Humeral lengthening and proximal deformity correction with monorail external fixator in young adults.

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Ruan, Hongjiang; Zhu, Yi; Liu, Shen; Kang, Qinglin

2018-05-01

Several humeral lengthening or simultaneous deformity corrections through one osteotomy using various external fixators were reported, while literature regarding correction of shortening and proximal varus deformity is scarce. This retrospective clinical study evaluated the results of preforming an acute correction and delayed lengthening in young adults through two osteotomies using monorail external fixator. We report seven patients with various pathologies who underwent humeral proximal deformity correction and lengthening between 2009 and 2015. Pre-operative and post-operative clinical and radiographic data were collected. The mean follow-up time was 33.4 months (25-46 months). The humeral neck-shaft angle improved from 97.9° (85-110°) to 138.6° (135-145°). The magnitude of lengthening achieved was average 7.6 cm (range, 6-10 cm) at an average healing index of lengthening of 30.2 days/cm (range, 27.7-35.4 days/cm). There was a significant increase in range of shoulder abduction, and active abduction improved from pre-operative 136.4° (range, 95-160°) to post-operative 166.4° (range, 150-180°). The DASH score improved significance from 23.29 ± 8.36 to 6.57 ± 3.65 (t = 4.848; p monorail external fixator can be used for humeral shortening and proximal varus angular deformity. Functional improvement is expected after surgery and post-operative therapy.

Development and treatment of spinal deformity in patients with cerebral palsy

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Tsirikos Athanasios

2010-01-01

Full Text Available Scoliosis is a common deformity in children and adolescents with cerebral palsy. This is usually associated with pelvic obliquity due to extension of the curve to the sacrum. Sagittal plane deformity is less common and often develops along with scoliosis. Spinal deformity in patients with severe neurological handicaps can affect their ability to sit and cause significant back pain or pain due to rib impingement against the elevated side of the pelvis on the concavity of the curvature. Surgical correction followed by spinal arthrodesis is indicated in patients with progressive deformities which interfere with their level of function and quality of life. Spinal deformity correction is a major task in children with multiple medical co-morbidities and can be associated with a high risk of complications including death. A well-coordinated multidisciplinary approach is required in the assessment and treatment of this group of patients with the aim to minimize the complication rate and secure a satisfactory surgical outcome. Good knowledge of the surgical and instrumentation techniques, as well as the principles of management is needed to achieve optimum correction of the deformity and balancing of the spine and pelvis. Spinal fusion has a well-documented positive impact even in children with quadriplegia or total body involvement and is the only surgical procedure which has such a high satisfaction rate among parents and caregivers.

M to T Rearrangement: An Approach to Correct Webbed Neck Deformity

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Ananth S. Murthy

2014-01-01

Full Text Available For the Noonan syndrome patient, the most concerning physical defect is often congenital webbing of the neck or pterygium colli. We present a patient with pterygium colli and a low and laterally displaced nuchal hairline. Since its description, various surgical approaches have been implemented to correct the deformity. Previously reported posterior and lateral approaches have notable disadvantages with regard to hairline displacement and recurrence. In order to address these disadvantages, a new surgical technique was used on this patient. We have termed this technique an M to T rearrangement. Using a lateral approach, the M and T incisions are made and the trapezial fascial web is directly visualized and able to be completely excised. This prevents the recurrence seen with the use of posterior techniques. Inferolateral displacement of hair-bearing skin can be removed with resection of the superior intervening triangle and improves the appearance of the low nuchal hairline. The excision of excess skin along with the zig-zag closure also prevents postoperative scar contraction and recurrence. An important effect of this technique is the prevention of anterior displacement of hair bearing skin. M to T rearrangement is an effective technique for the correction of webbed neck deformities seen in Noonan and Turner syndromes.

The Taylor saddle effacement: a new technique for correction of saddle nose deformity.

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Taylor, S Mark; Rigby, Matthew H

2008-02-01

To describe a novel technique, the Taylor saddle effacement (TSE), for correction of saddle nose deformity using autologous grafts from the lower lateral cartilages. A prospective evaluation of six patients, all of whom had the TSE performed. Photographs were taken in combination with completion of a rhinoplasty outcomes questionnaire preoperatively and at 6 months. The questionnaire included a visual analogue scale (VAS) of nasal breathing and a rhinoplasty outcomes evaluation (ROE) of nasal function and esthetics. All six patients had improvement in both their global nasal airflow on the VAS and on their ROE that was statistically significant. The mean preoperative VAS score was 5.8 compared with our postoperative mean of 8.5 of a possible 10. Mean ROE scores improved from 34.7 to 85.5. At 6 months, all patients felt that their nasal appearance had improved. The TSE is a simple and reliable technique for correction of saddle nose deformity. This prospective study has demonstrated improvement in both nasal function and esthetics when it is employed.

Surgical correction of severe spinal deformities using a staged protocol of external and internal techniques.

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Prudnikova, Oksana G; Shchurova, Elena N

2018-02-01

There is high risk of neurologic complications in one-stage management of severe rigid spinal deformities in adolescents. Therefore, gradual spine stretching variants are applied. One of them is the use of external transpedicular fixation. Our aim was to retrospectively study the outcomes of gradual correction with an apparatus for external transpedicular fixation followed by internal fixation used for high-grade kyphoscoliosis in adolescents. Twenty five patients were reviewed (mean age, 15.1 ± 0.4 years). Correction was performed in two stages: 1) gradual controlled correction with the apparatus for external transpedicular fixation; and 2) internal posterior transpedicular fixation. Rigid deformities in eight patients required discapophysectomy. Clinical and radiographic study of the outcomes was conducted immediately after treatment and at a mean long-term period of 3.8 ± 0.4 years. Pain was evaluated using the visual analogue scale (VAS, 10 points). The Oswestry questionnaire (ODI scale) was used for functional assessment. Deformity correction with the external apparatus was 64.2 ± 4.6% in the main curve and 60.7 ± 3.7% in the compensatory one. It was 72.8 ± 4.1% and 66.2 ± 5.3% immediately after treatment and 70.8 ± 4.6% and 64.3 ± 4.2% at long term, respectively. Pain relieved by 33.2 ± 4.2% (p external transpedicular fixation provides gradual controlled correction for high-grade kyphoscoliosis in adolescents. Transition to internal fixation preserves the correction achieved, and correction is maintained at long term.

Unilateral cleft nasal deformity correction using conchal cartilage lily flower graft.

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Hwang, Kun; Kim, Han Joon; Paik, Moo Hyun

2012-11-01

We present a conchal cartilage lily flower graft for correcting depressed and laterally displaced alar cartilage for correction of unilateral cleft nasal deformity.After making a V incision at the base of the columellar and then marginal incisions, the alar cartilages were exposed. A fusiform-shaped cartilage larger than 2.5 cm in length and 1 cm in width was obtained. The midline long axis was scored with a No. 15 knife, and the lateral one third was split. Two-thirds length portions were folded in half, and they became straightened in the shape of a stalk of a lily flower. Two symmetrical one-third length portions were fanned out bilaterally in the shape of the leaf of a lily flower. The stalk portion was positioned in a pocket between the medial crura, and the 2 leaf portions were placed on the dome of the alar cartilages. The marked points of the cleft side and contralateral side were secured with sutures. The V incision at the base of the columellar and the marginal incisions were closed with a V-Y shape. In this technique, the 2 leaf portions were placed on the dome of the alar cartilages and sutured; therefore, the suture holds the dome of the cleft side to the contralateral side without peaking.Thirteen patients (6 male and 7 female subjects; age range, 13-30 years) were operated. Among them, 6 patients were very satisfied, and 5 patients were satisfied with the results. Two patients felt they were improved.We think the conchal cartilage lily flower graft might be a good method for correction of depressed and laterally displaced alar cartilage in unilateral cleft nasal deformity.

Mandibular Deformity Correction by Distraction Osteogenesis

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Md Asaduzzaman

2011-02-01

Full Text Available Distraction osteogenesis (DO is a biological process of new bone formation. It could be used as an alternative treatment method for the correction of mandibular hypoplastic deformity. Modern distraction osteogenesis evolved primarily from the work of Gavriel llizarov. DO has been first applied to craniofacial region since McCarthy et al. In this case report, the patient was 17 years old male with bird face deformity due to hypoplasia of mandible resulted from bilateral TMJ ankylosis due to the fracture of both condyle at the age of 4 years. Patient’s intraincisal opening was absent 1 year back. He underwent condylectomy in both sides to release the ankylosis and to increase intraincisal opening. His mandibular length was markedly short. To increase his mandibular antero-posterior length, mandibular body distraction was done in Oral and Maxillofacial Surgery department, BSMMU. Through this procedure length of the body of mandibule was increased by 10 mm, occlusion was edge to edge and his lower facial appearance increased markedly. Mandibular body distraction osteogenesis was considerably effective when performed in a hypoplastic mandible to facilitate post-operative functional and esthetic restoration. Long term follow-up is necessary to evaluate relapse and complications. DOI: 10.3329/bsmmuj.v3i2.7061BSMMU J 2010; 3(2: 103-106

Accuracy of radiotherapy dose calculations based on cone-beam CT: comparison of deformable registration and image correction based methods

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Marchant, T. E.; Joshi, K. D.; Moore, C. J.

2018-03-01

Radiotherapy dose calculations based on cone-beam CT (CBCT) images can be inaccurate due to unreliable Hounsfield units (HU) in the CBCT. Deformable image registration of planning CT images to CBCT, and direct correction of CBCT image values are two methods proposed to allow heterogeneity corrected dose calculations based on CBCT. In this paper we compare the accuracy and robustness of these two approaches. CBCT images for 44 patients were used including pelvis, lung and head & neck sites. CBCT HU were corrected using a ‘shading correction’ algorithm and via deformable registration of planning CT to CBCT using either Elastix or Niftyreg. Radiotherapy dose distributions were re-calculated with heterogeneity correction based on the corrected CBCT and several relevant dose metrics for target and OAR volumes were calculated. Accuracy of CBCT based dose metrics was determined using an ‘override ratio’ method where the ratio of the dose metric to that calculated on a bulk-density assigned version of the same image is assumed to be constant for each patient, allowing comparison to the patient’s planning CT as a gold standard. Similar performance is achieved by shading corrected CBCT and both deformable registration algorithms, with mean and standard deviation of dose metric error less than 1% for all sites studied. For lung images, use of deformed CT leads to slightly larger standard deviation of dose metric error than shading corrected CBCT with more dose metric errors greater than 2% observed (7% versus 1%).

Correction of Facial Deformity in Sturge–Weber Syndrome

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Yamaguchi, Kazuaki; Lonic, Daniel; Chen, Chit

2016-01-01

Background: Although previous studies have reported soft-tissue management in surgical treatment of Sturge–Weber syndrome (SWS), there are few reports describing facial bone surgery in this patient group. The purpose of this study is to examine the validity of our multidisciplinary algorithm for correcting facial deformities associated with SWS. To the best of our knowledge, this is the first study on orthognathic surgery for SWS patients. Methods: A retrospective chart review included 2 SWS patients who completed the surgical treatment algorithm. Radiographic and clinical data were recorded, and a treatment algorithm was derived. Results: According to the Roach classification, the first patient was classified as type I presenting with both facial and leptomeningeal vascular anomalies without glaucoma and the second patient as type II presenting only with a hemifacial capillary malformation. Considering positive findings in seizure history and intracranial vascular anomalies in the first case, the anesthetic management was modified to omit hypotensive anesthesia because of the potential risk of intracranial pressure elevation. Primarily, both patients underwent 2-jaw orthognathic surgery and facial bone contouring including genioplasty, zygomatic reduction, buccal fat pad removal, and masseter reduction without major complications. In the second step, the volume and distribution of facial soft tissues were altered by surgical resection and reposition. Both patients were satisfied with the surgical result. Conclusions: Our multidisciplinary algorithm can systematically detect potential risk factors. Correction of the asymmetric face by successive bone and soft-tissue surgery enables the patients to reduce their psychosocial burden and increase their quality of life. PMID:27622111

Deformities of contour after breast conserving therapy and the possibilities of correction

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Deutinger, M.; Tairych, G.

1999-01-01

Background: Breast conserving treatment is increasing for primary treatment of breast carcinoma because of the importance of the cosmetic outcome. Patients and method: We examined 195 patients after breast conserving therapy which was performed between 1983 and 1992. For evaluation of the cosmetic result symmetry, contour of the breast and location of the areola were examined. Radiation effect on breast tissue was evaluated by the Lent score. 72% of the patients had been treated with quadrantectomy and 28% with lumpectomy. Results: Deformities of the contour were visible in 59% of the patients depending on the primary location of the tumor. Lumpectomy from medial quadrants caused poor results. Dislocation of the areola of more than 2 cm was detected in 32% of the patients. The dislocation depended on the primary kind of incision and resulted in 89% of the patients after a radial incision and only in 11% after curvilinear incisions. Telangiectasies were absent in 84% of the patients, the others showed telangiectasies Grade 1 to 3. In 48% of the patients no signs of fibrosis could be detected, in 49% fibrosis Grade 1 to 2 was found. 68% of the patients estimated the cosmetic result as very good or good. Only 10% of the patients estimated the result as fair or bad. The examiner estimated the results as good or very good in 28%. Examples of operative procedures for primary and secondary correction are demonstrated. Conclusions: Our results showed an adverse effect of long radial incisions. For lumpectomy and axillary node dissection separate incisions should be used. Correction of contour deformities should be done primarily in breast conserving procedures. This is possible by using modified reduction mammaplasties, local flaps of the breast tissue or switching a latissimus dorsi muscle flap. For secondary correction of defects after breast conserving treatment a latissimus dorsi muscle can be used as well as z-plasty for scar contracture. (orig.) [de

Surgical correction of class II skeletal malocclusion in an adult patient

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Ramakrishnan Balachander

2014-01-01

Full Text Available Correction of skeletal deformities in adult patients with orthodontics is limited. Orthognathic surgery is the best option for cases when camouflage treatment is questionable and growth modulation is not possible. This case report illustrates the benefit of the team approach in correcting vertical maxillary excess along with class II skeletal deformity. A cosmetic correction was achieved by superior repositioning of maxilla with LeFort I osteotomy and augmentation genioplasty, along with orthodontic treatment. The patient′s facial appearance was markedly improved along with functional and stable occlusion

Successful correction of tibial bone deformity through multiple surgical procedures, liquid nitrogen-pretreated bone tumor autograft, three-dimensional external fixation, and internal fixation in a patient with primary osteosarcoma: a case report.

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Takeuchi, Akihiko; Yamamoto, Norio; Shirai, Toshiharu; Nishida, Hideji; Hayashi, Katsuhiro; Watanabe, Koji; Miwa, Shinji; Tsuchiya, Hiroyuki

2015-12-07

In a previous report, we described a method of reconstruction using tumor-bearing autograft treated by liquid nitrogen for malignant bone tumor. Here we present the first case of bone deformity correction following a tumor-bearing frozen autograft via three-dimensional computerized reconstruction after multiple surgeries. A 16-year-old female student presented with pain in the left lower leg and was diagnosed with a low-grade central tibial osteosarcoma. Surgical bone reconstruction was performed using a tumor-bearing frozen autograft. Bone union was achieved at 7 months after the first surgical procedure. However, local tumor recurrence and lung metastases occurred 2 years later, at which time a second surgical procedure was performed. Five years later, the patient developed a 19° varus deformity and underwent a third surgical procedure, during which an osteotomy was performed using the Taylor Spatial Frame three-dimensional external fixation technique. A fourth corrective surgical procedure was performed in which internal fixation was achieved with a locking plate. Two years later, and 10 years after the initial diagnosis of tibial osteosarcoma, the bone deformity was completely corrected, and the patient's limb function was good. We present the first report in which a bone deformity due to a primary osteosarcoma was corrected using a tumor-bearing frozen autograft, followed by multiple corrective surgical procedures that included osteotomy, three-dimensional external fixation, and internal fixation.

The results of bone deformity correction using a spider frame with web-based software for lower extremity long bone deformities.

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Tekin, Ali Çağrı; Çabuk, Haluk; Dedeoğlu, Süleyman Semih; Saygılı, Mehmet Selçuk; Adaş, Müjdat; Esenyel, Cem Zeki; Büyükkurt, Cem Dinçay; Tonbul, Murat

2016-03-22

To present the functional and radiological results and evaluate the effectiveness of a computer-assisted external fixator (spider frame) in patients with lower extremity shortness and deformity. The study comprised 17 patients (14 male, 3 female) who were treated for lower extremity long bone deformity and shortness between 2012 and 2015 using a spider frame. The procedure's level of difficulty was determined preoperatively using the Paley Scale. Postoperatively, the results for the patients who underwent tibial operations were evaluated using the Paley criteria modified by ASAMI, and the results for the patients who underwent femoral operations were evaluated according to the Paley scoring system. The evaluations were made by calculating the External Fixator and Distraction indexes. The mean age of the patients was 24.58 years (range, 5-51 years). The spider frame was applied to the femur in 10 patients and to the tibia in seven. The mean follow-up period was 15 months (range, 6-31 months) from the operation day, and the mean amount of lengthening was 3.0 cm (range, 1-6 cm). The mean duration of fixator application was 202.7 days (range, 104-300 days). The mean External Fixator Index was 98 days/cm (range, 42-265 days/cm). The mean Distraction Index was 10.49 days/cm (range, 10-14 days/cm). The computer-assisted external fixator system (spider frame) achieves single-stage correction in cases of both deformity and shortness. The system can be applied easily, and because of its high-tech software, it offers the possibility of postoperative treatment of the deformity.

Correction of the axial and appendicular deformities in a patient with Silver-Russel syndrome

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Ali Al Kaissi

2015-01-01

Full Text Available Background: Scoliosis and limb length discrepancy are the major orthopaedic abnormalities in patients with Silver-Russel syndrome (SRS. In this paper, we describe a series of orthopaedic interventions in an attempt to overcome the progressive pathologic mechanism in a 7-year-old girl who manifested the full phenotypic features of SRS. Materials and Methods: Unilateral hip dislocation, progressive scoliosis and limb length discrepancy have been dealt with through Pemberton osteotomy, spinal fusion and Taylor-Spatial-Frame respectively. Results: In order to correct the axial and the appendicular deformities a sum of seven operations were performed (between the age of 7 years and 13 years. Pemberton osteotomy was performed to treat dislocation of her right hip because of developmental dysplasia of the hip. Spinal fusion (spondylodesis of segments Th3-L5 was done to correct her scoliosis. And, to overcome the limb length discrepancy of 15-cm we used Taylor-Spatial-Frame with percutaneous distal corticotomy of the femur, and the proximal tibia, as well as the foot, were performed. We were able to minimize the limb length discrepancy to 5 cm. The girl became able to walk with the aid of a below knee orthosis and through lifting the left limb with 5-cm height shoe. Conclusion: Limb lengthening surgery in patients with multiple malformation complex as in SRS is associated with high recurrence risk because of; muscular hypotonia, overtubulation of the long bones, and the poor bone regenerative quality. Our interventions were principally directed towards improving the cosmetic outlook, functions and the biomechanics.

Does correction of preoperative coronal imbalance make a difference in outcomes of adult patients with deformity?

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Daubs, Michael D; Lenke, Lawrence G; Bridwell, Keith H; Kim, Yongjung J; Hung, Man; Cheh, Gene; Koester, Linda A

2013-03-15

Retrospective study with prospectively collected outcomes data. Determine the significance of coronal balance on spinal deformity surgery outcomes. Sagittal balance has been confirmed as an important radiographic parameter correlating with adult deformity treatment outcomes. The significance of coronal balance on functional outcomes is less clear. Eighty-five patients with more than 4 cm of coronal imbalance who underwent reconstructive spinal surgery were evaluated to determine the significance of coronal balance on functional outcomes as measured with the Oswestry Disability Index (ODI) and Scoliosis Research Society outcomes questionnaires. Sixty-two patients had combined coronal (>4 cm) and sagittal imbalance (>5 cm), while 23 patients had coronal imbalance alone. Postoperatively, 85% of patients demonstrated improved coronal balance. The mean improvement in the coronal C7 plumb line was 26 mm for a mean correction of 42%. The mean preoperative sagittal C7 plumb line in patients with combined coronal and sagittal imbalance was 118 mm (range, 50-310 mm) and improved to a mean 49 mm. The mean preoperative and postoperative ODI scores were 42 (range, 0-90) and 27 (range, 0-78), for a mean improvement of 15 (36%) (P = 0.00001; 95% CI, 12-20). The mean Scoliosis Research Society scores improved by 17 points (29%) (P = 0.00). Younger age (P = 0.008) and improvement in sagittal balance (P = 0.014) were positive predictors for improved ODI scores. Improvement in sagittal balance (P = 0.010) was a positive predictor for improved Scoliosis Research Society scores. In patients with combined coronal and sagittal imbalance, improvement in sagittal balance was the most significant predictor for improved ODI scores (P = 0.009). In patients with preoperative coronal imbalance alone, improvement in coronal balance trended toward, but was not a significant predictor for improved ODI (P = 0.092). Sagittal balance improvement is the strongest predictor of improved outcomes in

The results of bone deformity correction using a spider frame with web-based software for lower extremity long bone deformities

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Tekin Ali Çağrı

2016-01-01

Full Text Available Aim: To present the functional and radiological results and evaluate the effectiveness of a computer-assisted external fixator (spider frame in patients with lower extremity shortness and deformity. Materials and methods: The study comprised 17 patients (14 male, 3 female who were treated for lower extremity long bone deformity and shortness between 2012 and 2015 using a spider frame. The procedure’s level of difficulty was determined preoperatively using the Paley Scale. Postoperatively, the results for the patients who underwent tibial operations were evaluated using the Paley criteria modified by ASAMI, and the results for the patients who underwent femoral operations were evaluated according to the Paley scoring system. The evaluations were made by calculating the External Fixator and Distraction indexes. Results: The mean age of the patients was 24.58 years (range, 5–51 years. The spider frame was applied to the femur in 10 patients and to the tibia in seven. The mean follow-up period was 15 months (range, 6–31 months from the operation day, and the mean amount of lengthening was 3.0 cm (range, 1–6 cm. The mean duration of fixator application was 202.7 days (range, 104–300 days. The mean External Fixator Index was 98 days/cm (range, 42–265 days/cm. The mean Distraction Index was 10.49 days/cm (range, 10–14 days/cm. Conclusion: The computer-assisted external fixator system (spider frame achieves single-stage correction in cases of both deformity and shortness. The system can be applied easily, and because of its high-tech software, it offers the possibility of postoperative treatment of the deformity.

PLATFORM DEFORMATION PHASE CORRECTION FOR THE AMiBA-13 COPLANAR INTERFEROMETER

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Liao, Yu-Wei; Lin, Kai-Yang; Huang, Yau-De; Ho, Paul T. P.; Chen, Ming-Tang; Locutus Huang, Chih-Wei; Koch, Patrick M.; Nishioka, Hiroaki; Umetsu, Keiichi; Han, Chih-Chiang; Li, Chao-Te; Martin-Cocher, Pierre; Oshiro, Peter [Institute of Astronomy and Astrophysics, Academia Sinica, P.O. Box 23-141, Taipei 10617, Taiwan (China); Proty Wu, Jiun-Huei; Cheng, Tai-An; Fu, Szu-Yuan; Wang, Fu-Cheng [Department of Physics, Institute of Astrophysics, and Center for Theoretical Sciences, National Taiwan University, Taipei 10617, Taiwan (China); Liu, Guo-Chin [Department of Physics, Tamkang University, 251-37 Tamsui, New Taipei City, Taiwan (China); Molnar, Sandor M. [Leung Center for Cosmology and Particle Astrophysics, National Taiwan University, Taipei 10617, Taiwan (China); Chang, Yu-Yen, E-mail: ywliao@asiaa.sinica.edu.tw, E-mail: jhpw@phys.ntu.edu.tw [Max-Planck-Institut fuer Astronomie, Koenigstuhl 17, D-69117 Heidelberg (Germany)

2013-05-20

We present a new way to solve the platform deformation problem of coplanar interferometers. The platform of a coplanar interferometer can be deformed due to driving forces and gravity. A deformed platform will induce extra components into the geometric delay of each baseline and change the phases of observed visibilities. The reconstructed images will also be diluted due to the errors of the phases. The platform deformations of The Yuan-Tseh Lee Array for Microwave Background Anisotropy (AMiBA) were modeled based on photogrammetry data with about 20 mount pointing positions. We then used the differential optical pointing error between two optical telescopes to fit the model parameters in the entire horizontal coordinate space. With the platform deformation model, we can predict the errors of the geometric phase delays due to platform deformation with a given azimuth and elevation of the targets and calibrators. After correcting the phases of the radio point sources in the AMiBA interferometric data, we recover 50%-70% flux loss due to phase errors. This allows us to restore more than 90% of a source flux. The method outlined in this work is not only applicable to the correction of deformation for other coplanar telescopes but also to single-dish telescopes with deformation problems. This work also forms the basis of the upcoming science results of AMiBA-13.

PLATFORM DEFORMATION PHASE CORRECTION FOR THE AMiBA-13 COPLANAR INTERFEROMETER

International Nuclear Information System (INIS)

Liao, Yu-Wei; Lin, Kai-Yang; Huang, Yau-De; Ho, Paul T. P.; Chen, Ming-Tang; Locutus Huang, Chih-Wei; Koch, Patrick M.; Nishioka, Hiroaki; Umetsu, Keiichi; Han, Chih-Chiang; Li, Chao-Te; Martin-Cocher, Pierre; Oshiro, Peter; Proty Wu, Jiun-Huei; Cheng, Tai-An; Fu, Szu-Yuan; Wang, Fu-Cheng; Liu, Guo-Chin; Molnar, Sandor M.; Chang, Yu-Yen

2013-01-01

We present a new way to solve the platform deformation problem of coplanar interferometers. The platform of a coplanar interferometer can be deformed due to driving forces and gravity. A deformed platform will induce extra components into the geometric delay of each baseline and change the phases of observed visibilities. The reconstructed images will also be diluted due to the errors of the phases. The platform deformations of The Yuan-Tseh Lee Array for Microwave Background Anisotropy (AMiBA) were modeled based on photogrammetry data with about 20 mount pointing positions. We then used the differential optical pointing error between two optical telescopes to fit the model parameters in the entire horizontal coordinate space. With the platform deformation model, we can predict the errors of the geometric phase delays due to platform deformation with a given azimuth and elevation of the targets and calibrators. After correcting the phases of the radio point sources in the AMiBA interferometric data, we recover 50%-70% flux loss due to phase errors. This allows us to restore more than 90% of a source flux. The method outlined in this work is not only applicable to the correction of deformation for other coplanar telescopes but also to single-dish telescopes with deformation problems. This work also forms the basis of the upcoming science results of AMiBA-13.

Platform Deformation Phase Correction for the AMiBA-13 Coplanar Interferometer

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Liao, Yu-Wei; Lin, Kai-Yang; Huang, Yau-De; Proty Wu, Jiun-Huei; Ho, Paul T. P.; Chen, Ming-Tang; Locutus Huang, Chih-Wei; Koch, Patrick M.; Nishioka, Hiroaki; Cheng, Tai-An; Fu, Szu-Yuan; Liu, Guo-Chin; Molnar, Sandor M.; Umetsu, Keiichi; Wang, Fu-Cheng; Chang, Yu-Yen; Han, Chih-Chiang; Li, Chao-Te; Martin-Cocher, Pierre; Oshiro, Peter

2013-05-01

We present a new way to solve the platform deformation problem of coplanar interferometers. The platform of a coplanar interferometer can be deformed due to driving forces and gravity. A deformed platform will induce extra components into the geometric delay of each baseline and change the phases of observed visibilities. The reconstructed images will also be diluted due to the errors of the phases. The platform deformations of The Yuan-Tseh Lee Array for Microwave Background Anisotropy (AMiBA) were modeled based on photogrammetry data with about 20 mount pointing positions. We then used the differential optical pointing error between two optical telescopes to fit the model parameters in the entire horizontal coordinate space. With the platform deformation model, we can predict the errors of the geometric phase delays due to platform deformation with a given azimuth and elevation of the targets and calibrators. After correcting the phases of the radio point sources in the AMiBA interferometric data, we recover 50%-70% flux loss due to phase errors. This allows us to restore more than 90% of a source flux. The method outlined in this work is not only applicable to the correction of deformation for other coplanar telescopes but also to single-dish telescopes with deformation problems. This work also forms the basis of the upcoming science results of AMiBA-13.

Long-term results of forearm lengthening and deformity correction by the Ilizarov method.

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Orzechowski, Wiktor; Morasiewicz, Leszek; Krawczyk, Artur; Dragan, Szymon; Czapiński, Jacek

2002-06-30

Background. Shortening and deformity of the forearm is most frequently caused by congenital disorders or posttraumatic injury. Given its complex anatomy and biomechanics, the forearm is clearly the most difficult segment for lengthening and deformity correction. Material and methods. We analyzed 16 patients with shortening and deformity of the forearm, treated surgically, using the Ilizarov method in our Department from 1989 to 2001. in 9 cases 1-stage surgery was sufficient, while the remaining 7 patients underwent 2-5 stages of treatment. At total of 31 surgical operations were performed. The extent of forearm shortening ranged from 1,5 to 14,5 cm (5-70%). We development a new fixator based on Schanz half-pins. Results. The length of forearm lengthening per operative stage averaged 2,35 cm. the proportion of lengthening ranged from 6% to 48% with an average of 18,3%. The mean lengthening index was 48,15 days/cm. the per-patient rate of complications was 88% compared 45% per stage of treatment, mostly limited rotational mobility and abnormal consolidation of regenerated bone. Conclusions. Despite the high complication rate, the Ilizarov method is the method of choice for patients with forearm shortenings and deformities. Treatment is particularly indicated in patients with shortening caused by disproportionate length of the ulnar and forearm bones. Treatment should be managed so as cause the least possible damage to arm function, even at the cost of limited lengthening. Our new stabilizer based on Schanz half-pins makes it possible to preserve forearm rotation.

Correction of deformational plagiocephaly in early infancy using the plagio cradle orthotic.

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Seruya, Mitchel; Oh, Albert K; Sauerhammer, Tina M; Taylor, Jonathan H; Rogers, Gary F

2013-03-01

The purpose of this study was to assess early treatment of deformational plagiocephaly using the Plagio Cradle, a modifiable cranial orthotic. Infants were included if they had treatment of deformational plagiocephaly with the Plagio Cradle beginning at 4 months or younger. Patients were prospectively stratified by the age treatment was initiated: group 1: under 10 weeks (n = 50); group 2: 10 to 20 weeks (n = 113). Pretreatment and posttreatment calvarial asymmetry was measured using direct anthropometry and reported as a transcranial difference (TCD). The end point for therapy was a TCD of 5 mm or less, falling within 2 SDs of published normative data. One hundred sixty-three infants were included. Initial TCD was significantly higher for group 1 as compared with group 2 (initial TCD: 11.0 vs 9.0 mm; P Plagio Cradle can fully correct deformational plagiocephaly early in life. Nevertheless, treatment is more effective if initiated before 10 weeks of age.

Midterm outcome after correction of hallux valgus deformity using scarf osteotomy in adult population

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Laura Ibrahim Alolayan

2017-01-01

Full Text Available Context: Determining the efficacy of any surgical treatment is the key to achieve better practice and best outcomes for patients. Aims: This study is designed to address midterm outcome in adult patients with moderate-to-severe hallux valgus (HV, who underwent scarf osteotomy from 2012 to 2014. Settings and Design: This is a retrospective cohort study in which charts of all adult patients with moderate-to-severe HV who underwent scarf osteotomy from 2011 to 2014 were reviewed. Subjects and Methods: Between 2011 and 2014, 39 patients (41 feet who underwent scarf osteotomy for correction of HV deformity were retrospectively evaluated. Standard weight-bearing dorsoplantar radiographs were obtained pre- and postoperatively. HV angle (HVA, intermetatarsal angle (IMA and distal metatarsal articular angles (DMAA were measured pre- and postoperatively to evaluate the efficacy of the surgery. The complication rate was reported. The average follow-up was 13.5 months, and the patients' mean age was 37 years. Statistical Analysis Used: Data were compared using Chi-square test or Fisher's exact test whichever was appropriate. All tests were two-sided, and a P> 0.01 was considered statistically significant. Results: The average preoperative HVA and IMA were 32° and 14.3°, which improved to 11° and 7.9°, respectively. The changes were statistically significant (P 0.18. Conclusions: This study suggests that scarf osteotomy surgery is a very versatile osteotomy in correcting moderate-to-severe HV deformity. It offers a greater degree of correction and stability, lower rate of complications and good outcome. However, long-term follow-up studies are still needed.

Correction of coronal plane deformities around the knee using a tension band plate in children younger than 10 years

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Ruta M Kulkarni

2015-01-01

Full Text Available Background: Guided growth through temporary hemiepiphysiodesis has gained acceptance as the preferred primary treatment in treating pediatric lower limb deformities as it is minimally invasive with a lesser morbidity than the traditional osteotomy. The tension band plate is the most recent development in implants used for temporary hemiepiphysiodesis. Our aim was to determine its safety and efficacy in correcting coronal plane deformities around the knee in children younger than 10 years. Materials and Methods: A total of 24 children under the age of 10 were operated for coronal plane deformities around the knee with a single extra periosteal tension band plate and two nonlocking screws. All the children had a pathological deformity for which a detailed preoperative work-up was carried out to ascertain the cause of the deformity and rule out physiological ones. The average age at hemiepiphysiodesis was 5 years 3 months (range: 2 years to 9 years 1 month. Results: The plates were inserted for an average of 15.625 months (range: 7 months to 29 months. All the patients showed improvement in the mechanical axis. Two patients showed partial correction. Two cases of screw loosening were observed. In the genu valgum group, the tibiofemoral angle improved from a preoperative mean of 19.89° valgus (range: 10° valgus to 40° valgus to 5.72° valgus (range: 2° varus to 10° valgus. In patients with genu varum the tibiofemoral angle improved from a mean of 28.27° varus (range: 13° varus to 41° varus to 1.59° valgus (range: 0-8° valgus. Conclusion: Temporary hemiepiphysiodesis through the application of the tension band plate is an effective method to correct coronal plane deformities around the knee with minimal complications. Its ease and accuracy of insertion has extended the indication of temporary hemiepiphysiodesis to patients younger than 10 years and across a wide variety of diagnosis including pathological physis, which were traditionally

The results of high tibial open wedge osteotomy in patients with varus deformity

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Mahmood Jabalameli

2013-07-01

Full Text Available Background: High tibial open wedg osteotomy is one of the most important modality for treatment of varus deformity in order to correct deformity and improving signs and symptoms of patients with primary degenerative osteoarthritis. The aim of this study was to investigate the results of high tibial open wedge osteotomy in patients with varus deformities.Methods: This retrospective study conducted on twenty nine patients (36 knees undergone proximal tibial osteotomy operation in Shafa Yahyaian University Hospital from 2004 to 2010. Inclusion criteria were: age less than 60 years, high physical activity, varus deformity and involvement of medical compartment of knee. Patients with obesity, smoking, patelofemoral pain, lateral compartment lesion, deformity degree more than 20 degree, extension limitation and range of motion less than 90 degree were excluded. The clinical and radiologic characteristics were measured before and after operation.Results: Fourteen patients were females. All of them were younger than 50 years, with mean (±SD 27.64 (±10.88. The mean (±SD of follow up time was 4.33 (±1.7. All the patients were satisfied with the results of operation. Tenderness and pain decreased in all of them. In all patients autologus bone graft were used, in 15 cases (42.5% casting and in the rest T.Buttress plate were used for fixation of fractures. In both groups of primary and double varus the International knee documentation committee (IKDC and modified Larson indices were improved after operation, but there was no significant difference between two groups.Conclusion: High tibial open wedge osteotomy can have satisfying results in clinical signs and symptoms of patients with primary medial joint degenerative osteoarthritis. This procedure also may correct the deformity and improves the radiologic parameters of the patients.

Paediatric lower limb deformity correction using the Ilizarov technique: a statistical analysis of factors affecting the complication rate.

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Oostenbroek, Hubert J; Brand, Ronald; van Roermund, Peter M; Castelein, René M

2014-01-01

Limb length discrepancy (LLD) and other patient factors are thought to influence the complication rate in (paediatric) limb deformity correction. In the literature, information is conflicting. This study was performed to identify clinical factors that affect the complication rate in paediatric lower-limb lengthening. A consecutive group of 37 children was analysed. The median proportionate LLD was 15 (4-42)%. An analysis was carried out on several patient factors that may complicate the treatment or end result using logistic regression in a polytomous logistic regression model. The factors analysed were proportionate LLD, cause of deformity, location of corrected bone, and the classification of the deformity according to an overall classification that includes the LLD and all concomitant deformity factors. The median age at the start of the treatment was 11 (6-17) years. The median lengthening index was 1.5 (0.8-3.8) months per centimetre lengthening. The obstacle and complication rate was 69% per lengthened bone. Proportionate LLD was the only statistically significant predictor for the occurrence of complications. Concomitant deformities did not influence the complication rate. From these data we constructed a simple graph that shows the relationship between proportionate LLD and risk for complications. This study shows that only relative LLD is a predictor of the risk for complications. The additional value of this analysis is the production of a simple graph. Construction of this graph using data of a patient group (for example, your own) may allow a more realistic comparison with results in the literature than has been possible before.

Spinal deformity in patients with Sotos syndrome (cerebral gigantism).

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Tsirikos, Athanasios I; Demosthenous, Nestor; McMaster, Michael J

2009-04-01

Retrospective review of a case series. To present the clinical characteristics and progression of spinal deformity in patients with Sotos syndrome. There is limited information on the development of spinal deformity and the need for treatment in this condition. The medical records and spinal radiographs of 5 consecutive patients were reviewed. All patients were followed to skeletal maturity (mean follow-up: 6.6 y). The mean age at diagnosis of spinal deformity was 11.9 years (range: 5.8 to 14.5) with 4 patients presenting in adolescence. The type of deformity was not uniform. Two patients presented in adolescence with relatively small and nonprogressive thoracolumbar and lumbar scoliosis, which required observation but no treatment until the end of spinal growth. Three patients underwent spinal deformity correction at a mean age of 11.7 years (range: 6 to 15.4). The first patient developed a double structural thoracic and lumbar scoliosis and underwent a posterior spinal arthrodesis extending from T3 to L4. Five years later, she developed marked degenerative changes at the L4/L5 level causing symptomatic bilateral lateral recess stenosis and affecting the L5 nerve roots. She underwent spinal decompression at L4/L5 and L5/S1 levels followed by extension of the fusion to the sacrum. The second patient developed a severe thoracic kyphosis and underwent a posterior spinal arthrodesis. The remaining patient presented at the age of 5.9 years with a severe thoracic kyphoscoliosis and underwent a 2-stage antero-posterior spinal arthrodesis. The development of spinal deformity is a common finding in children with Sotos syndrome and in our series it occurred in adolescence in 4 out of 5 patients. There is significant variability on the pattern of spine deformity, ranging from a scoliosis through kyphoscoliosis to a pure kyphosis, and also the age at presentation and need for treatment.

Development of a Detailed Volumetric Finite Element Model of the Spine to Simulate Surgical Correction of Spinal Deformities

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Mark Driscoll

2013-01-01

Full Text Available A large spectrum of medical devices exists; it aims to correct deformities associated with spinal disorders. The development of a detailed volumetric finite element model of the osteoligamentous spine would serve as a valuable tool to assess, compare, and optimize spinal devices. Thus the purpose of the study was to develop and initiate validation of a detailed osteoligamentous finite element model of the spine with simulated correction from spinal instrumentation. A finite element of the spine from T1 to L5 was developed using properties and geometry from the published literature and patient data. Spinal instrumentation, consisting of segmental translation of a scoliotic spine, was emulated. Postoperative patient and relevant published data of intervertebral disc stress, screw/vertebra pullout forces, and spinal profiles was used to evaluate the models validity. Intervertebral disc and vertebral reaction stresses respected published in vivo, ex vivo, and in silico values. Screw/vertebra reaction forces agreed with accepted pullout threshold values. Cobb angle measurements of spinal deformity following simulated surgical instrumentation corroborated with patient data. This computational biomechanical analysis validated a detailed volumetric spine model. Future studies seek to exploit the model to explore the performance of corrective spinal devices.

Facial contour deformity correction with microvascular flaps based on the 3-dimentional template and facial moulage

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Dinesh Kadam

2013-01-01

Full Text Available Introduction: Facial contour deformities presents with varied aetiology and degrees severity. Accurate assessment, selecting a suitable tissue and sculpturing it to fill the defect is challenging and largely subjective. Objective assessment with imaging and software is not always feasible and preparing a template is complicated. A three-dimensional (3D wax template pre-fabricated over the facial moulage aids surgeons to fulfil these tasks. Severe deformities demand a stable vascular tissue for an acceptable outcome. Materials and Methods: We present review of eight consecutive patients who underwent augmentation of facial contour defects with free flaps between June 2005 and January 2011. De-epithelialised free anterolateral thigh (ALT flap in three, radial artery forearm flap and fibula osteocutaneous flap in two each and groin flap was used in one patient. A 3D wax template was fabricated by augmenting the deformity on facial moulage. It was utilised to select the flap, to determine the exact dimensions and to sculpture intraoperatively. Ancillary procedures such as genioplasty, rhinoplasty and coloboma correction were performed. Results: The average age at the presentation was 25 years and average disease free interval was 5.5 years and all flaps survived. Mean follow-up period was 21.75 months. The correction was aesthetically acceptable and was maintained without any recurrence or atrophy. Conclusion: The 3D wax template on facial moulage is simple, inexpensive and precise objective tool. It provides accurate guide for the planning and execution of the flap reconstruction. The selection of the flap is based on the type and extent of the defect. Superiority of vascularised free tissue is well-known and the ALT flap offers a versatile option for correcting varying degrees of the deformities. Ancillary procedures improve the overall aesthetic outcomes and minor flap touch-up procedures are generally required.

Early rehabilitation treatment combined with equinovarus foot deformity surgical correction in stroke patients: safety and changes in gait parameters.

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Giannotti, Erika; Merlo, Andrea; Zerbinati, Paolo; Longhi, Maria; Prati, Paolo; Masiero, Stefano; Mazzoli, Davide

2016-06-01

Equinovarus foot deformity (EVFD) compromises several prerequisites of walking and increases the risk of falling. Guidelines on rehabilitation following EVFD surgery are missing in current literature. The aim of this study was to analyze safety and adherence to an early rehabilitation treatment characterized by immediate weight bearing with an ankle-foot orthosis (AFO) in hemiplegic patients after EVFD surgery and to describe gait changes after EVFD surgical correction combined with early rehabilitation treatment. Retrospective observational cohort study. Inpatient rehabilitation clinic. Forty-seven adult patients with hemiplegia consequent to ischemic or haemorrhagic stroke (L/R 20/27, age 56±15 years, time from lesion 6±5 years). A specific rehabilitation protocol with a non-articulated AFO, used to allow for immediate gait training, started one day after EVFD surgery. Gait analysis (GA) data before and one month after surgery were analyzed. The presence of differences in GA space-time parameters, in ankle dorsiflexion (DF) values and peaks at initial contact (DF at IC), during stance (DF at St) and swing (DF at Sw) were assessed by the Wilcoxon Test while the presence of correlations between pre- and post-operative values by Spearman's correlation coefficient. All patients completed the rehabilitation protocol and no clinical complications occurred in the sample. Ankle DF increased one month after surgery at all investigated gait phases (Wilcoxon Test, Prehabilitation associated with surgical procedure is safe and may be suitable to correct EVFD by restoring both the neutral heel foot-ground contact and the ankle DF peaks during stance and swing at one month from surgery. The proposed protocol is a safe and potentially useful rehabilitative approach after EVFD surgical correction in stroke patients.

THE CORRECTION OF HALLUX VARUS DEFORMITY IN CONSEQUENCE OF SURGICAL TREATMENT FOR HALLUX VALGUS

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V. M. Mashkov

2010-01-01

Full Text Available The analysis of treatment of 21 patients (24 feet with postoperative hallux varus deformity which have arisen after operations apropos hallux valgus is carried out. For correction of vicious position of the first finger we successfully carried out the Brandes procedure, sometimes in a combination to operations on sinews of muscles of the first finger - an adductor hallucis tendotomy and/or lengthening of the extensor hallucis longus tendon.

Rating of intra-operative neuro-monitoring results in operative correction of the spinal deformities

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A. A. Skripnikov

2015-01-01

Full Text Available Purpose of the work was filing the electrophysiological phenomena observed in the process of intra-operative neuromonitoring followed by development of the results’ scale of intra-operative neuro-physiological testing of the pyramidal tract. Materials and мethods. The selection for evaluation included data of 147 protocols of intra-operative neuromonitoring in 135 patients (53 males, 82 females, aged from 1 y. 5 m. to 52 years (14,1±0,7 years with spinal deformities of different etiology who underwent instrumentation spinal correction followed by fixation of thoracic / thoracolumbar spine segments using various variants of internal systems of trans-pedicular fixation. Intra-operative neuro-monitoring was performed using system «ISIS IOM» (Inomed Medizintechnik GmbH, Germany. The changes of motor evoked potentials were evaluated according to this scale. Results. Five types of pyramidal system reaction to operative invasion were revealed. According to neurophysiological criteria three grades of the risk of neurological disorders development during operative spinal deformity correction and, correspondingly, three levels of anxiety for the surgeon were defined. Conclusion. Intra-operative neurophysiological monitoring is the effective highly technological instrument to prevent neurological disorders in the spinal deformity. Offered rating scale of the risk of neurological complications gives the possibility to highlight three levels of anxiety during operative invasion.

CORRECTIVE SURGERY IN CONGENITAL TALIPES EQUINOVARUS DEFORMITY: A CAMP APPROACH

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Antony R.

2015-09-01

Full Text Available The study was intended to assess the results of soft tissue release and bony corrective surgery in patients of moderate to severe deformed rigid club foot (CTEV and neglected clubfoot (CTEV at free disabled surgical camps at Chhattisgarh state . MATERIAL AND METHODS : In our study 50 patients were included with 70% male and 30% female with 4 - 16 years of age grou p and 70% unilateral and 30% bilateral foot involvement. Patients were admitted and operated in different free disabled surgical camps at Chhattisgarh state over the period of 36 months (1 may 2004 to 30 th April 2007. Improvement in functional ability and locomotion of all operated patients were assessed by physical and clinical examination. RESULTS : All patients who were operated in our study showed significant improvement in functional ability and locomotion after surgery. All patients were maintaining f unctional ability at follow up duration of 12 months (1 year. 75% patients were walking normally, 10% cases were walking with internal rotation of leg and 5% cases were walking with midtarsal varus foot with AFO with medial bar support. CONCLUSION : Our st udy showed and established that excellent results can be obtained in congenital talipes equinovarus (CTEV patients by soft tissue release with bony corrective surgery. The team work of devoted surgeons, paramedical and rehabilitation staff in whole durati on of camps to achieve the goal. With an aim to help more number of CTEV cases by surgery, our team has started doing surgeries in small institutions, and organize charity camps to help poor patients and mankind even in small clinics

Complication Rates and Short-Term Outcomes After Operative Hammertoe Correction in Older Patients.

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Mueller, Claire Mackenzie; Boden, Stephanie Ann; Boden, Allison Lee; Maidman, Samuel David; Cutler, Anya; Mignemi, Danielle; Bariteau, Jason

2018-02-01

Hammertoe deformities are the most common lesser toe deformity. To date, no studies have looked at outcomes of operative management in the geriatric population, which may be at greater risk for complications or functional compromise because of comorbidities. Data on 58 patients undergoing operative correction of hammertoe deformities were prospectively collected. Clinical outcomes were assessed using preoperative and postoperative visual analogue scale (VAS) and Short Form Health Survey (SF-36) scores with a minimum of 6-month follow-up. Patients were divided into 2 groups on the basis of age at the time of surgery: younger than 65 and 65 and older. Complication rates and mean VAS and SF-36 improvement were compared. Forty-seven patients met inclusion criteria (7 men, 40 women), with 26 patients (37 toes) in the younger cohort and 21 patients (39 toes) in the older cohort. Overall, patients demonstrated significant improvement from baseline to 6 and 12 months postoperatively in VAS ( P < .001 and P < .001) and SF-36 ( P < .001 and P < .001) scores. Mean improvement in VAS and SF-36 scores was not significantly different between the groups at 6 and 12 months postoperatively. Complications occurred in 13.5% and 10.3% of patients in the younger and older cohorts, respectively. Outcomes of operative correction of hammertoe deformities in older patients were similar to outcomes in younger patients after greater than 6 months of follow-up. Overall improvement in VAS and SF-36 was statistically significant for both cohorts. There was no associated increase in complications for older patients. Level, III comparative series.

Rebound Deformity After Growth Modulation in Patients With Coronal Plane Angular Deformities About the Knee: Who Gets It and How Much?

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Leveille, Lise A; Razi, Ozan; Johnston, Charles E

2017-05-18

With observed success and increased popularity of growth modulation techniques, there has been a trend toward use in progressively younger patients. Younger age at growth modulation increases the likelihood of complete deformity correction and need for implant removal before skeletal maturity introducing the risk of rebound deformity. The purpose of this study was to quantify magnitude and identify risk factors for rebound deformity after growth modulation. We performed a retrospective review of all patients undergoing growth modulation with a tension band plate for coronal plane deformity about the knee with subsequent implant removal. Exclusion criteria included completion epiphysiodesis or osteotomy at implant removal, ongoing growth modulation, and modulation, before implant removal, and at final follow-up. In total, 67 limbs in 45 patients met the inclusion criteria. Mean age at growth modulation was 9.8 years (range, 3.4 to 15.4 y) and mean age at implant removal was 11.4 years (range, 5.3 to 16.4 y). Mean change in HKA after implant removal was 6.9 degrees (range, 0 to 23 degrees). In total, 52% of patients had >5 degrees rebound and 30% had >10 degrees rebound in HKA after implant removal. Females below 10 years and males below 12 years at time of growth modulation had greater mean change in HKA after implant removal compared with older patients (8.4 vs. 4.7 degrees, P=0.012). Patients with initial deformity >20 degrees had an increased frequency of rebound >10 degrees compared with patients with less severe initial deformity (78% vs. 22%, P=0.002). Rebound deformity after growth modulation is common. Growth modulation at a young age and large initial deformity increases risk of rebound. However, rebound does not occur in all at risk patients, therefore, we recommend against routine overcorrection. Level IV-retrospective study.

Early Outcomes of Minimally Invasive Anterior Longitudinal Ligament Release for Correction of Sagittal Imbalance in Patients with Adult Spinal Deformity

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Armen R. Deukmedjian

2012-01-01

Full Text Available The object of this study was to evaluate a novel surgical technique in the treatment of adult degenerative scoliosis and present our early experience with the minimally invasive lateral approach for anterior longitudinal ligament release to provide lumbar lordosis and examine its impact on sagittal balance. Methods. All patients with adult spinal deformity (ASD treated with the minimally invasive lateral retroperitoneal transpsoas interbody fusion (MIS LIF for release of the anterior longitudinal ligament were examined. Patient demographics, clinical data, spinopelvic parameters, and outcome measures were recorded. Results. Seven patients underwent release of the anterior longitudinal ligament (ALR to improve sagittal imbalance. All cases were split into anterior and posterior stages, with mean estimated blood loss of 125 cc and 530 cc, respectively. Average hospital stay was 8.3 days, and mean follow-up time was 9.1 months. Comparing pre- and postoperative 36′′ standing X-rays, the authors discovered a mean increase in global lumbar lordosis of 24 degrees, increase in segmental lumbar lordosis of 17 degrees per level of ALL released, decrease in pelvic tilt of 7 degrees, and decrease in sagittal vertical axis of 4.9 cm. At the last followup, there was a mean improvement in VAS and ODI scores of 26.2% and 18.3%. Conclusions. In the authors’ early experience, release of the anterior longitudinal ligament using the minimally invasive lateral retroperitoneal transpsoas approach may be a feasible alternative in correcting sagittal deformity.

Correction of axial deformity during lengthening in fibular hypoplasia: Hexapodal versus monorail external fixation.

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Chalopin, A; Geffroy, L; Pesenti, S; Hamel, A; Launay, F

2017-09-01

Childhood fibular hypoplasia is a rare pathology which may or may not involve limb-length discrepancy and axial deformity in one or more dimensions. The objective of the present study was to compare the quality of the axial correction achieved in lengthening procedures by hexapodal versus monorail external fixators. The hypothesis was that the hexapodal fixator provides more precise correction. A retrospective multicenter study included 52 children with fibular hypoplasia. Seventy-two tibias were analyzed, in 2 groups: 52 using a hexapodal fixator, and 20 using a monorail fixator. Mean age was 10.2 years. Mean lengthening was 5.7cm. Deformities were analyzed and measured in 3 dimensions and classified in 4 preoperative types and 4 post-lengthening types according to residual deformity. Complete correction was achieved in 26 tibias in the hexapodal group (50%) and 2 tibias in the monorail group (10%). Mean post-correction mechanical axis deviation was smaller in the hexapodal group: 12.83mm, versus 14.29mm in the monorail group. Mean post-correction mechanical lateral distal femoral angle was 87.5° in the hexapodal group, versus 84.3° in the monorail group (P=0.002), and mean mechanical medial proximal tibial angle 86.9° versus 89.5°, respectively (P=0.015). No previous studies focused on this congenital pathology in lengthening and axial correction programs for childhood lower-limb deformity. The present study found the hexapodal fixator to be more effective in conserving or restoring mechanical axes during progressive bone lengthening for fibular hypoplasia. The hexapodal fixator met the requirements of limb-length equalization in childhood congenital lower-limb hypoplasia, providing better axial correction than the monorail fixator. IV. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Multidisciplinary approach for management of dentofacial deformity of a patient with goldenhar syndrome

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Usha Shenoy

2018-01-01

Full Text Available Goldenhar syndrome is a rare congenital craniofacial deformity, associated with anomalies of the head and spinal cord. The syndrome may affect the eyes, ears, face, and mouth and can also differ greatly in the degree of seriousness. The precise etiology of this syndrome is still not identified. Adult patients with dentoskeletal deformities usually need orthodontic and surgical corrections, requiring an integrated approach, patient cooperation, and systemized treatment planning. A poor facial appearance is often the patient's chief complaint, but it may be accompanied by functional problems, temporomandibular joints disorders, or psychosocial handicaps. The present case report highlights the orthodontic and surgical management of a patient with Goldenhar syndrome.

Errors and complications in surgical treatment of non-stable equino-plano-valgus foot deformity in patients with cerebral palsy, with use of the calcaneus correcting osteotomy technique

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Valery V. Umnov

2017-03-01

Full Text Available Aims. To examine the results of treatment for patients with a non-stable form of equino-plano-valgus foot deformity in cerebral palsy with the use of corrective osteotomy of the calcaneus. To further analyze the errors and complications that occurred in patients treated with this technique. Materials and methods. From 2006 to 2014, 64 patients (103 feet aged 3 to 17 years were operated using the described method of calcaneus correcting osteotomy. The equinus contracture was eliminated by transection of the gastrocnemius muscle tendon and extending achilloplastic surgery. The abnormal muscle tone was reduced either by administering the drug Dysport into the gastrocnemius muscle or by selective neurotomy of the tibial nerve. Results. The analysis revealed that there were good results for 75%, satisfactory results for 18%, and unacceptable results for 7% of patients. The unacceptable results of treatment were due to several technical and tactical errors, which were grouped and analyzed. Conclusion. The analysis of errors and complications of calcaneus corrective osteotomy for patients with cerebral palsy with a mobile form of talipes equinoplanovalgus will enable their future avoidance and improvement of the treatment quality.

ERRORS AND COMPLICATIONS IN SURGICAL TREATMENT OF NON-STABLE EQUINO-PLANO-VALGUS FOOT DEFORMITY IN PATIENTS WITH CEREBRAL PALSY, WITH USE OF THE CALCANEUS CORRECTING OSTEOTOMY TECHNIQUE

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Valery V. Umnov

2017-03-01

Full Text Available Aims. To examine the results of treatment for patients with a non-stable form of equino-plano-valgus foot deformity in cerebral palsy with the use of corrective osteotomy of the calcaneus. To further analyze the errors and complications that occurred in patients treated with this technique. Materials and methods. From 2006 to 2014, 64 patients (103 feet aged 3 to 17 years were operated using the described method of calcaneus correcting osteotomy. The equinus contracture was eliminated by transection of the gastrocnemius muscle tendon and extending achilloplastic surgery. The abnormal muscle tone was reduced either by administering the drug Dysport into the gastrocnemius muscle or by selective neurotomy of the tibial nerve. Results. The analysis revealed that there were good results for 75%, satisfactory results for 18%, and unacceptable results for 7% of patients. The unacceptable results of treatment were due to several technical and tactical errors, which were grouped and analyzed. Conclusion. The analysis of errors and complications of calcaneus corrective osteotomy for patients with cerebral palsy with a mobile form of talipes equinoplanovalgus will enable their future avoidance and improvement of the treatment quality.

