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Sample records for tibial nerve seps

  1. Multichannel recording of tibial-nerve somatosensory evoked potentials

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    de Wassenberg, W. J. G. van; Kruizinga, W. J.; van der Hoeven, J. H.; Leenders, K. L.; Maurits, N. M.

    2008-01-01

    Study aims. -The topography of the peaks of tibial.-nerve somatosensory evoked potential (SEP) varies among healthy subjects, most likely because of differences in position and orientation of their cortical generator(s). Therefore, amplitude estimation with a standard one- or two-channel derivation

  2. Giant early components of somatosensory evoked potentials to tibial nerve stimulation in cortical myoclonus.

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    Anzellotti, Francesca; Onofrj, Marco; Bonanni, Laura; Saracino, Antonio; Franciotti, Raffaella

    2016-01-01

    Enlarged cortical components of somatosensory evoked potentials (giant SEPs) recorded by electroencephalography (EEG) and abnormal somatosensory evoked magnetic fields (SEFs) recorded by magnetoencephalography (MEG) are observed in the majority of patients with cortical myoclonus (CM). Studies on simultaneous recordings of SEPs and SEFs showed that generator mechanism of giant SEPs involves both primary sensory and motor cortices. However the generator sources of giant SEPs have not been fully understood as only one report describes clearly giant SEPs following lower limb stimulation. In our study we performed a combined EEG-MEG recording on responses elicited by electric median and tibial nerve stimulation in a patient who developed consequently to methyl bromide intoxication CM with giant SEPs to median and tibial nerve stimuli. SEPs wave shapes were identified on the basis of polarity-latency components (e.g. P15-N20-P25) as defined by earlier studies and guidelines. At EEG recording, the SEP giant component did not appear in the latency range of the first cortical component for median nerve SEP (N20), but appeared instead in the range of the P37 tibial nerve SEP, which is currently identified as the first cortical component elicited by tibial nerve stimuli. Our MEG and EEG SEPs recordings also showed that components in the latency range of P37 were preceded by other cortical components. These findings suggest that lower limb P37 does not correspond to upper limb N20. MEG results confirmed that giant SEFs are the second component from both tibial (N43m-P43m) and median (N27m-P27m) nerve stimulation. MEG dipolar sources of these giant components were located in the primary sensory and motor area.

  3. Percutaneous tibial nerve stimulation for fecal incontinence: a video demonstration.

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    Hotouras, Alexander; Allison, Marion; Currie, Ann; Knowles, Charles H; Chan, Christopher L; Thaha, Mohamed A

    2012-06-01

    Fecal incontinence is an increasingly common condition with significant negative impact on quality on life and health care resources. It frequently presents a therapeutic challenge to clinicians. Emerging evidence suggests that percutaneous tibial nerve stimulation is an effective treatment for fecal incontinence with the added benefit of being minimally invasive and cost effective. Pursuant to the preliminary report of our early experience of percutaneous tibial nerve stimulation in patients with fecal incontinence published in this journal in 2010, in this dynamic article, we now describe and demonstrate the actual technique that can be performed in a nurse-led clinic or outpatient or community setting. Percutaneous tibial nerve stimulation is a technically simple procedure that can potentially be performed in an outpatient or community setting. The overall early success rate of 68% following its use reported by our unit compares favorably with the success rate following other forms of neuromodulation, including sacral nerve stimulation. When completed, our long-term outcome data will provide further information on the efficacy of tibial nerve stimulation in a larger cohort of patients (n > 100). Future studies, including our currently planned randomized controlled trial of percutaneous tibial nerve stimulation vs sham stimulation, will provide controlled efficacy data and may provide information on its exact mechanism of action.

  4. Changes of medium-latency SEP-components following peripheral nerve lesion

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    Straschill Max

    2006-10-01

    Full Text Available Abstract Background Animal studies have demonstrated complex cortical reorganization following peripheral nerve lesion. Central projection fields of intact nerves supplying skin areas which border denervated skin, extended into the deafferentiated cortical representation area. As a consequence of nerve lesions and subsequent reorganization an increase of the somatosensory evoked potentials (SEPs was observed in cats when intact neighbouring nerves were stimulated. An increase of SEP-components of patients with nerve lesions may indicate a similar process of posttraumatic plastic cortical reorganization. Methods To test if a similar process of post-traumatic plastic cortical reorganization does occur in humans, the SEP of intact neighbouring hand nerves were recorded in 29 patients with hand nerve lesions. To hypothetically explain the observed changes of SEP-components, SEP recording following paired stimulation of the median nerve was performed in 12 healthy subjects. Results Surprisingly 16 of the 29 patients (55.2% showed a reduction or elimination of N35, P45 and N60. Patients with lesions of two nerves showed more SEP-changes than patients with a single nerve lesion (85.7%; 6/7 nerves; vs. 34.2%; 13/38 nerves; Fisher's exact test, p Conclusion The results of the present investigation do not provide evidence of collateral innervation of peripherally denervated cortical neurons by neurons of adjacent cortical representation areas. They rather suggest that secondary components of the excitatory response to nerve stimulation are lost in cortical areas, which surround the denervated region.

  5. Transcutaneous stimulation of the posterior tibial nerve for treating refractory urge incontinence of idiopathic and neurogenic origin.

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    Valles-Antuña, C; Pérez-Haro, M L; González-Ruiz de L, C; Quintás-Blanco, A; Tamargo-Diaz, E M; García-Rodríguez, J; San Martín-Blanco, A; Fernandez-Gomez, J M

    2017-09-01

    To assess the efficacy of treatment with transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with urge urinary incontinence, of neurogenic or nonneurogenic origin, refractory to first-line therapeutic options. We included 65 patients with urge urinary incontinence refractory to medical treatment. A case history review, a urodynamic study and a somatosensory evoked potentials (SEP) study were conducted before the TPTNS, studying the functional urological condition by means of a voiding diary. The treatment consisted of 10 weekly sessions of TPTNS lasting 30minutes. Some 57.7% of the patients showed abnormal tibial SEPs, and 42% showed abnormal pudendal SEPs. A statistically significant symptomatic improvement was observed in all clinical parameters after treatment with TPTNS, and 66% of the patients showed an overall improvement, regardless of sex, the presence of underlying neurological disorders, detrusor hyperactivity in the urodynamic study or SEP disorders. There were no adverse effects during the treatment. TPTNS is an effective and well tolerated treatment in patients with urge incontinence refractory to first-line therapies and should be offered early in the treatment strategy. New studies are needed to identify the optimal parameters of stimulation, the most effective treatment protocols and long-term efficacy, as well as its applicability to patients with a neurogenic substrate. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Bilateral transcutaneous tibial nerve stimulation for chronic constipation.

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    Iqbal, F; Collins, B; Thomas, G P; Askari, A; Tan, E; Nicholls, R J; Vaizey, C J

    2016-02-01

    Chronic constipation is difficult to treat when symptoms are intractable. Colonic propulsion may be altered by distal neuromodulation but this is conventionally delivered percutaneously. Transcutaneous tibial nerve stimulation is noninvasive and cheap: this study aimed to assess its efficacy in chronic constipation. Eighteen patients (median age 46 years, 12 female) with chronic constipation were recruited consecutively. Conservative and behavioural therapy had failed to improve symptoms in all 18. Thirty minutes of daily bilateral transcutaneous tibial nerve stimulation was administered by each patient at home for 6 weeks. The primary outcome measure was a change in the Patient Assessment of Constipation Quality of Life (PAC-QoL) score. Change in Patient Assessment of Constipation Symptoms (PAC-SYM), weekly bowel frequency and visual analogue scale (VAS) score were also measured. Fifteen patients (12 female) completed the trial. The PAC-QoL score improved significantly with treatment [pretreatment, median 2.95, interquartile range (IQR) 1.18; posttreatment, median 2.50, IQR 0.70; P = 0.047]. There was no change in PAC-SYM score (pretreatment, median 2.36, IQR 1.59; posttreatment, median 2.08, IQR 0.92; P = 0.53). Weekly stool frequency improved as did VAS score, but these did not reach statistical significance (P = 0.229 and 0.161). The PAC-QoL and PAC-SYM scores both improved in four (26%) patients. Two patients reported complete cure. There were no adverse events reported. Bilateral transcutaneous tibial nerve stimulation appears to be effective in a quarter of patients with chronic constipation. Carefully selected patients with less severe disease may benefit more. This requires further study. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  7. Posterior tibial nerve stimulation vs parasacral transcutaneous neuromodulation for overactive bladder in children.

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    Barroso, Ubirajara; Viterbo, Walter; Bittencourt, Joana; Farias, Tiago; Lordêlo, Patrícia

    2013-08-01

    Parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation have emerged as effective methods to treat overactive bladder in children. However, to our knowledge no study has compared the 2 methods. We evaluated the results of parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation in children with overactive bladder. We prospectively studied children with overactive bladder without dysfunctional voiding. Success of treatment was evaluated by visual analogue scale and dysfunctional voiding symptom score, and by level of improvement of each specific symptom. Parasacral transcutaneous electrical nerve stimulation was performed 3 times weekly and posterior tibial nerve stimulation was performed once weekly. A total of 22 consecutive patients were treated with posterior tibial nerve stimulation and 37 with parasacral transcutaneous electrical nerve stimulation. There was no difference between the 2 groups regarding demographic characteristics or types of symptoms. Concerning the evaluation by visual analogue scale, complete resolution of symptoms was seen in 70% of the group undergoing parasacral transcutaneous electrical nerve stimulation and in 9% of the group undergoing posterior tibial nerve stimulation (p = 0.02). When the groups were compared, there was no statistically significant difference (p = 0.55). The frequency of persistence of urgency and diurnal urinary incontinence was nearly double in the group undergoing posterior tibial nerve stimulation. However, this difference was not statistically significant. We found that parasacral transcutaneous electrical nerve stimulation is more effective in resolving overactive bladder symptoms, which matches parental perception. However, there were no statistically significant differences in the evaluation by dysfunctional voiding symptom score, or in complete resolution of urgency or diurnal incontinence. Copyright © 2013 American Urological

  8. Primary neurolymphoma of the tibial nerve: A case report with characteristic MRI findings

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    Lee, Jung Eun; An, Ji Young; Park, Ji Seon; Ryu, Kyung Nam; Moon, Sung Kyung [Dept. of Radiology, Kyung Hee University Hospital, Seoul (Korea, Republic of)

    2016-11-15

    Primary neurolymphoma (NL) involving the peripheral nervous system is a rare disease that involves the invasion of a nerve or nerve plexus by neoplastic lymphocytes. Although there have been a few reported clinical and pathological cases presenting as primary NL involving the peripheral nerve, the detailed radiological features of NL have not yet been discussed. In this report, we present a case of primary NL involving the tibial nerve and describe the detailed imaging findings on MRI including features used for differential diagnosis.

  9. Tibial nerve intraneural ganglion cyst in a 10-year-old boy

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    Squires, Judy H. [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati, OH (United States); Emery, Kathleen H.; Johnson, Neil [Cincinnati Children' s Hospital Medical Center, Division of Radiology, Cincinnati, OH (United States); Sorger, Joel [Cincinnati Children' s Hospital Medical Center, Division of Orthopedics, Cincinnati, OH (United States)

    2014-04-15

    Intraneural ganglion cysts are uncommon cystic lesions of peripheral nerves that are typically encountered in adults. In the lower extremity, the peroneal nerve is most frequently affected with involvement of the tibial nerve much less common. This article describes a tibial intraneural ganglion cyst in a 10-year-old boy. Although extremely rare, intraneural ganglion cysts of the tibial nerve should be considered when a nonenhancing cystic structure with intra-articular extension is identified along the course of the nerve. This report also details the unsuccessful attempt at percutaneous treatment with US-guided cyst aspiration and steroid injection, an option recently reported as a viable alternative to open surgical resection. (orig.)

  10. Effectiveness of percutaneous tibial nerve stimulation in managing refractory constipation.

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    Kumar, L; Liwanag, J; Athanasakos, E; Raeburn, A; Zarate-Lopez, N; Emmanuel, A V

    2017-01-01

    Chronic constipation can be aetiopathogenically classified into slow transit constipation (STC), rectal evacuation difficulty (RED) or a combination (BOTH). Although the efficacy of percutaneous tibial nerve stimulation (PTNS) in faecal incontinence has been well proved, a current literature search identifies only one study which assessed its effect on constipation. We aimed to evaluate the effectiveness of PTNS in patients with different causes of constipation. Thirty-four patients [30 women, median age 50 (20-79) years] with constipation who had previously failed maximal laxative and biofeedback therapy participated in the study. All patients underwent a baseline radio-opaque marker transit study and anorectal physiology examination. All had 12 sessions of PTNS of 30 min per session. A fall in the Wexner constipation score to ≤15 or by ≥5 points was taken as the primary outcome. Secondary outcomes included the results of pre- and post- PTNS transit and anorectal physiology studies. Eleven patients had STC, 14 had RED and nine had BOTH. A response was seen in four patients (1/11 STC, 2/14 RED and 1/9 BOTH). Comparing pre- and post- PTNS, there was no significant change in the mean Wexner score (P = 0.10). There was no change in colonic transit time among the whole population (P = 0.56) or among those with STC (P = 0.47). There was no improvement in balloon expulsion in the whole group (P = 0.73) or in patients with RED (P = 0.69). PTNS is of no benefit to patients with constipation, whatever aetiopathogenic mechanism is responsible for the symptoms. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  11. Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome

    NARCIS (Netherlands)

    Wall, L.L. de; Heesakkers, J.P.F.A.

    2017-01-01

    Overactive bladder syndrome (OAB) is a common condition affecting adults and children worldwide, resulting in a substantial economic and psychological burden. Percutaneous tibial nerve stimulation (PTNS) is derived from acupuncture used in Chinese traditional medicine and was first described in the

  12. Percutaneous tibial nerve stimulation in the treatment of overactive bladder: urodynamic data.

    NARCIS (Netherlands)

    Vandoninck, V.; Balken, M.R. van; Finazzi Agro, E.; Petta, F.; Micali, F.; Heesakkers, J.P.F.A.; Debruyne, F.M.J.; Kiemeney, L.A.L.M.; Bemelmans, B.L.H.

    2003-01-01

    AIM: The aim of this study was to evaluate urodynamic changes after percutaneous tibial nerve stimulation (PTNS) for the treatment of complaints related to overactive bladder syndrome and to search for urodynamic-based predictive factors. METHODS: Ninety consecutive patients with symptoms related to

  13. Posterior tibial nerve stimulation for treating neurologic bladder in women: a randomized clinical trial.

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    Eftekhar, Tahereh; Teimoory, Nastaran; Miri, Elahe; Nikfallah, Abolghasem; Naeimi, Mahsa; Ghajarzadeh, Mahsa

    2014-01-01

    Overactive bladder (OAB) is a disabling disorder. Treatment of cases with OAB includes behavioral, pharmacological, surgical interventions and peripheral electrical stimulation. The goal of this study was to determine effects of posterior tibial nerve stimulation on sexual function and pelvic disorders in women with Overactive bladder (OAB). Fifty women were randomly assigned to PTNS (posterior tibial nerve stimulation) plus tolterodine or tolterodine alone treatment. Tolterodine group received 4 mg tolterodine daily for three months while the other group received this treatment plus percutaneous tibial nerve stimulation for 12 consequence weeks. Two in PTNS group and 8 in the control group withdrew from the study. Age, education level, and occupation status were not significantly different between two groups. Mean total FSFI and its subscales were not significantly different before and after treatment between two groups. Urine leakage associated with a feeling of urgency and loss of stool or gas from the rectum beyond patient's control became significantly different after treatment between two groups. Posterior tibial nerve stimulation could help urinary problems in women with a neurologic bladder.

  14. Posterior tibial nerve stimulation for treating neurologic bladder in women: a randomized clinical trial.

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    Tahereh Eftekhar

    2014-11-01

    Full Text Available Overactive bladder (OAB is a disabling disorder. Treatment of cases with OAB includes behavioral, pharmacological, surgical interventions and peripheral electrical stimulation. The goal of this study was to determine effects of posterior tibial nerve stimulation on sexual function and pelvic disorders in women with Overactive bladder (OAB. Fifty women were randomly assigned to PTNS (posterior tibial nerve stimulation plus tolterodine or tolterodine alone treatment. Tolterodine group received 4 mg tolterodine daily for three months while the other group received this treatment plus percutaneous tibial nerve stimulation for 12 consequence weeks. Two in PTNS group and 8 in the control group withdrew from the study. Age, education level, and occupation status were not significantly different between two groups. Mean total FSFI and its subscales were not significantly different before and after treatment between two groups. Urine leakage associated with a feeling of urgency and loss of stool or gas from the rectum beyond patient's control became significantly different after treatment between two groups. Posterior tibial nerve stimulation could help urinary problems in women with a neurologic bladder.

  15. Acute urodynamic effects of posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with MS.

    NARCIS (Netherlands)

    Fjorback, M.V.; Rey, F. van; Pal, F. van der; Rijkhoff, N.J.M.; Petersen, T.; Heesakkers, J.P.

    2007-01-01

    OBJECTIVES: The aim of this study was to investigate whether acute electrical stimulation of the posterior tibial nerve could suppress detrusor contractions in multiple sclerosis (MS) patients with neurogenic detrusor overactivity. METHODS: Two successive slow-fill cystometries (16 ml/min) were

  16. Dipole source analyses of early median nerve SEP components obtained from subdural grid recordings.

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    Baumgärtner, Ulf; Vogel, Hagen; Ohara, Shinji; Treede, Rolf-Detlef; Lenz, Fred A

    2010-12-01

    The median nerve N20 and P22 SEP components constitute the initial response of the primary somatosensory cortex to somatosensory stimulation of the upper extremity. Knowledge of the underlying generators is important both for basic understanding of the initial sequence of cortical activation and to identify landmarks for eloquent areas to spare in resection planning of cortex in epilepsy surgery. We now set out to localize the N20 and P22 using subdural grid recording with special emphasis on the question of the origin of P22: Brodmann area 4 versus area 1. Electroencephalographic dipole source analysis of the N20 and P22 responses obtained from subdural grids over the primary somatosensory cortex after median nerve stimulation was performed in four patients undergoing epilepsy surgery. Based on anatomical landmarks, equivalent current dipoles of N20 and P22 were localized posterior to (n = 2) or on the central sulcus (n = 2). In three patients, the P22 dipole was located posterior to the N20 dipole, whereas in one patient, the P22 dipole was located on the same coordinate in anterior-posterior direction. On average, P22 sources were found to be 6.6 mm posterior [and 1 mm more superficial] compared with the N20 sources. These data strongly suggest a postcentral origin of the P22 SEP component in Brodmann area 1 and render a major precentral contribution to the earliest stages of processing from the primary motor cortex less likely.

  17. Serial recording of median nerve stimulated subcortical somatosensory evoked potentials (SEPs) in developing brain death.

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    Buchner, H; Ferbert, A; Hacke, W

    1988-01-01

    Subcortical somatosensory evoked potentials (SEPs) to median nerve stimulation were recorded serially in 35 patients during the evolution towards brain death and in brain death. Neuropathological alterations of the central nervous system down to the C1/C2 spinal cord segment in brain death are well known. SEP components supposed to be generated above this level should be lost in brain death, while components generated below should not be altered. Erb's point, scalp and neck potentials were recorded at C3/4, or over the spinous process C7, using an Fz reference. In 10 patients additional montages, including spinous process C2-Fz, a non-cephalic reference (Fz-contralateral shoulder) and a posterior to anterior neck montage (spinous process C7-jugulum) were used. The cephalic referenced N9 and N11 peaks remained unchanged until brain death. N9 and N11 decreased in parallel in amplitude and increased in latency after systemic effects like hypoxia or hypothermia occurred. The cephalic referenced 'N14' decreased in amplitude and increased in latency after the clinical brain death syndrome was observed, while N13 in the posterior to anterior neck montage remained unchanged. The alteration of 'N14' went parallel to the decrease of the P14 amplitude. The subcortical SEPs in the cephalic referenced lead are supposed to be a peak composed by a horizontally orientated dorsal horn generated N13 and a rostrally orientated P14 arising at the level of the foramen magnum. The deterioration of the non-cephalic referenced P14 and of its cephalic referenced reflection 'N14' seems to provide an additional objective criterion for the diagnosis of brain death.

  18. Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome

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    de Wall LL

    2017-08-01

    Full Text Available Liesbeth L de Wall, John PFA Heesakkers Department of Urology, Radboud University Medical Centre, Nijmegen, The NetherlandsAbstract: Overactive bladder syndrome (OAB is a common condition affecting adults and children worldwide, resulting in a substantial economic and psychological burden. Percutaneous tibial nerve stimulation (PTNS is derived from acupuncture used in Chinese traditional medicine and was first described in the early 1980s. It is a neuromodulation technique used to modulate bladder function and facilitate storage. Being a minimally invasive, easily applicable, but time-consuming treatment, future developments with implantable devices might be the solution for the logistical problems and economic burden associated with PTNS on the long term. This nonsystematic review provides a current overview on PTNS and its effectiveness in the treatment of OAB for both adults and children. Keywords: overactive bladder, percutaneous tibial nerve stimulation, neuromodulation, electrical stimulation 

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

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    Ruth Weiss

    2016-01-01

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

  20. Cystic degeneration of the tibial nerve. Magnetic resonance neurography and sonography appearances of an intraneural ganglion cyst

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    Sampaio Silveira, Claudio Regis [Sao Carlos Imaging/Sao Carlos Hospital, Musculoskeletal Imaging Division, Fortaleza, CE (Brazil); Maia Vieira, Clarissa Gadelha; Machado Pereira, Brenda [Sao Carlos Imaging/Sao Carlos Hospital, Fortaleza, CE (Brazil); Pinto Neto, Luiz Holanda [Articular Clinic, Fortaleza, CE (Brazil); Chhabra, Avneesh [UT Southwestern, Radiology and Orthopaedic Surgery, Dallas, TX (United States)

    2017-12-15

    Extra- and intraneural ganglion cysts have been described in the literature. The tibial nerve ganglion is uncommon and its occurrence without intra-articular extension is atypical. The pathogenesis of cystic degeneration localized to connective and perineural tissue secondary to chronic mechanical irritation or idiopathic mucoid degeneration is hypothesized. Since the above pathology is extremely rare and the magnetic resonance imaging examination detects the defining characteristics of the intrinsic alterations of the tibial nerve, the authors illustrate such a case of tibial intaneural ganglion cyst with its magnetic resonance neurography and sonography appearances. (orig.)

  1. A rare case of intraneural ganglion cyst involving the tibial nerve.

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    Patel, Purvak; Schucany, William G

    2012-04-01

    Cystic lesions around the knee are a relatively common occurrence. Several types of cysts have been reported, including synovial, bursal, and ganglion. Ganglion cysts are not lined by synovial cells. Their location is highly variable, with occurrences described in the fat pads near the tibia or femur, muscles, nerves, and arteries. Intraneural ganglia are rare nonneoplastic cysts caused by the accumulation of thick mucinous fluid within the epineurium of peripheral nerves, encased in a dense fibrous capsule. These cysts can cause compression of the adjacent nerve fascicles, resulting in pain, paresthesias, weakness, muscle denervation, and atrophy. They are most commonly manifested by local and radiating pain, but sensory and motor deficits have also been described. Involvement of the tibial nerve is exceptionally rare, with ganglion cyst in a young woman. We also discuss the imaging features, differential considerations, proposed pathogenesis and anatomic origin, and treatment of this rare entity.

  2. In Vivo MR Microneurography of the Tibial and Common Peroneal Nerves

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    Paolo F. Felisaz

    2014-01-01

    Full Text Available MR microneurography is a noninvasive technique that provides visualization of the microanatomy of peripheral nerves, otherwise available only with histopathology. The objective of this study was to present a protocol to visualize the microstructure of peripheral nerves in vivo, using a 3T MRI scanner with a clinical set of coils and sequences. The tibial and the common peroneal nerves of healthy volunteers were imaged above the medial malleolus and at the level of the fibular head, respectively. The acquired images provided details about the internal structure of peripheral nerves, with visualization of the fascicles, the interfascicular fat, the epineurium, and the perineurium. MR microneurography can be performed in a clinical setting with acceptable imaging times and can be a potentially powerful tool that complements standard MR neurography.

  3. Management of overactive bladder review: the role of percutaneous tibial nerve stimulation

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    Elita Wibisono

    2017-01-01

    Full Text Available Overactive bladder (OAB is a common condition that is experienced by around 455 million people (11% of the world population and associated with significant impact in patients’ quality of life. The first line treatments of OAB are conservative treatment and anti-muscarinic medication. For the refractory OAB patients, the treatment options available are surgical therapy, electrical stimulation, and botulinum toxin injection. Among them, percutaneous tibial nerve stimulation (PTNS is a minimally invasive option that aims to stimulate sacral nerve plexus, a group of nerve that is responsible for regulation of bladder function. After its approval by food and drug administration (FDA in 2007, PTNS revealed considerable promise in OAB management. In this review, several non-comparative and comparative studies comparing PTNS with sham procedure, anti-muscarinic therapy, and multimodal therapy combining PTNS and anti-muscarinic had supportive data to this consideration.

  4. Injury to the infrapatellar branch of the saphenous nerve, a possible cause for anterior knee pain after tibial nailing?

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    Leliveld, M S; Verhofstad, M H J

    2012-06-01

    The purpose of this study was to determine the long-term incidence of infrapatellar nerve damage after tibial nailing and its relation to anterior knee pain. We retrospectively evaluated 71 patients in whom 72 isolated tibial shaft fractures were treated with an intramedullary nail. The mean follow-up time was 84 months. Twenty-seven patients (38%) complained of chronic anterior knee pain. Infrapatellar nerve damage was found in 43 patients (60%). Of the 27 patients with knee pain, 21 (78%) had sensory deficits in the distribution area of the infrapatellar nerve, compared to 22 of the 45 patients (49%) without knee pain (p=0.025). Patient and fracture characteristics showed no significant differences between the two groups. At time of follow-up a total of 33 nails were removed of which twelve were taken out because of knee pain. The pain persisted in seven of these twelve patients (58%). The incidence of iatrogenic damage to the infrapatellar nerve after tibial nailing is high and lasting. Injury to this nerve appears to be associated with anterior knee pain after tibial nailing. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Antinociceptive and antiallodynic effects of Momordica charantia L. in tibial and sural nerve transection-induced neuropathic pain in rats.

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    Jain, Vivek; Pareek, Ashutosh; Paliwal, Nishant; Ratan, Yashumati; Jaggi, Amteshwar Singh; Singh, Nirmal

    2014-02-01

    This study was designed to investigate the ameliorative potential of Momordica charantia L. (MC) in tibial and sural nerve transection (TST)-induced neuropathic pain in rats. TST was performed by sectioning tibial and sural nerve portions (2 mm) of the sciatic nerve, and leaving the common peroneal nerve intact. Acetone drop, pin-prick, hot plate, paint-brush, and walking track tests were performed to assess cold allodynia, mechanical and heat hyperalgesia, and dynamic mechanical allodynia and tibial functional index, respectively. The levels of tumour necrosis factor (TNF)-alpha and thio-barbituric acid reactive substances (TBARS) were measured in the sciatic nerve as an index of inflammation and oxidative stress. MC (all doses, orally, once daily) was administered to the rats for 24 consecutive days. TST led to significant development of cold allodynia, mechanical and heat hyperalgesia, dynamic mechanical allodynia, and functional deficit in walking along with rise in the levels of TBARS and TNF-alpha. Administration of MC (200, 400, and 800 mg/kg) significantly attenuated TST-induced behavioural and biochemical changes. Furthermore, pretreatment of BADGE (120 mg/kg, intraperitoneally) abolished the protective effect of MC in TST-induced neuropathic pain. Collectively, it is speculated that PPAR-gamma agonistic activity, anti-inflammatory, and antioxidative potential is critical for antinociceptive effect of MC in neuropathic pain.

  6. Sacral nerve stimulation versus percutaneous tibial nerve stimulation for faecal incontinence: a systematic review and meta-analysis.

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    Simillis, Constantinos; Lal, Nikhil; Qiu, Shengyang; Kontovounisios, Christos; Rasheed, Shahnawaz; Tan, Emile; Tekkis, Paris P

    2018-02-22

    Percutaneous tibial nerve stimulation (PTNS) and sacral nerve stimulation (SNS) are both second-line treatments for faecal incontinence (FI). To compare the clinical outcomes and effectiveness of SNS versus PTNS for treating FI in adults. A literature search of MEDLINE, Embase, Science Citation Index Expanded and Cochrane was performed in order to identify studies comparing SNS and PTNS for treating FI. A risk of bias assessment was performed using The Cochrane Collaboration's risk of bias tool. A random effects model was used for the meta-analysis. Four studies (one randomised controlled trial and three nonrandomised prospective studies) reported on 302 patients: 109 underwent SNS and 193 underwent PTNS. All included studies noted an improvement in symptoms after treatment, without any significant difference in efficacy between SNS and PTNS. Meta-analysis demonstrated that the Wexner score improved significantly with SNS compared to PTNS (weighted mean difference 2.27; 95% confidence interval 3.42, 1.12; P < 0.01). Moreover, SNS was also associated with a significant reduction in FI episodes per week and a greater improvement in the Fecal Incontinence Quality of Life coping and depression domains, compared to PTNS on short-term follow-up. Only two studies reported on adverse events, reporting no serious adverse events with neither SNS nor PTNS. Current evidence suggests that SNS results in significantly improved functional outcomes and quality of life compared to PTNS. No serious adverse events were identified with either treatment. Further, high-quality, multi-centre randomised controlled trials with standardised outcome measures and long-term follow-up are required in this field.

  7. Effects of percutaneous tibial nerve stimulation on adult patients with overactive bladder syndrome: a systematic review.

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    Moossdorff-Steinhauser, Heidi F A; Berghmans, Bary

    2013-03-01

    To assess the effectiveness of percutaneous tibial nerve stimulation (PTNS) on adult patients with overactive bladder syndrome, using a systematic review of randomized controlled trials (RCTs), clinical controlled trials (CCTs), and prospective observational cohort studies. A computer-aided literature search was performed in: PubMed, EMBASE and CENTRAL (2000 to November 15, 2011) to identify RCTs, CCTs, and prospective observational cohort studies. The study had to investigate the effect of PTNS on overactive bladder syndrome. The methodological quality of each study was assessed and a qualitative analysis was performed to establish the levels of evidence. Four RCTs and six prospective observational cohort studies were identified. There is strong evidence for the efficacy of PTNS versus a sham treatment. There is limited evidence that the use of PTNS and tolterodine ER is equally effective. No additional effect of a combination of Stoller afferent nerve stimulation (SANS) and anticholinergic medication compared to SANS alone. Most cohort studies suggested decreased frequency and improvement of incontinence and nocturia. However, the level of evidence was insufficient to make any firm conclusions. Because the total duration of all included trials varied between 6 and 12 weeks, so far there is little information on treatment periods. PTNS is efficacious for frequency and urgency urinary incontinence. More high quality studies are needed to improve the level of evidence concerning the efficacy of PTNS with regard to urgency and nocturia, to specify patient selection criteria, optimal treatment modalities and long-term effects as well as the effectiveness in more pragmatic trials. Copyright © 2012 Wiley Periodicals, Inc.

  8. [Transcutaneous tibial nerve stimulation in the overactive bladder syndrome in patients with Parkinson's syndromes].

    Science.gov (United States)

    Ohannessian, A; Kaboré, F A; Agostini, A; Lenne Aurier, K; Witjas, T; Azulay, J-P; Karsenty, G

    2013-09-01

    To evaluate the efficacy of chronic transcutaneous tibial nerve stimulation (TNS) on overactive bladder syndrome in female patients with Parkinson's disease (PD) and multiple system atrophy (MSA). A prospective monocentric study enrolled six female patients with PD or MSA suffering from overactive bladder syndrome for a six-week study period. Daily sessions of 20 minutes of TNS were provided. The primary outcome measurement was the Patient Global Impression of Improvement (PGI-I scale). The secondary outcomes measurements were symptom and quality of life scores, bladder diary and urodynamics. The outcomes after 6 weeks of TNS were compared to baseline. TNS was considered as an effective treatment by five patients out of six (83%) who ask to pursue the treatment and were still doing it 6 months after the end of the study. A trend improvement was observed in only two of the secondary evaluation criteria the V8 median score 21/40 to 14/40 (P=0.2) and the maximum cystometric capacity increased from 211 mL ± 106 to 260 mL ± 226 (P=0.6) after SNT. Although urodynamics and symptoms scores did not show significant difference, an efficacy of TNS on overactive bladder in PD and MSA is possible. Additional placebo controlled works enrolling more patients are required to ensure these preliminary results. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  9. The effects of posterior tibial nerve stimulation on refractory overactive bladder syndrome and bladder circulation.

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    Onal, Murat; Ugurlucan, Funda Gungor; Yalcin, Onay

    2012-12-01

    We aimed to evaluate if posterior tibial nerve stimulation (PTNS) exerts its effects on overactive bladder symptoms through changes in bladder circulation. Eighteen women who applied to Istanbul Medical Faculty with symptoms of urgency, frequency±urge incontinence and did not respond to anticholinergic treatment and behavioral modification were enrolled in the study. Weekly PTNS in 30-min sessions for 12 weeks was performed. Urogynecologic symptom assessment, 1-h pad test, bladder diary, King's Health Questionnaire (KHQ), and transvaginal Doppler ultrasonography were performed before and after treatment. Ten patients (55.5%) were cured, five (27.8%) improved, and no effect was observed in three (16.7%). No significant change was observed in systolic and diastolic flow rate, pulsatility index, resistive index, systolic/diastolic ratio and average flow rate. Significant decrease in frequency, urgency, urge incontinence, pad test results and increase in fluid intake was observed. There was a significant improvement in physical limitations and sleeping/energy domains of KHQ. No significant change was observed in urodynamics. PTNS does not have any effect on the bladder circulation despite positive effects on bladder diary, pad test, and quality of life in overactive bladder syndrome.

  10. Does percutaneous tibial nerve stimulation improve global pelvic function in women with faecal incontinence?

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    Kelly, S L; Radley, S C; Brown, S R

    2016-05-01

    Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive treatment for faecal incontinence. Many patients with faecal incontinence have coexisting pelvic floor disorders such as urinary incontinence and vaginal symptoms. We utilized a pelvic floor assessment tool to analyse any effect of PTNS on global pelvic floor function. Patients with faecal incontinence attending our institution who had failed to respond sufficiently to biofeedback were offered a course of PTNS. Patients underwent pre- and post-stimulation assessment with a validated electronic Personal Assessment Questionnaire - Pelvic Floor (ePAQ-PF) for pelvic floor disorders. Scores were compared to assess the effect of treatment on global pelvic floor function. During the study period pre- and post-stimulation ePAQ-PF data were available for 60 patients (55% of all patients starting PTNS). In this cohort there was a significant improvement in bowel continence, bowel related quality of life, irritable bowel syndrome and bowel evacuation with a large effect size for continence and bowel related quality of life. There was also a significant improvement in non-bowel related symptoms, including urinary pain and stress incontinence, urinary related quality of life and bowel related sexual function. Sixty-five per cent of those who answered the question reported improvement in global health after stimulation. For patients presenting with faecal incontinence, PTNS appears to have a positive effect on bowel related function in approximately two-thirds of patients. However, for treatment responders, improvement appears to relate mainly to improvement in bowel related function rather than a global pelvic floor effect. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  11. Percutaneous Tibial Nerve Stimulation Improves Female Sexual Function in Women With Overactive Bladder Syndrome.

    Science.gov (United States)

    Musco, Stefania; Serati, Maurizio; Lombardi, Giuseppe; Lumi, Ermal; Parisi, Annunziata Isabella; Del Popolo, Giulio; Finazzi Agrò, Enrico

    2016-02-01

    Percutaneous tibial nerve stimulation (PTNS) is an established treatment for overactive bladder (OAB), especially in women with other concomitant pelvic disorders, such as sexual impairment. To evaluate the impact of PTNS on female sexual dysfunction (FSD) in women undergoing PTNS for OAB and analyze the results. An observational prospective study was conducted in two Italian centers. Consecutive women undergoing PTNS for dry OAB were enrolled from May 2013 to June 2014. All patients were asked to complete the Female Sexual Function Index (FSFI), the OAB short-form questionnaire, and a 24-hour bladder diary at baseline and 3 months later, at the end of the PTNS course. Patients with an FSFI total score no higher than 26.55 at inclusion were considered as presenting with FSD. Patients with an FSFI total score higher than 26.55 after treatment (if the increase in FSFI score was ≥20%) were considered FSD objective responders. Sexuality was assessed using the FSFI. The 24-hour bladder diary and completed OAB short-form questionnaire were assessed before and after PTNS to evaluate OAB symptoms. Forty-one women were evaluable. Twenty-one of 41 women (51%; mean age = 51 ± 10.67 years) were considered affected by FSD at inclusion. All FSFI domains showed statistically significant improvement in women with FSD (P < .05). In particular, 9 of 21 patients with FSD (43%) objectively responded (before treatment: mean FSFI total score = 18.11, range 10.8-26.3; after treatment: mean FSFI total score = 31.04, range 27.6-35). Also, women without FSD at baseline reported statistically significant improvement in their sexual function based on FSFI scores (P < .05). No significant correlations were seen between data questionnaires. PTNS improves sexual function in women with dry OAB. This amelioration is independent of urinary symptoms. Further studies are needed to confirm a possible role of PTNS in treating FSD. Copyright © 2016 International Society for Sexual Medicine

  12. Evaluation of transcutaneous electrical posterior tibial nerve stimulation for the treatment of fecal and urinary leaks in children: preliminary results.

    Science.gov (United States)

    Lecompte, Jean-François; Hery, Geraldine; Guys, Jean-Michel; Louis-Borrione, Claude

    2015-04-01

    To examine the effectiveness of posterior tibial nerve stimulation (PTNS) for the treatment of fecal and urinary incontinence in children with malformations of the bowel or neurological pathologies. Treatment of fecal and urinary leaks, in cases of congenital malformations remains a challenge. Recent studies in adults have shown the effectiveness of PTNS. Eight children: 4 with anorectal malformations, 3 with neurological causes (1 medullary lipoma, 1 Arnold Chiari malformation, 1 sacrococcygeal teratoma) and 1 with Hirschsprung's disease presenting with serious anal incontinence, despite extensive bowel management during at least 2 years, were treated with PTNS. Six children had associated urinary leaks. Jorge-Wexner score for defecation and Schurch score for urine were used before treatment and after the second and sixth months of stimulation. After six months, five patients had no more fecal leakage, two patients were improved and one did not respond. Five out of the 6 patients with urinary leaks were continent at 6 months. PTNS is a noninvasive technique and painless modality which seems to be effective for the treatment of fecal and urinary leaks in children even with congenital digestive pathologies or neurological malformations. These results will be confirmed in a prospective study. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Short-term outcome of percutaneous posterior tibial nerve stimulation (PTNS) for the treatment of faecal incontinence.

    Science.gov (United States)

    Peña Ros, E; Parra Baños, P A; Benavides Buleje, J A; Muñoz Camarena, J M; Escamilla Segade, C; Candel Arenas, M F; Gonzalez Valverde, F M; Albarracín Marín-Blázquez, A

    2016-01-01

    The aim of the present study was to establish the efficacy of percutaneous posterior tibial nerve stimulation (PTNS) in treating flatal, urge and passive faecal incontinence (FI). A prospective study with 55 patients with FI was carried out. Clinical anamnesis, physical examination, a reverse visual analogue scale (VAS) score, Wexner score and the American Society of Colon and Rectal Surgeons quality of life score were recorded at baseline and 6 months, along with an incontinence diary. Subjects underwent one weekly session for 12 consecutive weeks and then continued with six additional fortnightly sessions. An intention-to-treat analysis was performed. Fifty-five patients (44 females; mean age 58.62 ± 10.74 years) with FI were treated with PTNS. The origins of the incontinence were obstetric (52.7 %) and perineal surgery (34.5 %). Eight patients did not continue with the second stage of treatment. The median Wexner baseline value was 9.98. After 6 months, it had decreased to 4.55 (p < 0.001). The visual analogue scale (VAS) increased from 4.94 to 6.80 (p < 0.001). There was a significant improvement in lifestyle, coping/behaviour, depression/self-perception and embarrassment scores. With respect to different types of FI, there was an improvement in the Wexner score both in patients with true passive FI and in those with urge or mixed FI. PTNS is an effective treatment for FI. Patients with passive or urge FI can benefit from this therapy, with improvement of the Wexner score and quality of life variables.

  14. Short-term effects of thermotherapy for spasticity on tibial nerve F-waves in post-stroke patients

    Science.gov (United States)

    Matsumoto, Shuji; Kawahira, Kazumi; Etoh, Seiji; Ikeda, Satoshi; Tanaka, Nobuyuki

    2006-03-01

    Thermotherapy is generally considered appropriate for post-stroke patients with spasticity, yet its acute antispastic effects have not been comprehensively investigated. F-wave parameters have been used to demonstrate changes in motor neuron excitability in spasticity and pharmacological antispastic therapy. The present study aimed to confirm the efficacy of thermotherapy for spasticity by evaluating alterations in F-wave parameters in ten male post-stroke patients with spastic hemiparesis (mean age: 49.0±15.0 years) and ten healthy male controls (mean age: 48.7±4.4 years). The subjects were immersed in water at 41°C for 10 min. Recordings were made over the abductor hallucis muscle, and antidromic stimulation was performed on the tibial nerve at the ankle. Twenty F-waves were recorded before, immediately after, and 30 min following thermotherapy for each subject. F-wave amplitude and F-wave/M-response ratio were determined. Changes in body temperature and surface-skin temperature were monitored simultaneously. The mean and maximum values of both F-wave parameters were higher on the affected side before thermotherapy. In the post-stroke patients, the mean and maximum values of both parameters were significantly reduced after thermotherapy ( P<0.01). Hence, the antispastic effects of thermotherapy were indicated by decreased F-wave parameters. Body temperature was significantly increased both immediately after and 30 min after thermotherapy in all subjects. This appeared to play an important role in decreased spasticity. Surface-skin temperature increased immediately after thermotherapy in both groups and returned to baseline 30 min later. These findings demonstrate that thermotherapy is an effective nonpharmacological antispastic treatment that might facilitate stroke rehabilitation.

  15. Asynchronous recruitment of low-threshold motor units during repetitive, low-current stimulation of the human tibial nerve

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    Jesse eDean

    2014-12-01

    Full Text Available Motoneurons receive a barrage of inputs from descending and reflex pathways. Much of our understanding about how these inputs are transformed into motor output in humans has come from recordings of single motor units during voluntary contractions. This approach, however, is limited because the input is ill-defined. Herein, we quantify the discharge of soleus motor units in response to well-defined trains of afferent input delivered at physiologically-relevant frequencies. Constant frequency stimulation of the tibial nerve (10-100 Hz for 30 s, below threshold for eliciting M-waves or H-reflexes with a single pulse, recruited motor units in 7/9 subjects. All 25 motor units recruited during stimulation were also recruited during weak (<10% MVC voluntary contractions. Higher frequencies recruited more units (n=3/25 at 10 Hz; n=25/25 at 100 Hz at shorter latencies (19.4±9.4 s at 10 Hz; 4.1±4.0 s at 100 Hz than lower frequencies. When a second unit was recruited, the discharge of the already active unit did not change, suggesting that recruitment was not due to increased synaptic drive. After recruitment, mean discharge rate during stimulation at 20 Hz (7.8 Hz was lower than during 30 Hz (8.6 Hz and 40 Hz (8.4 Hz stimulation. Discharge was largely asynchronous from the stimulus pulses with time-locked discharge occurring at an H-reflex latency with only a 24% probability. Motor units discharged after the stimulation ended in 89% of trials, although at a lower rate (5.8 Hz than during the stimulation (7.9 Hz. This work supports the idea that the afferent volley evoked by repetitive stimulation recruits motor units through the integration of synaptic drive and intrinsic properties of motoneurons, resulting in physiological recruitment which adheres to Henneman's size principle and results in relatively low discharge rates and asynchronous firing.

  16. Randomized clinical trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in patients with faecal incontinence.

    Science.gov (United States)

    van der Wilt, A A; Giuliani, G; Kubis, C; van Wunnik, B P W; Ferreira, I; Breukink, S O; Lehur, P A; La Torre, F; Baeten, C G M I

    2017-08-01

    The aim was to assess the effects of percutaneous tibial nerve stimulation (PTNS) in the treatment of faecal incontinence (FI) by means of an RCT. Patients aged over 18 years with FI were included in a multicentre, single-blinded RCT. The primary endpoint was reduction in the median or mean number of FI episodes per week. Secondary endpoints were changes in measures of FI severity, and disease-specific and generic quality of life. Outcomes were compared between PTNS and sham stimulation after 9 weeks of treatment. A higher proportion of patients in the PTNS (13 of 29) than in the sham (6 of 30) group showed a reduction of at least 50 per cent in the median number of FI episodes/week (incidence rate ratio (IRR) 2·40, 95 per cent c.i. 1·10 to 5·24; P = 0·028), but not in the mean number of episodes/week (10 of 29 versus 8 of 30; IRR 1·42, 0·69 to 2·92; P = 0·347). The absolute median number of FI episodes per week decreased in the PTNS but not in the sham group (IRR 0·66, 0·44 to 0·98; P = 0·041), as did the mean number (IRR 0·65 (0·45 to 0·97); P = 0·034). Scores on the Cleveland Clinic Florida faecal incontinence scale decreased significantly in both groups, but more steeply in the PTNS group (mean difference -1·3, 95 per cent c.i. -2·6 to 0·0; P = 0·049). The aggregated mental component score of Short Form 36 improved in the PTNS but not in the sham group (mean difference 5·1, 0·5 to 9·6; P = 0·028). PTNS may offer a small advantage in the clinical management of FI that is insufficiently responsive to conservative treatment. The key challenge will be to identify patients who may benefit most from this minimally invasive surgical procedure. Registration number: NCT00974909 (http://www.clinicaltrials.gov). © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  17. Tibial nerve dysfunction

    Science.gov (United States)

    ... feet or a high arch Body-wide (systemic) diseases, such as diabetes, low thyroid function, arthritis In some cases, no cause can be found. Symptoms Symptoms may include any of the following: Sensation ...

  18. A new, lateral, continuous, combined, femoral–sciatic nerve approach via a single skin puncture for postoperative analgesia in intramedullary tibial nail insertion

    Directory of Open Access Journals (Sweden)

    Imbelloni LE

    2013-02-01

    Full Text Available Luiz Eduardo Imbelloni,1,2 Carlos Rava,1,3 Marildo A Gouveia21Faculdade de Medicina Nova Esperança, 2Institute for Regional Anesthesia, 3Complexo Hospitalar de Mangabeira Governador Tarcisio Burity, João Pessoa, BrazilBackground: The prevalence of anterior knee pain following intramedullary tibial nail insertion is high. Continuous peripheral nerve blockade is an alternative method of pain control to opiods. This case illustrates the use of femoral nerve and sciatic nerve peripheral catheters with an elastomeric infusion pump for major intramedullary nailing surgery.Case report: A 36-year-old male with fractures to the left leg bones presented for placement of an intramedullary nail under spinal anesthesia. At the end of the procedure, access to the lateral femoral and sciatic continuous nerve block was achieved by using a stimulator connected to a 110 mm 18G Tuohy needle. Postoperative analgesia was provided with a 40-hour infusion of 0.1% bupivacaine (400 mL at a rate of 10 mL hour-1 with an elastomeric pump. Anesthetic dispersion and contrast were investigated. The analog scale remained with scores below 3 during the 40 hours after surgery, and boluses were not necessary.Conclusion: The use of a femoral and sciatic nerve peripheral catheter offered an alternative to conventional pain control. Continuous femoral–sciatic peripheral blockade via a skin puncture with an infusion of 0.1% bupivacaine with elastomeric pumps is a safe and effective procedure in adults.Keywords: local anesthetic, bupivacaine, continuous peripheral nerve block, orthopedic surgery, tibia, elastomeric pump

  19. Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study.

