods common in theoretical population genetics have been of limited utility in analyzing this coupling between the fates of different mutations. In the past few years it has become increasingly clear that this is a crucial gap in our understanding, as sequence data has begun to show that selection appears to act pervasively on many linked sites in a wide range of populations, including viruses, microbes, Drosophila, and humans. I will describe approaches that combine analytical tools drawn from statistical physics and dynamical systems with traditional methods in theoretical population genetics to address this problem, and describe how experiments in budding yeast can help us directly observe these evolutionary dynamics.

  20. Assembly considerations for large reflectors

    Science.gov (United States)

    Bush, H.

    1988-01-01

    The technologies developed at LaRC in the area of erectable instructures are discussed. The information is of direct value to the Large Deployable Reflector (LDR) because an option for the LDR backup structure is to assemble it in space. The efforts in this area, which include development of joints, underwater assembly simulation tests, flight assembly/disassembly tests, and fabrication of 5-meter trusses, led to the use of the LaRC concept as the baseline configuration for the Space Station Structure. The Space Station joint is linear in the load and displacement range of interest to Space Station; the ability to manually assemble and disassemble a 45-foot truss structure was demonstrated by astronauts in space as part of the ACCESS Shuttle Flight Experiment. The structure was built in 26 minutes 46 seconds, and involved a total of 500 manipulations of untethered hardware. Also, the correlation of the space experience with the neutral buoyancy simulation was very good. Sections of the proposed 5-meter bay Space Station truss have been built on the ground. Activities at LaRC have included the development of mobile remote manipulator systems (which can traverse the Space Station 5-meter structure), preliminary LDR sun shield concepts, LDR construction scenarios, and activities in robotic assembly of truss-type structures.

  1. Large superconducting coil fabrication development

    International Nuclear Information System (INIS)

    Brown, R.L.; Allred, E.L.; Anderson, W.C.; Burn, P.B.; Deaderick, R.I.; Henderson, G.M.; Marguerat, E.F.

    1975-01-01

    Toroidal fields for some fusion devices will be produced by an array of large superconducting coils. Their size, space limitation, and field requirements dictate that they be high performance coils. Once installed, accessibility for maintenance and repairs is severely restricted; therefore, good reliability is an obvious necessity. Sufficient coil fabrication will be undertaken to develop and test methods that are reliable, fast, and economical. Industrial participation will be encouraged from the outset to insure smooth transition from development phases to production phases. Initially, practice equipment for three meter bore circular coils will be developed. Oval shape coil forms will be included in the practice facility later. Equipment that is more automated will be developed with the expectation of winding faster and obtaining good coil quality. Alternate types of coil construction, methods of winding and insulating, will be investigated. Handling and assembly problems will be studied. All technology developed must be feasible for scaling up when much larger coils are needed. Experimental power reactors may need coils having six meter or larger bores

  2. Large earthquakes and creeping faults

    Science.gov (United States)

    Harris, Ruth A.

    2017-01-01

    Faults are ubiquitous throughout the Earth's crust. The majority are silent for decades to centuries, until they suddenly rupture and produce earthquakes. With a focus on shallow continental active-tectonic regions, this paper reviews a subset of faults that have a different behavior. These unusual faults slowly creep for long periods of time and produce many small earthquakes. The presence of fault creep and the related microseismicity helps illuminate faults that might not otherwise be located in fine detail, but there is also the question of how creeping faults contribute to seismic hazard. It appears that well-recorded creeping fault earthquakes of up to magnitude 6.6 that have occurred in shallow continental regions produce similar fault-surface rupture areas and similar peak ground shaking as their locked fault counterparts of the same earthquake magnitude. The behavior of much larger earthquakes on shallow creeping continental faults is less well known, because there is a dearth of comprehensive observations. Computational simulations provide an opportunity to fill the gaps in our understanding, particularly of the dynamic processes that occur during large earthquake rupture and arrest.

  3. Pressing technology for large bottoms

    International Nuclear Information System (INIS)

    Jilek, L.

    1986-01-01

    The technology has been selected of a circular plate bent into the shape of a trough, for pressing bottoms of pressure vessels from a circular plate of large diameter. The initial sheet is first bent in the middle by heating with the edges remaining straight. These are then welded longitudinally by electroslag welding and the circular shape is flame cut. The result will be a plate with a straight surface in the middle with raised edges which may be pressed into the desired shape. In this manner it is also possible to press pressure vessel bottoms with tube couplings from plates which are thickened in the middle and drilled; additional welding is then eliminated. Deformation from heat treatment may be avoided by the use of a fixture in the shape of a ring with a groove into which is fixed the edge of the bottom. During hardening of the bottom it will be necessary to care for the withdrawal of vapours and gases which would hamper uniform cooling. Bottom hardening with the grill and the cupola downwards has been proven. Deformation which occurs during treatment may to a certain extent be removed by calibration which cannot, however, be made without special fixtures and instruments. (J.B.)

  4. Relaxing a large cosmological constant

    International Nuclear Information System (INIS)

    Bauer, Florian; Sola, Joan; Stefancic, Hrvoje

    2009-01-01

    The cosmological constant (CC) problem is the biggest enigma of theoretical physics ever. In recent times, it has been rephrased as the dark energy (DE) problem in order to encompass a wider spectrum of possibilities. It is, in any case, a polyhedric puzzle with many faces, including the cosmic coincidence problem, i.e. why the density of matter ρ m is presently so close to the CC density ρ Λ . However, the oldest, toughest and most intriguing face of this polyhedron is the big CC problem, namely why the measured value of ρ Λ at present is so small as compared to any typical density scale existing in high energy physics, especially taking into account the many phase transitions that our Universe has undergone since the early times, including inflation. In this Letter, we propose to extend the field equations of General Relativity by including a class of invariant terms that automatically relax the value of the CC irrespective of the initial size of the vacuum energy in the early epochs. We show that, at late times, the Universe enters an eternal de Sitter stage mimicking a tiny positive cosmological constant. Thus, these models could be able to solve the big CC problem without fine-tuning and have also a bearing on the cosmic coincidence problem. Remarkably, they mimic the ΛCDM model to a large extent, but they still leave some characteristic imprints that should be testable in the next generation of experiments.

  5. The LUVOIR Large Mission Concept

    Science.gov (United States)

    O'Meara, John; LUVOIR Science and Technology Definition Team

    2018-01-01

    LUVOIR is one of four large mission concepts for which the NASA Astrophysics Division has commissioned studies by Science and Technology Definition Teams (STDTs) drawn from the astronomical community. We are currently developing two architectures: Architecture A with a 15.1 meter segmented primary mirror, and Architecture B with a 9.2 meter segmented primary mirror. Our focus in this presentation is the Architecture A LUVOIR. LUVOIR will operate at the Sun-Earth L2 point. It will be designed to support a broad range of astrophysics and exoplanet studies. The initial instruments developed for LUVOIR Architecture A include 1) a high-performance optical/NIR coronagraph with imaging and spectroscopic capability, 2) a UV imager and spectrograph with high spectral resolution and multi-object capability, 3) a high-definition wide-field optical/NIR camera, and 4) a high resolution UV/optical spectropolarimeter. LUVOIR will be designed for extreme stability to support unprecedented spatial resolution and coronagraphy. It is intended to be a long-lifetime facility that is both serviceable, upgradable, and primarily driven by guest observer science programs. In this presentation, we will describe the observatory, its instruments, and survey the transformative science LUVOIR can accomplish.

  6. Large-scale galaxy bias

    Science.gov (United States)

    Desjacques, Vincent; Jeong, Donghui; Schmidt, Fabian

    2018-02-01

    This review presents a comprehensive overview of galaxy bias, that is, the statistical relation between the distribution of galaxies and matter. We focus on large scales where cosmic density fields are quasi-linear. On these scales, the clustering of galaxies can be described by a perturbative bias expansion, and the complicated physics of galaxy formation is absorbed by a finite set of coefficients of the expansion, called bias parameters. The review begins with a detailed derivation of this very important result, which forms the basis of the rigorous perturbative description of galaxy clustering, under the assumptions of General Relativity and Gaussian, adiabatic initial conditions. Key components of the bias expansion are all leading local gravitational observables, which include the matter density but also tidal fields and their time derivatives. We hence expand the definition of local bias to encompass all these contributions. This derivation is followed by a presentation of the peak-background split in its general form, which elucidates the physical meaning of the bias parameters, and a detailed description of the connection between bias parameters and galaxy statistics. We then review the excursion-set formalism and peak theory which provide predictions for the values of the bias parameters. In the remainder of the review, we consider the generalizations of galaxy bias required in the presence of various types of cosmological physics that go beyond pressureless matter with adiabatic, Gaussian initial conditions: primordial non-Gaussianity, massive neutrinos, baryon-CDM isocurvature perturbations, dark energy, and modified gravity. Finally, we discuss how the description of galaxy bias in the galaxies' rest frame is related to clustering statistics measured from the observed angular positions and redshifts in actual galaxy catalogs.

  7. Large-scale galaxy bias

    Science.gov (United States)

    Jeong, Donghui; Desjacques, Vincent; Schmidt, Fabian

    2018-01-01

    Here, we briefly introduce the key results of the recent review (arXiv:1611.09787), whose abstract is as following. This review presents a comprehensive overview of galaxy bias, that is, the statistical relation between the distribution of galaxies and matter. We focus on large scales where cosmic density fields are quasi-linear. On these scales, the clustering of galaxies can be described by a perturbative bias expansion, and the complicated physics of galaxy formation is absorbed by a finite set of coefficients of the expansion, called bias parameters. The review begins with a detailed derivation of this very important result, which forms the basis of the rigorous perturbative description of galaxy clustering, under the assumptions of General Relativity and Gaussian, adiabatic initial conditions. Key components of the bias expansion are all leading local gravitational observables, which include the matter density but also tidal fields and their time derivatives. We hence expand the definition of local bias to encompass all these contributions. This derivation is followed by a presentation of the peak-background split in its general form, which elucidates the physical meaning of the bias parameters, and a detailed description of the connection between bias parameters and galaxy (or halo) statistics. We then review the excursion set formalism and peak theory which provide predictions for the values of the bias parameters. In the remainder of the review, we consider the generalizations of galaxy bias required in the presence of various types of cosmological physics that go beyond pressureless matter with adiabatic, Gaussian initial conditions: primordial non-Gaussianity, massive neutrinos, baryon-CDM isocurvature perturbations, dark energy, and modified gravity. Finally, we discuss how the description of galaxy bias in the galaxies' rest frame is related to clustering statistics measured from the observed angular positions and redshifts in actual galaxy catalogs.

  8. One to Large N Gradiometry

    Science.gov (United States)

    Langston, C. A.

    2017-12-01

    The seismic wave gradient tensor can be derived from a variety of field observations including measurements of the wavefield by a dense seismic array, strain meters, and rotation meters. Coupled with models of wave propagation, wave gradients along with the original wavefield can give estimates of wave attributes that can be used to infer wave propagation directions, apparent velocities, spatial amplitude behavior, and wave type. Compact geodetic arrays with apertures of 0.1 wavelength or less can be deployed to provide wavefield information at a localized spot similar to larger phased arrays with apertures of many wavelengths. Large N, spatially distributed arrays can provide detailed information over an area to detect structure changes. Key to accurate computation of spatial gradients from arrays of seismic instruments is knowledge of relative instrument responses, particularly component sensitivities and gains, along with relative sensor orientations. Array calibration has been successfully performed for the 14-element Pinyon Flat, California, broadband array using long-period teleseisms to achieve relative precisions as small as 0.2% in amplitude and 0.35o in orientation. Calibration has allowed successful comparison of horizontal seismic strains from local and regional seismic events with the Plate Boundary Observatory (PBO) borehole strainmeter located at the facility. Strains from the borehole strainmeter in conjunction with ground velocity from a co-located seismometer are used as a "point" array in estimating wave attributes for the P-SV components of the wavefield. An effort is underway to verify the calibration of PBO strainmeters in southern California and their co-located borehole seismic sensors to create an array of point arrays for use in studies of regional wave propagation and seismic sources.

