WorldWideScience

Sample records for rapid cooling contracture

  1. An unusual case of rapidly progressive contractures: Case report and brief review

    Directory of Open Access Journals (Sweden)

    Subasree R

    2008-01-01

    Full Text Available An 8-year-old boy, diagnosed as cervical dystonia, was referred to our tertiary center. After a trivial trauma he had developed painful lumps in the axial region, which was followed by restricted movements of neck, shoulder, and abdominal muscles over 4 months. He had kyphoscoliosis, torticollis, rigid abdomen, and multiple muscle contractures. He also had short great toes. A detailed skeletal survey showed calcification in the soft tissues surrounding the shoulder anterior chest wall, thorax, and paraspinal muscles; there was also beaking of vertebrae, which was confirmed by CT thorax. This report showcases the diagnostic challenge posed by myositis ossificans progressiva, which can rarely cause rapidly progressing muscle contractures. A brief review of literature is also presented.

  2. Contracture deformity

    Science.gov (United States)

    Deformity - contracture ... Contracture can be caused by any of the following: Brain and nervous system disorders, such as cerebral ... Follow your health care provider's instructions for treating contracture at home. Treatments may include: Doing exercises and ...

  3. Volkmann ischemic contracture

    Science.gov (United States)

    Ischemic contracture - Volkmann; Compartment syndrome - Volkmann ischemic contracture ... Volkmann contracture occurs when there is a lack of blood flow (ischemia) to the forearm. This occurs when there ...

  4. Advances in rapid cooling treatment for heat stroke

    Directory of Open Access Journals (Sweden)

    Jia-jia ZHAO

    2014-10-01

    Full Text Available Heat stroke is a life-threatening disease characterized clinically by central nervous system dysfunction and severe hyperthermia (core temperature rises to higher than 40℃. The unchecked rise of body core temperature overwhelms intrinsic or extrinsic heat generation mechanism, thus overwhelms homoeostatic thermoregulation. Hyperthermia causes cellular and organ dysfunction with progressive exacerbation resulting in multi-organ failure and death. Rapid cooling to reduce core temperature as quickly as possible is the primary and most effective treatment, as it has been shown that the major determinant of outcome in heatstroke is the degree and duration of hyperthermia. If suppression of body temperature is delayed, the fatality rate will be elevated. Several cooling methods are available, including physical cooling by conduction, convection and evaporation with ice/cold water immersion, internal cooling by invasive methods such as hemofiltration, intravascular cooling, cold water gastric and rectal lavage, and cooling with drugs. It is crucial to formulate a scientific and reasonable strategy for the subsequent treatment in accordance with the patient's physical condition, the condition of cooling equipment, and the manipulator's proficiency in cooling methods and equipment usage. This article reviews the domestic and international advances in study of rapid and efficient cooling measures for heat stroke. DOI: 10.11855/j.issn.0577-7402.2014.10.17

  5. Dupuytren's contracture.

    Science.gov (United States)

    Benson, L S; Williams, C S; Kahle, M

    1998-01-01

    Dupuytren's contracture is a fibroproliferative disorder of autosomal dominant inheritance that most commonly affects men over age 60 who are of Scandinavian, Irish, or eastern European descent. Local microvessel ischemia in the hand and specific platelet-derived and fibroblast growth factors act at the cellular level to promote the dense myofibroblast population and altered collagen profiles seen in affected tissue. Surgical treatment depends to some degree on patient preference and a clear understanding of the possible complications and considerable postoperative therapy commitment. Operative management is appropriate when metacarpophalangeal or proximal interphalangeal joint contracture exceeds 30 degrees. A volar zigzag Brunner incision in the digit and palm provides reliable exposure and leads to predictable healing in most cases. The mainstay of postoperative hand therapy is early active-flexion range-of-motion exercises to restore grip strength. A nighttime extension splint is often used for several months postoperatively to maintain the correction achieved in the operating room. Early recurrence of disease is most common in individuals with Dupuytren's diathesis; use of full-thickness skin grafts may be helped for these patients.

  6. Contracture deformity (image)

    Science.gov (United States)

    A contracture is a fixed tightening of muscle, tendons, ligaments, or skin. It prevents normal movement of the associated ... injury such as a severe burn can cause contracture of the skin. The skin becomes scarred and ...

  7. Structural evolution in the crystallization of rapid cooling silver melt

    Science.gov (United States)

    Tian, Z. A.; Dong, K. J.; Yu, A. B.

    2015-03-01

    The structural evolution in a rapid cooling process of silver melt has been investigated at different scales by adopting several analysis methods. The results testify Ostwald's rule of stages and Frank conjecture upon icosahedron with many specific details. In particular, the cluster-scale analysis by a recent developed method called LSCA (the Largest Standard Cluster Analysis) clarified the complex structural evolution occurred in crystallization: different kinds of local clusters (such as ico-like (ico is the abbreviation of icosahedron), ico-bcc like (bcc, body-centred cubic), bcc, bcc-like structures) in turn have their maximal numbers as temperature decreases. And in a rather wide temperature range the icosahedral short-range order (ISRO) demonstrates a saturated stage (where the amount of ico-like structures keeps stable) that breeds metastable bcc clusters. As the precursor of crystallization, after reaching the maximal number bcc clusters finally decrease, resulting in the final solid being a mixture mainly composed of fcc/hcp (face-centred cubic and hexagonal-closed packed) clusters and to a less degree, bcc clusters. This detailed geometric picture for crystallization of liquid metal is believed to be useful to improve the fundamental understanding of liquid-solid phase transition.

  8. Structural evolution in the crystallization of rapid cooling silver melt

    Energy Technology Data Exchange (ETDEWEB)

    Tian, Z.A., E-mail: ze.tian@gmail.com [School of Physics and Electronics, Hunan University, Changsha 410082 (China); Laboratory for Simulation and Modelling of Particulate Systems School of Materials Science and Engineering, University of New South Wales, Sydney, NSW 2052 (Australia); Dong, K.J.; Yu, A.B. [Laboratory for Simulation and Modelling of Particulate Systems School of Materials Science and Engineering, University of New South Wales, Sydney, NSW 2052 (Australia)

    2015-03-15

    The structural evolution in a rapid cooling process of silver melt has been investigated at different scales by adopting several analysis methods. The results testify Ostwald’s rule of stages and Frank conjecture upon icosahedron with many specific details. In particular, the cluster-scale analysis by a recent developed method called LSCA (the Largest Standard Cluster Analysis) clarified the complex structural evolution occurred in crystallization: different kinds of local clusters (such as ico-like (ico is the abbreviation of icosahedron), ico-bcc like (bcc, body-centred cubic), bcc, bcc-like structures) in turn have their maximal numbers as temperature decreases. And in a rather wide temperature range the icosahedral short-range order (ISRO) demonstrates a saturated stage (where the amount of ico-like structures keeps stable) that breeds metastable bcc clusters. As the precursor of crystallization, after reaching the maximal number bcc clusters finally decrease, resulting in the final solid being a mixture mainly composed of fcc/hcp (face-centred cubic and hexagonal-closed packed) clusters and to a less degree, bcc clusters. This detailed geometric picture for crystallization of liquid metal is believed to be useful to improve the fundamental understanding of liquid–solid phase transition. - Highlights: • A comprehensive structural analysis is conducted focusing on crystallization. • The involved atoms in our analysis are more than 90% for all samples concerned. • A series of distinct intermediate states are found in crystallization of silver melt. • A novelty icosahedron-saturated state breeds the metastable bcc state.

  9. Apparatus and method for rapid cooling of large area substrates in vacuum

    Science.gov (United States)

    Barth, Kurt L.; Enzenroth, Robert A.; Sampath, Walajabad S.

    2010-09-28

    The present invention is directed to an apparatus and method for rapid cooling of a large substrate in a vacuum environment. A first cooled plate is brought into close proximity with one surface of a flat substrate. The spatial volume between the first cooling plate and the substrate is sealed and brought to a higher pressure than the surrounding vacuum level to increase the cooling efficiency. A second cooled plate is brought into close proximity with the opposite surface of the flat substrate. A second spatial volume between the second cooling plate and the substrate is sealed and the gas pressure is equalized to the gas pressure in the first spatial volume. The equalization of the gas pressure on both sides of the flat substrate eliminates deflection of the substrate and bending stress in the substrate.

  10. Superfluid phases of triplet pairing and rapid cooling of the neutron star in Cassiopeia A

    Directory of Open Access Journals (Sweden)

    Lev B. Leinson

    2015-02-01

    Full Text Available In a simple model it is demonstrated that the neutron star surface temperature evolution is sensitive to the phase state of the triplet superfluid condensate. A multicomponent triplet pairing of superfluid neutrons in the core of a neutron star with participation of several magnetic quantum numbers leads to neutrino energy losses exceeding the losses from the unicomponent pairing. A phase transition of the neutron condensate into the multicomponent state triggers more rapid cooling of superfluid core in neutron stars. This makes it possible to simulate an anomalously rapid cooling of neutron stars within the minimal cooling paradigm without employing any exotic scenarios suggested earlier for rapid cooling of isolated neutron star in Cassiopeia A.

  11. Controlled cooling versus rapid freezing of teratozoospermic semen samples: Impact on sperm chromatin integrity

    Directory of Open Access Journals (Sweden)

    Shivananda N Kalludi

    2011-01-01

    Full Text Available Aim: The present study evaluates the impact of controlled slow cooling and rapid freezing techniques on the sperm chromatin integrity in teratozoospermic and normozoospermic samples. Setting: The study was done in a university infertility clinic, which is a tertiary healthcare center serving the general population. Design: It was a prospective study designed in vitro. Materials and Methods: Semen samples from normozoospermic (N=16 and teratozoospermic (N=13 infertile men were cryopreserved using controlled cooling and rapid freezing techniques. The sperm chromatin integrity was analyzed in fresh and frozen-thawed samples. Statistical Analysis Used: Data were reported as mean and standard error (mean ± SEM of mean. The difference between two techniques was determined by a paired t-test. Results: The freeze-thaw induced chromatin denaturation was significantly (P<0.01 elevated in the post-thaw samples of normozoospermic and teratozoospermic groups. Compared to rapid freezing, there was no difference in the number of red sperms (with DNA damage by the controlled slow cooling method in both normozoospermic and teratozoospermic groups. Freeze-thaw induced sperm chromatin denaturation in teratozoospermic samples did not vary between controlled slow cooling and rapid freezing techniques. Conclusions: Since the controlled slow cooling technique involves the use of expensive instrument and is a time consuming protocol, rapid freezing can be a good alternative technique for teratozoospermic and normozoospermic samples when sperm DNA damage is a concern.

  12. Joint Contracture Orthosis (JCO)

    Science.gov (United States)

    Lunsford, Thomas R.; Parsons, Ken; Krouskop, Thomas; McGee, Kevin

    1997-01-01

    The purpose of this project was to develop an advanced orthosis which is effective in reducing upper and lower limb contractures in significantly less time than currently required with conventional methods. The team that developed the JCO consisted of an engineer, orthotist, therapist, and physician.

  13. Transient Response to Rapid Cooling of a Stainless Steel Sodium Heat Pipe

    Science.gov (United States)

    Mireles, Omar R.; Houts, Michael G.

    2011-01-01

    Compact fission power systems are under consideration for use in long duration space exploration missions. Power demands on the order of 500 W, to 5 kW, will be required for up to 15 years of continuous service. One such small reactor design consists of a fast spectrum reactor cooled with an array of in-core alkali metal heat pipes coupled to thermoelectric or Stirling power conversion systems. Heat pipes advantageous attributes include a simplistic design, lack of moving parts, and well understood behavior. Concerns over reactor transients induced by heat pipe instability as a function of extreme thermal transients require experimental investigations. One particular concern is rapid cooling of the heat pipe condenser that would propagate to cool the evaporator. Rapid cooling of the reactor core beyond acceptable design limits could possibly induce unintended reactor control issues. This paper discusses a series of experimental demonstrations where a heat pipe operating at near prototypic conditions experienced rapid cooling of the condenser. The condenser section of a stainless steel sodium heat pipe was enclosed within a heat exchanger. The heat pipe - heat exchanger assembly was housed within a vacuum chamber held at a pressure of 50 Torr of helium. The heat pipe was brought to steady state operating conditions using graphite resistance heaters then cooled by a high flow of gaseous nitrogen through the heat exchanger. Subsequent thermal transient behavior was characterized by performing an energy balance using temperature, pressure and flow rate data obtained throughout the tests. Results indicate the degree of temperature change that results from a rapid cooling scenario will not significantly influence thermal stability of an operating heat pipe, even under extreme condenser cooling conditions.

  14. The I-Xe System in Lodranites Suggests Impact-related Rapid Cooling

    Science.gov (United States)

    Crowther, S. A.; Whitby, J. A.; Busfield, A.; Holland, G.; Busemann, H.; Gilmour, J. D.

    2009-03-01

    The I-Xe system of three lodranites has been investigated. Two metal and one silicate separate from GRA 95209 gave ages consistent with each other (and the I-Xe age of Acapulco feldspar), suggesting the parent material underwent a period of rapid cooling.

  15. Effect of TEMPO-oxidization and rapid cooling on thermo-structural properties of nanocellulose.

    Science.gov (United States)

    Mhd Haniffa, Mhd Abd Cader; Ching, Yern Chee; Chuah, Cheng Hock; Yong Ching, Kuan; Nazri, Nik; Abdullah, Luqman Chuah; Nai-Shang, Liou

    2017-10-01

    Recently, surface functionality and thermal property of the green nanomaterials have received wide attention in numerous applications. In this study, microcrystalline cellulose (MCC) was used to prepare the nanocrystalline celluloses (NCCs) using acid hydrolysis method. The NCCs was treated with TEMPO [(2,2,6,6-tetramethylpiperidin-1-yl)oxy radical]-oxidation to prepare TEMPO-oxidized NCCs. Cellulose nanofibrils (CNFs) also prepared from MCC using TEMPO-oxidation. The effects of rapid cooling and chemical treatments on the thermo-structural property studies of the prepared nanocelluloses were investigated through FTIR, thermogravimetric analysis-derivative thermogravimetric (TGA-DTG), and XRD. A posteriori knowledge of the FTIR and TGA-DTG analysis revealed that the rapid cooling treatment enhanced the hydrogen bond energy and thermal stability of the TEMPO-oxidized NCC compared to other nanocelluloses. XRD analysis exhibits the effect of rapid cooling on pseudo 2I helical conformation. This was the first investigation performed on the effect of rapid cooling on structural properties of the nanocellulose. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Anaesthetic Management of Mentosternal Contractures Where ...

    African Journals Online (AJOL)

    Objective: Perioperative airway management in postburn mentosternal contractures often pose great challenges to the anaesthetist as well as the plastic ... deformities in postburn mentosternal contractures could present serious airway challenges to the attending anaesthetist during contracture release and skin cover.

  17. Influence of cooling rate on microstructure formation during rapid solidification of binary TiAl alloys

    Energy Technology Data Exchange (ETDEWEB)

    Kenel, C., E-mail: Christoph.Kenel@empa.ch; Leinenbach, C.

    2015-07-15

    Highlights: • Rapid solidification studies with varying cooling rates were realized for Ti–Al. • Experiments were combined with finite element simulations of heat transfer. • The resulting microstructure of Ti–Al alloys is strongly dependent on the Al content. • The microstructure and phase transformation behavior can be predicted. • The method allows alloy development for processes involving rapid solidification. - Abstract: Titanium aluminides as structural intermetallics are possible candidates for a potential weight reduction and increased performance of high temperature components. A method for the characterization of the microstructure formation in rapidly solidified alloys was developed and applied for binary Ti–(44–48)Al (at.%). The results show a strong dependency of the microstructure on the Al content at cooling rates between 6 ⋅ 10{sup 2} and 1.5 ⋅ 10{sup 4} K s{sup −1}. The formation of α → α{sub 2} ordering, lamellar α{sub 2} + γ colonies and interdendritic TiAl γ-phase were observed, depending on the Al amount. Based on thermodynamic calculations the observed microstructure can be explained using the CALPHAD approach taking into account the non-equilibrium conditions. The presented method provides a useful tool for alloy development for processing techniques involving rapid solidification with varying cooling rates.

  18. Rapid cooling of the neutron star in Cassiopeia A triggered by neutron superfluidity in dense matter.

    Science.gov (United States)

    Page, Dany; Prakash, Madappa; Lattimer, James M; Steiner, Andrew W

    2011-02-25

    We propose that the observed cooling of the neutron star in Cassiopeia A is due to enhanced neutrino emission from the recent onset of the breaking and formation of neutron Cooper pairs in the (3)P(2) channel. We find that the critical temperature for this superfluid transition is ≃0.5×10(9) K. The observed rapidity of the cooling implies that protons were already in a superconducting state with a larger critical temperature. This is the first direct evidence that superfluidity and superconductivity occur at supranuclear densities within neutron stars. Our prediction that this cooling will continue for several decades at the present rate can be tested by continuous monitoring of this neutron star. © 2011 American Physical Society

  19. Atomic and electronic structure transformations of silver nanoparticles under rapid cooling conditions.

    Science.gov (United States)

    Lobato, I; Rojas, J; Landauro, C V; Torres, J

    2009-02-04

    The structural evolution and dynamics of silver nanodrops Ag(2869) (4.4 nm in diameter) under rapid cooling conditions have been studied by means of molecular dynamics simulations and electronic density of state calculations. The interaction of silver atoms is modelled by a tight-binding semiempirical interatomic potential proposed by Cleri and Rosato. The pair correlation functions and the pair analysis technique are used to reveal the structural transition in the process of solidification. It is shown that Ag nanoparticles evolve into different nanostructures under different cooling processes. At a cooling rate of 1.5625 × 10(13) K s(-1) the nanoparticles preserve an amorphous-like structure containing a large amount of 1551 and 1541 pairs which correspond to icosahedral symmetry. For a lower cooling rate (1.5625 × 10(12) K s(-1)), the nanoparticles transform into a crystal-like structure consisting mainly of 1421 and 1422 pairs which correspond to the face centred cubic and hexagonal close packed structures, respectively. The variations of the electronic density of states for the differently cooled nanoparticles are small, but in correspondence with the structural changes.

  20. Atomic and electronic structure transformations of silver nanoparticles under rapid cooling conditions

    OpenAIRE

    Lobato, I.; Rojas, J.; Landauro, C.V.; Torres, J

    2008-01-01

    The structural evolution and dynamics of silver nanodrops Ag${}_{2896}$ (4.4 nm in diameter) during rapid cooling conditions has been studied by means of molecular dynamics simulations and electronic density of state calculations. The interaction of silver atoms is modeled by a tight-binding semiempirical interatomic potential proposed by Cleri and Rosato. The pair correlation functions and the pair analysis technique is applied to reveal the structural transition in the process of solidifica...

  1. Genetics Home Reference: Dupuytren contracture

    Science.gov (United States)

    ... disorders can appear in every generation of a family and can affect both males and females, but fathers do not pass traits associated with changes in mtDNA to their children. In some cases Dupuytren contracture is not inherited ...

  2. Properties of polycrystals and nanotwinned structures in silicon during rapid cooling process

    Science.gov (United States)

    Gao, Tinghong; Li, Kaiwen; Tian, Zean; Xie, Quan; Hu, Xuechen; Li, Yidan; Luo, Xiangyan; Ren, Lei

    2017-11-01

    The evolution characteristics of polycrystals and nano-twinned structures during the rapid solidification of silicon under cooling rate of 1010 K s‑1 are investigated based on molecular dynamics simulation. The microstructural properties of silicon were analyzed by several structural characterization methods. The distorted tetrahedral units with 5 nearest-neighbor atoms play different roles in three stages of the quenching process. As transitional structures, they play a significant part in liquid to liquid and liquid to crystal transition, and break the translational symmetry of the crystalline structures. The tetrahedral units can aggregate to form polycrystals with high stability in this system. When the temperature was decreased at a cooling rate of 1010 K s‑1, Coherent twin boundaries, having excellent structural stability and configurational continuity, were easily formed between zinc-blende and wurtzite structures.

  3. Rapid shelf-wide cooling response of a stratified coastal ocean to hurricanes

    Science.gov (United States)

    Seroka, Greg; Miles, Travis; Xu, Yi; Kohut, Josh; Schofield, Oscar; Glenn, Scott

    2017-06-01

    Large uncertainty in the predicted intensity of tropical cyclones (TCs) persists compared to the steadily improving skill in the predicted TC tracks. This intensity uncertainty has its most significant implications in the coastal zone, where TC impacts to populated shorelines are greatest. Recent studies have demonstrated that rapid ahead-of-eye-center cooling of a stratified coastal ocean can have a significant impact on hurricane intensity forecasts. Using observation-validated, high-resolution ocean modeling, the stratified coastal ocean cooling processes observed in two U.S. Mid-Atlantic hurricanes were investigated: Hurricane Irene (2011)—with an inshore Mid-Atlantic Bight (MAB) track during the late summer stratified coastal ocean season—and Tropical Storm Barry (2007)—with an offshore track during early summer. For both storms, the critical ahead-of-eye-center depth-averaged force balance across the entire MAB shelf included an onshore wind stress balanced by an offshore pressure gradient. This resulted in onshore surface currents opposing offshore bottom currents that enhanced surface to bottom current shear and turbulent mixing across the thermocline, resulting in the rapid cooling of the surface layer ahead-of-eye-center. Because the same baroclinic and mixing processes occurred for two storms on opposite ends of the track and seasonal stratification envelope, the response appears robust. It will be critical to forecast these processes and their implications for a wide range of future storms using realistic 3-D coupled atmosphere-ocean models to lower the uncertainty in predictions of TC intensities and impacts and enable coastal populations to better respond to increasing rapid intensification threats in an era of rising sea levels.

  4. Rapid shelf‐wide cooling response of a stratified coastal ocean to hurricanes

    Science.gov (United States)

    Miles, Travis; Xu, Yi; Kohut, Josh; Schofield, Oscar; Glenn, Scott

    2017-01-01

    Abstract Large uncertainty in the predicted intensity of tropical cyclones (TCs) persists compared to the steadily improving skill in the predicted TC tracks. This intensity uncertainty has its most significant implications in the coastal zone, where TC impacts to populated shorelines are greatest. Recent studies have demonstrated that rapid ahead‐of‐eye‐center cooling of a stratified coastal ocean can have a significant impact on hurricane intensity forecasts. Using observation‐validated, high‐resolution ocean modeling, the stratified coastal ocean cooling processes observed in two U.S. Mid‐Atlantic hurricanes were investigated: Hurricane Irene (2011)—with an inshore Mid‐Atlantic Bight (MAB) track during the late summer stratified coastal ocean season—and Tropical Storm Barry (2007)—with an offshore track during early summer. For both storms, the critical ahead‐of‐eye‐center depth‐averaged force balance across the entire MAB shelf included an onshore wind stress balanced by an offshore pressure gradient. This resulted in onshore surface currents opposing offshore bottom currents that enhanced surface to bottom current shear and turbulent mixing across the thermocline, resulting in the rapid cooling of the surface layer ahead‐of‐eye‐center. Because the same baroclinic and mixing processes occurred for two storms on opposite ends of the track and seasonal stratification envelope, the response appears robust. It will be critical to forecast these processes and their implications for a wide range of future storms using realistic 3‐D coupled atmosphere‐ocean models to lower the uncertainty in predictions of TC intensities and impacts and enable coastal populations to better respond to increasing rapid intensification threats in an era of rising sea levels. PMID:28944132

  5. Rapid shelf-wide cooling response of a stratified coastal ocean to hurricanes.

    Science.gov (United States)

    Seroka, Greg; Miles, Travis; Xu, Yi; Kohut, Josh; Schofield, Oscar; Glenn, Scott

    2017-06-01

    Large uncertainty in the predicted intensity of tropical cyclones (TCs) persists compared to the steadily improving skill in the predicted TC tracks. This intensity uncertainty has its most significant implications in the coastal zone, where TC impacts to populated shorelines are greatest. Recent studies have demonstrated that rapid ahead-of-eye-center cooling of a stratified coastal ocean can have a significant impact on hurricane intensity forecasts. Using observation-validated, high-resolution ocean modeling, the stratified coastal ocean cooling processes observed in two U.S. Mid-Atlantic hurricanes were investigated: Hurricane Irene (2011)-with an inshore Mid-Atlantic Bight (MAB) track during the late summer stratified coastal ocean season-and Tropical Storm Barry (2007)-with an offshore track during early summer. For both storms, the critical ahead-of-eye-center depth-averaged force balance across the entire MAB shelf included an onshore wind stress balanced by an offshore pressure gradient. This resulted in onshore surface currents opposing offshore bottom currents that enhanced surface to bottom current shear and turbulent mixing across the thermocline, resulting in the rapid cooling of the surface layer ahead-of-eye-center. Because the same baroclinic and mixing processes occurred for two storms on opposite ends of the track and seasonal stratification envelope, the response appears robust. It will be critical to forecast these processes and their implications for a wide range of future storms using realistic 3-D coupled atmosphere-ocean models to lower the uncertainty in predictions of TC intensities and impacts and enable coastal populations to better respond to increasing rapid intensification threats in an era of rising sea levels.

  6. New method for vitrifying water and other liquids by rapid cooling of their aerosols

    Science.gov (United States)

    Mayer, Erwin

    1985-07-01

    A method for the vitrification of pure liquid water and dilute aqueous solutions is described which is the only one without a liquid cryomedium for heat transfer: rapid cooling of aqueous aerosol droplets on a solid cryoplate. This method is not limited to water and aqueous solutions, but can be used for the vitrification of any liquid aerosol, the only impurity being some codeposited vapor. The method can be applied in diverse fields such as cryobiology, cryomicroscopy, and low-temperature spectroscopy of water and dilute aqueous solutions to avoid the formation of crystalline ice.

  7. Mechanical response of local rapid cooling by spray water on constrained steel frame structure at high temperature in fire

    Directory of Open Access Journals (Sweden)

    Xia Yunchun

    2015-01-01

    Full Text Available Locally rapid cooling of spray water had strong impact on high temperature steel structure. When temperature of beam reached 600°C and cooling rate was more than 20°C/s, the maximum axial tension could reach more than 5 times of the originally compressive force. The compressive bending moment at joint of beam-to-column changed to tensile bending moment, and the maximum bending moment could reach above 4 times as that when heated. After rapid cooling by spray water, deflection at mid-span increased slightly.

  8. Numerical Modelling of Micro-Stresses in Carbonised Austenitic Cast Steel under Rapid Cooling Conditions

    Directory of Open Access Journals (Sweden)

    Tuleja J.

    2017-06-01

    Full Text Available The paper presents a method of the numerical modelling of micro-stresses in carbonised austenitic cast steel being developed during rapid cooling due to differences in the values of thermal expansion coefficients for this material phases – carbides and austenitic matrix. Micro-stresses are indicated as the main cause of crack initiation in the tooling elements of carburising furnaces being mainly made of austenitic cast steel. A calculation model of carbonised and thermally fatigued austenitic cast steel was developed based on the microstructure images obtained using light microscopy techniques and the phase composition evaluated with the X-ray diffraction method. The values of the stress tensor components and the reduced stress in the complex models of test material structure were determined numerically by the finite element method. The effort analysis was performed and the areas where development of cracks is to be expected were identified, which was experimentally confirmed.

  9. Precipitation of metallic chromium during rapid cooling of Cr2O3 slags

    Directory of Open Access Journals (Sweden)

    J. Burja

    2017-01-01

    Full Text Available The slag systems of CaO-SiO2- Cr2O3 and Al2O3-CaO-MgO-SiO2- Cr2O3 were analyzed. These slag systems occur in the production of stainless steel and are important from the process metallurgy point of view. Synthetic slag samples with different chromium oxide content were prepared and melted. The melted slag samples where then rapidly cooled on large steel plates, so that the high temperature microstructure was preserved. The samples were analyzed by scanning electron microscopy (SEM and X-ray diffraction (XRD. The precipitation of different chromium oxide phases was studied, but most importantly the precipitation of metallic chromium was observed. These findings help us interpret industrial slag samples.

  10. Partial fasciectomy for Dupuytren's contractures.

    Science.gov (United States)

    Mavrogenis, Andreas F; Spyridonos, Sarantis G; Ignatiadis, Ioannis A; Antonopoulos, Dimitrios; Papagelopoulos, Panayiotis J

    2009-01-01

    One hundred ninety-six patients with Dupuytren's contractures were treated by partial fasciectomy and adequate postoperative rehabilitation. All patients had flexion contracture of the proximal interphalangeal joint of >20 degrees ; 93 patients had flexion contracture of the associated metacarpophalangeal joint of >30 degrees ; 143 patients had risk factors for Dupuytren's disease. Primary skin closure and splinting were done in all patients. Range of motion was begun by the 1st week. Splinting was discontinued by the 2nd week, followed by night-time splinting until the 8th week. The mean follow-up was 6.6 years (range, 2-9 years). At the latest examination, 72.5% of the patients had complete range of motion of the metacarpophalangeal and proximal interphalangeal joints; 20.2% had 5 degrees -10 degrees of extension deficit and 7.3% had recurrent contractures of >20 degrees at the proximal interphalangeal joint and were subjected to reoperation. Complications included digital neurovascular injury in 5%, complex regional pain syndrome in 10.1%, and wound-healing problems and superficial infections in 15.1%.

  11. Combination of Cooling Curve and Micro-Chemical Phase Analysis of Rapidly Quenched Magnesium AM60B Alloy

    Science.gov (United States)

    Marchwica, P. C.; Gesing, A. J.; Sokolowski, J. H.; Blawert, C.; Jekl, J.; Berkmortel, R.

    Macro test samples of magnesium alloy AM60B were melted and quenched at maximum instantaneous cooling rates ranging from -5°C/s to -500°C/s and the resultant cooling curves were analyzed. Characteristic reactions on these curves corresponding to formation of individual phases were identified with the aid of literature data as well as metallographic and micro-chemical analysis. The results indicate that these phases, their size and location in the micro structure, their chemistry and their relative proportions all change in response to the increase in the cooling rate. These rapid cooling rates are typical of real industrial solidification processes such as die casting. These findings can be used to improve future computer models of casting solidification processes for magnesium and for other alloys.

  12. [Joint contractures in nursing textbooks].

    Science.gov (United States)

    Bartoszek, G; Meyer, G; Thiesemann, R

    2014-01-01

    The transparency criteria of the German statutory health insurance on joint contracture prevention have led to controversies about the appropriate assessment, prevention and treatment as well as to various actions in nursing practice. However, appropriate nursing assessments and proven treatment options are lacking so far. It is unclear whether textbooks on nursing reflect these uncertainties. Search for textbooks on nursing through internet-based search engines and publisher registers, data extraction by one investigator and control by a second. A total of 35 textbooks with contributions on joint contractures were identified of which 25 included a definition, causes/risk factors are presented in 32 textbooks and assessments are presented in 5 books. Most often positioning into a physiological or functional neutral position and passive moving of limbs are recommended as passive prophylaxis. Recommended therapeutic and preventive options do not differ. None of the textbooks reflect that there is a lack of scientific knowledge on the subject. Textbooks on nursing do not deal with complete and scientific sound information on joint contractures.

  13. Volkmann's ischemic contracture of the upper extremity.

    Science.gov (United States)

    Botte, M J; Keenan, M A; Gelberman, R H

    1998-08-01

    Upper extremity deformity of ischemic contracture usually includes elbow flexion, forearm pronation, wrist flexion, thumb flexion and adduction, digital metacarpophalangeal joint extension, and interphalangeal joint flexion. Treatment of mild contractures consists of either nonoperative management with a comprehensive rehabilitation program (to increase range of motion and strenght) or operative management consisting of infarct excision or tendon lengthening. Treatment of moderate-to-severe contractures consists of release of secondary nerve compression, treatment of contractures (with tendon lengthening or recession), tendon or free-tissue transfers to restore lost function, and/or salvage procedures for the severely contracted or neglected extremity.

  14. Genetics Home Reference: congenital contractural arachnodactyly

    Science.gov (United States)

    ... 5 links) Encyclopedia: Arachnodactyly Encyclopedia: Contracture Deformity Encyclopedia: Skeletal Limb Abnormalities Health Topic: Connective Tissue Disorders Health Topic: Muscle Disorders Genetic and Rare Diseases Information Center (1 ...

  15. Rapid on-site monitoring of Legionella pneumophila in cooling tower water using a portable microfluidic system.

    Science.gov (United States)

    Yamaguchi, Nobuyasu; Tokunaga, Yusuke; Goto, Satoko; Fujii, Yudai; Banno, Fumiya; Edagawa, Akiko

    2017-06-08

    Legionnaires' disease, predominantly caused by the bacterium Legionella pneumophila, has increased in prevalence worldwide. The most common mode of transmission of Legionella is inhalation of contaminated aerosols, such as those generated by cooling towers. Simple, rapid and accurate methods to enumerate L. pneumophila are required to prevent the spread of this organism. Here, we applied a microfluidic device for on-chip fluorescent staining and semi-automated counting of L. pneumophila in cooling tower water. We also constructed a portable system for rapid on-site monitoring and used it to enumerate target bacterial cells rapidly flowing in the microchannel. A fluorescently-labelled polyclonal antibody was used for the selective detection of L. pneumophila serogroup 1 in the samples. The counts of L. pneumophila in cooling tower water obtained using the system and fluorescence microscopy were similar. The detection limit of the system was 10 4  cells/ml, but lower numbers of L. pneumophila cells (10 1 to 10 3  cells/ml) could be detected following concentration of 0.5-3 L of the water sample by filtration. Our technique is rapid to perform (1.5 h), semi-automated (on-chip staining and counting), and portable for on-site measurement, and it may therefore be effective in the initial screening of Legionella contamination in freshwater.

  16. Magnetocaloric and Hopkinson effects in slowly and rapidly cooled Gd{sub 7}Pd{sub 3}

    Energy Technology Data Exchange (ETDEWEB)

    Talik, Ewa; Guzik, Adam; Oboz, Monika; Zajdel, Pawel; Ziolkowski, Grzegorz [Silesia Univ., Katowice (Poland). Inst. of Physics

    2016-01-15

    Gd{sub 7}Pd{sub 3} intermetallic compound was prepared as slowly cooled polycrystal and rapidly cooled (rc) casts. The slowly cooled polycrystalline samples were obtained by melting in an induction coil. The rc-cast Gd{sub 7}Pd{sub 3} sample was obtained by means of a mould casting technique. The samples were characterized by means of X-ray diffraction, SQUID magnetometry and scanning electron microscopy in order to elucidate the Hopkinson effect and magnetocaloric properties in relation to the technological aspects. The investigated ferromagnetic system is sensitive to grain size. The magnetocaloric and Hopkinson effect decreases with the decrease of the grain size. The results were compared to the data of single crystal obtained by the Czochralski method from a levitating melt.

  17. Core temperature cooling in healthy volunteers after rapid intravenous infusion of cold and room temperature saline solution.

    Science.gov (United States)

    Moore, Tracy M; Callaway, Clifton W; Hostler, David

    2008-02-01

    Studies have suggested that inducing mild hypothermia improves neurologic outcomes after traumatic brain injury, major stroke, traumatic hemorrhage, and cardiac arrest. Although infusion of cold normal saline solution is a simple and inexpensive method for initiating hypothermia, human cold-defense mechanisms potentially make this route stressful or ineffective. We hypothesize that rapid infusion of 30 mL/kg of cold (4 degrees C, 39.2 degrees F) 0.9% saline solution during 30 minutes to healthy subjects (aged 27 [standard deviation (SD) 4] years) will reduce core body temperature to the therapeutic range of 33 degrees C to 35 degrees C (91.4 degrees F to 95 degrees F). Sixteen subjects were randomly assigned to receive either cold (4 degrees C, 39.2 degrees F) or room temperature (23 degrees C, 73.4 degrees F) normal saline solution. Subjects were not informed of their assignment, but blinding was not possible after initiation of the infusion. Core temperature, skin temperature, and vital signs were recorded every 2 minutes. Subjects indicated global discomfort during the infusion on a 100-mm visual analog scale at 5-minute intervals. Core temperature decreased in both the cold saline solution (1.0 degrees C [SD 0.4 degrees C]/1.8 degrees F [0.7 degrees F]) and room temperature saline solution (0.5 degrees C [SD 0.1 degrees C]/0.9 degrees F [0.2 degrees F]) groups, whereas skin temperature was unchanged. Slopes calculated from the core temperature cooling curves indicate that the majority of cooling occurred during the first half of the infusion. Examination of the core temperature cooling curves revealed a 2-phase temporal pattern in 30-minute cooling curves. The early phase, spanning 0 to 14 minutes, demonstrated rapid cooling in both groups, with a larger effect observed in subjects receiving cold saline solution. In this pilot study of healthy volunteers, rapid administration of cold saline solution to awake normothermic volunteers resulted in 1 degrees C (1

  18. Anaesthetic Management of Mentosternal Contractures Where ...

    African Journals Online (AJOL)

    Objective: Perioperative airway management in postburn mentosternal contractures often pose great challenges to the anaesthetist as well as the plastic surgeon. This is more so where resources are limited. Method: Patients with postburn mentosternal contracture who had surgery between January 2000 and December ...

  19. Contemporary management of dupuytren contracture.

    Science.gov (United States)

    Rizzo, Marco; Stern, Peter J; Benhaim, Prosper; Hurst, Lawrence C

    2014-01-01

    Dupuytren contracture is a condition that affects the palmar fascia. It most commonly affects men of northern European ancestry and initially presents at middle age. The diseased fascia may form cords that extend into the digits, resulting in limited motion and function. Treatment is aimed at either releasing or removing the diseased cord so that the finger can extend fully. Common interventions include surgery, needle aponeurotomy, and collagenase injection. Surgery remains the gold standard in treatment and most commonly includes a limited fasciectomy. Although often successful, surgery carries inherent risks and may involve a lengthy recovery with extensive therapy. Needle aponeurotomy and collagenase injections are office-based alternatives that aim to weaken the cord and release the contracture. Needle aponeurotomy involves repeated needling along the cord in intervals and collagenase injections to dissolve a portion of the cord. Despite being less invasive, problems such as nerve and/or tendon injury, skin tears, and autoimmune reactions have been reported. Regardless of treatment, recurrence remains a concern.

  20. Rapid short-term cooling following the Chicxulub impact at the Cretaceous-Paleogene boundary

    NARCIS (Netherlands)

    Vellekoop, Johan; Sluijs, Appy|info:eu-repo/dai/nl/311474748; Smit, Jan; Schouten, Stefan|info:eu-repo/dai/nl/137124929; Weijers, Johan W H|info:eu-repo/dai/nl/310911516; Sinninghe Damsté, Jaap S.|info:eu-repo/dai/nl/07401370X; Brinkhuis, Henk|info:eu-repo/dai/nl/095046097

    2014-01-01

    The mass extinction at the Cretaceous-Paleogene boundary, ~66 Ma, is thought to be caused by the impact of an asteroid at Chic-xulub, present-day Mexico. Although the precise mechanisms that led to this mass extinction remain enigmatic, most postulated scenarios involve a short-lived global cooling,

  1. Rapid short-term cooling following the Chicxulub impact at the Cretaceous–Paleogene boundary

    NARCIS (Netherlands)

    Vellekoop, J.; Sluijs, A.; Smit, J.; Schouten, S.; Weijers, J.W.H.; Damsté, J.S.S.; Brinkhuis, H.

    2014-01-01

    The mass extinction at the Cretaceous-Paleogene boundary, ~66 Ma, is thought to be caused by the impact of an asteroid at Chic-xulub, present-day Mexico. Although the precise mechanisms that led to this mass extinction remain enigmatic, most postulated scenarios involve a short-lived global cooling,

  2. Digital flexor musculotendinous contracture in two Devon Rex cats.

    Science.gov (United States)

    Thom, Leonie K; Pool, Roy R; Malik, Richard

    2017-03-01

    Clinical summary: A 13-year-old, spayed Devon Rex with unilateral digital flexor musculotendinous contracture of the forelimb was treated by surgical tenotomy. The condition improved transiently, but recurred rapidly and became bilateral. Histopathologic analysis of necropsy tissues resulted in a morphologic diagnosis of fibromyositis of the antebrachial muscles causing contracture and flexural deformity of the carpi and phalanges of both thoracic limbs. A search for similar cases yielded the clinical notes of a second cat, a 10-year-old, spayed Devon Rex, also with bilateral disease. This second case responded well to surgical tenotomy but tissue biopsies were not obtained to permit microscopic assessment of the underlying pathologic process. Relevance and novel information: Acquired and permanent contracture of the digital flexor muscles and/or tendons of the forelimbs is a rare and poorly described condition of cats. The very limited number of documented cases describing disease affecting one or more digits (but not the carpus) infers a causal link with onychectomy, but reported histopathologic changes have been limited to the tendons. The two cases described in this report suffered contracture of the carpus and all digits bilaterally, one without previous onychectomy and the other 9 years after onychectomy. There were novel histopathologic findings in the muscles of the one case for which biopsy material was available. Information gained from these two cases provides a new perspective for the investigation and treatment of future cases. Specifically, consideration should be given to an underlying immune-mediated myopathic process and a possible genetic predisposition in the Devon Rex breed. Currently, the poorly understood etiopathogenesis hinders our ability to definitively recommend treatment options, which might include corticosteroids and other forms of immunosuppressive therapy.

  3. Complications following surgical treatment for Dupuytren's contracture.

    Science.gov (United States)

    Prosser, R; Conolly, W B

    1996-01-01

    Dupuytren's disease is a proliferative fibroplasia that can lead to a significant contracture of the metacarpophalangeal (MCP) and interphalangeal (IP) joints, causing a functional disability. Surgical excision of the Dupuytren's tissue and release of the contracted joints may be necessary to restore function. Most patients require hand therapy postoperatively. Postoperative complications have been reported at 17%. These include excessive inflammation, hematoma, ischemic skin necrosis, infection, granuloma formation, transient paresthesia, scar contracture, persistent proximal interphalangeal (PIP) flexion contracture, distal interphalangeal (DIP) hyperextension deformity, joint stiffness, poor flexion and grip strength, pain, and reflex sympathetic dystrophy (RSD). The hand therapist plays a vital role in the early detection and treatment of many of these complications.

  4. Minimally invasive partial fasciectomy for Dupuytren contractures.

    Science.gov (United States)

    Gelman, Scott E; Schlenker, Robert; Jacoby, Sidney M; Shin, Eon K; Culp, Randall W

    2012-12-01

    Treatment options for the Dupuytren contractures vary from percutaneous needle aponeurotomy, open fasciotomy or fasciectomy, dermofasciectomy, and more recently, injectable collagenase. Although utilization of injectable collagenase avoids a formal surgical procedure, not all patients are eligible and some patients do not feel comfortable with an enzyme injection or the associated risks, which may include hematoma, wound dehiscence, or tendon rupture. This study describes the technique and early results of partial fasciectomy through a mini-incision approach as an additional treatment option for Dupuytren contractures. We found that this procedure results in contracture correction with a low rate of complications and thus provides the surgeon with an alternative treatment option to offer patients.

  5. Management of posttraumatic proximal interphalangeal joint contracture.

    Science.gov (United States)

    Houshian, Shirzad; Jing, Shan Shan; Chikkamuniyappa, Chandrasekar; Kazemian, Gholam Hussein; Emami-Moghaddam-Tehrani, Mohammad

    2013-08-01

    Chronic flexion contracture of the proximal interphalangeal (PIP) joint presents a common yet challenging problem to hand surgeons. Over the years, multiple treatment modalities have been described for this problem, producing limited results. Nonoperative treatment using serial casting and splints should be tried before attempting open surgical release, which should be done in selected patients. The use of external fixation for treating PIP contracture has been encouraging and can be a useful alterative. This review provides an update on the current management of PIP joint contractures and presents a flowchart of treatment to aid decision making. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  6. Baron Guillaume Dupuytren: Dupuytren's contracture.

    Science.gov (United States)

    Ellis, Harold

    2013-05-01

    Dupuytren's contracture of the hand is an extremely common deformity in middle aged and elderly men but it is rarely encountered in women. It usually involves the fifth and fourth fingers, less commonly the other two fingers, and never the thumb. There is a flexion deformity between the head of the metacarpal and the adjacent proximal phalanx and at the proximal interphalangeal joint. However, the distal interphalangeal joint is not affected. Indeed, in a severe case, the distal phalanx may actually be extended as it becomes progressively pressed into the palm of the hand. It is often bilateral and may affect the sole of the foot--although I have only had one old gentleman where his foot lesion troubled him enough for him to request surgical cure.

  7. Deltoid contracture: A study of nineteen cases

    Directory of Open Access Journals (Sweden)

    Banerji Debabrata

    2008-01-01

    Full Text Available Objective: Deltoid contracture is not uncommon in India. Contractures of deltoid often do not have definite etiology. We have critically analyzed the condition as regards the etiopathogenesis and its surgical results. Materials and Methods: Nineteen patients with deltoid contracture operated between June 1990 and September 2001 were enrolled for a unicentric retrospective study. The surgery was indicated in patients with abduction deformity of more than 30° at the shoulder. The etiology of deltoid contracture was idiopathic ( n = 13 intramuscular injection in deltoid muscle ( n = 5 and blunt trauma ( n = 1. All were operated by distal release (incision near the insertion of the deltoid muscle. The average follow-up was of 9.5 years (range 6-17 years. They were evaluated based on parameters like pain, persistence of deformity, range of shoulder movements and strength of deltoid. Results: All patients recovered painless full range of shoulder motion except one. The correction of deformity was achieved in all patients and there was no loss of strength of deltoid compared to the opposite side. Histology of excised tissue showed features of chronic inflammation. The complications observed were hypertrophic scar ( n = 1, painful terminal restriction of shoulder movements ( n = 1 and prominent vertebral border of scapula ( n = 1. Conclusion: Deltoid contracture has features of chronic inflammation, and the intramuscular deltoid injection is the most incriminating factor in its etiopathogenesis. The condition can be effectively managed surgically by distal release of the deltoid muscle combined with excision of the muscular fibrotic contracture band.

  8. Plantarflexion contracture in the mdx mouse.

    Science.gov (United States)

    Garlich, Michael W; Baltgalvis, Kristen A; Call, Jarrod A; Dorsey, Lisa L; Lowe, Dawn A

    2010-12-01

    Contractures are a major clinical issue for patients with muscular dystrophies. However, it is unknown whether contractures are present in the widely used mdx mouse model of Duchenne muscular dystrophy. Therefore, the objectives of this study were to develop methods to measure muscle contractures in mice, to determine whether plantarflexion contractures are present in mdx mice, and to analyze the composition of the major muscles involved. Hindlimbs of eight wild type and six mdx mice were assessed every 2 wks during the course of a 12-wk study. Assessments included range of motion and in vivo torques about the ankle. At the end of the study, mice were euthanized, and muscles were analyzed for composition. The mdx mice had ∼10 degrees less dorsiflexion, increased passive torque moving the ankle into dorsiflexion, and an increased passive-to-active torque ratio relative to wild type mice. Gastrocnemius muscle composition alterations included increased wet mass, decreased protein content, and increased collagen. The results indicate that mdx mice have plantarflexion contractures similar to those seen in children with Duchenne muscular dystrophy. In future studies, these measures can be used to assess strategies to slow the progression of contractures that occur with muscular dystrophies.

  9. DES14X3taz: A TYPE I SUPERLUMINOUS SUPERNOVA SHOWING A LUMINOUS, RAPIDLY COOLING INITIAL PRE-PEAK BUMP

    Energy Technology Data Exchange (ETDEWEB)

    Smith, M.; Sullivan, M.; D’Andrea, C. B.; Castander, F. J.; Casas, R.; Prajs, S.; Papadopoulos, A.; Nichol, R. C.; Karpenka, N. V.; Bernard, S. R.; Brown, P.; Cartier, R.; Cooke, J.; Curtin, C.; Davis, T. M.; Finley, D. A.; Foley, R. J.; Gal-Yam, A.; Goldstein, D. A.; González-Gaitán, S.; Gupta, R. R.; Howell, D. A.; Inserra, C.; Kessler, R.; Lidman, C.; Marriner, J.; Nugent, P.; Pritchard, T. A.; Sako, M.; Smartt, S.; Smith, R. C.; Spinka, H.; Thomas, R. C.; Wolf, R. C.; Zenteno, A.; Abbott, T. M. C.; Benoit-Lévy, A.; Bertin, E.; Brooks, D.; Buckley-Geer, E.; Rosell, A. Carnero; Kind, M. Carrasco; Carretero, J.; Crocce, M.; Cunha, C. E.; Costa, L. N. da; Desai, S.; Diehl, H. T.; Doel, P.; Estrada, J.; Evrard, A. E.; Flaugher, B.; Fosalba, P.; Frieman, J.; Gerdes, D. W.; Gruen, D.; Gruendl, R. A.; James, D. J.; Kuehn, K.; Kuropatkin, N.; Lahav, O.; Li, T. S.; Marshall, J. L.; Martini, P.; Miller, C. J.; Miquel, R.; Nord, B.; Ogando, R.; Plazas, A. A.; Reil, K.; Romer, A. K.; Roodman, A.; Rykoff, E. S.; Sanchez, E.; Scarpine, V.; Schubnell, M.; Sevilla-Noarbe, I.; Soares-Santos, M.; Sobreira, F.; Suchyta, E.; Swanson, M. E. C.; Tarle, G.; Walker, A. R.; Wester, W.

    2016-02-03

    We present DES14X3taz, a new hydrogen-poor superluminous supernova (SLSN-I) discovered by the Dark Energy Survey (DES) supernova program, with additional photometric data provided by the Survey Using DECam for Superluminous Supernovae. Spectra obtained using Optical System for Imaging and low-Intermediate-Resolution Integrated Spectroscopy on the Gran Telescopio CANARIAS show DES14X3taz is an SLSN-I at z = 0.608. Multi-color photometry reveals a double-peaked light curve: a blue and relatively bright initial peak that fades rapidly prior to the slower rise of the main light curve. Our multi-color photometry allows us, for the first time, to show that the initial peak cools from 22,000 to 8000 K over 15 rest-frame days, and is faster and brighter than any published core-collapse supernova, reaching 30% of the bolometric luminosity of the main peak. No physical Ni-56-powered model can fit this initial peak. We show that a shock-cooling model followed by a magnetar driving the second phase of the light curve can adequately explain the entire light curve of DES14X3taz. Models involving the shock-cooling of extended circumstellar material at a distance of similar or equal to 400 R-circle dot are preferred over the cooling of shock-heated surface layers of a stellar envelope. We compare DES14X3taz to the few double-peaked SLSN-I events in the literature. Although the rise. times and characteristics of these initial peaks differ, there exists the tantalizing possibility that they can be explained by one physical interpretation

  10. Research on rapid-cooling press hardening process and its effect for formability of ultra high strength steel

    Science.gov (United States)

    Ying, L.; Hu, P.; Zhao, X.; Shi, D. Y.; Dai, M. H.; Yu, H. Y.; Chang, Y.

    2013-05-01

    In this study, a new rapid-cooling process in press hardening based on theoretical analysis, experimental test and optimal formability simulation were investigated for improving formability and obdurability of 22MnB5 boron steel. A series of non-isothermal flow behaviors in different plastic strain rates from 0.001s-1 to 0.1s-1 was investigated by thermal-mechanical uniaxial tensile tests. Furthermore, martensite transformation measurement was also involved in the temperature range from 600° to 800°. According to an interrelated Norton-Hoff constitutive model was developed to describe the complicated thermal-mechanical-phase transformation couple model, a typical deep drawing box used to simulate formability so as to compare with actual press hardening experiments used by the self-developed multi-field coupled static-explicit FE software KMAS and dynamic-explicit commercial software LS-DYNA respectively. The results showed the rapid-cooling process indicate the validity and efficiency of meeting the forming performance characteristics and the optimal process which temperature range from 650°C˜700°C can contribute to improve formability of press hardening manufacture.

  11. Rapid short-term cooling following the Chicxulub impact at the Cretaceous-Paleogene boundary.

    Science.gov (United States)

    Vellekoop, Johan; Sluijs, Appy; Smit, Jan; Schouten, Stefan; Weijers, Johan W H; Sinninghe Damsté, Jaap S; Brinkhuis, Henk

    2014-05-27

    The mass extinction at the Cretaceous-Paleogene boundary, ∼ 66 Ma, is thought to be caused by the impact of an asteroid at Chicxulub, present-day Mexico. Although the precise mechanisms that led to this mass extinction remain enigmatic, most postulated scenarios involve a short-lived global cooling, a so-called "impact winter" phase. Here we document a major decline in sea surface temperature during the first months to decades following the impact event, using TEX86 paleothermometry of sediments from the Brazos River section, Texas. We interpret this cold spell to reflect, to our knowledge, the first direct evidence for the effects of the formation of dust and aerosols by the impact and their injection in the stratosphere, blocking incoming solar radiation. This impact winter was likely a major driver of mass extinction because of the resulting global decimation of marine and continental photosynthesis.

  12. Rapid short-term cooling following the Chicxulub impact at the Cretaceous–Paleogene boundary

    Science.gov (United States)

    Vellekoop, Johan; Sluijs, Appy; Smit, Jan; Schouten, Stefan; Weijers, Johan W. H.; Sinninghe Damsté, Jaap S.; Brinkhuis, Henk

    2014-01-01

    The mass extinction at the Cretaceous–Paleogene boundary, ∼66 Ma, is thought to be caused by the impact of an asteroid at Chicxulub, present-day Mexico. Although the precise mechanisms that led to this mass extinction remain enigmatic, most postulated scenarios involve a short-lived global cooling, a so-called “impact winter” phase. Here we document a major decline in sea surface temperature during the first months to decades following the impact event, using TEX86 paleothermometry of sediments from the Brazos River section, Texas. We interpret this cold spell to reflect, to our knowledge, the first direct evidence for the effects of the formation of dust and aerosols by the impact and their injection in the stratosphere, blocking incoming solar radiation. This impact winter was likely a major driver of mass extinction because of the resulting global decimation of marine and continental photosynthesis. PMID:24821785

  13. Multi-Resolution Rapid Prototyping of Vehicle Cooling Systems: Approach and Test Results

    Science.gov (United States)

    2014-08-01

    components within the system. 3. System-level: assembly of reduced-order models of components for rapid generation of results for the entire vehicle...using reduced-order models (with increased resolution) on specific components/ assemblies , while using regular reduced-order models for the remaining...Single and Multi-Evaporator Subcritical Vapor Compression Systems”, M.S. Thesis, University of Illinois at Urbana- Champaign. Siegel, J., 2007, Corba

  14. Rapid short-duration hypothermia with cold saline and endovascular cooling before reperfusion reduces microvascular obstruction and myocardial infarct size

    Directory of Open Access Journals (Sweden)

    Heiberg Einar

    2008-04-01

    Full Text Available Abstract Background The aim of this study was to evaluate the combination of a rapid intravenous infusion of cold saline and endovascular hypothermia in a closed chest pig infarct model. Methods Pigs were randomized to pre-reperfusion hypothermia (n = 7, post-reperfusion hypothermia (n = 7 or normothermia (n = 5. A percutaneous coronary intervention balloon was inflated in the left anterior descending artery for 40 min. Hypothermia was started after 25 min of ischemia or immediately after reperfusion by infusion of 1000 ml of 4°C saline and endovascular hypothermia. Area at risk was evaluated by in vivo SPECT. Infarct size was evaluated by ex vivo MRI. Results Pre-reperfusion hypothermia reduced infarct size/area at risk by 43% (46 ± 8% compared to post-reperfusion hypothermia (80 ± 6%, p Conclusion Rapid hypothermia with cold saline and endovascular cooling before reperfusion reduces myocardial infarct size and microvascular obstruction. A novel finding is that hypothermia at the onset of reperfusion reduces microvascular obstruction without reducing myocardial infarct size. Intravenous administration of cold saline combined with endovascular hypothermia provides a method for a rapid induction of hypothermia suggesting a potential clinical application.

  15. Dupuytren contracture in the pediatric population: a systematic review.

    Science.gov (United States)

    Izadpanah, Ali; Viezel-Mathieu, Alex; Izadpanah, Arash; Luc, Mario

    2015-04-01

    Dupuytren contracture of the palm is a relatively common benign fibroproliferative disease of the palmar fascia typically affecting the adult population. There have however been several reported cases of Dupuytren contracture in children. We sought to review the literature for Dupuytren contracture and highlight the main clinical features and management of the disease in children. Georg Thieme Verlag KG Stuttgart · New York.

  16. [Surgical strategy for postburn cervical scar contracture].

    Science.gov (United States)

    Feng, Shaoqing; Su, Weijie; Xi, Wenjing; Min, Peiru; Pu, Zheming; Zhang, Yan; Zhang, Yixin

    2015-08-01

    To explore the surgical strategy for postburn cervical scar contracture. Sixty-five patients with scar contracture as a result of burn injury in the neck were hospitalized from July 2013 to July 2014. Release of cervical scar contracture was conducted according to different demands of the 3 anatomic subunits of neck, i.e. lower lip vermilion border-supramaxillary region, submaxillary region, and anterior region of neck. After release of contracture, platysma was released. For some cases with chin retrusion, genioplasty with horizontal osteotomy was performed. The coverage of wound followed the principle of similarity, i.e. the skin tissue covering the wound in the neck should be similar to the characters of skin around the wound in terms of color, texture, and thickness. Based on this principle, except for the preschool children in whom skin grafting was performed, the wounds of the other patients were covered by local skin flaps, adjacent skin flaps, or free skin flaps. All patients underwent release of scar and platysma, while 9 patients underwent genioplasty with horizontal osteotomy. Wounds were covered with local skin flaps in 32 patients, with adjacent skin flaps in 7 patients, with free skin flaps in 11 patients, and with skin grafts in 15 patients. All skin grafts and flaps survived. Good range of motion was achieved in the neck of all patients, with the cervicomental angle after reconstruction ranging from 90 to 120°. All patients were followed up for 6 to 24 months. Six patients who had undergone skin grafting were found to have some degrees of skin contracture, while none of the patients who had undergone flap coverage showed any signs of contracture recurrence. Restoration of the cervicomental angle is critical in the treatment of postburn cervical scar contracture, and the release of scar contracture should conform to the subunit principle. The coverage of wound should be based on the principle of similarity, with repair by skin flaps as the first

  17. Post-burn scars and scar contractures

    Directory of Open Access Journals (Sweden)

    Goel Arun

    2010-10-01

    Full Text Available The mortality and morbidity from burns have diminished tremendously over the last six to seven decades. However, these do not truly reflect whether the victim could go back to society as a useful person or not and lead a normal life because of the inevitable post-burn scars, contractures and other deformities which collectively have aesthetic and functional considerations. This article gives an overview of the post-burn scars and scar contractures, especially their prevention, minimisation and principles of management.

  18. Effects of contracture on gait kinematics: A systematic review.

    Science.gov (United States)

    Attias, Michael; Chevalley, Odile; Bonnefoy-Mazure, Alice; De Coulon, Geraldo; Cheze, Laurence; Armand, Stéphane

    2016-03-01

    Contractures of a major joint in the lower limbs may impair human walking in addition to other daily living activities. A contracture is defined as the inability of a joint to perform the full range of motion and excessive resistance during passive mobilization of the joint. Few studies have reported methods describing how to evaluate contractures. Understanding the association among all of these studies seems essential to improve patient management. Therefore, we conducted a systematic review on this topic to elucidate the influence of contractures on gait kinematics. An electronic search in the literature will be conducted. Studies were screened by title and abstract and full texts were evaluated secondarily for definitive inclusion. The quality of the included studies was assessed independently by the two review authors with the Modified Quality Assessment Checklist. The included studies were separated into three categories: pathological contracture versus healthy controls (descriptive), simulated contracture versus healthy controls (experimental), and pre- and post-kinematics after surgical muscle lengthening (surgery). From a total of 4402 references, 112 original articles were selected, and 28 studies were identified in this systematic review. No significant difference between raters was observed on the total score of the Modified Quality Assessment Checklist. Contractures influence walking depending on the location (muscle) and the contracture level (muscle-tendon length). After giving a definition of contracture, this review identified some contracture alterations, such as plantarflexion, knee flexion and hip flexion contractures, with a kinematic description and presented possible different compensations. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Osteogenesis imperfecta with joint contractures: Bruck syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Blacksin, M.F. [Department of Radiology, University of Medicine and Dentistry of New Jersey, 150 Bergen St., Rm. C320, Newark, NJ 07103-2426 (United States); Pletcher, B.A. [Center for Human and Molecular Genetics, Department of Pediatrics, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (United States); David, M. [Department of Radiology, Newark-Beth Israel Medical Center, Newark, New Jersey (United States)

    1998-02-01

    We describe an Egyptian boy with osteogenesis imperfecta who was born with thumb contractures and bilateral antecubital pterygia. He was seen at 16 months of age with femur and tibial fractures, thoracic vertebral compression fractures, scoliosis and Wormian bones. The findings are consistent with a diagnosis of Bruck syndrome. (orig.) With 1 fig., 5 refs.

  20. Volkmann's Ischemic Contracture Treatment: Our Experience ...

    African Journals Online (AJOL)

    Background: Volkmann's Ischemic Contracture (VIC) follows treatment of limb fractures by traditional bone setters in our environment and usually present for treatment of the deformity. Objectives: This study highlights the result of treatment by tendon elongation and subsequent physiotherapy. Methods: All patients ...

  1. Second-generation stars in globular clusters from rapid radiative cooling of pre-supernova massive star winds

    Science.gov (United States)

    Lochhaas, Cassandra; Thompson, Todd A.

    2017-09-01

    Following work by Wünsch and collaborators, we investigate a self-enrichment scenario for second-generation star formation in globular clusters wherein wind material from the first-generation massive stars rapidly radiatively cools. Radiative energy loss allows retention of fast winds within the central regions of clusters, where it fuels star formation. Secondary star formation occurs in ˜3-5 Myr, before supernovae, producing uniform iron abundances in both populations. We derive the critical criteria for radiative cooling of massive star winds and the second-generation mass as a function of cluster mass, radius and metallicity. We derive a critical condition on M/R, above which second-generation star formation can occur. We speculate that above this threshold the strong decrease in the cluster wind energy and momentum allows ambient gas to remain from the cluster formation process. We reproduce large observed second-generation fractions of ˜30-80 per cent if wind material mixes with ambient gas. Importantly, the mass of ambient gas required is only of order the first generation's stellar mass. Second-generation helium enrichment ΔY is inversely proportional to mass fraction in the second generation; a large second generation can form with ΔY ˜ 0.001-0.02, while a small second generation can reach ΔY ˜ 0.16. Like other self-enrichment models for the second generation, we are not able to simultaneously account for both the full range of the Na-O anticorrelation and the second-generation fraction.

  2. Polyphase exhumation in the western Qinling Mountains, China: Rapid Early Cretaceous cooling along a lithospheric-scale tear fault and pulsed Cenozoic uplift.

    Science.gov (United States)

    Heberer, Bianca; Anzenbacher, Thomas; Neubauer, Franz; Genser, Johann; Dong, Yunpeng; Dunkl, István

    2014-03-17

    The western sector of the Qinling-Dabie orogenic belt plays a key role in both Late Jurassic to Early Cretaceous "Yanshanian" intracontinental tectonics and Cenozoic lateral escape triggered by India-Asia collision. The Taibai granite in the northern Qinling Mountains is located at the westernmost tip of a Yanshanian granite belt. It consists of multiple intrusions, constrained by new Late Jurassic and Early Cretaceous U-Pb zircon ages (156 ± 3 Ma and 124 ± 1 Ma). Applying various geochronometers ( 40 Ar/ 39 Ar on hornblende, biotite and K-feldspar, apatite fission-track, apatite [U-Th-Sm]/He) along a vertical profile of the Taibai Mountain refines the cooling and exhumation history. The new age constraints record the prolonged pre-Cenozoic intracontinental deformation as well as the cooling history mostly related to India-Asia collision. We detected rapid cooling for the Taibai granite from ca. 800 to 100 °C during Early Cretaceous (ca. 123 to 100 Ma) followed by a period of slow cooling from ca. 100 Ma to ca. 25 Ma, and pulsed exhumation of the low-relief Cretaceous peneplain during Cenozoic times. We interpret the Early Cretaceous rapid cooling and exhumation as a result from activity along the southern sinistral lithospheric scale tear fault of the recently postulated intracontinental subduction of the Archean/Palaeoproterozoic North China Block beneath the Alashan Block. A Late Oligocene to Early Miocene cooling phase might be triggered either by the lateral motion during India-Asia collision and/or the Pacific subduction zone. Late Miocene intensified cooling is ascribed to uplift of the Tibetan Plateau.

  3. Complications Following Collagenase Treatment for Dupuytren Contracture.

    Science.gov (United States)

    Wozniczka, Jennifer; Canepa, Clifford; Mirarchi, Adam; Solomon, Joel S

    2017-09-01

    Collagenase Clostridium histolyticum (CCH) injection and manipulation is a relatively new method for treating Dupuytren contracture that is growing in popularity. Although side effects such as swelling and ecchymosis are common, they are typically mild and self-limited. Major complications are rare but have included flexor tendon rupture and complex regional pain syndrome. This study describes a case report of 2 patients seen at our institution. Here, we report 2 patients seen at our institution each with different, yet serious complications after CCH injection and manipulation. One patient had extensive skin loss and chose amputation over reconstruction. The other patient had loss of perfusion and required finger amputation. Although it is unclear how directly the administration of CCH is connected to the observed complications, physicians should recognize the potential for serious rare complications in any treatment of Dupuytren contracture.

  4. Injectable collagenase clostridium histolyticum for Dupuytren's contracture.

    Science.gov (United States)

    Hurst, Lawrence C; Badalamente, Marie A; Hentz, Vincent R; Hotchkiss, Robert N; Kaplan, F Thomas D; Meals, Roy A; Smith, Theodore M; Rodzvilla, John

    2009-09-03

    Dupuytren's disease limits hand function, diminishes the quality of life, and may ultimately disable the hand. Surgery followed by hand therapy is standard treatment, but it is associated with serious potential complications. Injection of collagenase clostridium histolyticum, an office-based, nonsurgical option, may reduce joint contractures caused by Dupuytren's disease. We enrolled 308 patients with joint contractures of 20 degrees or more in this prospective, randomized, double-blind, placebo-controlled, multicenter trial. The primary metacarpophalangeal or proximal interphalangeal joints of these patients were randomly assigned to receive up to three injections of collagenase clostridium histolyticum (at a dose of 0.58 mg per injection) or placebo in the contracted collagen cord at 30-day intervals. One day after injection, the joints were manipulated. The primary end point was a reduction in contracture to 0 to 5 degrees of full extension 30 days after the last injection. Twenty-six secondary end points were evaluated, and data on adverse events were collected. Collagenase treatment significantly improved outcomes. More cords that were injected with collagenase than cords injected with placebo met the primary end point (64.0% vs. 6.8%, P Dupuytren's disease. (ClinicalTrials.gov number, NCT00528606.) 2009 Massachusetts Medical Society

  5. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice

    Directory of Open Access Journals (Sweden)

    Hannah Headon

    2015-09-01

    Full Text Available Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured implants, a subglandular (vs. submuscular placement, use of a silicone (vs. saline filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer.

  6. Joint contracture following prolonged stay in the intensive care unit

    Science.gov (United States)

    Clavet, Heidi; Hébert, Paul C.; Fergusson, Dean; Doucette, Steve; Trudel, Guy

    2008-01-01

    Background Prolonged immobility during a critical illness may predispose patients to the development of joint contracture. We sought to document the incidence of, the risk factors for and the reversibility of joint contractures among patients who stayed in a tertiary intensive care unit (ICU) for 2 weeks or longer. Methods We conducted a chart review to collect data on the presence of and risk factors for joint contractures in the shoulders, elbows, hips, knees and ankles among patients admitted to the ICU between January 2003 and March 2005. Results At the time of transfer out of the ICU, at least 1 joint contracture was recorded in 61 (39%) of 155 patients; 52 (34%) of the patients had joint contractures of an extent documented to impair function. Time spent in the ICU was a significant risk factor for contracture: a stay of 8 weeks or longer was associated with a significantly greater risk of any joint contracture than a stay of 2 to 3 weeks (adjusted odds ratio [OR] 7.09, 95% confidence interval (CI) 1.29–38.9; p = 0.02). Among the variables tested, only the use of steroids conferred a protective effect against joint contractures (adjusted OR 0.35, 95% CI 0.14–0.83; p = 0.02). At the time of discharge to home, which occurred a median of 6.6 weeks after transfer out of intensive care, 50 (34%) of the 147 patients not lost to follow-up still had 1 or more joint contractures, and 34 (23%) of the patients had at least 1 functionally significant joint contracture. Interpretation Following a prolonged stay in the ICU, a functionally significant contracture of a major joint occurred in more than one-third of patients, and most of these contractures persisted until the time of discharge to home. PMID:18332384

  7. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice

    Science.gov (United States)

    Headon, Hannah; Kasem, Adbul

    2015-01-01

    Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer. PMID:26430623

  8. Postburn Neck Lateral Contracture Anatomy and Treatment: A New Approach.

    Science.gov (United States)

    Grishkevich, Viktor M; Grishkevich, Max

    2015-01-01

    Lateral contracture of the neck is a rare and insufficiently researched burn consequent. Contracture restricts head motion, can cause a secondary face deformity, presents severe cosmetic defects, and, therefore, requires surgical reconstruction. Literature does not sufficiently address the issue; therefore, anatomy not researched and treatment techniques not developed. The anatomy of postburn lateral cervical flexion contracture was studied in 21 operated patients. Using obtained data, new approaches were investigated, which were directed toward maximal efficacy of the local tissues use. Follow-up results were observed from 6 months to 9 years. Lateral cervical contractures were divided into two types based on their anatomy: edge and medial. Edge contractures were caused by burns and scars located on the posterior neck surface and were characterized by the presence of the fold in central lateral zone. In the fold, only one (posterior) sheet is scars that cause the contracture. Medial contractures were caused by scars located on the lateral cervical surface and were characterized by the presence of the fold in which both sheets were scars. In both types, contracture was caused by scar sheet surface deficiency in length, which has a trapezoid form (contracture cause). In all cases, there was surface surplus in the fold's sheets allowed contracture release with local tissue. The technique that allows the maximum local tissue use and ensures full contracture elimination is the trapeze-flap plasty. Two anatomic types of lateral cervical scar contractures were identified: edge and medial. An anatomically justified efficacy reconstructive technique for both types is trapeze-flap plasty.

  9. THE FORMATION OF SECONDARY STELLAR GENERATIONS IN MASSIVE YOUNG STAR CLUSTERS FROM RAPIDLY COOLING SHOCKED STELLAR WINDS

    Energy Technology Data Exchange (ETDEWEB)

    Wünsch, R.; Palouš, J.; Ehlerová, S. [Astronomical Institute, Academy of Sciences of the Czech Republic, Boční II 1401, 141 31 Prague (Czech Republic); Tenorio-Tagle, G. [Instituto Nacional de Astrofísica Optica y Electrónica, AP 51, 72000 Puebla, México (Mexico)

    2017-01-20

    We study a model of rapidly cooling shocked stellar winds in young massive clusters and estimate the circumstances under which secondary star formation, out of the reinserted winds from a first stellar generation (1G), is possible. We have used two implementations of the model: a highly idealized, computationally inexpensive, spherically symmetric semi-analytic model, and a complex, three-dimensional radiation-hydrodynamic, simulation; they are in a good mutual agreement. The results confirm our previous findings that, in a cluster with 1G mass 10{sup 7} M {sub ⊙} and half-mass–radius 2.38 pc, the shocked stellar winds become thermally unstable, collapse into dense gaseous structures that partially accumulate inside the cluster, self-shield against ionizing stellar radiation, and form the second generation (2G) of stars. We have used the semi-analytic model to explore a subset of the parameter space covering a wide range of the observationally poorly constrained parameters: the heating efficiency, η {sub he}, and the mass loading, η {sub ml}. The results show that the fraction of the 1G stellar winds accumulating inside the cluster can be larger than 50% if η {sub he} ≲ 10%, which is suggested by the observations. Furthermore, for low η {sub he}, the model provides a self-consistent mechanism predicting 2G stars forming only in the central zones of the cluster. Finally, we have calculated the accumulated warm gas emission in the H30 α recombination line, analyzed its velocity profile, and estimated its intensity for super star clusters in interacting galaxies NGC4038/9 (Antennae) showing that the warm gas should be detectable with ALMA.