MRI non-uniformity correction through interleaved bias estimation and B-spline deformation with a template.

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Fletcher, E; Carmichael, O; Decarli, C

2012-01-01

We propose a template-based method for correcting field inhomogeneity biases in magnetic resonance images (MRI) of the human brain. At each algorithm iteration, the update of a B-spline deformation between an unbiased template image and the subject image is interleaved with estimation of a bias field based on the current template-to-image alignment. The bias field is modeled using a spatially smooth thin-plate spline interpolation based on ratios of local image patch intensity means between the deformed template and subject images. This is used to iteratively correct subject image intensities which are then used to improve the template-to-image deformation. Experiments on synthetic and real data sets of images with and without Alzheimer's disease suggest that the approach may have advantages over the popular N3 technique for modeling bias fields and narrowing intensity ranges of gray matter, white matter, and cerebrospinal fluid. This bias field correction method has the potential to be more accurate than correction schemes based solely on intrinsic image properties or hypothetical image intensity distributions.

MRI Non-Uniformity Correction Through Interleaved Bias Estimation and B-Spline Deformation with a Template*

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Fletcher, E.; Carmichael, O.; DeCarli, C.

2013-01-01

We propose a template-based method for correcting field inhomogeneity biases in magnetic resonance images (MRI) of the human brain. At each algorithm iteration, the update of a B-spline deformation between an unbiased template image and the subject image is interleaved with estimation of a bias field based on the current template-to-image alignment. The bias field is modeled using a spatially smooth thin-plate spline interpolation based on ratios of local image patch intensity means between the deformed template and subject images. This is used to iteratively correct subject image intensities which are then used to improve the template-to-image deformation. Experiments on synthetic and real data sets of images with and without Alzheimer’s disease suggest that the approach may have advantages over the popular N3 technique for modeling bias fields and narrowing intensity ranges of gray matter, white matter, and cerebrospinal fluid. This bias field correction method has the potential to be more accurate than correction schemes based solely on intrinsic image properties or hypothetical image intensity distributions. PMID:23365843

Free-flap surgical correction of facial deformity after anteromedial maxillectomy.

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Sarukawa, Shunji; Kamochi, Hideaki; Noguchi, Tadahide; Sunaga, Ataru; Uda, Hirokazu; Mori, Yoshiyuki; Nishino, Hiroshi; Yoshimura, Kotaro

2017-09-01

Anteromedial maxillectomy is typically performed in conjunction with low-dose radiotherapy and intraarterial chemotherapy. In doing so, the extent of surgical defects is reduced. However, nasal deviation and oral incompetence may ensue, due to cicatricial contracture of wounds, and may be distressing to these patients. Herein, we report a series of eight free perforator flap procedures (anterolateral thigh [ALT] flap, 6; thoracodorsal artery perforator [TAP] flap, 2) used to correct such deformities. The TAP flap was combined with scapular tip [ST] osseous flap in patients with added zygomatic prominence defects. Three adipocutaneous parts developed from each perforator flap were applied as follows: two to reconstruct nasal lining and oral vestibule, and one to augment cheek volume. All aesthetic results proved satisfactory, although orbital dystopia and contracture of mimic muscles were not resolved completely. These secondary interventions are suitable for sequelae of simple anteromedial maxillectomy. Immediate reconstruction should be considered if orbital floor and mimic muscles are involved. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Direct aperture deformation: An interfraction image guidance strategy

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Feng Yuanming; Castro-Pareja, Carlos; Shekhar, Raj; Yu, Cedric

2006-01-01

A new scheme, called direct aperture deformation (DAD), for online correction of interfraction geometric uncertainties under volumetric imaging guidance is presented. Using deformable image registration, the three-dimensional geometric transformation matrix can be derived that associates the planning image set and the images acquired on the day of treatment. Rather than replanning or moving the patient, we use the deformation matrix to morph the treatment apertures as a potential online correction method. A proof-of-principle study using an intensity-modulated radiation therapy plan for a prostate cancer patient was conducted. The method, procedure, and algorithm of DAD are described. The dose-volume histograms from the original plan, reoptimized plan, and rigid-body translation plan are compared with the ones from the DAD plan. The study showed the feasibility of the DAD as a general method for both target dislocation and deformation. As compared with using couch translation to move the patient, DAD is capable of correcting both target dislocation and deformations. As compared with reoptimization, online correction using the DAD scheme could be completed within a few minutes rather than tens of minutes and the speed gain would be at a very small cost of plan quality

Computer-aided surgical planner for a new bone deformity correction device using axis-angle representation.

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Wu, Ying Ying; Plakseychuk, Anton; Shimada, Kenji

2014-11-01

Current external fixators for distraction osteogenesis (DO) are unable to correct all types of deformities in the lower limb and are difficult to use because of the lack of a pre-surgical planning system. We propose a DO system that consists of a surgical planner and a new, easy-to-setup unilateral fixator that not only corrects all lower limb deformity, but also generates the contralateral/predefined bone shape. Conventionally, bulky constructs with six or more joints (six degrees of freedom, 6DOF) are needed to correct a 3D deformity. By applying the axis-angle representation, we can achieve that with a compact construct with only two joints (2DOF). The proposed system makes use of computer-aided design software and computational methods to plan and simulate the planned procedure. Results of our stress analysis suggest that the stiffness of our proposed fixator is comparable to that of the Orthofix unilateral external fixator. We tested the surgical system on a model of an adult deformed tibia and the resulting bone trajectory deviates from the target bone trajectory by 1.8mm, which is below our defined threshold error of 2mm. We also extracted the transformation matrix that defines the deformity from the bone model and simulated the planned procedure. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

Repair of pectus deformities: Experience and outcome in 317 cases

International Nuclear Information System (INIS)

Geric, O.; Gurkok, S.; Gozubuyuk, A.; Dakak, M.; Caytak, H.; Yucels, O.

2006-01-01

The most common congenital chest wall reformatories are pectus excavatum and pectus carinatum. Various techniques have been described for correction of pectus deformities. We describe our experience with surgical repair of pectus deformity (PD) in adults, including our new techniques, which uses a restorable plaque for fixation of the sternum. We reviewed the records of 317 patients who underwent surgical correction of PD between October 1997 and December 2005. All of the patients were male and the median age was 21.3 years (range 16-32 years). Of 317 patients, the type of deformity was a pectus excavatum in 230 patients and a pectus carination in 87 of the patients. Four different operative techniques were used. There were no intraoperative deaths or major perioperative morbidity. The complications rate was 17%. Overall mean hospital stay was 14.25 days. In 208 patients who underwent a mid-term outpatient follow up (mean, 8 months), there was no recurrence. Patient satisfaction was excellent in 234 patients, good in 79 patients and fair in 4 patients. The majority of patients with pectus deformity have been operated on during childhood; therefore there is limited published information about the correction of pectus cranium deformation in adults. The most important point in pectus correction is to achieve proper and long term stability of the sternum following osteotomy. Various techniques can be used for this purpose. (author)

Joint deformable liver registration and bias field correction for MR-guided HDR brachytherapy.

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Rak, Marko; König, Tim; Tönnies, Klaus D; Walke, Mathias; Ricke, Jens; Wybranski, Christian

2017-12-01

In interstitial high-dose rate brachytherapy, liver cancer is treated by internal radiation, requiring percutaneous placement of applicators within or close to the tumor. To maximize utility, the optimal applicator configuration is pre-planned on magnetic resonance images. The pre-planned configuration is then implemented via a magnetic resonance-guided intervention. Mapping the pre-planning information onto interventional data would reduce the radiologist's cognitive load during the intervention and could possibly minimize discrepancies between optimally pre-planned and actually placed applicators. We propose a fast and robust two-step registration framework suitable for interventional settings: first, we utilize a multi-resolution rigid registration to correct for differences in patient positioning (rotation and translation). Second, we employ a novel iterative approach alternating between bias field correction and Markov random field deformable registration in a multi-resolution framework to compensate for non-rigid movements of the liver, the tumors and the organs at risk. In contrast to existing pre-correction methods, our multi-resolution scheme can recover bias field artifacts of different extents at marginal computational costs. We compared our approach to deformable registration via B-splines, demons and the SyN method on 22 registration tasks from eleven patients. Results showed that our approach is more accurate than the contenders for liver as well as for tumor tissues. We yield average liver volume overlaps of 94.0 ± 2.7% and average surface-to-surface distances of 2.02 ± 0.87 mm and 3.55 ± 2.19 mm for liver and tumor tissue, respectively. The reported distances are close to (or even below) the slice spacing (2.5 - 3.0 mm) of our data. Our approach is also the fastest, taking 35.8 ± 12.8 s per task. The presented approach is sufficiently accurate to map information available from brachytherapy pre-planning onto interventional data. It

Corrections of diverse forms of lower limb deformities in patients with mucopolysaccharidosis type IVA (Morquio syndrome

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Ali Al Kaissi

2016-01-01

Full Text Available Background: Thoracolumbar kyphosis has been considered as the first presenting deformity and is often a key diagnostic clue noted in children with mucopolysaccharidosis (MPS type IV (Morquio′s syndrome. However, we observed that the progressive irregularities of the epiphyses of the long bones were the most prominent skeletal pathology, causing effectively the development of diverse forms of lower limbs deformities with extreme variation in age of onset. Materials and Methods: Ten patients (seven children and three adults with an average age of 15 years have been enrolled in this study. Age of diagnosis of MPS IVA has a variable age of onset and a MISLEADING rate of severity. Hip dislocations, genu valgum, protrusio acetabuli and osteoarthritis were the most common lower limbs deformities in these patients. Clinical and radiographic phenotypes were the baseline tools of documentation. Urinary screening and genotypic characterizations have been applied accordingly. Results: Combined pelvic and femoral procedures for hip dislocation, epiphysiodeses and supracondylar osteotomy for genu valgum and hip arthroplasty for protrusio acetabuli have been performed. All patients manifested insufficient activity of N-acetylgalactosamine-6-sulphate sulphatase, an enzyme that degrades keratin sulphate and chondroitin-6 sulphate. Conclusion: The extensive clinical heterogeneity contributed significantly in the delay in establishing the diagnosis particularly in adult patients with MPS IV. The epiphyseal irregularities of the long bones and the progressive flattening pathology of MPS IV A were the reason to falsely diagnose some patients as spondyloepiphyseal dysplasia congenital and/or tarda. Proximal femoral osteotomy, realignment osteotomy and total hip arthroplasty have been performed for coxa vara, genu valgum and protrusio acetabuli, respectively, in children and adult group of patients. The importance of early diagnosis on MPS IV A is to receive enzyme

Simultaneous correction of large low-order and high-order aberrations with a new deformable mirror technology

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Rooms, F.; Camet, S.; Curis, J. F.

2010-02-01

A new technology of deformable mirror will be presented. Based on magnetic actuators, these deformable mirrors feature record strokes (more than +/- 45μm of astigmatism and focus correction) with an optimized temporal behavior. Furthermore, the development has been made in order to have a large density of actuators within a small clear aperture (typically 52 actuators within a diameter of 9.0mm). We will present the key benefits of this technology for vision science: simultaneous correction of low and high order aberrations, AO-SLO image without artifacts due to the membrane vibration, optimized control, etc. Using recent papers published by Doble, Thibos and Miller, we show the performances that can be achieved by various configurations using statistical approach. The typical distribution of wavefront aberrations (both the low order aberration (LOA) and high order aberration (HOA)) have been computed and the correction applied by the mirror. We compare two configurations of deformable mirrors (52 and 97 actuators) and highlight the influence of the number of actuators on the fitting error, the photon noise error and the effective bandwidth of correction.

An Assessment of the Quality of Life of Patients With Class III Deformities Treated With Orthognathic Surgery.

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Kilinc, Adnan; Ertas, Umit

2015-07-01

To evaluate quality of life (QoL) from a broad perspective by a comparison of Turkish patients undergoing orthognathic surgery to correct Angle Class III skeletal deformity with a control group composed of participants without dentofacial deformity using general health, generic oral health, and condition-specific QoL approaches. Thirty patients who underwent orthognathic surgery to correct Class III relations (monomaxillary and bimaxillary groups) and 30 participants with Class I skeletal structure and good dentofacial harmony (control group) were evaluated. Condition-specific QoL through a 22-item Orthognathic Quality of Life Questionnaire (OQLQ), generic oral health-related QoL through a 14-item Short-Form Oral Health Impact Profile (OHIP-14), and generic health-related QoL through a 36-item Short-Form Health Survey (SF-36) were assessed. When the groups were compared, OQLQ scores showed a significant difference in the oral function domain only in the bimaxillary group (P orthognathic surgical patients appeared to be similar to that of participants without dentofacial deformities. Oral health-related QoL of orthognathic surgical patients seemed moderately similar to that of participants without dentofacial deformities. The combined use of these methods is helpful for evaluating QoL from a larger perspective. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

The Correction of a Secondary Bilateral Cleft Lip Nasal Deformity Using Refined Open Rhinoplasty with Reverse-U Incision, V-Y Plasty, and Selective Combination with Composite Grafting: Long-term Results

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Byung Chae Cho

2012-05-01

Full Text Available Background This article presents long-term outcomes after correcting secondary bilateralcleft lip nasal deformities using a refined reverse-U incision and V-Y plasty or in combinationwith a composite graft in order to elongate the short columella.Methods A total of forty-six patients underwent surgery between September 1996 andDecember 2008. The age of the patients ranged from 3 to 19 years of age. A bilateral reverse-Uincision and V-Y plasty were used in 24 patients. A composite graft from the helical rootwas combined with a bilateral reverse-U incision in the 22 patients who possessed a severelyshortened columella. The follow-up period ranged between 2 and 10 years.Results A total of 32 patients out of 46 were evaluated postoperatively. The average columellalength was significantly improved from an average of 3.7 mm preoperatively to 8.5 mmpostoperatively. The average ratio of the columella height to the alar base width was 0.18preoperatively and 0.29 postoperatively. The postoperative basal and lateral views revealed abetter shape of the nostrils and columella. The elongated columella, combined with a compositegraft, presented good maintenance of the corrected position with no growth disturbance. Acomposite graft showed color mismatching in several patients. Twenty-six patients demonstratedno alar-columella web deformity and satisfactory symmetry of the nostrils. Four patientsexperienced a drooping and overhanging of the corrected alar-columella web.Conclusions A bilateral reverse-U incision with V-Y plasty or in combination with acomposite graft was effective in correcting secondary bilateral cleft lip nasal deformity.

Simultaneous evaluation of the shell and pairing corrections to the nuclear deformation energy: the case of odd-systems

International Nuclear Information System (INIS)

Benhamouda, N.; Oudih, M.R.

2002-01-01

A method of simultaneous evaluation of the shell and pairing corrections to the nuclear deformation energy, recently proposed for the even-even nuclei, is generalized to the case of odd systems. * By means of the blocked-level technique, a level density with explicit dependence on pairing correlations is defined. The microscopic corrections to the deformation energy are then determined by a procedure which is analogous to that of Strutinsky. The method is applied to the ground state of Europium isotopes using the single-particle energies of a deformed Woods-Saxon mean-field. The obtained results are in good agreement with the experimental values

The Correction of a Secondary Bilateral Cleft Lip Nasal Deformity Using Refined Open Rhinoplasty with Reverse-U Incision, V-Y Plasty, and Selective Combination with Composite Grafting: Long-term Results

Directory of Open Access Journals (Sweden)

Byung Chae Cho

2012-05-01

Full Text Available BackgroundThis article presents long-term outcomes after correcting secondary bilateral cleft lip nasal deformities using a refined reverse-U incision and V-Y plasty or in combination with a composite graft in order to elongate the short columella.MethodsA total of forty-six patients underwent surgery between September 1996 and December 2008. The age of the patients ranged from 3 to 19 years of age. A bilateral reverse-U incision and V-Y plasty were used in 24 patients. A composite graft from the helical root was combined with a bilateral reverse-U incision in the 22 patients who possessed a severely shortened columella. The follow-up period ranged between 2 and 10 years.ResultsA total of 32 patients out of 46 were evaluated postoperatively. The average columella length was significantly improved from an average of 3.7 mm preoperatively to 8.5 mm postoperatively. The average ratio of the columella height to the alar base width was 0.18 preoperatively and 0.29 postoperatively. The postoperative basal and lateral views revealed a better shape of the nostrils and columella. The elongated columella, combined with a composite graft, presented good maintenance of the corrected position with no growth disturbance. A composite graft showed color mismatching in several patients. Twenty-six patients demonstrated no alar-columella web deformity and satisfactory symmetry of the nostrils. Four patients experienced a drooping and overhanging of the corrected alar-columella web.ConclusionsA bilateral reverse-U incision with V-Y plasty or in combination with a composite graft was effective in correcting secondary bilateral cleft lip nasal deformity.

Management of Commonly Encountered Secondary Cleft Deformities of Face-A Case Series

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Jacob John

2017-10-01

Full Text Available Orofacial clefts are one of the commonest congenital deformities occurring due to disturbances during the embryological formation, development and growth of orofacial region. The treatment of cleft deformities in the early period of life is mandatory to address the aesthetic, functional and psychological problems affecting the child. A considerable number of surgical modalities for definitive correction of unilateral and bilateral cleft lip, nose, and eyelid deformities have been reported over the past half century. After the initial cleft repair, there is a long period of dramatic growth. This powerful variable of growth may ultimately distort the immediate surgical result. Hence, the correction of secondary deformities plays a very important part in the care of these patients. In this article we are enlisting some simple techniques to correct the commonly encountered secondary cleft deformities of face that gave acceptable results to the patients. These corrective surgeries not only improved the function and aesthetics but also increased the confidence level, satisfaction and overall quality of life of the patient.

Simultaneous evaluation of the shell and pairing corrections to the nuclear deformation energy: the case of odd-systems

Energy Technology Data Exchange (ETDEWEB)

Benhamouda, N [Laboratoire de Physique Theoique, Faculte des Sciences, USTHB BP 32 El-Alia, 16111 Bab-Ezzouar, Algers (Algeria); Oudih, M R [CRNA, 2. Bd Frantz Fanon, BP 399 Alger-Gare, Algers (Algeria)

2002-09-15

A method of simultaneous evaluation of the shell and pairing corrections to the nuclear deformation energy, recently proposed for the even-even nuclei, is generalized to the case of odd systems. {sup *} By means of the blocked-level technique, a level density with explicit dependence on pairing correlations is defined. The microscopic corrections to the deformation energy are then determined by a procedure which is analogous to that of Strutinsky. The method is applied to the ground state of Europium isotopes using the single-particle energies of a deformed Woods-Saxon mean-field. The obtained results are in good agreement with the experimental values.

Research on the Phase Aberration Correction with a Deformable Mirror Controlled by a Genetic Algorithm

International Nuclear Information System (INIS)

Yang, P; Hu, S J; Chen, S Q; Yang, W; Xu, B; Jiang, W H

2006-01-01

In order to improve laser beam quality, a real number encoding genetic algorithm based on adaptive optics technology was presented. This algorithm was applied to control a 19-channel deformable mirror to correct phase aberration in laser beam. It is known that when traditional adaptive optics system is used to correct laser beam wave-front phase aberration, a precondition is to measure the phase aberration information in the laser beam. However, using genetic algorithms, there is no necessary to know the phase aberration information in the laser beam beforehand. The only parameter need to know is the Light intensity behind the pinhole on the focal plane. This parameter was used as the fitness function for the genetic algorithm. Simulation results show that the optimal shape of the 19-channel deformable mirror applied to correct the phase aberration can be ascertained. The peak light intensity was improved by a factor of 21, and the encircled energy strehl ratio was increased to 0.34 from 0.02 as the phase aberration was corrected with this technique

[Posttraumatic torsional deformities of the forearm : Methods of measurement and decision guidelines for correction].

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Blossey, R D; Krettek, C; Liodakis, E

2018-03-01

Forearm fractures are common in all age groups. Even if the adjacent joints are not directly involved, these fractures have an intra-articular character. One of the most common complications of these injuries is a painful limitation of the range of motion and especially of pronation and supination. This is often due to an underdiagnosed torsional deformity; however, in recent years new methods have been developed to make these torsional differences visible and quantifiable through the use of sectional imaging. The principle of measurement corresponds to that of the torsion measurement of the lower limbs. Computed tomography (CT) or magnetic resonance imaging (MRI) scans are created at defined heights. By searching for certain landmarks, torsional angles are measured in relation to a defined reference line. A new alternative is the use of 3D reformation models. The presence of a torsional deformity, especial of the radius, leads to an impairment of the pronation and supination of the forearm. In the presence of torsional deformities, radiological measurements can help to decide if an operation is needed or not. Unlike the lower limbs, there are still no uniform cut-off values as to when a correction is indicated. Decisions must be made together with the patient by taking the clinical and radiological results into account.

Fixator-Assisted Lengthening and Deformity Correction Over an Intramedullary Nail in a Patient with Achondroplasia

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Erdal Uzun

2016-05-01

Full Text Available Achondroplasia is the most frequently encountered form of nonlethal skeletal dysplasia and a type of rhizomelic dwarfism. It results in considerable physical and psychologic handicaps owing to the disproportionate stature of the body and difficulty in performing routine activities of daily living. They also have major musculoskeletal problems including symptomatic malalignment of the lower limbs. Limb lengthening has been used in patients with achondroplasia by different techniques (Intramedullar nailing, monolateral or circular external fixator. We report our treatment of a patient 17 years of age with achondroplasia for bilateral lower limb length discrepancy and bilateral tibial varus deformity.

Outcomes of a Stepcut Lengthening Calcaneal Osteotomy for Adult-Acquired Flatfoot Deformity.

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Demetracopoulos, Constantine A; Nair, Pallavi; Malzberg, Andrew; Deland, Jonathan T

2015-07-01

Lateral column lengthening is used to correct abduction deformity at the midfoot and improve talar head coverage in patients with flatfoot deformity. It was our hypothesis that following a stepcut lengthening calcaneal osteotomy (SLCO), patients would have adequate correction of the deformity, a high union rate of the osteotomy, and improvement in clinical outcome scores. We retrospectively reviewed 37 consecutive patients who underwent SLCO for the treatment of stage IIB flatfoot deformity with a minimum 2-year follow-up. Deformity correction was assessed using preoperative and postoperative weight-bearing radiographs. Healing of the osteotomy was assessed by computed tomography. Clinical outcomes included the FAOS and SF-36 questionnaires. The Wilcoxon signed-rank test was used to compare clinical outcome scores. An alpha level of .05 was deemed statistically significant. Healing of the osteotomy occurred at a mean of 7.7 weeks postoperatively. The talonavicular (TN) coverage angle improved from 34.0 to 8.8 (P lengthening. Level IV, retrospective case review. © The Author(s) 2015.

TREATMENT OUTCOMES IN ELDERLY AND SENILE PATIENTS WITH DEGENERATIVE DEFORMATIONS AND INSTABILITY OF THE SPINAL COLUMN

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D. A. Mikhaylov

2017-01-01

levels on both  sides without implants  for fixation. This group was used as the  comparison  group.  Patients in group  II  underwent fixation  the  affected  spinal  motion  segments  locally  with transpedicular system without correction of deformity  and with decompression  of neural structures at the level of spine stenosis.  Patients of group  III  underwent surgery  for fixation  of affected  PDS  up to lower thoracic  spine using short transpedicular system along with decompression  of the neural  structures and correction of spine deformity.  Patients in group IV underwent surgery  for fixation  of affected PDS  up to upper thoracic  spine using transpedicular system, bone cement, decompression  of neural structures and correction of spine deformity.The average postoperative follow up was 5 years (from 3 months  to 15 years, 266 patients were followed for more than three years.Results.  The  best  results   were  obtained  in  group  IV:  good  results   – 57,2%  (60  patients,  satisfactory  40% (42 patients, poor 2,8% (3 patients.The  worst  results  were  obtained in group  I: after  5 years  follow up satisfactory results  were  observed  in 13,4% (15 patients, poor in 86,6% (97 patients and no good results were reported.Conclusion. Thus, the performed  study  and observed outcomes indicate  the rationale for performing a full deformity correction by transpedicular fixation and bone cement, applying all the required  methods  and techniques of osteotomy. This approach  allows to maximally  quickly  achieve  the  desired  treatment outcomes  in mid-and long-term follow up period and to avoid complications and revisions.

Post-operative Hypertension following Correction of Flexion Deformity of the Knees in a Spastic Diplegic Child: A Case Report

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Vipin Mohan

2016-11-01

Full Text Available An adolescent boy with spastic diplegic cerebral palsy presented with crouch gait. He had bilateral severe flexion deformities of knees and hips. He was treated with single event multilevel surgery for the correction of deformities. Surgical procedures included bilateral adductor release, iliopsoas lengthening, bilateral femoral shortening and patella plication. Persistent hypertension was noted in the post-operative period. All causes of secondary hypertension were ruled out. Having persistent hypertension following the femoral shortening procedure is unusual. Antihypertensive medication controlled his blood pressure 15 months after surgery. Hypertension following correction of knee flexion deformity and limb lengthening is well known. Hypertension has not been described with the shortening osteotomy of the femur. Hypertension is a rare complication following the corrective surgery for the treatment of crouch gait. Blood pressure should be monitored during the post-operative period to detect such a rare complication.

The use of blocking screws with internal lengthening nail and reverse rule of thumb for blocking screws in limb lengthening and deformity correction surgery

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Saravanaraja Muthusamy

2016-09-01

Full Text Available Abstract Internal lengthening nail (ILN is a recent development in limb lengthening and deformity correction specialty. The ILN has the distinct advantage of combining acute deformity correction with gradual lengthening of bone. While using ILN, the short metaphyseal bone fragment may develop a deformity at the time of osteotomy and nail insertion or during bone lengthening because of the wide medullary canal. These deformities are typically predictable, and blocking screws (Poller screws are helpful in these situations. This manuscript describes the common deformities that occur in femur and tibia with osteotomies at different locations while using ILN in antegrade and retrograde nailing technique. Also, a systematic approach to the appropriate use of blocking screws in these deformities is described. In addition, the “reverse rule of thumb” is introduced as a quick reference to determine the ideal location(s and number of blocking screws. These principles are applicable to limb lengthening and deformity correction as well as fracture fixation using intramedullary nails.

The use of blocking screws with internal lengthening nail and reverse rule of thumb for blocking screws in limb lengthening and deformity correction surgery.

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Muthusamy, Saravanaraja; Rozbruch, S Robert; Fragomen, Austin T

2016-11-01

Internal lengthening nail (ILN) is a recent development in limb lengthening and deformity correction specialty. The ILN has the distinct advantage of combining acute deformity correction with gradual lengthening of bone. While using ILN, the short metaphyseal bone fragment may develop a deformity at the time of osteotomy and nail insertion or during bone lengthening because of the wide medullary canal. These deformities are typically predictable, and blocking screws (Poller screws) are helpful in these situations. This manuscript describes the common deformities that occur in femur and tibia with osteotomies at different locations while using ILN in antegrade and retrograde nailing technique. Also, a systematic approach to the appropriate use of blocking screws in these deformities is described. In addition, the "reverse rule of thumb" is introduced as a quick reference to determine the ideal location(s) and number of blocking screws. These principles are applicable to limb lengthening and deformity correction as well as fracture fixation using intramedullary nails.

Reversible postoperative blindness caused by bilateral status epilepticus amauroticus following thoracolumbar deformity correction: case report.

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Ibrahim, Tarik F; Sweis, Rochelle T; Nockels, Russ P

2017-07-01

Postoperative vision loss (POVL) is a devastating complication and has been reported after complex spine procedures. Anterior ischemic optic neuropathy and posterior optic neuropathy are the 2 most common causes of POVL. Bilateral occipital lobe seizures causing complete blindness are rare and have not been reported as a cause of POVL after spine surgery with the patient prone. The authors report the case of a 67-year-old man without a history of seizures who underwent a staged thoracolumbar deformity correction and developed POVL 6 hours after surgery. Imaging, laboratory, and ophthalmological examination results were nonrevealing. Routine electroencephalography study results were negative, but continuous electroencephalography captured bilateral occipital lobe seizures. The patient developed nonconvulsive status epilepticus despite initial treatment with benzodiazepines and loading doses of levetiracetam and lacosamide. He was therefore intubated for status epilepticus amauroticus and received a midazolam infusion. After electrographic seizure cessation for 48 hours, the patient was weaned off midazolam. The patient was maintained on levetiracetam and lacosamide without seizure recurrence and returned to his preoperative visual baseline status.

The Simulation and Correction to the Brain Deformation Based on the Linear Elastic Model in IGS

Institute of Scientific and Technical Information of China (English)

MU Xiao-lan; SONG Zhi-jian

2004-01-01

@@ The brain deformation is a vital factor affecting the precision of the IGS and it becomes a hotspot to simulate and correct the brain deformation recently.The research organizations, which firstly resolved the brain deformation with the physical models, have the Image Processing and Analysis department of Yale University, Biomedical Modeling Lab of Vanderbilt University and so on. The former uses the linear elastic model; the latter uses the consolidation model.The linear elastic model only needs to drive the model using the surface displacement of exposed brain cortex,which is more convenient to be measured in the clinic.

Deformation of Prostate and Seminal Vesicles Relative to Intraprostatic Fiducial Markers

International Nuclear Information System (INIS)

Wielen, Gerard J. van der; Mutanga, Theodore F.; Incrocci, Luca; Kirkels, Wim J.; Vasquez Osorio, Eliana M.; Hoogeman, Mischa S.; Heijmen, Ben J.M.; Boer, Hans C.J. de

2008-01-01

Purpose: To quantify the residual geometric uncertainties after on-line corrections with intraprostatic fiducial markers, this study analyzed the deformation of the prostate and, in particular, the seminal vesicles relative to such markers. Patients and Methods: A planning computed tomography (CT) scan and three repeat CT scans were obtained for 21 prostate cancer patients who had had three to four cylindrical gold markers placed. The prostate and whole seminal vesicles (clinical target volume [CTV]) were delineated on each scan at a slice thickness of 1.5 mm. Rigid body transformations (translation and rotation) mapping the markers onto the planning scan positions were obtained. The translation only (T only ) or both translation and rotation were applied to the delineated CTVs. Next, the residue CTV surface displacements were determined using nonrigid registration of the delineated contours. For translation and rotation of the CTV, the residues represented deformation; for T only , the residues stemmed from deformation and rotation. T only represented the residues for most currently applied on-line protocols. The patient and population statistics of the CTV surface displacements were calculated. The intraobserver delineation variation was similarly quantified using repeat delineations for all patients and corrected for. Results: The largest CTV deformations were observed at the anterior and posterior side of the seminal vesicles (population average standard deviation ≤3 mm). Prostate deformation was small (standard deviation ≤1 mm). The increase in these deviations when neglecting rotation (T only ) was small. Conclusion: Although prostate deformation with respect to implanted fiducial markers was small, the corresponding deformation of the seminal vesicles was considerable. Adding marker-based rotational corrections to on-line translation corrections provided a limited reduction in the estimated planning margins

The role of simultaneous gap arthroplasty and distraction osteogenesis in the management of temporo-mandibular joint ankylosis with mandibular deformity in children.

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Rao, Krishna; Kumar, Sudhir; Kumar, Vijay; Singh, Arun Kumar; Bhatnagar, Sudhir Kumar

2004-02-01

Temporo-mandibular joint ankylosis is a common cause of acquired deformity in children. Surgical correction of the ankylosis only leaves the patient with an uncorrected mandibular deformity. This study was to evaluate the use of distraction osteogenesis for simultaneous correction of the mandibular deformity. This study was done on six children with temporo-mandibular joint ankylosis and mandibular deformity. Uniaxial double pin distractors with Schanz pins were used in this study. The patients underwent simultaneous gap arthroplasty and mandibular osteotomy (retromolar) with distractor insertion. Distraction was started on the fifth post-operative day. The patients were put on dynamic temporo-mandibular joint exercises on the first post-operative day. All patients had a satisfactory mouth opening on follow-up. Satisfactory cosmetic correction of the mandibular deformity was also achieved in all these patients. Some degree of malocclusion resulted from treatment due to which the patients were placed on orthodontic treatment. Distraction osteogenesis can be used simultaneously with gap arthroplasty in patients with temporo-mandibular ankylosis, for the correction of the mandibular deformity.

Application of computed tomography and stereolithography to correct a complex angular and torsional limb deformity in a donkey.

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Radtke, Alexandra; Morello, Samantha; Muir, Peter; Arnoldy, Courtney; Bleedorn, Jason

2017-11-01

To report the evaluation, surgical planning, and outcome for correction of a complex limb deformity in the tibia of a donkey using computed tomographic (CT) imaging and a 3D bone model. Case report. A 1.5-year-old, 110 kg donkey colt with an angular and torsional deformity of the right pelvic limb. Findings on physical examimation included a severe, complex deformity of the right pelvic limb that substantially impeded ambulation. Both hind limbs were imaged via CT, and imaging software was used to characterize the bone deformity. A custom stereolithographic bone model was printed for preoperative planning and rehersal of the surgery. A closing wedge ostectomy with de-rotation of the tibia was stabilized with 2 precontoured 3.5-mm locking compression plates. Clinical follow-up was available for 3.5 years postoperatively. CT allowed characterization of the angular and torsional bone deformity of the right tibia. A custom bone model facilitated surgical planning and rehearsal of the procedure. Tibial corrective ostectomy was performed without complication. Postoperative management included physical rehabilitation to help restore muscular function and pelvic limb mechanics. Short-term and long-term follow-up confirmed bone healing and excellent clinical function. CT imaging and stereolithography facilitated the evaluation and surgical planning of a complex limb deformity. This combination of techniques may improve the accuracy of the surgeons' evaluation of complex bone deformities in large animals, shorten operating times, and improve outcomes. © 2017 The American College of Veterinary Surgeons.

Wavefront correction performed by a deformable mirror of arbitrary actuator pattern within a multireflection waveguide.

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Ma, Xingkun; Huang, Lei; Bian, Qi; Gong, Mali

2014-09-10

The wavefront correction ability of a deformable mirror with a multireflection waveguide was investigated and compared via simulations. By dividing a conventional actuator array into a multireflection waveguide that consisted of single-actuator units, an arbitrary actuator pattern could be achieved. A stochastic parallel perturbation algorithm was proposed to find the optimal actuator pattern for a particular aberration. Compared with conventional an actuator array, the multireflection waveguide showed significant advantages in correction of higher order aberrations.

Correction of gynecomastia in body builders and patients with good physique.

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Blau, Mordcai; Hazani, Ron

2015-02-01

Temporary gynecomastia in the form of breast buds is a common finding in young male subjects. In adults, permanent gynecomastia is an aesthetic impairment that may result in interest in surgical correction. Gynecomastia in body builders creates an even greater distress for patients seeking surgical treatment because of the demands of professional competition. The authors present their experience with gynecomastia in body builders as the largest study of such a group in the literature. Between the years 1980 and 2013, 1574 body builders were treated surgically for gynecomastia. Of those, 1073 were followed up for a period of 1 to 5 years. Ages ranged from 18 to 51 years. Subtotal excision in the form of subcutaneous mastectomy with removal of at least 95 percent of the glandular tissue was used in virtually all cases. In cases where body fat was extremely low, liposuction was performed in fewer than 2 percent of the cases. Aesthetically pleasing results were achieved in 98 percent of the cases based on the authors' patient satisfaction survey. The overall rate of hematomas was 9 percent in the first 15 years of the series and 3 percent in the final 15 years. There were no infections, contour deformities, or recurrences. This study demonstrates the importance of direct excision of the glandular tissue over any other surgical technique when correcting gynecomastia deformities in body builders. The novice surgeon is advised to proceed with cases that are less challenging, primarily with patients that require excision of small to medium glandular tissue. Therapeutic, IV.

[Distal soft-tissue procedure in hallux valgus deformity].

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Arbab, D; Wingenfeld, C; Frank, D; Bouillon, B; König, D P

2016-04-01

Distal, lateral soft tissue release to restore mediolateral balance of the first metatarsophalangeal (MTP) joint in hallux valgus deformity. Incision of the adductor hallucis tendon from the fibular sesamoid, the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament. Hallux valgus deformities or recurrent hallux valgus deformities with an incongruent MTP joint. General medical contraindications to surgical interventions. Painful stiffness of the MTP joint, osteonecrosis, congruent joint. Relative contraindications: connective tissue diseases (Marfan syndrome, Ehler-Danlos syndrome). Longitudinal, dorsal incision in the first intermetatarsal web space between the first and second MTP joint. Blunt dissection and identification of the adductor hallucis tendon. Release of the adductor tendon from the fibular sesamoid. Incision of the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament. Postoperative management depends on bony correction. In joint-preserving procedures, dressing for 3 weeks in corrected position. Subsequently hallux valgus orthosis at night and a toe spreader for a further 3 months. Passive mobilization of the first MTP joint. Postoperative weight-bearing according to the osteotomy. A total of 31 patients with isolated hallux valgus deformity underwent surgery with a Chevron and Akin osteotomy and a distal medial and lateral soft tissue balancing. The mean preoperative intermetatarsal (IMA) angle was 12.3° (range 11-15°); the hallux valgus (HV) angle was 28.2° (25-36°). The mean follow-up was 16.4 months (range 12-22 months). The mean postoperative IMA correction ranged between 2 and 7° (mean 5.2°); the mean HV correction was 15.5° (range 9-21°). In all, 29 patients (93%) were satisfied or very satisfied with the postoperative outcome, while 2 patients (7%) were not satisfied due to one delayed wound healing and one recurrent hallux valgus deformity. There were no

Facial asymmetry correction with moulded helmet therapy in infants with deformational skull base plagiocephaly.

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Kreutz, Matthias; Fitze, Brigitte; Blecher, Christoph; Marcello, Augello; Simon, Ruben; Cremer, Rebecca; Zeilhofer, Hans-Florian; Kunz, Christoph; Mayr, Johannes

2018-01-01

The recommendation issued by the American Academy of Pediatrics in the early 1990s to position infants on their back during sleep to prevent sudden infant death syndrome (SIDS) has dramatically reduced the number of deaths due to SIDS but has also markedly increased the prevalence of positional skull deformation in infants. Deformation of the base of the skull occurs predominantly in very severe deformational plagiocephaly and is accompanied by facial asymmetry, as well as an altered ear position, called ear shift. Moulded helmet therapy has become an accepted treatment strategy for infants with deformational plagiocephaly. The aim of this study was to determine whether facial asymmetry could be corrected by moulded helmet therapy. In this retrospective, single-centre study, we analysed facial asymmetry of 71 infants with severe deformational plagiocephaly with or without deformational brachycephaly who were undergoing moulded helmet therapy between 2009 and 2013. Computer-assisted, three-dimensional, soft-tissue photographic scanning was used to record the head shape before and after moulded helmet therapy. The distance between two landmarks in the midline of the face (i.e., root of the nose and nasal septum) and the right and left tragus were measured on computer-generated indirect and objective 3D photogrammetry images. A quotient was calculated between the two right- and left-sided distances to the midline. Quotients were compared before and after moulded helmet therapy. Infants without any therapy served as a control group. The median age of the infants before onset of moulded helmet therapy was 5 months (range 3-16 months). The median duration of moulded helmet therapy was 5 months (range 1-16 months). Comparison of the pre- and post-treatment quotients of the left vs. right distances measured between the tragus and root of the nose (n = 71) and nasal septum (n = 71) revealed a significant reduction of the asymmetry (Tragus-Nasion-Line Quotient: 0

[Clinical effect of total knee arthroplasty on patients with knee osteoarthritis combined with mild to moderate valgus knee deformity].

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Chen, Peng; Zeng, Min; Xie, Jie; Wang, Long; Su, Weiping; Hu, Yihe

2016-09-28

To investigate the clinical effect of total knee arthroplasty on patients with knee osteoarthritis combined with mild to moderate valgus knee deformity.
 A total of 15 patients received total knee arthroplasty for correcting mild (10°-15°) to moderate (15°-30°) valgus knee between January 2011 and February 2014 in Xiangya Hospital of Central South University. We adopted a stable prosthesis surgery through patellar medial approach, osteophytes cleaning, conventional osteotomy, a selective soft tissue release and balance technical correcting of knee valgus deformity. Then conventional anticoagulation and symptomatic rehabilitation was utilized. Preoperative and postoperative X-ray was conducted in patients with measuring femor-tibial angle (FTA) and inspecting the prosthesis position. FTA, visual analog scale (VAS) standard, and parallel knee scoring system (KSS) were used to evaluate the clinical effect.
 Fifteen patients were followed up for 14 to 36 (22.40±11.88) months. The hospitalization time was 7-13 (7.73±1.58) d; operative time was 58-110 (81.8±16.85) min, the dominant blood loss was 140-600 (337.30±143.65) mL. Two cases had knee extension hysteresis, and the knee activity recovered after exercise. Leg power lines were normal. Three postoperative cases suffered anterior knee pain. They were subjected to celecoxib analgesic treatment and the pain gradually eased after 3 months. One postoperative case showed incision discharge and swelling, which was healed after change of dressing. During follow-up, review of X-ray film does not show prosthesis loose, subsidence and other complications. The knee valgus angle (8.1±1.8)°, knee motion range (107.33±9.61)°, KSS knee score (74.7±14.5, 75.3±2.7) and pain score (2.5±0.9) were significantly better than the preoperative (Pclinical and function KSS scores showed that the improvement rate was 80%. 
 Total knee arthroplasty is an effective way to treat patients with knee osteoarthritis combined with

Surgical correction of the webbed neck: an alternative lateral approach

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Mehri Turki, Imen

2017-03-01

Full Text Available Objective: The webbed neck deformity or pterygium colli is the number one symptom of the Turner syndrome that leads the patient to consult a doctor. Various but rare surgical approaches have been described to correct this deformity. We reviewed our experience with the surgical correction of the pterygium colli.Methods: Through five clinical cases, we describe the surgical technique with a lateral approach which provides a better control of the operative site, allows for the excision of the underlying trapezial fascial web, thus preventing recurrence seen in the posterior approach, and restores a normal hairline. Results: No postoperative wound infection occurred. No recurrence was observed through 24 months. Three patients developed hypertrophic scars.Conclusion: The lateral approach associated with an advanced flap and a Z-plasty is an effective technique for correction of this neck deformity. The presence of a multidisciplinary team, formed with maxillofacial and plastic surgeons, endocrinologists and psychologists, is required to treat these patients allowing reintegration into society and family.

Multi-axial correction system in the treatment of radial club hand.

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Bhat, Suneel B; Kamath, Atul F; Sehgal, Kriti; Horn, B David; Hosalkar, Harish S

2009-12-01

Radial club hand is a well-recognized congenital malformation characterized by hypoplasia of bone and soft tissue on the radial aspect of the forearm and hand. The modalities of treatment have traditionally varied from stretching casts with soft-tissue procedures to the use of multiple corrective osteotomies. These osteotomies can be stabilized by a variety of methods, including external fixators that allow the possibility of gradual distraction with neohistiogenesis. This current study outlines the usage of one such device (multi-axial correction system [MAC]) in the management of deformity associated with severe radial club hand. Three consecutive cases of unilateral or bilateral severe (Bayne type IV) congenital radial club hand were corrected using MAC fixation in the last 5 years. This is a retrospective review of all three cases. Data parameters included: patient demographics, presentation findings, degree of deformity, amount of correction/lengthening, length of procedure, length of treatment, and associated complications. The surgical technique is described in detail for the benefit of the readership. The three patients with severe congenital radial club hand had a total of four limb involvements that underwent correction using osteotomies and usage of the MAC device for external fixation. All three patients underwent successful correction of deformity with the restoration of alignment, lengthening of forearm for improvement of function, and stabilization of the wrist (mean duration, mean lengthening, mean time to consolidation). The MAC system was well tolerated in all patients and associated complications were limited. The MAC fixator seems to be a good alternative modality of stabilization and correction for severe congenital radial club hand deformities. Its usage is fairly simple and it provides the ease of application of a mono-lateral fixator with far superior three-dimensional control, like the circular external fixator. We recommend that

Scoliosis corrective force estimation from the implanted rod deformation using 3D-FEM analysis.

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Abe, Yuichiro; Ito, Manabu; Abumi, Kuniyoshi; Sudo, Hideki; Salmingo, Remel; Tadano, Shigeru

2015-01-01

Improvement of material property in spinal instrumentation has brought better deformity correction in scoliosis surgery in recent years. The increase of mechanical strength in instruments directly means the increase of force, which acts on bone-implant interface during scoliosis surgery. However, the actual correction force during the correction maneuver and safety margin of pull out force on each screw were not well known. In the present study, estimated corrective forces and pull out forces were analyzed using a novel method based on Finite Element Analysis (FEA). Twenty adolescent idiopathic scoliosis patients (1 boy and 19 girls) who underwent reconstructive scoliosis surgery between June 2009 and Jun 2011 were included in this study. Scoliosis correction was performed with 6mm diameter titanium rod (Ti6Al7Nb) using the simultaneous double rod rotation technique (SDRRT) in all cases. The pre-maneuver and post-maneuver rod geometry was collected from intraoperative tracing and postoperative 3D-CT images, and 3D-FEA was performed with ANSYS. Cobb angle of major curve, correction rate and thoracic kyphosis were measured on X-ray images. Average age at surgery was 14.8, and average fusion length was 8.9 segments. Major curve was corrected from 63.1 to 18.1 degrees in average and correction rate was 71.4%. Rod geometry showed significant change on the concave side. Curvature of the rod on concave and convex sides decreased from 33.6 to 17.8 degrees, and from 25.9 to 23.8 degrees, respectively. Estimated pull out forces at apical vertebrae were 160.0N in the concave side screw and 35.6N in the convex side screw. Estimated push in force at LIV and UIV were 305.1N in the concave side screw and 86.4N in the convex side screw. Corrective force during scoliosis surgery was demonstrated to be about four times greater in the concave side than in convex side. Averaged pull out and push in force fell below previously reported safety margin. Therefore, the SDRRT maneuver was

Left Atrial Deformation Analysis in Patients with Corrected Tetralogy of Fallot by 3D Speckle-Tracking Echocardiography (from the MAGYAR-Path Study)

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Havasi, Kálmán; Domsik, Péter; Kalapos, Anita; McGhie, Jackie S.; Roos-Hesselink, Jolien W.; Forster, Tamás; Nemes, Attila

2017-01-01

Background Three-dimensional (3D) echocardiography coupled with speckle-tracking echocardiographic (STE) capability is a novel methodology which has been demontrated to be useful for the assessment of left atrial (LA) volumes and functional properties. There is increased scientific interest on myocardial deformation analysis in adult patients with corrected tetralogy of Fallot (cTOF). Objectives To compare LA volumes, volume-based functional properties and strain parameters between cTOF patients and age- and gender-matched healthy controls. Methods The study population consisted of 19 consecutive adult patients with cTOF in sinus rhythm nursing at the University of Szeged, Hungary (mean age: 37.9 ± 11.3 years, 8 men, who had repair at the age of 4.1 ± 2.5 years). They all had undergone standard transthoracic two-dimensional Doppler echocardiographic study extended with 3DSTE. Their results were compared to 23 age- and gender-matched healthy controls (mean age: 39.2 ± 10.6 years, 14 men). Results Increased LA volumes and reduced LA emptying fractions respecting cardiac cycle could be demonstrated in cTOF patients compared to controls. LA stroke volumes featuring all LA functions showed no differences between the 2 groups examined. LA global and mean segmental uni- and multidirectional peak strains featuring LA reservoir function were found to be diminished in adult patients with cTOF as compared to controls. Similarly to peak strains reduced global and mean segmental LA strains at atrial contraction characterizing atrial booster pump function could be demonstrated in cTOF patients as compared to controls. Conclusions Significant deterioration of all LA functions could be demonstrated in adult patients with cTOF late after repair. PMID:28327874

Left Atrial Deformation Analysis in Patients with Corrected Tetralogy of Fallot by 3D Speckle-Tracking Echocardiography (from the MAGYAR-Path Study

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Kálmán Havasi

Full Text Available Abstract Background: Three-dimensional (3D echocardiography coupled with speckle-tracking echocardiographic (STE capability is a novel methodology which has been demontrated to be useful for the assessment of left atrial (LA volumes and functional properties. There is increased scientific interest on myocardial deformation analysis in adult patients with corrected tetralogy of Fallot (cTOF. Objectives: To compare LA volumes, volume-based functional properties and strain parameters between cTOF patients and age- and gender-matched healthy controls. Methods: The study population consisted of 19 consecutive adult patients with cTOF in sinus rhythm nursing at the University of Szeged, Hungary (mean age: 37.9 ± 11.3 years, 8 men, who had repair at the age of 4.1 ± 2.5 years. They all had undergone standard transthoracic two-dimensional Doppler echocardiographic study extended with 3DSTE. Their results were compared to 23 age- and gender-matched healthy controls (mean age: 39.2 ± 10.6 years, 14 men. Results: Increased LA volumes and reduced LA emptying fractions respecting cardiac cycle could be demonstrated in cTOF patients compared to controls. LA stroke volumes featuring all LA functions showed no differences between the 2 groups examined. LA global and mean segmental uni- and multidirectional peak strains featuring LA reservoir function were found to be diminished in adult patients with cTOF as compared to controls. Similarly to peak strains reduced global and mean segmental LA strains at atrial contraction characterizing atrial booster pump function could be demonstrated in cTOF patients as compared to controls. Conclusions: Significant deterioration of all LA functions could be demonstrated in adult patients with cTOF late after repair.

Relationship of forces acting on implant rods and degree of scoliosis correction.

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Salmingo, Remel Alingalan; Tadano, Shigeru; Fujisaki, Kazuhiro; Abe, Yuichiro; Ito, Manabu

2013-02-01

Adolescent idiopathic scoliosis is a complex spinal pathology characterized as a three-dimensional spine deformity combined with vertebral rotation. Various surgical techniques for correction of severe scoliotic deformity have evolved and became more advanced in applying the corrective forces. The objective of this study was to investigate the relationship between corrective forces acting on deformed rods and degree of scoliosis correction. Implant rod geometries of six adolescent idiopathic scoliosis patients were measured before and after surgery. An elasto-plastic finite element model of the implant rod before surgery was reconstructed for each patient. An inverse method based on Finite Element Analysis was used to apply forces to the implant rod model such that it was deformed the same after surgery. Relationship between the magnitude of corrective forces and degree of correction expressed as change of Cobb angle was evaluated. The effects of screw configuration on the corrective forces were also investigated. Corrective forces acting on rods and degree of correction were not correlated. Increase in number of implant screws tended to decrease the magnitude of corrective forces but did not provide higher degree of correction. Although greater correction was achieved with higher screw density, the forces increased at some level. The biomechanics of scoliosis correction is not only dependent to the corrective forces acting on implant rods but also associated with various parameters such as screw placement configuration and spine stiffness. Considering the magnitude of forces, increasing screw density is not guaranteed as the safest surgical strategy. Copyright © 2012 Elsevier Ltd. All rights reserved.

Single Stage Tibial Osteotomy and Long Stem Total Knee Arthroplasty to Correct Adverse Consequences of Unequal Tibial Lengthening with an Ilizarov Circular Fixator.

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Fletcher, M D

2015-01-01

Correction of limb alignment or length discrepancy by circular external fixation is an accepted technique which relies on the correct biomechanical application of the frame and precise corrections which are frequently delegated to the patient to perform. Errors can occur in the execution of the correction by the patient and may result in significant deformity that requires remedial intervention. A 67 Caucasian female underwent multifocal limb reconstruction of the lower limb utilising a complex Ilizarov frame. Attendance at follow-up visits did not occur and the patient presented at 6 months with severe deformity due to incorrect execution of the correction protocol which resulted in a 45 degree varus deformity of the tibia. Subsequent correction via acute tibial osteotomy and stabilisation with a stemmed total knee replacement resulted in a good outcome. Patient compliance with post-operative management is paramount with distraction osteogenesis and should be ensured prior to embarking on lengthening or deformity correction.

Effect of early correction of nasal septal deformity in unilateral cleft lip and palate on inferior turbinate hypertrophy and nasal patency.

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Pinto, Valentina; Piccin, Ottavio; Burgio, Luca; Summo, Valeria; Antoniazzi, Elisa; Morselli, Paolo G

2018-05-01

A relatively neglected aspect of cleft lip nasal deformity is the effect of septal deviation and inferior turbinate hypertrophy (ITH) on the functional airway. In particular, ITH in the noncleft side can be especially problematic, because it reduces the healthy nasal area, creating bilateral nasal obstruction that might affect the growth of the maxillofacial skeleton. Although these anatomic and functional changes are documented, few recommendations have been developed regarding the proper approach to ITH. The aim of the present study was to asses the ITH severity and determine the degree of nasal airway patency in patients who have undergone primary correction of the nasal septum during lip repair compared to patients operated on without primary septal correction. The study population included two groups. One group consisted of twenty unilateral cleft lip palate UCLP patients who have previously undergone primary rhinoseptoplasty as part of their treatment plan. The control group consisted of twenty UCLP patients operated on without rhinoseptal correction. The Nasal Obstructive Symptom Evaluation (NOSE) scale and nasal endoscopy were used to assess nasal obstruction. The overall untreated group reported severe symptoms across all NOSE scale dimensions more frequently than children who have undergone primary rhinoseptoplasty. The difference was statistically significant for each dimensions (p cleft lip repair results in a statistically significant reduction in IT size and improvement of nasal patency. Copyright © 2018 Elsevier B.V. All rights reserved.

Mobility of the First Ray in Patients With or Without Hallux Valgus Deformity: Systematic Review and Meta-Analysis.

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Shibuya, Naohiro; Roukis, Thomas S; Jupiter, Daniel C

The hypermobility theory of the first ray is the reason for the popularization of procedures such as the modified Lapidus procedure involving arthrodesis of the first tarsal-metatarsal joint for correction of hallux valgus deformity. Although many studies have involved motion of the first ray in hallux valgus patients, the presence and clinical significance of hypermobility in the first ray remains controversial. We performed a systematic review and meta-analysis to evaluate the difference in the first ray range of motion between patients with or without hallux valgus deformity. The databases used for the present review included Ovid EMBASE, Ovid MEDLINE, CINAHL, and the Cochrane Database. We searched for comparative studies that had evaluated the motion of the first ray in patients with or without hallux valgus. After screening for inclusion and exclusion criteria, we identified 3 studies that were relevant to our study question. All 3 studies showed more first ray motion in the hallux valgus group. Our quantitative synthesis showed a mean difference in the range of motion of the first ray of 3.62 mm (95% confidence interval 2.26 to 4.98) between those with and without hallux valgus deformity. Thus, we found statistically significantly increased first ray motion in patients with hallux valgus deformity compared with those without hallux valgus deformity. However, the clinical significance of this small amount of increased sagittal plane motion as a response to or a cause of hallux valgus remains unanswered. Published by Elsevier Inc.

Treatment of hallux valgus deformity.

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Fraissler, Lukas; Konrads, Christian; Hoberg, Maik; Rudert, Maximilian; Walcher, Matthias

2016-08-01

Hallux valgus deformity is a very common pathological condition which commonly produces painful disability. It is characterised as a combined deformity with a malpositioning of the first metatarsophalangeal joint caused by a lateral deviation of the great toe and a medial deviation of the first metatarsal bone.Taking the patient's history and a thorough physical examination are important steps. Anteroposterior and lateral weight-bearing radiographs of the entire foot are crucial for adequate assessment in the treatment of hallux valgus.Non-operative treatment of the hallux valgus cannot correct the deformity. However, insoles and physiotherapy in combination with good footwear can help to control the symptoms.There are many operative techniques for hallux valgus correction. The decision on which surgical technique is used depends on the degree of deformity, the extent of degenerative changes of the first metatarsophalangeal joint and the shape and size of the metatarsal bone and phalangeal deviation. The role of stability of the first tarsometatarsal joint is controversial.Surgical techniques include the modified McBride procedure, distal metatarsal osteotomies, metatarsal shaft osteotomies, the Akin osteotomy, proximal metatarsal osteotomies, the modified Lapidus fusion and the hallux joint fusion. Recently, minimally invasive percutaneous techniques have gained importance and are currently being evaluated more scientifically.Hallux valgus correction is followed by corrective dressings of the great toe post-operatively. Depending on the procedure, partial or full weight-bearing in a post-operative shoe or cast immobilisation is advised. Post-operative radiographs are taken in regular intervals until osseous healing is achieved. Cite this article: Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. EFORT Open Rev 2016;1:295-302. DOI: 10.1302/2058-5241.1.000005.

First and second-order corrections to the eikonal phase shifts for the interactions of two deformed nuclei

International Nuclear Information System (INIS)

Metawei, Z.

2000-01-01

We present the first and second - order corrections to the eikonal phase shifts for the interactions of two deformed nuclei. The elastic scattering differential cross-section has been calculated for both the interactions of I2 C- 12 C system (at energies 1016, 1449 and 2400 MeV) and 16 O- 12 C system (at energy 1503 MeV). The calculated results corrections seems to improve the agreement with the experimental data.The deflection function, the S-matrix,the near-side and the far-side decompositions of the scattering amplitude has been calculated using the same corrections

Surgical-orthodontic correction of a Class III dentofacial deformity.