  9. Large capacity temporary visual memory

    Science.gov (United States)

    Endress, Ansgar D.; Potter, Mary C.

    2014-01-01

    Visual working memory (WM) capacity is thought to be limited to three or four items. However, many cognitive activities seem to require larger temporary memory stores. Here, we provide evidence for a temporary memory store with much larger capacity than past WM capacity estimates. Further, based on previous WM research, we show that a single factor — proactive interference — is sufficient to bring capacity estimates down to the range of previous WM capacity estimates. Participants saw a rapid serial visual presentation (RSVP) of 5 to 21 pictures of familiar objects or words presented at rates of 4/s or 8/s, respectively, and thus too fast for strategies such as rehearsal. Recognition memory was tested with a single probe item. When new items were used on all trials, no fixed memory capacities were observed, with estimates of up to 9.1 retained pictures for 21-item lists, and up to 30.0 retained pictures for 100-item lists, and no clear upper bound to how many items could be retained. Further, memory items were not stored in a temporally stable form of memory, but decayed almost completely after a few minutes. In contrast, when, as in most WM experiments, a small set of items was reused across all trials, thus creating proactive interference among items, capacity remained in the range reported in previous WM experiments. These results show that humans have a large-capacity temporary memory store in the absence of proactive interference, and raise the question of whether temporary memory in everyday cognitive processing is severely limited as in WM experiments, or has the much larger capacity found in the present experiments. PMID:23937181

  10. Seismic analysis of large pools

    Energy Technology Data Exchange (ETDEWEB)

    Dong, R.G.; Tokarz, F.J.

    1976-11-17

    Large pools for storing spent, nuclear fuel elements are being proposed to augment present storage capacity. To preserve the ability to isolate portions of these pools, a modularization requirement appears desirable. The purpose of this project was to investigate the effects of modularization on earthquake resistance and to assess the adequacy of current design methods for seismic loads. After determining probable representative pool geometries, three rectangular pool configurations, all 240 x 16 ft and 40 ft deep, were examined. One was unmodularized; two were modularized into 80 x 40 ft cells in one case and 80 x 80 ft cells in the other. Both embedded and above-ground installations for a hard site and embedded installations for an intermediate hard site were studied. It was found that modularization was unfavorable in terms of reducing the total structural load attributable to dynamic effects, principally because one or more cells could be left unfilled. The walls of unfilled cells would be subjected to significantly higher loads than the walls of a filled, unmodularized pool. Generally, embedded installations were preferable to above-ground installations, and the hard site was superior to the intermediate hard site. It was determined that Housner's theory was adequate for calculating hydrodynamic effects on spent fuel storage pools. Current design methods for seismic loads were found to be satisfactory when results from these methods were compared with those from LUSH analyses. As a design method for dynamic soil pressure, we found the Mononobe-Okabe theory, coupled with correction factors as suggested by Seed, to be acceptable. The factors we recommend for spent fuel storage pools are tabulated.

  11. Seismic analysis of large pools

    International Nuclear Information System (INIS)

    Dong, R.G.; Tokarz, F.J.

    1976-01-01

    Large pools for storing spent, nuclear fuel elements are being proposed to augment present storage capacity. To preserve the ability to isolate portions of these pools, a modularization requirement appears desirable. The purpose of this project was to investigate the effects of modularization on earthquake resistance and to assess the adequacy of current design methods for seismic loads. After determining probable representative pool geometries, three rectangular pool configurations, all 240 x 16 ft and 40 ft deep, were examined. One was unmodularized; two were modularized into 80 x 40 ft cells in one case and 80 x 80 ft cells in the other. Both embedded and above-ground installations for a hard site and embedded installations for an intermediate hard site were studied. It was found that modularization was unfavorable in terms of reducing the total structural load attributable to dynamic effects, principally because one or more cells could be left unfilled. The walls of unfilled cells would be subjected to significantly higher loads than the walls of a filled, unmodularized pool. Generally, embedded installations were preferable to above-ground installations, and the hard site was superior to the intermediate hard site. It was determined that Housner's theory was adequate for calculating hydrodynamic effects on spent fuel storage pools. Current design methods for seismic loads were found to be satisfactory when results from these methods were compared with those from LUSH analyses. As a design method for dynamic soil pressure, we found the Mononobe-Okabe theory, coupled with correction factors as suggested by Seed, to be acceptable. The factors we recommend for spent fuel storage pools are tabulated

  12. Large optics inspection, tilting, and washing stand

    Science.gov (United States)

    Ayers, Marion Jay [Brentwood, CA; Ayers, Shannon Lee [Brentwood, CA

    2010-08-24

    A large optics stand provides a risk free means of safely tilting large optics with ease and a method of safely tilting large optics with ease. The optics are supported in the horizontal position by pads. In the vertical plane the optics are supported by saddles that evenly distribute the optics weight over a large area.

  13. Large dams and risk management

    International Nuclear Information System (INIS)

    Cazelais, N.

    2003-01-01

    In July 1996, Quebec's Saguenay region was subjected to intensive rainfall which caused severe floods and uncontrolled release of several reservoirs, resulting in extensive damage to dam structures and reservoirs. The probability of occurrence for that disaster was 1:10,000. Following the disaster, the Quebec government established a dam management body entitled the Commission scientifique et technique sur la gestion des barrages, which pointed out several safety shortcomings of existing dams. Many were either very old or had undergone significant function change without being subsequently re-evaluated. A report by the Commission stated that damage following the floods could have been limited if the design and operating standards of the dams had been more stringent. A Dam Safety Act was adopted by the Quebec National Assembly on May 30, 2000 following recommendations to retain safer structures. The Act demands regular reporting of operating procedures. Seismic activity was noted as being a topic that requires in-depth examination since Quebec's St. Lawrence Valley, particularly the Charlevoix region, is one of Canada's largest seismic zones. The other is on the west coast in British Columbia. Earthquakes in Quebec are less intense than the ones in British Columbia, but they have higher frequency content which exerts a quasi-resonance wave effect which impacts roads, bridges, buildings and hydroelectric generating facilities. Hydro-Quebec is a public utility which owns 563 retaining structures, of which 228 are ranked as large dams that measure more than 15 metres high, 400 metres long and with a reservoir capacity of more than 1 million cubic metres of water. Hydro-Quebec addresses hydrological, seismic, technological and human risks through a dam safety procedure that includes structured plans for choosing best alternatives through staged exercises. Hazard levels are minimized through the adoption of emergency, prevention and alleviation measures. The utility

  14. Large truck and bus crash facts, 2010.

    Science.gov (United States)

    2012-09-01

    This annual edition of Large Truck and Bus Crash Facts contains descriptive statistics about fatal, injury, and : property damage only crashes involving large trucks and buses in 2010. Selected crash statistics on passenger : vehicles are also presen...

  15. Large truck and bus crash facts, 2012.

    Science.gov (United States)

    2014-06-01

    This annual edition of Large Truck and Bus Crash Facts contains descriptive statistics about fatal, injury, and property damage only crashes involving large trucks and buses in 2012. Selected crash statistics on passenger vehicles are also presented ...

  16. Large truck and bus crash facts, 2013.

    Science.gov (United States)

    2015-04-01

    This annual edition of Large Truck and Bus Crash Facts contains descriptive statistics about fatal, injury, and property damage only crashes involving large trucks and buses in 2013. Selected crash statistics on passenger vehicles are also presented ...

  17. Large truck and bus crash facts, 2009.

    Science.gov (United States)

    2011-10-01

    This annual edition of Large Truck and Bus Crash Facts contains descriptive statistics about fatal, injury, and : property damage only crashes involving large trucks and buses in 2009. Selected crash statistics on passenger : vehicles are also presen...

  18. Large truck and bus crash facts, 2011.

    Science.gov (United States)

    2013-10-01

    This annual edition of Large Truck and Bus Crash Facts contains descriptive statistics about fatal, injury, and : property damage only crashes involving large trucks and buses in 2011. Selected crash statistics on passenger : vehicles are also presen...

  19. Superconducting materials for large scale applications

    International Nuclear Information System (INIS)

    Dew-Hughes, D.

    1975-01-01

    Applications of superconductors capable of carrying large current densities in large-scale electrical devices are examined. Discussions are included on critical current density, superconducting materials available, and future prospects for improved superconducting materials. (JRD)

  20. Investing in a Large Stretch Press

    Science.gov (United States)

    Choate, M.; Nealson, W.; Jay, G.; Buss, W.

    1986-01-01

    Press for forming large aluminum parts from plates provides substantial economies. Study assessed advantages and disadvantages of investing in large stretch-forming press, and also developed procurement specification for press.

  1. Large-scale energy consumers pay less

    International Nuclear Information System (INIS)

    Denneman, A.

    2012-01-01

    The price of electricity in the Netherlands rose with 6 percent in the first quarter of 2012, whereas large business consumers are paying less. The natural gas price has risen with about 10 percent in the last year, both for households and for large business consumers. Meanwhile, households are paying twice as much for electricity and gas as large business consumers. [nl

  2. 27 CFR 19.915 - Large plants.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Large plants. 19.915... OF THE TREASURY LIQUORS DISTILLED SPIRITS PLANTS Distilled Spirits For Fuel Use Permits § 19.915 Large plants. Any person wishing to establish a large plant shall make application for and obtain an...

  3. 75 FR 73983 - Assessments, Large Bank Pricing

    Science.gov (United States)

    2010-11-30

    ... 327 RIN 3064-AD66 Assessments, Large Bank Pricing AGENCY: Federal Deposit Insurance Corporation (FDIC... Pricing. This correction clarifies that the comment period for the Assessments, Large Bank Pricing ends January 3, 2011. FOR FURTHER INFORMATION CONTACT: Lisa Ryu, Chief, Large Bank Pricing Section, Division of...

  4. 76 FR 10671 - Assessments, Large Bank Pricing

    Science.gov (United States)

    2011-02-25

    ... 327 Assessments, Large Bank Pricing; Final Rule #0;#0;Federal Register / Vol. 76 , No. 38 / Friday... Part 327 RIN 3064-AD66 Assessments, Large Bank Pricing AGENCY: Federal Deposit Insurance Corporation..., (202) 898-6796; Lisa Ryu, Chief, Large Bank Pricing Section, Division of Insurance and Research, (202...

  5. Why did humans develop a large brain?

    OpenAIRE

    Muscat Baron, Yves

    2012-01-01

    "Of all animals, man has the largest brain in proportion to his size"- Aristotle. Dr Yves Muscat Baron shares his theory on how humans evolved large brains. The theory outlines how gravity could have helped humans develop a large brain- the author has named the theory 'The Gravitational Vascular Theory'. http://www.um.edu.mt/think/why-did-humans-develop-a-large-brain/

  6. Large N baryons, strong coupling theory, quarks

    International Nuclear Information System (INIS)

    Sakita, B.

    1984-01-01

    It is shown that in QCD the large N limit is the same as the static strong coupling limit. By using the static strong coupling techniques some of the results of large N baryons are derived. The results are consistent with the large N SU(6) static quark model. (author)

  7. Forecasting distribution of numbers of large fires

    Science.gov (United States)

    Haiganoush K. Preisler; Jeff Eidenshink; Stephen Howard; Robert E. Burgan

    2015-01-01

    Systems to estimate forest fire potential commonly utilize one or more indexes that relate to expected fire behavior; however they indicate neither the chance that a large fire will occur, nor the expected number of large fires. That is, they do not quantify the probabilistic nature of fire danger. In this work we use large fire occurrence information from the...