  10. Rapid quantification of viable Legionella in nuclear cooling tower waters using filter cultivation, fluorescent in situ hybridization and solid-phase cytometry.

    Science.gov (United States)

    Baudart, J; Guillaume, C; Mercier, A; Lebaron, P; Binet, M

    2015-05-01

    To develop a rapid and sensitive method to quantify viable Legionella spp. in cooling tower water samples. A rapid, culture-based method capable of quantifying as few as 600 Legionella microcolonies per litre within 2 days in industrial waters was developed. The method combines a short cultivation step of microcolonies on GVPC agar plate, specific detection of Legionella cells by a fluorescent in situ hybridization (FISH) approach, and a sensitive enumeration using a solid-phase cytometer. Following optimization of the cultivation conditions, the qualitative and quantitative performance of the method was assessed and the method was applied to 262 nuclear power plant cooling water samples. The performance of this method was in accordance with the culture method (NF-T 90-431) for Legionella enumeration. The rapid detection of viable Legionella in water is a major concern to the effective monitoring of this pathogenic bacterium in the main water sources involved in the transmission of legionellosis infection (Legionnaires' disease). The new method proposed here appears to be a robust, efficient and innovative means for rapidly quantifying cultivable Legionella in cooling tower water samples within 48 h. © 2015 The Society for Applied Microbiology.

  11. Incidence of postoperative elbow contracture release in New York State.

    Science.gov (United States)

    Schrumpf, Mark A; Lyman, Stephen; Do, Huong; Schreiber, Joseph J; Gay, David M; Marx, Robert; Daluiski, Aaron

    2013-09-01

    To determine the incidence of elbow contracture requiring release after surgically treated elbow trauma and to identify patient, injury, and treatment factors that may predict contracture development. The New York Statewide Planning and Research Cooperative System database identified 32,708 patients who were surgically treated for elbow trauma from 1997 to 2009. The database identified 270 of those patients who underwent subsequent contracture release. The median time from index fracture procedure to contracture release was 31 weeks. Patients requiring a contracture release were younger (43 vs 56 y) and more commonly male (57%). Injuries classified as severe were more common in the contracture group (11% vs 5%), as were open fractures (17% vs 11%). A multivariate regression analysis revealed that patients with burns were 16 times more likely to require surgical contracture release, and the use of internal fixation to treat the fracture was protective against contracture development. The incidence of elbow contractures treated with release after surgically treated elbow trauma was low but increased with the severity of the initial trauma. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. [Muscle contractures. Essay on a physiopathological approach to clarify the nomenclature].

    Science.gov (United States)

    Serratrice, G; Rowland, L P

    1999-09-25

    There is a good deal of confusion in the international literature concerning the use of the term contracture. A pathophysiological approach would help in defining a more precise terminology. Antalgic contracture principally concerns a compensating phenomenon related to a polysynaptic reflex Painful contracture includes different varieties of cramps and metabolic-induced contractures. Painless contracture groups together myostatic and myostatic contractures. We suggest a simplified nomenclature.

  13. Avoiding unfavorable results in postburn contracture hand

    Directory of Open Access Journals (Sweden)

    Sameek Bhattacharya

    2013-01-01

    Full Text Available Deformities of the hands are a fairly common sequel of burn especially in the developing world. This is because of high incidence of burns, limited access to standard treatment and rehabilitation. The best outcome of a burnt hand is when deformities are prevented from developing. A good functional result is possible when due consideration is paid to hands during resuscitation, excisional surgery, reconstructive surgery and physiotherapy. The post-burns deformities of hand develop due direct thermal damage or secondary to intrinsic minus position due to oedema or vascular insufficiency. During the acute phase the concerns are, maintenance circulation minimize oedema prevent unphysiological positioning and wound closure with autogenous tissue as soon as possible. The rehabilitation program during the acute phase starts from day one and goes on till the hand has healed and has regained full range of motion. Full blown hand contractures are challenging to correct and become more difficult as time passes. Long-standing cases often land up with attenuation of extensor apparatus leading to swan neck and boutonniere deformity, muscle shortening and bony ankylosis. The major and most common pitfall after contracture release is relapse. The treatment protocol of contracture is solely directed towards countering this tendency. This article aims to guide a surgeon in obtaining optimal hand function and avoid pit falls at different stages of management of hand burns. The reasons of an unfavourable outcome of a burnt hand are possible lack of optimal care in the acute phase, while planning and performing reconstructive procedure and during aftercare and rehabilitation.

  14. Avoiding unfavorable results in postburn contracture hand

    Science.gov (United States)

    Bhattacharya, Sameek

    2013-01-01

    Deformities of the hands are a fairly common sequel of burn especially in the developing world. This is because of high incidence of burns, limited access to standard treatment and rehabilitation. The best outcome of a burnt hand is when deformities are prevented from developing. A good functional result is possible when due consideration is paid to hands during resuscitation, excisional surgery, reconstructive surgery and physiotherapy. The post-burns deformities of hand develop due direct thermal damage or secondary to intrinsic minus position due to oedema or vascular insufficiency. During the acute phase the concerns are, maintenance circulation minimize oedema prevent unphysiological positioning and wound closure with autogenous tissue as soon as possible. The rehabilitation program during the acute phase starts from day one and goes on till the hand has healed and has regained full range of motion. Full blown hand contractures are challenging to correct and become more difficult as time passes. Long-standing cases often land up with attenuation of extensor apparatus leading to swan neck and boutonniere deformity, muscle shortening and bony ankylosis. The major and most common pitfall after contracture release is relapse. The treatment protocol of contracture is solely directed towards countering this tendency. This article aims to guide a surgeon in obtaining optimal hand function and avoid pit falls at different stages of management of hand burns. The reasons of an unfavourable outcome of a burnt hand are possible lack of optimal care in the acute phase, while planning and performing reconstructive procedure and during aftercare and rehabilitation. PMID:24501479

  15. Prevalence of scar contractures after burn : A systematic review

    NARCIS (Netherlands)

    Oosterwijk, Anouk M; Mouton, Leonora J; Schouten, Hennie; Disseldorp, Laurien M; van der Schans, Cees P.; Nieuwenhuis, Marianne K

    OBJECTIVE: Burn scar contractures are the pathological outcome of excessive scarring and ongoing scar contraction. Impairment of joint range of motion is a threat to performing activities in daily living. To direct treatment strategies to prevent and/or correct such contractures, insight into the

  16. management of contractures: a five-year experience at komfo ...

    African Journals Online (AJOL)

    David Ofori-Adjei

    2011-06-01

    Jun 1, 2011 ... This classification is useful for assessing function be- fore and after surgical and physical management of contractures, though it lacks the scope of the socio- cultural handicaps contained in the WHO classifica- tion. Patients with contractures in Grade III and IV of this modified classification had surgical ...

  17. Results of surgical treatment of quadriceps femoris/ contracture in ...

    African Journals Online (AJOL)

    knee was grouped as follows: two cases had dislocated knees, three had hyperextension contractures, thirteen (0-30 degrees) ... Conclusion: Quadriceps femoris/contracture responds well to surgical treatment with an expected gain in flexion of 94.7 .... physiotherapy and manipulation were ineffective except in mild and ...

  18. Experimental model of capsular contracture in silicone implants

    Directory of Open Access Journals (Sweden)

    Bastos Érika Malheiros

    2003-01-01

    Full Text Available The breast implant procedure is one of the most performed into Plastic Surgery and the contracture that occurs the capsule formed around the breast implants one of most frequent complication. We describe here one experimental model of capsule contracture in rats.

  19. G. Dupuytren's contracture: an inaccurate denomination.

    Science.gov (United States)

    Vrebos, J

    2009-10-01

    The question of priority in describing 'Dupuytren's disease' as a result of permanent retraction of the palmar aponeurosis has been debated for a long time. This article tries to identify the pioneers who were involved in the research of the origin of permanent contracture of fingers and palm of the hand, and to find out to whom the priority of this affection should be attributed. Selected passages of several authors, as well as of Dupuytren's writings (mainly in italics and translated into English) are used to try and find the truth concerning the primary description of the disease.

  20. Potassium-induced contractures in crab (Callinectes danae) muscle fibers.

    Science.gov (United States)

    Leal-Cardoso, J H; Suarez-Kurtz, G

    1984-01-01

    The contractures induced by 20-200 mM [K+]o in single crab muscle fibers were resolved into two components. The first component, consisting of single twitches or brief tetanic contractions, was associated with electrogenic membrane responses. The second occurred after spiking subsided with an amplitude that increased linearly with the [K+]o between 20 and 90 mM. The amplitude and time course of the contractures elicited by a given [K+]o differed markedly between different fibers. Contracture reproducibility of a single fiber was best when 90 mM [K+]o was used. The K-induced contractures were abolished after brief (3 min) exposure of the fibers to a calcium-free solution and were greatly depressed by 8 mM procaine. The data suggest that the contractures require both Ca2+-influx across the sarcolemma and release of Ca2+ stored in the sarcoplasmic reticulum.

  1. Muscle contracture diagnosis: the role of sonoelastography.

    Science.gov (United States)

    Bruschetta, Daniele; Milardi, Demetrio; Trimarchi, Fabio; DI Mauro, Debora; Valenti, Andrea; Arrigo, Alessandro; Valenti, Barbara; Santoro, Giuseppe; Cascio, Filippo; Vaccarino, Gianluigi; Cacciola, Alberto

    2016-12-01

    Sonoelastography plays today a major role in musculoskeletal disease, showing minor muscle injuries not well appreciable in conventional B-mode ultrasonography and integrating it in major muscle injuries diagnosis. The aim of this study was to demonstrate the ability of elastosonography in the diagnosis of muscular contracture in football players presenting negative basic echography. We examined twenty-two football players using basic echography and elastosonography approximately 24-48 hours after the traumatic event and we subsequently re-evaluated them after two weeks. Conventional echography showed, in the early stage, no muscle injuries; in twenty-two out of twenty-two patients, sonoelastography had instead underlined a heterogeneous colorimetric map, related to decreased elasticity in the area of the muscle contracture. An evaluation effected 1-2 weeks later showed a clear improvement of the sonoelastographic appearance. This information will be useful for prognostication, post-traumatic monitoring and to detect subclinical changes in MIs even before there are changes on the routine B-mode ultrasound.

  2. Rapid atmospheric CO2 changes associated with the 8,200-years-B.P. cooling event

    NARCIS (Netherlands)

    Wagner, F.; Aaby, B.; Visscher, H.

    2002-01-01

    By applying the inverse relation between numbers of leaf stomata and atmospheric CO2 concentration, stomatal frequency analysis of fossil birch leaves from lake deposits in Denmark reveals a century-scale CO2 change during the prominent Holocene cooling event that occurred in the North Atlantic

  3. Rapid Cooling Of The Neutron Star In The Quiescent Super-Eddington Transient XTE J1701-462

    NARCIS (Netherlands)

    Fridriksson, Joel K.; Homan, J.; Wijnands, R.; Mendez, M.; Cackett, E. M.; Altamirano, D.; Belloni, T. M.; Brown, E. F.; Degenaar, N.; Lewin, W. H. G.

    2010-01-01

    In the past decade the observing of cooling neutron star transients after long-duration (year or longer) outbursts has entered as a new approach to constraining the properties of matter inside neutron stars. We present Chandra and XMM-Newton observations of the super-Eddington neutron star transient

  4. Rapid Cooling of the Neutron Star in the Quiescent Super-Eddington Transient XTE J1701--462

    NARCIS (Netherlands)

    Fridriksson, Joel K.; Homan, Jeroen; Wijnands, Rudy; Méndez, Mariano; Cackett, Edward M.; Altamirano, Diego; Belloni, Tomaso M.; Brown, Edward F.; Degenaar, Nathalie; Lewin, Walter H. G.

    2009-01-01

    In the past decade the observing of cooling neutron star transients after long-duration (year or longer) outbursts has entered as a new approach to constraining the properties of matter inside neutron stars. We present Chandra and XMM-Newton observations of the super-Eddington neutron star transient

  5. Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment: the importance of clear definitions.

    Science.gov (United States)

    Werker, Paul M N; Pess, Gary M; van Rijssen, Annet L; Denkler, Keith

    2012-10-01

    To call attention to the wide variety of definitions for recurrence that have been employed in studies of different invasive procedures for the treatment of Dupuytren contracture and how this important limitation has contributed to the wide range of reported results. This study reviewed definitions and rates of contracture correction and recurrence in patients undergoing invasive treatment of Dupuytren contracture. A literature search was carried out in January 2011 using the terms "Dupuytren" AND ("fasciectomy" OR "fasciotomy" OR "dermofasciectomy" OR "aponeurotomy" OR "aponeurectomy") and limited to studies in English. The search returned 218 studies, of which 21 had definitions, quantitative results for contracture correction and recurrence, and a sample size of at least 20 patients. Definitions for correction of contracture and recurrence varied greatly among articles and were almost always qualitative. Percentages of patients who achieved correction of contracture (ie, responder rate) when evaluated at various times after completion of surgery ranged from 15% to 96% for fasciectomy/aponeurectomy. Responder rates were not reported for fasciotomy/aponeurotomy. Recurrence rates ranged from 12% to 73% for patients treated with fasciectomy/aponeurectomy and from 33% to 100% for fasciotomy/aponeurotomy. Review of these reports underscored the difficulty involved in comparing correction of contracture and recurrence rates for different surgical interventions because of differences in definition and duration of follow-up. Clearly defined objective definitions for correction of contracture and for recurrence are needed for more meaningful comparisons of results achieved with different surgical interventions. Recurrence after surgical intervention for Dupuytren contracture is common. This study, which evaluated reported rates of recurrence following surgical treatment of Dupuytren contracture, provides clinicians with practical information regarding expected long

  6. Effect of Mn and Fe on the Formation of Fe- and Mn-Rich Intermetallics in Al-5Mg-Mn Alloys Solidified Under Near-Rapid Cooling.

    Science.gov (United States)

    Liu, Yulin; Huang, Gaoren; Sun, Yimeng; Zhang, Li; Huang, Zhenwei; Wang, Jijie; Liu, Chunzhong

    2016-01-29

    Mn was an important alloying element used in Al-Mg-Mn alloys. However, it had to be limited to a low level (alloy with low Fe content (alloys (0.5 wt % Fe), intermetallic Al₆(Fe,Mn) became the dominant phase, even in the alloy with low Mn content (0.39 wt %). Cooling rate played a critical role in the refinement of the intermetallics. Under near-rapid cooling, intermetallic Al₆(Fe,Mn) was extremely refined. Even in the high Mn and/or high-Fe-containing alloys, it still demonstrated fine Chinese script structures. However, once the alloy composition passed beyond the eutectic point, the primary intermetallic Al₆(Fe,Mn) phase displayed extremely coarse platelet-like morphology. Increasing the content of Fe caused intermetallic Al₆(Fe,Mn) to become the primary phase at a lower Mn content.

  7. Effect of Mn and Fe on the Formation of Fe- and Mn-Rich Intermetallics in Al–5Mg–Mn Alloys Solidified Under Near-Rapid Cooling

    Science.gov (United States)

    Liu, Yulin; Huang, Gaoren; Sun, Yimeng; Zhang, Li; Huang, Zhenwei; Wang, Jijie; Liu, Chunzhong

    2016-01-01

    Mn was an important alloying element used in Al–Mg–Mn alloys. However, it had to be limited to a low level (alloy with low Fe content (alloys (0.5 wt % Fe), intermetallic Al6(Fe,Mn) became the dominant phase, even in the alloy with low Mn content (0.39 wt %). Cooling rate played a critical role in the refinement of the intermetallics. Under near-rapid cooling, intermetallic Al6(Fe,Mn) was extremely refined. Even in the high Mn and/or high-Fe-containing alloys, it still demonstrated fine Chinese script structures. However, once the alloy composition passed beyond the eutectic point, the primary intermetallic Al6(Fe,Mn) phase displayed extremely coarse platelet-like morphology. Increasing the content of Fe caused intermetallic Al6(Fe,Mn) to become the primary phase at a lower Mn content. PMID:28787888

  8. Prevalence of scar contractures after burn: A systematic review.

    Science.gov (United States)

    Oosterwijk, Anouk M; Mouton, Leonora J; Schouten, Hennie; Disseldorp, Laurien M; van der Schans, Cees P; Nieuwenhuis, Marianne K

    2017-02-01

    Burn scar contractures are the pathological outcome of excessive scarring and ongoing scar contraction. Impairment of joint range of motion is a threat to performing activities in daily living. To direct treatment strategies to prevent and/or correct such contractures, insight into the prevalence, course, and determinants is essential. A literature search was conducted including Pubmed, Cochrane library, CINAHL, and PEDro. Articles were included if they provided burn scar contracture data to calculate the point prevalence. The quality of the articles was scored. Data were extracted regarding study, subject and burn characteristics, method of scar contracture assessment, point prevalence, and possible determinants. Nine articles and one abstract could be included for data extraction. The prevalence at discharge was 38-54%, but with a longer time after burn, the prevalence was lower. Contractures were more likely to occur in more severe burns, flame burns, children, female, the cervical spine, and the upper extremity. The prevalence of burn scar contractures varies considerably between studies. When prevalence is unclear, it is also difficult to investigate potential determinants and evaluate changes in interventions. There is a need for extensive, well-designed longitudinal (inter)national studies that investigate prevalence of scar contractures, their evolvement over time, and risk factors. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  9. TREATMENT OF POSTTRAUMATIC ISCHEMIC CONTRACTURES OF THE THUMB

    Directory of Open Access Journals (Sweden)

    K. S. Melikhov

    2010-01-01

    Full Text Available Results of surgical treatment of 21 patients with posttraumatic ischemic contractures of the first finger of a hand were analyzed. The working classification in which there are three degrees of a contracture depending on size of deficiency of a dermal cord of the first interdigital interval was offered. Advanced tactics of surgical treatment of such pathology was developed. Thus, during the first stage we carried out abduction of the first finger by the elimination of cicatrical, muscle and arthrogenic contracture components. At the second stage of treatment, if it was necessary, active opposition of the first finger was restored.

  10. Evidence-based medicine: Dupuytren contracture.

    Science.gov (United States)

    Eaton, Charles

    2014-05-01

    After studying this article, the participant should be able to: (1) Describe features and clinical importance of Dupuytren diathesis. (2) Explain the difference between the new definition of recurrence used in collagenase studies compared with prior definitions of recurrence. (3) Compare and list the main advantage/main disadvantage of fasciectomy versus minimally invasive treatment (collagenase injection or needle aponeurotomy) of Dupuytren contracture. The large body of existing literature on Dupuytren disease is spread across many journals in many specialties. It is thus a daunting task for practitioners to follow trends and practice recommendations. It is also a testimony to the lack of an acceptable solution to this common problem. Recent publications provide evidence to highlight controversies and challenge some traditional teachings. Literature from 2010 to 2012 was reviewed with the intent of clarifying some of these issues.

  11. [Dupuytren's contracture: surgery is no longer necessary].

    Science.gov (United States)

    Lellouche, Henri

    2008-12-01

    Dupuytren contracture or disease of the hand is the retraction of the palmar aponeurosis. Its course is progressive and leads to an irreducible flexion deformity of one or more fingers. Early diagnosis is necessary for the table test, which determines the need for treatment. Needle aponeurotomy should be the first option treatment. This minimally invasive outpatient procedure minimizes sick leave and does not require immobilization or physical therapy. Several studies confirmed the short- and intermediate-term effectiveness of this treatment and the minimal side effects when performed by experienced operators. Multiple procedures for extensive disease (several knots) can be performed in the hospital. Close medical and surgical collaboration is necessary for treatment of severe forms, treatment failures, and multiple recurrences.

  12. Coexisting Acquired Digital Fibrokeratoma and Dupuytren′s Contracture

    Directory of Open Access Journals (Sweden)

    K Pavithran

    1986-01-01

    Full Text Available A 38 year old male developed acquired digital fibrokeratomas on the right hand associated with Dupuytren′s contracture on the left hand. The possible relationship between these two fibrodysplastic conditions is considered.

  13. [Management of Flexion Contracture in Primary Total Knee Arthroplasty].

    Science.gov (United States)

    Hube, R; Mayr, H O; Pfitzner, T; von Roth, P

    2015-06-01

    Flexion contracture is a common deformity of the arthritic knee. The present publication describes causes, clinical relevance and surgical technique in the presence of flexion contractures in total knee arthroplasty. Flexion contracture can be attributed to different causes. Basically it is a mismatch between flexion and extension gaps. Moderate and severe deformities have to be corrected by additional surgical interventions. In most cases soft tissue techniques with release of contracted structures, the removal of osteophytes and additional distal femoral bone resection are necessary. The goal of these interventions is to achieve full extension of the knee. During rehabilitation attention has to be paid to maintain it with intensive physical therapy. A remaining flexion contracture is associated with inferior functional outcome and persistent pain. Georg Thieme Verlag KG Stuttgart · New York.

  14. Investigating cryoinjury using simulations and experiments. 1: TF-1 cells during two-step freezing (rapid cooling interrupted with a hold time).

    Science.gov (United States)

    Ross-Rodriguez, L U; Elliott, J A W; McGann, L E

    2010-08-01

    There is significant interest in designing a cryopreservation protocol for hematopoietic stem cells (HSC) which does not rely on dimethyl sulfoxide (Me(2)SO) as a cryoprotectant. Computer simulations that describe cellular osmotic responses during cooling and warming can be used to optimize the viability of cryopreserved HSC; however, a better understanding of cellular osmotic parameters is required for these simulations. As a model for HSC, the erythroleukemic human cell line TF-1 was used in this study. Simulations, based on the osmotic properties of TF-1 cells and on the solution properties of the intra- and extracellular compartments, were used to interpret cryoinjury associated with a two-step cryopreservation protocol. Calculated intracellular supercooling was used as an indicator of cryoinjury related to intracellular ice formation. Simulations were applied to the two-step cooling protocol (rapid cooling interrupted with a hold time) for TF-1 cells in the absence of Me(2)SO or other cryoprotectants and optimized by minimizing the indicator of cryoinjury. A comparison of simulations and experimental measurements of membrane integrity supports the concept that, for two-step cooling, increasing intracellular supercooling is the primary contributor to potential freezing injury due to the increase in the likelihood of intracellular ice formation. By calculating intracellular supercooling for each step separately and comparing these calculations with cell recovery data, it was demonstrated that it is not optimal simply to limit overall supercooling during two-step freezing procedures. More aptly, appropriate limitations of supercooling differ from the first step to the second step. This study also demonstrates why high cell recovery after cryopreservation could be achieved in the absence of traditional cryoprotectants. (c) 2010 Elsevier Inc. All rights reserved.

  15. Association between plantar fasciitis and isolated contracture of the gastrocnemius.

    Science.gov (United States)

    Patel, Amar; DiGiovanni, Benedict

    2011-01-01

    Current evidence suggests that limited ankle dorsiflexion is an etiologic factor for plantar fasciitis. This limitation can arise from either an isolated contracture of the gastrocnemius or from a contracture of the gastrocnemius-soleus complex. This study's aim was to determine the proportion of patients with plantar fasciitis that have an associated isolated gastrocnemius contracture. This investigation was a prospective evaluation of patients with either acute or chronic plantar fasciitis. Two hundred fifty-four patients with plantar fasciitis were included. Patients were assessed for the existence of limited ankle dorsiflexion which was further characterized by noting the presence of an isolated gastrocnemius contracture or contracture of the gastrocnemius-soleus complex. The patient's duration of symptoms, type of occupation, and body mass index were also documented. Patients with acute plantar fasciitis were defined as having symptom duration of 9 months or less while those with chronic plantar fasciitis were those with over 9 months of symptoms. The Wilcoxon rank sum and chi square tests were used to compare characteristics between the acute and chronic populations. Eighty-three percent (211 of 254 patients) had limited ankle dorsiflexion. Fifty-seven percent (145 of 254) had an isolated contracture of the gastrocnemius, 26% (66 of 254) had a contracture of the gastrocnemius-soleus complex, and 17% (43 of 254) did not have a dorsiflexion limitation. Patients were further stratified into acute versus chronic symptom duration at the time of presentation. Equinus contracture was noted in 83% (129 of 155) of acute cases, and 82% (82 of 99) of chronic cases. An isolated contracture of the gastrocnemius was found in 60% (93 of 155) of acute, and 52% (52 of 99) of chronic cases. A gastrocnemius-soleus complex contracture was noted in 23% (36 of 155) of acute cases, and 30% (30 of 99) of chronic cases. Patients with chronic plantar fasciitis had a significantly

  16. Capsular Contracture In Silicone Breast Implants: Insights From Rat Models

    Directory of Open Access Journals (Sweden)

    VILBERTO J. VIEIRA

    Full Text Available ABSTRACT Breast augmentation with silicone implants is one of the most common procedures performed by plastic surgeons around the world. Capsular contracture is a frequent complication in breast augmentation and reconstructive surgery, that requires invasive intervention. The inflammatory response to implanted mammary prostheses appears to be directly associated to capsular contracture. This review discusses the evidences from rat models studies, on the role of inflammation and fibrosis in capsular contraction and its relation to silicone breast implants surface.

  17. Dupuytren’s contracture: A demographic, retrospective analysis

    OpenAIRE

    ÇIRAKLI, Alper; PİŞKİN, Ahmet; ERDOĞAN, Murat; VARLI, Ali; ULUSOY, Serdar

    2013-01-01

    Dupuytren’s contracture is a pathological contracture of the palmar fascia which results in flexion deformity in the fingers, causing restricted movement. It is most frequently seen in elderly males, most commonly in the 4th and 5th fingers. Although the etiology of the disease is not fully known, various factors are held responsible. As there is fascia involvement, it may be seen in different areas of the body. Treatment includes conservative and surgical methods. It is important that the su...

  18. Rapid alkali catalyzed transesterification of microalgae lipids to biodiesel using simultaneous cooling and microwave heating and its optimization.

    Science.gov (United States)

    Chee Loong, Teo; Idris, Ani

    2014-12-01

    Biodiesel with improved yield was produced from microalgae biomass under simultaneous cooling and microwave heating (SCMH). Nannochloropsis sp. and Tetraselmis sp. which were known to contain higher lipid species were used. The yield obtained using this novel technique was compared with the conventional heating (CH) and microwave heating (MWH) as the control method. The results revealed that the yields obtained using the novel SCMH were higher; Nannochloropsis sp. (83.33%) and Tetraselmis sp. (77.14%) than the control methods. Maximum yields were obtained using SCMH when the microwave was set at 50°C, 800W, 16h of reaction with simultaneous cooling at 15°C; and water content and lipid to methanol ratio in reaction mixture was kept to 0 and 1:12 respectively. GC analysis depicted that the biodiesel produced from this technique has lower carbon components (<19 C) and has both reasonable CN and IV reflecting good ignition and lubricating properties. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Bacterial biofilms and capsular contracture in patients with breast implants.

    Science.gov (United States)

    Rieger, U M; Mesina, J; Kalbermatten, D F; Haug, M; Frey, H P; Pico, R; Frei, R; Pierer, G; Lüscher, N J; Trampuz, A

    2013-05-01

    It has been hypothesized that bacterial biofilms on breast implants may cause chronic inflammation leading to capsular contracture. The association between bacterial biofilms of removed implants and capsular contracture was investigated. Breast implants explanted between 2006 and 2010 at five participating centres for plastic and reconstructive surgery were investigated by sonication. Bacterial cultures derived from sonication were correlated with patient, surgical and implant characteristics, and the degree of capsular contracture. The study included 121 breast implants from 84 patients, of which 119 originated from women and two from men undergoing gender reassignment. Some 50 breast prostheses were implanted for reconstruction, 48 for aesthetic reasons and 23 implants were used as temporary expander devices. The median indwelling time was 4·0 (range 0·1-32) years for permanent implants and 3 (range 1-6) months for temporary devices. Excluding nine implants with clinical signs of infection, sonication cultures were positive in 40 (45 per cent) of 89 permanent implants and in 12 (52 per cent) of 23 temporary devices. Analysis of permanent implants showed that a positive bacterial culture after sonication correlated with the degree of capsular contracture: Baker I, two of 11 implants; Baker II, two of ten; Baker III, nine of 23; and Baker IV, 27 of 45 (P contracture, indicating the potential causative role of bacterial biofilms in the pathogenesis of capsular contracture. NCT01138891 (http://www.clinicaltrials.gov). © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

  20. The Stanford-ReSurge Burn Scar Contracture Scale for Neck: Development and Initial Validation for Burn Scar Contracture.

    Science.gov (United States)

    Cai, Lawrence; Puri, Vinita; Dangol, Mohan Krishna; Mannan, Iftekhar Ibne; Khundkar, Shafquat Hussain; Le Thua, Trung-Hau; Muguti, Godfrey; Rai, Shankar Man; Karanas, Yvonne; Chang, James

    2016-11-01

    Burn contractures can cause significant disability, particularly in patients in resource-limited settings. However, a gap exists in our ability to measure outcomes in patients with burn contractures of the neck. The objective of this study was to develop and validate the Stanford-ReSurge Burn Scar Contracture Scale-Neck to longitudinally assess functional status and measure functional improvement following contracture release of the neck. A literature review was performed to identify scales used in neck assessment and burn assessment. Items were then removed from the pool based on redundancy, feasibility, cultural appropriateness, and applicability to patients in international resource-limited environments. Remaining items were administered to patients with burn contracture of the neck. The initial literature review found 33 scales that were combined to create an initial pool of 714 items, which was first reduced to 40 items. Feedback from field testing then yielded a 20-item outcome tool to assess appearance, activities of daily living, somatosensation, satisfaction, and range of motion, with a floor of 20 and a ceiling score of 100 points. Preliminary testing with 10 patients showed an average preoperative score of 58 points and an average 1-month postoperative score of 42 points. The authors have created an outcome tool for measuring functional status following burn contracture release of the neck, which can easily be implemented in resource-limited settings where the burden of burn injuries and morbidities is disproportionately high. Ongoing work includes a multicountry study to evaluate validity and reliability.

  1. Can bipolar vaporization be considered an alternative energy source in the endoscopic treatment of urethral strictures and bladder neck contracture?

    Directory of Open Access Journals (Sweden)

    Erem K. Basok

    2008-10-01

    Full Text Available OBJECTIVE: We evaluated the outcome of bipolar energy by using PlasmaKinetic™ cystoscope instruments in the treatment of urethral stricture and bladder neck contracture. MATERIALS AND METHODS: Twenty-two male patients with urethral stricture and five with bladder neck contracture were treated by endoscopic bipolar vaporization. The most common etiology for stricture formation was iatrogenic (85.2% and the mean stricture length was 12.2 mm. All patients were evaluated with urethrography and uroflowmetry one month and 3 months after surgery. Urethroscopy was routinely performed at the end of the first year. Preoperative mean maximum flow rate (Q max was 4.9 mL/s for urethral stricture and mean Q max was 3.4 mL/s for bladder neck contracture. The results were considered as "successful” in patients where re-stenosis was not identified with both urethrography and urethroscopy. Minimum follow-up was 13.8 months (range 12 to 20. RESULTS: Tissue removal was rapid, bleeding was negligible and excellent visualization was maintained throughout the vaporization of the fibrotic tissue. Postoperative mean Q max was 14.9 mL/s and the success rate was 77.3% for urethral stricture at mean follow-up time of 14.2 months. The success rate was 60% with a mean follow-up time of 12.2 months for bladder neck contracture and the mean Q max was 16.2 mL/s, postoperatively. CONCLUSIONS: The study suggests that bipolar vaporization is a safe, inexpensive and reliable procedure with good results, minimal surgical morbidity, negligible blood loss, and thus, it could be considered as a new therapeutic option for the endoscopic treatment of urethral stricture and bladder neck contracture.

  2. Gluteal muscle contracture: diagnosis and management options

    Science.gov (United States)

    Rai, Saroj; Meng, Chunqing; Wang, Xiaohong; Chaudhary, Nabin; Jin, Shengyang; Yang, Shuhua; Wang, Hong

    2017-01-01

    Gluteal muscle contracture (GMC), a debilitating disease, exists all over the globe but it is much more prevalent in China. Patients typically present with abduction and external rotation of the hip and are unable to bring both the knees together while squatting. Multiple etiologies have been postulated, the commonest being repeated intramuscular injection into the buttocks. The disease is diagnosed primarily by clinical features but radiological features are necessary for the exclusion of other pathological conditions. Non-operative treatment with physiotherapy can be tried before surgery is considered but it usually fails. Different surgical techniques have been described and claimed to have a better outcome of one over another but controversy still exists. Based on published literatures, the clinical outcome is exceptionally good in all established methods of surgery. However, endoscopic surgery is superior to conventional open surgery in terms of cosmetic outcome with fewer complications. Nevertheless, its use has been limited by lack of adequate knowledge, instrumentations, and some inherent limitations. Above all, post-operative rehabilitation plays a key role in better outcome, which however should be started gradually. PMID:28059055

  3. Gastrocnemius Contracture in Patients With Rheumatoid Arthritis.

    Science.gov (United States)

    Jastifer, James R; Green, Adam

    2017-12-01

    Rheumatoid arthritis is a chronic disease affecting multiple joints of the body. More than 90% of patients affected by rheumatoid arthritis develop foot or ankle pain over the course of their disease. The purpose of the current study was to report ankle dorsiflexion in rheumatoid arthritis patients as well as a control group utilizing a validated measurement instrument. Using a previously validated device, 70 patients presenting with rheumatoid arthritis and 70 controls were measured for ankle range motion and isolated gastrocnemius contractures. Clinical and goniometer measurement of ankle range of motion was also performed. The rheumatoid arthritis group had a mean dorsiflexion of 12.3 degrees compared to a mean of 17.3 degrees in the control group ( P rheumatoid arthritis had less ankle dorsiflexion than the control group. The clinical significance of this study is that it provides evidence that patients with rheumatoid arthritis have decreased ankle dorsiflexion even despite a lack of foot and ankle pain. In light of the high lifetime incidence of foot and ankle pain in these patients, this study provides some evidence that the decreased ankle dorsiflexion may be a contributing factor in foot and ankle pain, but further studies are needed. Level II, prospective cohort study.

  4. Effect of Mn and Fe on the Formation of Fe- and Mn-Rich Intermetallics in Al–5Mg–Mn Alloys Solidified Under Near-Rapid Cooling

    Directory of Open Access Journals (Sweden)

    Yulin Liu

    2016-01-01

    Full Text Available Mn was an important alloying element used in Al–Mg–Mn alloys. However, it had to be limited to a low level (<1.0 wt % to avoid the formation of coarse intermetallics. In order to take full advantage of the benefits of Mn, research was carried out to investigate the possibility of increasing the content of Mn by studying the effect of cooling rate on the formation of Fe- and Mn-rich intermetallics at different content levels of Mn and Fe. The results indicated that in Al–5Mg–Mn alloy with low Fe content (<0.1 wt %, intermetallic Al6(Fe,Mn was small in size and amount. With increasing Mn content, intermetallic Al6(Fe,Mn increased, but in limited amount. In high-Fe-containing Al–5Mg–Mn alloys (0.5 wt % Fe, intermetallic Al6(Fe,Mn became the dominant phase, even in the alloy with low Mn content (0.39 wt %. Cooling rate played a critical role in the refinement of the intermetallics. Under near-rapid cooling, intermetallic Al6(Fe,Mn was extremely refined. Even in the high Mn and/or high-Fe-containing alloys, it still demonstrated fine Chinese script structures. However, once the alloy composition passed beyond the eutectic point, the primary intermetallic Al6(Fe,Mn phase displayed extremely coarse platelet-like morphology. Increasing the content of Fe caused intermetallic Al6(Fe,Mn to become the primary phase at a lower Mn content.

  5. Tennis in hot and cool conditions decreases the rapid muscle torque production capacity of the knee extensors but not of the plantar flexors.

    Science.gov (United States)

    Girard, Olivier; Racinais, Sébastien; Périard, Julien D

    2014-04-01

    To assess the time course of changes in rapid muscle force/torque production capacity and neuromuscular activity of lower limb muscles in response to prolonged (∼2 h) match-play tennis under heat stress. The rates of torque development (RTD) and electromyographic activity (EMG; ie, root mean square) rise were recorded from 0 to 30, -50, -100 and -200 ms during brief (3-5 s) explosive maximal isometric voluntary contractions (MVC) of the knee extensors (KE) and plantar flexors (PF), along with the peak RTD within the entirety of the torque-time curve. These values were recorded in 12 male tennis players before (prematch) and after (postmatch, 24 and 48 h) match-play in HOT (∼37°C) and COOL (∼22°C) conditions. The postmatch core temperature was greater in the HOT (∼39.4°C) vs COOL (∼38.7°C) condition (ptorque. Furthermore, the rate of KE EMG activity rise remained unchanged. Conversely, the PF contractile RTD and rate of EMG activity rise were unaffected by the exercise or environmental conditions. In the KE, a reduction in maximal torque production capacity following prolonged match-play tennis appears to account for the decrease in the rate of torque development, independent of environmental conditions, while remaining unchanged in the PF.

  6. Effect of rapid cooling and acidic pH on cellular homeostasis of Pectinatus frisingensis, a strictly anaerobic beer-spoilage bacterium.

    Science.gov (United States)

    Chihib, N E; Tholozan, J L

    1999-06-01

    Pectinatus frisingensis is a strictly anaerobic mesophilic bacterium involved in bottled beer spoilage. Cellular volume, adenylate energy charge, intracellular pH and intracellular potassium concentration measurements were performed in late exponential-phase cell suspensions placed in different physiological conditions, to evaluate the capability of this bacterium to maintain cellular homeostasis. The intracellular pH was calculated from the intracellular accumulation of a [carboxyl-14C]benzoic acid. Optimum physiological conditions were the presence of a carbon source and pH of 6.2, hostile conditions were a pH 4.5, absence of a carbon source, and rapid cooling treatment. The cell was able to maintain a higher intracellular pH than the external pH under all conditions. Intracellular volume was lower at pH 4.5 than at pH 6.2. A low net potassium efflux rate was routinely measured in starving cells, while glucose addition promoted immediate net potassium uptake from the medium. Cooling treatment resulted in sudden net potassium efflux from the cell, a decrease of the intracellular pH, and low modifications of the adenylate energy charge in metabolizing-glucose cell suspensions. Thus, cold treatment perturbs the P. frisingensis homeostasis but the bacteria were able to restore their homeostasis in the presence of a carbon source, and under warm conditions.

  7. Enhanced mechanical properties of tungsten inert gas welded AZ31 magnesium alloy joint using two-pass friction stir processing with rapid cooling

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Nan, E-mail: xunan@hhu.edu.cn; Bao, Yefeng

    2016-02-08

    In this study, tungsten inert gas (TIG) welded AZ31 magnesium alloy joint was subjected to two-pass rapid cooling friction stir processing (RC-FSP). The main results show that, two-pass RC-FSP causes the significant dissolution of the coarse eutectic β-Mg{sub 17}Al{sub 12} phase into the magnesium matrix and the remarkable grain refinement in the stir zone. The low-hardness region which frequently located at heat-affected zone was eliminated. The stir zone showed ultrafine grains of 3.1 μm, and exhibited a good combination of ultrahigh tensile strength of 284 MPa and large elongation of 7.1%. This work provides an effective strategy to enhance the strength of TIG welded magnesium alloy joint without ductility loss.

  8. Rapid cooling and exhumation as a consequence of extension and crustal thinning: Inferences from the Late Miocene to Pliocene Palu Metamorphic Complex, Sulawesi, Indonesia

    Science.gov (United States)

    Hennig, Juliane; Hall, Robert; Forster, Margaret A.; Kohn, Barry P.; Lister, Gordon S.

    2017-08-01

    Metamorphic complexes forming high mountains of 1.5-2 km in Western Sulawesi were previously considered to be Mesozoic or older basement of Gondwana crust. However, many of the metamorphic rocks are much younger than previously thought. Some have Eocene sedimentary protoliths. New geothermobarometric and geochronological data from metamorphic rocks of the Palu Metamorphic Complex (PMC) and associated granitoids provide information on the timing and mechanisms of Neogene metamorphism and contemporaneous rapid exhumation. The metamorphic rocks are strongly deformed and some were partially melted to form migmatites. Schists contain relict andalusite, cordierite, staurolite and Mn-rich garnet which are wrapped by a pervasive fabric. 40Ar/39Ar dating of biotite, white mica and amphibole from strongly deformed, mylonitic schists and recrystallised amphibolites reveals cooling occurred in the Early Pliocene (c. 5.3-4.8 Ma) in the northern part and during the Late Pliocene (c. 3.1-2.7 Ma) in the southern part of the PMC. U-Pb, 40Ar/39Ar and (U-Th)/He analyses of various minerals from PMC metamorphic and S-type magmatic rocks give very similar mid to Late Pliocene ages, indicating very fast cooling and rapid exhumation, and show the high speed at which tectonic processes, including magmatism, exhumation, and reworking into a sediment, must have occurred. The high rates could be unique to this area but we suggest they record the true speed of metamorphic complex exhumation in a very young orogenic belt. Rates in older orogens appear lower because they are averages measured over longer periods of time. Contemporaneous magmatism and deformation are interpreted as a consequence of decompressional melting due to extension and thinning of the crust, promoted by possible detachment faults and normal faulting at the major NW-trending Palu-Koro and Tambarana Faults. In contrast, I-type magmatic rocks, separated from the PMC by the Palu-Koro Fault, were exhumed from upper crustal

  9. Anaesthetic management of mentosternal contractures where resources are limited.

    Science.gov (United States)

    Embu, H Y; Yiltok, S J; Isamade, E S

    2008-01-01

    Perioperative airway management in postburn mentosternal contractures often pose great challenges to the anaesthetist as well as the plastic surgeon. This is more so where resources are limited. Patients with postburn mentosternal contracture who had surgery between January 2000 and December 2006 at the Jos University Teaching Hospital, Jos Nigeria were retrospectively reviewed. The information obtained from the anaesthetic chart as well as the patients' case notes included demographic data, type of anaesthetic induction and maintenance as well as the type of airway management. There were 15 patients (12 males and 3 females), aged between 6 and 65 years. A total of 17 procedures were performed on the patients. Five of the patients were induced with ketamine and maintained with the same drug until adequate release was achieved. In five others the release were done under inhalational anaesthesia using a facemask after induction with ketamine. Six of the cases had laryngeal mask airway (LMA) inserted while one patient had a tracheostomy under local anaesthesia. After adequate release endotracheal tubes were inserted except in those who had LMA which were maintained to the end of the surgery. The rest of the procedure was then continued under general inhalational anaesthesia. Fixed flexion deformities in postburn mentosternal contractures could present serious airway challenges to the attending anaesthetist during contracture release and skin cover. This could be overcome by the use of ketamine, inhalational anaesthesia as well as the use of LMA before contracture release.

  10. Perforator-Based Interposition Flaps for Sustainable Scar Contracture Release: A Versatile, Practical, and Safe Technique

    NARCIS (Netherlands)

    Verhaegen, Pauline D. H. M.; Stekelenburg, Carlijn M.; van Trier, Antoine J. M.; Schade, Frank B.; van Zuijlen, Paul P. M.

    2011-01-01

    Background: Problematic scar contractures are frequently observed following extensive (burn) wounds. In this study, the authors investigated the applicability of islanded and nonislanded perforator-based interposition flaps as a technique for release of scar contracture. Methods: Patients requiring

  11. Degree of Contracture Related to Residual Muscle Shoulder Strength in Children with Obstetric Brachial Plexus Lesions

    NARCIS (Netherlands)

    van Gelein Vitringa, V. M.; van Noort, A.; Ritt, M.J.P.F.; van Royen, B.J.; van der Sluijs, J.A.

    2015-01-01

    Background and Objectives Little is known about the relation between residual muscle strength and joint contracture formation in neuromuscular disorders. This study aimed to investigate the relation between residual muscle strength and shoulder joint contractures in children with sequelae of

  12. Genetics Home Reference: hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis

    Science.gov (United States)

    ... Hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis Printable PDF Open All Close All Enable Javascript ... Hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis (abbreviated POIKTMP ), is a disorder that affects many ...

  13. Not cool with cooling

    Science.gov (United States)

    Blain, Barry

    2010-09-01

    I confess that I may have missed the point of Roland Ennos's article "Urban cool" (August pp22-25), which describes methods of cooling cities by mitigating and reversing the effect of solar heating and includes an illustration of "evapotranspiration" in, of all places, Greater Manchester.

  14. Nonoperative treatment of PIPJ flexion contractures associated with Dupuytren's disease.

    Science.gov (United States)

    Larocerie-Salgado, J; Davidson, J

    2012-10-01

    Post-surgical outcomes in patients with Dupuytren's disease causing flexion contractures of the proximal interphalangeal joint can be inconsistent and are often associated with protracted rehabilitation, reduced flexion, recurrence of the contracture, and patient dissatisfaction. An alternative treatment option, comprised of splinting and soft tissue mobilization techniques, was introduced to stabilize early contractures of the proximal interphalangeal joint in the hopes of delaying or obviating surgery. Over the course of approximately 12.6 months (± 7.8), thirteen patients were followed at the hand clinic at Hotel Dieu Hospital in Kingston. One patient was unable to complete the course of therapy. Of the remaining patients, analysis showed significant improvement in active proximal interphalangeal joint extension of approximately 14.6° (SD: ± 5.1°; range: 5-25°) over the course of the treatment (p Dupuytren's disease.

  15. Surgical intervention and capsular contracture after breast augmentation

    DEFF Research Database (Denmark)

    Henriksen, Trine F; Fryzek, Jon P; Hölmich, Lisbet R

    2005-01-01

    -requiring complications and capsular contracture grades III to IV among 2277 women who underwent cosmetic breast implantation from June 1999 through April 2003. During an average follow-up period of 1.6 years after implantation, 4.3% of these women (3% of implants) required secondary surgery as a result of short......-term complications. The most frequent clinical indications for surgery were displacement of the implant (38%), capsular contracture grades III to IV (16%), ptosis (13%), and hematoma (11%). Overall, the authors found that inframammary incision and subglandular placement were associated with decreased risks...... of developing complications requiring surgical intervention, whereas implants larger than 350 mL increased the risk of such complications (relative risk [RR], 2.3; 95% confidence interval [CI], 1.3-4.0). Thirty-nine Baker III to IV capsular contractures were identified, of which 22 were treated surgically...

  16. Dupuytren's contracture: A retrospective database analysis to determine hospitalizations in the Netherlands

    NARCIS (Netherlands)

    J.A. Overbeek (Jetty); F.J.A. Penning-Van Beest (Fernie); E.M. Heintjes (Edith); R.A. Gerber (Robert); J.C. Cappelleri (Joseph); S.E.R. Hovius (Steven); R.M.C. Herings (Ron)

    2011-01-01

    textabstractBackground: Dupuytren's contracture is a condition of the palmar fascia involving contractures of the fascia and skin in the hand. Current treatment for Dupuytren's contracture is mainly limited to surgery. In the Netherlands, little is known about the prevalence of Dupuytren's

  17. Serial splintage: Preoperative treatment of upper limb contracture.

    Science.gov (United States)

    Puri, Vinita; Khare, Nishant; Venkateshwaran, N; Bharadwaj, Sumit; Choudhary, Sushant; Deshpande, Omkarnath; Borkar, Rupali

    2013-09-01

    The present study aimed to study the efficacy of preoperative splints in treatment of upper limb contractures and to evaluate the response of contracture to splints depending on the etiology and the joint involved. Ninety joints of 42 patients were studied. Patients age, gender, etiology, duration of contracture, contracture site and joint and type of contracture was noted. The range of motion of the involved joint was recorded. Serial static splints made of thermoplastic material were applied after customizing them for each patient. The range of motion and percentage movement was recorded at weekly interval and the splints were modified as per need. Time taken to reach a plateau stage was noted. To compare the statistical significance between two groups and more than two groups of continuous variable unpaired t-test and one way ANOVA respectively was applied. We considered differences to be statistically significant when the p value was below 0.05. The strength of relationship between the two continuous variables was analyzed by Pearson correlation analysis. Etiological factors were thermal burns (36.7%), electrical burns (13.3%), post traumatic (35.6%) and post cellulitis (14.4%). Age ranged from 2 to 70 years with a mean of 28.9±13.4 years. Sixty-two patients treated were males (68.9%) and 28 were female (31.1%). The mean range of motion present across all joints before starting the therapy was 54.7±23.6 degrees. The mean improvement in contracture angle obtained by serial splintage was 37.4±28.1 degrees. The mean time taken to achieve plateau was 23.6±3.2 days. Maximum improvement was seen in thermal burn contractures (41.2±30.3 degrees). Least improvement was seen in contractures due to cellulitis (6.5±16.2 degrees). This finding was statistically significant [F(3,86)=4.25, p=0.005]. Significant difference was seen in response to therapy based on the joint involved [F(3,86)=3.36, p=0.02]. Highest improvement in the range of motion was seen in the

  18. Surgery for Dupuytren's contracture of the fingers.

    Science.gov (United States)

    Rodrigues, Jeremy N; Becker, Giles W; Ball, Cathy; Zhang, Weiya; Giele, Henk; Hobby, Jonathan; Pratt, Anna L; Davis, Tim

    2015-12-09

    Dupuytren's disease is a benign fibroproliferative disorder that causes the fingers to be drawn into the palm via formation of new tissue under the glabrous skin of the hand. This disorder causes functional limitations, but it can be treated through a variety of surgical techniques. As a chronic condition, it tends to recur. To assess the benefits and harms of different surgical procedures for treatment of Dupuytren's contracture of the index, middle, ring and little fingers. We initially searched the following databases on 17 September 2012, then re-searched them on 10 March 2014 and on 20 May 2015: the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, the British Nursing Index and Archive (BNI), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Latin American Caribbean Health Sciences Literature (LILACS), Ovid MEDLINE, Ovid MEDLINE-In-Process and Other Non-Indexed Citations, ProQuest (ABI/INFORM Global and Dissertations & Theses), the Institute for Scientific Information (ISI) Web of Science and clinicaltrials.gov. We reviewed the reference lists of short-listed articles to identify additional suitable studies. We included randomised clinical trials and controlled clinical trials in which groups received surgical intervention for Dupuytren's disease of the index, middle, ring or little finger versus control, or versus another intervention (surgical or otherwise). We excluded the thumb, as cords form on the radial aspect of the thumb and thus are not readily accessible in terms of angular deformity. Furthermore, thumb disease is rare. A minimum of two review authors independently reviewed search results to select studies for inclusion by using pre-specified criteria, assessed risk of bias of included studies and extracted data from included studies.We grouped outcomes into the following categories: (1) hand function, (2) other patient-reported outcomes (e.g. satisfaction, pain), (3) early objective

  19. Pediatric Contractures in Burn Injury: A Burn Model System National Database Study.

    Science.gov (United States)

    Goverman, Jeremy; Mathews, Katie; Goldstein, Richard; Holavanahalli, Radha; Kowalske, Karen; Esselman, Peter; Gibran, Nicole; Suman, Oscar; Herndon, David; Ryan, Colleen M; Schneider, Jeffrey C

    Joint contractures are a major cause of morbidity and functional deficit. The incidence of postburn contractures and their associated risk factors in the pediatric population has not yet been reported. This study examines the incidence and severity of contractures in a large, multicenter, pediatric burn population. Associated risk factors for the development of contractures are determined. Data from the National Institute on Disability and Rehabilitation Research Burn Model System database, for pediatric (younger than 18 years) burn survivors from 1994 to 2003, were analyzed. Demographic and medical data were collected on each subject. The primary outcome measures included the presence of contractures, number of contractures per patient, and severity of contractures at each of nine locations (shoulder, elbow, hip, knee, ankle, wrist, neck, lumbar, and thoracic) at time of hospital discharge. Regression analysis was performed to determine predictors of the presence, severity, and numbers of contractures, with P burned, and TBSA grafted. This is the first study to report the epidemiology of postburn contractures in the pediatric population. Approximately one quarter of children with a major burn injury developed a contracture at hospital discharge, and this could potentially increase as the child grows. Contractures develop despite early therapeutic interventions such as positioning and splinting; therefore, it is essential that we identify novel and more effective prevention strategies.

  20. Incidence and predictors of contracture after spinal cord injury--a prospective cohort study.

    Science.gov (United States)

    Diong, J; Harvey, L A; Kwah, L K; Eyles, J; Ling, M J; Ben, M; Herbert, R D

    2012-08-01

    Prospective cohort study. To determine incidence of contracture and develop prediction models to identify patients susceptible to contracture after spinal cord injury. Two Sydney spinal cord injury units. A total of 92 consecutive patients with acute spinal cord injury were assessed within 35 days of injury and 1 year later. Incidence of contracture at 1 year was measured in all major appendicular joints by categorizing range of motion on a 4-point scale (0-no contracture to 3-severe contracture), and in the wrist, elbow, hip and ankle by measuring range of motion at standardized torque. Multivariate models were developed to predict contracture at 1 year using age, neurological status, spasticity, pain and limb fracture recorded at the time of injury. At 1 year, 66% of participants developed at least one contracture (defined as ≥1 point deterioration on the 4-point scale). Incidence of contracture at each joint was: shoulder 43%, elbow and forearm 33%, wrist and hand 41%, hip 32%, knee 11% and ankle 40%. Incidence of contracture determined by standardized torque measures of range (defined as loss of ≥10 degrees) was: elbow 27%, wrist 26%, hip 23% and ankle 25%. Prediction models were statistically significant but lacked sufficient predictive accuracy to be clinically useful (R(2)≤31%). The incidence of contracture in major joints 1 year after spinal cord injury ranges from 11-43%. The ankle, wrist and shoulder are most commonly affected. It is difficult to accurately predict those susceptible to contracture soon after injury.

  1. Serum Mast Cell Tryptase as a Marker of Posttraumatic Joint Contracture in a Rabbit Model.

    Science.gov (United States)

    Kopka, Michaela; Monument, Michael J; Befus, A Dean; Zhang, Mei; Hart, David A; Salo, Paul T; Schneider, Prism S; Fan, Cun-Yi; Liang, Xiangdang; Garven, Alexandra; Hildebrand, Kevin A

    2017-03-01

    Mast cells have been identified as key mediators of posttraumatic joint contracture, and stabilizing medications (ketotifen) have been shown to decrease contracture severity. Serum mast cell tryptase (SMCT) levels are used clinically to monitor mast cell-mediated conditions. The goals of this study were to determine if SMCT levels are elevated in the setting of joint contracture, if they can be decreased in association with ketotifen therapy, and if they correlate with contracture severity. This study used a previously developed rabbit model in which 39 animals were divided into 4 groups: operatively created joint contracture (ORC, n = 13), operatively created contracture treated with ketotifen at 2 doses (KF0.5, n = 9; KF1.0, n = 9), and healthy rabbits (NC, n = 8). Range of motion measures were performed at 8 weeks after the surgery. Serum samples were collected on postoperative days 1, 3, 5, 7, 21, 35, and 49. SMCT levels were measured using a rabbit-specific enzyme-linked immunosorbent assay. Levels of SMCT were highest in the operatively created joint contracture group and were significantly greater compared with both ketotifen groups (P contracture severity was observed in all operative groups (P contracture, decreased in association with ketotifen therapy, and positively correlated with contracture severity. This is the first study to establish a relationship between SMCT and joint injury. Measurement of SMCT may be valuable in identifying those at risk of posttraumatic joint contracture.

  2. Management of contractures: A five-year experience at Komfo ...

    African Journals Online (AJOL)

    Patients with minimal functional impairment underwent physical therapy without surgery. Results: Sixty-eight patients comprising 44 males and 24 females were seen. Male to female ratio is 1.83:1. Their ages ranged from 0.66 to 60 years, mean age was 22.53 years. Seventy-six contractures were studied. Fifty-eight of the ...

  3. Transforming growth factor-beta: possible roles in Dupuytren's contracture

    NARCIS (Netherlands)

    Kloen, P.; Jennings, C. L.; Gebhardt, M. C.; Springfield, D. S.; Mankin, H. J.

    1995-01-01

    Transforming growth factor-beta (TGF-beta) is a multifunctional polypeptide that stimulates extracellular matrix deposition and fibroblast proliferation. Because both these features characterize Dupuytren's contracture, we investigated a possible role for TGF-beta in the etiology of this disorder.

  4. A review of attitudes to splintage in Dupuytren's contracture.

    Science.gov (United States)

    Abbott, K; Denney, J; Burke, F D; McGrouther, D A

    1987-10-01

    A questionnaire on the use of splintage before and after operations for Dupuytren's contracture has been completed by 45 hand surgeons and ten hand therapists. None considered that preoperative splintage was beneficial, but nearly all used some form of splintage after operation. The types of splint and programmes for using them varied widely, and these are discussed.

  5. Camptodactyly: A Phenotype of Dupuytren′s Contracture

    Directory of Open Access Journals (Sweden)

    Kamleader Singh

    1985-01-01

    Full Text Available A 15 year old boy had permanent flexion contractures at proximal interphalangeal joints of the little and ring fingers of both hands, along with slight hemiatrophy of face and bilateral mild ptosis. The hand deformity superficially resembled. Dupuytren′s contacture. This combination of features does not fit with the syndromes described so far, whose one of, the components is camptodactyly.

  6. Static Progressive Orthoses for Elbow Contracture: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Bin Chen

    2017-01-01

    Full Text Available Background. As one of the most common musculoskeletal complications following trauma, elbow contracture is a frequent source of disabled daily activities. Conventional interventions are inadequate to provide favorable outcome. The static progressive orthoses are getting popular in the treatment of this problem. Objective. The purpose of this review was to assess the effectiveness of static progressive orthoses for elbow contracture. Methods. Literatures when written in English published during 1 January 1997 and 31 January 2017 were searched in the following databases: Web of Science, Cochrane Library, PubMed, and EBSCOhost. Articles are quality-assessed by two assessors, each article was summarized in evidence tables, and a narrative synthesis was also performed. Results. Ten clinical trials were included. The study design and outcome measures used varied. Significant immediate improvement in the range of motion was reported by all studies, and those effects were still significant at follow-up. No significant difference was shown between static progressive and dynamic orthoses for elbow contracture in one randomized control trial. Conclusions. Current low-quality evidence suggested that static progressive orthoses provided assistance for elbow contracture through improving range of motion. Further research is recommended using high-quality randomized controlled trials.

  7. Results of surgical treatment of quadriceps femoris/contracture in ...

    African Journals Online (AJOL)

    Gain in flexion ranged from minus forty degrees to positive 140 degrees. The average gain in flexion was 94.7 degrees. Five patients underwent a second procedure to improve flexion. Soft tissue complications developed in four cases. Conclusion: Quadriceps femoris/contracture responds well to surgical treatment with an ...

  8. Recurrence of Dupuytren's contracture: A consensus-based definition

    NARCIS (Netherlands)

    H.J. Kan (Hester); F.W. Verrijp (Frank); S.E.R. Hovius (Steven); C.A. van Nieuwenhoven (Christianne); R.W. Selles (Ruud); P.C. Amadio (Peter ); Degreef, I. (Ilse); Denkler, K. (Keith); J.J. Dias (Joseph); Eaton, C. (Charles); Goldfarb, C.A. (Charles A.); Hentz, V. (Vincent); E Horch, R. (Raymund); Hurst, L. (Lawrence); Jerosch-Herold, C. (Christina); R.K. Khouri (Roger); Lalonde, D. (Donald); Leclercq, C. (Caroline); McGrouther, D.A. (Ducan Angus); J. Nanchahal (Jagdeep); Pelissier, P. (Phillipe); Tonkin, M. (Michael); P.M.N. Werker (Paul); Wilbrand, S. (Stephan); Zyluk, A. (Andrzej)

    2017-01-01

    textabstractPurpose: One of the major determinants of Dupyutren disease (DD) treatment efficacy is recurrence of the contracture. Unfortunately, lack of agreement in the literature on what constitutes recurrence makes it nearly impossible to compare the multiple treatments alternatives available

  9. Shoulder contracture and osseous deformity in obstetrical brachial plexus injuries

    NARCIS (Netherlands)

    Hoeksma, Agnes F.; ter Steeg, Anne Marie; Dijkstra, Piet; Nelissen, Rob G. H. H.; Beelen, Anita; de Jong, Bareld A.

    2003-01-01

    The purposes of this study were to determine the prevalence of and the association between shoulder contracture and osseous deformity in a cohort of children with an obstetrical brachial plexus injury and to identify the risk factors for these complications. In a retrospective cohort study, all

  10. Obstetrical brachial plexus injuries: incidence, natural course and shoulder contracture

    NARCIS (Netherlands)

    Hoeksma, A. F.; Wolf, H.; Oei, S. L.

    2000-01-01

    The incidence of obstetric brachial plexus injury (OBPI) was investigated and the natural course of this disorder and the frequency of shoulder contracture described. Between 1988 and 1997 13,366 children with a gestational age of 30 weeks or more, were born at the Academic Medical Center,

  11. Overstretching of sarcomeres may not cause cerebral palsy muscle contracture

    NARCIS (Netherlands)

    Smeulders, Mark J. C.; Kreulen, Michiel; Hage, J. Joris; Huijing, Peter A.; van der Horst, Chantal M. A. M.

    2004-01-01

    To answer the question whether the muscle contracture in patients with cerebral palsy is caused by overstretching of in-series sarcomeres we studied the active and passive force-length relationship of the flexor carpi ulnaris muscle (FCU) in relation to its operating length range in 14 such patients

  12. Multidisciplinary conservative management in classical Volkmann's contracture: A case report

    NARCIS (Netherlands)

    Reinders, M.F.; Geertzen, J.H.B.; Eisma, W.H.

    1996-01-01

    This clinical note describes the case of a nine-year-old girl with classical Volkmann's contracture of the left forearm. The report demonstrates the results and follow-up of conservative orthotic management used as a mode of treatment by a multidisciplinary team. When using an orthosis it is

  13. Delayed manipulation after collagenase clostridium histolyticum injection for Dupuytren contracture.

    Science.gov (United States)

    Kaplan, F Thomas D; Badalamente, Marie A; Hurst, Lawrence C; Merrell, Gregory A; Pahk, Raymond

    2015-09-01

    Collagenase clostridium histolyticum (CCH) injection for Dupuytren contracture was approved in the USA in 2010. Current FDA guidelines stipulate that finger manipulation occurs the day following injection. To investigate the safety and efficacy of delaying manipulation to 2 or 4 days following CCH injection, we conducted a prospective, randomized trial at two sites. Patients with Dupuytren contracture involving the metacarpophalangeal (MCP) joint ≥20° caused by a palpable cord participated. All patients received one dose of CCH (0.58 mg/0.25 ml) and were followed for 90 days. The primary end point was the percent of patients maintaining clinical success (reduction of contracture to 0°-5°) at 90 days post-injection. Adverse events and change in Michigan Hand Questionnaire (MHQ) score were recorded as secondary end points. Thirty-seven patients enrolled; 13 were manipulated on day 1, 11 on day 2, and 13 on day 4. At 30 days after injection, the percentage of patients obtaining reduction of contracture to <0°-5° extension was 92, 82, and 85 % in groups 1, 2, and 3, respectively, with no significant difference. At 90 days follow-up, the percentage of patients maintaining 0°-5° extension was 91, 82, and 83 % in groups 1, 2, and 3, respectively, with no significant difference. Adverse events were comparable to rates in prior studies. There were no serious adverse events. There was no statistical difference in MHQ scores between groups at any time point. Delaying manipulation to day 2 or 4 following CCH injection for MCP joint contractures does not increase adverse events or result in loss of efficacy. Therapeutic, Level II.

  14. Z-plasty for severe gluteal muscle contracture in children.

    Science.gov (United States)

    Zha, Kun; Liu, GuoHui; Yang, Shuhua; Cao, Faqi

    2016-12-01

    To review the records of 363 patients with severe gluteal muscle contracture to determine its mechanism, underlying pathology, and treatment outcome. Records of 136 males and 227 females aged 5 to 18 (mean, 12.2) years who underwent Z-plasty for bilateral (n=347) or unilateral (n=16) severe gluteal muscle contracture were reviewed. Severe gluteal muscle contracture was classified as typical (n=52) or special (n=311). The typical type is associated with symptoms of positive out-toe gait, Ober sign, back-extending test, cross-leg test, squatting with knee side-by-side test, and hip dysfunction. It is further subdivided into mild (n=0), moderate (n=40), or severe (n=12). The special type is associated with additional symptoms of pelvic tilt and leg length discrepancy (4 cm in 48 hips). 311 hips had pelvic tilt and 47 hips had lumbar compensatory scoliosis. Treatment outcome was assessed at 6 months. Hip functional score was assessed at the final follow-up. The mean hospitalisation period was 11 days. After a mean follow-up of 1.5 years, the mean hip functional score improved from 8.03 to 11.69; improvement was higher in children (age 5-13 years) than in adolescents (age 14-18 years) [3.7 vs. 2.9, p4 cm, and intra-operatively the contracture band severely affected the joint capsule. The third patient did not comply with postoperative exercises. Surgical treatment for severe gluteal muscle contracture achieved good outcome.

  15. Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment : the importance of clear definitions

    NARCIS (Netherlands)

    Werker, Paul M N; Pess, Gary M; van Rijssen, Annet L; Denkler, Keith

    2012-01-01

    PURPOSE: To call attention to the wide variety of definitions for recurrence that have been employed in studies of different invasive procedures for the treatment of Dupuytren contracture and how this important limitation has contributed to the wide range of reported results. METHODS: This study

  16. In Situ Synchrotron X-Ray Diffraction and Small Angle X-Ray Scattering Studies on Rapidly Heated and Cooled Ti-Al and Al-Cu-Mg Alloys Using Laser-Based Heating

    Science.gov (United States)

    Kenel, C.; Schloth, P.; Van Petegem, S.; Fife, J. L.; Grolimund, D.; Menzel, A.; Van Swygenhoven, H.; Leinenbach, C.

    2016-03-01

    Beam-based additive manufacturing (AM) typically involves high cooling rates in a range of 103-104 K/s. Therefore, new techniques are required to understand the non-equilibrium evolution of materials at appropriate time scales. Most technical alloys have not been optimized for such rapid solidification, and microstructural, phase, and elemental solubility behavior can be very different. In this work, the combination of complementary in situ synchrotron micro-x-ray diffraction (microXRD) and small angle x-ray scattering (SAXS) studies with laser-based heating and rapid cooling is presented as an approach to study alloy behavior under processing conditions similar to AM techniques. In rapidly solidified Ti-48Al, the full solidification and phase transformation sequences are observed using microXRD with high temporal resolution. The high cooling rates are achieved by fast heat extraction. Further, the temperature- and cooling rate-dependent precipitation of sub-nanometer clusters in an Al-Cu-Mg alloy can be studied by SAXS. The sensitivity of SAXS on the length scales of the newly formed phases allows their size and fraction to be determined. These techniques are unique tools to help provide a deeper understanding of underlying alloy behavior and its influence on resulting microstructures and properties after AM. Their availability to materials scientists is crucial for both in-depth investigations of novel alloys and also future production of high-quality parts using AM.

  17. Postburn shoulder medial-adduction contracture: anatomy and treatment with trapeze-flap plasty.

    Science.gov (United States)

    Grishkevich, Viktor M

    2013-03-01

    Shoulder-adduction contractures after burn, most frequent among big joints, cause functional deficiency of the upper limb and, therefore, benefits from surgical correction. Many reconstructive techniques and flaps have been suggested for contracture treatment, but the problem in choosing an adequate reconstructive technique based on the anatomy of the contracture remains. Shoulder-adduction contracture has been given less emphasis in research than any other type and its surgical reconstructive technique remains of concern. Anatomic features of scar shoulder-adduction contractures were studied in 346 patients, personally operated upon. This allowed us to classify all contractures into three types: edge, medial and total. New surgical techniques specifically for medial contractures were developed. Eighty percent of patients had edge contractures in which the axillary fossa was spared. In 20% of patients, axilla, including the hairy dome, was involved. These cases were anatomically classified into two types: medial, making up 30% of the cases, when contracted scars involved only axilla, and total caused by scars, tightly surrounding the shoulder joint. The scars, causing medial contracture, form a crescent-shaped fold along the medial axillary line. The fold's sheets are scars in which there is skin surface surplus in width, which allows the contracture release with local tissues. Surface deficiency in length has a trapezoid form. Medial contracture can be successfully treated with opposite transposition of trapezoid adipose-scar flaps prepared from both sheets of the fold. Medial shoulder-adduction contracture is a newly described type with specific anatomic features. Contracture can be successfully treated with local tissues using trapeze-flap plasty. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  18. Drowning of a barrier coastline under rapid rates of relative sea-level rise during the 8.2 ka cooling event: Cause or coincidence?

    Science.gov (United States)

    Mellett, C.; Hodgson, D. M.; Lang, A.; Mauz, B.; Plater, A. J.

    2012-12-01

    Examples where barrier landforms and deposits are preserved offshore of a highstand shoreline are rare on contemporary continental shelves, and in the rock record. Therefore, understanding of the conditions required for preservation and the sedimentary processes-response to such factors is limited and heavily dependent on simulation models. Here, an integrated dataset of multibeam bathymetry and 2D seismic reflection profiles has uncovered an exceptionally well preserved drowned barrier complex at Hastings Bank, on the English Channel continental shelf, offshore of southeast England. Mapping of nine seismic stratigraphic units calibrated with lithological information from multiple vibrocores has enabled the interpretation of fluvial, shoreface, barrier, washover fan, back-barrier and tidal environments of deposition. Stratigraphic architecture is used as the basis for landscape evolution reconstructions that reveal phases of barrier progradation, degradation and retreat. Optical Stimulated Luminescence (OSL) dating of shoreface and beach deposits revealed ages in the range of 8.4 ± 0.2 ka and 7.8 ± 0.2 ka. These ages indicate the barrier developed under rapid rates of early Holocene sea-level rise and more specifically, correlate to the time period surrounding the 8.2 ka cooling event and associated sea-level 'jump'. To preserve a barrier beach including the barrier foreshore under such rapid rates of relative sea-level rise, sediment supply would have to be sufficient to keep pace to prevent the shoreline responding through continuous reworking, i.e. rollover. Further, the rate of transgression is conditioned by inherited topography with higher rates of retreat, and hence greater potential for drowning, expected across the shallowly dipping substrate. Using Hastings Bank as an example, it has also been demonstrated that the morphodynamic state of the barrier complex in terms of its ability to respond dynamically to relative sea-level rise, conditions its

  19. Paraplegic flexion contracture of hip joints: An unsolvable problem.

    Science.gov (United States)

    Bhattacharyya, Sailendra

    2016-01-01

    Paraplegic flexion contracture of hip joints beyond 90° is a difficult condition to treat for any orthopedic surgeon. There is no fixed protocol of treatment described, by and large it is individualized. A 20 year old female presented with paraplegia for last 15 years due to irrecoverable spinal cord disease with complete sensory and motor loss of both lower extremities and was admitted with acute flexion contracture of both hip joints with trunk resting on thighs. She underwent bilateral proximal femoral resection. Both hip joints were straight immediately after surgery and patient could lie on her back. In a course of time, she started sitting on her buttocks, led a comfortable wheelchair life with a sitting balance. Proximal femoral resection is an effective method to treat long standing irrecoverable paraplegic acute flexion deformity of the hip joint.

  20. Reconstruction of hand contracture by reverse ulnar perforator flap

    Directory of Open Access Journals (Sweden)

    Cengiz Eser

    2016-04-01

    Full Text Available Hand burn scar contractures affect patients in aesthetic and functional aspects. After releasing these scars, the defects should be repaired. The reconstruction methods include primary suturation, Z plasty, skin grafting, local or free flaps, etc. All methods have their own advantages and disadvantages. One of the most useful flaps is the reverse ulnar perforator flap. We performed a two-staged procedure for repairing a post-burn contracture release defect in a 40-year-old male. In the first stage we applied reverse ulnar perforator flap for the hand defect, and ulnar artery and vein repair in the second stage. In conclusion, this two-staged procedure is a non-primary but useful option for hand and finger defects and prevents major vascular structure damage of the forearm. [Hand Microsurg 2016; 5(1.000: 40-43

  1. Linear Hand Burn Contracture Release under Local Anesthesia without Tourniquet.

    Science.gov (United States)

    Prasetyono, Theddeus O H; Koswara, Astrid F

    2015-10-01

    The objective of this report is to present a case of hand burn linear contracture release performed under local anesthesia. It also introduces the one-per-mil tumescent solution consisted of 0.2% lidocaine and 1:1.000.000 epinephrine as a local anesthesia formula, which has the potential of providing adequate anesthesia as well as hemostatic effect during surgery of the hand without tourniquet. The surgery was performed on a 19 year-old male patient with multiple thumb and fingers flexion linear contracture for 105 minutes without any obstacle. The patient did not complain any pain and discomfort during the procedure; while bloodless operative field was successfully achieved. At four-month follow up, the patient could fully extend his thumb, middle and ring finger, while the index was limited by 10° at the DIP joint. Overall, the patient was satisfied with the outcome.