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Devanna, Raghu; Kakkirala, Neelima

2010-04-01

This case report describes the surgical-orthodontic treatment of a 26-year-old post-pubertal male patient with a Class III dentofacial deformity. In the pre-surgical orthodontic phase of treatment, a reverse overjet of 5.5 mm was created and arch compatibility was obtained. A mandibualr set back with BSSO was performed during surgery to restore ideal overjet, overbite, occlusion and optimal esthetics. After 1 year of treatment, the results remained stable.

Assessment of striatal & postural deformities in patients with Parkinson's disease

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Sanjay Pandey

2016-01-01

Interpretation & conclusions: Our results showed that striatal and postural deformities were common and present in about half of the patients with PD. These deformities we more common in patients with advanced stage of PD.

Margin Evaluation in the Presence of Deformation, Rotation, and Translation in Prostate and Entire Seminal Vesicle Irradiation With Daily Marker-Based Setup Corrections

International Nuclear Information System (INIS)

Mutanga, Theodore F.; Boer, Hans C.J. de; Wielen, Gerard J. van der; Hoogeman, Mischa S.; Incrocci, Luca; Heijmen, Ben J.M.

2011-01-01

Purpose: To develop a method for margin evaluation accounting for all measured displacements during treatment of prostate cancer. Methods and Materials: For 21 patients treated with stereographic targeting marker-based online translation corrections, dose distributions with varying margins and gradients were created. Sets of possible cumulative delivered dose distributions were simulated by moving voxels and accumulating dose per voxel. Voxel motion was simulated consistent with measured distributions of systematic and random displacements due to stereographic targeting inaccuracies, deformation, rotation, and intrafraction motion. The method of simulation maintained measured correlation of voxel motions due to organ deformation. Results: For the clinical target volume including prostate and seminal vesicles (SV), the probability that some part receives <95% of the prescribed dose, the changes in minimum dose, and volume receiving 95% of prescription dose compared with planning were 80.5% ± 19.2%, 9.0 ± 6.8 Gy, and 3.0% ± 3.7%, respectively, for the smallest studied margins (3 mm prostate, 5 mm SV) and steepest dose gradients. Corresponding values for largest margins (5 mm prostate, 8 mm SV) with a clinical intensity-modulated radiotherapy dose distribution were 46.5% ± 34.7%, 6.7 ± 5.8 Gy, and 1.6% ± 2.3%. For prostate-only clinical target volume, the values were 51.8% ± 17.7%, 3.3 ± 1.6 Gy, and 0.6% ± 0.5% with the smallest margins and 5.2% ± 7.4%, 1.8 ± 0.9 Gy, and 0.1% ± 0.1% for the largest margins. Addition of three-dimensional rotation corrections only improved these values slightly. All rectal planning constraints were met in the actual reconstructed doses for all studied margins. Conclusion: We developed a system for margin validation in the presence of deformations. In our population, a 5-mm margin provided sufficient dosimetric coverage for the prostate. In contrast, an 8-mm SV margin was still insufficient owing to deformations. Addition of

Surgical-orthodontic correction of a Class III dentofacial deformity

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Raghu Devanna

2010-01-01

Full Text Available This case report describes the surgical-orthodontic treatment of a 26-year-old post-pubertal male patient with a Class III dentofacial deformity. In the pre-surgical orthodontic phase of treatment, a reverse overjet of 5.5 mm was created and arch compatibility was obtained. A mandibualr set back with BSSO was performed during surgery to restore ideal overjet, overbite, occlusion and optimal esthetics. After 1 year of treatment, the results remained stable.

The use of expanded polytetrafluoroethylene in depressed deformities of the face.

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Liu, Xiaowei; Zhang, Yiming; Wang, Shaoliang; Lei, Zeyuan; Li, Xiang; Fan, Dongli

2016-11-01

Expanded polytetrafluoroethylene (ePTFE) has been extensively used for facial soft tissue augmentation procedures, and is regarded as safe and reliable and suitable as a permanent implant. This implant is generally used in the lower third of the face for lips filling, nasal augmentation, nasolabial folds and chin augmentation, and rarely for congenital or acquired depressed deformities of the face. The aim of the present study was to assess the effects of ePTFE in congenital or acquired depressed deformities of the face. From September, 2008 to January, 2014, 26 patients were implanted with the material ePTFE to correct depressed deformities of the face. The average age at operation was 23.2 years, with a range of 17-45 years. The depressed deformities were lateralized. The follow-up period was 6-18 months (average 9 months). The etiologies of the depressed deformities included stable hemifacial atrophy (3 cases), craniofacial microsomia (13 cases), bony depression after trauma (8 cases), and other unclear reasons (2 cases). The operations were performed under local anesthesia. ePTFE was inserted in different tissue planes that varied among the different subanatomical areas in the face: beneath the superficial temporal fascia in the temporal area, and on the surface of the superficial musculoaponeurotic system in the zygomatic area, cheek and mandibular area. All of the patients were followed up. Most of the patients [25 of 26 patients (96.2%)] were satisfied with the results, while 1 patient (3.8%) was not satisfied for incomplete correction of the depressed deformity. In conclusion, aside from lipofilling and a free flap transfer, the results showed that ePTFE was an alternative treatment for facial depressed deformity.

The substantiation of the elastic–viscoplastic model of the human spine for modeling the correction process of kyphoscoliotic deformation

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Konstantin S Sergeev

2018-01-01

Value: The materials of the article can be useful for scientists, doctors and specialists in conducting scientific research on the problem of spine deformation correction and the development of appropriate technical means.

Dynamic control of knee axial deformities

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E. E. Malyshev

2013-01-01

Full Text Available The authors have evaluated the clinical examination of the patients with axial malalignments in the knee by the original method and device which was named varovalgometer. The measurements were conducted by tension of the cord through the spina iliaca anterior superior and the middle of the lower pole of patella. The deviation of the center of the ankle estimated by metal ruler which was positioned perpendicular to the lower leg axis on the level of the ankle joint line. The results of comparison of our method and computer navigation in 53 patients during the TKA show no statistically significant varieties but they differ by average 5° of valgus in clinical examination in comparison with mechanical axis which was identified by computer navigation. The dynamic control of axial malalignment can be used in clinical practice for estimation of the results of treatment of pathology with axial deformities in the knee; for the control of reduction and secondary displacement of the fractures around the knee; for assessment of instability; in planning of correctional osteotomies and intraoperative control of deformity correction; for estimation of Q angle in subluxation and recurrent dislocation of patella; in planning of TKA; during the growth of child it allows to assess the progression of deformity.

Logarithmic correction in the deformed AdS5 model to produce the heavy quark potential and QCD beta function

International Nuclear Information System (INIS)

He Song; Huang Mei; Yan Qishu

2011-01-01

We study the holographic QCD model, which contains a quadratic term -σz 2 and a logarithmic term -c 0 log[(z IR -z)/z IR ] with an explicit infrared cutoff z IR in the deformed AdS 5 warp factor. We investigate the heavy-quark potential for three cases, i.e., with only a quadratic correction, with both quadratic and logarithmic corrections, and with only a logarithmic correction. We solve the dilaton field and dilation potential from the Einstein equation and investigate the corresponding beta function in the Guersoy-Kiritsis-Nitti framework. Our studies show that in the case with only a quadratic correction, a negative σ or the Andreev-Zakharov model is favored to fit the heavy-quark potential and to produce the QCD beta function at 2-loop level; however, the dilaton potential is unbounded in the infrared regime. One interesting observation for the case of positive σ is that the corresponding beta function exists in an infrared fixed point. In the case with only a logarithmic correction, the heavy-quark Cornell potential can be fitted very well, the corresponding beta function agrees with the QCD beta function at 2-loop level reasonably well, and the dilaton potential is bounded from below in the infrared. At the end, we propose a more compact model which has only a logarithmic correction in the deformed warp factor and has less free parameters.

Use of the modified Stainsby procedure in correcting severe claw toe deformity in the rheumatoid foot: a retrospective review.

LENUS (Irish Health Repository)

Queally, Joseph M

2009-06-01

In claw toe deformity, the plantar plate of the metarsophalangeal joint becomes displaced onto the dorsal aspect of the metatarsal head. The Stainsby procedure replaces the displaced plantar plate to its correct position beneath the metatarsal head.

New Methods for Imaging Evaluation of Chest Wall Deformities

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Ana Lain

2017-12-01

Full Text Available AimThe purpose of this study is to describe the development of an external 3-dimensional (3D scanner as a noninvasive method for imaging chest wall deformities. It allows objective assessment, reconstruction of the area of interest, and evaluation of the severity of the deformity by using external indexes.External 3D scanning systemThe OrtenBodyOne scanner (Orten, Lyon, France uses depth sensors to scan the entire 3D external body surface of a patient. The depth sensors combine structured light with two classic computer vision techniques: depth from focus and depth from stereo. The data acquired are processed and analyzed using the Orten-Clinic software.Materials and methodsTo investigate the performance of the device, a preliminary prospective study (January 2015–March 2016 was carried out in patients attending our hospital chest wall deformities unit. In total, 100 patients (children and young adults with pectus excavatum or pectus carinatum, treated by surgery or non-operative methods were included. In patients undergoing non-operative treatment, external 3D scanning was performed monthly until complete correction was achieved. In surgically treated patients, scanning was done before and after surgical correction. In 42 patients, computed tomography (CT was additionally performed and correlations between the Haller index calculated by CT and the external Haller index using external scanning were investigated using a Student’s test (r = 0.83.ConclusionExternal scanning is an effective, objective, radiation-free means to diagnose and follow-up patients with chest wall deformities. Externally measured indexes can be used to evaluate the severity of these conditions and the treatment outcomes.

Evaluation of Hallux Valgus Correction With Versus Without Akin Proximal Phalanx Osteotomy.

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Shibuya, Naohiro; Thorud, Jakob C; Martin, Lanster R; Plemmons, Britton S; Jupiter, Daniel C

2016-01-01

Although the efficacy of Akin proximal phalanx closing wedge osteotomy as a sole procedure for correction of hallux valgus deformity is questionable, when used in combination with other osseous corrective procedures, the procedure has been believed to be efficacious. However, a limited number of comparative studies have confirmed the value of this additional procedure. We identified patients who had undergone osseous hallux valgus correction with first metatarsal osteotomy or first tarsometatarsal joint arthrodesis with (n = 73) and without (n = 81) Akin osteotomy and evaluated their radiographic measurements at 3 points (preoperatively, within 3 months after surgery, and ≥6 months after surgery). We found that those people who had undergone the Akin procedure tended to have a larger hallux abduction angle and a more laterally deviated tibial sesamoid position preoperatively. Although the radiographic correction of the deformity was promising immediately after corrective surgery with the Akin osteotomy, maintenance of the correction was questionable in our cohort. The value of additional Akin osteotomy for correction of hallux valgus deformity is uncertain. Published by Elsevier Inc.

High prevalence of morphometric vertebral deformities in patients with inflammatory bowel disease.

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Heijckmann, Anna Caroline; Huijberts, Maya S P; Schoon, Erik J; Geusens, Piet; de Vries, Jolanda; Menheere, Paul P C A; van der Veer, Eveline; Wolffenbuttel, Bruce H R; Stockbrugger, Reinhold W; Dumitrescu, Bianca; Nieuwenhuijzen Kruseman, Arie C

2008-08-01

Earlier studies have documented that the prevalence of decreased bone mineral density (BMD) is elevated in patients with inflammatory bowel disease. The objective of this study was to investigate the prevalence of vertebral deformities in inflammatory bowel disease patients and their relation with BMD and bone turnover. One hundred and nine patients with Crohn's disease (CD) and 72 with ulcerative colitis (UC) (age 44.5+/-14.2 years) were studied. BMD of the hip (by dual X-ray absorptiometry) was measured and a lateral single energy densitometry of the spine for assessment of vertebral deformities was performed. Serum markers of bone resorption (carboxy-terminal cross-linked telopeptide of type I collagen) and formation (procollagen type I amino-terminal propeptide) were measured, and determinants of prevalent vertebral deformities were assessed using logistic regression analysis. Vertebral deformities were found in 25% of both CD and UC patients. Comparing patients with and without vertebral deformities, no significant difference was found between Z-scores and T-scores of BMD, or levels of serum carboxy-terminal cross-linked telopeptide of type I collagen and serum procollagen type I amino-terminal propeptide. Using logistic regression analysis the only determinant of any morphometric vertebral deformity was sex. The presence of multiple vertebral deformities was associated with older age and glucocorticoid use. The prevalence of morphometric vertebral deformities is high in CD and UC. Male sex, but neither disease activity, bone turnover markers, clinical risk factors, nor BMD predicted their presence. The determinants for having more than one vertebral deformity were age and glucocorticoid use. This implies that in addition to screening for low BMD, morphometric assessment of vertebral deformities is warranted in CD and UC.

Halo-gravity traction in the treatment of severe spinal deformity: a systematic review and meta-analysis.

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Yang, Changsheng; Wang, Huafeng; Zheng, Zhaomin; Zhang, Zhongmin; Wang, Jianru; Liu, Hui; Kim, Yongjung Jay; Cho, Samuel

2017-07-01

Halo-gravity traction has been reported to successfully assist in managing severe spinal deformity. This is a systematic review of all studies on halo-gravity traction in the treatment of spinal deformity to provide information for clinical practice. A comprehensive search was conducted for articles on halo-gravity traction in the treatment of spinal deformity according to the PRISMA guidelines. Appropriate studies would be included and analyzed. Preoperative correction rate of spinal deformity, change of pulmonary function and prevalence of complications were the main measurements. Sixteen studies, a total of 351 patients, were included in this review. Generally, the initial Cobb angle was 101.1° in the coronal plane and 80.5° in the sagittal plane, and it was corrected to 49.4° and 56.0° after final spinal fusion. The preoperative correction due to traction alone was 24.1 and 19.3%, respectively. With traction, the flexibility improved 6.1% but postoperatively the patients did not have better correction. Less aggressive procedures and improved pulmonary function were observed in patients with traction. The prevalence of traction-related complications was 22% and three cases of neurologic complication related to traction were noted. The prevalence of total complications related to surgery was 32% and that of neurologic complications was 1%. Partial correction could be achieved preoperatively with halo-gravity traction, and it may help decrease aggressive procedures, improve preoperative pulmonary function, and reduce neurologic complications. However, traction could not increase preoperative flexibility or final correction. Traction-related complications, although usually not severe, were not rare.

Spine deformities in patients with Ehlers-Danlos syndrome, type IV - late results of surgical treatment

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Tesiorowski Maciej

2010-11-01

Full Text Available Abstract Background Spinal deformities in Ehlers-Danlos syndrome are usually progressive and may require operative treatment. There is limited number of studies describing late results of surgery in this disease. Methods This is a retrospective study of the records of 11 patients with Ehlers-Danlos syndrome type IV, treated surgically between 1990 and 2007. All patients underwent surgical treatment for spinal deformity. Duration of operation, type of instrumentation, intraoperative blood loss, complications and number of additional surgeries were noted. Radiographic measurement was performed on standing AP and lateral radiographs acquired before surgery, just after and at final follow up. Results The mean follow up period was 5.5 ± 2.9 years (range 1-10 years. The mean preoperative thoracic and lumbar curve were 109.5 ± 19.9° (range 83° - 142° and 75.6 ± 26.7° (range 40° - 108° respectively. Posterior spine fusion alone was performed on 6 patients and combined anterior and posterior fusion (one- or two stage on 5 cases. Posterior segmental spinal instrumentation was applied with use of hooks, screws and wires. The mean postoperative thoracic and lumbar curve improved to 79.3 ± 16.1° (range 56° - 105° and 58.5 ± 27.7° (range 10° - 95° respectively, with a slight loss of correction during follow up. The average thoracic and lumbar correction was 26.4 ± 14.9% (range 5.3 - 50.4% and 26.3 ± 21.2% (range 7.9 - 75%. Postoperatively, the mean kyphosis was 79.5 ± 40.3° (range 21° -170°, and lordosis was 50.8 ± 18.6° (range 20° -79°. Hyperkyphosis increased during follow up while lordosis remained stable. Mean Th12-L2 angle was -3.5 ±9.9° (range -19° - 15° postoperatively and did not change significantly during follow up. Conclusions Huge spinal deformities in patients with Ehlers-Danlos syndrome require complex and extensive surgery. There is a big risk of sagittal imbalance in this group.

Lengthening osteotomy at the intertrochanteric level with simultaneous correction of angular deformities

NARCIS (Netherlands)

Marti, R. K.; ten Holder, E. J.; Kloen, P.

2001-01-01

Fixed multiplane deformities around the hip representing a combination of rotational, angular, and leg-length discrepancies are disabling for the patient and pose a challenge for the orthopaedic surgeon. We describe a joint-preserving, one-stage procedure to address these complex problems using an

Evaluation of the stress level of children with idiopathic scoliosis in relation to the method of treatment and parameters of the deformity.

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Leszczewska, Justyna; Czaprowski, Dariusz; Pawłowska, Paulina; Kolwicz, Aleksandra; Kotwicki, Tomasz

2012-01-01

Stress level due to existing body deformity as well as to the treatment with a corrective brace is one of factors influencing the quality of life of children with idiopathic scoliosis undergoing non-surgical management. The purpose of the study was to evaluate the stress level among children suffering from idiopathic scoliosis in relation to the method of treatment and the parameters of the deformity. Seventy-three patients with idiopathic scoliosis participated in the study. Fifty-two children were treated by means of physiotherapy, while 21 patients were treated with both Cheneau corrective brace and physiotherapy. To assess the stress level related to the deformity itself and to the method of treatment with corrective brace, the two Bad Sobernheim Stress Questionnaires (BSSQs) were applied, the BSSQ Deformity and the BSSQ Brace, respectively.

Evaluation of the Stress Level of Children with Idiopathic Scoliosis in relation to the Method of Treatment and Parameters of the Deformity

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Justyna Leszczewska

2012-01-01

Full Text Available Stress level due to existing body deformity as well as to the treatment with a corrective brace is one of factors influencing the quality of life of children with idiopathic scoliosis undergoing non-surgical management. The purpose of the study was to evaluate the stress level among children suffering from idiopathic scoliosis in relation to the method of treatment and the parameters of the deformity. Seventy-three patients with idiopathic scoliosis participated in the study. Fifty-two children were treated by means of physiotherapy, while 21 patients were treated with both Cheneau corrective brace and physiotherapy. To assess the stress level related to the deformity itself and to the method of treatment with corrective brace, the two Bad Sobernheim Stress Questionnaires (BSSQs were applied, the BSSQ Deformity and the BSSQ Brace, respectively.

The increased prevalence of cervical spondylosis in patients with adult thoracolumbar spinal deformity.

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Schairer, William W; Carrer, Alexandra; Lu, Michael; Hu, Serena S

2014-12-01

Retrospective cohort study. To assess the concomitance of cervical spondylosis and thoracolumbar spinal deformity. Patients with degenerative cervical spine disease have higher rates of degeneration in the lumbar spine. In addition, degenerative cervical spine changes have been observed in adult patients with thoracolumbar spinal deformities. However, to the best of our knowledge, there have been no studies quantifying the association between cervical spondylosis and thoracolumbar spinal deformity in adult patients. Patients seen by a spine surgeon or spine specialist at a single institution were assessed for cervical spondylosis and/or thoracolumbar spinal deformity using an administrative claims database. Spinal radiographic utilization and surgical intervention were used to infer severity of spinal disease. The relative prevalence of each spinal diagnosis was assessed in patients with and without the other diagnosis. A total of 47,560 patients were included in this study. Cervical spondylosis occurred in 13.1% overall, but was found in 31.0% of patients with thoracolumbar spinal deformity (OR=3.27, Pspondylosis (OR=3.26, Pspondylosis or thoracolumbar spinal deformity had significantly higher rates of the other spinal diagnosis. This correlation was increased with increased severity of disease. Patients with both diagnoses were significantly more likely to have received a spine fusion. Further research is warranted to establish the cause of this correlation. Clinicians should use this information to both screen and counsel patients who present for cervical spondylosis or thoracolumbar spinal deformity.

Correction for near vision in pseudophakic patients

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Dujić Mirjana

2004-01-01

Full Text Available Objective of the study was to show the mean values of correction for near vision and to discuss the presbyopic correction in pseudophakic patients. Setting was the Eye department where authors work. Inclusion criteria for 55 patients were native or corrected distant vision of 0.8-1.0 on Snellen's chart; 0,6 on Jagger's chart for near vision; round pupil and good position of the implant. Biometry of the anterior chamber depth with Alcon biophysics during distant and near vision was performed in our study. „Hi square" test was carried out and it was concluded that patients younger than 59 years (41 eyes had median correction of +2.0 dsph, while patients older than 60 years (36 eyes had correction of+3.0 dsph, but it was not statistically significant. There was no statistically significant difference of the correction between pseudophakic (41 and phakic (19 eyes in patients younger than 59 years. The anterior movement of the IOL was 0.18 mm in the younger group and 0.15 mm in the older group. With good IOL movement and new materials which could have changeable refractive power, the problem of pseudophakic correction for near vision might be solved.

Surgical correction of scoliosis in children with spastic quadriplegia: benefits, adverse effects, and patient selection.

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Legg, Julian; Davies, Evan; Raich, Annie L; Dettori, Joseph R; Sherry, Ned

2014-04-01

Cerebral palsy (CP) is a group of nonprogressive syndromes of posture and motor impairment associated with lesions of the immature brain. Spastic quadriplegia is the most severe form with a high incidence of scoliosis, back pain, respiratory compromise, pelvic obliquity, and poor sitting balance. Surgical stabilization of the spine is an effective technique for correcting deformity and restoring sitting posture. The decision to operate in this group of patients is challenging. The aim of this study is to determine the benefits of surgical correction of scoliosis in children with spastic quadriplegia, the adverse effects of this treatment, and what preoperative factors affect patient outcome after surgical correction. A systematic review was undertaken to identify studies describing benefits and adverse effects of surgery in spastic quadriplegia. Factors affecting patient outcome following surgical correction of scoliosis were assessed. Studies involving adults and nonspastic quadriplegia were excluded. A total of 10 case series and 1 prospective and 3 retrospective cohort studies met inclusion criteria. There was significant variation in the overall risk of complications (range, 10.9-70.9%), mortality (range, 2.8-19%), respiratory/pulmonary complications (range, 26.9-57.1%), and infection (range, 2.5-56.8%). Factors associated with a worse outcome were a significant degree of thoracic kyphosis, days in the intensive care unit, and poor nutritional status. Caregivers report a high degree of satisfaction with scoliosis surgery for children with spastic quadriplegia. There is limited evidence of preoperative factors that can predict patient outcome after scoliosis. There is a need for well-designed prospective studies of scoliosis surgery in spastic quadriplegia.

Multi-stage 3D-2D registration for correction of anatomical deformation in image-guided spine surgery

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Ketcha, M. D.; De Silva, T.; Uneri, A.; Jacobson, M. W.; Goerres, J.; Kleinszig, G.; Vogt, S.; Wolinsky, J.-P.; Siewerdsen, J. H.

2017-06-01

A multi-stage image-based 3D-2D registration method is presented that maps annotations in a 3D image (e.g. point labels annotating individual vertebrae in preoperative CT) to an intraoperative radiograph in which the patient has undergone non-rigid anatomical deformation due to changes in patient positioning or due to the intervention itself. The proposed method (termed msLevelCheck) extends a previous rigid registration solution (LevelCheck) to provide an accurate mapping of vertebral labels in the presence of spinal deformation. The method employs a multi-stage series of rigid 3D-2D registrations performed on sets of automatically determined and increasingly localized sub-images, with the final stage achieving a rigid mapping for each label to yield a locally rigid yet globally deformable solution. The method was evaluated first in a phantom study in which a CT image of the spine was acquired followed by a series of 7 mobile radiographs with increasing degree of deformation applied. Second, the method was validated using a clinical data set of patients exhibiting strong spinal deformation during thoracolumbar spine surgery. Registration accuracy was assessed using projection distance error (PDE) and failure rate (PDE  >  20 mm—i.e. label registered outside vertebra). The msLevelCheck method was able to register all vertebrae accurately for all cases of deformation in the phantom study, improving the maximum PDE of the rigid method from 22.4 mm to 3.9 mm. The clinical study demonstrated the feasibility of the approach in real patient data by accurately registering all vertebral labels in each case, eliminating all instances of failure encountered in the conventional rigid method. The multi-stage approach demonstrated accurate mapping of vertebral labels in the presence of strong spinal deformation. The msLevelCheck method maintains other advantageous aspects of the original LevelCheck method (e.g. compatibility with standard clinical workflow, large

Does lumbar paraspinal muscles improve after corrective fusion surgery in degenerative flat black?

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Jung Hwan Lee

2017-01-01

Conclusions: Severity of atrophy or fat infiltration of PSE showed correlation with degree of angular deformity in patients with DFB and with less improvement after corrective surgery. Dynamic parameters showed more prominent correlation with PSE conditions than static parameters and also showed segmental specificity between PSE and angular deformity.

Despite worse baseline status depressed patients achieved outcomes similar to those in nondepressed patients after surgery for cervical deformity.

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Poorman, Gregory W; Passias, Peter G; Horn, Samantha R; Frangella, Nicholas J; Daniels, Alan H; Hamilton, D Kojo; Kim, Hanjo; Sciubba, Daniel; Diebo, Bassel G; Bortz, Cole A; Segreto, Frank A; Kelly, Michael P; Smith, Justin S; Neuman, Brian J; Shaffrey, Christopher I; LaFage, Virginie; LaFage, Renaud; Ames, Christopher P; Hart, Robert; Mundis, Gregory M; Eastlack, Robert

2017-12-01

OBJECTIVE Depression and anxiety have been demonstrated to have negative impacts on outcomes after spine surgery. In patients with cervical deformity (CD), the psychological and physiological burdens of the disease may overlap without clear boundaries. While surgery has a proven record of bringing about significant pain relief and decreased disability, the impact of depression and anxiety on recovery from cervical deformity corrective surgery has not been previously reported on in the literature. The purpose of the present study was to determine the effect of depression and anxiety on patients' recovery from and improvement after CD surgery. METHODS The authors conducted a retrospective review of a prospective, multicenter CD database. Patients with a history of clinical depression, in addition to those with current self-reported anxiety or depression, were defined as depressed (D group). The D group was compared with nondepressed patients (ND group) with a similar baseline deformity determined by propensity score matching of the cervical sagittal vertical axis (cSVA). Baseline demographic, comorbidity, clinical, and radiographic data were compared among patients using t-tests. Improvement of symptoms was recorded at 3 months, 6 months, and 1 year postoperatively. All health-related quality of life (HRQOL) scores collected at these follow-up time points were compared using t-tests. RESULTS Sixty-six patients were matched for baseline radiographic parameters: 33 with a history of depression and/or current depression, and 33 without. Depressed patients had similar age, sex, race, and radiographic alignment: cSVA, T-1 slope minus C2-7 lordosis, SVA, and T-1 pelvic angle (p > 0.05). Compared with nondepressed individuals, depressed patients had a higher incidence of osteoporosis (21.2% vs 3.2%, p = 0.028), rheumatoid arthritis (18.2% vs 3.2%, p = 0.012), and connective tissue disorders (18.2% vs 3.2%, p = 0.012). At baseline, the D group had greater neck pain (7.9 of

Angular Deformities of the Knee in Children | Solagberu | Nigerian ...

African Journals Online (AJOL)

Additionally, Blount's disease was seen in ten, six of who were girls. Two boys had posttraumatic genu valga. The commonest presentation was bilateral genu deformities. Diagnosis of rickets was made clinically and radiologically, serum biochemistry was not contributory. Thirty-four patients had corrective osteotomy.

Triplanar correction of adolescent idiopathic scoliosis by asymmetrically shaped and simultaneously applied rods associated with direct vertebral rotation: clinical and radiological analysis of 36 patients.

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Faldini, Cesare; Perna, Fabrizio; Geraci, Giuseppe; Pardo, Francesco; Mazzotti, Antonio; Pilla, Federico; Ruffilli, Alberto

2018-04-17

Aim of this study was to investigate the effectiveness of a new surgical corrective manoeuvre for adolescent idiopathic scoliosis (AIS) by asymmetrically shaped and simultaneously applied rods and in combination with direct vertebral rotation, to control both the triplanar deformity and the kyphosis apex location. We retrospectively reviewed 36 patients who undergo surgical treatment using simultaneous translation on two differently contoured rods, in combination with direct vertebral rotation. Patients were divided into three main groups according to the scoliotic curve type. The average follow-up was 1.8 years (range 1-3 years). Mean thoracic Cobb angle decreased from 64.6° to 17.0 (p < 0.05). Mean lumbar Cobb angle decreased from 54.9 to 13°. T5-T12 kyphosis values improved from 16.2 to 22.8° (p < 0.05). Apical vertebral rotation decreased from 25.3 to 9.7°. Mean total SRS-22 score values improved from 2.3 on pre-operative to 3.8 at the last available follow-up. Two major and two minor perioperative complications were recorded. Nor deformity progression or screw pull-out or non-union was recorded at the last available follow-up. The corrective manoeuvre using two differently contoured rods simultaneously in combination with direct vertebral rotation can provide a good triplanar deformity correction and improve patient's quality of life and self-image perception in mild-to-moderate AIS. Moreover, the described technique allows the positioning of the desired kyphosis apex at a different level from the scoliosis apex. This procedure allows a better sagittal contour restoration while maintaining a comparable amount of correction on the frontal and axial plane of the already available techniques. These slides can be retrieved under Electronic Supplementary Material.

[Double Osteotomy of the First Metatarsal for Treatment of Juvenile Hallux Valgus Deformity - Our Experience].

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Jochymek, J; Peterková, T

2016-01-01

The aim of the study was to evaluate the mid-term results in a group of selected patients undergoing corrective surgery for juvenile hallux valgus, using double osteotomy of the first metatarsal. The group included eight patients, seven girls and one boy, with a more severe form of this deformity treated by double osteotomy of the first metatarsal between 2010 and 2013. The indication for corrective surgery was serious pain when walking; all patients had previously undergone conservative treatment with no effect. All patients had pre-operative clinical examination, the affected foot was X-rayed with the patient standing and radiographic assessments of the intermetatarsal and hallux valgus angles were made. The evaluation of treatment outcomes was based on the scoring system of the American Orthopaedic Foot and Ankle Society (AOFAS) and X-ray images of the foot. The average follow-up was 37 months. Post-operatively, none of the patients reported pain while walking, only two of them experienced pain during sports activities. The average post-operative AOFAS score was 92 points. Both the intermetatarsal angle and the hallux valgus angle improved after surgery in all patients, with two reporting only mild hallux valgus deformity. One patient showed postoperative restriction of motion at the first metatarsophalangeal joint. This was the only complication recorded in association with the surgery. Almost all authors dealing with the treatment of hallux valgus deformity primarily prefer conservative therapy. However, this treatment is usually not very effective in severe forms of the disorder. Surgical management is indicated in symptomatic patients or in those with severe juvenile hallux valgus deformity. In paediatric patients it is necessary to respect the presence of an epiphyseal growth plate in the first proximal metatarsal and therefore it is often preferred to use distal first metatarsal osteotomy. At our department, Mitchell's osteotomy for hallux valgus deformity

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

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Vander Griend, Robert

2017-02-01

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

Augmentation Rhinoplasty in Cleft Lip Nasal Deformity: Preliminary Patients’ Perspective

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William H. C. Tiong

2014-01-01

Full Text Available The correction of cleft lip nasal deformity is challenging and there have been numerous methods described in the literature with little demonstrated technical superiority of one over another. The common clinical issues associated with cleft lip nasal deformity are its lack of symmetry, alar collapse on the affected side, obtuse nasal labial angle, short nasal length, loss of tip definition, and altered columella show among others. We carried out augmentation of cleft lip rhinoplasties with rib graft in 16 patients over the one-year study period. Each of these patients was reviewed and given questionnaire before and after surgery to evaluate their response on the outcome to the approach. Preoperatively, nasal asymmetry is the main complaint (14/16, 87.5% among our series of patients. Postoperatively, 12 (75% patients out of the 16 reported significant improvement in their nasal symmetry with the other four marginal. All patients reported excellent nasal projection postoperatively with good nasal tip definition. Our series of patients reported overall good satisfaction outcome and will recommend this procedure to other patients with cleft lip nasal deformity. In conclusion, augmentation of cleft lip rhinoplasty can be employed to achieve perceivable and satisfactory outcome in patients with cleft lip nasal deformity.

Arm rotated medially with supination – the ARMS variant: description of its surgical correction

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Melcher Sonya E

2009-03-01

Full Text Available Abstract Background Patients who have suffered obstetric brachial plexus injury (OBPI have a high incidence of musculoskeletal complications stemming from the initial nerve injury. The presence of muscle imbalances and contractures leads to typical bony changes affecting the shoulder, including the SHEAR (Scapular Hypoplasia, Elevation and Rotation deformity. The SHEAR deformity commonly occurs in conjunction with Medial Rotation Contracture (MRC of the arm. OBPI also causes muscle imbalances at the level of the forearm, that lead to a fixed supination deformity (SD in a small number of patients. Both MRC and SD will cause severe functional limitations without surgical intervention. Methods Fourteen OBPI patients were diagnosed with MRC of the shoulder and SD of the forearm along with SHEAR deformity during a 16 month study period, with eight patients available to long-term follow-up (age range 2.2 – 18 years. Surgical correction of the MRC was performed as a triangle tilt or humeral osteotomy depending on the age of the child, after which, the patients were treated with a radial osteotomy to correct the fixed supination deformity. Function was assessed using the modified Mallet scale, examination of apparent supination and appearance of the extremity at rest. Results Significant functional improvements were observed in patients with surgical reconstruction. Mallet score increased by an average of 5.2 (p Conclusion The simultaneous presence of two opposing deformities in the same limb will visually offset each other at the level of the wrist and hand, giving the false impression of neutral positioning of the limb. In reality, the neutral-appearing position of the hand indicates a fixed supination posture of the forearm in the face of a medial rotation contracture of the shoulder. Both of these deformities require surgical attention, and the presence of concurrent MRC and SD should be monitored for in OBPI patients.

Kyphosis in patients with cerebral palsy: causes of its development and correctional possibilities (literature review

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Valery Vladimirovich Umnov

2015-09-01

Full Text Available In this article, the literature pertaining to the treatment of kyphosis in patients with cerebral palsy was reviewed. Among the most common causes of kyphosis is the connection with pathological reflexes of newborns and infants with cerebral palsy, the presence of a hamstring syndrome, as well as weaknesses of the extensor muscles of the trunk. Attention is paid to a fundamental decrease in the quality of life of patients if they have pronounced kyphosis. Among the treatments, different variants of corsets are used, but the effectiveness of this method of treatment is low. It is notable that in some adolescent patients, they develop a fixed deformity that was successfully corrected and stabilized with spinal surgery. Therefore, a variety of techniques and devices for fixation have been used

Multiple-hook fixation in revision spinal deformity surgery for patients with a previous multilevel fusion mass: technical note and preliminary outcomes.

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Liu, Ning; Wood, Kirkham B

2017-03-01

OBJECTIVE A previous multilevel fusion mass encountered during revision spinal deformity surgery may obscure anatomical landmarks, making instrumentation unworkable or incurring substantial blood loss and operative time. This study introduced a surgical technique of multiple-hook fixation for fixating previous multilevel fusion masses in revision spinal deformity surgeries and then evaluated its outcomes. METHODS Patients with a previous multilevel fusion mass who underwent revision corrective surgery down to the lumbosacral junction were retrospectively studied. Multiple hooks were used to fixate the fusion mass and linked to distal pedicle screws in the lumbosacral-pelvic complex. Radiological and clinical outcomes were evaluated. RESULTS The charts of 8 consecutive patients with spinal deformity were retrospectively reviewed (7 women, 1 man; mean age 56 years). The primary diagnoses included flat-back deformity (6 cases), thoracolumbar kyphoscoliosis (1 case), and lumbar spondylosis secondary to a previous scoliosis fusion (1 case). The mean follow-up duration was 30.1 months. Operations were performed at T3/4-ilium (4 cases), T7-ilium (1 case), T6-S1 (1 case), T12-S1 (1 case), and T9-L5 (1 case). Of 8 patients, 7 had sagittal imbalance preoperatively, and their mean C-7 plumb line improved from 10.8 ± 2.9 cm preoperatively to 5.3 ± 3.6 cm at final follow-up (p = 0.003). The mean lumbar lordosis of these patients at final follow-up was significantly greater than that preoperatively (35.2° ± 12.6° vs 16.8° ± 11.8°, respectively; p = 0.005). Two perioperative complications included osteotomy-related leg weakness in 1 patient and a stitch abscess in another. CONCLUSIONS The multiple-hook technique provides a viable alternative option for fixating a previous multilevel fusion mass in revision spinal deformity surgery.

Considerations for the Management of Cryptotia Based on the Experience of 34 Patients

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Seok-Kwun Kim

2012-11-01

Full Text Available BackgroundCryptotia is a congenital ear deformity in which the upper pole appears buried beneath the mastoid skin. Cryptotia is a common auricular malformation among Asians. The aim of this paper is to examine the surgical techniques for and complications of 34 cryptotic patients.MethodsSurgery was performed for 34 cryptotic deformities (January 2005 to January 2012. Twenty-two patients (64.7% were classified as having type I cryptotia, and 12 patients (37.5% type II cryptotia. Among the type I cryptotia patients, 8 patients had mild deformity and 14 severe deformity. Among the type II cryptotia patients, 10 patients had mild deformity and 2 severe deformity.ResultsThe mild deformities were corrected via Z-plasty, V-Y plasty, full-thickness skin graft, and transposition flap, while the severe deformities were corrected via cartilage graft or Medporfor the spread of cartilage adhesion of antihelix. There were two cases of reinvagination in the autologous cartilage graft group. Implant exposure occurred with Medpor (two cases. There were two cases of hypertrophic scar on the previous surgical wound with Medpor. There were no complications in the 18 patients who had mild deformities.ConclusionsThe type I cryptotia patients had more severe deformities than the type II cryptotia patients. As most of the type II cryptotia patients had only mild deformities, their deformities were corrected without using autologous conchal cartilage graft or Medpor, except for two patients. Through more case analyses, researchers should make an effort to identify methods for recurrence and prevention of complication.

Modified french osteotomy for cubitus varus deformity

International Nuclear Information System (INIS)

Ahmad, I.; Idrees, M.

2007-01-01

To evaluate the outcome of Modified French Osteotomy for correction of cubitus varus deformity. All children, aged 3-12 years, with cubitus varus deformity were included in the study. Pre-operative clinical as well as radiological assessment of upper extremities were done in all cases. Modified French osteotomy was done to correct the deformity. All patients were followed for seven months. Physical examination for the range of motion, scar and post-operative complications were assessed. Antero-posterior and lateral radiographs of the elbow were obtained, and the carrying angles and lateral condylar prominence index were measured and recorded. Out of the total 30 patients, 26 were male and four female. Left side was involved in 24 cases and the right side in six. The average age at the time of osteotomy was seven years (range 3.5-12 years). The average pre-operative carrying angle was 25.2 degree (range 18-30 degree) and the post-operative angle 8.7 degree (range 5-13 degree valgus). The average pre- operative range of motion was 122.6 degree (range 105-135 degree) and the post-operative range 123.86 degree (range 90-135 degree). The average pre-operative lateral condylar prominence index (LCPI) was 175.56 (range 128-232) and the post-operative lateral condylar prominence 156 (range 100-240). Based on Bellmore criteria, 25 patients showed excellent, three good and two a poor result. Modified French technique of supracondylar osteotomy has excellent results in the management of cubitus varus in terms of cosmesis, radiological findings and fewer complications. (author)

Fat injection to correct contour deformities of the reconstructed breast: a single surgeon experience

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Youssef Tahiri

2015-06-01

Full Text Available Aim: Autologous fat grafting has gained acceptance as a technique to improve aesthetic outcomes in breast reconstruction. The purpose of this study was to share our clinical experience using autologous fat injection to correct contour deformities during breast reconstruction. Methods: A single surgeon, prospectively maintained database of patients who underwent autologous fat injection during breast reconstruction from January 2008 to November 2013 at McGill University Health Center was reviewed. Patient characteristics, breast history, type of breast reconstruction, volume of fat injected, and complications were analyzed. Results: One hundred and twenty-four patients benefited from autologous fat injection from January 2008 to November 2013, for a total of 187 treated breasts. The patients were on average 49.3 years old (΁ 8.9 years. Fat was harvested from the medial thighs (20.5%, flanks (39.1%, medial thighs and flanks (2.9%, trochanters (13.3%, medial knees (2.7%, and abdomen (21.9%. An average of 49.25 mL of fat was injected into each reconstructed breast. A total of 187 breasts in 124 patients were lipo-infiltrated during the second stage of breast reconstruction. Thirteen breasts (in 12 separate patients were injected several years after having undergone lumpectomy and radiotherapy. Of the 187 treated breasts, 118 were reconstructed with expanders to implants, 45 with deep inferior epigastric perforator flaps, 9 with latissimus dorsi flaps with implants, 4 with transverse rectus abdominis myocutaneous flaps, and 13 had previously undergone lumpectomy and radiotherapy. Six complications were noted in the entire series, for a rate of 3.2%. All were in previously radiated breasts. Average follow-up time was 12 months (range: 2-36 months. Conclusion: Fat injection continues to grow in popularity as an adjunct to breast reconstruction. Our experience demonstrates a low complication rate as compared to most surgical interventions of the breast

Low-Cost Smartphone-Based Photogrammetry for the Analysis of Cranial Deformation in Infants.

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Barbero-García, Inés; Lerma, José Luis; Marqués-Mateu, Ángel; Miranda, Pablo

2017-06-01

Cranial deformation, including deformational plagiocephaly, brachycephaly, and craniosynostosis, is a condition that affects a large number of infants. Despite its prevalence, there are no standards for the systematic evaluation of the cranial deformation. Usually, the deformation is measured manually by the use of calipers. Experts, however, do not agree on the suitability of these measurements to correctly represent the deformation. Other methodologies for evaluation include 3-dimensional (3D) photography and radiologic scanners. These techniques require either patient's sedation and ionizing radiation or high investment. The aim of this study is to develop a novel, low-cost, and minimally invasive methodology to correctly evaluate the cranial deformation using 3D imagery. A smart phone was used to record a slow motion video sequence on 5 different patients. Then, the videos were processed to create accurate 3D models of the patients' head, and the results were compared with the measurements obtained by the manual caliper. The correspondence between the manual and the photogrammetric 3D model measurements was high as far as head marks are available, with differences of 2 mm ± 0.9 mm; without marks, measurement results differed up to 20 mm. Smartphone-based photogrammetry is a low-cost, highly useful methodology to evaluate cranial deformation. This technique provides a much larger quantity of information than linear measurements with a similar accuracy as far as head marks exist. In addition, a new approach for the evaluation is pointed out: the comparison between the head 3D model and an ideal head, represented by a 3-axis ellipsoid. Copyright © 2017 Elsevier Inc. All rights reserved.

Hallux valgus interphalangeus deformity: A case series in the pediatric population.

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Grawe, Brian; Parikh, Shital; Crawford, Alvin; Tamai, Junichi

2012-03-01

The objective of this report is to describe three cases (four feet) of hallux valgus interphalangeus deformity in the pediatric population. A retrospective review was completed to identify three patients (four feet) with a deformity consistent with hallux valgus interphalangeus. Patients were followed at regular intervals for a minimum of 6 months. Treatment modalities and clinical results were reviewed for all patients for this relatively rare entity in the skeletally immature population. All patients in this report had a deformity that was not consistent with a traumatic etiology. Case number 1 had a significantly symptomatic deformity that failed conservative treatment, and eventually necessitated full surgical correction of the deformity. Symptom free unrestricted activity was obtained post-operatively, however final follow-up radiographs have demonstrated early changes consistent with arthritis. Case numbers 2 & 3 were relatively asymptomatic throughout their course of treatment, and responded well to non-operative intervention. Based on these findings excision of the exostosis and soft-tissue realignment appears to be a reliable option for symptom relief for patients who present with a painful symptomatic hallux valgus interphalangeus deformity. However, the risk of degenerative changes following spur removal must be entertained prior to the procedure. On the contrary a pain free deformity that does not impact functionality of toe, or impair shoe ware may be treated successfully with conservative measures. Copyright © 2011 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Surgical correction of hallux valgus complicated with adult-type pes plano-valgus.

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Choi, Jun Young; Yoon, Hyeong Hwa; Suh, Yu Min; Suh, Jin Soo

2017-01-01

To investigate the efficiency of simultaneous correction of moderate to severe hallux valgus deformity and adult-type pes planus. Twenty cases of moderate to severe hallux valgus complicated with adult-type pes planus in 19 consecutive patients (15 (79%) women, 4 (11%) men; mean age: 44.50 ± 17.13 years, mean follow-up duration: 31.30 ± 17.02 months) were included. Medial calcaneal sliding osteotomy was performed to correct hindfoot valgus, whereas treatments of hallux valgus were case dependent. The mean postoperative hallux valgus angle, intermetatarsal angle, hindfoot alignment angle, and hindfoot alignment ratio were 8.40 ± 5.29°, 4.20 ± 2.54°, 3.09 ± 2.92º and 0.41 ± 0.17, respectively. Although a hallux varus deformity occurred as a postoperative complication in one case (5%), there were no cases of postoperative recurrence. Simultaneous correction of hallux valgus and pes plano-valgus using medial calcaneal sliding osteotomy is an effective technique that reduces recurrence of hallux valgus and increases satisfaction in patients with moderate to severe hallux valgus deformity complicated with adult-type pes planus accompanying hindfoot valgus.

Comparative analysis of perioperative complications between a multicenter prospective cervical deformity database and the Nationwide Inpatient Sample database.

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Passias, Peter G; Horn, Samantha R; Jalai, Cyrus M; Poorman, Gregory; Bono, Olivia J; Ramchandran, Subaraman; Smith, Justin S; Scheer, Justin K; Sciubba, Daniel M; Hamilton, D Kojo; Mundis, Gregory; Oh, Cheongeun; Klineberg, Eric O; Lafage, Virginie; Shaffrey, Christopher I; Ames, Christopher P

2017-11-01

Complication rates for adult cervical deformity are poorly characterized given the complexity and heterogeneity of cases. To compare perioperative complication rates following adult cervical deformity corrective surgery between a prospective multicenter database for patients with cervical deformity (PCD) and the Nationwide Inpatient Sample (NIS). Retrospective review of prospective databases. A total of 11,501 adult patients with cervical deformity (11,379 patients from the NIS and 122 patients from the PCD database). Perioperative medical and surgical complications. The NIS was queried (2001-2013) for cervical deformity discharges for patients ≥18 years undergoing cervical fusions using International Classification of Disease, Ninth Revision (ICD-9) coding. Patients ≥18 years from the PCD database (2013-2015) were selected. Equivalent complications were identified and rates were compared. Bonferroni correction (pdatabases. A total of 11,379 patients from the NIS database and 122 patiens from the PCD database were identified. Patients from the PCD database were older (62.49 vs. 55.15, pdatabase. The PCD database had an increased risk of reporting overall complications than the NIS (odds ratio: 2.81, confidence interval: 1.81-4.38). Only device-related complications were greater in the NIS (7.1% vs. 1.1%, p=.007). Patients from the PCD database displayed higher rates of the following complications: peripheral vascular (0.8% vs. 0.1%, p=.001), gastrointestinal (GI) (2.5% vs. 0.2%, pdatabases (p>.004). Based on surgicalapproach, the PCD reported higher GI and neurologic complication rates for combined anterior-posterior procedures (pdatabase revealed higher overall and individual complication rates and higher data granularity. The nationwide database may underestimate complications of patients with adult cervical deformity (ACD) particularly in regard to perioperative surgical details owing to coding and deformity generalizations. The surgeon-maintained database

Serial casting for reconstruction of a deformed Charcot foot: a case report.

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Rosenblum, Jonathan I; Weiss, Shmuel; Gazes, Michael; Amit-Kohn, Michal

2015-05-01

Charcot neuroarthropathy may occur in patients with peripheral neuropathy who do not notice pain while their bones and joints collapse or breakdown under the constant pressure of body weight. This can lead to ulcerations from severe deformity and potentially limb-threatening and life-threatening infections. Current treatments vary from immobilization to extensive reconstructive surgical interventions. Serial casting, used to correct many pediatric deformities while bones are often more pliable, was used with a 63-year-old male patient who presented with an active phase of Charcot foot with ulceration. The patient previously underwent foot reconstruction and had all hardware removed prior to serial casting. Due to the potential pliability of the bones, serial casting was attempted to reform the shape and position of the foot in a reverse Ponseti-type serial casting to create a more stable structure with less deformity that could lead to epithelial breakdown. The patient regained full ambulation with a plantargrade foot and no wounds, and was followed without complications for 36 months. Serial weekly casting was an effective modality for treatment of this patient's Charcot foot deformity.

Shortening Scarf osteotomy for correction of severe hallux valgus. Does shortening affect the outcome?

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Karpe, Prasad; Killen, Marie C; Pollock, Raymond D; Limaye, Rajiv

2016-12-01

Translation and shortening of Scarf osteotomy allows correction of severe hallux valgus deformity. Shortening may result in transfer metatarsalgia. To evaluate outcome of patients undergoing shortening Scarf osteotomy for severe hallux valgus deformities. Fifteen patients (20feet, mean age 58 years) underwent shortening Scarf osteotomy for severe hallux valgus deformities. Outcomes were pre and postoperative AOFAS scores, IM and HV angles, patient satisfaction. Mean follow-up was 25 months (range 22-30). The IM angle improved from a median of 18.60 (range 13.4-26.20) preoperatively to 9.70 (range 8.0-13.70) postoperatively (8.9; 95% CI=7.6-10.3; phallux valgus deformities with no transfer metatarsalgia. Copyright © 2016 Elsevier Ltd. All rights reserved.

Treatment of Rigid Hammer-Toe Deformity: Permanent Versus Removable Implant Selection.

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Doty, Jesse F; Fogleman, Jason A

2018-03-01

Hammer-toe deformities that fail nonoperative treatment can be successfully addressed with proximal interphalangeal joint resection arthroplasty or fusion. The goal of surgery is to eliminate the deformity and rigidly fix the toe in a well-aligned position. Hammer-toe correction procedures can be performed with temporary Kirschner wire (K-wire) fixation for 3 to 6 weeks with high success rates. Pain relief with successful hammer-toe correction approaches 90%; patient satisfaction rates approximate 84%. Although complication rates are rare in most series, there remains a concern regarding exposed temporary K-wire fixation, which has led to the development of multiple permanent internal fixation options. Copyright © 2017 Elsevier Inc. All rights reserved.

Orthodontic and surgical management of a patient with severe skeletal Class II deformity and facial asymmetry: A case report with a 5-year follow-up.

Science.gov (United States)

Gao, Xiang; Wang, Tao; Song, Jinlin

2017-04-01

In this case report, we present the orthodontic and surgical management of an 18-year-old girl who had a severe craniofacial deformity, including maxillary prognathism, vertical maxillary excess (gummy smile), mandibular retrognathism, receding chin, and facial asymmetry caused by unilateral temporomandibular joint ankylosis. For correction of the facial asymmetry, the patient's right mandibular ramus and body were lengthened via distraction osteogenesis after 5 months of preoperative orthodontic therapy. Subsequently, extraction of 4 first premolars, bimaxillary anterior segmental osteotomy, and genioplasty were simultaneously performed in the second-stage operation to correct the skeletal deformities in the sagittal and vertical planes. Postoperative orthodontic treatment completed the final occlusal adjustment. The total active treatment period lasted approximately 30 months. The clinical results show that the patient's facial esthetics were significantly improved with minimal surgical invasion and distress, and a desirable occlusion was achieved. These pleasing results were maintained during the 5-year follow-up. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Problems, acceptance and social inequality: a study of the deformed leprosy patients and their families.

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Kopparty, S N

1995-09-01

Though the impact of social inequality on health conditions is widely known, its impact on the chronic and stigmatized disease, leprosy, has received little attention. Deformity sometimes leads to disabilities and to handicaps causing problems to the patient and his family. In this paper an attempt has been made to understand the impact of social inequality, prevalent in the form of the caste system in India on the deformed leprosy patients and on their families. This impact was examined in terms of the problems faced by the patients. A sample of 150 deformed patients and their families, drawn from two districts in Tamil Nadu, was selected for the study. About 57% of the deformed patients experienced their deformity as a handicap which caused social and economic problems while the rest did not. Of the three caste groups, the Lower Caste group experienced more severe economic problems while the Upper Caste group faced more social problems. The extent of acceptance of deformed patients in their family varied significantly among those facing and not facing problems due to their deformity. The deformed patients without any handicap were accepted in a large majority of their families (82%) regardless of their caste status. In contrast the deformed but handicapped patients were accepted differentially among the three caste groups with the Upper group accepting them in most of their families (80%) while in the Lower group much less number of families (54%) did. All the families of the deformed but not handicapped patients desired to keep their patients till their death irrespective of their caste status. On the contrary, while all the families in the Upper Caste group expressed their willingness to keep their handicapped patients in the family till their death, 10% in the Middle and 22% in the Lower Caste groups did not want to do so. This suggests the gradual marginalization, rejection and dehabilitation of the affected. Thus, one's caste status can be a broad indicator

Neurologic Outcomes of Complex Adult Spinal Deformity Surgery

DEFF Research Database (Denmark)

Lenke, Lawrence G; Fehlings, Michael G; Shaffrey, Christopher I

2016-01-01

STUDY DESIGN: Prospective, multicenter, international observational study. OBJECTIVE: To evaluate motor neurologic outcomes in patients undergoing surgery for complex adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: The neurologic outcomes after surgical correction for ASD have been...... and 16.42% showed an improvement. At 6 months, 10.82% patients showed a decline in preoperative LEMS, 20.52% improvement, and 68.66% maintenance. This was a significant change compared with 6 weeks and at discharge. CONCLUSION: Although complex ASD surgery can restore neurologic function in patients...

Corrective Jaw Surgery

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Full Text Available ... Jaw Surgery Download Download the ebook for further information Corrective jaw, or orthognathic surgery is performed by ... your treatment. Correction of Common Dentofacial Deformities ​ ​ The information provided here is not intended as a substitute ...

Return to sports after surgery to correct adolescent idiopathic scoliosis: a survey of the Spinal Deformity Study Group.

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Lehman, Ronald A; Kang, Daniel G; Lenke, Lawrence G; Sucato, Daniel J; Bevevino, Adam J

2015-05-01

There are no guidelines for when surgeons should allow patients to return to sports and athletic activities after spinal fusion for adolescent idiopathic scoliosis (AIS). Current recommendations are based on anecdotal reports and a survey performed more than a decade ago in the era of first/second-generation posterior implants. To identify current recommendations for return to sports and athletic activities after surgery for AIS. Questionnaire-based survey. Adolescent idiopathic scoliosis after corrective surgery. Type and time to return to sports. A survey was administered to members of the Spinal Deformity Study Group. The survey consisted of surgeon demographic information, six clinical case scenarios, three different construct types (hooks, pedicle screws, hybrid), and questions regarding the influence of lowest instrumented vertebra (LIV) and postoperative physical therapy. Twenty-three surgeons completed the survey, and respondents were all experienced expert deformity surgeons. Pedicle screw instrumentation allows earlier return to noncontact and contact sports, with most patients allowed to return to running by 3 months, both noncontact and contact sports by 6 months, and collision sports by 12 months postoperatively. For all construct types, approximately 20% never allow return to collision sports, whereas all surgeons allow eventual return to contact and noncontact sports regardless of construct type. In addition to construct type, we found progressively distal LIV resulted in more surgeons never allowing return to collision sports, with 12% for selective thoracic fusion to T12/L1 versus 33% for posterior spinal fusion to L4. Most respondents also did not recommend formal postoperative physical therapy (78%). Of all surgeons surveyed, there was only one reported instrumentation failure/pullout without neurologic deficit after a patient went snowboarding 2 weeks postoperatively. Modern posterior instrumentation allows surgeons to recommend earlier return

Bilateral cleft lip nasal deformity

Directory of Open Access Journals (Sweden)

Singh Arun

2009-01-01

Full Text Available Bilateral cleft lip nose deformity is a multi-factorial and complex deformity which tends to aggravate with growth of the child, if not attended surgically. The goals of primary bilateral cleft lip nose surgery are, closure of the nasal floor and sill, lengthening of the columella, repositioning of the alar base, achieving nasal tip projection, repositioning of the lower lateral cartilages, and reorienting the nares from horizontal to oblique position. The multiplicity of procedures in the literature for correction of this deformity alludes to the fact that no single procedure is entirely effective. The timing for surgical intervention and its extent varies considerably. Early surgery on cartilage may adversely affect growth and development; at the same time, allowing the cartilage to grow in an abnormal position and contributing to aggravation of deformity. Some surgeons advocate correction of deformity at an early age. However, others like the cartilages to grow and mature before going in for surgery. With peer pressure also becoming an important consideration during the teens, the current trend is towards early intervention. There is no unanimity in the extent of nasal dissection to be done at the time of primary lip repair. While many perform limited nasal dissection for the fear of growth retardation, others opt for full cartilage correction at the time of primary surgery itself. The value of naso-alveolar moulding (NAM too is not universally accepted and has now more opponents than proponents. Also most centres in the developing world have neither the personnel nor the facilities for the same. The secondary cleft nasal deformity is variable and is affected by the extent of the original abnormality, any prior surgeries performed and alteration due to nasal growth. This article reviews the currently popular methods for correction of nasal deformity associated with bilateral cleft lip, it′s management both at the time of cleft lip repair

Correction of anterior open bite in a case of achondroplasia

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Karpagam S

2005-01-01

Full Text Available Treatment planning for patients with skeletal deformities is often considered challenging. This article reports a female patient with achondroplasia who presented with severe maxillary retrognathism and vertical excess along with anterior open bite. The clinical and cephalometric findings of the patient are detailed here. The treatment plan consisted of modified anterior maxillary osteotomy for simultaneous vertical and sagittal augmentation along with orthodontic intervention. The course of surgical-orthodontic treatment and the results are presented. This treatment is to be followed by correction of vertical maxillary excess after completion of growth. This paper concludes that the dentoalveolar component of a skeletal deformity can be handled independent of the craniofacial management.