  8. Large-group psychodynamics and massive violence

    Directory of Open Access Journals (Sweden)

    Vamik D. Volkan

    2006-06-01

    Full Text Available Beginning with Freud, psychoanalytic theories concerning large groups have mainly focused on individuals' perceptions of what their large groups psychologically mean to them. This chapter examines some aspects of large-group psychology in its own right and studies psychodynamics of ethnic, national, religious or ideological groups, the membership of which originates in childhood. I will compare the mourning process in individuals with the mourning process in large groups to illustrate why we need to study large-group psychology as a subject in itself. As part of this discussion I will also describe signs and symptoms of large-group regression. When there is a threat against a large-group's identity, massive violence may be initiated and this violence in turn, has an obvious impact on public health.

  9. Ethics of large-scale change

    OpenAIRE

    Arler, Finn

    2006-01-01

      The subject of this paper is long-term large-scale changes in human society. Some very significant examples of large-scale change are presented: human population growth, human appropriation of land and primary production, the human use of fossil fuels, and climate change. The question is posed, which kind of attitude is appropriate when dealing with large-scale changes like these from an ethical point of view. Three kinds of approaches are discussed: Aldo Leopold's mountain thinking, th...

  10. Large Display Interaction Using Mobile Devices

    OpenAIRE

    Bauer, Jens

    2015-01-01

    Large displays become more and more popular, due to dropping prices. Their size and high resolution leverages collaboration and they are capable of dis- playing even large datasets in one view. This becomes even more interesting as the number of big data applications increases. The increased screen size and other properties of large displays pose new challenges to the Human- Computer-Interaction with these screens. This includes issues such as limited scalability to the number of users, diver...

  11. Large transverse momentum behavior of gauge theories

    International Nuclear Information System (INIS)

    Coquereaux, Robert; De Rafael, Eduardo.

    1977-05-01

    The large transverse momentum behavior of Compton scattering and Moeller scattering in Quantum Electrodynamics; and of elastic quark-quark scattering in Quantum Chromodynamics are examined in perturbation theory. The results strongly suggest that the large transverse momentum regime in gauge theories is governed by a differential equation of the Callan-Symanzik type with a suitable momentum dependent anomalous dimension term. An explicit solution for the quark-quark elastic scattering amplitude at large transverse momentum is given

  12. Large-scale grid management; Storskala Nettforvaltning

    Energy Technology Data Exchange (ETDEWEB)

    Langdal, Bjoern Inge; Eggen, Arnt Ove

    2003-07-01

    The network companies in the Norwegian electricity industry now have to establish a large-scale network management, a concept essentially characterized by (1) broader focus (Broad Band, Multi Utility,...) and (2) bigger units with large networks and more customers. Research done by SINTEF Energy Research shows so far that the approaches within large-scale network management may be structured according to three main challenges: centralization, decentralization and out sourcing. The article is part of a planned series.

  13. Reliability of large and complex systems

    CERN Document Server

    Kolowrocki, Krzysztof

    2014-01-01

    Reliability of Large and Complex Systems, previously titled Reliability of Large Systems, is an innovative guide to the current state and reliability of large and complex systems. In addition to revised and updated content on the complexity and safety of large and complex mechanisms, this new edition looks at the reliability of nanosystems, a key research topic in nanotechnology science. The author discusses the importance of safety investigation of critical infrastructures that have aged or have been exposed to varying operational conditions. This reference provides an asympt

  14. Implementing Large Projects in Software Engineering Courses

    Science.gov (United States)

    Coppit, David

    2006-01-01

    In software engineering education, large projects are widely recognized as a useful way of exposing students to the real-world difficulties of team software development. But large projects are difficult to put into practice. First, educators rarely have additional time to manage software projects. Second, classrooms have inherent limitations that…

  15. Asian Eden : large herbivore ecology in India

    NARCIS (Netherlands)

    Ahrestani, F.S.

    2009-01-01

    The study of large mammalian herbivore ecology has a strong allometric tradition. The
    majority of studies that have helped better understand how body mass affects large herbivore
    ecology in the tropics, from a biological, functional, and ecological perspective, are from
    Africa.

  16. The large deviation approach to statistical mechanics

    International Nuclear Information System (INIS)

    Touchette, Hugo

    2009-01-01

    The theory of large deviations is concerned with the exponential decay of probabilities of large fluctuations in random systems. These probabilities are important in many fields of study, including statistics, finance, and engineering, as they often yield valuable information about the large fluctuations of a random system around its most probable state or trajectory. In the context of equilibrium statistical mechanics, the theory of large deviations provides exponential-order estimates of probabilities that refine and generalize Einstein's theory of fluctuations. This review explores this and other connections between large deviation theory and statistical mechanics, in an effort to show that the mathematical language of statistical mechanics is the language of large deviation theory. The first part of the review presents the basics of large deviation theory, and works out many of its classical applications related to sums of random variables and Markov processes. The second part goes through many problems and results of statistical mechanics, and shows how these can be formulated and derived within the context of large deviation theory. The problems and results treated cover a wide range of physical systems, including equilibrium many-particle systems, noise-perturbed dynamics, nonequilibrium systems, as well as multifractals, disordered systems, and chaotic systems. This review also covers many fundamental aspects of statistical mechanics, such as the derivation of variational principles characterizing equilibrium and nonequilibrium states, the breaking of the Legendre transform for nonconcave entropies, and the characterization of nonequilibrium fluctuations through fluctuation relations.

  17. Large Scale Computations in Air Pollution Modelling

    DEFF Research Database (Denmark)

    Zlatev, Z.; Brandt, J.; Builtjes, P. J. H.

    Proceedings of the NATO Advanced Research Workshop on Large Scale Computations in Air Pollution Modelling, Sofia, Bulgaria, 6-10 July 1998......Proceedings of the NATO Advanced Research Workshop on Large Scale Computations in Air Pollution Modelling, Sofia, Bulgaria, 6-10 July 1998...

  18. Reflections on Teaching a Large Class.

    Science.gov (United States)

    Miner, Rick

    1992-01-01

    Uses an analysis of small- and large-class differences as a framework for planning for and teaching a large class. Analyzes the process of developing and offering an organizational behavior class to 141 college students. Suggests ways to improve teaching effectiveness by minimizing psychological and physical distances, redistributing resources,…

  19. Superconducting magnets technologies for large accelerator

    International Nuclear Information System (INIS)

    Ogitsu, Toru

    2017-01-01

    The first hadron collider with superconducting magnet technologies was built at Fermi National Accelerator Laboratory as TEVATRON. Since then, the superconducting magnet technologies are widely used in large accelerator applications. The paper summarizes the superconducting magnet technologies used for large accelerators. (author)

  20. Automating large-scale reactor systems

    International Nuclear Information System (INIS)

    Kisner, R.A.

    1985-01-01

    This paper conveys a philosophy for developing automated large-scale control systems that behave in an integrated, intelligent, flexible manner. Methods for operating large-scale systems under varying degrees of equipment degradation are discussed, and a design approach that separates the effort into phases is suggested. 5 refs., 1 fig

  1. Comb-drive actuators for large displacements

    NARCIS (Netherlands)

    Legtenberg, Rob; Legtenberg, R.; Groeneveld, A.W.; Elwenspoek, Michael Curt

    The design, fabrication and experimental results of lateral-comb-drive actuators for large displacements at low driving voltages is presented. A comparison of several suspension designs is given, and the lateral large deflection behaviour of clamped-clamped beams and a folded flexure design is

  2. Large-scale perspective as a challenge

    NARCIS (Netherlands)

    Plomp, M.G.A.

    2012-01-01

    1. Scale forms a challenge for chain researchers: when exactly is something ‘large-scale’? What are the underlying factors (e.g. number of parties, data, objects in the chain, complexity) that determine this? It appears to be a continuum between small- and large-scale, where positioning on that

  3. Computing in Large-Scale Dynamic Systems

    NARCIS (Netherlands)

    Pruteanu, A.S.

    2013-01-01

    Software applications developed for large-scale systems have always been difficult to de- velop due to problems caused by the large number of computing devices involved. Above a certain network size (roughly one hundred), necessary services such as code updating, topol- ogy discovery and data

  4. Decentralized Large-Scale Power Balancing

    DEFF Research Database (Denmark)

    Halvgaard, Rasmus; Jørgensen, John Bagterp; Poulsen, Niels Kjølstad

    2013-01-01

    problem is formulated as a centralized large-scale optimization problem but is then decomposed into smaller subproblems that are solved locally by each unit connected to an aggregator. For large-scale systems the method is faster than solving the full problem and can be distributed to include an arbitrary...

  5. Large Mines and the Community : Socioeconomic and ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    1 janv. 2001 ... Large Mines and the Community : Socioeconomic and Environmental Effects in Latin America, Canada, and Spain. Couverture du livre Large Mines and the Community : Socioeconomic and Environmental Effects in Latin America. Directeur(s):. Gary McMahon et Felix Remy. Maison(s) d'édition: Banque ...

  6. The algebras of large N matrix mechanics

    Energy Technology Data Exchange (ETDEWEB)

    Halpern, M.B.; Schwartz, C.

    1999-09-16

    Extending early work, we formulate the large N matrix mechanics of general bosonic, fermionic and supersymmetric matrix models, including Matrix theory: The Hamiltonian framework of large N matrix mechanics provides a natural setting in which to study the algebras of the large N limit, including (reduced) Lie algebras, (reduced) supersymmetry algebras and free algebras. We find in particular a broad array of new free algebras which we call symmetric Cuntz algebras, interacting symmetric Cuntz algebras, symmetric Bose/Fermi/Cuntz algebras and symmetric Cuntz superalgebras, and we discuss the role of these algebras in solving the large N theory. Most important, the interacting Cuntz algebras are associated to a set of new (hidden!) local quantities which are generically conserved only at large N. A number of other new large N phenomena are also observed, including the intrinsic nonlocality of the (reduced) trace class operators of the theory and a closely related large N field identification phenomenon which is associated to another set (this time nonlocal) of new conserved quantities at large N.

  7. The large deviation approach to statistical mechanics

    Science.gov (United States)

    Touchette, Hugo

    2009-07-01

    The theory of large deviations is concerned with the exponential decay of probabilities of large fluctuations in random systems. These probabilities are important in many fields of study, including statistics, finance, and engineering, as they often yield valuable information about the large fluctuations of a random system around its most probable state or trajectory. In the context of equilibrium statistical mechanics, the theory of large deviations provides exponential-order estimates of probabilities that refine and generalize Einstein’s theory of fluctuations. This review explores this and other connections between large deviation theory and statistical mechanics, in an effort to show that the mathematical language of statistical mechanics is the language of large deviation theory. The first part of the review presents the basics of large deviation theory, and works out many of its classical applications related to sums of random variables and Markov processes. The second part goes through many problems and results of statistical mechanics, and shows how these can be formulated and derived within the context of large deviation theory. The problems and results treated cover a wide range of physical systems, including equilibrium many-particle systems, noise-perturbed dynamics, nonequilibrium systems, as well as multifractals, disordered systems, and chaotic systems. This review also covers many fundamental aspects of statistical mechanics, such as the derivation of variational principles characterizing equilibrium and nonequilibrium states, the breaking of the Legendre transform for nonconcave entropies, and the characterization of nonequilibrium fluctuations through fluctuation relations.

  8. Efficient querying of large process model repositories

    NARCIS (Netherlands)

    Jin, Tao; Wang, Jianmin; La Rosa, M.; Hofstede, ter A.H.M.; Wen, Lijie

    2013-01-01

    Recent years have seen an increased uptake of business process management technology in industries. This has resulted in organizations trying to manage large collections of business process models. One of the challenges facing these organizations concerns the retrieval of models from large business

  9. Displaced trochanteric fragments lead to poor functional outcome in pertrochanteric fractures treated by cephalomedullary nails.