  2. Orofacial contracture management outcomes following partial thickness facial burns.

    Science.gov (United States)

    Clayton, N A; Ward, E C; Maitz, P K M

    2015-09-01

    To examine clinical outcomes following non-surgical exercise for contracture management post partial thickness orofacial burn. A cohort of 229 patients with partial thickness orofacial burn was recruited over 3 years. Orofacial contracture management combining exercise and stretching was initiated within 48h of admission and continued until functional goals were consistently achieved. A second cohort of 120 healthy controls was recruited for normative comparison. Vertical and horizontal mouth opening measures were recorded at the start and completion of orofacial intervention for patients and once only for controls. At commencement of intervention, participants with orofacial burns had significantly (pcontracture management for patients with partial thickness orofacial burn. Despite this, some functional loss remained with patients demonstrating persistent reduced vertical mouth opening at conclusion of treatment compared to their healthy counterparts. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  3. Neonatal Volkmann Ischemic Contracture: Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Hitesh Agrawal

    2014-11-01

    Full Text Available Background - Neonatal Volkmann ischemic contracture in newborns is a devastating condition with lifelong consequences. Case Report - We report a neonate born with necrotic skin lesions and bullae on right dorsal thenar aspect of hand, who subsequently developed compartment syndrome requiring fasciotomy. Review and Conclusion - Necrotic skin lesions with/without swelling, bullae are invariably present at birth in these patients and should be recognized as a sentinel finding of underlying tissue ischemia/compartment syndrome. Early recognition and prompt surgical intervention can be limb saving. A range of radiologic abnormalities and contractures were noted in upto 84% of such patients followed long term. Hence, we recommend close follow-up until occurrence of epiphyseal fusion in these patients.

  4. Intraoperative Manipulation for Flexion Contracture During Total Knee Arthroplasty.

    Science.gov (United States)

    Matsui, Yoshio; Minoda, Yukihide; Fumiaki, Inori; Nakagawa, Sigeru; Okajima, Yoshiaki; Kobayashi, Akio

    2016-11-01

    Joint gap balancing during total knee arthroplasty (TKA) is important for ensuring postoperative joint stability and range of motion. Although the joint gap should be balanced to ensure joint stability, it is not easy to achieve perfect balancing during TKA. In particular, relative extension gap shortening can induce flexion contracture. Intraoperative manipulation is often empirically performed. This study evaluated the tension required for this manipulation and investigated the influence of intraoperative manipulation on the joint gap in cadaveric knees. Total knee arthroplasty was performed in 6 cadaveric knees from whole body cadavers. Flexion contracture was induced using an insert that was 4 mm thicker than the extension gap, and intraoperative manipulation was performed. Study measurements included the changes in the joint gap after manipulation at 6 positions, with the knee bending from extension to 120° flexion, and the manipulation tension that was required to create a 4-mm increase in the gap. The manipulation tension needed to create a 4-mm increase in the extension gap was 303±17 N. The changes in the joint gap after manipulation were 0.4 mm, 0.6 mm, 0.2 mm, -0.2 mm, -0.4 mm, and -0.6 mm at 0°, 30°, 45°, 60°, 90°, and 120° flexion, respectively. Therefore, the joint gap was not significantly changed by the manipulation. Intraoperative manipulation does not resolve flexion contracture. Therefore, if flexion contracture occurs during TKA, treatment with additional bone cutting and soft tissue release is likely more appropriate than manipulation. [Orthopedics. 2016; 39(6):e1070-e1074.]. Copyright 2016, SLACK Incorporated.

  5. Collagenase enzymatic fasciotomy for Dupuytren contracture in patients on chronic immunosuppression.

    Science.gov (United States)

    Waters, Michael J; Belsky, Mark R; Blazar, Philip E; Leibman, Matthew I; Ruchelsman, David E

    2015-11-01

    Collagenase enzymatic fasciotomy is an accepted nonsurgical treatment for disabling hand contractures caused by Dupuytren disease. We conducted a study to investigate use of collagenase in an immunosuppressed population. We retrospectively reviewed data from 2 academic hand surgical practices. Eight patients on chronic immunosuppressive therapies were treated with collagenase for digital contractures between 2010 and 2011. Thirteen collagenase enzymatic fasciotomies were performed in these 8 patients. Mean preinjection contracture was 53.0°. At mean follow-up of 6.7 months, mean magnitude of contracture improved to 12.9°. Mean metacarpophalangeal joint contracture improved from 42.0° to 4.2°. Mean proximal interphalangeal joint contracture improved from 65.8° to 21.7°. Three of the enzymatic fasciotomies were complicated by skin tears. There were no infections. As more patients seek nonsurgical treatment for Dupuytren disease, its safety and efficacy in select cohorts of patients should continue to be evaluated prospectively.

  6. The natural history of a newly developed flexion contracture following primary total knee arthroplasty.

    Science.gov (United States)

    Anania, Andres; Abdel, Matthew P; Lee, Yuo-yu; Lyman, Stephen; González Della Valle, Alejandro

    2013-10-01

    We investigated the incidence, natural history, and functional consequences of a newly developed flexion contracture after total knee arthroplasty (TKA). Forty patients with full knee extension preoperatively who developed a postoperative flexion contracture were match-paired 1:2 with 80 patients who had full extension. The incidence of a newly developed flexion contracture, ROM, and Knee Society scores (KSS) at six weeks, four months, and one year were analysed. The incidence of a new flexion contracture at six weeks was 14%, but diminished to 5% and 0.3% at four months and one year, respectively. One year after surgery, there was no difference in the KSS (p = 0.5). This study showed that the majority of patients who developed a new flexion contracture after TKA have full knee extension one year postoperatively. Moreover, knee extension and KSS at one year are equivalent to those patients who did not developed a flexion contracture.

  7. Contractures in orthopaedic and neurological conditions: a review of causes and treatment.

    Science.gov (United States)

    Farmer, S E; James, M

    2001-09-10

    To examine the techniques used for the treatment of contracture in the context of current scientific knowledge of muscle. Synthesis of data available from MEDLINE, RECAL, EMBASE, the Cochrane Library and relevant texts. The development of contractures through immobilisation, muscle weakness and spasticity is described. The effects of passive stretching, continuous passive movement, serial plastering, splinting, electrical stimulation, botulinum injections and surgical tenotomies in the treatment of contractures in persons with neurological and orthopaedic conditions are identified. The strengths and weaknesses of these modalities are discussed. Predisposing factors persist after treatment of contractures thus for treatment to be effective long-term management programmes need to be developed. New treatment techniques, used in series or combined, offer the prospect of improved management of contracture. Scientific and clinical research is needed to investigate the effect of contracture treatment.

  8. Stochastic Cooling

    Energy Technology Data Exchange (ETDEWEB)

    Blaskiewicz, M.

    2011-01-01

    Stochastic Cooling was invented by Simon van der Meer and was demonstrated at the CERN ISR and ICE (Initial Cooling Experiment). Operational systems were developed at Fermilab and CERN. A complete theory of cooling of unbunched beams was developed, and was applied at CERN and Fermilab. Several new and existing rings employ coasting beam cooling. Bunched beam cooling was demonstrated in ICE and has been observed in several rings designed for coasting beam cooling. High energy bunched beams have proven more difficult. Signal suppression was achieved in the Tevatron, though operational cooling was not pursued at Fermilab. Longitudinal cooling was achieved in the RHIC collider. More recently a vertical cooling system in RHIC cooled both transverse dimensions via betatron coupling.

  9. Review of Partial Fasciectomy for Dupuytren's Contracture in Southern Chinese Patients

    OpenAIRE

    Chan, Wai-Chung; Wan, Siu-Ho; Ip, Fu-Keung

    2012-01-01

    Dupuytren's contracture is a fibroproliferative disease of the palmar fascia producing fascial fibrosis in nodular or cord form, and results in flexion contracture of the involved fingers. In contrast to Western populations, Dupuytren's contracture, especially the severe form of the disease, is not common in Southern Chinese patients: there have been only scant reports from the Southern Chinese region. In addition, the natural history and surgical outcome may be different from those of Wester...

  10. Postinfective skin contracture: a rare cause of fifth metatarsophalangeal joint subluxation

    Science.gov (United States)

    Prakash, Jatin; Mehtani, Anil

    2014-01-01

    Dislocation or subluxation of the metatarsophalangeal joint (MTP) is common and usually follows a traumatic event. Non-traumatic causes usually include inflammatory arthritis (rheumatoid arthritis), connective tissue disorders, crowded shoewear or flexor digitorum longus tendon contracture. We present a very unusual case of subluxation of the fifth MTP joint following a postboil skin contracture. The case was treated with the release of contracture by Z-plasty. It resulted in concentric reduction of the joint and normal skin healing. PMID:25199201

  11. Airway management of a patient with severe post burn mento-sternal contracture: A novel approach

    Directory of Open Access Journals (Sweden)

    Poonam Gupta

    2017-07-01

    Full Text Available Airway management in patients with severe post burn mentosternal contracture is always a challenge for the anaesthesiologist. Difficulty in intubation occurs due to contracture and fixed flexion deformity of the neck resulting in nonalignment of oropharyngeal and laryngeal axis. We are reporting a case with severe postburn mentosternal contracture in whom endotracheal intubation was done successfully by using a Pro seal Laryngeal Mask Airway without its introducer along with a tube exchanger after a failed awake fibreoptic intubation.

  12. Mechanical modelling of rapid cooling in porcelain tile-type systems; Modelizacion mecanica del enfriamiento rapido en sistemas tipo gres porcelanico

    Energy Technology Data Exchange (ETDEWEB)

    Dal Bo, M.; Cantavella, Y.; Sanchez, E.; Hotza, D.; Boschi, A.

    2012-07-01

    This paper analyses the effect of cooling on mechanical behaviour, in particular, on the residual stresses that appear when materials of the porcelain tile type are involved. However, these compositions have a very complex microstructure, in which there are several crystalline phases and the glassy phase is not homogeneous. In this study a simpler composition was therefore formulated, using sodium feldspar as starting material to which quartz with different particle sizes was added. A viscoelastic model was used to estimate the residual stresses that develop during cooling. The parameters of the model were obtained either from the literature or were determined in laboratory tests. An assembly was designed that allowed non-contact measurement of the temperature at the top and bottom surfaces of the test pieces during cooling. The test pieces were subjected to different types of cooling and their residual stresses were then determined by the strain relaxation slotting method. (Author)

  13. The quantitative role of flexor sheath incision in correcting Dupuytren proximal interphalangeal joint contractures.

    Science.gov (United States)

    Blazar, P E; Floyd, E W; Earp, B E

    2016-07-01

    Controversy exists regarding intra-operative treatment of residual proximal interphalangeal joint contractures after Dupuytren's fasciectomy. We test the hypothesis that a simple release of the digital flexor sheath can correct residual fixed flexion contracture after subtotal fasciectomy. We prospectively enrolled 19 patients (22 digits) with Dupuytren's contracture of the proximal interphalangeal joint. The average pre-operative extension deficit of the proximal interphalangeal joints was 58° (range 30-90). The flexion contracture of the joint was corrected to an average of 28° after fasciectomy. In most digits (20 of 21), subsequent incision of the flexor sheath further corrected the contracture by an average of 23°, resulting in correction to an average flexion contracture of 4.7° (range 0-40). Our results support that contracture of the tendon sheath is a contributor to Dupuytren's contracture of the joint and that sheath release is a simple, low morbidity addition to correct Dupuytren's contractures of the proximal interphalangeal joint. Additional release of the proximal interphalangeal joint after fasciectomy, after release of the flexor sheath, is not necessary in many patients. IV (Case Series, Therapeutic). © The Author(s) 2015.

  14. Field trial of three different Plasmodium vivax-detecting rapid diagnostic tests with and without evaporative cool box storage in Afghanistan

    Directory of Open Access Journals (Sweden)

    Mohammad Nader

    2011-06-01

    Full Text Available Abstract Background Accurate parasitological diagnosis of malaria is essential for targeting treatment where more than one species coexist. In this study, three rapid diagnostic tests (RDTs (AccessBio CareStart (CSPfPan, CareStart PfPv (CSPfPv and Standard Diagnostics Bioline (SDBPfPv were evaluated for their ability to detect natural Plasmodium vivax infections in a basic clinic setting. The potential for locally made evaporative cooling boxes (ECB to protect the tests from heat damage in high summer temperatures was also investigated. Methods Venous blood was drawn from P. vivax positive patients in Jalalabad, Afghanistan and tested against a panel of six RDTs. The panel comprised two of each test type; one group was stored at room temperature and the other in an ECB. RDT results were evaluated against a consensus gold standard based on two double-read reference slides and PCR. The sensitivity, specificity and a measure of global performance for each test were determined and stratified by parasitaemia level and storage condition. Results In total, 306 patients were recruited, of which 284 were positive for P. vivax, one for Plasmodium malariae and none for Plasmodium falciparum; 21 were negative. All three RDTs were specific for malaria. The sensitivity and global performance index for each test were as follows: CSPfPan [98.6%, 95.1%], CSPfPv [91.9%, 90.5%] and SDBPfPv [96.5%, 82.9%], respectively. CSPfPv was 16% less sensitive to a parasitaemia below 5,000/μL. Room temperature storage of SDBPfPv led to a high proportion of invalid results (17%, which reduced to 10% in the ECB. Throughout the testing period, the ECB maintained ~8°C reduction over ambient temperatures and never exceeded 30°C. Conclusions Of the three RDTs, the CSPfPan test was the most consistent and reliable, rendering it appropriate for this P. vivax predominant region. The CSPfPv test proved unsuitable owing to its reduced sensitivity at a parasitaemia below 5,000/

  15. Laser cooling of solids

    Energy Technology Data Exchange (ETDEWEB)

    Epstein, Richard I [Los Alamos National Laboratory; Sheik-bahae, Mansoor [UNM

    2008-01-01

    We present an overview of solid-state optical refrigeration also known as laser cooling in solids by fluorescence upconversion. The idea of cooling a solid-state optical material by simply shining a laser beam onto it may sound counter intuitive but is rapidly becoming a promising technology for future cryocooler. We chart the evolution of this science in rare-earth doped solids and semiconductors.

  16. Plantar fibromatosis and Dupuytren’s contracture in an adolescent

    Directory of Open Access Journals (Sweden)

    Nikolić Jelena

    2011-01-01

    Full Text Available Background. Fibromatosis represents a wide group of benign, locally proliferative disorders of fibroblasts. Dupuytren` s disease is a benign proliferative disease of palmar aponeurosis which usually affects adults between 40 and 60 years of age. Ledderhose`s disease or plantar fibromatosis is plantar equivalent of Dupuyten`s disease most often affecting middle- aged and older men, usually bilateral, represented with painless nodule in the medial division of plantar fascia. Case report. We presented a 19-year old adolescent that turned to a plastic surgeon complaining to his small finger contracture. He noticed palmar thickening with nodule over the metacarpophalangeal joint of small finger of his right hand when he was 16 years old. A year later a finger started to band. During physical checkup we noticed plantar nodule that also had his father and grandmother. Magnetic resonance and tumor biopsy confirmed a suspicion on plantar fibromatosis - Ledderhose`s disease. Clinical exam of the hand clearly led to a conclusion that the patient had Dupuytren`s contracture with pretendinous cord over the small finger flexor tendons and lack of extension of proximal interphalangeal (PIP joint. On the extensor side of the PIP joints there were Garrod`s nodes. The patient refused surgical treatment of plantar tumor, but agreed to surgical correction of finger contracture. Conclusion. Despite the fact that Dupuytren`s disease and plantar fibromatosis are diseases of adults, the possibility of conjoint appearance of these forms of fibromatosis in adolescent period of life should be kept in mind especially in patients with strong genetic predisposition.

  17. New perspectives on the development of muscle contractures following central motor lesions

    DEFF Research Database (Denmark)

    Pingel, Jessica; Bartels, Else Marie; Nielsen, Jens Bo

    2017-01-01

    suggested to be involved, but none of these mechanisms are sufficient to explain the development of muscle contractures alone. Here we propose that changes in tissue homeostasis in the neuro-muscular-tendon-connective tissue complex is at the heart of the development of contractures, and that an integrated...

  18. Airway Management of Post-burn Neck Contracture with Microstomia: Age Old Technique Revisited

    Directory of Open Access Journals (Sweden)

    Vrinda Oza

    2012-12-01

    Full Text Available This case report describes airway management of a patient of post burn neck contracture with fixed flexion deformity and restricted mouth opening. Attempt to intubate the patient with fiberoptic bronchoscope failed so the neck contracture was released under tumescent anaesthesia. The patient was then intubated with the help of stylet.

  19. Dupuytren Contracture in a Patient with Congenital Camptodactyly and Incidental Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    S Mahendran

    2008-11-01

    Full Text Available Dupuytren contracture is commonly seen in northern European populations but not in Asians. Even more rare is a presentation of flexion deformity of fingers involving two different pathologies with incidental carpal tunnel syndrome in the same patient. We report herein a case of Dupuytren contracture with congenital camptodactyly and unilateral carpal tunnel syndrome.

  20. A systematic review on burn scar contracture treatment: searching for evidence

    NARCIS (Netherlands)

    Stekelenburg, C.M.; Marck, R.E.; Tuinebreijer, W.E.; de Vet, H.C.W.; Ogawa, R.; van Zuijlen, P.P.M.

    2015-01-01

    Treating burn scar contracture remains a challenging problem for reconstructive surgeons. At present, no consensus exists on when to use what kind of technique. Therefore, a systematic review was performed on the effectiveness of the different surgical techniques after burn scar contracture release.

  1. Thickening of the inferior glenohumeral capsule: an ultrasound sign for shoulder capsular contracture.

    Science.gov (United States)

    Michelin, Paul; Delarue, Yohann; Duparc, Fabrice; Dacher, Jean Nicolas

    2013-10-01

    The aim of this retrospective study was to measure the inferior glenohumeral capsule thickness of shoulders clinically affected by capsular contracture by comparison to the contralateral asymptomatic side. Bilateral shoulder ultrasound (US) examinations of 20 patients with clinically or MRI proven unilateral capsular contracture were retrospectively assessed. Inferior capsule evaluation was performed with a transducer placed within the axilla in maximally abducted shoulders. Measurements were symmetrically performed orthogonally to the inferior glenohumeral ligament (IGHL) in the axial plane; the coronal plane was used to ensure the tension of the IGHL. The significance of any difference in thickening was assessed with the Mann-Whitney test. The average thickness was 4.0 mm in shoulders with capsular contracture vs. 1.3 mm in asymptomatic contralateral shoulders (P contracture and inferior capsule thickness increase showed US features of other painful diseases of the rotator cuff. The thickness of the inferior capsule is measurable through ultrasound examination and appears to be increased in shoulders with capsular contracture. Exploration of the inferior aspect of the shoulder joint could be added to shoulder US examination protocols for capsular contracture assessment even if other rotator cuff abnormalities are diagnosed by US. • Ultrasound is increasingly used to diagnose shoulder problems. • The thickness of the inferior glenohumeral ligament is measurable in the axilla. • The inferior glenohumeral ligament appears thickened in shoulders with capsular contracture. • Capsular contracture ultrasound features can be associated with other rotator cuff problems.

  2. Experience in the management of axillary post-burn scar contractures

    African Journals Online (AJOL)

    Background: Axillary post-burn scar contracture is a challenging problem to the reconstructive surgeon owing to the wide range of abduction that should be achieved. The aim of this paper is to highlight the various management options used in managing axillary contractures in our hospitals and to itemize the complications ...

  3. [Supplementary arthrolysis of the proximal interphalangeal joint of fingers in surgical treatment of Dupuytren's contracture].

    Science.gov (United States)

    Hohendorff, B; Biber, F; Sauer, H; Ries, C; Spies, C; Franke, J

    2016-02-01

    Correction of residual flexion deformity of the proximal interphalangeal (PIP) joint after excision of diseased connective tissue in Dupuytren's contracture by stepwise arthrolysis. Flexion deformity of the PIP joint of 20° or more after excision of the diseased connective tissue in Dupuytren's contracture. Joint deformities, osteoarthrosis, intrinsic muscle contracture, instability of the PIP joint. Arthrolysis of the PIP joint is performed by six consecutive steps: dissection of the remaining skin ligaments, opening the flexor tendon sheath by transverse incision at the distal end of the A2 pulley, dissection of the checkrein ligaments, dissection of the accessory collateral ligaments, releasing the palmar plate proximally, releasing the palmar plate up to its insertion at the middle phalanx base. Dorsal plaster of Paris with extended fingers and compressive dressing in the palm for 2 days, occupational/physical therapy, static and possible dynamic extension splint several weeks/months. A total of 31 fingers in 28 patients with Dupuytren's contracture were evaluated an average of 22 months after arthrolysis of the PIP joint. In all, 26 joints with an average recurrent flexion contracture of 29° were improved compared to the preoperative flexion contracture of 81°; 4 PIP joints with a recurrent flexion contracture averaging 60° were worse. In one patient, PIP flexion contracture of 90° was unchanged at follow-up although the joint could be extended intraoperatively to 10° of flexion.

  4. Treatment of the Upper Extremity Contracture/Deformities.

    Science.gov (United States)

    Oishi, Scott N; Agranovich, Olga; Pajardi, Giorgio E; Novelli, Chiara; Baindurashvili, Alexey G; Trofimova, Svetlana I; Abdel-Ghani, Hisham; Kochenova, Evgenia; Prosperpio, Giulietta; Jester, Andrea; Yilmaz, Güney; Şenaran, Hakan; Kose, Oksana; Butler, Lesley

    Patients with arthrogryposis multiplex congenita have a characteristic upper extremity resting posture consisting of internal rotation of the shoulders, elbow extension, flexed wrists, thumb-in palm deformities, and variable degrees of finger contractures. Treatment of these patients is aimed at improving independence and performance of activities of daily living. Although each area needs to be assessed independently for the most appropriate surgical procedure, often multiple areas can be addressed at the same operative setting. This limits the number of anesthetic exposures and cast immobilization time. The following is a synopsis of treatment strategies presented at the second international symposium on Arthrogryposis which took place in St Petersburg in September 2014.

  5. [The Extended Percutaneous Needle Fasciotomy Technique (PNF+) For Dupuytren's Contracture].

    Science.gov (United States)

    Lenze, Wolfgang Paul

    2017-02-01

    The extended percutaneous needle fasciotomy (PNF+) is a minimal invasive technique especially suitable for treating severe Dupuytren's contractures and recurrences. The familiar needle fasciotomy is complemented by a spontaneous tearing of the skin and a full-thickness graft to cover the defect. Skin tears in fingers and palm are not a complication, but an integral part of the PNF+. The neurovascular bundles remain intact. This surgical procedure may be repeated as often as required. © Georg Thieme Verlag KG Stuttgart · New York.

  6. Adjustable distractor for management of thumb web contracture.

    Science.gov (United States)

    Kamath, B J; Bhardwaj, P

    2009-03-01

    Thumb web contracture is a progressive disabling deformity, and prevention or early intervention is advisable. We describe the use in 18 cases of an external adjustable thumb web distractor, with one static and one mobile block on K-wires fixed transversely to the metacarpal shafts. The mobile block can be moved, causing distraction or compression between the two blocks, to maintain or correct thumb web expansion. This inexpensive and effective device can be safely applied to an injured hand, allows movement at the first carpometacarpal joint and hence obtains good functional outcome. The only complication has been minor pin site infection.

  7. Rapid Endovascular Catheter Core Cooling combined with cold saline as an Adjunct to Percutaneous Coronary Intervention For the Treatment of Acute Myocardial Infarction (The CHILL-MI trial)

    DEFF Research Database (Denmark)

    Erlinge, David; Götberg, Matthias; Lang, Irene

    2014-01-01

    OBJECTIVES: The aim of this study was to confirm the cardioprotective effects of hypothermia using a combination of cold saline and endovascular cooling. BACKGROUND: Hypothermia has been reported to reduce infarct size (IS) in patients with ST-segment elevation myocardial infarctions. METHODS: In...

  8. Splinting after contracture release for Dupuytren's contracture (SCoRD): protocol of a pragmatic, multi-centre, randomized controlled trial.

    Science.gov (United States)

    Jerosch-Herold, Christina; Shepstone, Lee; Chojnowski, Adrian J; Larson, Debbie

    2008-04-30

    Splinting as part of the overall post-surgical management of patients after release of Dupuytren's contracture has been widely reported, though there is variation in practice and criteria for using it. The evidence on its effectiveness is sparse, of poor quality and contradictory with studies reporting negative and positive effects. A multi-centre, pragmatic, randomized, controlled trial is being conducted to evaluate the effect of static night splinting for six months on hand function, range of movement, patient satisfaction and recurrence at 1 year after fasciectomy or dermofasciectomy. Using a centrally administered computer randomization system consented patients will be allocated to one of two groups: i) splint group who will be given a static splint at approximately 10 to 14 days after surgery to be worn for 6 months at night time only as well as hand therapy; ii) non-splint group, who will receive hand therapy only. The primary outcome measure is the patient-reported Disabilities of the Arm, Hand and Shoulder Questionnaire (DASH). Secondary outcomes are total active flexion and extension of fingers, patient satisfaction and recurrence of contracture. Outcome measures will be collected prior to surgery, 3 months, 6 months and 1 year after surgery. Using the DASH as the primary outcome measure, where a difference of 15 points is considered to be a clinically important difference a total of 51 patients will be needed in each group for a power of 90%. An intention-to-treat analysis will be used. This pragmatic randomized controlled trial will provide much needed evidence on the clinical effectiveness of post-operative night splinting in patients who have undergone fasciectomy or dermofasciectomy for Dupuytren's contracture of the hand. Current Controlled Trials ISRCTN 57079614.

  9. Splinting after contracture release for Dupuytren's contracture (SCoRD: protocol of a pragmatic, multi-centre, randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Chojnowski Adrian J

    2008-04-01

    Full Text Available Abstract Background Splinting as part of the overall post-surgical management of patients after release of Dupuytren's contracture has been widely reported, though there is variation in practice and criteria for using it. The evidence on its effectiveness is sparse, of poor quality and contradictory with studies reporting negative and positive effects. Methods/Design A multi-centre, pragmatic, randomized, controlled trial is being conducted to evaluate the effect of static night splinting for six months on hand function, range of movement, patient satisfaction and recurrence at 1 year after fasciectomy or dermofasciectomy. Using a centrally administered computer randomization system consented patients will be allocated to one of two groups: i splint group who will be given a static splint at approximately 10 to 14 days after surgery to be worn for 6 months at night time only as well as hand therapy; ii non-splint group, who will receive hand therapy only. The primary outcome measure is the patient-reported Disabilities of the Arm, Hand and Shoulder Questionnaire (DASH. Secondary outcomes are total active flexion and extension of fingers, patient satisfaction and recurrence of contracture. Outcome measures will be collected prior to surgery, 3 months, 6 months and 1 year after surgery. Using the DASH as the primary outcome measure, where a difference of 15 points is considered to be a clinically important difference a total of 51 patients will be needed in each group for a power of 90%. An intention-to-treat analysis will be used. Discussion This pragmatic randomized controlled trial will provide much needed evidence on the clinical effectiveness of post-operative night splinting in patients who have undergone fasciectomy or dermofasciectomy for Dupuytren's contracture of the hand. Trial Registration Current Controlled Trials ISRCTN 57079614

  10. Collagenase clostridium histolyticum in Dupuytren's contracture: a systematic review.

    Science.gov (United States)

    Smeraglia, Francesco; Del Buono, Angelo; Maffulli, Nicola

    2016-06-01

    In the last few years, the use of collagenase clostridium histolyticum for management of Dupuytren's contracture has increased. The procedure of enzymatic fasciectomy has become popular because it is non-invasive, safe and fast to perform. A systematic search was performed on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'Dupuytren collagenase' and 'Dupuytren clostridium histolyticum'. Forty-three studies were identified. The quality of the studies was assessed using the Coleman Methodological Score. The use of collagenase clostridium histolyticum provides better outcomes in patients with mild-moderate joint contracture, with lower complications and side effects than open fasciectomy. Manipulation can be performed 2-7 days after the injection. The use of collagenase is cost-effective. Most of the studies did not report patient-related outcomes. The role of dynamic splint has to be investigated with randomized clinical trials. The shorter recovery time and the low incidence of serious or major adverse effects are the main advantages of this new technology. There is a need to perform studies with longer follow-up because the recurrence rate seems to increase with time. Further investigations are necessary to assess whether it is safe and effective to inject two or more cords at the same time. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. Dupuytren contracture: comparative study between partial fasciectomy and percutaneous fasciectomy

    Directory of Open Access Journals (Sweden)

    Samuel Ribak

    2013-12-01

    Full Text Available Objectives: To compare the clinical results obtained by using the techniques of open limited fasciectomy (FP and percutaneous needle fasciectomy (FPC in patients with Dupuytren's contracture after one year follow up. Methods: Thirty-three patients and a total of 50 fingers with Dupuytren's contracture were divided non-randomly and evaluated after undergoing procedures with FP or FPC. The results were evaluated based on the Tubiana classification, DASH score (Disabilities of the Arm, Shoulder, and Hand, time until return to professional activities, total passive extension deficit (DTEP, the relationship between the extension deficit and DASH, recurrence and complications. Results: Twenty-six fingers were treated with FPC technique and 24 fingers with FP. The DTEP was significantly lower in FP group (10.23º when compared to FPC group (23.46º at 12 months postoperatively (p = 0.038. The remaining items assessed did not show any statistically significant differences. Conclusion: Total passive extension deficit at 12 months is lower in the group of open limited fasciectomy. There are no significant differences between groups FP and FPC over the classification of Tubiana, the DASH score, time until return to professional activities and the incidence of recurrence.

  12. Congenital Heart Disease in Adolescents With Gluteal Muscle Contracture

    Science.gov (United States)

    You, Tian; Zhang, Xin-tao; Zha, Zhen-gang; Zhang, Wen-tao

    2015-01-01

    Abstract Gluteal muscle contracture (GMC), presented with hip abduction and external rotation when crouching, is common in several ethnicities, particularly in Chinese. It remains unclear that the reasons why these children are weak and have no choice to accept repeated intramuscular injection. Here, we found some unique cases which may be useful to explain this question. We describe a series of special GMC patients, who are accompanied with congenital heart disease (CHD). These cases were first observed in preoperative examinations of a patient with atrial septal defect (ASD), which was proved by chest X-ray and cardiac ultrasound. From then on, we gradually identified additional 3 GMC patients with CHD. The original patient with ASD was sent to cardiosurgery department to repair atrial septal first and received arthroscopic surgery later. While the other 3 were cured postoperative of ventricular septal defect (VSD), tetralogy of fallot (TOF), patent ductus arteriosus (PDA), respectively, and had surgery directly. The study gives us 3 proposals: (1) as to CHD children, it is essential to decrease the use of intramuscular injection, (2) paying more attention to cardiac examination especially cardiac ultrasound in perioperative period, and (3) taking 3D-CT to reconstruct gluteal muscles for observing contracture bands clearly in preoperation. However, more larger series of patients are called for to confirm these findings. PMID:25654394

  13. Gastrocnemius Contracture in Patients With and Without Foot Pathology.

    Science.gov (United States)

    Jastifer, James R; Marston, Jessica

    2016-11-01

    Several studies report performing a recession of the gastrocnemius tendon as surgical treatment of foot and ankle pain related to an isolated gastrocnemius contracture. Few report ankle range of motion using a validated measurement device or report a control group. All previous studies reporting measurements using a validated device have been small in number. Using a previously validated device, 66 patients presenting with foot or ankle pain and 66 controls were measured for ankle range of motion and isolated gastrocnemius contractures. Clinical and goniometer measurement of ankle range of motion was also performed. The foot and ankle pain group had a mean dorsiflexion of 11.6 degrees compared with a mean of 17.2 degrees in the control group (P < .0001). No patients in either group had less than 15 degrees of motion with the knee flexed. The difference in dorsiflexion was less using a goniometer than using the validated device, which may be due to measurement technique and external landmarks. Patients with foot and ankle pain had less ankle dorsiflexion than the control group. This is the largest study to date using a validated measurement device as well as a control group and supports the findings of previous authors. Level II, prospective cohort study. © The Author(s) 2016.

  14. Recurrence of Dupuytren's contracture: A consensus-based definition.

    Directory of Open Access Journals (Sweden)

    Hester J Kan

    Full Text Available One of the major determinants of Dupyutren disease (DD treatment efficacy is recurrence of the contracture. Unfortunately, lack of agreement in the literature on what constitutes recurrence makes it nearly impossible to compare the multiple treatments alternatives available today. The aim of this study is to bring an unbiased pool of experts to agree upon what would be considered a recurrence of DD after treatment; and from that consensus establish a much-needed definition for DD recurrence.To reach an expert consensus on the definition of recurrence we used the Delphi method and invited 43 Dupuytren's research and treatment experts from 10 countries to participate by answering a series of questionnaire rounds. After each round the answers were analyzed and the experts received a feedback report with another questionnaire round to further hone in of the definition. We defined consensus when at least 70% of the experts agreed on a topic.Twenty-one experts agreed to participate in this study. After four consensus rounds, we agreed that DD recurrence should be defined as "more than 20 degrees of contracture recurrence in any treated joint at one year post-treatment compared to six weeks post-treatment". In addition, "recurrence should be reported individually for every treated joint" and afterwards measurements should be repeated and reported yearly.This study provides the most comprehensive to date definition of what should be considered recurrence of DD. These standardized criteria should allow us to better evaluate the many treatment alternatives.

  15. Dupuytren's contracture: a retrospective database analysis to determine hospitalizations in the Netherlands.

    Science.gov (United States)

    Overbeek, Jetty A; Penning-van Beest, Fernie Ja; Heintjes, Edith M; Gerber, Robert A; Cappelleri, Joseph C; Hovius, Steven Er; Herings, Ron Mc

    2011-10-12

    Dupuytren's contracture is a condition of the palmar fascia involving contractures of the fascia and skin in the hand. Current treatment for Dupuytren's contracture is mainly limited to surgery. In the Netherlands, little is known about the prevalence of Dupuytren's contracture. In this study we determined the prevalence of patients with a hospitalization for Dupuytren's contracture in the Netherlands and characterized their (re)hospitalizations. From the PHARMO database, which consists of multiple observational databases linked on a patient level, all patients hospitalized for Dupuytren's contracture between 2004 and 2007 were included in the source population (ICD-9-CM code 728.6). Numbers from this source population were used to provide estimates of hospitalizations for Dupuytren's contracture in the Netherlands. Patients with a medical history in the PHARMO database of at least 12 months before their hospitalization were included in the study cohort and followed until end of data collection, death, or end of study period, whichever occurred first. Type of admission, length of stay, recorded procedures, treating specialty, number of rehospitalizations for Dupuytren's contracture, and time to first rehospitalization were assessed. Of 3, 126 patients included in the source population, 3, 040 were included in the study population. The overall prevalence of patients with a hospitalization for Dupuytren's contracture was 0.04%, with the highest prevalence (0.25%) among 60-79 year old males. The majority (85%) of all hospitalizations were day-case admissions. Of the admitted inpatients (15%) the majority (81%) had one overnight stay in the hospital. The most common recorded procedure was fasciectomy (87%) and 78% of patients was treated by a plastic surgeon. During a median (IQR) follow-up of 2.9 (1.8-4.0) years, 523 patients were rehospitalized for Dupuytren's contracture. The median (IQR) time to first rehospitalization was 0.8 (0.4-1.9) years. This study is a first

  16. Dupuytren's contracture: a retrospective database analysis to determine hospitalizations in the Netherlands

    Directory of Open Access Journals (Sweden)

    Gerber Robert A

    2011-10-01

    Full Text Available Abstract Background Dupuytren's contracture is a condition of the palmar fascia involving contractures of the fascia and skin in the hand. Current treatment for Dupuytren's contracture is mainly limited to surgery. In the Netherlands, little is known about the prevalence of Dupuytren's contracture. In this study we determined the prevalence of patients with a hospitalization for Dupuytren's contracture in the Netherlands and characterized their (rehospitalizations. Methods From the PHARMO database, which consists of multiple observational databases linked on a patient level, all patients hospitalized for Dupuytren's contracture between 2004 and 2007 were included in the source population (ICD-9-CM code 728.6. Numbers from this source population were used to provide estimates of hospitalizations for Dupuytren's contracture in the Netherlands. Patients with a medical history in the PHARMO database of at least 12 months before their hospitalization were included in the study cohort and followed until end of data collection, death, or end of study period, whichever occurred first. Type of admission, length of stay, recorded procedures, treating specialty, number of rehospitalizations for Dupuytren's contracture, and time to first rehospitalization were assessed. Results Of 3, 126 patients included in the source population, 3, 040 were included in the study population. The overall prevalence of patients with a hospitalization for Dupuytren's contracture was 0.04%, with the highest prevalence (0.25% among 60-79 year old males. The majority (85% of all hospitalizations were day-case admissions. Of the admitted inpatients (15% the majority (81% had one overnight stay in the hospital. The most common recorded procedure was fasciectomy (87% and 78% of patients was treated by a plastic surgeon. During a median (IQR follow-up of 2.9 (1.8-4.0 years, 523 patients were rehospitalized for Dupuytren's contracture. The median (IQR time to first rehospitalization

  17. Are mechanically sensitive regulators involved in the function and (patho)physiology of cerebral palsy-related contractures?

    DEFF Research Database (Denmark)

    Pingel, Jessica; Suhr, Frank

    2017-01-01

    mechanosensing and metabolism cause and contribute to many diseases, i.e. muscular dystrophies/myopathies, cardiovascular diseases, COPD or diabetes mellitus type 2. A less commonly focused muscle-related disorder is clinically known as muscle contractures that derive from cerebral palsy (CP) conditions in young...... role in CP-related contractures. The aims of this review are (1) to summarize CP-related contracture mechanisms, (2) to raise novel hypotheses on the genesis of contractures with a focus on Cstms, and (3) to stimulate novel approaches to study CP-related contractures....

  18. Adult Hip Flexion Contracture due to Neurological Disease: A New Treatment Protocol—Surgical Treatment of Neurological Hip Flexion Contracture

    Directory of Open Access Journals (Sweden)

    Alberto Nicodemo

    2014-01-01

    Full Text Available Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible.

  19. Cost comparison of open fasciectomy versus percutaneous needle aponeurotomy for treatment of Dupuytren contracture.

    Science.gov (United States)

    Herrera, Fernando Antonio; Benhaim, Prosper; Suliman, Ahmed; Roostaeian, Jason; Azari, Kodi; Mitchell, Scott

    2013-04-01

    Many surgical options exist for the treatment of Dupuytren contracture. Little has been written regarding their financial implications. The purpose of this study was to compare the immediate direct costs of open fasciectomy to percutaneous needle aponeurotomy (NA) for the surgical treatment of Dupuytren contracture. A retrospective review was performed comparing patients treated with open fasciectomy (group 1) to patients treated with percutaneous NA (group 2) for the treatment of Dupuytren disease from 2008 to 2010. Financial and medical records were reviewed. Direct cost of treatment was calculated from hospital billing records, including surgical, anesthesia, and facility fees. Statistical analysis was performed using unpaired t test. Twenty-four patients received open segmental palmar and/or digital fasciectomy (group 1). Average preoperative metacarpophalangeal joint flexion contracture was 30 degrees, and proximal interphalangeal joint flexion contracture was 42 degrees. Group 2 consisted of 24 patients. Average preoperative metacarpophalangeal flexion contracture was 31 degrees, and proximal interphalangeal flexion contracture was 27 degrees. Mean cost for group 1 was $11,240 and mean cost for group 2 was $4657 (P < 0.0001). Immediate postoperative contracture correction was similar between both. Two complications occurred in group 1 (wound dehiscence and nerve injury); no complications in group 2. Percutaneous NA is associated with decreased direct costs in the short-term compared to traditional open fasciectomy with comparable deformity correction.

  20. Functional and subjective assessment of burn contracture release in a mission setting.

    Science.gov (United States)

    Sinha, Indranil; Zhu, Dagny; Ojomo, Kristin; Gfrerer, Lisa; Sawh-Martinez, Rajendra; Patel, Anup; Chan, Rodney K; Watkins, James F

    2016-03-01

    Burns and subsequent contractures are common in developing nations. Contracture release is performed to treat such patients with functional limitations. The aim of this study is to evaluate post-operative functional and psychosocial outcomes following contracture release in a mission setting. During a surgical mission in Mumbai, India, 39 patients burn contractures underwent surgical release. A total of 31 patients (64% female, mean age 27 years) chose to participate in the study. Patients were scored preoperatively and postoperatively using a SF-36 validated survey and AMA impairment guideline assessment. Thirty-one patients completed questionnaires pre-operative and 6-weeks post operatively. Twenty-four patients completed a survey 3-months post operatively (77.4%). Among those enrolled, 67% were women with the majority sustaining contractures (80.6%). SF-36 physical component score increased from a mean score of 49.8 preoperatively to 55.6 by 3 months following contracture release (Pcontracture release, confirming both functional and psychologic improvement following surgery. During the acute post-operative period, this study suggests that contracture release in a mission setting is of benefit to patients. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  1. Use of preputial skin for coverage of post-burn contractures of fingers in children

    Directory of Open Access Journals (Sweden)

    Mohammed I Zaroo

    2011-01-01

    Full Text Available Objective: Hand burns are common injuries. Children frequently sustain burn injuries, especially to their hands. Contractures are a common sequel of severe burns around joints. The prepuce, or foreskin, has been used as a skin graft for a number of indications. We conducted this study to evaluate the feasibility of utilising the preputial skin for the management of post-burn contractures of fingers in uncircumcised male children. Materials and Methods: Preputial skin was used for the coverage of released contractures of fingers in 12 patients aged 2-6 years. The aetiology of burns was "Kangri" burn in eight patients and scalding in four patients. Six patients had contracture in two fingers, four patients in one finger, and two patients had contractures in three fingers. Results: None of the patients had graft loss, and all the wounds healed within 2 weeks. All patients had complete release of contractures without any recurrence. Hyperpigmentation of the grafts was observed over a period of time, which was well accepted by the parents. Conclusions: Preputial skin can be used successfully for male children with mild-to-moderate contractures of 2-3 fingers for restoration of the hand function, minimal donor site morbidity.

  2. Impaired growth of denervated muscle contributes to contracture formation following neonatal brachial plexus injury.

    Science.gov (United States)

    Nikolaou, Sia; Peterson, Elizabeth; Kim, Annie; Wylie, Christopher; Cornwall, Roger

    2011-03-02

    The etiology of shoulder and elbow contractures following neonatal brachial plexus injury is incompletely understood. With use of a mouse model, the current study tests the novel hypothesis that reduced growth of denervated muscle contributes to contractures following neonatal brachial plexus injury. Unilateral brachial plexus injuries were created in neonatal mice by supraclavicular C5-C6 nerve root excision. Shoulder and elbow range of motion was measured four weeks after injury. Fibrosis, cross-sectional area, and functional length of the biceps, brachialis, and subscapularis muscles were measured over four weeks following injury. Muscle satellite cells were cultured from denervated and control biceps muscles to assess myogenic capability. In a comparison group, shoulder motion and subscapularis length were assessed following surgical excision of external rotator muscles. Shoulder internal rotation and elbow flexion contractures developed on the involved side within four weeks following brachial plexus injury. Excision of the biceps and brachialis muscles relieved the elbow flexion contractures. The biceps muscles were histologically fibrotic, whereas fatty infiltration predominated in the brachialis and rotator cuff muscles. The biceps and brachialis muscles displayed reduced cross-sectional and longitudinal growth compared with the contralateral muscles. The upper subscapularis muscle similarly displayed reduced longitudinal growth, with the subscapularis shortening correlating with internal rotation contracture. However, excision of the external rotators without brachial plexus injury caused no contractures or subscapularis shortening. Myogenically capable satellite cells were present in denervated biceps muscles despite impaired muscle growth in vivo. Injury of the upper trunk of the brachial plexus leads to impaired growth of the biceps and brachialis muscles, which are responsible for elbow flexion contractures, and impaired growth of the subscapularis

  3. The Prevalence, Rate of Progression, and Treatment of Elbow Flexion Contracture in Children with Brachial Plexus Birth Palsy

    Science.gov (United States)

    Sheffler, Lindsey C.; Lattanza, Lisa; Hagar, Yolanda; Bagley, Anita; James, Michelle A.

    2012-01-01

    Background: Elbow flexion contracture is a well-known complication of brachial plexus birth palsy that adversely affects upper-extremity function. The prevalence, risk factors, and rate of progression of elbow flexion contracture associated with brachial plexus birth palsy have not been established, and the effectiveness of nonoperative treatment involving nighttime splinting or serial casting has not been well studied. Methods: The medical records of 319 patients with brachial plexus birth palsy who had been seen at our institution between 1992 and 2009 were retrospectively reviewed to identify patients with an elbow flexion contracture (≥10°). The chi-square test for trend and the Kaplan-Meier estimator were used to evaluate risk factors for contracture, including age, sex, and the extent of brachial plexus involvement. Longitudinal models were used to estimate the rate of contracture progression and the effectiveness of nonoperative treatment. Results: An elbow flexion contracture was present in 48% (152) of the patients with brachial plexus birth palsy. The median age of onset was 5.1 years (range, 0.25 to 14.8 years). The contracture was ≥30° in 36% (fifty-four) of these 152 patients and was accompanied by a documented radial head dislocation in 6% (nine). The prevalence of contracture increased with increasing age (p contracture increased by 4.4% per year before treatment (p contracture decreased by 31% when casting was performed (p contracture did not improve when splinting was performed but the rate of increase thereafter decreased to contracture in children with brachial plexus birth palsy may be greater than clinicians perceive. The prevalence increased with patient age but was not significantly affected by sex or by the extent of brachial plexus involvement. Serial casting may initially improve severe contractures, whereas nighttime splinting may prevent further progression of milder contractures. Level of Evidence: Therapeutic Level IV. See

  4. Ventilative Cooling

    DEFF Research Database (Denmark)

    Heiselberg, Per Kvols; Kolokotroni, Maria

    -of-the-art of ventilative cooling potentials and limitations, its consideration in current energy performance regulations, available building components and control strategies and analysis methods and tools. In addition, the report provides twenty six examples of operational buildings using ventilative cooling ranging from...

  5. Orbital socket contracture: a complication of inflammatory orbital disease in patients with Wegener’s granulomatosis

    Science.gov (United States)

    Talar-Williams, C; Sneller, M C; Langford, C A; Smith, J A; Cox, T A; Robinson, M R

    2005-01-01

    Aim: To describe the clinical characteristics of orbital socket contracture in patients with Wegener’s granulomatosis (WG). Methods: A retrospective cohort study The medical records of 256 patients with WG examined at the National Institutes of Health from 1967 to 2004 were reviewed to identify patients with orbital socket contracture. Details of the orbital disease including Hertel exophthalmometry readings, radiological findings, and results of eye examinations were recorded. Orbital socket contracture was defined as orbital inflammation with proptosis followed by the development of enophthalmos and radiographic evidence of residual fibrotic changes in the orbit. To examine for risk factors in the development of a contracted orbit, patients with orbital socket contracture were compared to patients without contracture with respect to multiple variables including history of orbital surgery, orbital disease severity, and major organ system involvement. The main outcome measures were the clinical characteristics of orbital socket contracture associated with inflammatory orbital disease in patients with WG. Results: Inflammatory orbital disease occurred in 34 of 256 (13%) patients and detailed clinical data on 18 patients were available and examined. Orbital socket contracture occurred during the clinical course in six patients; the features included restrictive ophthalmopathy (five), chronic orbital pain (three), and ischaemic optic nerve disease (two) resulting in blindness (no light perception) in one patient. The orbital socket contracture occurred within 3 months of treatment with immunosuppressive medications for inflammatory orbital disease in five patients and was not responsive to immunosuppressive medications. The median degree of enophthalmos in the contracted orbit compared with the fellow eye was 2.8 mm (range 1.5–3.5 mm) by Hertel exophthalmometry. There were no risk factors that predicted development of orbital socket contracture. Conclusions: In

  6. Glenohumeral abduction contracture in children with unresolved neonatal brachial plexus palsy.

    Science.gov (United States)

    Eismann, Emily A; Little, Kevin J; Laor, Tal; Cornwall, Roger

    2015-01-21

    Following neonatal brachial plexus palsy, the Putti sign-obligatory tilt of the scapula with brachiothoracic adduction-suggests the presence of glenohumeral abduction contracture. In the present study, we utilized magnetic resonance imaging (MRI) to quantify this glenohumeral abduction contracture and evaluate its relationship to shoulder joint deformity, muscle atrophy, and function. We retrospectively reviewed MRIs of the thorax and shoulders obtained before and after shoulder rebalancing surgery (internal rotation contracture release and external rotation tendon transfer) for twenty-eight children with unresolved neonatal brachial plexus palsy. Two raters measured the coronal positions of the scapula, thoracic spine, and humeral shaft bilaterally on coronal images, correcting trigonometrically for scapular protraction on axial images. Supraspinatus, deltoid, and latissimus dorsi muscle atrophy was assessed, blinded to other measures. Correlations between glenohumeral abduction contracture and glenoid version, humeral head subluxation, passive external rotation, and Mallet shoulder function before and after surgery were performed. MRI measurements were highly reliable between raters. Glenohumeral abduction contractures were present in twenty-five of twenty-eight patients, averaging 33° (range, 10° to 65°). Among those patients, abductor atrophy was present in twenty-three of twenty-five, with adductor atrophy in twelve of twenty-five. Preoperatively, greater abduction contracture severity correlated with greater Mallet global abduction and hand-to-neck function. Abduction contracture severity did not correlate preoperatively with axial measurements of glenohumeral dysplasia, but greater glenoid retroversion was associated with worse abduction contractures postoperatively. Surgery improved passive external rotation, active abduction, and hand-to-neck function, but did not change the abduction contracture. A majority of patients with persistent shoulder weakness

  7. The Relationship of Bacterial Biofilms and Capsular Contracture in Breast Implants

    Science.gov (United States)

    Ajdic, Dragana; Zoghbi, Yasmina; Gerth, David; Panthaki, Zubin J.; Thaller, Seth

    2016-01-01

    Capsular contracture is a common sequelae of implant-based breast augmentation. Despite its prevalence, the etiology of capsular contracture remains controversial. Numerous studies have identified microbial biofilms on various implantable materials, including breast implants. Furthermore, biofilms have been implicated in subclinical infections associated with other surgical implants. In this review, we discuss microbial biofilms as a potential etiology of capsular contracture. The review also outlines the key diagnostic modalities available to identify the possible infectious agents found in biofilm, as well as available preventative and treatment measures. PMID:26843099

  8. Assessment of an electronic goniometer designed to measure equinus contracture.

    Science.gov (United States)

    Assal, Mathieu; Shofer, Jane B; Rohr, Eric; Price, Robert; Czerniecki, Joseph; Sangeorzan, Bruce J

    2003-01-01

    To achieve more objective and repeatable measurements of equinus contracture, we developed the equinometer, a device that allows the measurement of ankle range of motion under controlled torque conditions. This study assessed its accuracy across different subjects and examiners. Two examiners used the equinometer to measure the angle of ankle dorsiflexion at 15 N x m torque on five subjects. Accounting for variation in measurements because of subjects, examiners, and placement of device, we used linear mixed-effects models. Accounting for the variation because of subject, different placements of the equinometer within each subject and the adjustment for the effects of examiner and trial sequence, the standard deviation was 0.94 degrees, 95% confidence interval (0.79 degrees, 1.13 degrees). An upper standard deviation of 1.36 degrees is felt to be acceptable for clinical investigation.

  9. Knee flexion contracture in haemophilia: treatment with circular external fixator.

    Science.gov (United States)

    Balci, H I; Kocaoglu, M; Eralp, L; Bilen, F E

    2014-11-01

    Haemophilia, a bleeding disorder, causes recurrent intra-articular bleeding of the joints result-ing in chronic haemophilic arthropathy with fixed knee flexion deformity. Mid-long-term results (between 2002 and 2006) of deformity correction in haemophilic patients with Ilizarov type circular external fixators were retrospectively evaluated. There were six patients (five haemophilia A and one haemophilia B). The mean age was 14.7 years (range, 8-22 years) at the time of initial surgery. The mean knee flexion contracture was 45 degrees (range, 30-75 degrees). The mean arc of motion was 58.3 degrees (range, 40-100) before the surgery. The mean duration of follow-up was 8 years (range, 5.5-10 years). The mean duration of external fixation was 4.4 months (range, 2.5-10.5 months). Full extension of the knee joint was obtained in all patients in the early postoperative period. No bleeding, neurological or vascular complications were encountered. The mean amount of recurrence in knee flexion contracture was 10 degrees (range, 0-15 degrees). The amount of the correction was significant (P = 0.0012) and the mean arc of motion was 51.6 degrees (range, 25-90 degrees) that show a decrease of 6.7 degrees (P = 0.04) at the end of follow-up. The circular external fixator is an important, safe and less invasive alternative surgical treatment modality with low recurrence rate. Using the external hinges and distraction during the correction has a protective effect on the joint. It requires a team-work consisting of a haematologist, an orthopaedic surgeon and a physical therapist. © 2014 John Wiley & Sons Ltd.

  10. Improvement in elastic properties of CuAl{sub 0.4}Fe{sub 1.6}O{sub 4} spinel ferrite by rapid thermal cooling

    Energy Technology Data Exchange (ETDEWEB)

    Modi, K. B., E-mail: kunalbmodi2003@yahoo.com; Shah, S. J., E-mail: kunalbmodi2003@yahoo.com; Pathak, T. K., E-mail: kunalbmodi2003@yahoo.com; Vasoya, N. H., E-mail: kunalbmodi2003@yahoo.com; Lakhani, V. K., E-mail: kunalbmodi2003@yahoo.com [Department of Physics, Saurashtra University, Rajkot-360005 (India); Yahya, A. K. [School of Physics and Materials Studies, University Technology MARA, 40450 Shah Alam, Selangor (Malaysia)

    2014-04-24

    The elastic properties of spinel ferrite composition, CuAl{sub 0.4}Fe{sub 1.6}O{sub 4}, quenched from final sintering temperature of 1373 K to liquid nitrogen temperature (∼ 80K) have been studied by means of X-ray powder diffractometry and pulse echo-overlap technique (9 MHz) at 300 K. The magnitude of elastic constants is found to enhance by 15% compared to slowly-cooled counterpart. The observed mechanical strengthening has been discussed in the light of compressive stress on the surface, with tensile stresses at interior regions and corresponding changes in structural parameters. The B{sub o}/G{sub o} ratio indicates the brittle nature of CuAl{sub 0.4}Fe{sub 1.6}O{sub 4}.

  11. Rapid endovascular catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction. The CHILL-MI trial: a randomized controlled study of the use of central venous catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction.

    Science.gov (United States)

    Erlinge, David; Götberg, Matthias; Lang, Irene; Holzer, Michael; Noc, Marko; Clemmensen, Peter; Jensen, Ulf; Metzler, Bernhard; James, Stefan; Bötker, Hans Erik; Omerovic, Elmir; Engblom, Henrik; Carlsson, Marcus; Arheden, Håkan; Ostlund, Ollie; Wallentin, Lars; Harnek, Jan; Olivecrona, Göran K

    2014-05-13

    The aim of this study was to confirm the cardioprotective effects of hypothermia using a combination of cold saline and endovascular cooling. Hypothermia has been reported to reduce infarct size (IS) in patients with ST-segment elevation myocardial infarctions. In a multicenter study, 120 patients with ST-segment elevation myocardial infarctions (cold saline and endovascular cooling or standard of care. Hypothermia was initiated before percutaneous coronary intervention and continued for 1 h after reperfusion. The primary end point was IS as a percent of myocardium at risk (MaR), assessed by cardiac magnetic resonance imaging at 4 ± 2 days. Mean times from symptom onset to randomization were 129 ± 56 min in patients receiving hypothermia and 132 ± 64 min in controls. Patients randomized to hypothermia achieved a core body temperature of 34.7°C before reperfusion, with a 9-min longer door-to-balloon time. Median IS/MaR was not significantly reduced (hypothermia: 40.5% [interquartile range: 29.3% to 57.8%; control: 46.6% [interquartile range: 37.8% to 63.4%]; relative reduction 13%; p = 0.15). The incidence of heart failure was lower with hypothermia at 45 ± 15 days (3% vs. 14%, p cold saline and endovascular cooling was feasible and safe, and it rapidly reduced core temperature with minor reperfusion delay. The primary end point of IS/MaR was not significantly reduced. Lower incidence of heart failure and a possible effect in patients with early anterior ST-segment elevation myocardial infarctions need confirmation. (Efficacy of Endovascular Catheter Cooling Combined With Cold Saline for the Treatment of Acute Myocardial Infarction [CHILL-MI]; NCT01379261). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  12. Hinged cast brace for persistent flexion contracture following total knee replacement.

    Science.gov (United States)

    Karam, Matthew D; Pugely, Andrew; Callaghan, John J; Shurr, Donald

    2011-01-01

    The reported incidence of persistent knee flexion contracture following total knee arthroplasty (TKA) has varied from 1-15 percent Various treatment modalities have been described in attempts to manage this often difficult problem. This paper describes a novel method of treatment by using a hinged cast brace (previously reported for treatment of femur fractures and knee contractures secondary to hemophilia and cerebral palsy) for use in patients with symptomatic knee flexion contractures. Application of this cast brace with frequent adjustment (every three to four days, initially) toward full extension can often improve knee extension, after physical therapy and other modalities such as extension-assist braces have failed. Care must be taken in the application and use of this device which utilizes frequent manipulations to reduce and maintain the knee flexion angle. We report two clinical cases in which this protocol was effectively used in decreasing symptomatic knee flexion contractures.

  13. Functional Outcome of Collagenase Injections Compared with Fasciectomy in Treatment of Dupuytren's Contracture

    National Research Council Canada - National Science Library

    Naam, Nash H

    2013-01-01

    ...) and fasciectomy for patients with Dupuytren's contracture (DC). Methods A single-center, retrospective, observational, longitudinal chart review was conducted of 25 patients treated with CCH injections and 21 patients undergoing fasciectomy...

  14. Computer navigation results in less severe flexion contracture following total knee arthroplasty.

    Science.gov (United States)

    Bin Abd Razak, Hamid Rahmatullah; Yeo Jin, Seng; Chong Chi, Hwei

    2014-12-01

    We compared postoperative flexion contracture in navigated total knee arthroplasty (TKA) versus conventional TKA. Two groups (Group 1: conventional, Group 2: navigated) of 235 consecutive patients matched for age and gender were retrospectively compared. Range of motion, mechanical axes, Knee Society Scores, Oxford Knee Scores and Short Form-36® (SF-36) scores were collected prospectively and compared preoperatively and at 2years following TKA. At 2years, patients who underwent navigated TKA averaged significantly lesser flexion contracture of 1 degree compared to 6 degrees in patients who underwent conventional TKA. There were a significantly larger proportion of outliers in the conventional group. Computer navigation results in less severe flexion contracture and less frequent flexion contracture of more than 5 degrees as compared to conventional techniques. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. An extraordinary case of axillary contracture: trapped healthy skin and its adnexes under contracted scar.

    Science.gov (United States)

    Nisanci, Mustafa; Sahin, Ismail; Guzey, Serbulent

    2014-01-01

    Although striking improvements have been achieved in overall management of burn injury, postburn contractures are still an ongoing challenge to burn surgeons. Axillary adduction contracture is one of the most common types of these disabling postburn complications that usually result from suboptimal treatment after acute burns. An unusual and complicated case of axillary contracture in which the unburned, healthy axillary dome skin was trapped as a cystic mass under the scarred area was reconstructed by transfer of a big (17×13-cm) thoracodorsal artery perforator flap after contracture release. The result was satisfactory in terms of function and acceptable cosmetically. The underlying reasons for the inadequate treatment the patient received after surviving a severe electrical injury were discussed.

  16. Collagenase Treatment in Dupuytren Contractures: A Review of the Current State Versus Future Needs

    OpenAIRE

    Degreef, Ilse

    2016-01-01

    Dupuytren disease is highly prevalent and the finger contractures can be very extensile, compromising the patients? hand function. To restore full function, contractures have been addressed by cutting the causative strands for nearly 200?years, ever since Baron Guillaume Dupuytren demonstrated his technique at the beginning of the nineteenth century. Surgery can be minimal (fasciotomy) or quite invasive (fasciectomy and even skin replacement). However, in the last decade translational researc...

  17. Collagenase Treatment in Dupuytren Contractures: A Review of the Current State Versus Future Needs.

    Science.gov (United States)

    Degreef, Ilse

    2016-06-01

    Dupuytren disease is highly prevalent and the finger contractures can be very extensile, compromising the patients' hand function. To restore full function, contractures have been addressed by cutting the causative strands for nearly 200 years, ever since Baron Guillaume Dupuytren demonstrated his technique at the beginning of the nineteenth century. Surgery can be minimal (fasciotomy) or quite invasive (fasciectomy and even skin replacement). However, in the last decade translational research has introduced the non-surgical technique of enzymatic fasciotomy with collagenase injections. Now, finger contractures can be released with single injections on monthly intervals, to address one joint contracture at a time. However, in hands affected with Dupuytren contractures to the extent that the patient calls for treatment, most often more than one joint is involved. In surgical treatment options all contracted joints are addressed in a single procedure. Nevertheless, extensile surgery withholds inherent risks of complications and intense rehabilitation. Today, the minimally-invasive method with enzymatic fasciotomy by collagenase injection has demonstrated reliable outcomes with few morbidities and early recovery. However, single-site injection is todays' standard procedure and multiple joints are addressed in several sessions with monthly intervals. This triggers a longer recovery and treatment burden in severely affected hands even though surgery is avoided. Therefore, further treatment modalities of collagenase use are explored. Adjustments in the treatment regimes' flexibility and collagenase injections addressing more than one joint contracture simultaneously will improve the burden of multiple sessions and, therefore, enzymatic fasciotomy may become the preferred method in more extensile Dupuytren contractures. In this independent review, the challenge of Dupuytren disease affecting a single versus multiple joints is presented. The pros and cons of collagenase

  18. Skin injuries and joint contractures of the upper extremities in Rett syndrome.

    Science.gov (United States)

    Hirano, D; Taniguchi, T

    2018-01-01

    The purpose of this study was to investigate the incidence and type of skin injuries and joint contractures of the upper extremities in individuals with Rett syndrome. In 2016, a questionnaire regarding skin injuries and joint contractures was sent to 1016 directors of schools for special needs education and 204 directors of departments of rehabilitation [consisting of 130 facilities for persons with severe motor and intellectual disabilities (SMID), 73 wards for patients with SMID, and the National Hospital Organisation and National Centre Hospital, National Centre of Neurology and Psychiatry] in Japan. Descriptive statistics were used to indicate frequency in each question. Information was acquired from 216 cases (3-53 years old) with Rett syndrome. Skin injuries and joint contractures of the upper extremities were observed in 41% and 49% of individuals with Rett syndrome, respectively. Most of the skin injuries were observed on the hands (19%) and fingers (29%). The incidence of skin injuries was not affected by age or disease severity. Many joint contractures were observed in the shoulder (33%) and elbow (29%) joints. Joint contractures tended to occur in individuals aged over 10 years or with severe locomotor impairment. Almost half of the Rett syndrome subjects assessed in the present study had skin injuries and joint contractures. Especially, the incidence of joint contractures was affected by age and disease severity. Thus, it is important that medical staff attempt to prevent the occurrence of skin injuries and joint contractures in this patient population. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  19. A Goniometry Paradigm Shift to Measure Burn Scar Contracture in Burn Patients

    Science.gov (United States)

    2016-10-01

    objectives were met and study equipment was distributed. • Reliability testing of goniometry measurement methods within and between investigators...1 AD______________ AWARD NUMBER: W81XWH-14-2-0148 TITLE: A Goniometry Paradigm Shift to Measure Burn Scar Contracture in Burn Patients...SUBTITLE A Goniometry Paradigm Shift to Measure Burn Scar Contracture in Burn Patients 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-14-2-0148 5c

  20. Serial casting for elbow flexion contractures in neonatal brachial plexus palsy.

    Science.gov (United States)

    Duijnisveld, B J; Steenbeek, D; Nelissen, R G H H

    2016-09-02

    The objective of this study was to evaluate the effectiveness of serial casting of elbow flexion contractures in neonatal brachial plexus palsy. A prospective consecutive cohort study was performed with a median follow-up of 5 years. Forty-one patients with elbow flexion contractures ≥ 30° were treated with serial casting until the contracture was ≤ 10°, for a maximum of 8 weeks. Range of motion, number of recurrences and patient satisfaction were recorded and analyzed using Wilcoxon signed-rank and Cox regression tests. Passive extension increased from a median of -40° (IQR -50 to -30) to -15° (IQR -10 to -20, p casting had to be prematurely replaced by night splinting due to complaints. Serial casting improved elbow flexion contractures, although recurrences were frequent. The severity of elbow flexion contracture is a predictor of recurrence. We recommend more research on muscle degeneration and determinants involved in elbow flexion contractures to improve treatment strategies and prevent side-effects.

  1. Sonographic analyses of pulley and flexor tendon in idiopathic trigger finger with interphalangeal joint contracture.

    Science.gov (United States)

    Sato, Junko; Ishii, Yoshinori; Noguchi, Hideo; Takeda, Mitsuhiro

    2014-06-01

    This study investigated the sonographic appearance of the pulley and flexor tendon in idiopathic trigger finger in correlation with the contracture of the interphalangeal (IP) joint in the thumb or proximal IP (PIP) joint in the other digits. Sonographic measurements using axial images were performed in 177 affected digits including 17 thumbs and 34 other digits judged to have IP or PIP joint contracture and 77 contralateral control digits. The A1 pulley of the contracture group was significantly thicker than that of the non-contracture group in all digits, whereas the flexor tendon was thicker only in digits other than the thumb. In the analysis using calculated cut-off values, A1 pulley thickening in the thumb and A1 pulley and flexor tendon thickening in the other digits showed statistically significant correlations with IP or PIP joint contracture. This study sonographically confirmed previous reports showing that enlargement of the flexor tendons contribute to the pathogenesis of PIP joint contracture. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  2. Minimally invasive soft tissue release of foot and ankle contracture secondary to stroke.

    Science.gov (United States)

    Boffeli, Troy J; Collier, Rachel C

    2014-01-01

    Lower extremity contracture associated with stroke commonly results in a nonreducible, spastic equinovarus deformity of the foot and ankle. Rigid contracture deformity leads to gait instability, pain, bracing difficulties, and ulcerations. The classic surgical approach for stroke-related contracture of the foot and ankle has been combinations of tendon lengthening, tendon transfer, osteotomy, and joint fusion procedures. Recovery after traditional foot and ankle reconstructive surgery requires a period of non-weightbearing that is not typically practical for these patients. Little focus has been given in published studies on minimally invasive soft tissue release of contracture. We present the case of a 61-year-old female with an equinovarus foot contracture deformity secondary to stroke. The patient underwent Achilles tendon lengthening, posterior tibial tendon Z lengthening, and digital flexor tenotomy of each toe with immediate weightbearing in a walking boot, followed by transition to an ankle-foot orthosis. The surgical principles and technique tips are presented to demonstrate our minimally invasive approach to release of foot and ankle contracture secondary to stroke. The main goal of this approach is to improve foot and ankle alignment for ease of bracing, which, in turn, will improve gait, reduce the risk of falls, decrease pain, and avoid the development of pressure sores. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Total knee arthroplasty treatment of rheumatoid arthritis with severe versus moderate flexion contracture

    Science.gov (United States)

    2013-01-01

    Background This study aims to explore the technique of soft tissue balance and joint tension maintenance in total knee arthroplasty (TKA) for the rheumatoid arthritis (RA) patients with flexion contracture of the knee. Methods This retrospective study reviewed flexion contracture deformity of RA patients who underwent primary TKA and ligament and soft tissue balancing. Based on the flexion contracture deformity, the remaining 76 patients available for analysis were divided into two groups, i.e., severe flexion group (SF) and moderate flexion group (MF). Results There were no intraoperative complications in this study. All patients had improved Knee Society Rating System scores and range of motion. The flexion contracture was completely corrected in MF and SF patients. There were no cases of patellar dislocation, but three cases had mild mediolateral instability in severe flexion group. Four knees (two knees in SF versus two knees in MF) had transient peroneal nerve palsy but recovered after conservative therapy. Conclusions TKA can be performed successfully in the RA knees with severe flexion contracture. It is very important in TKA to maintain the joint stability in the condition of severe flexion contracture deformity of the RA knee. PMID:24229435

  4. Synthesis of renewable diesel through hydrodeoxygenation reaction from nyamplung oil (Calophyllum Inophyllum oil) using NiMo/Z and NiMo/C catalysts with rapid heating and cooling method

    Science.gov (United States)

    Susanto, B. H.; Prakasa, M. B.; Shahab, M. H.

    2016-11-01

    The synthesis of metal nanocrystal was conducted by modification preparation from simple heating method which heating and cooling process run rapidly. The result of NiMo/Z 575 °C characterizations are 33.73 m2/gram surface area and 31.80 nm crystal size. By used NiMo/C 700 °C catalyst for 30 minutes which had surface area of 263.21 m2/gram, had 31.77 nm crystal size, and good morphology, obtained catalyst with high activity, selectivity, and stability. After catalyst activated, synthesis of renewable diesel performed in hydrogenation reactor at 375 °C, 12 bar, and 800 rpm. The result of conversion was 81.99%, yield was 68.08%, and selectivity was 84.54%.

  5. Dupuytren's disease or Cooper's contracture?: Kenneth Fitzpatrick Russell Memorial Lecture.

    Science.gov (United States)

    Thurston, Alan

    2003-07-01

    In his position as curator of the Cowlishaw collection of historical medical books in the Library of the College, Kenneth Russell prepared the definitive catalogue of the collection. This catalogue is comprehensive and for almost all entries there is an annotation that demonstrates his meticulous attention to detail and the love of the book collection that he managed to secure for the College. It is from this catalogue that I have chosen two books in particular that bring together two great surgeons of the turn of the 19th century. Although he was a pupil of the great John Hunter, the young Astley Cooper possessed good manners and a gift of oratory of which the Scot, his teacher, was devoid. After his apprenticeship with Henry Cline senior, Cooper came to share the podium with Cline at Guy's and St Thomas' hospitals and the two dominated surgical teaching in London for some 22 years, until Cline's retirement in 1811. It was the latter who was first to recognize the true nature of the condition now known as Dupuytren's disease. Later, in 1822, Cooper wrote a detailed description of the contracture of the palmar aponeurosis and recommended fasciotomy as being curative. His book A Treatise on Dislocations and Fractures of the Joints, which contains this description of Dupuytren's contracture, is held in the Cowlishaw Collection. On the other side of the English Channel, M. le Baron Dupuytren repeatedly misquoted Cooper and stated that Cooper believed that the disease was incurable. In his famous lecture given to the staff of the Hôtel Dieu in Paris on 5th December 1931, he admitted to having seen 30 or 40 cases over 20 years of practice. It seems likely that he was not aware of the true cause of the condition before 1831 when he treated his first case. This lecture, along with others, are recorded in his Leçons Orales de Clinique Chirurgicale, a copy of which is also to be found in the Cowlishaw Collection.

  6. [Arthroscope monitored solution of adult intramuscular injection associated gluteal muscle contracture by radiofrequency].