The impact of patient self assessment of deformity on HRQL in adults with scoliosis

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Moss Nathan D

2007-10-01

Full Text Available Abstract Background Body image and HRQL are significant issues for patients with scoliosis due to cosmetic deformity, physical and psychological symptoms, and treatment factors. A selective review of scoliosis literature revealed that self report measures of body image and HRQL share unreliable correlations with radiographic measures and clinician recommendations for surgery. However, current body image and HRQL measures do not indicate which aspects of scoliosis deformity are the most distressing for patients. The WRVAS is an instrument designed to evaluate patient self assessment of deformity, and may show some promise in identifying aspects of deformity most troubling to patients. Previous research on adolescents with scoliosis supports the use of the WRVAS as a clinical tool, as the instrument shares strong correlations with radiographic measures and quality of life instruments. There has been limited use of this instrument on adult populations. Methods The WRVAS and the SF-36v2, a HRQL measure, were administered to 71 adults with scoliosis, along with a form to report age and gender. Preliminary validation analyses were performed on the WRVAS (floor and ceiling effects, internal consistency and collinearity, correlations with the SF-36v2, and multiple regression with the WRVAS total score as the predictor, and SF-36v2 scores as outcomes. Results The psychometric properties of the WRVAS were acceptable. Older participants perceived their deformities as more severe than younger participants. More severe deformities were associated with lower scores on the Physical Component Summary Score of the SF-36v2. Total WRVAS score also predicted Physical Component Summary scores. Conclusion The results of the current study indicate that the WRVAS is a reliable tool to use with adult patients, and that patient self assessment of deformity shared a relationship with physical rather than psychological aspects of HRQL. The current and previous studies

Talectomy for Equinovarus Deformity in Family Members with Hereditary Motor and Sensory Neuropathy Type I

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Hristo Georgiev

2014-01-01

Full Text Available The treatment of severe rigid neurogenic clubfoot deformities still remains a challenging problem in modern paediatric orthopaedics. In those cases, in spite of being a palliative procedure, talectomy has been advocated for the correction of the deformity thus providing a stable plantigrade foot which allows pain-free walking with standard footwear. Herein, we present the results after talectomy in two patients (brother and sister affected by a hereditary motor and sensory neuropathy type I, with rigid severe pes equinovarus deformities.

First Metatarsal Proximal Opening Wedge Osteotomy for Correction of Hallux Valgus Deformity: Comparison of Straight versus Oblique Osteotomy

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Han, Seung Hwan; Park, Eui Hyun; Jo, Joon; Koh, Yong Gon; Lee, Jin Woo; Choi, Woo Jin

2015-01-01

Purpose The aim of this study was to compare clinical and radiographic outcomes of proximal opening wedge osteotomy using a straight versus oblique osteotomy. Materials and Methods We retrospectively reviewed 104 consecutive first metatarsal proximal opening wedge osteotomies performed in 95 patients with hallux valgus deformity. Twenty-six feet were treated using straight metatarsal osteotomy (group A), whereas 78 feet were treated using oblique metatarsal osteotomy (group B). The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and distance from the first to the second metatarsal (distance) were measured for radiographic evaluation, whereas the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used for clinical evaluation. Results Significant corrections in the HVA, IMA, and distance from the first to the second metatarsal were obtained in both groups at the last follow-up (p<0.001). There was no difference in the mean IMA correction between the 2 groups (6.1±2.7° in group A and 6.0±2.1° in group B). However, a greater correction in the HVA and distance from the first to the second metatarsal were found in group B (HVA, 13.2±8.2°; distance, 25.1±0.2 mm) compared to group A (HVA, 20.9±7.7°; distance, 28.1±0.3 mm; p<0.001). AOFAS scores were improved in both groups. However, group B demonstrated a greater improvement relative to group A (p=0.005). Conclusion Compared with a straight first metatarsal osteotomy, an oblique first metatarsal osteotomy yielded better clinical and radiological outcomes. PMID:25837181

Identifying Septal Support Reconstructions for Saddle Nose Deformity: The Cakmak Algorithm.

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Cakmak, Ozcan; Emre, Ismet Emrah; Ozkurt, Fazil Emre

2015-01-01

The saddle nose deformity is one of the most challenging problems in nasal surgery with a less predictable and reproducible result than other nasal procedures. The main feature of this deformity is loss of septal support with both functional and aesthetic implications. Most reports on saddle nose have focused on aesthetic improvement and neglected the reestablishment of septal support to improve airway. To explain how the Cakmak algorithm, an algorithm that describes various fixation techniques and grafts in different types of saddle nose deformities, aids in identifying saddle nose reconstructions that restore supportive nasal framework and provide the aesthetic improvements typically associated with procedures to correct saddle nose deformities. This algorithm presents septal support reconstruction of patients with saddle nose deformity based on the experience of the senior author in 206 patients with saddle nose deformity. Preoperative examination, intraoperative assessment, reconstruction techniques, graft materials, and patient evaluation of aesthetic success were documented, and 4 different types of saddle nose deformities were defined. The Cakmak algorithm classifies varying degrees of saddle nose deformity from type 0 to type 4 and helps identify the most appropriate surgical procedure to restore the supportive nasal framework and aesthetic dorsum. Among the 206 patients, 110 women and 96 men, mean (range) age was 39.7 years (15-68 years), and mean (range) of follow-up was 32 months (6-148 months). All but 12 patients had a history of previous nasal surgeries. Application of the Cakmak algorithm resulted in 36 patients categorized with type 0 saddle nose deformities; 79, type 1; 50, type 2; 20, type 3a; 7, type 3b; and 14, type 4. Postoperative photographs showed improvement of deformities, and patient surveys revealed aesthetic improvement in 201 patients and improvement in nasal breathing in 195 patients. Three patients developed postoperative infection

The minimally invasive spinal deformity surgery algorithm: a reproducible rational framework for decision making in minimally invasive spinal deformity surgery.

Science.gov (United States)

Mummaneni, Praveen V; Shaffrey, Christopher I; Lenke, Lawrence G; Park, Paul; Wang, Michael Y; La Marca, Frank; Smith, Justin S; Mundis, Gregory M; Okonkwo, David O; Moal, Bertrand; Fessler, Richard G; Anand, Neel; Uribe, Juan S; Kanter, Adam S; Akbarnia, Behrooz; Fu, Kai-Ming G

2014-05-01

Minimally invasive surgery (MIS) is an alternative to open deformity surgery for the treatment of patients with adult spinal deformity. However, at this time MIS techniques are not as versatile as open deformity techniques, and MIS techniques have been reported to result in suboptimal sagittal plane correction or pseudarthrosis when used for severe deformities. The minimally invasive spinal deformity surgery (MISDEF) algorithm was created to provide a framework for rational decision making for surgeons who are considering MIS versus open spine surgery. A team of experienced spinal deformity surgeons developed the MISDEF algorithm that incorporates a patient's preoperative radiographic parameters and leads to one of 3 general plans ranging from MIS direct or indirect decompression to open deformity surgery with osteotomies. The authors surveyed fellowship-trained spine surgeons experienced with spinal deformity surgery to validate the algorithm using a set of 20 cases to establish interobserver reliability. They then resurveyed the same surgeons 2 months later with the same cases presented in a different sequence to establish intraobserver reliability. Responses were collected and tabulated. Fleiss' analysis was performed using MATLAB software. Over a 3-month period, 11 surgeons completed the surveys. Responses for MISDEF algorithm case review demonstrated an interobserver kappa of 0.58 for the first round of surveys and an interobserver kappa of 0.69 for the second round of surveys, consistent with substantial agreement. In at least 10 cases there was perfect agreement between the reviewing surgeons. The mean intraobserver kappa for the 2 surveys was 0.86 ± 0.15 (± SD) and ranged from 0.62 to 1. The use of the MISDEF algorithm provides consistent and straightforward guidance for surgeons who are considering either an MIS or an open approach for the treatment of patients with adult spinal deformity. The MISDEF algorithm was found to have substantial inter- and

Three-dimensional deformation of orthodontic brackets

OpenAIRE

Melenka, Garrett W; Nobes, David S; Major, Paul W; Carey, Jason P

2013-01-01

Braces are used by orthodontists to correct the misalignment of teeth in the mouth. Archwire rotation is a particular procedure used to correct tooth inclination. Wire rotation can result in deformation to the orthodontic brackets, and an orthodontic torque simulator has been designed to examine this wire?bracket interaction. An optical technique has been employed to measure the deformation due to size and geometric constraints of the orthodontic brackets. Images of orthodontic brackets are c...

Clinical utility of the Taylor spatial frame for limb deformities

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Keshet D

2017-05-01

Full Text Available Doron Keshet, Mark Eidelman Pediatric Orthopedics Unit, Rambam Health Care Center, Haifa, Israel Abstract: The Taylor spatial frame (TSF is a hexapod external fixator that can correct six-axis deformities. The mathematical base of all hexapod systems is projective geometry, which describes complex repositioning of an object in space. The Taylor brothers developed one of the first six-axis correction systems, which is known today as TSF. Over the years, this system has become the most used six-axis deformity correction device. In this review, we describe the history behind TSF development, and describe the principles and clinical utility for application of the TSF in different settings, such as acute trauma, malunions, and various deformities of the lower and upper limb. Keywords: external fixator, deformity correction, hexapod

Porous Titanium Wedges in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity.

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Moore, Spencer H; Carstensen, S Evan; Burrus, M Tyrrell; Cooper, Truitt; Park, Joseph S; Perumal, Venkat

2017-10-01

Lateral column lengthening (LCL) is a common procedure for reconstruction of stage II flexible adult-acquired flatfoot deformity (AAFD). The recent development of porous titanium wedges for this procedure provides an alternative to allograft and autograft. The purpose of this study was to report radiographic and clinical outcomes achieved with porous titanium wedges in LCL. A retrospective analysis of 34 feet in 30 patients with AAFD that received porous titanium wedges for LCL from January 2011 to October 2014. Deformity correction was assessed using both radiographic and clinical parameters. Radiographic correction was assessed using the lateral talo-first metatarsal angle, the talonavicular uncoverage percentage, and the first metatarsocuneiform height. The hindfoot valgus angle was measured. Patients were followed from a minimum of 6 months up to 4 years (mean 16.1 months). Postoperative radiographs demonstrated significant correction in all 3 radiographic criteria and the hindfoot valgus angle. We had no cases of nonunion, no wedge migration, and no wedges have been removed to date. The most common complication was calcaneocuboid joint pain (14.7%). Porous titanium wedges in LCL can achieve good radiographic and clinical correction of AAFD with a low rate of nonunion and other complications. Level IV: Case series.

Real-time wavefront correction system using a zonal deformable mirror and a Hartmann sensor

International Nuclear Information System (INIS)

Salmon, J.T.; Bliss, E.S.; Long, T.W.; Orham, E.L.; Presta, R.W.; Swift, C.D.; Ward, R.S.

1991-07-01

We have developed an adaptive optics system that corrects up to five waves of 2nd-order and 3rd-order aberrations in a high-power laser beam to less than 1/10th wave RMS. The wavefront sensor is a Hartmann sensor with discrete lenses and position-sensitive photodiodes; the deformable mirror uses piezoelectric actuators with feedback from strain gauges bonded to the stacks. The controller hardware uses a VME bus. The system removes thermally induced aberrations generated in the master-oscillator-power-amplifier chains of a dye laser, as well as aberrations generated in beam combiners and vacuum isolation windows for average output powers exceeding 1 kW. The system bandwidth is 1 Hz, but higher bandwidths are easily attainable

Emotional and behavioral reactions to facially deformed patients before and after craniofacial surgery.

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Barden, R C; Ford, M E; Wilhelm, W M; Rogers-Salyer, M; Salyer, K E

1988-09-01

The present experiment investigated whether observers' emotional and behavioral reactions to facially deformed patients could be substantially improved by surgical procedures conducted by well-trained specialists in an experienced multidisciplinary team. Also investigated was the hypothesis that emotional states mediate the effects of physical attractiveness and facial deformity on social interaction. Twenty patients between the ages of 3 months and 17 years were randomly selected from over 2000 patients' files of Kenneth E. Salyer of Dallas, Texas. Patient diagnoses included facial clefts, hypertelorism, Treacher Collins syndrome, and craniofacial dysostoses (Crouzon's and Apert's syndromes). Rigorously standardized photographs of patients taken before and after surgery were shown to 22 "naive" raters ranging in age from 18 to 54 years. Raters were asked to predict their emotional and behavioral responses to the patients. These ratings indicated that observers' behavioral reactions to facially deformed children and adolescents would be more positive following craniofacial surgery. Similarly, the ratings indicated that observers' emotional reactions to these patients would be more positive following surgery. The results are discussed in terms of current sociopsychologic theoretical models for the effects of attractiveness on social interaction. A new model is presented that implicates induced emotional states as a mediating process in explaining the effects of attractiveness and facial deformity on the quality of social interactions. Limitations of the current investigation and directions for future research are also discussed.

Bunionette deformity.

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Cohen, Bruce E; Nicholson, Christopher W

2007-05-01

The bunionette, or tailor's bunion, is a lateral prominence of the fifth metatarsal head. Most commonly, bunionettes are the result of a widened 4-5 intermetatarsal angle with associated varus of the metatarsophalangeal joint. When symptomatic, these deformities often respond to nonsurgical treatment methods, such as wider shoes and padding techniques. When these methods are unsuccessful, surgical treatment is based on preoperative radiographs and associated lesions, such as hyperkeratoses. In rare situations, a simple lateral eminence resection is appropriate; however, the risk of recurrence or overresection is high with this technique. Patients with a lateral bow to the fifth metatarsal are treated with a distal chevron-type osteotomy. A widened 4-5 intermetatarsal angle often requires a diaphyseal osteotomy for correction.

Real time noninvasive assessment of external trunk geometry during surgical correction of adolescent idiopathic scoliosis

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Mac-Thiong Jean-Marc

2009-02-01

Full Text Available Abstract Background The correction of trunk deformity is crucial in scoliosis surgery, especially for the patient's self-image. However, direct visualization of external scoliotic trunk deformity during surgical correction is difficult due to the covering draping sheets. Methods An optoelectronic camera system with 10 passive markers is used to track the trunk geometry of 5 scoliotic patients during corrective surgery. The position of 10 anatomical landmarks and 5 trunk indices computed from the position of the passive markers are compared during and after instrumentation of the spine. Results Internal validation of the accuracy of tracking was evaluated at 0.41 +/- 0.05 mm RMS. Intra operative tracking during surgical maneuvers shows improvement of the shoulder balance during and after correction of the spine. Improvement of the overall patient balance is observed. At last, a minor increase of the spinal length can be noticed. Conclusion Tracking of the external geometry of the trunk during surgical correction is useful to monitor changes occurring under the sterile draping sheets. Moreover, this technique can used be used to reach the optimal configuration on the operating frame before proceeding to surgery. The current tracking technique was able to detect significant changes in trunk geometry caused by posterior instrumentation of the spine despite significant correction of the spinal curvature. It could therefore become relevant for computer-assisted guidance of surgical maneuvers when performing posterior instrumentation of the scoliotic spine, provide important insights during positioning of patients.

Surgery for the correction of hallux valgus: minimum five-year results with a validated patient-reported outcome tool and regression analysis.

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Chong, A; Nazarian, N; Chandrananth, J; Tacey, M; Shepherd, D; Tran, P

2015-02-01

This study sought to determine the medium-term patient-reported and radiographic outcomes in patients undergoing surgery for hallux valgus. A total of 118 patients (162 feet) underwent surgery for hallux valgus between January 2008 and June 2009. The Manchester-Oxford Foot Questionnaire (MOXFQ), a validated tool for the assessment of outcome after surgery for hallux valgus, was used and patient satisfaction was sought. The medical records and radiographs were reviewed retrospectively. At a mean of 5.2 years (4.7 to 6.0) post-operatively, the median combined MOXFQ score was 7.8 (IQR:0 to 32.8). The median domain scores for pain, walking/standing, and social interaction were 10 (IQR: 0 to 45), 0 (IQR: 0 to 32.1) and 6.3 (IQR: 0 to 25) respectively. A total of 119 procedures (73.9%, in 90 patients) were reported as satisfactory but only 53 feet (32.7%, in 43 patients) were completely asymptomatic. The mean (SD) correction of hallux valgus, intermetatarsal, and distal metatarsal articular angles was 18.5° (8.8°), 5.7° (3.3°), and 16.6° (8.8°), respectively. Multivariable regression analysis identified that an American Association of Anesthesiologists grade of >1 (Incident Rate Ratio (IRR) = 1.67, p-value = 0.011) and recurrent deformity (IRR = 1.77, p-value = 0.003) were associated with significantly worse MOXFQ scores. No correlation was found between the severity of deformity, the type, or degree of surgical correction and the outcome. When using a validated outcome score for the assessment of outcome after surgery for hallux valgus, the long-term results are worse than expected when compared with the short- and mid-term outcomes, with 25.9% of patients dissatisfied at a mean follow-up of 5.2 years. ©2015 The British Editorial Society of Bone & Joint Surgery.

Osteotomy around young deformed knees: 38-year super-long-term follow-up to detect osteoarthritis.

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Koshino, Tomihisa

2010-02-01

Since 1969 corrective osteotomy has been performed at our institute in young patients (under 40 years) with bowlegs, knock knees and flexion or rotational deformities around the knee. Fifty-seven knees (29 left, 28 right) of 45 patients (19 boys, 26 girls) were followed-up for a period ranging from 30 to 38 years in seven patients with seven knees, from 20 to 29 years in nine patients with 11 knees, and from ten to 19 years in 29 patients with 39 knees. Supracondylar femoral osteotomy was performed on 12 knees (11 patients), high tibial osteotomy above the tibial tuberosity on eight knees (six patients) and below the tuberosity on 37 knees (28 patients). At the final follow-up (age range 42-73 years), all of the deformities were satisfactorily corrected, with no symptoms apart from nine knees, seven of which had dull pain after strenuous sport with osteophytes, etc. in the radiograph. Total knee arthroplasty was performed in the remaining two knees, at ten and 26 years, respectively, after the initial osteotomy. Osteoarthritis developed in the contralateral knee to the initial osteotomy in two patients after 34 years at age 73 and after 33 years at age 67.

Effects of Exercise on Spinal Deformities and Quality of Life in Patients with Adolescent Idiopathic Scoliosis

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Shahnawaz Anwer

2015-01-01

Full Text Available Objectives. This systematic review was conducted to examine the effects of exercise on spinal deformities and quality of life in patients with adolescent idiopathic scoliosis (AIS. Data Sources. Electronic databases, including PubMed, CINAHL, Embase, Scopus, Cochrane Register of Controlled Trials, PEDro, and Web of Science, were searched for research articles published from the earliest available dates up to May 31, 2015, using the key words “exercise,” “postural correction,” “posture,” “postural curve,” “Cobb’s angle,” “quality of life,” and “spinal deformities,” combined with the Medical Subject Heading “scoliosis.” Study Selection. This systematic review was restricted to randomized and nonrandomized controlled trials on AIS published in English language. The quality of selected studies was assessed by the PEDro scale, the Cochrane Collaboration’s tool, and the Grading of Recommendations Assessment, Development, and Evaluation System (GRADE. Data Extraction. Descriptive data were collected from each study. The outcome measures of interest were Cobb angle, trunk rotation, thoracic kyphosis, lumbar kyphosis, vertebral rotation, and quality of life. Data Synthesis. A total of 30 studies were assessed for eligibility. Six of the 9 selected studies reached high methodological quality on the PEDro scale. Meta-analysis revealed moderate-quality evidence that exercise interventions reduce the Cobb angle, angle of trunk rotation, thoracic kyphosis, and lumbar lordosis and low-quality evidence that exercise interventions reduce average lateral deviation. Meta-analysis revealed moderate-quality evidence that exercise interventions improve the quality of life. Conclusions. A supervised exercise program was superior to controls in reducing spinal deformities and improving the quality of life in patients with AIS.

High Rate of Recurrence Following Proximal Medial Opening Wedge Osteotomy for Correction of Moderate Hallux Valgus.

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Iyer, Sravisht; Demetracopoulos, Constantine A; Sofka, Carolyn M; Ellis, Scott J

2015-07-01

The proximal medial opening wedge (PMOW) osteotomy has become more popular to treat moderate to severe hallux valgus with the recent development of specifically designed, low-profile modular plates. Despite the promising results previously reported in the literature, we have noted a high incidence of recurrence in patients treated with a PMOW. The purpose of this study was to report the clinical and radiographic outcomes of an initial cohort of patients treated with a PMOW osteotomy for moderate hallux valgus. We retrospectively analyzed prospectively gathered data on a cohort of 17 consecutive patients who were treated by the senior author using a PMOW osteotomy for moderate hallux valgus deformity. Average time to follow-up was 2.4 years (range, 1.0-3.5 years). The intermetatarsal angle (IMA), the hallux valgus angle (HVA), and the distal metatarsal articular angle (DMAA) were assessed on standard weightbearing radiographs of the foot preoperatively and at all follow-up visits. The Foot and Ankle Outcome Score (FAOS) was collected on all patients preoperatively and at final follow-up. Despite demonstrating good correction of their deformity initially, 11 of the 17 patients (64.7%) had evidence of recurrence of their hallux valgus deformity at final follow-up. Patients who recurred had a greater preoperative HVA (P = .023) and DMAA (P = .049) than patients who maintained their correction. Improvement in the quality-of-life subscale of the FAOS was noted at final follow-up for all patients (P = .05). There was no significant improvement in any of the other FAOS subscales. There was a high rate of recurrence of the hallux valgus deformity in this cohort of patients. Recurrence was associated with greater preoperative deformity and an increased preoperative DMAA. The PMOW without a concomitant distal metatarsal osteotomy may be best reserved for patients with mild hallux valgus deformity without an increased DMAA. Level IV, retrospective case series. © The Author

Mozart Ear Deformity: a Rare Diagnosis in the Ear Reconstruction Clinic.

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Telich-Tarriba, Jose E; Victor-Baldin, Andre; Apellaniz-Campo, Armando

2017-07-01

Mozart ear is a rare auricular deformity; clinically the auricle is characterized by the bulging appearance of the anterosuperior portion of the auricle due to fusion of the crura of the antihelix, an inversion in the normal form of the cavum conchae resulting in its convexity and a slit-like narrowing of the orifice of the external auditory meatus.A retrospective review of clinical and photographic records of patients attended at the ear reconstruction clinic of our hospital between June of 2010 and May 2016 was performed; out of 576 consecutive patients only 3 fulfilled the inclusion criteria, with a prevalence of 0.5%. The authors present these patients.Surgical interventions mainly focus on the correction of the convex concha; however, the procedure should be tailored to the severity of the deformity and the wishes of the patient.

Patients cured of acromegaly do not experience improvement of their skull deformities.

Science.gov (United States)

Rick, Jonathan W; Jahangiri, Arman; Flanigan, Patrick M; Aghi, Manish K

2017-04-01

Acromegaly is a rare disease that is associated with many co-morbidities. This condition also causes progressive deformity of the skull which includes frontal bossing and cranial thickening. Surgical and/or medical management can cure this condition in many patients, but it is not understood if patients cured of acromegaly experience regression of their skull deformities. We performed a retrospective analysis on patients treated at our dedicated pituitary center from 2009 to 2014. We looked at all MRI images taken during the treatment of these patients and recorded measurements on eight skull dimensions. We then analyzed these measurements for changes over time. 29 patients underwent curative treatment for acromegaly within our timeframe. The mean age for this population was 45.0 years old (range 19-70) and 55.2 % (n = 16) were female. All of these patients were treated with a transsphenoidal resection for a somatotropic pituitary adenoma. 9 (31.1%) of these patients required further medical therapy to be cured. We found statically significant variation in the coronal width of the sella turcica after therapy, which is likely attributable to changes from transsphenoidal surgery. None of the other dimensions had significant variation over time after cure. Patients cured of acromegaly should not expect natural regression of their skull deformities. Our study suggests that both frontal bossing and cranial thickening do not return to normal after cure.

Segmentation-free empirical beam hardening correction for CT

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Schüller, Sören; Sawall, Stefan [German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120 (Germany); Stannigel, Kai; Hülsbusch, Markus; Ulrici, Johannes; Hell, Erich [Sirona Dental Systems GmbH, Fabrikstraße 31, 64625 Bensheim (Germany); Kachelrieß, Marc, E-mail: marc.kachelriess@dkfz.de [German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany)

2015-02-15

Purpose: The polychromatic nature of the x-ray beams and their effects on the reconstructed image are often disregarded during standard image reconstruction. This leads to cupping and beam hardening artifacts inside the reconstructed volume. To correct for a general cupping, methods like water precorrection exist. They correct the hardening of the spectrum during the penetration of the measured object only for the major tissue class. In contrast, more complex artifacts like streaks between dense objects need other techniques of correction. If using only the information of one single energy scan, there are two types of corrections. The first one is a physical approach. Thereby, artifacts can be reproduced and corrected within the original reconstruction by using assumptions in a polychromatic forward projector. These assumptions could be the used spectrum, the detector response, the physical attenuation and scatter properties of the intersected materials. A second method is an empirical approach, which does not rely on much prior knowledge. This so-called empirical beam hardening correction (EBHC) and the previously mentioned physical-based technique are both relying on a segmentation of the present tissues inside the patient. The difficulty thereby is that beam hardening by itself, scatter, and other effects, which diminish the image quality also disturb the correct tissue classification and thereby reduce the accuracy of the two known classes of correction techniques. The herein proposed method works similar to the empirical beam hardening correction but does not require a tissue segmentation and therefore shows improvements on image data, which are highly degraded by noise and artifacts. Furthermore, the new algorithm is designed in a way that no additional calibration or parameter fitting is needed. Methods: To overcome the segmentation of tissues, the authors propose a histogram deformation of their primary reconstructed CT image. This step is essential for the

Segmentation-free empirical beam hardening correction for CT.

Science.gov (United States)

Schüller, Sören; Sawall, Stefan; Stannigel, Kai; Hülsbusch, Markus; Ulrici, Johannes; Hell, Erich; Kachelrieß, Marc

2015-02-01

The polychromatic nature of the x-ray beams and their effects on the reconstructed image are often disregarded during standard image reconstruction. This leads to cupping and beam hardening artifacts inside the reconstructed volume. To correct for a general cupping, methods like water precorrection exist. They correct the hardening of the spectrum during the penetration of the measured object only for the major tissue class. In contrast, more complex artifacts like streaks between dense objects need other techniques of correction. If using only the information of one single energy scan, there are two types of corrections. The first one is a physical approach. Thereby, artifacts can be reproduced and corrected within the original reconstruction by using assumptions in a polychromatic forward projector. These assumptions could be the used spectrum, the detector response, the physical attenuation and scatter properties of the intersected materials. A second method is an empirical approach, which does not rely on much prior knowledge. This so-called empirical beam hardening correction (EBHC) and the previously mentioned physical-based technique are both relying on a segmentation of the present tissues inside the patient. The difficulty thereby is that beam hardening by itself, scatter, and other effects, which diminish the image quality also disturb the correct tissue classification and thereby reduce the accuracy of the two known classes of correction techniques. The herein proposed method works similar to the empirical beam hardening correction but does not require a tissue segmentation and therefore shows improvements on image data, which are highly degraded by noise and artifacts. Furthermore, the new algorithm is designed in a way that no additional calibration or parameter fitting is needed. To overcome the segmentation of tissues, the authors propose a histogram deformation of their primary reconstructed CT image. This step is essential for the proposed

Loading History Effect on Creep Deformation of Rock

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Wendong Yang

2018-06-01

Full Text Available The creep characteristics of rocks are very important for assessing the long-term stability of rock engineering structures. Two loading methods are commonly used in creep tests: single-step loading and multi-step loading. The multi-step loading method avoids the discrete influence of rock specimens on creep deformation and is relatively time-efficient. It has been widely accepted by researchers in the area of creep testing. However, in the process of multi-step loading, later deformation is affected by earlier loading. This is a key problem in considering the effects of loading history. Therefore, we intend to analyze the deformation laws of rock under multi-step loading and propose a method to correct the disturbance of the preceding load. Based on multi-step loading creep tests, the memory effect of creep deformation caused by loading history is discussed in this paper. A time-affected correction method for the creep strains under multi-step loading is proposed. From this correction method, the creep deformation under single-step loading can be estimated by the super-position of creeps obtained by the dissolution of a multistep creep. We compare the time-affected correction method to the coordinate translation method without considering loading history. The results show that the former results are more consistent with the experimental results. The coordinate translation method produces a large error which should be avoided.

Use of a percutaneous osteotomy with plate fixation in hallux valgus correction.

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Díaz Fernández, Rodrigo

2017-09-20

With hundreds of operative methods described for correction of hallux valgus we can state that the ideal surgical treatment is still controversial. The Bösch technique has been used as a percutaneous way of correcting hallux valgus deformities with the use of a pin fixation. The aim of this study is to evaluate a new method of fixation by using a percutaneous locking plate. Between June 2013 and January 2015, 24 consecutive percutaneous subcapital osteotomies of the first metatarsal bone were performed for the treatment of painful hallux valgus deformities in 24 patients. Additional surgical procedures included DMMO's (Distal Metatarsal Minimally-Invasive Osteotomies) in 12 of the operated feet (44.44%); minor digits were corrected in 7 cases (25.9%). An Akin procedure was performed in 81% of cases and all cases underwent an adductor hallucis tenotomy. All patients were clinically assessed using the AOFAS score. Radiographic measures included the preoperative and postoperative values of the Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), and the Distal Metatarsal Articular Angle (DMAA). The mean correction achieved improved for AHV from 36.57±7.1 to 12.22±8.69°, for IMA from 13.8±1.59 to 7.08±2.72 and for DMAA from 13.98±7.38 to 6.07±4.99. Clinically, scores on the AOFAS scale improved from a 45.8±9.6 to 91.29±9.8. Although healing of the osteotomies was observed radiographically within 6 to 12 weeks, two cases (8.3%) exhibited delayed healing. There were no cases of nonunion. There were no superficial or deep infections or wound healing problems. Plate had to be removed in 3 cases (12.5%). This technique modification is an acceptable procedure to correct hallux valgus in patients with a moderate level of deformity. Level IV. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Three-dimensional deformation of orthodontic brackets

Science.gov (United States)

Melenka, Garrett W; Nobes, David S; Major, Paul W

2013-01-01

Braces are used by orthodontists to correct the misalignment of teeth in the mouth. Archwire rotation is a particular procedure used to correct tooth inclination. Wire rotation can result in deformation to the orthodontic brackets, and an orthodontic torque simulator has been designed to examine this wire–bracket interaction. An optical technique has been employed to measure the deformation due to size and geometric constraints of the orthodontic brackets. Images of orthodontic brackets are collected using a stereo microscope and two charge-coupled device cameras, and deformation of orthodontic brackets is measured using a three-dimensional digital image correlation technique. The three-dimensional deformation of orthodontic brackets will be evaluated. The repeatability of the three-dimensional digital image correlation measurement method was evaluated by performing 30 archwire rotation tests using the same bracket and archwire. Finally, five Damon 3MX and five In-Ovation R self-ligating brackets will be compared using this technique to demonstrate the effect of archwire rotation on bracket design. PMID:23762201

Three-dimensional deformation of orthodontic brackets.

Science.gov (United States)

Melenka, Garrett W; Nobes, David S; Major, Paul W; Carey, Jason P

2013-01-01

Braces are used by orthodontists to correct the misalignment of teeth in the mouth. Archwire rotation is a particular procedure used to correct tooth inclination. Wire rotation can result in deformation to the orthodontic brackets, and an orthodontic torque simulator has been designed to examine this wire-bracket interaction. An optical technique has been employed to measure the deformation due to size and geometric constraints of the orthodontic brackets. Images of orthodontic brackets are collected using a stereo microscope and two charge-coupled device cameras, and deformation of orthodontic brackets is measured using a three-dimensional digital image correlation technique. The three-dimensional deformation of orthodontic brackets will be evaluated. The repeatability of the three-dimensional digital image correlation measurement method was evaluated by performing 30 archwire rotation tests using the same bracket and archwire. Finally, five Damon 3MX and five In-Ovation R self-ligating brackets will be compared using this technique to demonstrate the effect of archwire rotation on bracket design.

Morphologic assessment of thoracic deformities for the preoperative evaluation of pectus excavatum by magnetic resonance imaging

Energy Technology Data Exchange (ETDEWEB)

Lollert, A.; Funk, J.; Tietze, N.; Laudemann, K.; Dueber, C.; Staatz, G. [Medical Center of the Johannes Gutenberg University, Department of Diagnostic and Interventional Radiology, Section Pediatric Radiology, Mainz (Germany); Turial, S. [Medical Center of the Johannes Gutenberg University, Department of Pediatric Surgery, Mainz (Germany)

2014-10-15

To assess whether MRI is a suitable modality for the preoperative assessment and quantification of pectus excavatum. A total of 69 patients (57 male, 12 female; median age 15 years, range 5-35 years) with pectus excavatum were evaluated preoperatively using standardized MRI sequences on 1.5- and 3-Tesla systems (T2-HASTE/inspiration and expiration, T1-VIBE, T2-TRUFI free-breathing, T2-BLADE). The MR sequences were analysed for quality semiquantitatively. The Haller index, correction index, sternal rotation angle and asymmetry index were assessed; correlations between these indices and changes in inspiration and expiration were evaluated. T2-HASTE was the best sequence to assess pectus excavatum morphology, with a higher quality at 3 T than at 1.5 T. All indices could be assessed in every patient. A total of 37 patients had a symmetric deformity, 32 patients an asymmetric deformity. The Haller index correlated significantly (p < 0.001) with the correction index, both becoming higher in expiration. The asymmetry index correlated with the sternal rotation angle (p < 0.001) and did not change significantly in expiration (p = 0.28). Thoracic MRI is suitable for the preoperative evaluation of patients with pectus excavatum. An exact morphologic assessment is possible without radiation exposure as well as the determination of several indices to quantify the deformities. (orig.)

Application of computer-aided design osteotomy template for treatment of cubitus varus deformity in teenagers: a pilot study.

Science.gov (United States)

Zhang, Yuan Z; Lu, Sheng; Chen, Bin; Zhao, Jian M; Liu, Rui; Pei, Guo X

2011-01-01

Treatment of cubitus varus deformity from a malunited fracture is a challenge. Anatomically accurate correction is the key to obtaining good functional outcomes after corrective osteotomy. The aim of this study was to attempt to increase the accuracy of treatment by use of 3-dimensional (3D) computer-aided design. We describe a novel method for ensuring an accurate osteotomy method in the treatment of cubitus varus deformity in teenagers by means of 3D reconstruction and reverse engineering. Between January 2006 and May 2008, 12 male and 6 female patients with cubitus varus deformities underwent scanning with spiral computed tomography (CT) preoperatively. The mean age was 15.7 years, ranging from 13 to 19 years. Three-dimensional CT image data of the affected and contralateral normal bones of cubitus were transferred to a computer workstation. Three-dimensional models of cubitus were reconstructed by use of MIMICS software. The 3D models were then processed by Imageware software. An osteotomy template that best fitted the angle and range of osteotomy was "reversely" built from the 3D model. These templates were manufactured by a rapid prototyping machine. The osteotomy templates guide the osteotomy of cubitus. An accurate angle of osteotomy was confirmed by postoperative radiography. After 12 to 24 months' follow-up, the mean postoperative carrying angle in 18 patients with cubitus varus deformity was 7.3° (range, 5° to 11°), with a mean correction of 21.9° (range, 12° to 41°). The patient-specific template technique is easy to use, can simplify the surgical act, and generates highly accurate osteotomy in cubitus varus deformity in teenagers. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Safety and efficacy of botox injection in alleviating post-operative pain and improving quality of life in lower extremity limb lengthening and deformity correction

Directory of Open Access Journals (Sweden)

Finley Allen

2007-09-01

Full Text Available Abstract Background Distraction osteogenesis is the standard treatment for the management of lower limb length discrepancy of more than 3 cm and bone loss secondary to congenital anomalies, trauma or infection. This technique consists of an osteotomy of the bone to be lengthened, application of an external fixator, followed by gradual and controlled distraction of the bone ends. Although limb lengthening using the Ilizarov distraction osteogenesis principle yields excellent results in most cases, the technique has numerous problems and is not well tolerated by many children. The objective of the current study is to determine if Botulinum Toxin A (BTX-A, which is known to possess both analgesic and paralytic actions, can be used to alleviate post-operative pain and improve the functional outcome of children undergoing distraction osteogenesis. Methods/Design The study design consists of a multi centre, randomized, double-blinded, placebo-controlled trial. Patients between ages 5–21 years requiring limb lengthening or deformity correction using distraction will be recruited from 6 different sites (Shriners Hospital for Children in Montreal, Honolulu, Philadelphia and Portland as well as DuPont Hospital for Children in Wilmington, Delaware and Hospital for Sick Children in Toronto, Ont. Approximately 150 subjects will be recruited over 2 years and will be randomized to either receive 10 units per Kg of BTX-A or normal saline (control group intraoperatively following the surgery. Functional outcome effects will be assessed using pain scores, medication dosages, range of motion, flexibility, strength, mobility function and quality of life of the patient. IRB approval was obtained from all sites and adverse reactions will be monitored vigorously and reported to IRB, FDA and Health Canada. Discussion BTX-A injection has been widely used world wide with no major side effects reported. However, to the best of our knowledge, this is the first time BTX

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

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

2018-05-03

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

Local setup errors in image-guided radiotherapy for head and neck cancer patients immobilized with a custom-made device.

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Giske, Kristina; Stoiber, Eva M; Schwarz, Michael; Stoll, Armin; Muenter, Marc W; Timke, Carmen; Roeder, Falk; Debus, Juergen; Huber, Peter E; Thieke, Christian; Bendl, Rolf

2011-06-01

To evaluate the local positioning uncertainties during fractionated radiotherapy of head-and-neck cancer patients immobilized using a custom-made fixation device and discuss the effect of possible patient correction strategies for these uncertainties. A total of 45 head-and-neck patients underwent regular control computed tomography scanning using an in-room computed tomography scanner. The local and global positioning variations of all patients were evaluated by applying a rigid registration algorithm. One bounding box around the complete target volume and nine local registration boxes containing relevant anatomic structures were introduced. The resulting uncertainties for a stereotactic setup and the deformations referenced to one anatomic local registration box were determined. Local deformations of the patients immobilized using our custom-made device were compared with previously published results. Several patient positioning correction strategies were simulated, and the residual local uncertainties were calculated. The patient anatomy in the stereotactic setup showed local systematic positioning deviations of 1-4 mm. The deformations referenced to a particular anatomic local registration box were similar to the reported deformations assessed from patients immobilized with commercially available Aquaplast masks. A global correction, including the rotational error compensation, decreased the remaining local translational errors. Depending on the chosen patient positioning strategy, the remaining local uncertainties varied considerably. Local deformations in head-and-neck patients occur even if an elaborate, custom-made patient fixation method is used. A rotational error correction decreased the required margins considerably. None of the considered correction strategies achieved perfect alignment. Therefore, weighting of anatomic subregions to obtain the optimal correction vector should be investigated in the future. Copyright © 2011 Elsevier Inc. All rights

Transcranial motor evoked potential waveform changes in corrective fusion for adolescent idiopathic scoliosis.

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Kobayashi, Kazuyoshi; Imagama, Shiro; Ito, Zenya; Ando, Kei; Hida, Tetsuro; Ito, Kenyu; Tsushima, Mikito; Ishikawa, Yoshimoto; Matsumoto, Akiyuki; Nishida, Yoshihiro; Ishiguro, Naoki

2017-01-01

OBJECTIVE Corrective surgery for spinal deformities can lead to neurological complications. Several reports have described spinal cord monitoring in surgery for spinal deformity, but only a few have included patients younger than 20 years with adolescent idiopathic scoliosis (AIS). The goal of this study was to evaluate the characteristics of cases with intraoperative transcranial motor evoked potential (Tc-MEP) waveform deterioration during posterior corrective fusion for AIS. METHODS A prospective database was reviewed, comprising 68 patients with AIS who were treated with posterior corrective fusion in a prospective database. A total of 864 muscles in the lower extremities were chosen for monitoring, and acceptable baseline responses were obtained from 819 muscles (95%). Intraoperative Tc-MEP waveform deterioration was defined as a decrease in intraoperative amplitude of ≥ 70% of the control waveform. Age, Cobb angle, flexibility, operative time, estimated blood loss (EBL), intraoperative body temperature, blood pressure, number of levels fused, and correction rate were examined in patients with and without waveform deterioration. RESULTS The patients (3 males and 65 females) had an average age of 14.4 years (range 11-19 years). The mean Cobb angles before and after surgery were 52.9° and 11.9°, respectively, giving a correction rate of 77.4%. Fourteen patients (20%) exhibited an intraoperative waveform change, and these occurred during incision (14%), after screw fixation (7%), during the rotation maneuver (64%), during placement of the second rod after the rotation maneuver (7%), and after intervertebral compression (7%). Most waveform changes recovered after decreased correction or rest. No patient had a motor deficit postoperatively. In multivariate analysis, EBL (OR 1.001, p = 0.085) and number of levels fused (OR 1.535, p = 0.045) were associated with waveform deterioration. CONCLUSIONS Waveform deterioration commonly occurred during rotation maneuvers

Corrección de "labio ondulado" en el síndrome de Melkersson-Rosenthal Upper lip "ruffle deformity" correction in Melkerson- Rosenthal's syndrome

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C. Gutiérrez Gómez

2009-03-01

Full Text Available El Síndrome de Melkersson-Rosenthal es una entidad rara caracterizada por edema granulomatoso orofacial, episodios de parálisis facial y lengua plegada. La presentación monosintomática de labios se denomina queilitis granulomatosa de Miescher. Clásicamente se ha tratado con múltiples medicamentos con respuesta parcial o insatisfactoria, por lo que el tratamiento ideal es el quirúrgico, que obtiene resultados permanentes y permite al paciente relaciones interpersonales satisfactorias. Sin embargo la corrección propuesta por los diferentes autores disminuye el grosor del labio a expensas de dejar un estigma de deformidad de labio "ondulado" ya que no se acorta el labio en sentido transverso y únicamente se adelgaza. El presente artículo describe el tratamiento propuesto para corregir esta deformidad mediante la resección en bloque del tercio medio del labio superior. Además hace referencia a la afectación del cuello en el caso que presentamos, no descrita en la bibliografía actual al respecto, que daba al paciente un aspecto de cuello de "iguana", y que fue corregida mediante resección en huso y liposucción.Melkersson-Rosenthal Syndrome is a rare entity characterized by granulomatous orofacial swelling, recurrent facial palsy and lingua plicata. It's monosyntomatic form affecting only lips is known as Miescher granulomatous cheilitis. Many conservative treatments have been proposed to resolve the swelling; however many times they present recurrence or fail to respond. The surgical correction permit permanent improvement and better appearance. The surgical posterior reduction cheiloplastry removing mucosa and submucosa all along the lip proposed by several authors, gives the lips an stigma of the " ruffle" aspect; this is because there is no shortening of the total length of the previously enlarged lip because of the granulomatous swelling. We report the correction of this deformity by total thickness resection of the middle third

Aortic valve-sparing operation after correction of heart displacement due to pectus excavatum using Nuss procedure in a Marfan syndrome patient.

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Fukunaga, Naoto; Yuzaki, Mitsuru; Hamakawa, Hiroshi; Nasu, Michihiro; Takahashi, Yutaka; Okada, Yukikatsu

2012-01-01

Cardiovascular surgery in the setting of chest wall deformities is a clinical challenge. Pectus excavatum, for example, can cause heart displacement to the left thoracic cavity, following the poor operative field. This report highlights a case in which a successful aortic valve-sparing operation via conventional median sternotomy after correction of the heart displacement due to pectus excavatum using Nuss procedure in Marfan syndrome. This technique can be one surgical option in Marfan syndrome patients with pectus excavatum and thoracic aortic aneurysm under close follow up.

MO-FG-CAMPUS-JeP1-05: Water Equivalent Path Length Calculations Using Scatter-Corrected Head and Neck CBCT Images to Evaluate Patients for Adaptive Proton Therapy

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Kim, J; Park, Y; Sharp, G; Winey, B [Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States)

2016-06-15

Purpose: To establish a method to evaluate the dosimetric impact of anatomic changes in head and neck patients during proton therapy by using scatter-corrected cone-beam CT (CBCT) images. Methods: The water equivalent path length (WEPL) was calculated to the distal edge of PTV contours by using tomographic images available for six head and neck patients received photon therapy. The proton range variation was measured by calculating the difference between the distal WEPLs calculated with the planning CT and weekly treatment CBCT images. By performing an automatic rigid registration, six degrees-of-freedom (DOF) correction was made to the CBCT images to account for the patient setup uncertainty. For accurate WEPL calculations, an existing CBCT scatter correction algorithm, whose performance was already proven for phantom images, was calibrated for head and neck patient images. Specifically, two different image similarity measures, mutual information (MI) and mean square error (MSE), were tested for the deformable image registration (DIR) in the CBCT scatter correction algorithm. Results: The impact of weight loss was reflected in the distal WEPL differences with the aid of the automatic rigid registration reducing the influence of patient setup uncertainty on the WEPL calculation results. The WEPL difference averaged over distal area was 2.9 ± 2.9 (mm) across all fractions of six patients and its maximum, mostly found at the last available fraction, was 6.2 ± 3.4 (mm). The MSE-based DIR successfully registered each treatment CBCT image to the planning CT image. On the other hand, the MI-based DIR deformed the skin voxels in the planning CT image to the immobilization mask in the treatment CBCT image, most of which was cropped out of the planning CT image. Conclusion: The dosimetric impact of anatomic changes was evaluated by calculating the distal WEPL difference with the existing scatter-correction algorithm appropriately calibrated. Jihun Kim, Yang-Kyun Park

Use of repeat anterior maxillary distraction to correct residual midface hypoplasia in cleft patients.

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Richardson, Sunil; Krishna, Shreya; Bansal, Avi

2017-12-01

The study was designed to evaluate the efficacy of performing a second, repeat anterior maxillary distraction (AMD) to treat residual cleft maxillary hypoplasia. Five patients between the ages of 12 to 15 years with a history of AMD and with residual cleft maxillary hypoplasia were included in the study. Inclusion was irrespective of gender, type of cleft lip and palate, and the amount of advancement needed. Repeat AMD was executed in these patients 4 to 5 years after the primary AMD procedure to correct the cleft maxillary hypoplasia that had developed since the initial procedure. Orthopantomogram (OPG) and lateral cephalograms were taken for evaluation preoperatively, immediately after distraction, after consolidation, and one year postoperatively. The data obtained was tabulated and a Mann Whitney U-test was used for statistical comparisons. At the time of presentation, a residual maxillary hypoplasia was observed with a well maintained distraction gap on the OPG which ruled out the occurrence of a relapse. Favorable movement of the segments without any resistance was seen in all patients. Mean maxillary advancement of 10.56 mm was achieved at repeat AMD. Statistically significant increases in midfacial length, SNA angle, and nasion perpendicular to point A distance was achieved ( P =0.012, P =0.011, and P =0.012, respectively). Good profile was achieved for all patients. Minimal transient complications, for example anterior open bite and bleeding episodes, were managed. Addressing the problem of cleft maxillary hypoplasia at an early age (12-15 years) is beneficial for the child. Residual hypoplasia may develop in some patients, which may require additional corrective procedures. The results of our study show that AMD can be repeated when residual deformity develops with the previous procedure having no negative impact on the results of the repeat procedure.

Surgical treatment of gross posttraumatic deformations in thoracic spine

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Aleksei E. Shul’ga

2017-10-01

Full Text Available Rigid severe post-traumatic thoracic spine deformities result from frequent, recent high-energy trauma in children with an increasing frequency due to a variety of reasons. These types of injuries are commonly followed by spinal cord anatomic injury; therefore, the treatment of these patients warrants special attention from the ethical viewpoint. Generally, the only indication for surgical intervention is spinal dysfunction. Considering this and the patients’ ordinary severe somatic state, surgical trauma should be minimized as much as possible. However, for adequate deformity correction, effective spine stabilization and restoration of liquorodynamics is necessary. Recent studies have reported the successful use of different methods of dorsal interventions (P/VCR in cases with unstable damages in children. Here, we present the case of a 15-year-old boy who underwent surgical treatment for coarse post-traumatic thoracic spine deformity with chronic fracture-dislocation of Th7 vertebra.

Calculation of the Target Lumbar Lordosis Angle for Restoring an Optimal Pelvic Tilt in Elderly Patients With Adult Spinal Deformity.

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Yamato, Yu; Hasegawa, Tomohiko; Kobayashi, Sho; Yasuda, Tatsuya; Togawa, Daisuke; Arima, Hideyuki; Oe, Shin; Iida, Takahiro; Matsumura, Akira; Hosogane, Naobumi; Matsumoto, Morio; Matsuyama, Yukihiro

2016-02-01

This investigation consisted of a cross-sectional study and a retrospective multicenter case series. This investigation sought to identify the ideal lumbar lordosis (LL) angle for restoring an optimal pelvic tilt (PT) in patients with adult spinal deformity (ASD). To achieve successful corrective fusion in ASD patients with sagittal imbalance, it is essential to correct the sagittal spinal alignment and obtain a suitable pelvic inclination. We determined the LL angle that would restore the optimal PT following ASD surgery. The cross-sectional study included 184 elderly volunteers (mean age 64 years) with an Oswestry Disability Index score less than 20%. The relationship between PT or LL and the pelvic incidence (PI) in normal individuals was investigated. The second study included 116 ASD patients (mean age 66 years) who underwent thoracolumbar corrective fusion at 1 of 4 spine centers. The postoperative PT values were calculated using the parameters measured. On the basis of these studies, an ideal LL angle was determined. In the cross-sectional study, the linear regression equation for the optimal PT as a function of PI was "optimal PT = 0.47 × PI - 7.5." In the second study, the postoperative PT was determined as a function of PI and corrected LL, using the equation "postoperative PT = 0.7 × PI - 0.5 × corrected LL + 8.1." The target LL angle was determined by mathematically equalizing the PTs of these 2 equations: "target LL = 0.45 × PI + 31.8." The ideal LL angle can be determined using the equation "LL = 0.45 × PI + 31.8," which can be used as a reference during surgical planning in ASD cases. 4.

Vertebral Column Resection for Rigid Spinal Deformity.

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Saifi, Comron; Laratta, Joseph L; Petridis, Petros; Shillingford, Jamal N; Lehman, Ronald A; Lenke, Lawrence G

2017-05-01

Broad narrative review. To review the evolution, operative technique, outcomes, and complications associated with posterior vertebral column resection. A literature review of posterior vertebral column resection was performed. The authors' surgical technique is outlined in detail. The authors' experience and the literature regarding vertebral column resection are discussed at length. Treatment of severe, rigid coronal and/or sagittal malalignment with posterior vertebral column resection results in approximately 50-70% correction depending on the type of deformity. Surgical site infection rates range from 2.9% to 9.7%. Transient and permanent neurologic injury rates range from 0% to 13.8% and 0% to 6.3%, respectively. Although there are significant variations in EBL throughout the literature, it can be minimized by utilizing tranexamic acid intraoperatively. The ability to correct a rigid deformity in the spine relies on osteotomies. Each osteotomy is associated with a particular magnitude of correction at a single level. Posterior vertebral column resection is the most powerful posterior osteotomy method providing a successful correction of fixed complex deformities. Despite meticulous surgical technique and precision, this robust osteotomy technique can be associated with significant morbidity even in the most experienced hands.

Prior-based artifact correction (PBAC) in computed tomography

International Nuclear Information System (INIS)

Heußer, Thorsten; Brehm, Marcus; Ritschl, Ludwig; Sawall, Stefan; Kachelrieß, Marc

2014-01-01

Purpose: Image quality in computed tomography (CT) often suffers from artifacts which may reduce the diagnostic value of the image. In many cases, these artifacts result from missing or corrupt regions in the projection data, e.g., in the case of metal, truncation, and limited angle artifacts. The authors propose a generalized correction method for different kinds of artifacts resulting from missing or corrupt data by making use of available prior knowledge to perform data completion. Methods: The proposed prior-based artifact correction (PBAC) method requires prior knowledge in form of a planning CT of the same patient or in form of a CT scan of a different patient showing the same body region. In both cases, the prior image is registered to the patient image using a deformable transformation. The registered prior is forward projected and data completion of the patient projections is performed using smooth sinogram inpainting. The obtained projection data are used to reconstruct the corrected image. Results: The authors investigate metal and truncation artifacts in patient data sets acquired with a clinical CT and limited angle artifacts in an anthropomorphic head phantom data set acquired with a gantry-based flat detector CT device. In all cases, the corrected images obtained by PBAC are nearly artifact-free. Compared to conventional correction methods, PBAC achieves better artifact suppression while preserving the patient-specific anatomy at the same time. Further, the authors show that prominent anatomical details in the prior image seem to have only minor impact on the correction result. Conclusions: The results show that PBAC has the potential to effectively correct for metal, truncation, and limited angle artifacts if adequate prior data are available. Since the proposed method makes use of a generalized algorithm, PBAC may also be applicable to other artifacts resulting from missing or corrupt data

Mistakes and complications in the surgical treatment of ambulatory equino planovalgus foot deformities in patients with cerebral palsy using extra-articular subtalar arthrodesis

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Valery V Umnov

2016-06-01

Full Text Available Aim. To evaluate the results of a modified technique for extra-articular arthrodesis of the subtalar joint for patients with cerebral palsy with an ambulatory form of equine-planovalgus deformity of the foot. The mistakes and complications that occurred during treatment with this technique are discussed. Materials and methods. Between 2005 and 2015, this surgical method for performing arthrodesis of the subtalar joint, was performed on 544 patients (989 feet between 4 and 15 years old. Correction of equinus contracture was performed using Achilles tendon plasty or dissection of the tendon of the gastrocnemius muscle. Abnormal muscle tone was reduced either by administering Dysport® in the calf muscle or by selective neurotomy of the tibial nerve. Results. Good results were achieved for 72% of cases, satisfactory for 23% of cases, and unsatisfactory for 5% of cases. Unsatisfactory results of treatment were associated with overvaluation of the degree of mobility of the deformity and with a number of technical and tactical mistakes. Conclusion. This analysis of mistakes and complications of extra-articular arthrodesis of the subtalar joint will allow surgeons to avoid these issues in the future and improve the quality of treatment for similar patients.

Methods to score vertebral deformities in patients with rheumatoid arthritis

NARCIS (Netherlands)

Lems, W. F.; Jahangier, Z. N.; Raymakers, J. A.; Jacobs, J. W.; Bijlsma, J. W.

1997-01-01

The objective was to compare four different scoring methods for vertebral deformities: the semiquantitative Kleerekoper score and three quantitative scores (according to Minne, Melton and Raymakers) in patients with rheumatoid arthritis (RA). Lateral radiographs of the thoracic and lumbar vertebral

Predictors of emotional functioning in youth after surgical correction of idiopathic scoliosis.

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Zebracki, Kathy; Thawrani, Dinesh; Oswald, Timothy S; Anadio, Jennifer M; Sturm, Peter F

2013-09-01

Patients with idiopathic scoliosis, although otherwise healthy, often have significant concerns about their self-image and appearance. In a group of juveniles and adolescents, this can impact adjustment in school, functioning in peer groups, and general sense of well-being. There are limited data to help physicians reliably and precisely identify those who are at higher risk of poor emotional adjustment even after spine deformity correction. The purpose of this study was to determine the predictors of emotional maladjustment in juvenile and adolescent patients after surgical correction of idiopathic scoliosis. A total of 233 juveniles, mean age 11.26 ± 1.02 (range, 8 to 12) years and 909 adolescents, mean age 14.91 ± 1.61 (range, 13 to 21) years, who underwent surgical correction for idiopathic scoliosis and who were participating in a prospective longitudinal multicenter database, were enrolled in the study. Participants completed the Scoliosis Research Society-22 (SRS-22) questionnaire before surgery and 2 years postoperatively. Radiographs were used to measure Cobb angle and surface measurements were used to determine decompensation and trunk shift. Adolescents reported poorer mental health preoperatively (Pself-image (Pself-image (Padolescent group, mental health 2 years postoperatively was predicted by preoperative mental health (Pself-image 2 years postoperatively was predicted by preoperative mental health (Pself-image (PSelf-image and mental health are significantly improved after spine deformity correction in juveniles and adolescents with idiopathic scoliosis. However, consistent with normative development, adolescents are at higher risk for emotional maladjustment than juveniles. Surgical decision making in scoliosis correction should take the emotional status of the patient into consideration.