    Science.gov (United States)

    Studer, Patrick; Suhm, Norbert; Wang, Qing; Rosenthal, Rachel; Saleh, Hatem Al-Fadel; Jakob, Marcel

    2015-12-01

    The importance of the greater trochanter and its attached abductor muscles for physiological gait is well accepted. However the influence of a displaced greater trochanter fracture after a pertrochanteric fracture is unknown. The aim of this study is to determine if there is an association between the greater trochanter position and the level of patient mobility following internal fixation of pertrochanteric fractures. One hundred and thirty-three consecutive elderly patients with a median age of 85 (interquartile range [IQR] 79-91) years, who were treated for pertrochanteric fractures at a level I trauma centre, were recruited. AO 31 A3.1 and A3.2 fracture types were excluded from the statistical analysis. Patient mobility was prospectively assessed before the fracture and one year following fracture treatment using the Parker mobility score. In a multivariable analysis, the influence of a displaced greater trochanter on patient mobility at one-year follow-up was assessed. The analysis was adjusted for age, gender, body mass index, Charlson comorbidity index, AO fracture classification, varus-/valgus malposition of the neck-shaft fragments, and Parker mobility score before fracture. Post-operative X-rays were available in 125 patients, out of which 66 (53%) patients were identified with a displaced or migrated greater trochanter. One year mortality rate was 22% (n=27). In the 82 patients who had functional assessment one year post-operatively, the median Parker mobility score before fracture and at one-year follow-up was 7 (IQR 4-9) and 7 (IQR 3-9) in patients without, and 7 (IQR 4-9) and 3 (IQR 2-5) in patients with a displaced greater trochanter. In multivariable analysis, a displaced greater trochanter was significantly associated with a lower Parker mobility score (-1.74, 95% confidence interval -2.37, -1.12, pfractures with a cephalomedullary nail is associated with a poor functional outcome. Greater attention to achieve adequate reduction and stabilisation of this fragment during internal fixation of pertrochanteric hip fractures should be aimed for despite the inability of current cephalomedullary implants to do so. III prognostic and epidemiological study. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Comparison of Short vs Long Anti-rotation in Treating Trochanteric Fractures

    Directory of Open Access Journals (Sweden)

    Raval P

    2016-03-01

    Full Text Available Introduction: A comparative evaluation of the surgical treatment and outcome of patients with pertrochanteric fractures treated with short versus long proximal femoral nail antirotation. Materials and methods: A retrospective review was conducted of patients with pertrochanteric fractures treated between January 2011 and June 2012. In all 80 patients were enrolled in the study, of which 40 were treated with short PFNA and the remaining with long PFNA. Comparative analyses of demographic data, peri-operative outcome and complications were carried out. Results: There was no significant difference noted in the two groups with regards to Arbeitsgemeinschaft fur Osteosynthesefragen (AO fracture classification, time from injury to surgery, blood transfusion post surgery and hospital stay. The surgical duration for a short PFNA procedure was significantly less (58 minutes when compared to that of a long PFNA (87 minutes. Similarly intra-operative blood loss was significantly higher in the long PFNA group as compared to the short PFNA. Conclusions: A relatively quicker surgical time of just under an hour , lesser blood loss and better learning curve with trainee surgeons make short PFNA a better implant choice in the treatment of pertrochanteric fractures.

  11. The Impact of the Osteosynthesis Devices over the Trochanteric Area: Analysis Using the Finite Elements Method

    Directory of Open Access Journals (Sweden)

    Ştefan CHINDRIŞ

    2008-12-01

    Full Text Available The present research’s aim was to examine the ability to create an experimental model of the proximal femural region, to simulate the presence of an unstable intertrochanteric fracture line and an implant used for fracture fixation, using the finite element analysis. In addition, the PC software I used had the ability to examine the stress induced by static forces over the bone and implant and the deformation of the bone-implant assembly. The results are consistent and have clinical relevance, being useful in the choice of the implant design or implantation site in the operating area.

  12. Age-related changes in dynamic compressive properties of trochanteric soft tissues over the hip.

    Science.gov (United States)

    Choi, W J; Russell, C M; Tsai, C M; Arzanpour, S; Robinovitch, S N

    2015-02-26

    Hip fracture risk increases dramatically with age, and 90% of fractures are due to falls. During a fall on the hip, the soft tissues overlying the hip region (skin, fat, and muscle) act as shock absorbers to absorb energy and reduce the peak force applied to the underlying bone. We conducted dynamic indentation experiments with young women (aged 19-30; n=17) and older women (aged 65-81; n=17) to test the hypothesis that changes occur with age in the stiffness and damping properties of these tissues. Tissue stiffness and damping were derived from experiments where subjects lay sideways on a bed with the greater trochanter contacting a 3.8cm diameter indenter, which applied sinusoidal compression between 5 to 30Hz with a peak-to-peak amplitude of 1mm. Soft tissue thickness was measured using ultrasound. On average, stiffness was 2.9-fold smaller in older than young women (5.7 versus 16.8kN/m, p=0.0005) and damping was 3.5-fold smaller in older than young women (81 versus 282Ns/m, p=0.001). Neither parameter associated with soft tissue thickness. Our results indicate substantial age-related reductions in the stiffness and damping of soft tissues over the hip region, which likely reduce their capacity to absorb and dissipate energy (before "bottoming out") during a fall. Strategies such as wearable hip protectors or compliant flooringmay compensate for age-related reductions in the shock-absorbing properties of soft tissues and decrease the injury potential of falls. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Tuberculous trochanteric bursitis, a rare cause of hip pain in an ...

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    was no history of trauma, diabetes mellitus, renal failure and immunosuppressant or corticosteroid use. Constitutional symptoms like fever, weight loss and anorexia were absent. There was no obvious history of contact with tuberculosis. She reported a similar episode of pain and swelling at the same site about 10 years ...

  14. Distal fascia lata lengthening: an alternative surgical technique for recalcitrant trochanteric bursitis

    Science.gov (United States)

    Ortega, Javier; García-Rayo, Ramón; Resines, Carlos

    2009-01-01

    This article presents a simple technique for fascia lata lengthening that is less aggressive, can be performed under local anaesthetic with little morbidity and disability, and has excellent results. Eleven patients (13 hips) were enrolled in this study. Mean age was 54.6 years, there was one man and ten women. Outcomes were assessed by using a visual analog pain scale, Harris hip score and Lickert scale (satisfaction). There was a mean follow-up time of 43 months (range 15–84). All patients were scored by the Harris hip scale with a mean improvement from 61 (range 48–77) to 91 (range 76–95) after surgery. The mean visual analogue scale (VAS) score improved from 83 (range 60–99) to 13 (range 0–70). We had 12 of 13 patients reporting a good result. Mean surgical time was 15 min, and only one seroma was reported as a complication. No inpatient management was needed. In conclusion, distal “Z” lengthening of the fascia lata appears to be a good alternative for treatment of this condition. PMID:19214507

  15. Comparing two intramedullary devices for treating trochanteric fractures: A prospective study

    Directory of Open Access Journals (Sweden)

    Kontogeorgakos Vasileios

    2010-02-01

    Full Text Available Abstract Background Intertrochanteric fractures are surgically treated by using different methods and implants. The optional type of surgical stabilization is still under debate. However, between devices with the same philosophy, different design characteristics may substantially influence fracture healing. This is a prospective study comparing the complication and final functional outcome of two intramedullary devices, the intramedullary hip screw (IMHS and the ENDOVIS nail. Materials and methods Two hundred fifteen patients were randomized on admission in two treatment groups. Epidemiology features and functional status was similar between two treatment groups. Fracture stability was assessed according to the Evan's classification. One hundred ten patients were treated with IMHS and 105 with ENDOVIS nail. Results There were no significant statistical differences between the two groups regarding blood loss, transfusion requirements and mortality rate. In contrast, the number of total complications was significantly higher in the ENDOVIS nail group. Moreover, the overall functional and walking competence was superior in the patients treated with the IMHS nail. Conclusions These results indicate that the choice of the proper implant plays probably an important role in the final outcome of surgical treatment of intertrochanteric fractures. IMHS nail allows for accurate surgical technique, for both static and dynamic compression and high rotational stability. IMHS nail proved more reliable in our study regarding nail insertion and overall uncomplicated outcome.

  16. Environmental effects and large space systems

    Science.gov (United States)

    Garrett, H. B.

    1981-01-01

    When planning large scale operations in space, environmental impact must be considered in addition to radiation, spacecraft charging, contamination, high power and size. Pollution of the atmosphere and space is caused by rocket effluents and by photoelectrons generated by sunlight falling on satellite surfaces even light pollution may result (the SPS may reflect so much light as to be a nuisance to astronomers). Large (100 Km 2) structures also will absorb the high energy particles that impinge on them. Altogether, these effects may drastically alter the Earth's magnetosphere. It is not clear if these alterations will in any way affect the Earth's surface climate. Large structures will also generate large plasma wakes and waves which may cause interference with communications to the vehicle. A high energy, microwave beam from the SPS will cause ionospheric turbulence, affecting UHF and VHF communications. Although none of these effects may ultimately prove critical, they must be considered in the design of large structures.

  17. Entanglement transitions induced by large deviations

    Science.gov (United States)

    Bhosale, Udaysinh T.

    2017-12-01

    The probability of large deviations of the smallest Schmidt eigenvalue for random pure states of bipartite systems, denoted as A and B , is computed analytically using a Coulomb gas method. It is shown that this probability, for large N , goes as exp[-β N2Φ (ζ ) ] , where the parameter β is the Dyson index of the ensemble, ζ is the large deviation parameter, while the rate function Φ (ζ ) is calculated exactly. Corresponding equilibrium Coulomb charge density is derived for its large deviations. Effects of the large deviations of the extreme (largest and smallest) Schmidt eigenvalues on the bipartite entanglement are studied using the von Neumann entropy. Effect of these deviations is also studied on the entanglement between subsystems 1 and 2, obtained by further partitioning the subsystem A , using the properties of the density matrix's partial transpose ρ12Γ. The density of states of ρ12Γ is found to be close to the Wigner's semicircle law with these large deviations. The entanglement properties are captured very well by a simple random matrix model for the partial transpose. The model predicts the entanglement transition across a critical large deviation parameter ζ . Log negativity is used to quantify the entanglement between subsystems 1 and 2. Analytical formulas for it are derived using the simple model. Numerical simulations are in excellent agreement with the analytical results.

  18. Analysis of large databases in vascular surgery.

    Science.gov (United States)

    Nguyen, Louis L; Barshes, Neal R

    2010-09-01

    Large databases can be a rich source of clinical and administrative information on broad populations. These datasets are characterized by demographic and clinical data for over 1000 patients from multiple institutions. Since they are often collected and funded for other purposes, their use for secondary analysis increases their utility at relatively low costs. Advantages of large databases as a source include the very large numbers of available patients and their related medical information. Disadvantages include lack of detailed clinical information and absence of causal descriptions. Researchers working with large databases should also be mindful of data structure design and inherent limitations to large databases, such as treatment bias and systemic sampling errors. Withstanding these limitations, several important studies have been published in vascular care using large databases. They represent timely, "real-world" analyses of questions that may be too difficult or costly to address using prospective randomized methods. Large databases will be an increasingly important analytical resource as we focus on improving national health care efficacy in the setting of limited resources.

  19. Recent quality of ultra large rotor shafts

    International Nuclear Information System (INIS)

    Suzuki, Akira; Kinoshita, Shushi; Morita, Kikuo; Kikuchi, Hideo; Takada, Masayoshi

    1983-01-01

    Large size and high quality are required for rotor shafts accompanying recent trend of thermal and nuclear power generation toward large capacity. As for the low pressure rotor shafts for large capacity turbines, the disks and a shaft tend to be made into one body instead of conventional shrink fit construction, because of the experience of rotor accidents and the improvement of reliability. Therefore the ingots required become more and more large, and excellent production techniques are required for steel making, forging and heat treatment. Kobe Steel Ltd. have made about 20 large generator shafts from 420 t and 500 t ingots, and confirmed their stable high quality. Also a one-body low pressure rotor of 2600 mm diameter was made for trial, and its quality was examined. It was confirmed that the effect of forging and heat treatment was given sufficiently, and the production techniques for super-large one-body rotors were established. In steel making, vacuum degassing was applied twice to decrease hydrogen content, and VV restriction forging and pre-stage treatment were carried out. The properties of large rotors are reported. (Kako, I.)