    Science.gov (United States)

    Liu, Yu-Jie; Xue, Jing; Zhou, Mi; Wang, Zhi-Gang; Li, Zhong-Li; Cai, Xu; Wei, Min; Wang, Yan; Zhu, Juan-Li

    2008-07-01

    To evaluate the result of releasing adult intramuscular injection associated gluteal muscle contracture under the monitor of arthroscope by radiofrequency probe. From June 2001 to June 2005, 108 cases of bilateral gluteal muscle contracture were treated with radiofrequency colation under the arthroscope and solution with an average age of 24 years (from 18 to 40 years). There were 57 males and 51 females. Preoperatively, the course of the outline of the femur greater trochanter the sciatic nerve in buttocks and the area of gluteal muscle contracture were marked. With the patients firmly anchored in the straight lateral position, normal saline (which contains Adnephrin) was injected between the surface of contracted gluteus and subcutaneous fat to reduce bleeding in operation. The ports for the motorized shaver and radiofrequency probe were located at the edge of gluteal muscle contracture and were 5 mm superior to the greater trochanter. The 6 mm diameter port for the arthroscope was 3 cm inferior to the greater trochanter. Space was made between contracture bands and overlying subcutaneous tissue with a periosteal elevator by blunt dissection. After the anterior and posterior edge of the contracture bands were fully revealed, normal saline were filled in the space. With the monitor of arthroscope, the procedures were: removing fatty tissue from the surface of the contracture bands with motorized shaver, then cutting off the contracture bands curve and carefully probing and cutting off contracture bands which were mixed in gluteus maximus with radiofrequency probe, finally hemostasis by radiofrequency probe. In the operation flexion, adduction, internal rotation and straightening hip joint were repeated, until it got normal range of motion without snap and bleeding. Results One hundred and one patients were followed up with an average of 19 months. According to a comprehensive evaluating system, 91 cases were excellent, 7 were good, and 3 were fair. No infection

  7. Dupuytren contracture recurrence following treatment with collagenase clostridium histolyticum (CORDLESS study): 3-year data.

    Science.gov (United States)

    Peimer, Clayton A; Blazar, Philip; Coleman, Stephen; Kaplan, F Thomas D; Smith, Ted; Tursi, James P; Cohen, Brian; Kaufman, Gregory J; Lindau, Tommy

    2013-01-01

    To evaluate long-term efficacy and safety of collagenase clostridium histolyticum (CCH) after the third year of a 5-year nontreatment follow-up study, Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study. This study enrolled Dupuytren contracture patients from 5 previous clinical studies. Beginning 2 years after their first CCH injection, we re-evaluated patients annually for joint contracture and safety. Recurrence in a previously successfully treated joint (success = 0° to 5° contracture after CCH administration) was defined as 20° or greater worsening in contracture in the presence of a palpable cord or medical/surgical intervention to correct new or worsening contracture. We assessed partially corrected joints (joints reduced 20° or more from baseline contracture but not to 0° to 5°) for nondurable response, also defined as 20° or greater worsening of contracture or medical/surgical intervention. Of 1,080 CCH-treated joints (648 metacarpophalangeal [MCP]; 432 proximal interphalangeal [PIP]; n = 643 patients), 623 (451 MCP, 172 PIP) had achieved 0° to 5° contracture in the original study. Of these joints, 35% (217 of 623) recurred (MCP 27%; PIP 56%). Of these recurrences, an intervention was performed in 7%. Of the 1,080 CCH-treated joints, 301 were partially corrected in the original study. Of these, 50% (150 of 301; MCP: 38% [57 of 152]; PIP: 62% [93 of 149]) had nondurable response. We identified no new long-term or serious adverse events attributed to CCH during follow-up. Anti-clostridial type I collagenase and/or anti-clostridial type II collagenase antibodies were reported for 96% or more of patients who received 2 or more CCH injections and 82% who received 1 injection. The recurrence rate, which is comparable to other standard treatments, and the absence of long-term adverse events 3 years after initial treatment indicate that CCH is an effective and safe treatment for Dupuytren contracture. Most successfully

  8. Neutronics - thermal-hydraulics coupling: application to the helium-cooled fast reactor; Couplage neutronique - thermohydraulique: application au reacteur a neutrons rapides refroidi a l'helium

    Energy Technology Data Exchange (ETDEWEB)

    Vaiana, F.

    2009-11-15

    This thesis focuses on the study of interactions between neutron-kinetics and thermal-hydraulics. Neutron-kinetics allow to calculate the power in a nuclear reactor and the temperature evolution of materials where this power is deposited is known thanks to thermal-hydraulics. Moreover, when the temperatures evolve, the densities and cross sections change. These two disciplines are thus coupled. The first part of this work corresponds to the study and development of a method which allows to simulate transients in nuclear reactors and especially with a Monte-Carlo code for neutron-kinetics. An algorithm for the resolution of the neutron transport equation has been established and validated with a benchmark. In thermal-hydraulics, a porous media approach, based on another thesis, is considered. This gives the opportunity to solve the equations on the whole core without unconscionable computation time. Finally, a theoretical study has been performed on the statistical uncertainties which result from the use of a Monte-Carlo code and which spread from the reactivity to the power and from the power to the temperatures. The second part deals with the study of a misplaced control rod withdrawing in a GFR (helium-cooled fast reactor), a fourth generation reactor. Some models allowing to calculate neutron-kinetics and thermal-hydraulics in the core (which contains assemblies built up with fuel plates) were defined. In thermal-hydraulics, a model for the core based on the porous media approach and a fuel plate homogenization model have been set up. A similar homogenization model has been studied for neutron-kinetics. Finally, the control rod withdrawing transient where we can observe the power raising and the stabilisation by thermal feedback has been performed with the Monte-Carlo code Tripoli for neutron-kinetics and the code Trio-U for thermal-hydraulics. (author)

  9. Update on the management of Dupuytren’s contracture

    Directory of Open Access Journals (Sweden)

    Linda Vi

    2010-08-01

    Full Text Available Linda Vi1, David B O’Gorman2, Bing Siang Gan31Department of Physiology and Pharmacology, 2Hand and Upper Limb Centre, Lawson Health Research Institute, Departments of Surgery and Biochemistry, 3Hand and Upper Limb Centre, Lawson Health Research Institute, Departments of Surgery and Medical Biophysics, University of Western Ontario, London, Ontario, CanadaAbstract: Dupuytren’s disease (DD is a pathological condition of the palmar fascia that is characterized by the formation of tight collagenous disease cords leading to permanent finger contractures. The disease is most prevalent in Caucasian men, and its incidence increases with age advancement. The most common complaint from patients having DD is the impairment of normal hand function. At present, the disease is incurable and the pathophysiology of DD is unknown. The most common treatment for DD is surgery; however, this treatment is associated with a high rate of recurrence. More recently, researchers have begun to explore the molecular basis of DD in the hopes of developing new, more effective treatment for DD. This review will summarize the history and clinical presentation of the disease, highlight current and emerging molecular treatments, and explore the implications of these advancements for future work.Keywords: Dupuytren’s disease, etiology, clinical presentation, treatment

  10. Direct and indirect costs associated with Dupuytren's contracture.

    Science.gov (United States)

    Macaulay, Dendy; Ivanova, Jasmina; Birnbaum, Howard; Sorg, Rachael; Skodny, Paul

    2012-01-01

    To compare direct (medical and drug) and indirect (work loss) costs between privately insured US employees with Dupuytren's contracture (DC) and demographically matched controls without DC. Employees aged 18-64 with ≥ 1 DC diagnosis (ICD-9-CM: 728.6, 718.44) with service dates 1/1/2000-3/31/2009 were selected from a de-identified, privately insured claims database (n∼3,000,000). The index date was defined as the most recent DC diagnosis with continuous eligibility for 6 months prior (baseline period) and 1 year after (study period) diagnosis. Employees with DC were matched 1:1 on age, region, gender, and index date to controls without DC, Peyronie's, or Ledderhose disease diagnoses in their claims histories. Descriptive analyses compared demographic characteristics, comorbidities, resource utilization, direct costs, and indirect costs inflated to 2009 dollars. DC employees (n=1406, mean age 49 years) with matched controls met the inclusion criteria. DC employees compared with controls had significantly (all pindirect costs ($2737 vs $1309), and total costs ($8712 vs $4485) compared with controls during the study period. Findings did not account for lost productivity at work and were based on a privately insured, employed population, which may not be generalizable to all DC patients. Employees with DC had substantially higher comorbidity rates, utilization, and direct and indirect costs compared with demographically matched controls.

  11. Intelligent stretching of ankle joints with contracture/spasticity.

    Science.gov (United States)

    Zhang, Li-Qun; Chung, Sun G; Bai, Zhiqiang; Xu, Dali; van Rey, Elton M T; Rogers, Mark W; Johnson, Marjorie E; Roth, Elliot J

    2002-09-01

    An intelligent stretching device was developed to treat the spastic/contractured ankle of neurologically impaired patients. The device stretched the ankle safely throughout the range of motion (ROM) to extreme dorsiflexion and plantarflexion until a specified peak resistance torque was reached with the stretching velocity controlled based on the resistance torque. The ankle was held at the extreme position for a period of time to let stress relaxation occur before it was rotated back to the other extreme position. Stretching was slow at the joint extreme positions, making it possible to reach a larger ROM safely and it was fast in the middle ROM so the majority of the treatment was spent in stretching the problematic extreme ROM. Furthermore, the device evaluated treatment outcome quantitatively in multiple aspects, including active and passive ROM, joint stiffness and viscous damping and reflex excitability. The stretching resulted in considerable changes in joint passive ROM, stiffness, viscous damping and reflex gain. The intelligent control and yet simple design of the device suggest that with appropriate simplification, the device can be made portable and low cost, making it available to patients and therapists for frequent use in clinics/home and allowing more effective treatment and long-term improvement.

  12. Collagenase Dupuytren Contracture: Achieving Single Treatment Success with a Hand Therapist-Based Protocol.

    Science.gov (United States)

    Malafa, Menyoli M; Lehrman, Craig; Criley, Jerry W; Amirlak, Bardia

    2016-02-01

    Surgery remains the gold standard in the treatment of Dupuytren contracture but is technically demanding, carries significant risk of complications, and requires prolonged recovery time. Collagenase injection is an efficacious alternative to surgery; however, contracture release often requires multiple treatments spaced a month apart. We report our experience with a new collagenase treatment protocol aimed to minimize the total treatment time per joint contracture. We performed a single institution retrospective review of patients with Dupuytren contracture treated with collagenase using our protocol from 2011 to 2013. Patients returned 24 hours after collagenase injection for cord manipulation by a certified hand therapist while under digital block. Treatment success was defined as reduction in contracture to 5 degrees or less. Successfully treated joints were evaluated for recurrence (>10 degrees contracture) at 30-day and 6-month follow-up appointments. Serious adverse events, including skin tears, were recorded. Success was achieved in 36 of 47 treated joints (76.6%) after a single injection. There were 2 recurrences in 32 joints at 30-day follow-up (6.2%) and no recurrences in 17 joints available at 6-month follow-up. Skin tears were the only serious adverse event occurring in 18 of 47 cord ruptures (38.3%). All healed secondarily without complication. Our protocol preserves treatment efficacy while maximizing efficiency. Achieving successful cord rupture with a single injection allows earlier return of function, reduced cost of treatment, and increased convenience for the patient. Patients, particularly those with greater contractures, should be counseled regarding the risk of skin tear during cord manipulation.

  13. Development of arthrogenic joint contracture as a result of pathological changes in remobilized rat knees.

    Science.gov (United States)

    Kaneguchi, Akinori; Ozawa, Junya; Kawamata, Seiichi; Yamaoka, Kaoru

    2017-07-01

    This study aimed to elucidate how rats recover from immobilization-induced knee joint contracture. Rats' right knees were immobilized by an external fixator at a flexion of 140° for 3 weeks. After removal of the fixator, the joints were allowed to move freely (remobilization) for 0, 1, 3, 7, or 14 days (n = 5 each). To distinguish myogenic and arthrogenic contractures, the passive extension range of motion was measured before and after myotomy of the knee flexors. Knee joints were histologically analyzed and the expression of genes encoding inflammatory or fibrosis-related mediators, interleukin-1β (1L-1β), fibrosis-related transforming growth factor-β1 (TGF-β1), and collagen type I (COL1A1) and III (COL3A1), were examined in the knee joint posterior capsules using real-time PCR. Both myogenic and arthrogenic contractures were established within 3 weeks of immobilization. During remobilization, the myogenic contracture decreased over time. In contrast, the arthrogenic contracture developed further during the remobilization period. On day 1 of remobilization, inflammatory changes characterized by edema, inflammatory cell infiltration, and upregulation of IL-1β gene started in the knee joint posterior capsule. In addition, collagen deposition accompanied by fibroblast proliferation, with upregulation of TGF-β1, COL1A1, and COL3A1 genes, appeared in the joint capsule between days 7 and 14. These results suggest the progression of arthrogenic contracture following remobilization, which is characterized by fibrosis development, is possibly triggered by inflammation in the joint capsule. It is therefore necessary to focus on developing new treatment strategies for immobilization-induced joint contracture. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1414-1423, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  14. Treating burn-associated joint contracture: results of an inpatient rehabilitation stretching protocol.

    Science.gov (United States)

    Godleski, Matthew; Oeffling, Amy; Bruflat, Angela K; Craig, Emily; Weitzenkamp, David; Lindberg, Gordon

    2013-01-01

    The prevention and treatment of scar contracture is critical after significant burn injuries to avoid functional impairment. However, descriptions of specific contracture treatment interventions and outcomes are limited. Our objective is to provide detailed information and range of motion outcomes regarding the use of an intensive stretching protocol for burn-associated contracture. As part of a quality improvement measure, all patients admitted to inpatient rehabilitation with burn injury were treated with at least 1 hour of daily stretching by experienced therapists and were tracked with standardized range of motion measurements. Eighty-eight joint contractures were treated across nine patients for up to 4 weeks. The average weekly improvement in range of motion was 8.2 degrees (95% confidence interval [CI], 6.5-9.9). The largest gains were seen in the first week of treatment with an average improvement of 11.2 degrees (95% CI, 8.7-13.6). Eighteen digit contractures were treated across four patients. The average weekly improvement in flexion was 7.2 mm (95% CI, 5.2-9.1) again with larger gains in the first week of treatment-12.8 mm (95% CI, 10.3-15.4). Thumb opposition improved across five patients in the first week with an average improvement of 1.4 on the opposition scale (95% CI, 0.4-2.5). Intensive stretching by experienced therapists yielded significant improvements in joint range of motion for patients with burn-associated joint contracture. Defining specific burn contracture interventions remains a key goal in advancing burn rehabilitation in the future.

  15. Resection of the flexor digitorum superficialis for trigger finger with proximal interphalangeal joint positional contracture.

    Science.gov (United States)

    Favre, Yann; Kinnen, Louis

    2012-11-01

    Open release of the A1 pulley is a widely known procedure for the treatment of trigger finger. A subset of patients presents with both trigger finger and a positional contracture of the proximal interphalangeal (PIP) joint. These patients usually have a long history of trigger finger or have already undergone a surgical release of the annular pulley. This study is a retrospective review of the outcomes of resection of the flexor digitorum superficialis (FDS) for patients whose trigger finger was associated with a positional contracture of the PIP joint. Thirty-six patients (39 fingers) were treated by resection of the FDS after section of the A1 pulley. The mean age of the patients was 63 years (range, 45-90 y). Seven patients (19 %) had previously undergone an open release of the A1 pulley and had developed a positional contracture of the PIP joint 2 to 5 months afterward. We performed a retrospective review with a mean follow-up of 30 months (range, 12-60 mo). No patient was lost to follow-up. The active range of motion was recorded at the PIP joint before and after surgery. The mean preoperative positional contracture of the PIP joint was 24° (range, 15°-30°). The mean postoperative positional contracture of the PIP joint was 4° (range, 0°-10°). The most commonly affected digit was the middle finger (26 fingers, 67%). In 28 fingers (72%), full extension was achieved following only the surgical procedure. The remaining 11 fingers (28%) had a postoperative residual positional contracture (range, 5°-10°). However, all fingers achieved a full range of motion after physical therapy and an injection of betamethasone. All of the resected tendons had histological damage. This technique is a useful treatment for selected patients whose trigger finger is associated with a positional contracture. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  16. The Modification of Five-Flap Z-Plasty for Web Contracture.

    Science.gov (United States)

    Chen, Baoguo; Song, Huifeng

    2015-12-01

    Web contractures are fairly commonly encountered in those who have suffered from burn injury or other trauma. Numerous local flaps have been adopted previously. The five-flap Z-plasty is one that has been used frequently. To release the scar as much as possible, based on the traditional design, we developed a modified technique of the five-flap Z-plasty to reconstruct the axillary and elbow web contractures. Hence, the length of the axis of the cicatrix could be much lengthened. Twenty patients (12 females and 8 males, 7 to 48 years-old) with 27 web contractures were arranged for the operation using the new flap. The contractures were formed on by burn injury in 17 patients, surgery in 2 patients, and traumatic cicatrix in 1 case. All patients were operated on using a modified five-flap Z-plasty to reach the aim of maximum contracture relaxation. All flaps survived well. No flap tip necrosis occurred. Good function was gained in all patients postoperatively by the one year average follow-up. There was no recurrence. The contracture band was freed satisfactorily. The technique is very easy to execute and can be used both in web and linear contractures. With the virtue of extending the length of the scar axis to a higher degree compared to the traditional method, we suggest this modified five-flap Z-plasty application. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  17. Localized type Volkmann's contracture treated with tendon transfer and tension-reduced early mobilization

    Science.gov (United States)

    Kaji, Yoshio; Nakamura, Osamu; Yamaguchi, Konosuke; Tobiume, Sachiko; Yamamoto, Tetsuji

    2017-01-01

    Abstract Rationale: For localized type Volkmann's contracture, in which degeneration of the flexor digitorum profundus (FDP) muscle to one or two fingers and restriction of finger extension occur, dissection or excision of the affected muscle is usually recommended. However, these surgical procedures need relatively wide exposure of the muscle, because the FDP muscle is in the deep portion of the forearm. Patient concerns: In this report, the case of a 35-year-old woman with localized type Volkmann's contracture is presented. Her left forearm had been compressed with an industrial roller 4 months earlier, and severe flexion contracture of the long finger and mild flexion contracture of the ring finger developed gradually. Diagnoses: localized type Volkmann's contracture. Intervention: Five months after the injury, transection of the FDP tendon to the long finger and transfer of the transected tendon to the FDP tendon to the index finger was performed after adjusting the tonus of these two tendons using a small skin incision. This procedure was followed by a tension-reduced early mobilization technique in which a tension-reduced position of the tendon suture site was maintained by taping the long finger to the volar side of the index finger, and then immediate active range of motion (ROM) exercise was started. Outcomes: Within 9 weeks after surgery, full ROM had been regained. Lessons: Using the treatment procedure presented in this case report, a good clinical result was obtained in a minimally invasive manner. PMID:28072735

  18. [Etiological analysis and significance of anterior knee pain induced by gluteal muscles contracture].

    Science.gov (United States)

    Zhao, Gang; Liu, Yu-jie; Wang, Jun-liang; Qi, Wei; Qu, Feng; Yuan, Bang-tuo; Wang, Jiang-tao; Shen, Xue-zhen; Liu, Yang; Zhu, Juan-li

    2014-12-01

    To explore causes of gluteal muscle contracture induced anterior knee pain and curative effect of arthroscopic release. From March 2002 to August 2013,36 patients with gluteal muscle contracture induced anterior knee pain were treated, including 15 males, 21 females, aged from 9 to 40 years old with an average (18.7±7.2) years old; the courses of diseases ranged from 4 to 30 years. The clinical manifestations involved limited to symmelia, positive Ober sign, buttocks touch contracture belts, knee and patella slide to lateral when doing squat activities. All patients were performed gluteal muscle contracture release under arthroscopic. Postoperative complications were observed, Kujala scoring before and after operation was used for compare curative effect. All patients were followed up with an average of 29 months. The incision were healed well, and no complications were occurred. Postoperative Kujala score were improved more than preoperative. Gluteal muscle contracture release could alleviate hypertension of lateral patella, and palys an important role in preventing patellofemoral arthritis.

  19. Is ankle contracture after stroke due to abnormal intermuscular force transmission?

    Science.gov (United States)

    Diong, Joanna; Herbert, Robert D

    2015-02-01

    Contracture after stroke could be due to abnormal mechanical interactions between muscles. This study examined if ankle plantarflexor muscle contracture after stroke is due to abnormal force transmission between the gastrocnemius and soleus muscles. Muscle fascicle lengths were measured from ultrasound images of soleus muscles in five subjects with stroke and ankle contracture and six able-bodied subjects. Changes in soleus fascicle length or pennation during passive knee extension at fixed ankle angle were assumed to indicate intermuscular force transmission. Changes in soleus fascicle length or pennation were adjusted for changes in ankle motion. Subjects with stroke had significant ankle contracture. After adjustment for ankle motion, 9 of 11 subjects demonstrated small changes in soleus fascicle length with knee extension, suggestive of intermuscular force transmission. However, the small changes in fascicle length may have been artifacts caused by movement of the ultrasound transducers. There were no systematic differences in change in fascicle length (median between-group difference adjusting for ankle motion = -0.01, 95% CI -0.26-0.08 mm/degree of knee extension) or pennation (-0.05, 95% CI -0.15-0.07 degree/ degree of knee extension). This suggests ankle contractures after stroke were not due to abnormal (systematically increased or decreased) intermuscular force transmission between the gastrocnemius and soleus.

  20. Evaluation of the severity of capsular contracture using elastography after breast implant reconstruction.

    Science.gov (United States)

    Sowa, Yoshihiro; Yokota, Isao; Itsukage, Sizu; Nakatsukasa, Katsuhiko; Sakaguchi, Koichi; Taguchi, Tetsuya; Numajiri, Toshiaki

    2017-01-01

    Capsular contracture around implants is a common complication after breast reconstruction. Strain elastography (STE) and shear-wave elastography (SWE) are noninvasive imaging techniques that can measure tissue stiffness and thickness of the capsule. The purposes of the study were to compare STE and SWE for measurement of capsular contracture after breast implant reconstruction using intra-class correlation coefficients (ICCs) and to investigate the correlation of these data with the Baker score, which is the most frequently used clinical staging scale for capsule contracture. The subjects were 20 patients (27 implants) who underwent breast reconstruction. The reproducibility of SWE (ICC: 0.878) was higher than that of STE (ICC: 0.724) for measurement of capsular contracture. The correlation coefficient between measurements with the two methods was low (r = 0.6788). The Baker score had a higher correlation with measurements with SWE (r = 0.8124) compared to those with STE (r = 0.6983). These results suggest that SWE is a better tool for assessment of the degree of capsule contracture surrounding implants after breast reconstruction.

  1. A systematic review on burn scar contracture treatment: searching for evidence.

    Science.gov (United States)

    Stekelenburg, Carlijn M; Marck, Roos E; Tuinebreijer, Wim E; de Vet, Henrica C W; Ogawa, Rei; van Zuijlen, Paul P M

    2015-01-01

    Treating burn scar contracture remains a challenging problem for reconstructive surgeons. At present, no consensus exists on when to use what kind of technique. Therefore, a systematic review was performed on the effectiveness of the different surgical techniques after burn scar contracture release. Electronic databases were searched using a predefined search strategy. Studies evaluating the outcome of surgical techniques for the treatment of burn scar contractures were included. The methodological quality was tested and the data were summarized. One thousand six hundred fourty-nine papers were identified of which 17 met the inclusion criteria. Three papers reported on a controlled trial, 14 were cohort studies, including 10 of a pre-post operative design and 4 of a comparative design. The papers described outcomes of grafts, flaps with random or defined vascularization, and dermal substitutes. All studies had methodological shortcomings and most used inappropriate statistical methods. The current evidence on the effectiveness of reconstruction techniques for burn scar contractures was summarized. Due to the scarcity and low quality of the included studies, no definitive conclusions could be reached about the effectiveness of different techniques. Therefore, no direct implications for daily practice could be made. However, recommendations could be given for improvement of the quality of further primary research on the effectiveness of surgical treatment strategies for burn scar contracture release.

  2. Predictors of Proximal Interphalangeal Joint Flexion Contracture After Homodigital Island Flap.

    Science.gov (United States)

    Nakanishi, Akito; Omokawa, Shohei; Iida, Akio; Kaji, Daisuke; Tanaka, Yasuhito

    2015-11-01

    To identify independent predictors of postoperative proximal interphalangeal (PIP) joint contracture after direct-flow homodigital island flap transfer. Forty-four fingertip amputations in 39 patients treated with oblique triangular flaps were evaluated at a minimum of 1 year after surgery. Five variables were examined: patient age, injured finger, mechanism of injury, flap advancement distance, and time required for wound healing. Univariate and multivariate linear regression analyses were performed to identify the extent to which these variables affected the flexion contracture of the PIP joint. The average reduction in the passive extension angle of the PIP joint was 16° at final follow-up. Univariate analysis indicated significant correlations of PIP joint flexion contracture with age, injured finger, and time for wound healing, but no significant correlation with the distance the flap was advanced. Multivariate analysis indicated that the age and duration of wound healing were independent predictors of the flexion contracture of the PIP joint. Elderly people and cases with delayed wound healing are at risk for postoperative PIP joint contracture after homodigital flap transfer. Intervention with early hand therapy and orthotics may be useful in elderly patients with delayed wound healing. Prognostic II. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Free groin flap for recurrent severe contractures of the neck in children

    Directory of Open Access Journals (Sweden)

    Ghosh Abhishek

    2010-10-01

    Full Text Available Context: Severe post burns contracture in children not only leads to functional impairment but also has profound psychological impact on the child. Untreated neck contractures have been shown to inhibit mandibular growth. Skin grafting in children has a higher rate of recurrence and in these cases a thin pliable flap seems to provide a durable solution. Aim : To study the feasibility of using primarily thinned free groin flap in the treatment of recurrent neck contractures in children. Materials and Methods: Five patients, in the age group of 5-10 years, with recurrent neck contractures and operated between 2005 and 2008 were included in this study. The sternomental distance, lateral flexion angle and cervicomental angle were measured preoperatively, postoperatively and during the subsequent follow-up visits. The patients were followed up for a period between 1 and 3 years with a mean of 29 months. Results: All the flaps survived. The cervicomental angle improved significantly to 90-105°, the lateral flexion angle improved to 35-45° and the sternomental distance increased considerably. Conclusions: Recurrent post burns contracture of the neck in children causes not only functional and aesthetic impairment but also psychological problems. A free micro-thinned groin flap provides a very attractive solution for this problem and should be seen as an effective alternative in recurrent cases.

  4. Comprehensive clinical and molecular assessment of 32 probands with congenital contractural arachnodactyly: report of 14 novel mutations and review of the literature.

    NARCIS (Netherlands)

    Callewaert, B.L.; Loeys, B.L.; Ficcadenti, A.; Vermeer, S.; Landgren, M.; Kroes, H.Y.; Yaron, Y.; Pope, M.; Foulds, N.; Boute, O.; Galan, F.; Kingston, H.; Aa, N. van der; Salcedo, I.; Swinkels, M.E.; Wallgren-Pettersson, C.; Gabrielli, O.; Backer, J. de; Coucke, P.J.; Paepe, A.M. De

    2009-01-01

    Beals-Hecht syndrome or congenital contractural arachnodactyly (CCA) is a rare, autosomal dominant connective tissue disorder characterized by crumpled ears, arachnodactyly, contractures, and scoliosis. Recent reports also mention aortic root dilatation, a finding previously thought to differentiate

  5. A very cool cooling system

    CERN Multimedia

    Antonella Del Rosso

    2015-01-01

    The NA62 Gigatracker is a jewel of technology: its sensor, which delivers the time of the crossing particles with a precision of less than 200 picoseconds (better than similar LHC detectors), has a cooling system that might become the precursor to a completely new detector technique.   The 115 metre long vacuum tank of the NA62 experiment. The NA62 Gigatracker (GTK) is composed of a set of three innovative silicon pixel detectors, whose job is to measure the arrival time and the position of the incoming beam particles. Installed in the heart of the NA62 detector, the silicon sensors are cooled down (to about -20 degrees Celsius) by a microfluidic silicon device. “The cooling system is needed to remove the heat produced by the readout chips the silicon sensor is bonded to,” explains Alessandro Mapelli, microsystems engineer working in the Physics department. “For the NA62 Gigatracker we have designed a cooling plate on top of which both the silicon sensor and the...

  6. Prevention of Thumb Web Space Contracture With Multiplanar External Fixation.

    Science.gov (United States)

    Harper, Carl M; Iorio, Matthew L

    2016-09-01

    Thumb web space contracture following hand trauma can be disabling with numerous reconstructive procedures existing to correct the resultant deformity. Following marked soft tissue injury to the hand we utilized the Stryker Hoffmann II Micro External Fixator System to link the first and second metacarpals by a multiplanar system using 1.6 or 2.0 mm self-drilling half-pins and 3 mm carbon fiber connecting rods. This facilitated placement of the thumb in maximal palmar abduction as well as allowed adjustment of thumb position throughout the postoperative period. This technique was performed on 5 patients. Two patients were treated with a first web space external fixator for table saw injuries to the radial aspect of the hand. An additional 2 patients were treated with a first web space external fixator following metacarpophalangeal joint capsular release in the setting of thermal burns. A fifth patient underwent second ray amputation, trapeziectomy and trapezoidectomy for squamous cell carcinoma with subsequent stabilization with the external fixator. The external fixator was left in place until soft tissues were healed (average 5.5 wk). The patients were allowed to mobilize their hand in as much as the external fixator allowed, and no device-associated complications were noted. Thumb web space was preserved with passive and supple thumb circumduction and web space abduction/adduction in all patients at an average follow-up of 5 months. The average Quick Dash Score was 35±5 and the average Modern Activity Subjective Survey of 2007 was 30±8.

  7. The prevalence of Dupuytren contractures in patients with psoriasis.

    Science.gov (United States)

    Patel, M; Freeman, N R; Dhaliwal, S; Wright, N; Daoud, Y; Ryan, C; Dibella, A V; Menter, A

    2014-12-01

    Dupuytren contracture (DC) is a fibrocontractile disease of the palms, affecting approximately 4% of the population, while psoriasis is an immune-mediated disease, affecting 2% of the population. Through clinical observation in our psoriasis clinic, we found an apparent increased prevalence of DC in patients with psoriasis compared with the general population. This has not previously been statistically verified in a clinical study. To evaluate the prevalence of DC in the full range of clinical psoriasis phenotypes. In total, 98 patients with psoriasis attending our psoriasis clinic were examined for DC, based on predetermined criteria. In addition, 84 patients with DC, obtained from a specialist hand clinic, were assessed using a validated psoriasis questionnaire. We utilized Bayes theorem and bootstrap simulation to calculate the conditional prevalence of DC, then we used the results to compare the prevalence of DC between patients with psoriasis and a nonpsoriasis population. The percentage of patients with DC was 19.6% in the psoriasis population and 3.6% in the nonpsoriasis population. Development of DC showed a phenotypic predilection, with 39.1% of patients with predominantly palmoplantar involvement and 38.9% of patients with intertriginous psoriasis developing DC compared with 12.7% of patients with psoriasis who did not have these two phenotypical presentations. Our data show a positive correlation between psoriasis and DC. Patients with the palmoplantar phenotype of psoriasis were more likely to develop DC. By understanding this relationship, dermatologists may diagnose DC early in its onset in patients with psoriasis, prompting referral to hand surgeons when appropriate. © 2014 British Association of Dermatologists.

  8. A review on static splinting therapy to prevent burn scar contracture: Do clinical and experimental data warrant its clinical application?

    NARCIS (Netherlands)

    Schouten, H.J.; Nieuwenhuis, M.K.; van Zuijlen, P.P.M.

    2012-01-01

    Background: Static splinting therapy is widely considered an essential part in burn rehabilitation to prevent scar contractures in the early phase of wound healing. However, scar contractures are still a common complication. In this article we review the information concerning the incidence of scar

  9. The Efficacy and Safety of Concurrent Collagenase Clostridium Histolyticum Injections for 2 Dupuytren Contractures in the Same Hand

    DEFF Research Database (Denmark)

    Gaston, R. G.; Larsen, Søren; Pess, G. M.

    2015-01-01

    Purpose To evaluate efficacy and safety of concurrent administration of 2 collagenase clostridium histolyticum (CCH) injections to treat 2 joints in the same hand with Dupuytren fixed flexion contractures (FFCs). Methods Patients with 2 or more contractures in the same hand caused by palpable cor...

  10. Severe contracture of the proximal interphalangeal joint in Dupuytren's disease: does capsuloligamentous release improve outcome?

    Science.gov (United States)

    Beyermann, K; Prommersberger, K J; Jacobs, C; Lanz, U B

    2004-06-01

    This prospective study assessed whether patients with severe proximal interphalangeal joint contracture (#10878;60 degrees ) due to Dupuytren's disease which persisted after fasciectomy alone benefited from an additional capsuloligamentous release. Forty-three patients with 43 severely contracted proximal interphalangeal joints underwent operative correction followed by a standardized postoperative rehabilitation programme. All were followed for 6 months. In 11 patients correction of the proximal interphalangeal joint to 20 degrees could not be achieved by fasciectomy alone, and an additional capsuloligamentous release was performed which effectively corrected all their residual flexion contractures. There were no statistically significant differences between the capsulotomy and the non-capsulotomy group with respect to the residual proximal interphalangeal joint contracture at the end of surgery, or at their last follow-up examination.

  11. Neurovascular Advancement Flap to Release Flexion Contracture of the Proximal Interphalangeal Joint.

    Science.gov (United States)

    Tseng, James; Lin, Yu-Te

    2017-04-01

    Various methods have been described to surgically release posttraumatic flexion contracture of the proximal interphalangeal joint. Extension of the distal digit often creates a soft tissue defect on the volar aspect of the finger. Although various flaps and skin grafting have been utilized for coverage of this defect, they can be associated with morbidity. We present our experience with a volar neurovascular advancement flap to achieve soft tissue release in proximal interphalangeal joint flexion contracture. This advancement flap is designed to include both digital neurovascular bundles and eliminates the need for a secondary procedure as it allows primary closure of the subsequent defect. It is indicated for contracture lengthening of 10 to 14 mm. Surgical considerations of flap design are discussed. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. Physiotherapy program of physical rehabilitation of patients with contracture of the elbow

    Directory of Open Access Journals (Sweden)

    Natalia Talova

    2014-12-01

    Full Text Available Purpose: To develop physical rehabilitation program for patients with contracture of the elbow joint, which includes early use of specific simulators. Materials and Methods: state of the upper extremity of patients was determined using anthropometric and functional methods. Were examined 60 en aged 35–45 ears with contracture of the elbow joint. Results: based on the results of the study was designed to include a comprehensive program of special simulators (vertical mill, RB-660V; horizontal grinder, RB-661G; Simulator 3 in 1 for the upper body, RB-662M; Multi Minibike, RB-665Z in second period of physical rehabilitation. Conclusions: the proposed program during of physical rehabilitation contracture of the elbow joint in the second period of rehabilitation.

  13. Review of Partial Fasciectomy for Dupuytren's Contracture in Southern Chinese Patients

    Directory of Open Access Journals (Sweden)

    Wai-Chung Chan

    2012-12-01

    Full Text Available Dupuytren's contracture is a fibroproliferative disease of the palmar fascia producing fascial fibrosis in nodular or cord form, and results in flexion contracture of the involved fingers. In contrast to Western populations, Dupuytren's contracture, especially the severe form of the disease, is not common in Southern Chinese patients: there have been only scant reports from the Southern Chinese region. In addition, the natural history and surgical outcome may be different from those of Western patients. The purpose of our study was to evaluate the clinical outcomes of Southern Chinese patients with Dupuytren's contracture treated with partial fasciectomy through a Bruner's incision. Twenty-nine Chinese patients (45 fingers with Dupuytren's contracture were reviewed retrospectively from 1999 to 2008. All patients underwent partial fasciectomy performed under general anaesthesia. The ranges of movement of the metacarpophalangeal (MCPJ and proximal interphalangeal (PIPJ joints were measured preoperatively and during follow-up to assess the degree of correction after surgery. A total of 34 out of 45 fingers (75.6% and 30 out of 45 fingers (66.7% had regained a full range of movement of the MCPJs and PIPJs, respectively. In addition, 26 out of 29 patients (89.6% had an improvement in extension of their MCPJs, and 20 out of 29 patients (68.9% showed a gain in extension of their PIPJs. One in 29 patients (3.4% developed a wound infection and needed further surgery for debridement. One patient had recurrent PIPJ contracture after partial fasciectomy (3.4%. None of our patients had a neurovascular injury or wound healing problem. We conclude that partial fasciectomy with a Bruner's incision yields satisfactory results in Southern Chinese patients that are comparable to results from Western studies.

  14. Collagenase treatment of Dupuytren’s contracture using a modified injection method

    Science.gov (United States)

    Nordenskjöld, Jesper; Lauritzson, Anna; Ahlgren, Eva; Waldau, Johanna; Waldén, Markus

    2015-01-01

    Background and purpose Treatment of Dupuytren’s contracture (DC) with collagenase Clostridium histolyticum (CCH) consists of injection followed by finger manipulation. We used a modified method, injecting a higher dose than recommended on the label into several parts of the cord, which allows treatment of multiple joint contractures in 1 session and may increase efficacy. We studied the occurrence of skin tears and short-term outcome with this procedure. Patients and methods We studied 164 consecutive hands with DC, palpable cord, and extension deficit of ≥ 20º in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint (mean patient age 70 years, 82% men). A hand surgeon injected all the content of 1 CCH vial (approximately 0.80 mg) into multiple spots in the cord and performed finger extension under local anesthesia after 1 or 2 days. A nurse recorded skin tears on a diagram and conducted a standard telephone follow-up within 4 weeks. A hand therapist measured joint contracture before injection and at a median of 23 (IQR: 7–34) days after finger extension. Results A skin tear occurred in 66 hands (40%). The largest diameter of the tear was ≤ 5 mm in 30 hands and > 10 mm in 14 hands. Hands with skin tear had greater mean pretreatment MCP extension deficit than those without tear: 59º (SD 26) as opposed to 32º (SD 23). Skin tear occurred in 21 of 24 hands with MCP contracture of ≥ 75º. All tears healed with open-wound treatment. No infections occurred. Mean improvement in total (MCP + PIP) extension deficit was 55º (SD 28). Interpretation Skin tears occurred in 40% of hands treated with collagenase injections, but only a fifth of them were larger than 1 cm. Tears were more likely in hands with severe MCP joint contracture. All tears healed without complications. Short-term contracture reduction was good. PMID:25695745

  15. Surgical capsular release reduces flexion contracture in a rabbit model of arthrofibrosis.

    Science.gov (United States)

    Barlow, Jonathan D; Hartzler, Robert U; Abdel, Matthew P; Morrey, Mark E; An, Kai-Nan; Steinmann, Scott P; Morrey, Bernard F; Sanchez-Sotelo, Joaquin

    2013-10-01

    Animal models of joint contracture may be used to elucidate the mechanisms of arthrofibrosis. Patients with joint contracture commonly undergo surgical capsular release. Previous animal models of joint contracture do not simulate this aspect of arthrofibrosis. We hypothesize that a surgical capsular release will decrease the severity of arthrofibrosis in this rabbit model. A capsular contracture was surgically created in 20 skeletally mature rabbits. Eight weeks later, ten rabbits underwent capsular release, which consisted of elevation of the posterior capsule through a lateral incision and manipulation under anesthesia. Ten rabbits had a sham incision, without release (control group). Immediately after release or sham surgery, extension loss (calculated by subtracting the knee extension angle (degrees) of the operative limb from the nonoperative, contralateral limb) was measured using fluoroscopy. All animals were sacrificed following 16 weeks of postoperative free cage activity. At sacrifice, joint contracture was measured using a custom, calibrated device. The histology of the posterior joint capsule was assessed at sacrifice. All animals survived both operations without complications. Immediately after surgical release or sham surgery, the average extension loss was 129.2 ± 10.7° in the control group versus 29.6 ± 8.2° in the capsular release group (p = 0.0002). Following 16 weeks of remobilization, the average extension loss of the control and capsular release animals were 49.0 ± 12.7° and 36.5 ± 14.2°, respectively (p = 0.035). There were no histological differences between the two groups. In this animal model, a surgical capsular release decreased the extension loss (flexion contracture) immediately after surgery, as well as following sixteen weeks of remobilization. There were no histological changes detected in the posterior joint capsule. Copyright © 2013 Orthopaedic Research Society.

  16. Cyclooxygenase-2 inhibitor celecoxib attenuates joint contracture following immobilization in rat knees.

    Science.gov (United States)

    Ozawa, Junya; Kaneguchi, Akinori; Tanaka, Ryo; Kito, Nobuhiro; Moriyama, Hideki

    2016-10-24

    The aim of this study is to clarify the following two points: First, whether a cyclooxygenase-2 mediated pathway is involved in the formation of immobilization-induced joint contracture and, second, the effectiveness of oral administration of non-steroidal anti-inflammatory drug celecoxib (CBX) for the prevention of myogenic and arthrogenic contracture following immobilization in a rat model. Thirty male rats were randomly divided into three groups: immobilization (Im), Im + CBX, and control (n = 10 each). External fixation immobilized the right knee joint of Im and Im + CBX groups in flexion for 3 weeks. 50 mg/kg of CBX was administrated daily to the Im + CBX group during this period. The passive range of motion (ROM) of knee joints was measured before and after transection of knee flexor muscles and myogenic and arthrogenic ROM restrictions were calculated. The semitendinosus muscles and knee joints were investigated histologically to elucidate factors responsible for contracture. Myogenic ROM restrictions were exhibited both in Im and Im + CBX groups (44 ± 5 and 36 ± 8 °, respectively), but restrictions significantly decreased in the Im + CBX group compared to the Im group. Significant reductions of the muscle length ratios (Rt/Lt) and sarcomere number ratios (Rt/Lt) in knee flexor semitendinosus muscle, which are responsible for myogenic contracture, were also seen both in Im group (92 ± 5 and 92 ± 4 %, respectively) and Im + CBX group (97 ± 3 and 97 ± 3 %, respectively), but were inhibited by CBX administration (P immobilization. These results imply that inflammation and nociception are involved in myogenic contracture formation independently of joint immobilization, and that CBX is effective in preventing joint contracture following immobilization in rats.

  17. [Effectiveness of dorsal metacarpal island flap for treating scar contracture of finger web].

    Science.gov (United States)

    Qian, Jun; Rui, Yongjun; Zhang, Quanrong; Xue, Mingyu; Zhang, Zhihai

    2011-11-01

    To investigate the effectiveness of dorsal metacarpal island flap for treating scar contracture of the finger web. Between June 2009 and December 2010, 10 patients with scar contracture of the finger web were treated. There were 6 males and 4 females with an average age of 30 years (range, 14-57 years). Scar contracture was caused by injury in 8 cases, by burn in 1 case, and by operation in 1 case. The locations were the 1st web space in 1 case, the 2nd web space in 3 cases, the 3rd web space in 5 cases, and the 4th web space in 1 case. The disease duration was 3 to 9 months with an average of 5 months. The maximum abduction was 10-20 degrees. After web space scar release, the dorsal metacarpal island flap (3.5 cm x 1.2 cm-4.0 cm x 2.0 cm in size) was used to reconstruct web space (2.0 cm x 1.0 cm-3.0 cm x 1.8 cm in size). The donor site was directly sutured or repaired with local flaps. At 2 days after operation, necrosis occurred in 1 flap, which healed by extractive treatment. The other flaps survived and wound healed by first intention; all the flaps at donor sites survived and incision healed by first intention. Ten patients were followed up 6 to 15 months (mean, 9 months). The reconstructed web space had good appearance, the maximum abduction was 80 degrees in 1 case of the 1st web space scars contracture, and the maximum abduction was 35-45 degrees (mean, 40 degrees) in the other 9 cases. In 8 scar patients causing by injury, no scar contracture recurred during follow-up. It can achieve good results in appearance and function to use dorsal metacarpal island flap for treating scar contracture of the finger web.

  18. Safe method for release of severe post burn neck contracture under tumescent local anaesthesia and ketamine

    Directory of Open Access Journals (Sweden)

    Agarwal Pawan

    2004-01-01

    Full Text Available Severe post burn neck contracture results in difficult intubation, which can be life threatening and can result in multiple serious complications and sequels. Thirty patients with age ranging from 12 to 50 years were operated under local tumescent anesthesia supplemented with intravenous ketamine for release of post burn neck contracture and split skin grafted. This technique obviates the need for endotracheal intubation. There were no complications attributed to this anesthesia technique. There was no graft loss and blood loss was minimal.

  19. Congenital gluteus maximus contracture syndrome - a case report with review of imaging findings

    Science.gov (United States)

    Kotha, Vamshi Krishna; Reddy, Rajasekhar; Reddy, M. Venkateshwar; Moorthy, Rangubatla Sathyanrayana; Kishan, Tatikonda Venkat

    2014-01-01

    Although the clinical features of gluteus maximus contracture syndrome have been frequently described, imaging features have been seldom described. Most commonly reported cases are those following intramuscular injection in the gluteal region although congenital contracture is an uncommon but important occurrence. This condition has most often been reported in children of school going age. These patients often present with difficulty in squatting, limitation of hip motion or specific deformities and often require surgical correction. We describe the plain radiography, ultrasonography (USG) and magnetic resonance imaging (MRI) features of this condition in a patient with no previous known history of intramuscular injections. PMID:24967033

  20. Congenital gluteus maximus contracture syndrome--a case report with review of imaging findings.

    Science.gov (United States)

    Kotha, Vamshi Krishna; Reddy, Rajasekhar; Reddy, M Venkateshwar; Moorthy, Rangubatla Sathyanrayana; Kishan, Tatikonda Venkat

    2014-04-01

    Although the clinical features of gluteus maximus contracture syndrome have been frequently described, imaging features have been seldom described. Most commonly reported cases are those following intramuscular injection in the gluteal region although congenital contracture is an uncommon but important occurrence. This condition has most often been reported in children of school going age. These patients often present with difficulty in squatting, limitation of hip motion or specific deformities and often require surgical correction. We describe the plain radiography, ultrasonography (USG) and magnetic resonance imaging (MRI) features of this condition in a patient with no previous known history of intramuscular injections.

  1. The effect of isolated gastrocnemius contracture and gastrocnemius recession on lower extremity kinematics and kinetics during stance.

    Science.gov (United States)

    Chimera, Nicole J; Castro, Michael; Davis, Irene; Manal, Kurt

    2012-11-01

    Isolated gastrocnemius contracture limits ankle dorsiflexion with full knee extension and is potentially problematic during mid-stance of gait when 10° of dorsiflexion and full knee extension are needed. It is during this time that patients with isolated gastrocnemius contracture may demonstrate altered kinematics and/or kinetics. When conservative management fails to resolve painful foot pathologies associated with non-spastic isolated gastrocnemius contracture, gastrocnemius recession surgery has been suggested to resolve contracture and improve function and strength. However, there are no published reports on lower extremity kinematics/kinetics in the non-spastic isolated gastrocnemius contracture population. Assessment of alterations in gait mechanics is necessary to examine the effects of this potential surgical intervention. Lower extremity kinematics and kinetics were assessed in 6 patients clinically diagnosed with isolated gastrocnemius contracture pre- and post-surgical recession compared with 33 healthy control participants. Pre-operatively, patients with isolated gastrocnemius contracture demonstrated significantly increased peak knee flexion angles and knee flexion moments during mid-stance. There were no differences in peak ankle dorsiflexion angle or peak plantar flexion moment. Gastrocnemius recession did not alter gait kinematics/kinetics following surgery. Joint kinematic strategies utilized to compensate for isolated gastrocnemius contracture varied minimally between participants with IGC; most employed a flexed knee strategy, while one participant utilized a reduced ankle dorsiflexion strategy. Select post-surgical gait mechanics were unaltered; however, gait mechanics were not similar between non-spastic isolated gastrocnemius contracture patients and healthy control participants. Surgical intervention for patients with isolated gastrocnemius contracture does not appear to create any negative gait adaptations; however, patients may benefit

  2. Shoulder adduction contracture after burn: anatomy and treatment with quadrangular local scar subcutaneous pedicled flap, a new approach.

    Science.gov (United States)

    Grishkevich, Viktor M

    2013-11-01

    Axillary adduction contracture is caused by scars that tightly surround the shoulder joint impairing the function of the upper limb. Due to severe scar surface deficiency, contracture release presents a challenge for surgeons since a method of release is transfer of tissue in the form of a large pedicled or free flap(s). Thus, development of simpler, less traumatic techniques, using local tissues, persists. Anatomic studies of shoulder adduction contractures after burn (pre-operative, during surgery, post-reconstruction) were done in 346 pediatric and adult patients. All were divided into three groups according to contracture types: with edge contractures (80%), medial (6%) and total (14%). Anatomical study covered peculiarities of total contractures and possibilities for their treatment using local scarred tissue. Total contractures (48 patients) were caused by scars tightly surrounding the joint on three sides: anterior, posterior, and axillary. There were two specific forms of contracture: (a) shoulder close to the chest wall (22 of 48 patients) which was treated with thoracic pedicled or free flaps; (b) in 26 out of 48 patients a flat scar and skin graft surface laid along the shoulder and chest wall, in axillary projection, which were used for contracture release in the form of a subcutaneous pedicled quadrangular flap. The flap was mobilized only peripherally, descending to the apex of the axilla, forming the central axillary zone, and suspension of the axilla on a normal level. Wounds aside the flaps were covered with skin graft. Acceptable functional and cosmetic results were achieved in all 26 patients. Total shoulder adduction contractures have two forms: (a) shoulder close/fused with the chest wall; and (b) along the chest wall and shoulder there is a flat surface, the tissue of which can be used for reconstruction in a form of scar subcutaneous pedicled quadrangular flap. Based on this flap, a new technique is described which is relatively easy to

  3. REACTOR COOLING

    Science.gov (United States)

    Quackenbush, C.F.

    1959-09-29

    A nuclear reactor with provisions for selectively cooling the fuel elements is described. The reactor has a plurality of tubes extending throughout. Cylindrical fuel elements are disposed within the tubes and the coolant flows through the tubes and around the fuel elements. The fuel elements within the central portion of the reactor are provided with roughened surfaces of material. The fuel elements in the end portions of the tubes within the reactor are provlded with low conduction jackets and the fuel elements in the region between the central portion and the end portions are provided with smooth surfaces of high heat conduction material.

  4. Cool collapsible

    OpenAIRE

    Linnér, Fredrik

    2010-01-01

    Cool collabsible är ett projekt som har handlat om att skapa ett hopfällbart utomhusbord. Arbetet har utförts tillsammans med aka buna design consult. Projektet har fokuserats på att hitta en funktion, teknik och material för att sedan transformera detta till ett innovativt utomhusbord. Genom ett utförligt arbete med att definiera målgruppen skapades ramar som format ett bord till den typiska brukaren. Resultatet blev ett hopfällbart bord som hämtat sin inspiration från naturen. Ett bord som ...

  5. Congenital contractural arachnodactyly Síndrome de la arcnodactilia contractural: estudio de un caso esporádico y revisión de la literatura

    Directory of Open Access Journals (Sweden)

    Betty Nishikuni

    1991-02-01

    Full Text Available

    The Congenital Contractural Arachnodactyly Syndrome is a heredltary disorder of connective tissue characterized by multiple congenital contractures, arachnodactyly, dolichostenomella, kyphoscollosis, abnormalities of the external ears and autosomal dominant inheritance. Nearly 50 cases have previously been reported. A new sporadic case is presented. Some clinical and genetic aspects, differential diagnosis and therapeutic approach of this syndrome are discussed.

    El síndrome de la aracnodactilia contractural es una alteración hereditaria del tejido conectivo, caracterizada por múltiples contracturas congénitas, aracnodactilia, dolicostenomelia, cifoescoliosis, dismorfia de los pabellones auriculares y un patrón de herencia autonómico dominante. Se han Informado aproximadamente 50 casos, a los cuales se adiciona uno nuevo, esporádico. Se discuten algunos aspectos clínicos y genéticos, el diagnóstico diferencial y el manejo de estos pacientes.

  6. Lentivirus-mediated ERK2 siRNA reduces joint capsule fibrosis in a rat model of post-traumatic joint contracture.

    Science.gov (United States)

    Li, Fengfeng; Liu, Shen; Fan, Cunyi

    2013-10-17

    Extracellular signal-regulated kinase (ERK)-2 is presumed to play an important role in the development of post-traumatic joint contractures. Using a rat injury model, we investigated whether treatment with ERK2 small interfering RNA (siRNA) could reduce the extent of joint capsule fibrosis after an induced injury. Rats were separated into three groups (n = 32 each): non-operated control group, operated contracture group and contracture-treatment group. Stable post-traumatic joint contracture was created through surgical intra-articular joint injury followed by eight weeks of immobilization. In the contracture-treatment group, the rats were treated with lentivirus (LV)-mediated ERK2 siRNA at days 3 and 7 post-surgery. The posterior joint capsule was assessed by western blotting, immunohistochemistry and biochemical analysis for changes in ERK2, phosphorylated (p)-ERK2, myofibroblast, total collagen and relative collagen Type III expression level. Biomechanical testing was used to assess the development of flexion contractures. Statistical analysis was performed using an analysis of variance. In the operated contracture group, rats that developed flexion contractures also showed elevated phosphorylated p-ERK2 expression. In the contracture-treatment group, ERK2 siRNA significantly reduced p-ERK2 expression levels, as well as the severity of flexion contracture development (p contractures and the resultant increase of joint capsule fibrosis can be reduced by LV-mediated ERK2 siRNA treatment.

  7. Tendon transfer for treatment of internal rotation contracture of the shoulder in brachial plexus birth palsy.

    Science.gov (United States)

    Abdel-Ghani, H; Hamdy, K A; Basha, N; Tarraf, Y N

    2012-10-01

    We retrospectively analyzed 63 patients with internal rotation contracture of the shoulder secondary to brachial plexus birth palsy treated with subscapularis sliding combined with either latissimus dorsi transfer (group A: n = 18) or latissimus dorsi and teres major transfer (group B: n = 45) to the rotator cuff. The mean age at time of surgery was 43 months (SD 21 months; range 8 months to 9 years). We used a modification of the Gilbert shoulder grading system for assessment. All patients showed statistically significant improvement of active shoulder abduction and external rotation without significant differences between the two groups. Significant external rotation contracture of the shoulder (inability to touch the abdomen with the wrist extended) occurred in 42 of 63 patients, and there was a greater incidence of external rotation contracture in group B. We conclude that surgery should be restricted to latissimus dorsi transfer without teres major transfer to avoid external rotation contractures. Our modification of the Gilbert grading system appears to be valid and applicable.

  8. Characterization of the Capsule Surrounding Smooth and Textured Tissue Expanders and Correlation with Contracture

    Directory of Open Access Journals (Sweden)

    Erika Kuriyama, MD

    2017-07-01

    Full Text Available Background:. Capsular contracture is a common complication after breast augmentation surgery. This study pathologically evaluated the soft-tissue response to surface modifications in both smooth and textured tissue expander prostheses. Methods:. Smooth tissue expanders and textured tissue expanders in 5 cases each were used for breast reconstruction after mastectomy. Histological samples were harvested from the capsules when the tissue expanders were replaced by silicone implants. Collagen orientation and cellular responses were assessed histologically. Capsular contracture was evaluated using the Baker classification 6 months and 2 years after the removal of the tissue expander. Results:. The capsules surrounding the smooth tissue expanders tended to produce more contracture than those surrounding the textured tissue expanders. The collagen architecture of the capsules of the smooth tissue expanders showed random orientation with fragmentation. Conversely, the capsules of the textured tissue expanders showed parallel orientation with collagen bundles of almost normal structure. Significantly more fibrils of elastin and myofibroblasts were found in the capsules surrounding the smooth tissue than in those surrounding the textured ones. Conclusions:. The collagen fibers surrounding the smooth tissue expanders could be cracked during expansion, which may lead to scarring and contracture. Conversely, the collagen orientation surrounding the textured tissue expanders was excellent. Moreover, the increase in elastic fibers and myofibroblasts in the capsules surrounding the smooth tissue expanders may be associated with in vivo contraction patterns. Therefore, the surface type of tissue expanders affects capsular contraction after replacement with definitive implants.

  9. Digital flexor tendon contracture treated by tenectomy: different clinical presentations in three cats

    Directory of Open Access Journals (Sweden)

    Quentin Cabon

    2015-07-01

    Full Text Available Case series summary Three cats, Siamese or Siamese cross, were presented with a chronic thoracic limb weightbearing lameness. Previous anti-inflammatory administrations were unable to improve lameness consistently in the three cats. Two of the three cats had undergone onychectomy several years before presentation. A permanent flexion of the proximal interphalangeal joint of one or more digits, associated with a difficult and painful extension of the proximal interphalangeal joint, was noticed during orthopedic examination. A digital flexor tendon contracture was suspected and confirmed with radiographic examination. Surgical exploration was then performed. For all cats, treatment consisted of a tenectomy or tenotomy of the superficial and deep digital flexor tendons in order to release the contracture. The three cats responded well to the surgical treatment and became sound around 2–4 weeks after surgery. Relevance and novel information Digital flexor tendon contracture is rarely reported as a cause of lameness in cats. It should be considered in a differential diagnosis of feline lameness whenever onychectomy has been performed in the past. The precise etiology that explains this tendon contracture is unknown, but trauma or breed predisposition could represent potential causes.

  10. Feasibility of an Exoskeleton-Based Interactive Video Game System for Upper Extremity Burn Contractures.

    Science.gov (United States)

    Schneider, Jeffrey C; Ozsecen, Muzaffer Y; Muraoka, Nicholas K; Mancinelli, Chiara; Della Croce, Ugo; Ryan, Colleen M; Bonato, Paolo

    2016-05-01

    Burn contractures are common and difficult to treat. Measuring continuous joint motion would inform the assessment of contracture interventions; however, it is not standard clinical practice. This study examines use of an interactive gaming system to measure continuous joint motion data. To assess the usability of an exoskeleton-based interactive gaming system in the rehabilitation of upper extremity burn contractures. Feasibility study. Eight subjects with a history of burn injury and upper extremity contractures were recruited from the outpatient clinic of a regional inpatient rehabilitation facility. Subjects used an exoskeleton-based interactive gaming system to play 4 different video games. Continuous joint motion data were collected at the shoulder and elbow during game play. Visual analog scale for engagement, difficulty and comfort. Angular range of motion by subject, joint, and game. The study population had an age of 43 ± 16 (mean ± standard deviation) years and total body surface area burned range of 10%-90%. Subjects reported satisfactory levels of enjoyment, comfort, and difficulty. Continuous joint motion data demonstrated variable characteristics by subject, plane of motion, and game. This study demonstrates the feasibility of use of an exoskeleton-based interactive gaming system in the burn population. Future studies are needed that examine the efficacy of tailoring interactive video games to the specific joint impairments of burn survivors. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  11. Elastic Changes of Capsule in a Rat Knee Contracture Model Assessed by Scanning Acoustic Microscopy

    Science.gov (United States)

    Hagiwara, Y.; Chimoto, E.; Ando, A.; Saijo, Y.; Itoi, E.

    Sound speed of a capsule in a rat knee contracture model was measured by scanning acoustic microscopy. There was no statistical significant difference in the anterior capsule compared with the control group. However, the sound speed of the posterior capsule was significantly greater compared with the control group after prolonged immobilization.

  12. The pudendal thigh flap as YV advanced flap for the release of perineum burns contractures.

    Science.gov (United States)

    Benito, P; De Juan, A; Cano, M

    2012-05-01

    Contractures secondary to burns affecting the perineum often cause severe functional, aesthetic and psychological harm. Many different surgical techniques are used to treat such conditions ranging from grafts, to triangular plasty transposition or advancement flaps of local tissue. It is usually advisable to use a flap or local perineoplasty because the quality of reconstruction tends to be better and the risk of reoccurrence of the contracture is lower. The pudendal thigh fasciocutaneous (PTF) flap is an axial patterned and sensate flap based on the groin crease. It has frequently been used for perineal and vaginal reconstructions. Technically, it is not difficult to perform, with a well tolerated scar located in the inguinal crease, and it is characterized by its thinness and its ready adaptation to the defects, and because it maintains sensitivity. To the best of our knowledge, no previous case of perineal contracture treatment has been reported with the use of a PTF flap harvested as an YV advanced flap. Here we report the case of a patient with a severe contracture who was treated using the flap described above, a satisfactory result being achieved. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. Treatment of upper motoneuron plantarflexion contractures by using an adjustable ankle-foot orthosis.

    Science.gov (United States)

    Grissom, S P; Blanton, S

    2001-02-01

    To assess the effectiveness of an adjustable ankle-foot orthosis in the treatment of plantarflexion contractures after central nervous system injury or disease. Prospective, nonrandomized, interventional trial. University medical center's acute inpatient rehabilitation hospital. Nine ankles with plantarflexion contractures that could not be passively reduced to less than neutral position occurring in 6 patients with stroke or other acquired brain injury. To assure differentiation between spastic deformity and true contracture, patients received a 2% lidocaine block of the posterior tibial nerve. The adjustable ankle-foot orthosis was then applied on the affected ankle for 23 hours per day for 14 days. Adjustments to increase dorsiflexion passive range of motion (PROM) ranged from 0 degrees to 4.5 degrees and were attempted every 48 to 72 hours. Dorsiflexion PROM at the ankle with the knee extended. Increased PROM (average, 20.1 degrees; range, 6 degrees--36 degrees ) was statistically significant (p =.0078). Complications related to pressure with erythema or blister formation associated with pain occurred in 44% of treated ankles at some time during the 2-week trial period. Plantarflexion contractures can be significantly reduced by using the adjustable ankle-foot orthosis with minimal complications.

  14. PREDICTIVE FACTORS OF DIFFICULT INTUBATION IN POST BURN NECK CONTRACTURE – A STUDY OF 30 CONSECUTIVE CASES

    Directory of Open Access Journals (Sweden)

    Vijay

    2015-06-01

    Full Text Available The peri - operative management of post - burn contractures of the neck is a challenge not only to the surgeon but also the anaesthesiologist. A proper co - ordination between them is needed for providing a hassle - free patient care. This is a prospective study done on 30 consecutive patients of post burn contractures of the neck to compare the surgeon’s assessment of the type and pattern of post - burn contracture of the neck and the anaesthesiologist’s assessment of the airway. T he association of this with the peri - operative management of patients was also studied. The data analysed was type of contracture , mento - sternal distance , and preoperative grading of the airway. The method of securing intra - operative airway was documented . A direct co - relation was noted between the type of contracture with the Mallampatti grading of the airway and the sterno - mental distance. All type III contractures required release before intubation. In conclusion , it is advisable for the surgeon to be w ell - versed with the anaesthesiologist’s assessment of the airway and the anaesthesiologist to aware of the types of neck contracture in order to properly plan and execute the peri - operative management of these patients.

  15. Comparative study on the effectiveness of corticosteroid injections between trigger fingers with and without proximal interphalangeal joint flexion contracture.

    Science.gov (United States)

    Shinomiya, R; Sunagawa, T; Nakashima, Y; Kawanishi, Y; Masuda, T; Ochi, M

    2016-02-01

    Trigger fingers with proximal interphalangeal joint flexion contracture are suggested to have a poorer response to corticosteroid injection than those without contracture, though this has not been proven scientifically. We compared the clinical response to corticosteroid injection between trigger fingers with and without proximal interphalangeal joint contracture, and investigated the influence of the injection on the A1 pulley and flexor digitorum tendons using ultrasonography. One month after injection, pain was significantly reduced in the no contracture group, and 56% of trigger fingers with proximal interphalangeal joint contracture resolved. Before injection, relative thickening of the A1 pulley and flexor digitorum tendons, and a partial hypoechoic lesion of the flexor digitorum superficialis tendon were observed in the contracture group. One month after injection, the thickening of the tendons and the A1 pulley was reduced, but the partial hypoechoic lesion was still observed in significant numbers. We have demonstrated that the presence of a proximal interphalangeal joint contracture was associated with a reduced clinical response to corticosteroid injection, and we suggest that the pathologic change in the flexor digitorum superficialis tendon, represented by the partial hypoechoic lesion, contributed to corticosteroid injection resistance. IV. © The Author(s) 2015.

  16. Neuro-musculoskeletal simulation of instrumented contracture and spasticity assessment in children with cerebral palsy.

    Science.gov (United States)

    van der Krogt, Marjolein Margaretha; Bar-On, Lynn; Kindt, Thalia; Desloovere, Kaat; Harlaar, Jaap

    2016-07-16

    Increased resistance in muscles and joints is an important phenomenon in patients with cerebral palsy (CP), and is caused by a combination of neural (e.g. spasticity) and non-neural (e.g. contracture) components. The aim of this study was to simulate instrumented, clinical assessment of the hamstring muscles in CP using a conceptual model of contracture and spasticity, and to determine to what extent contracture can be explained by altered passive muscle stiffness, and spasticity by (purely) velocity-dependent stretch reflex. Instrumented hamstrings spasticity assessment was performed on 11 children with CP and 9 typically developing children. In this test, the knee was passively stretched at slow and fast speed, and knee angle, applied forces and EMG were measured. A dedicated OpenSim model was created with motion and muscles around the knee only. Contracture was modeled by optimizing the passive muscle stiffness parameters of vasti and hamstrings, based on slow stretch data. Spasticity was modeled using a velocity-dependent feedback controller, with threshold values derived from experimental data and gain values optimized for individual subjects. Forward dynamic simulations were performed to predict muscle behavior during slow and fast passive stretches. Both slow and fast stretch data could be successfully simulated by including subject-specific levels of contracture and, for CP fast stretches, spasticity. The RMS errors of predicted knee motion in CP were 1.1 ± 0.9° for slow and 5.9 ± 2.1° for fast stretches. CP hamstrings were found to be stiffer compared with TD, and both hamstrings and vasti were more compliant than the original generic model, except for the CP hamstrings. The purely velocity-dependent spasticity model could predict response during fast passive stretch in terms of predicted knee angle, muscle activity, and fiber length and velocity. Only sustained muscle activity, independent of velocity, was not predicted by our model. The

  17. Biceps Brachii Long Head Overactivity Associated with Elbow Flexion Contracture in Brachial Plexus Birth Palsy

    Science.gov (United States)

    Sheffler, Lindsey C.; Lattanza, Lisa; Sison-Williamson, Mitell; James, Michelle A.

    2012-01-01

    Background: The etiology of elbow flexion contracture in children with brachial plexus birth palsy remains unclear. We hypothesized that the long head of the biceps brachii muscle assists with shoulder stabilization in children with brachial plexus birth palsy and that overactivity of the long head during elbow and shoulder activity is associated with an elbow flexion contracture. Methods: Twenty-one patients with brachial plexus birth palsy-associated elbow flexion contracture underwent testing with surface electromyography. Twelve patients underwent repeat testing with fine-wire electromyography. Surface electrodes were placed on the muscle belly, and fine-wire electrodes were inserted bilaterally into the long and short heads of the biceps brachii. Patients were asked to perform four upper extremity tasks: elbow flexion-extension, hand to head, high reach, and overhead ball throw. The mean duration of muscle activity in the affected limb was compared with that in the contralateral, unaffected limb, which was used as a control. Three-dimensional motion analysis, surface dynamometry, and validated function measures were used to evaluate upper extremity kinematics, elbow flexor-extensor muscle imbalance, and function. Results: The mean activity duration of the long head of the biceps brachii muscle was significantly higher in the affected limb as compared with the contralateral, unaffected limb during hand-to-head tasks (p = 0.02) and high-reach tasks (p = 0.03). No significant differences in mean activity duration were observed for the short head of the biceps brachii muscle between the affected and unaffected limbs. Isometric strength of elbow flexion was not significantly higher than that of elbow extension in the affected limb (p = 0.11). Conclusions: Overactivity of the long head of the biceps brachii muscle is associated with and may contribute to the development of elbow flexion contracture in children with brachial plexus birth palsy. Elbow flexion

  18. Cool visitors

    CERN Document Server

    2006-01-01

    Pictured, from left to right: Tim Izo (saxophone, flute, guitar), Bobby Grant (tour manager), George Pajon (guitar). What do the LHC and a world-famous hip-hop group have in common? They are cool! On Saturday, 1st July, before their appearance at the Montreux Jazz Festival, three members of the 'Black Eyed Peas' came on a surprise visit to CERN, inspired by Dan Brown's Angels and Demons. At short notice, Connie Potter (Head of the ATLAS secretariat) organized a guided tour of ATLAS and the AD 'antimatter factory'. Still curious, lead vocalist Will.I.Am met CERN physicist Rolf Landua after the concert to ask many more questions on particles, CERN, and the origin of the Universe.

  19. Cool Snacks

    DEFF Research Database (Denmark)

    Krogager, Stinne Gunder Strøm; Grunert, Klaus G; Brunsø, Karen

    2016-01-01

    Young people snack and their snacking habits are not always healthy. We address the questions whether it is possible to develop a new snack product that adolescents will find attractive, even though it is based on ingredients as healthy as fruits and vegetables, and we argue that developing...... such a product requires an interdisciplinary effort where researchers with backgrounds in psychology, anthropology, media science, philosophy, sensory science and food science join forces. We present the COOL SNACKS project, where such a blend of competences was used first to obtain thorough insight into young...... people's snacking behaviour and then to develop and test new, healthier snacking solutions. These new snacking solutions were tested and found to be favourably accepted by young people. The paper therefore provides a proof of principle that the development of snacks that are both healthy and attractive...

  20. Outcome of Dupuytren Contractures After Collagenase Clostridium Histolyticum Injection: A Single-institution Experience.

    Science.gov (United States)

    Hwee, Yin Kan; Park, Daniel; Vinas, Marisa; Litts, Christopher; Friedman, David

    2017-08-01

    Collagenase clostridium histolyticum (CCH) injection is an alternative to surgery for patients with Dupuytren disease (DD) of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. The success of surgical and nonsurgical treatment modalities for DD is reported to vary widely between 25% and 80% (J Bone Joint Surg Am. 1985;67:1439-1443; Plast Reconstr Surg. 2007;120:44e-54e; J Bone Joint Surg Am. 2007;89:189-198; J Hand Surg Am. 2011:36:936-942; J Hand Surg Am. 1990;15:755-761; J Hand Surg Br. 1996;21:797-800; J Bone Joint Surg Br. 2000;82:90-94; Plast Reconstr Surg. 2005;115:802-810; Ann Plast Surg. 2006;57:13-17). This study presents the outcomes of patients with DD contractures treated with CCH injections at a single institution. An institutional review board-approved retrospective study was conducted of patients with DD of the hand treated with CCH injections in a single institution from February 2010 to April 2015. All patients received the recommended dose of 0.58 mg of CCH and returned for joint manipulation the following day. Data for follow-up at 7 and 30 days postoperatively and up to 5 years for patients who returned seeking further therapy for recurrent symptoms were reviewed. One hundred thirteen patients with a total of 146 affected joints (72 MCP; 74 PIP) were treated with CCH injections (95 males; 18 females; age, 40-92 y). Successful CCH therapy occurred in 75% of injected joints (109/146 joints; 59 MCP; 50 PIP), as defined by less than 5 degrees of contracture after treatment. Twenty-three percent of treated joints had partial correction (34/146 joints; 13 MCP; 21 PIP), as defined by between 5 and 30 degrees of residual contracture after treatment. Three patients (2%) had a failure of treatment, as defined by unchanged or worsened contracture from pretreatment baseline measurements. Fifteen patients (13%) returned to the clinic seeking additional therapy for recurrent joint contracture symptoms in 17 joints over a span of 1

  1. Postburn neck anterior contracture treatment in children with scar-fascial local trapezoid flaps: a new approach.

    Science.gov (United States)

    Grishkevich, Viktor M; Grishkevich, Max; Menzul, Vasiliy

    2015-01-01

    One of the dramatic consequences of burns is scar contracture and deformities of the neck. Cervical contracture in children is especially dangerous, leading to face disfigurement and kyphosis; therefore, early reconstruction is indicated. Despite the existence of many various surgical techniques, the successful neck contracture treatment in pediatric patients remains a challenge for surgeons. Eleven children (aged 5 to 14 years) with postburn neck anterior contractures were studied to develop a new approach for reconstruction that would employ the use of local scar-fascial flaps. The new approach and technique for postburn pediatric contracture treatment was developed which is especially effective in the treatment of children who cannot undergo complex and long surgical procedures that are aimed at both contracture elimination and neck skin restoration. The technique consists of two trapezoid scar-fascial flaps mobilization which includes all the anterior neck surfaces and consists of scars, fat layer, platysma, and deep cervical fascia. Counter transposition of flaps with tension elongated neck anterior surface was 100 to 200%. The contracture was fully eliminated, and neck contours, mentocervical angle, and head movement were restored. In case of severe contracture, residual wound in submandibular region and above clavicles were skin-grafted. The full range of head motion (functional results) was achieved in all the 11 patients. The flaps continued to grow and the skin grafts shrinkage was moderate. Local trapeze-flap plasty allows neck contracture elimination in children in the cases when a more complex technique is impossible or undesirable to use. Early surgical intervention prevents secondary complications, allotting enough time for patients to mature and be ready for more complex procedures.