Use of 3D Printed Bone Plate in Novel Technique to Surgically Correct Hallux Valgus Deformities

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Smith, Kathryn E.; Dupont, Kenneth M.; Safranski, David L.; Blair, Jeremy; Buratti, Dawn; Zeetser, Vladimir; Callahan, Ryan; Lin, Jason; Gall, Ken

2016-01-01

Three-dimensional (3-D) printing offers many potential advantages in designing and manufacturing plating systems for foot and ankle procedures that involve small, geometrically complex bony anatomy. Here, we describe the design and clinical use of a Ti-6Al-4V ELI bone plate (FastForward™ Bone Tether Plate, MedShape, Inc., Atlanta, GA) manufactured through 3-D printing processes. The plate protects the second metatarsal when tethering suture tape between the first and second metatarsals and is a part of a new procedure that corrects hallux valgus (bunion) deformities without relying on doing an osteotomy or fusion procedure. The surgical technique and two clinical cases describing the use of this procedure with the 3-D printed bone plate are presented within. PMID:28337049

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

Science.gov (United States)

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

2016-03-01

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

Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction

DEFF Research Database (Denmark)

Biering-Sorensen, Tor; Jensen, Jan Skov; Pedersen, Sune H

2016-01-01

deformation in comparison to GLS, conventional echocardiography and clinical information. Method In total 391 patients were admitted with ST-Segment elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention and subsequently examined by echocardiography. All patients were...... information to clinical and conventional echocardiographic information (Harrell's c-statistics: 0.63 vs. 0.67, p = 0.032). In addition, impaired longitudinal deformation outside the culprit lesion perfusion region was significantly associated with an adverse outcome (p...). Conclusion Regional longitudinal myocardial deformation measures, regardless if determined by TDI or 2DSE, are superior prognosticators to GLS. In addition, impaired longitudinal deformation in the inferior myocardial segment provides prognostic information over and above clinical and conventional...

Hi-speed compact deformable mirror: status, applications, and perspectives

Science.gov (United States)

Rooms, F.; Camet, S.; Curis, J.-F.

2010-02-01

Membrane deformable mirrors based on magnetic actuators have been known for years. State-of-the-art deformable mirrors usually have large strokes but low bandwidth. Furthermore, this bandwidth decreases with the diameter. In this paper, we present the results of a new actuator principle based on magnetic forces allowing high bandwidth (up to a few kHz), very large stroke (>30μm) with a record pitch of 1.5mm. The benefits of this technology will be presented for three applications: astronomy, vision science and microscopy. The parameters of the mirrors have been tuned such that the inter-actuator stroke of the deformable (more than 2.0μm) in order to fit the atmosphere turbulence characteristics. In vision science, efforts have been made to correct both simultaneously the low and high order aberrations (more than 45μm of wavefront correction on astigmatism and focus). Finally, we will demonstrate how we have developed a deformable mirror able to correct spherical aberrations (microscopy). The last part of the article is devoted to give some perspectives about this technology.

Automated landmark-guided deformable image registration.

Science.gov (United States)

Kearney, Vasant; Chen, Susie; Gu, Xuejun; Chiu, Tsuicheng; Liu, Honghuan; Jiang, Lan; Wang, Jing; Yordy, John; Nedzi, Lucien; Mao, Weihua

2015-01-07

The purpose of this work is to develop an automated landmark-guided deformable image registration (LDIR) algorithm between the planning CT and daily cone-beam CT (CBCT) with low image quality. This method uses an automated landmark generation algorithm in conjunction with a local small volume gradient matching search engine to map corresponding landmarks between the CBCT and the planning CT. The landmarks act as stabilizing control points in the following Demons deformable image registration. LDIR is implemented on graphics processing units (GPUs) for parallel computation to achieve ultra fast calculation. The accuracy of the LDIR algorithm has been evaluated on a synthetic case in the presence of different noise levels and data of six head and neck cancer patients. The results indicate that LDIR performed better than rigid registration, Demons, and intensity corrected Demons for all similarity metrics used. In conclusion, LDIR achieves high accuracy in the presence of multimodality intensity mismatch and CBCT noise contamination, while simultaneously preserving high computational efficiency.

Automated landmark-guided deformable image registration

International Nuclear Information System (INIS)

Kearney, Vasant; Chen, Susie; Gu, Xuejun; Chiu, Tsuicheng; Liu, Honghuan; Jiang, Lan; Wang, Jing; Yordy, John; Nedzi, Lucien; Mao, Weihua

2015-01-01

The purpose of this work is to develop an automated landmark-guided deformable image registration (LDIR) algorithm between the planning CT and daily cone-beam CT (CBCT) with low image quality. This method uses an automated landmark generation algorithm in conjunction with a local small volume gradient matching search engine to map corresponding landmarks between the CBCT and the planning CT. The landmarks act as stabilizing control points in the following Demons deformable image registration. LDIR is implemented on graphics processing units (GPUs) for parallel computation to achieve ultra fast calculation. The accuracy of the LDIR algorithm has been evaluated on a synthetic case in the presence of different noise levels and data of six head and neck cancer patients. The results indicate that LDIR performed better than rigid registration, Demons, and intensity corrected Demons for all similarity metrics used. In conclusion, LDIR achieves high accuracy in the presence of multimodality intensity mismatch and CBCT noise contamination, while simultaneously preserving high computational efficiency. (paper)

Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction.

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Tor Biering-Sørensen

Full Text Available Global longitudinal systolic strain (GLS has recently been demonstrated to be a superior prognosticator to conventional echocardiographic measures in patients after myocardial infarction (MI. The aim of this study was to evaluate the prognostic value of regional longitudinal myocardial deformation in comparison to GLS, conventional echocardiography and clinical information.In total 391 patients were admitted with ST-Segment elevation myocardial infarction (STEMI, treated with primary percutaneous coronary intervention and subsequently examined by echocardiography. All patients were examined by tissue Doppler imaging (TDI and two-dimensional strain echocardiography (2DSE.During a median-follow-up of 5.3 (IQR 2.5-6.1 years the primary endpoint (death, heart failure or a new MI was reached by 145 (38.9% patients. After adjustment for significant confounders (including conventional echocardiographic parameters and culprit lesion, reduced longitudinal performance in the anterior septal and inferior myocardial regions (but not GLS remained independent predictors of the combined outcome. Furthermore, inferior myocardial longitudinal deformation provided incremental prognostic information to clinical and conventional echocardiographic information (Harrell's c-statistics: 0.63 vs. 0.67, p = 0.032. In addition, impaired longitudinal deformation outside the culprit lesion perfusion region was significantly associated with an adverse outcome (p<0.05 for all deformation parameters.Regional longitudinal myocardial deformation measures, regardless if determined by TDI or 2DSE, are superior prognosticators to GLS. In addition, impaired longitudinal deformation in the inferior myocardial segment provides prognostic information over and above clinical and conventional echocardiographic risk factors. Furthermore, impaired longitudinal deformation outside the culprit lesion perfusion region seems to be a paramount marker of adverse outcome.

Guidelines for patient-specific jawline definition with titanium implants in esthetic, deformity, and malformation surgery.

Science.gov (United States)

Mommaerts, Maurice Yves

2016-01-01

Asymmetry and unfavorable esthetics of the jawline have become possible to correct in three dimensions using computer aided design and computer aided manufacturing. The aim of this study was to provide esthetic, technical, and operative guidelines for mandibular angle and border augmentation using patient-specific titanium implants made by selective laser melting. University hospital - prospective registry. Twelve patients and 17 implantation sites were documented and prospectively registered. Malformational, deformational, and purely esthetic indications were encountered. Descriptive. Patient satisfaction was high, probably because the patients had input into the planned dimensions and shape. A serious infection with implant removal occurred in one patient who had six previous surgeries at the same sites. Technical and surgical guidelines were developed including splitting implants into two segments when the mental nerve was at risk, using a three-dimensional (3D) puzzle connection, providing at least two screw holes per segment, using scaffolds at the bony contact side, using a "satin" finish at the periosteal side, referring to anatomical structures where possible, making provisions for transbuccal and transoral fixation, using a high vestibular incision, and using a double-layer closure. Esthetic guidelines are discussed but could not be upgraded. Mirroring techniques and 3D print accuracy up to 0.1 mm allow precise planning of jaw angle implants. Patients are pleased when given preoperative renderings for their consideration. Infections can be managed using technical and operative recommendations and careful patient selection.

Aesthetic acceptance equals to nature's compensation plus surgical correction.

Science.gov (United States)

Vadgaonkar, Vaishali; Gangurde, Parag; Karandikar, Anita; Mahajan, Nikhil

2013-07-25

Orthognathic surgery has become an acceptable treatment plan for patients with various maxillofacial deformities. The rehabilitation of severe class III adult patients requires a complex interdisciplinary orthodontic and orthognathic approach. This presentation aims to show a case of combination of camouflage and bilateral sagittal split osteotomy (BSSO).Camouflage in maxillary arch was accepted after analysing visual treatment objective (VTO) and pleasing soft tissue compensation which gave us the clue to go ahead for surgical correction of excess mandibular length to achieve best aesthetic outcome while maintaining nature's compensation in upper arch.

Adaptive radial basis function mesh deformation using data reduction

Science.gov (United States)

Gillebaart, T.; Blom, D. S.; van Zuijlen, A. H.; Bijl, H.

2016-09-01

Radial Basis Function (RBF) mesh deformation is one of the most robust mesh deformation methods available. Using the greedy (data reduction) method in combination with an explicit boundary correction, results in an efficient method as shown in literature. However, to ensure the method remains robust, two issues are addressed: 1) how to ensure that the set of control points remains an accurate representation of the geometry in time and 2) how to use/automate the explicit boundary correction, while ensuring a high mesh quality. In this paper, we propose an adaptive RBF mesh deformation method, which ensures the set of control points always represents the geometry/displacement up to a certain (user-specified) criteria, by keeping track of the boundary error throughout the simulation and re-selecting when needed. Opposed to the unit displacement and prescribed displacement selection methods, the adaptive method is more robust, user-independent and efficient, for the cases considered. Secondly, the analysis of a single high aspect ratio cell is used to formulate an equation for the correction radius needed, depending on the characteristics of the correction function used, maximum aspect ratio, minimum first cell height and boundary error. Based on the analysis two new radial basis correction functions are derived and proposed. This proposed automated procedure is verified while varying the correction function, Reynolds number (and thus first cell height and aspect ratio) and boundary error. Finally, the parallel efficiency is studied for the two adaptive methods, unit displacement and prescribed displacement for both the CPU as well as the memory formulation with a 2D oscillating and translating airfoil with oscillating flap, a 3D flexible locally deforming tube and deforming wind turbine blade. Generally, the memory formulation requires less work (due to the large amount of work required for evaluating RBF's), but the parallel efficiency reduces due to the limited

Entanglement entropy evolution under double-trace deformation

Energy Technology Data Exchange (ETDEWEB)

Song, Yushu [College of Physical Science and Technology, Hebei University, Baoding (China)

2017-12-15

In this paper, we study the bulk entanglement entropy evolution in conical BTZ black bole background using the heat kernel method. This is motivated by exploring the new examples where the quantum correction of the entanglement entropy gives the leading contribution. We find that in the large black hole limit the bulk entanglement entropy decreases under the double-trace deformation which is consistent with the holographic c theorem and in the small black hole limit the bulk entanglement entropy increases under the deformation. We also discuss the minimal area correction. (copyright 2017 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

Corrective Jaw Surgery

Medline Plus

Full Text Available ... surgery. It is important to understand that your treatment, which will probably include orthodontics before and after ... to realistically estimate the time required for your treatment. Correction of Common Dentofacial Deformities ​ ​ The information provided ...

Patient Satisfaction with Surgical Outcome after Hypospadias Correction

NARCIS (Netherlands)

Dokter, E.M.J.; Moues, C.M.; Rooij, I.A.L.M. van; Biezen, J.J. van der

2017-01-01

Background: Hypospadias is a congenital malformation in which surgical correction is indicated in most cases. Postoperative patient satisfaction is important because of its influence on the child's psychological development. Objective: To evaluate patient satisfaction with surgical outcome after

Transantral distraction devices in correction of severe maxillary deformity in cleft patients.

Science.gov (United States)

Shokirov, Shokhruh; Wangerin, Konrad

2011-01-01

Maxillary advancement by Le Fort I osteotomy in cleft patients has an average relapse of about 40-60 percent. With extraoral distraction devices it is possible to obtain an almost unlimited advancement of the upper jaw. Due to the social problems the retention period is normally reduced to some monthes. A relapse of 10-25 % can be seen in these cases. Le Fort I internal distraction osteogenesis offers an alternative to one-step orthognathic advancement, with advantages of gradual lengthening through scar and earlier treatment in growing patients. The objective of this study was to present our experience in the treatment of maxillary deficiency in cleft patients using transantral internal distraction devices. The distraction procedure was successfully accomplished in seventeen patients. For all the seventeen patients maxillary distraction device designed by Konrad Wangerin was used. The distraction distances were 8 to 24 mm. Preoperative, postoperative, and follow-up (12 and 24 months) lateral cephalogram measurements were compared including angular and linear changes. A good new bone was found that was formed in distraction pitch between lines of osteotomy. After distraction of median facial zone, occlusion and profile of soft tissues were considerably improved. All patients after postoperative time required final orthodontic treatment and their final occlusal relationships were satisfactory. The transantral distraction device is a new option for the treatment of severe maxillary hypoplasia in cleft patients.

Individualised distal femoral cut improves femoral component placement and limb alignment during total knee replacement in knees with moderate and severe varus deformity.

Science.gov (United States)

Palanisami, Dhanasekararaja; Iyyampillai, Geethan; Shanmugam, Sivaraj; Natesan, Rajkumar; S, Rajasekaran

2016-10-01

Our aim was to determine the variation in valgus correction angle and the influence of individualised distal femoral cut on femoral component placement and limb alignment during total knee replacement (TKR) in knees with varus deformity. The study was done prospectively in two stages. In the first stage, the valgus correction angle (VCA) was calculated in long-limb radiographs of 227 patients and correlated with pre-operative parameters of femoral bowing, neck-shaft angle and hip-knee-ankle angle. In the second part comprising of 240 knees with varus deformity, 140 (group 1) had the distal femoral cut individualised according to the calculated VCA, while the remaining 100 knees (group 1) were operated with a fixed distal femoral cut of 5°. The outcome of surgery was studied by grouping the knees as varus 15°. Of the 227 limbs analysed in stage I, 70 knees (31 %) had a VCA angle outside 5-7°. Coronal bowing (p shaft angle (p alignment when VCA was individualised in the groups of knees with varus 10-15° (p 0.002) and varus >15° (p 0.002). Valgus correction angle is highly variable and is influenced by femoral bowing, neck-shaft angle and pre-operative deformity. Individualisation of VCA is preferable in patients with moderate and severe varus deformity. Level 2.

Finite Element Analysis of High Heat Load Deformation and Mechanical Bending Correction of a Beamline Mirror for the APS Upgrade

Science.gov (United States)

Goldring, Nicholas

The impending Advanced Photon Source Upgrade (APS-U) will introduce a hard x-ray source that is set to surpass the current APS in brightness and coherence by two to three orders of magnitude. To achieve this, the storage ring light source will be equipped with a multi-bend achromat (MBA) lattice. In order to fully exploit and preserve the integrity of new beams actualized by upgraded storage ring components, improved beamline optics must also be introduced. The design process of new optics for the APS-U and other fourth generation synchrotrons involves the challenge of accommodating unprecedented heat loads. This dissertation presents an ex-situ analysis of heat load deformation and the subsequent mechanical bending correction of a 400 mm long, grazing-incidence, H2O side-cooled, reflecting mirror subjected to x-ray beams produced by the APS-U undulator source. Bending correction is measured as the smallest rms slope error, sigmarms, that can be resolved over a given length of the heat deformed geometry due to mechanical bending. Values of sigmarms in the account for finish errors or other contributions to sigmarms beyond the scope of thermal deformation and elastic bending. The methodology of this research includes finite element analysis (FEA) employed conjointly with an analytical solution for mechanical bending deflection by means of an end couple. Additionally, the study will focus on two beam power density profiles predicted by the APS-U which were created using the software SRCalc. The profiles account for a 6 GeV electron beam with second moment widths of 0.058 and 0.011 mm in the x- and y- directions respectively; the electron beam is passed through a 4.8 m long, 28 mm period APS-U undulator which produces the x-ray beam incident at a 3 mrad grazing angle on the flat mirror surface for both cases. The first power density profile is the most extreme case created by the undulator at it's closest gap with a critical energy of 3 keV (k y=2.459); the second

Impact of Cervical Spine Deformity on Preoperative Disease Severity and Postoperative Outcomes Following Fusion Surgery for Degenerative Cervical Myelopathy: Sub-analysis of AOSpine North America and International Studies.

Science.gov (United States)

Kato, So; Nouri, Aria; Wu, Dongjin; Nori, Satoshi; Tetreault, Lindsay; Fehlings, Michael G

2018-02-15

Sub-analysis of the prospective AOSpine CSM North America and International studies. The aim of this study was to investigate the impact of cervical spine deformity on pre- and postoperative outcomes in fusion surgeries for degenerative cervical myelopathy. The associations between cervical alignment and patient outcomes have been reported but are not well established in a myelopathy cohort. The impact of deformity correction in this population also needs to be elucidated. A total of 757 patients were enrolled in two prospective international multicenter AOSpine studies. Among those who underwent anterior or posterior fusion surgeries, pre- and 1-year postoperative upright neutral lateral radiographs of cervical spine were investigated to measure C2-7 Cobb angle and C2-7 sagittal vertical axis (SVA). Patient outcome measures included the modified Japanese Orthopedic Association score for myelopathy severity, Neck Disability Index (NDI), and Short-form 36 (SF-36). These scores were compared between patients with and without cervical deformity, which was defined as C2-7 Cobb >10° kyphosis and/or SVA >40 mm. A total of 178 patients were included with complete pre- and postoperative radiographs. SVA significantly increased postoperatively (27.4 vs. 30.7 mm, P = 0.004). All outcome measurement showed significant improvements above minimal clinically important differences. 23.6% of the patients had cervical deformity preoperatively; preoperative deformity was associated with worse preoperative NDI scores (45.7 vs. 38.9, P = 0.04). Postoperatively, those with deformity exhibited significantly lower SF-36 physical component scores (37.2 vs. 41.4, P = 0.048). However, when focusing on the preoperatively deformed cohort, we did not find any significant differences in the postoperative outcome scores between those with and without residual deformity. There was a significant association between cervical deformity and both preoperative disease severity and

Historical overview of spinal deformities in ancient Greece

Science.gov (United States)

Vasiliadis, Elias S; Grivas, Theodoros B; Kaspiris, Angelos

2009-01-01

Little is known about the history of spinal deformities in ancient Greece. The present study summarizes what we know today for diagnosis and management of spinal deformities in ancient Greece, mainly from the medical treatises of Hippocrates and Galen. Hippocrates, through accurate observation and logical reasoning was led to accurate conclusions firstly for the structure of the spine and secondly for its diseases. He introduced the terms kyphosis and scoliosis and wrote in depth about diagnosis and treatment of kyphosis and less about scoliosis. The innovation of the board, the application of axial traction and even the principle of trans-abdominal correction for correction of spinal deformities have their origin in Hippocrates. Galen, who lived nearly five centuries later impressively described scoliosis, lordosis and kyphosis, provided aetiologic implications and used the same principles with Hippocrates for their management, while his studies influenced medical practice on spinal deformities for more than 1500 years. PMID:19243609

Historical overview of spinal deformities in ancient Greece

Directory of Open Access Journals (Sweden)

Kaspiris Angelos

2009-02-01

Full Text Available Abstract Little is known about the history of spinal deformities in ancient Greece. The present study summarizes what we know today for diagnosis and management of spinal deformities in ancient Greece, mainly from the medical treatises of Hippocrates and Galen. Hippocrates, through accurate observation and logical reasoning was led to accurate conclusions firstly for the structure of the spine and secondly for its diseases. He introduced the terms kyphosis and scoliosis and wrote in depth about diagnosis and treatment of kyphosis and less about scoliosis. The innovation of the board, the application of axial traction and even the principle of trans-abdominal correction for correction of spinal deformities have their origin in Hippocrates. Galen, who lived nearly five centuries later impressively described scoliosis, lordosis and kyphosis, provided aetiologic implications and used the same principles with Hippocrates for their management, while his studies influenced medical practice on spinal deformities for more than 1500 years.

Lower lip deformity in patients with cleft and non-cleft Class III malocclusion before and after orthognathic surgery.

Science.gov (United States)

Park, Joo Seok; Koh, Kyung S; Choi, Jong Woo

2015-10-01

Orthognathic surgery does not yield the same cosmetic benefits in patients with Class III jaw deformities associated with clefts as for patients without clefts. Preoperative upper lip tightness caused by cleft lip repair may not fully explain this difference, suggesting that a lower lip deformity is present. The study compared the outcomes of orthognathic surgery in patients with cleft and non-cleft Class III malocclusion, focusing on lip relationship. The surgical records of 50 patients with Class III malocclusion, including 25 with and 25 without clefts, who had undergone orthognathic surgery, were retrospectively analyzed. Lateral cephalometric tracings, preoperatively and at 6 months postoperatively, were superimposed to analyze the soft tissue changes at seven reference points. At 6 months after surgery, there were no significant differences in skeletal location, whereas the soft tissues of the lower lip differed significantly between patients with and without cleft (p=0.002), indicating the persistence of a lower lip deformity in cleft patients. Moreover, the soft tissues of the lower lip receded in non-cleft patients and protruded in cleft patients after orthognathic surgery. Lower lip deformity and upper lip tightness may result in an unsatisfactory relationship between the upper and lower lips of patients with cleft-related jaw deformity after orthognathic surgery. Other factors were less important than the pathology of the lower lip. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

SPINAL DEFORMITIES AFTER SELECTIVE DORSAL RHIZOTOMY

Directory of Open Access Journals (Sweden)

PATRICIO PABLO MANZONE

Full Text Available ABSTRACT Objective: Selective dorsal rhizotomy (SDR used for spasticity treatment could worsen or develop spinal deformities. Our goal is to describe spinal deformities seen in patients with cerebral palsy (CP after being treated by SDR. Methods: Retrospective study of patients operated on (SDR between January/1999 and June/2012. Inclusion criteria: spinal Rx before SDR surgery, spinography, and assessment at follow-up. We evaluated several factors emphasizing level and type of SDR approach, spinal deformity and its treatment, final Risser, and follow-up duration. Results: We found 7 patients (6 males: mean age at SDR 7.56 years (4.08-11.16. Mean follow-up: 6.64 years (2.16-13, final age: 14.32 years (7.5-19. No patient had previous deformity. GMFCS: 2 patients level IV, 2 level III, 3 level II. Initial walking status: 2 community walkers, 2 household walkers, 2 functional walkers, 1 not ambulant, at the follow-up, 3 patients improved, and 4 kept their status. We found 4 TL/L laminotomies, 2 L/LS laminectomies, and 1 thoracic laminectomy. Six spinal deformities were observed: 2 sagittal, 3 mixed, and 1 scoliosis. There was no association among the type of deformity, final gait status, topographic type, GMFCS, age, or SDR approach. Three patients had surgery indication for spinal deformity at skeletal maturity, while those patients with smaller deformities were still immature (Risser 0 to 2/3 although with progressive curves. Conclusions: After SDR, patients should be periodically evaluated until they reach Risser 5. The development of a deformity does not compromise functional results but adds morbidity because it may require surgical treatment.

Zernike polynomial based Rayleigh-Ritz model of a piezoelectric unimorph deformable mirror

CSIR Research Space (South Africa)

Long, CS

2012-04-01

Full Text Available Piezoelectric bimorph- or unimorph-type deformable mirrors are commonly used in adaptive optics to correct for time-dependent phase aberrations. In the optics community, the surface deformations that deformable mirrors are required to achieve...

Cervical Lordosis Actually Increases With Aging and Progressive Degeneration in Spinal Deformity Patients.

Science.gov (United States)

Kim, Han Jo; Lenke, Lawrence G; Oshima, Yasushi; Chuntarapas, Tapanut; Mesfin, Addisu; Hershman, Stuart; Fogelson, Jeremy L; Riew, K Daniel

2014-09-01

Retrospective. The authors hypothesized that cervical lordosis (CL) would decrease with aging and increasing degeneration. It is theorized that with age and degeneration, the cervical spine loses lordosis and becomes progressively more kyphotic; however, no studies support these conclusions in patients with various spinal deformities. The authors performed a radiographic analysis of asymptomatic adults (referring to their cervical spine) of varying ages, with differing forms of spinal deformity to the thoracic/lumbar spine to see how cervical lordosis changes with increasing age. A total of 104 total spine EOS X-rays of adult (aged >18 years) spinal deformity patients without documented neck pain, prior neck surgery, or cervical deformity were reviewed. The researchers only reviewed EOS X-rays because they allow complete visualization from occiput to feet. Cervical lordosis, standard Cobb measurements, sagittal balance parameters, and cervical degeneration were quantified radiographically by the method previously described by Gore et al. Statistical analysis was performed with 1-way analysis of variance to compare significant differences between groups aged 60 years as well as changes in sagittal balance. A p-value 60 years, respectively; p 60 years, respectively; p < .01), with the highest degeneration at the C5-6 and C6-7 disc spaces (3.7 ± 3.3 and 3.2 ± 2.9, respectively; p < .01). This increase did not correlate with the increase in CL seen with aging (r = 0.02; p = .84). Cervical lordosis increased with aging in adult spinal deformity patients. There was no relationship between cervical degeneration and lordosis despite the strong relationship seen between increasing CL in older age groups. Copyright © 2014 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Correction of severe post-traumatic kyphosis by posterior vertebra column resection.

Science.gov (United States)

Zhang, Xue-song; Zhang, Yong-gang; Wang, Zheng; Chen, Chao; Wang, Yan

2010-03-20

Post-traumatic kyphosis is a common potential complication of spinal trauma and correct management of this problem is becoming ever more important. Although posterior vertebra column resection has been increasingly adopted to correct severe spinal deformity, no series of reports were found on severe post-traumatic kyphosis in the thoracolumbar region. Therefore, the present cohort retrospective study is presented to evaluate the clinical and radiographic results of posterior vertebra column resection with instrument fusion performed in patients with severe post-traumatic kyphosis. From May 2004 to May 2006, 53 patients (38 male, 15 female) at an average age of 37.6 years (range, 24 to 66 years), were surgically treated for symptomatic post-traumatic thoracolumbar kyphosis with a posterior wedge closing osteotomy at our hospital. Among them, 5 consecutive adult patients with severe post-traumatic kyphosis were included in this study. Operation time, blood loss and complications were noted in each case. Radiographic documentation was made on the basis of standing anterior-posterior (AP) and lateral views and three dimensional reconstruction images of computed tomography (CT) scans were used to further identify the apex region of a sharp angular deformity. Sagittal correction was assessed in terms of effective regional deformity (ERD) for the injury level. Assessment of radiological fusion at follow-up was based on the presence of trabecular bone bridging at the osteotomy site according to Brantigan. Preoperative and postoperative clinical assessments were performed by using Oswestry disability index (ODI), back pain was rated in all patients by the visual analog scale (VAS) preoperatively, postoperatively and at the latest follow-up. The mean operating time was 265 minutes (220 - 408 minutes), with an average blood loss of 1362 ml (870 - 2570 ml). Each patient finished at least two years of follow-up. The average ERD significantly decreased from 69 degrees (58

Custom-Made Titanium 3-Dimensional Printed Interbody Cages for Treatment of Osteoporotic Fracture-Related Spinal Deformity.

Science.gov (United States)

Siu, Timothy L; Rogers, Jeffrey M; Lin, Kainu; Thompson, Robert; Owbridge, Mark

2018-03-01

Advances in minimally invasive interbody fusion have greatly enhanced surgeons' capability to correct adult spinal deformity with reduced morbidity. However, the feasibility of such approaches is limited in patients with previous osteoporotic fractures as the resultant vertebral deformity renders the end plate geometry incongruous with conventional interbody implants. Current 3-dimensional (3D) printing technology offers a novel solution by fabricating custom-made implants tailored to individual anatomy. We present the results of a patient with osteoporotic lumbar fractures treated by such technology. A 74-year-old woman, with previous osteoporotic fractures at L2 and L3 resulting in concave deformity of the end plates, presented with intractable radiculopathy secondary to lateral recess and foraminal stenosis (L2-3 and L3-4). A minimally invasive lateral lumbar interbody fusion at L2-3 and L3-4 was considered favorable, but due to the associated vertebral collapse, off-the-shelf implants were not compatible with patient anatomy. In silico simulation based on preoperative computed tomography (CT) imaging was thus conducted to design customized cages to cater for the depressed recipient end plates and vertebral loss. The design was converted to implantable titanium cages through 3D additive manufacturing. At surgery, a tight fit between the implants and the targeted disk space was achieved. Postoperative CT scan confirmed excellent implant-end plate matching and restoration of lost disk space. The patient began to ambulate from postoperative day 1 and at 6-month follow-up resolution of radicular symptoms and CT evidence of interbody fusion were recorded. 3D-printed custom-made interbody cages can help overcome the difficulties in deformity correction secondary to osteoporotic fractures. Copyright © 2017 Elsevier Inc. All rights reserved.

Aesthetic acceptance equals to nature’s compensation plus surgical correction

Science.gov (United States)

Vadgaonkar, Vaishali; Gangurde, Parag; Karandikar, Anita; Mahajan, Nikhil

2013-01-01

Orthognathic surgery has become an acceptable treatment plan for patients with various maxillofacial deformities. The rehabilitation of severe class III adult patients requires a complex interdisciplinary orthodontic and orthognathic approach. This presentation aims to show a case of combination of camouflage and bilateral sagittal split osteotomy (BSSO).Camouflage in maxillary arch was accepted after analysing visual treatment objective (VTO) and pleasing soft tissue compensation which gave us the clue to go ahead for surgical correction of excess mandibular length to achieve best aesthetic outcome while maintaining nature’s compensation in upper arch. PMID:23887991

Progression of spinal deformity in wheelchair-dependent patients with Duchenne muscular dystrophy who are not treated with steroids: coronal plane (scoliosis) and sagittal plane (kyphosis, lordosis) deformity.

Science.gov (United States)

Shapiro, F; Zurakowski, D; Bui, T; Darras, B T

2014-01-01

We determined the frequency, rate and extent of development of scoliosis (coronal plane deformity) in wheelchair-dependent patients with Duchenne muscular dystrophy (DMD) who were not receiving steroid treatment. We also assessed kyphosis and lordosis (sagittal plane deformity). The extent of scoliosis was assessed on sitting anteroposterior (AP) spinal radiographs in 88 consecutive non-ambulatory patients with DMD. Radiographs were studied from the time the patients became wheelchair-dependent until the time of spinal fusion, or the latest assessment if surgery was not undertaken. Progression was estimated using a longitudinal mixed-model regression analysis to handle repeated measurements. Scoliosis ≥ 10° occurred in 85 of 88 patients (97%), ≥ 20° in 78 of 88 (89%) and ≥ 30° in 66 of 88 patients (75%). The fitted longitudinal model revealed that time in a wheelchair was a highly significant predictor of the magnitude of the curve, independent of the age of the patient (p lordosis (16 (27%) abnormal and seven (11%) normal). This study provides a baseline to assess the effects of steroids and other forms of treatment on the natural history of scoliosis in patients with DMD, and an approach to assessing spinal deformity in the coronal and sagittal planes in wheelchair-dependent patients with other neuromuscular disorders.

Phonon operators in deformed nuclei

International Nuclear Information System (INIS)

Soloviev, V.G.

1981-01-01

For the description of the excited states in deformed nuclei new phonon operators are introduced, which depend on the sign of the angular momentum projection onto the symmetry axis of a deformed nucleus. In the calculations with new phonons the Pauli principle is correctly taken into account in the two-phonon components of the wave functions. There is a difference in comparison with the calculation with phonons independent of the sign of the angular momentum projection. The new phonons should be used in deformed nuclei if the Pauli principle is consistently taken into account and in the calculations with the excited state wave functions having the components with more than one phonon operator [ru

Impact of orthognathic surgery on oral health-related quality of life in patients with jaw deformities.

Science.gov (United States)

Kurabe, K; Kojima, T; Kato, Y; Saito, I; Kobayashi, T

2016-12-01

The purpose of this study was to clarify the impact of orthognathic surgery on oral health-related quality of life (OHRQOL) in patients with jaw deformities. The subjects were 65 patients (21 males and 44 females) who underwent orthognathic surgery. The mean age of the patients was 23.6 years. Forty-seven patients had skeletal class III malocclusions, eight patients had skeletal class II, and 10 patients had skeletal class I with facial asymmetry and/or open bite. OHRQOL was assessed using the Japanese version of the Oral Health Impact Profile (OHIP-J54) before and 6 months after surgery. While OHIP-J54 scores in the patients before surgery were significantly higher than those in the control subjects, OHIP-J54 scores after surgery were significantly lower than those before surgery. OHIP-J54 scores in older patients were significantly higher than those in younger patients. In conclusion, most patients with jaw deformities have lower OHRQOL than individuals with normal occlusion, and orthognathic surgery has a positive impact on OHRQOL. The determination of OHRQOL in patients with jaw deformities seems to be very useful for understanding the patients' problems and for assessing the extent of changes in terms of patient well-being. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Research on Kalman Filtering Algorithm for Deformation Information Series of Similar Single-Difference Model

Institute of Scientific and Technical Information of China (English)

L(U) Wei-cai; XU Shao-quan

2004-01-01

Using similar single-difference methodology(SSDM) to solve the deformation values of the monitoring points, there is unstability of the deformation information series, at sometimes.In order to overcome this shortcoming, Kalman filtering algorithm for this series is established,and its correctness and validity are verified with the test data obtained on the movable platform in plane. The results show that Kalman filtering can improve the correctness, reliability and stability of the deformation information series.

An Analysis of Deformities in Revision Surgeries for Secondary Unilateral Cleft Lip

International Nuclear Information System (INIS)

Cheema, S. A.; Asim, M.

2014-01-01

Objective: To analyze the secondary cleft lip deformities and the possible causes in a cohort of cases. Study Design: A case series. Place and Duration of Study: Services Institute of Medical Sciences and WAPDA Teaching Hospital Complex, Lahore, from September 2008 to March 2012. Methodology: Consecutive cases of secondary unilateral cleft lip deformities were selected for the study. These cases were interviewed and deformities recorded. Pre and postoperative photographs were taken for comparison. Per operative photographs were taken, after marking of the incisions, to keep a record of the intervention needed to correct the deformities. These cases were then further analyzed to know the deformities and interventions needed for correction of these deformities. Results: Study subjects comprised 114 males and 75 females. Secondary correction was the most common in second decade of life with 82 cases in this group. The most common deformity was unfavorable scar in 150 cases followed by notch at the vermilion border in 124 cases. Short lip was found in 119 cases. Complete revision of the repair was required in 158 cases and 25 cases required partial redo of the initial repair. In other 6 cases, only scar revision was carried out. Conclusion: Unfavorable scar followed by vermilion notch and short lip were the most common secondary cleft lip deformities. Better technique helps favorable scar. Vermilion notch and short lip can be overcome by switching from rotation advancement repair to the triangular flap repair of Noordhoff. (author)

Sex Differences in Patients With CAM Deformities With Femoroacetabular Impingement: 3-Dimensional Computed Tomographic Quantification.

Science.gov (United States)

Yanke, Adam B; Khair, M Michael; Stanley, Robert; Walton, David; Lee, Simon; Bush-Joseph, Charles A; Espinoza Orías, Alejandro; Espinosa Orias, Alejandro A; Inoue, Nozomu; Nho, Shane J

2015-12-01

To determine if significant differences exist between male and female CAM deformities using quantitative 3-dimensional (3D) volume and location analysis. Retrospective analysis of preoperative computed tomographic (CT) scans for 138 femurs (69 from male patients and 69 from female patients) diagnosed with impingement from November 2009 to November 2011 was completed. Those patients who presented with hip complaints and had a history, physical examination (limited range of motion, positive impingement signs), plain radiographs (anteroposterior pelvis, 90° Dunn view, false profile view), and magnetic resonance images consistent with femoroacetabular impingement (FAI) and in whom a minimum of 6 months of conservative therapy (oral anti-inflammatory agents, physical therapy, and activity modification) had failed were indicated for arthroscopic surgery and had a preoperative CT scan. Scans were segmented, converted to point cloud data, and analyzed with a custom-written computer program. Analysis included mean CAM height and volume, head radius, and femoral version. Differences were analyzed using an unpaired t test with significance set at P position ± the 2:51 o'clock position to the 3:28 o'clock position ± the 1:59 o'clock position, with an average span from the 3:06 o'clock position ± the 1:29 o'clock position (male patients, the 11:23 o'clock position ± the 0:46 o'clock position to the 3:05 o'clock position ± the 1:20 o'clock position; female patients, the 11:33 o'clock position ± the 0:37 o'clock position to the 2:27 o'clock position ± the 0:45 o'clock position). There were no differences in the posterior (P = .60) or anterior (P = .14) extent of CAM deformities. However, the span on the clock face of the CAM deformities varied when comparing men with women (male patients, the 3:43 o'clock position ± the 1:29 o'clock position; female patients, the 2:54 o'clock position ± the 1:09 o'clock position; P = .02). Our data show that female CAM deformities

Trochantoplasty for Total Hip Arthroplasty in Patients With Coxa Vara Deformity.

Science.gov (United States)

Yoo, Jun-Il; Parvizi, Javad; Song, Ji-Ung; Ha, Yong-Chan; Lee, Young-Kyun; Koo, Kyung-Hoi

2017-07-01

In total hip arthroplasty (THA) of hips with coxa vara, the femoral stems might be inserted in a varus alignment. To avoid varus insertion, we designed a technique, which we termed "trochantoplasty." In this procedure, the medial half of the greater trochanter was removed during THA. We evaluated 30 patients (31 hips) who had coxa vara deformity and underwent THA using trochantoplasty at the mean follow-up of 5 years (range, 3-9 years). All stems were inserted in the neutral position. One Vancouver type 1 periprosthetic femoral fracture occurred after a fall at postoperative 2 months. At the latest follow-up, the mean power of abductor was 4.3 (range, 3-5). Four patients had moderate limp whereas 26 patients had slight limp. The abduction at 90° flexion ranged from 15° to 45° (mean, 35°). There was no revision. All prostheses had bone-ingrown stability without any detectable wear or osteolysis. The mean Harris hip score was improved from 66.9 to 89.4 points. Trochantoplasty can be used to avoid varus insertion of the femoral stem while performing THA in patients with coxa vara deformity without compromising the abductor mechanism. Copyright © 2017 Elsevier Inc. All rights reserved.

Interest of corrective makeup in the management of patients in dermatology.

Science.gov (United States)

Seité, S; Deshayes, P; Dréno, B; Misery, L; Reygagne, P; Saiag, P; Stengel, F; Roguedas-Contios, Am; Rougier, A

2012-01-01

Disfiguring dermatoses may have a significant impact on patients' quality of life, namely on their relationship with others, self image, and self esteem. Some previous studies have suggested that corrective foundation can improve the quality of life (QOL) of patients with facial dermatoses; in particular, in patients with acne vulgaris or pigmentary disorders. The aim of this prospective study was to evaluate the impact of the skin conditions of patients with various skin diseases affecting their face (scars, acne, rosacea, melasma, vitiligo, hypo or hyperpigmentation, lentigines, etc) on their QOL and the improvement afforded by the use of corrective makeup for 1 month after being instructed on how to use it by a medical cosmetician during an initial medical consultation. One hundred and twenty-nine patients with various skin diseases affecting the patients' face were investigated. The patients were instructed by a cosmetician on how to use corrective makeup (complexion, eyes, and lips) and applied it for 1 month. The safety of the makeup application was evaluated and the QOL was assessed via a questionnaire (DLQI) and using a 10-cm visual analog scale (VAS) completed before the first application and at the final visit. The amelioration of their appearance was documented by standardized photography. No side effects occurred during the course of the study. A comparison of the standardized photographs taken at each visit showed the patients' significant improvement in appearance due to the application of corrective makeup. The mean DLQI score dropped significantly from 9.90 ± 0.73 to 3.49 ± 0.40 (P makeup to improve their appearance and their QOL. Corrective makeup can also complement the treatment of face dermatological diseases in order to improve patient's adherence.

Hindfoot Arthrodesis for Neuropathic Deformity

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Peng-Ju Huang

2007-03-01

Full Text Available Acquired neurologic disorders of the foot lead to arthrosis, deformities, instabilities, and functional disabilities. Hindfoot arthrodesis is the current option available for irreducible or nonbraceable deformities of neuropathic feet. However, the role of ankle arthrodesis in these patients has been questioned because of high nonunion and complication rates. From 1990 to 2001, 17 cases of acquired neuropathic foot deformities were treated by four tibiotalocalcaneal (TTC arthrodeses and 13 ankle arthrodeses. TTC arthrodesis was performed on cases with combined ankle and subtalar arthritis or cases whose deformities or instabilities could not be corrected by ankle fusion alone. There was no nonunion of TTC arthrodesis and seven ununited ankle arthrodeses were salvaged by two TTC-attempted arthrodeses and five revision ankle-attempted arthrodeses. Eventually in these cases, there was one nonunion in TTC arthrodesis and one nonunion in revision ankle arthrodesis. The final fusion rate was 88% (15 of 17 cases with average union time of 6.9 months (range, 2.5–18 months. The American Orthopaedic Foot and Ankle Society ankle hind-foot functional scores were evaluated: one was excellent (5.8%, seven were good (41%, eight were fair (53.3%, and one was poor (5.8% in terms of total functional outcome. We conclude that TTC arthrodesis is indicated for cases with ankle and subtalar involvement and ankle arthrodesis is an alternative for cases with intact subtalar joint. We recommend revision ankle arthrodesis if the ankle fails to fuse and the bone stock of the talus is adequate. TTC arthrodesis is reserved for ankles with poor bone stock of the talus with fragmentation.

IATROGENIC HALLUX VARUS: CAUSES OF DEFORMITY AND POSSIBILITIES OF PERCUTANEOUS SURGICAL CORRECTION (RETROSPECTIVE ANALYSIS OF CASE REPORTS

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S. Yu. Berezhnoy

2017-01-01

Full Text Available Introduction. Hallux varus is a relatively rare foot deformity. Commonly, hallux varus is a complication after the hallux valgus surgery and typically is the result of the first metatarsal medial eminence over resection, first and second metatarsal excessive convergence, over release of the lateral soft tissues, overtightening of the medial soft tissues and soft tissue imbalance of the first metatarsophalangeal joint.The purpose of this study was to clarify the causes and timing of the iatrogenic hallux varus formation and to evaluate the possibility and efficiency of percutaneous techniques in its surgical treatment.Material and methods. Thirty-one feet (31 females suffering from iatrogenic hallux varus were examined clinically and radiologically, including 14 patients who underwent surgery. The average age of the whole group was 57 years (range, 39 to 74, the subgroup of operated patients — 60 years (range from 53 to 68. The time after primary interventions before the examination varied from 2 to 44 years. The mean follow-up after surgery was 6 months (range from 1.5 to 54.Results. No infection or wound-healing issues were observed. Overall, the patients were completely satisfied with the outcomes of 12 surgeries and satisfied with reservation in 2 cases.Conclusions. The visual manifestations of hallux varus are determined not only by the hallux varus angle, but also by the value of the first intermetatarsal angle. In addition to well-known factors, hallux varus formation is determined by first metatarsal bone elongation and first metatarsophalangeal joint instability. In rare cases, only one of the factors leads to the hallux varus; as a rule, we see a combination of factors with their mutual reinforcement. Despite the demonstration of usage possibility and the efficiency of percutaneous techniques in hallux varus correcting, a small number of observations in the study does not yet allow giving recommendations on the use of specific

Corrective Surgery for Congenital Scoliosis Associated with Split Cord Malformation: It May Be Safe to Leave Diastematomyelia Untreated in Patients with Intact or Stable Neurological Status.

Science.gov (United States)

Shen, Jianxiong; Zhang, Jianguo; Feng, Fan; Wang, Yipeng; Qiu, Guixing; Li, Zheng

2016-06-01

The treatment of congenital scoliosis associated with split cord malformation (SCM) raises the issue of how to best manage such patients to avoid neurological deficit while achieving a satisfactory correction. This prospective clinical study was performed at our center from March 2000 through June 2013. We enrolled a total of 214 patients (61 male and 153 female) with congenital scoliosis associated with SCM who were undergoing spinal correction surgery. The mean age at surgery was 14.1 years. The inclusion criteria were congenital scoliosis with confirmed SCM; status as neurologically intact or stable over the preceding 2 years; and no neurological deterioration as evidenced on traction, side-bending, or fulcrum-bending radiographs. Patients with unstable neurological status or for whom vertebral column resection surgery was planned were excluded. All patients underwent scoliosis surgery without prophylactic detethering. On the basis of the Pang classification, 73 patients were in the type-I SCM group, and 141 were in the type-II SCM group. The groups did not differ significantly with respect to preoperative characteristics, operative time, blood loss, or number of levels fused. The mean follow-up was 37 months (range, 24 to 108 months). The rate of scoliosis correction was lower in the type-I group than in the type-II group (p patients experienced transient neurological complications, with no significant difference between the groups (p = 0.415). No patient experienced permanent neurological deficit during surgery or follow-up. Patients with congenital scoliosis associated with SCM, regardless of type, can safely and effectively undergo spinal deformity correction and achieve spinal balance without neurological intervention. For such patients with intact or stable neurological status, prophylactic detethering prior to scoliosis surgery may not be necessary. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence

Comparison of Srs-24 And Srs-22 Scores in Thirty Eight Adolescent Idiopathic Scoliosis Patients Who Had Undergone Surgical Correction

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CYW Chan

2009-05-01

Full Text Available Adolescent idiopathic scoliosis is a spinal deformity that affects patients’ self image and confidence. Surgery is offered when the curvature is greater than 50 degrees based on the likelihood of curvature progression. Outcome measures for scoliosis correction can be described in terms of radiological improvement or improvement of health related quality of life scores. The Scoliosis Research Society 22 (SRS-22 and Scoliosis Research Society 24 (SRS-24 questionnaires are widely accepted and used to characterize clinical results. Therefore, this prospective study of 38 patients aims to investigate how the SRS-24 and SRS-22 questionnaires compare to each other in terms of scoring when the same group of patients is evaluated. The SRS-22 questionnaire tends to give an inflated value in the overall score, pain and self image domain compared to the SRS-24 questionnaire.

Optimization Correction Strength Using Contra Bending Technique without Anterior Release Procedure to Achieve Maximum Correction on Severe Adult Idiopathic Scoliosis

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Ahmad Jabir Rahyussalim

2016-01-01

Full Text Available Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain. Posterior-only approach with rod and screw corrective manipulation to add strength of contra bending manipulation has correction achievement similar to that obtained by conventional combined anterior release and posterior approach. It also avoids the complications related to the thoracic approach. We reported a case of 25-year-old male adult idiopathic scoliosis with double curve. It consists of main thoracic curve of 150 degrees and lumbar curve of 89 degrees. His curve underwent direct contra bending posterior approach using rod and screw corrective manipulation technique to achieve optimal correction. After surgery the main thoracic Cobb angle becomes 83 degrees and lumbar Cobb angle becomes 40 degrees, with 5 days length of stay and less than 800 mL blood loss during surgery. There is no complaint at two months after surgery; he has already come back to normal activity with good functional activity.

Impact of large field angles on the requirements for deformable mirror in imaging satellites

Science.gov (United States)

Kim, Jae Jun; Mueller, Mark; Martinez, Ty; Agrawal, Brij

2018-04-01

For certain imaging satellite missions, a large aperture with wide field-of-view is needed. In order to achieve diffraction limited performance, the mirror surface Root Mean Square (RMS) error has to be less than 0.05 waves. In the case of visible light, it has to be less than 30 nm. This requirement is difficult to meet as the large aperture will need to be segmented in order to fit inside a launch vehicle shroud. To reduce this requirement and to compensate for the residual wavefront error, Micro-Electro-Mechanical System (MEMS) deformable mirrors can be considered in the aft optics of the optical system. MEMS deformable mirrors are affordable and consume low power, but are small in size. Due to the major reduction in pupil size for the deformable mirror, the effective field angle is magnified by the diameter ratio of the primary and deformable mirror. For wide field of view imaging, the required deformable mirror correction is field angle dependant, impacting the required parameters of a deformable mirror such as size, number of actuators, and actuator stroke. In this paper, a representative telescope and deformable mirror system model is developed and the deformable mirror correction is simulated to study the impact of the large field angles in correcting a wavefront error using a deformable mirror in the aft optics.

SU-E-J-254: Utility of Pinnacle Dynamic Planning Module Utilizing Deformable Image Registration in Adaptive Radiotherapy

International Nuclear Information System (INIS)

Jani, S

2014-01-01

Purpose For certain highly conformal treatment techniques, changes in patient anatomy due to weight loss and/or tumor shrinkage can result in significant changes in dose distribution. Recently, the Pinnacle treatment planning system added a Dynamic Planning module utilizing Deformable Image Registration (DIR). The objective of this study was to evaluate the effectiveness of this software in adapting to altered anatomy and adjusting treatment plans to account for it. Methods We simulated significant tumor response by changing patient thickness and altered chin positions using a commercially-available head and neck (H and N) phantom. In addition, we studied 23 CT image sets of fifteen (15) patients with H and N tumors and eight (8) patients with prostate cancer. In each case, we applied deformable image registration through Dynamic Planning module of our Pinnacle Treatment Planning System. The dose distribution of the original CT image set was compared to the newly computed dose without altering any treatment parameter. Result was a dose if we did not adjust the plan to reflect anatomical changes. Results For the H and N phantom, a tumor response of up to 3.5 cm was correctly deformed by the Pinnacle Dynamic module. Recomputed isodose contours on new anatomies were within 1 mm of the expected distribution. The Pinnacle system configuration allowed dose computations resulting from original plans on new anatomies without leaving the planning system. Original and new doses were available side-by-side with both CT image sets. Based on DIR, about 75% of H and N patients (11/15) required a re-plan using new anatomy. Among prostate patients, the DIR predicted near-correct bladder volume in 62% of the patients (5/8). Conclusions The Dynamic Planning module of the Pinnacle system proved to be an accurate and useful tool in our ability to adapt to changes in patient anatomy during a course of radiotherapy

Evaluation of right atrial dysfunction in patients with corrected tetralogy of Fallot using 3D speckle-tracking echocardiography. Insights from the CSONGRAD Registry and MAGYAR-Path Study.

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Nemes, Attila; Havasi, Kálmán; Domsik, Péter; Kalapos, Anita; Forster, Tamás

2015-11-01

In recent studies, alterations in ventricular deformations were demonstrated in adult patients with corrected tetralogy of Fallot by three-dimensional speckle-tracking echocardiography. The present study was designed to assess three-dimensional speckle-tracking echocardiography-derived right atrial volumetric and strain parameters in corrected tetralogy of Fallot. A total of 17 patients with corrected tetralogy of Fallot were included in the study. Their results were compared with 18 age- and gender-matched healthy controls. Complete two-dimensional echocardiography and three-dimensional speckle-tracking echocardiography were performed in all cases. Significantly increased right atrial volumes respecting heart cycle were detected in patients with corrected tetralogy of Fallot. Total and passive atrial emptying fractions proved to be significantly decreased in patients with corrected tetralogy of Fallot (26.4 ± 12.4 % vs. 39.1 ± 8.8 %, p = 0.001 and 11.2 ± 6.8 % vs. 19.8 ± 9.0 %, p = 0.003, respectively). Global and mean segmental peak longitudinal (17.3 ± 9.2 % vs. 30.8 ± 11.2 %, p = 0.0007 and 20.6 ± 10.7 % vs. 34.4 ± 10.5 %, p = 0.0005) and area strains (20.1 ± 17.6 % vs. 41.0 ± 19.8 %, p = 0.004 and 28.1 ± 19.8 % vs. 49.1 ± 19.7 %, p = 0.004) as well as global radial peak strain (-9.1 ± 5.1 % vs. -15.0 ± 10.0 %, p = 0.05) were reduced in patients with corrected tetralogy of Fallot compared with controls. The complexity of right atrial dysfunction can be demonstrated by three-dimensional speckle-tracking echocardiography in patients with corrected tetralogy of Fallot.

Hallux Valgus Deformity and Treatment: A Three-Dimensional Approach: Modified Technique for Lapidus Procedure.

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Santrock, Robert D; Smith, Bret

2018-06-01

In a hallux valgus deformity, the problem is deviation of the hallux at the metatarsophalangeal joint and of the first metatarsal at the tarsometatarsal joint. Although anterior-posterior radiograph findings have been prioritized, deviation in the other planes can substantially change visible cues. The modified technique for Lapidus procedure procedure, uses all 3 planes to evaluate and correct the deformity, making radiographic measurements less useful. Using a triplane framework and focusing on the apex of the deformity, all bunions become the same modified technique for Lapidus procedure can be performed regardless of the degree of deformity, always includes triplane correction, and deformity size becomes irrelevant. Copyright © 2018 Elsevier Inc. All rights reserved.

Registration of deformed multimodality medical images

International Nuclear Information System (INIS)

Moshfeghi, M.; Naidich, D.

1989-01-01

The registration and combination of images from different modalities have several potential applications, such as functional and anatomic studies, 3D radiation treatment planning, surgical planning, and retrospective studies. Image registration algorithms should correct for any local deformations caused by respiration, heart beat, imaging device distortions, and so forth. This paper reports on an elastic matching technique for registering deformed multimodality images. Correspondences between contours in the two images are used to stretch the deformed image toward its goal image. This process is repeated a number of times, with decreasing image stiffness. As the iterations continue, the stretched image better approximates its goal image

Twist operators in N=4 beta-deformed theory

NARCIS (Netherlands)

de Leeuw, M.; Łukowski, T.

2010-01-01

In this paper we derive both the leading order finite size corrections for twist-2 and twist-3 operators and the next-to-leading order finite-size correction for twist-2 operators in beta-deformed SYM theory. The obtained results respect the principle of maximum transcendentality as well as

Surgical results of strabismus correction in patients with myelomeningocele

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Dayane Cristine Issaho

2015-02-01

Full Text Available Purpose: Myelomeningocele is one of the most common birth defects. It is associated with severe neurological deficiencies, and ocular changes, such as strabismus, are very common. The purpose of this study was to describe indications for strabismus surgery in patients with myelomeningocele and to evaluate the results achieved with surgical correction. Methods: We retrospectively reviewed records of all patients with myelomeningocele who underwent surgery for strabismus correction in a 5-year period in an institution for disabled children. Results: The main indications for strabismus surgery were esotropia and A-pattern anisotropia. Excellent surgical results were achieved in 60.9% of patients, satisfactory in 12.2%, and unsatisfactory in 26.9%. Conclusion: Patients with myelomeningocele and strabismus had a high incidence of esotropia and A-pattern anisotropia. Strabismus surgery in these patients had an elevated percentage of excellent and satisfactory results, not only for the ocular deviation, but also for improvement of head posture.

High prevalence of morphometric vertebral deformities in patients with inflammatory bowel disease

OpenAIRE

Heijckmann, AC; Huijberts, MSP; Schoon, EJ; GEUSENS, Piet; de Vries, J.; Menheere, Paul P. C. A.; van der Veer, E.; Wolffenbuttel, BHR; Stockbrugger, RW; Dumitrescu, B; Kruseman, ACN

2008-01-01

Background Earlier studies have documented that the prevalence of decreased bone mineral density (BMD) is elevated in patients with inflammatory bowel disease. The objective of this study was to investigate the prevalence of vertebral deformities in inflammatory bowel disease patients and their relation with BMD and bone turnover. Methods One hundred and nine patients with Crohn's disease (CD) and 72 with ulcerative colitis (UC) (age 44.5 +/- 14.2 years) were studied. BMD of the hip (by dual ...