  20. Distributed simulation of large computer systems

    International Nuclear Information System (INIS)

    Marzolla, M.

    2001-01-01

    Sequential simulation of large complex physical systems is often regarded as a computationally expensive task. In order to speed-up complex discrete-event simulations, the paradigm of Parallel and Distributed Discrete Event Simulation (PDES) has been introduced since the late 70s. The authors analyze the applicability of PDES to the modeling and analysis of large computer system; such systems are increasingly common in the area of High Energy and Nuclear Physics, because many modern experiments make use of large 'compute farms'. Some feasibility tests have been performed on a prototype distributed simulator

  1. Large scale network-centric distributed systems

    CERN Document Server

    Sarbazi-Azad, Hamid

    2014-01-01

    A highly accessible reference offering a broad range of topics and insights on large scale network-centric distributed systems Evolving from the fields of high-performance computing and networking, large scale network-centric distributed systems continues to grow as one of the most important topics in computing and communication and many interdisciplinary areas. Dealing with both wired and wireless networks, this book focuses on the design and performance issues of such systems. Large Scale Network-Centric Distributed Systems provides in-depth coverage ranging from ground-level hardware issu

  2. The Amateurs' Love Affair with Large Datasets

    Science.gov (United States)

    Price, Aaron; Jacoby, S. H.; Henden, A.

    2006-12-01

    Amateur astronomers are professionals in other areas. They bring expertise from such varied and technical careers as computer science, mathematics, engineering, and marketing. These skills, coupled with an enthusiasm for astronomy, can be used to help manage the large data sets coming online in the next decade. We will show specific examples where teams of amateurs have been involved in mining large, online data sets and have authored and published their own papers in peer-reviewed astronomical journals. Using the proposed LSST database as an example, we will outline a framework for involving amateurs in data analysis and education with large astronomical surveys.

  3. Electronic and atomic impacts on large clusters

    International Nuclear Information System (INIS)

    Gspann, J.

    1982-01-01

    Describing first the generation and properties of molecular beams of large Van der Waals clusters such as speed distribution, cluster size distribution, and internal temperature of the clusters, the review then features the results of electronic impacts on large clusters: metastable electronic cluster excitations, ejection of positive cluster ions of less than 100 atoms from much larger parent clusters, and ionization of the large clusters. Atomic impacts at thermal energies are treated with respect to the scattering cross section of the clusters, their drag coefficient in free molecular flow, and the peculiarities of impacts on helium clusters of either isotope. (Auth.)

  4. Large polarons in lead halide perovskites

    OpenAIRE

    Miyata, Kiyoshi; Meggiolaro, Daniele; Trinh, M. Tuan; Joshi, Prakriti P.; Mosconi, Edoardo; Jones, Skyler C.; De Angelis, Filippo; Zhu, X.-Y.

    2017-01-01

    Lead halide perovskites show marked defect tolerance responsible for their excellent optoelectronic properties. These properties might be explained by the formation of large polarons, but how they are formed and whether organic cations are essential remain open questions. We provide a direct time domain view of large polaron formation in single-crystal lead bromide perovskites CH3NH3PbBr3 and CsPbBr3. We found that large polaron forms predominantly from the deformation of the PbBr3 ? framewor...

  5. Laparoscopic transperitoneal ureterolithotomy for large ureteric stones

    Directory of Open Access Journals (Sweden)

    Ahmed Al-Sayyad

    2012-01-01

    Conclusion: Laparoscopic transperitoneal ureterolithotomy is a safe and effective approach for selected patients with large proximal ureteric stones with reduced postoperative pain and short hospital stay, and should be considered as a treatment option for such stones.

  6. Large-scale numerical simulations of plasmas

    International Nuclear Information System (INIS)

    Hamaguchi, Satoshi

    2004-01-01

    The recent trend of large scales simulations of fusion plasma and processing plasmas is briefly summarized. Many advanced simulation techniques have been developed for fusion plasmas and some of these techniques are now applied to analyses of processing plasmas. (author)

  7. Large Truck Crash Causation Study (LTCCS)

    Data.gov (United States)

    Department of Transportation — The Large Truck* Crash Causation Study (LTCCS) is based on a three-year data collection project conducted by the Federal Motor Carrier Safety Administration (FMCSA)...

  8. A large-scale study of misophonia

    NARCIS (Netherlands)

    Rouw, R.; Erfanian, M.

    2018-01-01

    Objective We aim to elucidate misophonia, a condition in which particular sounds elicit disproportionally strong aversive reactions. Method A large online study extensively surveyed personal, developmental, and clinical characteristics of over 300 misophonics. Results Most participants indicated

  9. The Expanded Very Large Array Project

    Science.gov (United States)

    Perley, Rick

    2012-10-01

    The Expanded Very Large Array Project, begun in 2001, is now completed -- on time, on budget, and ``on spec.'' The major goal of the project was to multiply the key observational capabilities of the Very Large Array -- the world's most powerful, versatile, and productive radio telescope -- by a factor of at least an order of magnitude by implementation of modern technologies. The result of the project is an operationally new telescope -- renamed the Jansky Very Large Array -- which is capable of new science unimagined in 1980, when the original VLA was completed. In this talk, I will review the goals of the project, and describe the new capabilities of the Jansky Very Large Array. Already, the array is providing fabulous new insights into the physics of the universe,and I will spend the majority of the time describing examples of new results.

  10. Nonlinear continuum mechanics and large inelastic deformations

    CERN Document Server

    Dimitrienko, Yuriy I

    2010-01-01

    This book provides a rigorous axiomatic approach to continuum mechanics under large deformation. In addition to the classical nonlinear continuum mechanics - kinematics, fundamental laws, the theory of functions having jump discontinuities across singular surfaces, etc. - the book presents the theory of co-rotational derivatives, dynamic deformation compatibility equations, and the principles of material indifference and symmetry, all in systematized form. The focus of the book is a new approach to the formulation of the constitutive equations for elastic and inelastic continua under large deformation. This new approach is based on using energetic and quasi-energetic couples of stress and deformation tensors. This approach leads to a unified treatment of large, anisotropic elastic, viscoelastic, and plastic deformations. The author analyses classical problems, including some involving nonlinear wave propagation, using different models for continua under large deformation, and shows how different models lead t...

  11. Large-scale computing with Quantum Espresso

    International Nuclear Information System (INIS)

    Giannozzi, P.; Cavazzoni, C.

    2009-01-01

    This paper gives a short introduction to Quantum Espresso: a distribution of software for atomistic simulations in condensed-matter physics, chemical physics, materials science, and to its usage in large-scale parallel computing.

  12. Swarm Manipulation of Large Surface Vessels

    National Research Council Canada - National Science Library

    Smith, Erik T

    2007-01-01

    The goal of this Trident project was to develop an independent control scheme to allow a team of autonomous tugboats to move a large disabled vessel, such as a barge, to a desired position and orientation...

  13. South African red data book - large mammals

    CSIR Research Space (South Africa)

    Skinner, JD

    1977-11-01

    Full Text Available Data sheets are provided for 22 threatened South African large mammals, one exterminated (Liechtenstein1s hartebeest), eight endangered (cheetah, hunting dog, dugong, Cape mountain zebra, black rhinoceros, tsessebe, roan antelope, suni), one...

  14. Computational Modeling of Large Wildfires: A Roadmap

    KAUST Repository

    Coen, Janice L.; Douglas, Craig C.

    2010-01-01

    Wildland fire behavior, particularly that of large, uncontrolled wildfires, has not been well understood or predicted. Our methodology to simulate this phenomenon uses high-resolution dynamic models made of numerical weather prediction (NWP) models

  15. Remotely controlled large container disposal methodology

    International Nuclear Information System (INIS)

    Amir, S.J.

    1994-09-01

    Remotely Handled Large Containers (RHLC), also called drag-off boxes, have been used at the Hanford Site since the 1940s to dispose of large pieces of radioactively contaminated equipment. These containers are typically large steel-reinforced concrete boxes, which weigh as much as 40 tons. Because large quantities of high-dose waste can produce radiation levels as high as 200 mrem/hour at 200 ft, the containers are remotely handled (either lifted off the railcar by crane or dragged off with a cable). Many of the existing containers do not meet existing structural and safety design criteria and some of the transportation requirements. The drag-off method of pulling the box off the railcar using a cable and a tractor is also not considered a safe operation, especially in view of past mishaps

  16. Large-bandwidth planar photonic crystal waveguides

    DEFF Research Database (Denmark)

    Søndergaard, Thomas; Lavrinenko, Andrei

    2002-01-01

    A general design principle is presented for making finite-height photonic crystal waveguides that support leakage-free guidance of light over large frequency intervals. The large bandwidth waveguides are designed by introducing line defects in photonic crystal slabs, where the material in the line...... defect has appropriate dispersion properties relative to the photonic crystal slab material surrounding the line defect. A three-dimensional theoretical analysis is given for large-bandwidth waveguide designs based on a silicon-air photonic crystal slab suspended in air. In one example, the leakage......-free single-mode guidance is found for a large frequency interval covering 60% of the photonic band-gap....

  17. Large Area Sputter Coating on Glass

    Science.gov (United States)

    Katayama, Yoshihito

    Large glass has been used for commercial buildings, housings and vehicles for many years. Glass size for flat displays is getting larger and larger. The glass for the 8th generation is more than 5 m2 in area. Demand of the large glass is increasing not only in these markets but also in a solar cell market growing drastically. Therefore, large area coating is demanded to plus something else on glass more than ever. Sputtering and pyrolysis are the major coating methods on large glass today. Sputtering process is particularly popular because it can deposit a wide variety of materials in good coating uniformity on the glass. This paper describes typical industrial sputtering system and recent progress in sputtering technology. It also shows typical coated glass products in architectural, automotive and display fields and comments on their functions, film stacks and so on.

  18. Large-scale regions of antimatter

    International Nuclear Information System (INIS)

    Grobov, A. V.; Rubin, S. G.

    2015-01-01

    Amodified mechanism of the formation of large-scale antimatter regions is proposed. Antimatter appears owing to fluctuations of a complex scalar field that carries a baryon charge in the inflation era

  19. Large-scale regions of antimatter

    Energy Technology Data Exchange (ETDEWEB)

    Grobov, A. V., E-mail: alexey.grobov@gmail.com; Rubin, S. G., E-mail: sgrubin@mephi.ru [National Research Nuclear University MEPhI (Russian Federation)

    2015-07-15

    Amodified mechanism of the formation of large-scale antimatter regions is proposed. Antimatter appears owing to fluctuations of a complex scalar field that carries a baryon charge in the inflation era.

  20. Innovation Initiatives in Large Software Companies

    DEFF Research Database (Denmark)

    Edison, Henry; Wang, Xiaofeng; Jabangwe, Ronald

    2018-01-01

    empirical studies on innovation initiative in the context of large software companies. A total of 7 studies are conducted in the context of large software companies, which reported 5 types of initiatives: intrapreneurship, bootlegging, internal venture, spin-off and crowdsourcing. Our study offers three......Context: To keep the competitive advantage and adapt to changes in the market and technology, companies need to innovate in an organised, purposeful and systematic manner. However, due to their size and complexity, large companies tend to focus on the structure in maintaining their business, which...... can potentially lower their agility to innovate. Objective:The aims of this study are to provide an overview of the current research on innovation initiatives and to identify the challenges of implementing those initiatives in the context of large software companies. Method: The investigation...