  2. Prospective randomized controlled trial comparing 1- versus 7-day manipulation following collagenase injection for dupuytren contracture.

    Science.gov (United States)

    Mickelson, Dayne T; Noland, Shelley S; Watt, Andrew J; Kollitz, Kathleen M; Vedder, Nicholas B; Huang, Jerry I

    2014-10-01

    To compare the efficacy, tolerance, and safety of manual manipulation at day 7 to day 1 following collagenase Clostridium histolyticum (CCH) injection for Dupuytren contracture. Eligible patients were randomized to manipulation at day 1 versus day 7 following CCH injection. Preinjection, premanipulation, postmanipulation, and 30-day follow-up metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint contractures were measured. Pain scores were recorded at each time point. Data were stratified per cohort based on primary joint treated (MCP vs PIP). Means were compared using paired and unpaired t-tests. Forty-three patients with 46 digits were eligible and were randomized to 1-day (22 digits) and 7-day (24 digits) manipulation. For MCP joints, there were no significant differences in flexion contractures between 1- and 7-day cohorts for initial (47° vs 46°), postmanipulation (0° vs 2°), or 30-day follow-up (1° vs 2°) measurements. Premanipulation, the residual contracture was significantly lower in the 7-day group (23° vs 40°). For PIP joints, there were no significant differences between 1- and 7-day cohorts for initial (63° vs 62°), premanipulation (56° vs 52°), postmanipulation (13° vs 15°), or 30-day (14° vs 16°) measurements. There were no significant differences in pain or skin tears between the 2 groups. No flexor tendon ruptures were observed. The effectiveness of CCH in achieving correction of Dupuytren contractures was preserved when manipulation was performed on day 7, with no differences in correction, pain, or skin tears. These data suggest that manipulation can be scheduled at the convenience of the patient and surgeon within the first 7 days after injection. Therapeutic I. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation

    Science.gov (United States)

    2016-01-01

    Background: The prevailing theory for capsular contracture after breast augmentation is a subclinical capsular infection. A capsulectomy, site change, and implant replacement are recommended. An open capsulotomy leaves the capsule in the patient. Theoretically, such a procedure would be ineffective because it does not remove the infected tissue. Recurrences occurred frequently in women treated in the 1970s when leaky silicone gel implants were in use. Open capsulotomy has not been studied in women implanted with third-generation devices. Methods: Seventy-five consecutive women with Baker III/IV capsular contractures after breast augmentation treated with open capsulotomies between 1996 and 2016 were retrospectively evaluated. The original implants were usually saline-filled (72.2%). Replacements were all smooth and round, and 92.6% were also saline-filled. Results: Seventeen women (22.7%) developed a recurrent capsular contracture. Two patients (2.7%) experienced a second recurrence. Patients with ruptured silicone gel implants (n = 13) had a significantly greater risk of recurrence (P = 0.01). There was no significant difference in recurrence rates comparing patients whose intact implants were reinserted (12.5%) with women whose intact implants were replaced (18.2%). Povidone–iodine irrigation did not affect the recurrence rate. Capsular contracture was corrected with 1 procedure in 77.3% of patients and 2 procedures in 97.3% of patients. Conclusions: Open capsulotomy is a safe and effective treatment that avoids the additional morbidity and cost of a capsulectomy. The findings challenge the infected biofilm theory of capsular contracture. Open capsulotomy deserves reconsideration by plastic surgeons. PMID:27826488

  4. Factors Affecting Burn Contracture Outcome in Developing Countries: A Review of 2506 Patients.

    Science.gov (United States)

    Garcia, Lauren P; Huang, Alice; Corlew, Daniel Scott; Aeron, Kush; Aeron, Yogi; Rai, Shankar Man; Jovic, Goran; Agag, Richard L

    2016-09-01

    Burn contractures hinder joint mobility, resulting in functional impairment and reduced quality of life. This is of greater significance in developing countries where there are fewer resources for assistance with such impairments. Contracture release reduces deformity, but multiple factors affect the extent of postsurgical improvements and outcomes. Elucidating these factors may enable surgeons to better care for burn patients. This study assesses factors that impact burn contracture resolution in developing nations. A retrospective review of 2506 burn contractures was performed using information extracted from a large nongovernment organization (ReSurge International) database from Nepal, India, and Zambia. Data points included age, type of burn, time elapsed between injury and release, and extent of final release achieved based on preoperative and postoperative images of hand (n = 1960), elbow (n = 371), and knee (n = 176) contractures. Hand improvement was scored based on digit/wrist involvement (severity of dysfunction) and joint extension capability (functionality); elbow and knee improvement were calculated using preoperative and postoperative joint angles. Multivariate analysis was performed. Hands burned by hot liquid had greater functionality after surgery than open-fire burns (P < 0.01). Improvement in severity of dysfunction and functionality were inversely correlated to age (P < 0.01) and time until surgery (P < 0.01). Elbow improvement decreased as age increased (P < 0.01). Postoperative increase of knee extension decreased for each year elapsed between injury and surgery (P < 0.01). Burn type, age when burned, and timing of surgery were significant factors affecting hand outcomes, whereas age affected elbow outcomes, and time elapsed until surgery affected knee results. An algorithm was formulated to enable physicians in developing countries with limited resources to triage patients and optimize patient outcomes.

  5. Quality of life in older individuals with joint contractures in geriatric care settings.

    Science.gov (United States)

    Heise, Marco; Müller, Martin; Fischer, Uli; Grill, Eva

    2016-09-01

    The purpose of this study was to analyze the association between functioning and disability and quality of life (QoL) in older individuals with joint contractures in the geriatric care setting. More specifically, this study aimed to identify determinants of QoL out of a defined set of contracture-related categories of the International Classification of Functioning, Disability and Health (ICF). Participants for this multicenter cross-sectional survey were recruited from acute geriatric rehabilitation hospitals, nursing homes, and community nursing facilities in Germany between February and October 2013. QoL was assessed using the validated German version of the EQ-5D index score and the EQ-5D visual analog scale (VAS). Manual and automatic variable selection methods were used to identify the most relevant variables out of 125 contracture-related ICF categories. A total of 241 eligible participants (34.9 % male, mean age 80.1 years) were included. The final models contained 14 ICF categories as predictors of the EQ-5D index score and 15 categories as predictors of the EQ-5D VAS. The statistically significant ICF categories from both models were 'muscle power functions (b730),' 'memory functions (b144),' 'taking care of plants (d6505),' 'recreation and leisure (d920),' 'religion and spirituality (d930),' 'drugs (e1101),' and 'products and technology for personal use in daily living (e115).' We identified the most relevant ICF categories for older individuals with joint contractures and their health-related quality of life. These items describe potential determinants of QoL which may provide the basis for future health interventions aiming to improve QoL for the patients with joint contractures.

  6. Stretching After Heat But Not After Cold Decreases Contractures After Spinal Cord Injury in Rats.

    Science.gov (United States)

    Iwasawa, Hiroyuki; Nomura, Masato; Sakitani, Naoyoshi; Watanabe, Kosuke; Watanabe, Daichi; Moriyama, Hideki

    2016-12-01

    Contractures are a prevalent and potentially severe complication in patients with neurologic disorders. Although heat, cold, and stretching are commonly used for treatment of contractures and/or spasticity (the cause of many contractures), the sequential effects of these modalities remain unclear. Using an established rat model with spinal cord injury with knee flexion contracture, we sought to determine what combination of heat or cold before stretching is the most effective for treatment of contractures derived from spastic paralyses and investigated which treatment leads to the best (1) improvement in the loss of ROM; (2) restoration of deterioration in the muscular and articular factors responsible for contractures; and (3) amelioration of histopathologic features such as muscular fibrosis in biceps femoris and shortening of the joint capsule. Forty-two adolescent male Wistar rats were used. After spasticity developed at 2 weeks postinjury, each animal with spinal cord injury underwent the treatment protocol daily for 1 week. Knee extension ROM was measured with a goniometer by two examiners blinded to each other's scores. The muscular and articular factors contributing to contractures were calculated by measuring ROM before and after the myotomies. We quantitatively measured the muscular fibrosis and the synovial intima length, and observed the distribution of collagen of skeletal muscle. The results were confirmed by a blinded observer. The ROM of heat alone (34° ± 1°) and cold alone (34° ± 2°) rats were not different with the numbers available from that of rats with spinal cord injury (35° ± 2°) (p = 0.92 and 0.89, respectively). Stretching after heat (24° ± 1°) was more effective than stretching alone (27° ± 3°) at increasing ROM (p stretching after cold (25° ± 1°) and stretching alone (p = 0.352). Stretching after heat was the most effective for percentage improvement of muscular (29%) and articular (50%) factors of contractures. Although

  7. Renewable Heating and Cooling

    Science.gov (United States)

    Renewable heating and cooling is a set of alternative resources and technologies that can be used in place of conventional heating and cooling technologies for common applications such as water heating, space heating, space cooling and process heat.

  8. The role of two-sided splinting for recalcitrant paediatric post-burn hand flexion contracture: a case report.

    Science.gov (United States)

    Prasetyono, Toh; Caroline, I

    2017-07-01

    A 2-year-old boy presented to the plastic and reconstructive surgery outpatient clinic with bilateral post-burn hand flexion contracture. The contracture had been released twice elsewhere. The third surgical repair on one hand at a time was conducted by the author (TOHP). However, inadeq.uate compliance to the postoperative splinting and exercise led to the recurrence of the contracture in the following year. A customised two-sided splint was therefore created to ensure proper placement and compliance. Reinforcement to the parents to encourage the boy to practise active exercise on demand was also an integral part of the management. Good functional and cosmetic outcome were presented at 1-year follow-up. This case highlights the value of a two-sided splint for the management of post-burn hand flexion contracture in children whose compliance is inevitably cannot be guaranteed.

  9. The impact of simulated ankle plantarflexion contracture on the knee joint during stance phase of gait: a within-subject study.

    Science.gov (United States)

    Leung, Joan; Smith, Richard; Harvey, Lisa Anne; Moseley, Anne M; Chapparo, Joseph

    2014-04-01

    Ankle plantarflexion contractures are common in adults with neurological disorders and known to cause secondary gait deviations. However, their impact on the knee joint is not fully understood. The aims of this study are to describe the effect of simulated plantarflexion contractures on knee biomechanics during the stance phase and on the spatiotemporal characteristics of gait. Mild (10-degree plantarflexion) and severe (20-degree plantarflexion) ankle contractures were simulated in thirteen able-bodied adults using an ankle-foot-orthosis. A no contracture condition was compared with two simulated contracture conditions. There was an increase in knee extension, sometimes resulting in hyperextension, throughout stance for the two contracture conditions compared to the no contracture condition (mean increase in knee extension ranged from 5° to 9°; 95% CI 0° to 17°). At the same time, there were reductions in extension moment and power generation at the knee. Simulated plantarflexion contractures also reduced gait velocity, bilateral step length and cadence. All these changes were more pronounced in the severe contracture condition than mild contracture condition. While the majority of participants adopted a foot-flat pattern on landing and exhibited an increase in knee extension during stance, two participants used a toe-walking pattern and exhibited an increase in knee flexion. Ankle plantarflexion contractures are associated with an increase in knee extension during stance phase. However, some people with simulated ankle contractures may walk with an increase in knee flexion instead. Ankle plantarflexion contractures also adversely affect gait velocity, step length and cadence. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. RECONSTRUCTION OF SUPPLE SCAR OF POST BURN CONTRACTURE OF NECK BY Z - PLASTY

    Directory of Open Access Journals (Sweden)

    Subha Dhua

    2015-02-01

    Full Text Available Denonvilliers in 1856 was the first one to describe Z - plasty technique as a surgical co rrection for lower lid ectrpion and it was McCurdy who made the first reference to this technique in the American Literature in 1913 for treatment of contracture at the oral commissure. In 1929 Limberg came up with a more geometric description but geometri c details showing optimal angles and length were provided by Davis in 1946. 1 Z - Plasty is one of the most versatile and widely used technique after number of modifications namely multiple serial, 2 four - flap, 3 five - flap, 4,5 and six - flap, 6 double - opposing Z - p lasties, and other, less commonly used modifications. 7,8 These are not just theoretical extensions of the Z - Plasty, but practical and applicable procedures. Z - plasty was chosen in our studies to release contracture of the neck scar. In our case we have performed the release of contracture of the neck for improving functional and cosmetic appearance of post burn contracture of the neck. Through multiple Z - plasty techni que without excision of Supple Scar, it is possible to lengthen the contracted scars due to burns through changing the direction of the scar. This technique has helped to interrupt and break the scar for better camouflage. The paper describes correction of 20 post burn cases of scar contracture in the neck. The majority of the cases happen to be female who sustained flame burns while cooking. The major disability of limitation was of neck movement as well as of the lower jaw was effectively addressed throug h this technique by creating longer final gain in length of the contracted scar. The final results obtained by changing the direction of the scar and aligning it with the skin tension lines gave excellent camouflage and cosmetically acceptable outcome. Thi s technique has given the following advantages: Achieve good extension of the neck to normal. There is no chance of recurrence of contracture of neck

  11. Restaurant food cooling practices.

    Science.gov (United States)

    Brown, Laura Green; Ripley, Danny; Blade, Henry; Reimann, Dave; Everstine, Karen; Nicholas, Dave; Egan, Jessica; Koktavy, Nicole; Quilliam, Daniela N

    2012-12-01

    Improper food cooling practices are a significant cause of foodborne illness, yet little is known about restaurant food cooling practices. This study was conducted to examine food cooling practices in restaurants. Specifically, the study assesses the frequency with which restaurants meet U.S. Food and Drug Administration (FDA) recommendations aimed at reducing pathogen proliferation during food cooling. Members of the Centers for Disease Control and Prevention's Environmental Health Specialists Network collected data on food cooling practices in 420 restaurants. The data collected indicate that many restaurants are not meeting FDA recommendations concerning cooling. Although most restaurant kitchen managers report that they have formal cooling processes (86%) and provide training to food workers on proper cooling (91%), many managers said that they do not have tested and verified cooling processes (39%), do not monitor time or temperature during cooling processes (41%), or do not calibrate thermometers used for monitoring temperatures (15%). Indeed, 86% of managers reported cooling processes that did not incorporate all FDA-recommended components. Additionally, restaurants do not always follow recommendations concerning specific cooling methods, such as refrigerating cooling food at shallow depths, ventilating cooling food, providing open-air space around the tops and sides of cooling food containers, and refraining from stacking cooling food containers on top of each other. Data from this study could be used by food safety programs and the restaurant industry to target training and intervention efforts concerning cooling practices. These efforts should focus on the most frequent poor cooling practices, as identified by this study.

  12. Effect of stump flexion contracture with and without prosthetic alignment intervention towards postural stability among transtibial prosthesis users

    Science.gov (United States)

    Ghazali, M. F.; Razak, N. A. Abd; Abu Osman, N. A.; Gholizadeh, H.

    2017-06-01

    Knee flexion contracture on a stump side is a phenomenon in which the stump cannot move in normal range of motion (ROM) or cannot be fully extended. This study has been carried out by using Biodex Stability System (BSS) in order to investigate the effect of stump flexion contracture towards the postural stability among the transtibial prosthesis users with the intervention of alignment accommodation. The BSS provides the reading of anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and overall stability index (OSI). Higher reading of the index indicates lesser stability. Each of the subjects had been tested in three different sessions that were Visit 1 (before contracture improvement), Visit 2 (after contracture improvement without alignment readjustment), and Visit 3 (after contracture improvement with alignment readjustment). The APSI reading was significantly higher during Visit 2 compared to Visit 1 and Visit 3. The OSI during Visit 2 was also found significantly higher compared to Visit 3. In Visit 2, the degree of contracture was significantly improved with 44.1% less than Visit 1. The stability index in anterior-posterior aspect (APSI) was proven to be lower as the prosthetic alignment was adjusted according to the ROM of knee. This finding explained that the alignment set up based on the adaptation with the stump’s ROM can contribute positively in maintaining postural stability.

  13. [Insertion of gluteus maximus tendo-chilles lengthening with Z-shaped for the treatment of severe gluteal muscle contracture].

    Science.gov (United States)

    Chen, Huan-shi; Yang, Xiao-long

    2015-06-01

    To investigate clinical curative effects of gluteal muscle contracture release combined with insertion of gluteus maximus tendo-chilles lengthening with Z-shaped in treating severe gluteal muscles contracture. From 2006 May to 2011 May, 20 patients (35 sides) with severe gluteal muscle contracture were collected, including 12 males and 8 females, aged from 8 to 34 years old with an average of 13 years old; the courses of disease ranged from 3 to 21 years. All patients manifested abnormal gait at different degree, knees close together cannot squat,positive syndrome of Ober, positive test of alice leg. Gluteus contracture fascia release were performed firstly in operation, then insertion of tendo-chilles lengthening with Z-shaped were carried out. Preoperative and postoperative gait, and knee flexion hip extensor squat test, cross leg test, adduction and internal rotary activity of hip joint, stretch strength and motor ability after hip abduction were observed and compared. Twenty patients were followed up for 1 to 5 years. Gluteus maximus were released thoroughly, and snapping hip was disappeared, Ober syndrome were negative. There was significant differences in knee flexion hip extensor squat test, adduction and internal rotary activity of hip joint,stretch before and after operation (Pcontracture,insertion of gluteus maximus tendo-chilles lengthening with Z-shaped performed after gluteus contracture fascia release could release gluteal muscle contracture to the greatest extent and obtain postoperative curative effect without resection of normal hip muscle fibers and destroy joint capsule.

  14. Fracture behaviour of bread crust: Effect of bread cooling conditions

    NARCIS (Netherlands)

    Primo-Martín, C.; Beukelaer, H. de; Hamer, R.J.; Vliet, T. van

    2008-01-01

    The effect of air and vacuum cooling on the fracture behaviour and accompanying sound emission, moisture content and crispness of bread crust were investigated. Vacuum cooling resulted in rapid evaporative cooling of products that contained high moisture content. Fracture experiments showed a clear

  15. Bethlem myopathy: An autosomal dominant myopathy with flexion contractures, keloids, and follicular hyperkeratosis

    Directory of Open Access Journals (Sweden)

    Aralikatte Onkarappa Saroja

    2013-01-01

    Full Text Available Bethlem myopathy and Ullrich congenital muscular dystrophy form a spectrum of collagenopathies caused by genetic mutations encoding for any of the three subunits of collagen VI. Bethlem phenotype is relatively benign and is characterized by proximal dominant myopathy, keloids, contractures, distal hyperextensibility, and follicular hyperkeratosis. Three patients from a single family were diagnosed to have Bethlem myopathy based on European Neuromuscular Centre Bethlem Consortium criteria. Affected father and his both sons had slowly progressive proximal dominant weakness and recurrent falls from the first decade. Both children aged 18 and 20 years were ambulant at presentation. All had flexion contractures, keloids, and follicular hyperkeratosis without muscle hypertrophy. Creatinine kinase was mildly elevated and electromyography revealed myopathic features. Muscle imaging revealed severe involvement of glutei and vasti with "central shadow" in rectus femoris. Muscle biopsy in the father showed dystrophic changes with normal immmunostaining for collagen VI, sarcoglycans, and dysferlin.

  16. Bethlem myopathy: An autosomal dominant myopathy with flexion contractures, keloids, and follicular hyperkeratosis.

    Science.gov (United States)

    Saroja, Aralikatte Onkarappa; Naik, Karkal Ravishankar; Nalini, Atcharayam; Gayathri, Narayanappa

    2013-10-01

    Bethlem myopathy and Ullrich congenital muscular dystrophy form a spectrum of collagenopathies caused by genetic mutations encoding for any of the three subunits of collagen VI. Bethlem phenotype is relatively benign and is characterized by proximal dominant myopathy, keloids, contractures, distal hyperextensibility, and follicular hyperkeratosis. Three patients from a single family were diagnosed to have Bethlem myopathy based on European Neuromuscular Centre Bethlem Consortium criteria. Affected father and his both sons had slowly progressive proximal dominant weakness and recurrent falls from the first decade. Both children aged 18 and 20 years were ambulant at presentation. All had flexion contractures, keloids, and follicular hyperkeratosis without muscle hypertrophy. Creatinine kinase was mildly elevated and electromyography revealed myopathic features. Muscle imaging revealed severe involvement of glutei and vasti with "central shadow" in rectus femoris. Muscle biopsy in the father showed dystrophic changes with normal immmunostaining for collagen VI, sarcoglycans, and dysferlin.

  17. Percutaneous Aponeurotomy and Lipofilling (PALF): A Regenerative Approach to Dupuytren Contracture.

    Science.gov (United States)

    Hovius, Steven E R; Kan, Hester J; Verhoekx, Jennifer S N; Khouri, Roger K

    2015-07-01

    Dupuytren disease is a progressive fibroproliferative disorder, which leads to flexion contractures of the digits. A minimally invasive technique consisting of an extensive percutaneous aponeurotomy of the cord with a needle combined with lipofilling is presented. The selective cutting of the cords under continuous tension disintegrates the cords while sparing the looser neurovascular bundles. Subsequently, lipoaspirate is injected subcutaneously. The authors' prospective results show a significantly shorter recovery time and less overall complications in this technique when compared with open surgery, while no significant difference was observed in the extent of immediate contracture correction and in the recurrence rate at 1 year follow-up. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Non Surgical Treatment of Established Forearm’s Volkmann Contracture in Child: A Case Report

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    Seyed Ali Hosseini

    2010-04-01

    Full Text Available The acute compartment syndrome of the forearm is rare and may therefore be easily missed. Although many clinicians will not see such a patient during their entire career, profound knowledge of the symptoms is required to recognize the syndrome in time. Besides immediate identification of the compartment syndrome early surgical treatment is mandatory to avoid its devastating consequences. Then the functional results can be good, but it can't be correct in child because of more chance to survive necrotic muscle and regain motion with splinting and hand therapy. This study reported the nonsurgical treatment for ischemic contracture of hand and forearm due to displaced supra-condylar fracture of the humorous at 6 years old boy, after fixed contractures.

  19. Efficacy and safety of collagenase Clostridium histolyticum injection for Dupuytren contracture: report of 40 cases.

    Science.gov (United States)

    Alberton, F; Corain, M; Garofano, A; Pangallo, L; Valore, A; Zanella, V; Adani, R

    2014-12-01

    Dupuytren's disease (DD) is a fibroproliferative pathology that affects the palmar aponeurosis causing the development of nodules and collagen cords and the progressive flexion of the fingers. The standard procedure is surgical fasciectomy, followed by high recurrence rates. Collagenase Clostridium histolyticum (CCH) injection represents an innovative noninvasive approach to the treatment of DD. This prospective study was designed to examine the efficacy and safety of CCH injection performed in the outpatient, using local anesthesia. Forty patients [32 metacarpophalangeal (MP), 8 proximal interphalangeal (PIP)] with Dupuytren's contracture of at least 20° for MP joint and any degree for PIP joint were included. The mean age was 66. All joints were treated with a single vial of collagenase injection and manual breaking of the cord 24 h after. All adverse effects (AEs) were monitored. Patients were checked 7, 30, 90, and 180 days after the injection. Primary endpoint was a reduction in digit contracture within 0°-5° of normal extension. Secondary endpoints were the improvement of range of motion, the evaluation of AEs incidence, and cost-effectiveness of collagenase treatment. About 67.5 % of patients obtained a clinical success. At 6 months, a further 7.5% attained the same result. The mean contracture of treated joints was 5.3º for MP and 6.8° for PIP joints. Twenty-three patients had one or more mild-to-moderate side effects. The use of collagenase appears to be an effective and safe method for the treatment of Dupuytren's contracture. Therapeutic success was achieved in a significant percentage of patients. The incidence of side effects was higher, but they were local reactions of short duration. The use of a single collagenase vial in patients treated in day surgery appears more cost-effective than surgery.

  20. Measurement Properties of the Brief Michigan Hand Outcomes Questionnaire in Patients With Dupuytren Contracture.

    Science.gov (United States)

    Wehrli, Martina; Hensler, Stefanie; Schindele, Stephan; Herren, Daniel B; Marks, Miriam

    2016-09-01

    The brief Michigan Hand Outcomes Questionnaire (briefMHQ) was developed as a shorter version of the Michigan Hand Outcomes Questionnaire (MHQ), but its measurement properties have not been investigated in patients with Dupuytren contracture. The objective of the study was to investigate the reliability, validity, responsiveness, and interpretability of the briefMHQ. Fifty-seven patients diagnosed with Dupuytren contracture completed the briefMHQ as well as the full-length MHQ and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at baseline. Two to 14 days after baseline and 1 year after collagenase injection or surgery, patients again filled out the briefMHQ. Reliability was determined using the intraclass correlation coefficient and by calculating internal consistency (Cronbach alpha). Validity was tested by quantifying correlations with the full-length MHQ and QuickDASH. Responsiveness, based on the standardized response mean and the minimally clinically important change, was also determined. The briefMHQ had an intraclass correlation coefficient of 0.87, Cronbach alpha of 0.88, and correlations of r = 0.88 and -0.82 with the original MHQ and QuickDASH, respectively. The standardized response mean was 0.9 and the minimally clinically important change was 7 points. Overall, the briefMHQ demonstrates excellent reliability, good validity, and high responsiveness in patients with Dupuytren contracture. The briefMHQ is an accurate and time-saving tool to evaluate patients with Dupuytren contracture and the effect of a corresponding treatment. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  1. Dupuytren’s contracture of hand and its medical and social review

    OpenAIRE

    V. O. Vishnevskiy

    2014-01-01

    Introduction Dupuytren's contracture is a disease of connective tissue with the affection of palmar aponeurosis, frequently with chronic recurrent course, the flexion deformities of fingers and dysfunction of the hand. It composed 11,8 % among of all types of the hand pathology. The mostly it develops in men of middle-aged and elderly. At young age it occurs more rarely, but with fast progressing current, which in 67 % of cases leads to impaired ability to perform professional hand-work a...

  2. PERIPHERAL APPLICATION OF REPETITIVE PULSE MAGNETIC STIMULATION ON JOINT CONTRACTURE FOR MOBILITY RESTORATION: CONTROLLED RANDOMIZED STUDY

    Directory of Open Access Journals (Sweden)

    Efthimios J. Kouloulas

    2016-10-01

    Full Text Available Background: Joint contracture is a limitation in the passive or active range of motion (ROM of a joint, where in addition to the mobility limiting factor the pain is also present. Repetitive pulsed Magnetic Stimulation (rPMS appears to be an effective, non-invasive and safety solution for treating this condition. Therefore aim of this study was to evaluate the effect of rPMS in treating joint contracture. Methods: 30 subjects with joint contracture in the knee were enrolled in this study and divided respectively into Treatment and Control group. The treatment group were delivered with rPMS therapy. The control group was delivered with conventional physiotherapy method (ultrasound. The primary outcome measurements were: 1. Mobility evaluation by goniometry (ROM in degrees while performing flexion and Patient Functional Assessment Questionnaire (PFAQ for ability to perform Activities of Daily Living (ADL and 2. Pain evaluation by 10-point Visual Analog Scale (VAS for pain perception. Absence of adverse events was set as a secondary measure. Results: The results of the study show statistical difference (p<0.05 between the levels of improvement of all studied parameters while comparing between both groups. The results suggest greater immobility restoration and pain relieving effect of the rPMS in comparison to conventional physiotherapy method. Conclusion: rPMS an effective and safe non-invasive method for mobility restoration and pain relief in case of joint contractures. This study suggests the method as beneficial and quality of life ameliorating among patients suffering from immobilized joints accompanied by pain.

  3. Prolonged blockade of the brachial plexus for the early rehabilitation of children with posttraumatic elbow contractures

    Directory of Open Access Journals (Sweden)

    D. V. Zabolotsky

    2015-01-01

    Full Text Available Objective. Improvement of surgical treatment outcomes in children with post-traumatic elbow contractures. Materials and methods. The study is based on the diagnostic findings of 48 children with post-traumatic elbow contractures who were treated at the Turner Scientific and Research Institute for Children’s Orthopedics. All children underwent complex rehabilitation after reconstructive intra-articular surgery to work out passive motions in the elbow using ARTROMOT-E2 device. The patients of the study group started rehabilitation in the first days after reconstructive intra-articular surgery in the background of prolonged blockade of the brachial plexus. In the control group, the rehabilitation was carried out traditionally on the 6th day after surgery without regional anesthesia. The patients of the study group were supplied with Contiplex SU perinural catheters for prolonged blockade of the brachial plexus using ultrasound (Edge SonoSite and neurostimulation (Stimuplex® HNS12 before surgery. For perioperative blockade of the brachial plexus we used intermittent injection of 0.5% ropivacaine (2 mg / kg. The severity of pain at the stages of rehabilitation was assessed using 10-point grading scale (FPS-R. The range of active and passive motions in the joints was evaluated by measuring the range of motions with a fleximeter. Results. Intermittent injection of ropivacaine before rehabilitation allowed to correct post-traumatic elbow contractures in children in the first days after surgery associated with the minimum subjective pain level and stable hemodynamic parameteres, accompanied with a significant increase of the elbow motion range in comparison with the group of the patients who were not performed regional anesthesia . Conclusion. Prolonged blockade of the brachial plexus in rehabilitation treatment of children with post-traumatic contractures provides appropriate analgesic and myoneural block components from the 1st day after intra

  4. Roles of TGF-β/Smad signaling pathway in pathogenesis and development of gluteal muscle contracture.

    Science.gov (United States)

    Zhang, Xintao; Ma, Yukun; You, Tian; Tian, Xiaopeng; Zhang, Honglei; Zhu, Qi; Zhang, Wentao

    2015-02-01

    Gluteal muscle contracture (GMC) is a chronic fibrotic disease of gluteal muscles which is characterized by excessive deposition of collagen in the extracellular matrix. Transforming growth factor (TGF)-βs have been shown to play an important role in the progression of GMC. However, the underlying mechanisms are not entirely clear. We sought to explore the expression of TGF-β/Smad pathway proteins and their downstream targets in gluteal muscle contracture disease. The expression levels of collagens type I/III, TGF-β1, Smad2/3/4/7 and PAI-1 (plasminogen activator inhibitor type 1) in gluteal muscle contraction (GMC) patients were measured using immunohistochemistry, reverse transcription and polymerase chain reaction (RT-PCR) and western blot assays. The expressions of collagens type I/III and TGF-β1 were significantly increased in the contraction band compared with unaffected muscle. In addition, R-Smad phosphorylation and Smad4 protein expression in the contraction band were also elevated, while the expression of Smad7 was significantly decreased in the fibrotic muscle of the GMC patients compared to the unaffected adjacent muscle. The protein and mRNA levels of PAI-1 were also remarkably increased in the contraction band compared with adjacent muscle. Immunohistochemical analysis also demonstrated that the expression levels of TGF-β1 and PAI-1 were higher in contraction band than those in the adjacent muscle. Our data confirm the stimulating effects of the TGF-β/Smad pathway in gluteal muscle contracture disease and reveal the internal changes of TGF-β/Smad pathway proteins and their corresponding targets in gluteal muscle contracture patients.

  5. [EFFECTIVENESS OF DIFFERENT FLAPS FOR REPAIR OF SEVERE PALM SCAR CONTRACTURE DEFORMITY].

    Science.gov (United States)

    Pang, Mengru; Xiao, Haitao; Wang, Huaisheng; Liu, Xiaoxue; Chen, Junjie; Cen, Ying

    2016-03-01

    To evaluate the effectiveness of different flaps for repair of severe palm scar contracture deformity. Between February 2013 and March 2015, thirteen cases of severe palm scar contracture deformity were included in the retrospective review. There were 10 males and 3 females, aged from 14 to 54 years (mean, 39 years). The causes included burn in 9 cases, hot-crush injury in 2 cases, chemical burn in 1 case, and electric burn in 1 case. The disease duration was 6 months to 6 years (mean, 2.3 years). After excising scar, releasing contracture and interrupting adherent muscle and tendon, the soft tissues and skin defects ranged from 6.0 cm x 4.5 cm to 17.0 cm x 7.5 cm. The radial artery retrograde island flap was used in 2 cases, the pedicled abdominal flaps in 4 cases, the thoracodorsal artery perforator flap in 2 cases, the anterolateral thigh flap in 1 case, and the scapular free flap in 4 cases. The size of flap ranged from 6.0 cm x 4.5 cm to 17.0 cm x 7.5 cm. All flaps survived well. Venous thrombosis of the pedicled abdominal flaps occurred in 1 case, which was cured after dressing change, and healing by first intention was obtained in the others. The mean follow-up time was 8 months (range, 6-14 months). Eight cases underwent operation for 1-3 times to make the flap thinner. At last follow-up, the flaps had good color, and the results of appearance and function were satisfactory. Severe palm scar contracture deformity can be effectively repaired by proper application of different flaps.

  6. Non-ablative fractional resurfacing in the treatment of scar contracture.

    Science.gov (United States)

    Finney, Robert; Torbeck, Richard; Saedi, Nazanin

    2016-02-01

    A 28-year-old female presented with extensive scarring after a traumatic injury to her right lower extremity. She had been hit by a vehicle one year prior to presentation and had several open fractures with extensive overlying cutaneous damage, which required multiple surgeries and skin grafts. She had limited range of motion of the affected limb secondary to scar contracture. The patient received 6 treatments with a non-ablative fractional resurfacing (NAFR) device with two wavelengths (Fraxel DUAL, Solta Medical, Hayward, CA) spaced 4-8 weeks apart. The patient received two treatments with the 1927 nm NAFR thulium laser (10 mJ, 30% density, 8 passes) and two treatments with the 1550 nm NAFR laser (40 mJ, 17-26% density, 8 passes). Before and after treatment photographs were taken, as well as range of motion measurements with respect to her right ankle. The patient had 50-75% improvement in the texture and discoloration. There was both subjective and objective improvement in the range of motion of her right lower extremity. The patient experienced mild erythema and edema, both of which resolved after 7-10 days. Recent studies have shown great functional improvement in scar contractures with ablative fractional laser treatments; however, these treatments are accompanied by significant downtime along with risk of further scarring and infection. NAFR is an accessible treatment with a low side effect profile and to our knowledge has not been reported as efficacious in the treatment of scar contracture. This case report is novel in its demonstration of the utility of a dual wavelength NAFR in the treatment of scar contracture and functional impairment. © 2015 Wiley Periodicals, Inc.

  7. Needle aponeurotomy for Dupuytren contracture: Effectiveness of postoperative night extension splinting.

    Science.gov (United States)

    Tam, Louisa; Chung, Yin-Yin

    2016-01-01

    Night extension splinting has been used to treat patients with Dupuytren contracture to improve active range of motion (AROM) of the hand. A published case study demonstrated the benefit of splinting following needle aponeurotomy; however, no larger studies have evaluated the impact of postoperative splinting. To compare the impact of night extension splinting on AROM, specifically extension, following needle aponeurotomy for Dupuytren contracture. A retrospective chart review was conducted in which the charts of 53 patients who underwent needle aponeurotomy for Dupuytren contracture between 2009 and 2013 were reviewed. The control group consisted of patients who underwent needle aponeurotomy only, whereas the treatment group was also referred for fabrication of custom night extension splints after surgery. Comparisons in pre- and postoperative AROM measurements for the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were made between both groups of patients. The degrees of change in AROM for each joint were categorized in terms of levels of change: mild (0° to 29°); moderate (30° to 60°); and significant (≥61°). All patients exhibited increased AROM after surgery for both MCP and PIP joints. Both groups had a greater increase in AROM in the MCP joint. Twelve joints from the control group had moderate changes and two from the treatment group had significant changes. When both groups were compared, the levels of change of AROM between both groups did not vary significantly. Night extension splinting following needle aponeurotomy may not improve AROM of the MCP or PIP joints.

  8. Early-Onset LMNA-Associated Muscular Dystrophy with Later Involvement of Contracture.

    Science.gov (United States)

    Lee, Younggun; Lee, Jung Hwan; Park, Hyung Jun; Choi, Young Chul

    2017-10-01

    The early diagnosis of LMNA-associated muscular dystrophy is important for preventing sudden arrest related to cardiac conduction block. However, diagnosing early-onset Emery-Dreifuss muscular dystrophy (EDMD) with later involvement of contracture and limb-girdle muscular dystrophy type 1B is often delayed due to heterogeneous clinical presentations. We aimed to determine the clinical features that contribute to a delayed diagnosis. We reviewed four patients who were recently diagnosed with LMNA-associated muscular dystrophy by targeted exome sequencing and who were initially diagnosed with nonspecific or other types of muscular dystrophy. Certain clinical features such as delayed contracture involvement and calf hypertrophy were found to contribute to a delayed diagnosis. Muscle biopsies were not informative for the diagnosis in these patients. Genetic testing of single or multiple genes is useful for confirming a diagnosis of LMNA-associated muscular dystrophy. Even EDMD patients could experience the later involvement of contracture, so clinicians should consider early genetic testing for patients with undiagnosed muscular dystrophy or laminopathy.

  9. Reconstruction of Postburn Contracture of the Forefoot Using the Anterolateral Thigh Flap.

    Science.gov (United States)

    Lee, Sang Hyun; An, Sung Jin; Kim, Nu Ri; Kim, Um Ji; Kim, Jeung Il

    2016-12-01

    Severe forefoot deformities, particularly those involving the dorsum of the foot, cause inconvenience in daily activities of living including moderate pain on the dorsal aspect of the contracted foot while walking and difficulty in wearing nonsupportive shoes due to toe contractures. This paper presents clinical results of reconstruction of severe forefoot deformity using the anterolateral thigh (ALT) free flap. Severe forefoot deformities were reconstructed using ALT flaps in 7 patients (8 cases) between March 2012 and December 2015. The mean contracture duration was 28.6 years. All the flaps survived completely. The size of the flaps ranged from 8 cm × 5 cm to 19 cm × 8 cm. The mean follow-up period was 10 months (range, 7 to 15 months). There was no specific complication at both the recipient and donor sites. There was one case where the toe contracture could not be completely treated after surgery. All of the patients were able to wear shoes and walk without pain. Also, the patients were highly satisfied with cosmetic results. The ALT flap may be considered ideal for the treatment of severe forefoot deformity.

  10. Blocking collagen fibril formation in injured knees reduces flexion contracture in a rabbit model.

    Science.gov (United States)

    Steplewski, Andrzej; Fertala, Jolanta; Beredjiklian, Pedro K; Abboud, Joseph A; Wang, Mark L Y; Namdari, Surena; Barlow, Jonathan; Rivlin, Michael; Arnold, William V; Kostas, James; Hou, Cheryl; Fertala, Andrzej

    2017-05-01

    Post-traumatic joint contracture is a frequent orthopaedic complication that limits the movement of injured joints, thereby severely impairing affected patients. Non-surgical and surgical treatments for joint contracture often fail to improve the range of motion. In this study, we tested a hypothesis that limiting the formation of collagen-rich tissue in the capsules of injured joints would reduce the consequences of the fibrotic response and improve joint mobility. We targeted the formation of collagen fibrils, the main component of fibrotic deposits formed within the tissues of injured joints, by employing a relevant rabbit model to test the utility of a custom-engineered antibody. The antibody was delivered directly to the cavities of injured knees in order to block the formation of collagen fibrils produced in response to injury. In comparison to the non-treated control, mechanical tests of the antibody-treated knees demonstrated a significant reduction of flexion contracture. Detailed microscopic and biochemical studies verified that this reduction resulted from the antibody-mediated blocking of the assembly of collagen fibrils. These findings indicate that extracellular processes associated with excessive formation of fibrotic tissue represent a valid target for limiting post-traumatic joint stiffness. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1038-1046, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  11. Using transurethral Ho:YAG-laser resection to treat urethral stricture and bladder neck contracture

    Science.gov (United States)

    Bo, Juanjie; Dai, Shengguo; Huang, Xuyuan; Zhu, Jing; Zhang, Huiguo; Shi, Hongmin

    2005-07-01

    Objective: Ho:YAG laser had been used to treat the common diseases of urinary system such as bladder cancer and benign prostatic hyperplasia in our hospital. This study is to assess the efficacy and safety of transurethral Ho:YAG-laser resection to treat the urethral stricture and bladder neck contracture. Methods: From May 1997 to August 2004, 26 cases of urethral stricture and 33 cases of bladder neck contracture were treated by transurethral Ho:YAG-laser resection. These patients were followed up at regular intervals after operation. The uroflow rate of these patients was detected before and one-month after operation. The blood loss and the energy consumption of holmium-laser during the operation as well as the complications and curative effect after operation were observed. Results: The therapeutic effects were considered successful, with less bleeding and no severe complications. The Qmax of one month postoperation increased obviously than that of preoperation. Of the 59 cases, restenosis appeared in 11 cases (19%) with the symptoms of dysuria and weak urinary stream in 3-24 months respectively. Conclusions: The Ho:YAG-laser demonstrated good effect to treat the obstructive diseases of lower urinary tract such as urethral stricture and bladder neck contracture. It was safe, minimal invasive and easy to operate.

  12. Occurrence and severity of upper eyelid skin contracture in facial nerve palsy.

    Science.gov (United States)

    Ziahosseini, K; Venables, V; Neville, C; Nduka, C; Patel, B; Malhotra, R

    2016-05-01

    PurposeTo describe the occurrence and severity of upper eyelid skin contracture in facial nerve palsy (FNP).MethodsWe enroled consecutive patients with unilateral FNP into this study. Patients with previous upper eyelid surgery for either side were excluded. We developed a standardised technique to measure the distance between the upper eyelid margin and the lower border of brow (LMBD). FNP was graded using the Sunnybrook grading scale. Its aetiology, duration, and treatment were noted. Upper and lower marginal reflex distance and lagophthalmos were also noted.ResultsSixty-six patients (mean age 51 years) were included. FNP was owing to a variety of aetiologies. LMBD on the paralytic side was shorter than the normal contralateral side in 47 (71%), equal in 15 (23%), and larger in four (6%) patients. The mean contracture was 3.4 mm (median: 3, range: 1-12) with 11 (17%) patients showing 5 mm or more of skin contracture. The mean LMBD on the paralytic side in all patients was significantly smaller than the contralateral side; 30±3.7 (median: 30; 95% CI 29-31) compared with 32±3.7 (median: 32; 95% CI 32-33), respectively, Pcontracture and to caution surgeons against unnecessary upper eyelid skin excision.

  13. Percutaneous quadriceps tendon pie-crusting release of extension contracture of the knee.

    Science.gov (United States)

    Liu, H X; Wen, H; Hu, Y Z; Yu, H C; Pan, X Y

    2014-05-01

    To release extension contracture of the knee, the authors used a minimally invasive technique: percutaneous quadriceps tendon pie-crusting release. Percutaneous pie-crusting release was performed using an 18-gauge needle to puncture the stiff fibrous band of the distal and lateral quadriceps tendon under maximum knee flexion. Quadriceps contracture was gradually released by multiple needle punctures. A knee brace was prescribed for one week and knee flexion exercises were performed on the first postoperative day. This technique was performed in seven post-traumatic stiff knees and five stiff total knee arthroplasties. Mean maximum flexion increased from 37° preoperatively to 50° after arthrolysis and 107(o) after pie-crusting. At a mean follow-up of eight months, mean maximum flexion was 103°. There were no major complications. The technique of quadriceps tendon pie-crusting release is a simple, minimally invasive and effective treatment for knee extension contracture. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  14. [EFFECTIVENESS OF DEEP INFERIOR EPIGASTRIC ARTERY PERFORATOR FLAP FOR REPAIR OF PERINEAL AND PERIANAL CICATRICIAL CONTRACTURE].

    Science.gov (United States)

    Du, Liping; You, Xiaobo; Tang, Kuangyun; Fu, Rong

    2015-08-01

    To discuss the effectiveness of deep inferior epigastric artery perforator flap to repair perineal and perianal cicatricial contracture. Between March 2007 and December 2013, 23 patients with perineal and perianal cicatricial contracture were treated with deep inferior epigastric artery perforator flap. There were 15 males and 8 females, aged from 21 to 62 years (mean, 42 years). Burn depth was III degree. The burning scars involved in the fascia, even deeper, which was rated as peripheral type (mild stenosis of the anal region and perianal cicatricial contracture) in 13 cases and as central type (severe stenosis of the anal region and anal canal with shift or defect of external genitalia) in 10 cases. All patients had limited hip abduction and squatting. Repair operation was performed at 3 months to 2 years (mean, 6 months) after wound healing. The size of soft tissue defects ranged from 10 cmx6 cm to 28 cm x 13 cm after scar excision and release. The size of flaps ranged from 12 cmx7 cm to 30 cmx15 cm. The donor site was sutured directly in 16 cases and repaired by autograft of skin in 7 cases. The flap had distal necrosis, distal cyanosis, and spotted necrosis in 1 case, 2 cases, and 1 case respectively, which were cured after symptomatic treatment; the other flaps survived and wound healed primarily. Twenty-one patients were followed up 6 months to 2 years (mean, 1 year). Nineteen patients had good appearance of the perinea and position of external genitalia, normal function of defecation function; stenosis of the anal region was relived, and the flaps had good texture and elasticity. Linear scar contracture was observed at the edge of flap in 2 cases, and the appearance of the perineum was restored after Z plasty. The hip abduction reached 30-40°. No abdominal hernia was found at donor site. Deep inferior epigastric artery perforator flap has stable blood supply and flexible design, which is similar to the perianal and perineal tissues. The good effectiveness

  15. Predictors for success of internal urethrotomy in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries.

    Science.gov (United States)

    Hong, Young-Kwon; Choi, Kyung-Hwa; Lee, Young-Tae; Lee, Seung-Ryeol

    2017-05-01

    Internal urethrotomy (IU) in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries (PRPFUI) is troublesome. We evaluated the clinical factors affecting the surgical outcome of IU for urethral contracture after PRPFUI. We retrospectively reviewed the records of 35 patients who underwent IU for urethral contracture after PRPFUI between March 2004 and June 2013. Ages of patients ranged from 18 to 50, and their follow-up duration was more than 1year after IU. The urethral contracture was confirmed by retrograde urethrogram or cysto-urethroscopy. Success was defined as greater than 15mL/s of peak urinary flow rate at 1year after IU without any clinical evidence of urethral contracture. Success rates were investigated according to the number of IU. Age, body mass index, urethral defect length before PRPFUI, time interval between the original urethral injury and the PRPFUI or between a previous operation and the PRPFUI, time interval between the PRPFUI and the urethral contracture, number of PRPFUI performed, and the type of urethral lengthening procedure were compared between patients with and without success according to the number of IU. Among the 35 patients, the overall success rate of IU was 37% (13/35) during the mean follow-up period of 53 months (range: 17-148 months). There were 8 and 5 patients with success in first and second IU, respectively. However, there was no success after third IU. Urethral defect length before PRPFUI was significantly shorter in patients with success who underwent first and second IU (psuccess between patients with and without previous repeated failures of PRPFUI in first and second IU (p<0.05). Short urethral defect length and no previous surgical failures before PRPFUI are good prognostic factors for IU following PRPFUI. Only one or two IUs will be helpful in patients with urethral contracture following PRPFUI. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Serial casting versus stretching technique to treat knee flexion contracture in children with spina bifida: a comparative study.

    Science.gov (United States)

    Al-Oraibi, S; Tariah, Hashem Abu; Alanazi, Abdullah

    2013-01-01

    Severe knee contractures that develop soon after muscle imbalance may not improve with stretching exercises and splinting. An alternative treatment is serial casting, which has been used to promote increased range of motion. The purpose of this study was to compare the effectiveness of using serial casting and passive stretching approaches to treat knee flexion contracture in children with spina bifida. In a pre/post randomized controlled study, ten participants were included in the serial casting group, while eight participants were included in the passive stretching intervention group. The degree of knee extension was measured at baseline, immediately after intervention, and at a one-year follow-up using a standard goniometer. Both groups showed significant improvements in the degree of flexion contracture at the post-treatment evaluation and the follow-up evaluation. The serial casting group showed significant improvements in knee flexion contracture at the post-treatment evaluation, t (9)=13.4, p contracture at the post-treatment evaluation, t (7) =2.6, p contracture were found at the immediate post-treatment evaluation, F(1, 15)=246, p=0.0001, and the one-year follow-up evaluation, F (1, 15)=51.5, p=0.0001. The outcomes of this study provide the first evidence that serial casting may be a useful intervention in treating knee flexion contracture in children with spina bifida. However, further investigations into serial casting, as well as investigations into the use of serial casting with other interventions, are warranted.

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

    Science.gov (United States)

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

    2014-09-01

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

  18. Molecular landscape of arthrofibrosis: Microarray and bioinformatic analysis of the temporal expression of 380 genes during contracture genesis.

    Science.gov (United States)

    Morrey, Mark E; Abdel, Matthew P; Riester, Scott M; Dudakovic, Amel; van Wijnen, Andre J; Morrey, Bernard F; Sanchez-Sotelo, Joaquin

    2017-04-30

    Inflammatory changes are suspected in the pathophysiology of arthrofibrosis formation and require early molecular examination. Here, we assessed the hypothesis that early inflammatory genes are related to arthrofibrosis by ascertaining gene expression during the early stages of contracture genesis in an animal model. Joint trauma was incited surgically in a cohort of rabbits (n=36) knees followed by immobilization in a model of contracture. Six groups of 6 rabbits were sacrificed at multiple time points (0, 6, 12, 24, 72h and 2weeks). Microarray expression and RT-qPCR profiling were performed to determine genes that are significantly up or downregulated. Bioinformatic analysis was carried out to understand which biological programs and functional groups of genes are modulated in arthrofibrosis. Gene expression profiling revealed a large number biologically relevant genes (>100) that are either upregulated or downregulated by at least a 1.5 fold (log2) during the first two weeks after joint injury during contracture development. Gene ontology analysis identified molecular pathways and programs that act during the course of fibrosis and joint contracture. Our main finding is that the development of contractures occur concomitant with modulation of genes mediating inflammatory responses, ECM remodeling and the epithelial-to-mesenchymal transition. The genesis of joint contracture reflects an imbalance between pro- and anti-fibrotic expression. Our study indicates that inflammatory genes may be involved in the process of contracture genesis and initiated at relatively early stages. Our findings also may inform clinical practice in the future by suggesting potential therapeutic targets in preventing the long-term development of arthrofibrosis. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Restaurant Food Cooling Practices†

    Science.gov (United States)

    BROWN, LAURA GREEN; RIPLEY, DANNY; BLADE, HENRY; REIMANN, DAVE; EVERSTINE, KAREN; NICHOLAS, DAVE; EGAN, JESSICA; KOKTAVY, NICOLE; QUILLIAM, DANIELA N.

    2017-01-01

    Improper food cooling practices are a significant cause of foodborne illness, yet little is known about restaurant food cooling practices. This study was conducted to examine food cooling practices in restaurants. Specifically, the study assesses the frequency with which restaurants meet U.S. Food and Drug Administration (FDA) recommendations aimed at reducing pathogen proliferation during food cooling. Members of the Centers for Disease Control and Prevention’s Environmental Health Specialists Network collected data on food cooling practices in 420 restaurants. The data collected indicate that many restaurants are not meeting FDA recommendations concerning cooling. Although most restaurant kitchen managers report that they have formal cooling processes (86%) and provide training to food workers on proper cooling (91%), many managers said that they do not have tested and verified cooling processes (39%), do not monitor time or temperature during cooling processes (41%), or do not calibrate thermometers used for monitoring temperatures (15%). Indeed, 86% of managers reported cooling processes that did not incorporate all FDA-recommended components. Additionally, restaurants do not always follow recommendations concerning specific cooling methods, such as refrigerating cooling food at shallow depths, ventilating cooling food, providing open-air space around the tops and sides of cooling food containers, and refraining from stacking cooling food containers on top of each other. Data from this study could be used by food safety programs and the restaurant industry to target training and intervention efforts concerning cooling practices. These efforts should focus on the most frequent poor cooling practices, as identified by this study. PMID:23212014

  20. Adiabatic Cooling of Antiprotons

    CERN Document Server

    Gabrielse, G; McConnell, R; Richerme, P; Kalra, R; Novitski, E; Grzonka, D; Oelert, W; Sefzick, T; Zielinski, M; Fitzakerley, D; George, M C; Hessels, E A; Storry, C H; Weel, M; Mullers, A; Walz, J

    2011-01-01

    Adiabatic cooling is shown to be a simple and effective method to cool many charged particles in a trap to very low temperatures. Up to 3 x 10(6) (p) over bar are cooled to 3.5 K-10(3) times more cold (p) over bar and a 3 times lower (p) over bar temperature than previously reported. A second cooling method cools (p) over bar plasmas via the synchrotron radiation of embedded (p) over bar (with many fewer (p) over bar than (p) over bar) in preparation for adiabatic cooling. No (p) over bar are lost during either process-a significant advantage for rare particles.

  1. Proposition of a protocol to evaluate upper-extremity functional deficits and compensation mechanisms: application to elbow contracture.

    Science.gov (United States)

    Fradet, Laetitia; Liefhold, Beate; Rettig, Oliver; Bruckner, Thomas; Akbar, Michael; Wolf, Sebastian I

    2015-03-01

    Instrumented gait analysis is widely accepted as an objective assessment of lower-extremity function. Conversely, upper-extremity function suffers from lack of objective evaluation. The present paper aims at proposing a protocol to be used to clinically and objectively evaluate upper-extremity function whatever the pathological joint. Secondly, it aims at better understanding the consequences on upper-extremity function and the compensation mechanisms induced by elbow contracture. Elbow contracture was simulated in this study by using a brace. Twelve healthy subjects followed an instrumented 3D movement analysis while performing 11 daily life movements. The movements were performed with 3 different elbow contracture conditions, simulated by wearing an adjustable elbow brace. The proposed protocol was successful in creating a wide range of motion at all the upper-extremity joints. The activity-related range of motion and the mean range of motion computed on the whole set of daily life movements were effective in evaluating the severity of elbow contracture. The lack of elbow flexion was compensated by trunk flexion, hand flexion and radial deviation, and combined movement of shoulder flexion, abduction, and humeral internal rotation. Deficit in elbow extension was mainly compensated by the use of trunk flexion. A protocol could be proposed for the objective evaluation of upper-extremity function. Its application to elbow contracture suggests that loss of elbow flexion affects more movements than loss of elbow extension.

  2. Collagenase clostridium histolyticum for dupuytren contracture: patterns of use and effectiveness in clinical practice.

    Science.gov (United States)

    Peimer, Clayton A; Skodny, Paul; Mackowiak, John I

    2013-12-01

    To collect data on the real-world effectiveness of collagenase clostridium histolyticum (CCH) during its first year of use following U.S. Food and Drug Administration approval and compare those results with clinical trial efficacy data. This retrospective chart review was conducted at 10 U.S. community and academic practice sites with major experience using CCH. Charts of patients treated with CCH between February and December 2010 were abstracted, and anonymized data were analyzed. Clinical use, including number of injections per cord and effectiveness outcomes (joint contracture and range of motion) were compared with results from 2 registration trials. Data were collected from 501 patients (74% male; 48% employed; mean [SD] age, 65 [10] y); 463 patients had sufficient data for analysis. We found that 1.08 CCH injections were used per treated joint, compared with a mean of 1.7 injections in registration trials. Ninety-three percent of joints received only 1 injection. The mean (SD) number of visits per injection was 2.92 (1.0). Mean (SD) contracture was reduced by 75% from 49° (21) at baseline to 12° (17), similar to the 71% to 79% reduction in clinical trials. Mean (SD) range of motion was improved by 37° from 44° (20) at baseline to 81° (14), similar to the increase of 35° and 37° in the 2 clinical trials; and 67% of first injections resulted in full correction to 0° to 5°, compared with the clinical trial rate of 39%. Despite a lower injection rate, correction of joint contracture and range of motion was similar to findings from clinical trials. Effectiveness reports using this kind of surveillance design could provide patients, physicians, and payers with the information needed to make better treatment and reimbursement decisions. Therapeutic III. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Region-oriented and staged treatment strategy in reconstruction of severe cervical contracture.

    Science.gov (United States)

    Luo, Xusong; Liu, Fei; Wang, Xi; Yang, Qun; Wang, Shoubao; Zhou, Xianyu; Qian, Yunliang; Yang, Jun; Levin, Lawrence Scott

    2015-01-01

    Severe cervical contracture after burns causes obvious impairment of neck movement and the aesthetic silhouette. Although various surgical techniques for treatment have been described, there is not a definitive strategy to guide treatment. Over the past 6 years, we have been utilizing a region-oriented and staged treatment strategy to guide reconstruction of severe cervical contracture. Satisfactory results have been achieved with this strategy. The first stage of treatment focuses on the anterior cervical region and submental region. Procedures include cicatrix resection, contracture release, division and elevation of the platysma to form two platysma flaps, and skin grafting. Three to six months later, the second stage treatment is performed, which localize to the mental region. This includes scar resection, correction of the lower lip eversion, and reconstruction with free (para)scapular skin flap. Three subtypes of cervicomental angle that we proposed were measured as quantitative tool for evaluation of the reconstruction. 24 patients who completed the treatment were reviewed. By the 3rd postoperative month, their CM angles changed significantly: the soft tissue CM angle was reduced from 135.0° ± 17.3° to 111.1° ± 11.3°, the osseous CM angle increased from 67.1° ± 9.0° to 90.5° ± 11.6° and the dynamic CM angle increased from 21.9° ± 8.7° to 67.4° ± 13.1°. 22 in 24 (91.7%) of these patients gained notable improvement of cervical motion and aesthetic contour. Our results suggest that the region-oriented and staged treatment strategy can achieve satisfactory functional and aesthetic results, combining usage of both skin graft and skin flap while minimizing the donor site morbidity.

  4. Palmar contracture release with arterialized venous instep flap: An anatomical and clinical study.

    Science.gov (United States)

    Zor, Fatih; Yalçın, Bülent; Tekin, Levent; Eski, Muhitdin; Işık, Selcuk; Şengezer, Mustafa

    2015-07-01

    Plantar skin has similar histologic features to the palmar area and appears to be the ideal tissue for reconstruction of the palmar region. In this study, an anatomic examination was performed to determine the superficial venous architecture of the instep area, and the use of arterialized venous instep flaps for palmar contracture release was assessed. The anatomical study was performed on 12 fresh cadaver feet. The arterialized venous instep flap, including the skin, subcutaneous tissue and superficial venous plexus, was harvested. To determine the venous structure, dissection (n = 6) and injection-corrosion (n = 6) techniques were used. In the clinical study, nine arterialized venous instep flaps were used for palmar contracture release. All flaps were harvested above the deep fascia and included skin, subcutaneous fat, and the superficial venous plexus. At the plantar site of the flap, two or three veins, one of which was used, were dissected for a sufficient length for the arterial anastomosis. The saphenous vein was used for the venous anastomosis. Dissection and injection-corrosion techniques revealed that the flap had 7-12 and 4-6 veins at its plantar and superior edges, respectively, with numerous anastomoses and interconnections between the veins. The flap dimensions were between 3 × 5 cm and 4 × 6 cm. All flaps survived, with two partial flap necrosis that healed with spontaneous epithelization. No debulking procedures were undertaken and all flaps adapted well to the recipient site. The arterialized venous instep flap is a good alternative to reconstruct palmar contractures by adding similar tissue that is thin and pliable with minimal donor site morbidity. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Post Prostatectomy Vesicourethral Stenosis or Bladder Neck Contracture with Concomitant Urinary Incontinence: Our Experience and Recommendations.

    Science.gov (United States)

    Bang, Shieh L; Yallappa, Sachin; Dalal, Fatima; Almallah, Yahia Z

    2017-04-01

    To present our experience in the management of bladder neck contracture with concomitant post prostatectomy incontinence and to provide our recommendations based on the updated literature. Between Jan 2010 and June 2015, 37 patients from our cohort of 341 patients with post prostatectomy incontinence were evaluated. Patient data were retrospectively collected. Patients with bladder neck contracture confirmed on flexible cystoscopy underwent subsequent rigid cystoscopy and deep endoscopic bladder neck incision (BNI). A follow up flexible cystoscopy would be performed 3 months later. If there was no recurrence of the bladder neck contracture, an artificial urethral sphincter (AUS) or a male sling was recommended. The mean age of patients was 68 years (range 59-77) and the mean BMI was 31 (range 21-41) kg/m(2). Twenty-five (67.7%) patients had open prostatectomy and 12 (32.4%) patients had laparoscopic prostatectomy. Fourteen patients (37.8%) underwent adjuvant radiotherapy. Twenty-four (64.8%) patients had one BNI procedure, 8 (21.6%) patients had two procedures and 5 (13.5%) patients had more than 2 procedures. Twenty-one (91.3%) patients had AUS implantation and 2 (8.7%) patients had male sling placement. Besides, 85.7% of AUS and 50% of male sling patients managed to achieve successful outcomes with a mean follow up period of 13.1 months (range 2-33 months). Initial management with aggressive BNI followed by implantation of an AUS or male sling when bladder neck is stable is essential to achieve a satisfactory urinary continence outcome.

  6. Thoracic Outlet Syndrome and Volkmann's Contracture in a Field Hockey Player

    Directory of Open Access Journals (Sweden)

    Morgan Sawyer

    2016-05-01

    Full Text Available Background: A 19-year-old female field hockey player presents with bilateral upper trapezius and rhomboid tightness and spasm beginning in January of 2016. She has no previous history of upper back pain or injury. The student first reported the injury immediately after running sprints. She stated that she could not move or feel her fingers or hands. She presents with a visible hump on her left upper trapezius. She also has forward-rounded shoulders. She has regular and equal radial pulses. She has decreased sensation upon palpation of her fingers, hands and forearms. After extraneous exercise, the athlete’s hands, wrists and forearms go into contracture and flexion and she is unable to move from this position until manual extension is applied, or 10 or more minutes of rest occurs. She is TTP over her upper trapezius musculature. She had a positive Military Brace test. Differential Diagnosis: Based on evaluation, the athlete could simply just have upper trapezius musculature spasms. The diagnosis could also be shoulder impingement syndrome, due to the neurological signs and symptoms. Compartment syndrome could produce similar s/s that the athlete experiences, as well. Treatment: X-rays show no bony abnormalities and no extra ribs. The athlete’s injury has been treated with ice post-practice, heat pre-practice and upper body stretching exercises. Three days a week the athlete works on postural exercises that strengthen her back musculature. The athlete also receives combination therapy over her upper trapezius trigger points, along with massage and Hawkgrip technique over the same areas. Uniqueness: The uniqueness in this case is that the athlete has both TOS and Volkmann’s contracture. Volkmann’s contractures typically occur in pediatrics, which is another reason why this particular case is unique. Conclusion: This case allows other clinicians to understand the causes of TOS and the secondary s/s that TOS can potentially cause.

  7. New flap for widening of the web space and correction of palmar contracture in complex clasped thumb.

    Science.gov (United States)

    Mahmoud, Mostafa; Abdel-Ghani, Hisham; Elfar, John C

    2013-11-01

    In our experience, previous flaps designed for correction of the skin deficiency in complex clasped thumb do not sufficiently address the palmar contracture of the deformity. Moreover, the index finger flap, previously described by Ezaki and Oishi, provides insufficient skin at its apex with the possibility of incomplete correction and the frequent need of a thenar release incision. This article describes a flap designed for widening of the narrow thumb-index web space and release of the palmar thumb contracture in cases of congenital clasped thumb. This flap provides sufficient correction of the palmar contracture and at the same time provides adequate width and depth of the thumb-index web space. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  8. A new flap design for release of parallel contracture bands: dual opposing five-flap z-plasty.

    Science.gov (United States)

    Ersoy, Burak

    2014-12-01

    Skin contractures secondary to burn and other types of trauma can be encountered on almost every part of human body, best addressed by a custom treatment protocol tailored for each patient. Skin graft, local flap as well as distant flap options are available, each with intrinsic advantages and disadvantages. In the presence of weblike contracture the utilization of local tissue, when available, is a prefered approach for a relatively better appearance through a reasonably simpler surgical intervention, compared to skin graft applications and distant flap options. Among many other techniques and modalities utilized for this purpose, the dual opposing five-flap z-plasty method which is a novel method designed as a modification of the paired five-flap z-plasty technique promises to be a useful treatment option for the release of parallel contracture bands with satisfactory results in selected patients. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  9. Cook & Chill - Rapid Chilling of Food 'in situ'

    DEFF Research Database (Denmark)

    Paul, Joachim

    2003-01-01

    Rapid cooling of products is of increasing importance for food preservation and for industrial processes. Slurry ice (Binary Ice) is a two-phase cooling fluid consisting of suspended ice crystals in an aqueous solution or mixture. Latent energy contained in the fluid yields rapid cooling which...

  10. Clinical effectiveness of post-operative splinting after surgical release of Dupuytren's contracture: a systematic review

    Directory of Open Access Journals (Sweden)

    Jerosch-Herold Christina

    2008-07-01

    Full Text Available Abstract Background Splinting after contracture release for Dupuytren's disease of the hand is widely advocated. The purpose of this systematic review was to evaluate the quantity and quality of evidence regarding the effectiveness of splinting in the post-surgical management of Dupuytren's contractures. Methods Studies were identified by searching the electronic databases Medline, AMED, CINAHL and EMBASE. Studies were included if they met the following inclusion criteria: prospective or retrospective, experimental, quasi-experimental or observational studies investigating the effectiveness of static or dynamic splints worn day and/or night-time for at least 6 weeks after surgery and reporting either individual joint or composite finger range of motion and/or hand function. The methodological quality of the selected articles was independently assessed by the two authors using the guidelines for evaluating the quality of intervention studies developed by McDermid. Results Four studies, with sample sizes ranging from 23 to 268, met the inclusion criteria for the systematic review. Designs included retrospective case review, prospective observational and one controlled trial without randomisation. Interventions included dynamic and static splinting with a mean follow-up ranging from 9 weeks to 2 years. Pooling of results was not possible due to the heterogeneity of interventions (splint type, duration and wearing regimen and the way outcomes were reported. Conclusion There is empirical evidence to support the use of low load prolonged stretch through splinting after hand surgery and trauma, however only a few studies have investigated this specifically in Dupuytren's contracture. The low level evidence regarding the effect of post-operative static and dynamic splints on final extension deficit in severe PIP joint contracture (>40° is equivocal, as is the effect of patient adherence on outcome. Whilst total active extension deficit improved in some

  11. Clinical effectiveness of post-operative splinting after surgical release of Dupuytren's contracture: a systematic review.

    Science.gov (United States)

    Larson, Debbie; Jerosch-Herold, Christina

    2008-07-21

    Splinting after contracture release for Dupuytren's disease of the hand is widely advocated. The purpose of this systematic review was to evaluate the quantity and quality of evidence regarding the effectiveness of splinting in the post-surgical management of Dupuytren's contractures. Studies were identified by searching the electronic databases Medline, AMED, CINAHL and EMBASE. Studies were included if they met the following inclusion criteria: prospective or retrospective, experimental, quasi-experimental or observational studies investigating the effectiveness of static or dynamic splints worn day and/or night-time for at least 6 weeks after surgery and reporting either individual joint or composite finger range of motion and/or hand function. The methodological quality of the selected articles was independently assessed by the two authors using the guidelines for evaluating the quality of intervention studies developed by McDermid. Four studies, with sample sizes ranging from 23 to 268, met the inclusion criteria for the systematic review. Designs included retrospective case review, prospective observational and one controlled trial without randomisation. Interventions included dynamic and static splinting with a mean follow-up ranging from 9 weeks to 2 years. Pooling of results was not possible due to the heterogeneity of interventions (splint type, duration and wearing regimen) and the way outcomes were reported. There is empirical evidence to support the use of low load prolonged stretch through splinting after hand surgery and trauma, however only a few studies have investigated this specifically in Dupuytren's contracture. The low level evidence regarding the effect of post-operative static and dynamic splints on final extension deficit in severe PIP joint contracture (>40 degrees ) is equivocal, as is the effect of patient adherence on outcome. Whilst total active extension deficit improved in some patients wearing a splint there were also deficits in

  12. Efficacy and safety of concurrent collagenase clostridium histolyticum injections for multiple Dupuytren contractures.

    Science.gov (United States)

    Coleman, Stephen; Gilpin, David; Kaplan, F Thomas D; Houston, Anthony; Kaufman, Gregory J; Cohen, Brian M; Jones, Nigel; Tursi, James P

    2014-01-01

    To assess the safety and efficacy of 2 concurrent injections of collagenase clostridium histolyticum (CCH) in the same hand to treat multiple Dupuytren flexion contractures. In a multicenter, open-label phase IIIb study, 60 patients received two 0.58-mg CCH doses injected into cords affecting 2 joints in the same hand during 1 visit, followed by finger extension approximately 24 hours later. Efficacy at postinjection day 30 (change in flexion contracture and active range of motion, patient satisfaction, physician-rated improvement, and rates of clinical success [flexion contracture 5° or less]) and adverse events were summarized. The concurrent injections were most commonly administered in cords affecting metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints on the same finger (47%) or 2 MCP joints on different fingers of the same hand (37%). Mean total (sum of the 2 treated joints) flexion contracture decreased 76%, from 87° to 24° (MCP joints: 86%; PIP joints: 66%). Mean total range of motion increased from 100° to 161°. Clinical success was 76% for MCP joints and 33% for PIP joints. Most patients were very satisfied (60%) or quite satisfied (28%) with treatment. Most investigators rated treated joints as very much improved (55%) or much improved (37%). The most common treatment-related adverse events (> 75% of patients) were contusion, pain in extremity, and edema peripheral (local edema). Most adverse events were mild to moderate in severity. Serious complications included 1 pulley rupture related to study medication and 1 flexor tendon rupture (following conclusion of the study). There were no systemic complications. Results suggest that 2 affected joints can be effectively and safely treated with concurrent CCH injections. There was an increased incidence of some adverse events with concurrent treatment (pruritus, lymphadenopathy, blood blister, and skin laceration) compared with treatment of a single joint. High degrees of patient

  13. Spastic paretic hemifacial contracture as a presenting feature of multiple sclerosis.

    Science.gov (United States)

    Koutsis, Georgios; Breza, Marianthi; Evangelopoulos, Maria-Eleftheria; Anagnostouli, Maria; Andreadou, Elisavet; Karagiorgis, Georgios; Kokotis, Panagiotis; Kilidireas, Costas; Karandreas, Nikolaos

    2017-04-01

    Spastic paretic hemifacial contracture (SPHC) is characterized by sustained unilateral contraction of the facial muscles associated with mild ipsilateral facial paresis. Rarely described in the context of multiple sclerosis (MS), it has never been reported as presenting symptom of MS. Two patients developed SPHC within the context of a clinically isolated syndrome suggestive of MS. EMG revealed continuous resting activity of irregularly firing motor unit potentials, associated with impaired recruitment upon voluntary contraction. SPHC remitted fully in both patients. SPHC, a rare but distinct clinical and EMG entity, can occasionally be the presenting feature of MS. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Surgical Correction of Rigid Equinovarus Contracture Utilizing Extensive Soft Tissue Release.