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    Scaldazza, Carlo Vecchioli; Morosetti, Carolina; Giampieretti, Rosita; Lorenzetti, Rossana; Baroni, Marinella

    2017-01-01

    This study compared percutaneous tibial nerve stimulation (PTNS) versus electrical stimulation with pelvic floor muscle training (ES + PFMT) in women with overactive bladder syndrome (OAB). 60 women with OAB were enrolled. Patients were randomized into two groups. In group A, women underwent ES with PFMT, in group B women underwent PTNS. A statistically significant reduction in the number of daily micturitions, episodes of nocturia and urge incontinence was found in the two groups but the difference was more substantial in women treated with PTNS; voided volume increased in both groups. Quality of life improved in both groups, whereas patient perception of urgency improved only in women treated with PTNS. Global impression of improvement revealed a greater satisfaction in patients treated with PTNS. This study demonstrates the effectiveness of PTNS and ES with PFMT in women with OAB, but greater improvements were found with PTNS. Copyright® by the International Brazilian Journal of Urology.

  20. Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study

    Directory of Open Access Journals (Sweden)

    Carlo Vecchioli Scaldazza

    Full Text Available ABSTRACT Introduction This study compared percutaneous tibial nerve stimulation (PTNS versus electrical stimulation with pelvic floor muscle training (ES + PFMT in women with overactive bladder syndrome (OAB. Materials and Methods 60 women with OAB were enrolled. Patients were randomized into two groups. In group A, women underwent ES with PFMT, in group B women underwent PTNS. Results A statistically significant reduction in the number of daily micturitions, episodes of nocturia and urge incontinence was found in the two groups but the difference was more substantial in women treated with PTNS; voided volume increased in both groups. Quality of life improved in both groups, whereas patient perception of urgency improved only in women treated with PTNS. Global impression of improvement revealed a greater satisfaction in patients treated with PTNS. Conclusion This study demonstrates the effectiveness of PTNS and ES with PFMT in women with OAB, but greater improvements were found with PTNS.

  1. Combined application of neutrophin-3 gene and neural stem cells is ameliorative to delay of denervated skeletal muscular atrophy after tibial nerve transection in rats.

    Science.gov (United States)

    Lin, Sen; Xu, Jianguang; Hu, Shaonan; Xu, Lei; Zhang, Changqing; Wang, Yang; Gu, Yudong

    2011-01-01

    Examination of the therapeutic efficacy of neural stem cells (NSCs) has recently become the focus of much investigation. In this study we present an insight of the effects of combined application with neurotrophin-3 (NT-3) and NSCs that derived from rat embryo spinal cord on delaying denervated skeletal muscular atrophy after tibial nerve was severed. NT-3 gene was amplified by PCR and subcloned into lentiviral vector pWPXL-MOD to construct a lentiviral expression vector pWPXL-MOD-NT-3. A positive clone expressing NT-3 (named NSCs-NT-3) was obtained and used for differentiation in vitro and transplantation. Sixty adult rats, whose tibial nerves were sectioned, were divided into two groups: one grafted with NSCs-NT-3 (experimental group, n = 30) and the other with NSCs transfected by pWPXL-MOD (control group, n = 30). The cell survival and differentiation, NT-3 gene expression, and effect of delaying denervated skeletal muscular atrophy were examined through immunohistostaining, RT-PCR, Western blot, electrophysiological analysis, and mean cross-sectional area (CSA) of gastrocnemius, respectively. The results show that the NT-3 gene, which is comprised of 777 bp, was cloned and significantly different expression were detected between NSCs and NSCs-NT-3 in vitro. Quantitative analysis of the choline acetyltransferase (ChAT) immunopositive cells revealed a significant increase in experimental group compared to the control group 4 weeks after implantation (p muscular atrophy is indicated in the EMG examination and mean CSA of gastrocnemius. These findings suggest that the neural stem cells expressing NT-3 endogenously would be a better graft candidate for the delay of denervated skeletal muscular atrophy.

  2. Motor and sensory responses after percutaneous tibial nerve stimulation in multiple sclerosis patients with lower urinary tract symptoms treated in daily practice.

    Science.gov (United States)

    Zecca, C; Digesu, G A; Robshaw, P; Puccini, F; Khullar, V; Tubaro, A; Gobbi, C

    2014-03-01

    Posterior tibial nerve stimulation (PTNS) is an effective treatment option for lower urinary tract symptoms (LUTS) in multiple sclerosis (MS) patients. Patients with MS and LUTS unresponsive to medical treatment received PTNS for 12 weeks after saline urodynamics to evaluate the prevalence of motor, sensory and combined responses during PTNS and to determine whether the type of response can predict treatment outcome. LUTS were also assessed using a 3-day bladder diary, patient perception of bladder condition (PPBC) questionnaire, patient perception of intensity of urgency scale (PPIUS), Kings Health QOL questionnaire (KHQ) and Overactive Bladder Questionnaire (OAB-q) before and after treatment. Patients were considered as "responders" if they reported an improvement >50% in their LUTS according to the PPBC. Sensory, motor and combined sensory/motor responses were compared between responders and non-responders. Eighty-three patients were included. 61% (51/83) of patients were responders. Sensory, motor and combined sensory/motor responses were found in 64% (53/83), 6% (5/83) and 30% (25/83) of patients respectively. A sensory response alone, or in combination with a motor response, was better associated with a successful outcome than the presence of a motor response alone (P = 0.001). A sensory response, either alone or in combination with a motor response, is more frequent and seems to be better associated with a successful outcome of PTNS than motor response alone. © 2014 The Author(s) European Journal of Neurology © 2014 EFNS.

  3. The tibial nerve compression test for the diagnosis of lumbar spinal canal stenosis-A simple and reliable physical examination for use by primary care physicians.

    Science.gov (United States)

    Adachi, Shu; Nakano, Atsushi; Kin, Akihiro; Baba, Ichiro; Kurokawa, Yoshitaka; Neo, Masashi

    2018-01-01

    In the present study, we aimed to evaluate the diagnostic accuracy and suitability of the 'Tibial Nerve Compression Test (TNCT)' as a screening tool for lumbar spinal canal stenosis (LSS). A total of 108 consecutive patients admitted to our hospital for surgical treatment or diagnosis of LSS were included in this study. Fifty healthy volunteers were examined as a control group. The severity of tenderness was scored (tenderness score) and measured on a visual analogue scale (P-VAS score). These scores were compared between the LSS and control groups. Moreover, they were compared before and after the operation among operated patients. The positive tenderness rate was significantly higher (92.6% [100/108]) in the LSS group than in the control group (30% [15/50]). The sensitivity and specificity of TNCT (95% confidence interval) were 0.93 (0.88-0.96) and 0.70 (0.61-0.77), respectively. Positive tenderness rates and P-VAS scores were significantly higher in the LSS group (p Test is a useful screening tool for LSS diagnosis in a primary care setting. Level II, diagnostic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  4. Giant SEPs and SEP-recovery function in Unverricht-Lundborg disease.

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    Visani, E; Canafoglia, L; Rossi Sebastiano, D; Agazzi, P; Panzica, F; Scaioli, V; Ciano, C; Franceschetti, S

    2013-05-01

    To evaluate the relationship between sensory hyperexcitability as revealed by giant SEPs and the SEP recovery function (SEP-R) in a series of patient with progressive myoclonic epilepsy of Unverricht-Lundborg type, identified as epilepsy, progressive myoclonic 1A (EPM1A), MIM #254800. We evaluated SEPs by applying median nerve stimuli and SEP-R using paired stimuli at inter-stimulus intervals (ISIs) of between 20 and 600 ms in 25 patients and 20 controls. The SEPs were considered "giant" if the N20P25 and P25N33 amplitudes exceeded normal mean values by +3SD. During the paired-stimulus protocol, the SEPs elicited by the second stimulus (S2) were detectable at all ISIs but consistently suppressed in the 13 patients with giant SEPs reflecting a significantly delayed SEP-R. Maximal suppression roughly corresponded to the plateau of a broad middle latency (>100 ms) wave pertaining to the S1 response. The cortical processing dysfunction generating giant SEPs in EPM1A patients consistently combines with a long-lasting suppression of hyperexcitability that leads to a delayed giant SEP-R without obstructing the response to incoming stimuli. The delayed SEP-R is not due to true inhibition but the suppression of aberrant hyper-synchronisation sustaining giant SEPs. A broad middle latency SEP component adds a significantly suppressive effect. This suggests that cortico-subcortical circuitries contribute to both the gigantism and the delayed SEP-R. Copyright © 2012 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  5. Effectiveness of Short Term Percutaneous Tibial Nerve Stimulation for Non-neurogenic Overactive Bladder Syndrome in Adults: A Meta-analysis

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    Elita Wibisono

    2015-07-01

    Full Text Available Aim: to evaluate the effectiveness of short-term PTNS for non-neurogenic OAB in adults systematically by comparing with sham procedure and other treatments. Methods: we performed a systematic review of cohort study. Data sources were MEDLINE, EMBASE, CINAHL, National Library for Health, Cochrane, and google scholar from 2005 through 2015. Meta-analysis was performed using the random effects model. Heterogeneity of effects was assessed by calculating I2 statistic. Statistical analysis was performed using Review Manager 5.3 for RCT meta-analysis. Results: we analized 11 randomised controlled trial (RCT and five prospective non-comparative studies with variable success rate. Based on percentage of responders, the results were 37.3% - 81.8% in PTNS group, 0% - 20.9% in sham group, 54.8% in anti-muscarinic group, and 89.7% in multimodal group. The decrease of voiding symptoms episodes per day was found in PTNS (0.7-4.5, sham (0.3-1.5, and anti-muscarinic (0.6-2.9 groups. In meta-analysis of four RCTs, the results favour PTNS over sham procedure with overall risk ratio of 7.32(95% CI of 1.69-32.16, p=0.09, I2=54%. Conclusion: there is an evidence of effectiveness of short term PTNS in treatment of non-neurogenic OAB. PTNS is proven significantly better than sham procedure. Key words: overactive bladder, percutaneous tibial nerve stimulation, sham, anti-muscarinic, voiding symptoms.

  6. Time Course of the Soleus M Response and H Reflex after Lidocaine Tibial Nerve Block in the Rat

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    Kévin Buffenoir

    2013-01-01

    Full Text Available Aims. In spastic subjects, lidocaine is often used to induce a block predictive of the result provided by subsequent surgery. Lidocaine has been demonstrated to inhibit the Hoffmann (H reflex to a greater extent than the direct motor (M response induced by electrical stimulation, but the timecourse of these responses has not been investigated. Methods. An animal (rat model of the effects of lidocaine on M and H responses was therefore developed to assess this time course. M and H responses were recorded in 18 adult rats before and after application of lidocaine to the sciatic nerve. Results. Two to five minutes after lidocaine injection, M responses were markedly reduced (mean reduction of 44% and H reflexes were completely abolished. Changes were observed more rapidly for the H reflex. The effects of lidocaine then persisted for 100 minutes. The effect of lidocaine was therefore more prolonged on the H reflex than on the M response. Conclusion. This study confirms that lidocaine blocks not only alpha motoneurons but also Ia afferent fibres responsible for the H reflex. The authors describe, for the first time, the detailed time course of the effect of lidocaine on direct or reflex activation of motoneurons in the rat.

  7. Inhibition of transmitter release and attenuation of anti-retroviral-associated and tibial nerve injury-related painful peripheral neuropathy by novel synthetic Ca2+ channel peptides.

    Science.gov (United States)

    Wilson, Sarah M; Schmutzler, Brian S; Brittain, Joel M; Dustrude, Erik T; Ripsch, Matthew S; Pellman, Jessica J; Yeum, Tae-Sung; Hurley, Joyce H; Hingtgen, Cynthia M; White, Fletcher A; Khanna, Rajesh

    2012-10-12

    with a heterozygous mutation of Nf1 linked to neurofibromatosis type 1. Ct-dis peptide, administered intraperitoneally, exhibited antinociception in a zalcitabine (2'-3'-dideoxycytidine) model of AIDS therapy-induced and tibial nerve injury-related peripheral neuropathy. This study suggests that CaV peptides, by perturbing interactions with the neuromodulator CRMP2, contribute to suppression of neuronal hypersensitivity and nociception.

  8. Effect of age on electrical nerve conduction in the somatosensory pathway and its correlation with somatometry and plasma concentrations of musculoskeletal enzymes in male rhesus monkeys (Macaca mulatta) held in captivity.

    Science.gov (United States)

    Hernández-Godínez, Braulio; Poblano, Adrián; Bonilla-Jaime, Herlinda; Artega-Silva, Marcela; Sánchez-Torres, Stephanie; Mondragón-Lozano, Rodrigo; Ibáñez-Contreras, Alejandra

    2018-03-13

    Somatosensory evoked potentials (SEPs) make it possible to obtain functional data on the activity of somatosensory pathway. To evaluate the ontogeny of electrical nerve conduction in male rhesus monkeys using SEPs in correlation with the development of the musculoskeletal system based on somatometry and musculoskeletal enzymes. Somatosensory evoked potentials of the medial and tibial nerves were performed, and somatometric measurements were obtained: total length, arm and forearm length, and thigh and calf length. Analysis of the musculoskeletal enzymes, lactic dehydrogenase, and creatininase was conducted using blood samples in 20 rhesus monkeys divided into 5 groups. Statistical analysis manifested a delay in the appearance of latencies as age increased. Also evident was a strong, direct relation between the lengths and the value of the latencies of the SEP, together with an inverse relation between the musculoskeletal enzymes. These findings contribute to standardizing this animal model in the neurophysiological sciences. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. [Comparison of the post-surgical analgesic effectiveness of tibial (at internal malleolus level) and common peroneal nerve block with infiltration of the surgical wound in Outpatient Surgery of the hallux valgus].

    Science.gov (United States)

    Martín, M A; Ollé, G; Pellejero, J A; Torruella, R; Yuste, M; Pou, N

    2012-04-01

    To compare the post-operative analgesic effectiveness of blocking the posterior tibial and the common peroneal nerves against that of wound infiltration using local anaesthesia, in ambulatory surgery of hallux valgus. A randomised clinical study was conducted on ambulatory patients subjected to Hallux valgus surgery, assigned into two groups: BNP: peripheral nerve blockage: posterior tibial and the common peroneal with 80mg of lidocaine, 100mg of mepivacaine and 25mg of levobupivacaine. INF: surgical wound infiltration with 50mg of levobupivacaine. The following aspects were evaluated during the first 24h after surgery: pain level using a visual analogue scale (VAS), the need to use rescue analgesia, and the incidence of secondary effects and readmissions due to pain. A total of 111 Patients were included (55 BNP, 56 INF), 93 per cent were women and the average age was 59 (SD10) years. The average VAS score in the first 24h was 2.9 (SD1.7) for the BNP group and 2.7 (SD1.6) for the INF group (P=.62). Less than half (42%) of patients needed rescue anaesthetic with tramadol, with no significant differences between the groups (P=.28). A 33 per cent had secondary postoperative effects were observed in 33% of cases, with a significant difference between INF and BNP (P=.01). One patient from INF group, had to be admitted for pain. The peripheral nerve block and wound infiltration are valid techniques for controlling pain at home after ambulatory surgery of hallux valgus, therefore both methods appear to be safe in an outpatient setting. Copyright © 2011 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  10. Decreased Nerve Conduction Velocity in Football Players

    Directory of Open Access Journals (Sweden)

    Daryoush Didehdar

    2014-06-01

    Full Text Available Background: Lower limbs nerves are exposed to mechanical injuries in the football players and the purpose of this study is to evaluate the influence of football on the lower leg nerves. Materials and Methods: Nerve conduction studies were done on 35 male college students (20 football players, 15 non active during 2006 to 2007 in the Shiraz rehabilitation faculty. Standard nerve conduction techniques using to evaluate dominant and non dominant lower limb nerves. Results: The motor latency of deep peroneal and tibial nerves of dominant leg of football players and sensory latency of superficial peroneal, tibial and compound nerve action potential of tibial nerve of both leg in football players were significantly prolonged (p<0.05. Motor and sensory nerve conduction velocity of tibial and common peroneal in football players were significant delayed (p<0.05. Conclusion: It is concluded that football is sport with high contact and it causes sub-clinical neuropathies due to nerve entrapment.

  11. Nerve excitability in the rat forelimb

    DEFF Research Database (Denmark)

    Arnold, Ria; Moldovan, Mihai; Rosberg, Mette Romer

    2017-01-01

    a novel setup to explore the ulnar nerve excitability in rodents. We provide normative ulnar data in 11 adult female Long Evans rats under anaesthesia by comparison with tibial and caudal nerves. Additionally, these measures were repeated weekly on 3 occasions to determine the repeatability of these tests....... Results Nerve excitability assessment of ulnar nerve proved to be a longitudinally repeatable measure of axonal function mature in rats, as were measures in tibial and caudal nerves. Comparison with existing method: Ulnar nerve motor excitability measures were different from the caudal and tibial...

  12. Injury to the anterior tibial system during percutaneous plating of a proximal tibial fracture.

    Science.gov (United States)

    Gary, Joshua L; Sciadini, Marcus F

    2012-07-01

    Minimally invasive osteosynthesis of proximal tibial fractures has grown in popularity in recent years. This article describes a patient with a Schatzker type VI proximal tibial fracture (AO/OTA type 41.C3) and previous compartment syndrome treated with definitive fixation 8 weeks after initial injury with a precontoured proximal tibial plate and a distal targeting device. Brisk bleeding occurred during percutaneous insertion of a cortical screw at the midshaft of the tibia. Surgical exploration revealed sidewall tearing of the anterior tibial artery and vein, which were clipped at the screw insertion site. After the bleeding was controlled, the patient had a strong palpable posterior tibial pulse with no palpable dorsalis pedis pulse, and the foot remained well perfused. Function of the deep peroneal nerve was normal postoperatively. Previous concerns regarding the percutaneous treatment of proximal tibial fractures have focused on the risks of damage to the superficial peroneal nerve from distal screws. Based on cadaveric studies, percutaneously and laterally based screw placement in the distal tibial metaphysis threatens injury to the anterior tibial system. However, with alterations to the normal anatomy caused by severe trauma, previously described safe zones may be changed and neurovascular structures may be exposed to risk in locations that were previously thought safe. Copyright 2012, SLACK Incorporated.

  13. Autologous mononuclear bone marrow cells in the regeneration of tibial nerve of rabbits submitted to neurectomy: morphofunctional aspectsCélulas mononucleares autólogas de medula óssea na regeneração do nervo tibial de coelhos submetidos à neurectomia: aspectos morfofuncionais

    Directory of Open Access Journals (Sweden)

    Camila França de Paula Orlando-Goulart

    2013-10-01

    Full Text Available The functional recovery after peripheral nerve injury is the main goal of therapeutic intervention. Therefore the aim of this study was to clinically evaluate functional recovery in rabbits after neurectomy and treatment with bone marrow mononuclear cells associated with the tubulization technique. For this, 24 New Zealand rabbits, were used. They were divided into two groups with 12 animals each, mononuclear cell group (MCG and saline group (SSG. The rabbits underwent right tibial nerve section and repair by the tubulization technique using silicone hollow tube, which received 0.1 ml of autologous mononuclear bone marrow cells (2 x 106 cells in the MCG and of saline solution in the SSG, in order to compare the evolution of functional recovery of the operated limbs. Gait and planimetry were performed. Planimetry of the pelvic limb footprint printed on paper with water-based ink applied to the plantar area, before (M0 and after 7 (M7, 15 (M15, 30 (M30, 45 (M45 and 60 (M60 days after surgery. The results showed no functional recovery of the tibial nerve in both groups, without differences between them in different times and among times within groups, except when compared to M0.A recuperação funcional de nervos periféricos após lesão é o principal objetivo da intervenção terapêutica. Por isso o objetivo deste estudo foi avaliar clinicamente a recuperação funcional de coelhos após neurectomia e tratamento com células mononucleares de medula óssea associada à técnica de tubulização. Foram utilizados para isto, 24 coelhos da raça Nova Zelândia, alocados em dois grupos com 12 animais cada, denominados grupo célula mononuclear (GCM e grupo solução salina (GSS. Os coelhos foram submetidos à secção do nervo tibial direito e reparação por meio da técnica de tubulização utilizando tubo oco de silicone, para então, receberem no interior do tubo, 0,1mL de suspensão de células mononucleares autólogas de medula óssea (2 x 106

  14. Evaluation of quality of life and loss urine of women with overactive bladder treated with intravaginal or tibial nerve electro stimulation

    OpenAIRE

    Franco, Maíra de Menezes; Souza, Flaviane de Oliveira; Vasconcelos, Elaine Cristine Lemes Mateus de; Freitas, Maurício Mesquita Sabino de; Ferreira, Cristine Homsi Jorge

    2011-01-01

    Trata-se de um ensaio clínico prospectivo comparativo que objetivou comparar os efeitos do tratamento com eletroestimulação transvaginal (ET) e do nervo tibial (ENT) sobre a qualidade de vida (QV) e queixas de perda urinária em mulheres com bexiga hiperativa. Participaram 42 pacientes com bexiga hiperativa ou incontinência urinária (IU) mista e foram divididas para tratamento com ET ou ENT. A QV foi avaliada pelo questionário de QV genérico, o Medical Outcomes Study Short Form 36 (SF-36) e um...

  15. Common peroneal nerve entrapment with the communication ...

    African Journals Online (AJOL)

    Sciatic nerve divides into tibial nerve and common peroneal nerve at the level of superior angle of popliteal fossa and variations in its branching pattern are common. The most common nerve entrapment syndrome in the lower limbs is common peroneal nerve entrapment at fibular head. Invariably it can also be trapped in ...

  16. Res Cover Sep 07

    Indian Academy of Sciences (India)

    THOLASI

    2007-09-19

    Sep 19, 2007 ... Objectives and Structure: The principal objec- tives are to identify and nurture students with special talent in Mathematics. About 30 of the top performers in KRMO are selected for participation in the INMO (Indian National Mathematical Olym- piad). About 30 of the top performers in INMO are awarded a ...

  17. Effectiveness and durability of solifenacin versus percutaneous tibial nerve stimulation versus their combination for the treatment of women with overactive bladder syndrome: a randomized controlled study with a follow-up of ten months

    Directory of Open Access Journals (Sweden)

    Carlo Vecchioli-Scaldazza

    Full Text Available ABSTRACT Purpose To assess effectiveness and durability of Solifenacin (SS versus tibial nerve stimulation (PTNS versus combination therapy (PTNS + SS in women with overactive bladder syndrome (OAB. Materials and Methods 105 women with OAB were divided randomly into three groups of 35 patients each. In group A women received SS, in group B women underwent PTNS, in group C women underwent combination of PTNS + SS. Improvements in OAB symptoms were assessed with OABSS questionnaire; patients’ quality of life was assessed with OAB-q SF questionnaire. Evaluation of effectiveness of treatments was performed with PGI-I questionnaire. OABSS and PGI-I were also assessed monthly for ten months. Results All treatments were effective on symptoms. PTNS showed a greater effectiveness than SS, but PTNS + SS was more effective than SS and PTNS. Furthermore, PTNS + SS showed a greater duration of effectiveness than PTNS and SS. Conclusions Combination of PTNS with SS showed more effectiveness and more durability than PTNS and SS alone.

  18. MAVEN SEP Calibrated Data Bundle

    Data.gov (United States)

    National Aeronautics and Space Administration — The maven.sep.calibrated Level 2 Science Data Bundle contains fully calibrated SEP data, as well as the raw count data from which they are derived, and ancillary...

  19. Double-blind randomised controlled trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in the treatment of faecal incontinence: CONtrol of Faecal Incontinence using Distal NeuromodulaTion (the CONFIDeNT trial).

    Science.gov (United States)

    Horrocks, Emma J; Bremner, Stephen A; Stevens, Natasha; Norton, Christine; Gilbert, Deborah; O'Connell, P Ronan; Eldridge, Sandra; Knowles, Charles H

    2015-09-01

    Faecal incontinence (FI) is a common condition which is often under-reported. It is distressing for those suffering from it, impacting heavily on their quality of life. When conservative strategies fail, treatment options are limited. Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive outpatient treatment, shown in preliminary case series to have significant effectiveness; however, no randomised controlled trial has been conducted. To assess the effectiveness of PTNS compared with sham electrical stimulation in the treatment of patients with FI in whom initial conservative strategies have failed. Multicentre, parallel-arm, double-blind randomised (1 : 1) controlled trial. Eighteen UK centres providing specialist nurse-led (or equivalent) treatment for pelvic floor disorders. Participants aged > 18 years with FI who have failed conservative treatments and whose symptoms are sufficiently severe to merit further intervention. PTNS was delivered via the Urgent(®) PC device (Uroplasty Limited, Manchester, UK), a hand-held pulse generator unit, with single-use leads and fine-needle electrodes. The needle was inserted near the tibial nerve on the right leg adhering to the manufacturer's protocol (and specialist training). Treatment was for 30 minutes weekly for a duration of 12 treatments. Validated sham stimulation involved insertion of the Urgent PC needle subcutaneously at the same site with electrical stimulation delivered to the distal foot using transcutaneous electrical nerve stimulation. Outcome measures were assessed at baseline and 2 weeks following treatment. Clinical outcomes were derived from bowel diaries and validated, investigator-administered questionnaires. The primary outcome classified patients as responders or non-responders, with a responder defined as someone having achieved ≥ 50% reduction in weekly faecal incontinence episodes (FIEs). In total, 227 patients were randomised from 373 screened: 115 received PTNS and 112 received

  20. Dynamic SEP event probability forecasts

    Science.gov (United States)

    Kahler, S. W.; Ling, A.

    2015-10-01

    The forecasting of solar energetic particle (SEP) event probabilities at Earth has been based primarily on the estimates of magnetic free energy in active regions and on the observations of peak fluxes and fluences of large (≥ M2) solar X-ray flares. These forecasts are typically issued for the next 24 h or with no definite expiration time, which can be deficient for time-critical operations when no SEP event appears following a large X-ray flare. It is therefore important to decrease the event probability forecast with time as a SEP event fails to appear. We use the NOAA listing of major (≥10 pfu) SEP events from 1976 to 2014 to plot the delay times from X-ray peaks to SEP threshold onsets as a function of solar source longitude. An algorithm is derived to decrease the SEP event probabilities with time when no event is observed to reach the 10 pfu threshold. In addition, we use known SEP event size distributions to modify probability forecasts when SEP intensity increases occur below the 10 pfu event threshold. An algorithm to provide a dynamic SEP event forecast, Pd, for both situations of SEP intensities following a large flare is derived.

  1. Transcutaneous tibial nerve stimulation in the treatment of lower urinary tract symptoms and its impact on health-related quality of life in patients with Parkinson disease: a randomized controlled trial.

    Science.gov (United States)

    Perissinotto, Maria Carolina; DʼAncona, Carlos Arturo Levi; Lucio, Adélia; Campos, Renata Martins; Abreu, Anelyssa

    2015-01-01

    A randomized controlled trial study was performed to evaluate the efficacy of transcutaneous tibial nerve stimulation (TTNS) and sham TTNS, in patients with Parkinson disease (PD) with lower urinary tract symptoms (LUTS). Randomized controlled trial. Thirteen patients with a diagnosis of PD and bothersome LUTS were randomly allocated to one of the following groups: Group I: TTNS group (n = 8) and group II: Sham group (n = 5). Both groups attended twice a week during 5 weeks; each session lasted 30 minutes. Eight patients received TTNS treatment and 5 subjects allocated to group II were managed with sham surface electrodes that delivered no electrical stimulation. Assessments were performed before and after the treatment; they included a 3-day bladder diary, Overactive Bladder Questionnaire (OAB-V8), and the International Consultation on Incontinence Quality of Life Questionnaire Short Form (ICIQ-SF), and urodynamic evaluation. Following 5 weeks of treatment, patients allocated to TTNS demonstrated statistically significant reductions in the number of urgency episodes (P = .004) and reductions in nocturia episodes (P < .01). Participants allocated to active treatment also showed better results after treatment in the OAB-V8 and ICIQ-SF scores (P < .01, respectively). Urodynamic testing revealed that patients in the active treatment group showed improvements in intravesical volume at strong desire to void (P < .05) and volume at urgency (P < .01) when compared to subjects in the sham treatment group. These findings suggest that TTNS is effective in the treatment of LUTS in patients with PD, reducing urgency and nocturia episodes and improving urodynamic parameters as well as symptom scores measured by the OAB-V8 and health-related quality-of-life scores measured by the ICIQ-SF.

  2. Axonal elongation through long acellular nerve segments depends on recruitment of phagocytic cells from the near-nerve environment. Electrophysiological and morphological studies in the cat

    DEFF Research Database (Denmark)

    Sørensen, J; Fugleholm, K; Moldovan, M

    2001-01-01

    The distal nerve stump plays a central role in the regeneration of peripheral nerve but the relative importance of cellular and humoral factors is not clear. We have studied this question by freezing the tibial nerve distal to a crush lesion in cat. The importance of constituents from the near......-nerve environment was assessed by modification of the contact between the tibial nerve and the environment. Silicone cuffs, containing electrodes for electrophysiological assessment of nerve regeneration, were placed around the tibial nerve distal to the crush site. The interaction between long acellular frozen...... nerve segments (ANS) and the near-nerve environment was ascertained by breaching the silicone cuff to allow access of cellular or humoral components. Tibial nerves were crushed and frozen for 40 mm and enclosed in nerve cuffs with 0.45-microm holes or 2.0-mm holes to allow access of humoral factors...

  3. [Reduced muscular oxygen tension and nerve impulse transmission from antishock hose. Reduction of oxygen tension in the tibial muscle and impulse transmission in the peroneal nerve from pneumatic -1 pressure from antishock hose].

    Science.gov (United States)

    Willy, C; Völker, H U; Weber, F; Albert, U; Sterk, J; Helm, M; Gerngross, H; Thomas, A

    1998-07-01

    The aim of the study was to assess, whether the pneumatic pressure of an antishock-trouser (AST) of 20-40 mm Hg induces a decreased oxygenation of the anterior tibial muscle and attenuates muscular response potential (MRP) of n. peronaeus profundus? Among 22 normotensive, healthy volunteers the AST were tested by applying pressure values between 0 and 100 mm Hg and measuring the intracompartmental pressure, the muscular oxygen pressure as well as the MRP by electroneurographic means within a period of 6 hours. The median initial intracompartmental pressure value of the m. tibialis anterior was 12.0 mm Hg (Q25%/Q75%: 8.9/17.3), the muscular oxygen pressure 14.8 mm Hg (Q25%/Q75%: 11.5/22.0). Transmission of the pneumatic AST-leg segment pressure to the muscle: 97.7% (Q25%/Q75%: 89.2/99.8). Already in the low AST pressure field (20-40 mm Hg) a severe hypoxia occurred in one case. A reduction of MRP was noticed at an AST pressure rate of 10 mm Hg. In 5 of 6 cases AST pressure values of 60 mm Hg led to pathological pO2-values within 5-20 minutes. Almost without exception AST-pressure rates < 60 mm Hg resulted in an anoxia of the muscle and loss of the MRP. We should demand that the AST are only applied with models where the pressure generated within the single segments can be controlled by pressure gauge. The application of the AST seems to be justified for polytraumatised in severe haemorrhagic shock where the risk of a local tissue ischemia with systemical consequences must deliberately be accepted.

  4. Avaliação da qualidade de vida e da perda urinária de mulheres com bexiga hiperativa tratadas com eletroestimulação transvaginal ou do nervo tibial Evaluation of quality of life and loss urine of women with overactive bladder treated with intravaginal or tibial nerve electro stimulation

    Directory of Open Access Journals (Sweden)

    Maíra de Menezes Franco

    2011-06-01

    Full Text Available Trata-se de um ensaio clínico prospectivo comparativo que objetivou comparar os efeitos do tratamento com eletroestimulação transvaginal (ET e do nervo tibial (ENT sobre a qualidade de vida (QV e queixas de perda urinária em mulheres com bexiga hiperativa. Participaram 42 pacientes com bexiga hiperativa ou incontinência urinária (IU mista e foram divididas para tratamento com ET ou ENT. A QV foi avaliada pelo questionário de QV genérico, o Medical Outcomes Study Short Form 36 (SF-36 e um questionário específico para IU, o Incontinence Quality of Life Instrument (I-QOL. Os relatos de perdas urinárias e incômodos ocasionados foram avaliados, respectivamente, por meio do diário miccional de 24 horas e Escala Visual Analógica (EVA. O tratamento foi realizado uma vez por semana, totalizando doze semanas. O grupo da ENT teve melhora significativa em três domínios do I-QOL, na EVA, que avaliou o grau de incômodo causado pela IU e em quatro aspectos do diário miccional. No grupo de ET houve melhora significativa de dois domínios do SF-36, três domínios do I-QOL, na EVA e em quatro aspectos do diário. Houve melhora da QV em ambos os grupos, assim como uma diminuição das queixas de perda urinária, entretanto, o grupo que recebeu ET obteve melhora nos escores em dois domínios do questionário de QV genérico após o tratamento, que teve limitação por aspectos físicos e limitação por aspectos emocionais. O que não ocorreu com o grupo de ENT.This is a prospective comparative clinical study. This study aimed to compare the effects of intravaginal electrical stimulation therapy (IS and the tibial nerve (TNS on quality of life (QOL and complaints of urinary incontinence in women with overactive bladder. Participants 42 patients with overactive bladder or urinary incontinence (UI mix and were divided for treatment with IS or TNS. To assess QOL we used a generic QOL questionnaire, the Medical Outcomes Study Short Form 36 (SF-36 and

  5. Comparison of the operation of arthroscopic tibial inlay and traditional tibial inlay for posterior cruciate ligament reconstruction.

    Science.gov (United States)

    Lu, Daifeng; Xiao, Mochao; Lian, Yongyun; Zhou, Yong; Liu, Xuefeng

    2014-01-01

    To perform dual-bundle reconstruction of posterior cruciate ligament using full arthroscopic tibial inlay technology with self-designed tibia tunnel drilling system and to compare the effect of arthroscopic tibial inlay versus traditional technique for posterior cruciate ligament reconstruction. 32 patients were randomly divided into experiment group (improved tibial inlay, n = 17) and control group (traditional tibial inlay, n = 15). Self-designed tibia tunnel drill system was used to produce intraoperative deep-limited bone tunnel. During follow-up, the location of the bone block and the healing situation were checked by knee X-ray and spiral CT scan. Blood loss, operation time and nerve vascular injuries were evaluated. Mean intraoperative blood loss was 123.53 ± 74.05 ml in the improved tibial inlay group compared with 332 ± 114.26 ml in the traditional tibial inlay group (t = 6.12, P inlay group compared with 346.37 ± 59.67 min in the traditional tibial inlay group (t = 5.19, P inlay technique compared with 14 negative cases and 2 positive cases of traditional tibial Inlay technique. The X-ray and spiral CT scan showed the location of the bone block were perfect and healed well with the patent who received improved tibial inlay technology after 12 weeks postoperatively. Accurate depth-limited bone tunnel can be produced by the tibia tunnel drill system with minor trauma, less bleeding and reducing of nerves or vessels and the recent clinical effects of PCL reconstruction were pretty good.

  6. Percutaneous tibial nerve stimulation versus sham electrical stimulation for the treatment of faecal incontinence in adults (CONFIDeNT): a double-blind, multicentre, pragmatic, parallel-group, randomised controlled trial.

    Science.gov (United States)

    Knowles, Charles H; Horrocks, Emma J; Bremner, Stephen A; Stevens, Natasha; Norton, Christine; O'Connell, P Ronan; Eldridge, Sandra

    2015-10-24

    Percutaneous tibial nerve stimulation (PTNS) is a new ambulatory therapy for faecal incontinence. Data from case series suggest it has beneficial outcomes in 50-80% patients; however its effectiveness against sham electrical stimulation has not been investigated. We therefore aimed to assess the short-term efficacy of PTNS against sham electrical stimulation in adults with faecal incontinence. We did a double-blind, multicentre, pragmatic, parallel-group, randomised controlled trial (CONtrol of Faecal Incontinence using Distal NeuromodulaTion [CONFIDeNT]) in 17 specialist hospital units in the UK that had the skills to manage patients with faecal incontinence. Eligible participants aged 18 years or older with substantial faecal incontinence for whom conservative treatments (such as dietary changes and pelvic floor exercises) had not worked, were randomly assigned (1:1) to receive either PTNS (via the Urgent PC neuromodulation system) or sham stimulation (via a transcutaneous electrical nerve stimulation machine to the lateral forefoot) once per week for 12 weeks. Randomisation was done with permuted block sizes of two, four, and six, and was stratified by sex and then by centre for women. Patients and outcome assessors were both masked to treatment allocation for the 14-week duration of the trial (but investigators giving the treatment were not masked). The primary outcome was a clinical response to treatment, which we defined as a 50% or greater reduction in episodes of faecal incontinence per week. We assessed this outcome after 12 treatment sessions, using data from patients' bowel diaries. Analysis was by intention to treat, and missing data were multiply imputed. This trial is registered with the ISRCTN registry, number 88559475, and is closed to new participants. Between Jan 23, 2012, and Oct 31, 2013, we randomly assigned 227 eligible patients (of 373 screened) to receive either PTNS (n=115) or sham stimulation (n=112). 12 patients withdrew from the trial

  7. Qualidade de vida de mulheres com bexiga hiperativa refratária tratadas com estimulação elétrica do nervo tibial posterior Quality of life in women with refractory overactive bladder treated with percutaneous tibial nerve stimulation

    Directory of Open Access Journals (Sweden)

    Francine O. Fischer-Sgrott

    2009-12-01

    Full Text Available OBJETIVO: Verificar o impacto do tratamento por estimulação elétrica do nervo tibial posterior (PTNS na qualidade de vida (QV de mulheres com bexiga hiperativa (BH. MÉTODOS: Ensaio clínico não controlado com 11 mulheres com presença de contrações não inibidas do detrusor (CNI no exame urodinâmico, todas anteriormente submetidas ao tratamento com anticolinérgicos, sem resposta. O tratamento fisioterápico constituiu-se de 12 sessões de 30 minutos da PTNS com o eletroestimulador Dualpex 961®, duas vezes na semana. Para avaliar a QV, foram utilizados os questionários King's Health Questionnaire (KHQ e o "Internacional Consultation on Incontinence Questionnaire - Short-Form" (ICIQ-SF, e os seus escores pré e pós-tratamento foram comparados pelo teste de Wilcoxon para amostras pareadas, com nível de significância de 0,05. RESULTADOS: Observou-se melhora significativa na QV em todos os domínios do KHQ, exceto na percepção geral da saúde (51,36±30,75 versus 37,73±25,63; p=0,068: impacto da incontinência (74,55±27,75 versus 38,18±13,82; p=0,008, limitações das atividades diárias (66,45±25,89 versus 26,91±11,22; p=0,008, limitações físicas (73,91±29,46 versus 30,91±12,79; p=0,008, limitações sociais (39,18±35,60 versus 17,45±12,26; p=0,028, relações pessoais (25,64±29,16 versus 10,45±15,23; p=0,043, emoções (65,82±38,56 versus 26,00±20,45; p=0,005, sono/disposição (39,18±37,51 versus 16,45±18,17; p=0,012 e nas medidas de gravidade (62,00±17,70 versus 33,00±16,59; p=0,003. Os escores do ICIQ-SF demonstraram também melhora na QV (10,09±6,50 versus 3,73±3,00; p=0,008. CONCLUSÕES: A terapia com PTNS foi capaz de melhorar a QV de mulheres com queixa de BH e refratárias ao tratamento medicamentoso. A PTNS mostra-se, portanto, uma boa alternativa terapêutica, além de ser segura e com baixo custo operacional.OBJECTIVE: To investigate the effect of percutaneous tibial nerve stimulation (PTNS in the

  8. Anatomical variations in the level of bifurcation of the sciatic nerve in ...

    African Journals Online (AJOL)

    Background: The sciatic nerve, the largest nerve in the body is derived from the sacral plexus. It is composed of tibial and common fibular nerves; the division of this nerve varies; it may occur within the pelvis, gluteal region, upper, mid and lower part of thigh. Injury of the nerve may lead to loss of sensation in posterior thigh, ...

  9. Vascularized nerve grafts for lower extremity nerve reconstruction.

    Science.gov (United States)

    Terzis, Julia K; Kostopoulos, Vasileios K

    2010-02-01

    Vascularized nerve grafts (VNG) were introduced in 1976 but since then, there have been no reports of their usage in lower extremity reconstruction systematically. The factors influencing outcomes as well as a comparison with conventional nerve grafts will be presented.Since 1981, 14 lower extremity nerve injuries in 12 patients have been reconstructed with VNG. Common peroneal nerve was injured in 12 and posterior tibial nerve in 5 patients. The level of the injury was at the knee or thigh. Twelve sural nerves were used as VNG with or without concomitant vascularized posterior calf fascia.All patients regained improved sensibility and adequate posterior tibial nerve function. For common peroneal nerve reconstructions, all patients with denervation time less than 6 months regained muscle strength of grade at least 4, even when long grafts were used for defects of 20 cm or more. Late cases, yielded inadequate muscle function even with the use of VNG.Denervation time of 6 months or less was critical for reconstruction with vascularized nerve graft. Not only the results were statistically significant compared with late cases, but also all early operated patients achieved excellent results. VNG are strongly recommended in traction avulsion injuries of the lower extremity with lengthy nerve damage.

  10. Tibial Plateau Fractures

    DEFF Research Database (Denmark)

    Elsøe, Rasmus

    This PhD thesis reported an incidence of tibial plateau fractures of 10.3/100,000/year in a complete Danish regional population. The results reported that patients treated for a lateral tibial plateau fracture with bone tamp reduction and percutaneous screw fixation achieved a satisfactory level...... of radiological outcomes and a level of health related quality of life (Eq5d) below but not significantly different from the Danish reference population at a mean of 5.2 years follow-up. Furthermore, a knee injury-specific questionnaire (KOOS) reported a level of disability close to a reference population...... with only the subgroup Sport significantly below the age matched reference population. The thesis reports a level of health related quality of life (Eq5d) and disability (KOOS) significantly below established reference populations for patients with bicondylar tibial plateau fracture treated with a ring...

  11. EAMJ Nephrotoxicity Sep 09.indd

    African Journals Online (AJOL)

    2009-09-01

    Sep 1, 2009 ... of amphotericin B therapy but most commonly used tests include serum urea and serum creatinine concentration, complete blood count (CBC), serum magnesium and potassium levels. The main objective of this study was to determine the incidence of nephrotoxicity through serial creatinine, creatinine ...

  12. EAMJ Congenital Sep 09.indd

    African Journals Online (AJOL)

    2009-09-09

    Sep 9, 2009 ... Stocker, J.T., Madewell, J.E. and Drake, R.M.. Congenital cystic adenomatoid malformation of the lung: classification and morphologic spectrum. Hum. Pathol. 1977; 8:155-171. 6. Benjamin, D.R. and Cahill, J.L. Bronchioloalveolar carcinoma of the lung and congenital cystic adenomatoid malformation.

  13. EAMJ Pregnancy Sep 09.indd

    African Journals Online (AJOL)

    2009-09-09

    Sep 9, 2009 ... stigma and discrimination as a consequence. Concerns about unknown effects of any investigational agent on an embryo and foetus, and potential risks to the future reproductive capacity of female participants (9) demands that pregnant women be excluded from enrolling into trials of investigational.

  14. EAMJ Congenital Sep 09.indd

    African Journals Online (AJOL)

    2009-09-09

    Sep 9, 2009 ... between congenital lobar emphysema, congenital cystic adenomatoid malformation and tension pneumothorax on radiography. For this reason, a CT of the chest was carried out and this demonstrated cystic over expansion of the right lung base. Distinguishing between CCAM, especially type. 1, which has ...

  15. EAMJ Diagnosis Sep 09.indd

    African Journals Online (AJOL)

    2009-09-01

    Sep 1, 2009 ... Mullins, C., Eisen, G., Popper, S., et al. Highly active antiretroviral therapy and viral response in HIV type. 2 infection. Clin. Infect. Dis. 2004; 38: 1771-1779. 2. Schutten, M., Van der Ende, M.E. and Osterhaus, A.D.. Antiretroviral therapy in patients with dual infection with human immunodeficiency virus types ...

  16. EAMJ Aetiology Sep 09.indd

    African Journals Online (AJOL)

    2009-09-09

    Sep 9, 2009 ... have shown that in many cases the aetiologic agent cannot be identified (3, 4). ... and sanitary practices. All HIV-positive participants ... day. Diarrhoea was treated with oral rehydration solution and, if indicated, antimicrobial and anti- motility agents. Only one stool sample was collected for each episode of ...

  17. EAMJ Aetiology Sep 09.indd

    African Journals Online (AJOL)

    2009-09-09

    Sep 9, 2009 ... Shigella, Yersinia spp., Campylobacter spp. and Escherichia coli was done using selective and differential culture ... negative DNA probe controls for identification of enteropathogenic E. coli (EPEC) and ... Polymerase chain reaction (PCR) was conducted on all HIV-reactive dried blood specimens (DBS) ...

  18. Posterior Tibial Neuropathy by a Baker’s Cyst: Case Report

    OpenAIRE

    Lee, Ji-Hyun; Jun, Jae-Bum; Choi, Choong-Hyeok; Park, Si-Bog; Yoo, Dae-Hyun; Hong, Eun-Kyung; Kim, Seong Yoon

    2000-01-01

    Baker’s cysts are rare cause of peripheral nerve entrapment and only a few cases of tibial nerve entrapment resulting from the popliteal cyst in the calf muscle have been reported in the literature. We present a case of rheumatoid arthritis complicated by a Baker’s cyst with a tibial nerve entrapment. It is important to diagnose a Baker’s cyst early and to differentiate it from thrombophlebitis, a popliteal aneurysm, tumor or muscle tear to effect optimal therapy and to obviate a potential ne...

  19. Anomalous common peroneal nerve supplying the gluteus maximus ...

    African Journals Online (AJOL)

    On dissection of a 60-year-old adult male cadaver, a high division of the sciatic nerve was observed on the right side along with an accessory slip of the piriformis. In this case, the common peroneal nerve pierced through and the tibial nerve passed below the accessory slip of the piriformis. Additionally, there was an ...

  20. TIBIAL SHAFT FRACTURES

    OpenAIRE

    Kojima, Kodi Edson; Ferreira, Ramon Venzon

    2015-01-01

    The long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical...