  1. Production of baryons with large transverse momentum

    International Nuclear Information System (INIS)

    Landshoff, P.V.; Polkinghorne, J.C.; Scott, D.M.

    1975-01-01

    The multiple scattering of constituent quarks provides a natural mechanism for fairly copious production of large-transverse-momentum baryons in nucleon--nucleon collisions. The predicted scaling law agrees well with available data, and the mechanism provides a qualitative explanation of nuclear-target effects. In comparison with previous parton models, correlations are predicted to be qualitatively different, and large-p/sub T/ baryon production by meson beams is relatively suppressed

  2. Neutrino bi-large mixings and family

    International Nuclear Information System (INIS)

    Bando, Masako; Obara, Midori

    2004-01-01

    After a brief review of quark-lepton relations in grand unified theories (GUT), we show that the Pati-Salam relation with only one type of Higgs field configuration with ''four zero symmetric texture'' can reproduce two large neutrino mixings as well as observed mass differences. This is quite in contrast to the case of SU(5) where bi-large mixings essentially come from the charged lepton sector with non-symmetric charged lepton mass matrix. (author)

  3. Cruas site: inception of 'large jobsite' procedure

    International Nuclear Information System (INIS)

    Bottini, R.

    1980-01-01

    In France, the construction sites of nuclear plants are governed by a series of government decisions approved in July 1975 relating to so-called 'large jobsites of territorial improvements'. Using as an example the 'large jobsite' of the Cruas plant, now under construction, the author illustrates the practical application of the considered procedure, amongst others from the standpoints of organization measures and the quality of the living conditions of workers [fr

  4. LYCORIS - A Large Area Strip Telescope

    CERN Document Server

    Krämer, U; Stanitzki, M; Wu, M

    2018-01-01

    The LYCORIS Large Area Silicon Strip Telescope for the DESY II Test Beam Facility is presented. The DESY II Test Beam Facility provides elec- tron and positron beams for beam tests of up to 6 GeV. A new telescope with a large 10 × 20 cm2 coverage area based on a 25 μm pitch strip sensor is to be installed within the PCMAG 1 T solenoid. The current state of the system is presented.

  5. Transport Coefficients from Large Deviation Functions

    OpenAIRE

    Gao, Chloe Ya; Limmer, David T.

    2017-01-01

    We describe a method for computing transport coefficients from the direct evaluation of large deviation functions. This method is general, relying on only equilibrium fluctuations, and is statistically efficient, employing trajectory based importance sampling. Equilibrium fluctuations of molecular currents are characterized by their large deviation functions, which are scaled cumulant generating functions analogous to the free energies. A diffusion Monte Carlo algorithm is used to evaluate th...

  6. A very large multigap resistive plate chamber

    CERN Document Server

    Cerron-Zeballos, E; Hatzifotiadou, D; Kim, D W; Lamas-Valverde, J; Lee, S C; Platner, E D; Roberts, J; Williams, M C S; Zichichi, A

    1999-01-01

    We have built and tested a very large multigap resistive plate chamber (MRPC). We discuss the suitability of the multigap RPC for the construction of large area modules. We give details of the construction technique and results from a scan across the surface of the chamber. We also report on the implementation of `half-strip resolution', where we improve the spatial resolution by a factor 2 without increasing the number of read-out channels. (9 refs).

  7. Vanishing large ovarian cyst with thyroxine therapy

    OpenAIRE

    Dharmshaktu, Pramila; Kutiyal, Aditya; Dhanwal, Dinesh

    2013-01-01

    Summary A 21-year-old female patient recently diagnosed with severe hypothyroidism was found to have a large ovarian cyst. In view of the large ovarian cyst, she was advised to undergo elective laparotomy in the gynaecology department. She was further evaluated in our medical out-patient department (OPD), and elective surgery was withheld. She was started on thyroxine replacement therapy, and within a period of 4 months, the size of the cyst regressed significantly, thereby improving the cond...

  8. The large deviations theorem and ergodicity

    International Nuclear Information System (INIS)

    Gu Rongbao

    2007-01-01

    In this paper, some relationships between stochastic and topological properties of dynamical systems are studied. For a continuous map f from a compact metric space X into itself, we show that if f satisfies the large deviations theorem then it is topologically ergodic. Moreover, we introduce the topologically strong ergodicity, and prove that if f is a topologically strongly ergodic map satisfying the large deviations theorem then it is sensitively dependent on initial conditions

  9. Workflow management in large distributed systems

    International Nuclear Information System (INIS)

    Legrand, I; Newman, H; Voicu, R; Dobre, C; Grigoras, C

    2011-01-01

    The MonALISA (Monitoring Agents using a Large Integrated Services Architecture) framework provides a distributed service system capable of controlling and optimizing large-scale, data-intensive applications. An essential part of managing large-scale, distributed data-processing facilities is a monitoring system for computing facilities, storage, networks, and the very large number of applications running on these systems in near realtime. All this monitoring information gathered for all the subsystems is essential for developing the required higher-level services—the components that provide decision support and some degree of automated decisions—and for maintaining and optimizing workflow in large-scale distributed systems. These management and global optimization functions are performed by higher-level agent-based services. We present several applications of MonALISA's higher-level services including optimized dynamic routing, control, data-transfer scheduling, distributed job scheduling, dynamic allocation of storage resource to running jobs and automated management of remote services among a large set of grid facilities.

  10. Political consultation and large-scale research

    International Nuclear Information System (INIS)

    Bechmann, G.; Folkers, H.

    1977-01-01

    Large-scale research and policy consulting have an intermediary position between sociological sub-systems. While large-scale research coordinates science, policy, and production, policy consulting coordinates science, policy and political spheres. In this very position, large-scale research and policy consulting lack of institutional guarantees and rational back-ground guarantee which are characteristic for their sociological environment. This large-scale research can neither deal with the production of innovative goods under consideration of rentability, nor can it hope for full recognition by the basis-oriented scientific community. Policy consulting knows neither the competence assignment of the political system to make decisions nor can it judge succesfully by the critical standards of the established social science, at least as far as the present situation is concerned. This intermediary position of large-scale research and policy consulting has, in three points, a consequence supporting the thesis which states that this is a new form of institutionalization of science: These are: 1) external control, 2) the organization form, 3) the theoretical conception of large-scale research and policy consulting. (orig.) [de

  11. Workflow management in large distributed systems

    Science.gov (United States)

    Legrand, I.; Newman, H.; Voicu, R.; Dobre, C.; Grigoras, C.

    2011-12-01

    The MonALISA (Monitoring Agents using a Large Integrated Services Architecture) framework provides a distributed service system capable of controlling and optimizing large-scale, data-intensive applications. An essential part of managing large-scale, distributed data-processing facilities is a monitoring system for computing facilities, storage, networks, and the very large number of applications running on these systems in near realtime. All this monitoring information gathered for all the subsystems is essential for developing the required higher-level services—the components that provide decision support and some degree of automated decisions—and for maintaining and optimizing workflow in large-scale distributed systems. These management and global optimization functions are performed by higher-level agent-based services. We present several applications of MonALISA's higher-level services including optimized dynamic routing, control, data-transfer scheduling, distributed job scheduling, dynamic allocation of storage resource to running jobs and automated management of remote services among a large set of grid facilities.

  12. Large Payload Ground Transportation and Test Considerations

    Science.gov (United States)

    Rucker, Michelle A.

    2016-01-01

    Many spacecraft concepts under consideration by the National Aeronautics and Space Administration’s (NASA’s) Evolvable Mars Campaign take advantage of a Space Launch System payload shroud that may be 8 to 10 meters in diameter. Large payloads can theoretically save cost by reducing the number of launches needed--but only if it is possible to build, test, and transport a large payload to the launch site in the first place. Analysis performed previously for the Altair project identified several transportation and test issues with an 8.973 meters diameter payload. Although the entire Constellation Program—including Altair—has since been canceled, these issues serve as important lessons learned for spacecraft designers and program managers considering large payloads for future programs. A transportation feasibility study found that, even broken up into an Ascent and Descent Module, the Altair spacecraft would not fit inside available aircraft. Ground transportation of such large payloads over extended distances is not generally permitted, so overland transportation alone would not be an option. Limited ground transportation to the nearest waterway may be possible, but water transportation could take as long as 67 days per production unit, depending on point of origin and acceptance test facility; transportation from the western United States would require transit through the Panama Canal to access the Kennedy Space Center launch site. Large payloads also pose acceptance test and ground processing challenges. Although propulsion, mechanical vibration, and reverberant acoustic test facilities at NASA’s Plum Brook Station have been designed to accommodate large spacecraft, special handling and test work-arounds may be necessary, which could increase cost, schedule, and technical risk. Once at the launch site, there are no facilities currently capable of accommodating the combination of large payload size and hazardous processing such as hypergolic fuels

  13. Why large cells dominate estuarine phytoplankton

    Science.gov (United States)

    Cloern, James E.

    2018-01-01

    Surveys across the world oceans have shown that phytoplankton biomass and production are dominated by small cells (picoplankton) where nutrient concentrations are low, but large cells (microplankton) dominate when nutrient-rich deep water is mixed to the surface. I analyzed phytoplankton size structure in samples collected over 25 yr in San Francisco Bay, a nutrient-rich estuary. Biomass was dominated by large cells because their biomass selectively grew during blooms. Large-cell dominance appears to be a characteristic of ecosystems at the land–sea interface, and these places may therefore function as analogs to oceanic upwelling systems. Simulations with a size-structured NPZ model showed that runs of positive net growth rate persisted long enough for biomass of large, but not small, cells to accumulate. Model experiments showed that small cells would dominate in the absence of grazing, at lower nutrient concentrations, and at elevated (+5°C) temperatures. Underlying these results are two fundamental scaling laws: (1) large cells are grazed more slowly than small cells, and (2) grazing rate increases with temperature faster than growth rate. The model experiments suggest testable hypotheses about phytoplankton size structure at the land–sea interface: (1) anthropogenic nutrient enrichment increases cell size; (2) this response varies with temperature and only occurs at mid-high latitudes; (3) large-cell blooms can only develop when temperature is below a critical value, around 15°C; (4) cell size diminishes along temperature gradients from high to low latitudes; and (5) large-cell blooms will diminish or disappear where planetary warming increases temperature beyond their critical threshold.

  14. Dissecting the large-scale galactic conformity

    Science.gov (United States)

    Seo, Seongu

    2018-01-01

    Galactic conformity is an observed phenomenon that galaxies located in the same region have similar properties such as star formation rate, color, gas fraction, and so on. The conformity was first observed among galaxies within in the same halos (“one-halo conformity”). The one-halo conformity can be readily explained by mutual interactions among galaxies within a halo. Recent observations however further witnessed a puzzling connection among galaxies with no direct interaction. In particular, galaxies located within a sphere of ~5 Mpc radius tend to show similarities, even though the galaxies do not share common halos with each other ("two-halo conformity" or “large-scale conformity”). Using a cosmological hydrodynamic simulation, Illustris, we investigate the physical origin of the two-halo conformity and put forward two scenarios. First, back-splash galaxies are likely responsible for the large-scale conformity. They have evolved into red galaxies due to ram-pressure stripping in a given galaxy cluster and happen to reside now within a ~5 Mpc sphere. Second, galaxies in strong tidal field induced by large-scale structure also seem to give rise to the large-scale conformity. The strong tides suppress star formation in the galaxies. We discuss the importance of the large-scale conformity in the context of galaxy evolution.

  15. Evolution and interaction of large interplanetary streams

    International Nuclear Information System (INIS)

    Whang, Y.C.; Burlaga, L.F.