    Science.gov (United States)

    Reeves, Christopher L; Shane, Amber M; Zappasodi, Francesca; Payne, Trevor

    2016-01-01

    Although deforming contractures of the lower extremities after acute cerebrovascular events are well documented in the literature, there is limited literature regarding specific surgical considerations for the correction of these deformities, which are nonosseus in nature. The equinovarus foot, regardless of its origin, is a challenging pathologic condition for the foot and ankle surgeon. It is critical to have a firm understanding of the cause and symptoms behind an equinovarus deformity before treatment. The clinical presentation is discussed with special attention to deformities in adults with rigid equinovarus deformities after cerebrovascular-related accidents or peripheral ischemic events. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Vicious Cycle of Multiple Invasive Treatments in a Hemophilic Inhibitor Positive Child with Resistant Knee Flexion Contracture, A Case Report

    Directory of Open Access Journals (Sweden)

    Amir Reza Kachooei

    2013-12-01

    Full Text Available Uncontrolled recurrent hemarthrosis can end to contracture, deformity, pain, joint destruction and gait disorders which are disabling. We are going to report a challenge, a unilateral knee flexion contracture in a child with severe hemophilia A and inhibitor who underwent different treatment options with unsatisfactory improvement of knee range of motion. Mismanaging postoperatively, patient and parents irresponsibility in managing self-care, lack of access and affordability to treatment and unavailability of proper treatment can be the reasons of recurrence in addition to the tough nature of a patient with inhibitor.

  16. Cooling water distribution system

    Science.gov (United States)

    Orr, Richard

    1994-01-01

    A passive containment cooling system for a nuclear reactor containment vessel. Disclosed is a cooling water distribution system for introducing cooling water by gravity uniformly over the outer surface of a steel containment vessel using an interconnected series of radial guide elements, a plurality of circumferential collector elements and collector boxes to collect and feed the cooling water into distribution channels extending along the curved surface of the steel containment vessel. The cooling water is uniformly distributed over the curved surface by a plurality of weirs in the distribution channels.

  17. Validity of gait parameters for hip flexor contracture in patients with cerebral palsy

    Directory of Open Access Journals (Sweden)

    Lee Sang Hyeong

    2011-01-01

    Full Text Available Abstract Background Psoas contracture is known to cause abnormal hip motion in patients with cerebral palsy. The authors investigated the clinical relevance of hip kinematic and kinetic parameters, and 3D modeled psoas length in terms of discriminant validty, convergent validity, and responsiveness. Methods Twenty-four patients with cerebral palsy (mean age 6.9 years and 28 normal children (mean age 7.6 years were included. Kinematic and kinetic data were obtained by three dimensional gait analysis, and psoas lengths were determined using a musculoskeletal modeling technique. Validity of the hip parameters were evaluated. Results In discriminant validity, maximum psoas length (effect size r = 0.740, maximum pelvic tilt (0.710, maximum hip flexion in late swing (0.728, maximum hip extension in stance (0.743, and hip flexor index (0.792 showed favorable discriminant ability between the normal controls and the patients. In convergent validity, maximum psoas length was not significantly correlated with maximum hip extension in stance in control group whereas it was correlated with maximum hip extension in stance (r = -0.933, p Conclusions Maximum pelvic tilt, maximum psoas length, hip flexor index, and maximum hip extension in stance were found to be clinically relevant parameters in evaluating hip flexor contracture.

  18. [Razemon's lateral digital rotation flap in severe Dupuytren contracture of the fifth finger].

    Science.gov (United States)

    Ould-Slimane, M; Guinet, V; Foulongne, E; Melconian, A; Beccari, R; Milliez, P-Y; Auquit-Auckbur, I

    2013-10-01

    In Dupuytren's disease, correction of severe contracture deformities and excision of dermal lesions are often responsible for palmar skin defects. This study aimed to assess the results of the lateral digital flap described by Razemon. Thirty-seven patients were analysed retrospectively for functional and trophic results. Twelve months of follow-up were at least required. The lack of extension was appreciated through Thomine's coefficient. Subjective patient's opinion was noted about function of fifth finger and hand. The flap trophicity was evaluated through softness, coverage quality and esthetic aspect. In the preoperative period, the average lack of extension was 105°; 89% of the patients were ranked as stages 3 or 4 of Tubiana's classification. At the 12th month, the average Thomine's coefficient was 0.74; 70% of the patients were very satisfied. Two patients exhibited some lack of suppleness and seven a dyschromic scars. The lateral digital rotation flap is a quite simple surgical procedure. It allows satisfactory results corresponding to functional and trophic coverage in severe Dupuytren's contracture involving the fifth finger. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  19. Night Orthosis After Surgical Correction of Dupuytren Contractures: A Systematic Review.

    Science.gov (United States)

    Samargandi, Osama A; Alyouha, Sarah; Larouche, Patricia; Corkum, Joseph P; Kemler, Marius A; Tang, David T

    2017-10-01

    To determine the role of night orthosis use after surgical correction of Dupuytren contracture. We searched MEDLINE, EMBASE, CINAHL, AMED, OTSeeker, and CENTRAL for articles published from inception of the databases to August 2015. Assessment was undertaken by 2 independent reviewers (O.A.S. and S.A.). Methodological quality of randomized controlled trials was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa instrument. Seven studies met the standard for inclusion in this review. A total of 659 patients across these 7 studies were included in the analysis, with follow-up ranging from 3 to 72 months. None of the included studies assessed recurrence. The analysis revealed no significant improvement in range of motion of hand joints for patients who received a static night orthosis after Dupuytren surgery compared with patients without an orthosis. Similarly, no differences were found in patient-reported functional status across the 2 groups. The current literature does not appear to support the use of static night orthosis in addition to hand therapy after surgical correction of Dupuytren contracture. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  20. Restoring range of motion via stress relaxation and static progressive stretch in posttraumatic elbow contractures.

    Science.gov (United States)

    Ulrich, Slif D; Bonutti, Peter M; Seyler, Thorsten M; Marker, David R; Morrey, Bernard F; Mont, Michael A

    2010-03-01

    Loss of range of motion after injury or surgery of the elbow is a common complication. We hypothesized that an orthosis that used progressive stretch and stress relaxation principles would improve elbow range of motion. This study evaluated the result of a patient-directed, bidirectional orthosis that uses static progressive stretch and stress relaxation principles to improve elbow range of motion in patients who had posttraumatic elbow contractures. Treatment in 37 elbows consisted of a 30-minute stretching protocol performed in 1 to 3 sessions daily for a mean of 10 weeks (range, 2-22 weeks). The mean gain in range of motion was 26 degrees (range, 2 degrees -60 degrees ). Gains of motion were noted in 35 of 37 elbows. Patients lowered their analgesic use and were highly satisfied with the device (mean satisfaction score of 8.5 of 10 points possible). This device compared favorably with reports of other devices. Consistent improvements in restoring range of motion can be achieved with short treatment times by using a device based on the principles of static progressive stretch and stress relaxation in patients with posttraumatic elbow contractures. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  1. Temperature responsive cooling apparatus

    Energy Technology Data Exchange (ETDEWEB)

    Weker, M.L.; Stearns, R.M.

    1987-08-11

    A temperature responsive cooling apparatus is described for an air conditioner or refrigeration system in operative association with a reservoir of fluid, the air conditioner or refrigeration system having an air cooled coil and means for producing a current of air for cooling the coil, the temperature responsive cooling apparatus comprising: (a) means for transferring the fluid from the reservoir to the air conditioner temperature responsive cooling apparatus, (b) a fluid control device activated by the current of air for cooling the coil; (c) a temperature activated, nonelectrical device for terminating and initiating the flow of fluid therethrough in an intermittent fashion for enhancing the operability of the compressor associated with the refrigeration system and for reducing the quantity of fluid required to cool the coil of the refrigeration system, (d) a fluid treatment device for preventing, reducing or mitigating the deposition of nonevaporative components on the air cooled coil, and (e) means for dispersing the fluid to the air cooled coil from the fluid control device for cooling the coil and increasing the efficiency of the air conditioner thereby reducing the cost of operating and maintaining the air conditioner without damaging the air conditioner and without the deposition of nonevaporative components thereupon.

  2. Gas turbine cooling system

    Science.gov (United States)

    Bancalari, Eduardo E.

    2001-01-01

    A gas turbine engine (10) having a closed-loop cooling circuit (39) for transferring heat from the hot turbine section (16) to the compressed air (24) produced by the compressor section (12). The closed-loop cooling system (39) includes a heat exchanger (40) disposed in the flow path of the compressed air (24) between the outlet of the compressor section (12) and the inlet of the combustor (14). A cooling fluid (50) may be driven by a pump (52) located outside of the engine casing (53) or a pump (54) mounted on the rotor shaft (17). The cooling circuit (39) may include an orifice (60) for causing the cooling fluid (50) to change from a liquid state to a gaseous state, thereby increasing the heat transfer capacity of the cooling circuit (39).

  3. Analysis of efficacy and safety of treatment with collagenase Clostridium histolyticum among subgroups of patients with Dupuytren contracture.

    Science.gov (United States)

    Raven, Raymond B; Kushner, Harvey; Nguyen, Dat; Naam, Nash; Curtin, Catherine

    2014-09-01

    Collagenase Clostridium histolyticum (CCH) injection is a nonoperative treatment of hand contractures from Dupuytren disease. This study assessed the efficacy and safety of CCH in several subgroups of patients with increased surgical risk.Data were pooled from 3 randomized, placebo-controlled, double-blind trials. This analysis included 271 patients with metacarpophalangeal (n = 167) or proximal interphalangeal (n = 104) joint contractures greater than or equal to 20 degrees treated with CCH (0.58 mg collagenase per injection). Subgroups included age, sex, and diabetes status. End points included rate of clinical success (reduction in contracture to 0-5 degrees of normal) and percentage of adverse events.There was no significant difference in clinical success by age, diabetes status, or sex with 63% reaching the end point. There was no difference in adverse events among the subgroups, with peripheral edema, contusion, and injection-site hemorrhage being most common.High-risk subgroups do not demonstrate differences in efficacy or safety with CCH treatment of Dupuytren-related contractures.

  4. Intra- and inter-observer agreement on diagnosis of Dupuytren disease, measurements of severity of contracture, and disease extent

    NARCIS (Netherlands)

    Broekstra, Dieuwke C.; Lanting, Rosanne; Werker, Paul M. N.; van den Heuvel, Edwin R.

    Introduction: Dupuytren disease (DD) is a fibrosing disease affecting the palmar aponeurosis, and is mostly treated by surgery based on measurement of severity of flexion contracture of the fingers. Literature concerning the measurement reliability is scarce. This study aimed to determine the intra-

  5. Identification of molecular phenotypic descriptors of breast capsular contracture formation using informatics analysis of the whole genome transcriptome.

    Science.gov (United States)

    Kyle, Daniel J T; Harvey, Alison G; Shih, Barbara; Tan, Kian T; Chaudhry, Iskander H; Bayat, Ardeshir

    2013-01-01

    Breast capsular contracture formation following silicone implant augmentation/reconstruction is a common complication that remains poorly understood. The aim of this study was to identify potential biomarkers implicated in breast capsular contracture formation by using, for the first time, whole genome arrays. Biopsy samples were taken from 18 patients (23 breast capsules) with Baker Grade I-II (Control) and Baker Grade III-IV (Contracted). Whole genome microarrays were performed and six significantly dysregulated genes were selected for further validation with quantitative reverse transcriptase polymerase chain reaction and immunohistochemistry. Hematoxylin and eosin was also carried out to compare the histological characteristics of control and contracted samples. Microarray results showed that aggrecan, tissue inhibitor of metalloproteinase 4 (TIMP4), and tumor necrosis factor superfamily (ligand) member 11 were significantly down-regulated in contracted capsules; while matrix metallopeptidase 12, serum amyloid A 1, and interleukin 8 (IL8) were significantly up-regulated. The dysregulation of aggrecan, tumor necrosis factor superfamily (ligand) member 11, TIMP4, and IL8 was validated by quantitative reverse transcriptase polymerase chain reaction (p contracture formation. IL8 and TIMP4 may serve as potential key diagnostic, therapeutic, and prognostic biomarkers in capsular contracture formation. © 2013 by the Wound Healing Society.

  6. Changes in burn scar contracture: utilization of a severity scale and predictor of return to duty for service members.

    Science.gov (United States)

    Niedzielski, Lt Stephanie; Chapman, Maj Ted

    2015-01-01

    A medical records review of Operation Iraqi Freedom and Operation Enduring Freedom burn injury survivors admitted to the U.S. Army Institute of Surgical Research Burn Center from April 2003 to August 2005 was conducted. The study proposed the use of a newly developed scale, the Burn Scar Contracture Severity Scale, to potentially provide standardization in quantifying burn scar contracture severity. Changes in the active range of motion from in-patient discharge to out-patient follow-up of individuals with upper extremity burn injuries were compared. Changes in the impairment via American Medical Association impairment scores and perceived disability using the disabilities of the arm, shoulder, and hand questionnaire scores from the in-patient discharge to the out-patient follow-up were also compared. A weak, yet positive correlation (r = .417, .451, P ≤ .001) between the proposed scale and the disabilities of the arm, shoulder, and hand questionnaire and the American Medical Association impairment scores was found, respectively. A receiver operating characteristic curve analysis revealed a cut-off score of 6.5 for the burn scar contracture severity scale, indicating that individuals scoring below a 6.5 returned to duty and those scoring above 6.5 did not return to duty. Results suggest that the burn scar contracture severity scale is able to discriminate between the individuals who returned to duty and those who did not return to duty.

  7. Ten novel FBN2 mutations in congenital contractural arachnodactyly : Delineation of the molecular pathogenesis and clinical phenotype

    NARCIS (Netherlands)

    Gupta, PA; Putnam, EA; Carmical, SG; Kaitila, [No Value; Steinmann, B; Child, A; Danesino, C; Metcalfe, K; Berry, SA; Chen, E; Delorme, CV; Thong, MK; Ades, LC; Milewicz, DM

    2002-01-01

    Congenital contractural arachnodactyly (CCA) is an autosomal dominant condition that shares skeletal features with Marfan syndrome (MFS), but does not have the ocular and cardiovascular complications that characterize MFS. CCA and MFS result from mutations in highly similar genes, FBN2 and FBN1,

  8. Evaporative Cooling Availability in Water Based Sensible Cooling Systems

    OpenAIRE

    Costelloe, Ben; Finn, Donal

    2001-01-01

    Recent developments have prompted a review of evaporative cooling technology as an effective means of cooling modern deep plan buildings. Prominent among these developments is the success of high temperature sensible cooling systems, such as chilled ceilings, which require a supply of cooling water at 14 to 18°C. Crucial to the success of evaporative cooling technology, as a significant means of cooling in modern applications, is the ability to generate cooling water, in an indirect circuit, ...

  9. Radiant Floor Cooling Systems

    DEFF Research Database (Denmark)

    Olesen, Bjarne W.

    2008-01-01

    In many countries, hydronic radiant floor systems are widely used for heating all types of buildings such as residential, churches, gymnasiums, hospitals, hangars, storage buildings, industrial buildings, and smaller offices. However, few systems are used for cooling.This article describes a floor...... cooling system that includes such considerations as thermal comfort of the occupants, which design parameters will influence the cooling capacity and how the system should be controlled. Examples of applications are presented....

  10. Amount of torque and duration of stretching affects correction of knee contracture in a rat model of spinal cord injury.

    Science.gov (United States)

    Moriyama, Hideki; Tobimatsu, Yoshiko; Ozawa, Junya; Kito, Nobuhiro; Tanaka, Ryo

    2013-11-01

    Joint contractures are a common complication of many neurologic conditions, and stretching often is advocated to prevent and treat these contractures. However, the magnitude and duration of the stretching done in practice usually are guided by subjective clinical impressions. Using an established T8 spinal cord injury rat model of knee contracture, we sought to determine what combination of static or intermittent stretching, varied by magnitude (high or low) and duration (long or short), leads to the best (1) improvement in the limitation in ROM; (2) restoration of the muscular and articular factors leading to contractures; and (3) prevention and treatment of contracture-associated histologic alterations of joint capsule and articular cartilage. Using a rat animal model, the spinal cord was transected completely at the level of T8. The rats were randomly assigned to seven treatment groups (n = 4 per group), which were composed of static or intermittent stretching in combination with different amounts of applied torque magnitude and duration. We assessed the effect of stretching by measuring the ROM and evaluating the histologic alteration of the capsule and cartilage. Contractures improved in all treated groups except for the low-torque and short-duration static stretching conditions. High-torque stretching was effective against shortening of the synovial membrane and adhesions in the posterosuperior regions. Collagen Type II and VEGF in the cartilage were increased by stretching. High-torque and long-duration static stretching led to greater restoration of ROM than the other torque and duration treatment groups. Stretching was more effective in improving articular components of contractures compared with the muscular components. Stretching in this rat model prevented shortening and adhesion of the joint capsule, and affected biochemical composition, but did not change morphologic features of the cartilage. This animal study tends to support the ideas that static

  11. Dupuytren’s contracture of hand and its medical and social review

    Directory of Open Access Journals (Sweden)

    V. O. Vishnevskiy

    2014-02-01

    Full Text Available Introduction Dupuytren's contracture is a disease of connective tissue with the affection of palmar aponeurosis, frequently with chronic recurrent course, the flexion deformities of fingers and dysfunction of the hand. It composed 11,8 % among of all types of the hand pathology. The mostly it develops in men of middle-aged and elderly. At young age it occurs more rarely, but with fast progressing current, which in 67 % of cases leads to impaired ability to perform professional hand-work and in 3 % patients to physical inability. Predisposing factors for this fibromatosis are numerous, but one of the popular opinion among of authors is a hereditary character of disease. In clinical practice, the most frequently used fourth degree’s classification of Dupuytren's contracture includes severity of deformation and function disorders of the hand. It is correspond to the normative standards of medical and social expertise The aim of research: to specify the most optimal methods of surgical treatment, the criteria of medical and social examination and rehabilitation, clinical and labor prognosis, indications to establishment of disability after operations concerning of Dupuytren’s contracture. In our clinic was performed three methods of operation: aponeurotomia “open hand”, partial aponeuroectomia, total aponeuroectomia. Errors in the treatment of palmar fibromatosis we shared on: preoperated, intraoperated and associated with violations of the mode of rehabilitation. The next clinical observation of 68 patients (up to 3 years after surgery with Dupuytren’s contracture of hand showed the recurrence rate amounted to 31,7%, and physical inability level is 5,9% of cases. In our opinion the most optimal operative methodic is total aponeuroectomia with rational surgical approaches. Clinical and labour prognosis depends on the manifestations of disease which can develop regardless of the stage, methods of treatment and patient's age. Disadvantageous

  12. Initial Cooling Experiment (ICE)

    CERN Multimedia

    Photographic Service; CERN PhotoLab

    1978-01-01

    In 1977, in a record-time of 9 months, the magnets of the g-2 experiment were modified and used to build a proton/antiproton storage ring: the "Initial Cooling Experiment" (ICE). It served for the verification of the cooling methods to be used for the "Antiproton Project". Stochastic cooling was proven the same year, electron cooling followed later. Also, with ICE the experimental lower limit for the antiproton lifetime was raised by 9 orders of magnitude: from 2 microseconds to 32 hours. For its previous life as g-2 storage ring, see 7405430. More on ICE: 7711282, 7809081, 7908242.

  13. Turbine airfoil cooling system with cooling systems using high and low pressure cooling fluids

    Science.gov (United States)

    Marsh, Jan H.; Messmann, Stephen John; Scribner, Carmen Andrew

    2017-10-25

    A turbine airfoil cooling system including a low pressure cooling system and a high pressure cooling system for a turbine airfoil of a gas turbine engine is disclosed. In at least one embodiment, the low pressure cooling system may be an ambient air cooling system, and the high pressure cooling system may be a compressor bleed air cooling system. In at least one embodiment, the compressor bleed air cooling system in communication with a high pressure subsystem that may be a snubber cooling system positioned within a snubber. A delivery system including a movable air supply tube may be used to separate the low and high pressure cooling subsystems. The delivery system may enable high pressure cooling air to be passed to the snubber cooling system separate from low pressure cooling fluid supplied by the low pressure cooling system to other portions of the turbine airfoil cooling system.

  14. A nanomedicine approach to effectively inhibit contracture during bladder acellular matrix allograft-induced bladder regeneration by sustained delivery of vascular endothelial growth factor.

    Science.gov (United States)

    Xiong, Qianwei; Lin, Houwei; Hua, Xiaolin; Liu, Li; Sun, Ping; Zhao, Zhen; Shen, Xiaowei; Cui, Daxiang; Xu, Maosheng; Chen, Fang; Geng, Hongquan

    2015-01-01

    Macroscopic evidence of contracture has been identified as a major issue during the regeneration process. We hypothesize that lack of angiogenesis is the primary cause of contracture and explore a nanomedicine approach to achieve sustained release of vascular endothelial growth factor (VEGF) to stimulate angiogenesis. We evaluate the efficacy of poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) for long-term (3 months) sustained release of VEGF in bladder acellular matrix allografts (BAMA) in a swine model. We anticipate that the sustained release of VEGF could stimulate angiogenesis along the regeneration process and thereby inhibit contracture. Bladder was replaced with BAMA (5×5 cm), modified with PLGA NPs encapsulated with VEGF in a pig model. The time points chosen for sampling were 1, 2, 4, and 12 weeks. The regenerated areas were then measured to obtain the contracture rate, and the extent of revascularization was calculated using histological and morphological features. In the control group of animals, the bladder was replaced with only BAMA. The in vivo release of VEGF was evident for ∼3 months, achieving the goal of long-acting sustained release, and successfully promoted the regeneration of blood vessels and smooth muscle fibers. In addition, less collagen deposition was observed in the experimental group compared with control. Most importantly, the inhibition of contracture was highly significant, and the ultimate contracture rate decreased by ∼57% in the experimental group compared with control. In isolated strips analysis, there were no significant differences between BAMA-regenerated (either VEGF added or not) and autogenous bladder. BAMA modified with VEGF-loaded PLGA-NPs can sustainably release VEGF in vivo (>3 months) to stimulate angiogenesis leading to the inhibition of contracture. This is the first study to report a viable nanomedicine-based strategy to overcome contracture during bladder regeneration induced by BAMA. Furthermore

  15. Different Roles for Contracture and Calpain in Calcium Paradox-Induced Heart Injury

    Science.gov (United States)

    Zhang, Jian-Ying; Bi, Sheng-Hui; Xu, Ming; Jin, Zhen-Xiao; Yang, Yang; Jiang, Xiao-Fan; Zhou, Jing-Jun

    2012-01-01

    The Ca2+ paradox represents a good model to study Ca2+ overload injury in ischemic heart diseases. We and others have demonstrated that contracture and calpain are involved in the Ca2+ paradox-induced injury. This study aimed to elucidate their roles in this model. The Ca2+ paradox was elicited by perfusing isolated rat hearts with Ca2+-free KH media for 3 min or 5 min followed by 30 min of Ca2+ repletion. The LVDP was measured to reflect contractile function, and the LVEDP was measured to indicate contracture. TTC staining and the quantification of LDH release were used to define cell death. Calpain activity and troponin I release were measured after Ca2+ repletion. Ca2+ repletion of the once 3-min Ca2+ depleted hearts resulted in almost no viable tissues and the disappearance of contractile function. Compared to the effects of the calpain inhibitor MDL28170, KB-R7943, an inhibitor of the Na+/Ca2+ exchanger, reduced the LVEDP level to a greater extent, which was well correlated with improved contractile function recovery and tissue survival. The depletion of Ca2+ for 5 min had the same effects on injury as the 3-min Ca2+ depletion, except that the LVEDP in the 5-min Ca2+ depletion group was lower than the level in the 3-min Ca2+ depletion group. KB-R7943 failed to reduce the level of LVEDP, with no improvement in the LVDP recovery in the hearts subjected to the 5-min Ca2+ depletion treatment; however, KB-R7943 preserved its protective effects in surviving tissue. Both KB-R7943 and MDL28170 attenuated the Ca2+ repletion-induced increase in calpain activity in 3 min or 5 min Ca2+ depleted hearts. However, only KB-R7943 reduced the release of troponin I from the Ca2+ paradoxic heart. These results provide evidence suggesting that contracture is the main cause for contractile dysfunction, while activation of calpain mediates cell death in the Ca2+ paradox. PMID:23284963

  16. Forearm Pronation Osteotomy for Supination Contracture Secondary to Obstetrical Brachial Plexus Palsy: A Retrospective Cohort Study.

    Science.gov (United States)

    Gladstein, Aharon Z; Sachleben, Brant; Ho, Emily S; Anthony, Alison; Clarke, Howard M; Hopyan, Sevan

    2017-09-01

    Obstetrical brachial plexus palsy can lead to fixed forearm supination contracture. Fixed supination may lead to functional deficits as the affected hand cannot be positioned optimally for activities on a desk such as writing and typing, or for using tools including utensils, which require a neutral or pronated forearm. Forearm pronation osteotomy has been used to address this problem, although the functional benefit over nonoperative management has not been clearly defined. Potentially deleterious consequences on hand function that requires supination or fine motor skills are also uncertain. Patients with fixed forearm supination contracture were selected from our institutional brachial plexus database. Those who underwent both bone forearm rotational osteotomy were analyzed for age at time of surgery, preoperative forearm resting position, active and passive supination and pronation, and preoperative function assessed by the brachial plexus outcome measure (BPOM) and active movement scale (AMS). Preoperative results were compared with values obtained at follow-up at least 12 months postoperatively. A matched cohort of children with fixed forearm supination contracture that were treated nonoperatively and followed for at least 12 months, was also selected. For this group, forearm resting position, movement, AMS, and BPOM scores were analyzed at a baseline clinic visit and the most recent follow-up. Changes in forearm resting position, AMS, and BPOM activity scale scores were then compared between groups. Records were obtained for 14 cases and 10 controls. Study groups were similar with respect to resting forearm position, hand function, and time from initial to final evaluation. Groups differed with respect to age and active supination. We observed a statistically significant change in resting position among operative patients compared with their preoperative status and compared with controls. Hand-specific AMS score did not change significantly in the operative

  17. The effect of post-mastectomy radiation therapy on breast implants: Unveiling biomaterial alterations with potential implications on capsular contracture

    Energy Technology Data Exchange (ETDEWEB)

    Ribuffo, Diego; Lo Torto, Federico [Department of Plastic Surgery, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); Giannitelli, Sara M. [Tissue Engineering Unit, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome (Italy); Urbini, Marco; Tortora, Luca [Surface Analysis Laboratory, Department of Mathematics and Physics, University “Roma Tre”, Via della Vasca Navale 84, 00146 Rome (Italy); INFN — National Institute of Nuclear Physics, Section of Roma Tre, Via della Vasca Navale 84, 00146 Rome (Italy); Mozetic, Pamela; Trombetta, Marcella [Tissue Engineering Unit, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome (Italy); Basoli, Francesco; Licoccia, Silvia [Department of Chemical Science and Technologies, University of Rome “Tor Vergata”, Via della Ricerca Scientifica 1, 00173 Rome (Italy); Tombolini, Vincenzo [Department of Radiation Oncology, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); Spencer-Lorillard Foundation, Viale Regina Elena 291, 00161 Rome (Italy); Cassese, Raffaele [Department of Radiation Oncology, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); Scuderi, Nicolò [Department of Plastic Surgery, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); and others

    2015-12-01

    Post-mastectomy breast reconstruction with expanders and implants is recognized as an integral part of breast cancer treatment. Its main complication is represented by capsular contracture, which leads to poor expansion, breast deformation, and pain, often requiring additional surgery. In such a scenario, the debate continues as to whether the second stage of breast reconstruction should be performed before or after post-mastectomy radiation therapy, in light of potential alterations induced by irradiation to silicone biomaterial. This work provides a novel, multi-technique approach to unveil the role of radiotherapy in biomaterial alterations, with potential involvement in capsular contracture. Following irradiation, implant shells underwent mechanical, chemical, and microstructural evaluation by means of tensile testing, Attenuated Total Reflectance Fourier Transform InfraRed spectroscopy (ATR/FTIR), Scanning Electron Microscopy (SEM), high resolution stylus profilometry, and Time of Flight Secondary Ion Mass Spectrometry (ToF-SIMS). Our findings are consistent with radiation-induced modifications of silicone that, although not detectable at the microscale, can be evidenced by more sophisticated nanoscale surface analyses. In light of these results, biomaterial irradiation cannot be ruled out as one of the possible co-factors underlying capsular contracture. - Highlights: • The debate continues whether to perform breast reconstruction before or after PMRT. • Radiation therapy may alter implant material, concurring to capsular contracture. • In this work, irradiated implants were investigated by a multi-technique approach. • Radiation-induced alterations could be evidenced by ATR/FTIR and ToF-SIMS. • Reported alteration might represent a co-factor underlying capsular contracture.

  18. Development and analysis of a new integrated power and cooling ...

    Indian Academy of Sciences (India)

    Cooling needs are increasing rapidly at hot climatic countries with increased global warming. The existed vapour compression refrigeration (VCR) system demands electricity for its operation which is more expensive. The concept of a newly proposed cooling cogeneration cycle has been developed by clubbing the power ...

  19. Solar absorption cooling

    NARCIS (Netherlands)

    Kim, D.S.

    2007-01-01

    As the world concerns more and more on global climate changes and depleting energy resources, solar cooling technology receives increasing interests from the public as an environment-friendly and sustainable alternative. However, making a competitive solar cooling machine for the market still

  20. Cooling of electronic equipment

    DEFF Research Database (Denmark)

    A. Kristensen, Anders Schmidt

    2003-01-01

    Cooling of electronic equipment is studied. The design size of electronic equipment decrease causing the thermal density to increase. This affect the cooling which can cause for example failures of critical components due to overheating or thermal induced stresses. Initially a pin fin heat sink...

  1. Measure Guideline: Ventilation Cooling

    Energy Technology Data Exchange (ETDEWEB)

    Springer, D.; Dakin, B.; German, A.

    2012-04-01

    The purpose of this measure guideline on ventilation cooling is to provide information on a cost-effective solution for reducing cooling system energy and demand in homes located in hot-dry and cold-dry climates. This guideline provides a prescriptive approach that outlines qualification criteria, selection considerations, and design and installation procedures.

  2. The final cool down

    CERN Multimedia

    Thursday 29th May, the cool-down of the final sector (sector 4-5) of LHC has begun, one week after the start of the cool-down of sector 1-2. It will take five weeks for the sectors to be cooled from room temperature to 5 K and a further two weeks to complete the cool down to 1.9 K and the commissioning of cryogenic instrumentation, as well as to fine tune the cryogenic plants and the cooling loops of cryostats.Nearly a year and half has passed since sector 7-8 was cooled for the first time in January 2007. For Laurent Tavian, AT/CRG Group Leader, reaching the final phase of the cool down is an important milestone, confirming the basic design of the cryogenic system and the ability to operate complete sectors. “All the sectors have to operate at the same time otherwise we cannot inject the beam into the machine. The stability and reliability of the cryogenic system and its utilities are now very important. That will be the new challenge for the coming months,” he explains. The status of the cool down of ...

  3. Results after surgery for severe Dupuytren's contracture: does a dynamic extension splint influence outcome?

    Science.gov (United States)

    Ebskov, L B; Boeckstyns, M E; Sørensen, A I; Søe-Nielsen, N

    2000-06-01

    Seventy-six consecutive patients were operated on for advanced Dupuytren's contracture and the results evaluated after nine months with special reference to the use of a dynamic extension splint. The patients were separated into three groups: those in whom the splint was used according to our guidelines (n = 15); those in whom the splint was used, but inadequately (n = 15); and those who did not require splinting (n = 24). Our results nine months postoperatively were similar to those of other studies in showing that the fifth proximal interphalangeal joint constituted the greatest problem. Comparison of the three groups indicated that splinting the way we used it did not influence the natural course of the disease after operation.

  4. Concomitant Contracture of the Knee and Ankle Joint After Gastrocnemius Muscle Rupture: A Case Report.

    Science.gov (United States)

    Ryu, Dong Jin; Kim, Joon Mee; Kim, Bom Soo

    Injury of the medial head of the gastrocnemius, also called "tennis leg," is known to heal uneventfully in most cases with compression and immobilization therapy. Failure to heal or long-term complications, including ongoing pain and pes equinus, have been documented in only a limited number of case reports. To the best of our knowledge, a severe concomitant contracture of the knee and ankle joint as a consequence of a maltreated gastrocnemius muscle rupture has not been previously reported in English-language reports. The purpose of the present study was to report a serious complication of neglected tennis leg with a review of the published data. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Arthrogryposis (multiple congenital contractures): diagnostic approach to etiology, classification, genetics, and general principles.

    Science.gov (United States)

    Hall, Judith G

    2014-08-01

    Arthrogryposis has been the term used to describe multiple congenital contractures for over a century. It is a descriptive term and present in over 400 specific conditions. Responsible gene abnormalities have been found for more than 150 specific types of arthrogryposis. Decreased fetal movement is present in all affected individuals which leads to a variety of secondary deformations. Decreased fetal movement (fetal akinesia) is associated with increased connective tissue around the immobilized joint, skin dimpling overlying the immobilized joint, disuse atrophy of the muscles that mobilize the joint and abnormal surface of the joint depending on the immobilized position. Other frequently observed features include: micrognathia, mildly shortened limbs, intrauterine growth restriction, pulmonary hypoplasia and short and/or immature gut. Primary etiologies include neuropathic processes; myopathic processes; end-plate abnormalities; maternal illness, trauma and drugs; limitation of fetal space; vascular compromise; and metabolic disorders to the developing embryo/fetus. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  6. [Transtibial amputation of the lower extremity in patients with ischemic foot contracture].

    Science.gov (United States)

    Liabakh, A P; Mikhnevych, O E; Dolhopolov, O V

    2014-07-01

    The results of operative treatment of 8 patients was analyzed, in whom the lower extremity amputation on the upper third of the shin was performed for severe stage of the ischemic foot contacture. Operative interventions is expedient to perform in a specialized stationary, were exists possibility of further prosthesis. It is necessary to perform the extremity amputation in a residual period of the foot ischemic contracture, when operations for restoration of the sole sensitivity are nonperspective as well as in presence of severe trophic disorders on the sole and the shin, but without purulent--necrotic signs. Confirmed data of clinic--instrumental investigations for chronic course of the ischemic process constitutes an absolute indication for operation.

  7. INITIAL COOLING EXPERIMENT (ICE)

    CERN Multimedia

    CERN PhotoLab

    1979-01-01

    ICE was built in 1977, using the modified bending magnets of the g-2 muon storage ring (see 7405430). Its purpose was to verify the validity of stochastic and electron cooling for the antiproton project. Stochastic cooling proved a resounding success early in 1978 and the antiproton project could go ahead, now entirely based on stochastic cooling. Electron cooling was experimented with in 1979. The 26 kV equipment is housed in the cage to the left of the picture, adjacent to the "e-cooler" located in a straight section of the ring. With some modifications, the cooler was later transplanted into LEAR (Low Energy Antiproton Ring) and then, with further modifications, into the AD (Antiproton Decelerator), where it cools antiprotons to this day (2006). See also: 7711282, 7802099, 7809081.

  8. Initial Cooling Experiment (ICE)

    CERN Multimedia

    CERN PhotoLab

    1978-01-01

    ICE was built in 1977, in a record time of 9 months, using the modified bending magnets of the g-2 muon storage ring. Its purpose was to verify the validity of stochastic and electron cooling for the antiproton project, to be launched in 1978. Already early in 1978, stochastic cooling proved a resounding success, such that the antiproton (p-pbar)project was entirely based on it. Tests of electron cooling followed later: protons of 46 MeV kinetic energy were cooled with an electron beam of 26 kV and 1.3 A. The cage seen prominently in the foreground houses the HV equipment, adjacent to the "cooler" installed in a straight section of the ring. With some modifications, the cooler was later transplanted into LEAR (Low Energy Antiproton Ring) and then, with further modifications, into the AD (Antiproton Decelerator), where it cools antiprotons to this day (2006). See also: 7711282, 7802099, 7908242.

  9. Prevention of Cutaneous Tissue Contracture During Removal of Craniofacial Implant Superstructures for CT and MRI Studies

    Directory of Open Access Journals (Sweden)

    Maureen Sullivan

    2010-04-01

    Full Text Available Objectives: Head and neck cancer patients who have lost facial parts following surgical intervention frequently require craniofacial implant retained facial prostheses for restoration. Many craniofacial implant patients require computed tomography and magnetic resonance imaging scans as part of their long-term follow-up care. Consequently removal of implant superstructures and peri-abutment tissue management is required for those studies. The purpose of the present paper was to describe a method for eliminating cranial imaging artifacts in patients with craniofacial implants.Material and Methods: Three patients wearing extraoral implant retained facial prostheses needing either computed tomography or magnetic resonance imaging studies were discussed. Peri-implant soft tissues contracture after removal of percutaneous craniofacial implant abutments during computed tomography and magnetic resonance imaging studies was prevented using a method proposed by authors. The procedure involves temporary removal of the supra-implant components prior to imaging and filling of the tissue openings with polyvinyl siloxane dental impression material.Results: Immediately after filling of the tissue openings with polyvinyl siloxane dental impression material patients were sent for the imaging studies, and were asked to return for removal of the silicone plugs and reconnection of all superstructure hardware after imaging procedures were complete. The silicone plugs were easily removed with a dental explorer. The percutaneous abutments were immediately replaced and screwed into the implants which were at the bone level.Conclusions: Presented herein method eliminates the source of artifacts and prevents contracture of percutaneous tissues upon removal of the implant abutments during imaging.

  10. Use of the caffeine-halothane contracture test for the diagnosis of malignant hyperthermia in Brazil

    Directory of Open Access Journals (Sweden)

    R.T. Sudo

    2010-06-01

    Full Text Available Malignant hyperthermia (MH is a pharmacogenetic disease triggered by volatile anesthetics and succinylcholine. Deaths due to MH have been reported in Brazil. The first Malignant Hyperthermia Diagnostic and Research Center in Latin America was inaugurated in 1993 at the Federal University of Rio de Janeiro, Brazil. The center followed the diagnostic protocols of the North America MH Group, in which the contractures of biopsies from the vastus lateralis muscle are analyzed after exposure to caffeine and halothane (CHCT. CHCT was performed in individuals who survived, their relatives and those with signs/symptoms somewhat related to MH susceptibility (MHS. Here, we report data from 194 patients collected over 16 years. The Southeast (N = 110 and South (N = 71 represented the majority of patients. Median age was 25 (4-70 years, with similar numbers of males (104 and females (90. MHS was found in 90 patients and 104 patients were normal. Abnormal responses to both caffeine and halothane were observed in 59 patients and to caffeine or halothane in 20 and 11 patients, respectively. The contracture of biopsies from MHS exposed to caffeine and halothane was 1.027 ± 0.075 g (N = 285 and 4.021 ± 0.255 g (N = 226, respectively. MHS was found in patients with either low or high blood creatine kinase and also, with a low score on the clinical grading scale. Thus, these parameters cannot be used with certainty to predict MHS. We conclude that the CHCT protocol described by the North America MH Group contributed to identification of MHS in suspected individuals at an MH center in Brazil with 100% sensitivity and 65.7% specificity.

  11. Recurrence of Dupuytren’s contracture: A consensus-based definition

    Science.gov (United States)

    Kan, Hester J.; Verrijp, Frank W.; Hovius, Steven E. R.; van Nieuwenhoven, Christianne A.; Selles, Ruud W.

    2017-01-01

    Purpose One of the major determinants of Dupyutren disease (DD) treatment efficacy is recurrence of the contracture. Unfortunately, lack of agreement in the literature on what constitutes recurrence makes it nearly impossible to compare the multiple treatments alternatives available today. The aim of this study is to bring an unbiased pool of experts to agree upon what would be considered a recurrence of DD after treatment; and from that consensus establish a much-needed definition for DD recurrence. Methods To reach an expert consensus on the definition of recurrence we used the Delphi method and invited 43 Dupuytren’s research and treatment experts from 10 countries to participate by answering a series of questionnaire rounds. After each round the answers were analyzed and the experts received a feedback report with another questionnaire round to further hone in of the definition. We defined consensus when at least 70% of the experts agreed on a topic. Results Twenty-one experts agreed to participate in this study. After four consensus rounds, we agreed that DD recurrence should be defined as “more than 20 degrees of contracture recurrence in any treated joint at one year post-treatment compared to six weeks post-treatment”. In addition, “recurrence should be reported individually for every treated joint” and afterwards measurements should be repeated and reported yearly. Conclusion This study provides the most comprehensive to date definition of what should be considered recurrence of DD. These standardized criteria should allow us to better evaluate the many treatment alternatives. PMID:28505187

  12. Evaluation of treatment results of patients with Dupuytren's contracture--our clinical experience.

    Science.gov (United States)

    Kobus, Kazimierz; Wójcicki, Piotr; Dydymski, Tomasz; Wegrzyn, Marek; Hamlawi, Fahed

    2007-01-01

    Dupuytren's contracture is a common condition leading to impairment of the function of the hand which affects from 2 to 12 % of the population, mainly males, and presents as progressive contracture of fingers caused by shortening of the palmar aponeurosis. The objective of the work was to present our own approach to managing Dupuytren's disease and evaluate treatment results in patients with hypertrophy of the palmar aponeurosis. Material and method 288 patients with Dupuytren's disease were treated at the Plastic Surgery Hospital in Polanica Zdroj over a period of 25 years (1977-2002). The present paper is a retrospective analysis of treatment results in 253 patients for whom complete medical documentation was available. All patients were operated in local anaesthesia in ischemia. A Bunnell flap skin incision was followed by a fasciectomy of the hypertrophied segment of the palmar aponeurosis. The skin wound was closed using V-Y plasty. Postoperative management involved hand elevation and early rehabilitation. Results Restoration of the full range of motion and total extension in the MP joint and the interphalangeal joints were achieved in 70% and 68% of patients, respectively. Of 145 patients who were professionally active, 132 were able to return to work. Finger amputation was necessary in 2 patients, one patient suffered from arthrodesis and two other developed skin necrosis which was removed with the wound closed by skin grafts. A follow-up examination 6 months after the operation revealed a recurrence in 8 patients and deterioration of hand dexterity with finger stiffness in 4. Conclusions A low complication rate and good treatment results are arguments in favour of the approach adopted at our hospital, i.e. surgery in local anaesthesia in ischemia with compressive bandaging, using a Bunnell flap skin incision followed by radical fasciectomy and V-Y plasty.

  13. Stealthy role of size-driven stresses in biomechanics of breast implants capsular contracture.

    Science.gov (United States)

    Fraldi, Massimiliano; Esposito, Luca; Cutolo, Arsenio; Carotenuto, Angelo Rosario; Adamo, Ciro; Molea, Guido

    2016-12-01

    Breast Capsular Contracture (BCC) is one of the adverse complications occurring with greater incidence in breast augmentation surgical procedures. Its formation can be interpreted as the conclusive result of the physiological process known as response to a foreign body. From a biochemical standpoint, the formation of the peri-prosthetic capsule is certainly a multifactorial process: many hypotheses concerning its etiology have been suggested in the literature and a number of related pharmacological protocols have been consequently proposed to clinically treat this pathology with the aim to prevent further complications and avoid future re-interventions. However, the vast majority of these theories seems to be only partially supported by clinical outcomes and thus a shared opinion on this matter is still absent among specialists. Within this framework, by starting from clinical observations which highlighted an unexpected correlation between histo-morphological features of fibrotic capsules and overall size of breast implants, the present study investigates the hypothesis that the biomechanical interaction between prosthesis and host tissue may play a crucial role in the biological processes governing the pathological phenomenon at hand. Therefore, to shed light on the underlying mechanisms which could trigger the breast capsular contracture, both simple analytical solutions, in which elasticity and growth are simultaneously taken into account, and more accurate geometrically faithful Finite Element-based numerical simulations have been exploited. The theoretical findings demonstrate that somehow counter-intuitive radial and hoop stress fields occur at the capsula-implant interface in a way such that their combined action, independently from other possible concurrent factors, results significantly amplified for small-size breast prostheses, localized stress peaks in these cases promoting detaching and rippling phenomena actually observed in BCC clinical

  14. Dupuytren's contracture: an analysis of outcomes of percutaneous needle fasciotomy versus open fasciectomy.

    Science.gov (United States)

    Toppi, Jason T; Trompf, Leisel; Smoll, Nicolas R; Lim, Vivian; Smith, Katrina; Findlay, Michael W; Hunter-Smith, David J

    2015-09-01

    Percutaneous needle fasciotomy (PNF) is a minimally invasive technique used to manage Dupuytren's contracture. We compared outcomes of PNF versus open fasciectomy (OF) to examine the suitability of PNF in Australia. A retrospective cohort study using two questionnaires regarding Dupuytren's treatment was used to assess patients with uncomplicated primary disease. The primary outcomes were immediate and medium-term correction of contracture (2-year mean follow-up to time of survey). Secondary outcomes were patient satisfaction and complications including tendon/nerve injury, infection, skin necrosis and vascular damage. One hundred fifty-five out of 191 surveys were returned (81%). The final analysis included 125 cases (65%), 73 PNF and 52 OF. No significant differences were observed between both groups with regards to follow-up time, gender, smoking status, co-morbidities or preoperative deformity grade. No significant differences were observed in terms of immediate or medium-term deformity correction, tendon/nerve injury or circulatory complications. The postoperative infection rate was higher with OF, with these patients 7.57 (95% confidence interval 1.56, 36.77; P = 0.01) times as likely to have a postoperative infection as patients undergoing PNF. A higher number of patients who underwent PNF were told that they would require another operation (30% versus 12%; P = 0.02). Satisfaction scores were similar (OF 33.2 versus PNF 32.6; P = 0.82). The OF and PNF procedures provide comparable deformity correction for uncomplicated primary Dupuytren's disease in the immediate perioperative period. The reduced side effect profile of PNF should prompt surgeons to consider incorporating it in their practice for the first-line management of uncomplicated primary Dupuytren's disease. © 2014 Royal Australasian College of Surgeons.

  15. Severe Spastic Contractures and Diabetes Mellitus Independently Predict Subsequent Minimal Trauma Fractures Among Long-Term Care Residents.

    Science.gov (United States)

    Lam, Kuen; Leung, Man Fuk; Kwan, Chi Wai; Kwan, Joseph

    2016-11-01

    The study aimed to examine the epidemiology of hypertonic contractures and its relationship with minimal trauma fracture (MTF), and to determine the incidence and predictors of (MTF) in long-term care residents. This was a longitudinal cohort study of prospectively collected data. Participants were followed from March 2007 to March 2016 or until death. A 300-bed long-term care hospital in Hong Kong. All long-term care residents who were in need of continuous medical and nursing care for their activities of daily living. Information on patients' demographic data, severe contracture defined as a decrease of 50% or more of the normal passive range of joint movement of the joint, and severe limb spasticity defined by the Modified Ashworth Scale higher than grade 3, medical comorbidities, functional status, cognitive status, nutritional status including body mass index and serum albumin, past history of fractures, were evaluated as potential risk factors for subsequent MTF. Three hundred ninety-six residents [148 males, mean ± standard deviation (SD), age = 79 ± 16 years] were included for analysis. The presence of severe contracture was highly prevalent among the study population: 91% of residents had at least 1 severe contracture, and 41% of residents had severe contractures involving all 4 limbs. Moreover, there were a significant proportion of residents who had severe limb spasticity with the elbow flexors (32.4%) and knee flexors (33.9%) being the most commonly involved muscles. Twelve residents (3%) suffered from subsequent MTF over a median follow-up of 33 (SD = 30) months. Seven out of these 12 residents died during the follow-up period, with a mean survival of 17.8 months (SD = 12.6) after the fracture event. The following 2 factors were found to independently predict subsequent MTF in a multivariate Cox regression: bilateral severe spastic knee contractures (hazard ratio = 16.5, P diabetes mellitus (hazard ratio = 4.0. P = .018, confidence

  16. Second sector cool down

    CERN Multimedia

    2007-01-01

    At the beginning of July, cool-down is starting in the second LHC sector, sector 4-5. The cool down of sector 4-5 may occasionally generate mist at Point 4, like that produced last January (photo) during the cool-down of sector 7-8.Things are getting colder in the LHC. Sector 7-8 has been kept at 1.9 K for three weeks with excellent stability (see Bulletin No. 16-17 of 16 April 2007). The electrical tests in this sector have got opt to a successful start. At the beginning of July the cryogenic teams started to cool a second sector, sector 4-5. At Point 4 in Echenevex, where one of the LHC’s cryogenic plants is located, preparations for the first phase of the cool-down are underway. During this phase, the sector will first be cooled to 80 K (-193°C), the temperature of liquid nitrogen. As for the first sector, 1200 tonnes of liquid nitrogen will be used for the cool-down. In fact, the nitrogen circulates only at the surface in the ...

  17. The Efficacy and Safety of Concurrent Collagenase Clostridium Histolyticum Injections for 2 Dupuytren Contractures in the Same Hand: A Prospective, Multicenter Study.

    Science.gov (United States)

    Gaston, R Glenn; Larsen, Søren Erik; Pess, Gary M; Coleman, Stephen; Dean, Brian; Cohen, Brian M; Kaufman, Gregory J; Tursi, James P; Hurst, Lawrence C

    2015-10-01

    To evaluate efficacy and safety of concurrent administration of 2 collagenase clostridium histolyticum (CCH) injections to treat 2 joints in the same hand with Dupuytren fixed flexion contractures (FFCs). Patients with 2 or more contractures in the same hand caused by palpable cords participated in a 60-day, multicenter, open-label, phase 3b study. Two 0.58 mg CCH doses were injected into 1 or 2 cords in the same hand (1 injection per affected joint) during the same visit. Finger extension was performed approximately 24, 48, or 72 or more hours later. Changes in FFC and range of motion, incidence of clinical success (FFC ≤ 5°), and adverse events (AEs) were summarized. The study enrolled 715 patients (725 treated joint pairs), and 714 patients (724 joint pairs) were analyzed for efficacy. At day 31, mean total FFC (sum of 2 treated joints) decreased 74%, from 98° to 27°. Mean total range of motion increased from 90° to 156°. The incidence of clinical success was 65% in metacarpophalangeal joints and 29% in proximal interphalangeal joints. Most treatment-related AEs were mild to moderate, resolving without intervention; the most common were swelling of treated extremity, contusion, and pain in extremity. The incidence of skin lacerations was 22% (160 of 715). Efficacy and safety were similar regardless of time to finger extension. Collagenase clostridium histolyticum can be used to effectively treat 2 affected joints concurrently without a greater risk of AEs than treatment of a single joint, with the exception of skin laceration. The incidence of clinical success in this study after 1 injection per joint was comparable to phase 3 study results after 3 or more injections per joint. Two concurrent CCH injections may allow more rapid overall treatment of multiple affected joints, and the ability to vary the time between CCH injection and finger extension may allow physicians and patients greater flexibility with scheduling treatment. Copyright © 2015 American

  18. Indirect evaporative cooling systems

    Energy Technology Data Exchange (ETDEWEB)

    Wooldridge, M.J.; Chapman, H.L.; Pescod, D.

    1976-01-01

    Characteristics and applications of three indirect evaporative cooling systems are described. The rock bed regenerative unit is now in licensed production and some operational experience is available, while the plastic plate heat exchanger unit has been demonstrated to be effective. A third system, based on a rotary heat exchanger is included. Although less development has been done on it, several successful applications of the heat exchanger are operational. All systems provide comfort cooling in which building indoor temperature varies over the day at an operating cost less than 50% of that of a comparable refrigerated cooling system.

  19. Cryogenic generator cooling

    Science.gov (United States)

    Eckels, P. W.; Fagan, T. J.; Parker, J. H., Jr.; Long, L. J.; Shestak, E. J.; Calfo, R. M.; Hannon, W. F.; Brown, D. B.; Barkell, J. W.; Patterson, A.

    The concept for a hydrogen cooled aluminum cryogenic generator was presented by Schlicher and Oberly in 1985. Following their lead, this paper describes the thermal design of a high voltage dc, multimegawatt generator of high power density. The rotor and stator are cooled by saturated liquid and supercritical hydrogen, respectively. The brushless exciter on the same shaft is also cooled by liquid hydrogen. Component development testing is well under way and some of the test results concerning the thermohydraulic performance of the conductors are reported. The aluminum cryogenic generator's characteristics are attractive for hydrogen economy applications.

  20. Volkmann?s Ischemic Contracture with Atrophic Non-union of Ulna Managed by Bone Shortening and Transposition of Radial Autograft

    OpenAIRE

    L, Maheshwar; Kiran K, K; KC, Vamshi; Prasad R, Siva

    2015-01-01

    Introduction: Volkmann?s ischemic contracture (VIC) is a complex and variable flexion deformity of wrist and fingers resulting from fibrosis and contracture of flexor muscles of forearm. It is caused by ischemic injury to the deep tissues enclosed in the tight unyielding osteo-facial compartments secondary to neglected acute compartment syndrome. VIC may be associated with malunion or non-union of forearm fractures. To the best of our knowledge, this article is the first case report of VIC as...

  1. Extension gap needs more than 1-mm laxity after implantation to avoid post-operative flexion contracture in total knee arthroplasty.

    Science.gov (United States)

    Okamoto, Shigetoshi; Okazaki, Ken; Mitsuyasu, Hiroaki; Matsuda, Shuichi; Mizu-Uchi, Hideki; Hamai, Satoshi; Tashiro, Yasutaka; Iwamoto, Yukihide

    2014-12-01

    In total knee arthroplasty (TKA), a high soft-tissue tension in extension at the time of operation would cause a post-operative flexion contracture. However, how tight the extension gap should be during surgery to avoid a post-operative flexion contracture remains unclear. The hypothesis is that some laxity in the intraoperative extension gap is necessary to avoid the post-operative flexion contracture. A posterior-stabilized TKA was performed for 75 osteoarthritic knees with a varus deformity. The intraoperative extension gap was measured using a tensor device that provides the gap length and the angle between the femoral component and the tibial cut surface. The medial component gap was defined as the gap calculated by subtracting the selected thickness of the tibial component, including the polyethylene liner, from the extension gap at the medial side. Then, the patients were divided into three groups according to the medial component gap, and post-operative extension angle measured 1 year after the surgery was compared between each groups. One year post-operatively, a flexion contracture of more than 5° was found in 0/34 patients when the medial component gap was more than 1 mm, in 2/26 (8%) patients when the gap was between 0 and 1 mm, and in 3/15 (20%) patients when the gap was contracture. As a clinical relevance, this study clarified the optimal extension gap to avoid the post-operative flexion contracture. Prospective comparative study, Level II.

  2. LHC cooling gains ground

    CERN Multimedia

    Huillet-Miraton Catherine

    The nominal cryogenic conditions of 1.9 K have been achieved in sectors 5-6 and 7-8. This means that a quarter of the machine has reached the nominal conditions for LHC operation, having attained a temperature of below 2 K (-271°C), which is colder than interstellar space! Elsewhere, the cryogenic system in Sector 8-1 has been filled with liquid helium and cooled to 2K and will soon be available for magnet testing. Sectors 6-7 and 2-3 are being cooled down and cool-down operations have started in Sector 3-4. Finally, preparations are in hand for the cool-down of Sector 1-2 in May and of Sector 4-5, which is currently being consolidated. The LHC should be completely cold for the summer. For more information: http://lhc.web.cern.ch/lhc/Cooldown_status.htm.

  3. Warm and Cool Dinosaurs.

    Science.gov (United States)

    Mannlein, Sally

    2001-01-01

    Presents an art activity in which first grade students draw dinosaurs in order to learn about the concept of warm and cool colors. Explains how the activity also helped the students learn about the concept of distance when drawing. (CMK)

  4. Cooling of wood briquettes

    Directory of Open Access Journals (Sweden)

    Adžić Miroljub M.

    2013-01-01

    Full Text Available This paper is concerned with the experimental research of surface temperature of wood briquettes during cooling phase along the cooling line. The cooling phase is an important part of the briquette production technology. It should be performed with care, otherwise the quality of briquettes could deteriorate and possible changes of combustion characteristics of briquettes could happen. The briquette surface temperature was measured with an IR camera and a surface temperature probe at 42 sections. It was found that the temperature of briquette surface dropped from 68 to 34°C after 7 minutes spent at the cooling line. The temperature at the center of briquette, during the 6 hour storage, decreased to 38°C.

  5. Epicyclic helical channels for parametric resonance ionization cooling

    Energy Technology Data Exchange (ETDEWEB)

    Johson, Rolland Paul [Thomas Jefferson National Accelerator Facility (TJNAF), Newport News, VA (United States); Derbenev, Yaroslav [Muons, Inc., Batavia, IL (United States)

    2015-08-23

    Proposed next-generation muon colliders will require major technical advances to achieve rapid muon beam cooling requirements. Parametric-resonance Ionization Cooling (PIC) is proposed as the final 6D cooling stage of a high-luminosity muon collider. In PIC, a half-integer parametric resonance causes strong focusing of a muon beam at appropriately placed energy absorbers while ionization cooling limits the beam’s angular spread. Combining muon ionization cooling with parametric resonant dynamics in this way should then allow much smaller final transverse muon beam sizes than conventional ionization cooling alone. One of the PIC challenges is compensation of beam aberrations over a sufficiently wide parameter range while maintaining the dynamical stability with correlated behavior of the horizontal and vertical betatron motion and dispersion. We explore use of a coupling resonance to reduce the dimensionality of the problem and to shift the dynamics away from non-linear resonances. PIC simulations are presented.

  6. Cooling tower waste reduction

    Energy Technology Data Exchange (ETDEWEB)

    Coleman, S.J.; Celeste, J.; Chine, R.; Scott, C.

    1998-05-01

    At Lawrence Livermore National Laboratory (LLNL), the two main cooling tower systems (central and northwest) were upgraded during the summer of 1997 to reduce the generation of hazardous waste. In 1996, these two tower systems generated approximately 135,400 lbs (61,400 kg) of hazardous sludge, which is more than 90 percent of the hazardous waste for the site annually. At both, wet decks (cascade reservoirs) were covered to block sunlight. Covering the cascade reservoirs reduced the amount of chemical conditioners (e.g. algaecide and biocide), required and in turn the amount of waste generated was reduced. Additionally, at the northwest cooling tower system, a sand filtration system was installed to allow cyclical filtering and backflushing, and new pumps, piping, and spray nozzles were installed to increase agitation. the appurtenance upgrade increased the efficiency of the cooling towers. The sand filtration system at the northwest cooling tower system enables operators to continuously maintain the cooling tower water quality without taking the towers out of service. Operational costs (including waste handling and disposal) and maintenance activities are compared for the cooling towers before and after upgrades. Additionally, the effectiveness of the sand filter system in conjunction with the wet deck covers (northwest cooling tower system), versus the cascade reservoir covers alone (south cooling tower south) is discussed. the overall expected return on investment is calculated to be in excess of 250 percent. this upgrade has been incorporated into the 1998 DOE complex-wide water conservation project being led by Sandia National Laboratory/Albuquerque.

  7. Isometric exercises with elements postisometric relaxation to eliminate the knee joint contracture after arthroscopic plastics of anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Pylypenko O.V.

    2014-02-01

    Full Text Available Purpose : to determine the efficiency of isometric exercises and post isometric relaxation of character for removal and prevention of contractures and recovery of motor function after arthroscopic reconstruction of the anterior cruciate ligament in the late postoperative period. Material: The study involved 22 patients aged less than 40 years. Results: The results showed that the level of pain decreased equally in patients of main and control group from 3 to 0 points, the performance difference in the amplitude of the bending of the knee joint during the goniometry in the treatment group was 70 in the control group – 30 and the extension 10 – fixed, reaching 5 hyperextension and not changed in the control group. Conclusions: The use of isometric exercises and post isometric relaxation prevent postoperative contracture of the knee joint. Methods of their application are recommended for use in the comprehensive rehabilitation of patients after arthroscopic plastics anterior cruciate ligament.

  8. Stacking with Stochastic Cooling

    CERN Document Server

    Caspers, Friedhelm

    2004-01-01

    Accumulation of large stacks of antiprotons or ions with the aid of stochastic cooling is more delicate than cooling a constant intensity beam. Basically the difficulty stems from the fact that the optimized gain and the cooling rate are inversely proportional to the number of particles seen by the cooling system. Therefore, to maintain fast stacking, the newly injected batch has to be strongly protected from the Schottky noise of the stack. Vice versa the stack has to be efficiently shielded against the high gain cooling system for the injected beam. In the antiproton accumulators with stacking ratios up to 105, the problem is solved by radial separation of the injection and the stack orbits in a region of large dispersion. An array of several tapered cooling systems with a matched gain profile provides a continuous particle flux towards the high-density stack core. Shielding of the different systems from each other is obtained both through the spatial separation and via the revolution frequencies (filters)....

  9. The effect of night extension orthoses following surgical release of Dupuytren contracture: a single-center, randomized, controlled trial.

    Science.gov (United States)

    Collis, Julie; Collocott, Shirley; Hing, Wayne; Kelly, Edel

    2013-07-01

    To clarify the efficacy and detrimental effects of orthoses used to maintain finger extension following surgical release of Dupuytren contracture. We conducted a single-center, randomized, controlled trial to investigate the effect of night extension orthoses on finger range of motion and hand function for 3 months following surgical release of Dupuytren contracture. We also wanted to determine how well finger extension was maintained in the total sample. We randomized 56 patients to receive a night extension orthosis plus hand therapy (n = 26) or hand therapy alone (n = 30). The primary outcome was total active extension of the operated fingers (°). Secondary outcomes were total active flexion of the operated fingers (°), active distal palmar crease (cm), grip strength (kg), and self-reported hand function using the Disabilities of the Arm, Shoulder, and Hand questionnaire (0-100 scale). There were no statistically significant differences between the no-orthosis and orthosis groups for total active extension or for any of the secondary outcomes. Between the first postoperative measure and 3 months after surgery, 62% of little fingers had maintained or improved total active extension. The use of a night extension orthosis in combination with standard hand therapy has no greater effect on maintaining finger extension than hand therapy alone in the 3 months following surgical release of Dupuytren contracture. Our results indicate that the practice of providing every patient with a night extension orthosis following surgical release of Dupuytren contracture may not be justified except for cases in which extension loss occurs after surgery. Our results also challenge clinicians to research ways of maintaining finger extension in a greater number of patients. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  10. Reverse-flow anterolateral thigh perforator: an ad hoc flap for severe post-burn knee contracture.

    Science.gov (United States)

    Ismail, H A; El-Bassiony, L E

    2016-03-31

    We evaluate function outcomes of the reverse-flow ALT perforator flap to reconstruct severe post-burn knee contracture. Between October 2012 and December 2014, 10 patients with severe post-burn knee contracture were subjected to reconstruction with 10 ipsilateral reversed-flow ALT perforator flaps. All the patients were male. Ages ranged from 15 to 47 years (mean = 32 years). Time from burn injury to patient presentation ranged from 2-8 months. All patients demonstrated post-burn flexion contracture of the knee joint, ranging from 35 to 75 degrees. Flap sizes ranged from 8×16 to 12×26 cm. The flaps and skin grafts were carried out without major complications. Only minor complications occurred, such as transient, mild congestion immediately after inset in two flaps. Two flaps developed superficial necrosis at the distal edge. One case sustained partial skin graft loss due to haematoma. One case complained of skin hyperpigmentation and hypertrophic scars around the graft. Secondary debulking procedures were required in two cases. The entire donor sites were closed by partial thickness skin graft with acceptable appearance, except one case that was closed primarily. Eight out of ten patients (80%) demonstrated gradual improvement in range of knee motion after a specialized rehabilitation program. Two patients (20%) did not get back full range of motion. RALT perforator flap is the cornerstone for the reconstruction of soft-tissue defects around the knee with acceptable aesthetic and functional results provided that the following items are fulfilled: inclusion of muscle cuff around the pedicle, the pivot point, prevention of pedicle compression after transfer and early surgical intervention on the post-burn knee contracture.

  11. Should we consider Dupuytren's contracture as work-related? A review and meta-analysis of an old debate

    Directory of Open Access Journals (Sweden)

    Jauffret Pénélope

    2011-05-01

    Full Text Available Abstract Background In view of the conflicting opinions published, a meta-analysis was undertaken on epidemiological studies in order to assess any association between Dupuytren's contracture and work exposure. Methods Using the key words: "occupational disease", "work" and "Dupuytren contracture" without limitation on language or year of publication, epidemiological studies were selected from four databases (Pub-Med, Embase, Web of science, BDSP after two rounds (valid control group, valid work exposure. A quality assessment list was constructed and used to isolate papers with high quality methodological criteria (scores of 13 or above, HQMC. Relevant associations between manual work, vibration exposure (at work and Dupuytren's contracture were extracted from the articles and a metarisk calculated using the generic variance approach (meta-odds ratios, meta-OR. Results From 1951 to 2007, 14 epidemiological studies (including 2 cohort studies, 3 case-control studies, and 9 cross-sectional studies/population surveys were included. Two different results could be extracted from five studies (based on different types of exposure, leading to 19 results, 12 for manual work (9 studies, and 7 for vibration exposure (5 studies. Six studies met the HQMC, yielding 9 results, 5 for manual work and 4 for vibration exposure. Five studies found a dose-response relationship. The meta-OR for manual work was 2.02[1.57;2.60] (HQMC studies only: 2.01[1.51;2.66], and the meta-OR for vibration exposure was 2.88 [1.36;6.07] (HQMC studies only: 2.14[1.59;2.88]. Conclusion These results support the hypothesis of an association between high levels of work exposure (manual work and vibration exposure and Dupuytren's contracture in certain cases.

  12. Interventions for the prevention and treatment of disability due to acquired joint contractures in older people: a systematic review.

    Science.gov (United States)

    Saal, Susanne; Beutner, Katrin; Bogunski, Julia; Obermüller, Kathrin; Müller, Martin; Grill, Eva; Meyer, Gabriele

    2017-05-01

    acquired joint contractures have significant effects on quality of life and functioning. to determine the effects of interventions to prevent and treat disabilities in older people with acquired joint contractures. systematic search (last 8/2016) via Cochrane Library, PubMed, EMBASE, PEDro, CINAHL, trial registries, reference lists of retrieved articles and scientific congress pamphlets. Controlled and randomised controlled trials in English or German comparing an intervention with another intervention or standard care were included. Two independent researchers performed the selection of publications, data extraction and critical appraisal. seventeen studies with 992 participants met the inclusion criteria: 16 randomised controlled trials and 1 controlled trial (nursing homes = 4, community settings = 13). The methodological quality of the studies varied. Splints were examined in four studies, stretching exercises in nine studies, and ultrasound, passive movement therapy, bed-positioning and group exercise were each examined in one study. Studies on splints revealed inconclusive results regarding joint mobility or spasticity. Five of seven studies that assessed active stretching programmes for healthy older people reported statistically significant effects on joint mobility in favour of the intervention. Pain, quality of life, activity limitations and participation restrictions were rarely assessed. the evidence for the effectiveness of interventions to prevent and treat disability due to joint contractures is weak, particularly for established nursing interventions such as positioning and passive movement. Better understanding is required regarding the delivery of interventions, such as their intensity and duration. In addition to functional issues, activities and social participation should also be studied as outcomes.

  13. Cool Flame Quenching

    Science.gov (United States)

    Pearlman, Howard; Chapek, Richard

    2001-01-01

    Cool flame quenching distances are generally presumed to be larger than those associated with hot flames, because the quenching distance scales with the inverse of the flame propagation speed, and cool flame propagation speeds are often times slower than those associated with hot flames. To date, this presumption has never been put to a rigorous test, because unstirred, non-isothermal cool flame studies on Earth are complicated by natural convection. Moreover, the critical Peclet number (Pe) for quenching of cool flames has never been established and may not be the same as that associated with wall quenching due to conduction heat loss in hot flames, Pe approx. = 40-60. The objectives of this ground-based study are to: (1) better understand the role of conduction heat loss and species diffusion on cool flame quenching (i.e., Lewis number effects), (2) determine cool flame quenching distances (i.e, critical Peclet number, Pe) for different experimental parameters and vessel surface pretreatments, and (3) understand the mechanisms that govern the quenching distances in premixtures that support cool flames as well as hot flames induced by spark-ignition. Objective (3) poses a unique fire safety hazard if conditions exist where cool flame quenching distances are smaller than those associated with hot flames. For example, a significant, yet unexplored risk, can occur if a multi-stage ignition (a cool flame that transitions to a hot flame) occurs in a vessel size that is smaller than that associated with the hot quenching distance. To accomplish the above objectives, a variety of hydrocarbon-air mixtures will be tested in a static reactor at elevated temperature in the laboratory (1g). In addition, reactions with chemical induction times that are sufficiently short will be tested aboard NASA's KC-135 microgravity (mu-g) aircraft. The mu-g results will be compared to a numerical model that includes species diffusion, heat conduction, and a skeletal kinetic mechanism

  14. Improvement of the decay heat removal characteristics of the generation IV gas-cooled fast reactor; Amelioration des caracteristiques de la dissipation de la chaleur de decroissance pour les reacteurs a neutrons rapides de quatrieme generation refroidi au gaz

    Energy Technology Data Exchange (ETDEWEB)

    Epiney, A.S.

    2010-09-07

    The main drawback of the GFR is the difficulty to evacuate decay heat following a loss-of-coolant accident (LOCA) due to the low thermal inertia of the core, as well as to the low coolant density. The present doctoral research focuses on the improvement of decay heat removal (DHR) for the Generation-IV GFR. The reference GFR system design considered in the thesis is the 2006 CEA concept, with a power of 2400 MWth. The CEA 2006 DHR strategy foresees, in all accidental cases (independent of the system pressure), that the reactor is shut down. For high pressure events, dedicated DHR loops with blowers and heat exchangers are designed to operate when the power conversion system cannot be used to provide acceptable core temperatures under natural convection conditions. For de-pressurized events, the strategy relies on a dedicated small containment (called the guard containment) providing an intermediate back-up pressure. The DHR blowers, designed to work under these pressure conditions, need to be powered either by the power grid or by batteries for at least 24 hours. The specific contributions of the present research - aimed at achieving enhanced passivity of the DHR system for the GFR - are design and analysis related to (1) the injection of heavy gas into the primary circuit after a LOCA, to enable natural convection cooling at an intermediate-pressure level, and (2) an autonomous Brayton loop to evacuate decay heat at low primary pressure in case of a loss of the guard containment pressure. Both these developments reduce the dependence on blower power availability considerably. First, the thermal-hydraulic codes used in the study - TRACE and CATHARE - are validated for gas cooling. The validation includes benchmark comparisons between the codes, serving to identify the sensitivity of the results to the different modeling assumptions. The parameters found to be the most sensitive in this analysis, such as heat transfer and friction models, are then validated via a

  15. Prevalence of Peyronie's Disease-Like Symptoms in Men Presenting With Dupuytren Contractures.

    Science.gov (United States)

    Shindel, Alan W; Sweet, Genevieve; Thieu, William; Durbin-Johnson, Blythe; Rothschild, Jennifer; Szabo, Robert

    2017-09-01

    Peyronie's disease (PD) and Dupuytren contractures (DC) are often comorbid and are believed to have a similar underlying pathophysiologic mechanism. To investigate the prevalence of PD-like symptoms (PDLS) in men with DC. From October 2013 to December 2016, men who were seen and evaluated for DC were offered the opportunity to participate in an anonymous survey. The survey assessed several basic demographic and sexual health factors and included items from the International Index of Erectile Function and the Erection Hardness Scale. Men who reported PDLS were asked a series of questions derived from the Peyronie's Disease Questionnaire and for their opinions on theoretical treatment modalities for sexual problems and penile deformity. Prevalence of PDLS in men with DC. One hundred forty men with DC were invited to participate; 85 surveys were returned (response rate = 61%). Twenty-two respondents (26%, 95% confidence interval = 17-35) reported PDLS. Approximately one fourth of all respondents had an Erection Hardness Scale score lower than 3. The most common specific PDLS concerns were penile curvature (91%), length loss (55%), narrowing (36%), and hinging (32%). In men with PDLS, 73% felt at least a little bothered by the symptoms when attempting sexual activity and 40% reported having sex less frequently because of the symptoms. Just 27% of men with PDLS had ever used a treatment for a sexual concern. In terms of treatments for penile deformities, 64% of men with PDLS expressed an interest in treatment administered in the form of an in-office procedure; 41% were potentially amenable to a surgical procedure. The prevalence of PDLS in men with DC is similar to the prevalence of DC in men diagnosed with PD. A substantial number of these men have distress and would consider standard-of-care treatments for PD. Shindel AW, Sweet G, Thieu W, et al. Prevalence of Peyronie's Disease-Like Symptoms in Men Presenting With Dupuytren Contractures. Sex Med 2017;5:e135-e141

  16. Fast Quasi-Adiabatic Gas Cooling: An Experiment Revisited

    Science.gov (United States)

    Oss, S.; Gratton, L. M.; Calza, G.; Lopez-Arias, T.