  1. Fraturas do planalto tibial Tibial plateau fractures

    Directory of Open Access Journals (Sweden)

    Maurício Kfuri Júnior

    2009-01-01

    Full Text Available As fraturas do planalto tibial são lesões articulares cujos princípios de tratamento envolvem a redução anatômica da superfície articular e a restauração funcional do eixo mecânico do membro inferior. Contribuem para a tomada de decisões no tratamento dessas fraturas o perfil do paciente, as condições do envelope de tecidos moles, a existência de outros traumatismos associados e a infraestrutura disponível para abordagens cirúrgicas. Para as fraturas de alta energia, o tratamento estagiado, seguindo o princípio do controle de danos, tem como prioridade a manutenção do alinhamento do membro enquanto se aguarda a resolução das más condições de tecidos moles. Já nos traumas de baixa energia, desde que os tecidos moles não sejam um fator adverso, o tratamento deve ser realizado em tempo único, com osteossíntese definitiva. Fixação estável e movimento precoce são variáveis diretamente relacionadas com os melhores prognósticos. Desenvolvimentos recentes, como os implantes com estabilidade angular, substitutos ósseos e imagens tridimensionais para controle intraoperatório, deverão contribuir para cirurgias menos invasivas e melhores resultados.Tibial plateau fractures are joint lesions that require anatomical reduction of joint surface and functional restoration of mechanical axis of a lower limb. Patient profile, soft tissue conditions, presence of associated injuries and the available infrastructure for the treatment all contribute to the decision making about the best treatment for these fractures. High-energy fractures are usually approached in a staged manner respecting the principle of damage control, and are primarily targeted to maintain limb alignment while the resolution unfavorable soft tissue conditions is pending. Low-energy trauma can be managed on a single-stage basis, provided soft tissues are not an adverse factor, with open reduction and internal f-ixation. Stable fixation and early painless joint

  2. Changes in the EEG and SEP of patients with cerebrovascular major strokes

    International Nuclear Information System (INIS)

    Iwayama, Kaoru; Tanaka, Keisei; Yamashiro, Katsumi; Mori, Kazuo

    1980-01-01

    Changes in the electroencephalogram (EEG) and somatosensory evoked potential (SEP) were studied in 27 cases with unilateral cerebrovascular disorders. From the CT findings (EMI-1010), the locations of the diseases were divided into two types: superficial (within the cortex and subcortical white matter) or deep (at the level of the basal ganglia and thalamus). Each of these was then further subdivided according to the nature of the disease, whether hemorrhage or infarction. The EEG and SEP were recorded from the scalp area corresponding to the post-Rolandic arm area (Shagass' point) throughout the investigation. The stimulus intensities applied to the median nerve were fixed at 5 - 10 V. higher than the motor threshold. EEG power spectrum analysis was done with an ATAC 2300 computer, while slow-wave indices (SWI), the ratio of power in the slow-wave range (2 - 6 Hz) to the total power (2 - 25 Hz), were calculated manually. In deep lesions, the deterioration of the SEP was prominent. Especially in the 5 cases with bleeding, all 5 showed a ''flat SEP.'' These patients also revealed motor and sensory disturbance clinically. In the 6 cases with infarction, although no one showed sensory disturbances, the changes in the SEP were also remarkable. In deep lesions, a decrease in the amplitude of the early components of SEP (N 1 , P 1 ) was the most conspicuous feature. On the contrary, in superficial lesions, changes in the SEP were less prominent, and if they occurred, the late components (P 2 , N 3 ) were more easily affected. The amount of the slow wave increased remarkably and bilaterally in these superficial cases, and the slower the frequency of the EEG, the more attenuation of the amplitude of SEP was noted on the lesion side. On the opposite side, however, no such correlations could be noted between an increased slow-wave power and a decreased amplitude of SEP. Further studies to clarify these differences will be necessary. (author)

  3. Pediatric Tibial Osteomyelitis.

    Science.gov (United States)

    Stone, Brad; Street, Matthew; Leigh, Warren; Crawford, Haemish

    2016-01-01

    Osteomyelitis shows a strong predilection for the tibia in the pediatric population and is a significant source of complications. The purpose of this article is to retrospectively review a large series of pediatric patients with tibial osteomyelitis. We compare our experience with that in the literature to determine any factors that may aid diagnosis and/or improve treatment outcomes. A 10-year retrospective review was performed of clinical records of all cases of pediatric tibial osteomyelitis managed at the 2 children's orthopaedic departments in the Auckland region. The Osteomyelitis Database was used to identify all cases between 1997 and 2007, at Starship Children's Hospital, and 1998 and 2008 at Middlemore's Kids First Hospital. One hundred ninety-one patients fulfilled the inclusion criteria, and had a review of clinical notes and relevant investigations. The average duration of symptoms before presentation to hospital was 5.7 days. Less than 40% of patients had a recent episode of trauma. Almost 60% of patients could not bear weight on admission. Over 40% of patients had a temperature above 38°C. Erythrocyte sedimentation rate was elevated in 78% and the C-reactive protein was elevated in 90% of patients. In total, 42% of blood cultures and almost 75% of tissue cultures were positive, with Staphylococcus aureus being the most commonly cultured organism. X-rays, bone scans, and magnetic resonance imaging were all used to aid the diagnosis. About 43% of patients had surgery. Treatment length was an average of 2 weeks 6 days of intravenous antibiotics followed by 3 weeks 2 days of oral treatment. Six postsurgical complications and 46 readmissions were noted: 25 for relapse, with the remainder due to social and antibiotic-associated complications. Although generally diagnosed on presentation, pediatric tibial osteomyelitis can require more sophisticated investigations and prolonged management. Treatment with intravenous and oral antibiotics and surgical

  4. Collagen turnover after tibial fractures

    DEFF Research Database (Denmark)

    Joerring, S; Krogsgaard, M; Wilbek, H

    1994-01-01

    Collagen turnover after tibial fractures was examined in 16 patients with fracture of the tibial diaphysis and in 8 patients with fracture in the tibial condyle area by measuring sequential changes in serological markers of turnover of types I and III collagen for up to 26 weeks after fracture....... The markers were the carboxy-terminal extension peptide of type I procollagen (PICP), the amino-terminal extension peptide of type III procollagen (PIIINP), and the pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP). The latter is a new serum marker of degradation of type I...... collagen. A group comparison showed characteristic sequential changes in the turnover of types I and III collagen in fractures of the tibial diaphysis and tibial condyles. The turnover of type III collagen reached a maximum after 2 weeks in both groups. The synthesis of type I collagen reached a maximum...

  5. Collagen turnover after tibial fractures

    DEFF Research Database (Denmark)

    Joerring, S; Krogsgaard, M; Wilbek, H

    1994-01-01

    Collagen turnover after tibial fractures was examined in 16 patients with fracture of the tibial diaphysis and in 8 patients with fracture in the tibial condyle area by measuring sequential changes in serological markers of turnover of types I and III collagen for up to 26 weeks after fracture...... collagen. A group comparison showed characteristic sequential changes in the turnover of types I and III collagen in fractures of the tibial diaphysis and tibial condyles. The turnover of type III collagen reached a maximum after 2 weeks in both groups. The synthesis of type I collagen reached a maximum...... after 2 weeks in the diaphyseal fractures and after 6 weeks in the condylar fractures. The degradation of type I collagen increased after 4 days and reached a maximum at 2 weeks in both groups. The interindividual variation was wide. On a group basis, the turnover of types I and III collagen had...

  6. The functional results of acute nerve grafting in traumatic sciatic nerve injuries.

    Science.gov (United States)

    Vayvada, Haluk; Demirdöver, Cenk; Menderes, Adnan; Yılmaz, Mustafa; Karaca, Can

    2013-03-01

    The sciatic and peroneal nerves are the most frequently injured in lower extremities, followed by tibial and femoral nerves. The aim of this study is to evaluate the functional results of acute nerve grafting in traumatic sciatic nerve injuries. A total of 9 patients with sciatic nerve defect were treated with primary nerve grafting. The mean age was 31.7 years. The etiologic factors were gunshot wounds, traffic accident, and penetrating trauma. All of the patients had sciatic nerve defects ranging from 3.4 to 13.6 cm. The follow-up period ranged between 25 and 84 months. The tibial nerve motor function was "good" or "very good" (M3-M4) in 5 patients (55.6%). The plantar flexion was not sufficient for the rest of the patients. The peroneal nerve motor function was also "good" and "very good" in 3 patients (33.3%). The functional results of the acute nerve grafting of the sciatic nerve within the first week after the injury are poorer than reported in the related literature. This protocol should only be applied to select patients who have adequate soft tissue coverage and healthy nerve endings.

  7. The impact of motor and sensory nerve architecture on nerve regeneration.

    Science.gov (United States)

    Moradzadeh, Arash; Borschel, Gregory H; Luciano, Janina P; Whitlock, Elizabeth L; Hayashi, Ayato; Hunter, Daniel A; Mackinnon, Susan E

    2008-08-01

    Sensory nerve autografting is the standard of care for injuries resulting in a nerve gap. Recent work demonstrates superior regeneration with motor nerve grafts. Improved regeneration with motor grafting may be a result of the nerve's Schwann cell basal lamina tube size. Motor nerves have larger SC basal lamina tubes, which may allow more nerve fibers to cross a nerve graft repair. Architecture may partially explain the suboptimal clinical results seen with sensory nerve grafting techniques. To define the role of nerve architecture, we evaluated regeneration through acellular motor and sensory nerve grafts. Thirty-six Lewis rats underwent tibial nerve repairs with 5 mm double-cable motor or triple-cable sensory nerve isografts. Grafts were harvested and acellularized in University of Wisconsin solution. Control animals received fresh motor or sensory cable isografts. Nerves were harvested after 4 weeks and histomorphometry was performed. In 6 animals per group from the fresh motor and sensory cable graft groups, weekly walking tracks and wet muscle mass ratios were performed at 7 weeks. Histomorphometry revealed more robust nerve regeneration in both acellular and cellular motor grafts. Sensory groups showed poor regeneration with significantly decreased percent nerve, fiber count, and density (parchitecture (size of SC basal lamina tubes) plays an important role in nerve regeneration in a mixed nerve gap model.

  8. Sciatic nerve transection in the adult rat : Abnormal EMG patterns during locomotion by aberrant innervation of hindleg muscles

    NARCIS (Netherlands)

    Gramsbergen, A; IJkema-Paassen, J; Meek, MF

    The effects of lesions in the sciatic nerve were studied in adult rats, In the left hindleg, a segment 12 mm long was resected from the proximal part of the nerve, before the bifurcation into the peroneal and tibial nerves, This segment in a reversed orientation was used as a nerve graft. EMG

  9. Lower extremity nerve decompression in painful diabetic polyneuropathy

    NARCIS (Netherlands)

    Macare van Maurik, A.F.

    2014-01-01

    The aim of the study was to evaluate the effect of surgical decompression of nerves in the lower extremity in patients with painful diabetic polyneuropathy (DPN). Influences on pain, tactile sensation, anatomical aspects of the tibial nerve and thickness of the flexor retinaculum, use of pain

  10. Intraexaminer and interexaminer reliability of manual palpation and pressure algometry of the lower limb nerves in asymptomatic subjects.

    LENUS (Irish Health Repository)

    Fingleton, Caitriona P

    2014-02-01

    Nerve palpation is a method of clinically identifying mechanosensitivity of neural tissue by means of pressure algometry and manual palpation. There are few investigations of the reliability of lower limb nerve palpation, and femoral nerve palpation has never been previously reported. The aim of this study was to investigate the reliability of nerve palpation of the femoral, sciatic, tibial, and common peroneal nerves and to report normative values for the femoral nerve.

  11. SEP Mission Design Space for Mars Orbiters

    Science.gov (United States)

    Woolley, Ryan C.; Nicholas, Austin K.

    2015-01-01

    The advancement of solar-electric propulsion (SEP) technologies and larger, light-weight solar arrays offer a tremendous advantage to Mars orbiters in terms of both mass and timeline flexibility. These advantages are multiplied for round-trip orbiters (e.g. potential Mars sample return) where a large total Delta V would be required. In this paper we investigate the mission design characteristics of mission concepts utilizing various combinations and types of SEP thrusters, solar arrays, launch vehicles, launch dates, arrival dates, etc. SEP allows for greater than 50% more mass delivered and launch windows of months to years. We also present the SEP analog to the ballistic Porkchop plot - the "Bacon" plot.

  12. Nerve cross-bridging to enhance nerve regeneration in a rat model of delayed nerve repair.

    Directory of Open Access Journals (Sweden)

    Tessa Gordon

    Full Text Available There are currently no available options to promote nerve regeneration through chronically denervated distal nerve stumps. Here we used a rat model of delayed nerve repair asking of prior insertion of side-to-side cross-bridges between a donor tibial (TIB nerve and a recipient denervated common peroneal (CP nerve stump ameliorates poor nerve regeneration. First, numbers of retrogradely-labelled TIB neurons that grew axons into the nerve stump within three months, increased with the size of the perineurial windows opened in the TIB and CP nerves. Equal numbers of donor TIB axons regenerated into CP stumps either side of the cross-bridges, not being affected by target neurotrophic effects, or by removing the perineurium to insert 5-9 cross-bridges. Second, CP nerve stumps were coapted three months after inserting 0-9 cross-bridges and the number of 1 CP neurons that regenerated their axons within three months or 2 CP motor nerves that reinnervated the extensor digitorum longus (EDL muscle within five months was determined by counting and motor unit number estimation (MUNE, respectively. We found that three but not more cross-bridges promoted the regeneration of axons and reinnervation of EDL muscle by all the CP motoneurons as compared to only 33% regenerating their axons when no cross-bridges were inserted. The same 3-fold increase in sensory nerve regeneration was found. In conclusion, side-to-side cross-bridges ameliorate poor regeneration after delayed nerve repair possibly by sustaining the growth-permissive state of denervated nerve stumps. Such autografts may be used in human repair surgery to improve outcomes after unavoidable delays.

  13. TIBIAL SHAFT FRACTURES.

    Science.gov (United States)

    Kojima, Kodi Edson; Ferreira, Ramon Venzon

    2011-01-01

    The long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical parameters and constant clinical monitoring. Once the diagnosis has been made, fasciotomy should be performed. It is always difficult to assess consolidation, but the RUST method may help in this. Radiography is assessed in two projections, and points are scored for the presence of the fracture line and a visible bone callus. Today, the dogma of six hours for cleaning the exposed fracture is under discussion. It is considered that an early start to intravenous antibiotic therapy and the lesion severity are very important. The question of early or late closure of the lesion in an exposed fracture has gone through several phases: sometimes early closure has been indicated and sometimes late closure. Currently, whenever possible, early closure of the lesion is recommended, since this diminishes the risk of infection. Milling of the canal when the intramedullary nail is introduced is still a controversial subject. Despite strong personal positions in favor of milling, studies have shown that there may be some advantage in relation to closed fractures, but not in exposed fractures.

  14. Myelography for nerve root avulsion in birth palsy

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Tsutomu; Mitomo, Masanori; Hirabuki, Norio; Miura, Takashi; Kawai, Ryuji; Imakita, Satoshi; Harada, Koshi; Nakamura, Hironobu; Kozuka, Takahiro (Osaka Univ. (Japan). Faculty of Medicine)

    1990-04-01

    Myelography and CT myelography (CMT) were reviewed in 18 cases of birth palsy with clinically suspected avulsion injury. Root-somatosensory evoked potential (root-SEP) was also reviewed for myelographic evaluation of the nerve root avolusion in birth palsy. Root-SEP is not induced in case of avulsed nerve roots, but is induced in case of both normal and incompletely avulsed roots. Myelography demonstrated 58 abnormal nerve roots in 18 cases (19 limbs); 45 (78%) complete and 13 (22%) incomplete nerve root avulsions. Each of complete and incomplete avulsions was defined as total absence and partial presence of rootlets on myelography, respectively. Traumatic meningoceles were detected at 46 roots (79%) on myelography and/or CTM; 35 roots on myelography and 45 roots on CTM. CTM could not detect only a very small meningocele at one root. At 11 roots CTM was superior to myelography in delineating a meningocele because CTM is sensitive to a poorly enhanced meningocele. CTM, however, could not diagnose nerve root avulsions so accurately as myelography, since myelography detected 12 (7 completely and 5 incompletely) avulsed roots without meningocele, whereas CTM could not delineate the nerve roots clearly. Thus, myelography is indispensable to evaluate nerve root avulsions without meningocele. Root-SEP was examined in 9 patients who underwent branchial plexus exploration. SEP was negative at 22/25 roots with complete avulsion and was positive at 7/7 roots with myelographically incomplete avulsion, regardless of presence or absence of any traumatic meningocele. Myelography and root-SEP correlated well at 29 (92%) out of 32 roots in evaluating complete and incomplete avulsion injuries. Myelography and root-SEP were not considered in 3 roots. Though myelography demonstrated complete avulsions with traumatic meningocele, SEP was positive in these three roots, which were interpreted as partially avulsed roots. (J.P.N.).

  15. Myelography for nerve root avulsion in birth palsy

    International Nuclear Information System (INIS)

    Hashimoto, Tsutomu; Mitomo, Masanori; Hirabuki, Norio; Miura, Takashi; Kawai, Ryuji; Imakita, Satoshi; Harada, Koshi; Nakamura, Hironobu; Kozuka, Takahiro

    1990-01-01

    Myelography and CT myelography (CMT) were reviewed in 18 cases of birth palsy with clinically suspected avulsion injury. Root-somatosensory evoked potential (root-SEP) was also reviewed for myelographic evaluation of the nerve root avolusion in birth palsy. Root-SEP is not induced in case of avulsed nerve roots, but is induced in case of both normal and incompletely avulsed roots. Myelography demonstrated 58 abnormal nerve roots in 18 cases (19 limbs); 45 (78%) complete and 13 (22%) incomplete nerve root avulsions. Each of complete and incomplete avulsions was defined as total absence and partial presence of rootlets on myelography, respectively. Traumatic meningoceles were detected at 46 roots (79%) on myelography and/or CTM; 35 roots on myelography and 45 roots on CTM. CTM could not detect only a very small meningocele at one root. At 11 roots CTM was superior to myelography in delineating a meningocele because CTM is sensitive to a poorly enhanced meningocele. CTM, however, could not diagnose nerve root avulsions so accurately as myelography, since myelography detected 12 (7 completely and 5 incompletely) avulsed roots without meningocele, whereas CTM could not delineate the nerve roots clearly. Thus, myelography is indispensable to evaluate nerve root avulsions without meningocele. Root-SEP was examined in 9 patients who underwent branchial plexus exploration. SEP was negative at 22/25 roots with complete avulsion and was positive at 7/7 roots with myelographically incomplete avulsion, regardless of presence or absence of any traumatic meningocele. Myelography and root-SEP correlated well at 29 (92%) out of 32 roots in evaluating complete and incomplete avulsion injuries. Myelography and root-SEP were not considered in 3 roots. Though myelography demonstrated complete avulsions with traumatic meningocele, SEP was positive in these three roots, which were interpreted as partially avulsed roots. (J.P.N.)

  16. Neuromas of the calcaneal nerves.

    Science.gov (United States)

    Kim, J; Dellon, A L

    2001-11-01

    A neuroma of a calcaneal nerve has never been reported. A series of 15 patients with heel pain due to a neuroma of a calcaneal nerve are reviewed. These patients previously had either a plantar fasciotomy (n = 4), calcaneal spur removal (n = 2), ankle fusion (n = 2), or tarsal tunnel decompression (n = 7). Neuromas occurred on calcaneal branches that arose from either the posterior tibial nerve (n = 1), lateral plantar nerve (n = 1), the medial plantar nerve (n = 9), or more than one of these nerves (n = 4). Operative approach was through an extended tarsal tunnel incision to permit identification of all calcaneal nerves. The neuroma was resected and implanted into the flexor hallucis longus muscle. Excellent relief of pain occurred in 60%, and good relief in 33%. One patient (17%) had no improvement and required resection of the lateral plantar nerve. Awareness that the heel may be innervated by multiple calcaneal branches suggests that surgery for heel pain of neural origin employ a surgical approach that permits identification of all possible calcaneal branches.

  17. Comparison of the fastest regenerating motor and sensory myelinated axons in the same peripheral nerve.

    Science.gov (United States)

    Moldovan, Mihai; Sørensen, Jesper; Krarup, Christian

    2006-09-01

    Functional outcome after peripheral nerve regeneration is often poor, particularly involving nerve injuries far from their targets. Comparison of sensory and motor axon regeneration before target reinnervation is not possible in the clinical setting, and previous experimental studies addressing the question of differences in growth rates of different nerve fibre populations led to conflicting results. We developed an animal model to compare growth and maturation of the fastest growing sensory and motor fibres within the same mixed nerve after Wallerian degeneration. Regeneration of cat tibial nerve after crush (n = 13) and section (n = 7) was monitored for up to 140 days, using implanted cuff electrodes placed around the sciatic and tibial nerves and wire electrodes at plantar muscles. To distinguish between sensory and motor fibres, recordings were carried out from L6-S2 spinal roots using cuff electrodes. The timing of laminectomy was based on the presence of regenerating fibres along the nerve within the tibial cuff. Stimulation of unlesioned tibial nerves (n = 6) evoked the largest motor response in S1 ventral root and the largest sensory response in L7 dorsal root. Growth rates were compared by mapping the regenerating nerve fibres within the tibial nerve cuff to all ventral or dorsal roots and, regardless of the lesion type, the fastest growth was similar in sensory and motor fibres. Maturation was assessed as recovery of the maximum motor and sensory conduction velocities (CVs) within the tibial nerve cuff. Throughout the observation period the CV was approximately 14% faster in regenerated sensory fibres than in motor fibres in accordance with the difference observed in control nerves. Recovery of amplitude was only partial after section, whereas the root distribution pattern was restored. Our data suggest that the fastest growth and maturation rates that can be achieved during regeneration are similar for motor and sensory myelinated fibres.

  18. SEP's during Halloween storms and space weather

    Science.gov (United States)

    Hady, Ahmed; Saleh, Ahmed

    2014-05-01

    The solar energetic particles (SEP's) could be accelerated to higher energies of order of MeV per nucleon. A modified model for SEP's acceleration has been given and applied for Halloween storms event during the decline phase of solar cycle 23. The estimated values of the solar magnetic field during the solar particle event were introduced. The solar magnetic field describes a sophisticated feature of discrete sectors/regions over the period that starts from 28 October 2003 to 4 November 2003. The applications of the suggested model on the solar particle event show that a homogeneous structure is in agreement with the observations. The SEP and CME events lead to severe effects in geo-space and on earth, such as power blackouts, disruption of communications, and damage to satellites. Daily Geomagnetic storm changes, during Halloween storms were studied

  19. Lifecourse SEP and tobacco and cannabis use.

    Science.gov (United States)

    Bowes, Lucy; Chollet, Aude; Fombonne, Eric; Galéra, Cédric; Melchior, Maria

    2013-04-01

    Social inequalities in substance use have been well-documented; however, the impact of changes in socio-economic position from childhood to adulthood is unclear. We examined the relationship between intergenerational trajectories of social position and tobacco and cannabis use among young adults. Data come from 1103 participants (mean age: 28.9 years) of the Trajectoires Epidémiologiques en Population (TEMPO) study and their parents, participants of the GAZEL study, France. Multinomial regression analyses were used to examine associations between lifecourse socio-economic position (SEP) assessed using the parent's reports of family income (1989 and 2002) and the participant's educational attainment, occupational grade and job stability in 2009, with self-reported tobacco and cannabis use in 2009. Compared with participants with stable intermediate/high SEP, those with stable low SEP and those with declining SEP were more likely to use tobacco (age- and sex-adjusted ORs = 2.03 and 2.26). Participants who experienced declining SEP were also disproportionately likely to use and abuse cannabis (adjusted ORs = 2.22 and 2.73). Associations remained significant after adjusting for family (parental smoking, alcohol use, ill health, unemployment, depression and divorce) and individual (early tobacco and cannabis use, academic difficulties, juvenile internalizing and externalizing problems) risk factors. Cross-sectional studies indicate social inequalities in substance use. Our longitudinal findings suggest that individuals who experienced declining SEP from childhood to adulthood may be twice as likely to use tobacco and cannabis compared with individuals with a stable/high trajectory. Interventions targeting substance abuse should take into account lifecourse determinants including the interplay between individuals' socio-economic origins and later attainment.

  20. Alabama SEP Final Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    Grimes, Elizabeth M.

    2014-06-30

    Executive Summary In the fall of 2010, the Alabama Department of Economic and Community Affairs (ADECA) launched the Multi-State Model for Catalyzing the National Home Energy Retrofit Market Project (Multi-State Project). This residential energy efficiency pilot program was a collaborative effort among the states of Alabama, Massachusetts, Virginia, and Washington, and was funded by competitive State Energy Program (SEP) awards through the U.S. Department of Energy (DOE). The objective of this project was to catalyze the home energy efficiency retrofit market in select areas within the state of Alabama. To achieve this goal, the project addressed a variety of marketplace elements that did not exist, or were underdeveloped, at the outset of the effort. These included establishing minimum standards and credentials for marketplace suppliers, educating and engaging homeowners on the benefits of energy efficiency and addressing real or perceived financial barriers to investments in whole-home energy efficiency, among others. The anticipated effect of the activities would be increased market demand for retrofits, improved audit to retrofit conversion rates and growth in overall community understanding of energy efficiency. The four-state collaborative was created with the intent of accelerating market transformation by allowing each state to learn from their peers, each of whom possessed different starting points, resources, and strategies for achieving the overall objective. The four partner states engaged the National Association of State Energy Officials (NASEO) to oversee a project steering committee and to manage the project evaluation for all four states. The steering committee, comprised of key program partners, met on a regular basis to provide overall project coordination, guidance, and progress assessment. While there were variances in program design among the states, there were several common elements: use of the Energy Performance Score (EPS) platform; an

  1. Tibial microdissection for diabetic wounds.

    Science.gov (United States)

    Alexandrescu, V; Vincent, G; Ngongang, C; Ledent, G; Hubermont, G

    2012-02-01

    Few data are available focusing on controlled blunt microdissection during below-the-knee interventions as sole or synchronous technique coupled to subintimal angioplasty, particularly in the management of diabetic critical-ischemic foot wounds. We present two cases of targeted recanalizations in the tibial and pedal trunks for plantar and forefoot diabetic ischemic tissue defects, following an angiosome-model for perfusion.

  2. The bilateral anatomical variation of the sural nerve and a review of relevant literature.

    Science.gov (United States)

    Vuksanovic-Bozaric, Aleksandra; Radunovic, Miroslav; Radojevic, Nemanja; Abramovic, Marija

    2014-01-01

    The sural nerve is a sensory nerve, usually formed in the distal part of the leg by the union of the lateral sural cutaneous nerve or the communicating fibular branch with the medial sural cutaneous nerve. The aim of this paper is to present a case of a variant formation of the sural nerve and a review of the literature related to this case. During the dissection of an adult male cadaver, the medial sural cutaneous nerve and communicating fibular branch, after respectively deriving from the tibial and common fibular nerve, were noticed to continue their course without any formation of a unique nerve trunk on the posterior side of both lower limbs. A transverse communicating branch, connecting these two nerves, was present in both legs. As the sural nerve is of significant diagnostic and therapeutic importance, detailed knowledge of the sural nerve's anatomy and its contributing nerves is also of great importance.

  3. Outcomes of selective tibial artery repair following combat-related extremity injury.

    Science.gov (United States)

    Burkhardt, Gabriel E; Cox, Mitchell; Clouse, W Darrin; Porras, Chantel; Gifford, Shaun M; Williams, Ken; Propper, Brandon W; Rasmussen, Todd E

    2010-07-01

    Selective tibial revascularization refers to the practice of vessel repair vs ligation or observation based on factors observed at the time of injury. Although commonly employed, the effectiveness of this strategy and its impact on sustained limb salvage is unknown. The objective of this study is to define the factors most relevant in selective tibial artery revascularization and to characterize limb salvage following tibial-level vascular injury. The cohort of active-duty military patients undergoing infrapopliteal artery repair comprises the tibial Bypass group. A similarly injured cohort of patients that did not undergo operative vascular intervention (No Bypass group) was identified. All tibial vessel injuries were documented by angiography. Data were compiled via medical records and patient interview. The primary outcome measure was failure of limb salvage. Multivariate regression was performed to identify factors associated with revascularization and to describe factors associated with amputation. Between March 2003 and September 2008, 135 of 1332 patients with battle-related vascular injuries had documented tibial vessel disruption or occlusion. Of these, 104 were included for analysis. Twenty-one underwent autologous vein bypass at the time of injury (Bypass group), and the remaining 83 patients were managed without revascularization (No Bypass group). Mean follow-up (39 vs 41 months; P = .27), age (25 vs 27 years; P = .66), and mechanism of injury (88% vs 92% penetrating blast; P = .56) were similar, but the No Bypass group had higher Injury Severity Scores (ISS; 16.3 vs 11.7; P Injury characteristics, including Gustilo III classification (49% vs 43%; P = .81) and nerve injury (55% vs 53%; P = 1.0), were similar. Subjects were more likely to receive tibial bypass with an increasing number of tibial vessel occlusions and documented ischemia on initial exam. However, of the 23 in the No Bypass group with initially unobtainable Doppler signals, 17 (74

  4. Low- and high-frequency subcortical SEP amplitude reduction during pure passive movement.

    Science.gov (United States)

    Insola, Angelo; Padua, Luca; Mazzone, Paolo; Valeriani, Massimiliano

    2015-12-01

    To investigate the effect of pure passive movement on both cortical and subcortical somatosensory evoked potentials (SEPs). Median nerve SEPs were recorded in 8 patients suffering from Parkinson's disease (PD) and two patients with essential tremor. PD patients underwent electrode implantation in the subthalamic (STN) nucleus (3 patients) and pedunculopontine (PPTg) nucleus (5 patients), while 2 patients with essential tremor were implanted in the ventral intermediate nucleus (VIM) of the thalamus. In anesthetized patients, SEPs were recorded at rest and during a passive movement of the thumb of the stimulated wrist from the intracranial electrode contacts and from the scalp. Also the high-frequency oscillations (HFOs) were analyzed. Amplitudes of both deep and scalp components were decreased during passive movement, but the reduction was higher at cortical than subcortical level. Also the HFOs were reduced by movement. The different amount of the movement-related decrease suggests that the cortical SEP gating is not only the result of a subcortical somatosensory volley attenuation, but a further mechanism acting at cortical level should be considered. Our results are important for understanding the physiological mechanism of the sensory-motor interaction during passive movement. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  5. Medial tibial “spackling” to lessen chronic medial tibial soft tissue irritation

    Directory of Open Access Journals (Sweden)

    J. Ryan Martin, MD

    2016-09-01

    Full Text Available We describe a unique, utilitarian reconstructive treatment option known as tibial “spackling” for chronic, localized medial joint line pain corresponding with progressive radiographic peripheral medial tibial bone loss beneath a well-fixed revision total knee arthroplasty tibial baseplate. It is believed that this localized pain is due to chronic irritation of the medial capsule and collateral ligament from the prominent medial edge of the tibial component. In the setting of failed nonoperative treatment, our experience with utilizing bone cement to reconstruct the medial tibial bone defect and create a smooth medial tibial surface has been successful in eliminating chronic medial soft tissue irritation.

  6. Tibial Torsion Among Filipinos: A Cadaveric Study

    Directory of Open Access Journals (Sweden)

    Villamin CAC

    2012-07-01

    Full Text Available Tibial torsion, the twisting of the tibia about its long axis, can affect rotational positioning in total knee replacement. This angle varies depending on the ethnicity of the subject. There are no published studies to date to determine the tibial torsion among Filipinos. In this study, 28 cadaveric limbs were examined. Our results show that the average tibial torsion among adult Filipinos is 28.9°.

  7. A novel suture method to place and adjust peripheral nerve catheters

    DEFF Research Database (Denmark)

    Rothe, C.; Steen-Hansen, C.; Madsen, M. H.

    2015-01-01

    We have developed a peripheral nerve catheter, attached to a needle, which works like an adjustable suture. We used in-plane ultrasound guidance to place 45 catheters close to the femoral, saphenous, sciatic and distal tibial nerves in cadaver legs. We displaced catheters after their initial...

  8. Tibial tuberosity fractures in adolescents.

    Science.gov (United States)

    Frey, Steven; Hosalkar, Harish; Cameron, Danielle B; Heath, Aaron; David Horn, B; Ganley, Theodore J

    2008-12-01

    Tibial tuberosity fractures in adolescents are uncommon. We retrospectively reviewed all tibial tuberosity fractures in adolescents (10-19) who presented to our level 1 pediatric trauma center over a 7-year period to review fracture morphology, mechanism of injury, fracture management including return to play, as well as complications. Additionally, we present a review of the literature and treatment algorithm. We reviewed the clinical charts and radiographs of consecutive patients with tibial tuberosity fractures between 01 January 2000 and 01 January 2007. Data parameters included the following: patients age and gender, involved side, injury classification, co-morbidities, mechanism of injury, treatment, return to activity and complications. Data were extracted and reviewed, and a treatment algorithm is proposed with some additional insights into the epidemiology of the injury. Nineteen patients met the inclusion criteria. There were 19 patients with 20 tibial tuberosity fractures. The mean age was 13.7 years. There were 18 males and 1 female patient. There were nine left-sided injuries and eleven right-sided including one patient with bilateral fractures. Mechanism of injuries included basketball injury (8), running injury (5), football injury (3), fall from a scooter (2), high jump (1) and fall (1). Co-morbidities included three patients with concurrent Osgood-Schlatter disease and one with osteogenesis imperfecta. All were treated with ORIF, including arthroscopic-assisted techniques in two cases. Complications included four patients with pre-operative presentation of compartment syndrome all requiring fasciotomy, one post-operative stiffness and one painful hardware requiring removal. Range of motion was started an average of 4.3 weeks post-operatively and return to play was an average of 3.9 months post-operatively. Although uncommon, tibial tuberosity fractures in adolescents are clinically important injuries. Early recognition and treatment (closed or open

  9. Sepä man : [luuletused] / Pent Nurmekund

    Index Scriptorium Estoniae

    Nurmekund, Pent, 1906-1996

    2002-01-01

    Sisu: Sepä man ; Vihtsekülä ; Laul rüäakkest ; "Pihläpmar'r'a om küds'ä ..." ; Kun mia elä ; Kõllanõmme ; Üits perätü kip'ev pill ; Üts küsümüs. Eluloolisi andmeid autori kohta lk. 371

  10. Nerve conduction

    Science.gov (United States)

    ... the central nervous system (CNS) and peripheral nervous system (PNS). The CNS contains the brain and the spinal cord and the PNS consists of thousands of nerves that connect the spinal cord to muscles and sensory receptors. A peripheral nerve is composed of nerve ...

  11. The Level of Fibula Osteotomy and Incidence of Peroneal Nerve ...

    African Journals Online (AJOL)

    2010-06-29

    Jun 29, 2010 ... Journal of Surgical Technique and Case Report | Jan-Jun 2010 | Vol-2 | Issue-1. 17. The Level of Fibula Osteotomy and Incidence of Peroneal. Nerve Palsy in Proximal Tibial Osteotomy. A. O. Ogbemudia, P. F. A. Umebese, A. Bafor, E. Igbinovia, P. E. Ogbemudia. INTRODUCTION. Osteotomy of the fibula is ...

  12. Anastomotic stoma coated with chitosan film as a betamethasone dipropionate carrier for peripheral nerve regeneration

    Directory of Open Access Journals (Sweden)

    Ping Yao

    2018-01-01

    Full Text Available Scar hyperplasia at the suture site is an important reason for hindering the repair effect of peripheral nerve injury anastomosis. To address this issue, two repair methods are often used. Biological agents are used to block nerve sutures and the surrounding tissue to achieve physical anti-adhesion effects. Another agent is glucocorticosteroid, which can prevent scar growth by inhibiting inflammation. However, the overall effect of promoting regeneration of the injured nerve is not satisfactory. In this regard, we envision that these two methods can be combined and lead to shared understanding for achieving improved nerve repair. In this study, the right tibial nerve was transected 1 cm above the knee to establish a rat tibial nerve injury model. The incision was directly sutured after nerve transection. The anastomotic stoma was coated with 0.5 × 0.5 cm2 chitosan sheets with betamethasone dipropionate. At 12 weeks after injury, compared with the control and poly (D, L-lactic acid groups, chitosan-betamethasone dipropionate film slowly degraded with the shape of the membrane still intact. Further, scar hyperplasia and the degree of adhesion at anastomotic stoma were obviously reduced, while the regenerated nerve fiber structure was complete and arranged in a good order in model rats. Electrophysiological study showed enhanced compound muscle action potential. Our results confirm that chitosan-betamethasone dipropionate film can effectively prevent local scar hyperplasia after tibial nerve repair and promote nerve regeneration.

  13. Incomplete linear tibial fractures in two horses

    International Nuclear Information System (INIS)

    Johnson, P.J.; Allhands, R.V.; Baker, G.J.; Boero, M.J.; Foreman, J.H.; Hyyppa, T.; Huhn, J.C.

    1988-01-01

    Incomplete linear tibial fractures were identified in two horses with the aid of scintigraphy. Both horses were treated successfully by strict stall confinement, and both returned to normal athletic activity. Scintigraphy can be used to facilitate the generally difficult diagnosis of incomplete tibial fractures

  14. Medial tibial stress syndrome: a critical review

    NARCIS (Netherlands)

    Moen, Maarten H.; Tol, Johannes L.; Weir, Adam; Steunebrink, Miriam; de Winter, Theodorus C.

    2009-01-01

    Medial tibial stress syndrome (MTSS) is one of the most common leg injuries in athletes and soldiers. The incidence of MTSS is reported as being between 4% and 35% in military personnel and athletes. The name given to this condition refers to pain on the posteromedial tibial border during exercise,

  15. Exploring the potential of microwave diagnostics in SEP forecasting: The occurrence of SEP events

    Science.gov (United States)

    Zucca, P.; Núñez, M.; Klein, K.

    2017-06-01

    Solar energetic particles (SEPs), especially protons and heavy ions, may be a space-weather hazard when they impact spacecraft and the terrestrial atmosphere. Forecasting schemes have been developed, which use earlier signatures of particle acceleration to predict the arrival of solar protons and ions in the space environment of the Earth. The UMASEP (University of MAlaga Solar particle Event Predictor) scheme forecasts the occurrence and the importance of an SEP event based on combined observations of soft X-rays, their time derivative and protons above 10 MeV at geosynchronous orbit. We explore the possibility to replace the derivative of the soft X-ray time history with the microwave time history in the UMASEP scheme. To this end we construct a continuous time series of observations for a 13-month period from December 2011 to December 2012 at two microwave frequencies, 4.995 and 8.8 GHz, using data from the four Radio Solar Telescope Network (RSTN) patrol stations of the US Air Force, and feed this time series to the UMASEP prediction scheme. During the selected period the Geostationary Operational Environmental Satellites (GOES) detected nine SEP events related to activity in the western solar hemisphere. We show that the SEP forecasting using microwaves has the same probability of detection as the method using soft X-rays, but no false alarm in the considered period, and a slightly increased warning time. A detailed analysis of the missed events is presented. We conclude that microwave patrol observations improve SEP forecasting schemes that employ soft X-rays. High-quality microwave data available in real time appear as a significant addition to our ability to predict SEP occurrence.

  16. Exploring the potential of microwave diagnostics in SEP forecasting: The occurrence of SEP events

    Directory of Open Access Journals (Sweden)

    Zucca Pietro

    2017-01-01

    Full Text Available Solar energetic particles (SEPs, especially protons and heavy ions, may be a space-weather hazard when they impact spacecraft and the terrestrial atmosphere. Forecasting schemes have been developed, which use earlier signatures of particle acceleration to predict the arrival of solar protons and ions in the space environment of the Earth. The UMASEP (University of MAlaga Solar particle Event Predictor scheme forecasts the occurrence and the importance of an SEP event based on combined observations of soft X-rays, their time derivative and protons above 10 MeV at geosynchronous orbit. We explore the possibility to replace the derivative of the soft X-ray time history with the microwave time history in the UMASEP scheme. To this end we construct a continuous time series of observations for a 13-month period from December 2011 to December 2012 at two microwave frequencies, 4.995 and 8.8 GHz, using data from the four Radio Solar Telescope Network (RSTN patrol stations of the US Air Force, and feed this time series to the UMASEP prediction scheme. During the selected period the Geostationary Operational Environmental Satellites (GOES detected nine SEP events related to activity in the western solar hemisphere. We show that the SEP forecasting using microwaves has the same probability of detection as the method using soft X-rays, but no false alarm in the considered period, and a slightly increased warning time. A detailed analysis of the missed events is presented. We conclude that microwave patrol observations improve SEP forecasting schemes that employ soft X-rays. High-quality microwave data available in real time appear as a significant addition to our ability to predict SEP occurrence.

  17. Comparison of the fastest regenerating motor and sensory myelinated axons in the same peripheral nerve

    DEFF Research Database (Denmark)

    Moldovan, Mihai; Sørensen, Jesper; Krarup, Christian

    2006-01-01

    the question of differences in growth rates of different nerve fibre populations led to conflicting results. We developed an animal model to compare growth and maturation of the fastest growing sensory and motor fibres within the same mixed nerve after Wallerian degeneration. Regeneration of cat tibial nerve......Functional outcome after peripheral nerve regeneration is often poor, particularly involving nerve injuries far from their targets. Comparison of sensory and motor axon regeneration before target reinnervation is not possible in the clinical setting, and previous experimental studies addressing...... after crush (n = 13) and section (n = 7) was monitored for up to 140 days, using implanted cuff electrodes placed around the sciatic and tibial nerves and wire electrodes at plantar muscles. To distinguish between sensory and motor fibres, recordings were carried out from L6-S2 spinal roots using cuff...

  18. Anatomical aspects of the nerves of the leg and foot of the giant anteater (Myrmecophaga tridactyla, Linnaeus, 1758

    Directory of Open Access Journals (Sweden)

    V.S. Cruz

    2014-10-01

    Full Text Available Although distal stifle joint nerve distribution has been well established in domestic animals, this approach is scarcely reported in wild animals. Therefore, the aim of this study was to describe the nerves of the leg and foot of Myrmecophaga tridactyla with emphasis on their ramification, distribution, topography and territory of innervation. For this purpose, six adult cadavers fixed and preserved in 10% formalin solution were used. The nerves of the leg and foot of the M. tridactyla were the saphenous nerve (femoral nerve branch, fibular and tibial nerves and lateral sural cutaneous nerve (branches of the sciatic nerve and caudal sural cutaneous nerve (tibial nerve branch. The saphenous nerve branches to the skin, the craniomedial surface of the leg, the medial surface of the tarsal and metatarsal regions and the dorsomedial surface of the digits I and II (100% of cases, III (50% of cases and IV (25% of cases. The lateral sural cutaneous nerve innervates the skin of the craniolateral region of the knee and leg. The fibular nerve innervates the flexor and extensor muscles of the tarsal region of the digits and skin of the craniolateral surface of the leg and dorsolateral surface of the foot. The tibial nerve innervates the extensor muscles of the tarsal joint and flexor, adductor and abductor muscles of the digits and the skin of the plantar surface. The caudal sural cutaneous nerve innervates the skin of the caudal surface of the leg. The nerves responsible for the leg and foot innervation were the same as reported in domestic and wild animals, but with some differences, such as the more distal division of the common fibular nerve, the absence of dorsal metatarsal branches of the deep fibular nerve and a greater involvement of the saphenous nerve in the digital innervation with branches to the digits III and IV, in addition to digits I and II.

  19. Terminal nerve: cranial nerve zero

    Directory of Open Access Journals (Sweden)

    Jorge Eduardo Duque Parra

    2006-12-01

    Full Text Available It has been stated, in different types of texts, that there are only twelve pairs of cranial nerves. Such texts exclude the existence of another cranial pair, the terminal nerve or even cranial zero. This paper considers the mentioned nerve like a cranial pair, specifying both its connections and its functional role in the migration of liberating neurons of the gonadotropic hormone (Gn RH. In this paper is also stated the hypothesis of the phylogenetic existence of a cerebral sector and a common nerve that integrates the terminal nerve with the olfactory nerves and the vomeronasals nerves which seem to carry out the odors detection function as well as in the food search, pheromone detection and nasal vascular regulation.

  20. ELECTRODIAGNOSTIC ASSESSMENT OF PERIPHERAL NERVE INJURIES IN KICK-BOXERS

    Directory of Open Access Journals (Sweden)

    M.R EMAD

    2002-06-01

    Full Text Available Introducti0n. Peripheral nerve injuries are one of the common traumas in various sport fields. Nowadays, thera are a growing tendency to Martial arts among young people. Insufficient knowlodage about the biomechanics and true skills in these sports can expose the athletes to many neuromusculoskeletal injuries including peripheral nerve injuries. The aim of this study was assessment of peripheral nerve injuries among Kick-boxers. Methods. The research was done on 30 male kick-boxers Aged between 17-28 years. Ulnar, tibial and median nerves were studied for the presence of unlar nerve entrapment on elbow, trasal tunnel syndrom and carpal tunnel syndrom. Results. Ulnar neuropathy was observed in 12 cases. Tibial entrapment was detected in 13 cases. No median nerve intrapment of CTS was detected. There was a significant correlation between the age of the participants and nerve entrapment. Discussion. Peripheral nerve injuries should be considered in athletes and should be trained to apply preventive and thrapeutic procedures.

  1. Incidence and epidemiology of tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Hansen, Sandra Hope

    2015-01-01

    Introduction: The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large and compl......Introduction: The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large...... the highest frequency between the age of 30 and 40. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. The majority of tibial shaft fractures occur during walking, indoor activity and sports. The distribution among genders shows that males present a higher...... frequency of fractures while participating in sports activities and walking. Women present the highest frequency of fractures while walking and during indoor activities. Conclusion: This study shows an incidence of 16.9/100,000/year for tibial shaft fractures. AO-type 42-A1 was the most common fracture type...

  2. Imaging of the nerves of the knee region

    Energy Technology Data Exchange (ETDEWEB)

    Damarey, B., E-mail: benjdam@hotmail.com [Service de Radiologie et d’Imagerie musculosquelettique, CCIAL, Hôpital Roger Salengro, CHRU de Lille, Rue Emile Laine, 59037 Lille Cedex (France); Laboratoire d’anatomie, Faculté de médecine, CHRU de Lille, 1 Place de Verdun, 59045 Lille Cedex (France); Demondion, X. [Service de Radiologie et d’Imagerie musculosquelettique, CCIAL, Hôpital Roger Salengro, CHRU de Lille, Rue Emile Laine, 59037 Lille Cedex (France); Laboratoire d’anatomie, Faculté de médecine, CHRU de Lille, 1 Place de Verdun, 59045 Lille Cedex (France); Wavreille, G. [Laboratoire d’anatomie, Faculté de médecine, CHRU de Lille, 1 Place de Verdun, 59045 Lille Cedex (France); Service d’orthopédie, Hôpital Roger Salengro, CHRU de Lille, Rue Emile Laine, 59037 Lille Cedex (France); Pansini, V.; Balbi, V.; Cotten, A. [Service de Radiologie et d’Imagerie musculosquelettique, CCIAL, Hôpital Roger Salengro, CHRU de Lille, Rue Emile Laine, 59037 Lille Cedex (France)

    2013-01-15

    Peripheral neuropathies are a frequent, but often underdiagnosed, cause of pain and functional impairment. The clinical symptoms can be subtle, and other neurologic or non neurologic clinical entities are often evoked. MRI and ultrasonography are the imaging modalities of choice for depicting nerves and assessing neuropathies. Common neuropathies in the knee area involve the saphenous, the tibial, the common peroneal and the sural nerves. The most frequent mechanisms of nerve injury in this area are nerve entrapment and nerve stretching. A perfect knowledge of the normal imaging anatomy is essential for accurate assessment of neuropathies. In this article, we will review the anatomy of the nerves around the knee, and their normal and pathological appearance.

  3. Solar Electric Propulsion (SEP) Tug Power System Considerations

    Science.gov (United States)

    Kerslake, Thomas W.; Bury, Kristen M.; Hojinicki, Jeffrey S.; Sajdak, Adam M.; Scheiddegger, Robert J.

    2011-01-01

    Solar electric propulsion (SEP) technology is truly at the "intersection of commercial and military space" as well as the intersection of NASA robotic and human space missions. Building on the use of SEP for geosynchronous spacecraft station keeping, there are numerous potential commercial and military mission applications for SEP stages operating in Earth orbit. At NASA, there is a resurgence of interest in robotic SEP missions for Earth orbit raising applications, 1-AU class heliocentric missions to near Earth objects (NEOs) and SEP spacecraft technology demonstrations. Beyond these nearer term robotic missions, potential future human space flight missions to NEOs with high-power SEP stages are being considered. To enhance or enable this broad class of commercial, military and NASA missions, advancements in the power level and performance of SEP technologies are needed. This presentation will focus on design considerations for the solar photovoltaic array (PVA) and electric power system (EPS) vital to the design and operation of an SEP stage. The engineering and programmatic pros and cons of various PVA and EPS technologies and architectures will be discussed in the context of operating voltage and power levels. The impacts of PVA and EPS design options on the remaining SEP stage subsystem designs, as well as spacecraft operations, will also be discussed.