GUP parameter from quantum corrections to the Newtonian potential

Energy Technology Data Exchange (ETDEWEB)

Scardigli, Fabio, E-mail: fabio@phys.ntu.edu.tw [Dipartimento di Matematica, Politecnico di Milano, Piazza L. da Vinci 32, 20133 Milano (Italy); Department of Applied Mathematics, University of Waterloo, Ontario N2L 3G1 (Canada); Yukawa Institute for Theoretical Physics, Kyoto University, Kyoto 606-8502 (Japan); Lambiase, Gaetano, E-mail: lambiase@sa.infn.it [Dipartimento di Fisica “E.R. Caianiello”, Universita' di Salerno, I-84084 Fisciano (Italy); INFN – Gruppo Collegato di Salerno (Italy); Vagenas, Elias C., E-mail: elias.vagenas@ku.edu.kw [Theoretical Physics Group, Department of Physics, Kuwait University, P.O. Box 5969, Safat 13060 (Kuwait)

2017-04-10

We propose a technique to compute the deformation parameter of the generalized uncertainty principle by using the leading quantum corrections to the Newtonian potential. We just assume General Relativity as theory of Gravitation, and the thermal nature of the GUP corrections to the Hawking spectrum. With these minimal assumptions our calculation gives, to first order, a specific numerical result. The physical meaning of this value is discussed, and compared with the previously obtained bounds on the generalized uncertainty principle deformation parameter.

A two-dimensional deformable phantom for quantitatively verifying deformation algorithms

Energy Technology Data Exchange (ETDEWEB)

Kirby, Neil; Chuang, Cynthia; Pouliot, Jean [Department of Radiation Oncology, University of California San Francisco, San Francisco, California 94143-1708 (United States)

2011-08-15

Purpose: The incorporation of deformable image registration into the treatment planning process is rapidly advancing. For this reason, the methods used to verify the underlying deformation algorithms must evolve equally fast. This manuscript proposes a two-dimensional deformable phantom, which can objectively verify the accuracy of deformation algorithms, as the next step for improving these techniques. Methods: The phantom represents a single plane of the anatomy for a head and neck patient. Inflation of a balloon catheter inside the phantom simulates tumor growth. CT and camera images of the phantom are acquired before and after its deformation. Nonradiopaque markers reside on the surface of the deformable anatomy and are visible through an acrylic plate, which enables an optical camera to measure their positions; thus, establishing the ground-truth deformation. This measured deformation is directly compared to the predictions of deformation algorithms, using several similarity metrics. The ratio of the number of points with more than a 3 mm deformation error over the number that are deformed by more than 3 mm is used for an error metric to evaluate algorithm accuracy. Results: An optical method of characterizing deformation has been successfully demonstrated. For the tests of this method, the balloon catheter deforms 32 out of the 54 surface markers by more than 3 mm. Different deformation errors result from the different similarity metrics. The most accurate deformation predictions had an error of 75%. Conclusions: The results presented here demonstrate the utility of the phantom for objectively verifying deformation algorithms and determining which is the most accurate. They also indicate that the phantom would benefit from more electron density heterogeneity. The reduction of the deformable anatomy to a two-dimensional system allows for the use of nonradiopaque markers, which do not influence deformation algorithms. This is the fundamental advantage of this

Real-time motion compensated patient positioning and non-rigid deformation estimation using 4-D shape priors.

Science.gov (United States)

Wasza, Jakob; Bauer, Sebastian; Hornegger, Joachim

2012-01-01

Over the last years, range imaging (RI) techniques have been proposed for patient positioning and respiration analysis in motion compensation. Yet, current RI based approaches for patient positioning employ rigid-body transformations, thus neglecting free-form deformations induced by respiratory motion. Furthermore, RI based respiration analysis relies on non-rigid registration techniques with run-times of several seconds. In this paper we propose a real-time framework based on RI to perform respiratory motion compensated positioning and non-rigid surface deformation estimation in a joint manner. The core of our method are pre-procedurally obtained 4-D shape priors that drive the intra-procedural alignment of the patient to the reference state, simultaneously yielding a rigid-body table transformation and a free-form deformation accounting for respiratory motion. We show that our method outperforms conventional alignment strategies by a factor of 3.0 and 2.3 in the rotation and translation accuracy, respectively. Using a GPU based implementation, we achieve run-times of 40 ms.

Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity.

Science.gov (United States)

Eberbach, Helge; Mehl, Julian; Feucht, Matthias J; Bode, Gerrit; Südkamp, Norbert P; Niemeyer, Philipp

2017-03-01

straight-leg axis and an anatomic postoperative joint line with a tolerance of ±4°, the ideal site of a corrective osteotomy was tibial in 55.2% of cases and femoral in 19.5% of cases. A double-level osteotomy would be necessary in 25.2% of cases. With a tolerance of ±2°, the ideal osteotomy site was the proximal tibia in 41.0% of cases and the distal femur in 13.6% of cases; a double-level osteotomy would be necessary in 45.5% of cases. In contrast to the widespread belief that valgus malalignment is usually caused by a femoral deformity, this study found that valgus malalignment was attributable to tibial deformity in the majority of patients. In addition, a combined femoral- and tibial-based deformity was more common than an isolated femoral-based deformity. As a clinical consequence, varus osteotomies to treat lateral compartment osteoarthritis must be performed at the tibial site or as a double-level osteotomy in a relevant number of patients to avoid an oblique joint line.

GUP parameter from quantum corrections to the Newtonian potential

Directory of Open Access Journals (Sweden)

Fabio Scardigli

2017-04-01

Full Text Available We propose a technique to compute the deformation parameter of the generalized uncertainty principle by using the leading quantum corrections to the Newtonian potential. We just assume General Relativity as theory of Gravitation, and the thermal nature of the GUP corrections to the Hawking spectrum. With these minimal assumptions our calculation gives, to first order, a specific numerical result. The physical meaning of this value is discussed, and compared with the previously obtained bounds on the generalized uncertainty principle deformation parameter.

Phonon operators for deformed nuclei

International Nuclear Information System (INIS)

Solov'ev, V.G.

1982-01-01

The mathematical formalism with the phonon operators independent of the signature of the angular momentum projection turns out to be inadequate for describing excited states of deformed nuclei. New phonon operators are introduced which depend on the signature of the angular momentum projection on the symmetry axis of a deformed nucleus. It is shown that the calculations with the new phonons take correctly into account the Pauli principle in two-phonon components of wave functions. The results obtained differ from those given by the phonons independent of the signature of the angular momentum projection. The new phonons must be used in deformed nuclei at taking systematically the Pauli principle into account and in calculations involving wave functions of excited states having components with more than one-phonon operator

Varus deformity of the left lower extremity causing degenerative lesion of the posterior horn of the left medial meniscus in a patient with Paget’s disease of bone

Directory of Open Access Journals (Sweden)

Al Kaissi, Ali

2014-09-01

Full Text Available [english] We report on a 42-year-old woman who presented with persistent pain in her left knee with no history of trauma. Sagittal T1-weighted MRI of the left knee showed discontinuity between the anterior and posterior horns of the left medial meniscus, causing effectively the development of degenerative lesion of the posterior horn. The latter was correlated to varus deformity of the left lower extremity associated with subsequent narrowing of the medial knee joint. The unusual craniofacial contour of the patient, the skeletal survey and the elevated serum alkaline phosphatase were compatible with the diagnosis of Paget’s disease of the bone. To alleviate the adverse effect of the mal-alignment of the left femur onto the left knee, corrective osteotomy of the left femoral diaphysis by means of fixators was performed. To the best of our knowledge this is the first clinical report describing the management and the pathological correlation of a unilateral varus deformity of the femoral shaft and degenerative lesions of the left knee in a patient with Paget’s disease of the bone.

Detection and correction of patient movement in prostate brachytherapy seed reconstruction

Science.gov (United States)

Lam, Steve T.; Cho, Paul S.; Marks, Robert J., II; Narayanan, Sreeram

2005-05-01

Intraoperative dosimetry of prostate brachytherapy can help optimize the dose distribution and potentially improve clinical outcome. Evaluation of dose distribution during the seed implant procedure requires the knowledge of 3D seed coordinates. Fluoroscopy-based seed localization is a viable option. From three x-ray projections obtained at different gantry angles, 3D seed positions can be determined. However, when local anaesthesia is used for prostate brachytherapy, the patient movement during fluoroscopy image capture becomes a practical problem. If uncorrected, the errors introduced by patient motion between image captures would cause seed mismatches. Subsequently, the seed reconstruction algorithm would either fail to reconstruct or yield erroneous results. We have developed an algorithm that permits detection and correction of patient movement that may occur between fluoroscopy image captures. The patient movement is decomposed into translational shifts along the tabletop and rotation about an axis perpendicular to the tabletop. The property of spatial invariance of the co-planar imaging geometry is used for lateral movement correction. Cranio-caudal movement is corrected by analysing the perspective invariance along the x-ray axis. Rotation is estimated by an iterative method. The method can detect and correct for the range of patient movement commonly seen in the clinical environment. The algorithm has been implemented for routine clinical use as the preprocessing step for seed reconstruction.

Special distraction osteogenesis before bone grafting for alveolar cleft defects to correct maxillary deformities in patients with bilateral cleft lips and palates: distraction osteogenesis performed separately for each bone segment.

Science.gov (United States)

Mitsukawa, Nobuyuki; Saiga, Atsuomi; Morishita, Tadashi; Satoh, Kaneshige

2014-07-01

Patients with bilateral cleft lips and palates have premaxillary protrusion and characteristic jaw deformities involving three-dimensional malposition of the premaxilla and bilateral maxillary bone segments. This study examined patients with bilateral cleft lips and palates who had deviation and hypoplasia of the premaxillas and bilateral maxillary segments. Before bone grafting, the patients were treated with special distraction performed separately for each bone segment using a halo-type external device. This report describes this novel treatment method which produced good results. The subjects were five patients with severe jaw deformities due to bilateral cleft lip and palate. They were treated with maxillary Le Fort I osteotomy and subsequent distraction performed separately for each bone segment using a halo device. In three of five patients, premaxillary osteotomy was not performed, and osteotomy and distraction were performed only for the right and left lateral segments with severe hypoplasia. All patients achieved distraction close to the desired amount. The widths of the alveolar clefts were narrowed, and satisfactory occlusion and maxillary arch form were achieved. After the surgery, three of five patients underwent bone grafting for bilateral alveolar cleft defects and the bone graft survival was satisfactory. This method had many benefits, including narrowing of alveolar clefts, improvement of maxillary hypoplasia, and achievement of a good maxillary arch form. In addition, subsequent bone grafting for alveolar cleft defects was beneficial, dental prostheses were unnecessary, and frequency of surgery and surgical invasiveness were reduced. This method is a good surgical procedure that should be considered for patients with bilateral cleft lips and palates who have premaxillary protrusion and hypoplasia of the right and left lateral segments. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights

Assessment of stability during gait in patients with spinal deformity-A preliminary analysis using the dynamic stability margin.

Science.gov (United States)

Simon, Anne-Laure; Lugade, Vipul; Bernhardt, Kathie; Larson, A Noelle; Kaufman, Kenton

2017-06-01

Daily living activities are dynamic, requiring spinal motion through space. Current assessment of spinal deformities is based on static measurements from full-spine standing radiographs. Tools to assess dynamic stability during gait might be useful to enhance the standard evaluation. The aim of this study was to evaluate gait dynamic imbalance in patients with spinal deformity using the dynamic stability margin (DSM). Twelve normal subjects and 17 patients with spinal deformity were prospectively recruited. A kinematic 3D gait analysis was performed for the control group (CG) and the spinal deformity group (SDG). The DSM (distance between the extrapolated center of mass and the base of support) and time-distance parameters were calculated for the right and left side during gait. The relationship between DSM and step length was assessed using three variables: gait stability, symmetry, and consistency. Variables' accuracy was validated by a discriminant analysis. Patients with spinal deformity exhibited gait instability according to the DSM (0.25m versus 0.31m) with decreased velocity (1.1ms -1 versus 1.3ms -1 ) and decreased step length (0.32m versus 0.38m). According to the discriminant analysis, gait stability was the more accurate variable (area under the curve AUC=0.98) followed by gait symmetry and consistency. However, gait consistency showed 100% of specificity, sensitivity, and accuracy of precision. The DSM showed that patients with spinal malalignment exhibit decreased gait stability, symmetry, and consistency besides gait time-distance parameter changes. Additional work is required to determine how to apply the DSM for preoperative and postoperative spinal deformity management. Copyright © 2017. Published by Elsevier B.V.

[Minimally invasive therapy for hallux valgus with deformity of little toe varus].

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Gu, Shi-Wei; Yang, Ke; Zhao, Si-Qiao; Gao, Zhan-Ao; Ma, Shun-Qian; Zhang, Wen-Qing

2018-03-25

To explore clinical effect of minimally corrective osteotomy for the treatment of hallux valgus with deformity of little toe varus through small incision. From January 2013 to June 2016, 168 hallux valgus patients with deformity of little toe varus were treated by minimally corrective osteotomy through small incision. Among them, 7 males and 161 females were aged from 22 to 75 years old with an average of(59.3±3.5) years old. Preoperative clinical manifestation mainly focus on red and swollen of bunion, pain around with metatarsal bones, and diagnosed as hallux valgus with deformity of little toe varus through small incision. Operative time, postoperative complications, pre and post-operative IMA(angle between the first and the second metatarsal bones), HVA (hallux valgus angle), LDA(valgus angle of the fifth metatarsal bones), MPA(valgus angle of little toe), IM4-5 (angle between the forth and the fifth metatarsal bones) and PASA(fixed angle of proximal joint), postoperative AOFAS score were used to evaluate foot function. One hundred and sixty-eight patients were followed up for 6 to 48 months with an average of (28.6±3.2) months. All wounds were healed well without infection, sinus tract and other complications. Operative time ranged from 16 to 28 min with an average of (18.3±2.1) min. IMA, HVA, LDA, MPA and IM A 4-5 were (10.1±2.1)°, (32.6±4.2)°, (6.9±2.3)°, (18.5±5.2)°, (15.1±2.9)°preoperatively, improved to (8.3±2.2)°, (10.9±2.9)°, (2.7±0.4)°, (6.5±1.6)°, (8.9±1.8)° postoperatively, and had significant differences before and after operation. While there was no difference in PASA before (9.1±2.1)°and after operation(8.7±1.9)°. AOFAS score were improved from (31.6±3.9) before operation to(83.7±5.2) after operation, but no significant difference( P >0.05). According to AOFAS score, 147 patients obtained excellent results, 13 good, 6 moderate and 2 poor. Minimally corrective osteotomy for the treatment of hallux valgus with deformity

Pollybeak Deformity in Middle Eastern Rhinoplasty: Prevention and Treatment.

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Hussein, Wael K A; Foda, Hossam M T

2016-08-01

The pollybeak deformity is one of the commonest causes of revision rhinoplasty. The Middle Eastern nose has certain criteria that predispose to the development of pollybeak deformity. The aim of this study is to detect the factors contributing to the development of pollybeak deformity in the Middle Eastern nose and methods used to prevent as well as to treat such deformity. Out of the 1,160 revision patients included in this study, 720 (62%) patients had a pollybeak deformity. The commonest contributing factors included underprojected tip with poor support in 490 (68%) patients, excessive supratip scarring in 259 (36%) patients, overresected bony dorsum in 202 (28%) patients, and high anterior septal angle in 173 (24%) patients. The methods used by the authors to treat the pollybeak deformity are described, along with the local steroid injection protocol used to guard against the recurrence of pollybeak deformity. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Deformidade de Sprengel: tratamento cirúrgico pela técnica de green modificada Sprengel's deformity: surgical correction by a modified green procedure

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Sandro da Silva Reginaldo

2009-06-01

Full Text Available OBJETIVO: Demonstrar os resultados estéticos e funcionais de pacientes submetidos à correção cirúrgica de escápula alta congênita - deformidade de Sprengel - por uma modificação da técnica de Green, bem como avaliar o grau de satisfação dos pacientes e as complicações da técnica utilizada. MÉTODOS: Foram avaliados nove pacientes operados pela técnica de Green modificada, no período de setembro de 1993 a abril de 2008. Como modificação da técnica original foram realizados descolamento muscular subperiosteal, ressecção apenas da porção súpero-medial da escápula e, em vez da utilização de tração esquelética, optou-se pela fixação com fio de aço subcutâneo da porção medial da espinha da escápula à crista ilíaca posterior contralateral. A idade média dos pacientes foi de sete anos e três meses. O seguimento pós-operatório médio foi de três anos e sete meses. RESULTADOS: Houve incremento médio na elevação de cerca de 39º (variando de 0º a 80º . Segundo a classificação de Cavendish, obteve-se a melhora estética de dois graus em oito casos e de três graus em um. Todos os pacientes ficaram satisfeitos com o resultado. CONCLUSÕES: Os pacientes com deformidade de Sprengel submetidos a tratamento cirúrgico por meio de uma modificação da técnica de Green, com fixação da escápula na crista ilíaca posterior contralateral em vez de se utilizar tração esquelética, apresentaram melhora tanto funcional como estética; todos os pacientes e/ou familiares ficaram satisfeitos e as complicações relacionadas com a técnica cirúrgica não interferiram no resultado final.OBJECTIVE: To evaluate the cosmetic and functional results of patients submitted to surgical correction of Congenital High Scapula (Sprengel's Deformity using modified Green's Procedure, as well as patients' satisfaction and complications. METHODS: Nine patients submitted to surgical treatment from September 1993 to April 2008 have

Role of thoracoscopy for the sagittal correction of hypokyphotic adolescent idiopathic scoliosis patients.

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Ferrero, E; Pesenti, S; Blondel, B; Jouve, J L; Mazda, K; Ilharreborde, B

2014-12-01

Thoracic adolescent idiopathic scoliosis (AIS) curves (Lenke 1-4) are often characterized by hypokyphosis. Sagittal alignment remains challenging to correct, even with recent posterior segmental instrumentation. Some authors recommend anterior endoscopic release (AER) to reduce anterior column height, and facilitate thoracic kyphosis correction. The aim of this study was to assess the contribution of AER to sagittal correction in hypokyphotic AIS. Fifty-six hypokyphotic (T4T12<20°) AIS patients were included. In group 1 (28 patients), patients first underwent AER, followed by posterior instrumentation and correction 5-7 days later. In group 2 (28 patients), patients underwent the same posterior procedure without AER. Posterior correction was performed in all cases using posteromedial translation and hybrid constructs consisting of lumbar pedicle screws and thoracic sublaminar bands. From radiological measurements performed using low-dose EOS radiographs, the correction of thoracic kyphosis was compared between the two groups. Groups 1 and 2 were comparable regarding demographic data and preoperative thoracic kyphosis (group 1: 11.7° ± 6.9° vs group 2: 12.1° ± 6.3°, p = 0.89). Postoperative thoracic kyphosis increase averaged 18.3° ± 13.6° in group 1 and 15.2° ± 9.0° in group 2. The benefit of anterior release was not statistically significant (p = 0.35). Although previous studies have suggested that thoracoscopic release improved correction compared to posterior surgery alone, the current study did not confirm this finding. Moreover, results of the current series showed that no significant benefit can be expected from AER in terms of sagittal plane improvement when the posteromedial translation technique is used, even in challenging hypokyphotic patients.

[Domestic external fixator application in the treatment of limb deformities: 7 289 cases application report].

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Qin, S H; Guo, B F; Zheng, X J; Jiao, S F; Xia, H T; Peng, A M; Pan, Q; Zang, J C; Wang, Z J

2017-09-01

Objective: To discuss the clinical application and effects of domestic external fixator in the treatment of patients with malformations of limbs. Methods: A total of 7 289 patients with malformation of limbs who had been operated in Qin Sihe orthopedic surgery team from January 1989 to June 2016 were retrospective analyzed. The patients were treated with domestic external fixator, including 4 033 males and 3 256 females, aging from 2 to 82 years with a mean age of 23.4 years. There were 2 732 patients using Ilizarov external fixator, 4 713 patients using hybrid external fixator, 57 patients using monobrachial external fixator, 232 patients using Ilizarov external fixator and hybrid external fixator. The Ilizarov, hybrid and monobrachial external fixator were used in 67, 65 and 0 patients on the upper limbs and in 2 665, 4 616 and 57 patients on the lower limbs. There were 3 028 patients operated on the left limbs, 3 260 patients operated on the right limbs and 1 001 patients operated on the bilateral limbs. The top three types of diseases were sequelae of poliomyelitis, cerebral palsy and post-traumatic stress disorder peromely. Deformity types inclued talipes equinovarus, knee flexion deformity, cavus foot and so on. Results: All the patients were followed up for a period of 2.5 months to 22.4 years, with an average follow-up time of 5.4 years. All of the external fixators were used for single once, and there was no substitute for external fixator quality problem. All the patients were completed surgery goal until removing external fixation except 1 patient gave up treatment and 1 removed the fixator because of metal allergy. The common complications included wire or pin infection and joint movement limitation and so on. Conclusions: The domestic external fixator developed and produced based on the characteristics of Chinese limb deformity disability. The domestic external fixator can be used to treat kinds of limb deformities with the advantages of practical

Chest wall deformity and respiratory distress in a 17-year-old patient with achondroplasia: CT and MRI evaluation

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Herman, T.E.; Siegel, M.J.; McAlister, W.H. (Washington Univ. School of Medicine, St. Louis, MO (United States). Mallinckrodt Inst. of Radiology)

1992-06-01

A marked thoracic deformity associated with intrathoracic tracheal narrowing was seen in a 17-year old with achondroplasia and dyspnea. The role of chest deformity and its evaluation by CT and MRI in achondroplastic patients with respiratory symptoms are considered. (orig.).

Chest wall deformity and respiratory distress in a 17-year-old patient with achondroplasia: CT and MRI evaluation

International Nuclear Information System (INIS)

Herman, T.E.; Siegel, M.J.; McAlister, W.H.

1992-01-01

A marked thoracic deformity associated with intrathoracic tracheal narrowing was seen in a 17-year old with achondroplasia and dyspnea. The role of chest deformity and its evaluation by CT and MRI in achondroplastic patients with respiratory symptoms are considered. (orig.)

The contribution of thoracic vertebral deformity and arthropathy to trunk pain in patients with chronic obstructive pulmonary disease (COPD).

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Chen, Yi-Wen; Coxson, Harvey O; Coupal, Tyler M; Lam, Stephen; Munk, Peter L; Leipsic, Jonathon; Reid, W Darlene

2018-04-01

Pain, commonly localized to the trunk in individuals with COPD, may be due to osteoporosis-related vertebral deformity and chest wall hyper-expansion causing misalignment of joints between the ribs and vertebrae. The purpose of this study was to determine if thoracic vertebral deformity and arthropathy were independent contributors to trunk pain in COPD patients compared to people with a significant smoking history. Participants completed the Brief Pain Inventory (BPI) on the same day as chest CT scans and spirometry. Current and ex-smokers were separated into COPD (n = 91) or non-COPD (n = 80) groups based on spirometry. Subsequently, CT images were assessed for thoracic vertebral deformity, bone attenuation values, and arthropathy of thoracic vertebral joints. The trunk area was the most common pain location in both COPD and non-COPD groups. Thoracic vertebral deformity and costotransverse joint arthropathy were independent contributors to trunk pain in COPD patients (adjusted OR = 3.55 and 1.30, respectively) whereas alcohol consumption contributed to trunk pain in the non-COPD group (adjusted OR = 0.35 in occasional alcohol drinkers; 0.08 in non-alcohol drinkers). The spinal deformity index and the number of narrowed disc spaces were significantly positively related to the BPI intensity, interference, and total scores significantly in COPD patients. Trunk pain, at least in part, is caused by thoracic vertebral deformity, and costotransverse and intervertebral arthropathy in patients living with COPD. The results of this study provided the foundation for the management of pain, which requires further exploration. Copyright © 2018 Elsevier Ltd. All rights reserved.

Walking ability in patients with arthrogryposis multiplex congenita

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Perajit Eamsobhana

2014-01-01

Conclusion: AMC is a rare disease that causes disability, requiring multiple surgeries to correct deformities. Our study showed that residual knee flexion contracture was associated with nonambulatory status of patients with AMC.

Total and corrected antioxidant capacity in hemodialyzed patients

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Margioris Andrew N

2003-07-01

Full Text Available Abstract Background Oxidative stress may play a critical role in the vascular disease of end stage renal failure and hemodialysis patients. Studies, analyzing either discrete analytes and antioxidant substances, or the integrated total antioxidant activity of human plasma during hemodialysis, give contradictory results. Methods Recently, we have introduced a new automated method for the determination of Total Antioxidant Capacity (TAC of human plasma. We have serially measured TAC and corrected TAC (cTAC: after subtraction of the interactions due to endogenous uric acid, bilirubin and albumin in 10 patients before the onset of the dialysis session, 10 min, 30 min, 1 h, 2 h and 3 h into the procedure and after completion of the session. Results Our results indicate that TAC decreases, reaching minimum levels at 2 h. However, corrected TAC increases with t1/2 of about 30 min. We then repeated the measurements in 65 patients undergoing dialysis with different filters (36 patients with ethylene vinyl alcohol copolymer resin filter -Eval-, 23 patients with two polysulfone filters -10 with F6 and 13 with PSN140-, and 6 patients with hemophan filters. Three specimens were collected (0, 30, 240 min. The results of this second group confirm our initial results, while no significant difference was observed using either filter. Conclusions Our results are discussed under the point of view of possible mechanisms of modification of endogenous antioxidants, and the interaction of lipid- and water-soluble antioxidants.

High-resolution adaptive optics scanning laser ophthalmoscope with multiple deformable mirrors

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Chen, Diana C.; Olivier, Scot S.; Jones; Steven M.

2010-02-23

An adaptive optics scanning laser ophthalmoscopes is introduced to produce non-invasive views of the human retina. The use of dual deformable mirrors improved the dynamic range for correction of the wavefront aberrations compared with the use of the MEMS mirror alone, and improved the quality of the wavefront correction compared with the use of the bimorph mirror alone. The large-stroke bimorph deformable mirror improved the capability for axial sectioning with the confocal imaging system by providing an easier way to move the focus axially through different layers of the retina.

Adaptive radiotherapy with an average anatomy model: Evaluation and quantification of residual deformations in head and neck cancer patients

International Nuclear Information System (INIS)

Kranen, Simon van; Mencarelli, Angelo; Beek, Suzanne van; Rasch, Coen; Herk, Marcel van; Sonke, Jan-Jakob

2013-01-01

Background and purpose: To develop and validate an adaptive intervention strategy for radiotherapy of head-and-neck cancer that accounts for systematic deformations by modifying the planning-CT (pCT) to the average misalignments in daily cone beam CT (CBCT) measured with deformable registration (DR). Methods and materials: Daily CBCT scans (808 scans) for 25 patients were retrospectively registered to the pCT with B-spline DR. The average deformation vector field ( ) was used to deform the pCT for adaptive intervention. Two strategies were simulated: single intervention after 10 fractions and weekly intervention with an from the previous week. The model was geometrically validated with the residual misalignment of anatomical landmarks both on bony-anatomy (BA; automatically generated) and soft-tissue (ST; manually identified). Results: Systematic deformations were 2.5/3.4 mm vector length (BA/ST). Single intervention reduced deformations to 1.5/2.7 mm (BA/ST). Weekly intervention resulted in 1.0/2.2 mm (BA/ST) and accounted better for progressive changes. 15 patients had average systematic deformations >2 mm (BA): reductions were 1.1/1.9 mm (single/weekly BA). ST improvements were underestimated due to observer and registration variability. Conclusions: Adaptive intervention with a pCT modified to the average anatomy during treatment successfully reduces systematic deformations. The improved accuracy could possibly be exploited in margin reduction and/or dose escalation

Intensity of early correction of hyperglycaemia and outcome of critically ill patients with diabetic ketoacidosis.

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Mårtensson, Johan; Bailey, Michael; Venkatesh, Balasubramanian; Pilcher, David; Deane, Adam; Abdelhamid, Yasmine Ali; Crisman, Marco; Verma, Brij; MacIsaac, Christopher; Wigmore, Geoffrey; Shehabi, Yahya; Suzuki, Takafumi; French, Craig; Orford, Neil; Kakho, Nima; Prins, Johannes; Ekinci, Elif I; Bellomo, Rinaldo

2017-09-01

To determine the impact of the intensity of early correction of hyperglycaemia on outcomes in patients with diabetic ketoacidosis (DKA) admitted to the intensive care unit. We studied adult patients with DKA admitted to 171 ICUs in Australia and New Zealand from 2000 to 2013. We used their blood glucose levels (BGLs) in the first 24 hours after ICU admission to determine whether intensive early correction of hyperglycemia to ≤ 180 mg/dL was independently associated with hypoglycaemia, hypokalaemia, hypo-osmolarity or mortality, compared with partial early correction to > 180 mg/dL as recommended by DKA-specific guidelines. Among 8553 patients, intensive early correction of BGL was applied to 605 patients (7.1%). A greater proportion of these patients experienced hypoglycaemia (20.2% v 9.1%; P < 0.001) and/or hypo-osmolarity (29.4% v 22.0%; P < 0.001), but not hypokalaemia (16.7% v 15.6%; P = 0.47). Overall, 11 patients (1.8%) in the intensive correction group and 112 patients (1.4%) in the partial correction group died (P = 0.42). However, after adjustment for illness severity, partial early correction of BGL was independently associated with a lower risk of hypoglycaemia (odds ratio [OR], 0.38; 95% CI, 0.30-0.48; P < 0.001), lower risk of hypo-osmolarity (OR, 0.80; 95% CI, 0.65-0.98; P < 0.03) and lower risk of death (OR, 0.44; 95% CI, 0.22-0.86; P = 0.02). In a large cohort of patients with DKA, partial early correction of BGL according to DKA-specific guidelines, when compared with intensive early correction of BGL, was independently associated with a lower risk of hypoglycaemia, hypo-osmolarity and death.

Relation between self-image score of SRS-22 with deformity measures in female adolescent idiopathic scoliosis patients.

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Wang, L; Wang, Y P; Yu, B; Zhang, J G; Shen, J X; Qiu, G X; Li, Y

2014-11-01

Adolescent idiopathic scoliosis (AIS) is a pathology which affects the individual's functioning in the widely understood physical, psychic, and social aspects. More attention should be paid to patients' perception of self-image when evaluating the spine deformity. The present retrospective study evaluated the associations between the deformity measures and self-image score as determined by the SRS-22 questionnaire in Chinese female AIS patients. The self-image score correlates significantly with deformity measures. The location of main curve apex and the number of curve could affect the self-image score. We retrospectively reviewed the records of 202 female patients, collected data on patient's age, body mass index, radiographic and physical measures and self-image score of SRS-22 questionnaire. According to the location of main curve apex and the number of curve, the patients were divided to different subgroups. Correlations between deformity measures and self-image score of different groups were evaluated by the Spearman correlation test. The self-image score correlated negatively with the main Cobb angle, apical vertebral translation (AVT), and razor hump height. There is no significant difference of self-image score between thoracic curve (TC) and thoracolumbar curve (TL/LC) subgroups. And the self-image scores of one-curve, two-curve and three-curve subgroups are similar. For Chinese female AIS patients in our study, self-image was found to correlate negatively with the main Cobb angle, AVT and razor hump height. And the location of scoliosis apex and the number of curve are not influencing factors of self-image perception. Level IV, retrospective study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Relationship between Postural Deformities and Frontal Function in Parkinson's Disease

OpenAIRE

Ninomiya, Satoko; Morita, Akihiko; Teramoto, Hiroko; Akimoto, Takayoshi; Shiota, Hiroshi; Kamei, Satoshi

2015-01-01

Postural deformities and executive dysfunction (ED) are common symptoms of Parkinson's disease (PD); however, the relationship between postural deformities and ED in patients with PD remains unclear. This study assessed the relationship between postural deformities and ED in patients with PD. Sixty-five patients with sporadic PD were assessed for the severity of postural deformities and executive function. The severity of postural deformities was scored using the United Parkinson's Disease Ra...

Canny edge-based deformable image registration.

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Kearney, Vasant; Huang, Yihui; Mao, Weihua; Yuan, Baohong; Tang, Liping

2017-02-07

This work focuses on developing a 2D Canny edge-based deformable image registration (Canny DIR) algorithm to register in vivo white light images taken at various time points. This method uses a sparse interpolation deformation algorithm to sparsely register regions of the image with strong edge information. A stability criterion is enforced which removes regions of edges that do not deform in a smooth uniform manner. Using a synthetic mouse surface ground truth model, the accuracy of the Canny DIR algorithm was evaluated under axial rotation in the presence of deformation. The accuracy was also tested using fluorescent dye injections, which were then used for gamma analysis to establish a second ground truth. The results indicate that the Canny DIR algorithm performs better than rigid registration, intensity corrected Demons, and distinctive features for all evaluation matrices and ground truth scenarios. In conclusion Canny DIR performs well in the presence of the unique lighting and shading variations associated with white-light-based image registration.

Patient motion correction for single photon emission computed tomography (SPECT)

International Nuclear Information System (INIS)

Geckle, W.J.; Becker, L.C.; Links, J.M.; Frank, T.

1986-01-01

An investigation has been conducted to develop and validate techniques for the correction of projection images in SPECT studies of the myocardium subject to misalignment due to voluntary patient motion. The problem is frequently encountered due to the uncomfortable position the patient must assume during the 30 minutes required to obtain a 180 degree set of projection images. The reconstruction of misaligned projections can lead to troublesome artifacts in reconstructed images and degrade the diagnostic potential of the procedure. Significant improvement in the quality of heart reconstructions has been realized with the implementation of an algorithm to provide detection of and correction for patient motion. Normal, involuntary motion is not corrected for, however, since such movement is below the spatial resolution of the thallium imaging system under study. The algorithm is based on a comparison of the positions of an object in a set of projection images to the known, sinusoidal trajectory of an off-axis fixed point in space. Projection alignment, therefore, is achieved by shifting the position of a point or set of points in a projection image to the sinusoid of a fixed position in space

Combined Use of Facial Osteoplasty and Orthognathic Surgery for Treatment of Dentofacial Deformities.

Science.gov (United States)

Li, Yunfeng; Hu, Zhiai; Ye, Bin; Liu, Yao; Ren, Xiaochun; Zhu, Songsong

2016-12-01

Orthognathic surgery is an efficient procedure for cosmetic and functional aims. However, when functional improvement is achieved by mandibular or maxillary operations, additional esthetic corrections may be imperative for some patients. This study aims to introduce our primary practice of simultaneous facial bone contouring and orthognathic surgery for esthetic reasons. Ten patients with dentofacial deformities as well as a prominent angle, asymmetric deformities, or a high zygoma and zygomatic arch were recruited from West China Hospital of Stomatology, Sichuan University (Chengdu, China), between January 1, 2014, and July 31, 2015. Traditional orthognathic surgical procedures such as bilateral sagittal split osteotomy and Le Fort I osteotomy combined with facial osteoplasty including mandibular angle ostectomy, outer cortex ostectomy of the mandibular angle, and zygoma and zygomatic arch reduction were performed. Radiographs and medical photographs were taken before and after surgery to compare the effectiveness of the combined use of facial osteoplasty and orthognathic surgery. All patients had an uneventful postoperative recovery, with no signs of infection, jaw displacement, or osteonecrosis. Radiographs taken 1 week after surgery and pictures of the facial profile and occlusion taken 6 months after surgery showed satisfactory esthetic outcomes. All patients were satisfied with the functional and cosmetic results. This study indicated the clinical feasibility of simultaneous facial bone contouring and orthognathic surgery for the treatment of dentofacial deformities. Simultaneous facial bone contouring seems to be an alternative procedure in addition to conventional orthognathic surgery for cosmetic aims in certain patients. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Determining the most stable breathing phase for respiratory gating using velocity deformable registration in patients with lung cancer

International Nuclear Information System (INIS)

Aarons, Y.; Wightman, F.; Roxby, P.; Kron, T.

2011-01-01

Full text: Respiratory gated radiotherapy is a high-precision technique where the treatment beam is turned on during a predetermined phase of the breathing cycle in order to minimise dose to surrounding healthy dose sensitive structures. We aim to compare inspiration and expiration phases to determine which is more stable in the breathing cycle to perform respiratory gating. Methods Nine patients underwent a planning time resolved 4DCT (Philips Brilliance 16-multislice widebore) and repeat 4DCT during weeks I, 3 and 5 of a radical course of radiotherapy for lung cancer. Inspiration scans were co-registered to the same phase image of the original planning CT using rigid and then deformable registration with Velocity software. The process was repeated for scans at exhalation phase. The deformation matrix for the diaphragm was used to compare the reproducibility of breathing phases. In the majority of patients (seven of nine) the expiration phase was found to be the more stable compared with inspiration. The maximum diaphragm displacement exceeded 3 cm in one case for the registered inhalation images while the deformation was typically half of that in the exhalation images. Interestingly, several patients showed significant differences in deformation for the left and right diaphragm. Conclusions In a group of lung cancer patients we found the expiration phase to be more reproducible for delivering respiratory gated RT, when compared with inspiration.

Deformation of contour and Hawking temperature

International Nuclear Information System (INIS)

Ding Chikun; Jing Jiliang

2010-01-01

It was found that, in an isotropic coordinate system, the tunneling approach brings a factor of 1/2 for the Hawking temperature of a Schwarzschild black hole. In this paper, we address this kind of problem by studying the relation between the Hawking temperature and the deformation of the integral contour for the scalar and Dirac particles tunneling. We find that the correct Hawking temperature can be obtained exactly as long as the integral contour deformed corresponding to the radial coordinate transform if the transformation is a non-regular or zero function at the event horizon.

Coincidence detection FDG-PET (Co-PET) in the management of oncological patients: attenuation correction versus non-attenuation correction

International Nuclear Information System (INIS)

Chan, W.L.; Freund, J.; Pocock, N.; Szeto, E.; Chan, F.; Sorensen, B.; McBride, B.

2000-01-01

Full text: This study was to determine if attenuation correction (AC) in FDG Co-PET improved image quality, lesion detection, patient staging and management of various malignant neoplasms, compared to non-attenuation-corrected (NAC) images. Thirty patients (25 men, 5 women, mean age 58 years) with known or suspected malignant neoplasms, including non-small-cell lung cancer, non Hodgkin's and Hodgkin's lymphoma, carcinoma of the breast, head and neck cancer and melanoma, underwent FDG Co-PET, which was correlated with histopathology, CT and other conventional imaging modalities and clinical follow-up. Whole body tomography was performed (ADAC Vertex MCD) 60 min after 200 MBq of 18 F-FDG (>6h fasting). The number and location of FDG avid lesions detected on the AC images and NAC Co-PET images were blindly assessed by two independent observers. Semi-quantitative grading of image clarity and lesion-to-background quality was performed. This revealed markedly improved image clarity and lesion-to-background quality, in the AC versus NAC images. AC and NAC Co-PET were statistically different in relation to lesion detection (p<0.01) and tumour staging (p<0.0 1). NAC Co-PET demonstrated 51 of the 65 lesions (78%) detected by AC Co-PET. AC Co-PET staging was correct in 27 patients (90%), compared with NAC Co-PET in 22 patients (73%). AC Co-PET altered tumour staging in five of 30 patients (16%) and NAC Co-PET did not alter tumour staging in any of the patients- management was altered in only two of these five patients (7%). In conclusion, AC Co-PET resulted in better image quality with significantly improved lesion detectability and tumour staging compared to NAC Co-PET. Its additional impact on patient management in this relatively small sample was minor. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

Interest of corrective makeup in the management of patients in dermatology

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Seité S

2012-09-01

Full Text Available S Seité,1 P Deshayes,2 B Dréno,3 L Misery,4 P Reygagne,5 P Saiag,6 F Stengel,7 AM Roguedas-Contios,4 A Rougier11La Roche-Posay Pharmaceutical Laboratories, Asnières, France; 2Service de Dermatologie, Caen, France; 3Hôtel-Dieu, Nantes, France; 4CHU de Brest-Hôpital Morvan, Brest, France; 5Centre Sabouraud, Hôpital Saint-Louis, Paris, France; 6CHU Ambroise Paré, Boulogne, France; 7Department of Dermatology, Buenos Aires, ArgentinaBackground: Disfiguring dermatoses may have a significant impact on patients’ quality of life, namely on their relationship with others, self image, and self esteem. Some previous studies have suggested that corrective foundation can improve the quality of life (QOL of patients with facial dermatoses; in particular, in patients with acne vulgaris or pigmentary disorders.Objective: The aim of this prospective study was to evaluate the impact of the skin conditions of patients with various skin diseases affecting their face (scars, acne, rosacea, melasma, vitiligo, hypo or hyperpigmentation, lentigines, etc on their QOL and the improvement afforded by the use of corrective makeup for 1 month after being instructed on how to use it by a medical cosmetician during an initial medical consultation.Methods: One hundred and twenty-nine patients with various skin diseases affecting the patients’ face were investigated. The patients were instructed by a cosmetician on how to use corrective makeup (complexion, eyes, and lips and applied it for 1 month. The safety of the makeup application was evaluated and the QOL was assessed via a questionnaire (DLQI and using a 10-cm visual analog scale (VAS completed before the first application and at the final visit. The amelioration of their appearance was documented by standardized photography.Results: No side effects occurred during the course of the study. A comparison of the standardized photographs taken at each visit showed the patients’ significant improvement in

Finite-element analysis of the deformation of thin Mylar films due to measurement forces.

Energy Technology Data Exchange (ETDEWEB)

Baker, Michael Sean; Robinson, Alex Lockwood; Tran, Hy D.

2012-01-01

Significant deformation of thin films occurs when measuring thickness by mechanical means. This source of measurement error can lead to underestimating film thickness if proper corrections are not made. Analytical solutions exist for Hertzian contact deformation, but these solutions assume relatively large geometries. If the film being measured is thin, the analytical Hertzian assumptions are not appropriate. ANSYS is used to model the contact deformation of a 48 gauge Mylar film under bearing load, supported by a stiffer material. Simulation results are presented and compared to other correction estimates. Ideal, semi-infinite, and constrained properties of the film and the measurement tools are considered.

Defining a core outcome set for adolescent and young adult patients with a spinal deformity.

Science.gov (United States)

de Kleuver, Marinus; Faraj, Sayf S A; Holewijn, Roderick M; Germscheid, Niccole M; Adobor, Raphael D; Andersen, Mikkel; Tropp, Hans; Dahl, Benny; Keskinen, Heli; Olai, Anders; Polly, David W; van Hooff, Miranda L; Haanstra, Tsjitske M

2017-12-01

Background and purpose - Routine outcome measurement has been shown to improve performance in several fields of healthcare. National spine surgery registries have been initiated in 5 Nordic countries. However, there is no agreement on which outcomes are essential to measure for adolescent and young adult patients with a spinal deformity. The aim of this study was to develop a core outcome set (COS) that will facilitate benchmarking within and between the 5 countries of the Nordic Spinal Deformity Society (NSDS) and other registries worldwide. Material and methods - From August 2015 to September 2016, 7 representatives (panelists) of the national spinal surgery registries from each of the NSDS countries participated in a modified Delphi study. With a systematic literature review as a basis and the International Classification of Functioning, Disability and Health framework as guidance, 4 consensus rounds were held. Consensus was defined as agreement between at least 5 of the 7 representatives. Data were analyzed qualitatively and quantitatively. Results - Consensus was reached on the inclusion of 13 core outcome domains: "satisfaction with overall outcome of surgery", "satisfaction with cosmetic result of surgery", "pain interference", physical functioning", "health-related quality of life", "recreation and leisure", "pulmonary fatigue", "change in deformity", "self-image", "pain intensity", "physical function", "complications", and "re-operation". Panelists agreed that the SRS-22r, EQ-5D, and a pulmonary fatigue questionnaire (yet to be developed) are the most appropriate set of patient-reported measurement instruments that cover these outcome domains. Interpretation - We have identified a COS for a large subgroup of spinal deformity patients for implementation and validation in the NSDS countries. This is the first study to further develop a COS in a global perspective.

A Comparative Study of Sagittal Balance in Patients with Neuromuscular Scoliosis

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Paulo Alvim Borges

Full Text Available OBJECTIVES: Spinopelvic alignment has been associated with improved quality of life in patients with vertebral deformities, and it helps to compensate for imbalances in gait. Although surgical treatment of scoliosis in patients with neuromuscular spinal deformities promotes correction of coronal scoliotic deformities, it remains poorly established whether this results in large changes in sagittal balance parameters in this specific population. The objective of this study is to compare these parameters before and after the current procedure under the hypothesis is that there is no significant modification. METHODS: Sampling included all records of patients with neuromuscular scoliosis with adequate radiographic records treated at Institute of Orthopedics and Traumatology of Clinics Hospital of University of São Paulo (IOT-HCFMUSP from January 2009 to December 2013. Parameters analyzed were incidence, sacral inclination, pelvic tilt, lumbar lordosis, thoracic kyphosis, spinosacral angle, spinal inclination and spinopelvic inclination obtained using the iSite-Philips digital display system with Surgimap and a validated method for digital measurements of scoliosis radiographs. Comparison between the pre- and post-operative conditions involved means and standard deviations and the t-test. RESULTS: Based on 101 medical records only, 16 patients met the inclusion criteria for this study, including 7 males and 9 females, with an age range of 9-20 and a mean age of 12.9±3.06; 14 were diagnosed with cerebral palsy. No significant differences were found between pre and postoperative parameters. CONCLUSIONS: Despite correction of coronal scoliotic deformity in patients with neuromuscular deformities, there were no changes in spinopelvic alignment parameters in the group studied.

METHODS FOR CORRECTION OF RHINOPHONIA IN PATIENTS WITH ACQUIRED MAXILLARY DEFECTS

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E. G. Matyakin

2012-01-01

Full Text Available Speech recovery sessions were conducted in 63 patients with acquired maxillary defects. Assessment of speech quality in patients after auditory maxillary resection without a prosthestic has indicated 100 % significant rhinolalia, indistinct articulation. Prosthetic defect replacement completely corrects speech dysfunction and creates conditions for forming correct speech stereotypes. Speech therapy sessions and testing are aimed at increasing the performance of the speech apparatus and at improving the automatizaton of speaking skills. The techniques to remove nasal emission include: – articulation exercises (activation of the muscles of the lips, cheeks, tongue, pharynx, neck, and larynx; – speech respiratory gymnastics; – phonopedic (vocal exercises. The elements of rational psychotherapy have extensive applications during each session and include suggestion, an emotional exposure to correct personality disorders, as well as pedagogical elements. 

Characterization of gait in female patients with moderate to severe hallux valgus deformity.

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Chopra, S; Moerenhout, K; Crevoisier, X

2015-07-01

Hallux valgus is one of the most common forefoot problems in females. Studies have looked at gait alterations due to hallux valgus deformity, assessing temporal, kinematic or plantar pressure parameters individually. The present study, however, aims to assess all listed parameters at once and to isolate the most clinically relevant gait parameters for moderate to severe hallux valgus deformity with the intent of improving post-operative patient prognosis and rehabilitation. The study included 26 feet with moderate to severe hallux valgus deformity and 30 feet with no sign of hallux valgus in female participants. Initially, weight bearing radiographs and foot and ankle clinical scores were assessed. Gait assessment was then performed utilizing pressure insoles (PEDAR) and inertial sensors (Physilog) and the two groups were compared using a non-parametric statistical hypothesis test (Wilcoxon rank sum, Phallux valgus group compared to controls and 9 gait parameters (effect size between 1.03 and 1.76) were successfully isolated to best describe the altered gait in hallux valgus deformity (r(2)=0.71) as well as showed good correlation with clinical scores. Our results, and nine listed parameters, could serve as benchmark for characterization of hallux valgus and objective evaluation of treatment efficacy. Copyright © 2015 Elsevier Ltd. All rights reserved.

Geodetic deformation monitoring at Pendidikan Diponegoro Dam

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Yuwono, Bambang Darmo; Awaluddin, Moehammad; Yusuf, M. A.; Fadillah, Rizki

2017-07-01

Deformation monitoring is one indicator to assess the feasibility of Dam. In order to get the correct result of the deformation, it is necessary to determine appropriate deformation monitoring network and the observation data should be analyse and evaluated carefully. Measurement and analysis of deformation requires relatively accurate data and the precision is high enough, one of the observation method that used is GPS (Global Positioning System). The research was conducted at Pendidikan Undip Dams is Dam which is located in Tembang. Diponegoro Dam was built in 2013 and a volume of 50.86 m3 of water, inundation normal width of up to 13,500 m2. The main purpose of these building is not only for drainage but also for education and micro hydro power plant etc. The main goal of this reasearch was to monitor and analyze the deformation at Pendidikan Undip Dam and to determaine whether GPS measurement could meet accuracy requirement for dam deformation measurements. Measurements were made 2 times over 2 years, 2015 and 2016 using dual frequency GPS receivers with static methods and processed by Scientific Software GAMIT 10.6

Lung deformations and radiation-induced regional lung collapse in patients treated with stereotactic body radiation therapy

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Diot, Quentin, E-mail: quentin.diot@ucdenver.edu; Kavanagh, Brian; Vinogradskiy, Yevgeniy; Gaspar, Laurie; Miften, Moyed [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045 (United States); Garg, Kavita [Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado 80045 (United States)

2015-11-15

Purpose: To differentiate radiation-induced fibrosis from regional lung collapse outside of the high dose region in patients treated with stereotactic body radiation therapy (SBRT) for lung tumors. Methods: Lung deformation maps were computed from pre-treatment and post-treatment computed tomography (CT) scans using a point-to-point translation method. Fifty anatomical landmarks inside the lung (vessel or airway branches) were matched on planning and follow-up scans for the computation process. Two methods using the deformation maps were developed to differentiate regional lung collapse from fibrosis: vector field and Jacobian methods. A total of 40 planning and follow-ups CT scans were analyzed for 20 lung SBRT patients. Results: Regional lung collapse was detected in 15 patients (75%) using the vector field method, in ten patients (50%) using the Jacobian method, and in 12 patients (60%) by radiologists. In terms of sensitivity and specificity the Jacobian method performed better. Only weak correlations were observed between the dose to the proximal airways and the occurrence of regional lung collapse. Conclusions: The authors presented and evaluated two novel methods using anatomical lung deformations to investigate lung collapse and fibrosis caused by SBRT treatment. Differentiation of these distinct physiological mechanisms beyond what is usually labeled “fibrosis” is necessary for accurate modeling of lung SBRT-induced injuries. With the help of better models, it becomes possible to expand the therapeutic benefits of SBRT to a larger population of lung patients with large or centrally located tumors that were previously considered ineligible.

A case of severe and rigid congenital thoracolumbar lordoscoliosis with diastematomyelia presenting with type 2 respiratory failure: managed by staged correction with controlled axial traction.

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Kanagaraju, Vijayanth; Chhabra, H S; Srivastava, Abhishek; Mahajan, Rajat; Kaul, Rahul; Bhatia, Pallav; Tandon, Vikas; Nanda, Ankur; Sangondimath, Gururaj; Patel, Nishit

2016-10-01

Congenital lordoscoliosis is an uncommon pathology and its management poses formidable challenge especially in the presence of type 2 respiratory failure and intraspinal anomalies. In such patients standard management protocols are not applicable and may require multistage procedure to minimize risk and optimize results. A 15-year-old girl presented in our hospital emergency services with severe breathing difficulty. She had a severe and rapidly progressing deformity in her back, noted since 6 years of age, associated with severe respiratory distress requiring oxygen and BiPAP support. She was diagnosed to have a severe and rigid congenital right thoracolumbar lordoscoliosis (coronal Cobb's angle: 105° and thoracic lordosis -10°) with type 1 split cord malformation with bony septum extending from T11 to L3. This leads to presentation of restrictive lung disease with type 2 respiratory failure. As her lung condition did not allow for any major procedure, we did a staged procedure rather than executing in a single stage. Controlled axial traction by halogravity was applied initially followed by halo-femoral traction. Four weeks later, this was replaced by halo-pelvic distraction device after a posterior release procedure with asymmetric pedicle substraction osteotomies at T7 and T10. Halo-pelvic distraction continued for 4 more weeks to optimize and correct the deformity. Subsequently definitive posterior stabilization and fusion was done. The detrimental effect of diastematomyelia resection in such cases is clearly evident from literature, so it was left unresected. A good scoliotic correction with improved respiratory function was achieved. Three years follow-up showed no loss of deformity correction, no evidence of pseudarthrosis and a good clinical outcome with reasonably balanced spine. The management of severe and rigid congenital lordoscoliotic deformities with intraspinal anomalies is challenging. Progressive reduction in respiratory volume in untreated

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

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Zheng-lei WANG

2011-08-01

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

First Clinical Investigation of Cone Beam Computed Tomography and Deformable Registration for Adaptive Proton Therapy for Lung Cancer

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Veiga, Catarina [Proton and Advanced RadioTherapy Group, Department of Medical Physics and Biomedical Engineering, University College London, London (United Kingdom); Janssens, Guillaume [Ion Beam Applications SA, Louvain-la-Neuve (Belgium); Teng, Ching-Ling [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Baudier, Thomas; Hotoiu, Lucian [iMagX Project, ICTEAM Institute, Université Catholique de Louvain, Louvain-la-Neuve (Belgium); McClelland, Jamie R. [Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London (United Kingdom); Royle, Gary [Proton and Advanced RadioTherapy Group, Department of Medical Physics and Biomedical Engineering, University College London, London (United Kingdom); Lin, Liyong; Yin, Lingshu; Metz, James; Solberg, Timothy D.; Tochner, Zelig; Simone, Charles B.; McDonough, James [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Kevin Teo, Boon-Keng, E-mail: teok@uphs.upenn.edu [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)

2016-05-01

Purpose: An adaptive proton therapy workflow using cone beam computed tomography (CBCT) is proposed. It consists of an online evaluation of a fast range-corrected dose distribution based on a virtual CT (vCT) scan. This can be followed by more accurate offline dose recalculation on the vCT scan, which can trigger a rescan CT (rCT) for replanning. Methods and Materials: The workflow was tested retrospectively for 20 consecutive lung cancer patients. A diffeomorphic Morphon algorithm was used to generate the lung vCT by deforming the average planning CT onto the CBCT scan. An additional correction step was applied to account for anatomic modifications that cannot be modeled by deformation alone. A set of clinical indicators for replanning were generated according to the water equivalent thickness (WET) and dose statistics and compared with those obtained on the rCT scan. The fast dose approximation consisted of warping the initial planned dose onto the vCT scan according to the changes in WET. The potential under- and over-ranges were assessed as a variation in WET at the target's distal surface. Results: The range-corrected dose from the vCT scan reproduced clinical indicators similar to those of the rCT scan. The workflow performed well under different clinical scenarios, including atelectasis, lung reinflation, and different types of tumor response. Between the vCT and rCT scans, we found a difference in the measured 95% percentile of the over-range distribution of 3.4 ± 2.7 mm. The limitations of the technique consisted of inherent uncertainties in deformable registration and the drawbacks of CBCT imaging. The correction step was adequate when gross errors occurred but could not recover subtle anatomic or density changes in tumors with complex topology. Conclusions: A proton therapy workflow based on CBCT provided clinical indicators similar to those using rCT for patients with lung cancer with considerable anatomic changes.

Equilibrium deformations of single-particle states of odd nuclei of rare earth region

International Nuclear Information System (INIS)

Alikov, B.A.; Tsoj, E.G.; Zuber, K.; Pashkevich, V.V.

1983-01-01

In terms of the Strutinsky shell-correction method using the Woods-Saxon non-spherical potential the energies, quadrupole, and hexadecapole momenta of the ground and excited states of odd-proton nuclei with 61 6 deformation on atomic nuclei non-rotation states energies is discussed. It is shown that account of deformation of α 6 type slightly influences on the quadrupole and hexadecapole deformation value

Ambulatory Anesthesia in an Adult Patient with Corrected Hypoplastic Left Heart Syndrome

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Jennifer Knautz

2012-01-01

congenital heart defects are surviving into adulthood and presenting for noncardiac surgeries. We describe one such example of a 26-year-old patient with corrected hypoplastic left heart syndrome presenting for knee arthroscopy and performed under general anesthesia with preoperative ultrasound guided saphenous nerve block. In this case, we review the anesthetic implications of corrected single ventricle physiology, anesthetic implications, as well as discuss the technique and role of saphenous nerve block in patients undergoing knee arthroscopy.

Stair-shaped Achilles tendon lengthening in continuity - A new method to treat equinus deformity in patients with spastic cerebral palsy.