    1985-02-01

    A computer simulation for the evolution and interaction of large interplanetary streams based on multi-spacecraft observations and an unsteady, one-dimensional MHD model is presented. Two events, each observed by two or more spacecraft separated by a distance of the order of 10 AU, were studied. The first simulation is based on the plasma and magnetic field observations made by two radially-aligned spacecraft. The second simulation is based on an event observed first by Helios-1 in May 1980 near 0.6 AU and later by Voyager-1 in June 1980 at 8.1 AU. These examples show that the dynamical evolution of large-scale solar wind structures is dominated by the shock process, including the formation, collision, and merging of shocks. The interaction of shocks with stream structures also causes a drastic decrease in the amplitude of the solar wind speed variation with increasing heliocentric distance, and as a result of interactions there is a large variation of shock-strengths and shock-speeds. The simulation results shed light on the interpretation for the interaction and evolution of large interplanetary streams. Observations were made along a few limited trajectories, but simulation results can supplement these by providing the detailed evolution process for large-scale solar wind structures in the vast region not directly observed. The use of a quantitative nonlinear simulation model including shock merging process is crucial in the interpretation of data obtained in the outer heliosphere

  16. Large-scale multimedia modeling applications

    International Nuclear Information System (INIS)

    Droppo, J.G. Jr.; Buck, J.W.; Whelan, G.; Strenge, D.L.; Castleton, K.J.; Gelston, G.M.

    1995-08-01

    Over the past decade, the US Department of Energy (DOE) and other agencies have faced increasing scrutiny for a wide range of environmental issues related to past and current practices. A number of large-scale applications have been undertaken that required analysis of large numbers of potential environmental issues over a wide range of environmental conditions and contaminants. Several of these applications, referred to here as large-scale applications, have addressed long-term public health risks using a holistic approach for assessing impacts from potential waterborne and airborne transport pathways. Multimedia models such as the Multimedia Environmental Pollutant Assessment System (MEPAS) were designed for use in such applications. MEPAS integrates radioactive and hazardous contaminants impact computations for major exposure routes via air, surface water, ground water, and overland flow transport. A number of large-scale applications of MEPAS have been conducted to assess various endpoints for environmental and human health impacts. These applications are described in terms of lessons learned in the development of an effective approach for large-scale applications

  17. Hot seeding using large Y-123 seeds

    International Nuclear Information System (INIS)

    Scruggs, S J; Putman, P T; Zhou, Y X; Fang, H; Salama, K

    2006-01-01

    There are several motivations for increasing the diameter of melt textured single domain discs. The maximum magnetic field produced by a trapped field magnet is proportional to the radius of the sample. Furthermore, the availability of trapped field magnets with large diameter could enable their use in applications that have traditionally been considered to require wound electromagnets, such as beam bending magnets for particle accelerators and electric propulsion. We have investigated the possibility of using large area epitaxial growth instead of the conventional point nucleation growth mechanism. This process involves the use of large Y123 seeds for the purpose of increasing the maximum achievable Y123 single domain size. The hot seeding technique using large Y-123 seeds was employed to seed Y-123 samples. Trapped field measurements indicate that single domain samples were indeed grown by this technique. Microstructural evaluation indicates that growth can be characterized by a rapid nucleation followed by the usual peritectic grain growth which occurs when large seeds are used. Critical temperature measurements show that no local T c suppression occurs in the vicinity of the seed. This work supports the suggestion of using an iterative method for increasing the size of Y-123 single domains that can be grown

  18. Abelian scalar theory at large global charge

    Energy Technology Data Exchange (ETDEWEB)

    Loukas, Orestis [Albert Einstein Center for Fundamental Physics, Institute for Theoretical Physics, University of Bern (Switzerland)

    2017-09-15

    We elaborate on Abelian complex scalar models, which are dictated by natural actions (all couplings are of order one), at fixed and large global U(1) charge in an arbitrary number of dimensions. The ground state vertical stroke v right angle is coherently constructed by the zero modes and the appearance of a centrifugal potential is quantum mechanically verified. Using the path integral formulation we systematically analyze the quantum fluctuations around vertical stroke v right angle in order to derive an effective action for the Goldstone mode, which becomes perturbatively meaningful when the charge is large. In this regime we explicitly show, by computing the first few loop corrections, that the whole construction is stable against quantum effects, in the sense that any higher derivative couplings to Goldstone's tree-level action are suppressed by appropriate powers of the large charge. (copyright 2017 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  19. Primary cutaneous anaplastic large-cell lymphoma.

    Science.gov (United States)

    Perry, Edward; Karajgikar, Jay; Tabbara, Imad A

    2013-10-01

    Since the recognition of the anaplastic large-cell lymphomas in the 1980s, much has been learned about the diagnosis, clinical presentation, and treatment of these malignant conditions. The systemic and primary cutaneous types of anaplastic large cell lymphomas have been differentiated on clinical and immunophenotypical findings, but further research is required to elucidate their exact etiologies and pathogeneses. Primary cutaneous anaplastic large-cell lymphoma has a 95% disease-specific 5-year survival, owing partly to the relatively benign course of the disease and partly to the variety of effective treatments that are available. As with many other oncological diseases, new drugs are continually being tested and developed, with immunotherapy and biological response modifiers showing promise.

  20. Charging in the environment of large spacecraft

    International Nuclear Information System (INIS)

    Lai, S.T.

    1993-01-01

    This paper discusses some potential problems of spacecraft charging as a result of interactions between a large spacecraft, such as the Space Station, and its environment. Induced electric field, due to VXB effect, may be important for large spacecraft at low earth orbits. Differential charging, due to different properties of surface materials, may be significant when the spacecraft is partly in sunshine and partly in shadow. Triple-root potential jump condition may occur because of differential charging. Sudden onset of severe differential charging may occur when an electron or ion beam is emitted from the spacecraft. The beam may partially return to the ''hot spots'' on the spacecraft. Wake effects, due to blocking of ambient ion trajectories, may result in an undesirable negative potential region in the vicinity of a large spacecraft. Outgassing and exhaust may form a significant spacecraft induced environment; ionization may occur. Spacecraft charging and discharging may affect the electronic components on board

  1. Endoscopic treatment of large vesical calculi

    International Nuclear Information System (INIS)

    Rauf, A.; Ahmed, I.; Rauf, M.H.; Rauf, M.

    2015-01-01

    Objective: To determine the efficiency and safety of endoscopic treatment of large vesical calculi with the available modern endoscopic instruments. Methology: In case series, patients were collected randomly from 2007 to 2014. Patients were diagnosed with ultrasound and Nephroscope with Swiss pneumatic lithoclast, lithotrite and stone punch were used for treatment. Results: Majority of the patient could be managed with the method adopted. Stone size, hardness or softness, gender were the factors affecting treatment. Associated prostate pathology was seen in four patients. Postoperative complications included hemorrhage, perforation, residual stone and transurethral resection of prostate syndrome. Conclusion: Overall, it is a safe procedure except in patients with large enlarged prostate and large vesical calculi. Very hard vesical calculus may need vesicolithotomy. (author)

  2. Growth Limits in Large Scale Networks

    DEFF Research Database (Denmark)

    Knudsen, Thomas Phillip

    limitations. The rising complexity of network management with the convergence of communications platforms is shown as problematic for both automatic management feasibility and for manpower resource management. In the fourth step the scope is extended to include the present society with the DDN project as its......The Subject of large scale networks is approached from the perspective of the network planner. An analysis of the long term planning problems is presented with the main focus on the changing requirements for large scale networks and the potential problems in meeting these requirements. The problems...... the fundamental technological resources in network technologies are analysed for scalability. Here several technological limits to continued growth are presented. The third step involves a survey of major problems in managing large scale networks given the growth of user requirements and the technological...

  3. ISLA: An Isochronous Spectrometer with Large Acceptances

    Energy Technology Data Exchange (ETDEWEB)

    Bazin, D., E-mail: bazin@nscl.msu.edu; Mittig, W.

    2013-12-15

    A novel type of recoil mass spectrometer and separator is proposed for the future secondary radioactive beams of the ReA12 accelerator at NSCL/FRIB, inspired from the TOFI spectrometer developed at the Los Alamos National Laboratory for online mass measurements. The Isochronous Spectrometer with Large Acceptances (ISLA) is able to achieve superior characteristics without the compromises that usually plague the design of large acceptance spectrometers. ISLA can provide mass-to-charge ratio (m/q) measurements to better than 1 part in 1000 by using an optically isochronous time-of-flight independent of the momentum vector of the recoiling ions, despite large acceptances of 20% in momentum and 64 msr in solid angle. The characteristics of this unique design are shown, including requirements for auxiliary detectors around the target and the various types of reactions to be used with the re-accelerated radioactive beams of the future ReA12 accelerator.

  4. A large electrically excited synchronous generator

    DEFF Research Database (Denmark)

    2014-01-01

    This invention relates to a large electrically excited synchronous generator (100), comprising a stator (101), and a rotor or rotor coreback (102) comprising an excitation coil (103) generating a magnetic field during use, wherein the rotor or rotor coreback (102) further comprises a plurality...... adjacent neighbouring poles. In this way, a large electrically excited synchronous generator (EESG) is provided that readily enables a relatively large number of poles, compared to a traditional EESG, since the excitation coil in this design provides MMF for all the poles, whereas in a traditional EESG...... each pole needs its own excitation coil, which limits the number of poles as each coil will take up too much space between the poles....

  5. Trust dynamics in a large system implementation

    DEFF Research Database (Denmark)

    Schlichter, Bjarne Rerup; Rose, Jeremy

    2013-01-01

    outcomes, but largely ignored the dynamics of trust relations. Giddens, as part of his study of modernity, theorises trust dynamics in relation to abstract social systems, though without focusing on information systems. We use Giddens’ concepts to investigate evolving trust relationships in a longitudinal......A large information systems implementation (such as Enterprise Resource Planning systems) relies on the trust of its stakeholders to succeed. Such projects impact diverse groups of stakeholders, each with their legitimate interests and expectations. Levels of stakeholder trust can be expected...... case analysis of a large Integrated Hospital System implementation for the Faroe Islands. Trust relationships suffered a serious breakdown, but the project was able to recover and meet its goals. We develop six theoretical propositions theorising the relationship between trust and project outcomes...

  6. Emerging large-scale solar heating applications

    International Nuclear Information System (INIS)

    Wong, W.P.; McClung, J.L.

    2009-01-01

    Currently the market for solar heating applications in Canada is dominated by outdoor swimming pool heating, make-up air pre-heating and domestic water heating in homes, commercial and institutional buildings. All of these involve relatively small systems, except for a few air pre-heating systems on very large buildings. Together these applications make up well over 90% of the solar thermal collectors installed in Canada during 2007. These three applications, along with the recent re-emergence of large-scale concentrated solar thermal for generating electricity, also dominate the world markets. This paper examines some emerging markets for large scale solar heating applications, with a focus on the Canadian climate and market. (author)

  7. Constituent models and large transverse momentum reactions

    International Nuclear Information System (INIS)

    Brodsky, S.J.

    1975-01-01

    The discussion of constituent models and large transverse momentum reactions includes the structure of hard scattering models, dimensional counting rules for large transverse momentum reactions, dimensional counting and exclusive processes, the deuteron form factor, applications to inclusive reactions, predictions for meson and photon beams, the charge-cubed test for the e/sup +-/p → e/sup +-/γX asymmetry, the quasi-elastic peak in inclusive hadronic reactions, correlations, and the multiplicity bump at large transverse momentum. Also covered are the partition method for bound state calculations, proofs of dimensional counting, minimal neutralization and quark--quark scattering, the development of the constituent interchange model, and the A dependence of high transverse momentum reactions

  8. Policy and planning for large infrastructure projects

    DEFF Research Database (Denmark)

    Flyvbjerg, Bent

    2005-01-01

    This paper focuses on problems and their causes and cures in policy and planning for large infrastructure projects. First, it identifies as the main problem in major infrastructure development pervasive misinformation about the costs, benefits, and risks involved. A consequence of misinformation ...... for large infrastructure projects, with a focus on better planning methods and changed governance structures, the latter being more important.......This paper focuses on problems and their causes and cures in policy and planning for large infrastructure projects. First, it identifies as the main problem in major infrastructure development pervasive misinformation about the costs, benefits, and risks involved. A consequence of misinformation...... the likelihood that it is their projects, and not the competition's, that gain approval and funding. This results in the "survival of the unfittest," where often it is not the best projects that are built, but the most misrepresented ones. Finally, the paper presents measures for reforming policy and planning...