  4. The effect of tibial plateau leveling osteotomy position on cranial tibial subluxation: an in vitro study.

    Science.gov (United States)

    Kowaleski, Michael P; Apelt, Detlef; Mattoon, John S; Litsky, Alan S

    2005-01-01

    To compare centered versus distal tibial plateau leveling osteotomy (TPLO) position on cranial tibial subluxation, postoperative tibial plateau angle (TPA), and tibial long axis shift (TLAS). In vitro biomechanical evaluation. Six pairs of canine cadaveric hind limbs. One limb of each pair was randomly assigned to the distal (TPLO-D) or centered (TPLO-C) osteotomy group. Cranial tibial subluxation (CTS) under load was quantified sequentially under 3 conditions: intact, after cranial cruciate ligament transection, and after TPLO; a corrected CTS value was also calculated. Postoperative TPA and TLAS were measured. Comparisons were made using 1-way repeated measures ANOVA with a Tukey's multiple comparison post hoc test for CTS, and a Wilcoxon's sign rank test for TPA and TLAS. Significance was set at Pcranial tibial thrust. The centered osteotomy position is geometrically more precise, and biomechanically more effective than the distal position.

  5. Measurement of tibial torsion by computer tomography

    International Nuclear Information System (INIS)

    Jend, H.-H.; Heller, M.; Dallek, M.; Schoettle, H.

    1981-01-01

    A CT procedure for objective measurements of tibial torsion independent of axial rotation in the nearby joints is described. Transverse sections in defined planes of the tibia permit easy calculation of normal and abnormal congenital or posttraumatic angles of torsion. In 69 limbs normal tibial torsion was 40 0 +-9 0 . In a series of 42 limbs with complicated healing of a fracture of both bones of the leg it is shown that tibial maltorsion is a deformity which in most cases leads to arthrosis of the ankle joint. (Auth.)

  6. Measurement of tibial torsion by computer tomography

    Energy Technology Data Exchange (ETDEWEB)

    Jend, H.H.; Heller, M.; Dallek, M.; Schoettle, H. (Hamburg Univ. (Germany, F.R.))

    1981-01-01

    A CT procedure for objective measurements of tibial torsion independent of axial rotation in the nearby joints is described. Transverse sections in defined planes of the tibia permit easy calculation of normal and abnormal congenital or posttraumatic angles of torsion. In 69 limbs normal tibial torsion was 40/sup 0/+-9/sup 0/. In a series of 42 limbs with complicated healing of a fracture of both bones of the leg it is shown that tibial maltorsion is a deformity which in most cases leads to arthrosis of the ankle joint.

  7. Regeneration of peripheral nerve fibres following Haloxon-induced degeneration

    Directory of Open Access Journals (Sweden)

    Maria Veronica de Souza

    1996-12-01

    Full Text Available Delayed neurotoxicity has been associated with organophosphorus poisoning for years. In order to study such condition in sheep, 11 animals were given either one or two high doses of Haloxon. Exposed sheep were observed daily and between 16 and 25 days after administration neurological signs as incoordination and ataxia were detected in six of them. Biopsies of tibial and laryngeal nerves were performed as soon as neurotoxicity was diagnosed, and after death fragments of selected nerves were collected together with CNS tissues for light and electron microscopy and teased fiber studies. Laryngeal, tibial and sciatic nerves showed the most pronouced changes, consisting chiefly of wallerian degeneration that was seen either as a single fiber or as a complete fascicle feature. Exams performed after death clearly showed regenerating fascicles with axonal sprouts growing within a Schwann cell old basal lamina, and some thinly myelinated axonal sprouts.

  8. [TIBIAL PERIOSTEAL FLAP PEDICLED WITH INTERMUSCULAR BRANCH OF POSTERIOR TIBIAL VESSELS COMBINED WITH AUTOLOGOUS BONE GRAFT FOR TIBIAL BONE DEFECT].

    Science.gov (United States)

    Ni, Yulong; Gao, Shunhong; Zhang, Jingyu; Dong, Huishuang; Zhang, Yunpeng; Fu, Jiansong

    2015-10-01

    To investigate the effectiveness of tibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft in the treatment of tibial bone defects. Between January 2007 and December 2013, 19 cases of traumatic tibia bone and soft tissue defects were treated. There were 14 males and 5 females, aged from 18 to 49 years (mean, 28 years). The tibial fracture site located at the middle tibia in 6 cases and at the distal tibia in 13 cases. According to Gustilo type, 4 cases were rated as type III A, 14 cases as type III B, and 1 case as type III C (injury of anterior tibial artery). The length of bone defect ranged from 4.3 to 8.5 cm (mean, 6.3 cm). The soft tissue defects ranged from 8 cm x 5 cm to 17 cm x 9 cm. The time from injury to operation was 3 to 8 hours (mean, 4 hours). One-stage operation included debridement, external fixation, and vacuum sealing drainage. After formation of granulation tissue, the fresh wound was repaired with sural neurovascular flap or posterior tibial artery perforator flap. The flap size ranged from 10 cmx6 cm to 19 cm x 11 cm. In two-stage operation, tibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft was used to repair tibial defect. The periosteal flap ranged from 6.5 cm x 4.0 cm to 9.0 cm x 5.0 cm; bone graft ranged from 4.5 to 9.0 cm in length. External fixation was changed to internal fixation. All flaps survived with soft texture, and no ulcer and infection occurred. All incisions healed by the first intention. All patients were followed up 18-40 months (mean, between normal and affected sides.The function of the knee an ankle joint was good without infection, malunion, and equinus. According to the Johner standard at last follow-up, the results were excellent in 15 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 94.7%. Tibial periosteal flap pedicled with intermuscular branch of

  9. The risk of iatrogenic injury to anterior tibial artery variations during tibial nail distal interlocking.

    Science.gov (United States)

    Fanter, Nathan J; Inouye, Sandra E; Beiser, Christopher W

    2017-01-01

    Tibial intramedullary nailing remains a common tibial fracture fixation method. Tibial nailing indications continue to expand. Neurovascular complications from tibial nailing have been described; however, the proximity of distal tibial locking bolts to the anterior tibial artery (ATA) variants has not. 52 cadaveric legs were dissected identifying three common ATA variants. Each ATA variant received an intraluminal wire to facilitate fluoroscopic identification. Three different intramedullary tibial nails were inserted in each of the three ATA variant specimens. With fluoroscopy, the proximity of the distal locking holes of each tibial nail to the intraluminal wire representing the ATA variant course was measured. Of the 40 measurements, the intraluminal wire was directly in the bolt insertional path in 8 of 40 (20%) and within 5 mm in 16 of 40 (40%). All specimens had the wire cross the locking bolt insertional path at least once in each of the nails. The ATA variant taking a more lateral course deep to the extensor digitorum longus and peroneus tertius to overlay the lateral malleolus had the highest occurrence of measurements less than 5 mm. The close proximity of tibial nail distal locking bolt holes to ATA variants presents a risk for iatrogenic vascular injury during insertion. The coronal locking bolts pose the greatest iatrogenic risk to the most laterally positioned ATA variant.

  10. Improving tibial component coronal alignment during total knee arthroplasty with use of a tibial planing device.

    Science.gov (United States)

    Patil, Shantanu; D'Lima, Darryl D; Fait, James M; Colwell, Clifford W

    2007-02-01

    The outcomes of knee arthroplasty have been shown to be affected by component alignment. Intramedullary and extramedullary alignment instrumentation are fairly effective for achieving the desired mean tibial component coronal alignment. However, there are outliers representing >3 degrees of varus or valgus alignment with respect to the anatomic tibial shaft axis. We measured the efficacy of a custom tibial planing device for reducing the outliers in tibial alignment. We designed a tibial planing tool in an effort to improve tibial alignment. In one cohort (100 knees), we used traditional intramedullary alignment instrumentation to make the tibial bone cut. In a second cohort (120 knees), we used intramedullary alignment instrumentation to make the cut and also used a custom tool to check the cut and to correct an inexact cut. Tibial tray alignment relative to the long axis of the tibial shaft was measured in the coronal and sagittal planes on postoperative radiographs. The target coronal alignment was 90 degrees with respect to the tibial shaft axis (with alignment). A total of 100 anteroposterior radiographs and sixty-five lateral radiographs were analyzed for the group that was treated with traditional instrumentation alone, and a total of 120 anteroposterior radiographs and fifty-five lateral radiographs were analyzed for the group that was treated with use of the custom tibial planing device. The mean coronal alignment of the tibial component was 89.5 degrees +/- 2.1 degrees in the group that was treated with traditional instrumentation alone and 89.6 degrees +/- 1.4 degrees in the group that was treated with use of the custom planing device. Although the mean coronal alignment was not significantly different, the number of outliers was substantially reduced when the custom planing device was used. All 120 components that had been aligned with use of the custom planing device were within 3 degrees of the target coronal alignment, compared with only eighty

  11. Terminal nerve: cranial nerve zero

    OpenAIRE

    Jorge Eduardo Duque Parra; Carlos Alberto Duque Parra

    2006-01-01

    It has been stated, in different types of texts, that there are only twelve pairs of cranial nerves. Such texts exclude the existence of another cranial pair, the terminal nerve or even cranial zero. This paper considers the mentioned nerve like a cranial pair, specifying both its connections and its functional role in the migration of liberating neurons of the gonadotropic hormone (Gn RH). In this paper is also stated the hypothesis of the phylogenetic existence of a cerebral sector and a co...

  12. Regenerative scaffold electrodes for peripheral nerve interfacing.

    Science.gov (United States)

    Clements, Isaac P; Mukhatyar, Vivek J; Srinivasan, Akhil; Bentley, John T; Andreasen, Dinal S; Bellamkonda, Ravi V

    2013-07-01

    Advances in neural interfacing technology are required to enable natural, thought-driven control of a prosthetic limb. Here, we describe a regenerative electrode design in which a polymer-based thin-film electrode array is integrated within a thin-film sheet of aligned nanofibers, such that axons regenerating from a transected peripheral nerve are topographically guided across the electrode recording sites. Cultures of dorsal root ganglia were used to explore design parameters leading to cellular migration and neurite extension across the nanofiber/electrode array boundary. Regenerative scaffold electrodes (RSEs) were subsequently fabricated and implanted across rat tibial nerve gaps to evaluate device recording capabilities and influence on nerve regeneration. In 20 of these animals, regeneration was compared between a conventional nerve gap model and an amputation model. Characteristic shaping of regenerated nerve morphology around the embedded electrode array was observed in both groups, and regenerated axon profile counts were similar at the eight week end point. Implanted RSEs recorded evoked neural activity in all of these cases, and also in separate implantations lasting up to five months. These results demonstrate that nanofiber-based topographic cues within a regenerative electrode can influence nerve regeneration, to the potential benefit of a peripheral nerve interface suitable for limb amputees.

  13. Return to Sport After Tibial Shaft Fractures

    OpenAIRE

    Robertson, Greg A. J.; Wood, Alexander M.

    2015-01-01

    Context: Acute tibial shaft fractures represent one of the most severe injuries in sports. Return rates and return-to-sport times after these injuries are limited, particularly with regard to the outcomes of different treatment methods. Objective: To determine the current evidence for the treatment of and return to sport after tibial shaft fractures. Data Sources: OVID/MEDLINE (PubMed), EMBASE, CINAHL, Cochrane Collaboration Database, Web of Science, PEDro, SPORTDiscus, Scopus, and Google Sch...

  14. (SEP-D Kit) for intra-uterine insemination (IUI)

    African Journals Online (AJOL)

    Implementation of an office-based semen preparation method (SEP-D Kit) for intra-uterine insemination (IUI): A controlled randomised study to compare the IUI pregnancy outcome between a routine (swim-up) and the SEP-D Kit method.

  15. Implementation of an office-based semen preparation method (SEP ...

    African Journals Online (AJOL)

    Implementation of an office-based semen preparation method (SEP-D Kit) for intra-uterine insemination (IUI): A controlled randomised study to compare the IUI pregnancy outcome between a routine (swim-up) and the SEP-D Kit method.

  16. Comparison of the 26 May 2012 SEP Event with the 3 November 2011 SEP Event

    Science.gov (United States)

    Makela, P. A.; Gopalswamy, N.; Thakur, N.; Xie, H.

    2015-12-01

    We compare the solar and interplanetary events associated with two large solar energetic particle (SEP) events on 26 May 2012 and 3 November 2011. Both SEP events were detected at three longitudinally widely separated locations by STEREO A and B spacecraft (more than 100 deg away from Earth) and the Wind and SOHO spacecraft near Earth. In Earth view, the November 2011 eruption occurred far behind the east limb at N09E154, whereas the May 2012 eruption occurred closer to the west limb at N15W121, suggesting that SEPs accelerated during the 2012 event might have easier access to Earth. Even though the 2012 event was more intense in the GOES >10 MeV proton channel (peak intensity 14 pfu) than the 2011 event (peak intensity 4 pfu), we find that the latter event was more intense at higher energies (> 40 MeV). Also, the initial rise at lower energies was slightly faster for the 2011 event as measured by SOHO/ERNE. In addition, the CME associated with the May 2012 event was faster with an estimated space speed of ~2029 km/s than that in the November 2011 event (1188 km/s). STEREO/EUVI images of the associated post-eruption arcades (PEAs) indicate that their orientations were different: the PEA of the May 2012 event had a high inclination (north-south), while the inclination of the PEA of the 2011 event was more moderate. Differences in the flux rope orientation may also have effect on the longitudinal extent of the SEP events. These observations suggest that the dependence of solar proton intensities on the observer's longitudinal distance from the solar source is more complex than traditionally assumed.

  17. Side-To-Side Nerve Bridges Support Donor Axon Regeneration Into Chronically Denervated Nerves and Are Associated With Characteristic Changes in Schwann Cell Phenotype.

    Science.gov (United States)

    Hendry, J Michael; Alvarez-Veronesi, M Cecilia; Snyder-Warwick, Alison; Gordon, Tessa; Borschel, Gregory H

    2015-11-01

    Chronic denervation resulting from long nerve regeneration times and distances contributes greatly to suboptimal outcomes following nerve injuries. Recent studies showed that multiple nerve grafts inserted between an intact donor nerve and a denervated distal recipient nerve stump (termed "side-to-side nerve bridges") enhanced regeneration after delayed nerve repair. To examine the cellular aspects of axon growth across these bridges to explore the "protective" mechanism of donor axons on chronically denervated Schwann cells. In Sprague Dawley rats, 3 side-to-side nerve bridges were placed over a 10-mm distance between an intact donor tibial (TIB) nerve and a recipient denervated common peroneal (CP) distal nerve stump. Green fluorescent protein-expressing TIB axons grew across the bridges and were counted in cross section after 4 weeks. Immunofluorescent axons and Schwann cells were imaged over a 4-month period. Denervated Schwann cells dedifferentiated to a proliferative, nonmyelinating phenotype within the bridges and the recipient denervated CP nerve stump. As donor TIB axons grew across the 3 side-to-side nerve bridges and into the denervated CP nerve, the Schwann cells redifferentiated to the myelinating phenotype. Bridge placement led to an increased mass of hind limb anterior compartment muscles after 4 months of denervation compared with muscles whose CP nerve was not "protected" by bridges. This study describes patterns of donor axon regeneration and myelination in the denervated recipient nerve stump and supports a mechanism where these donor axons sustain a proregenerative state to prevent deterioration in the face of chronic denervation.

  18. Continuous EEG-SEP monitoring in severe brain injury.

    Science.gov (United States)

    Amantini, A; Fossi, S; Grippo, A; Innocenti, P; Amadori, A; Bucciardini, L; Cossu, C; Nardini, C; Scarpelli, S; Roma, V; Pinto, F

    2009-04-01

    To monitor acute brain injury in the neurological intensive care unit (NICU), we used EEG and somatosensory evoked potentials (SEP) in combination to achieve more accuracy in detecting brain function deterioration. Sixty-eight patients (head trauma and intracranial hemorrhage; GCSSEP and intracranial pressure monitoring (ICP). Fifty-five patients were considered "stable" or improving, considering the GCS and CT scan: in this group, SEP didn't show significant changes. Thirteen patients showed neurological deteriorations and, in all patients, cortical SEP showed significant alterations (amplitude decrease>50% often till complete disappearance). SEP deterioration anticipated ICP increase in 30%, was contemporary in 38%, and followed ICP increase in 23%. Considering SEP and ICP in relation to clinical course, all patients but one with ICP less than 20 mmHg were stable, while the three patients with ICP greater than 40 mmHg all died. Among the 26 patients with ICP of 20-40 mmHg, 17 were stable, while nine showed clinical and neurophysiological deterioration. Thus, there is a range of ICP values (20-40 mmHg) were ICP is scarcely indicative of clinical deterioration, rather it is the SEP changes that identify brain function deterioration. Therefore, SEP have a twofold interest with respect to ICP: their changes can precede an ICP increase and they can constitute a complementary tool to interpret ICP trends. It has been very important to associate SEP and EEG: about 60% of our patients were deeply sedated and, because of their relative insensitivity to anesthetics, only SEP allowed us to monitor brain damage evolution when EEG was scarcely valuable. We observed 3% of nonconvulsive status epilepticus compared to 18% of neurological deterioration. If the aim of neurophysiological monitoring is to "detect and protect", it may not be limited to detecting seizures, rather it should be able to identify brain deterioration, so we propose the combined monitoring of EEG with SEP.

  19. Normal and sonographic anatomy of selected peripheral nerves. Part III: Peripheral nerves of the lower limb

    Directory of Open Access Journals (Sweden)

    Berta Kowalska

    2012-06-01

    Full Text Available The ultrasonographic examination is currently increasingly used in imaging peripheral nerves, serving to supplement the physical examination, electromyography and magnetic resonance imaging. As in the case of other USG imaging studies, the examination of peripheral nerves is non-invasive and well-tolerated by patients. The typical ultrasonographic picture of peripheral nerves as well as the examination technique have been discussed in part I of this article series, following the example of the median nerve. Part II of the series presented the normal anatomy and the technique for examining the peripheral nerves of the upper limb. This part of the article series focuses on the anatomy and technique for examining twelve normal peripheral nerves of the lower extremity: the iliohypogastric and ilioinguinal nerves, the lateral cutaneous nerve of the thigh, the pudendal, sciatic, tibial, sural, medial plantar, lateral plantar, common peroneal, deep peroneal and superficial peroneal nerves. It includes diagrams showing the proper positioning of the sonographic probe, plus USG images of the successively discussed nerves and their surrounding structures. The ultrasonographic appearance of the peripheral nerves in the lower limb is identical to the nerves in the upper limb. However, when imaging the lower extremity, convex probes are more often utilized, to capture deeply-seated nerves. The examination technique, similarly to that used in visualizing the nerves of upper extremity, consists of locating the nerve at a characteristic anatomic reference point and tracking it using the “elevator technique”. All 3 parts of the article series should serve as an introduction to a discussion of peripheral nerve pathologies, which will be presented in subsequent issues of the “Journal of Ultrasonography”.

  20. Multiple Variations of the Nerves of Gluteal Region and their Clinical Implications

    Directory of Open Access Journals (Sweden)

    Prasad AM

    2016-01-01

    Full Text Available Knowledge of variations of nerves of gluteal region is important for clinicians administering intramuscular injections, for orthopedic surgeons dealing with the hip surgeries and possibly for physiotherapists managing the painful conditions and paralysis of this region. We report multiple variations of the nerves of gluteal region through this article. In the current case, the sciatic nerve was absent. The common peroneal and tibial nerves arose from sacral plexus and reached the gluteal region through greater sciatic foramen above and below piriformis respectively. The common peroneal nerve gave a muscular branch to the gluteus maximus. The inferior gluteal nerve and posterior cutaneous nerve of the thigh arose from a common trunk. The common trunk was formed by three roots. Upper and middle roots arose from sacral plexus and entered gluteal region through greater sciatic foramen respectively above and below piriformis. The lower root arose from the pudendal nerve and joined the common trunk. We discuss the clinical implications of the variations.

  1. The Energetic Particle Environment of the Lunar Nearside: SEP Influence

    Science.gov (United States)

    Xu, Xiaojun; Angelopoulos, Vassilis; Wang, Yi; Zuo, Pingbing; Wong, Hon-Cheng; Cui, Jun

    2017-11-01

    The energetic particle environment of the lunar nearside is quite different from that of the lunar farside. Due to the shielding of the Earth’s magnetosphere and the Moon, the lunar nearside may receive much fewer energetic particles from the Sun. It is currently impossible to directly measure the received energetic particle flux of the whole lunar surface. By using the ARTEMIS and Wind observations, we qualitatively studied the shielding effect of the Earth’s magnetosphere and the lunar body from solar energetic particles (SEPs). We found that the Earth’s magnetosphere can effectively shield SEPs with energies up to 4 Mev during the SEP event. However, in the solar wind, the Moon can provide partial shielding from SEPs with energies ≤100 KeV. SEPs with energies above 150 KeV in the lunar shadow show no difference in flux from in the solar wind, which suggests that the nearside and farside are the same in receiving SEPs with energies above 150 KeV during the SEP event.

  2. Type III Radio Burst Duration and SEP Events

    Science.gov (United States)

    Gopalswamy, N.; Makela, P.; Xie, H.

    2010-01-01

    Long-duration (>15 min), low-frequency (SEP events of solar cycle 23. The Type III durations are distributed symmetrically at 1 MHz yielding a mean value of approximately 33 min (median = 32 min) for the large SEP events. When the SEP events with ground level enhancement (GLE,) are considered, the distribution is essentially unchanged (mean = 32 min, median = 30 min). To test the importance of type III bursts in indicating SEP events, we considered a set of six type III bursts from the same active region (AR 10588) whose durations fit the "long duration" criterion. We analyzed the coronal mass ejections (CMEs), flares, and type II radio bursts associated with the type III bursts. The CMEs were of similar speeds and the flares are also of similar size and duration. All but one of the type III bursts was not associated with a type II burst in the metric or longer wavelength domains. The burst without type II burst also lacked a solar energetic particle (SEP) event at energies >25 MeV. The 1-MHz duration of the type III burst (28 rein) is near the median value of type III durations found for gradual SEP events and ground level enhancement (GLE) events. Yet, there was no sign of SEP events. On the other hand, two other type III bursts from the same active region had similar duration but accompanied by WAVES type 11 bursts; these bursts were also accompanied by SEP events detected by SOHO/ERNE. This study suggests that the type III burst duration may not be a good indicator of an SEP event, consistent with the statistical study of Cliver and Ling (2009, ApJ ).

  3. SEP solar array Shuttle flight experiment

    Science.gov (United States)

    Elms, R. V., Jr.; Young, L. E.; Hill, H. C.

    1981-01-01

    An experiment to verify the operational performance of a full-scale Solar Electric Propulsion (SEP) solar array is described. Scheduled to fly on the Shuttle in 1983, the array will be deployed from the bay for ten orbits, with dynamic excitation to test the structural integrity being furnished by the Orbiter verniers; thermal, electrical, and sun orientation characteristics will be monitored, in addition to safety, reliability, and cost effective performance. The blanket, with aluminum and glass as solar cell mass simulators, is 4 by 32 m, with panels (each 0.38 by 4 m) hinged together; two live Si cell panels will be included. The panels are bonded to stiffened graphite-epoxy ribs and are storable in a box in the bay. The wing support structure is detailed, noting the option of releasing the wing into space by use of the Remote Manipulator System if the wing cannot be refolded. Procedures and equipment for monitoring the array behavior are outlined, and comprise both analog data and TV recording for later playback and analysis. The array wing experiment will also aid in developing measurement techniques for large structure dynamics in space.

  4. 78 FR 57391 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-09-18

    ... Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Capacity...), the Centers for Disease Control and Prevention (CDC) announces the aforementioned SEP: Times and Dates...

  5. 77 FR 5026 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-02-01

    ... Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Occupational..., Disability, and Injury Prevention and Control SEP: Occupational Safety and Health Education and Research...

  6. Anatomic single-bundle ACL surgery: consequences of tibial tunnel diameter and drill-guide angle on tibial footprint coverage.

    Science.gov (United States)

    Van der Bracht, H; Verhelst, L; Stuyts, B; Page, B; Bellemans, J; Verdonk, P

    2014-05-01

    To investigate the consequences of differences in drill-guide angle and tibial tunnel diameter on the amount of tibial anatomical anterior cruciate ligament (ACL) footprint coverage and the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint. Twenty fresh-frozen adult human knee specimens with a median age of 46 years were used for this study. Digital templates mimicking the ellipsoid aperture of tibial tunnels with a different drill-guide angle and a different diameter were designed. The centres of these templates were positioned over the geometric centre of the tibial ACL footprint. The amount of tibial ACL footprint coverage and overhang was calculated. Risk factors for overhang were determined. Footprint coverage and the risk of overhang were also compared between a lateral tibial tunnel and a classic antero-medial tibial tunnel. A larger tibial tunnel diameter and a smaller drill-guide angle both will create significant more footprint coverage and overhang. In 45% of the knees, an overhang was created with a 10-mm diameter tibial tunnel with drill-guide angle 45°. Furthermore, a lateral tibial tunnel was found not to be at increased risk of overhang. A larger tibial tunnel diameter and a smaller drill-guide angle both will increase the amount of footprint coverage. Inversely, larger tibial tunnel diameters and smaller drill-guide angles will increase the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint. A lateral tibial tunnel does not increase the risk of overhang.

  7. Efficacy and quality of life after transcutaneous posterior tibial neuromodulation for faecal incontinence.

    Science.gov (United States)

    Jiménez-Toscano, M; Vega, D; Fernandez-Cebrián, J M; Valle Martín, B; Jiménez-Almonacid, P; Rueda Orgaz, J A

    2015-08-01

    The aim of this study was to evaluate the efficacy of transcutaneous neuromodulation of the posterior tibial nerve for faecal incontinence and to assess quality of life after the procedure. A prospective non-randomized cohort study was conducted in a tertiary centre from September 2010 to May 2013. All patients with faecal incontinence who met the inclusion criteria were included and were treated as outpatients during a 3-month period by unilateral neuromodulation of the posterior tibial nerve. The patients were followed 3-monthly for 1 year. Severity scales, a bowel diary and quality of life scales were evaluated prospectively before and after treatment. Twenty-seven patients of median age 67 (interquartile range 60-69) years and a male to female ratio of 1/6 were included. Faecal incontinence was for solid stools in 48.1% of patients with urgency in 55.6%. About one-third (34.6%) had a sphincter defect on ultrasound and reduction of anal canal pressure in 85.2%. There was a significant improvement in episodes of incontinence on the Wexner score and visual analogue scale assessment and a decrease in the number of episodes of incontinence per unit time. The Fecal Incontinence Quality of Life score was improved at the end of the follow-up. No adverse effects were observed. The cost of the treatment was €135 per patient. Transcutaneous posterior tibial nerve neuromodulation provides good treatment for faecal incontinence in terms of efficacy and quality of life. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  8. Intercalary bone segment transport in treatment of segmental tibial defects

    International Nuclear Information System (INIS)

    Iqbal, A.; Amin, M.S.

    2002-01-01

    Objective: To evaluate the results and complications of intercalary bone segment transport in the treatment of segmental tibial defects. Design: This is a retrospective analysis of patients with segmental tibial defects who were treated with intercalary bone segment transport method. Place and Duration of Study: The study was carried out at Combined Military Hospital, Rawalpindi from September 1997 to April 2001. Subjects and methods: Thirteen patients were included in the study who had developed tibial defects either due to open fractures with bone loss or subsequent to bone debridement of infected non unions. The mean bone defect was 6.4 cms and there were eight associated soft tissue defects. Locally made unilateral 'Naseer-Awais' (NA) fixator was used for bone segment transport. The distraction was done at the rate of 1mm/day after 7-10 days of osteotomy. The patients were followed-up fortnightly during distraction and monthly thereafter. The mean follow-up duration was 18 months. Results: The mean time in external fixation was 9.4 months. The m ean healing index' was 1.47 months/cm. Satisfactory union was achieved in all cases. Six cases (46.2%) required bone grafting at target site and in one of them grafting was required at the level of regeneration as well. All the wounds healed well with no residual infection. There was no residual leg length discrepancy of more than 20 mm nd one angular deformity of more than 5 degrees. The commonest complication encountered was pin track infection seen in 38% of Shanz Screws applied. Loosening occurred in 6.8% of Shanz screws, requiring re-adjustment. Ankle joint contracture with equinus deformity and peroneal nerve paresis occurred in one case each. The functional results were graded as 'good' in seven, 'fair' in four, and 'poor' in two patients. Overall, thirteen patients had 31 (minor/major) complications with a ratio of 2.38 complications per patient. To treat the bone defects and associated complications, a mean of

  9. Osteochondritis of the Distal Tibial Epiphysis

    Directory of Open Access Journals (Sweden)

    Firass EL Hajj

    2012-01-01

    Full Text Available Osteochondritis of the distal tibial epiphysis is a very rare entity. 9 cases have been described in 7 articles and 8 other cases have been mentioned in textbooks. This paper describes the 10th case of osteochondritis of the distal tibial epiphysis and summarizes the clinical and radiological presentations of the 9 other cases. The etiology of this entity is well debated in the literature. We believe that it results from a vascular abnormality in the distal tibial epiphysis associated with a mechanical stress (trauma, excessive overload, etc.. Since it is a self-limited disease, the prognosis is good and the younger the patient is the better the prognosis will be. In general, this entity responds well to conservative treatment.

  10. Tibial Stress Injuries: Decisive Diagnosis and Treatment of "Shin Splints."

    Science.gov (United States)

    Couture, Christopher J.; Karlson, Kristine A.

    2002-01-01

    Tibial stress injuries, commonly called shin splints, often result when bone remodeling processes adopt inadequately to repetitive stress. Physicians who are caring for athletic patients must have a thorough understanding of this continuum of injuries, including medial tibial stress syndrome and tibial stress fractures, because there are…

  11. Proximally evoked soleus H-reflex to S1 nerve root stimulation in sensory neuronopathies (ganglionopathies).

    Science.gov (United States)

    Zhu, Dong-Qing; Zhu, Yu; Qiao, Kai; Zheng, Chao-Jun; Bradley, Scott; Weber, Robert; Chen, Xiang-Jun

    2013-11-01

    Sensory neuronopathy (SNN) mimics distal sensory axonopathy. The conventional H-reflex elicited by tibial nerve stimulation (tibial H-reflex) is usually abnormal in both conditions. We evaluated the proximally evoked soleus H-reflex in response to S1 nerve root stimulation (S1 foramen H-reflex) in SNN. Eleven patients with SNN and 6 with distal sensory axonopathy were studied. Tibial and S1 foramen H-reflexes were performed bilaterally in each patient. Tibial and S1 foramen H-reflexes were absent bilaterally in all patients with SNN. In the patients with distal sensory axonopathy, tibial H-reflexes were absent in 4 and demonstrated prolonged latencies in 2, but S1 foramen H-reflexes were normal. Characteristic absence of the H-reflex after both proximal and distal stimulation reflects primary loss of dorsal root ganglion (DRG) neurons and the distinct non-length-dependent impairment of sensory nerve fibers in SNN. Copyright © 2013 Wiley Periodicals, Inc.

  12. Comparison of the operation of arthroscopic tibial inlay and traditional tibial inlay for posterior cruciate ligament reconstruction

    OpenAIRE

    Lu, Daifeng; Xiao, Mochao; Lian, Yongyun; Zhou, Yong; Liu, Xuefeng

    2014-01-01

    Objective: To perform dual-bundle reconstruction of posterior cruciate ligament using full arthroscopic tibial inlay technology with self-designed tibia tunnel drilling system and to compare the effect of arthroscopic tibial inlay versus traditional technique for posterior cruciate ligament reconstruction. Material and methods: 32 patients were randomly divided into experiment group (improved tibial inlay, n = 17) and control group (traditional tibial inlay, n = 15). Self-designed tibia tunne...

  13. Different SEP recovery cycle in adolescent migraineurs with exploding or imploding pain.

    Science.gov (United States)

    Iacovelli, Elisa; Tarantino, Samuela; Capuano, Alessandro; De Luca, Massimiliano; De Ranieri, Cristiana; Vigevano, Federico; Arendt-Nielsen, Lars; Valeriani, Massimiliano

    2013-01-01

    Our aim was to investigate whether migraine adolescents with pain directed inside (imploding pain--IP) and outside (exploding pain--EP) the head may have different levels of cortical excitability underlying their migraineous syndrome. Ten migraine children referring prevalent EP (mean age 14.5 ± 1.4 years, 3 girls, 7 boys), 10 patients with IP (mean age 14.1 ± 2.2 years, 4 girls, 6 boys), and 13 control subjects (mean age 13 ± 1.8 years, 6 males, 7 females) participated to the study. The recovery cycle of the somatosensory evoked potentials to electrical median nerve stimuli at interstimulus intervals of 5, 20, and 40 ms was measured. Anger expression, anxiety, and somatic concerns were investigated in migraine patients. Overall, SEP recovery cycle was shorter in migraineurs than in healthy controls. The recovery cycle of the frontal N30 SEP component was significantly shorter in IP than in EP patients. While among the EP patients those with faster N30 recovery cycle had higher Trait-Anger score, the opposite was found among the IP patients. Our results suggest that the inhibitory mechanisms within the somatosensory cortex are more impaired in IP than in EP migraine adolescents. The pathophysiological difference between IP and EP migraineurs was strengthened also by the opposite correlations between the brain excitability and the anger expression. Copyright © 2013 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.

  14. Tibial and fibular developmental fields defects

    International Nuclear Information System (INIS)

    Khoury, N.J.; Haddad, M.C.; Hourani, M.H.

    1999-01-01

    Malformations of the lower limbs are rare and heterogeneous anomalies. To explain the diversity and complexity of these abnormalities, authors introduced the concept of tibial and fibular developmental fields. Defects in these fields are responsible for different malformations, which have been described, to our knowledge, in only one report in the radiology literature. We present a case of a newborn with femoral bifurcation, absent fibulae and talar bones, ankle and foot malformations, and associated atrial septal defect. Our case is an example of defects in both fibular and tibial developmental fields. (orig.)

  15. SEP Montage Variability Comparison during Intraoperative Neurophysiologic Monitoring.

    Science.gov (United States)

    Hanson, Christine; Lolis, Athena Maria; Beric, Aleksandar

    2016-01-01

    Intraoperative monitoring is performed to provide real-time assessment of the neural structures that can be at risk during spinal surgery. Somatosensory evoked potentials (SEPs) are the most commonly used modality for intraoperative monitoring. SEP stability can be affected by many factors during the surgery. This study is a prospective review of SEP recordings obtained during intraoperative monitoring of instrumented spinal surgeries that were performed for chronic underlying neurologic and neuromuscular conditions, such as scoliosis, myelopathy, and spinal stenosis. We analyzed multiple montages at the baseline, and then followed their development throughout the procedure. Our intention was to examine the stability of the SEP recordings throughout the surgical procedure on multiple montages of cortical SEP recordings, with the goal of identifying the appropriate combination of the least number of montages that gives the highest yield of monitorable surgeries. Our study shows that it is necessary to have multiple montages for SEP recordings, as it reduces the number of non-monitorable cases, improves IOM reliability, and therefore could reduce false positives warnings to the surgeons. Out of all the typical montages available for use, our study has shown that the recording montage Cz-C4/Cz-C3 (Cz-Cc) is the most reliable and stable throughout the procedure and should be the preferred montage followed throughout the surgery.

  16. MR neurography of sciatic nerve injection injury.

    Science.gov (United States)

    Pham, Mirko; Wessig, Carsten; Brinkhoff, Jörg; Reiners, Karlheinz; Stoll, Guido; Bendszus, Martin

    2011-06-01

    We report on magnetic resonance neurography (MRN) as a supplementary diagnostic tool in sciatic nerve injection injury. The object of the study was to test if T2-weighted (w) contrast within the sciatic nerve serves as an objective criterion for sciatic injection injury. Three patients presented with acute sensory and/or motor complaints in the distribution of the sciatic nerve after dorsogluteal injection and underwent MRN covering gluteal, thigh and knee levels. Native and contrast-enhanced T1-w images were employed to identify the tibial and peroneal division of the sciatic nerve while T2-w images with fat suppression allowed visualization of the site and extent of the nerve lesion. MRN in the two patients with clinically severe sensory and motor impairment correctly depicted sciatic injury: continuity of the T2-w lesion within the nerve at the lesion site and distal to it corresponded well to severe injury confirmed by NCS/EMG as axonotmetic or neurotmetic. Topography of the T2-w lesion on cross-section corresponded to predominant peroneal involvement; moreover, associated denervation patterns of distal target muscles were revealed. One of these patients completely recovered with concomitant complete regression of MRN abnormalities on follow-up. The third patient experienced transient sensory and mild motor impairment with complete recovery after 2 weeks. In this patient, T2-w signal within the nerve and distal target muscles remained normal indicating only mild, non-axonal nerve affliction. Our case series shows that MRN can be very useful in precisely determining the site of sciatic injection injury and may provide diagnostic criteria for the assessment of lesion severity and recovery.

  17. Sex difference in the contribution of GABAB receptors to tibial neuromodulation of bladder overactivity in cats.

    Science.gov (United States)

    Fuller, Thomas W; Jiang, Xuewen; Bansal, Utsav; Lamm, Vladimir; Shen, Bing; Wang, Jicheng; Roppolo, James R; de Groat, William C; Tai, Changfeng

    2017-03-01

    This study investigated the role of γ-aminobutyric acid subtype B (GABA B ) receptors in tibial and pudendal neuromodulation of bladder overactivity induced by intravesical administration of dilute (0.5%) acetic acid (AA) in α-chloralose-anesthetized cats. To inhibit bladder overactivity, tibial or pudendal nerve stimulation (TNS or PNS) was applied at 5 Hz and two or four times threshold (T) intensity for inducing toe or anal sphincter twitch. TNS at 2T or 4T intensity significantly ( P 217 ± 18.8 and 221.3 ± 22.3% of control capacity, respectively. CGP52432 (a GABA B receptor antagonist) at intravenous dosages of 0.1-1 mg/kg completely removed the TNS inhibition in female cats but had no effect in male cats. CGP52432 administered intravenously also had no effect on control bladder capacity or the pudendal inhibition of bladder overactivity. These results reveal a sex difference in the role of GABA B receptors in tibial neuromodulation of bladder overactivity in cats and that GABA B receptors are not involved in either pudendal neuromodulation or irritation-induced bladder overactivity. Copyright © 2017 the American Physiological Society.

  18. Anterior tibial curved cortex is a reliable landmark for tibial rotational alignment in total knee arthroplasty.

    Science.gov (United States)

    Kim, Joong Il; Jang, Jak; Lee, Ki Woong; Han, Hyuk Soo; Lee, Sahnghoon; Lee, Myung Chul

    2017-06-12

    Rotational alignment of the tibial component is important for long-term success of total knee arthroplasty (TKA). This study aimed to compare five axes in normal and osteoarthritic (OA) knees to determine a reliable landmark for tibial rotational alignment in TKA. One hundred twenty patients with OA knees and 40 with normal knees were included. The angle between a line perpendicular to the surgical transepicondylar axis and each of five axes were measured on preoperative computed tomography. The five axes were as follows: a line from the center of the posterior cruciate ligament (PCL) to the medial border of the patellar tendon (PCL-PT), medial border of the tibial tuberosity (PCL-TT1), medial one-third of the tibial tuberosity (PCL-TT2), and apex of the tibial tuberosity (PCL-TT3), as well as the anteroposterior axis of the tibial prosthesis along the anterior tibial curved cortex (ATCC). For all five axes tested, the mean angles were smaller in OA knees than in normal knees. In normal knees, the angle of the ATCC axis had the smallest mean value and narrowest range (1.6° ± 2.8°; range, -1.7°-7.7°). In OA knees, the mean angle of the ATCC axis (0.8° ± 2.7°; range, -7.9°-9.2°) was larger than that of the PCL-TT1 axis (0.3° ± 5.5°; range, -19.7°-10.6°) (P = 0.461), while the angle of the ATCC axis had the smallest SD and narrowest range. The ATCC was found to be the most reliable and useful anatomical landmark for tibial rotational alignment in TKA.

  19. Irreducible tibial pilon fracture caused by incarceration of the fibula in the tibial medullary canal.

    Science.gov (United States)

    Ellanti, Prasad; Hammad, Yassir; Kosutic, Damir; Grieve, Philip P

    2012-01-01

    Fractures can be irreducible for several reasons, including soft tissue or bone fragment interposition. We report an unusual fracture configuration of a comminuted tibial pilon fracture in which the distal fibular shaft fragment was occupying the medullary canal of the proximal tibial shaft fragment and inhibiting reduction and fixation. To the best of our knowledge, this has not been previously reported in a published study. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Differential induction of c-Fos and phosphorylated ERK by a noxious stimulus after peripheral nerve injury.

    Science.gov (United States)

    Tabata, Mitsuyasu; Terayama, Ryuji; Maruhama, Kotaro; Iida, Seiji; Sugimoto, Tomosada

    2018-03-01

    In this study, we compared induction of c-Fos and phosphorylated extracellular signal-regulated kinase (p-ERK) in the spinal dorsal horn after peripheral nerve injury. We examined the spinal dorsal horn for noxious heat-induced c-Fos and p-ERK protein-like immunoreactive (c-Fos- and p-ERK-IR) neuron profiles after tibial nerve injury. The effect of administration of a MEK 1/2 inhibitor (PD98059) on noxious heat-induced c-Fos expression was also examined after tibial nerve injury. A large number of c-Fos- and p-ERK-IR neuron profiles were induced by noxious heat stimulation to the hindpaw in sham-operated animals. A marked reduction in the number of c-Fos- and p-ERK-IR neuron profiles was observed in the medial 1/3 (tibial territory) of the dorsal horn at 3 and 7 days after nerve injury. Although c-Fos-IR neuron profiles had reappeared by 14 days after injury, the number of p-ERK-IR neuron profiles remained decreased in the tibial territory of the superficial dorsal horn. Double immunofluorescence labeling for c-Fos and p-ERK induced by noxious heat stimulation to the hindpaw at different time points revealed that a large number of c-Fos-IR, but not p-ERK-IR, neuron profiles were distributed in the tibial territory after injury. Although administration of a MEK 1/2 inhibitor to the spinal cord suppressed noxious heat-induced c-Fos expression in the peroneal territory, this treatment did not alter c-Fos induction in the tibial territory after nerve injury. ERK phosphorylation may be involved in c-Fos induction in normal nociceptive responses, but not in exaggerated c-Fos induction after nerve injury.

  1. A posterior tibial tendon skipping rope

    NARCIS (Netherlands)

    van Sterkenburg, M. N.; Haverkamp, D.; van Dijk, C. N.; Kerkhoffs, G. M. M. J.

    2010-01-01

    This report presents an athletic patient with swelling and progressive pain on the posteromedial side of his right ankle on weight bearing. MRI demonstrated tenosynovitis and suspicion of a length rupture. On posterior tibial tendoscopy, there was no rupture, but medial from the tendon a tissue cord

  2. TIBIAL LANDMARKS IN ACL ANATOMIC REPAIR

    Directory of Open Access Journals (Sweden)

    M. V. Demesсhenko

    2016-01-01

    Full Text Available Purpose: to identify anatomical landmarks on tibial articular surface to serve as reference in preparing tibial canal with respect to the center of ACL footprint during single bundle arthroscopic repair.Materials and methods. Twelve frozen knee joint specimens and 68 unpaired macerated human tibia were studied using anatomical, morphometric, statistical methods as well as graphic simulation.Results. Center of the tibial ACL footprint was located 13,1±1,7 mm anteriorly from posterior border of intercondylar eminence, at 1/3 of the distance along the line connecting apexes of internal and external tubercles and 6,1±0,5 mm anteriorly along the perpendicular raised to this point.Conclusion. Internal and external tubercles, as well as posterior border of intercondylar eminence can be considered as anatomical references to determine the center of the tibial ACL footprint and to prepare bone canals for anatomic ligament repair.

  3. Role of metallothioneins in peripheral nerve function and regeneration

    DEFF Research Database (Denmark)

    Ceballos, D; Lago, N; Verdú, E

    2003-01-01

    postlesion (dpl) and electrophysiologically at 14 dpl. The quality of the regeneration was assessed by light microscopy and immunohistochemical methods. The results show that the regeneration distance was greater in the Mt3 KO than in the Mt1+ 2 KO mice, whereas control mice showed intermediate values....... Moreover, the number of regenerating axons in the distal tibial nerve was significantly higher in Mt3KO mice than in the other two strains at 14 dpl. Immunoreactive profiles to protein gene product 9.5 were present in the epidermis and the sweat glands of the plantar skin of the hindpaw of the Mt3 KO group....... The improved regeneration observed with the Mt3 KO mice was confirmed by compound nerve action potentials that were recorded from digital nerves at 14 dpl only in this group. We conclude that Mt3 normally inhibits peripheral nerve regeneration....

  4. Kinematically aligned total knee arthroplasty limits high tibial forces, differences in tibial forces between compartments, and abnormal tibial contact kinematics during passive flexion.

    Science.gov (United States)

    Roth, Joshua D; Howell, Stephen M; Hull, Maury L

    2017-09-07

    Following total knee arthroplasty (TKA), high tibial forces, large differences in tibial forces between the medial and lateral compartments, and anterior translation of the contact locations of the femoral component on the tibial component during passive flexion indicate abnormal knee function. Because the goal of kinematically aligned TKA is to restore native knee function without soft tissue release, the objectives were to determine how well kinematically aligned TKA limits high tibial forces, differences in tibial forces between compartments, and anterior translation of the contact locations of the femoral component on the tibial component during passive flexion. Using cruciate retaining components, kinematically aligned TKA was performed on thirteen human cadaveric knee specimens with use of manual instruments without soft tissue release. The tibial forces and tibial contact locations were measured in both the medial and lateral compartments from 0° to 120° of passive flexion using a custom tibial force sensor. The average total tibial force (i.e. sum of medial + lateral) ranged from 5 to 116 N. The only significant average differences in tibial force between compartments occurred at 0° of flexion (29 N, p = 0.0008). The contact locations in both compartments translated posteriorly in all thirteen kinematically aligned TKAs by an average of 14 mm (p forces due to the soft tissue restraints were limited to 116 N, average differences in tibial forces between compartments were limited to 29 N, and a net posterior translation of the tibial contact locations was observed in all kinematically aligned TKAs during passive flexion from 0° to 120°, which are similar to what has been measured previously in native knees. While confirmation in vivo is warranted, these findings give surgeons who perform kinematically aligned TKA confidence that the alignment method and surgical technique limit high tibial forces, differences in tibial forces between

  5. The spinal nerves that constitute the lumbosacral plexus and their distribution in the chinchilla

    Directory of Open Access Journals (Sweden)

    M. A. Martinez-Pereira

    2011-04-01

    Full Text Available In this study, the spinal nerves that constitute the lumbosacral plexus (plexus lumbosacrales (LSP and its distribution in Chinchilla lanigera were investigated. Ten chinchillas (6 males and 4 females were used in this research. The spinal nerves that constitute the LSP were dissected and the distribution of pelvic limb nerves originating from the plexus was examined. The iliohypogastric nerve arose from L1 and L2,, giving rise to the cranial and caudal nerves, and the ilioinguinal nerve arose from L3. The other branch of L3 gave rise to the genitofemoral nerve and 1 branch from L4 gave rise to the lateral cutaneous femoral nerve. The trunk formed by the union of L4–5 divided into medial (femoral nerve and lateral branches (obturator nerve. It was found that the LSP was formed by all the ventral branches of L4 at L6 and S1 at S3. At the caudal part of the plexus, a thick branch, the ischiadic plexus, was formed by contributions from L5–6 and S1. This root gave rise to the nerve branches which were disseminated to the posterior limb (cranial and caudal gluteal nerves, caudal cutaneous femoral nerve and ischiadic nerve. The ischiadic nerve divided into the caudal cutaneous surae, lateral cutaneous surae, common fibular and tibial nerve. The pudendal nerve arose from S1–2 and the other branch of S2 and S3 formed the rectal caudal nerve. The results showed that the origins and distribution of spinal nerves that constitute the LSP of chinchillas were similar to those of a few rodents and other mammals.