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Li, Zhengxun; Zhang, Ning; Wang, Yang; Cao, Songhua; Huang, Zheng; Hu, Yong

2017-10-27

Equinus of the ankle is a common deformity in spastic cerebral palsy. Achilles tendon lengthening is one of the effective options for the treatment of equinus deformity. In the study, a new stair-shaped Achilles tendon lengthening (ATL) procedure that preserves of the tendon continuity was performed in 28 tendons with equinus deformity (20 patients, mean age=10.5±2.6 years). The results were compared with a group of patients treated with the Z-lengthening procedure. During the latest follow-up visit, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scale score was much higher in the stair-shaped ATL group than in the Z-lengthening group (pantigravity stability and quicker recovery in patients. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Strategies for Online Organ Motion Correction for Intensity-Modulated Radiotherapy of Prostate Cancer: Prostate, Rectum, and Bladder Dose Effects

International Nuclear Information System (INIS)

Rijkhorst, Erik-Jan; Lakeman, Annemarie; Nijkamp, Jasper; Bois, Josien de; Herk, Marcel van; Lebesque, Joos V.; Sonke, Jan-Jakob

2009-01-01

Purpose: To quantify and evaluate the accumulated prostate, rectum, and bladder dose for several strategies including rotational organ motion correction for intensity-modulated radiotherapy (IMRT) of prostate cancer using realistic organ motion data. Methods and Materials: Repeat computed tomography (CT) scans of 19 prostate patients were used. Per patient, two IMRT plans with different uniform margins were created. To quantify prostate and seminal vesicle motion, repeat CT clinical target volumes (CTVs) were matched onto the planning CTV using deformable registration. Four different strategies, from online setup to full motion correction, were simulated. Rotations were corrected for using gantry and collimator angle adjustments. Prostate, rectum, and bladder doses were accumulated for each patient, plan, and strategy. Minimum CTV dose (D min ), rectum equivalent uniform dose (EUD, n = 0.13), and bladder surface receiving ≥78 Gy (S78), were calculated. Results: With online CTV translation correction, a 7-mm margin was sufficient (i.e., D min ≥ 95% of the prescribed dose for all patients). A 4-mm margin required additional rotational correction. Margin reduction lowered the rectum EUD(n = 0.13) by ∼2.6 Gy, and the bladder S78 by ∼1.9%. Conclusions: With online correction of both translations and rotations, a 4-mm margin was sufficient for 15 of 19 patients, whereas the remaining four patients had an underdosed CTV volume <1%. Margin reduction combined with online corrections resulted in a similar or lower dose to the rectum and bladder. The more advanced the correction strategy, the better the planned and accumulated dose agreed.

Visual performance in cataract patients with low levels of postoperative astigmatism: full correction versus spherical equivalent correction

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Lehmann RP

2012-03-01

Full Text Available Robert P Lehmann1, Diane M Houtman21Lehmann Eye Center, Nacogdoches, TX, 2Alcon Research Ltd, Fort Worth, TX, USAPurpose: To evaluate whether visual performance could be improved in pseudophakic subjects by correcting low levels of postoperative astigmatism.Methods: An exploratory, noninterventional study was conducted using subjects who had been implanted with an aspheric intraocular lens and had 0.5–0.75 diopter postoperative astigmatism. Monocular visual performance using full correction was compared with visual performance using spherical equivalent correction. Testing consisted of high- and low-contrast visual acuity, contrast sensitivity, and reading acuity and speed using the Radner Reading Charts.Results: Thirty-eight of 40 subjects completed testing. Visual acuities at three contrast levels (100%, 25%, and 9% were significantly better using full correction than when using spherical equivalent correction (all P < 0.001. For contrast sensitivity testing under photopic, mesopic, and mesopic with glare conditions, only one out of twelve outcomes demonstrated a significant improvement with full correction compared with spherical equivalent correction (at six cycles per degree under mesopic without glare conditions, P = 0.046. Mean reading speed was numerically faster with full correction across all print sizes, reaching statistical significance at logarithm of the reading acuity determination (logRAD 0.2, 0.7, and 1.1 (P , 0.05. Statistically significant differences also favored full correction in logRAD score (P = 0.0376, corrected maximum reading speed (P < 0.001, and logarithm of the minimum angle of resolution/logRAD ratio (P < 0.001.Conclusions: In this study of pseudophakic subjects with low levels of postoperative astigmatism, full correction yielded significantly better reading performance and high- and low-contrast visual acuity than spherical equivalent correction, suggesting that cataractous patients may benefit from surgical

Correcting atmospheric effects on InSAR with MERIS water vapour data and elevation-dependent interpolation model

KAUST Repository

Li, Z. W.; Xu, Wenbin; Feng, G. C.; Hu, J.; Wang, C. C.; Ding, X. L.; Zhu, J. J.

2012-01-01

The propagation delay when radar signals travel from the troposphere has been one of the major limitations for the applications of high precision repeat-pass Interferometric Synthetic Aperture Radar (InSAR). In this paper, we first present an elevation-dependent atmospheric correction model for Advanced Synthetic Aperture Radar (ASAR—the instrument aboard the ENVISAT satellite) interferograms with Medium Resolution Imaging Spectrometer (MERIS) integrated water vapour (IWV) data. Then, using four ASAR interferometric pairs over Southern California as examples, we conduct the atmospheric correction experiments with cloud-free MERIS IWV data. The results show that after the correction the rms differences between InSAR and GPS have reduced by 69.6 per cent, 29 per cent, 31.8 per cent and 23.3 per cent, respectively for the four selected interferograms, with an average improvement of 38.4 per cent. Most importantly, after the correction, six distinct deformation areas have been identified, that is, Long Beach–Santa Ana Basin, Pomona–Ontario, San Bernardino and Elsinore basin, with the deformation velocities along the radar line-of-sight (LOS) direction ranging from −20 mm yr−1 to −30 mm yr−1 and on average around −25 mm yr−1, and Santa Fe Springs and Wilmington, with a slightly low deformation rate of about −10 mm yr−1 along LOS. Finally, through the method of stacking, we generate a mean deformation velocity map of Los Angeles over a period of 5 yr. The deformation is quite consistent with the historical deformation of the area. Thus, using the cloud-free MERIS IWV data correcting synchronized ASAR interferograms can significantly reduce the atmospheric effects in the interferograms and further better capture the ground deformation and other geophysical signals.

Correcting atmospheric effects on InSAR with MERIS water vapour data and elevation-dependent interpolation model

KAUST Repository

Li, Z. W.

2012-05-01

The propagation delay when radar signals travel from the troposphere has been one of the major limitations for the applications of high precision repeat-pass Interferometric Synthetic Aperture Radar (InSAR). In this paper, we first present an elevation-dependent atmospheric correction model for Advanced Synthetic Aperture Radar (ASAR—the instrument aboard the ENVISAT satellite) interferograms with Medium Resolution Imaging Spectrometer (MERIS) integrated water vapour (IWV) data. Then, using four ASAR interferometric pairs over Southern California as examples, we conduct the atmospheric correction experiments with cloud-free MERIS IWV data. The results show that after the correction the rms differences between InSAR and GPS have reduced by 69.6 per cent, 29 per cent, 31.8 per cent and 23.3 per cent, respectively for the four selected interferograms, with an average improvement of 38.4 per cent. Most importantly, after the correction, six distinct deformation areas have been identified, that is, Long Beach–Santa Ana Basin, Pomona–Ontario, San Bernardino and Elsinore basin, with the deformation velocities along the radar line-of-sight (LOS) direction ranging from −20 mm yr−1 to −30 mm yr−1 and on average around −25 mm yr−1, and Santa Fe Springs and Wilmington, with a slightly low deformation rate of about −10 mm yr−1 along LOS. Finally, through the method of stacking, we generate a mean deformation velocity map of Los Angeles over a period of 5 yr. The deformation is quite consistent with the historical deformation of the area. Thus, using the cloud-free MERIS IWV data correcting synchronized ASAR interferograms can significantly reduce the atmospheric effects in the interferograms and further better capture the ground deformation and other geophysical signals.

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

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

2017-05-01

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

The level of detail required in a deformable phantom to accurately perform quality assurance of deformable image registration

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Saenz, Daniel L.; Kim, Hojin; Chen, Josephine; Stathakis, Sotirios; Kirby, Neil

2016-09-01

The primary purpose of the study was to determine how detailed deformable image registration (DIR) phantoms need to adequately simulate human anatomy and accurately assess the quality of DIR algorithms. In particular, how many distinct tissues are required in a phantom to simulate complex human anatomy? Pelvis and head-and-neck patient CT images were used for this study as virtual phantoms. Two data sets from each site were analyzed. The virtual phantoms were warped to create two pairs consisting of undeformed and deformed images. Otsu’s method was employed to create additional segmented image pairs of n distinct soft tissue CT number ranges (fat, muscle, etc). A realistic noise image was added to each image. Deformations were applied in MIM Software (MIM) and Velocity deformable multi-pass (DMP) and compared with the known warping. Images with more simulated tissue levels exhibit more contrast, enabling more accurate results. Deformation error (magnitude of the vector difference between known and predicted deformation) was used as a metric to evaluate how many CT number gray levels are needed for a phantom to serve as a realistic patient proxy. Stabilization of the mean deformation error was reached by three soft tissue levels for Velocity DMP and MIM, though MIM exhibited a persisting difference in accuracy between the discrete images and the unprocessed image pair. A minimum detail of three levels allows a realistic patient proxy for use with Velocity and MIM deformation algorithms.

Ipsilateral stress fracture of the proximal fibula after total knee arthroplasty in a patient with severe valgus knee deformity on a background of Rheumatoid arthritis

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Hirokazu Takai

Full Text Available Introduction: Previous studies have reported a lower extremity stress fracture after total knee arthroplasty (TKA. However, a fibular fracture after TKA is quite rare. We report a case of proximal fibula fracture after TKA in a patient with rheumatoid arthritis (RA. Presentation of case: A 45 year old woman with RA had severe knee and foot pain with an antalgic gait disturbance. There was a significant joint deformity in many of lower limb joints. Interval bilateral TKAs were performed two weeks apart. Right TKA was performed using a constraint-type prosthesis, through lateral parapatellar approach. Left TKA was performed using a posterior-stabilized (PS prosthesis through the more commonly employed, medial parapatellar approach. Seven weeks after the right TKA, the patient was found to have an atraumatic proximal fibular fracture. The fracture went on to heal conservatively. Discussion: The fracture was considered to have occurred after the TKA. The callus appeared eleven weeks after the TKA. The factors that contributed to the fracture were thought to be overload of the fragile bone secondarily to disuse osteopaenia, RA or potentially the significant valgus malalignment correction. The surgical approach, the implant or implantation or the persisting joint deformity, were thought to be contributing factors to the aetiology of the stress fracture. The resultant change in clinical outcome/course is outlined in this case report. Conclusion: A stress fracture of the proximal fibula has the potential in the aetiology of may cause other stress fractures, joint other instability, and/or malalignment of the total lower extremity. Keywords: Stress fracture, Insufficiency fracture, Total knee arthroplasty, Fibula fracture, Valgus deformity, Rheumatoid arthritis

Deformable mirror study. Final report, 21 July 1980-15 May 1981

International Nuclear Information System (INIS)

Budgor, A.B.

1981-03-01

The beam quality of a baseline system similar to the Helios system at Los Alamos Scientific Laboratory was analyzed with a two-dimensional beam train code based on a Fresnel propagator. The other components of the code include: (a) characterization of phase aberrations either in terms of Zernike polynomials synthesized directly from optical component interferograms when available, or by constructing a random wave front with specified statistics; (b) non-diffractive linear amplification via the Frantz-Nodvik equations; and (c) correction of accumulated phase aberration with continuous deformable mirrors whose surface is modeled by bicubic splines through the actuator points. The technical contents of this report will be presented in 4 sections. Section II will describe the physical optics of beam train propagation. A heuristic physical argument defining the zeroth order efficacy of adaptive optics to correct phase aberration is then derived. The results of applying the diffraction computer code to one beam line of the Helios laser system are described. The wave length scalability of deformable mirrors and efficacy of deformable mirror adaptive optics to correct phase aberration at UV wave lengths are then described

Relationship of frontal plane rotation of first metatarsal to proximal articular set angle and hallux alignment in patients undergoing tarsometatarsal arthrodesis for hallux abducto valgus: a case series and critical review of the literature.

Science.gov (United States)

Dayton, Paul; Feilmeier, Mindi; Kauwe, Merrell; Hirschi, Jordan

2013-01-01

Rotation of the first metatarsal, as a component of hallux abducto valgus, is rarely discussed and is not addressed as a component of most hallux valgus corrective procedures. We believe frontal plane rotation of the first metatarsal to be an integral component of hallux abducto valgus deformity (the "third plane of deformity") and believe de-rotation is necessary for complete deformity correction. We observed the change in angular measurements commonly used in the evaluation of hallux valgus deformity in patients who underwent a modified lapidus procedure. We measured the intermetatarsal angle, hallux abductus angle, proximal articular set angle, and tibial sesamoid position on weightbearing radiographs of 25 feet in 24 patients who had undergone tarsal metatarsal corrective arthrodesis and lateral capsular release. Specific attention was given to reduction of the frontal plane rotation of the first metatarsal during correction. Our results showed a change in the angular measurements observed by 4 investigators as follows. The mean change in the intermetatarsal angle was 10.1° (p hallux abductus angle was 17.8° (p valgus, or everted position of the first metatarsal, was noted as a component of the hallux abducto valgus deformity in our patient population and was corrected by varus rotation or inversion of the metatarsal. We also reviewed the current literature related to anatomic changes in the first ray in the patient with hallux valgus deformity and reviewed our hypothesis regarding the reduction in the proximal articular set angle, which we believe to be related to frontal plane rotation of the first metatarsal, resulting in a radiographic artifact. Copyright © 2013. Published by Elsevier Inc.

Comparison of Clinical Outcomes of Scarf and Chevron Osteotomies and the McBride Procedure in the Treatment of Hallux Valgus Deformity

Science.gov (United States)

Fakoor, Mohammad; Sarafan, Naser; Mohammadhoseini, Payam; Khorami, Mohsen; Arti, Hamidreza; Mosavi, SeyedShahnam; Aghaeeaghdam, Amir

2014-01-01

Background: Hallux valgus deformity is a common chronic problem with a reported prevalence of 28.4% and its chief complaint is pain. Thus far, different surgical procedures with their proposed indications have been introduced. This study compared three current procedures, namely the chevron and scarf osteotomies and the McBride procedure. Methods: This retrospective cohort was conducted at the Ahvaz University of Medical Sciences on 44 patients with moderate hallux valgus deformity from 2010 and 2013. All of the patients underwent one of the three procedures (chevron, scarf or McBride). Preoperative and follow up radiographies were evaluated in terms of hallux valgus and intermetatarsal angle correction. The Foot and Ankle Disability Index was filled out to assess the functional outcome and the Visual Analogue Scale was used to evaluate pain. Also, satisfaction, aesthetics and the rate of recurrence was evaluated. Results: Hallux valgus angle and intermetatarsal angle correction were significantly higher in scarf, but not in chevron and McBride. However, from amongst the three procedures, there was no significant difference in terms of the Foot and Ankle Disability Index score, aesthetics, satisfaction level, pain score and recurrence rate. Conclusions: Considering that scarf osteotomy had better results in this study, we think that scarf osteotomy can be considered as a first choice for the treatment of moderate hallux valgus deformity. PMID:25207310

Use of vacuum assisted closure in instrumented spinal deformities for children with postoperative deep infections

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Canavese Federico

2010-01-01

Full Text Available Background: Postoperative deep infections are relatively common in children with instrumented spinal deformities, whose healing potential is somewhat compromised. Children with underlying diagnosis of cerebral palsy, spina bifida and other chronic debilitating conditions are particularly susceptible. Vacuum-assisted closure (VAC is a newer technique to promote healing of wounds resistant to treatment by established methods. This article aims to review the efficacy of the VAC system in the treatment of deep spinal infections following spinal instrumentation and fusion in children and adolescents. Materials and Methods: We reviewed 33 patients with deep postoperative surgical site infection treated with wound VAC technique. We reviewed clinical and laboratory data, including the ability to retain the spinal hardware, loss of correction and recurrent infections. Results : All patients successfully completed their wound VAC treatment regime. None had significant loss of correction and one had persistent infection requiring partial hardware removal. The laboratory indices normalized in all but three patients. Conclusions: Wound VAC technique is a useful tool in the armamentarium of the spinal surgeon dealing with patients susceptible to wound infections, especially those with neuromuscular diseases. It allows for retention of the instrumentation and maintenance of the spinal correction. It is reliable and easy to use.

THE COMPLEX TREATMENT OF THE PATIENT WITH MULTIPLE SPINE AND SPINAL CORD MALFORMATIONS

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S. V. Vissarionov

2011-01-01

Full Text Available Clinical case of the patient with the congenital deformation of thoracic and lumbar parts of the spine due to multiple congenital anomalies of vertebrae (disturbance of formation, fusion and segmentation, a terminale filum lipoma at the level of L5, tethered cord, rightside lower leg monoparesis. Multistage surgical treatment was performed: removing of intracanal deformity, correction and stabilization of the deformity at the thoracic and lumbar part of the spine. Patient was followed up during 2,5 years after the last step of the surgical operation. No evidence of recurrence or neurological deterioration were observed.

Consequences of the center-of-mass correction in nuclear mean-field models

International Nuclear Information System (INIS)

Bender, M.; Rutz, K.; Reinhard, P.G.; Maruhn, J.A.

2000-01-01

We study the influence of the scheme for the correction for spurious center-of-mass motion on the fit of effective interactions for self-consistent nuclear mean-field calculations. We find that interactions with very simple center-of-mass correction have significantly larger surface coefficients than interactions for which the center-of-mass correction was calculated for the actual many-body state during the fit. The reason for that is that the effective interaction has to counteract the wrong trends with nucleon number of all simplified schemes for center-of-mass correction which puts a wrong trend with mass number into the effective interaction itself. The effect becomes clearly visible when looking at the deformation energy of largely deformed systems, e.g. superdeformed states or fission barriers of heavy nuclei. (orig.)

CORRECTION OF SEVERE STIFF SCOLIOSIS THROUGH EXTRAPLEURAL INTERBODY RELEASE AND OSTEOTOMY (LIEPO

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Cleiton Dias Naves

Full Text Available ABSTRACT Objective: To report a new technique for extrapleural interbody release with transcorporal osteotomy of the inferior vertebral plateau (LIEPO and to evaluate the correction potential of this technique and its complications. Method: We included patients with scoliosis with Cobb angle greater than 90° and flexibility less than 25% submitted to surgical treatment between 2012 and 2016 by the technique LIEPO at the National Institute of Traumatology and Orthopedics (INTO. Sagittal and coronal alignment, and the translation of the apical vertebra were measured and the degree of correction of the deformity was calculated through the pre and postoperative radiographs, and the complications were described. Results: Patients had an average bleed of 1,525 ml, 8.8 hours of surgical time, 123° of scoliosis in the preoperative period, and a mean correction of 66%. There was no case of permanent neurological damage and no surgical revision. Conclusion: The LIEPO technique proved to be effective and safe in the treatment of severe stiff scoliosis, reaching a correction potential close to the PEISR (Posterior extrapleural intervertebral space release technique and superior to that of the pVCR (posterior Vertebral Column Resection with no presence of infection and permanent neurological deficit. New studies are needed to validate this promising technique.

Approximation of Corrected Calcium Concentrations in Advanced Chronic Kidney Disease Patients with or without Dialysis Therapy

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Yoshio Kaku

2015-08-01

Full Text Available Background: The following calcium (Ca correction formula (Payne is conventionally used for serum Ca estimation: corrected total Ca (TCa (mg/dl = TCa (mg/dl + [4 - albumin (g/dl]; however, it is inapplicable to advanced chronic kidney disease (CKD patients. Methods: 1,922 samples in CKD G4 + G5 patients and 341 samples in CKD G5D patients were collected. Levels of TCa (mg/day, ionized Ca2+ (iCa2+ (mmol/l and other clinical parameters were measured. We assumed the corrected TCa to be equal to eight times the iCa2+ value (measured corrected TCa. We subsequently performed stepwise multiple linear regression analysis using the clinical parameters. Results: The following formula was devised from multiple linear regression analysis. For CKD G4 + G5 patients: approximated corrected TCa (mg/dl = TCa + 0.25 × (4 - albumin + 4 × (7.4 - pH + 0.1 × (6 - P + 0.22. For CKD G5D patients: approximated corrected TCa (mg/dl = TCa + 0.25 × (4 - albumin + 0.1 × (6 - P + 0.05 × (24 - HCO3- + 0.35. Receiver operating characteristic analysis showed the high values of the area under the curve of approximated corrected TCa for the detection of measured corrected TCa ≥8.4 mg/dl and ≤10.4 mg/dl for each CKD sample. Both intraclass correlation coefficients for each CKD sample demonstrated superior agreement using the new formula compared to the previously reported formulas. Conclusion: Compared to other formulas, the approximated corrected TCa values calculated from the new formula for patients with CKD G4 + G5 and CKD G5D demonstrates superior agreement with the measured corrected TCa.

Pressure relief and load redistribution by custom-made insoles in diabetic patients with neuropathy and foot deformity

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Bus, Sicco A.; Ulbrecht, Jan S.; Cavanagh, Peter R.

2004-01-01

Objective. To study the effects of custom-made insoles on plantar pressures and load redistribution in neuropathic diabetic patients with foot deformity. Design. Cross-sectional. Background. Although custom-made insoles are commonly prescribed to diabetic patients, little quantitative data on their

Modified Quad Helix for Correction of Severely Rotated Incisors in Cleft Cases

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Aneesha Ashok Shetty

2014-01-01

Full Text Available Clefts of the lip, alveolus and/or palate are often associated with several dental anomalies, the most common of which are severely rotated maxillary incisors. Patients with such congenital deformities seek orthodontic treatment as early as possible, for an esthetic as well as psychosocial benefit. Here, a new clinical technique is demonstrated for correction of a severely rotated maxillary central incisor which can be carried out in the mixed dentition phase itself, by modifying a commonly used palatal expansion appliance: the quad helix.

Presurgical Nasal Molding With a Nasal Spring in Patients With Mild-to-Moderate Nasal Deformity With Incomplete Unilateral Cleft Lip With or Without Cleft Palate.

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Peanchitlertkajorn, Supakit

2018-01-01

Traditional nasoalveolar molding (NAM) requires steep learning curve for clinicians and significant compliance from parents. Nasal springs have been developed by the author to simplify presurgical nasal molding. This article presents the design, construction, and application of the spring. The treatment goal is to improve nasal deformity prior to primary repair in infants born with incomplete unilateral cleft lip with or without cleft palate. The design, fabrication, and utility of the nasal spring are described. The spring has a simpler design and construction compared to a traditional NAM appliance. Two patients with incomplete unilateral cleft lip with and without cleft palate are presented. The spring is constructed and delivered. The active arm of the spring can be 3-dimensionally (3-D) adjusted to mold the alar cartilage of the affected nostril. The spring does not require an oral plate for adherence as a traditional NAM appliance does, hence an oral impression is not needed. The spring is easy for clinicians to adjust. It also requires less compliance by parents. Main Outcome Measures/Results: The presurgical molding achieved by the use of a nasal spring improved surgical nasolabial aesthetic outcomes. The nasal springs are effective in reducing the initial cleft nasal deformity. This facilitates primary surgical cleft lip and nose correction and improves surgical outcomes in patients with incomplete unilateral cleft lip with or without cleft palate.

Exactly marginal deformations from exceptional generalised geometry

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Ashmore, Anthony [Merton College, University of Oxford,Merton Street, Oxford, OX1 4JD (United Kingdom); Mathematical Institute, University of Oxford,Andrew Wiles Building, Woodstock Road, Oxford, OX2 6GG (United Kingdom); Gabella, Maxime [Institute for Advanced Study,Einstein Drive, Princeton, NJ 08540 (United States); Graña, Mariana [Institut de Physique Théorique, CEA/Saclay,91191 Gif-sur-Yvette (France); Petrini, Michela [Sorbonne Université, UPMC Paris 05, UMR 7589, LPTHE,75005 Paris (France); Waldram, Daniel [Department of Physics, Imperial College London,Prince Consort Road, London, SW7 2AZ (United Kingdom)

2017-01-27

We apply exceptional generalised geometry to the study of exactly marginal deformations of N=1 SCFTs that are dual to generic AdS{sub 5} flux backgrounds in type IIB or eleven-dimensional supergravity. In the gauge theory, marginal deformations are parametrised by the space of chiral primary operators of conformal dimension three, while exactly marginal deformations correspond to quotienting this space by the complexified global symmetry group. We show how the supergravity analysis gives a geometric interpretation of the gauge theory results. The marginal deformations arise from deformations of generalised structures that solve moment maps for the generalised diffeomorphism group and have the correct charge under the generalised Reeb vector, generating the R-symmetry. If this is the only symmetry of the background, all marginal deformations are exactly marginal. If the background possesses extra isometries, there are obstructions that come from fixed points of the moment maps. The exactly marginal deformations are then given by a further quotient by these extra isometries. Our analysis holds for any N=2 AdS{sub 5} flux background. Focussing on the particular case of type IIB Sasaki-Einstein backgrounds we recover the result that marginal deformations correspond to perturbing the solution by three-form flux at first order. In various explicit examples, we show that our expression for the three-form flux matches those in the literature and the obstruction conditions match the one-loop beta functions of the dual SCFT.

OUTCOMES OF PALLIATIVE ORTHOPEDIC SURGERY FOR HIP DISLOCATION IN PATIENTS WITH CEREBRAL PALSY

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R. R. Bidyamshin

2016-01-01

Full Text Available Introduction. Hip dislocation is the key problem in patients with severe cerebral palsy (GMFCS IV, V older than 10 years that affects life quality and limits functional capabilities. In the present study the authors evaluated the efficiency of the proximal femoral resection arthroplasty (pfra and valgus proximal osteotomy of the femur (VPOF associated with femoral head resection for pain control, improvement of postural management, hygiene and verticalization with total weight-bearing and correction of accompanying orthopaedic deformities. Material and мethods. A retrospective study compared two groups of patients where PFRA (7 cases, 13 hips or VPOF (14 patients, 23 hips were performed. Level V of GMFCS was reported in 10 patients, and level IV of GMFCS – in 11 patients. The mean age at time of surgery was 15.3±3.9 y.o. PFRA was performed in 7 cases (13 joints and VPOF – in 14 patients (23 joints. Results. The authors did not observe any difference between the methods in respect of pain control, postural management, comfortable sitting position and hygiene. The verticalization with total weight-bearing and life quality improvement was achieved only after PVOF with femoral head resection associated with simultaneous knee and foot deformity correction performed according to the principles of Single-Event Multilevel Orthopedic Surgery. Conclusion. Both palliative methods allow to control pain syndrome, to achieve satisfactory postural management, comfortable sitting position and hygiene. But only VPOF with simultaneous knee and foot deformity correction provides possibility to verticalize the patient with weight-bearing using different orthopedic devices.

Polarized electric dipole moment of well-deformed reflection asymmetric nuclei

International Nuclear Information System (INIS)

Denisov, V.Yu.

2012-01-01

The expression for polarized electric dipole moment of well-deformed reflection asymmetric nuclei is obtained in the framework of liquid-drop model in the case of geometrically similar proton and neutron surfaces. The expression for polarized electric dipole moment consists of the first and second orders terms. It is shown that the second-order correction terms of the polarized electric dipole moment are important for well-deformed nuclei

Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery.

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Elsamadicy, Aladine A; Adogwa, Owoicho; Lydon, Emily; Sergesketter, Amanda; Kaakati, Rayan; Mehta, Ankit I; Vasquez, Raul A; Cheng, Joseph; Bagley, Carlos A; Karikari, Isaac O

2017-08-01

OBJECTIVE Depression is the most prevalent affective disorder in the US, and patients with spinal deformity are at increased risk. Postoperative delirium has been associated with inferior surgical outcomes, including morbidity and mortality. The relationship between depression and postoperative delirium in patients undergoing spine surgery is relatively unknown. The aim of this study was to determine if depression is an independent risk factor for the development of postoperative delirium in patients undergoing decompression and fusion for deformity. METHODS The medical records of 923 adult patients (age ≥ 18 years) undergoing elective spine surgery at a single major academic institution from 2005 through 2015 were reviewed. Of these patients, 255 (27.6%) patients had been diagnosed with depression by a board-certified psychiatrist and constituted the Depression group; the remaining 668 patients constituted the No-Depression group. Patient demographics, comorbidities, and intra- and postoperative complication rates were collected for each patient and compared between groups. The primary outcome investigated in this study was rate of postoperative delirium, according to DSM-V criteria, during initial hospital stay after surgery. The association between depression and postoperative delirium rate was assessed via multivariate logistic regression analysis. RESULTS Patient demographics and comorbidities other than depression were similar in the 2 groups. In the Depression group, 85.1% of the patients were taking an antidepressant prior to surgery. There were no significant between-group differences in intraoperative variables and rates of complications other than delirium. Postoperative complication rates were also similar between the cohorts, including rates of urinary tract infection, fever, deep and superficial surgical site infection, pulmonary embolism, deep vein thrombosis, urinary retention, and proportion of patients transferred to the intensive care unit. In

ANALYSIS AND CORRECTION OF SYSTEMATIC HEIGHT MODEL ERRORS

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K. Jacobsen

2016-06-01

Full Text Available The geometry of digital height models (DHM determined with optical satellite stereo combinations depends upon the image orientation, influenced by the satellite camera, the system calibration and attitude registration. As standard these days the image orientation is available in form of rational polynomial coefficients (RPC. Usually a bias correction of the RPC based on ground control points is required. In most cases the bias correction requires affine transformation, sometimes only shifts, in image or object space. For some satellites and some cases, as caused by small base length, such an image orientation does not lead to the possible accuracy of height models. As reported e.g. by Yong-hua et al. 2015 and Zhang et al. 2015, especially the Chinese stereo satellite ZiYuan-3 (ZY-3 has a limited calibration accuracy and just an attitude recording of 4 Hz which may not be satisfying. Zhang et al. 2015 tried to improve the attitude based on the color sensor bands of ZY-3, but the color images are not always available as also detailed satellite orientation information. There is a tendency of systematic deformation at a Pléiades tri-stereo combination with small base length. The small base length enlarges small systematic errors to object space. But also in some other satellite stereo combinations systematic height model errors have been detected. The largest influence is the not satisfying leveling of height models, but also low frequency height deformations can be seen. A tilt of the DHM by theory can be eliminated by ground control points (GCP, but often the GCP accuracy and distribution is not optimal, not allowing a correct leveling of the height model. In addition a model deformation at GCP locations may lead to not optimal DHM leveling. Supported by reference height models better accuracy has been reached. As reference height model the Shuttle Radar Topography Mission (SRTM digital surface model (DSM or the new AW3D30 DSM, based on ALOS

Relationship between Postural Deformities and Frontal Function in Parkinson’s Disease

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Satoko Ninomiya

2015-01-01

Full Text Available Postural deformities and executive dysfunction (ED are common symptoms of Parkinson’s disease (PD; however, the relationship between postural deformities and ED in patients with PD remains unclear. This study assessed the relationship between postural deformities and ED in patients with PD. Sixty-five patients with sporadic PD were assessed for the severity of postural deformities and executive function. The severity of postural deformities was scored using the United Parkinson’s Disease Rating Scale item 28 score: no postural deformity (0, mild postural deformities (1, or severe postural deformities (2–4. Executive function was assessed using the Behavioral Assessment of the Dysexecutive Syndrome (BADS and an age-controlled standardized BADS score <70 was defined as ED. Age-controlled standardized BADS scores were compared across the three groups using the Kruskal-Wallis test. Relationship between ED and the severity of postural deformities was assessed using the Mann-Whitney U test. Age-controlled standardized BADS score significantly differed among the three groups P=0.005. ED was significantly related to the severity of postural deformities P=0.0005. The severity of postural deformities was associated with a lower age-controlled standardized BADS score and ED, and these findings suggest that postural deformities were associated with frontal dysfunction in patients with PD.

Deformed potential energy of $^{263}Db$ in a generalized liquid drop model

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Chen Bao Qiu; Zhao Yao Lin; 10.1088/0256-307X/20/11/009

2003-01-01

The macroscopic deformed potential energy for super-heavy nuclei /sup 263/Db, which governs the entrance and alpha decay channels, is determined within a generalized liquid drop model (GLDM). A quasi- molecular shape is assumed in the GLDM, which includes volume-, surface-, and Coulomb-energies, proximity effects, mass asymmetry, and an accurate nuclear radius. The microscopic single particle energies derived from a shell model in an axially deformed Woods- Saxon potential with a quasi-molecular shape. The shell correction is calculated by the Strutinsky method. The total deformed potential energy of a nucleus can be calculated by the macro-microscopic method as the summation of the liquid-drop energy and the Strutinsky shell correction. The theory is applied to predict the deformed potential energy of the experiment /sup 22/Ne+/sup 241/Am to /sup 263/Db* to /sup 259/Db+4 n, which was performed on the Heavy Ion Accelerator in Lanzhou. It is found that the neck in the quasi-molecular shape is responsible for t...

Quantifying the Erlenmeyer flask deformity

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Carter, A; Rajan, P S; Deegan, P; Cox, T M; Bearcroft, P

2012-01-01

Objective Erlenmeyer flask deformity is a common radiological finding in patients with Gaucher′s disease; however, no definition of this deformity exists and the reported prevalence of the deformity varies widely. To devise an easily applied definition of this deformity, we investigated a cohort of knee radiographs in which there was consensus between three experienced radiologists as to the presence or absence of Erlenmeyer flask morphology. Methods Using the presence or absence of Erlenmeyer flask morphology as a benchmark, we measured the diameter of the femur at the level of the physeal scar and serially at defined intervals along the metadiaphysis. Results A measured ratio in excess of 0.57 between the diameter of the femoral shaft 4 cm from the physis to the diameter of the physeal baseline itself on a frontal radiograph of the knee predicted the Erlenmeyer flask deformity with 95.6% sensitivity and 100% specificity in our series of 43 independently diagnosed adults with Gaucher′s disease. Application of this method to the distal femur detected the Erlenmeyer flask deformity reproducibly and was simple to carry out. Conclusion Unlike diagnostic assignments based on subjective review, our simple procedure for identifying the modelling deformity is based on robust quantitative measurement: it should facilitate comparative studies between different groups of patients, and may allow more rigorous exploration of the pathogenesis of the complex osseous manifestations of Gaucher′s disease to be undertaken. PMID:22010032

Innovation in prediction planning for anterior open bite correction.

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Almuzian, Mohammed; Almukhtar, Anas; O'Neil, Michael; Benington, Philip; Al Anezi, Thamer; Ayoub, Ashraf

2015-05-01

This study applies recent advances in 3D virtual imaging for application in the prediction planning of dentofacial deformities. Stereo-photogrammetry has been used to create virtual and physical models, which are creatively combined in planning the surgical correction of anterior open bite. The application of these novel methods is demonstrated through the surgical correction of a case.

Characteristics Of Congenital Chest Wall Deformities In Referred Patients To Tehran Imam Khomeini And Kashan Shahid Beheshti Hospital During 1991-2001

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Davoodabadi A

2004-08-01

Full Text Available Background: Infants and children present with a wide range of congenital chest wall deformities which have both physiologic psychologic consequences and are often associated with other abnormalities. Surgical intervention offers excellent cosmetic results with minimal morbidity and mortality. In order to investigation of chest wall deformities, and surgical results, this study was performed. Materials and Methods: A descriptive study on existing data on 60 consecutive patients with chest wall deformity during 10 years carried out. Patient's characteristics such as age, gender, signs and symptoms type of operation, associated disorder, syndrome, and surgical complications were considered. Results: Pectus excavatum 60% and pectus carinatum 30% Poland syn 6.7% 9 sternal cleft 3.2. Inpectus, M/F: Was 3/1 and others were 1:1. Age of admission 4 to 27 years 13.4±6.82 and association syndromes were, turner, Morgue and marfan, most patients were operated in delayed time (75 and hence, scoliosis was common than others. Conclusion: Pectus excavatum was the most common deformity and if scoliosis was prominent and most operation was done in old age but surgical result was excellent no anyone expired and complication was a little. So we recommended that all of the chest deformities must be operated in anytime.

A deformation-based morphometry study of patients with early-stage Parkinson's disease

DEFF Research Database (Denmark)

Borghammer, P; Østergaard, Karen; Cumming, P

2010-01-01

BACKGROUND AND PURPOSE: Previous volumetric magnetic resonance imaging (MRI) studies of Parkinson's disease (PD) utilized primarily voxel-based morphometry (VBM), and investigated mostly patients with moderate- to late-stage disease. We now use deformation-based morphometry (DBM), a method...... purported to be more sensitive than VBM, to test for atrophy in patients with early-stage PD. METHODS: T1-weighted MRI images from 24 early-stage PD patients and 26 age-matched normal control subjects were compared using DBM. Two separate studies were conducted, where two minimally-biased nonlinear...... intensity-average were created; one for all subjects and another for just the PD patients. The DBM technique creates an average population-based MRI-average in an iterative hierarchical fashion. The nonlinear transformations estimated to match each subject to the MRI-average were then analysed. RESULTS...

Availability of cosmetic treatment using novel cosmetics-based material on patients with craniofacial concavity.

Science.gov (United States)

Koyama, Shigeto; Kanetaka, Hiroyasu; Sagehashi, Yoshinori; Sasaki, Keiichi; Sato, Naoko

2018-03-08

Patients treated with maxillofacial prosthetics often experience emotional problems because of the remaining facial skin concavity such as a surgical scar. In such cases, cosmetic treatment can potentially correct their skin tone imperfections and deformities. This study aimed to evaluate the clinical availability of novel cosmetics-based material for craniofacial small concavity by initiating a cosmetic treatment in a preliminary case. Eighteen patients with aesthetic problems such as craniofacial deformities, small defects, and concavities on their faces underwent cosmetic treatment that was performed by makeup practitioners. Data were collected from the patient's charts and a survey questionnaire. A visual analog scale was used to conduct a survey regarding the satisfaction levels of the patients following cosmetic treatment with a novel cosmetics-based material. The cosmetic treatment was performed for a concavity on the left midface of a 67-year-old woman with partial maxillectomy. The novel cosmetics-based material was manufactured from a semi-translucent oil base. The satisfaction level of the patient increased after undergoing the cosmetic treatment. Regarding clinical applications, the novel cosmetics-based material can help reduce their cosmetic disturbance and restore the small deformity. These results suggest that the cosmetic treatment with the novel cosmetics-based material can be used as a subsidiary method for facial prostheses or an independent new method for correcting patients' small craniofacial concavity and for reducing visible deformity. Copyright © 2018 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Individualized Plastic Reconstruction Strategy for Patients With Ectodermal Dysplasia Syndrome.

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Hou, Yikang; Jin, Yunbo; Lin, Xiaoxi; Chai, Gang; Zhang, Yan; Qi, Zuoliang

2017-06-01

Ectodermal dysplasia syndrome is a hereditary disease of ectodermal origin. Appearances of nail dystrophy, alopecia or hypotrichosis, saddle nose deformity, and palmoplantar hyperkeratosis are usually associated with a lack of sweat glands as well as partial or complete absence of teeth. These manifestations are usually corrected only with oral rehabilitation by mounting dentures. In this study, plastic rehabilitation was developed to correct the special features of patients with ectodermal dysplasia. Four men and 1 woman with ectodermal dysplasia syndrome were treated. Four patients showed dysostosis of the midface, and rhinoplasty with costal bone was performed, whereas cosmetic operation aiming to repair soft tissue defects was adopted for the last patient. After plastic corrections, all 5 patients were satisfied with the results and had no social embarrassment.

Surgical correction of gynecomastia in thin patients.

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Cigna, Emanuele; Tarallo, Mauro; Fino, Pasquale; De Santo, Liliana; Scuderi, Nicolò

2011-08-01

Gynecomastia refers to a benign enlargement of the male breast. This article describes the authors' method of using power-assisted liposuction and gland removal through a subareolar incision for thin patients. Power-assisted liposuction is performed for removal of fatty breast tissue in the chest area to allow skin retraction. The subareolar incision is used to remove glandular tissue from a male subject considered to be within a normal weight range but who has bilateral grade 1 or 2 gynecomastia. Gynecomastia correction was successfully performed for all the patients. The average volume of aspirated fat breast was 100-200 ml on each side. Each breast had 5-80 g of breast tissue removed. At the 3-month, 6-month, and 1-year follow-up assessments, all the treated patients were satisfied with their aesthetic results. Liposuction has the advantages of reducing the fat tissue where necessary to allow skin retraction and of reducing the traces left by surgery. The combination of surgical excision and power-assisted lipoplasty also is a valid choice for the treatment of thin patients.

Hallux valgus angle as main predictor for correction of hallux valgus

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Malefijt Maarten

2008-05-01

Full Text Available Abstract Background It is recognized that different types of hallux valgus exist. Classification occurs with radiographic and clinical parameters. Severity of different parameters is used in algorithms to choose between different surgical procedures. Because there is no consensus about each parameter nor their cut-off point we conducted this study to analyze the influence of these variables on the postoperative hallux valgus angle. Methods After informed consent 115 patients (136 feet were included. Bunionectomy, osteotomy, lateralization of the distal fragment, lateral release and medial capsulorraphy were performed in all patients. Data were collected on preoperative and postoperative HVA, IMA and DMAA measurements. Forty cases were included since our findings in a previous article 1, therefore, current data concern an expanded study group with longer follow-up and were not published before. At least two-year follow-up data were evaluated with logistic regression and independent t-tests. Results Preoperative HVA was significant for prediction of postoperative HVA in logistic regression. IMA and DMAA were not significant for prediction of postoperative HVA in logistic regression, although they were significantly increased in larger deformities. In patients with preoperative HVA of 37 degrees or more, satisfactory correction could be obtained in 65 percent. The other nine of these 26 patients developed subluxation. Conclusion The preoperative HVA was the main radiological predictor for correction of hallux valgus, correction rate declined from preoperative HVA of 37. IMA and DMAA did have a minor role in patients with preoperative HVA lower than 37 degrees, however, likely contributed to preoperative HVA of 37 degrees or more.

INTRAOCULAR CORRECTION OF PRESBYOPIA BY MONOVISION IN PATIENTS WITH CATARACT AND CORNEAL ASTIGMATISM

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E. I. Belikova

2017-01-01

Full Text Available Purpose: To evaluate the results of intraocular correction of presbyopia by monovision in patients with cataract and primary corneal astigmatism and conduct a comparative analysis of these outcomes with the results of binocular multifocal IOLs implantation. Patients and methods. There were 21 patients with bilateral cataract surgery performed using toric monofocal intraocular lenses (monovision group in the study. The indications for the operation were: 1 primary corneal astigmatism ≥ 1.0D in patients with cataract, 2 inability to conduct excimer laser correction. Reduction of spectacle dependence by monovision was discussed during preoperative conversation. The age of patients range from 32 to 65 years. Target refraction: Emetronopia on the dominant eye (DG and myopia at 1.0–2.0 D in the non-dominant eye (NDG. Evaluation included measurement of uncorrected visual acuity, refraction, stereopsis, contrast sensitivity and patient satisfaction. The results were compared with the outcomes of binocular multifocal Iols implantation in 22 patients (44 eyes. Results. The spherical component decreased from 3.39±2.63D to 0.34±0.24D, cylinder decreased from 3.05±1.47D to 0.44±0,35D (P <0.01 in the monovision group three months after surgery . The deviation from target refraction was 0.30±0.35D. The mean difference between postoperative refraction on the two eyes was 1.92±0.57D. Postoperative corrected visual acuity significantly exceeded preoperative parameters. In 18 patients (88% the stereoscopic visual acuity did not exceed 60 seconds and corresponded to the age norm, in 3 patients (12% it was at the level of 80–100 arc seconds. In patients with multifocal IOLs, the stereovision values were identical (Ferrer-Blasco T. et al, 2008. Conclusion. The monovision is an effective method of reducing dependence on additional correction in patients with cataract and corneal astigmatism. Refractive outcomes, binocular visual acuity, predictability and

PROXIMAL DISABILITY AND SPINAL DEFORMITY INDEX IN PATIENTS WITH PROXIMAL FEMUR FRACTURES

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Sylvio Mistro Neto

2015-12-01

Full Text Available Objective : To evaluate the quality of life related to the spine in patients with proximal femoral fractures. Methods : Study conducted in a tertiary public hospital in patients with proximal femoral fractures caused by low-energy trauma, through the Oswestry Disability Index questionnaire to asses complaints related to the spine at the time of life prior to the femoral fracture. The thoracic and lumbar spine of patients were also evaluated applying the radiographic index described by Gennant (Spinal Deformity Index, which assesses the number and severity of fractures. Results : Seventeen subjects completed the study. All had some degree of vertebral fracture. Patients were classified in the categories of severe and very severe disability in the questionnaire about quality of life. It was found that the higher SDI, the better the quality of life. Conclusion : There is a strong association of disability related to the spine in patients with proximal femoral fracture, and this complaint must be systematically evaluated in patients with appendicular fracture.

Ground-State Band and Deformation of the Z = 102 Isotope N 254

International Nuclear Information System (INIS)

Reiter, P.; Khoo, T.L.; Lister, C.J.; Seweryniak, D.; Ahmad, I.; Alcorta, M.; Carpenter, M.P.; Cizewski, J.A.; Davids, C.N.; Gervais, G.; Greene, J.P.; Henning, W.F.; Janssens, R.V.; Lauritsen, T.; Siem, S.; Sonzogni, A.A.; Sullivan, D.; Uusitalo, J.; Wiedenhoever, I.; Amzal, N.; Butler, P.A.; Chewter, A.J.; Greenlees, P.T.; Herzberg, R.; Jones, G.D.; Cizewski, J.A.; Ding, K.Y.; Fotiades, N.; Fox, J.D.; Korten, W.; Leino, M.; Vetter, K.; Siem, S.

1999-01-01

The ground-state band of the Z=102 isotope 254 No has been identified up to spin 14, indicating that the nucleus is deformed. The deduced quadrupole deformation, β=0.27 , is in agreement with theoretical predictions. These observations confirm that the shell-correction energy responsible for the stability of transfermium nuclei is partly derived from deformation. The survival of 254 No up to spin 14 means that its fission barrier persists at least up to that spin. copyright 1999 The American Physical Society

Space Active Optics: toward optimized correcting mirrors for future large spaceborne observatories

Science.gov (United States)

Laslandes, Marie; Hugot, Emmanuel; Ferrari, Marc; Lemaitre, Gérard; Liotard, Arnaud

2011-10-01

Wave-front correction in optical instruments is often needed, either to compensate Optical Path Differences, off-axis aberrations or mirrors deformations. Active optics techniques are developed to allow efficient corrections with deformable mirrors. In this paper, we will present the conception of particular deformation systems which could be used in space telescopes and instruments in order to improve their performances while allowing relaxing specifications on the global system stability. A first section will be dedicated to the design and performance analysis of an active mirror specifically designed to compensate for aberrations that might appear in future 3m-class space telescopes, due to lightweight primary mirrors, thermal variations or weightless conditions. A second section will be dedicated to a brand new design of active mirror, able to compensate for given combinations of aberrations with a single actuator. If the aberrations to be corrected in an instrument and their evolutions are known in advance, an optimal system geometry can be determined thanks to the elasticity theory and Finite Element Analysis.

Occipital plagiocephaly: deformation or lambdoid synostosis ? II. a unifying theory regarding pathogenesis

International Nuclear Information System (INIS)

Dias, M.S.; Klein, D.M.

1997-01-01

Occipital plagiocephaly is characterized by both unilateral occipital flattening and ipsilateral frontal prominence with anterior deviation of the ipsilateral ear, yielding a characteristic parallelogram shape to the cranium. Radiographic changes in the lambdoid suture are often evident, but the lambdoid suture is usually patent over most or all of its length on skull X-rays and/or CT scans. Both lambdoid synostosis and deformational forces have been implicated as potentially causal in the pathogenesis of this deformity. We propose a unifying theory which incorporates a common pathogenesis for both deformational plagiocephaly and most cases of lambdoid ''synostosis''. According to this hypothesis, intrauterine and/or postnatal deformational forces are responsible for the primary calvarial deformation. These forces initially act in a reversible manner to produce the typical parallelogram-shaped skull deformity. How-ever, with continued deformation, more enduring secondary pathological changes may eventually occur in the lambdoid suture and basicranium which are more difficult to correct even if the offending deformational forces are subsequently removed or reversed. (authors)

Piezoelectric deformable mirror for intra-cavity laser adaptive optics.

CSIR Research Space (South Africa)

Long, CS

2008-03-01

Full Text Available This paper describes the development of a deformable mirror to be used in conjunction with diffractive optical elements inside a laser cavity. A prototype piezoelectric unimorph adaptive mirror was developed to correct for time dependent phase...

Carotid wall volume quantification from magnetic resonance images using deformable model fitting and learning-based correction of systematic errors

International Nuclear Information System (INIS)

Hameeteman, K; Niessen, W J; Klein, S; Van 't Klooster, R; Selwaness, M; Van der Lugt, A; Witteman, J C M

2013-01-01

We present a method for carotid vessel wall volume quantification from magnetic resonance imaging (MRI). The method combines lumen and outer wall segmentation based on deformable model fitting with a learning-based segmentation correction step. After selecting two initialization points, the vessel wall volume in a region around the bifurcation is automatically determined. The method was trained on eight datasets (16 carotids) from a population-based study in the elderly for which one observer manually annotated both the lumen and outer wall. An evaluation was carried out on a separate set of 19 datasets (38 carotids) from the same study for which two observers made annotations. Wall volume and normalized wall index measurements resulting from the manual annotations were compared to the automatic measurements. Our experiments show that the automatic method performs comparably to the manual measurements. All image data and annotations used in this study together with the measurements are made available through the website http://ergocar.bigr.nl. (paper)

Virtual simulation of the postsurgical cosmetic outcome in patients with Pectus Excavatum

Science.gov (United States)

Vilaça, João L.; Moreira, António H. J.; L-Rodrigues, Pedro; Rodrigues, Nuno; Fonseca, Jaime C.; Pinho, A. C. M.; Correia-Pinto, Jorge

2011-03-01

Pectus excavatum is the most common congenital deformity of the anterior chest wall, in which several ribs and the sternum grow abnormally. Nowadays, the surgical correction is carried out in children and adults through Nuss technic. This technic has been shown to be safe with major drivers as cosmesis and the prevention of psychological problems and social stress. Nowadays, no application is known to predict the cosmetic outcome of the pectus excavatum surgical correction. Such tool could be used to help the surgeon and the patient in the moment of deciding the need for surgery correction. This work is a first step to predict postsurgical outcome in pectus excavatum surgery correction. Facing this goal, it was firstly determined a point cloud of the skin surface along the thoracic wall using Computed Tomography (before surgical correction) and the Polhemus FastSCAN (after the surgical correction). Then, a surface mesh was reconstructed from the two point clouds using a Radial Basis Function algorithm for further affine registration between the meshes. After registration, one studied the surgical correction influence area (SCIA) of the thoracic wall. This SCIA was used to train, test and validate artificial neural networks in order to predict the surgical outcome of pectus excavatum correction and to determine the degree of convergence of SCIA in different patients. Often, ANN did not converge to a satisfactory solution (each patient had its own deformity characteristics), thus invalidating the creation of a mathematical model capable of estimating, with satisfactory results, the postsurgical outcome.

Comparative analysis of nasal deformities according to patient satisfaction.

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Baykal, Bahadir; Erdim, Ibrahim; Kayhan, Fatma Tulin; Oghan, Fatih

2014-03-01

The study aim was to compare patient satisfaction levels among patient groups with nasal hump deformity (NHD), nasal axis deviation (NAD), and NHD plus NAD using the Rhinoplasty Outcomes Evaluation Questionnaire (ROEQ) pre- and postoperatively. Forty-seven patients were divided into the NHD (n = 16), NAD (n = 13), and NHD + NAD (n = 18) groups according to the patients' physical examination results. Deviation angles were measured using frontal views and the AutoCAD 2012 computer program. Levels of patient satisfaction were assessed by the ROEQ pre- and postoperatively. The preoperative ROE scores were 6 in the NAD group and 4.9 in the NHD group. In the NAD + NHD group, the preoperative ROE score was 6.6. The postoperative ROE scores were 17.4, 21.4, and 19.1, respectively. The pre- and postoperative ROEQ scores were significantly different for all groups. The preoperative ROE score was 5.6 in women. The score was 18.6 at 6 months after surgery. In male patients, the preoperative ROE score was 6.2. The score was 20.4 at 6 months after surgery. The preoperative ROE score was 6.3 in patients younger than 30 years; the score was 19.4 in the postoperative period for this group. Preoperatively, the ROE score was 5.2 for patients older than 30 years. Postoperatively, the ROE score was 19.3 (P < .05). Patient satisfaction and quality of life should improve after rhinoplasty. Patient satisfaction ranged from high to low for patients, with the NHD group the most satisfied, followed by the NAD + NHD group and the NAD group. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Prevalence of flat foot and hallux valgus deformity among primary school female students in Kiar city of Chaharmahal and Bakhtiari

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Reza Vahab Kashani

2013-08-01

Full Text Available Introduction: Foot deformities are common among complaints of patients referred to the orthopedic centers. Most of naturally occurring lower limb deformities in children, which are rather common, would be corrected with further normal growth. However, a small percentage of these problems remain unresolved and may cause complications in the future. The main aim of this study is determination of prevalence of flat foot and hallux valgus deformity among primary school female students in Kiar city of Chaharmahal and BakhtiariMaterial and Methods: This is a cross sectional study. Foot posture index (FPI 6 test evaluate for 345 students in age range 7- 11 years and two groups of 7 to 9 years and 11 to 10 years. Also prevalence of hallux valgus among 345 students evaluated.Results: 7.8 % of studied subjects had flat foot deformity. Among 345 students, 12 (6.6% students in range of age 7 -9 years and 15 (9.3 % students in range of 10-11 had flat foot deformity. Also prevalence of hallux valgus was 16.5%.Conclusion: These findings point to the importance of proper physical examination, early diagnosis and on-time treatment of foot deformities such as flat foot and hallux valgus deformity in children.

External Validation of the Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) in the Scoli-RISK-1 Patient Database.

Science.gov (United States)

Miller, Emily K; Lenke, Lawrence G; Neuman, Brian J; Sciubba, Daniel M; Kebaish, Khaled M; Smith, Justin S; Qiu, Yong; Dahl, Benny T; Pellisé, Ferran; Matsuyama, Yukihiro; Carreon, Leah Y; Fehlings, Michael G; Cheung, Kenneth M; Lewis, Stephen; Dekutoski, Mark B; Schwab, Frank J; Boachie-Adjei, Oheneba; Mehdian, Hossein; Bess, Shay; Shaffrey, Christopher I; Ames, Christopher P

2018-05-14

Analysis of a prospective multicenter database. To assess the ability of the recently created Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) to predict odds of major complications and length of hospital stay for patients who had more severe preoperative deformity and underwent more invasive ASD surgery compared with patients in the database used to create the index. Accurate preoperative estimates of risk are necessary given the high complication rates currently associated with ASD surgery. Patients were enrolled by participating institutions in Europe, Asia, and North America from 2009 to 2011. ASD-FI scores were used to classify 267 patients as not frail (NF) (0.5). Multivariable logistic regression, adjusted for preoperative and surgical covariates such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and incidence of major complications, overall incidence of complications, and length of hospital stay. The mean ASD-FI score was 0.3 (range, 0-0.7). We categorized 105 patients as NF, 103 as frail, and 59 as SF. The adjusted odds of developing a major complication were higher for SF patients (odds ratio = 4.4; 95% CI 2.0, 9.9) compared with NF patients. After adjusting for covariates, length of hospital stay for SF patients increased by 19% (95% CI 1.4%, 39%) compared with NF patients. The odds of developing a major complication or having increased length of stay were similar between frail and NF patients. Greater patient frailty, as measured by the ASD-FI, is associated with a longer hospital stay and greater risk of major complications among patients who have severe preoperative deformity and undergo invasive surgical procedures. 2.

Deformation of the cubic open string field theory

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Lee, Taejin, E-mail: taejin@kangwon.ac.kr

2017-05-10

We study a consistent deformation of the cubic open bosonic string theory in such a way that the non-planar world sheet diagrams of the perturbative string theory are mapped onto their equivalent planar diagrams of the light-cone string field theory with some length parameters fixed. An explicit evaluation of the cubic string vertex in the zero-slope limit yields the correct relationship between the string coupling constant and the Yang–Mills coupling constant. The deformed cubic open string field theory is shown to produce the non-Abelian Yang–Mills action in the zero-slope limit if it is defined on multiple D-branes. Applying the consistent deformation systematically to multi-string world sheet diagrams, we may be able to calculate scattering amplitudes with an arbitrary number of external open strings.

Deformation of the cubic open string field theory

International Nuclear Information System (INIS)

Lee, Taejin

2017-01-01

We study a consistent deformation of the cubic open bosonic string theory in such a way that the non-planar world sheet diagrams of the perturbative string theory are mapped onto their equivalent planar diagrams of the light-cone string field theory with some length parameters fixed. An explicit evaluation of the cubic string vertex in the zero-slope limit yields the correct relationship between the string coupling constant and the Yang–Mills coupling constant. The deformed cubic open string field theory is shown to produce the non-Abelian Yang–Mills action in the zero-slope limit if it is defined on multiple D-branes. Applying the consistent deformation systematically to multi-string world sheet diagrams, we may be able to calculate scattering amplitudes with an arbitrary number of external open strings.