    2012-01-01

    The well-known experiment of the rapid expansion and cooling of the air contained in a bottle is performed with a rapidly responsive, yet very cheap thermometer. The adiabatic, low temperature limit is approached quite closely and measured with our apparatus. A straightforward theoretical model for this process is also presented and discussed.…

  17. Furnace for rapid thermal processing

    NARCIS (Netherlands)

    Roozeboom, F.; Duine, P.A.; Sluis, P. van der

    2001-01-01

    A Method (1) for Rapid Thermal Processing of a wafer (7), wherein the wafer (7) is heated by lamps (9), and the heat radiation is reflected by an optical switching device (15,17) which is in the reflecting state during the heating stage. During the cooling stage of the wafer (7), the heat is

  18. Palmar crease release and secondary full-thickness skin grafts for contractures in primary full-thickness skin grafts during growth spurts in pediatric palmar hand burns.

    Science.gov (United States)

    Oh, Suk-Joon; Kim, Seon Gyu; Cho, Jin Kyung; Sung, Chang Min

    2014-01-01

    Pediatric palmar hand burns are a difficult problem because of the serious hand deformity, with functional impairment resulting from rapid growth. In cases of severe pediatric palmar hand burns, a secondary full-thickness skin graft after a primary full-thickness skin graft offers a reliable way of obtaining the required functional and aesthetic outcomes.This study retrospectively evaluated 28 children who required palmar crease releases and secondary full-thickness skin grafts during the past 12 years. The case records were reviewed for sex and age distributions, injury mechanism, and time interval between the primary and secondary full-thickness skin grafts. Surgical procedures included secondary full-thickness skin grafts and incisional releases of grafted skin on the involved creases. There were 19 men and 9 women. The mean age at the time of the burn injury was 10.1 months (range, 5-19 months). The mean age at the time of the secondary full-thickness skin graft was 8.3 years (range, 3-17 years). The most common mechanism of burn injury was steam (n = 24). The median time interval from the primary to the secondary full-thickness skin graft was 67 months (range, 8-156 months). The number of released creases was 81. The number of palmar web contractures in 23 patients was 52. A secondary full-thickness skin graft was more frequently necessary in patients with a primary full-thickness skin graft in the proximal digital crease and palmar web areas. All patients achieved adequate digital length and palmar web contour after surgery. Our patients should be observed until the rapid pubertal growth period.

  19. Cool WISPs for stellar cooling excesses

    Science.gov (United States)

    Giannotti, Maurizio; Irastorza, Igor; Redondo, Javier; Ringwald, Andreas

    2016-05-01

    Several stellar systems (white dwarfs, red giants, horizontal branch stars and possibly the neutron star in the supernova remnant Cassiopeia A) show a mild preference for a non-standard cooling mechanism when compared with theoretical models. This exotic cooling could be provided by Weakly Interacting Slim Particles (WISPs), produced in the hot cores and abandoning the star unimpeded, contributing directly to the energy loss. Taken individually, these excesses do not show a strong statistical weight. However, if one mechanism could consistently explain several of them, the hint could be significant. We analyze the hints in terms of neutrino anomalous magnetic moments, minicharged particles, hidden photons and axion-like particles (ALPs). Among them, the ALP or a massless HP represent the best solution. Interestingly, the hinted ALP parameter space is accessible to the next generation proposed ALP searches, such as ALPS II and IAXO and the massless HP requires a multi TeV energy scale of new physics that might be accessible at the LHC.

  20. Solenoidal ionization cooling lattices

    Directory of Open Access Journals (Sweden)

    R. C. Fernow

    2007-06-01

    Full Text Available We explore a practical approach for designing ionization cooling channels with periodic solenoidal focusing. We examine the lattice characteristics in terms of the properties of the coils and the cell geometry. The peak magnetic field in the coils is an important engineering constraint in lattice design. We examine the dependence of the peak field, momentum passband locations, and the beta function on the coil parameters. We make a systematic examination of all allowed lattice configurations taking into account the symmetry properties of the current densities and the beta function. We introduce a unique classification for comparing cooling lattice configurations. While solutions with a single coil per cell illustrate most of the effects that are important for cooling channel design, the introduction of additional coils allows more flexibility in selecting the lattice properties. We look at example solutions for the problem of the initial transverse cooling stage of a neutrino factory or muon collider and compare our results with the properties of some published cooling lattice designs. Scaling laws are used to compare solutions from different symmetry classes.

  1. Beals syndrome (congenital contractural arachnodactyly in children: Clinical symptoms, diagnosis, treatment, and prevention

    Directory of Open Access Journals (Sweden)

    A. N. Semyachkina

    2016-01-01

    Full Text Available The paper deals with a rare monogenic connective tissue disease from a group of fibrillinopathies with autosomal dominant inheritance — Beals syndrome caused by a mutation in the FBN2 gene. Attention is drawn to the high phenotypic similarity of this disease and Marfan syndrome (FBN1 gene mutation, which is associated with the almost complete identity of two proteins: fibrillin 1 and fibrillin 2.The paper describes a clinical case of a child with Beals syndrome and the typical manifestations of the disease: asthenic constitution, arachnodactyly of the hands and feet, congenital contractures of the large and small joints, chest deformity, kyphoscoliosis, talpes, and crushed ears. The investigators made a differential diagnosis with other connective tissue diseases, such as Marfan syndrome, Stickler syndrome, Ehlers–Danlos syndrome, homocystenuria, and arthrogryposis. DNA diagnosis verified the Beals syndrome in the proband. Exon 28 in the FBN2 gene showed the previously undescribed missense mutation of c.3719G>A, resulting in the amino acid substitution of cysteine for tyrosine (p.Cys1240Tyr in the structure of the protein fibrillin 2. A de novo mutation occurred. There is evidence for its pathogenicity in the development of the clinical symptoms of the disease. The problems of effective medical genetic counseling in this family are discussed. 

  2. Knee flexion contracture treated with botulinum toxin type A in patients with haemophilia (PWH).

    Science.gov (United States)

    Daffunchio, C; Caviglia, H; Nassif, J; Morettil, N; Galatro, G

    2016-01-01

    Knee flexion contracture (KFC) remains a common complication of haemoarthrosis in children and young adults with haemophilia. If the KFC is not treated properly it produces disability, postural and gait abnormalities. Evaluate the effectiveness of conservative treatment of KFC with Botulinum toxin type A (BTX-A) in PWH. Seventeen patients were treated, with 21 affected knees. Mean age was 26 years. The mean follow up was 12 months. We evaluated flexion and KFC pretreatment BTX-A and up to 12 months posttreatment. BTX-A application was in hamstring and calf muscles. To evaluate the function, a questionnaire about different activities was made, and it was checked 3, 6 and 12 months after BTX-A. According to the degree of KFC, knees were divided into 3 groups: Group 1: -10° to -30° (n = 10), Group 2: -31° to -45° (n = 6) Group 3: -46° or more (n = 5). The average KFC improved from -38° to -24°. The improvement was 14° (P < 0.001). The average KFC improvement was 9° in group 1, 17° in group 2, and 23° in group 3. There was a high correlation between the improvement in KFC and the total score of the questionnaire R = 0.77. Treatment of KFC with BTX-A improves knee-related functional activities, with the advantage of being a low-cost procedure and easy to apply. © 2015 John Wiley & Sons Ltd.

  3. Acquired deforming hypertonia and contractures in elderly subjects: definition and prevalence in geriatric institutions (ADH survey).

    Science.gov (United States)

    Dehail, P; Simon, O; Godard, A L; Faucher, N; Coulomb, Y; Schnitzler, A; Denormandie, P; Jeandel, C

    2014-02-01

    By proposing a new terminology (acquired deforming hypertonia or ADH) and a new definition for contractures, the main objective of this study was to establish their prevalence among institutionalized elderly patients. Secondary objectives were to analyze the negative impact of ADH and collect the opinions of clinicians on the possible treatments available. A multicenter cross-sectional study was conducted among residents of 39 geriatric institutions (29 EHPAD and 10 USLD). All subjects presenting at least one ADH were surveyed over a one-week period. Among 3145 observed patients (mean age 88.9±9.7 years) 22% (n=692) presented at least one ADH. In average, each patient presented 4.4±3.2 ADHs. Negative consequences on self-care, nursing and difficulties in getting dressed were most frequently observed. Only 25.4% of clinicians considered the ADH to be potentially reversible. Physical therapy was the therapeutic option most frequently chosen over medication and surgery. This study confirms the important prevalence of ADH among elderly institutionalized patients. Consequences on the level of dependence were significant. It seems relevant to elaborate hierarchical therapeutic strategies in order to counter these disorders and the fatalism that ensues. Copyright © 2013. Published by Elsevier Masson SAS.

  4. Intensive swallowing and orofacial contracture rehabilitation after severe burn: A pilot study and literature review.

    Science.gov (United States)

    Clayton, Nicola A; Ward, Elizabeth C; Maitz, Peter K

    2017-02-01

    Dysphagia following severe burns can be significant and protracted, yet there is little evidence describing the rehabilitation principles, process or outcomes. Outline current evidence and detail the clinical outcomes of two cases who underwent a multifaceted intensive treatment programme aimed at rehabilitating dysphagia by strengthening swallow function and minimising orofacial contractures after severe head and neck burns. Two men (54 and 18 years) with full-thickness head and neck burns and inhalation injury underwent intensive orofacial scar management and dysphagia rehabilitation. Therapy was prescribed, consisting of scar stretching, splinting and pharyngeal swallow tasks. Horizontal and vertical range of movement (HROM; VROM), physiological swallow features, functional swallowing outcomes and related distress, were collected at baseline and routinely until dysphagia resolution and scar stabilisation. At presentation, both cases demonstrated severely reduced HROM and VROM, profound dysphagia and moderate dysphagia related distress. Therapy adherence was high. Resolution of dysphagia to full oral diet, nil physiological swallowing impairment, and nil dysphagia related distress was achieved by 222 and 77 days post injury respectively. VROM and HROM achieved normal range by 237 and 204 days. Active rehabilitation achieved full functional outcomes for swallowing and orofacial range of movement. A protracted duration of therapy can be anticipated in this complex population. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  5. Capsular contracture by silicone breast implants: possible causes, biocompatibility, and prophylactic strategies

    Directory of Open Access Journals (Sweden)

    Steiert AE

    2013-12-01

    Full Text Available Andreas E Steiert, Maria Boyce, Heiko Sorg Department of Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany Abstract: The most common implanted material in the human body consists of silicone. Breast augmentation and breast reconstruction using silicone-based implants are procedures frequently performed by reconstructive and aesthetic surgeons. A main complication of this procedure continues to be the development of capsular contracture (CC, displaying the result of a fibrotic foreign body reaction after the implantation of silicone. For many years, experimental and clinical trials have attempted to analyze the problem of its etiology, treatment, and prophylaxis. Different theories of CC formation are known; however, the reason why different individuals develop CC in days or a month, or only after years, is unknown. Therefore, we hypothesize that CC formation, might primarily be induced by immunological mechanisms along with other reasons. This article attempts to review CC formation, with special attention paid to immunological and inflammatory reasons, as well as actual prophylactic strategies. In this context, the word “biocompatibility” has been frequently used to describe the overall biological innocuousness of silicone in the respective studies, although without clear-cut definitions of this important feature. We have therefore developed a new five-point scale with distinct key points of biocompatibility. Hence, this article might provide the basis for ongoing discussion in this field to reduce single-publication definitions as well as increase the understanding of biocompatibility. Keywords: biofilm, foreign body reaction, breast augmentation, biocompatibility, fibrosis

  6. Nociception contributes to the formation of myogenic contracture in the early phase of adjuvant-induced arthritis in a rat knee.

    Science.gov (United States)

    Kaneguchi, Akinori; Ozawa, Junya; Moriyama, Hideki; Yamaoka, Kaoru

    2017-07-01

    It is unknown how joint contracture is generated in inflamed joints. This study aimed to clarify the role of nociception on the formation of joint contracture secondary to arthritis. Monoarthritis was induced by intra-articular injections of complete Freund's adjuvant (CFA) into rat knees. On day 5 after CFA injection, the passive extension range of motion (ROM) of knee joints were measured, both before and after myotomy of knee flexors, to evaluate the extent of muscular contribution to CFA-induced joint contracture. The steroidal anti-inflammatory drug dexamethasone could prevent ROM restrictions completely, both before and after myotomy. On the other hand, the opioid analgesic drug morphine did not prevent the development of restricted ROM observed after myotomy, while it did before myotomy. This indicates that nociception contributes to joint contracture through alterations in muscular structure (myogenic factors). Next, we tested the hypothesis that nociception-induced reflexive flexor muscle contractions cause myogenic contracture in arthritic joints. To do this, chemical denervation was performed by Botulinum toxin type A (BTX-A) injections into knee flexor muscles, simultaneously with CFA injections into the knee. As expected, BTX-A could alleviate ROM restrictions observed before myotomy. These findings suggest that nociceptive-related muscle contractions play an essential role in the formation of joint contracture. Thus, our study indicates that analgesic management during an early stage of joint arthritis is an essential mean to prevent the formation of joint contracture. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1404-1413, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  7. Monitoring Cray Cooling Systems

    Energy Technology Data Exchange (ETDEWEB)

    Maxwell, Don E [ORNL; Ezell, Matthew A [ORNL; Becklehimer, Jeff [Cray, Inc.; Donovan, Matthew J [ORNL; Layton, Christopher C [ORNL

    2014-01-01

    While sites generally have systems in place to monitor the health of Cray computers themselves, often the cooling systems are ignored until a computer failure requires investigation into the source of the failure. The Liebert XDP units used to cool the Cray XE/XK models as well as the Cray proprietary cooling system used for the Cray XC30 models provide data useful for health monitoring. Unfortunately, this valuable information is often available only to custom solutions not accessible by a center-wide monitoring system or is simply ignored entirely. In this paper, methods and tools used to harvest the monitoring data available are discussed, and the implementation needed to integrate the data into a center-wide monitoring system at the Oak Ridge National Laboratory is provided.

  8. Muon ionization cooling experiment

    CERN Multimedia

    CERN. Geneva

    2003-01-01

    A neutrino factory based on a muon storage ring is the ultimate tool for studies of neutrino oscillations, including possibly leptonic CP violation. It is also the first step towards muon colliders. The performance of this new and promising line of accelerators relies heavily on the concept of ionisation cooling of minimum ionising muons, for which much R&D is required. The concept of a muon ionisation cooling experiment has been extensively studied and first steps are now being taken towards its realisation by a joint international team of accelerator and particle physicists. The aim of the workshop is to to explore at least two versions of an experiment based on existing cooling channel designs. If such an experiment is feasible, one shall then select, on the basis of effectiveness, simplicity, availability of components and overall cost, a design for the proposed experiment, and assemble the elements necessary to the presentation of a proposal. Please see workshop website.

  9. ELECTRON COOLING FOR RHIC.

    Energy Technology Data Exchange (ETDEWEB)

    BEN-ZVI,I.; AHRENS,L.; BRENNAN,M.; HARRISON,M.; KEWISCH,J.; MACKAY,W.; PEGGS,S.; ROSER,T.; SATOGATA,T.; TRBOJEVIC,D.; YAKIMENKO,V.

    2001-06-18

    We introduce plans for electron-cooling of the Relativistic Heavy Ion Collider (RHIC). This project has a number of new features as electron coolers go: It will cool 100 GeV/nucleon ions with 50 MeV electrons; it will be the first attempt to cool a collider at storage-energy; and it will be the first cooler to use a bunched beam and a linear accelerator as the electron source. The linac will be superconducting with energy recovery. The electron source will be based on a photocathode gun. The project is carried out by the Collider-Accelerator Department at BNL in collaboration with the Budker Institute of Nuclear Physics.

  10. Improvement of Cooling Technology through Atmosphere Gas Management

    Energy Technology Data Exchange (ETDEWEB)

    Renard, Michel; Dosogne, Edgaar; Crutzen, Jean Pierre; Raick, Jean Mare [DREVER INTERNATIONAL S.A., Liege (Belgium); Ji, Ma Jia; Jun, Lv; Zhi, Ma Bing [SHOUGANG Cold Rolling Mill Headquarter, Beijin (China)

    2009-12-15

    The production of advanced high strength steels requires the improvement of cooling technology. The use of high cooling rates allows relatively low levels of expensive alloying additions to ensure sufficient hardenability. In classical annealing and hot-dip galvanizing lines a mixing station is used to provide atmosphere gas containing 3-5% hydrogen and 97-95% nitrogen in the various sections of the furnace, including the rapid cooling section. Heat exchange enhancement in this cooling section can be insured by the increased hydrogen concentration. Driver international developed a patented improvement of cooling technology based on the following features: pure hydrogen gas is injected only in the rapid cooling section whereas the different sections of the furnace are supplied with pure nitrogen gas: the control of flows through atmosphere gas management allows to get high hydrogen concentration in cooling section and low hydrogen content in the other furnace zones. This cooling technology development insures higher cooling rates without additional expensive hydrogen gas consumption and without the use of complex sealing equipment between zones. In addition reduction in electrical energy consumption is obtained. This atmosphere control development can be combined with geometrical design improvements in order to get optimised cooling technology providing high cooling rates as well as reduced strip vibration amplitudes. Extensive validation of theoretical research has been conducted on industrial lines. New lines as well as existing lines, with limited modifications, can be equipped with this new development. Up to now this technology has successfully been implemented on 6 existing and 7 new lines in Europe and Asia.

  11. How cool is Uchimizu?

    Science.gov (United States)

    Solcerova, Anna; van Emmerik, Tim; Hilgersom, Koen; van de Ven, Frans; van de Giesen, Nick

    2017-04-01

    The Urban Heat Island (UHI) was first described 200 years ago, but ways to mitigate heat in urban areas reach much further into the past. Uchimizu is a 17th century Japanese tradition, in which water is sprinkled around houses, temples, and in gardens to cool the ground surface and the air, and to settle the dust. Nowadays, megacities such as Tokyo are aiming to revive the - by modern technology suppressed - method, and uchimizu is promoted by local authorities as a "clever way to feel cool". Unfortunately, the number of published studies that have quantified the cooling effects of uchimizu is limited, and only uses measurements of the surface temperature, or air temperature at a single height, as a measure of the cooling effect. In this research a dense 3D Distributed Temperature Sensing (DTS) setup was used to measure air temperature within once cubic meter of air above an urban surface with high spatial and temporal resolution. Six experiments were performed to systematically study the effect of (1) applied water amount, (2) initial surface temperature, and (3) shading on the cooling effect of uchimizu. We present the results and the subsequent analyses of these experiments, done during summer in Delft, The Netherlands. We show that this simple water sprinkling method has the potential to decrease extreme temperatures in impervious and paved parts of urban areas considerably. Besides mitigating the UHI, uchimizu practice is also an opportunity to increase awareness among citizens, and stimulate citizen participation in solving heat stress problems and energy saving. By providing refreshing insights on the cooling effect of uchimizu, we aim to contribute to the modern revival of this old tradition.

  12. Superconductor rotor cooling system

    Science.gov (United States)

    Gamble, Bruce B.; Sidi-Yekhlef, Ahmed; Schwall, Robert E.; Driscoll, David I.; Shoykhet, Boris A.

    2002-01-01

    A system for cooling a superconductor device includes a cryocooler located in a stationary reference frame and a closed circulation system external to the cryocooler. The closed circulation system interfaces the stationary reference frame with a rotating reference frame in which the superconductor device is located. A method of cooling a superconductor device includes locating a cryocooler in a stationary reference frame, and transferring heat from a superconductor device located in a rotating reference frame to the cryocooler through a closed circulation system external to the cryocooler. The closed circulation system interfaces the stationary reference frame with the rotating reference frame.

  13. Elementary stochastic cooling

    Energy Technology Data Exchange (ETDEWEB)

    Tollestrup, A.V.; Dugan, G

    1983-12-01

    Major headings in this review include: proton sources; antiproton production; antiproton sources and Liouville, the role of the Debuncher; transverse stochastic cooling, time domain; the accumulator; frequency domain; pickups and kickers; Fokker-Planck equation; calculation of constants in the Fokker-Planck equation; and beam feedback. (GHT)

  14. Measure Guideline: Ventilation Cooling

    Energy Technology Data Exchange (ETDEWEB)

    Springer, D. [Alliance for Residential Building Innovation (ARBI), David, CA (United States); Dakin, B. [Alliance for Residential Building Innovation (ARBI), David, CA (United States); German, A. [Alliance for Residential Building Innovation (ARBI), David, CA (United States)

    2012-04-01

    The purpose of this measure guideline is to provide information on a cost-effective solution for reducing cooling system energy and demand in homes located in hot-dry and cold-dry climates. This guideline provides a prescriptive approach that outlines qualification criteria, selection considerations, and design and installation procedures.

  15. Cooling of Neutron Stars

    Directory of Open Access Journals (Sweden)

    Grigorian H.

    2010-10-01

    Full Text Available We introduce the theoretical basis for modeling the cooling evolution of compact stars starting from Boltzmann equations in curved space-time. We open a discussion on observational verification of different neutron star models by consistent statistics. Particular interest has the question of existence of quark matter deep inside of compact object, which has to have a specific influence on the cooling history of the star. Besides of consideration of several constraints and features of cooling evolution, which are susceptible of being critical for internal structure of hot compact stars we have introduced a method of extraction of the mass distribution of the neutron stars from temperature and age data. The resulting mass distribution has been compared with the one suggested by supernove simulations. This method can be considered as an additional checking tool for the consistency of theoretical modeling of neutron stars. We conclude that the cooling data allowed existence of neutron stars with quark cores even with one-flavor quark matter.

  16. ELECTRON COOLING FOR RHIC.

    Energy Technology Data Exchange (ETDEWEB)

    BEN-ZVI,I.

    2001-05-13

    The Accelerator Collider Department (CAD) at Brookhaven National Laboratory is operating the Relativistic Heavy Ion Collider (RHIC), which includes the dual-ring, 3.834 km circumference superconducting collider and the venerable AGS as the last part of the RHIC injection chain. CAD is planning on a luminosity upgrade of the machine under the designation RHIC II. One important component of the RHIC II upgrade is electron cooling of RHIC gold ion beams. For this purpose, BNL and the Budker Institute of Nuclear Physics in Novosibirsk entered into a collaboration aimed initially at the development of the electron cooling conceptual design, resolution of technical issues, and finally extend the collaboration towards the construction and commissioning of the cooler. Many of the results presented in this paper are derived from the Electron Cooling for RHIC Design Report [1], produced by the, BINP team within the framework of this collaboration. BNL is also collaborating with Fermi National Laboratory, Thomas Jefferson National Accelerator Facility and the University of Indiana on various aspects of electron cooling.

  17. Effect of pERK2 on extracellular matrix turnover of the fibrotic joint capsule in a post-traumatic joint contracture model.

    Science.gov (United States)

    Sun, Yangbai; Li, Fengfeng; Fan, Cunyi

    2016-02-01

    Lentivirus (LV)-mediated extracellular signal-regulated kinase (ERK)2 small interfering RNA (siRNA) has previously been demonstrated to reduce post-traumatic joint contractures: In the present study, the effect of ERK2 siRNA on extracellular matrix turnover within fibrotic joint capsules in post-traumatic joint contractures was examined. Rats were randomly assigned to one of three groups as follows: The non-operated control (CON), operated contracture (ORC) and contracture-treatment (CNT) groups. Representative post-traumatic joint contracture was created through 8 weeks of immobilization following intra-articular injury. In the CNT group, LV-mediated ERK2 siRNA was injected into the model knee at days 3 and 7 after surgery. The posterior joint capsule was examined by western blotting, histology and immunohistochemistry to evaluate alterations in ERK2, phosphorylated (p)ERK2, total collagen, collagen I, collagen III, matrix metalloproteinase (MMP)-1, MMP-13 and tissue inhibitor of metalloproteinase (TIMP)-13. In the ORC group, pERK2 was elevated and total collagen, collagen I, MMP-1 and MMP-13 were significantly increased (Pmatrix turnover can be affected by pERK2.

  18. Chaperonin containing T-complex polypeptide subunit eta is a potential marker of joint contracture: an experimental study in the rat.

    Science.gov (United States)

    He, Ronghan; Wang, Zhe; Lu, Yunxiang; Huang, Junqi; Ren, Jianhua; Wang, Kun

    2015-11-01

    Joint contracture is a fibroproliferative disorder that restricts joint mobility, resulting in tissue degeneration and deformity. However, the etiology of joint contracture is still unknown. Chaperonin containing T-complex polypeptide subunit eta (CCT-eta) is reported to increase in fibrotic diseases. The purpose of this study was to investigate whether CCT-eta is implicated in joint contracture and to determine the role of CCT-eta in the progression of joint contracture by analyzing a rat model. We immobilized the left knee joint of rat by internal fixation for 8 weeks. The non-immobilized right leg served as a control. The range of motion (ROM) of the knee was investigated. Fibroblasts were obtained from the posterior joint capsule of the joints. The outcome was followed by quantitative real-time polymerase chain reaction (qRT-PCR), Western blot, fibroblast migration assay, and collagen assay. The effect of CCT-eta on the functions of fibroblasts was observed by utilizing a short inhibitory RNA (siRNA) targeting CCT-eta. The ROM of the immobilized joints was significantly limited compared to the contralateral joints (p contracture disease.

  19. Electron Cooling Study for MEIC

    Energy Technology Data Exchange (ETDEWEB)

    He, Zhang [Jefferson Lab., Newport News, VA (United States); Douglas, David R. [Jefferson Lab., Newport News, VA (United States); Derbenev, Yaroslav S. [Jefferson Lab., Newport News, VA (United States); Zhang, Yuhong [Jefferson Lab., Newport News, VA (United States)

    2015-09-01

    Electron cooling of the ion beams is one critical R&D to achieve high luminosities in JLab's MEIC proposal. In the present MEIC design, a multi-staged cooling scheme is adapted, which includes DC electron cooling in the booster ring and bunched beam electron cooling in the collider ring at both the injection energy and the collision energy. We explored the feasibility of using both magnetized and non-magnetized electron beam for cooling, and concluded that a magnetized electron beam is necessary. Electron cooling simulation results for the newly updated MEIC design is also presented.

  20. Retrograde Renal Cooling to Minimize Ischemia

    Directory of Open Access Journals (Sweden)

    Janet L. Colli

    2013-01-01

    Full Text Available Objective: During partial nephrectomy, renal hypothermia has been shown to decrease ischemia induced renal damage which occurs from renal hilar clamping. In this study we investigate the infusion rate required to safely cool the entire renal unit in a porcine model using retrograde irrigation of iced saline via dual-lumen ureteral catheter. Materials and Methods: Renal cortical, renal medullary, bowel and rectal temperatures during retrograde cooling in a laparoscopic porcine model were monitored in six renal units. Iced normal saline was infused at 300 cc/hour, 600 cc/hour, 1000 cc/hour and gravity (800 cc/hour for 600 seconds with and without hilar clamping. Results: Retrograde cooling with hilar clamping provided rapid medullary renal cooling and significant hypothermia of the medulla and cortex at infusion rates ≥ 600 cc/hour. With hilar clamping, cortical temperatures decreased at -0.9° C/min. reaching a threshold temperature of 26.9° C, and medullary temperatures decreased at -0.90 C/min. reaching a temperature of 26.1° C over 600 seconds on average for combined data at infusion rates ≥ 600 cc/hour. The lowest renal temperatures were achieved with gravity infusion. Without renal hilum clamping, retrograde cooling was minimal at all infusion rates. Conclusions: Significant renal cooling by gravity infusion of iced cold saline via a duel lumen catheter with a clamped renal hilum was achieved in a porcine model. Continuous retrograde irrigation with iced saline via a two way ureteral catheter may be an effective method to induce renal hypothermia in patients undergoing robotic assisted and/or laparoscopic partial nephrectomy.

  1. Knee flexion contractures in institutionalized elderly: prevalence, severity, stability, and related variables.

    Science.gov (United States)

    Mollinger, L A; Steffen, T M

    1993-07-01

    The purpose of this study was to document the prevalence, severity, and progression of knee flexion contractures (KFCs) in a population of institutionalized elderly and to identify relationships between knee extension and other variables. The subjects were 112 nursing home residents who exhibited a broad range of ambulation and cognitive function abilities. Data were collected initially (T1) and after a 10-month period (T2). Only 25% of the population had extension in the 0- to 5-degree (lacking full extension) range bilaterally at T1 and T2, leaving the majority of subjects with some degree of unilateral KFC. Most of the subjects with a KFC greater than 20 degrees were nonambulatory and had a significantly higher occurrence of resistance to motion than did nonambulators with a KFC of less than 20 degrees. Knee extension measurements did not change in most subjects between T1 and T2. The knees that did show a change in KFC (either an increase or a decrease) had a significantly higher occurrence of resistance to passive motion than did other knees. Compared with the subjects who gained extension, the subjects who lost extension over the study period more frequently had minimal KFC at T1, were ambulatory at T1, showed a regression in ambulation at T2, and developed resistance to motion at T2. The data confirmed significant positive correlations between degree of KFC and presence of resistance to passive knee motion, cognitive impairment, impaired ambulation, and presence of knee pain. Physical therapy assessment and intervention may be appropriate in nonambulatory nursing home residents with resistance to passive motion, residents with KFC approaching 20 degrees, and ambulatory residents with minimal KFC who develop resistance and begin to regress in ambulation. Several areas for future study are suggested.

  2. Hand function and quality of life before and after fasciectomy for Dupuytren contracture.

    Science.gov (United States)

    Engstrand, Christina; Krevers, Barbro; Nylander, Göran; Kvist, Joanna

    2014-07-01

    To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease. This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60° or more from Dupuytren contracture were included. Outcomes measures were range of motion; sensibility; scar pliability; self-reported outcomes on expectations, recovery, and satisfaction with hand function; Disabilities of the Arm, Shoulder, and Hand scores; safety and social issues of hand function; physical activity habits; and quality of life with the Euroqol. The extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months, 32% considered hand function as fully recovered, and 73% were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder, and Hand score and the Euroqol improved over time. After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Dupuytren contracture recurrence project: reaching consensus on a definition of recurrence.

    Science.gov (United States)

    Felici, N; Marcoccio, I; Giunta, R; Haerle, M; Leclercq, C; Pajardi, G; Wilbrand, S; Georgescu, A V; Pess, G

    2014-12-01

    The aim of this study was to determine a definition of recurrence of Dupuytren disease that could be utilized for the comparison of the results independently from the treatment used. 24 hand surgeons from 17 countries met in an international consensus conference. The participants used the Delphi method to evaluate a series of statements: (1) the need for defining recurrence, (2) the concept of recurrence applied to the Tubiana staging system, (3) the concept of recurrence applied to each single treated joint, and (4) the concept of recurrence applied to the finger ray. For each item, the possible answer was given on a scale of 1-5: 1=maximum disagreement; 2=disagreement; 3=agreement; 4=strong agreement; 5=absolute agreement. There was consensus on disagreement if 1 and 2 comprised at least 66% of the recorded answers and consensus on agreement if 3, 4 and 5 comprised at least 66% of the recorded answers. If a threshold of 66% was not reached, the related statement was considered "not defined". A need for a definition of recurrence was established. The presence of nodules or cords without finger contracture was not considered an indication of recurrence. The Tubiana staging system was considered inappropriate for reporting recurrence. Recurrence was best determined by the measurement of a specific joint, rather than a total ray. Time 0 occurred between 6 weeks and 3 months. Recurrence was defined as a PED of more than 20° for at least one of treated joint, in the presence of a palpable cord, compared to the result obtained at time 0. This study determined the need for a standard definition of recurrence and reached consensus on that definition, which we should become the standard for the reporting of recurrence. If utilized in subsequent publications, this will allow surgeons to compare different techniques and make is easier to help patients make an informed choice. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Effects of joint immobilization on changes in myofibroblasts and collagen in the rat knee contracture model.

    Science.gov (United States)

    Sasabe, Ryo; Sakamoto, Junya; Goto, Kyo; Honda, Yuichiro; Kataoka, Hideki; Nakano, Jiro; Origuchi, Tomoki; Endo, Daisuke; Koji, Takehiko; Okita, Minoru

    2017-09-01

    The purpose of this study was to examine the time-dependent changes in the development of joint capsule fibrosis and in the number of myofibroblasts in the joint capsule after immobilization, using a rat knee contracture model. Both knee joints were fixed in full flexion for 1, 2, and 4 weeks (immobilization group). Untreated rats were bred for each immobilization period (control group). Histological analysis was performed to evaluate changes in the amount and density of collagen in the joint capsule. The changes in type I and III collagen mRNA were examined by in situ hybridization. The number of myofibroblasts in the joint capsule was assessed by immunohistochemical methods. In the immobilization group, the amount of collagen increased within 1 week and the density of collagen increased within 2 weeks, as compared with that in the control group. Type I collagen mRNA-positive cell numbers in the immobilization group increased at all time points. However, type III collagen mRNA-positive cell numbers did not increase. Myofibroblasts in the immobilization group significantly increased compared with those in the control group at all time points, and they increased significantly with the period of immobilization. These results suggest that joint capsule fibrosis with overexpression of type I collagen occurs and progresses within 1 week after immobilization, and an increase in myofibroblasts is related to the mechanism of joint capsule fibrosis. The findings suggest the need for a treatment targeting accumulation of type I collagen associated with an increase in myofibroblasts. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1998-2006, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  5. Transurethral front-firing Greenlight bladder autoaugmentation for bladder contracture: technique and clinical outcomes.

    Science.gov (United States)

    Bao, Ji-Ming; Tan, Wan-Long; Wang, Bing-Wei; Qiu, Xiao-Fu; Liu, Bai-Chuan; Zhong, Rui-Lun; Li, Gao-Yuan; Yang, Guo-Sheng

    2016-04-01

    To describe a novel transurethral front-firing Greenlight bladder autoaugmentation for the treatment of bladder contracture and report initial clinical outcomes. Between April 2014 and August 2015, five patients diagnosed with contracted bladder were all refractory to conservative treatment and received novel transurethral autoaugmentation. CT scan and urodynamics examination were conducted before operation for disease assessment. Mucosal and muscular layers of bladder wall in fundus were incised vertically and horizontally with front-firing Greenlight laser to enlarge bladder capacity in the operation. Imaging examination and periodical urodynamics study were performed to evaluate the clinical outcomes of the procedure in postoperative follow-up. Transurethral front-firing Greenlight bladder autoaugmentation was performed successfully on all the patients. The mean operative time was 59 min (range 52-65 min) with no significant blood loss. Urodynamic parameters of these patients after operation improved significantly compared with those before operation. Average maximum cystometric capacity (Vmax) increased from 91.2 to 333 ml (p < 0.01), average maximum flow rate (Qmax) ascended from 12.6 to 18.62 ml/min (p < 0.01), and average flow rate (Q(ave)) also increased from 5.74 to 13.18 ml/min (p < 0.01). At the last follow-up, all the patients could void spontaneously with good bladder emptying and their symptoms improved significantly. Our novel transurethral front-firing Greenlight bladder autoaugmentation is a safe and effective treatment for contracted bladders. Future studies with larger sample size and long-term follow-up are needed to confirm our findings.

  6. Sorption cooling: a valid extension to passive cooling

    NARCIS (Netherlands)

    Doornink, D.J.; Burger, Johannes Faas; ter Brake, Hermanus J.M.

    2008-01-01

    Passive cooling has shown to be a very dependable cryogenic cooling method for space missions. Several missions employ passive radiators to cool down their delicate sensor systems for many years, without consuming power, without exporting vibrations or producing electromagnetic interference. So for

  7. Comments on Ionization Cooling Channel Characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Neuffer, David [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States). Fermilab Center for Particle Astrophysics

    2013-12-04

    Ionization cooling channels with a wide variety of characteristics and cooling properties are being developed. These channels can produce cooling performances that are largely consistent with the ionization cooling theory developed previously. In this paper we review ionization cooling theory, discuss its application to presently developing cooling channels, and discuss criteria for optimizing cooling.

  8. Intra- and inter-observer agreement on diagnosis of Dupuytren disease, measurements of severity of contracture, and disease extent.

    Science.gov (United States)

    Broekstra, Dieuwke C; Lanting, Rosanne; Werker, Paul M N; van den Heuvel, Edwin R

    2015-08-01

    Dupuytren disease (DD) is a fibrosing disease affecting the palmar aponeurosis, and is mostly treated by surgery based on measurement of severity of flexion contracture of the fingers. Literature concerning the measurement reliability is scarce. This study aimed to determine the intra- and inter-observer agreement of four variables for diagnosing DD, determining severity of contracture, and disease extent. One of them is a new measurement on the area of nodules and cords for measuring the disease extent in early disease stages. An agreement study (n = 54) was performed by two trained investigators. Agreement was calculated per finger, based on an intraclass correlation coefficient (ICC) using a latent variable model on subjects for diagnosis and Tubiana stage. For total passive extension deficit (TPED) and the area of nodules and cords, agreement was calculated with an ICC using a one-way random effects model with subject as random effect. Inter-observer agreement was very good for diagnosing DD (ICC: 95.5%-99.9%) and good to very good for classifying Tubiana stage (ICC: 73.5%-94.9%). Agreements for area and TPED were moderate (middle finger) to very good (ICC: 48.4%-98.6% and 45.0%-99.5%, respectively). Intra-observer agreement was slightly higher on average than inter-observer agreement. Overall, the intra- and inter-observer agreement in diagnosing DD, and determining the severity of flexion contracture is high. Also, the newly introduced variable area of nodules and cords has high intra- and inter-observer agreement, indicating that it is suitable to measure disease extent. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Clinical and impression cytology findings of amniotic membrane and oral mucosal membrane transplantation for the management of socket contracture.

    Science.gov (United States)

    Kurtul, Bengi Ece; Erdener, Ugur; Mocan, Mehmet Cem; Irkec, Murat; Orhan, Mehmet

    2014-01-01

    To investigate and compare the cytopathological and clinical effects of amniotic membrane transplantation (AMT) and oral mucosal membrane transplantation (OMMT) in socket contraction. Twelve patients who could not be fitted with ocular prosthesis due to socket contracture were included in this study. Seven patients underwent AMT and 5 patients underwent OMMT. Thirteen patients who had healthy sockets were included as control group. Depth of inferior fornix, degree of inflammation, extent of the socket contracture and socket volume were measured in the preoperative period and at sixth and twelfth weeks postoperatively. Impression cytology of conjunctival fornices and tear transforming growth factor beta-1 (TGFβ1) levels were determined. In the AMT group, socket volume and lower fornix depth values were significantly higher (P=0.030 and P=0.004 respectively) and inflammation levels and impression cytology stages (P=0.037 and P=0.022 respectively) were significantly lower in postoperative period compared to preoperative period. In the OMMT group, no statistical differences were found in terms of clinical parameters, inflammation levels and impression cytology stages of preoperative versus postoperative values. Preoperative tear TGFβ1 levels were higher in AMT and OMMT groups compared to the control group (25.5 ng/mL, 26.3 ng/mL and 21.7 ng/mL respectively). Decreased tear TGFβ1 levels were observed in both the AMT and OMMT groups postoperatively (median decrease value=2.1 ng/mL and 2.7 ng/mL respectively). AMT is associated with postoperative improvement in inferior fornix depth, socket volume, inflammation and impression cytology levels and may be a more proper alternative method than OMMT in the management of socket contracture.

  10. Experimental total wrapping of breast implants with acellular dermal matrix: a preventive tool against capsular contracture in breast surgery?

    Science.gov (United States)

    Schmitz, Marweh; Bertram, Martin; Kneser, Ulrich; Keller, Andrea K; Horch, Raymund E

    2013-10-01

    Capsular contracture remains a hitherto unsolved complication after implantation of silicone gel-filled breast prostheses. Based on clinical and experimental data, the use of an acellular dermal matrix as a sheath around implants may lead to lesser capsular contracture acting as a proposed biological environment mimicking wound bed tissue. The aim of our study was to analyse the tissue reaction after implantation of silicone prosthesis with and without an envelope of acellular dermal matrix. Implantation of 60 silicone prostheses in the back of Lewis rats were carried out, randomly paired taking one rat from group A and one from group B. Group A included implants completely enveloped with xenogenic acellular dermis and group B undraped silicone implants. At 3, 6 and 12 weeks postoperatively, the samples were explanted and subjected to histological and immunohistochemical evaluation. A new myofibroblast tissue layer was identified in proximity to the implant in both groups. The thickness of the layer in group A was continuously thinner than in group B regarding the different explantation time points. Implants completely wrapped with acellular dermal matrix showed significantly lesser inflammatory signs at 3 and 12 weeks after implantation compared to controls. Cell proliferation after 12 weeks was significantly decreased in group A. The slight myofibroblast layer and reduced rate of inflammation and proliferation in the treatment group show a positive effect of total acellular dermal matrix envelope and hypothesise the decrease of capsular contracture in long-term periods. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Effectiveness of stretch for the treatment and prevention of contractures in people with neurological conditions: a systematic review.

    Science.gov (United States)

    Katalinic, Owen M; Harvey, Lisa A; Herbert, Robert D

    2011-01-01

    Contractures are a disabling complication of neurological conditions that are commonly managed with stretch. The purpose of this systematic review was to determine the effectiveness of stretch for the treatment and prevention of contractures. The review is part of a more-detailed Cochrane review. Only the results of the studies including patients with neurological conditions are reported here. Electronic searches were conducted in June 2010 in the following computerized databases: Cochrane CENTRAL Register of Controlled Trials, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA), MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, SCI-EXPANDED, and Physiotherapy Evidence Database (PEDro). The review included randomized controlled trials and controlled clinical trials of stretch applied for the purposes of treating or preventing contractures in people with neurological conditions. Two reviewers independently selected studies, extracted data, and assessed risk of bias. The primary outcome measures were joint mobility (range of motion) and quality of life. Secondary outcome measures were pain, spasticity, activity limitation, and participation restriction. Meta-analyses were conducted using random-effects models. Twenty-five studies met the inclusion criteria. These studies provide moderate-quality evidence that stretch has a small immediate effect on joint mobility (mean difference=3°, 95% confidence interval [CI]=0° to 5°) and high-quality evidence that stretch has little or no short-term or long-term effects on joint mobility (mean difference=1° and 0°, respectively, 95% CI=0° to 3° and -2° to 2°, respectively). There is little or no effect of stretch on pain, spasticity, and activity limitation. No studies were retrieved that investigated the effects of stretch for longer than 6 months. Regular stretch does not produce clinically important changes in joint mobility, pain

  12. Endoscopic Gastrocnemius Recession for the Treatment of Isolated Gastrocnemius Contracture: A Prospective Study on 320 Consecutive Patients.

    Science.gov (United States)

    Phisitkul, Phinit; Rungprai, Chamnanni; Femino, John E; Arunakul, Marut; Amendola, Annunziato

    2014-08-01

    Endoscopic gastrocnemius recession has been proposed as a minimally invasive technique for the treatment of isolated gastrocnemius contracture. We report on the safety and efficacy of endoscopic gastrocnemius recession, as an isolated procedure or combined with other concomitant procedures in terms of improvement in ankle dorsiflexion, functional outcome, and postoperative morbidities. The data were prospectively collected in this case series. Endoscopic gastrocnemius recession was performed by a single surgeon in 320 consecutive patients (344 feet) who were diagnosed with isolated gastrocnemius contracture and failed nonoperative treatments between March 2009 and December 2012. There were 180 women and 140 men with mean age, 47.1 ± 15.7 years. The minimum follow-up was 1 year (mean, 18 months; range, 12 to 53 months). Pre- and postoperative ankle dorsiflexion, pain (Visual Analog Scale [VAS]), SF-36, and Foot Function Index (FFI) were obtained and compared using paired sample t test and Wilcoxon signed-rank test. The mean ankle dorsiflexion significantly improved from -0.8 ± 5.4 degrees preoperatively to 11.0 ± 6.6 degrees at average of 13 months postoperatively (n = 294) (P plantarflexion (N = 11/320; 3.1% respectively) and sural nerve dysesthesia (N = 10/320; 3.4%). Wound complications or Achilles tendon rupture did not occur. There was no difference in the average improvement in ankle dorsiflexion, outcome scores, and rate of complications between the isolated and combined procedures. Endoscopic gastrocnemius recession demonstrated promising results in the treatment of isolated gastrocnemius contracture. Ankle dorsiflexion was significantly improved with minimal morbidity. The procedure was found effective in improving functional outcomes and relieving pain as a sole operative treatment and as a part of combined procedures in our patients. Level IV, case series. © The Author(s) 2014.

  13. Rapid cooling experiments and use of an anionic nuclear probe to sense the spin transition of the 1D coordination polymers [Fe(NH2trz)3]SnF6n x H2O (NH2trz=4-amino-1,2,4-triazole).

    Science.gov (United States)

    Garcia, Yann; Ksenofontov, Vadim; Mentior, Sophie; Dîrtu, Marinela M; Gieck, Christine; Bhatthacharjee, Ashis; Gütlich, Philipp

    2008-01-01

    [Fe(NH2trz)3]SnF6n x H2O (NH(2)trz=4-amino-1,2,4-triazole; n=1 (1), n=0.5 (2)) are new 1D spin-crossover coordination polymers. Compound 2 exhibits an incomplete spin transition centred at around 210 K with a thermal hysteresis loop approximately 16 K wide. The spin transition of 2 was detected by the Mössbauer resonance of the 119Sn atom in the SnF6 (2-) anion primarily on the basis of the evolution of its local distortion. Rapid-cooling 57Fe Mössbauer and superconducting quantum interference device experiments allow dramatic widening of the hysteresis width of 2 from 16 K up to 82 K and also shift the spin-transition curve into the room temperature region. This unusual behaviour of quenched samples on warming is attributed to activation of the molecular motion of the anions from a frozen distorted form towards a regular form at temperatures well above approximately 210 K. Potential applications of this new family of materials are discussed.

  14. Twelve weeks of nightly stretch does not reduce thumb web-space contractures in people with a neurological condition: a randomised controlled trial.

    Science.gov (United States)

    Harvey, Lisa; de Jong, Inge; Goehl, Gerlinde; Mardwedel, Samantha

    2006-01-01

    What is the effectiveness of 12 weeks of nightly stretch in reducing thumb web-space contracture in people with neurological conditions? Assessor-blinded, randomised controlled trial. Forty-four (one dropout)community-dwelling patients with a neurological condition (14 stroke, 7 traumatic brain injury, 23 spinal cord injury) who had uni or bilateral thumb web-space contractures (60 thumbs). The experimental thumbs were splinted into a stretched,abducted position each night for 12 weeks. The control thumbs were not splinted. Thumb web-space was measured as the carpometacarpal angle during the application of a 0.9 Nm abduction torque before and after intervention. The mean increase in thumb web-space after 12 weeks was 1 deg (95% CI, -1 to 2). Intensive stretch administered regularly over three months does not reduce thumb web-space contractures in neurological conditions.

  15. Changes of Achilles tendon properties via 12-week PNF based robotic rehabilitation of ankle joints with spasticity and/or contracture.

    Science.gov (United States)

    Zhou, Zhihao; Zhou, Yuan; Wang, Ninghua; Gao, Fan; Wang, Long; Wei, Kunlin; Wang, Qining

    2014-01-01

    Ankle joint with spasticity and/or contracture can severely affect mobility and independence of stroke survivors. Due to that, the Achilles tendon(AT) is affected. In this paper, we aim to study changes of AT properties via proprioceptive neuromuscular facilitation (PNF) treatment. A robotic ankle-foot rehabilitation system has been proposed, which consists of a robotic ankle-foot platform and a graphic user interface. In this pilot study, two post-stroke patients participated and carried out a 12-week PNF treatment with the robotic system. The treatment is evaluated quantitatively in AT properties. The evaluation shows that after the PNF treatment, the average decrease of AT length is 4.1 mm (6.5%) and the recovery ratio is 30.4%, while the thickness has no change. The results indicate that the PNF based robotic rehabilitation for ankle joints with spasticity and/or contracture is effective to improve the ankle spasticity/contracture.

  16. Management of difficult pediatric facial burns: reconstruction of burn-related lower eyelid ectropion and perioral contractures.

    Science.gov (United States)

    Egeland, Brent; More, Sunita; Buchman, Steven R; Cederna, Paul S

    2008-07-01

    Despite significant burn treatment advances, modern multidisciplinary care, and improved survival after burns, facial burn scars remain clinically challenging. Achieving a successful reconstruction requires a comprehensive approach, entailing many advanced techniques with an emphasis on preserving function and balancing intricate aesthetic requirements. Pediatric facial burns present the same reconstructive challenges seen in adults, with additional developmental and psychologic concerns. In this paper, we describe the basic principals of facial burn care in the pediatric burn population, with a specific focus on lower-eyelid burn ectropion and oral commissure burn scar contracture leading to microstomia. Several cases are demonstrated.

  17. Review of X-linked syndromes with arthrogryposis or early contractures-aid to diagnosis and pathway identification.

    Science.gov (United States)

    Hunter, Jesse M; Kiefer, Jeff; Balak, Christopher D; Jooma, Sonya; Ahearn, Mary Ellen; Hall, Judith G; Baumbach-Reardon, Lisa

    2015-05-01

    The following is a review of 50 X-linked syndromes and conditions associated with either arthrogryposis or other types of early contractures. These entities are categorized as those with known responsible gene mutations, those which are definitely X-linked, but the responsible gene has not been identified, and those suspected from family history to be X-linked. Several important ontology pathways for known disease genes have been identified and are discussed in relevance to clinical characteristics. Tables are included which help to identify distinguishing clinical features of each of the conditions. © 2015 Wiley Periodicals, Inc.

  18. Decreasing Complications of Quadricepsplasty for Knee Contracture after Femoral Fracture Treatment with an External Fixator: Report of Four Cases

    Directory of Open Access Journals (Sweden)

    Naoya Kashiwagi

    2013-01-01

    Full Text Available Introduction: In performing quadricepsplasty for contracture that develops after application of an external fixator for femoral fractures, surgeons must be aware of the potential risk for re-fracture and pin-related problems. The purpose of this report is to highlight these not well-detailed complications and to discuss specific findings and treatment suggestions.Case Report: 4 men (mean age, 40 years presenting with secondary to contracture that developed after application of an external fixator for femoral fractures were included in this study. The radiographs showed union across the fracture site however two of these patients couldn't stand on one leg raising suspicion about the union status. A computed tomographic image indeed demonstrated limited continuity of the cortex. Bone grafting was performed prior to quadricepsplasty. The mean extension and flexion before the quadricepsplasty were 0o and 570 , respectively. At the final follow-up examination, the mean active flexion of the knee had increased to 98o.Results: The incidence of re-fracture during and after quadricepsplasty has been reported to be between 10 and 25%. There are 2 preoperative features that may mislead surgeons into believing that complete union of the fractures has been attained: one is the patient's ability to stand on a single leg, and the other is the fact that plain radiographs may lend themselves to different interpretations. In such cases, computed tomography will provide evidence of the continuity of the cortical bone. Bone grafting in 2 of our patients is thought to have prevented the postoperative complications of re-fracture. Complications at pin sites induce contracture at surrounding structures. When extreme tightness of the skin is noted, a tension-releasing procedure such as a skin graft should be performed.Conclusion: In conclusion, re-fracture or pin-site contracture should be carefully managed before quadricepsplasty, because the patients who need a

  19. Sonography in capsular contracture after breast augmentation: value of established criteria, new techniques and directions for research.

    Science.gov (United States)

    Gossner, Johannes

    2017-03-01

    Capsular contracture or capsular fibrosis is the most common complication following breast augmentation with implants. Sonography is usually the initial imaging test performed to examine a suspicious implant. In contrast to the large number of patients developing capsular fibrosis there is only sparse literature reporting about sonographic findings. In this letter after a brief review of normal sonographic findings after breast augmentation, established ultrasound findings suggestive of capsular fibrosis (deformity, increased number of radial folds and thickening of the fibrous capsule) are discussed. The possible value of new techniques and possible directions for further research are addressed.

  20. Vaporization Would Cool Primary Battery

    Science.gov (United States)

    Bhandari, Pradeep; Miyake, Robert N.

    1991-01-01

    Temperature of discharging high-power-density primary battery maintained below specified level by evaporation of suitable liquid from jacket surrounding battery, according to proposal. Pressure-relief valve regulates pressure and boiling temperature of liquid. Less material needed in cooling by vaporization than in cooling by melting. Technique used to cool batteries in situations in which engineering constraints on volume, mass, and location prevent attachment of cooling fins, heat pipes, or like.

  1. Cooling Floor AC Systems

    Science.gov (United States)

    Jun, Lu; Hao, Ding; Hong, Zhang; Ce, Gao Dian

    The present HVAC equipments for the residential buildings in the Hot-summer-and-Cold-winter climate region are still at a high energy consuming level. So that the high efficiency HVAC system is an urgently need for achieving the preset government energy saving goal. With its advantage of highly sanitary, highly comfortable and uniform of temperature field, the hot-water resource floor radiation heating system has been widely accepted. This paper has put forward a new way in air-conditioning, which combines the fresh-air supply unit and such floor radiation system for the dehumidification and cooling in summer or heating in winter. By analyze its advantages and limitations, we found that this so called Cooling/ Heating Floor AC System can improve the IAQ of residential building while keep high efficiency quality. We also recommend a methodology for the HVAC system designing, which will ensure the reduction of energy cost of users.

  2. AIR COOLED NEUTRONIC REACTOR

    Science.gov (United States)

    Fermi, E.; Szilard, L.

    1958-05-27

    A nuclear reactor of the air-cooled, graphite moderated type is described. The active core consists of a cubicle mass of graphite, approximately 25 feet in each dimension, having horizontal channels of square cross section extending between two of the opposite faces, a plurality of cylindrical uranium slugs disposed in end to end abutting relationship within said channels providing a space in the channels through which air may be circulated, and a cadmium control rod extending within a channel provided in the moderator. Suitable shielding is provlded around the core, as are also provided a fuel element loading and discharge means, and a means to circulate air through the coolant channels through the fuel charels to cool the reactor.

  3. Heating, ventilation and cooling

    CSIR Research Space (South Africa)

    Osburn, L

    2009-02-01

    Full Text Available air and diluting the humidity or mixing the cool humid air with the air from a conventional air conditioner. Climate Specific The performance of an evaporative cooler is highly dependant on atmospheric conditions. Evaporative coolers work best... that an installed system is being maintained correctly by competent persons to ensure both smooth and efficient operation as well as to prevent mould growth. Legionnaires disease is a concern within evaporative coolers if it is not maintained correctly...

  4. Laser Cooling of Solids

    Science.gov (United States)

    2009-01-01

    Panel (b) com- pares the cooling efficiencies of available thermoelectric coolers ( TECs ) with ZBLANP:Yb3+-based optical refrigerators. Devices based...on materials with low parasitic heating will outperform TECs below 200 . Coolers made from current materials are less efficient than TECs at all...luminescence extraction efficiency are being explored as well. A novel method based on the frustrated total internal reflection across a vacuum “ nano -gap” is

  5. Outcome analysis of urethral wall stent insertion with artificial urinary sphincter placement for severe recurrent bladder neck contracture following radical prostatectomy.

    Science.gov (United States)

    Magera, James S; Inman, Brant A; Elliott, Daniel S

    2009-03-01

    We present outcome and quality of life analyses for the treatment of post-radical prostatectomy bladder neck contracture with urethral wall stent insertion and subsequent artificial urinary sphincter placement. A retrospective analysis from June 2001 to September 2007 identified 25 consecutive men who underwent urethral wall stent placement for severe, recurrent bladder neck contracture despite aggressive transurethral resection after radical prostatectomy. Assessment of symptoms and quality of life impact from urinary incontinence was conducted with a self-administered, standardized questionnaire. Nonparametric testing was used for comparing covariates among groups. Univariate Cox proportional hazards modeling was used to assess predictors of treatment failure. P values are double-sided and are considered statistically significant if bladder neck contracture was radical prostatectomy in all patients. Concurrent severe stress incontinence before treatment of bladder neck contracture was noted in 23 of 25 patients (92%). Before urethral wall stent insertion a median of 3 (IQR 2 to 5) failed endoscopic treatments were performed. Bladder neck contracture stabilization with insertion of 1 urethral wall stent was noted in 13 of 25 (52%) patients with a median followup of 2.9 years from last urethral wall stent insertion. Multiple urethral wall stent insertions (range 2 to 4) salvaged an additional 6 of 25 (24%) patients and failure to obtain patency was observed in 6 of 25 (24%). All patients responded to the questionnaire and quality of life improvement was noted in 23 of 25 patients (92%). Urethral wall stent and delayed artificial urinary sphincter placement for treatment of severe, recurrent bladder neck contracture and incontinence after radical prostatectomy is associated with improvement in quality of life. Long-term followup is required to further delineate the efficacy of this treatment approach.

  6. Non-Laser Cooling Techniques

    Science.gov (United States)

    Hilico, Laurent

    We first review trapped ion radiative cooling and show that it is only efficient for high frequency oscillating particles in Penning traps. We then describe in detail resistive cooling and explain in the frame of an exercice why and how thermal equilibrium with the resistor is reached. We finally discuss buffer gas cooling in Paul traps.

  7. Ice for air cooling

    Energy Technology Data Exchange (ETDEWEB)

    Voss, J.

    1987-04-09

    The first ice plant on an industrial scale came into service at Harmony goldmine in November 1985. This surface installation has a refrigeration output of about 5.2 MW, corresponding to 1000 t/d of ice. The ice melting tank is at a depth of 1088m. The planning and construction of this first industrial-scale ice plant were based on the result obtained from a research project which gave particular emphasis to investigating the problems related to the transport of ice in pipelines and to the ice-to-water heat transfer in ice-melting tanks. The particular advantage of ice as a coolant is that the mass circulation needed with ice is five times less than with water. It is claimed that, in the circumstances which are specific to Harmony mine, ice cooling is economically viable at a depth of only 1,100 m or thereabouts; however, calculations for very powerful cooling systems have shown that ice has a cost advantage over water + Pelton turbines only at depths of 3,000 m or more. Cost comparisons apart, this ice plant is useful for the testing of technology and safety in the production, transport and melting of the ice and prepares the way for a powerful ice cooling system which will work at great depths. 6 references.

  8. Low mass integrated cooling

    CERN Document Server

    Mapelli, Alessandro

    2014-01-01

    Low mass on - detec tor cooling systems are being developed and stud ied by the Detector Technology group (PH - DT) in the CERN Physics Department in close collaboration with LHC and non - LHC experiments . Two approaches are currently being investigated. The first approach, for barrel configurations, consists in integrating the cooli ng apparatus in light mechanical structures support ing the detectors. In this case , the thermal management can be achieved either with light cooling pipes and thin plates or with a network of microchannels embedded in thin strips of silicon or polyimide . Both configuratio ns are being investigated in the context of the 2018 upgrade program of the ALICE Inner Tracking System (ITS). Moreover, it is also possible to use a s ilicon microchannel cooling device itself as structural support for the detectors and electronics. Such a configur ation has been adopted by the NA62 collaboration for the ir GigaTracKer (GTK) as well as by the LHCb collaboration for the 2018 major upgrade of...

  9. Electron Cooling of RHIC

    CERN Document Server

    Ben-Zvi, Ilan; Barton, Donald; Beavis, Dana; Blaskiewicz, Michael; Bluem, Hans; Brennan, Joseph M; Bruhwiler, David L; Burger, Al; Burov, Alexey; Burrill, Andrew; Calaga, Rama; Cameron, Peter; Chang, Xiangyun; Cole, Michael; Connolly, Roger; Delayen, Jean R; Derbenev, Yaroslav S; Eidelman, Yury I; Favale, Anthony; Fedotov, Alexei V; Fischer, Wolfram; Funk, L W; Gassner, David M; Hahn, Harald; Harrison, Michael; Hershcovitch, Ady; Holmes, Douglas; Hseuh Hsiao Chaun; Johnson, Peter; Kayran, Dmitry; Kewisch, Jorg; Kneisel, Peter; Koop, Ivan; Lambiase, Robert; Litvinenko, Vladimir N; MacKay, William W; Mahler, George; Malitsky, Nikolay; McIntyre, Gary; Meng, Wuzheng; Merminga, Lia; Meshkov, Igor; Mirabella, Kerry; Montag, Christoph; Nagaitsev, Sergei; Nehring, Thomas; Nicoletti, Tony; Oerter, Brian; Parkhomchuk, Vasily; Parzen, George; Pate, David; Phillips, Larry; Preble, Joseph P; Rank, Jim; Rao, Triveni; Rathke, John; Roser, Thomas; Russo, Thomas; Scaduto, Joseph; Schultheiss, Tom; Sekutowicz, Jacek; Shatunov, Yuri; Sidorin, Anatoly O; Skrinsky, Aleksander Nikolayevich; Smirnov, Alexander V; Smith, Kevin T; Todd, Alan M M; Trbojevic, Dejan; Troubnikov, Grigory; Wang, Gang; Wei, Jie; Williams, Neville; Wu, Kuo-Chen; Yakimenko, Vitaly; Zaltsman, Alex; Zhao, Yongxiang; ain, Animesh K

    2005-01-01

    We report progress on the R&D program for electron-cooling of the Relativistic Heavy Ion Collider (RHIC). This electron cooler is designed to cool 100 GeV/nucleon at storage energy using 54 MeV electrons. The electron source will be a superconducting RF photocathode gun. The accelerator will be a superconducting energy recovery linac. The frequency of the accelerator is set at 703.75 MHz. The maximum electron bunch frequency is 9.38 MHz, with bunch charge of 20 nC. The R&D program has the following components: The photoinjector and its photocathode, the superconducting linac cavity, start-to-end beam dynamics with magnetized electrons, electron cooling calculations including benchmarking experiments and development of a large superconducting solenoid. The photoinjector and linac cavity are being incorporated into an energy recovery linac aimed at demonstrating ampere class current at about 20 MeV. A Zeroth Order Design Report is in an advanced draft state, and can be found on the web at http://www.ags...

  10. Cryopreservation: Vitrification and Controlled Rate Cooling.

    Science.gov (United States)

    Hunt, Charles J

    2017-01-01

    Cryopreservation is the application of low temperatures to preserve the structural and functional integrity of cells and tissues. Conventional cooling protocols allow ice to form and solute concentrations to rise during the cryopreservation process. The damage caused by the rise in solute concentration can be mitigated by the use of compounds known as cryoprotectants. Such compounds protect cells from the consequences of slow cooling injury, allowing them to be cooled at cooling rates which avoid the lethal effects of intracellular ice. An alternative to conventional cooling is vitrification. Vitrification methods incorporate cryoprotectants at sufficiently high concentrations to prevent ice crystallization so that the system forms an amorphous glass thus avoiding the damaging effects caused by conventional slow cooling. However, vitrification too can impose damaging consequences on cells as the cryoprotectant concentrations required to vitrify cells at lower cooling rates are potentially, and often, harmful. While these concentrations can be lowered to nontoxic levels, if the cells are ultra-rapidly cooled, the resulting metastable system can lead to damage through devitrification and growth of ice during subsequent storage and rewarming if not appropriately handled.The commercial and clinical application of stem cells requires robust and reproducible cryopreservation protocols and appropriate long-term, low-temperature storage conditions to provide reliable master and working cell banks. Though current Good Manufacturing Practice (cGMP) compliant methods for the derivation and banking of clinical grade pluripotent stem cells exist and stem cell lines suitable for clinical applications are available, current cryopreservation protocols, whether for vitrification or conventional slow freezing, remain suboptimal. Apart from the resultant loss of valuable product that suboptimal cryopreservation engenders, there is a danger that such processes will impose a selective

  11. Cooling lubricants; Kuehlschmierstoffe

    Energy Technology Data Exchange (ETDEWEB)

    Pfeiffer, W. [Berufsgenossenschaftliches Inst. fuer Arbeitssicherheit, St. Augustin (Germany); Breuer, D. [Berufsgenossenschaftliches Inst. fuer Arbeitssicherheit, St. Augustin (Germany); Blome, H. [Berufsgenossenschaftliches Inst. fuer Arbeitssicherheit, St. Augustin (Germany); Deininger, C. [Berufsgenossenschaftliches Inst. fuer Arbeitssicherheit, St. Augustin (Germany); Hahn, J.U. [Berufsgenossenschaftliches Inst. fuer Arbeitssicherheit, St. Augustin (Germany); Kleine, H. [Berufsgenossenschaftliches Inst. fuer Arbeitssicherheit, St. Augustin (Germany); Nies, E. [Berufsgenossenschaftliches Inst. fuer Arbeitssicherheit, St. Augustin (Germany); Pflaumbaum, W. [Berufsgenossenschaftliches Inst. fuer Arbeitssicherheit, St. Augustin (Germany); Stockmann, R. [Berufsgenossenschaftliches Inst. fuer Arbeitssicherheit, St. Augustin (Germany); Willert, G. [Berufsgenossenschaftliches Inst. fuer Arbeitssicherheit, St. Augustin (Germany); Sonnenschein, G. [Maschinenbau- und Metall-Berufsgenossenschaft, Duesseldorf (Germany)

    1996-08-01

    As a rule, the base substances used are certain liquid hydrocarbons from mineral oils as well as from native and synthetic oils. Through the addition of further substances the cooling lubricant takes on the particular qualities required for the use in question. Employees working with cooling lubricants are exposed to various hazards. The assessment of the concentrations at the work station is carried out on the basis of existing technical rules for contact with hazardous substances. However, the application/implementation of compulsory investigation and supervision in accordance with these rules is made difficult by the fact that cooling lubricants are, as a rule, made up of complicated compound mixtures. In addition to protecting employees from exposure to mists and vapours from the cooling lubricants, protection for the skin is also of particular importance. Cooling lubricants should not, if at all possible, be brought into contact with the skin. Cleansing the skin and skin care is just as important as changing working clothes regularly, and hygiene and cleanliness at the workplace. Unavoidable emissions are to be immediately collected at the point where they arise or are released and safely disposed of. This means taking into account all sources of emissions. The programme presented in this report therefore gives a very detailed account of the individual protective measures and provides recommendations for the design of technical protection facilities. (orig./MG) [Deutsch] Als Basisstoffe dienen in der Regel bestimmte fluessige Kohlenwasserstoffverbindungen aus Mineraloelen sowie aus nativen oder synthetischen Oelen. Durch die Zugabe von weiteren Stoffen erlangt der Kuehlschmierstoff seine fuer den jeweiligen Anwendungsabfall geforderten Eigenschaften. Beschaeftigte, die mit Kuehlschmierstoffen umgehen, sind unterschiedliche Gefahren ausgesetzt. Die Beurteilung der Kuehlschmierstoffkonzentrationen in der Luft am Arbeitsplatz erfolgt auf der Grundlage bestehender

  12. Laser cooling by adiabatic transfer

    Science.gov (United States)

    Norcia, Matthew; Cline, Julia; Bartolotta, John; Holland, Murray; Thompson, James

    2017-04-01

    We have demonstrated a new method of laser cooling applicable to particles with narrow linewidth optical transitions. This simple and robust cooling mechanism uses a frequency-swept laser to adiabatically transfer atoms between internal and motional states. The role of spontaneous emission is reduced (though is still critical) compared to Doppler cooling. This allows us to achieve greater slowing forces than would be possible with Doppler cooling, and may make this an appealing technique for cooling molecules. In this talk, I will present a demonstration of this technique in a cold strontium system. DARPA QUASAR, NIST, NSF PFC.

  13. Laser Cooling of Molecular Anions

    CERN Document Server

    Yzombard, Pauline; Gerber, Sebastian; Doser, Michael; Comparat, Daniel

    2015-01-01

    We propose a scheme for laser cooling of negatively charged molecules. We briefly summarise the requirements for such laser cooling and we identify a number of potential candidates. A detailed computation study with C$\\_2^-$, the most studied molecular anion, is carried out. Simulations of 3D laser cooling in a gas phase show that this molecule could be cooled down to below 1 mK in only a few tens of milliseconds, using standard lasers. Sisyphus cooling, where no photo-detachment process is present, as well as Doppler laser cooling of trapped C$\\_2^-$, are also simulated. This cooling scheme has an impact on the study of cold molecules, molecular anions, charged particle sources and antimatter physics.

  14. Biomedical implications from a morphoelastic continuum model for the simulation of contracture formation in skin grafts that cover excised burns.

    Science.gov (United States)

    Koppenol, Daniël C; Vermolen, Fred J

    2017-08-01

    A continuum hypothesis-based model is developed for the simulation of the (long term) contraction of skin grafts that cover excised burns in order to obtain suggestions regarding the ideal length of splinting therapy and when to start with this therapy such that the therapy is effective optimally. Tissue is modeled as an isotropic, heterogeneous, morphoelastic solid. With respect to the constituents of the tissue, we selected the following constituents as primary model components: fibroblasts, myofibroblasts, collagen molecules, and a generic signaling molecule. Good agreement is demonstrated with respect to the evolution over time of the surface area of unmeshed skin grafts that cover excised burns between outcomes of computer simulations obtained in this study and scar assessment data gathered previously in a clinical study. Based on the simulation results, we suggest that the optimal point in time to start with splinting therapy is directly after placement of the skin graft on its recipient bed. Furthermore, we suggest that it is desirable to continue with splinting therapy until the concentration of the signaling molecules in the grafted area has become negligible such that the formation of contractures can be prevented. We conclude this study with a presentation of some alternative ideas on how to diminish the degree of contracture formation that are not based on a mechanical intervention, and a discussion about how the presented model can be adjusted.

  15. Open arthrolysis with pie-crusting release of the triceps tendon for treating post-traumatic contracture of the elbow.

    Science.gov (United States)

    Wang, Wei; Zhan, Yu-lin; Yu, Shi-yang; Zheng, Xian-you; Liu, Shen; Fan, Cun-yi

    2016-05-01

    Extensive loss of elbow flexion compromises the performance of daily activities. We examined the clinical outcomes of patients with post-traumatic extension contracture of the elbow treated with open arthrolysis and pie-crusting release of the triceps tendon. We retrospectively reviewed the records of 7 patients (5 men and 2 women; mean age, 35 years) who underwent open arthrolysis via a combined lateral and medial approach with pie-crusting release of the triceps tendon for the treatment of post-traumatic elbow stiffness. All the patients had heterotopic ossification that restricted elbow motion and underwent removal of the ossified tissue and capsular release. The triceps tendon was gradually stretched by making multiple stab incisions on the tendon by using a No. 11 surgical blade. The range of motion of the elbow was recorded both preoperatively and at the final postoperative follow-up. Elbow function was assessed with the Mayo Elbow Performance Score. The patients were followed up for a mean of 24 months. After treatment, significant improvement was noted in the total arc of motion (from 44° to 116°, P pie-crusting release of the triceps tendon is an effective and safe treatment approach for post-traumatic extension contracture of the elbow. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  16. Quengel Casting for the Management of Pediatric Knee Flexion Contractures: A 26-Year Single Institution Experience.