  6. Using Dawn to Observe SEP Events Past 2 AU

    Science.gov (United States)

    Villarreal, Michaela; Russell, Christopher T.; Prettyman, Thomas H.

    2017-10-01

    The launch of the STEREO spacecraft provided much insight into the longitudinal and radial distribution of solar energetic particles (SEPs) relative to their origin site. However, almost all of the observations of SEP events have been made exclusively near 1 AU. The Dawn mission, which orbited around Vesta before arriving at Ceres, provides an opportunity to analyze these events at much further distances. Although Dawn's Gamma Ray and Neutron Detector (GRaND) is not optimized for SEP characterization, it is sensitive to protons greater than 4 MeV, making it capable of detecting a solar energetic particle event in its vicinity. Solar energetic particles in this area of the solar system are important as they are believed to cause sputtering at bodies such as Ceres and comets (Villarreal et al., 2017; Wurz et al., 2015). In this study, we use Dawn’s GRaND data from 2011-2015 when Dawn was at distances between 2-3 AU. We compare the SEP events seen by Dawn with particle measurements at 1 AU using STEREO, Wind, and ACE to understand how the SEP events evolved past 1 AU.References: Villarreal, M. N., et al. (2017), The dependence of the Cerean exosphere on solar energetic particle events, Astrophys. J. Lett., 838, L8.Wurz, P. et al. (2015), Solar wind sputtering of dust on the surface of 67P/Churyumov-Gerasimenko, A&A, 583, A22.

  7. Implications of the S-Web Model for Impulsive SEPs

    Science.gov (United States)

    Antiochos, Spiro K.; Higginson, Aleida K.; DeVore, C. Richard

    2017-08-01

    One of the most important discoveries of the STEREO mission is that impulsive Solar Energetic Particle (SEP) events frequently exhibit large longitudinal spread in the heliosphere, up to 100 degrees or more. This result is especially puzzling given the long-standing observations that impulsive SEPs originate in highly localized regions in the corona, angular extent less than one degree, and that the SEPs frequently show so-called drop-outs, effectively ruling out diffusion as a mechanism for the observed spread. We discuss the implications of the S-Web slow solar wind model for the propagation of SEPs and their distribution in the heliosphere. We present results from 3D MHD simulations demonstrating that for commonly-observed coronal magnetic topologies, the connectivity of the corona to heliosphere will be quasi-singular, with small regions near the Sun dynamically connecting to giant arcs in the heliosphere that span tens of degrees in both latitude and longitude. We show that the S-Web model can account for both SEP longitudinal spread and dropouts, and discuss implications for observations from the upcoming Solar Orbiter and Solar Probe Plus missions.This research was supported, in part, by the NASA LWS Program.

  8. Influence of coronal holes on CMEs in causing SEP events

    International Nuclear Information System (INIS)

    Shen Chenglong; Yao Jia; Wang Yuming; Ye Pinzhong; Wang Shui; Zhao Xuepu

    2010-01-01

    The issue of the influence of coronal holes (CHs) on coronal mass ejections (CMEs) in causing solar energetic particle (SEP) events is revisited. It is a continuation and extension of our previous work, in which no evident effects of CHs on CMEs in generating SEPs were found by statistically investigating 56 CME events. This result is consistent with the conclusion obtained by Kahler in 2004. We extrapolate the coronal magnetic field, define CHs as the regions consisting of only open magnetic field lines and perform a similar analysis on this issue for 76 events in total by extending the study interval to the end of 2008. Three key parameters, CH proximity, CH area and CH relative position, are involved in the analysis. The new result confirms the previous conclusion that CHs did not show any evident effect on CMEs in causing SEP events. (research papers)

  9. Accuracy of Motor Axon Regeneration Across Autograft, Single Lumen, and Multichannel Poly(lactic-co-glycolic Acid) (PLGA) Nerve Tubes

    Science.gov (United States)

    de Ruiter, Godard C.; Spinner, Robert J.; Malessy, Martijn J. A.; Moore, Michael J.; Sorenson, Eric J.; Currier, Bradford L.; Yaszemski, Michael J.; Windebank, Anthony J.

    2012-01-01

    Objective Accuracy of motor axon regeneration becomes an important issue in the development of a nerve tube for motor nerve repair. Dispersion of regeneration across the nerve tube may lead to misdirection and polyinnervation. In this study, we present a series of methods to investigate the accuracy of regeneration, which we used to compare regeneration across autografts and single lumen poly(lactic-co-glycolic acid) (PLGA) nerve tubes. We also present the concept of the multichannel nerve tube that may limit dispersion by separately guiding groups of regenerating axons. Methods Simultaneous tracing of the tibial and peroneal nerves with fast blue (FB) and diamidino yellow (DY), 8 weeks after repair of a 1-cm nerve gap in the rat sciatic nerve, was performed to determine the percentage of double-projecting motoneurons. Sequential tracing of the peroneal nerve with DY 1 week before and FB 8 weeks after repair was performed to determine the percentage of correctly directed peroneal motoneurons. Results In the cases in which there was successful regeneration across single lumen nerve tubes, more motoneurons had double projections to both the tibial and peroneal nerve branches after single lumen nerve tube repair (21.4%) than after autograft repair (5.9%). After multichannel nerve tube repair, this percentage was slightly reduced (16.9%), although not significantly. The direction of regeneration was nonspecific after all types of repair. Conclusion Retrograde tracing techniques provide new insights into the process of regeneration across nerve tubes. The methods and data presented in this study can be used as a basis in the development of a nerve tube for motor nerve repair. PMID:18728579

  10. SEP-225289 serotonin and dopamine transporter occupancy: a PET study.

    Science.gov (United States)

    DeLorenzo, Christine; Lichenstein, Sarah; Schaefer, Karen; Dunn, Judith; Marshall, Randall; Organisak, Lisa; Kharidia, Jahnavi; Robertson, Brigitte; Mann, J John; Parsey, Ramin V

    2011-07-01

    SEP-225289 is a novel compound that, based on in vitro potencies for transporter function, potentially inhibits reuptake at dopamine, norepinephrine, and serotonin transporters. An open-label PET study was conducted during the development of SEP-225289 to investigate its dopamine and serotonin transporter occupancy. Different single doses of SEP-225289 were administered to healthy volunteers in 3 cohorts: 8 mg (n = 7), 12 mg (n = 5), and 16 mg (n = 7). PET was performed before and approximately 24 h after oral administration of SEP-225289, to assess occupancy at trough levels. Dopamine and serotonin transporter occupancies were estimated from PET using (11)C-N-(3-iodoprop-2E-enyl)-2β-carbomethoxy-3β-(4-methylphenyl)nortropane ((11)C-PE2I) and (11)C-N,N-dimethyl-2-(2-amino-4-cyanophenylthio)benzylamine ((11)C-DASB), respectively. Plasma concentration of SEP-225289 was assessed before ligand injection, and subjects were monitored for adverse events. Average dopamine and serotonin transporter occupancies increased with increasing doses of SEP-225289. Mean dopamine and serotonin transporter occupancies were 33% ± 11% and 2% ± 13%, respectively, for 8 mg; 44% ± 4% and 9% ± 10%, respectively, for 12 mg; and 49% ± 7% and 14% ± 15%, respectively, for 16 mg. On the basis of the relationship between occupancy and plasma concentration, dopamine transporter IC(50) (the plasma concentration of drug at 50% occupancy) was determined (4.5 ng/mL) and maximum dopamine transporter occupancy was extrapolated (85%); however, low serotonin transporter occupancy prevented similar serotonin transporter calculations. No serious adverse events were reported. At the doses evaluated, occupancy of the dopamine transporter was significantly higher than that of the serotonin transporter, despite similar in vitro potencies, confirming that, in addition to in vitro assays, PET occupancy studies can be instrumental to the drug development process by informing early decisions about

  11. SEP-class genes in Prunus mume and their likely role in floral organ development.

    Science.gov (United States)

    Zhou, Yuzhen; Xu, Zongda; Yong, Xue; Ahmad, Sagheer; Yang, Weiru; Cheng, Tangren; Wang, Jia; Zhang, Qixiang

    2017-01-13

    Flower phylogenetics and genetically controlled development have been revolutionised during the last two decades. However, some of these evolutionary aspects are still debatable. MADS-box genes are known to play essential role in specifying the floral organogenesis and differentiation in numerous model plants like Petunia hybrida, Arabidopsis thaliana and Antirrhinum majus. SEPALLATA (SEP) genes, belonging to the MADS-box gene family, are members of the ABCDE and quartet models of floral organ development and play a vital role in flower development. However, few studies of the genes in Prunus mume have yet been conducted. In this study, we cloned four PmSEPs and investigated their phylogenetic relationship with other species. Expression pattern analyses and yeast two-hybrid assays of these four genes indicated their involvement in the floral organogenesis with PmSEP4 specifically related to specification of the prolificated flowers in P. mume. It was observed that the flower meristem was specified by PmSEP1 and PmSEP4, the sepal by PmSEP1 and PmSEP4, petals by PmSEP2 and PmSEP3, stamens by PmSEP2 and PmSEP3 and pistils by PmSEP2 and PmSEP3. With the above in mind, flower development in P. mume might be due to an expression of SEP genes. Our findings can provide a foundation for further investigations of the transcriptional factors governing flower development, their molecular mechanisms and genetic basis.

  12. Nerve transection repair using laser-activated chitosan in a rat model.

    Science.gov (United States)

    Bhatt, Neel K; Khan, Taleef R; Mejias, Christopher; Paniello, Randal C

    2017-08-01

    Cranial nerve transection during head and neck surgery is conventionally repaired with microsuture. Previous studies have demonstrated recovery with laser nerve welding (LNW), a novel alternative to microsuture. LNW has been reported to have poorer tensile strength, however. Laser-activated chitosan, an adhesive biopolymer, may promote nerve recovery while enhancing the tensile strength of the repair. Using a rat posterior tibial nerve injury model, we compared four different methods of nerve repair in this pilot study. Animal study. Animals underwent unilateral posterior tibial nerve transection. The injury was repaired by potassium titanyl phosphate (KTP) laser alone (n = 20), KTP + chitosan (n = 12), microsuture + chitosan (n = 12), and chitosan alone (n = 14). Weekly walking tracks were conducted to measure functional recovery (FR). Tensile strength (TS) was measured at 6 weeks. At 6 weeks, KTP laser alone had the best recovery (FR = 93.4% ± 8.3%). Microsuture + chitosan, KTP + chitosan, and chitosan alone all showed good FR (87.4% ± 13.5%, 84.6% ± 13.0%, and 84.1% ± 10.0%, respectively). One-way analysis of variance was performed (F(3,56) = 2.6, P = .061). A TS threshold of 3.8 N was selected as a control mean recovery. Three groups-KTP alone, KTP + chitosan, and microsuture + chitosan-were found to meet threshold 60% (95% confidence interval [CI]: 23.1%-88.3%), 75% (95% CI: 46.8%-91.1%), and 100% (95% CI: 75.8%-100.0%), respectively. In the posterior tibial nerve model, all repair methods promoted nerve recovery. Laser-activated chitosan as a biopolymer anchor provided good TS and appears to be a novel alternative to microsuture. This repair method may have surgical utility following cranial nerve injury during head and neck surgery. NA Laryngoscope, 127:E253-E257, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  13. Finite element analysis of tibial fractures

    DEFF Research Database (Denmark)

    Wong, Christian Nai En; Mikkelsen, Mikkel Peter W; Hansen, Leif Berner

    2010-01-01

    INTRODUCTION: Fractures of the tibial shaft are relatively common injuries. There are indications that tibial shaft fractures share characteristics in terms of site, type and local fracture mechanisms. In this study, we aimed to set up a mathematical, computer-based model using finite element...... of bony healing. The biomechanical results are the basis for fracture healing, biomechanical fall analysis and stability analysis of osteosynthesis. MATERIAL AND METHODS: A finite element model of the bony part of the lower leg was generated on the basis of computed tomography data from the Visible Human...... Project. The data consisted of 21,219 3D elements with a cortical shell and a trabecular core. Three types of load of torsion, a direct lateral load and axial compression were applied. RESULTS: The finite element linear static analysis resulted in relevant fracture localizations and indicated relevant...

  14. Finite element analysis of tibial fractures

    DEFF Research Database (Denmark)

    Wong, Christian Nai En; Mikkelsen, Mikkel Peter W; Hansen, Leif Berner

    2010-01-01

    INTRODUCTION: Fractures of the tibial shaft are relatively common injuries. There are indications that tibial shaft fractures share characteristics in terms of site, type and local fracture mechanisms. In this study, we aimed to set up a mathematical, computer-based model using finite element...... analysis of the bones of the lower leg to examine if such a model is adequate for prediction of fracture locations and patterns. In future studies, we aim to use these biomechanical results to examine fracture prevention, among others, and to simulate different types of osteosynthesis and the process...... of bony healing. The biomechanical results are the basis for fracture healing, biomechanical fall analysis and stability analysis of osteosynthesis. MATERIAL AND METHODS: A finite element model of the bony part of the lower leg was generated on the basis of computed tomography data from the Visible Human...

  15. SepD/SepL-dependent secretion signals of the type III secretion system translocator proteins in enteropathogenic Escherichia coli.

    Science.gov (United States)

    Deng, Wanyin; Yu, Hong B; Li, Yuling; Finlay, B Brett

    2015-04-01

    The type III protein secretion system (T3SS) encoded by the locus of enterocyte effacement (LEE) is essential for the pathogenesis of attaching/effacing bacterial pathogens, including enteropathogenic Escherichia coli (EPEC), enterohemorrhagic E. coli (EHEC), and Citrobacter rodentium. These pathogens use the T3SS to sequentially secrete three categories of proteins: the T3SS needle and inner rod protein components; the EspA, EspB, and EspD translocators; and many LEE- and non-LEE-encoded effectors. SepD and SepL are essential for translocator secretion, and mutations in either lead to hypersecretion of effectors. However, how SepD and SepL control translocator secretion and secretion hierarchy between translocators and effectors is poorly understood. In this report, we show that the secreted T3SS components, the translocators, and both LEE- and non-LEE-encoded effectors all carry N-terminal type III secretion and translocation signals. These signals all behave like those of the effectors and are sufficient for mediating type III secretion and translocation by wild-type EPEC and hypersecretion by the sepD and sepL mutants. Our results extended previous observations and suggest that the secretion hierarchy of the different substrates is determined by a signal other than the N-terminal secretion signal. We identified a domain located immediately downstream of the N-terminal secretion signal in the translocator EspB that is required for SepD/SepL-dependent secretion. We further demonstrated that this EspB domain confers SepD/SepL- and CesAB-dependent secretion on the secretion signal of effector EspZ. Our results thus suggest that SepD and SepL control and regulate secretion hierarchy between translocators and effectors by recognizing translocator-specific export signals. Many bacterial pathogens use a syringe-like protein secretion apparatus, termed the type III protein secretion system (T3SS), to secrete and inject numerous proteins directly into the host cells to

  16. Biomechanical Factors in Tibial Stress Fracture

    Science.gov (United States)

    2001-08-01

    University of Massachusetts, Amherst, MA. Background and Purpose. A stress fracture in the high performance collegiate athlete presents a difficult problem...et al. (1987) noted that varus malalignment (genu & tibial) was often present in athletes with stress fractures. This patient exhibits significant...force and neural potentiation in athletes . Medicine and Science in Sports and Exercise. 22:2, S69, April, 1990. Ebbeling, C. J., Hamill, J., Freedson

  17. Anterior Tibial Artery Pseudoaneurysm: Case Report

    Directory of Open Access Journals (Sweden)

    Funda Tor

    2012-06-01

    Full Text Available The aneurysmsatic changes of the infrapopliteal arteries are rarely seen. They are pseudoaneurysms rather than true aneursyms. The most important cause of them is trauma. There is not a standart treatment for infrapopliteal aneursyms. In this study, we have evaluated a case operated for anterior tibial artery pseudoaneurysm developed after penetrant trauma and diagnosed two weeks later. [Cukurova Med J 2012; 37(3.000: 172-175

  18. Sciatic nerve injury caused by a stretching exercise in a trained dancer.

    Science.gov (United States)

    Shim, Ho Yong; Lim, Oh Kyung; Bae, Keun Hwan; Park, Seok Min; Lee, Ju Kang; Park, Ki Deok

    2013-12-01

    Sciatic nerve injury after stretching exercise is uncommon. We report a case of an 18-year-old female trained dancer who developed sciatic neuropathy primarily involving the tibial division after routine stretching exercise. The patient presented with dysesthesia and weakness of the right foot during dorsiflexion and plantarflexion. The mechanism of sciatic nerve injury could be thought as hyperstretching alone, not caused by both hyperstretching and compression. Electrodiagnostic tests and magnetic resonance imaging revealed evidence of the right sciatic neuropathy from the gluteal fold to the distal tibial area, and partial tear of the left hamstring origin and fluid collection between the left hamstring and ischium without left sciatic nerve injury. Recovery of motor weakness was obtained by continuous rehabilitation therapy and some evidence of axonal regeneration was obtained by follow-up electrodiagnostic testing performed at 3, 5, and 12 months after injury.

  19. Systematic radiographic evaluation of tibial hemimelia with orthopedic implications

    Energy Technology Data Exchange (ETDEWEB)

    Kaplan-List, Katia [Rochester General Hospital, Department of Diagnostic Imaging, Rochester, NY (United States); Klionsky, Nina B. [University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY (United States); Golisano Children' s Hospital, Department of Radiology, Rochester, NY (United States); Sanders, James O. [University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY (United States); Golisano Children' s Hospital, Department of Orthopaedics, Rochester, NY (United States); Golisano Children' s Hospital, Department of Pediatrics, Rochester, NY (United States); Katz, Michael E. [St. Mary' s Medical Center and Palm Beach Children' s Hospital, Department of Radiology, West Palm Beach, FL (United States)

    2017-04-15

    Tibial hemimelia is a rare lower-extremity pre-axial longitudinal deficiency characterized by complete or partial absence of the tibia. The reported incidence is 1 in 1 million live births. In this pictorial essay, we define tibial hemimelia and describe associated conditions and principles of preoperative imaging assessment for a child with tibial hemimelia. We also indicate the imaging findings that might influence the choice of treatment, describe the most widely used classification systems, and briefly discuss current treatment approaches. (orig.)

  20. Systematic radiographic evaluation of tibial hemimelia with orthopedic implications

    International Nuclear Information System (INIS)

    Kaplan-List, Katia; Klionsky, Nina B.; Sanders, James O.; Katz, Michael E.

    2017-01-01

    Tibial hemimelia is a rare lower-extremity pre-axial longitudinal deficiency characterized by complete or partial absence of the tibia. The reported incidence is 1 in 1 million live births. In this pictorial essay, we define tibial hemimelia and describe associated conditions and principles of preoperative imaging assessment for a child with tibial hemimelia. We also indicate the imaging findings that might influence the choice of treatment, describe the most widely used classification systems, and briefly discuss current treatment approaches. (orig.)

  1. Radiographic quantitative assessment of cranial tibial subluxation before and after tibial plateau leveling osteotomy in dogs.

    Science.gov (United States)

    Kim, Stanley E; Lewis, Daniel D; Pozzi, Antonio; Seibert, Rachel L; Winter, Matthew D

    2011-03-01

    To determine the influence of stifle joint flexion angle, cranial cruciate ligament (CrCL) integrity, tibial plateau leveling osteotomy (TPLO), and cranial tibial subluxation on the distance between the location of the origin and insertion of the CrCL (CrCL(d)) in dogs. 4 pairs of pelvic limbs from adult dog cadavers weighing 23 to 34 kg. Procedures-Mediolateral projection radiographs of each stifle joint were obtained with the joint flexed at 90°, 105°, 120°, 135°, and 150°. Radiopaque markers were then placed at the sites of origin and insertion of the CrCL. Afterward, radiography was repeated in the same manner, before and after CrCL transection, with and without TPLO. Following CrCL transection, radiographs were obtained before and after inducing overt cranial tibial subluxation. Interobserver variation in measuring the CrCL(d) without fiduciary markers was assessed. The effect of CrCL integrity, cranial tibial subluxation, flexion angle, and TPLO on CrCL(d) was also determined. Interobserver agreement was strong, with an intraclass correlation coefficient of 0.859. The CrCL(d) was significantly shorter (Cranial tibial subluxation caused a 25% to 40% increase in CrCL(d). No effect of TPLO on CrCL(d) was found, regardless of CrCL integrity, forced stifle joint subluxation, or flexion angle. Overt cranial tibial subluxation in CrCL-deficient stifle joints can be detected on mediolateral projection radiographs by comparing CrCL(d) on neutral and stressed joint radiographs at joint angles between 105° and 150°, regardless of whether a TPLO has been performed.

  2. AJNT volume 5 issue 3 [Sep 2012].indd

    African Journals Online (AJOL)

    2012 Sep;5(3):141-4. Original Article. AJNT. Abstract. Introduction: The cause of the metabolic syndrome. (MS) is incompletely understood but represents a complex interaction between genetic, environmental, and metabolic factors, clearly including diet, and level of physical activity. The prevalence of MS is continuously.

  3. 186---07 Sep 2009 [Final version].indd

    African Journals Online (AJOL)

    2009-09-07

    Sep 7, 2009 ... it with a horizontal transcendence that accords with humans' biological makeup and with present- day scientific ..... than one) change under the influence of a shared worldview and social factors. Our self-perception changes as our view of our environment changes. .... It concerns our culture of human rights,.

  4. 725.pdf | 25sep2010 | currsci | Indian Academy of Sciences

    Indian Academy of Sciences (India)

    2010-09-25

    Sep 25, 2010 ... Joint Statement by the Three Science Academies of India on the teaching of the theory of evolution more... Introducing: Summer Schools. Posted on 21 December 2017. ASTROPHYSICS: An Observational View of the Universe. Math Art and Design: MAD about Math, Math Education and Outreach.

  5. 602.pdf | sep102007 | currsci | Indian Academy of Sciences

    Indian Academy of Sciences (India)

    Home; currsci; sep102007; 602.pdf. 404! error. The page your are looking for can not be found! Please check the link or use the navigation bar at the top. YouTube; Twitter; Facebook; Blog. Academy News. IAS Logo. Theory Of Evolution. Posted on 23 January 2018. Joint Statement by the Three Science Academies of India ...

  6. Nerve injuries sustained during warfare: part I--Epidemiology.

    Science.gov (United States)

    Birch, R; Misra, P; Stewart, M P M; Eardley, W G P; Ramasamy, A; Brown, K; Shenoy, R; Anand, P; Clasper, J; Dunn, R; Etherington, J

    2012-04-01

    We describe 261 peripheral nerve injuries sustained in war by 100 consecutive service men and women injured in Iraq and Afghanistan. Their mean age was 26.5 years (18.1 to 42.6), the median interval between injury and first review was 4.2 months (mean 8.4 months (0.36 to 48.49)) and median follow-up was 28.4 months (mean 20.5 months (1.3 to 64.2)). The nerve lesions were predominantly focal prolonged conduction block/neurapraxia in 116 (45%), axonotmesis in 92 (35%) and neurotmesis in 53 (20%) and were evenly distributed between the upper and the lower limbs. Explosions accounted for 164 (63%): 213 (82%) nerve injuries were associated with open wounds. Two or more main nerves were injured in 70 patients. The ulnar, common peroneal and tibial nerves were most commonly injured. In 69 patients there was a vascular injury, fracture, or both at the level of the nerve lesion. Major tissue loss was present in 50 patients: amputation of at least one limb was needed in 18. A total of 36 patients continued in severe neuropathic pain. This paper outlines the methods used in the assessment of these injuries and provides information about the depth and distribution of the nerve lesions, their associated injuries and neuropathic pain syndromes.

  7. Anatomical basis for sciatic nerve block at the knee level.

    Science.gov (United States)

    Barbosa, Fabiano Timbó; Barbosa, Tatiana Rosa Bezerra Wanderley; da Cunha, Rafael Martins; Rodrigues, Amanda Karine Barros; Ramos, Fernando Wagner da Silva; de Sousa-Rodrigues, Célio Fernando

    2015-01-01

    Recently, administration of sciatic nerve block has been revised due to the potential benefit for postoperative analgesia and patient satisfaction after the advent of ultrasound. The aim of this study was to describe the anatomical relations of the sciatic nerve in the popliteal fossa to determine the optimal distance the needle must be positioned in order to realize the sciatic nerve block anterior to its bifurcation into the tibial and common fibular nerve. The study was conducted by dissection of human cadavers' popliteal fossa, fixed in 10% formalin, from the Laboratory of Human Anatomy and Morphology Departments of the Universidade Federal de Alagoas and Universidade de Ciências da Saúde de Alagoas. Access to the sciatic nerve was obtained. 44 popliteal fossa were analyzed. The bifurcation of the sciatic nerve in relation to the apex of the fossa was observed. There was bifurcation in: 67.96% below the apex, 15.90% above the apex, 11.36% near the apex, and 4.78% in the gluteal region. The sciatic nerve bifurcation to its branches occurs at various levels, and the chance to succeed when the needle is placed between 5 and 7 cm above the popliteal is 95.22%. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  8. [Anatomical basis for sciatic nerve block at the knee level].

    Science.gov (United States)

    Barbosa, Fabiano Timbó; Barbosa, Tatiana Rosa Bezerra Wanderley; Cunha, Rafael Martins da; Rodrigues, Amanda Karine Barros; Ramos, Fernando Wagner da Silva; Sousa-Rodrigues, Célio Fernando de

    2015-01-01

    Recently, administration of sciatic nerve block has been revised due to the potential benefit for postoperative analgesia and patient satisfaction after the advent of ultrasound. The aim of this study was to describe the anatomical relations of the sciatic nerve in the popliteal fossa to determine the optimal distance the needle must be positioned in order to realize the sciatic nerve block anterior to its bifurcation into the tibial and common fibular nerve. The study was conducted by dissection of human cadavers' popliteal fossa, fixed in 10% formalin, from the Laboratory of Human Anatomy and Morphology Departments of the Universidade Federal de Alagoas and Universidade de Ciências da Saúde de Alagoas. Access to the sciatic nerve was obtained. 44 popliteal fossa were analyzed. The bifurcation of the sciatic nerve in relation to the apex of the fossa was observed. There was bifurcation in: 67.96% below the apex, 15.90% above the apex, 11.36% near the apex, and 4.78% in the gluteal region. The sciatic nerve bifurcation to its branches occurs at various levels, and the chance to succeed when the needle is placed between 5 and 7 cm above the popliteal is 95.22%. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  9. A retrospective study of tibial plateau translation following tibial plateau levelling osteotomy stabilisation using three different plate types.

    Science.gov (United States)

    Woodbridge, N; Corr, S A; Grierson, J; Arthurs, G

    2011-01-01

    To retrospectively evaluate mediolateral translation of the proximal tibial segment (tibial plateau) after tibial plateau levelling osteotomy (TPLO), stabilised with three types of plate. Pre- and postoperative radiographs of 79 dogs that had TPLO surgery using three different types of plates were reviewed. Two plate types incorporated non-locking screws: Slocum (22 cases) and Orthomed Delta (33 cases) plates. The third plate type incorporated locking screws: Synthes TPLO Locking Compression Plate (LCP) (24 cases). The radiographs were viewed by three Diplomate surgeons who were blinded to the type of implant used. Medial or lateral translation of the proximal tibial plateau relative to the tibial diaphysis was assessed and measured at the lateral tibial cortex at the osteotomy site. Mean lateral translation of the tibial plateau was significantly greater when using the Synthes TPLO LCP with locking screws (+2.1 mm) compared to the non-locking Slocum (+0.4 mm) or Orthomed Delta (0.0 mm) plates. The use of the Synthes TPLO LCP will maintain a malalignment of the tibial plateau. Accurate alignment of the tibial plateau must be ensured prior to application of the Synthes TPLO LCP.

  10. 78 FR 66937 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-11-07

    ... Control Special Emphasis Panel (SEP): Initial Review Notice of Cancellation: This notice concerns...). This SEP, scheduled to convene on November 6, 2013, is canceled. Notice will be provided if the meeting...

  11. 78 FR 23768 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-04-22

    ... Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Developing... Prevention (CDC) announces the aforementioned SEP: Time and Date: 1:00 p.m.-4:00 p.m., June 18, 2013 (Closed...

  12. 78 FR 66938 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-11-07

    ... Control Special Emphasis Panel (SEP): Initial Review Notice of Cancellation: This notice concerns...). This SEP, scheduled to convene on November 12-15, 2013, is canceled. Notice will be provided if the...

  13. 78 FR 28221 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-05-14

    ... Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Youth Violence... Disease Control and Prevention (CDC) announces the aforementioned SEP: Time and Date: 12:30 p.m.-5:00 p.m...

  14. 78 FR 24751 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-04-26

    ... Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Continuing... aforementioned SEP: Time and Date: 12:00 p.m.-3:30 p.m., June 13, 2013 (Closed). Place: Teleconference. Status...

  15. 78 FR 20319 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review.

    Science.gov (United States)

    2013-04-04

    ... Control Special Emphasis Panel (SEP): Initial Review. The meeting announced below concerns Research Grants...), the Centers for Disease Control and Prevention (CDC) announces the aforementioned SEP: Time and Date...

  16. Contribution of myelunated fibers from spinal L4, L5 and L6 nerves to the sciatic nerve and its main branches in the adult rat Contribución de fibras mielínicas provenientes de los nervios espinales lumbares L4, L5 y L6 al nervio ciático de rata adulta y sus ramas principales

    OpenAIRE

    Juan D. Robles; Marlen Arias; Miguel Baldovino; Jeanelle Ariza; José V. Montoya Guarín; John J. Sutachán; Hernán Hurtado

    2000-01-01

    The rat sciatic nerve is composed by the L4, L5 and L6 lumbar spinal nerves. However, the contribution in myelinated fibers originating from these nerves along this nervous trunk has not yet been defined. In the present study, the L4, L5 and L4-L5 spinal nerves were selectively transected. After one week the sciatic, tibial, sural and peroneal nerves were dissected. These samples were fixed and processed for optical microscopy, and both degenerated and normal myelinated fibers were counted in...

  17. Sacral nerve stimulation increases activation of the primary somatosensory cortex by anal canal stimulation in an experimental model.

    LENUS (Irish Health Repository)

    Griffin, K M

    2011-08-01

    Sacral and posterior tibial nerve stimulation may be used to treat faecal incontinence; however, the mechanism of action is unknown. The aim of this study was to establish whether sensory activation of the cerebral cortex by anal canal stimulation was increased by peripheral neuromodulation.

  18. Conjunct SEP and MEP monitoring in resection of infratentorial lesions: lessons learned in a cohort of 210 patients.

    Science.gov (United States)

    Kodama, Kunihiko; Javadi, Mani; Seifert, Volker; Szelényi, Andrea

    2014-12-01

    During the surgical removal of infratentorial lesions, intraoperative neuromonitoring is mostly focused on cranial nerve assessment and brainstem auditory potentials. Despite the known risk of perforating vessel injury during microdissection within the vicinity of the brainstem, there are few reports about intraoperative neuromonitoring with somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) assessing the medial lemniscus and corticospinal tract. This study analyses the occurrence of intraoperative changes in MEPs and SEPs with regard to lesion location and postoperative neurological outcome. The authors analyzed 210 cases in which patients (mean age 49 ± 13 years, 109 female) underwent surgeries involving the skull base (n = 104), cerebellum (n = 63), fourth ventricle (n = 28), brainstem (n = 12), and foramen magnum (n = 3). Of 210 surgeries, 171 (81.4%) were uneventful with respect to long-tract monitoring. Nine (23%) of the 39 SEP and/or MEP alterations were transient and were only followed by a slight permanent deficit in 1 case. Permanent deterioration only was seen in 19 (49%) of 39 cases; the deterioration was related to tumor dissection in 4 of these cases, and permanent deficit (moderate-severe) was seen in only 1 of these 4 cases. Eleven patients (28%) had losses of at least 1 modality, and in 9 of these 11 cases, the loss was related to surgical microdissection within the vicinity of the brainstem. Four of these 9 patients suffered a moderate-to-severe long-term deficit. For permanent changes, the positive predictive value for neuromonitoring of the long tracts was 0.467, the negative predictive value was 0.989, the sensitivity was 0.875, and the specificity 0.918. Twenty-eight (72%) of 39 SEP and MEP alterations occurred in 66 cases involving intrinsic brainstem tumors or tumors adjacent to the brainstem. Lesion location and alterations in intraoperative neuromonitoring significantly correlated with patients' outcome (p SEPs and

  19. Anterior cruciate ligament reconstruction with tibial attachment preserving hamstring graft without implant on tibial side

    Directory of Open Access Journals (Sweden)

    Skand Sinha

    2018-01-01

    Full Text Available Background: Tibial attachment preserving hamstring graft could prevent potential problems of free graft in anterior cruciate ligament (ACL reconstruction such as pull out before graft-tunnel healing or rupture before ligamentization. Different implants have been reportedly used for tibial side fixation with this technique. We investigated short-term outcome of ACL reconstruction (ACLR with tibial attachment sparing hamstring graft without implant on the tibial side by outside in technique. Materials and Methods: Seventy nine consecutive cases of ACL tear having age of 25.7 ± 6.8 years were included after Institutional Board Approval. All subjects were male. The mean time interval from injury to surgery was of 7.5 ± 6.4 months. Hamstring tendons were harvested with open tendon stripper leaving the tibial insertion intact. The free ends of the tendons were whip stitched, quadrupled, and whip stitched again over the insertion site of hamstring with fiber wire (Arthrex. Single bundle ACLR was done by outside in technique and the femoral tunnel was created with cannulated reamer. The graft was pulled up to the external aperture of femoral tunnel and fixed with interference screw (Arthrex. The scoring was done by Lysholm, Tegner, and KT 1000 by independent observers. All cases were followed up for 2 years. Results: The mean length of quadrupled graft attached to tibia was 127.65 ± 7.5 mm, and the mean width was 7.52 ± 0.78 mm. The mean preoperative Lysholm score of 47.15 ± 9.6, improved to 96.8 ± 2.4 at 1 year. All cases except two returned to the previous level of activity after ACLR. There was no significant difference statistically between preinjury (5.89 ± 0.68 and postoperative (5.87 ± 0.67 Tegner score. The anterior tibial translation (ATT (KT 1000 improved from 11.44 ± 1.93 mm to 3.59 ± 0.89 mm. The ATT of operated knee returned to nearly the similar value as of the opposite knee (3.47 ± 1.16 mm. The Pivot shift test was negative in

  20. The SEP "Robot": A Valid Virtual Reality Robotic Simulator for the Da Vinci Surgical System?

    NARCIS (Netherlands)

    van der Meijden, O. A. J.; Broeders, I. A. M. J.; Schijven, M. P.

    2010-01-01

    The aim of the study was to determine if the concept of face and construct validity may apply to the SurgicalSim Educational Platform (SEP) "robot" simulator. The SEP robot simulator is a virtual reality (VR) simulator aiming to train users on the Da Vinci Surgical System. To determine the SEP's

  1. Reconstruction of bilateral tibial aplasia and split hand-foot ...

    African Journals Online (AJOL)

    Background: Tibial aplasia is of heterogeneous aetiology, the majority of reports are sporadic. We describe the reconstruction procedures in two subjects - a daughter and father manifested autosomal dominant (AD) inheritance of the bilateral tibial aplasia and split hand-foot syndrome. Materials and Methods: ...

  2. Tibial sequestrectomy in the management of Osgood-Schlatter disease.

    Science.gov (United States)

    Trail, I A

    1988-01-01

    Two groups of patients with symptomatic Osgood-Schlatter disease were compared over a 4-5 year follow-up period. One group was treated surgically by tibial sequestrectomy and the other group was managed conservatively. Tibial sequestrectomy was found to offer no significant benefit over simple conservative methods of treatment. In addition, a significant complication rate was identified with this procedure.

  3. Tibial Plateau Fracture Characteristics: Reliability and Diagnostic Accuracy

    NARCIS (Netherlands)

    Mellema, Jos J.; Doornberg, Job N.; Molenaars, Rik J.; Ring, David; Kloen, Peter; Babis, George C.; Jeray, Kyle J.; Prayson, Michael J.; Pesantez, Rodrigo; Acacio, Ramos; Verbeek, Diederik O.; Melvanki, Parag; Kreis, Barbara E.; Mehta, Samir; Meylaerts, S.; Wojtek, S.; Yeap, Ewe J.; Haapasalo, Heidi; Kristan, Anže; Coles, Chad; Marsh, J. Lawrence; Mormino, Matthew; Memon, Matthew; Tyllianakis, Minos; Schandelmaier, Peter; Jenkinson, R. J.; Neuhaus, Valentin; Shahriar, Chegini M. H.; Belangero, William D.; Leonidovich, Golovakha M.; Davenport, J. H.; Kabir, Koroush; Althausen, Peter L.; Weil, Yoram; Toom, Alar; Sa da Costa, Daniel; Koukoulias, Nikolaos; Manidakis, Nikolaos; van den Bogaert, Max; Patczai, Balázs; Grauls, Anthony; Kurup, Harish; van den Bekerom, Michel P.; Lansdaal, Joris R.; Vale, Mário; Ousema, Paul; Barquet, Antonio; Cross, Brian J.; Broekhuyse, Henry; Haverkamp, Daniel; Merchant, Milind; Harvey, Edward; Stojkovska Pemovska, Emilija; Frihagen, Frede; Seibert, Franz Josef; Garnavos, Christos; van der Heide, Huub; Villamizar, Harold Alonso; Harris, Ian; Borris, Lars C.; Brink, Ole; Choudhari, Pradeep; Swiontkowski, Marc; Mittlmeier, Thomas; Tosounidis, Theodoros; van Rensen, Inge; Martinelli, N.; Park, D. H.; Lasanianos, Nikolaos; Vide, J.; Engvall, A.; Zura, R. D.; Jubel, Axel; Kawaguchi, Alan; Goost, Hans; Bishop, Julius; Mica, Ladislav; Pirpiris, Marinis; van Helden, S. H.; Bouaicha, Samy; Schepers, T.; Havliček, Tomo; Giordano, Vincenzo

    2016-01-01

    The purpose of this study was to assess the interobserver reliability and diagnostic accuracy for 2-dimensional (2D) and 3-dimensional (3D) computed tomography (CT)-based evaluation of tibial plateau fracture characteristics. We hypothesized that recognition of specific tibial plateau fracture

  4. The influence of gluteus maximus on transverse plane tibial rotation

    NARCIS (Netherlands)

    Preece, S.J.; Graham-Smith, P.; Nester, C.J.; Howard, D.; Hermens, Hermanus J.; Herrington, L.; Bowker, P.

    There is a common clinical belief that transverse plane tibial rotation is controlled by the rearfoot. Although distal structures may influence the motion of the tibia, transverse plane tibial rotation could be determined by the proximal hip musculature. Cadaver studies have identified gluteus

  5. Coverage of extensive tibial bone exposure in burn patients with ...

    African Journals Online (AJOL)

    Covering tibial bone exposure from third degree burns to the lower limbs is a challenging task for the plastic surgeon. We present our experience of covering tibial exposure from burns in three different patients, where four limbs were involved and three muscular flaps were used in conjunction with one another; i.e. the ...

  6. Posterior cruciate ligament's tibial insertions: topographic anatomy and morphometric study

    Directory of Open Access Journals (Sweden)

    Julio Cesar Gali

    2013-06-01

    Full Text Available OBJECTIVE: To provide anatomical and morphometric basis of the posterior cruciate ligament's tibial insertions in order to assist the creation of anatomical tibial tunnels, in the ligament surgical reconstruction. MATERIAL AND METHODS: The topographic anatomy and morphometry of the posterior cruciate ligament's anterolateral and posteromedial bundles' tibial insertions were analyzed in 24 anatomical knee pieces. The pieces were photographed by a digital camera and the images obtained were studied by the software ImageJ, where the bundles' insertion areas were measured in square millimeters, and the length of structures and the distances between significant points were measured in millimeters. RESULTS: In 54.2% of the knees the insertion' shape was concave; in most pieces (41.6% the form of insertion was oval. The average posterior cruciate ligament's tibial insertion total area was 88.33 ± 21.66 mm2; the average anterolateral bundle's tibial insertion area was 46.79 ± 14.10 mm2 and it was 41.54 ± 9.75 mm2 for the posteromedial bundle. CONCLUSIONS: The anterolateral bundle has a tibial insertion area larger than the posteromedial bundle; the insertion areas of those bundles in our study, were smaller than the ones found in the literature. The variations in the posterior cruciate ligament's tibial insertion area suggest that there should be an indication for anatomical reconstructions of this ligament using single or double tibial tunnels according to individual characteristics.

  7. Increased external tibial torsion and osteochondritis dissecans of the knee

    NARCIS (Netherlands)

    Bramer, J. A. M.; Maas, M.; Dallinga, R. J.; te Slaa, R. L.; Vergroesen, D. A.

    2004-01-01

    In the past, osteochondritis dissecans of the knee was associated with increased tibial exotorsion, established with a clinical measuring method. Now the gold standard for determining tibial torsion is computed tomography. The aim of the current study was to establish whether the abovementioned

  8. Therapeutical Management of the Tibial Plateau Fractures

    Directory of Open Access Journals (Sweden)

    Obada B.

    2016-11-01

    Full Text Available The study was aimed to identify the role of surgical treatment of tibial plateau fractures, its functional outcome and complications. Demographic data for the patients and details of current clinical and radiological follow-up findings were obtained to assess range of motion, clinical stability, alignment of the knee, and posttraumatic arthrosis (Kellgren/Lawrence score. 64 cases of tibial plateau fractures treated by different surgical methods and variuos implants type were studied from 2013 to 2015 and followed-up for minimum period of 6 months. The systematisation of the casuitry was made using Schatzker and AO classifications. The treatment methods consist of: percutaneous cannulated cancellous screws, ORIF with buttress plate with or without bone grafting, locking or nonlocking plates, external fixator. As complications we found: redepression 4 case, malunion 2 cases, knee stiffness 9, wound dehiscence in 1 cases and non-union or infection in none of our cases. The average flexion of the injured knee was significantly lower in comparison with the contralateral side (124.9°/135.2°. Knee stability did not differ statistically significantly. There were no signs of posttraumatic arthrosis in 45% of cases, mild signs in 30%, clear signs in 18%, and severe signs in 7%. As conclusion we found that surgical management of tibial plateau fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early motion and reduce arthrosis risk and hence to achieve optimal knee function. The choice of optimal surgical methods, proper approach and implant is made in relation to fracture type according Schatzker and AO classification.

  9. [Closed intramedullary nailing of tibial shaft fractures].

    Science.gov (United States)

    Verret, G

    1995-08-01

    To assess patient outcome after nailing of the tibial shaft with the unreamed AO/ASIF nail. A retrospective study of 54 nailed fractures of the tibial shaft treated between 1990 and 1994. Follow-up was done at the outpatient clinic and included measurements of the lower limbs and x-rays. The study was conducted at the Hôpital de l'Enfant-Jésus, Québec, a centre specializing in trauma care. Fifty-four acute displaced fractures of the tibial shaft occurring in 52 patients were studied. Nailing with the Synthes AO/ASIF unreamed locked nails. Time to bone fusion, rate of infection, incidence of deformity and failure rate of the implants, especially the lock screws. The majority of fractures were associated with a high-speed trauma (40/54 or 74% of cases) and 18 (33%) were open fractures. Osteitis developed in one (1.8%) open type IIIA fracture. Bone fusion was observed clinically and radiologically after 29 weeks on average; none of the fractures presented residual deformity on rotation of more than 5 degrees or a difference in length of more than 1 cm or a frontal or sagittal displacement of more than 10 degrees. A single case of pseudoarthrosis was noted. One or more lock screws became deformed or broke in 16 (34%) tibias; however, this did not lead to any reduction loss. Four compartment syndromes were diagnosed. Excellent results were obtained with respect to limb alignment and length. Loss of joint mobility was minimal. The number of lock screw failures indicates that a delayed weight bearing could prevent this complication, especially when an interfragment space remains after the nail placement.

  10. Effects of counteracting external valgus moment on lateral tibial cartilage contact conditions and tibial rotation.

    Science.gov (United States)

    Shriram, Duraisamy; Parween, Rizuwana; Lee, Yee Han Dave; Subburaj, Karupppasamy

    2017-07-01

    Knee osteoarthritis that prevalently occurs at the medial compartment is a progressive chronic disorder affecting the articular cartilage of the knee joint, and lead to loss of joint functionality. Valgus braces have been used as a treatment procedure to unload the medial compartment for patients with medial osteoarthritis. Valgus braces through the application of counteracting external valgus moment shift the load from medial compartment towards the lateral compartment. Previous biomechanical studies focused only on the changes in varus moments before and after wearing the brace. The objective of this study was to investigate the influence of opposing external valgus moment applied by knee braces on the lateral tibial cartilage contact conditions using a 3D finite element model of the knee joint. Finite element simulations were performed on the knee joint model without and with the application of opposing valgus moment to mimic the unbraced and braced conditions. Lateral tibial cartilage contact pressures and contact area, and tibial rotation (varus-valgus and internal-external) were estimated for the complete walking gait cycle. The opposing valgus moment increased the maximum contact pressure and contact area on the lateral tibial cartilage compared to the normal gait moment. A peak contact pressure of 8.2 MPa and maximum cartilage loaded area of 28% (loaded cartilage nodes) on the lateral cartilage with the application of external valgus moment were induced at 50% of the gait cycle. The results show that the use of opposing valgus moment may significantly increase the maximum contact pressures and contact area on the lateral tibial cartilage and increases the risk of articular cartilage damage on the lateral compartment.

  11. Return to Sport After Tibial Shaft Fractures

    Science.gov (United States)

    Robertson, Greg A. J.; Wood, Alexander M.

    2015-01-01

    Context: Acute tibial shaft fractures represent one of the most severe injuries in sports. Return rates and return-to-sport times after these injuries are limited, particularly with regard to the outcomes of different treatment methods. Objective: To determine the current evidence for the treatment of and return to sport after tibial shaft fractures. Data Sources: OVID/MEDLINE (PubMed), EMBASE, CINAHL, Cochrane Collaboration Database, Web of Science, PEDro, SPORTDiscus, Scopus, and Google Scholar were all searched for articles published from 1988 to 2014. Study Selection: Inclusion criteria comprised studies of level 1 to 4 evidence, written in the English language, that reported on the management and outcome of tibial shaft fractures and included data on either return-to-sport rate or time. Studies that failed to report on sporting outcomes, those of level 5 evidence, and those in non–English language were excluded. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: The search used combinations of the terms tibial, tibia, acute, fracture, athletes, sports, nonoperative, conservative, operative, and return to sport. Two authors independently reviewed the selected articles and created separate data sets, which were subsequently combined for final analysis. Results: A total of 16 studies (10 retrospective, 3 prospective, 3 randomized controlled trials) were included (n = 889 patients). Seventy-six percent (672/889) of the patients were men, with a mean age of 27.7 years. Surgical management was assessed in 14 studies, and nonsurgical management was assessed in 8 studies. Return to sport ranged from 12 to 54 weeks after surgical intervention and from 28 to 182 weeks after nonsurgical management (mean difference, 69.5 weeks; 95% CI, –83.36 to −55.64; P Fractures treated surgically had a return-to-sport rate of 92%, whereas those treated nonsurgically had a return rate of 67% (risk ratio, 1.37; 95% CI, 1.20 to 1.57; P displaced fractures

  12. articles32.htm | sep25 | currsci | Indian Academy of Sciences

    Indian Academy of Sciences (India)

    Home; currsci; sep25; articles32.htm. 404! error. The page your are looking for can not be found! Please check the link or use the navigation bar at the top. YouTube; Twitter; Facebook; Blog. Academy News. IAS Logo. 29th Mid-year meeting. Posted on 19 January 2018. The 29th Mid-year meeting of the Academy will be ...