Deformation of the cubic open string field theory

Directory of Open Access Journals (Sweden)

Taejin Lee

2017-05-01

Full Text Available We study a consistent deformation of the cubic open bosonic string theory in such a way that the non-planar world sheet diagrams of the perturbative string theory are mapped onto their equivalent planar diagrams of the light-cone string field theory with some length parameters fixed. An explicit evaluation of the cubic string vertex in the zero-slope limit yields the correct relationship between the string coupling constant and the Yang–Mills coupling constant. The deformed cubic open string field theory is shown to produce the non-Abelian Yang–Mills action in the zero-slope limit if it is defined on multiple D-branes. Applying the consistent deformation systematically to multi-string world sheet diagrams, we may be able to calculate scattering amplitudes with an arbitrary number of external open strings.

Minimally Invasive Distal Metatarsal Osteotomy for Mild-to-Moderate Hallux Valgus Deformity

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Yu-Chuan Lin

2009-08-01

Full Text Available Minimally invasive surgery has recently been introduced for foot and ankle surgery, and hallux valgus surgery is no exception. The purpose of our study was to analyze the early results and to present our experience of minimally invasive distal metatarsal osteotomy in correcting mild-to-moderate hallux valgus deformities. Between September 2005 and December 2006, 31 consecutive patients (47 feet with mild-to-moderate hallux valgus deformities underwent minimally invasive distal metatarsal osteotomies. The clinical and radiographic outcomes were assessed. The satisfaction rate was 90.32%. The mean total American Orthopedic Foot and Ankle Society halluxmetatarsophalangeal-interphalangeal scale was 92.7 points. Complications included two (4.26% episodes of stiffness, six (12.77% episodes of pin tract infection, and one (2.13% deep infection. There were no cases with nonunion, malunion, overcorrection, transfer metatarsalgia or osteonecrosis. On weight-bearing anteroposterior foot radiographs, the mean hallux valgus angle and first intermetatarsal angle corrections were 11.8° and 6.3°, respectively, which is a statistically significant difference (p < 0.001 between the preoperative and postoperative status. Here, minimally invasive distal metatarsal osteotomy was associated with good satisfaction, functional improvement and low complication rates. This technique offers an effective, safe and simple way to treat hallux valgus with a first intermetatarsal angle less than 15°.

Refined shear correction factor for very thick simply supported and uniformly loaded isosceles right triangular auxetic plates

International Nuclear Information System (INIS)

Lim, Teik-Cheng

2016-01-01

For moderately thick plates, the use of First order Shear Deformation Theory (FSDT) with a constant shear correction factor of 5/6 is sufficient to take into account the plate deflection arising from transverse shear deformation. For very thick plates, the use of Third order Shear Deformation Theory (TSDT) is preferred as it allows the shear strain distribution to be varied through the plate thickness. Therefore no correction factor is required in TSDT, unlike FSDT. Due to the complexity involved in TSDT, this paper obtains a more accurate shear correction factor for use in FSDT of very thick simply supported and uniformly loaded isosceles right triangular plates based on the TSDT. By matching the maximum deflections for this plate according to FSDT and TSDT, a variable shear correction factor is obtained. Results show that the shear correction factor for the simplified TSDT, i.e. 14/17, is least accurate. The commonly adopted shear correction factor of 5/6 in FSDT is valid only for very thin or highly auxetic plates. This paper provides a variable shear correction for FSDT deflection that matches the plate deflection by TSDT. This variable shear correction factor allows designers to justify the use of a commonly adopted shear correction factor of 5/6 even for very thick plates as long as the Poisson’s ratio of the plate material is sufficiently negative. (paper)

Radiative processes as a condensation phenomenon and the physical meaning of deformed canonical structures

International Nuclear Information System (INIS)

Gamboa, J.; Mendez, F.; Grigorio, L.S.; Guimaraes, M.S.; Wotzasek, C.

2008-01-01

We study the radiative corrections of QED 3 from the dual point of view and show that this process is the exact dual to the Julia-Toulouse mechanism introduced by Quevedo and Trugenberger [F. Quevedo, C.A. Trugenberger, Nucl. Phys. B 501 (1997) 143] some years ago. We discuss the physics behind this mechanism that involves condensation of topological defects. It is shown that the dual Stuckelberg mechanism is responsible for the 'rank-jump' phenomenon that transforms the scalar field (dual to Maxwell in this dimensionality) into the vectorial self-dual field. This phenomenon is studied using the ideas of noncommutative fields theory that examines possible deformations of the canonical structure of some well-known models in (2+1)D. A deformation is constructed linking the massless scalar field theory with the self-dual theory. This is the exact dual of the known deformation connecting the Maxwell theory with the Maxwell-Chern-Simons theory. Duality, radiative corrections, the Julia-Toulouse mechanism and canonical deformations are then used to establish a web of relations between the mentioned theories and to propose a physical picture of the deformation procedure adopted

WE-AB-207A-06: Progressive Dose Control for Cone Beam CT with Deformation Assisted Temporal Nonlocal Means Method

International Nuclear Information System (INIS)

Chen, L; Shen, C; Wang, J; Jiang, S; Jia, X

2016-01-01

Purpose: To reduce cone beam CT (CBCT) imaging dose, we previously proposed a progressive dose control (PDC) scheme to employ temporal correlation between CBCT images at different fractions for image quality enhancement. A temporal non-local means (TNLM) method was developed to enhance quality of a new low-dose CBCT using existing high-quality CBCT. To enhance a voxel value, the TNLM method searches for similar voxels in a window. Due to patient deformation among the two CBCTs, a large searching window was required, reducing image quality and computational efficiency. This abstract proposes a deformation-assisted TNLM (DA-TNLM) method to solve this problem. Methods: For a low-dose CBCT to be enhanced using a high-quality CBCT, we first performed deformable image registration between the low-dose CBCT and the high-quality CBCT to approximately establish voxel correspondence between the two. A searching window for a voxel was then set based on the deformation vector field. Specifically, the search window for each voxel was shifted by the deformation vector. A TNLM step was then applied using only voxels within this determined window to correct image intensity at the low-dose CBCT. Results: We have tested the proposed scheme on simulated CIRS phantom data and real patient data. The CITS phantom was scanned on Varian onboard imaging CBCT system with coach shifting and dose reducing for each time. The real patient data was acquired in four fractions with dose reduced from standard CBCT dose to 12.5% of standard dose. It was found that the DA-TNLM method can reduce total dose by over 75% on average in the first four fractions. Conclusion: We have developed a PDC scheme which can enhance the quality of image scanned at low dose using a DA-TNLM method. Tests in phantom and patient studies demonstrated promising results.

Evaluation of Sinus/Edge-Corrected Zero-Echo-Time-Based Attenuation Correction in Brain PET/MRI.

Science.gov (United States)

Yang, Jaewon; Wiesinger, Florian; Kaushik, Sandeep; Shanbhag, Dattesh; Hope, Thomas A; Larson, Peder E Z; Seo, Youngho

2017-11-01

In brain PET/MRI, the major challenge of zero-echo-time (ZTE)-based attenuation correction (ZTAC) is the misclassification of air/tissue/bone mixtures or their boundaries. Our study aimed to evaluate a sinus/edge-corrected (SEC) ZTAC (ZTAC SEC ), relative to an uncorrected (UC) ZTAC (ZTAC UC ) and a CT atlas-based attenuation correction (ATAC). Methods: Whole-body 18 F-FDG PET/MRI scans were obtained for 12 patients after PET/CT scans. Only data acquired at a bed station that included the head were used for this study. Using PET data from PET/MRI, we applied ZTAC UC , ZTAC SEC , ATAC, and reference CT-based attenuation correction (CTAC) to PET attenuation correction. For ZTAC UC , the bias-corrected and normalized ZTE was converted to pseudo-CT with air (-1,000 HU for ZTE 0.75), and bone (-2,000 × [ZTE - 1] + 42 HU for 0.2 ≤ ZTE ≤ 0.75). Afterward, in the pseudo-CT, sinus/edges were automatically estimated as a binary mask through morphologic processing and edge detection. In the binary mask, the overestimated values were rescaled below 42 HU for ZTAC SEC For ATAC, the atlas deformed to MR in-phase was segmented to air, inner air, soft tissue, and continuous bone. For the quantitative evaluation, PET mean uptake values were measured in twenty 1-mL volumes of interest distributed throughout brain tissues. The PET uptake was compared using a paired t test. An error histogram was used to show the distribution of voxel-based PET uptake differences. Results: Compared with CTAC, ZTAC SEC achieved the overall PET quantification accuracy (0.2% ± 2.4%, P = 0.23) similar to CTAC, in comparison with ZTAC UC (5.6% ± 3.5%, P PET quantification in brain PET/MRI, comparable to the accuracy achieved by CTAC, particularly in the cerebellum. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

A new corrective technique for adolescent idiopathic scoliosis (Ucar′s convex rod rotation

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Bekir Yavuz Ucar

2014-01-01

Full Text Available Study Design: Prospective single-center study. Objective: To analyze the efficacy and safety of a new technique of global vertebral correction with convex rod rotation performed on the patients with adolescent idiopathic scoliosis. Summary of Background Data: Surgical goal is to obtain an optimal curve correction in scoliosis surgery. There are various correction techniques. This report describes a new technique of global vertebral correction with convex rod rotation. Materials and Methods: A total of 12 consecutive patients with Lenke type I adolescent idiopathic scoliosis and managed by convex rod rotation technique between years 2012 and 2013 having more than 1 year follow-up were included. Mean age was 14.5 (range = 13-17 years years at the time of operation. The hospital charts were reviewed for demographic data. Measurements of curve magnitude and balance were made on 36-inch standing anteroposterior and lateral radiographs taken before surgery and at most recent follow up to assess deformity correction, spinal balance, and complications related to the instrumentation. Results: Preoperative coronal plane major curve of 62° (range = 50°-72° with flexibility of less than 30% was corrected to 11.5°(range = 10°-14° showing a 81% scoliosis correction at the final follow-up. Coronal imbalance was improved 72% at the most recent follow-up assessment. No complications were found. Conclusion: The new technique of global vertebral correction with Ucar′s convex rod rotation is an effective technique. This method is a vertebral rotation procedure from convex side and it allows to put screws easily to the concave side.

Health related quality of life and perception of deformity in patients with adolescent idiopathic scoliosis.

Science.gov (United States)

Çolak, Tuğba Kuru; Akgül, Turgut; Çolak, Ilker; Dereli, Elif Elçin; Chodza, Mehmet; Dikici, Fatih

2017-01-01

Quality of life and cosmethic appearance have gained importance as outcomes in AIS treatment. Improving aesthetic appearance and quality of life are defined as the primary aims of scoliosis treatment by health professionals. Studies that assess and compare the different treatment results in the field of quality of life and cosmethics are some what limited. A cross-sectional study was designed to compare quality of life and deformity perception in patients with adolescent idiopathic scoliosis (AIS) received conservative (exercise or exercise + brace) or surgical treatment. A total of 68 (58 females) patients aged 10-18 years with AIS received conservative (exercise or exercise+brace) or surgical treatment were invited to participate in the study. Quality of life (Scoliosis Research Society-23 (SRS-23)) and perception of deformity (Walter Reed Visual Assessment (WRVAS)) were assessed. Conservatively treated patients had significantly superior scores in function domain of SRS-23 than surgically treated patients (exercise/surgery, exercise+brace/surgery; p= 0.009, 0.004). Otherwise, surgically treated patients had significantly superior scores in self-image (p= 0.000, 0.000), and satisfaction with management (p= 0.001, 0.006) domains of SRS-23, and WRVAS (p= 0.000, 0.000) than conservative groups. In addition to radiographic assessments, quality of life, aesthetic perception, functionality, satisfaction with management, psycho-social status should carefully be taken into consideration by health professionals in the teratment of AIS.

Independent Association Between Preoperative Cognitive Status and Discharge Location After Surgery: A Strategy to Reduce Resource Use After Surgery for Deformity.

Science.gov (United States)

Adogwa, Owoicho; Elsamadicy, Aladine A; Sergesketter, Amanda; Vuong, Victoria D; Moreno, Jessica; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

2018-02-01

The aim of this study is to determine whether preoperative scores on a screening measure for cognitive status (the Saint Louis University mental status examination), were associated with discharge to a location other than home in older patients undergoing surgery for deformity. Older patients (≥65 years) undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Preoperative baseline cognition was assessed using the validated Saint Louis University mental status (SLUMS) test. SLUMS is 11 questions with a maximum of 30 points. Mild cognitive impairment was defined as a SLUMS score of 21-26 points, and severe cognitive impairment as a SLUMS score of 20 points or greater. Normal cognition was defined as a SLUMS score of 27 points or more. Postoperative length of stay and discharge location were recorded on all patients. Eighty-two subjects were included, with mean ± standard deviation age of 73.26 ± 6.08 years; 51% of patients were discharged to a facility (skilled nursing or acute rehabilitation). After adjustment for demographic variables, comorbidities, and baseline cognitive impairment, patients with preoperative cognitive impairment were 4-fold more likely to be discharged to a facility (skilled nursing or acute rehabilitation) compared with patients with normal cognitive status (odds ratio [OR], 3.93). In addition, patients who were not ambulatory before surgery were also more likely to be discharged to a facility (OR, 7.14). In geriatric patients undergoing surgery for deformity correction, cognitive screening before surgery can identify patients with impaired cognitive status who are less likely than those with normal cognitive status to return home after surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

Improving anatomical mapping of complexly deformed anatomy for external beam radiotherapy and brachytherapy dose accumulation in cervical cancer

International Nuclear Information System (INIS)

Vásquez Osorio, Eliana M.; Kolkman-Deurloo, Inger-Karine K.; Schuring-Pereira, Monica; Zolnay, András; Heijmen, Ben J. M.; Hoogeman, Mischa S.

2015-01-01

Purpose: In the treatment of cervical cancer, large anatomical deformations, caused by, e.g., tumor shrinkage, bladder and rectum filling changes, organ sliding, and the presence of the brachytherapy (BT) applicator, prohibit the accumulation of external beam radiotherapy (EBRT) and BT dose distributions. This work proposes a structure-wise registration with vector field integration (SW+VF) to map the largely deformed anatomies between EBRT and BT, paving the way for 3D dose accumulation between EBRT and BT. Methods: T2w-MRIs acquired before EBRT and as a part of the MRI-guided BT procedure for 12 cervical cancer patients, along with the manual delineations of the bladder, cervix-uterus, and rectum-sigmoid, were used for this study. A rigid transformation was used to align the bony anatomy in the MRIs. The proposed SW+VF method starts by automatically segmenting features in the area surrounding the delineated organs. Then, each organ and feature pair is registered independently using a feature-based nonrigid registration algorithm developed in-house. Additionally, a background transformation is calculated to account for areas far from all organs and features. In order to obtain one transformation that can be used for dose accumulation, the organ-based, feature-based, and the background transformations are combined into one vector field using a weighted sum, where the contribution of each transformation can be directly controlled by its extent of influence (scope size). The optimal scope sizes for organ-based and feature-based transformations were found by an exhaustive analysis. The anatomical correctness of the mapping was independently validated by measuring the residual distances after transformation for delineated structures inside the cervix-uterus (inner anatomical correctness), and for anatomical landmarks outside the organs in the surrounding region (outer anatomical correctness). The results of the proposed method were compared with the results of the

Improving anatomical mapping of complexly deformed anatomy for external beam radiotherapy and brachytherapy dose accumulation in cervical cancer

Energy Technology Data Exchange (ETDEWEB)

Vásquez Osorio, Eliana M., E-mail: e.vasquezosorio@erasmusmc.nl; Kolkman-Deurloo, Inger-Karine K.; Schuring-Pereira, Monica; Zolnay, András; Heijmen, Ben J. M.; Hoogeman, Mischa S. [Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam 3075 (Netherlands)

2015-01-15

Purpose: In the treatment of cervical cancer, large anatomical deformations, caused by, e.g., tumor shrinkage, bladder and rectum filling changes, organ sliding, and the presence of the brachytherapy (BT) applicator, prohibit the accumulation of external beam radiotherapy (EBRT) and BT dose distributions. This work proposes a structure-wise registration with vector field integration (SW+VF) to map the largely deformed anatomies between EBRT and BT, paving the way for 3D dose accumulation between EBRT and BT. Methods: T2w-MRIs acquired before EBRT and as a part of the MRI-guided BT procedure for 12 cervical cancer patients, along with the manual delineations of the bladder, cervix-uterus, and rectum-sigmoid, were used for this study. A rigid transformation was used to align the bony anatomy in the MRIs. The proposed SW+VF method starts by automatically segmenting features in the area surrounding the delineated organs. Then, each organ and feature pair is registered independently using a feature-based nonrigid registration algorithm developed in-house. Additionally, a background transformation is calculated to account for areas far from all organs and features. In order to obtain one transformation that can be used for dose accumulation, the organ-based, feature-based, and the background transformations are combined into one vector field using a weighted sum, where the contribution of each transformation can be directly controlled by its extent of influence (scope size). The optimal scope sizes for organ-based and feature-based transformations were found by an exhaustive analysis. The anatomical correctness of the mapping was independently validated by measuring the residual distances after transformation for delineated structures inside the cervix-uterus (inner anatomical correctness), and for anatomical landmarks outside the organs in the surrounding region (outer anatomical correctness). The results of the proposed method were compared with the results of the

Chiral trace relations in Ω-deformed N=2 theories

Energy Technology Data Exchange (ETDEWEB)

Beccaria, Matteo; Fachechi, Alberto; Macorini, Guido [Dipartimento di Matematica e Fisica Ennio De Giorgi,Università del Salento, Via Arnesano, 73100 Lecce (Italy); INFN - Sezione di LecceVia Arnesano, 73100 Lecce (Italy)

2017-05-04

We consider N=2SU(2) gauge theories in four dimensions (pure or mass deformed) and discuss the properties of the simplest chiral observables in the presence of a generic Ω-deformation. We compute them by equivariant localization and analyze the structure of the exact instanton corrections to the classical chiral ring relations. We predict exact relations valid at all instanton number among the traces 〈Trφ{sup n}〉, where φ is the scalar field in the gauge multiplet. In the Nekrasov-Shatashvili limit, such relations may be explained in terms of the available quantized Seiberg-Witten curves. Instead, the full two-parameter deformation enjoys novel features and the ring relations require non trivial additional derivative terms with respect to the modular parameter. Higher rank groups are briefly discussed emphasizing non-factorization of correlators due to the Ω-deformation. Finally, the structure of the deformed ring relations in the N=2{sup ⋆} theory is analyzed from the point of view of the Alday-Gaiotto-Tachikawa correspondence proving consistency as well as some interesting universality properties.

From labyrinthine aplasia to otocyst deformity.

Science.gov (United States)

Giesemann, Anja Maria; Goetz, Friedrich; Neuburger, Jürgen; Lenarz, Thomas; Lanfermann, Heinrich

2010-02-01

Inner ear malformations (IEMs) are rare and it is unusual to encounter the rarest of them, namely labyrinthine aplasia (LA) and otocyst deformity. They do, however, provide useful pointers as to the early embryonic development of the ear. LA is characterised as a complete absence of inner ear structures. While some common findings do emerge, a clear definition of the otocyst deformity does not exist. It is often confused with the common cavity first described by Edward Cock. Our purpose was to radiologically characterise LA and otocyst deformity. Retrospective analysis of CT and MRI data from four patients with LA or otocyst deformity. Middle and inner ear findings were categorised by two neuroradiologists. The bony carotid canal was found to be absent in all patients. Posterior located cystic structures were found in association with LA and otocyst deformity. In the most severe cases, only soft tissue was present at the medial border of the middle ear cavity. The individuals with otocyst deformity also had hypoplasia of the petrous apex bone. These cases demonstrate gradual changes in the two most severe IEMs. Clarification of terms was necessary and, based on these findings, we propose defining otocyst deformity as a cystic structure in place of the inner ear, with the cochlea, IAC and carotid canal absent. This condition needs to be differentiated from the common cavity described by Edward Cook. A clear definition of inner ear malformations is essential if outcomes following cochlear implantation are to be compared.

From labyrinthine aplasia to otocyst deformity

International Nuclear Information System (INIS)

Giesemann, Anja Maria; Goetz, Friedrich; Lanfermann, Heinrich; Neuburger, Juergen; Lenarz, Thomas

2010-01-01

Inner ear malformations (IEMs) are rare and it is unusual to encounter the rarest of them, namely labyrinthine aplasia (LA) and otocyst deformity. They do, however, provide useful pointers as to the early embryonic development of the ear. LA is characterised as a complete absence of inner ear structures. While some common findings do emerge, a clear definition of the otocyst deformity does not exist. It is often confused with the common cavity first described by Edward Cock. Our purpose was to radiologically characterise LA and otocyst deformity. Retrospective analysis of CT and MRI data from four patients with LA or otocyst deformity. Middle and inner ear findings were categorised by two neuroradiologists. The bony carotid canal was found to be absent in all patients. Posterior located cystic structures were found in association with LA and otocyst deformity. In the most severe cases, only soft tissue was present at the medial border of the middle ear cavity. The individuals with otocyst deformity also had hypoplasia of the petrous apex bone. These cases demonstrate gradual changes in the two most severe IEMs. Clarification of terms was necessary and, based on these findings, we propose defining otocyst deformity as a cystic structure in place of the inner ear, with the cochlea, IAC and carotid canal absent. This condition needs to be differentiated from the common cavity described by Edward Cook. A clear definition of inner ear malformations is essential if outcomes following cochlear implantation are to be compared. (orig.)

Consistent calculation of the polarization electric dipole moment by the shell-correction method

International Nuclear Information System (INIS)

Denisov, V.Yu.

1992-01-01

Macroscopic calculations of the polarization electric dipole moment which arises in nuclei with an octupole deformation are discussed in detail. This dipole moment is shown to depend on the position of the center of gravity. The conditions of consistency of the radii of the proton and neutron potentials and the radii of the proton and neutron surfaces, respectively, are discussed. These conditions must be incorporated in a shell-correction calculation of this dipole moment. A correct calculation of this moment by the shell-correction method is carried out. Dipole transitions between (on the one hand) levels belonging to an octupole vibrational band and (on the other) the ground state in rare-earth nuclei with a large quadrupole deformation are studied. 19 refs., 3 figs

Vortex deformation and reduction of the Lorentz force

International Nuclear Information System (INIS)

Vuorio, M.

1977-01-01

A vortex of an extreme II-type superconductor is considered in the presence of a transport current. The equivalence of Magnus and Lorentz forces in a static vortex is discussed and the effect of vortex deformation is included in calculating corrections to the conventional expression of the Lorentz force. (author)

Actuators of 3-element unimorph deformable mirror

Science.gov (United States)

Fu, Tianyang; Ning, Yu; Du, Shaojun

2016-10-01

Kinds of wavefront aberrations exist among optical systems because of atmosphere disturbance, device displacement and a variety of thermal effects, which disturb the information of transmitting beam and restrain its energy. Deformable mirror(DM) is designed to adjust these wavefront aberrations. Bimorph DM becomes more popular and more applicable among adaptive optical(AO) systems with advantages in simple structure, low cost and flexible design compared to traditional discrete driving DM. The defocus aberration accounted for a large proportion of all wavefront aberrations, with a simpler surface and larger amplitude than others, so it is very useful to correct the defocus aberration effectively for beam controlling and aberration adjusting of AO system. In this study, we desired on correcting the 3rd and 10th Zernike modes, analyze the characteristic of the 3rd and 10th defocus aberration surface distribution, design 3-element actuators unimorph DM model study on its structure and deformation principle theoretically, design finite element models of different electrode configuration with different ring diameters, analyze and compare effects of different electrode configuration and different fixing mode to DM deformation capacity through COMSOL finite element software, compare fitting efficiency of DM models to the 3rd and 10th Zernike modes. We choose the inhomogeneous electrode distribution model with better result, get the influence function of every electrode and the voltage-PV relationship of the model. This unimorph DM is suitable for the AO system with a mainly defocus aberration.

The early functional outcome of Mau osteotomy for the correction of moderate-severe hallux valgus

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Tanujan Thangarajah

2013-11-01

Full Text Available Hallux valgus is one of the commonest conditions of the foot and has been reported to affect nearly half of the adult population. It is most effectively treated by a corrective osteotomy of which there a numerous subtypes. The Mau osteotomy confers the greatest structural stability but is not thought to provide adequate correction of moderate-severe deformities. Accordingly, complications such as under correction and non-union are common. The aim of this study was to determine the functional outcome in patients with moderate-severe hallux valgus following a Mau osteotomy. A retrospective review of 23 patients with moderate-severe hallux valgus treated by Mau osteotomy was conducted. Patients were assessed clinically by the American Orthopedic Foot and Ankle Society (AOFAS scoring system and radiologically by measuring the first intermetatarsal (IM and hallux abductovalgus angles (HAV. The mean AOFAS score had improved from 47 preoperatively to 92 postoperatively (P<0.01. Additionally, preoperative HAV and IM angles improved from 39° and 15° respectively to 15° and 9° respectively (P<0.01. There were no cases of undercorrection or non-union. In this series, the Mau osteotomy was able to achieve good correction of the IM and HAV angles in patients with moderate-severe hallux valgus. This was reflected in a significantly higher postoperative AOFAS score. Contrary to other studies there were no cases of undercorrection and despite allowing patients to fully weight-bear postoperatively there were no cases of non-union.

Influence of mechanical cell salvage on red blood cell aggregation, deformability, and 2,3-diphosphoglycerate in patients undergoing cardiac surgery with cardiopulmonary bypass.

Science.gov (United States)

Gu, Y John; Vermeijden, Wytze J; de Vries, Adrianus J; Hagenaars, J Ans M; Graaff, Reindert; van Oeveren, Willem

2008-11-01

Mechanical cell salvage is increasingly used during cardiac surgery. Although this procedure is considered safe, it is unknown whether it affects the red blood cell (RBC) function, especially the RBC aggregation, deformability, and the contents of 2,3-diphosphoglycerate (2,3-DPG). This study examines the following: (1) whether the cell salvage procedure influences RBC function; and (2) whether retransfusion of the salvaged blood affects RBC function in patients. Forty patients undergoing cardiac surgery with cardiopulmonary bypass were randomly allocated to a cell saver group (n = 20) or a control group (n = 20). In the cell saver group, the blood aspirated from the wound area and the residual blood from the heart-lung machine were processed with a continuous-flow cell saver before retransfusion. In the control group this blood was retransfused without processing. The RBC aggregation and deformability were measured with a laser-assisted optical rotational cell analyzer and 2,3,-DPG by conventional laboratory test. The cell saver procedure did not influence the RBC aggregation but significantly reduced the RBC deformability (p = 0.007) and the content of RBC 2,3-DPG (p = 0.032). However, in patients receiving the processed blood, their intraoperative and postoperative RBC aggregation, deformability, and 2,3-DPG content did not differ from those of the control patients. Both groups of patients had a postoperative drop of RBC function as a result of hemodilution. The mechanical cell salvage procedure reduces the RBC deformability and the cell 2,3-DPG content. Retransfusion of the processed blood by cell saver does not further compromise the RBC function in patients undergoing cardiac surgery with cardiopulmonary bypass.

Calculating the mounting parameters for Taylor Spatial Frame correction using computed tomography.

Science.gov (United States)

Kucukkaya, Metin; Karakoyun, Ozgur; Armagan, Raffi; Kuzgun, Unal

2011-07-01

The Taylor Spatial Frame uses a computer program-based six-axis deformity analysis. However, there is often a residual deformity after the initial correction, especially in deformities with a rotational component. This problem can be resolved by recalculating the parameters and inputting all new deformity and mounting parameters. However, this may necessitate repeated x-rays and delay treatment. We believe that error in the mounting parameters is the main reason for most residual deformities. To prevent these problems, we describe a new calculation technique for determining the mounting parameters that uses computed tomography. This technique is especially advantageous for deformities with a rotational component. Using this technique, exact calculation of the mounting parameters is possible and the residual deformity and number of repeated x-rays can be minimized. This new technique is an alternative method to accurately calculating the mounting parameters.

A Survey On Physical Methods For Deformation Modeling

Directory of Open Access Journals (Sweden)

Huda Basloom

2015-08-01

Full Text Available Much effort has been dedicated to achieving realism in the simulation of deformable objects such as cloth hair rubber sea water smoke and human soft tissue in surgical simulation. However the deformable object in these simulations will exhibit physically correct behaviors true to the behavior of real objects when any force is applied to it and sometimes this requires real-time simulation. No matter how complex the geometry is real-time simulation is still required in some applications. Surgery simulation is an example of the need for real-time simulation. This situation has attracted the attention of a wide community of researchers such as computer scientists mechanical engineers biomechanics and computational geometers. This paper presents a review of the existing techniques for modeling deformable objects which have been developed within the last three decades for different computer graphics interactive applications.

On higher-order corrections in M theory

International Nuclear Information System (INIS)

Howe, P.S.; Tsimpis, D.

2003-01-01

A theoretical analysis of higher-order corrections to D=11 supergravity is given in a superspace framework. It is shown that any deformation of D=11 supergravity for which the lowest-dimensional component of the four-form G 4 vanishes is trivial. This implies that the equations of motion of D=11 supergravity are specified by an element of a certain spinorial cohomology group and generalises previous results obtained using spinorial or pure spinor cohomology to the fully non-linear theory. The first deformation of the theory is given by an element of a different spinorial cohomology group with coefficients which are local tensorial functions of the massless supergravity fields. The four-form Bianchi Identities are solved, to first order and at dimension -{1/2}, in the case that the lowest-dimensional component of G 4 is non-zero. Moreover, it is shown how one can calculate the first-order correction to the dimension-zero torsion and thus to the supergravity equations of motion given an explicit expression for this object in terms of the supergravity fields. The version of the theory with both a four-form and a seven-form is discussed in the presence of the five-brane anomaly-cancelling term. It is shown that the supersymmetric completion of this term exists and it is argued that it is the unique anomaly-cancelling invariant at this dimension which is at least quartic in the fields. This implies that the first deformation of the theory is completely determined by the anomaly term from which one can, in principle, read off the corrections to all of the superspace field strength tensors. (author)

A novel method to correct for pitch and yaw patient setup errors in helical tomotherapy

International Nuclear Information System (INIS)

Boswell, Sarah A.; Jeraj, Robert; Ruchala, Kenneth J.; Olivera, Gustavo H.; Jaradat, Hazim A.; James, Joshua A.; Gutierrez, Alonso; Pearson, Dave; Frank, Gary; Mackie, T. Rock

2005-01-01

An accurate means of determining and correcting for daily patient setup errors is important to the cancer outcome in radiotherapy. While many tools have been developed to detect setup errors, difficulty may arise in accurately adjusting the patient to account for the rotational error components. A novel, automated method to correct for rotational patient setup errors in helical tomotherapy is proposed for a treatment couch that is restricted to motion along translational axes. In tomotherapy, only a narrow superior/inferior section of the target receives a dose at any instant, thus rotations in the sagittal and coronal planes may be approximately corrected for by very slow continuous couch motion in a direction perpendicular to the scanning direction. Results from proof-of-principle tests indicate that the method improves the accuracy of treatment delivery, especially for long and narrow targets. Rotational corrections about an axis perpendicular to the transverse plane continue to be implemented easily in tomotherapy by adjustment of the initial gantry angle

Orthopaedic Disorders in Myotonic Dystrophy Type 1: descriptive clinical study of 21 patients

Science.gov (United States)

2013-01-01

Background Myotonic Dystrophy Type 1 (DM1) is the most common form of hereditary myopathy presenting in adults. This autosomal-dominant systemic disorder is caused by a CTG repeat, demonstrating various symptoms. A mild, classic and congenital form can be distinguished. Often the quality of life is reduced by orthopaedic problems, such as muscle weakness, contractures, foot or spinal deformities, which limit patients’ mobility. The aim of our study was to gather information about the orthopaedic impairments in patients with DM1 in order to improve the medical care of patients, affected by this rare disease. Methods A retrospective clinical study was carried out including 21 patients (11 male and 10 female), all diagnosed with DM1 by genetic testing. All patients were seen during our special consultations for neuromuscular diseases, during which patients were interviewed and examined. We also reviewed surgery reports of our hospitalized patients. Results We observed several orthopaedic impairments: spinal deformities (scoliosis, hyperkyphosis, rigid spine), contractures (of the upper extremities and the lower extremities), foot deformities (equinus deformity, club foot, pes cavus, pes planovalgus, pes cavovarus, claw toes) and fractures. Five patients were affected by pulmonary diseases (obstructive airway diseases, restrictive lung dysfunctions). Twelve patients were affected by cardiac disorders (congenital heart defects, valvular heart defects, conduction disturbances, pulmonary hypertension, cardiomyopathy). Our patients received conservative therapy (physiotherapy, logopaedic therapy, ergotherapy) and we prescribed orthopaedic technical devices (orthopaedic custom-made shoes, insoles, lower and upper leg orthoses, wheelchair, Rehab Buggy). We performed surgery for spinal and foot deformities: the scoliosis of one patient was stabilized and seven patients underwent surgery for correction of foot deformities. Conclusions An orthopaedic involvement in DM1

Ligament augmentation for prevention of proximal junctional kyphosis and proximal junctional failure in adult spinal deformity.

Science.gov (United States)

Safaee, Michael M; Deviren, Vedat; Dalle Ore, Cecilia; Scheer, Justin K; Lau, Darryl; Osorio, Joseph A; Nicholls, Fred; Ames, Christopher P

2018-05-01

OBJECTIVE Proximal junctional kyphosis (PJK) is a well-recognized, yet incompletely defined, complication of adult spinal deformity surgery. There is no standardized definition for PJK, but most studies describe PJK as an increase in the proximal junctional angle (PJA) of greater than 10°-20°. Ligament augmentation is a novel strategy for PJK reduction that provides strength to the upper instrumented vertebra (UIV) and adjacent segments while also reducing junctional stress at those levels. METHODS In this study, ligament augmentation was used in a consecutive series of adult spinal deformity patients at a single institution. Patient demographics, including age; sex; indication for surgery; revision surgery; surgical approach; and use of 3-column osteotomies, vertebroplasty, or hook fixation at the UIV, were collected. The PJA was measured preoperatively and at last follow-up using 36-inch radiographs. Data on change in PJA and need for revision surgery were collected. Univariate and multivariate analyses were performed to identify factors associated with change in PJA and proximal junctional failure (PJF), defined as PJK requiring surgical correction. RESULTS A total of 200 consecutive patients were included: 100 patients before implementation of ligament augmentation and 100 patients after implementation of this technique. The mean age of the ligament augmentation cohort was 66 years, and 67% of patients were women. Over half of these cases (51%) were revision surgeries, with 38% involving a combined anterior or lateral and posterior approach. The mean change in PJA was 6° in the ligament augmentation group compared with 14° in the control group (p historical cohort, ligament augmentation is associated with a significant decrease in PJK and PJF. These data support the implementation of ligament augmentation in surgery for adult spinal deformity, particularly in patients with a high risk of developing PJK and PJF.

Planning corrective osteotomy of the femoral bone using three-dimensional modeling. Part II

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Vladimir E. Baskov

2017-10-01

Full Text Available Introduction. Three-dimensional (3D modeling and prototyping are increasingly being used in various branches of surgery for planning and performing surgical interventions. In orthopedics, this technology was first used in 1990 for performing knee-joint surgery. This was followed by the development of protocols for creating and applying individual patterns for navigation in the surgical interventions for various bones. Aim. The study aimed to develop a new 3D method for planning and performing corrective osteotomy of the femoral bone using an individual pattern and to identify the advantages of the proposed method in comparison with the standard method of planning and performing surgical intervention. Materials and methods. A new method for planning and performing corrective osteotomy of the femoral bone in children with various pathologies of the hip joint is presented. The outcomes of planning and performing corrective osteotomy of the femoral bone in 27 patients aged 5 to 18 years (32 hip joints with congenital and acquired deformity of the femoral bone were analyzed. Conclusion. The use of computer 3D modeling for planning and implementing corrective interventions on the femoral bone improves the treatment results owing to an almost perfect performance accuracy achieved by the minimization of possible human errors reduction in the surgery duration; and reduction in the radiation exposure for the patient.

Patient-specific non-linear finite element modelling for predicting soft organ deformation in real-time: application to non-rigid neuroimage registration.

Science.gov (United States)

Wittek, Adam; Joldes, Grand; Couton, Mathieu; Warfield, Simon K; Miller, Karol

2010-12-01

Long computation times of non-linear (i.e. accounting for geometric and material non-linearity) biomechanical models have been regarded as one of the key factors preventing application of such models in predicting organ deformation for image-guided surgery. This contribution presents real-time patient-specific computation of the deformation field within the brain for six cases of brain shift induced by craniotomy (i.e. surgical opening of the skull) using specialised non-linear finite element procedures implemented on a graphics processing unit (GPU). In contrast to commercial finite element codes that rely on an updated Lagrangian formulation and implicit integration in time domain for steady state solutions, our procedures utilise the total Lagrangian formulation with explicit time stepping and dynamic relaxation. We used patient-specific finite element meshes consisting of hexahedral and non-locking tetrahedral elements, together with realistic material properties for the brain tissue and appropriate contact conditions at the boundaries. The loading was defined by prescribing deformations on the brain surface under the craniotomy. Application of the computed deformation fields to register (i.e. align) the preoperative and intraoperative images indicated that the models very accurately predict the intraoperative deformations within the brain. For each case, computing the brain deformation field took less than 4 s using an NVIDIA Tesla C870 GPU, which is two orders of magnitude reduction in computation time in comparison to our previous study in which the brain deformation was predicted using a commercial finite element solver executed on a personal computer. Copyright © 2010 Elsevier Ltd. All rights reserved.

Formation of diapiric structure in the deformation zone, central ...

Indian Academy of Sciences (India)

R. Narasimhan (Krishtel eMaging) 1461 1996 Oct 15 13:05:22

serpentinite layer existing near the base of the crust that is interpreted to have been formed at mid-ocean ... Keywords. Diffusive plate boundary; deformation zone; diapiric structure; serpentinized peridotites; crustal structure; ... calculated by applying Eotvos correction and nor- ..... trend of the basement and flat Moho, and.

Exploring of PST-TBPM in Monitoring Dynamic Deformation of Steel Structure in Vibration

Science.gov (United States)

Chen, Mingzhi; Zhao, Yongqian; Hai, Hua; Yu, Chengxin; Zhang, Guojian

2018-01-01

In order to monitor the dynamic deformation of steel structure in the real-time, digital photography is used in this paper. Firstly, the grid method is used correct the distortion of digital camera. Then the digital cameras are used to capture the initial and experimental images of steel structure to obtain its relative deformation. PST-TBPM (photographing scale transformation-time baseline parallax method) is used to eliminate the parallax error and convert the pixel change value of deformation points into the actual displacement value. In order to visualize the deformation trend of steel structure, the deformation curves are drawn based on the deformation value of deformation points. Results show that the average absolute accuracy and relative accuracy of PST-TBPM are 0.28mm and 1.1‰, respectively. Digital photography used in this study can meet accuracy requirements of steel structure deformation monitoring. It also can warn the safety of steel structure and provide data support for managers’ safety decisions based on the deformation curves on site.

Separating volcanic deformation and atmospheric signals at Mount St. Helens using Persistent Scatterer InSAR

Science.gov (United States)

Welch, Mark D.; Schmidt, David A.

2017-09-01

Over the past two decades, GPS and leveling surveys have recorded cycles of inflation and deflation associated with dome building eruptions at Mount St. Helens. Due to spatial and temporal limitations of the data, it remains unknown whether any deformation occurred prior to the most recent eruption of 2004, information which could help anticipate future eruptions. Interferometric Synthetic Aperture Radar (InSAR), which boasts fine spatial resolution over large areas, has the potential to resolve pre-eruptive deformation that may have occurred, but eluded detection by campaign GPS surveys because it was localized to the edifice or crater. Traditional InSAR methods are challenging to apply in the Cascades volcanic arc because of a combination of environmental factors, and past attempts to observe deformation at Mount St. Helens were unable to make reliable observations in the crater or on much of the edifice. In this study, Persistent Scatterer InSAR, known to mitigate issues of decorrelation caused by environmental factors, is applied to four SAR data sets in an attempt to resolve localized sources of deformation on the volcano between 1995 and 2010. Many interferograms are strongly influenced by phase delay from atmospheric water vapor and require correction, evidenced by a correlation between phase and topography. To assess the bias imposed by the atmosphere, we perform sensitivity tests on a suite of atmospheric correction techniques, including several that rely on the correlation of phase delay to elevation, and explore approaches that directly estimate phase delay using the ERA-Interim and NARR climate reanalysis data sets. We find that different correction methods produce velocities on the edifice of Mount St. Helens that differ by up to 1 cm/yr due to variability in how atmospheric artifacts are treated in individual interferograms. Additionally, simple phase-based techniques run the risk of minimizing any surface deformation signals that may themselves be

Teriparatide versus low-dose bisphosphonates before and after surgery for adult spinal deformity in female Japanese patients with osteoporosis.

Science.gov (United States)

Seki, Shoji; Hirano, Norikazu; Kawaguchi, Yoshiharu; Nakano, Masato; Yasuda, Taketoshi; Suzuki, Kayo; Watanabe, Kenta; Makino, Hiroto; Kanamori, Masahiko; Kimura, Tomoatsu

2017-08-01

Complications of adult spinal deformity surgery are problematic in osteoporotic individuals. We compared outcomes between Japanese patients treated perioperatively with teriparatide vs. low-dose bisphosphonates. Fifty-eight osteoporotic adult Japanese female patients were enrolled and assigned to perioperative teriparatide (33 patients) and bisphosphonate (25 patients) groups in non-blinded fashion. Pre- and post-operative X-ray and computed tomography imaging were used to assess outcome, and rates were compared between the groups and according to age. Pain scores and Oswestry Disability Indices (ODI) were calculated before and 2 years after surgery. Adjacent vertebral fractures and implant failure, fusion failure, and poor pain and ODI outcomes were significantly more common in the bisphosphonates group than the teriparatide group. Perioperative administration of teriparatide is more effective than that of low-dose bisphosphonates in preventing complications and maintaining fusion rates in osteoporotic Japanese females with spinal deformities undergoing surgery.

Effectiveness of couch height-based patient set-up and an off-line correction protocol in prostate cancer radiotherapy

International Nuclear Information System (INIS)

Lin, Emile N.J.Th. van; Nijenhuis, Edwin; Huizenga, Henk; Vight, Lisette van der; Visser, Andries

2001-01-01

Purpose: To investigate set-up improvement caused by applying a couch height-based patient set-up method in combination with a technologist-driven off-line correction protocol in nonimmobilized radiotherapy of prostate patients. Methods and Materials: A three-dimensional shrinking action level correction protocol is applied in two consecutive patient cohorts with different set-up methods: the traditional 'laser set-up' group (n=43) and the 'couch height set-up' group (n=112). For all directions, left-right, ventro-dorsal, and cranio-caudal, random and systematic set-up deviations were measured. Results: The couch height set-up method improves the patient positioning compared to the laser set-up method. Without application of the correction protocol, both systematic and random errors reduced to 2.2-2.4 mm (1 SD) and 1.7-2.2 mm (1 SD), respectively. By using the correction protocol, systematic errors reduced further to 1.3-1.6 mm (1 SD). One-dimensional deviations were within 5 mm for >90% of the measured fractions. The required number of corrections per patient in the off-line correction protocol was reduced significantly during the course of treatment from 1.1 to 0.6 by the couch height set-up method. The treatment time was not prolonged by application of the correction protocol. Conclusions: The couch height set-up method improves the set-up significantly, especially in the ventro-dorsal direction. Combination of this set-up method with an off-line correction strategy, executed by technologists, reduces the number of set-up corrections required

Evaluation of whole-body MR to CT deformable image registration.

Science.gov (United States)

Akbarzadeh, A; Gutierrez, D; Baskin, A; Ay, M R; Ahmadian, A; Riahi Alam, N; Lövblad, K O; Zaidi, H

2013-07-08

Multimodality image registration plays a crucial role in various clinical and research applications. The aim of this study is to present an optimized MR to CT whole-body deformable image registration algorithm and its validation using clinical studies. A 3D intermodality registration technique based on B-spline transformation was performed using optimized parameters of the elastix package based on the Insight Toolkit (ITK) framework. Twenty-eight (17 male and 11 female) clinical studies were used in this work. The registration was evaluated using anatomical landmarks and segmented organs. In addition to 16 anatomical landmarks, three key organs (brain, lungs, and kidneys) and the entire body volume were segmented for evaluation. Several parameters--such as the Euclidean distance between anatomical landmarks, target overlap, Dice and Jaccard coefficients, false positives and false negatives, volume similarity, distance error, and Hausdorff distance--were calculated to quantify the quality of the registration algorithm. Dice coefficients for the majority of patients (> 75%) were in the 0.8-1 range for the whole body, brain, and lungs, which satisfies the criteria to achieve excellent alignment. On the other hand, for kidneys, Dice coefficients for volumes of 25% of the patients meet excellent volume agreement requirement, while the majority of patients satisfy good agreement criteria (> 0.6). For all patients, the distance error was in 0-10 mm range for all segmented organs. In summary, we optimized and evaluated the accuracy of an MR to CT deformable registration algorithm. The registered images constitute a useful 3D whole-body MR-CT atlas suitable for the development and evaluation of novel MR-guided attenuation correction procedures on hybrid PET-MR systems.

Spinal deformities rehabilitation - state of the art review

Directory of Open Access Journals (Sweden)

Weiss Hans-Rudolf

2010-12-01

Full Text Available Abstract Background Medical rehabilitation aims at an improvement in function, capacity and participation. For the rehabilitation of spinal deformities, the goal is to maintain function and prevent secondary symptoms in the short- and long-term. In patients with scoliosis, predictable signs and symptoms include pain and reduced pulmonary function. Materials and methods A Pub Med review was completed in order to reveal substantial evidence for inpatient rehabilitation as performed in Germany. No evidence has been found in general to support claims for actual inpatient rehabilitation programmes as used today. Nevertheless, as there is some evidence that inpatient rehabilitation may be beneficial to patients with spinal deformities complicated by certain additional conditions, the body of evidence there is for conservative treatment of spinal deformities has been reviewed in order to allow suggestions for outpatient conservative treatment and inpatient rehabilitation. Discussion Today, for both children and adolescents, we are able to offer intensive rehabilitation programmes lasting three to five days, which enable the patients to acquire the skills necessary to prevent postures fostering scoliosis in everyday life without missing too much of school teaching subjects at home. The secondary functional impairments adult scoliosis patients might have, as in the opinion of the author, still today require the time of 3-4 weeks in the clinical in-patient setting. Time to address psychosocial as well as somatic limitations, namely chronic pains and cardiorespiratory malfunction is needed to preserve the patients working capability in the long-term. Conclusion Outpatient treatment/rehabilitation is sufficient for adolescents with spinal deformities. Inpatient rehabilitation is recommended for patients with spinal deformities and pain or severe restrictive ventilation disorder.

Correction of facial and mandibular asymmetry using a computer aided design/computer aided manufacturing prefabricated titanium implant.

Science.gov (United States)

Watson, Jason; Hatamleh, Muhanad; Alwahadni, Ahed; Srinivasan, Dilip

2014-05-01

Patients with significant craniofacial asymmetry may have functional problems associated with their occlusion and aesthetic concerns related to the imbalance in soft and hard tissue profiles. This report details a case of facial asymmetry secondary to left mandible angle deficiency due to undergoing previous radiotherapy. We describe the correction of the bony deformity using computer aided design/computer aided manufacturing custom-made titanium onlay using novel direct metal laser sintering. The direct metal laser sintering onlay proved a very accurate operative fit and showed a good aesthetic correction of the bony defect with no reported complications postoperatively. It is a useful low-morbidity technique, and there is no resorption or associated donor-site complications.

Extremely discrepant mutation spectrum of SLC26A4 between Chinese patients with isolated Mondini deformity and enlarged vestibular aqueduct.

Science.gov (United States)

Huang, Shasha; Han, Dongyi; Yuan, Yongyi; Wang, Guojian; Kang, Dongyang; Zhang, Xin; Yan, Xiaofei; Meng, Xiaoxiao; Dong, Min; Dai, Pu

2011-09-30

Mutations in SLC26A4 cause Pendred syndrome (hearing loss with goiter) or DFNB4 (non-syndromic hearing loss with inner ear malformation, such as enlarged vestibular aqueduct or Mondini deformity). The relationship between mutations in SLC26A4 and Mondini deformity without enlarged vestibular aqueduct has not been studied in any Chinese deaf population. The purpose of this study was to assess whether mutations in the SLC26A4 gene cause Mondini deformity without an enlarged vestibular aqueduct (isolated Mondini deformity) in a Chinese population. In total, 144 patients with sensorineural hearing loss were included and subjected to high-resolution temporal bone CT. Among them, 28 patients with isolated Mondini dysplasia (MD group), 50 patients with enlarged vestibular aqueduct with Mondini dysplasia (EVA with MD group), 50 patients with enlarged vestibular aqueduct without Mondini dysplasia (EVA group), and 16 patients with other types of inner ear malformations (IEM group) were identified. The coding exons of SLC26A4 were analyzed in all subjects. DNA sequence analysis of SLC26A4 was performed in all 144 patients. In the different groups, the detection rate of the SLC26A4 mutation differed. In the isolated MD group, only one single allelic mutation in SLC26A4 was found in one patient (1/28, 3.6%). In the EVA with MD group, biallelic and monoallelic SLC26A4 mutations were identified in 46 patients (46/50, 92.0%) and three patients (3/50, 6.0%), respectively. Also, in the EVA group, biallelic and monoallelic SLC26A4 mutations were identified in 46 patients (46/50, 92.0%) and three patients (3/50, 6.0%), respectively. These percentages were identical to those in the EVA plus MD group. Only two patients carried monoallelic mutations of the SLC26A4 gene in the IEM group (2/16, 12.5%). There were significant differences in the frequency of SLC26A4 mutation among the groups (P0.5). Although mutations in the SLC26A4 gene were frequently found in Chinese EVA patients with and

Three-dimensional translations following posterior three-column spinal osteotomies for the correction of severe and stiff kyphoscoliosis.

Science.gov (United States)

Li, Xueshi; Huang, Zifang; Deng, Yaolong; Fan, Hengwei; Sui, Wenyuan; Wang, Chongwen; Yang, Junlin

2017-12-01

Posterior three-column spinal osteotomies were shown to be effective to treat severe and stiff kyphoscoliosis. Translations at the site of osteotomy after deformity correction were commonly seen intraoperatively, which might cause potential neurologic deficits. However, this phenomenon was not thoroughly discussed in the current literature. This study aimed to evaluate the three-dimensional (3D) translations at the three-column osteotomy site and their effects on neurologic outcome in the surgical correction of severe and stiff kyphoscoliosis. A retrospective study was carried out. Sixty-nine patients treated by posterior three-column spinal osteotomy for severe kyphoscoliosis of idiopathic, congenital, neuromuscular, neurofibromatosis, and tuberculosis origin were included. General, coronal, and sagittal translations were graded three-dimensionally according to the theory of Meyerding. The charts of 69 clinical patients with severe and stiff kyphoscoliosis treated by posterior three-column osteotomy from January 2013 to June 2015 were reviewed. There were 35 male patients with an average age of 21.5 years and 34 female patients with an average age of 22.5 years. The etiologies of these spinal deformities were idiopathic, congenital, neuromuscular, neurofibromatosis, and tuberculosis. According to our classification system of spinal cord neurologic function, there were 41 type A, 13 type B, and 15 type C cases. The 3D spine models were reconstructed from thin-sliced computed tomography (CT) scan, and the 3D translations at the three-column osteotomy site were graded and analyzed. The incidences of general translation (GT), frontal translation (FT), and sagittal translation (ST) were 62.3%, 52.2%, and 26.1%. The incidence of evoked potential (EP) change in cases with GT/FT being or more than grade II (GT, 42.9%; FT, 50.0%) was significantly higher than that with GT/FT being less than grade II (GT, 16.7%; FT, 18.2%), whereas the incidence of EP change in cases with

Results of total knee replacement with a cruciate-retaining model for severe valgus deformity--a study of 48 patients followed for an average of 9 years.

Science.gov (United States)

Koskinen, Esa; Remes, Ville; Paavolainen, Pekka; Harilainen, Arsi; Sandelin, Jerker; Tallroth, Kaj; Kettunen, Jyrki; Ylinen, Pekka

2011-06-01

The objectives of the present study were to find out the results and the factors affecting survival after primary knee arthroplasty with a cruciate-retaining prosthesis in severe valgus deformity. Forty-eight patients (52 knees) participated in the current follow-up study. All patients were followed at least 5 years or to first revision. Mean follow-up time was 9 years (range, 1 to 17 years).The Kaplan-Meier analysis revealed 79% (95% CI 68% to 91%) survival rate with revision for any reason and 81% (95% CI 70% to 93%) survival rate with revision for instability as an endpoint at 10 years. Preoperatively TFA was 23° (range, 15°-51°) in valgus and 7° (range, 21° valgus-4° varus) in valgus postoperatively. Of the 14 re-operated patients, eight were revised because of progressive postoperative medial collateral ligament instability. All re-operations were performed during the first 4 years of the follow-up. The mean TFA was 15.5° valgus postoperatively for those eight and the odds ratio for a revision was 2 (95% CI 1-3, p = 0.025) when compared to the rest of the study population. The residual valgus deformity increases the risk of re-operation and it should be avoided. If proper soft-tissue balance cannot be achieved or there is no functional medial collateral ligament present more constrained implants should be used. In selected cases where both bony correction and ligament balancing have properly been achieved the use of a cruciate-retaining type of prosthesis is justified. Copyright © 2010 Elsevier B.V. All rights reserved.

Patients with migraine correctly estimate the visual verticality.

Science.gov (United States)

Crevits, Luc; Vanacker, Leen; Verraes, Anouk

2012-05-01

We wanted to study otolith function by measuring the static subjective visual vertical (SVV) in migraine patients and in controls with and without kinetosis (motion sickness). Forty-seven patients with moderately severe migraine and 96 healthy controls were enrolled. Using a questionnaire, persons with kinetosis were identified. The SVV test was performed in a totally dark room. Subjects wore a stiffneck to stabilize the head in an erect position. They were required to adjust an infrared line to the gravitational vertical with a hand-held infrared remote controlled potentiometer. The deviation of SVV in the group of migraine patients was not significantly different from that of controls, regardless of whether an aura was associated. SVV was not significantly influenced by the presence of dizziness/non specific vertigo or kinetosis. Patients with moderately severe migraine under prophylactic medication correctly estimate the visual verticality in the headache-free period. It is suggested that a deviation of SVV in a headache-free migraine patient may not be attributed to his migraine disorder as such regardless whether kinetosis is associated. Copyright © 2011 Elsevier B.V. All rights reserved.

Comparison of Srs-24 And Srs-22 Scores in Thirty Eight Adolescent Idiopathic Scoliosis Patients Who Had Undergone Surgical Correction

OpenAIRE

CYW Chan; LB Saw; MK Kwan

2009-01-01

Adolescent idiopathic scoliosis is a spinal deformity that affects patients’ self image and confidence. Surgery is offered when the curvature is greater than 50 degrees based on the likelihood of curvature progression. Outcome measures for scoliosis correction can be described in terms of radiological improvement or improvement of health related quality of life scores. The Scoliosis Research Society 22 (SRS-22) and Scoliosis Research Society 24 (SRS-24) questionnaires are widely accepted and ...

Wind sock deformity in rectal atresia

International Nuclear Information System (INIS)

Hosseini, Seyed M V; Ghahramani, Farhad; Shamsaeefar, Alireza; Razmi, Tannaz; Zarenezhad, Mohammad

2009-01-01

Rectal atresia is a rare anorectal deformity. It usually presents with neonatal obstruction and it is often a complete membrane or severe stenosis. Windsock deformity has not been reported in rectal atresia especially, having been missed for 2 years. A 2-year-old girl reported only a severe constipation despite having a 1.5-cm anal canal in rectal examination with scanty discharge. She underwent loop colostomy and loopogram, which showed a wind sock deformity of rectum with mega colon. The patient underwent abdominoperineal pull-through with good result and follow-up. This is the first case of the wind sock deformity in rectal atresia being reported after 2 years of age. (author)

Deformation mechanism of the Cryostat in the CADS Injector II

Science.gov (United States)

Yuan, Jiandong; Zhang, Bin; Wan, Yuqin; Sun, Guozhen; Bai, Feng; Zhang, Juihui; He, Yuan

2018-01-01

Thermal contraction and expansion of the Cryostat will affect its reliability and stability. To optimize and upgrade the Cryostat, we analyzed the heat transfer in a cryo-vacuum environment from the theoretical point first. The simulation of cryo-vacuum deformation based on a finite element method was implemented respectively. The completed measurement based on a Laser Tracker and a Micro Alignment Telescope was conducted to verify its correctness. The monitored deformations were consistent with the simulated ones. After the predictable deformations in vertical direction have been compensated, the superconducting solenoids and Half Wave Resonator cavities approached the ideal "zero" position under liquid helium conditions. These guaranteed the success of 25 MeV@170 uA continuous wave protons of Chinese accelerator driven subcritical system Injector II. By correlating the vacuum and cryo-deformation, we have demonstrated that the complete deformation was the superposition effect of the atmospheric pressure, gravity and thermal stress during both the process of cooling down and warming up. The results will benefit to an optimization for future Cryostat's design.