    Science.gov (United States)

    Wiley, Marcel R; Riccio, Anthony I; Felton, Kevin; Rodgers, Jennifer A; Wimberly, Robert L; Johnston, Charles E

    Quengel casting was introduced in 1922 for nonsurgical treatment of knee flexion contractures (KFC) associated with hemophilic arthropathy. It consists of an extension-desubluxation hinge fixed to a cast allowing for gradual correction of a flexion deformity while preventing posterior tibial subluxation. The purpose of this study is to report 1 center's experience with this technique for the treatment of pediatric KFC. A retrospective review was conducted over a 26-year period. All patients with KFC treated with Quengel casting were included. Demographic data, associated medical conditions, adjunctive soft tissue releases, complications, and the need for late surgical intervention were recorded. Tibiofemoral angle measurements in maximal extension were recorded at initiation and termination of casting, 1-year follow-up, and final follow-up. Success was defined as no symptomatic recurrence of KFC or need for subsequent surgery. Eighteen patients (26 knees) were treated for KFC with Quengel casting. Average age at initiation of casting was 8.1 years with average follow-up of 59.9 months. Fifteen knees (58%) underwent soft tissue releases before casting. An average of 1.5 casts per knee were applied over an average of 23.9 days. Average KFC before casting was 50.6 degrees (range, 15 to 100 degrees) which improved to 5.96 degrees (0 to 40 degrees) at cast removal (PKFC of those treated successfully was 6.8 degrees (range, 0 to 30 degrees) at 1 year and 8.2 degrees (range, 0 to 30 degrees) at final follow-up, averaging 71.4 months (P=0.81). Of the 11 knees deemed failures, all had recurrence of deformity within an average of 1 year from cast removal. Surgical release before Quengel casting did not improve the chances for success (P=0.09). Quengel casting can improve pediatric KFC an average of 44.2 degrees with minimal complications. Although 50% of treated patients will demonstrate significant recurrence or need later surgery, the majority of those treated successfully

  17. Dystrophin-deficient dogs with reduced myostatin have unequal muscle growth and greater joint contractures.

    Science.gov (United States)

    Kornegay, Joe N; Bogan, Daniel J; Bogan, Janet R; Dow, Jennifer L; Wang, Jiahui; Fan, Zheng; Liu, Naili; Warsing, Leigh C; Grange, Robert W; Ahn, Mihye; Balog-Alvarez, Cynthia J; Cotten, Steven W; Willis, Monte S; Brinkmeyer-Langford, Candice; Zhu, Hongtu; Palandra, Joe; Morris, Carl A; Styner, Martin A; Wagner, Kathryn R

    2016-01-01

    differential expression between GRMD and GRippet dogs. Satellite cell exhaustion was not observed in GRippets up to 3 years of age. Partial myostatin loss may exaggerate selective muscle hypertrophy or atrophy/hypoplasia in GRMD dogs and worsen contractures. While muscle imbalance is not a feature of myostatin inhibition in mdx mice, findings in a larger animal model could translate to human experience with myostatin inhibitors.

  18. Keeping cool, staying virtuous

    DEFF Research Database (Denmark)

    Waltorp, Karen

    2015-01-01

    their everyday lives. I focus on love and marriage, the imperatives of appearing cool among peers, and keeping the family’s honour intact through the display of virtuous behaviour. Building on Bourdieu’s writings on the split habitus, I introduce the term composite habitus, as it underscores the aspect...... of a habitus that is split between (sometimes contradictory) composite parts. The composite habitus of the young women is more than a hysteresis effect (where disposition and field are in mismatch and the habitus misfires), as the composite habitus also opens up to a range of possible strategies. I present...

  19. Cooling performance of solar cell driven, thermoelectric cooling prototype headgear

    Energy Technology Data Exchange (ETDEWEB)

    Hara, T.; Azuma, H.; Shimizu, H.; Obora, H.; Sato, S. [Nippon Inst. of Technology, Saitama (Japan). Dept. of Systems Engineering

    1998-11-01

    Cooling performance of solar cell-driven, thermoelectric cooling prototype headgear was examined experimentally. Three types of prototype headgear were made and examined. They were cooled by thermoelectric elements and driven by solar cells. Conventional cooling caps driven by solar cells only blow ambient air to the face with an electric fan. A thermoelectric element was set at the front of the headgear to cool the forehead. Solar cells were mounted on the top and the brim of the headgear to work the thermoelectric element. Three prototypes of headgear with solar cells and a thermoelectric element were made and tested. Refrigeration capacity and thermal comfort were examined by subject in cases of sitting, walking and bicycling. The temperature difference between ambient and cooling temperature was required to be 4-5 degrees Celsius for thermal comfort. (author)

  20. Onderzoeksrapportage duurzaam koelen : EOS Renewable Cooling

    NARCIS (Netherlands)

    Broeze, J.; Sluis, van der S.; Wissink, E.

    2010-01-01

    For reducing energy use for cooling, alternative methods (that do not rely on electricity) are needed. Renewable cooling is based on naturally available resources such as evaporative cooling, free cooling, phase change materials, ground subcooling, solar cooling, wind cooling, night radiation &

  1. Comparison of contracture, adhesion, tissue ingrowth, and histologic response characteristics of permanent and absorbable barrier meshes in a porcine model of laparoscopic ventral hernia repair.

    Science.gov (United States)

    Deeken, C R; Matthews, B D

    2012-02-01

    The objective of this study was to determine the mesh contracture, adhesion, tissue ingrowth, and histologic characteristics of a novel absorbable barrier mesh (Ventrio™ ST Hernia Patch) compared to existing permanent (Ventrio™ Hernia Patch) and absorbable barrier meshes (Sepramesh™ IP Composite and PROCEED™ Surgical Mesh). Standard laparoscopic technique was utilized to bilaterally implant meshes in 20 female Yorkshire pigs (n = 5 pigs/group). Meshes were fixated to the intact peritoneum with SorbaFix™ absorbable fixation devices. Mesh contracture, adhesion coverage, and adhesion tenacity were evaluated after 4 weeks. T-Peel testing and hematoxylin and eosin (H&E) staining were utilized to assess tissue ingrowth and host response. A significantly greater percent area contracture was demonstrated for PROCEED™ (26.9%) compared to Ventrio™ ST (8.8%), Ventrio™ (14.5%) and Sepramesh™ (9.2%). Ventrio™ ST demonstrated similar adhesion area, tenacity, and tissue ingrowth compared to all other meshes. Histological scoring revealed a comparable host inflammatory response for all meshes, with a few exceptions. A greater number of giant cells were observed in Ventrio™ ST and Sepramesh™ near the multifilament polyglycolic acid (PGA) fibers; a greater number of macrophages were observed in PROCEED™ compared to Ventrio™; and a greater number of neutrophils were observed in PROCEED™, compared to Sepramesh™ (P Hernia Patch demonstrated comparable contracture, adhesion, tissue ingrowth, and histologic characteristics compared to existing permanent and absorbable barrier meshes. Host inflammatory and fibrotic responses for all four meshes were minimal and representative of a biocompatible response.

  2. Spasticity and contractures at the wrist after stroke: time course of development and their association with functional recovery of the upper limb

    NARCIS (Netherlands)

    Malhotra, S.; Malhotra, S.; Pandyan, A.D.; Rosewilliam, S.; Roffe, C.; Hermens, Hermanus J.

    Objective: To investigate the time course of development of spasticity and contractures at the wrist after stroke and to explore if these are associated with upper limb functional recovery. - Design: Longitudinal observational study using secondary data from the control group of a randomized

  3. Treatment of internal rotation contracture of the shoulder in obstetric brachial plexus lesions by subscapular tendon lengthening and open reduction: early results and complications

    NARCIS (Netherlands)

    van der Sluijs, Johannes A.; van Ouwerkerk, Willem J. R.; de Gast, Arthur; Nollet, Frans; Winters, Hay; Wuisman, Paul I. J. M.

    2004-01-01

    In this prospective study of 19 consecutive children, the operative treatment of internal rotation contracture of the shoulder in obstetric brachial plexus lesions by subscapular tendon lengthening and open reduction of the humeral head is evaluated. The average age of the children was 3.7 years and

  4. Co-delivery of VEGF and bFGF via a PLGA nanoparticle-modified BAM for effective contracture inhibition of regenerated bladder tissue in rabbits

    Science.gov (United States)

    Jiang, Xincheng; Lin, Houwei; Jiang, Dapeng; Xu, Guofeng; Fang, Xiaoliang; He, Lei; Xu, Maosheng; Tang, Bingqiang; Wang, Zhiyong; Cui, Daxiang; Chen, Fang; Geng, Hongquan

    2016-02-01

    Graft contracture is a common problem associated with the regeneration processes of tissue-engineered bladders. Currently, most strategies used for incorporating bioactive molecules into biomaterial designs do not work during all phases of tissue regeneration. In this study, we used a growth factor-PLGA nanoparticle thermo-sensitive gel system (i.e., BAM with incorporated VEGF and bFGF-loaded PLGA nanoparticles and mixed with a hydrophilic gel) to promote bladder tissue regeneration in a rabbit model. At 4 and 12 weeks after surgery, contracture rate assessment and histological examination were conducted to evaluate bladder tissue regeneration. The results indicated that the functional composite scaffold continuously and effectively released VEGF and bFGF and promoted bladder reconstruction with a significant decrease in graft contracture. In addition, the number and arrangement of regenerated urothelial cells and smooth muscle cells as well as microvascular density and maturity were improved in the VEGF/bFGF nanoparticle group compared with the single factor VEGF or bFGF nanoparticle group and BAM alone. The nanoparticle thermo-sensitive gel system, which exhibited favourable performance, may effectively inhibit graft contracture and promote bladder tissue regeneration in rabbits.

  5. Efficacy and safety of collagenase clostridium histolyticum injection for Dupuytren contracture: short-term results from 2 open-label studies.

    Science.gov (United States)

    Witthaut, Jörg; Jones, Graeme; Skrepnik, Nebojsa; Kushner, Harvey; Houston, Anthony; Lindau, Tommy R

    2013-01-01

    The JOINT I (United States) and JOINT II (Australia and Europe) studies evaluated the efficacy and safety of collagenase clostridium histolyticum (CCH) injection for the treatment of Dupuytren contracture. Both studies used identical open-label protocols. Patients with fixed-flexion contractures of metacarpophalangeal (MCP) (20° to 100°) or proximal interphalangeal (PIP) joints (20° to 80°) could receive up to three 0.58-mg CCH injections per cord (up to 5 total injections per patient). We performed standardized finger extension procedures to disrupt injected cords the next day, with follow-up 1, 2, 6, and 9 months thereafter. The primary end point (clinical success) was reduction in contracture to within 0° to 5° of full extension 30 days after the last injection. Clinical improvement was defined as 50% or more reduction from baseline contracture. Dupuytren cords affecting 879 joints (531 MCP and 348 PIP) in 587 patients were administered CCH injections at 14 U.S. and 20 Australian/European sites, with similar outcomes in both studies. Clinical success was achieved in 497 (57%) of treated joints using 1.2 ± 0.5 (mean ± SD) CCH injections per cord. More MCP than PIP joints achieved clinical success (70% and 37%, respectively) or clinical improvement (89% and 58%, respectively). Less severely contracted joints responded better than those more severely contracted. Mean change in contracture was 55° for MCP joints and 25° for PIP joints. With average contracture reductions of 73% and improvements in range of motion by 30°, most patients (92%) were "very satisfied" (71%) or "quite satisfied" (21%) with treatment. Physicians rated change from baseline as "very much improved" (47%) or "much improved" (35%). The CCH injections were well tolerated, causing no tendon ruptures or systemic reactions. Collagenase clostridium histolyticum was an effective, minimally invasive option for the treatment of Dupuytren contracture of a broad range of severities. Most

  6. Direct cooled power electronics substrate

    Science.gov (United States)

    Wiles, Randy H [Powell, TN; Wereszczak, Andrew A [Oak Ridge, TN; Ayers, Curtis W [Kingston, TN; Lowe, Kirk T [Knoxville, TN

    2010-09-14

    The disclosure describes directly cooling a three-dimensional, direct metallization (DM) layer in a power electronics device. To enable sufficient cooling, coolant flow channels are formed within the ceramic substrate. The direct metallization layer (typically copper) may be bonded to the ceramic substrate, and semiconductor chips (such as IGBT and diodes) may be soldered or sintered onto the direct metallization layer to form a power electronics module. Multiple modules may be attached to cooling headers that provide in-flow and out-flow of coolant through the channels in the ceramic substrate. The modules and cooling header assembly are preferably sized to fit inside the core of a toroidal shaped capacitor.

  7. Theory of tapered laser cooling

    Energy Technology Data Exchange (ETDEWEB)

    Okamoto, Hiromi; Wei, J.

    1998-03-25

    A theory of tapered laser cooling for fast circulating ion beams in a storage ring is constructed. The authors describe the fundamentals of this new cooling scheme, emphasizing that it might be the most promising way to beam crystallization. The cooling rates are analytically evaluated to study the ideal operating condition. They discuss the physical implication of the tapering factor of cooling laser, and show how to determine its optimum value. Molecular dynamics method is employed to demonstrate the validity of the present theory.

  8. Volkmann's Ischemic Contracture with Atrophic Non-union of Ulna Managed by Bone Shortening and Transposition of Radial Autograft.

    Science.gov (United States)

    L, Maheshwar; Kiran K, K; Kc, Vamshi; Prasad R, Siva

    2015-01-01

    Volkmann's ischemic contracture (VIC) is a complex and variable flexion deformity of wrist and fingers resulting from fibrosis and contracture of flexor muscles of forearm. It is caused by ischemic injury to the deep tissues enclosed in the tight unyielding osteo-facial compartments secondary to neglected acute compartment syndrome. VIC may be associated with malunion or non-union of forearm fractures. To the best of our knowledge, this article is the first case report of VIC associated with atrophic non-union of ulna managed by shortening of forearm bones combined with transposition of intercalary auto graft from the fellow bone. A seven year old boy presented with flexion deformity of wrist and hand with inability to use his left hand since three and half months subsequent to an injury to his left forearm due to fall from a tree of six feet height. The patient was diagnosed and treated by a native traditional bone setter for his Radius and Ulna fracture of left forearm with massaging and tight bandaging. On examination there was wasting of left forearm with positive Volkmann's sign, flexion contracture of wrist with loss of grip strength and tenderness over the upper and middle third junction of left ulna with a palpable gap. The radiograph of forearm revealed atrophic non-union of left ulna. In order to tackle both the issues, shortening osteotomy of radius with transposition of tubular radius intercalary graft onto ulna was done. Radius was fixed with a dynamic compression plate and Ulna was fixed with a rush nail effecting overall two and half centimetres shortening of both bones of forearm. This approach has addressed both atrophic non-union of ulna and VIC in a single stage and gave excellent functional outcome till the last follow-up of three years from the date of surgery. Bone shortening and transposition of auto-graft from the fellow bone may prove to be an excellent treatment modality for VIC with associated non-union of involved compartmental bones in

  9. Treatment of Dupuytren’s contracture with collagenase clostridium histolyticum under clinical practice conditions: ReDUCTo study

    Directory of Open Access Journals (Sweden)

    Haerle, Max

    2015-08-01

    Full Text Available Background: To date, real-life data on non-surgical correction of Dupuytren’s contracture with collagenase clostridium histolyticum injection (CCH, Xiapex are limited. Methods and results: In an open-label non-interventional study in in Germany (mean age 65.1±9.8 years, 79.3% males, patients were followed up until 1 year after injection. 63 (73.3% received the injection at the MCP joint, and 23 (26.7% at the PIP. The mean grade of contracture in the presently treated finger at baseline was for the MCP joint 32.4°±25.1, for the PIP° 29.2±31.5, and for the DIP° 0.5±2.0. At days 30/360 compared to baseline, the degree of contracture of the MCP joint was reduced by 28.2°±24.6/30.8°±25.0, of the PIP by 20.0°±24.7/8.5°±29.6, and of the DIP by 0.01°±1.9/0.7±2.3. Improvement of hand function at day 30/360 was rated by physicians as very good in 69.5/60.9%, as good in 23.2/28.3%, and as poor in 7.3/8.7%, and none in 0.0/2.2%. No serious adverse drug reactions (SADR occurred. Adverse drug reactions (ADR were noted within injection in 64 patients (74.4%, mostly contusion/swelling, pain, blood blister or other bleeding at the injection site, or ecchymosis. In an overall assessment, at day 30/360, 73.5%/95.7% of the physicians rated tolerability of CCH in their patients as very good, 22.9%/2.2% as good, and 3.6%/2.2% as moderate. On the EQ-5D Visual Analog Scale the mean score improved from 79.5±17.9 to 83.8±15.8 at day 30, and to 85.4±14.1 at day 360. On the Michigan Hand Questionnaire, the total score was 67.5 points at baseline, at day 30 and 75.2 points at day 360.Conclusions: Overall, treatment with CCH under clinical practice conditions was effective and well tolerated. Quality of life and hand function improved substantially. No unknown safety issues were identified during the study.

  10. Hem-o-lok clip: a neglected cause of severe bladder neck contracture and consequent urinary incontinence after robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Cormio, Luigi; Massenio, Paolo; Lucarelli, Giuseppe; Di Fino, Giuseppe; Selvaggio, Oscar; Micali, Salvatore; Carrieri, Giuseppe

    2014-02-20

    Hem-o-lok clips are widely used during robot-assisted and laparoscopic radical prostatectomy to control the lateral pedicles. There are a few reports of hem-o-lok clip migration into the bladder or vesico-urethral anastomosis and only four cases of hem-o-lok clip migration resulting into bladder neck contracture. Herein, we describe the first case, to our knowledge, of hem-o-lok clip migration leading to severe bladder neck contracture and subsequent stress urinary incontinence. A 62-year-old Caucasian man underwent robot-assisted laparoscopic radical prostatectomy for a T1c Gleason 8 prostate cancer. One month after surgery the patient was fully continent; however, three months later, he presented with acute urinary retention requiring suprapubic drainage. Urethroscopy showed a hem-o-lok clip strongly attached to the area between the vesico-urethral anastomosis and the urethral sphincter and a severe bladder neck contracture behind it. Following cold-knife urethral incision and clip removal, the bladder neck contracture was widely resected. At 3-month follow-up, the patient voided spontaneously with a peak flow rate of 9.5 ml/sec and absence of post-void residual urine, but leaked 240 ml urine at the 24-hour pad test. To date, at 1-year follow-up, his voiding situation remains unchanged. The present report provides further evidence for the risk of hem-o-lok clip migration causing bladder neck contracture, and is the first to demonstrate the potential of such complication to result into stress urinary incontinence.

  11. ATLAS' major cooling project

    CERN Multimedia

    2005-01-01

    In 2005, a considerable effort has been put into commissioning the various units of ATLAS' complex cryogenic system. This is in preparation for the imminent cooling of some of the largest components of the detector in their final underground configuration. The liquid helium and nitrogen ATLAS refrigerators in USA 15. Cryogenics plays a vital role in operating massive detectors such as ATLAS. In many ways the liquefied argon, nitrogen and helium are the life-blood of the detector. ATLAS could not function without cryogens that will be constantly pumped via proximity systems to the superconducting magnets and subdetectors. In recent weeks compressors at the surface and underground refrigerators, dewars, pumps, linkages and all manner of other components related to the cryogenic system have been tested and commissioned. Fifty metres underground The helium and nitrogen refrigerators, installed inside the service cavern, are an important part of the ATLAS cryogenic system. Two independent helium refrigerators ...

  12. Magnetic entropy and cooling

    DEFF Research Database (Denmark)

    Hansen, Britt Rosendahl; Kuhn, Luise Theil; Bahl, Christian Robert Haffenden

    2010-01-01

    Some manifestations of magnetism are well-known and utilized on an everyday basis, e.g. using a refrigerator magnet for hanging that important note on the refrigerator door. Others are, so far, more exotic, such as cooling by making use of the magnetocaloric eect. This eect can cause a change...... in the temperature of a magnetic material when a magnetic eld is applied or removed. For many years, experimentalists have made use of dilute paramagnetic materials to achieve milliKelvin temperatures by use of the magnetocaloric eect. Also, research is done on materials, which might be used for hydrogen, helium...... the eect: the isothermal magnetic entropy change and the adiabatic temperature change. Some of the manifestations and utilizations of the MCE will be touched upon in a general way and nally I will talk about the results I have obtained on a sample of Gadolinium Iron Garnet (GdIG, Gd3Fe5O12), which...

  13. Film cooling for a closed loop cooled airfoil

    Science.gov (United States)

    Burdgick, Steven Sebastian; Yu, Yufeng Phillip; Itzel, Gary Michael

    2003-01-01

    Turbine stator vane segments have radially inner and outer walls with vanes extending therebetween. The inner and outer walls are compartmentalized and have impingement plates. Steam flowing into the outer wall plenum passes through the impingement plate for impingement cooling of the outer wall upper surface. The spent impingement steam flows into cavities of the vane having inserts for impingement cooling the walls of the vane. The steam passes into the inner wall and through the impingement plate for impingement cooling of the inner wall surface and for return through return cavities having inserts for impingement cooling of the vane surfaces. At least one film cooling hole is defined through a wall of at least one of the cavities for flow communication between an interior of the cavity and an exterior of the vane. The film cooling hole(s) are defined adjacent a potential low LCF life region, so that cooling medium that bleeds out through the film cooling hole(s) reduces a thermal gradient in a vicinity thereof, thereby the increase the LCF life of that region.

  14. Relationship between electromyographic activity of the vastus lateralis while standing and the extent of bilateral simulated knee-flexion contractures.

    Science.gov (United States)

    Potter, P J; Kirby, R L

    1991-12-01

    The effect of simulated bilateral knee-flexion contractures (KFC) on the electromyographic (EMG) activity of the vastus lateralis was studied by testing 10 normal subjects using surface EMG to test the hypothesis that the activity of the knee extensors would increase as a function of the severity of the contracture. The root mean square of the EMG activity was determined from four 4-s samples taken at 30-s intervals, during 2 min of standing in each of five positions of simulated KFC (0 degree, 10 degrees, 20 degrees, 30 degrees and 40 degrees). A randomly balanced order of conditions was used. KFC were simulated in each subject by means of an adjustable line from the subject's waist to the sole of each foot. An analysis of variance was used to contrast EMG activity, and a significant difference was found between each of the positions (P less than 0.05). The mean (+/- 1 SD) EMG activity, expressed as a percentage of the maximum voluntary contraction, was 0.3% (+/- 0.2) at 0 degree, 7.6% (+/- 5.6) at 10 degrees, 10.9% (+/- 7.6) at 20 degrees, 16.6% (+/- 12.4) at 30 degrees and 24.0% (+/- 14.0) at 40 degrees. A linear relationship was found (r2 = 0.986), expressed by the equation y = 0.62 + 0.56 x, where y represents EMG activity and x represents the extent of simulated KFC (P = 0.0007). The results provide insight into the increased knee extensor activity necessary to stand with KFC and underline the importance of treating this common disorder.

  15. Two novel MYH7 proline substitutions cause Laing Distal Myopathy-like phenotypes with variable expressivity and neck extensor contracture.

    Science.gov (United States)

    Feinstein-Linial, Miora; Buvoli, Massimo; Buvoli, Ada; Sadeh, Menachem; Dabby, Ron; Straussberg, Rachel; Shelef, Ilan; Dayan, Daniel; Leinwand, Leslie Anne; Birk, Ohad S

    2016-08-12

    Human skeletal muscles express three major myosin heavy chain (MyHC) isoforms: MyHCIIx (MYH1) in fast type 2B muscle fibers, MyHCIIa (MYH2) in fast type 2A fibers and MyHCI/β-cardiac MyHC (MYH7) in slow type I skeletal fibers and cardiac ventricles. In line with its expression pattern, MYH7 mutations have been reported in association with hypertrophic or dilated cardiomyopathy, skeletal myopathies or a combination of both. We analyzed the clinical and molecular phenotype of two unrelated families of Jewish Moroccan ancestry that presented with apparently autosomal dominant inheritance of progressive Laing-like distal myopathy with non-specific myopathic changes, but uncommon marked contractures and wasting of the neck extensors. Clinical phenotyping, whole exome sequencing and restriction analysis, generation of mutants followed by cell culture transfection and imaging. Using whole exome sequencing we identified in both families two novel heterozygous proline substitutions located in exon 31 of MYH7 within its rod domain: c.4309G>C (p.Ala1437Pro) and c.4301G>C (p.Arg1434Pro). Here we show that the phenotype caused by these mutations includes marked cervical muscle contracture, and report that the severity of the phenotype varies significantly, to the extent of non-penetrance in one of the families. Finally, we provide evidence that both proline substitutions impair myosin self-assembly in non-muscle cells transfected with β-myosin constructs carrying the mutations, but do not prevent incorporation of the mutant molecules into the sarcomere. This study expands our clinical and molecular knowledge of MYH7 rod mutations causing skeletal myopathies, and underscores the importance of discussing disease penetrance during genetic counseling.

  16. Newton's Law of Cooling Revisited

    Science.gov (United States)

    Vollmer, M.

    2009-01-01

    The cooling of objects is often described by a law, attributed to Newton, which states that the temperature difference of a cooling body with respect to the surroundings decreases exponentially with time. Such behaviour has been observed for many laboratory experiments, which led to a wide acceptance of this approach. However, the heat transfer…

  17. Be Cool, Man! / Jevgeni Levik

    Index Scriptorium Estoniae

    Levik, Jevgeni

    2005-01-01

    Järg 1995. aasta kriminaalkomöödiale "Tooge jupats" ("Get Shorty") : mängufilm "Be Cool, Chili Palmer on tagasi!" ("Be Cool") : režissöör F. Gary Gray, peaosades J. Travolta ja U. Thurman : USA 2005. Lisatud J. Travolta ja U. Thurmani lühiintervjuud

  18. Dialogues in the COOL Project

    NARCIS (Netherlands)

    Stalpers, S.I.P.; Kroeze, C.

    2013-01-01

    The Climate Options for the Long-term (COOL) Project is a participatory integrated assessment (PIA) comprising extensive dialogues at three levels: national, European and global. The objective of the COOL Project was to ‘develop strategic notions on how to achieve drastic reductions of greenhouse

  19. Cooling clothing utilizing water evaporation

    DEFF Research Database (Denmark)

    Sakoi, Tomonori; Tominaga, Naoto; Melikov, Arsen Krikor

    2014-01-01

    We developed cooling clothing that utilizes water evaporation to cool the human body and has a mechanism to control the cooling intensity. Clean water was supplied to the outer surface of the T-shirt of the cooling clothing, and a small fan was used to enhance evaporation on this outer surface....... To prevent wet discomfort, the T-shirt was made of a polyester material having a water-repellent silicon coating on the inner surface. The chest, front upper arms, and nape of the neck were adopted as the cooling areas of the human body. We conducted human subject experiments in an office with air...... temperature ranging from 27.4 to 30.7 °C to establish a suitable water supply control method. A water supply control method that prevents water accumulation in the T-shirt and water dribbling was validated; this method is established based on the concept of the water evaporation capacity under the applied...

  20. Closed loop steam cooled airfoil

    Science.gov (United States)

    Widrig, Scott M.; Rudolph, Ronald J.; Wagner, Gregg P.

    2006-04-18

    An airfoil, a method of manufacturing an airfoil, and a system for cooling an airfoil is provided. The cooling system can be used with an airfoil located in the first stages of a combustion turbine within a combined cycle power generation plant and involves flowing closed loop steam through a pin array set within an airfoil. The airfoil can comprise a cavity having a cooling chamber bounded by an interior wall and an exterior wall so that steam can enter the cavity, pass through the pin array, and then return to the cavity to thereby cool the airfoil. The method of manufacturing an airfoil can include a type of lost wax investment casting process in which a pin array is cast into an airfoil to form a cooling chamber.

  1. Film cooling air pocket in a closed loop cooled airfoil

    Science.gov (United States)

    Yu, Yufeng Phillip; Itzel, Gary Michael; Osgood, Sarah Jane; Bagepalli, Radhakrishna; Webbon, Waylon Willard; Burdgick, Steven Sebastian

    2002-01-01

    Turbine stator vane segments have radially inner and outer walls with vanes extending between them. The inner and outer walls are compartmentalized and have impingement plates. Steam flowing into the outer wall plenum passes through the impingement plate for impingement cooling of the outer wall upper surface. The spent impingement steam flows into cavities of the vane having inserts for impingement cooling the walls of the vane. The steam passes into the inner wall and through the impingement plate for impingement cooling of the inner wall surface and for return through return cavities having inserts for impingement cooling of the vane surfaces. To provide for air film cooing of select portions of the airfoil outer surface, at least one air pocket is defined on a wall of at least one of the cavities. Each air pocket is substantially closed with respect to the cooling medium in the cavity and cooling air pumped to the air pocket flows through outlet apertures in the wall of the airfoil to cool the same.

  2. 46 CFR 153.432 - Cooling systems.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Cooling systems. 153.432 Section 153.432 Shipping COAST... Control Systems § 153.432 Cooling systems. (a) Each cargo cooling system must have an equivalent standby... cooling system. (b) Each tankship that has a cargo tank with a required cooling system must have a manual...

  3. Central cooling: absorptive chillers

    Energy Technology Data Exchange (ETDEWEB)

    Christian, J.E.

    1977-08-01

    This technology evaluation covers commercially available single-effect, lithium-bromide absorption chillers ranging in nominal cooling capacities of 3 to 1,660 tons and double-effect lithium-bromide chillers from 385 to 1,060 tons. The nominal COP measured at operating conditions of 12 psig input steam for the single-effect machine, 85/sup 0/ entering condenser water, and 44/sup 0/F exiting chilled-water, ranges from 0.6 to 0.65. The nominal COP for the double-effect machine varies from 1.0 to 1.15 with 144 psig entering steam. Data are provided to estimate absorption-chiller performance at off-nominal operating conditions. The part-load performance curves along with cost estimating functions help the system design engineer select absorption equipment for a particular application based on life-cycle costs. Several suggestions are offered which may be useful for interfacing an absorption chiller with the remaining Integrated Community Energy System. The ammonia-water absorption chillers are not considered to be readily available technology for ICES application; therefore, performance and cost data on them are not included in this evaluation.

  4. Efficacy and safety of collagenase clostridium histolyticum in the treatment of proximal interphalangeal joints in dupuytren contracture: combined analysis of 4 phase 3 clinical trials.

    Science.gov (United States)

    Badalamente, Marie A; Hurst, Lawrence C; Benhaim, Prosper; Cohen, Brian M

    2015-05-01

    To examine the results of proximal interphalangeal (PIP) joint contractures from 4 phase 3 clinical trials of collagenase clostridium histolyticum (CCH) injection for Dupuytren contracture. Patients enrolled in Collagenase Option for Reduction of Dupuytren I/II and JOINT I/II with one or more PIP joint contractures (20° to 80°) received CCH 0.58 mg/0.20 mL or placebo (Collagenase Option for Reduction of Dupuytren I/II only) injected directly into a palpable cord. The percentage of PIP joints achieving clinical success (0° to 5° of full extension), clinical improvement (50% or more reduction in baseline contracture), and range of motion improvement at 30 days after the first and last CCH injections was assessed. The PIP joint contractures were classified into low (40° or less) and high (more than 40°) baseline severity. Adverse events were recorded. A total of 506 adults (mean age, 63 ± 10 y; 80% male) received 1,165 CCH injections in 644 PIP joint cords (mean, 1.6 injections/cord). Most patients (60%) received 1 injection, with 24%, 16%, and 1% receiving 2, 3, and 4 injections, respectively. Clinical success and clinical improvement occurred in 27% and 49% of PIP joints after one injection and in 34% and 58% after the last injection. Patients with lower baseline severity showed greater improvement and response was comparable between fingers, as were improvements in range of motion. Adverse events occurring in more than 10% of patients were peripheral edema (58%), contusion (38%), injection site hemorrhage (23%), injection site pain (21%), injection site swelling (16%), and tenderness (13%). This incidence was consistent with data reported in phase 3 trials. Two tendon ruptures occurred. No further ruptures occurred after a modified injection technique was adopted. Collagenase clostridium histolyticum was effective and well tolerated in the short term in patients with Dupuytren PIP joint contractures. Therapeutic II. Copyright © 2015 American Society for

  5. Active cooling system for Tokamak in-vessel operation manipulator

    Energy Technology Data Exchange (ETDEWEB)

    Yuan, Jianjun, E-mail: yuanjj@sjtu.edu.cn; Chen, Tan; Li, Fashe; Zhang, Weijun; Du, Liang

    2015-10-15

    Highlights: • We summarized most of the challenges of fusion devices to robot systems. • Propose an active cooling system to protect all of the necessary components. • Trial design test and theoretical analysis were conducted. • Overall implementation of the active cooling system was demonstrated. - Abstract: In-vessel operation/inspection is an indispensable task for Tokamak experimental reactor, for a robot/manipulator is more capable in doing this than human being with more precise motion and less risk of damaging the ambient equipment. Considering the demanding conditions of Tokamak, the manipulator should be adaptable to rapid response in the extreme conditions such as high temperature, vacuum and so on. In this paper, we propose an active cooling system embedded into such manipulator. Cameras, motors, gearboxes, sensors, and other mechanical/electrical components could then be designed under ordinary conditions. The cooling system cannot only be a thermal shield since the components are also heat sources in dynamics. We carry out a trial test to verify our proposal, and analyze the active cooling system theoretically, which gives a direction on the optimization by varying design parameters, components and distribution. And based on thermal sensors monitoring and water flow adjusting a closed-loop feedback control of temperature is added to the system. With the preliminary results, we believe that the proposal gives a way to robust and inexpensive design in extreme environment. Further work will concentrate on overall implementation and evaluation of this cooling system with the whole inspection manipulator.

  6. Note: A microfluidic freezer based on evaporative cooling of atomized aqueous microdroplets.

    Science.gov (United States)

    Song, Jin; Chung, Minsub; Kim, Dohyun

    2015-01-01

    We report for the first time water-based evaporative cooling integrated into a microfluidic chip for temperature control and freezing of biological solution. We opt for water as a nontoxic, effective refrigerant. Aqueous solutions are atomized in our device and evaporation of microdroplets under vacuum removes heat effectively. We achieve rapid cooling (-5.1 °C/s) and a low freezing temperature (-14.1 °C). Using this approach, we demonstrate freezing of deionized water and protein solution. Our simple, yet effective cooling device may improve many microfluidic applications currently relying on external power-hungry instruments for cooling and freezing.

  7. New Technique for Cryogenically Cooling Small Test Articles

    Science.gov (United States)

    Rodriquez, Karen M.; Henderson, Donald J.

    2011-01-01

    Convective heat removal techniques to rapidly cool small test articles to Earth-Moon L2 temperatures of 77 K were accomplished through the use of liquid nitrogen (LN2). By maintaining a selected pressure range on the saturation curve, test articles were cooled below the LN2 boiling point at ambient pressure in less than 30 min. Difficulties in achieving test pressures while maintaining the temperature tolerance necessitated a modification to the original system to include a closed loop conductive cold plate and cryogenic shroud

  8. Measurements of Beam Cooling in Muon Ionization Cooling Experiment

    Science.gov (United States)

    Mohayai, Tanaz; Snopok, Pavel; Rogers, Chris; Neuffer, David; Muon Ionization Cooling Experiment Collaboration

    2017-01-01

    Cooled muon beams are essential for production of high-flux neutrino beams at the Neutrino Factory and high luminosity muon beams at the Muon Collider. The international Muon Ionization Cooling Experiment, MICE aims to demonstrate muon beam cooling through ionization energy loss of muons in material. The standard figure of merit for cooling in MICE is the transverse RMS emittance reduction and to measure this, the individual muon positions and momenta are reconstructed using scintillating-fiber tracking detectors, before and after a low-Z absorbing material. In this study, in addition to a preview on the standard measurement technique, an alternative technique is described, which is the measurement of phase-space density using the novel Kernel Density Estimation method. Work supported by the U.S. Department of Energy under contract No. DE - AC05 - 06OR23100.

  9. CLIC inner detectors cooling simulations

    CERN Document Server

    Duarte Ramos, F.; Villarejo Bermudez, M.

    2014-01-01

    The strict requirements in terms of material budget for the inner region of the CLIC detector concepts require the use of a dry gas for the cooling of the respective sen- sors. This, in conjunction with the compactness of the inner volumes, poses several challenges for the design of a cooling system that is able to fulfil the required detec- tor specifications. This note introduces a detector cooling strategy using dry air as a coolant and shows the results of computational fluid dynamics simulations used to validate the proposed strategy.

  10. CO$_2$ cooling experience (LHCb)

    CERN Document Server

    Van Lysebetten, Ann; Verlaat, Bart

    2007-01-01

    The thermal control system of the LHCb VErtex LOcator (VELO) is a two-phase C0$_2$ cooling system based on the 2-Phase Accumulator Controlled Loop (2PACL) method. Liquid carbon dioxide is mechanically pumped in a closed loop, chilled by a water-cooled freon chiller and evaporated in the VELO detector. The main goal of the system is the permanent cooling of the VELO silicon sensors and of the heat producing front-end electronics inside a vacuum environment. This paper describes the design and the performance of the system. First results obtained during commissioning are also presented.

  11. Sympathetic Cooling of Quantum Simulators

    Science.gov (United States)

    Raghunandan, Meghana; Weimer, Hendrik

    2017-04-01

    We discuss the possibility of maximizing the cooling of a quantum simulator by controlling the system-environment coupling such that the system is driven into the ground state. We make use of various analytical tools such as effective operator formalism and the quantum master equations to exactly solve the model of an Ising spin chain consisting of N particles coupled to a radiation field. We maximize the cooling by finding the dependence of the effective rate of transitions of the various excited states into the ground state. We show that by adding a single dissipative qubit, we already get quite substantial cooling rates. Volkswagen Foundation, DFG.

  12. Cooling towers principles and practice

    CERN Document Server

    Hill, G B; Osborn, Peter D

    1990-01-01

    Cooling Towers: Principles and Practice, Third Edition, aims to provide the reader with a better understanding of the theory and practice, so that installations are correctly designed and operated. As with all branches of engineering, new technology calls for a level of technical knowledge which becomes progressively higher; this new edition seeks to ensure that the principles and practice of cooling towers are set against a background of up-to-date technology. The book is organized into three sections. Section A on cooling tower practice covers topics such as the design and operation of c

  13. Rapid Prototyping

    Science.gov (United States)

    1999-01-01

    Javelin, a Lone Peak Engineering Inc. Company has introduced the SteamRoller(TM) System as a commercial product. The system was designed by Javelin during a Phase II NASA funded small commercial product. The purpose of the invention was to allow automated-feed of flexible ceramic tapes to the Laminated Object Manufacturing rapid prototyping equipment. The ceramic material that Javelin was working with during the Phase II project is silicon nitride. This engineered ceramic material is of interest for space-based component.

  14. Passive low energy cooling of buildings

    CERN Document Server

    Givoni, Baruch

    1994-01-01

    A practical sourcebook for building designers, providing comprehensive discussion of the impact of basic architectural choices on cooling efficiency, including the layout and orientation of the structure, window size and shading, exterior color, and even the use of plantings around the site. All major varieties of passive cooling systems are presented, with extensive analysis of performance in different types of buildings and in different climates: ventilation; radiant cooling; evaporative cooling; soil cooling; and cooling of outdoor spaces.

  15. Advance in MEIC cooling studies

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Yuhong [JLAB, Newport News, VA (United States); Derbenev, Ya. [JLAB, Newport News, VA (United States); Douglas, D. [JLAB, Newport News, VA (United States); Hutton, A. [JLAB, Newport News, VA (United States); Kimber, A. [JLAB, Newport News, VA (United States); Li, R. [JLAB, Newport News, VA (United States); Nissen, E. [JLAB, Newport News, VA (United States); Tennant, [JLAB, Newport News, VA (United States); Zhang, H. [JLAB, Newport News, VA (United States)

    2013-06-01

    Cooling of ion beams is essential for achieving a high luminosity for MEIC at Jefferson Lab. In this paper, we present the design concept of the electron cooling system for MEIC. In the design, two facilities are required for supporting a multi-staged cooling scheme; one is a 2 MeV DC cooler in the ion pre-booster; the other is a high electron energy (up to 55 MeV) ERL-circulator cooler in the collider ring. The simulation studies of beam dynamics in an ERL-circulator cooler are summarized and followed by a report on technology development for this cooler. We also discuss two proposed experiments for demonstrating high energy cooling with a bunched electron beam and the ERL-circulator cooler.

  16. Cooled Ceramic Turbine Vane Project

    Data.gov (United States)

    National Aeronautics and Space Administration — N&R Engineering will investigate the feasibility of cooled ceramics, such as ceramic matrix composite (CMC) turbine blade concepts that can decrease specific...

  17. Extraluminal cooling of bilateral common carotid arteries as a method to achieve selective brain cooling for neuroprotection.

    Science.gov (United States)

    Wei, Guo; Hartings, Jed A; Yang, Xiaofang; Tortella, Frank C; Lu, Xi-Chun M

    2008-05-01

    Systemic cooling to achieve brain hypothermia has been investigated as a neuroprotective therapy but can present serious adverse effects. Here we describe a novel method to selectively cool the rat brain and investigate its neuroprotective effects following transient middle cerebral artery occlusion (MCAo). The novelty of our method of selective brain cooling (SBC) was that the extraluminal cooling of the carotid arterial blood was achieved by using a cooling cuff wrapped around each common carotid artery (CCA). Within 20 min of CCA cooling, brain temperature could be lowered by 2-5 degrees C below the baseline and maintained stable for approximately 2 h while maintaining body temperature at 37 degrees C. No adverse effects of SBC were observed on systemic physiology, regional cerebral blood flow (rCBF), bleeding time, or tissue histology in normal animals. In rats having sustained 2-h MCAo, intra-ischemic SBC for 90 min, initiated 30 min following the onset of ischemia, significantly reduced infarction measured at 24 h post-injury (normothermic rats=312+/-51 mm3, SBC rats=139+/-83 mm3). In subgroup experiments, the incidence of peri-infarct depolarization (PID) was assessed during the MCAo and cooling period. Compared to normothermic but ischemic rats, SBC significantly reduced the number of PID events from 6.2+/-2.5 to 2.0+/-2.5, and reduced infarct volumes from 323+/-79 to 139+/-102 mm3. In conclusion, this extralumimal cooling method of SBC provides a safe and efficient approach to rapidly and safely achieve hypothermic neuroprotection.

  18. Vacuum cooling of meat products: current state-of-the-art research advances.

    Science.gov (United States)

    Feng, Chaohui; Drummond, Liana; Zhang, Zhihang; Sun, Da-Wen; Wang, Qijun

    2012-01-01

    Vacuum cooling (VC) is commonly applied for cooling of several foodstuffs, to provide exceptionally rapid cooling rates with low energy consumption and resulting in high-quality food products. However, for products such as meat and cooked meat products, the higher cooling loss of vacuum cooling compared with established methods still means lower yields, and important meat quality parameters can be negatively affected. Substantial efforts during the past ten years have aimed to improve the technology in order to offer the meat industry, especially the cooked meat industry, optimized production in terms of safety regulations and guidelines, as well as meat quality. This review presents and discusses recent VC developments directed to the cooked meat industry. The principles of VC, and the basis for improvements of this technology, are firstly discussed; future prospects for research and development in this area are later explored, particularly in relation to cooling of cooked meat and meat products.

  19. Role of intracellular freezing in the death of cells cooled at supraoptimal rates. [Preservation of erythrocytes, bone marrow cells, and yeasts by freezing

    Energy Technology Data Exchange (ETDEWEB)

    Mazur, P.

    1976-01-01

    Cooling velocity is one of the major factors that determines whether viable cells can be frozen to temperatures that permit indefinite storage. Cooling either too slowly or too rapidly tends to be damaging. Optimum cooling rates are reported for mouse marrow stem cells, yeast, and human red cells.

  20. Lightweight Passive Microclimate Cooling Device

    Science.gov (United States)

    1993-03-01

    adsorption of working fluid vapor is exo- thermic , so this chamber will reject heat to the environment and will be finned to promote natural convection...estimate of the cooling capacity. The water reservoir was immersed in one liter of water contained in an insulated vessel. A heater was placed in the...placed in a pocket in the vest, which has insulation on the outside. This arrangement limits the cooling lost to the outside. 22 SH-cULI)ER STRAP CKET

  1. Perforator-Based Interposition Flaps Perform Better Than Full-Thickness Grafts for the Release of Burn Scar Contractures: A Multicenter Randomized Controlled Trial.

    Science.gov (United States)

    Stekelenburg, Carlijn M; Jaspers, Mariëlle E H; Jongen, Sandra J M; Baas, Dominique C; Gardien, Kim L M; Hiddingh, Jakob; van Zuijlen, Paul P M

    2017-02-01

    Burn scar contractures remain a significant problem for the severely burned patient. Reconstructive surgery is often indicated to improve function and quality of life. Skin grafts (preferably full-thickness grafts) are frequently used to cover the defect that remains after scar release. Local flaps are also used for this purpose and provide healthy skin subcutaneous tissue. The vascularization and versatility of local flaps can be further improved by enclosing a perforator at the base of the flap. Until now, no randomized controlled trial has been performed to determine which technique has the best effectiveness in burn scar contracture releasing procedures. A multicenter randomized controlled trial was performed to compare the effectiveness of perforator-based interposition flaps to full-thickness skin grafts for the treatment of burn scar contractures. The primary outcome parameter was change in the surface area of the flap or full-thickness skin graft. Secondary outcome parameters were width, elasticity, color, Patient and Observer Scar Assessment Scale score, and range of motion. Measurements were performed after 3 and 12 months. The mean surface area between flaps (n = 16) and full-thickness skin grafts (n = 14) differed statistically significantly at 3 months (123 percent versus 87 percent; p Scar Assessment Scale observer score and color), interposition flaps showed superior results compared with full-thickness skin grafts. Perforator-based interposition flaps result in a more effective scar contracture release than full-thickness skin grafts and should therefore be preferred over full-thickness skin grafts when possible. Therapeutic, I.

  2. Comparison of Treatment Outcome After Collagenase and Needle Fasciotomy for Dupuytren Contracture: A Randomized, Single-Blinded, Clinical Trial With a 1-Year Follow-Up.

    Science.gov (United States)

    Strömberg, Joakim; Ibsen-Sörensen, Allan; Fridén, Jan

    2016-09-01

    This study compared the efficacy of collagenase treatment and needle fasciotomy for contracture of the metacarpophalangeal (MCP) joint in Dupuytren disease. This is a prospective, single-blinded, randomized study with follow-up 1 week and 1 year after treatment. One hundred and forty patients with an MCP contracture of 20° or more in a single finger were enrolled, of whom 69 patients were randomized to collagenase treatment and 71 patients to needle fasciotomy. The patients were followed at 1 week and were examined by a physiotherapist after 1 year. Measurements of joint movement and grip strength were recorded as well as patient-perceived outcomes measured by the Unité Rhumatologique des Affections de la Main (URAM) questionnaire and a visual analog scale (VAS) for the estimation of procedural pain and subjective treatment efficacy. Eighty-eight percent of the patients in the collagenase group and 90% of the patients in the needle fasciotomy group had a reduction in their MCP contracture to less than 5° 1 week after treatment, and the median gains in passive MCP movement were 48° and 46°, respectively. The median VAS score for procedural pain was 4.9 of 10 in the collagenase group and 2.7 of 10 in the needle fasciotomy group. After 1 year, 90% of the patients in both groups had full extension of the treated MCP joint. One patient in each group had a recurrence of the contracture. The median improvement in URAM score was 8 units in both groups and the VAS estimation of treatment efficacy by the patients was 8.7 of 10 in both groups. There was no significant difference between the treatment outcomes after collagenase and needle fasciotomy treatment after 1 year. Therapeutic I. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. [A COMPARATIVE STUDY ON TREATMENT OF SCAR CONTRACTURE ON FACE, NECK, AND JOINTS WITH PRE-EXPANDED FLAPS AND SKIN GRAFTS].

    Science.gov (United States)

    Gao, Yashan; Zan, Tao; Li, Haizhou; Li, Qingfeng

    2015-09-01

    To study the treatment results of the pre-expanded flaps for scar contracture on face, neck, and joints by comparing with the skin grafts. A total of 240 cases of scar contracture between July 2004 and June 2014 were included in the study by random sampling; skin grafts were used in 120 cases (skin graft group), and pre-expanded flaps in 120 cases (pre-expanded flap group). There was no significant difference in age, sex, injury sites, and disease duration between 2 groups (P>0.05). Re-operation rate and A&F 0-6 quantization score were used to evaluate the treatment results. The patients were followed up 12 to 75 months (mean, 23.47 months) in the skin graft group, and 12 to 61 months (mean, 19.62 months) in the pre-expanded flap group. The re-operation rate of the skin graft group was 72.5% (87/120), and was significantly higher than that of the pre-expanded flap group (19.2%, 23/120) (P=0.000). The re-operation rate of the neck contracture in teenagers was the highest. It was 93.9% in the skin graft group and 35.0% in the pre-expanded flap group. In the patients who did not undergo re-operations, A&F 0-6 quantization score of the skin graft group was 2.85±1.12, and was significantly lower than that of the pre-expanded flap group (5.22±0.74) (t=13.830, P=0.000). Pre-expanded flap for scar contracture on face, neck, and joints has lower re-operation rate and better aesthetic and functional restoration than skin graft. It should be regarded as the preferred method for teenagers.

  4. The Clinical Application of Preexpanded and Prefabricated Super-Thin Skin Perforator Flap for Reconstruction of Post-Burn Neck Contracture.

    Science.gov (United States)

    Wang, Chunmei; Zhang, Junyi; Yang, Sifen; Hyakusoku, Hiko; Song, Ping; Pu, Lee L Q

    2016-02-01

    Based on our previous animal study, we applied the "bridging effect" to the neighboring axial flap through preexpansion and prefabrication of a skin perforator flap as a new method to reconstruct a large skin defect after release of severe neck burn scar contracture. Twelve patients suffering from severe post-burn cervical contractures underwent reconstruction of large skin defects after surgical release of severe scar contractures with preexpanded and prefabricated super-thin skin perforator flaps supplied primarily by a number of perforators via the "bridging effect" from the branches of the adjacent arteries as 2-stage procedures. During the first-stage operation, 2 tissue expanders were placed accordingly, and this was followed by a subsequent second-stage procedure where an expanded super-thin skin perforator flap was transposed to reconstruct a large neck skin defect. Follow-up was between 6 months and 3 years in this series. All super-thin skin perforator flaps survived in this series with primary healing except one with a distal flap necrosis that was treated with a subsequent skin graft. All patients have had a good contour with improved range of motion in the neck. The preexpansion and prefabrication of a super-thin skin perforator flap can possibly improve the anastomoses between neighboring subdermal vascular plexuses and extend the supplying area of these vessels to the flap. This method may provide a favorable super-thin skin flap that can be used for reconstruction of large neck defects after release of post-burn cervical scar contracture as demonstrated in this case series.

  5. Electrical stimulation and splinting were not clearly more effective than splinting alone for contracture management after acquired brain injury: a randomised trial.

    Science.gov (United States)

    Leung, Joan; Harvey, Lisa A; Moseley, Anne M; Tse, Charis; Bryant, Jane; Wyndham, Shirley; Barry, Siobhan

    2012-01-01

    Is electrical stimulation and splinting more effective than splinting alone for the management of wrist contracture following acquired brain injury? A multi-centre randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Thirty-six adults with first stroke or traumatic brain injury and mild to moderate wrist flexion contractures. The experimental group received electrical stimulation to the wrist and finger extensor muscles for 1 hour a day over 4 weeks while the control group did not. Both groups wore a splint for 12 hours a day during this 4-week period. The primary outcome was passive wrist extension measured with a 3Nm torque and with the fingers in extension. Secondary outcomes included passive wrist extension, wrist and finger extensor strength, wrist flexor spasticity, motor control of the hand, and Global Perceived Effect of Treatment, and perception of treatment credibility. Outcome measures were taken at baseline, at the end of the intervention period (4 weeks), and after a 2-week follow-up period (6 weeks). At 4 and 6 weeks, the mean between-group difference (95% CI) for passive wrist extension was 7 degrees (-2 to 15) and -3 degrees (-13 to 7), respectively. Secondary outcomes were statistically non-significant or were of borderline statistical significance. It is not clear whether electrical stimulation and splinting is more effective than splinting alone for the management of wrist contracture after acquired brain injury. Therapists' confidence in the efficacy of electrical stimulation for contracture management is not yet justified. Copyright © 2012 Australian Physiotherapy Association. Published by .. All rights reserved.

  6. Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury: a randomised trial.

    Science.gov (United States)

    Leung, Joan; Harvey, Lisa A; Moseley, Anne M; Whiteside, Bhavini; Simpson, Melissa; Stroud, Katarina

    2014-12-01

    Is a combination of standing, electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe brain injury? A multi-centre randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. Thirty-six adults with severe traumatic brain injury and ankle plantarflexion contractures. All participants underwent a 6-week program. The experimental group received tilt table standing, electrical stimulation and ankle splinting. The control group received tilt table standing alone. The primary outcome was passive ankle dorsiflexion with a 12Nm torque. Secondary outcomes included: passive dorsiflexion with lower torques (3, 5, 7 and 9Nm); spasticity; the walking item of the Functional Independence Measure; walking speed; global perceived effect of treatment; and perceived treatment credibility. OUTCOME MEASURES were taken at baseline (Week 0), end of intervention (Week 6), and follow-up (Week 10). The mean between-group differences (95% CI) for passive ankle dorsiflexion at Week 6 and Week 10 were -3 degrees (-8 to 2) and -1 degrees (-6 to 4), respectively, in favour of the control group. There was a small mean reduction of 1 point in spasticity at Week 6 (95% CI 0.1 to 1.8) in favour of the experimental group, but this effect disappeared at Week 10. There were no differences for other secondary outcome measures except the physiotherapists' perceived treatment credibility. Tilt table standing with electrical stimulation and splinting is not better than tilt table standing alone for the management of ankle contractures after severe brain injury. ACTRN12608000637347. [Leung J, Harvey LA, Moseley AM, Whiteside B, Simpson M, Stroud K (2014) Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury: a randomised trial.Journal of Physiotherapy60: 201-208]. Copyright © 2014

  7. The influence of contractures and variation in measurement stretching velocity on the reliability of the Modified Ashworth Scale in patients with severe brain injury.

    Science.gov (United States)

    Mehrholz, Jan; Major, Yvonne; Meissner, Daniel; Sandi-Gahun, Sahr; Koch, Rainer; Pohl, Marcus

    2005-01-01

    To determine the influence of contractures and different stretching velocities on the reliability of the Modified Ashworth Scale (MAS) in patients with severe brain injury and impaired consciousness. Cross-section observational study. A rehabilitation centre for adult persons with neurological disorders. Fifty patients with impaired consciousness due to severe cerebral damage of various aetiologies. MEASUREMENT PROTOCOL: Three experienced and trained medical professionals rated each patient in a randomized order once daily for two consecutive days. Shoulder, elbow, wrist, knee and ankle spasticity were assessed by the use of the MAS with different stretching velocities. The presence of contractures was assessed by a goniometer. Retest and inter-rater reliability (k(w) = weighted kappa) of the MAS. The retest reliability of the MAS was good (shoulder joints (k(w) 0.74), elbow joints (k(w) 0.74), wrist joints (k(w) 0.72), knee joints (k(w) 0.72), ankle joints (k(w) 0.77)) and the inter-rater reliability was moderate (shoulder joints (k(w) 0.49), elbow joints (k(w) 0.52), wrist joints (k(w) 0.51), knee joints (k(w) 0.54) ankle joints (k(w) 0.49)). The presence of contractures significantly influenced the reliability of MAS in shoulder and wrist joints. No influence of stretching velocity on the reliability of the MAS was found. In patients with impaired consciousness due to severe brain injury the MAS has good retest, but only limited inter-rater, reliability. The presence of contractures may influence reliability of the MAS, but stretching velocity does not.

  8. Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury: a randomised trial

    Directory of Open Access Journals (Sweden)

    Joan Leung

    2014-12-01

    Full Text Available Question: Is a combination of standing, electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe brain injury? Design: A multi-centre randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants: Thirty-six adults with severe traumatic brain injury and ankle plantarflexion contractures. Intervention: All participants underwent a 6-week program. The experimental group received tilt table standing, electrical stimulation and ankle splinting. The control group received tilt table standing alone. Outcome measures: The primary outcome was passive ankle dorsiflexion with a 12 Nm torque. Secondary outcomes included: passive dorsiflexion with lower torques (3, 5, 7 and 9 Nm; spasticity; the walking item of the Functional Independence Measure; walking speed; global perceived effect of treatment; and perceived treatment credibility. Outcome measures were taken at baseline (Week 0, end of intervention (Week 6, and follow-up (Week 10. Results: The mean between-group differences (95% CI for passive ankle dorsiflexion at Week 6 and Week 10 were –3 degrees (–8 to 2 and –1 degrees (–6 to 4, respectively, in favour of the control group. There was a small mean reduction of 1 point in spasticity at Week 6 (95% CI 0.1 to 1.8 in favour of the experimental group, but this effect disappeared at Week 10. There were no differences for other secondary outcome measures except the physiotherapists’ perceived treatment credibility. Conclusion: Tilt table standing with electrical stimulation and splinting is not better than tilt table standing alone for the management of ankle contractures after severe brain injury. Trial registration: ACTRN12608000637347. [Leung J, Harvey LA, Moseley AM, Whiteside B, Simpson M, Stroud K (2014 Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion

  9. Oil cooled, hermetic refrigerant compressor

    Science.gov (United States)

    English, W.A.; Young, R.R.

    1985-05-14

    A hermetic refrigerant compressor having an electric motor and compressor assembly in a hermetic shell is cooled by oil which is first cooled in an external cooler and is then delivered through the shell to the top of the motor rotor where most of it is flung radially outwardly within the confined space provided by the cap which channels the flow of most of the oil around the top of the stator and then out to a multiplicity of holes to flow down to the sump and provide further cooling of the motor and compressor. Part of the oil descends internally of the motor to the annular chamber to provide oil cooling of the lower part of the motor, with this oil exiting through vent hole also to the sump. Suction gas with entrained oil and liquid refrigerant therein is delivered to an oil separator from which the suction gas passes by a confined path in pipe to the suction plenum and the separated oil drops from the separator to the sump. By providing the oil cooling of the parts, the suction gas is not used for cooling purposes and accordingly increase in superheat is substantially avoided in the passage of the suction gas through the shell to the suction plenum. 3 figs.

  10. Upregulation of interleukin-1β/transforming growth factor-β1 and hypoxia relate to molecular mechanisms underlying immobilization-induced muscle contracture.

    Science.gov (United States)

    Honda, Yuichiro; Sakamoto, Junya; Nakano, Jiro; Kataoka, Hideki; Sasabe, Ryo; Goto, Kyo; Tanaka, Miho; Origuchi, Tomoki; Yoshimura, Toshiro; Okita, Minoru

    2015-09-01

    In this study we investigated the molecular mechanism underlying muscle contracture in rats. The rats were divided into immobilization and control groups, and soleus muscles of the right and left sides were selected for analyses. The levels of CD11b and α-SMA protein, IL-1β, and TGF-β1 mRNA, and type I and III collagen protein and mRNA were significantly greater in the immobilization group than in the control group at all time-points. HIF-1α mRNA levels were significantly higher in the immobilization group at 4 weeks. Moreover, HIF-1α, α-SMA, and type I collagen levels were significantly higher at 4 weeks than at 1 and 2 weeks in the immobilization group. In the early stages of immobilization, upregulation of IL-1β/TGF-β1 via macrophages may promote fibroblast differentiation that could affect muscle contracture. The soleus muscle became hypoxic in the later stages of immobilization, suggesting that hypoxia influences the progression of muscle contracture. © 2014 Wiley Periodicals, Inc.

  11. Relief of knee flexion contracture and gait improvement following adaptive training for an assist device in a transtibial amputee: A case study.

    Science.gov (United States)

    Kim, Sol-Bi; Ko, Chang-Yong; Son, Jinho; Kang, Sungjae; Ryu, Jeicheong; Mun, Museong

    2017-01-01

    Management of a knee contracture is important for regaining gait ability in transtibial amputees. However, there has been little study of prosthesis training for enhancing mobility and improving range of motion in cases of restricted knee extension. This study aimed to evaluate the effects of adaptive training for an assist device (ATAD) for a transtibial amputee with a knee flexion contracture (KFC). A male transtibial amputee with KFC performed 4 months of ATAD with a multidisciplinary team. During the ATAD, the passive range of motion (PROM) in the knee, amputee mobility predictor (AMP) assessment, center of pressure (COP) on a force plate-equipped treadmill, gait features determined by three-dimensional motion analysis, and Short-Form 36 Item Health Survey (SF-36) scores were evaluated. Following ATAD, PROM showed immediate improvement (135.6 ± 2.4° at baseline, 142.5 ± 1.7° at Step 1, 152.1 ± 1.8° at Step 2, 165.8 ± 1.9° at Step 3, and 166.0 ± 1.4° at Step 4); this was followed by an enhanced COP. Gradually, gait features also improved. Additionally, the AMP score (5 at baseline to 29 at Step 4) and K-level (K0 at baseline to K3 at Step 4) increased after ATAD. Along with these improvements, the SF-36 score also improved. ATAD could be beneficial for transtibial amputees by relieving knee contractures and improving gait.

  12. Passive stretching does not enhance outcomes in patients with plantarflexion contracture after cast immobilization for ankle fracture: a randomized controlled trial.

    Science.gov (United States)

    Moseley, Anne M; Herbert, Robert D; Nightingale, Elizabeth J; Taylor, Deborah A; Evans, Trish M; Robertson, Gavin J; Gupta, Sandeep K; Penn, Julie

    2005-06-01

    To compare the efficacy of short- and long-duration passive stretches with a control treatment for the management of plantarflexion contracture after cast immobilization for ankle fracture. Assessor-blinded, randomized controlled trial. Hospital physical therapy outpatient departments. Adults with plantarflexion contracture (N=150) after cast immobilization for ankle fracture. All subjects were weight bearing or partial weight bearing. Exercise only, exercise plus short-duration passive stretch, and exercise plus long-duration passive stretch. All subjects had a 4-week course of exercises. In addition, subjects in the short-duration stretch plus exercise group completed 6 minutes of stretching per day, and subjects in the long-duration stretch plus exercise group completed 30 minutes of stretching per day. Lower Extremity Functional Scale and passive dorsiflexion range of motion with the knee bent and straight at baseline, and at 4 weeks and 3 months postintervention. One hundred thirty-nine (93%) subjects completed the 4-week assessment and 134 (89%) subjects completed the 3-month assessment. There were no statistically significant or clinically important between-group differences for the primary outcomes. The addition of passive stretching confers no benefit over exercise alone for the treatment of plantarflexion contracture after cast immobilization for ankle fracture.

  13. Nuclear superfluidity and cooling time of neutron-star crust

    Energy Technology Data Exchange (ETDEWEB)

    Monrozeau, C.; Margueron, J. [Institut de Physique Nucleaire, Universite Paris Sud, F-91406 Orsay CEDEX (France); Sandulescu, N. [Institut de Physique Nucleaire, Universite Paris Sud, F-91406 Orsay CEDEX (France); Institute of Physics and Nuclear Engineering, RO-76900 Bucharest (Romania)

    2007-03-15

    We analyse the effect of neutron superfluidity on the cooling time of inner crust matter in neutron stars, in the case of a rapid cooling of the core. The specific heat of the inner crust, which determines the thermal response of the crust, is calculated in the framework of HFB approach at finite temperature. The calculations are performed with two paring forces chosen to simulate the pairing properties of uniform neutron matter corresponding respectively to Gogny-BCS approximation and to many-body techniques including polarisation effects. Using a simple model for the heat transport across the inner crust, it is shown that the two pairing forces give very different values for the cooling time. (authors)

  14. Radiotherapy in early-stage Dupuytren's contracture. Long-term results after 13 years

    Energy Technology Data Exchange (ETDEWEB)

    Betz, Nicolas; Ott, Oliver J.; Sauer, Rolf; Fietkau, Rainer [Dept. of Radiation Oncology, Univ. Hospital Erlangen (Germany); Adamietz, Boris [Radiologic Inst., Univ. Hospital Erlangen (Germany); Keilholz, Ludwig [Dept. of Radiation Oncology, Univ. Hospital Erlangen (Germany); Dept. of Radiotherapy, Klinikum Bayreuth GmbH (Germany)

    2010-02-15

    Background and Purpose: In early-stage Dupuytren's contracture, radiotherapy is applied to prevent disease progression. Long-term outcome and late toxicity of the treatment were evaluated in a retrospective analysis. Patients and Methods: Between 12/1982 and 02/2006, 135 patients (208 hands) were irradiated with orthovoltage (120 kV; 20 mA; 4-mm Al filter), in two courses with five daily fractions of 3.0 Gy to a total dose of 30 Gy; separated by a 6- to 8-week interval. The extent of disease was described according to a modified classification of Tubiana et al. Long-term outcome was analyzed at last follow-up between 02/2008 and 05/2008 with a median follow-up of 13 years (range, 2-25 years). Late treatment toxicity and objective reduction of symptoms as change in stage and numbers of nodules and cords were evaluated and used as evidence to assess treatment response. Results: According to the individual stages, 123 cases (59%) remained stable, 20 (10%) improved, and 65 (31%) progressed. In stage N 87% and in stage N/I 70% remained stable or even regressed. In more advanced stages, the rate of disease progression increased to 62% (stage I) or 86% (stage II). 66% of the patients showed a long-term relief of symptoms (i.e., burning sensations, itching and scratching, pressure and tension). Radiotherapy did not increase the complication rate after surgery in case of disease progression and only minor late toxicity (skin atrophy, dry desquamation) could be observed in 32% of the patients. There was no evidence for a second malignancy induced by radiotherapy. Conclusion: After a mean follow-up of 13 years radiotherapy is effective in prevention of disease progression and improves patients' symptoms in early-stage Dupuytren's contracture (stage N, N/I). In case of disease progression after radiotherapy, a ''salvage'' operation is still feasible. (orig.)

  15. Fibroblasts from phenotypically normal palmar fascia exhibit molecular profiles highly similar to fibroblasts from active disease in Dupuytren's Contracture

    Directory of Open Access Journals (Sweden)

    Satish Latha

    2012-05-01

    Full Text Available Abstract Background Dupuytren's contracture (DC is a fibroproliferative disorder characterized by the progressive development of a scar-like collagen-rich cord that affects the palmar fascia of the hand and leads to digital flexion contractures. DC is most commonly treated by surgical resection of the diseased tissue, but has a high reported recurrence rate ranging from 27% to 80%. We sought to determine if the transcriptomic profiles of fibroblasts derived from DC-affected palmar fascia, adjacent phenotypically normal palmar fascia, and non-DC palmar fascial tissues might provide mechanistic clues to understanding the puzzle of disease predisposition and recurrence in DC. Methods To achieve this, total RNA was obtained from fibroblasts derived from primary DC-affected palmar fascia, patient-matched unaffected palmar fascia, and palmar fascia from non-DC patients undergoing carpal tunnel release (6 patients in each group. These cells were grown on a type-1 collagen substrate (to better mimic their in vivo environments. Microarray analyses were subsequently performed using Illumina BeadChip arrays to compare the transcriptomic profiles of these three cell populations. Data were analyzed using Significance Analysis of Microarrays (SAM v3.02, hierarchical clustering, concordance mapping and Venn diagram. Results We found that the transcriptomic profiles of DC-disease fibroblasts and fibroblasts from unaffected fascia of DC patients exhibited a much greater overlap than fibroblasts derived from the palmar fascia of patients undergoing carpal tunnel release. Quantitative real time RT-PCR confirmed the differential expression of select genes validating the microarray data analyses. These data are consistent with the hypothesis that predisposition and recurrence in DC may stem, at least in part, from intrinsic similarities in the basal gene expression of diseased and phenotypically unaffected palmar fascia fibroblasts. These data also demonstrate that

  16. Fibroblasts from phenotypically normal palmar fascia exhibit molecular profiles highly similar to fibroblasts from active disease in Dupuytren's Contracture

    Science.gov (United States)

    2012-01-01

    Background Dupuytren's contracture (DC) is a fibroproliferative disorder characterized by the progressive development of a scar-like collagen-rich cord that affects the palmar fascia of the hand and leads to digital flexion contractures. DC is most commonly treated by surgical resection of the diseased tissue, but has a high reported recurrence rate ranging from 27% to 80%. We sought to determine if the transcriptomic profiles of fibroblasts derived from DC-affected palmar fascia, adjacent phenotypically normal palmar fascia, and non-DC palmar fascial tissues might provide mechanistic clues to understanding the puzzle of disease predisposition and recurrence in DC. Methods To achieve this, total RNA was obtained from fibroblasts derived from primary DC-affected palmar fascia, patient-matched unaffected palmar fascia, and palmar fascia from non-DC patients undergoing carpal tunnel release (6 patients in each group). These cells were grown on a type-1 collagen substrate (to better mimic their in vivo environments). Microarray analyses were subsequently performed using Illumina BeadChip arrays to compare the transcriptomic profiles of these three cell populations. Data were analyzed using Significance Analysis of Microarrays (SAM v3.02), hierarchical clustering, concordance mapping and Venn diagram. Results We found that the transcriptomic profiles of DC-disease fibroblasts and fibroblasts from unaffected fascia of DC patients exhibited a much greater overlap than fibroblasts derived from the palmar fascia of patients undergoing carpal tunnel release. Quantitative real time RT-PCR confirmed the differential expression of select genes validating the microarray data analyses. These data are consistent with the hypothesis that predisposition and recurrence in DC may stem, at least in part, from intrinsic similarities in the basal gene expression of diseased and phenotypically unaffected palmar fascia fibroblasts. These data also demonstrate that a collagen

  17. Impingement jet cooling in gas turbines

    CERN Document Server

    Amano, R S

    2014-01-01

    Due to the requirement for enhanced cooling technologies on modern gas turbine engines, advanced research and development has had to take place in field of thermal engineering. Impingement jet cooling is one of the most effective in terms of cooling, manufacturability and cost. This is the first to book to focus on impingement cooling alone.

  18. Cooled snubber structure for turbine blades

    Science.gov (United States)

    Mayer, Clinton A; Campbell, Christian X; Whalley, Andrew; Marra, John J

    2014-04-01

    A turbine blade assembly in a turbine engine. The turbine blade assembly includes a turbine blade and a first snubber structure. The turbine blade includes an internal cooling passage containing cooling air. The first snubber structure extends outwardly from a sidewall of the turbine blade and includes a hollow interior portion that receives cooling air from the internal cooling passage of the turbine blade.

  19. Cooled Low-Noise HEMT Microwave Amplifiers

    Science.gov (United States)

    Bautista, J. Javier; Ortiz, Gerardo G.; Duh, Kuanghann George

    1992-01-01

    Prototype cooled low-noise microwave amplifiers based on high-electron-mobility transistors (HEMT's) considered as replacements for cooled ruby masers used as low-noise receiver-front-end amplifiers in communications, radio science, radar systems, radio astronomy, and telemetry. HEMT amplifier operates at 12 K, requires less cooling power and operates at lower cost with simpler, more-reliable cooling system.

  20. Dupuytren Contracture Recurrence Following Treatment With Collagenase Clostridium histolyticum (CORDLESS [Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study]): 5-Year Data.

    Science.gov (United States)

    Peimer, Clayton A; Blazar, Philip; Coleman, Stephen; Kaplan, F Thomas D; Smith, Ted; Lindau, Tommy

    2015-08-01

    Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study was a 5-year noninterventional follow-up study to determine long-term efficacy and safety of collagenase clostridium histolyticum (CCH) treatment for Dupuytren contracture. Patients from previous CCH clinical studies were eligible. Enrolled patients were evaluated annually for contracture and safety at 2, 3, 4, and 5 years after their first injection (0.58 mg) of CCH. In successfully treated joints (≤ 5° contracture following CCH treatment), recurrence was defined as 20° or greater worsening (relative to day 30 after the last injection) with a palpable cord or any medical/surgical intervention to correct new/worsening contracture. A post hoc analysis was also conducted using a less stringent threshold (≥ 30° worsening) for comparison with criteria historically used to assess surgical treatment. Of 950 eligible patients, 644 enrolled (1,081 treated joints). At year 5, 47% (291 of 623) of successfully treated joints had recurrence (≥ 20° worsening)-39% (178 of 451) of metacarpophalangeal and 66% (113 of 172) of proximal interphalangeal joints. At year 5, 32% (198 of 623) of successfully treated joints had 30° or greater worsening (metacarpophalangeal 26% [119 of 451] and proximal interphalangeal 46% [79 of 172] joints). Of 105 secondary interventions performed in the successfully treated joints, 47% (49 of 105) received fasciectomy, 30% (32 of 105) received additional CCH, and 23% (24 of 105) received other interventions. One mild adverse event was attributed to CCH treatment (skin atrophy [decreased ring finger circumference from thinning of Dupuytren tissue]). Antibodies to clostridial type I and/or II collagenase were found in 93% of patients, but over the 5 years of follow-up, this did not correspond to any reported clinical adverse events. Five years after successful CCH treatment, the overall recurrence rate of 47% was comparable with published recurrence rates after