  9. Phonetic search methods for large speech databases

    CERN Document Server

    Moyal, Ami; Tetariy, Ella; Gishri, Michal

    2013-01-01

    “Phonetic Search Methods for Large Databases” focuses on Keyword Spotting (KWS) within large speech databases. The brief will begin by outlining the challenges associated with Keyword Spotting within large speech databases using dynamic keyword vocabularies. It will then continue by highlighting the various market segments in need of KWS solutions, as well as, the specific requirements of each market segment. The work also includes a detailed description of the complexity of the task and the different methods that are used, including the advantages and disadvantages of each method and an in-depth comparison. The main focus will be on the Phonetic Search method and its efficient implementation. This will include a literature review of the various methods used for the efficient implementation of Phonetic Search Keyword Spotting, with an emphasis on the authors’ own research which entails a comparative analysis of the Phonetic Search method which includes algorithmic details. This brief is useful for resea...

  10. Managing large-scale models: DBS

    International Nuclear Information System (INIS)

    1981-05-01

    A set of fundamental management tools for developing and operating a large scale model and data base system is presented. Based on experience in operating and developing a large scale computerized system, the only reasonable way to gain strong management control of such a system is to implement appropriate controls and procedures. Chapter I discusses the purpose of the book. Chapter II classifies a broad range of generic management problems into three groups: documentation, operations, and maintenance. First, system problems are identified then solutions for gaining management control are disucssed. Chapters III, IV, and V present practical methods for dealing with these problems. These methods were developed for managing SEAS but have general application for large scale models and data bases

  11. Accelerating sustainability in large-scale facilities

    CERN Multimedia

    Marina Giampietro

    2011-01-01

    Scientific research centres and large-scale facilities are intrinsically energy intensive, but how can big science improve its energy management and eventually contribute to the environmental cause with new cleantech? CERN’s commitment to providing tangible answers to these questions was sealed in the first workshop on energy management for large scale scientific infrastructures held in Lund, Sweden, on the 13-14 October.   Participants at the energy management for large scale scientific infrastructures workshop. The workshop, co-organised with the European Spallation Source (ESS) and  the European Association of National Research Facilities (ERF), tackled a recognised need for addressing energy issues in relation with science and technology policies. It brought together more than 150 representatives of Research Infrastrutures (RIs) and energy experts from Europe and North America. “Without compromising our scientific projects, we can ...

  12. Noise Pulses in Large Area Optical Modules

    International Nuclear Information System (INIS)

    Aiello, Sebastiano; Leonora, Emanuele; Giordano, Valentina

    2013-06-01

    A great number of large area photomultipliers are widely used in neutrino and astro-particle detector to measure Cherenkov light in medium like water or ice. The key element of these detectors are the so-called 'optical module', which consist in photodetectors closed in a transparent pressure-resistant container to protect it and ensure good light transmission. The noise pulses present on the anode of each photomultiplier affect strongly the performance of the detector. A large study was conducted on noise pulses of large area photomultipliers, considering time and charge distributions of dark pulses, prepulses, delayed pulses, and after pulses. The contribution to noise pulses due to the presence of the external glass spheres was also studied, even comparing two vessels of different brands. (authors)

  13. Transport Coefficients from Large Deviation Functions

    Directory of Open Access Journals (Sweden)

    Chloe Ya Gao

    2017-10-01

    Full Text Available We describe a method for computing transport coefficients from the direct evaluation of large deviation functions. This method is general, relying on only equilibrium fluctuations, and is statistically efficient, employing trajectory based importance sampling. Equilibrium fluctuations of molecular currents are characterized by their large deviation functions, which are scaled cumulant generating functions analogous to the free energies. A diffusion Monte Carlo algorithm is used to evaluate the large deviation functions, from which arbitrary transport coefficients are derivable. We find significant statistical improvement over traditional Green–Kubo based calculations. The systematic and statistical errors of this method are analyzed in the context of specific transport coefficient calculations, including the shear viscosity, interfacial friction coefficient, and thermal conductivity.

  14. Transport Coefficients from Large Deviation Functions

    Science.gov (United States)

    Gao, Chloe; Limmer, David

    2017-10-01

    We describe a method for computing transport coefficients from the direct evaluation of large deviation function. This method is general, relying on only equilibrium fluctuations, and is statistically efficient, employing trajectory based importance sampling. Equilibrium fluctuations of molecular currents are characterized by their large deviation functions, which is a scaled cumulant generating function analogous to the free energy. A diffusion Monte Carlo algorithm is used to evaluate the large deviation functions, from which arbitrary transport coefficients are derivable. We find significant statistical improvement over traditional Green-Kubo based calculations. The systematic and statistical errors of this method are analyzed in the context of specific transport coefficient calculations, including the shear viscosity, interfacial friction coefficient, and thermal conductivity.

  15. Emerging large-scale solar heating applications

    Energy Technology Data Exchange (ETDEWEB)

    Wong, W.P.; McClung, J.L. [Science Applications International Corporation (SAIC Canada), Ottawa, Ontario (Canada)

    2009-07-01

    Currently the market for solar heating applications in Canada is dominated by outdoor swimming pool heating, make-up air pre-heating and domestic water heating in homes, commercial and institutional buildings. All of these involve relatively small systems, except for a few air pre-heating systems on very large buildings. Together these applications make up well over 90% of the solar thermal collectors installed in Canada during 2007. These three applications, along with the recent re-emergence of large-scale concentrated solar thermal for generating electricity, also dominate the world markets. This paper examines some emerging markets for large scale solar heating applications, with a focus on the Canadian climate and market. (author)

  16. Anomalies and the Large N Limit

    International Nuclear Information System (INIS)

    Agarwal, A.; Akant, L.

    2003-01-01

    Operator algebra aspects of the Large N limit of Bosonic vector models are analyzed. It is shown that the Large N limit is a classical theory, and a general method, based on defromation quatization, for calculating the Poisson algebra of dynamical observables in the limiting classical theory is presented. The Poisson algebra of O(N) invariant observables of Bosonic vector models is constructed in this approach, and is shown to be a central extension of the Symplectic Lie algebra. The relation of the central term to anomalies is discussed. A comparision of the classical theories obtained in the Large N limit and that in the small (ℎ/2π) limit is also presented

  17. Risk Management of Large Component in Decommissioning

    Energy Technology Data Exchange (ETDEWEB)

    Nah, Kyung Ku; Kim, Tae Ryong [KEPCO International Nuclear Graduate School, Ulsan (Korea, Republic of)

    2014-10-15

    The need for energy, especially electric energy, has been dramatically increasing in Korea. Therefore, a rapid growth in nuclear power development has been achieved to have about 30% of electric power production. However, such a large nuclear power generation has been producing a significant amount of radioactive waste and other matters such as safety issue. In addition, owing to the severe accidents at the Fukushima in Japan, public concerns regarding NPP and radiation hazard have greatly increased. In Korea, the operation of KORI 1 has been scheduled to be faced with end of lifetime in several years and Wolsong 1 has been being under review for extending its life. This is the reason why the preparation of nuclear power plant decommissioning is significant in this time. Decommissioning is the final phase in the life-cycle of a nuclear facility and during decommissioning operation, one of the most important management in decommissioning is how to deal with the disused large component. Therefore, in this study, the risk in large component in decommissioning is to be identified and the key risk factor is to be analyzed from where can be prepared to handle decommissioning process safely and efficiently. Developing dedicated acceptance criteria for large components at disposal site was analyzed as a key factor. Acceptance criteria applied to deal with large components like what size of those should be and how to be taken care of during disposal process strongly affect other major works. For example, if the size of large component was not set up at disposal site, any dismantle work in decommissioning is not able to be conducted. Therefore, considering insufficient time left for decommissioning of some NPP, it is absolutely imperative that those criteria should be laid down.

  18. Risk Management of Large Component in Decommissioning

    International Nuclear Information System (INIS)

    Nah, Kyung Ku; Kim, Tae Ryong

    2014-01-01

    The need for energy, especially electric energy, has been dramatically increasing in Korea. Therefore, a rapid growth in nuclear power development has been achieved to have about 30% of electric power production. However, such a large nuclear power generation has been producing a significant amount of radioactive waste and other matters such as safety issue. In addition, owing to the severe accidents at the Fukushima in Japan, public concerns regarding NPP and radiation hazard have greatly increased. In Korea, the operation of KORI 1 has been scheduled to be faced with end of lifetime in several years and Wolsong 1 has been being under review for extending its life. This is the reason why the preparation of nuclear power plant decommissioning is significant in this time. Decommissioning is the final phase in the life-cycle of a nuclear facility and during decommissioning operation, one of the most important management in decommissioning is how to deal with the disused large component. Therefore, in this study, the risk in large component in decommissioning is to be identified and the key risk factor is to be analyzed from where can be prepared to handle decommissioning process safely and efficiently. Developing dedicated acceptance criteria for large components at disposal site was analyzed as a key factor. Acceptance criteria applied to deal with large components like what size of those should be and how to be taken care of during disposal process strongly affect other major works. For example, if the size of large component was not set up at disposal site, any dismantle work in decommissioning is not able to be conducted. Therefore, considering insufficient time left for decommissioning of some NPP, it is absolutely imperative that those criteria should be laid down

  19. Managing conflict between large carnivores and livestock.

    Science.gov (United States)

    van Eeden, Lily M; Crowther, Mathew S; Dickman, Chris R; Macdonald, David W; Ripple, William J; Ritchie, Euan G; Newsome, Thomas M

    2018-02-01

    Large carnivores are persecuted globally because they threaten human industries and livelihoods. How this conflict is managed has consequences for the conservation of large carnivores and biodiversity more broadly. Mitigating human-predator conflict should be evidence-based and accommodate people's values while protecting carnivores. Despite much research into human and large-carnivore coexistence strategies, there have been few attempts to document the success of conflict-mitigation strategies on a global scale. We conducted a meta-analysis of global research on conflict mitigation related to large carnivores and humans. We focused on conflicts that arise from the threat large carnivores pose to livestock. We first used structured and unstructured searching to identify replicated studies that used before-after or control-impact design to measure change in livestock loss as a result of implementing a management intervention. We then extracted relevant data from these studies to calculate an overall effect size for each intervention type. Research effort and focus varied among continents and aligned with the histories and cultures that shaped livestock production and attitudes toward carnivores. Livestock guardian animals most effectively reduced livestock losses. Lethal control was the second most effective control, although its success varied the most, and guardian animals and lethal control did not differ significantly. Financial incentives have promoted tolerance of large carnivores in some settings and reduced retaliatory killings. We suggest coexistence strategies be location-specific, incorporate cultural values and environmental conditions, and be designed such that return on financial investment can be evaluated. Improved monitoring of mitigation measures is urgently required to promote effective evidence-based policy. © 2017 Society for Conservation Biology.

  20. Moisture monitoring in large diameter boreholes

    International Nuclear Information System (INIS)

    Tyler, S.

    1985-01-01

    The results of both laboratory and field experiments indicate that the neutron moisture gauge traditionally used in soil physics experiments can be extended for use in large diameter (up to 15 cm) steel-cased boreholes with excellent results. This application will permit existing saturated zone monitoring wells to be used for unsaturated zone monitoring of recharge, redistribution and leak detection from waste disposal facilities. Its applicability to large diameter cased wells also gives the soil physicist and ground-water hydrologist and new set of monitoring points in the unsaturated zone to study recharge and aquifer properties. 6 refs., 6 figs., 2 tabs