  13. Study of Solar Energetics (SEPs) Using Largely Separated Spacecraft

    Science.gov (United States)

    2016-10-29

    Parker spiral, and so depends on the solar wind speed. The connection points of the spacecraft are obtained using synoptic magnetic field and ecliptic...determine the EUV wave properties using the ratio images (Figure 1). Figure 1. 2010 August 14 source region and EUV wave: (a) GONG synoptic magnetic...choosing the start and end positions of the wave. Table 1 lists the 12 SEP events and their associated solar phenomena. The events are related to

  14. 577.pdf | 10sep2010 | currsci | Indian Academy of Sciences

    Indian Academy of Sciences (India)

    Home; currsci; 10sep2010; 577.pdf. 404! error. The page your are looking for can not be found! Please check the link or use the navigation bar at the top. YouTube; Twitter; Facebook; Blog. Academy News. IAS Logo. 29th Mid-year meeting. Posted on 19 January 2018. The 29th Mid-year meeting of the Academy will be held ...

  15. The Noise Level Optimization for Induction Magnetometer of SEP System

    Science.gov (United States)

    Zhu, W.; Fang, G.

    2011-12-01

    The Surface Electromagnetic Penetration (SEP) System, subsidized by the SinoProbe Plan in China, is designed for 3D conductivity imaging in geophysical mineral exploration, underground water distribution exploration, oil and gas reservoir exploration. Both the Controlled Source Audio Magnetotellurics (CSAMT) method and Magnetotellurics (MT) method can be surveyed by SEP system. In this article, an optimization design is introduced, which can minimize the noise level of the induction magnetometer for SEP system magnetic field's acquisition. The induction magnetometer transfers the rate of the magnetic field's change to voltage signal by induction coil, and amplified it by Low Noise Amplifier The noise parts contributed to the magnetometer are: the coil's thermal noise, the equivalent input voltage and current noise of the pre-amplifier. The coil's thermal noise is decided by coil's DC resistance. The equivalent input voltage and current noise of the pre-amplifier depend on the amplifier's type and DC operation condition. The design here optimized the DC operation point of pre-amplifier, adjusted the DC current source, and realized the minimum of total noise level of magnetometer. The calculation and test results show that: the total noise is about 1pT/√Hz, the thermal noise of coils is 1.7nV/√Hz, the preamplifier equivalent input voltage and current noise is 3nV/ √Hz and 0.1pA/√Hz, the weight of the magnetometer is 4.5kg and meet the requirement of SEP system.

  16. Shock Geometry and Spectral Breaks in Large SEP Events

    Science.gov (United States)

    Li, G.; Zank, G. P.; Verkhoglyadova, Olga; Mewaldt, R. A.; Cohen, C. M. S.; Mason, G. M.; Desai, M. I.

    2009-09-01

    Solar energetic particle (SEP) events are traditionally classified as "impulsive" or "gradual." It is now widely accepted that in gradual SEP events, particles are accelerated at coronal mass ejection-driven (CME-driven) shocks. In many of these large SEP events, particle spectra exhibit double power law or exponential rollover features, with the break energy or rollover energy ordered as (Q/A)α, with Q being the ion charge in e and A the ion mass in units of proton mass mp . This Q/A dependence of the spectral breaks provides an opportunity to study the underlying acceleration mechanism. In this paper, we examine how the Q/A dependence may depend on shock geometry. Using the nonlinear guiding center theory, we show that α ~ 1/5 for a quasi-perpendicular shock. Such a weak Q/A dependence is in contrast to the quasi-parallel shock case where α can reach 2. This difference in α reflects the difference of the underlying parallel and perpendicular diffusion coefficients κ|| and κbottom. We also examine the Q/A dependence of the break energy for the most general oblique shock case. Our analysis offers a possible way to remotely examine the geometry of a CME-driven shock when it is close to the Sun, where the acceleration of particle to high energies occurs.

  17. The damage control in tibial pilon open fractures with a new external

    Directory of Open Access Journals (Sweden)

    Giuseppe Rollo

    2017-09-01

    Full Text Available Objective: To evaluate the effectiveness of the damage control, in emergency to treat the open tibial pilon fractures with Dolphix?External Fixator Frame(CITIEFFE? Calderara di Reno, Bologna, Italy. Methods: From January 2017 to August 2017, at the Department of Orthopedics and Traumatology of Vito Fazzi Hospital Lecce, we treated 23 open tibial pilon fractures with Dolphix?External Fixator Frame(CITIEFFE? Calderara di Reno, Bologna, Italy. The evaluation criteria of the case series were: the time needed to assemble the external fixator; the time taked to treat the ankle associated lesions; the time of skin healing; the ankle alignment; the subjective/objective Ovadia and Beals score; and complications. The Endpoint assessment was set at the days of the definitive surgery. Results: The results in terms of alignment, biomechanical stability of the frame, healing of soft tissue, complications were as good as the objective and subjective results according Ovadia and Beals score. Conclusion: Pilon fractures are complex and often present complications; the damage control treatment, in emergency, with Dolphix?External Fixator Frame(CITIEFFE? Calderara di Reno, Bologna, Italy permits a stable osteotaxis with minimal soft tissue damage and permit the repair of muscles, blood vessels and nerves with a stable bone and the soft tissue healing with vaccum therapy.

  18. Comparison of nerve conduction and injury degree in patients with lumbar disc herniation after microendoscopic discectomy and fenestration discectomy

    Directory of Open Access Journals (Sweden)

    Jun Li

    2017-09-01

    Full Text Available Objective: To study the difference of nerve conduction and injury degree in patients with lumbar disc herniation after microendoscopic discectomy and fenestration discectomy. Methods: Patients with single-segment lumbar disc herniation who were treated in Dazhou Central Hospital between May 2014 and February 2017 were selected as the research subjects, the history data were reviewed and the operation methods were referred to divide them into FD group and MED group who received fenestration discectomy and microendoscopic discectomy respectively. The conduction velocity of common peroneal nerve and tibial nerve were detected before operation and 4 weeks after operation; serum levels of nerve and muscle injury-related molecules as well as inflammation and stress-related molecules were detected before operation and 3 days after operation. Results: MNCV levels of common peroneal nerve and tibial nerve 4 weeks after operation as well as serum CRP, TNF-α, MDA and AOPP contents 3 d after operation of both groups of patients were significantly higher than those before operation, and the MNCV levels of common peroneal nerve and tibial nerve of MED group 4 weeks after operation were significantly higher than those of FD group while serum CRP, TNF-α, MDA and AOPP contents of MED group 3 d after operation were not significantly different from those of FD group; serum NSE, S100B, Tau, pNF-H, CPK, Myo and LDH contents of FD patients 3 d after operation were significantly higher than those before operation while serum NSE, S100B, Tau, pNF-H, CPK, Myo and LDH contents of MED group were not significantly different from those before operation. Conclusion: Microendoscopic discectomy for lumbar disc herniation can relieve the nerve and muscle injury, and is equivalent to fenestration discectomy in activating the systemic stress and inflammatory response.

  19. [Role of nerve stimulation at Erb point in early diagnosis of Guillain-Barré syndrome in children].

    Science.gov (United States)

    Sun, Rui-Di; Fu, Bin; Li, Cheng; Kuang, Guang-Tao; Luo, Xiao-Qing; Jiang, Jun

    2015-07-01

    To study the role of proximal nerve stimulation at Erb point in the early diagnosis of Guillain-Barré syndrome (GBS) in children. Thirty-two children who were diagnosed with GBS between October 2013 and December 2014 received neurophysiological examination. Thirty healthy children were used as controls. Compound muscle action potentials and distal motor latency of the median and ulnar nerves were determined and analyzed after nerve stimulation at the wrist, elbow, and Erb point in the two groups. Moreover, F-wave latency of the median nerve and H-reflex latency of the tibial nerve were measured and analyzed in the two groups. The F-wave and H-reflex latencies were significantly longer in the patient group than in the control group (P0.05). The nerve stimulation at Erb point holds promise as a routine examination for the early diagnosis of GBS.

  20. [Treatment of Tibial Shaft Fractures with the Stable Angle Tibial Nail Targon TX].

    Science.gov (United States)

    Chmielnicki, M; Prokop, A

    2016-10-01

    Tibial shaft fractures are among the most common long bone fractures in humans. The incidence is 1-2 per 100,000. The gold standard of treatment for AO type 42 A-C fractures is a locking intramedullary nail. The development of new implants has extended the indications for this minimally invasive technique, so that now AO types 41 and 43 can also be treated with special nails. Fixed-angle screw anchors increase primary stability and supplemental locking devices located proximally and distally extend the spectrum of use to metaphyseal fractures. The cannulated Targon TX titanium nail can be introduced, either with or without reaming. Using an operative video, the treatment of a tibial fracture with an intramedullary nail is demonstrated in stages and the operative steps further illustrated on artificial bone. Georg Thieme Verlag KG Stuttgart · New York.

  1. Tibial bowing in children - what is normal? A radiographic study

    International Nuclear Information System (INIS)

    Zbinden, Isabella; Rutz, Erich; Jacobson, Jon A.; Magerkurth, Olaf

    2015-01-01

    To define osseous landmarks on tibia radiographs in order to establish age-related normal values characterizing physiological tibial bowing in children. Five hundred and twenty-six patients aged 0-17 years with normal radiographs of the lower legs were identified and retrospectively reviewed by two blinded radiologists. In anteroposterior (ap)/lateral (lat)-views, 3 lines defined tibial length and angulation. Line-A connecting proximal to distal corner of tibial metaphysic, lines B and C corresponding to corners of tibial metaphysis. Angle A/B defines proximal, A/C distal tibial-angulation. Tibial curvature is defined by distance of line-D parallel to A and tangential to tibial cortex. Normal values were calculated with linear-regression. Intra-/Interreader agreement were tested with a Bland-Altman-plot. Intrareader-agreement: Reader 1 showed a bias of -0.1, standard-deviation of bias was 1.9 and 95 %-limits-of-agreement -3.9- 3.7. Reader 2: -0.01, 2.4 and -4.7- 4.7. Interreader: 0.2, 1.6 and -2.9- 3.3. Angle-A/B ap was 80-100 , increasing with age (86.5-88); angle-AC ap was 82-107 (96.8-90.5), angle-AB lat was 81-107 (93.0-98.0); angle-AC lat was 76-102 (89.5-86.5); depth of curve ap was 0-11 % (8-3.5) and lat 2-13 %, (8.5-3.5). Age dependent tibial bowing can be assessed with this new measurement system and age-related normal-values characterizing physiological tibial bowing in children is established. (orig.)

  2. The anatomical tibial axis: reliable rotational orientation in knee replacement.

    Science.gov (United States)

    Cobb, J P; Dixon, H; Dandachli, W; Iranpour, F

    2008-08-01

    The rotational alignment of the tibia is an unresolved issue in knee replacement. A poor functional outcome may be due to malrotation of the tibial component. Our aim was to find a reliable method for positioning the tibial component in knee replacement. CT scans of 19 knees were reconstructed in three dimensions and orientated vertically. An axial plane was identified 20 mm below the tibial spines. The centre of each tibial condyle was calculated from ten points taken round the condylar cortex. The tibial tubercle centre was also generated as the centre of the circle which best fitted eight points on the outside of the tubercle in an axial plane at the level of its most prominent point. The derived points were identified by three observers with errors of 0.6 mm to 1 mm. The medial and lateral tibial centres were constant features (radius 24 mm (SD 3), and 22 mm (SD 3), respectively). An anatomical axis was created perpendicular to the line joining these two points. The tubercle centre was found to be 20 mm (SD 7) lateral to the centre of the medial tibial condyle. Compared with this axis, an axis perpendicular to the posterior condylar axis was internally rotated by 6 degrees (SD 3). An axis based on the tibial tubercle and the tibial spines was also internally rotated by 5 degrees (sd 10). Alignment of the knee when based on this anatomical axis was more reliable than either the posterior surfaces or any axis involving the tubercle which was the least reliable landmark in the region.

  3. The clinical, electrophysiologic, and surgical characteristics of peripheral nerve injuries caused by gunshot wounds in adults: a 40-year experience.

    Science.gov (United States)

    Secer, Halil Ibrahim; Daneyemez, Mehmet; Tehli, Ozkan; Gonul, Engin; Izci, Yusuf

    2008-02-01

    There are few large-volume studies on the repair of peripheral nerve lesions caused by gunshot wounds. In this study, the results of peripheral nerve repair are analyzed, and the factors influencing the outcome are investigated. During a 40-year period, 2210 peripheral nerve lesions in 2106 patients who sustained gunshot injury were treated surgically in the Department of Neurosurgery. One thousand thirty-four patients had shrapnel injury, and 1072 patients had missile injury. Twelve peripheral nerves were included in this study, and all of them were repaired by direct suture, using nerve graft, or neurolysis. All patients underwent neurologic and electrophysiologic evaluations in the preoperative period and postoperatively at the end of the follow-up period. The mean time of follow-up was 2.6 years. Final outcome was based on the motor, sensory, and electrophysiologic recoveries, and a patient judgment scale. Using the muscle grading scale, sensory grading scale, EMNG, and patient judgments, the maximal recovery was achieved in the subscapular nerve, but there were only 4 subscapular nerve lesions, which is not sufficient for a statistically significant outcome. Furthermore, the tibial, median, and femoral nerve lesions showed the best recovery rate, whereas the peroneal nerve, ulnar nerve, and brachial plexus lesions had the worst. Type of the peripheral nerve, injury (repair) level, associated injuries, electrophysiologic findings, operation time, intraoperative findings, surgical techniques, and postoperative physical rehabilitation are the prognostic factors for peripheral nerve lesions due to gunshot wounds.

  4. Patella height changes post high tibial osteotomy

    Directory of Open Access Journals (Sweden)

    Siew Ghim Gooi

    2017-01-01

    Full Text Available Background: Medial opening wedge high tibial osteotomy (HTO is a well-described treatment in early medial compartmental osteoarthritis of the knee. However, two undesirable sequelae may follow –patella baja and changes in the posterior tibial slope (TS. Materials and Methods: We conducted a retrospective study in patients who underwent HTO in our center between September 2009 and February 2017. Preoperative and 6-week postoperative long-leg weight bearing films and lateral knee radiographs were assessed. Pre- and postoperative radiological measurements include the Caton-Deschamps Index (CDI, the mechanical axis deviation (MAD, and the posterior TS. Independant t-test and Pearson correlation test were performed. Results: A total of 106 knees were recruited. The mean age was 48.8 ± 10.8 years. 66 (62.3% and 40 (37.7% knees were from males and females, respectively. The mean pre- and postoperative measurements was (−9.70° ± 3.67° to 0.08° ± 2.80° (−varus; +valgus for the MAD, (7.14° ± 1.78° to 8.72° ± 3.11° for posterior TS, and (0.93° ± 0.084° to 0.82° ± 0.13° for CDI (P ≤ 0.001 for all. The association between patella height change and the level of osteotomy (supra-tubercle vs. infra-tubercle was statistically significant (P < 0.001. A supra-tubercle osteotomy cut significantly lowering patella height (P = 0.011. There was otherwise no statistically significant correlations between patella height changes and the correction angle (P = 0.187 or posterior TS change (P = 0.744. Conclusions: A medial opening wedge HTO above the tibial tubercle was significantly associated with lowering patella height or reducing CDI postoperatively. Based on our results, we would recommend the use of an infra-tubercle osteotomy during the corrective surgery to prevent the complication of patella baja.

  5. External skeletal fixation of the tibial shaft fractures

    OpenAIRE

    Milenković Saša; Mitković Milorad B.; Radenković Mile

    2005-01-01

    Aim. To present the possibility of a successful use of external skeletal fixation in treating the open and closed tibial shaft fractures with Mitković’s external fixator. Methods. External fixation was used in 115 patients with 118 fresh tibial shaft fractures, 82 males (71.3%) and 33 females (28.7%), average age 43.92 years (16−84). Open tibial shaft fractures were present in 37 (31.36%). All the fractures were treated with Mitković’s external fixator type M 20. Results. The results of exter...

  6. A novel jig arm to measure tibial plateau angle during tibial plateau leveling osteotomy.

    Science.gov (United States)

    Restle, Kyle N; Biskup, Jeffery J

    2017-10-01

    To determine the ability of a novel device attached to the proximal tibial plateau leveling osteotomy (TPLO) jig pin to accurately predict intraoperative change in tibial plateau angle (TPA). In vitro cadaveric study. Left hindlimbs of adult dogs (n = 9). A modified Slocum tibial plateau leveling (TPL) jig with the Rotational Osteotomy Measuring Arm (ROMA) was placed on the tibia and a radial TPLO osteotomy was performed. Based on preoperative radiographic TPA measurements, the proximal segment was rotated using the traditional method of marking points on the osteotomy a specified distance apart. After rotation, the predicted TPA was recorded based on the ROMA. Postoperative TPA was measured on radiographs. The ability of the ROMA to predict postoperative TPA was compared to that of the traditional method. The average final TPA achieved with the traditional method was 6.4° (range, 3.0-10.0°). The ROMA predicted a final TPA of 5.8° (range, 3.8-10.1°). No significant difference was found between the TPA predicted based on the traditional method and ROMA method. The ROMA may be an alternative to the traditional method of measuring proximal segment rotation during TPLO procedure. Performing a TPLO with the ROMA may accurately predict the postoperative TPA while eliminating the need for measuring chord length, making reference marks, or referencing TPA charts for various osteotomy blade sizes. © 2017 The American College of Veterinary Surgeons.

  7. Multimodality evoked potentials in HTLV-I associated myelopathy.

    OpenAIRE

    Kakigi, R; Shibasaki, H; Kuroda, Y; Endo, C; Oda, K; Ikeda, A; Hashimoto, K

    1988-01-01

    Multimodality evoked potentials (EPs) consisting of somatosensory EPs (SEPs), visual EPs (VEPs) and brainstem auditory EPs (BAEPs) were studied in 16 cases with HTLV-I associated myelopathy (HAM). Median nerve SEPs were normal in all cases. In posterior tibial nerve SEPs, the potential recorded at the 12th thoracic spinal process was normal in every case but cortical components were significantly prolonged in 10 cases, although five of these showed no sensory impairment. BAEPs were normal in ...

  8. A morphologic and quantitative comparison of mechanoreceptors in the tibial remnants of the ruptured human anterior cruciate ligament.

    Science.gov (United States)

    Sha, Lin; Xie, Guoming; Zhao, Song; Zhao, Jinzhong

    2017-02-01

    Reconstruction of the ruptured anterior cruciate ligament (ACL) does not always result in expected successful outcome. A satisfactory outcome depends not only on the tightness or strength of the graft but also on the quality of proprioceptive restoration. Mechanoreceptors of ACL are supposed to play considerable roles in the proprioceptive feedback system of knee. This study aimed to observe the condition and number of the surviving mechanoreceptors in the tibial remnant of ruptured ACL in human knees.From April 2009 to January 2012, 60 patients with existing free tibial remnants who had undergone arthroscopic ACL reconstruction were enrolled and divided into 4 groups according to the time duration of injury to surgery (Group I: no more than 3 months; Group II: 3 to 6 months; Group III, 6 months to 1 year; Group IV: more than 1 year). Six normal ACL specimens were taken as controls. Specimens were obtained from ACL tibial remnant and stained by the immunohistochemical staining method. The type, size, and quantity of mechanoreceptors were observed under the light microscope. A total of 92 Ruffini-like corpuscles, 9 Pacini-like corpuscles, 5 unclassified neural endings, and free nerve endings were identified via immunohistochemical staining.There were no significant differences in the number of mechanoreceptors in the 5 groups (P = 0.238). Some degenerative changes were observed in Group IV. The results suggest that the residual mechanoreceptors in the ruptured ACL exhibit long-term survival and showed no obvious signs of withering within 1 year.Residual mechanoreceptors do exist in the tibial remnants of ruptured anterior cruciate ligament in human knees and identified clearly by using immunohistochemistry staining. No significant difference was found regarding quantitative variation of the residual mechanoreceptors about the injury duration.

  9. Intramedullary nailing of tibial shaft fractures.

    Science.gov (United States)

    Kyrö, A; Lamppu, M; Böstman, O

    1995-01-01

    Sixty-four displaced tibial shaft fractures were treated using intramedullary nailing, either primarily or after an attempt at conservative treatment, which consisted of closed reduction under anaesthesia and immobilisation in a long-leg plaster cast. There were 37 closed and 27 open fractures. Three patients had a fracture of both tibiae. The median time period from the intramedullary nailing of the closed solitary fractures to union was about the same after primary nailing as after delayed nailing. Although the fractures were different in these groups, it is possible that the time spent in conservative treatment before intramedullary nailing brings no additional benefits. The incidence of deep infection in open fractures after primary nailing was 1/16. The fractures, in which an acceptable position could not be maintained using conservative methods, were mainly spiral in configuration and located in the distal third or at the junction of the middle and distal thirds of the tibia.

  10. The Relationship between Peripheral Nerve Conduction Velocity and Ophthalmological Findings in Type 2 Diabetes Patients with Early Diabetic Retinopathy

    Directory of Open Access Journals (Sweden)

    Azusa Ito

    2018-01-01

    Full Text Available Purpose. Nerve conduction velocity (NCV is an indicator of neuronal damage in the distal segment of the peripheral nerves. Here, we determined the association between NCV and other systemic and ocular clinical findings, in type 2 diabetes patients with early diabetic retinopathy (DR. Methods. This study included 42 eyes of 42 type 2 diabetes patients (median age: 54 years with no DR or with mild nonproliferative DR. Standard statistical techniques were used to determine associations between clinical findings. Results. Sural sensory conduction velocity (SCV and tibial motor conduction velocity (MCV were significantly lower in mild nonproliferative DR patients than patients with no DR (P=0.008 and P=0.01, resp.. Furthermore, logistic regression analyses revealed that sural SCV and tibial MCV were independent factors contributing to the presence of mild nonproliferative DR (OR 0.83, P=0.012 and OR 0.69 P=0.02, resp.. Tibial MCV was correlated with choroidal thickness (CT (P=0.01, and a multiple regression analysis revealed that age, tibial MCV, and carotid intima-media thickness were independent associating factors with CT (P=0.035, P=0.015, and P=0.008, resp.. Conclusions. Our findings suggest that reduced NCV may be closely associated with early DR in type 2 diabetes patients. Thus, reduced nerve conduction is a potential early biomarker of DR.

  11. Peripheral nervous system maturation in preterm infants: longitudinal motor and sensory nerve conduction studies.

    Science.gov (United States)

    Lori, S; Bertini, Giovanna; Bastianelli, M; Gabbanini, S; Gualandi, D; Molesti, E; Dani, C

    2018-04-10

    To study the evolution of sensory-motor nerves in the upper and lower limbs in neurologically healthy preterm infants and to use sensory-motor studies to compare the rate of maturation in preterm infants at term age and full-term healthy neonates. The study comprised 26 neurologically normal preterm infants born at 23-33 weeks of gestational age, who underwent sensory nerve conduction and motor nerve conduction studies from plantar medial and median nerves and from tibial and ulnar nerves, respectively. We repeated the same neurophysiological studies in 19 of the preterm infants every 2 weeks until postnatal term age. The data from the preterm infants at term was matched with a group of ten full-term babies a few days after birth. The motor nerve conduction velocity of the tibial and ulnar nerves showed progressive increases in values in relation to gestational age, but there was a decrease of values in distal latencies and F wave latencies. Similarly, there was a gradual increase of sensory nerve conduction velocity values of the medial plantar and median nerves and decreases in latencies in relation to gestational age. At term age, the preterm infants showed significantly lower values of conduction velocities and distal latencies than the full-term neonates. These results were probably because the preterm infants had significantly lower weights, total length and, in particular, distal segments of the limbs at term age. The sensory-motor conduction parameters were clearly related to gestational age, but extrauterine life did not affect the maturation of the peripheral nervous system in the very preterm babies who were neurologically healthy.

  12. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures.

    Science.gov (United States)

    Zelle, Boris A; Boni, Guilherme

    2015-01-01

    Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90 % can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.

  13. Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing?

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2004-01-01

    A convenience sample based on availability of tibial stress fracture cases a% local Sports Medicine Clinics will be selected over 4 years until forty subjects (20 male, 20 female) have been treated...

  14. Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2002-01-01

    A convenience sample based on availability of tibial stress fracture cases at local Sports Medicine Clinics will be selected over 2-3 years until forty subjects (20 male, 20 female) have been treated...

  15. Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2003-01-01

    A convenience sample based on availability of tibial stress fracture cases at local Sports Medicine Clinics will be selected over 2-3 years until forty subjects (20 male, 20 female) have been treated...

  16. Management of Posterior Articular Depression in Tibial Plateau Fractures.

    Science.gov (United States)

    Adams, John David; Della Rocca, Gregory J

    2016-01-01

    Fractures involving the posterior aspect of the tibial plateau are challenging fractures to treat. Articular depression in tibial plateau fractures is usually addressed by elevation of the fragment(s), filling the residual defect with bone graft or bone substitute, and "raft" support of the articular fracture reduction with screws through a medially and/or laterally based plate. Posterior tibial plateau articular depression presents unique challenges for obtaining and maintaining fracture reduction. To obtain the goals of anatomic reduction and stable fixation, a thorough understanding of the fracture, specific approaches, reduction techniques, and stabilization strategies is needed. This article reviews the most current strategies for treating tibial plateau fracture patients with posterior articular depression. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Nerve Injuries in Athletes.

    Science.gov (United States)

    Collins, Kathryn; And Others

    1988-01-01

    Over a two-year period this study evaluated the condition of 65 athletes with nerve injuries. These injuries represent the spectrum of nerve injuries likely to be encountered in sports medicine clinics. (Author/MT)

  18. Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    Science.gov (United States)

    2006-12-01

    USA Corresponding author Belinda R. Beck, Ph.D. Griffith University School of Physiotherapy and Exercise Science, PMB 50 Gold Coast Mail Centre Q...accelerate tibial stress fracture healing? Medicine and Science in Sport and Exercise , 31(5, Suppl. 1): 2006 2. Beck B.R., Bergman G., Arendt E...Predicting Recovery from Tibial Stress Fracture Medicine and Science in Sport and Exercise , 31(5, Suppl. 1): 2007 (submitted) 15 Presentations

  19. Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures

    OpenAIRE

    Sandeep Gurung; Dipendra KC; Roshni Khatri

    2016-01-01

    Introduction: Tibia fractures in the skeletally immature patient can usually be treated with above knee cast or patellar tendon bearing cast. The purpose of our study was to evaluate epidemiology and outcome of Elastic stable intramedullary nailing fixation of pediatric tibial shaft fractures treated at our institution. Methods: Over a period of one year, fifty pediatric patients of tibial shaft fractures, with average age of 9.68 yr (SD=2.37), were treated with elastic stable intramedul...

  20. Physeal growth arrest after tibial lengthening in achondroplasia

    Science.gov (United States)

    2012-01-01

    Background and purpose Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with acondroplasia. Methods We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who underwent bilateral tibial lengthening before skeletal maturity (lengthening group L) and 12 achondroplasia patients of similar height and age who did not undergo tibial lengthening (control group C). The mean amount of lengthening of tibia in group L was 9.2 cm (lengthening percentage: 60%) and the mean age at the time of lengthening was 8.2 years. The mean duration of follow-up was 9.8 years. Results Skeletal maturity (fusion of physis) occurred at 15.2 years in group L and at 16.0 years in group C. The actual length of tibia (without distraction) at skeletal maturity was 238 mm in group L and 277 mm in group C (p = 0.03). The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery. Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis. Interpretation Our findings indicate that physeal growth rate can be disturbed after tibial lengthening in achondroplasia, and a close watch should be kept for such an occurrence—especially when lengthening of more than 50% is attempted. PMID:22489887

  1. Displaced tibial shaft fractures treated with ASIF compression internal fixation

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Larsen, T K; Petersen, O C

    1990-01-01

    Fifty-one tibial shaft fractures treated by ASIF compression osteosynthesis were seen at follow-up at a median time of 46 weeks after injury. Twenty-four were open fractures and the patients received prophylactic antibiotics. The median stay in hospital was 15 days for open fractures and 6 days...... for closed fractures. There were complications in 26 cases, with deep infection in 9 cases. At present we cannot advocate the use of ASIF compression osteosynthesis for displaced tibial fractures....

  2. Predicting Atmospheric Ionization and Excitation by Precipitating SEP and Solar Wind Protons Measured By MAVEN

    Science.gov (United States)

    Jolitz, Rebecca; Dong, Chuanfei; Lee, Christina; Lillis, Rob; Brain, David; Curry, Shannon; Halekas, Jasper; Bougher, Stephen W.; Jakosky, Bruce

    2017-10-01

    Precipitating energetic particles ionize and excite planetary atmospheres, increasing electron content and producing aurora. At Mars, the solar wind and solar energetic particles (SEPs) can precipitate directly into the atmosphere because solar wind protons can charge exchange to become neutral and pass the magnetosheath, and SEPs are sufficiently energetic to cross the magnetosheath unchanged. We will compare ionization and Lyman alpha emission rates for solar wind and SEP protons during nominal solar activity and a CME shock front impact event on May 16 2016. We will use the Atmospheric Scattering of Protons and Energetic Neutrals (ASPEN) model to compare excitation and ionization rates by SEPs and solar wind protons currently measured by the SWIA (Solar Wind Ion Analyzer) and SEP instruments aboard the MAVEN spacecraft. Results will help quantify how SEP and solar wind protons influence atmospheric energy deposition during solar minimum.

  3. Improvement of the SEP protocol based on community structure of node degree

    Science.gov (United States)

    Li, Donglin; Wei, Suyuan

    2017-05-01

    Analyzing the Stable election protocol (SEP) in wireless sensor networks and aiming at the problem of inhomogeneous cluster-heads distribution and unreasonable cluster-heads selectivity and single hop transmission in the SEP, a SEP Protocol based on community structure of node degree (SEP-CSND) is proposed. In this algorithm, network node deployed by using grid deployment model, and the connection between nodes established by setting up the communication threshold. The community structure constructed by node degree, then cluster head is elected in the community structure. On the basis of SEP, the node's residual energy and node degree is added in cluster-heads election. The information is transmitted with mode of multiple hops between network nodes. The simulation experiments showed that compared to the classical LEACH and SEP, this algorithm balances the energy consumption of the entire network and significantly prolongs network lifetime.

  4. Peripheral nerve abnormalities in pediatric patients with spinal muscular atrophy.

    Science.gov (United States)

    Yonekawa, Takahiro; Komaki, Hirofumi; Saito, Yuko; Sugai, Kenji; Sasaki, Masayuki

    2013-02-01

    We examined the specific nerve conduction deficits distinguishing spinal muscular atrophy (SMA) subtypes I and II. Five SMA I patients (age, 0.2-1.1 years) and 10 SMA II patients (age, 1.0-2.8 years) were examined. Patients were compared to age-matched controls for motor and sensory conduction velocity (MCV and SCV) changes, compound muscle and sensory nerve action potential amplitudes (CMAP and SNAP), and F-wave occurrence (FO). Slower MCVs were found in three of five SMA I patients; all five exhibited markedly decreased CMAP amplitudes. Tibial nerve CMAP amplitudes significantly reduced in SMA II patients (pnerve of SMA II patients (p=0.031). Loss of motor units may be widespread in the early stage of SMA I, while specific to the legs in young SMA II patients. SMA I showed sensory nerve degeneration, especially of large myelinated fibers. SMA II showed no sensory nerve abnormalities. Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  5. Evaluation of Na+/K+ pump function following repetitive activity in mouse peripheral nerve

    DEFF Research Database (Denmark)

    Moldovan, Mihai; Krarup, Christian

    2006-01-01

    After conduction of prolonged trains of impulses the increased Na+/K+ pump activity leads to hyperpolarization. The aim of this study was to develop a mouse model to investigate the Na+/K+ pump function in peripheral nerve by measuring the decrease in excitability during activity...... change after repetitive stimulation of the mouse tibial nerve is an indicator of the Na+/K+ pump function in vivo. Evaluation of activity-dependent hyperpolarization may be an important indicator of axonal ability to cope with Na+ load....

  6. [Custom-designed 3D tibial augmentation for knee replacement].

    Science.gov (United States)

    Jirman, R; Vavrík, P; Horák, Z

    2009-02-01

    Reconstruction with the use of custom-made implants aims at optimal replacement of lost or damaged bone structures and restoration of their funkction. In this study the development and construction of a custom-made implant and the operative technique used for the treatment of an extensive tibial defect are described. The patient was a 65-year-old man treated for over 20 years for psoriatic arthritis and severe instability of the right knee, particularly in the frontal plane, with a worsening varus deformity. The radiogram showed an extensive destruction of the medial tibial condyle that also deeply involved the lateral condyle. The extent of defect made it impossible to use any commercial tibial augmentation. The geometry of the custom-designed implant for the medial tibial condyle was constructed on the basis of a 3D defect model and the shape of the medial tibial condyle of the collateral knee seen on CT scans. After its correct shape was verified on a plastic model, its coordinates were set in the software of a machine tool, and a titanium augmentation otherwise compatible with a standard knee replacement was produced.The use of such a custom implant to complete standard total knee arthroplasty has so far been demanding in terms of organisation and manufacture. Its production in the future could be facilitated by substituting titanium for plastic material such as poly-ether-ether-ketone (PEEK). Key words: custom-made implant, tibial augmentation, knee prosthesis.

  7. Nonreamed interlocked intramedullary tibial nailing. One community's experience.

    Science.gov (United States)

    Duwelius, P J; Schmidt, A H; Rubinstein, R A; Green, J M

    1995-06-01

    Forty-nine acute displaced tibial fractures (31 closed, 18 open: 5 Grade I, 7 Grade II, 4 Grade IIIA, and 2 Grade IIIB) were treated in 1 community with a standard operative protocol using a distractor without a fracture table, and an unreamed interlocked tibial nail. Forty-six fractures healed (94%). Complications included 3 nonunions (6%), 2 deep infections (4%), 9 delayed unions (18%), 4 angular malunions (8%), 2 rotatory malunions (4%), and 12 interlocking screws bent or broke (24%). Twenty-eight patients (57%) required at least 1 additional operation to obtain union, most commonly dynamization of a statically locked nail. The authors conclude that unreamed tibial nails provide adequate stabilization of displaced tibial fractures and can be used in the management of most open or closed tibial fractures. However, static locking is required in axially unstable fractures. Early dynamization or exchange nailing and bone grafting should be considered to hasten union and avoid screw failure. The distractor is an excellent adjunctive technique for reduction and alignment of tibial shaft fractures during intramedullary nailing.

  8. Optic Nerve Pit

    Science.gov (United States)

    ... Conditions Frequently Asked Questions Español Condiciones Chinese Conditions Optic Nerve Pit What is optic nerve pit? An optic nerve pit is a ... may be seen in both eyes. How is optic pit diagnosed? If the pit is not affecting ...

  9. Deficiency in monocarboxylate transporter 1 (MCT1) in mice delays regeneration of peripheral nerves following sciatic nerve crush

    KAUST Repository

    Morrison, Brett M.

    2015-01-01

    Peripheral nerve regeneration following injury occurs spontaneously, but many of the processes require metabolic energy. The mechanism of energy supply to axons has not previously been determined. In the central nervous system, monocarboxylate transporter 1 (MCT1), expressed in oligodendroglia, is critical for supplying lactate or other energy metabolites to axons. In the current study, MCT1 is shown to localize within the peripheral nervous system to perineurial cells, dorsal root ganglion neurons, and Schwann cells by MCT1 immunofluorescence in wild-type mice and tdTomato fluorescence in MCT1 BAC reporter mice. To investigate whether MCT1 is necessary for peripheral nerve regeneration, sciatic nerves of MCT1 heterozygous mice are crushed and peripheral nerve regeneration was quantified electrophysiologically and anatomically. Compound muscle action potential (CMAP) recovery is delayed from a median of 21. days in wild-type mice to greater than 38. days in MCT1 heterozygote mice. In fact, half of the MCT1 heterozygote mice have no recovery of CMAP at 42. days, while all of the wild-type mice recovered. In addition, muscle fibers remain 40% more atrophic and neuromuscular junctions 40% more denervated at 42. days post-crush in the MCT1 heterozygote mice than wild-type mice. The delay in nerve regeneration is not only in motor axons, as the number of regenerated axons in the sural sensory nerve of MCT1 heterozygote mice at 4. weeks and tibial mixed sensory and motor nerve at 3. weeks is also significantly reduced compared to wild-type mice. This delay in regeneration may be partly due to failed Schwann cell function, as there is reduced early phagocytosis of myelin debris and remyelination of axon segments. These data for the first time demonstrate that MCT1 is critical for regeneration of both sensory and motor axons in mice following sciatic nerve crush.

  10. Characterization of SEP events at high heliographic latitudes

    International Nuclear Information System (INIS)

    Dalla, S.; Balogh, A.; Krucker, S.; Posner, A.; Mueller-Mellin, R.; Anglin, J.D.; Hofer, M.Y.; Marsden, R.G.; Sanderson, T.R.; Heber, B.; Zhang, M.; McKibben, R.B.

    2003-01-01

    Between February 2000 and May 2002, the Ulysses spacecraft made the first ever measurements of solar energetic particles (SEPs) at high heliographic latitudes. Nine large gradual SEP events were detected at latitudes greater than 45 deg., their signatures being clearest at high particle energies, i.e. protons >30 MeV and electrons >0.1 MeV. In this paper we measure the onset times of Ulysses high latitude events in several energy channels, and plot them versus inverse particle speed. We repeat the procedure for near Earth observations by Wind and SOHO. Velocity dispersion is observed in all the events near Earth and in most of them at Ulysses. The plots of onset times versus inverse speed allow to derive an experimental path length and time of release from the solar atmosphere. We find that the derived path lengths at Ulysses are longer than the length of a Parker spiral magnetic field line connecting it to the Sun, by a factor between 1.2-2.7. The time of particle release from the Sun is typically between 100 and 200 mins later than the release time derived from in-ecliptic measurements. Unlike near Earth observations, Ulysses measurements are therefore not compatible with scatter-free propagation from the Sun to the spacecraft

  11. Eight years' clinical experience with the Orthofix tibial nailing system in the treatment of tibial shaft fractures.

    Science.gov (United States)

    Babis, George C; Benetos, Ioannis S; Karachalios, Theofilos; Soucacos, Panayotis N

    2007-02-01

    Intramedullary nailing has become a popular and effective procedure for the treatment of most tibial fractures. However, concerns regarding difficulties with reduction, the use and extent of intramedullary reaming, and hardware failure are probably the only constraints to its widespread use. In this prospective study, we present the clinical and radiographic results of the Orthofix tibial nailing system used in the treatment of tibial shaft fractures. One hundred and fifteen fresh tibial fractures in the same number of patients with a mean age of 37.5 years (17-85 years) were treated with operative stabilisation using the Orthofix tibial nailing system. All of the operations took place in a conventional operating theatre, on a simple tranlucent operating table and with manual reduction of the fracture. In the majority of the cases closed reduction and conventional reaming were performed and the mean duration of the operation was 38 min. Fracture healing occurred at 16 weeks (11-30 weeks) and was confirmed both clinically and radiographically. In six cases (two severely comminuted and four segmental fractures) delayed union occurred, however there were no tibial non-unions necessitating re-operation. There were no substantial differences in time to fracture union or in the rate of complications related to minimal open reduction. In addition, there seem to be more benefits than risks in the use of power intramedullary reaming during intramedullary fixation of tibial shaft fractures. In conclusion, most tibial shaft fractures can effectively and safely be treated using this type of locking intramedullary nailing device, with relatively few complications, and with satisfactory long-term clinical results.

  12. 75 FR 7284 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP...

    Science.gov (United States)

    2010-02-18

    ... review, discussion, and evaluation of applications received in response to ``Institutional Collaboration... Control Special Emphasis Panel (SEP): Institutional Collaboration Between Liverpool School of Tropical...

  13. Flare magnetic reconnection fluxes as possible signatures of flare contributions to gradual SEP events

    Science.gov (United States)

    Kahler, S. W.; Kazachenko, M.; Lynch, B. J.; Welsch, B. T.

    2017-09-01

    The primary sources of solar energetic (E > 20 MeV) particle (SEP) events are flares and CME-driven shocks. Some studies claim that even up to GeV energies solar flares are major contributors to SEP events. There are several candidate flare processes for producing SEPs, but acceleration in magnetic reconnection regions is probably the most efficient. Previous studies have relied on flare radiation signatures to determine the times and locations of SEP injections. An alternative approach is to use the amount of magnetic flux that gets reconnected during solar flares. The photospheric magnetic flux swept out by flare ribbons is thought to be directly related to the amount of magnetic reconnection in the corona and is therefore a key diagnostic tool for understanding the physical processes in flares and CMEs. We use the database of flare magnetic reconnection fluxes to compare these parameters with peak intensities of SEP events. We find that while sizes of 15 ∼25-MeV SEP events in the western hemisphere correlate with both CME speeds and reconnection fluxes, there are many cases of large reconnection fluxes with no observed SEP events. The occurrence of large reconnection fluxes accompanied by slow CMEs but no SEP events suggests that the CME shocks are the primary, if not the only, sources of high energy (E > 100 MeV) SEP events.

  14. Using satellite data for forecasting radiation hazards due to great SEP events

    Science.gov (United States)

    Lev, Dorman; Zukerman, Igor; Pustilnik, Lev; Dai, Uri; Shternlib, Abracham; Shai Applbaum, David; Kazantsev, Vasilii; Ben Israel, Isaac; Fatima, Keshtova

    The model is based on one minute satellite data (e.g., from the GOES series) available on the Internet in different energy ranges (from 4 MeV up to 500 MeV). First, we developed a program that automatically determines the beginning of an SEP by continuously analysing satellite data After the start of an SEP, we determine the SEP energy spectrum by using data in the four largest energy ranges. After a few (at least 4) minutes, we try to solve the inverse problem of SEP generation and propagation and estimate on the basis of determined changes of SEP energy spectrum in time the following main parameters: time of ejection into solar wind, energy spectrum of SEP generation, two-parametric diffusion coefficient in dependence of energy and distance from the Sun. With each new minute of observation obtained results of the inverse problem solution became more and more exactly. For each new minute of observation we then solve direct problem (by using estimated values of time of ejection into solar wind, energy spectrum of SEP generation, two-parametric diffusion coefficient) and determine expected SEP fluxes in different energy ranges not only during observed time (for checking solution of inverse problem), but also expected SEP fluxes in near future for forecasting of expected total radiation hazard in space, in magnetosphere, and in atmosphere for spacecrafts, satellites, and airplanes.

  15. In vitro comparison of tibial plateau leveling osteotomy with and without use of a tibial plateau leveling jig.

    Science.gov (United States)

    Schmerbach, Kay Ingo; Boeltzig, Christian Konrad Matthias; Reif, Ullrich; Wieser, Jan Carsten; Keller, Thomas; Grevel, Vera

    2007-02-01

    To evaluate the influence of a tibial plateau leveling jig on osteotomy orientation, fragment reduction, and postoperative tibial plateau angle (TPA) during tibial plateau leveling osteotomy (TPLO). In vitro experimental study. Large-breed canine cadavers (n=20). TPLO was performed on 40 hindlimbs using 4 methods. Group 1: Jig; dogs in dorsal recumbency with the osteotomy parallel to the distal jig pin. Groups 2-4: No jig; dogs in lateral recumbency with the osteotomy in a vertical orientation (group 2: tibia parallel to the table top; group 3: controlled superimposition of the femoral condyles; group 4: internal rotation of the tibia). Postoperative TPA, fragment reduction, and osteotomy orientation relative to the tibial plateau were compared. Positive or negative values denoted deviation from parallel relative to the tibial plateau. Postoperative TPA, fragment reduction, and proximodistal osteotomy orientation were not significantly different between groups. Craniocaudal osteotomy orientation was significantly different (Pjig is not essential for osteotomy orientation, tibial plateau rotation, or fragment reduction. Comparable results were achieved performing a vertical osteotomy with the tibia slightly internally rotated (10 degrees -15 degrees) and parallel to the table surface. TPLO without use of a jig reduces surgical trauma, is less time consuming, and reduces cost.

  16. Optic nerve oxygenation

    DEFF Research Database (Denmark)

    Stefánsson, Einar; Pedersen, Daniella Bach; Jensen, Peter Koch

    2005-01-01

    The oxygen tension of the optic nerve is regulated by the intraocular pressure and systemic blood pressure, the resistance in the blood vessels and oxygen consumption of the tissue. The oxygen tension is autoregulated and moderate changes in intraocular pressure or blood pressure do not affect...... the optic nerve oxygen tension. If the intraocular pressure is increased above 40 mmHg or the ocular perfusion pressure decreased below 50 mmHg the autoregulation is overwhelmed and the optic nerve becomes hypoxic. A disturbance in oxidative metabolism in the cytochromes of the optic nerve can be seen...... at similar levels of perfusion pressure. The levels of perfusion pressure that lead to optic nerve hypoxia in the laboratory correspond remarkably well to the levels that increase the risk of glaucomatous optic nerve atrophy in human glaucoma patients. The risk for progressive optic nerve atrophy in human...

  17. Optic nerve oxygenation

    DEFF Research Database (Denmark)

    Stefánsson, Einar; Pedersen, Daniella Bach; Jensen, Peter Koch

    2005-01-01

    at similar levels of perfusion pressure. The levels of perfusion pressure that lead to optic nerve hypoxia in the laboratory correspond remarkably well to the levels that increase the risk of glaucomatous optic nerve atrophy in human glaucoma patients. The risk for progressive optic nerve atrophy in human...... glaucoma patients is six times higher at a perfusion pressure of 30 mmHg, which corresponds to a level where the optic nerve is hypoxic in experimental animals, as compared to perfusion pressure levels above 50 mmHg where the optic nerve is normoxic. Medical intervention can affect optic nerve oxygen......-oxygenase inhibitor, indomethacin, which indicates that prostaglandin metabolism plays a role. Laboratory studies suggest that carbonic anhydrase inhibitors might be useful for medical treatment of optic nerve and retinal ischemia, potentially in diseases such as glaucoma and diabetic retinopathy. However, clinical...

  18. The adductor part of the adductor magnus is innervated by both obturator and sciatic nerves.

    Science.gov (United States)

    Takizawa, Megumi; Suzuki, Daisuke; Ito, Hajime; Fujimiya, Mineko; Uchiyama, Eiichi

    2014-07-01

    The hip adductor group, innervated predominantly by the obturator nerve, occupies a large volume of the lower limb. However, case reports of patients with obturator nerve palsy or denervation have described no more than minimal gait disturbance. Those facts are surprising, given the architectural characteristics of the hip adductors. Our aim was to investigate which regions of the adductor magnus are innervated by the obturator nerve and by which sciatic nerve and to consider the clinical implications. Twenty-one lower limbs were examined from 21 formalin-fixed cadavers, 18 males and 3 females. The adductor magnus was dissected and was divided into four parts (AM1-AM4) based on the locations of the perforating arteries and the adductor hiatus. AM1 was supplied solely by the obturator nerve. AM2, AM3, and AM4 received innervation from both the posterior branch of the obturator nerve and the tibial nerve portion of the sciatic nerve in 2 (9.5%), 20 (95.2%), and 6 (28.6%) of the cadavers, respectively. The double innervation in more than 90% of the AM3s is especially noteworthy. Generally, AM1-AM3 corresponds to the adductor part, traditionally characterized as innervated by the obturator nerve, and AM4 corresponds to the hamstrings part, innervated by the sciatic nerve. Here, we showed that the sciatic nerve supplies not only the hamstrings part but also the adductor part. These two nerves spread more widely than has generally been believed, which could have practical implications for the assessment and treatment of motor disability. Copyright © 2013 Wiley Periodicals, Inc.

  19. Imaging the trigeminal nerve

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Alexandra [Radiology Department, Instituto Portugues de Oncologia Francisco Gentil, Centro de Lisboa, Rua Prof. Lima Basto, 1093, Lisboa (Portugal)], E-mail: borgalexandra@gmail.com; Casselman, Jan [Department of Radiology, A. Z. St Jan Brugge and A. Z. St Augustinus Antwerpen Hospitals (Belgium)

    2010-05-15

    Of all cranial nerves, the trigeminal nerve is the largest and the most widely distributed in the supra-hyoid neck. It provides sensory input from the face and motor innervation to the muscles of mastication. In order to adequately image the full course of the trigeminal nerve and its main branches a detailed knowledge of neuroanatomy and imaging technique is required. Although the main trunk of the trigeminal nerve is consistently seen on conventional brain studies, high-resolution tailored imaging is mandatory to depict smaller nerve branches and subtle pathologic processes. Increasing developments in imaging technique made possible isotropic sub-milimetric images and curved reconstructions of cranial nerves and their branches and led to an increasing recognition of symptomatic trigeminal neuropathies. Whereas MRI has a higher diagnostic yield in patients with trigeminal neuropathy, CT is still required to demonstrate the bony anatomy of the skull base and is the modality of choice in the context of traumatic injury to the nerve. Imaging of the trigeminal nerve is particularly cumbersome as its long course from the brainstem nuclei to the peripheral branches and its rich anastomotic network impede, in most cases, a topographic approach. Therefore, except in cases of classic trigeminal neuralgia, in which imaging studies can be tailored to the root entry zone, the full course of the trigeminal nerve has to be imaged. This article provides an update in the most recent advances on MR imaging technique and a segmental imaging approach to the most common pathologic processes affecting the trigeminal nerve.

  20. MRI-validation of SEP monitoring for ischemic events during microsurgical clipping of intracranial aneurysms.

    Science.gov (United States)

    Krayenbühl, Niklaus; Sarnthein, Johannes; Oinas, Minna; Erdem, Eren; Krisht, Ali F

    2011-09-01

    During surgical clipping of intracranial aneurysms, reduction in SEP amplitude is thought to indicate cortical ischemia and subsequent neurological deficits. Since the sensitivity of SEP is questioned, we investigated SEP with respect to post-operative ischemia. In 36 patients with 51 intracranial aneurysms, clinical evaluation and diffusion-weighted MRI (DWI) was performed before and within 24h after surgery. During surgery, time of temporary occlusion was recorded. MRI images were reviewed for signs of ischemia. For 43 clip applications (84%), we observed neither pathologic SEP events nor ischemia in MRI. In two cases where reduction lasted >10 min after clip release, SEP events correlated with ischemia in the MRI. Only one of the ischemic patients was symptomatic and developed a transient hemiparesis. While pathologic SEP events correlated with visible ischemia in MRI only in two cases with late SEP recovery, ischemia in MRI may have been transient or may not have reached detection threshold in the other cases, in agreement with the absence of permanent neurological deficits. In complex aneurysm cases, where prolonged temporary occlusion is expected, SEP should be used to detect ischemia at a reversible stage to improve the safety of aneurysm clipping. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  1. 76 FR 55741 - Proposed Collection; Comment Request for Form 5305-SEP

    Science.gov (United States)

    2011-09-08

    ... Pension-Individual Retirement Accounts Contribution Agreement. DATES: Written comments should be [email protected] . SUPPLEMENTARY INFORMATION: Title: Simplified Employee Pension-Individual Retirement Accounts Contribution Agreement. OMB Number: 1545-0499. Form Number: 5305-SEP. Abstract: Form 5305-SEP is...

  2. External skeletal fixation of the tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Milenković Saša

    2005-01-01

    Full Text Available Aim. To present the possibility of a successful use of external skeletal fixation in treating the open and closed tibial shaft fractures with Mitković’s external fixator. Methods. External fixation was used in 115 patients with 118 fresh tibial shaft fractures, 82 males (71.3% and 33 females (28.7%, average age 43.92 years (16−84. Open tibial shaft fractures were present in 37 (31.36%. All the fractures were treated with Mitković’s external fixator type M 20. Results. The results of external fixation were excellent or good in 94.07% of the cases, and bad in 5.08%. Pin tract infection appeared in 7 (5.93% patients. In only 3 cases an external fixator was removed and treatment continued with the functional braces. Nonunion occurred in 6 (5.08% patients, of which 4 were with open fractures (2 Gustilo type IIIB, 1 Gustilo type IIIA, 1 Gustilo type II and 2 with the segment fractures. Compartment syndrome was observed in 1 (0.85% patient with closed fracture. Malunion was found in 2 (1.69% patients. Conclusion. External fixation of tibial shaft fractures is a simple and effective method to enable the safe healing of fractures, early mobilization of the patients, early weight-bearing, as well as early rehabilitation. Fixation of tibial shaft fractures was unilateral with convergent pins orientation, and there was also a possibility of compression and distraction.

  3. [External skeletal fixation of the tibial shaft fractures].

    Science.gov (United States)

    Milenković, Sasa; Mitković, Milorad; Radenković, Mile

    2005-01-01

    To present the possibility of a succesfful use of external skelatal fixation in treating the open and closed tibial shaft fractures with Mitković's external fixator. External fixation was used in 115 patients with 118 fresh tibial shaft fractures, 82 males (71.3%) and 33 females (28.7%), average age 43.92 years (16-84). Open tibial shaft fractures were present in 37 (31.36%). All the fractures were treated with Mitković's external fixator type M 20. The results of external fixation were excellent or good in 94.07% of the cases, and bad in 5.08%. Pin tract infection appeared in 7 (5.93%) patients. In only 3 cases an external fixator was removed and treatment continued with the functional braces. Nonunion occurred in 6 (5.08%) patients, of which 4 were with open fractures (2 Gustilo type IIIB, 1 Gustilo type IIIA, 1 Gustilo type II) and 2 with the segment fractures. Compartment syndrome was observed in 1 (0.85%) patient with closed fracture. Malunion was found in 2 (1.69%) patients. External fixation of tibial shaft fractures is a simple and effective method to enable the safe healing of fractures, early mobilization of the patients, early weight-bearing, as well as early rehabilitation. Fixation of tibial shaft fractures was unilateral with convergent pins orientation, and there was also a possibility of compression and distraction.

  4. Spontaneous collapse of the tibial plateau: radiological staging

    International Nuclear Information System (INIS)

    Carpintero, P.; Leon, F.; Zafra, M.; Montero, R.; Carreto, A.

    2005-01-01

    This paper proposes a radiological staging system for necrosis of the tibial plateau, similar to those already developed for the hip and the medial femoral condyle. We retrospectively studied the clinical case histories and radiographic findings of 14 patients (15 affected knees) with histologically proven osteonecrosis of the tibial plateau. Stage I was marked by normal radiograph, but increased uptake in bone scan and subchondral areas of abnormal marrow signal intensity in magnetic resonance imaging (MRI), as reported in other osteonecrosis sites. Stage II was characterised by cystic and sclerotic changes, and stage III fracture of the medial rim of the medial tibial plateau and tibial plateau collapse were present. Stage IV was marked by joint narrowing. These changes appeared earlier and were more pronounced when there was genu varum/valgum or involvement of the lateral tibial plateau. The radiological evolution of the disease appears to follow a four-stage course over a period of roughly one year from the onset of symptoms. (orig.)

  5. Reconstrucción tibial: transferencia sóleo-peroné ipsilateral. Tibialización peroneal Tibial reconstruction: ipsilateral soleus-fibula transfer. Fibular tibialization

    Directory of Open Access Journals (Sweden)

    E. Revelo Jiron

    2009-12-01

    Full Text Available Las transferencias óseas peroneales en forma libre o ipsilateral han sido propuestas para la reconstrucción de grandes defectos tibiales. Están también descritas varias modificaciones al respecto, siendo una de ellas la constitución de un colgajo compuesto soleo-peroné realizado como transferencia libre. En este estudio presentamos nuestra experiencia con esta variante, pero en forma ipsilateral. logrando la reconstrucción del defecto tibial por medio de la tibialización peroneal. Escogimos realizar un colgajo compuesto soleo-peroné ipsilateral a flujo anterógrado o retrogrado para la reconstrucción de una serie personal de 14 pacientes consecutivos, 13 hombre y 1 mujer, con edad media de 30 años, y con amplios defectos tibiales y de tejidos blandos causados por accidentes de transito en 12 casos, 1 por proyectil balístico y 1 por artefacto explosivo artesanal. El promedio de tamaño del defecto tibial fue de 9.4 cm. Elegimos la forma ipsilateral por no disponer de infraestructura adecuada para realizar una transferencia libre. La serie de estudio se realizó durante el periodo comprendido entre Abril de 1995 y Abril del 2005. Todos los colgajos sobrevivieron. Dos pacientes desarrollaron pseudoartrosis. El apoyo completo y la marcha en 12 pacientes, se logró en un periodo promedio de 9 meses. El seguimiento postoperatorio ha sido de 3 a 6 años. Doce pacientes se han incorporado a la vida activa. Discutimos algunos aspectos prácticos de la técnica como resultado de la experiencia quirúrgica obtenida de esta serie personal. Consideramos que el método es fiable, fácil de realizar y proporciona excelentes resultados.Fibular flaps such as in there free form or as ipsilateral transfers have been proposed for reconstruction of large tibial defects. Several modifications have been described for the use of this flap. In this study we will present our experience using the ipsilateral transfer of an osteomuscular soleous fibular flap

  6. Space Weather at Mars: MAVEN and MSL/RAD Observations of CME and SEP Events

    Science.gov (United States)

    Lee, C. O.; Ehresmann, B.; Lillis, R. J.; Dunn, P.; Rahmati, A.; Larson, D. E.; Guo, J.; Zeitlin, C.; Luhmann, J. G.; Halekas, J. S.; Espley, J. R.; Thiemann, E.; Hassler, D.

    2017-12-01

    While MAVEN have been observing the space weather conditions driven by ICMEs and SEPs in orbit around Mars, MSL/RAD have been measuring the surface radiation environment due to E > 150 MeV/nuc SEPs and the higher-energy galactic cosmic rays. The suite of MAVEN instruments measuring the particles (SEP), plasma (SWIA) and fields (MAG) information provides detailed local space weather information regarding the solar activity-related fluctuations in the measured surface dose rates. At the same time, the related enhancements in the RAD surface dose rates indicate the degree to which the SEPs affect the lower atmosphere and surface. We will present an overview of the MAVEN observations together with the MSL/RAD measurements and focus our discussion on a number of space weather events driven by CMEs and SEPs. During the March 2015 solar storm period, a succession of CMEs produced intense SEP proton fluxes that were detected by MAVEN/SEP in the 20 keV to 6 MeV detected energy channels. At higher energies, MAVEN/SEP record `FTO' SEP events that were triggered by > 13 MeV energetic protons passing through all three silicon detector layers (Front, Thick, and Open). Using the detector response matrix for an FTO event (incident energy vs detected energy), the minimum incident energy of the SEP protons observed in March 2015 was inferred to be > 40 MeV. The lack of any notable enhancements in the surface dose rate by MSL/RAD suggests that the highest incident energies of the SEP protons were energy channels. However, MAVEN/SEP did record an FTO event that coincided with the RAD dose rate enhancement, all of which suggest that > 150 MeV SEP protons impacted the Martian atmosphere and surface. The source of the October 2015 SEP event was probably the CME that erupted near the solar west limb with respect to the Sun-Mars line. As part of the discussion, we will also show solar-heliospheric observations from near-Earth assets together with WSA-Enlil-cone results for some global

  7. Tibial rotational osteotomy and distal tuberosity transfer for patella subluxation secondary to excessive external tibial torsion: surgical technique and clinical outcome.

    Science.gov (United States)

    Drexler, M; Dwyer, T; Dolkart, O; Goldstein, Y; Steinberg, E L; Chakravertty, R; Cameron, J C

    2014-11-01

    Recurrent patella subluxation may be secondary to excessive external tibial torsion. The purpose of this study is to evaluate the clinical and radiographic outcome of patients undergoing tibial derotation osteotomy and tibial tuberosity transfer for recurrent patella subluxation in association with excessive external tibial torsion. A combined tibial derotation osteotomy and tibial tuberosity transfer was performed in 15 knees (12 patients) with recurrent patella subluxation secondary to excessive external tibial torsion. Clinical evaluation was carried out using preoperative and post-operative Knee Society Score (KSS), Kujala Patellofemoral score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, the short form-12 (SF-12) and a visual analogue score (VAS) pain scale. The median follow-up period was 84 months (range 15-156) and median patient age was 34 years (range 19-57 years). The median preoperative external tibial torsion was 62° (range 55°-70°), with a median rotational correction of 36° (range 30°-45°) after surgery. Significant improvement (p 45° who underwent tibial derotation osteotomy and tibial tuberosity transfer achieved a satisfactory outcome in terms of pain relief and improved function. A significant complication was seen in 2/15 patients. Case series, Level IV.

  8. Bilateral tibial agenesis and syndactyly in a cat.

    Science.gov (United States)

    Di Dona, Francesco; Murino, Carla; Della Valle, Giovanni; Fatone, Gerardo

    2016-07-19

    A three-year-old cat was referred to the Veterinary Teaching Hospital, University of Naples, Italy. The cat had severe pelvic limb deformity, and abnormal development of all four paws. Radiographs revealed bilateral tibial agenesis, syndactyly, and digital hypoplasia. No treatment was instituted because of the severity of the injury, the adaptation of the cat to the abnormal condition, and the owner's refusal to permit any treatment. Congenital limb deformities are rarely reported in the cat and tibial agenesis is considered a very rare disease. This congenital anomaly is well documented and classified in man, and it has been associated with other abnormalities in more complex syndromes. This paper reports clinical and radiographic findings in a cat affected by bilateral complete tibial agenesis associated with other congenital anomalies.

  9. Increased external tibial torsion in Osgood-Schlatter disease.

    Science.gov (United States)

    Gigante, Antonio; Bevilacqua, Claudia; Bonetti, Massimo G; Greco, Francesco

    2003-08-01

    We studied the relationship between Osgood-Schlatter disease and torsional abnormalities of the lower limb in 21 boys with this condition and 20 age- and sex-matched controls. 3 groups of knees (20 control knees, 21 symptomatic and 21 asymptomatic or less symptomatic knees) were subjected to clinical, radiographic and CT evaluation. We found no statistically significant differences between patients and controls, as regards femoral anteversion, patellar congruence angle, patellar tilt angle and anterior tibial tuberosity-trochlear groove distance, but the condylomalleolar angle and tibial torsion angle were greater in patients. We found no differences between symptomatic and asymptomatic or less symptomatic knees in any of the parameters. All the symptomatic knees were on the side preferentially involved in jumping and sprinting. This increase in external tibial torsion may play a role as a predisposing mechanical factor in the onset of Osgood-Schlatter disease in male athletes.

  10. Osteoarthritis Imaging by Quantification of Tibial Trabecular Bone

    DEFF Research Database (Denmark)

    Marques, Joselene

    The pathogenesis of osteoarthritis (OA) includes complex events in the whole joint. In this project, we combined machine-learning techniques in a texture analysis framework and evaluated it in a longitudinal study, where magnetic resonance images of knees were used to quantify the tibial trabecular...... bone in both a marker for OA diagnosis and another marker for prediction of tibial cartilage loss. By multiple-instance learning, we also investigated which region of the tibia provided the best prognosis for cartilage loss. The inferior part of the tibial bone was classified as the most relevant...... region and a preliminary radiological reading of the knees with high and low risks of cartilage loss suggested the prognosis marker captured aspects of the tibia vertical trabecularization to define the prognosis. Besides presenting a bone marker able to predict disease progression and diagnostic marker...

  11. Modified fracture brace for tibial fracture with varus angulation: a case report.

    Science.gov (United States)

    Tang, S F; Au, T L; Wong, A M; Lee, M Y

    1995-08-01

    Sarmiento introduced the functional fracture brace for the management of tibial shaft fracture in 1963. However, tibial angulation with varus deformity cannot be prevented or corrected by such a device. In this paper, a case of tibial shaft fracture with varus angulation treated with a modified below-knee fracture brace was reported.

  12. tibialization of the fibula in a child with chronic osteomyelitis of the ...

    African Journals Online (AJOL)

    used in tibial reconstruction after resection of Ewing's sarcoma (6). A case report from Congo detailed how a 10-centimeter tibial bone loss was treated by inter- tibiofibula bone grafting, resulting in tibialization of the fibula. The patient was reviewed after 10 years; and the clinical result was satisfactory and stable (7).

  13. Treadmill Training Enhances Axon Regeneration In Injured Mouse Peripheral Nerves Without Increased Loss of Topographic Specificity

    Science.gov (United States)

    English, Arthur W.; Cucoranu, Delia; Mulligan, Amanda; Sabatier, Manning

    2009-01-01

    We investigated the extent of misdirection of regenerating axons when that regeneration was enhanced using treadmill training. Retrograde fluorescent tracers were applied to the cut proximal stumps of the tibial and common fibular nerves two or four weeks after transection and surgical repair of the mouse sciatic nerve. The spatial locations of retrogradely labeled motoneurons were studied in untreated control mice and in mice receiving two weeks of treadmill training, either according to a continuous protocol (10 m/min, one hour/day, five day/week) or an interval protocol (20 m/min for two minutes, followed by a five minute rest, repeated 4 times, five days/week). More retrogradely labeled motoneurons were found in both treadmill trained groups. The magnitude of this increase was as great as or greater than that found after using other enhancement strategies. In both treadmill trained groups, the proportions of motoneurons labeled from tracer applied to the common fibular nerve that were found in spinal cord locations reserved for tibial motoneurons in intact mice was no greater than in untreated control mice and significantly less than found after electrical stimulation or chondroitinase treatment. Treadmill training in the first two weeks following peripheral nerve injury produces a marked enhancement of motor axon regeneration without increasing the propensity of those axons to choose pathways leading to functionally inappropriate targets. PMID:19731339

  14. Nanofiber Nerve Guide for Peripheral Nerve Repair and Regeneration

    Science.gov (United States)

    2016-04-01

    project was to develop an alternative to autologous nerve grafts used in repair of peripheral nerve injuries in war and civilian life. Based on our...gradient compositions tested in Aim 1 in preparation to studies in the large animal model of peripheral nerve injury and repair . As it was not...this specific aim was to test the efficacy of optimized nanofiber nerve guide in a canine model of peripheral nerve injury and repair . Peripheral nerve

  15. Tibial tuberosity excision for symptomatic Osgood-Schlatter disease.

    Science.gov (United States)

    Flowers, M J; Bhadreshwar, D R

    1995-01-01

    A modified Ferciot procedure was used to excise the tibial tubercle in patients with persistently symptomatic Osgood-Schlatter disease. Forty-two knees in 35 patients were reviewed at a mean follow-up of 5 years to assess outcome. The results revealed relief of pain in 95% of patients and reduction of prominence in 85.5% with minimal complication, in particular no evidence of genu recurvatum. The pathogenesis of the condition is outlined, and some of the theories and treatment modalities discussed. Tibial tubercle excision is recommended as the treatment of choice in those few cases that fail with conservative treatment.

  16. Ischial hypoplasia, tibial hypoplasia and facial abnormalities: a new syndrome?

    International Nuclear Information System (INIS)

    Nishimura, G.; Haga, Yoshihiko; Aoki, Katsuhiko; Hasegawa, Tomoko

    1998-01-01

    A child with facial abnormalities, short stature and a variety of skeletal alterations is reported. The facial abnormalities comprised low-set ears, short nose with a long philtrum, micrognathia and cleft palate. The skeletal alterations included ischial hypoplasia, malformations of the cervical spine, hypoplasia of the lesser trochanters, tibial hypoplasia with bowing of the lower legs, tibio-fibular diastasis with malformed distal tibial epiphyses, clubfeet and brachymesophalangy. The constellation of clinical and radiological findings in the present patient do not fit any known malformation syndrome. (orig.)

  17. Ischial hypoplasia, tibial hypoplasia and facial abnormalities: a new syndrome?

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, G. [Department of Radiology, Dokkyo University School of Medicine (Japan); Haga, Yoshihiko [Department of Orthopaedics, Shizuoka Children`s Hospital, Shizuoka (Japan); Aoki, Katsuhiko [Department of Radiology, Shizuoka Children`s Hospital, Shizuoka (Japan); Hasegawa, Tomoko [Division of Clinical Genetics, Shizuoka Children`s Hospital, Shizuoka (Japan)

    1998-12-01

    A child with facial abnormalities, short stature and a variety of skeletal alterations is reported. The facial abnormalities comprised low-set ears, short nose with a long philtrum, micrognathia and cleft palate. The skeletal alterations included ischial hypoplasia, malformations of the cervical spine, hypoplasia of the lesser trochanters, tibial hypoplasia with bowing of the lower legs, tibio-fibular diastasis with malformed distal tibial epiphyses, clubfeet and brachymesophalangy. The constellation of clinical and radiological findings in the present patient do not fit any known malformation syndrome. (orig.) With 4 figs., 8 refs.

  18. Tibial and fibular angles in homozygous sickle cell disease

    International Nuclear Information System (INIS)

    Akamaguna, A.I.; Odita, J.C.; Ugbodaga, C.I.; Okafor, L.A.

    1986-01-01

    Measurements of the tibial and fibular angles made on ankle radiographs of 34 patients with sickle cell disease were compared with those of 36 normal Nigerians. Widening of the fibular angle, which is an indication of tibiotalar slant, was demonstrated in about 79% of sickle cell disease patients. By using fibular angle measurements as an objective method of assessing subtle tibiotalar slant, it is concluded that the incidence of this deformity is much higher among sickle cell disease patients than previously reported. The mean values of tibial and fibular angles in normal Nigerians are higher than has been reported amongst Caucasians. (orig.)

  19. Laminin-based Nanomaterials for Peripheral Nerve Tissue Engineering

    Science.gov (United States)

    Neal, Rebekah Anne

    Peripheral nerve transection occurs commonly in traumatic injury, causing motor and sensory deficits distal to the site of injury. One option for surgical repair is the nerve conduit. Conduits currently on the market are hollow tubes into which the nerve ends are sutured. Although these conduits fill the gap, they often fail due to the slow rate of regeneration over long gaps. To facilitate increased speed of regeneration and greater potential for functional recovery, the ideal conduit should provide biochemically relevant signals and physical guidance cues, thus playing an active role in peripheral nerve regeneration. In this dissertation, I fabricated laminin-1 and laminin-polycaprolactone (PCL) blend nanofibers that mimic the geometry and functionality of the peripheral nerve basement membrane. These fibers resist hydration in aqueous media and require no harsh chemical crosslinkers. Adhesion and differentiation of both neuron-like and neuroprogenitor cells is improved on laminin nanofibrous meshes over two-dimensional laminin substrates. Blend meshes with varying laminin content were characterized for composition, tensile properties, degradation rates, and bioactivity in terms of cell attachment and axonal elongation. I have established that 10% (wt) laminin content is sufficient to retain the significant neurite-promoting effects of laminin critical in peripheral nerve repair. In addition, I utilized modified collector plate design to manipulate electric field gradients during electrospinning for the fabrication of aligned nanofibers. These aligned substrates provide enhanced directional guidance cues to the regenerating axons. Finally, I replicated the clinical problem of peripheral nerve transection using a rat tibial nerve defect model for conduit implantation. When the lumens of conduits were filled with nanofiber meshes of varying laminin content and alignment, I observed significant recovery of sensory and motor function over six weeks. This recovery was

  20. Clinical applications of free medial tibial flap with posterior tibial artery for head and neck reconstruction after tumor resection.

    Science.gov (United States)

    Zhong, Qi; Fang, Jugao; Huang, Zhigang; Chen, Xiaohong; Hou, Lizhen; Zhang, Yang; Li, Pingdong; Ma, Hongzhi; Xu, Hongbo

    2017-06-01

    Tumor resection causes damage in the head and neck which creates problems in swallowing, chewing, articulation, and vision, all of which seriously affect patients' quality of life. In this work, we evaluated the application of a free medial tibial flap in reconstruction of head and neck defects after tumor resection. We discussed the anatomy, surgical technique, and the advantages and disadvantages of the flap. We found several benefits for the flap, such as, it is especially effective for the defects that require thin-layer epithelium to cover or the separated soft tissue defect; a two-team approach can be used because the donor site is far away from the head and neck; and the flap is easy to integrate because of the subcutaneous fat layer of the free medial tibial flap is thin and the flap is soft. Thus, the medial tibial flap could replace the forearm flap for certain applications.

  1. Peripheral nerves are pathologically small in cerebellar ataxia neuropathy vestibular areflexia syndrome: a controlled ultrasound study.

    Science.gov (United States)

    Pelosi, L; Mulroy, E; Leadbetter, R; Kilfoyle, D; Chancellor, A M; Mossman, S; Wing, L; Wu, T Y; Roxburgh, R H

    2018-04-01

    Sensory neuronopathy is a cardinal feature of cerebellar ataxia neuropathy vestibular areflexia syndrome (CANVAS). Having observed that two patients with CANVAS had small median and ulnar nerves on ultrasound, we set out to examine this finding systematically in a cohort of patients with CANVAS, and compare them with both healthy controls and a cohort of patients with axonal neuropathy. We have previously reported preliminary findings in seven of these patients with CANVAS and seven healthy controls. We compared the ultrasound cross-sectional area of median, ulnar, sural and tibial nerves of 14 patients with CANVAS with 14 healthy controls and 14 age- and gender-matched patients with acquired primarily axonal neuropathy. We also compared the individual nerve cross-sectional areas of patients with CANVAS and neuropathy with the reference values of our laboratory control population. The nerve cross-sectional area of patients with CANVAS was smaller than that of both the healthy controls and the neuropathy controls, with highly significant differences at most sites (P CANVAS. Small nerves in CANVAS probably reflect nerve thinning from loss of axons due to ganglion cell loss. This is distinct from the ultrasound findings in axonal neuropathy, in which nerve size was either normal or enlarged. Our findings indicate a diagnostic role for ultrasound in CANVAS sensory neuronopathy and in differentiating neuronopathy from neuropathy. © 2018 EAN.

  2. Observations of IMF coherent structures and their relationship to SEP dropout events

    Directory of Open Access Journals (Sweden)

    L. Trenchi

    2013-08-01

    Full Text Available The solar energetic particle (SEP events from impulsive solar flares are often characterized by short-timescale modulations affecting, at the same time, particles with different energies. Several models and simulations suggest that these modulations are observed when SEPs propagate through magnetic structures with a different connection with the flare site. However, in situ observations rarely showed clear magnetic signatures associated with these modulations. In this paper we used the Grad–Shafranov reconstruction to perform a detailed analysis of the local magnetic field topology during the SEP event of 9–10 January 1999, characterized by several SEP dropouts. An optimization procedure is used to identify, during this SEP event, the magnetic structures which better satisfy the Grad–Shafranov assumptions and to evaluate the direction of their invariant axis. We found that these two-dimensional structures, which are flux ropes or current sheets with a more complex field topology, are generally associated with the maxima in the SEP counts. This association suggests that the SEPs propagate within these structures and, since their gyration radii is much smaller than the transverse dimension of these structure, cannot escape from them.

  3. Isolated optic nerve pseudotumour

    International Nuclear Information System (INIS)

    Patankar, T.; Prasad, S.; Krishnan, A.; Laxminarayan, R.

    2000-01-01

    Isolated optic nerve involvement by the idiopathic inflammatory process is a rare finding and very few reports are available. Here a case of an isolated optic nerve inflammatory pseudotumour presenting with gradually progressive unilateral loss of vision is described. It showed dramatic response to a trial of steroids and its differential diagnoses are discussed. Copyright (1999) Blackwell Science Pty Ltd

  4. Diabetic Nerve Problems

    Science.gov (United States)

    ... vessels that bring oxygen to your nerves. Damaged nerves may stop sending messages, or may send messages slowly or at the wrong times. This damage is called diabetic neuropathy. Over half of people with diabetes get it. Symptoms may include Numbness in your ...

  5. Nerve growth factor with fibrin glue in end-to-side nerve repair in rats Fator de crescimento nervoso em cola de fibrina no reparo término-lateral de nervos em ratos

    Directory of Open Access Journals (Sweden)

    Daniel Nunes e Silva

    2012-04-01

    Full Text Available PURPOSE: To determine the effects of end-to-side nerve repair performed only with fibrin glue containing nerve growth in rats. METHODS: Seventy two Wistar rats were divided into six equal groups: group A was not submitted to nerve section; group B was submitted to nerve fibular section only. The others groups had the nerve fibular sectioned and then repaired in the lateral surface of an intact tibial nerve, with different procedures: group C: ETS with sutures; group D: ETS with sutures and NGF; group E: ETS with FG only; group F: ETS with FG containing NGF. The motor function was accompanied and the tibial muscle mass, the number and diameter of muscular fibers and regenerated axons were measured. RESULTS: All the analyzed variables did not show any differences among the four operated groups (p>0.05, which were statistically superior to group B (p0.05. CONCLUSION: The end-to-side nerve repair presented the same recovery pattern, independent from the repair used, showing that the addition of nerve growth factor in fibrin glue was not enough for the results potentiating.OBJETIVO: Determinar os efeitos do reparo nervoso término-lateral realizado apenas com cola de fibrina contendo fator de crescimento nervoso em ratos. MÉTODOS: Setenta e dois ratos Wistar foram distribuídos em seis grupos: A - não submetido à secção nervosa; B - secção do nervo fibular (sem reparo; Os outros grupos tiveram o nervo fibular seccionado e então reparado na superfície lateral do nervo tibial intacto, com diferentes procedimentos: C - RNTL com suturas; D - RNTL com suturas e FCN; E - RNTL apenas com CF; F - RNTL com CF contendo FCN. A função motora foi acompanhada e a massa do músculo tibial, o número e o diâmetro das fibras musculares e axônios regenerados foram medidos. RESULTADOS: Não houve diferença entre as variáveis avaliadas nos quatro grupos operados (p>0,05, os quais foram superiores ao grupo B (p0,05. CONCLUSÕES: O reparo nervoso t

  6. Interacting CMEs and their associated flare and SEP activities

    Science.gov (United States)

    Shanmugaraju, A.; Prasanna Subramanian, S.

    2014-08-01

    We have analyzed a set of 25 interacting events which are associated with the DH type II bursts. These events are selected from the Coronal Mass Ejections (CMEs) observed during the period 1997-2010 in SOHO/LASCO and DH type IIs observed in Wind/WAVES. Their pre and primary CMEs from nearby active regions are identified using SOHO/LASCO and EIT images and their height-time diagrams. Their interacting time and height are obtained, and their associated activities, such as, flares and Solar Energetic Particles (>10 pfu) are also investigated. Results from the analysis are: primary CMEs are much faster than the pre-CMEs, their X-ray flares are also stronger (X- and M-class) compared to the flares (C- and M-class) of pre-CMEs. Most of the events (22/25) occurred during the period 2000-2006. From the observed width and speed of pre and primary CMEs, it is found that the pre-CMEs are found to be less energetic than the primary CMEs. While the primary CMEs are tracked up to the end of LASCO field of view (30 Rs), most of the pre-CMEs can be tracked up to <26 Rs. The SEP intensity is found to be related with the integrated flux of X-ray flares associated with the primary CMEs for nine events originating from the western region.

  7. Collaboration on SEP Missions to the Moon and Small Bodies

    Science.gov (United States)

    Pieters, C. M.

    1997-01-01

    In response to the Discovery announcement of opportunity a team consisting of TRW Lewis Research Center, JPL and UCLA with scientific co-investigators from government and University laboratories have proposed to fly the first planetary solar electric propulsion (SEP) mission. Diana is designed to carry an X-ray and gamma ray spectrometer, and imaging spectrometer, a framing camera, a laser altimer an ion spectrometer and a magnetometer. In order to obtain lunar gravity data from the far side of the moon a relay satellite is placed into high polar orbit about the moon to relay the Doppler-shifted telemetry to Earth. Diana will spend two months in a 700 km polar orbit obtaining mineralogical data from a full spectral map of the lunar surface, and then spend a year in a 100 km (or below) polar orbit mapping the lunar elemental composition, its topography, gravity field, ions from its atmosphere and its permanent and induced magnetic fields. After the low altitude mapping phase the ion thrusters propel the spacecraft out of the lunar sphere of influence and onto a heloioscentric trajectory to rendezvous with dormant comet Wilson-Harrington. The ground truth provided by the returned lunar samples to validate the remote sensing instruments for lunar studies will also serve to validate the Wilson-Harrington observations since the same instruments will be used at both bodies.

  8. Magnetic resonance neurography and diffusion tensor imaging of the peripheral nerves in patients with Charcot-Marie-Tooth Type 1A.

    Science.gov (United States)

    Vaeggemose, Michael; Vaeth, Signe; Pham, Mirko; Ringgaard, Steffen; Jensen, Uffe B; Tankisi, Hatice; Ejskjaer, Niels; Heiland, Sabine; Andersen, Henning

    2017-12-01

    Investigation of peripheral neuropathies by magnetic resonance neurography (MRN) may provide increased diagnostic accuracy when performed in combination with diffusion tensor imaging (DTI). This study seeks to evaluate DTI in the detection of neuropathic abnormalities in Charcot-Marie-Tooth type 1A (CMT1A). MRI of the sciatic and tibial nerves, including MRN and DTI, was prospectively performed in 15 CMT1A patients and 30 healthy controls (HCs). The following MRI parameters were evaluated and correlated with clinical and neurophysiological findings: T2-relaxation time, proton spin density (PD) and DTI (fractional anisotropy [FA] and apparent diffusion coefficient [ADC]). DTI showed lower FA and higher ADC in CMT1A compared with HCs. T2 relaxation time showed no difference; however, PD of the sciatic nerve was higher in CMT1A. There were some close associations between neuropathy severity and MRN-DTI, with the closest correlation between FA and nerve conduction velocity in the sciatic nerve (r = 0.76, P < 0.01). MRN-DTI evaluation of sciatic and tibial nerves improves the detection of nerve abnormalities in patients with CMT1A. Muscle Nerve 56: E78-E84, 2017. © 2017 Wiley Periodicals, Inc.

  9. The Effect of Malrotation of Tibial Component of Total Knee Arthroplasty on Tibial Insert during High Flexion Using a Finite Element Analysis

    Directory of Open Access Journals (Sweden)

    Kei Osano

    2014-01-01

    Full Text Available One of the most common errors of total knee arthroplasty procedure is a malrotation of tibial component. The stress on tibial insert is closely related to polyethylene failure. The objective of this study is to analyze the effect of malrotation of tibial component for the stress on tibial insert during high flexion using a finite element analysis. We used Stryker NRG PS for analysis. Three different initial conditions of tibial component including normal, 15° internal malrotation, and 15° external malrotation were analyzed. The tibial insert made from ultra-high-molecular-weight polyethylene was assumed to be elastic-plastic while femoral and tibial metal components were assumed to be rigid. Four nonlinear springs attached to tibial component represented soft tissues around the knee. Vertical load was applied to femoral component which rotated from 0° to 135° while horizontal load along the anterior posterior axis was applied to tibial component during flexion. Maximum equivalent stresses on the surface were analyzed. Internal malrotation caused the highest stress which arose up to 160% of normal position. External malrotation also caused higher stress. Implanting prosthesis in correct position is important for reducing the risk of abnormal wear and failure.

  10. Partial resection of the PCL insertion site during tibial preparation in cruciate-retaining TKA.

    Science.gov (United States)

    Feyen, Hans; Van Opstal, Nick; Bellemans, Johan

    2013-12-01

    Based on the anatomy of the tibial PCL insertion site, we hypothesized that at least part of it is damaged while performing a standard tibial cut in a PCL-retaining total knee replacement. The purpose of this study was to determine and quantify the amount of resection of the tibial PCL attachment with a 9 mm tibial cut with 3 degrees of posterior slope. Twenty cadaver tibias were used. The borders of the PCL footprint were demarcated, and calibrated digital pictures were taken in order to determine the surface area. A standard tibial intramedullary guide was used to prepare and perform a tibial cut at a depth of 9 mm with 3 degrees posterior slope. After the tibial cut was made, a second digital picture was taken using the same methodology to measure the surface area of the remaining PCL insertion. The mean surface area of the intact tibial PCL footprint before the cut was 148.9 ± 25.8 mm(2) and after the tibial cut 47.1 ± 28.0 mm(2). On average, 68.8 ± 15.3 % of the surface area of the PCL insertion was removed. The results of this study, therefore, indicate that the conventional technique for tibial preparation in cruciate-retaining total knee arthroplasty can result in damage or removal of a significant part of the tibial PCL insertion.

  11. Neurilemmoma of Deep Peroneal Nerve Sensory Branch : Thermographic Findings with Compression Test.

    Science.gov (United States)

    Ryu, Seung Jun; Zhang, Ho Yeol

    2015-09-01

    We report a case of neurilemmoma of deep peroneal nerve sensory branch that triggered sensory change with compression test on lower extremity. After resection of tumor, there are evoked thermal changes on pre- and post-operative infrared (IR) thermographic images. A 52-year-old female presented with low back pain, sciatica, and sensory change on the dorsal side of the right foot and big toe that has lasted for 9 months. She also presented with right tibial mass sized 1.2 cm by 1.4 cm. Ultrasonographic imaging revealed a peripheral nerve sheath tumor arising from the peroneal nerve. IR thermographic image showed hyperthermia when the neurilemoma induced sensory change with compression test on the fibular area, dorsum of foot, and big toe. After surgery, the symptoms and thermographic changes were relieved and disappeared. The clinical, surgical, radiographic, and thermographic perspectives regarding this case are discussed.

  12. Rotational profile of lower limb and axis for tibial component alignment in varus osteoarthritic knees.

    Science.gov (United States)

    Khan, Mohammad Shahnawaz; Seon, Jong Keun; Song, Eun Kyoo

    2012-05-01

    The purposes of this study were to describe the changes in tibial torsion and knee rotation in varus osteoarthritic knees and to check the reliability of reference axis, for tibial component placement, based on femoral transepicondylar axis in these patients. A secondary goal was to determine which reference axis based on proximal tibia is most accurate for determining tibial component rotation. Fifty-two varus osteoarthritic knees and 20 normal knees were analyzed using computed tomographic scan. Tibial torsion and knee rotation were significantly reduced in patients with osteoarthritis. Reference axis based on posterior tibial condyles was most accurate and least variable for tibial component alignment. A significant negative correlation was found between knee rotation and tibial axis based on transepicondylar axis (r = -0.485). Copyright © 2012 Elsevier Inc. All rights reserved.

  13. Medial Tibial Stress Syndrome : Diagnosis, Treatment and Outcome Assessment

    NARCIS (Netherlands)

    Winters, M.

    2017-01-01

    Medial tibial stress syndrome (MTSS), also known as shin splints, is one of the most common sports injuries. Although 20% of the jumping and running athletes have MTSS at some point while engaging in sporting activities, we know little about it. There is a lack of knowledge regarding making the

  14. Total knee arthroplasty after high tibial osteotomy. A systematic review

    NARCIS (Netherlands)

    T.M. van Raaij (Tom); M. Reijman (Max); A. Furlan (Alessandro); J.A.N. Verhaar (Jan)

    2009-01-01

    textabstractBackground: Previous osteotomy may compromise subsequent knee replacement, but no guidelines considering knee arthroplasty after prior osteotomy have been developed. We describe a systematic review of non-randomized studies to analyze the effect of high tibial osteotomy on total knee

  15. Functional treatment of tibial fractures with a custom made brace

    NARCIS (Netherlands)

    W.M. Leeuwen

    1989-01-01

    textabstractThe aim of fracture treatment is rapid bone union with the preservation of perfect function, resulting in the patients' early return to normal daily activities with a minimum of complications. Many conservative and operative methods are used for the treatment of tibial fractures.

  16. Contact Stress Generation on the UHMWPE Tibial Insert

    Directory of Open Access Journals (Sweden)

    S. Petrović Savić

    2014-12-01

    Full Text Available Total knee replacement (TKR is considered, during last years, as a very successful surgical technique for removing knee joint deformities and eliminating pain caused by cartilage damage. In literature, as primary causes for knee joint endoprothesis damage are cited complex movements which cause occurrences of complex stress conditions, sagital radius conformity, sliding, types of materials etc. Aim of this study is analysis of contact stresses that occur on tibial implant for 15°, 45° and 60° knee flexion and 50 kg, 75 kg, 100 kg and 125 kg weight. Knee joint prosthesis model and finite elements method (FEM analysis are done in software Catia V5. For this analysis we used ultra-high molecular weight polyethylene (UHMWPE for tibial implant material and AISI 316, AISI 317, AISI 321, 17-4PH, CoCrMo, Ti6Al4V and SAE A-286 for femoral component materials. Results show that area of maximal contact stress is identified in medial and lateral part of tibial implant. Von Mises stress values vary regarding of flexion degree and weight, but values are approximate for types of chosen materials. Contact stress location corresponds to damage that occur on tibial implant during exploitation.

  17. Management of segmental tibial fractures | Motsitsi | East and ...

    African Journals Online (AJOL)

    Three currently favored methods of treatment are intramedullary locking nail , external Fixators (with their different constructs and versatility) and Plaster of Paris. It is important to note that more than two-thirds of segmental tibial fractures will require more than one surgical intervention. The surgeon therefore, needs to plan ...

  18. MR imaging findings of medial tibial crest friction

    Energy Technology Data Exchange (ETDEWEB)

    Klontzas, Michail E., E-mail: miklontzas@gmail.com; Akoumianakis, Ioannis D., E-mail: ioannis.akoumianakis@gmail.com; Vagios, Ilias, E-mail: iliasvagios@gmail.com; Karantanas, Apostolos H., E-mail: akarantanas@gmail.com

    2013-11-01

    Objective: Medial tibial condyle bone marrow edema (BME), associated with soft tissue edema (STe) surrounding the medial collateral ligament, was incidentally observed in MRI examinations of young and athletic individuals. The aim of the present study was to 1. Prospectively investigate the association between these findings and coexistence of localized pain, and 2. Explore the possible contribution of the tibial morphology to its pathogenesis. Methods: The medial tibial condyle crest was evaluated in 632 knee MRI examinations. The angle and depth were measured by two separate evaluators. The presence of STe and BME was recorded. A third evaluator blindly assessed the presence of pain at this site. Results: BME associated with STe was found in 24 patients (with no history of previous trauma, osteoarthritis, tumor or pes anserine bursitis). The mean crest angle was 151.3° (95%CI 147.4–155.3°) compared to 159.4° (95%CI 158.8–160°) in controls (Mann–Whitney test, P < 0.0001). MRI findings were highly predictive of localized pain (sensitivity 92% specificity 99%, Fisher's exact test, P < 0.0001). Conclusion: Friction at the medial tibial condyle crest is a painful syndrome. MRI is a highly specific and sensitive imaging modality for its diagnosis.

  19. MR imaging findings of medial tibial crest friction

    International Nuclear Information System (INIS)

    Klontzas, Michail E.; Akoumianakis, Ioannis D.; Vagios, Ilias; Karantanas, Apostolos H.

    2013-01-01

    Objective: Medial tibial condyle bone marrow edema (BME), associated with soft tissue edema (STe) surrounding the medial collateral ligament, was incidentally observed in MRI examinations of young and athletic individuals. The aim of the present study was to 1. Prospectively investigate the association between these findings and coexistence of localized pain, and 2. Explore the possible contribution of the tibial morphology to its pathogenesis. Methods: The medial tibial condyle crest was evaluated in 632 knee MRI examinations. The angle and depth were measured by two separate evaluators. The presence of STe and BME was recorded. A third evaluator blindly assessed the presence of pain at this site. Results: BME associated with STe was found in 24 patients (with no history of previous trauma, osteoarthritis, tumor or pes anserine bursitis). The mean crest angle was 151.3° (95%CI 147.4–155.3°) compared to 159.4° (95%CI 158.8–160°) in controls (Mann–Whitney test, P < 0.0001). MRI findings were highly predictive of localized pain (sensitivity 92% specificity 99%, Fisher's exact test, P < 0.0001). Conclusion: Friction at the medial tibial condyle crest is a painful syndrome. MRI is a highly specific and sensitive imaging modality for its diagnosis

  20. Anterior cruciate ligament reconstruction failure after tibial shaft malunion.

    Science.gov (United States)

    LaFrance, Russell M; Gorczyca, John T; Maloney, Michael D

    2012-02-17

    Anterior cruciate ligament (ACL) reconstruction is common, with >100,000 procedures performed each year in the United States. Several factors are associated with failure, including poor surgical technique, graft incorporation failure, overly aggressive rehabilitation, and trauma. Tibial shaft fracture is also common and frequently requires operative intervention. Failure to reestablish the anatomic alignment of the tibia may cause abnormal forces across adjacent joints, which can cause degenerative joint disease or attritional failure of the surrounding soft tissues. This article describes a case of ACL reconstruction failure after a tibial fracture that resulted in malunion. Excessive force across the graft from lower-extremity malalignment and improper tunnel placement likely contributed to the attritional failure of the graft. This patient required a staged procedure for corrective tibial osteotomy followed by revision ACL reconstruction. This article describes ACL reconstruction failure, tibial shaft malunions, their respective treatments, the technical details of each procedure, and the technical aspects that must be considered when these procedures are done in a staged manner by 2 surgeons. Copyright 2012, SLACK Incorporated.

  1. Preliminary evaluation of the tibial tuberosity-trochlear groove measurement

    DEFF Research Database (Denmark)

    Miles, James Edward; Kirpensteijn, Jolle; Svalastoga, Eiliv Lars

    guide surgical treatment. The TTTG measures tibial tuberosity position relative to the axis of the femoral trochlea. A preliminary investigation of TTTG measurement was performed using the red fox (Vulpes vulpes) cadavers as a morphologically similar and homogenous substitute for dog cadavers. CT...

  2. Avulsion fracture of the tibial tubercle associated with patellar ...

    African Journals Online (AJOL)

    We present a case of combined avulsion fracture of the tibial tubercle (AFTT) and avulsion of the patellar ligament in a 15-year-old boy. This injury was treated by open reduction and fixation of both lesions using staples with satisfactory results. This constellation of injury is rare but a high index of suspicion is needed when ...

  3. Epidemiology of open tibial fractures in a teaching hospital ...

    African Journals Online (AJOL)

    Methods: This is a prospective observational study of all open tibial fractures seen at the Accident and Emergency department of the University of Port Harcourt Teaching Hospital (UPTH) over a twelve- month period (July 2002- June 2003). Data from a pre-designed proforma for the study was analyzed and descriptive ...

  4. Locked intramedullary nailing for displaced tibial shaft fractures.

    Science.gov (United States)

    Alho, A; Ekeland, A; Strømsøe, K; Follerås, G; Thoresen, B O

    1990-09-01

    We analysed the results of 93 tibial shaft fractures treated with the Grosse-Kempf locked nail. Twenty-six fractures were comminuted, 19 were open grade I to II, and 54 were located outside the middle third of the tibia. The deep infection rate was 3.2%. There were only two poor results. The use of this method is recommended and discussed.

  5. Posterior tibial tendon dysfunction by bone imprisonment | Zejjari ...

    African Journals Online (AJOL)

    The posterior tibial tendon showed longitudinal laceration was sutured and the internal retromalleolar canal was closed. The race and the freedom of the tendon were considered satisfactory by the end of surgery. The evolution was marked by the disappearance of pain, recovery of a satisfactory sport and professional ...

  6. The influence of gluteus maximus on transverse plane tibial rotation.

    Science.gov (United States)

    Preece, Stephen J; Graham-Smith, Philip; Nester, Chris J; Howard, Dave; Hermens, Hermie; Herrington, Lee; Bowker, Peter

    2008-05-01

    There is a common clinical belief that transverse plane tibial rotation is controlled by the rearfoot. Although distal structures may influence the motion of the tibia, transverse plane tibial rotation could be determined by the proximal hip musculature. Cadaver studies have identified gluteus maximus as having the largest capacity for external rotation of the hip. This study was therefore undertaken to investigate the effect of gluteus maximus on tibial motion. Kinematic data were collected from the foot and tibia along with EMG data from gluteus maximus for 17 male subjects during normal walking. A number of kinematic parameters were derived to characterise early stance phase. Gluteus maximus function was characterised using RMS EMG and EMG on/off times. No differences in muscle timing were found to be associated with any of the kinematic parameters. In addition, no differences in gluteal activation levels were found between groups of subjects who had different amounts of tibial rotation. However, there was a significant difference (pgluteus maximus activation when groups were defined by the time taken to decelerate the tibia (time to peak internal velocity). Specifically, subjects with greater gluteus maximus activity had a lower time to decelerate the tibia. We suggest that a high level of gluteus maximus activity results in a larger external torque being applied to the femur, which ultimately leads to a more rapid deceleration of the tibia.

  7. Unilateral proximal focal femoral deficiency, fibular aplasia, tibial ...

    African Journals Online (AJOL)

    Rabah M. Shawky

    2014-04-30

    Apr 30, 2014 ... Unilateral proximal focal femoral deficiency, fibular aplasia, tibial campomelia and oligosyndactyly in an Egyptian child – Probable. FFU syndrome. Rabah M. ... We report for the first time an Egyptian child with a rare unilateral .... 4th and 5th metatarsal bones are absent), absent middle phalanx of the 2nd ...

  8. Treatment of medial tibial stress syndrome: a systematic review

    NARCIS (Netherlands)

    Winters, Marinus; Eskes, Michel; Weir, Adam; Moen, Maarten H.; Backx, Frank J. G.; Bakker, Eric W. P.

    2013-01-01

    Medial tibial stress syndrome (MTSS) is a common exercise-induced leg injury among athletes and military personnel. Several treatment options have been described in the literature, but it remains unclear which treatment is most effective. The objective of this systematic review was to assess the

  9. Injuries associated with fractured tibial shaft | Ikeanyi | Journal of ...

    African Journals Online (AJOL)

    The commonest cause of the injuries was motorcycle accidents (25.7%) followed closely by motor vehicular accidents (25%). The most common associated injuries in order of frequency were: ipsilateral fibular fractures, ankle injuries, ipsilateral femoral fractures and pelvic fractures. Conclusion: Tibial shaft fractures are ...

  10. Intrinsic factors associated with medial tibial stress syndrome in ...

    African Journals Online (AJOL)

    Background. Medial tibial stress syndrome (MTSS) is the most common lower-leg injury in athletes, and is thought to be caused by bony overload. To prevent MTSS, both pathophysiological and aetiological factors specific to MTSS need to be identified. The intrinsic risk factors that contribute to the development of MTSS are ...

  11. IMPRESSION FRACTURE OF THE TIBIAL CONDYLES – TIPICAL CARVING SKIINJURY

    Directory of Open Access Journals (Sweden)

    Matjaž Veselko

    2008-10-01

    In this paper we present typical mechanism of the fracture of the tibial condyle, due tosudden turn of the ski with carved edges. Mathematical model explains how the force transmitted to the knee multiplies due to sudden decrease of the carved turn radius, or due tosudden additional bowing of skies

  12. Anatomic anterior cruciate ligament reconstruction: reducing anterior tibial subluxation

    NARCIS (Netherlands)

    Muller, Bart; Duerr, Eric R. H.; van Dijk, C. Niek; Fu, Freddie H.

    2016-01-01

    To measure and compare the amount of anterior tibial subluxation (ATS) after anatomic ACL reconstruction for both acute and chronic ACL-deficient patients. Fifty-two patients were clinically and radiographically evaluated after primary, unilateral, anatomic ACL reconstruction. Post-operative true

  13. Conventional trans-tibial versus anatomic medial portal technique ...

    African Journals Online (AJOL)

    2015-10-12

    Oct 12, 2015 ... Aim: Method of femoral tunnel preparation in anterior cruciate ligament (ACL) reconstruction is controversial. In this study, we aimed to determine if there is any difference between the clinical outcomes of two most commonly used drilling techniques; which are conventional trans-tibial (TT) drilling of femoral ...

  14. Conventional trans‑tibial versus anatomic medial portal technique ...

    African Journals Online (AJOL)

    In this study, we aimed to determine if there is any difference between the clinical outcomes of two most commonly used drilling techniques; which are conventional trans‑tibial (TT) drilling of femoral tunnel and anatomic preparation of femoral tunnel through medial portal (MP), in patients who underwent ACL reconstruction.

  15. Sensory nerve cross-anastomosis and electrical muscle stimulation synergistically enhance functional recovery of chronically denervated muscle.

    Science.gov (United States)

    Willand, Michael P; Holmes, Michael; Bain, James R; de Bruin, Hubert; Fahnestock, Margaret

    2014-11-01

    Long-term muscle denervation leads to severe and irreversible atrophy coupled with loss of force and motor function. These factors contribute to poor functional recovery following delayed reinnervation. The authors' previous work demonstrated that temporarily suturing a sensory nerve to the distal motor stump (called sensory protection) significantly reduces muscle atrophy and improves function following reinnervation. The authors have also shown that 1 month of electrical stimulation of denervated muscle significantly improves function and reduces atrophy. In this study, the authors tested whether a combination of sensory protection and electrical stimulation would enhance functional recovery more than either treatment alone. Rat gastrocnemius muscles were denervated by cutting the tibial nerve. The peroneal nerve was then sutured to the distal tibial stump following 3 months of treatment (i.e., electrical stimulation, sensory protection, or both). Three months after peroneal repair, functional and histologic measurements were taken. All treatment groups had significantly higher muscle weight (pstimulation or sensory protection alone. The combined treatment also produced motor unit counts significantly greater than sensory protection alone (p<0.05). The combination treatment synergistically reduces atrophy and improves reinnervation and functional measures following delayed nerve repair, suggesting that these approaches work through different mechanisms. The authors' research supports the clinical use of both modalities together following peripheral nerve injury.

  16. Neurophysiological approach to disorders of peripheral nerve

    DEFF Research Database (Denmark)

    Crone, Clarissa; Krarup, Christian

    2013-01-01

    Disorders of the peripheral nerve system (PNS) are heterogeneous and may involve motor fibers, sensory fibers, small myelinated and unmyelinated fibers and autonomic nerve fibers, with variable anatomical distribution (single nerves, several different nerves, symmetrical affection of all nerves...

  17. [Effect of interlocking intramedullary nail in treatment of open tibial and fibula fractures].

    Science.gov (United States)

    Ji, Jianfei; Zhao, Yinsong; He, Xueyu; Zhou, Yang

    2009-03-01

    To determine the effect of interlocking intramedullary nail in treatment of open tibial and fibula fractures and analyze the method to promote the bone union. From December 2003 to June 2006, thirty-five patients with open tibial and fibula fracture were treated with emergency debridement, interlocked intramedullary fixation for tibia and fixed fibula at the same time. During operation, the bone marrow was collected and grafted into the fracture gaps. Among them, there were 27 males and 8 females, involving in 22 left legs and 13 right legs. Their ages ranged from 19 to 65 years, with an average of 34.7 years. The location of fracture was the middle of the tibia and fibula in 16 cases, the distal 1/3 of the tibia and fibula in 12 cases and the proximal 1/3 in 7 cases. According to the Gustilo classification of open injuries, there were 7 cases of type I, 19 cases of type II, 8 cases of type III a and 1 case of type III b. The mean range of knee motion was 48.3 degrees (45-70 degrees). The mean time from injury to operation was 4.3 hours (50 minutes to 7 hours). The mean operation time was 94 minutes (60-132 minutes) and the mean blood loss was 122 mL (100-350 mL). The wound healed by first intention in 32 patients. Incision was sutured in 2 cases of type III a fractures after operation 4 days, gastrocnemius flap graft was performed in 1 case of type III b fracture 1 week after operation. They all achieve good healing. No fractures split off, no iatrogenic nerve and vascular injury occurred, no osteofascial compartment syndromes or deep vein thrombus happened. Tension blisters appeared in 1 case of type II fracture after operation and subsided after 5 days. Patients were followed up for 14-43 months (mean 22 months). The X-ray films showed that fracture union was observe in 30 cases after 14 weeks of operation, in 3 cases after 18 weeks and in 1 case after 22 weeks of operation. The fractures union time was 15.2 weeks on average. About 2 cm nonunion in lateral

  18. Muscle involvement in leprosy: study of the anterior tibial muscle in 40 patients Alterações musculares na lepra: estudo do músculo tibial anterior em 40 pacientes

    Directory of Open Access Journals (Sweden)

    LINEU CESAR WERNECK

    1999-09-01

    Full Text Available The involvement of skeletal striated muscle in leprosy is considered secondary due to peripheral neuropathy, but some studies point it to a primary muscle lesion. In order to investigate the muscle involvement in leprosy, we studied 40 patients (lepromatous 23, tuberculoid 13, borderline 2 and indeterminate 2. The motor nerve conduction of the peroneal nerves had a reduction of the velocity, decreased compound muscle action potential and sometimes absence of potentials. The electromyographic study of the anterior tibial muscle showed signs of recent and chronic denervation in 77.5% of the cases and no myopathic potentials. The anterior tibial muscle biopsy revealed denervation in 45% of the cases, interstitial inflammatory myopathy in 30% and mixed (myopathic and neuropathic pattern in 12.5%. Acid fast bacillus was detected in 25% of the cases, always in the interstitial tissue. Inflammatory reaction was present in the interstitial space and in patients with the lepromatous type. The histological findings clearly defined the presence of the so-called "Leprous Interstitial Myositis" on the top of denervation signs.O envolvimento do músculo estriado na lepra é considerado secundário à lesão dos nervos periféricos, mas alguns estudos relataram acometimento muscular primário. A fim de verificar esta controvérsia estudamos 40 pacientes com lepra, sendo 23 da forma lepromatosa, 13 da tuberculoide, 2 borderline e 2 indeterminada. Realizamos a neurocondução do nervo peroneiro, junto com eletromiografia e biópsia do músculo tibial anterior. Encontramos redução de velocidade de condução, da amplitude e algumas vezes ausência de potenciais no nervo peroneiro. A eletromiografia do tibial anterior mostrou sinais de desinervação recente e crônica em 77,5% dos casos e não foi encontrada evidência de padrão "miopático". A biópsia do músculo tibial anterior revelou desinervação em 45% dos casos, miopatia inflamatória intersticial em

  19. 78 FR 19490 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-04-01

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting...; and Expanding Information about Dementia and Co- occurring Chronic Conditions among Older Adults...

  20. 75 FR 77645 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Pregnancy...

    Science.gov (United States)

    2010-12-13

    ... Control Special Emphasis Panel (SEP): Pregnancy Risk Assessment Monitoring System (PRAMS), DP11-001 Panel..., discussion, and evaluation of ``Pregnancy Risk Assessment Monitoring System (PRAMS), DP11-001 Panel E...

  1. 78 FR 17412 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Funding...

    Science.gov (United States)

    2013-03-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Funding Opportunity Announcement, Initial Review The meeting...

  2. 78 FR 13677 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Funding...

    Science.gov (United States)

    2013-02-28

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Funding Opportunity Announcement, Initial Review The meeting...

  3. Presentaci??n Fueros de Sep??lveda Biblioteca "San Isidoro"

    OpenAIRE

    Ort??z del Cueto, Jos?? Ram??n; Asenjo Rodriguez, Santiago; Hermida Alonso, Jos?? ??ngel; Villena Cort??s, Alberto

    2013-01-01

    El d??a 17 de mayo en la Biblioteca San Isidoro, con la presencia de Concha Casado, se expusieron los Fueros de Sep??lveda y se inaugur?? la exposici??n itinerante ???Una Historia, Un Convento, Un Museo???

  4. 76 FR 36622 - Proposed Collection; Comment Request for Form 5305A-SEP

    Science.gov (United States)

    2011-06-22

    ... Simplified Employee Pension-Individual Retirement Accounts Contribution Agreement. DATES: Written [email protected] . SUPPLEMENTARY INFORMATION: Title: Salary Reduction Simplified Employee Pension-Individual Retirement Accounts Contribution Agreement. OMB Number: 1545-1012. Form Number: 5305A-SEP...

  5. Fatigue behavior of Ilizarov frame versus tibial interlocking nail in a comminuted tibial fracture model: a biomechanical study

    Directory of Open Access Journals (Sweden)

    Stahel Philip F

    2006-12-01

    Full Text Available Abstract Background Treatment options for comminuted tibial shaft fractures include plating, intramedullary nailing, and external fixation. No biomechanical comparison between an interlocking tibia nail with external fixation by an Ilizarov frame has been reported to date. In the present study, we compared the fatigue behaviour of Ilizarov frames to interlocking intramedullary nails in a comminuted tibial fracture model under a combined loading of axial compression, bending and torsion. Our goal was to determine the biomechanical characteristics, stability and durability for each device over a clinically relevant three month testing period. The study hypothesis was that differences in the mechanical properties may account for differing clinical results and provide information applicable to clinical decision making for comminuted tibia shaft fractures. Methods In this biomechanical study, 12 composite tibial bone models with a comminuted fracture and a 25 mm diaphyseal gap were investigated. Of these, six models were stabilized with a 180-mm four-ring Ilizarov frame, and six models were minimally reamed and stabilized with a 10 mm statically locked Russell-Taylor Delta™ tibial nail. After measuring the pre-fatigue axial compression bending and torsion stiffness, each model was loaded under a sinusoidal cyclic combined loading of axial compression (2.8/28 lbf; 12.46/124.6 N and torque (1.7/17 lbf-in; 0.19/1.92 Nm at a frequency of 3 Hz. The test was performed until failure (implant breakage or ≥ 5° angulations and/or 2 cm shortening occurred or until 252,000 cycles were completed, which corresponds to approximately three months testing period. Results In all 12 models, both the Ilizarov frame and the interlocking tibia nail were able to maintain fracture stability of the tibial defect and to complete the full 252,000 cycles during the entire study period of three months. A significantly higher stiffness to axial compression and torsion was

  6. Racial and ethnic health disparities: evidence of discrimination's effects across the SEP spectrum.

    Science.gov (United States)

    D'Anna, Laura Hoyt; Ponce, Ninez A; Siegel, Judith M

    2010-04-01

    Perceived discrimination is a psychosocial stressor that plays a role in explaining racial/ethnic disparities in self-reported physical and mental health. The purpose of this paper is: (1) to investigate the association between perceived discrimination in receiving healthcare and racial/ethnic disparities in self-rated health status, physical, and emotional functional limitations among a diverse sample of California adults; (2) to assess whether discrimination effects vary by racial/ethnic group and gender; and (3) to evaluate how the effects of discrimination on health are manifest across the socioeconomic position (SEP) spectrum. Data were drawn from the 2001 California Health Interview Survey adult file (n=55,428). The analytic approach employed multivariate linear and logistic regressions. Discrimination is qualitatively identified into two types: (1) discrimination due to race/ethnicity, language, or accent, and (2) other discrimination. Findings show that both types of discrimination negatively influenced self-rated health, and were associated with a two to three-fold odds of limitations in physical and emotional health. Further, these effects varied by racial/ethnic group and gender, and the effects were mixed. Most notably, for emotional health, racial/ethnic discrimination penalized Latinas more than non-Latina Whites, but for physical health, other discrimination was less detrimental to Latinas than it was to non-Latina Whites. At higher levels of SEP, the effects of racial/ethnic discrimination on self-rated health and other discriminations' effects on physical health were attenuated. Higher SEP may serve as an important mitigator, particularly when comparing the medium to the low SEP categories. It is also possible that SEP effects cannot be extracted from the relationships of interest in that SEP is an expression of social discrimination. In fact, negative health effects associated with discrimination are evident across the SEP spectrum. This study

  7. Overview of the Cranial Nerves

    Science.gov (United States)

    ... to the back). Viewing the Cranial Nerves Twelve pairs of cranial nerves emerge from the underside of the brain, ... eye movement. Eye movement is controlled by 3 pairs of muscles. These muscles move the eye up and down, right and ... nerve 4th cranial nerve 6th ...

  8. Large Extremity Peripheral Nerve Repair

    Science.gov (United States)

    2016-12-01

    rodents as a function of time after surgery. As predicted, those animals in the negative control group (no repair following nerve deficit injury ...80% of penetrating injuries being associated with peripheral nerve damage, typically involve large segmental nerve deficits. Standard repair uses...technology for repair of peripheral nerve injuries involving significant neural deficit with improved functional outcomes for the wounded warrior. The

  9. Three-dimensional analysis of the tibial resection plane relative to the arthritic tibial plateau in total knee arthroplasty.

    Science.gov (United States)

    Johnson, J Michael; Mahfouz, Mohamed R; Midillioğlu, Mehmet Rüştü; Nedopil, Alexander J; Howell, Stephen M

    2017-08-08

    Kinematically aligned total knee arthroplasty strives to correct the arthritic deformity by restoring the native tibial joint line. However, the precision of such surgical correction needs to be quantified in order to reduce recuts of the resection and to design assisting instrumentation. This study describes a method for novel three-dimensional analysis of tibial resection parameters in total knee arthroplasty. Pre-operative versus post-operative differences in the slopes of the varus-valgus and flexion-extension planes and the proximal-distal level between the tibia resection and the arthritic tibial joint line can reliably be measured using the three-dimensional models of the tibia and fibula. This work uses the proposed comparison method to determine the parameters for resecting the tibia in kinematically aligned total knee arthroplasty. Three-dimensional shape registration was performed between arthritic surface models segmented from pre-operative magnetic resonance imaging scans and resected surface models segmented from post-operative computed tomography scans. Mean, standard deviation and 95% confidence intervals were determined for all measurements.  RESULTS: Results indicate that kinematically aligned total knee arthroplasty consistently corrects the varus deformity and restores the slope of the flexion-extension plane and the proximal-distal level of the arthritic tibial joint line. The slope of the varus-valgus plane is most precisely associated with the overall arthritic slope after approximately 3° of correction and the posterior slope is biased towards the overall arthritic plateau, though less precisely than the varus correlation. Use of this analysis on a larger population can quantify the effectiveness of the tibial resection for correcting pathologies, potentially reduce imprecisions in the surgical technique, and enable development of instrumentation that reduces the risk of resection recuts. The kinematic alignment technique consistently

  10. [Cognitive rehabilitation in multiple sclerosis: preliminary results and presentation of a new program, PROCOG-SEP].

    Science.gov (United States)

    Brissart, H; Leroy, M; Debouverie, M

    2010-04-01

    Although cognitive disorders are well-known in multiple sclerosis (MS), even in earlier stages of the disease, their management may be overlooked. Our objective was to elaborate and evaluate the efficiency of a remedial program (PROCOG-SEP) designed for MS patients. The evidence-based program proposes exercises to both stimulate preserved functions and develop new abilities compensating for cognitive disabilities. Twenty-four patients with MS participated in 10/2-hour PROCOG-SEP sessions over a 6-month period. A neuropsychologist recorded BCcog-SEP performances before and after the PROCOG-SEP program. In addition, the same neuropsychologist conducted psychoclinical interviews to complete the before and after cognitive evaluations. The statistical analysis used the t-test performed with Excel. Compared with the initial levels, subtests of BCcog-SEP showing improvement after PROCOG-SEP were: verbal memory (SRT), visuospatial memory (10/36), verbal fluency (animal categories) and response to conflicting orders. Also, individual psychological interviews tended to be in favor of a general improvement in quality of life (more social interactions for instance). To our knowledge, the management program we have elaborated is the first designed to improve cognitive deficits in MS. These encouraging results suggest possibilities for improving cognition and thus quality-of-life in MS patients. 2009 Elsevier Masson SAS. All rights reserved.

  11. Selenoprotein S/SEPS1 modifies endoplasmic reticulum stress in Z variant alpha1-antitrypsin deficiency.

    LENUS (Irish Health Repository)

    Kelly, Emer

    2009-06-19

    Z alpha(1)-antitrypsin (ZAAT) deficiency is a disease associated with emphysematous lung disease and also with liver disease. The liver disease of AAT deficiency is associated with endoplasmic reticulum (ER) stress. SEPS1 is a selenoprotein that, through a chaperone activity, decreases ER stress. To determine the effect of SEPS1 on ER stress in ZAAT deficiency, we measured activity of the grp78 promoter and levels of active ATF6 as markers of the unfolded protein response in HepG2 cells transfected with the mutant form of AAT, a ZAAT transgene. We evaluated levels of NFkappaB activity as a marker of the ER overload response. To determine the effect of selenium supplementation on the function of SEPS1, we investigated glutathione peroxidase activity, grp78 promoter activity, and NFkappaB activity in the presence or absence of selenium. SEPS1 reduced levels of active ATF6. Overexpression of SEPS1 also inhibited grp78 promoter and NFkappaB activity, and this effect was enhanced in the presence of selenium supplementation. This finding demonstrates a role for SEPS1 in ZAAT deficiency and suggests a possible therapeutic potential for selenium supplementation.

  12. Radial to axillary nerve transfer.

    Science.gov (United States)

    Vanaclocha, Vicente; Herrera, Juan Manuel; Rivera-Paz, Marlon; Martínez-Gómez, Deborah; Vanaclocha, Leyre

    2018-01-01

    Axillary nerve injury is common after brachial plexus injuries, particularly with shoulder luxation. Nerve grafting is the traditional procedure for postganglionic injuries. Nerve transfer is emerging as a viable option particularly in late referrals. At the proximal arm the radial and axillary nerves lie close by. Sacrificing one of the triceps muscle nerve branches induces little negative consequences. Transferring the long head of the triceps nerve branch is a good option to recover axillary nerve function. The surgical technique is presented in a video, stressing the steps to achieve a successful result. The video can be found here: https://youtu.be/WbVbpMuPxIE .

  13. Diabetes and nerve damage

    Science.gov (United States)

    Diabetic neuropathy; Diabetes - neuropathy; Diabetes - peripheral neuropathy ... In people with diabetes, the body's nerves can be damaged by decreased blood flow and a high blood sugar level. This condition is ...

  14. Optic Nerve Drusen

    Science.gov (United States)

    ... nerve. Ocular ultrasound, CT scan and/or fundus photography can also aid in the diagnosis. Drusen can ... Medical Disclaimer Search Site ▶ AAPOS Headquarters 655 Beach Street San Francisco, CA 94109-1336 Phone: (415) 561- ...

  15. Vagus Nerve Stimulation

    Science.gov (United States)

    ... you do certain activities such as public speaking, singing or exercising, or when you're eating if ... of life. Research is still mixed on the benefits of vagus nerve stimulation for the treatment of ...

  16. Laryngeal nerve damage

    Science.gov (United States)

    Symptoms include: Difficulty speaking Difficulty swallowing Hoarseness Injury to the left and right laryngeal nerves at the same time can cause a breathing problem. This can be an urgent medical problem.

  17. Optic nerve oxygen tension

    DEFF Research Database (Denmark)

    la Cour, M; Kiilgaard, Jens Folke; Eysteinsson, T

    2000-01-01

    To investigate the influence of acute changes in intraocular pressure on the oxygen tension in the vicinity of the optic nerve head under control conditions and after intravenous administration of 500 mg of the carbonic anhydrase inhibitor dorzolamide....

  18. Degenerative Nerve Diseases

    Science.gov (United States)

    Degenerative nerve diseases affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Many of these diseases are genetic. Sometimes the cause is a medical ...

  19. Non-formation of the main trunk of the sciatic nerve and unusual relationships to the piriformis muscle

    Directory of Open Access Journals (Sweden)

    J. Stoyanov

    2017-09-01

    Full Text Available Background: The sciatic nerve is the largest branch of the sacral plexus. Variations of its origin, exit from the pelvis, emergence and branching in the posterior region of the thigh, especially in regards to the piriformis muscle, are an object of interest due to the possibility to be involved in the pathogenensis of clinically significant non-discogenic sciatica or piriformis syndrome. Case report: We present a case of variant anatomy of the sciatic nerve, discovered during routine dissection of the left gluteal region of an adult female cadaver. We observed a non-formation of the main trunk of the nerve; rather, the tibial nerve passed inferiorly to the piriformis muscle, while the common peroneal nerve went through the body of the bifid piriformis muscle, immediately next to its tendon. The two branches continued their course in the thigh without joining and forming a proper sciatic nerve. The medical records of the body donor did not reveal any neurological impairment which could be linked to this anatomical peculiarity. Conclusion: The anatomy of the sciatic nerve could be considered to be a factor of clinical significance. The high prevalence of similar anatomical variations should be kept in mind during the diagnostic process of clinical entities involving the sciatic nerve.

  20. Optic nerve oxygen tension

    DEFF Research Database (Denmark)

    la Cour, M; Kiilgaard, Jens Folke; Eysteinsson, T

    2000-01-01

    To investigate the influence of acute changes in intraocular pressure on the oxygen tension in the vicinity of the optic nerve head under control conditions and after intravenous administration of 500 mg of the carbonic anhydrase inhibitor dorzolamide.......To investigate the influence of acute changes in intraocular pressure on the oxygen tension in the vicinity of the optic nerve head under control conditions and after intravenous administration of 500 mg of the carbonic anhydrase inhibitor dorzolamide....

  1. Conjoined lumbosacral nerve roots

    Directory of Open Access Journals (Sweden)

    Atila Yılmaz

    2012-03-01

    Full Text Available Lumbosacral nerve root anomalies are a rare group ofcongenital anatomical anomalies. Various types of anomaliesof the lumbosacral nerve roots have been documentedin the available international literature. Ttheseanomalies may consist of a bifid, conjoined structure, ofa transverse course or of a characteristic anastomizedappearance. Firstly described as an incidental findingduring autopsies or surgical procedures performed forlumbar disk herniations and often asymptomatic, lumbosacralnerve root anomalies have been more frequentlydescribed in the last years due to the advances made inradiological diagnosis.

  2. POSTERIOR TIBIAL SLOPE AS A RISK FACTOR FOR ANTERIOR CRUCIATE LIGAMENT RUPTURE IN SOCCER PLAYERS

    Directory of Open Access Journals (Sweden)

    Seçkin Şenışık

    2011-12-01

    Full Text Available Anterior cruciate ligament (ACL is the primary stabilizer of the knee. An impairment of any of the dynamic or static stability providing factors can lead to overload on the other factors and ultimately to deterioration of knee stability. This can result in anterior tibial translation and rupture of the ACL. The purpose of this study was to examine the influence of tibial slope on ACL injury risk on soccer players. A total of 64 elite soccer players and 45 sedentary controls were included in this longitudinal and controlled study. The angle between the tibial mid-diaphysis line and the line between the anterior and posterior edges of the medial tibial plateau was measured as the tibial slope via lateral radiographs. Individual player exposure, and injuries sustained by the participants were prospectively recorded. Eleven ACL injuries were documented during the study period. Tibial slope was not different between soccer players and sedentary controls. Tibial slope in the dominant and non-dominant legs was greater for the injured players compared to the uninjured players. The difference reached a significant level only for the dominant legs (p 0.05, a higher tibial slope was observed in dominant legs of injured players (p < 0.05. Higher tibial slope on injured soccer players compared to the uninjured ones supports the idea that the tibial slope degree might be an important risk factor for ACL injury.

  3. Diffusion tensor imaging can be used to detect lesions in peripheral nerves in patients with chronic inflammatory demyelinating polyneuropathy treated with subcutaneous immunoglobulin

    Energy Technology Data Exchange (ETDEWEB)

    Markvardsen, Lars H.; Andersen, Henning [Aarhus University Hospital, Department of Neurology, Aarhus C (Denmark); Vaeggemose, Michael [Aarhus University Hospital, Department of Neurology, Aarhus C (Denmark); Aarhus University Hospital, Department of Diagnostic Imaging: MR Research Centre, Aarhus (Denmark); Ringgaard, Steffen [Aarhus University Hospital, Department of Diagnostic Imaging: MR Research Centre, Aarhus (Denmark)

    2016-08-15

    Magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) has shown that fractional anisotropy (FA) is lower in peripheral nerves in chronic inflammatory demyelinating polyneuropathy (CIDP). We examined whether DTI correlates to muscle strength or impairment. MRI of sciatic and tibial nerves was performed on 3-T MR scanner by obtaining T2- and DTI-weighted sequences with fat saturation. On each slice of T2-weighted (T2w) and DTI, the tibial and sciatic nerves were segmented and served for calculation of signal intensity. On DTI images, pixel-by-pixel calculation of FA and apparent diffusion coefficient (ADC) was done. Muscle strength at knee and ankle was determined by isokinetic dynamometry and severity of CIDP by neuropathy impairment score (NIS). Fourteen CIDP patients treated with subcutaneous immunoglobulin were compared to gender- and age-matched controls. T2w values expressed as a nerve/muscle ratio (nT2w) were unchanged in CIDP versus controls 0.93 ± 0.21 versus 1.02 ± 0.21 (P = 0.10). FA values were lower in CIDP compared to controls 0.38 ± 0.07 versus 0.45 ± 0.05 (P < 0.0001), and ADC values were higher in CIDP versus controls 1735 ± 232 versus 1593 ± 116 x 10{sup -6} mm{sup 2}/s (P = 0.005). In CIDP, FA values correlated to clinical impairment (NIS) (r = -0.57, P = 0.03), but not to muscle strength. FA value in the sciatic nerve distinguishes CIDP from controls with a sensitivity and a specificity of 92.9 %. CIDP patients have unchanged nT2w values, lower FA values, and higher ADC values of sciatic and tibial nerves compared to controls. FA values correlated to NIS but were unrelated to muscle strength. DTI of sciatic nerves seems promising to differentiate CIDP from controls. (orig.)

  4. A preconditioning nerve lesion inhibits mechanical pain hypersensitivity following subsequent neuropathic injury

    Directory of Open Access Journals (Sweden)

    Wu Ann

    2011-01-01

    Full Text Available Abstract Background A preconditioning stimulus can trigger a neuroprotective phenotype in the nervous system - a preconditioning nerve lesion causes a significant increase in axonal regeneration, and cerebral preconditioning protects against subsequent ischemia. We hypothesized that a preconditioning nerve lesion induces gene/protein modifications, neuronal changes, and immune activation that may affect pain sensation following subsequent nerve injury. We examined whether a preconditioning lesion affects neuropathic pain and neuroinflammation after peripheral nerve injury. Results We found that a preconditioning crush injury to a terminal branch of the sciatic nerve seven days before partial ligation of the sciatic nerve (PSNL; a model of neuropathic pain induced a significant attenuation of pain hypersensitivity, particularly mechanical allodynia. A preconditioning lesion of the tibial nerve induced a long-term significant increase in paw-withdrawal threshold to mechanical stimuli and paw-withdrawal latency to thermal stimuli, after PSNL. A preconditioning lesion of the common peroneal induced a smaller but significant short-term increase in paw-withdrawal threshold to mechanical stimuli, after PSNL. There was no difference between preconditioned and unconditioned animals in neuronal damage and macrophage and T-cell infiltration into the dorsal root ganglia (DRGs or in astrocyte and microglia activation in the spinal dorsal and ventral horns. Conclusions These results suggest that prior exposure to a mild nerve lesion protects against adverse effects of subsequent neuropathic injury, and that this conditioning-induced inhibition of pain hypersensitivity is not dependent on neuroinflammation in DRGs and spinal cord. Identifying the underlying mechanisms may have important implications for the understanding of neuropathic pain due to nerve injury.

  5. Is conservative treatment of displaced tibial shaft fractures justified?

    Science.gov (United States)

    Haines, J F; Williams, E A; Hargadon, E J; Davies, D R

    1984-01-01

    All tibial shaft fractures treated at one hospital during a five-year period were studied in a prospective trial. Ninety-one displaced fractures in adults were treated using a conservative policy that included early bone grafting when indicated. Sound bony union was obtained in all cases. Those that healed primarily took on average 16.3 weeks whereas the 24 per cent that required bone grafts took 35.1 weeks. The number of complications, most of which were minor, was considered acceptable. It is concluded that provided early bone grafting is performed when necessary, a basically conservative policy of treatment is satisfactory; bony union of all displaced tibial fractures is achieved in a reasonable period of time.

  6. Asymmetry in gait pattern following tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Læssøe, Uffe; Rasmussen, Sten

    2017-01-01

    INTRODUCTION: Despite the high number of studies evaluating the outcomes following tibial shaft fractures, the literature lacks studies including objective assessment of patients' recovery regarding gait pattern. The purpose of the present study was to evaluate whether gait patterns at 6 and 12...... months post-operatively following intramedullary nailing of a tibial shaft fracture are different compared with a healthy reference population. PATIENTS AND METHODS: The study design was a prospective cohort study. The primary outcome measurement was the gait patterns at 6 and 12 months post......-operatively measured with a 6-metre-long pressure-sensitive mat. The mat registers footprints and present gait speed, cadence as well as temporal and spatial parameters of the gait cycle. Gait patterns were compared to a healthy reference population. RESULTS: 49 patients were included with a mean age of 43.1 years (18...

  7. MR evaluation of femoral neck version and tibial torsion

    International Nuclear Information System (INIS)

    Koenig, James Karl; Dwek, Jerry R.; Pring, Maya E.

    2012-01-01

    Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min. (orig.)

  8. Regeneration of Optic Nerve

    Directory of Open Access Journals (Sweden)

    Kwok-Fai So

    2011-05-01

    Full Text Available The optic nerve is part of the central nervous system (CNS and has a structure similar to other CNS tracts. The axons that form the optic nerve originate in the ganglion cell layer of the retina and extend through the optic tract. As a tissue, the optic nerve has the same organization as the white matter of the brain in regard to its glia. There are three types of glial cells: Oligodendrocytes, astrocytes, and microglia. Little structural and functional regeneration of the CNS takes place spontaneously following injury in adult mammals. In contrast, the ability of the mammalian peripheral nervous system (PNS to regenerate axons after injury is well documented. A number of factors are involved in the lack of CNS regeneration, including: (i the response of neuronal cell bodies against the damage; (ii myelin-mediated inhibition by oligodendrocytes; (iii glial scarring, by astrocytes; (iv macrophage infiltration; and (v insufficient trophic factor support. The fundamental difference in the regenerative capacity between CNS and PNS neuronal cell bodies has been the subject of intensive research. In the CNS the target normally conveys a retrograde trophic signal to the cell body. CNS neurons die because of trophic deprivation. Damage to the optic nerve disconnects the neuronal cell body from its target-derived trophic peptides, leading to the death of retinal ganglion cells. Furthermore, the axontomized neurons become less responsive to the peptide trophic signals they do receive. On the other hand, adult PNS neurons are intrinsically responsive to neurotrophic factors and do not lose trophic responsiveness after axotomy. In this talk different strategies to promote optic-nerve regeneration in adult mammals are reviewed. Much work is still needed to resolve many issues. This is a very important area of neuroregeneration and neuroprotection, as currently there is no cure after traumatic optic nerve injury or retinal disease such as glaucoma, which

  9. The SEP "robot": a valid virtual reality robotic simulator for the Da Vinci Surgical System?

    Science.gov (United States)

    van der Meijden, O A J; Broeders, I A M J; Schijven, M P

    2010-04-01

    The aim of the study was to determine if the concept of face and construct validity may apply to the SurgicalSim Educational Platform (SEP) "robot" simulator. The SEP robot simulator is a virtual reality (VR) simulator aiming to train users on the Da Vinci Surgical System. To determine the SEP's face validity, two questionnaires were constructed. First, a questionnaire was sent to users of the Da Vinci system (reference group) to determine a focused user-group opinion and their recommendations concerning VR-based training applications for robotic surgery. Next, clinical specialists were requested to complete a pre-tested face validity questionnaire after performing a suturing task on the SEP robot simulator. To determine the SEP's construct validity, outcome parameters of the suturing task were compared, for example, relative to participants' endoscopic experience. Correlations between endoscopic experience and outcome parameters of the performed suturing task were tested for significance. On an ordinal five-point, scale the average score for the quality of the simulator software was 3.4; for its hardware, 3.0. Over 80% agreed that it is important to train surgeons and surgical trainees to use the Da Vinci. There was a significant but marginal difference in tool tip trajectory (p = 0.050) and a nonsignificant difference in total procedure time (p = 0.138) in favor of the experienced group. In conclusion, the results of this study reflect a uniform positive opinion using VR training in robotic surgery. Concepts of face and construct validity of the SEP robotic simulator are present; however, these are not strong and need to be improved before implementation of the SEP robotic simulator in its present state for a validated training curriculum to be successful .

  10. ISO 50001 and SEP Faster and Cheaper - Exploring the Enterprise-Wide Approach

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Jingjing [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Rao, Prakash [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Therkelsen, Peter [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sheaffer, Paul [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Scheihing, Paul [USDOE, Washington, DC (United States); Tamm, Yannick [Energetics, Inc. (United States)

    2017-06-01

    ISO 50001 and other management systems (e.g., ISO 9001 and ISO 14001) allow for implementation and certification at the enterprise level. The "Central Office" concept, which allows a small group of employees to manage and facilitate the organization’s energy management system (EnMS) at the enterprise level, was introduced within the ISO 50003 standard to provide guidance to ISO 50001 certification bodies. Four industrial companies have partnered with the United States Department of Energy to pilot the enterprise-wide ISO 50001/SEP concept under the Better Buildings Superior Energy Performance (SEP) Enterprise-wide Accelerator. Each organization developed a Central Office to host their EnMS while implementing ISO 50001/SEP at multiple physically separated sites. The four corporate partners tailored their Central Office implementation model to meet their own specific circumstances and needs. This paper reviews the commonalities, differences, and benefits of each of these enterprise-wide implementation models, including organizational structures, Central Office staff responsibilities, and key strategies. The cost savings and benefits of using the enterprise-wide approach were assessed, including the cost per site compared with that of a conventional, single-site ISO 50001/SEP implementation approach. This paper also discusses the drivers for the cost reductions realized through these enterprise-wide approaches. The four partner companies worked with 30 total sites. On average, these 30 sites improved energy performance by 5% annually over their SEP achievement periods, saved more than $600,000 annually in energy costs and reduced implementation cost for ISO 50001 and SEP by $19,000 and 0.8 Full Time Equivalent × years (FTE-yr) of staff time per site. The results can inform other organizations seeking to implement enterprise-wide ISO 50001/SEP, as well as energy efficiency organizations seeking to promote wider adoption of ISO 50001 implementation.

  11. Tibial acceleration profiles during the menstrual cycle in female athletes.

    Science.gov (United States)

    Hohmann, Erik; Bryant, Adam L; Livingstone, Elisabeth; Reaburn, Peter; Tetsworth, Kevin; Imhoff, Andreas

    2015-10-01

    Fluctuating levels of endogenous estrogen are thought to have an adverse effect on lower limb biomechanics, given the observed higher rate of ACL injury at certain phases of the menstrual cycle. The purpose of this study was to investigate the effects of fluctuating endogenous estrogen levels during the menstrual cycle on acceleration transients at the proximal tibia in young physically active females. Eleven females aged 16-18 years participated in this study and were compared to a male control group. Female subjects were tested at each of the four phases of the menstrual cycle: menses, follicular, ovulation and luteal. On each test occasion, acceleration transients at the proximal tibia were measured while subjects performed an abrupt deceleration task (simulated netball landing). No significant differences were found between the different phases of the menstrual cycle for peak tibial acceleration (PTA; P = 0.57), and time to zero tibial acceleration (TZTA; P = 0.59). However, there was a significant difference for time to peak tibial acceleration (TPTA) between menstruation and follicular (P = 0.04), menstruation and ovulation (P = 0.001), menstruation and luteal phase (P = 0.002), and follicular phase and ovulation (P = 0.007). In the male control group, no significant between-test session differences were observed for PTA (P = 0.48), TZTA (P = 0.08) and TPTA (P = 0.29). While there were no significant between-group differences for PTA (P = 0.21) and TZTA (P = 0.48), significant between-group differences were observed for TPTA (P = 0.001). The results of this project strongly suggest that serum estrogen fluctuations have an effect on tibial acceleration profiles in young female athletes during different phases of the menstrual cycle.

  12. Biomechanical Factors in the Etiology of Tibial Stress Fractures

    Science.gov (United States)

    2006-08-01

    because we initially advertised this study as a tibial stress fracture study and not as a running injury study. We have since changed this advertising ...1-0515. Appendix B Advertisement Flyer 1 ATTENTION FEMALE RUNNERS We are looking for Female Distance Runners who...Newsletter, Fall, 1990. Hamill, J., Clarkson, P. M., Holt, K. G., Freedson, P. S. Muscle Soreness. Nike Sport Research Review, December/March, 1991

  13. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures

    OpenAIRE

    Zelle, Boris A.; Boni, Guilherme

    2015-01-01

    Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction ...

  14. Tibial shaft fracture and ankle injury - Case report.

    Science.gov (United States)

    Zamboni, Caio; Campos, Felipe Augusto Garcez de; Foni, Noel Oizerovici; Souza, Rafael Carboni; Christian, Ralph Walter; Mercadante, Marcelo Tomanik

    2016-01-01

    The authors report on a case of tibial shaft fracture associated with ankle injury. The clinical, radiological and surgical characteristics are discussed. Assessment of associated injuries is often overlooked and these injuries are hard to diagnose. When torque occurs in the lower limb, the ankle becomes susceptible to simultaneous injury. It is essential to make careful assessment based on clinical, radiographic, intraoperative and postoperative characteristics in order to attain functional recovery.

  15. Tibial shaft fracture and ankle injury - Case report

    Directory of Open Access Journals (Sweden)

    Caio Zamboni

    Full Text Available ABSTRACT The authors report on a case of tibial shaft fracture associated with ankle injury. The clinical, radiological and surgical characteristics are discussed. Assessment of associated injuries is often overlooked and these injuries are hard to diagnose. When torque occurs in the lower limb, the ankle becomes susceptible to simultaneous injury. It is essential to make careful assessment based on clinical, radiographic, intraoperative and postoperative characteristics in order to attain functional recovery.

  16. [Tibial plateau fractures in winter sports. Current treatment options].

    Science.gov (United States)

    Zimmermann, V

    2014-01-01

    Tibial plateau fractures overall and especially in winter sports are rare. However, the incidence in recent years is increasing. In a retrospective study from 2009-2012, we found 52 injuries affiliated with winter sports. Noticeable was the high rate of severe injury patterns. In 20 of the 52 cases, there were complete articular or bicondylar fractures (38 %). In 25 cases (48 %), fragment dislocation corresponding to the Moore classification was observed. The operative algorithm was based on the initial soft tissue damage and the type of fracture. A two or more stage procedure with first line soft tissue management and temporary external fixation stabilization was performed 12 times. The final internal osteosynthesis was based on the morphology of the fracture, i.e., direct exposition and stabilization of relevant fracture patterns. In 24 cases (46 %), there was a need for two (or more) approaches. In the anterior aspect of the tibial head, customary implants were used; posterior pathologies were stabilized with low-dimension implants. Summarizing with regard to the literature, there is a more discriminating view of tibial plateau fractures, regarding all relevant fracture patterns. Thus, different options in operative access and choice of implants can be made.

  17. Do Tibial Plateau Fractures Worsen Outcomes of Knee Ligament Injuries? A Matched Cohort Analysis

    OpenAIRE

    Cinque, Mark E.; Godin, Jonathan A.; Moatshe, Gilbert; Chahla, Jorge; Kruckeberg, Bradley M.; Pogorzelski, Jonas; LaPrade, Robert F.

    2017-01-01

    Background: Tibial plateau fractures account for a small portion of all fractures; however, these fractures can pose a surgical challenge when occurring concomitantly with ligament injuries. Purpose/Hypothesis: The purpose of this study was to compare 2-year outcomes of soft tissue reconstruction with or without a concomitant tibial plateau fracture and open reduction internal fixation. We hypothesized that patients with a concomitant tibial plateau fracture at the time of soft tissue surgery...

  18. A STUDY ON ROLE OF INTERLOCK NAILING IN THE MANAGEMENT OF TIBIAL DIAPHYSEAL FRACTURES

    OpenAIRE

    Venkateswara Rao; Chinta Shyam; Anvesh

    2015-01-01

    Tibial fractures are one of the commonest orthopedic injuries. Tibial fractures are one of the commonest orthopedic injuries. In the past several years there has been a trend towards by use of small diameter nails without remaining in the management of unstable tibial shaft fractures. However it is important to remember that many closed fractures with less severe soft tissue injury, Treatment with an intramedullary nail with reaming allows placement of larger implan...

  19. Predictors of dimercaptosuccinic acid chelatable lead and tibial lead in former organolead manufacturing workers

    OpenAIRE

    Schwartz, B. S.; Stewart, W. F.; Todd, A. C.; Links, J. M.

    1999-01-01

    OBJECTIVES: To identify predictors of tibial and dimercaptosuccinic acid (DMSA) chelatable lead in 543 organolead manufacturing workers with past exposure to organic and inorganic lead. METHODS: In this cross sectional study, tibial lead (by 109Cd K-shell x ray fluorescence), DMSA chelatable lead (4 hour urinary lead excretion after oral administration of 10 mg/kg), and several exposure measures were obtained on study participants, mean (SD) age 57.6 (7.6) years. RESULTS: Tibial lead co...

  20. Minimally invasive osteosynthesis of distal tibial fractures using anterolateral locking plate: Evaluation of results and complications

    OpenAIRE

    Lakhotia, Devendra; Sharma, Gaurav; Khatri, Kavin; Kumar, G.N. Kiran; Sharma, Vijay; Farooque, Kamran

    2016-01-01

    Purpose Soft tissue healing is of paramount importance in distal tibial fractures for a successful outcome. There is an increasing trend of using anterolateral plate due to an adequate soft tissue cover on anterolateral distal tibia. The aim of this study was to evaluate the results and complications of minimally invasive anterolateral locking plate in distal tibial fractures. Methods This is a retrospective study of 42 patients with distal tibial fractures treated with minimally invasive ant...

  1. Role of the fibula in the stability of diaphyseal tibial fractures fixed by intramedullary nailing

    OpenAIRE

    Galbraith, John G.; Daly, Charles J.; Harty, James A.; Dailey, Hannah L.

    2016-01-01

    Background: For tibial fractures, the decision to fix a concomitant fibular fracture is undertaken on a case-by-case basis. To aid in this clinical decision-making process, we investigated whether loss of integrity of the fibula significantly destabilises midshaft tibial fractures, whether fixation of the fibula restores stability to the tibia, and whether removal of the fibula and interosseous membrane for expediency in biomechanical testing significantly influences tibial interfragmentary m...

  2. Aneurisma verdadeiro bilateral de artéria tibial posterior True bilateral aneurysm of the posterior tibial artery

    Directory of Open Access Journals (Sweden)

    Silvio Romero de Barros Marques

    2006-03-01

    Full Text Available Neste artigo, faz-se o relato de um caso de aneurisma verdadeiro bilateral da artéria tibial posterior em paciente de 57 anos. Os aneurismas surgiram em épocas diferentes. Os aspectos clínicos, diagnósticos e terapêuticos deste caso são discutidos. Este relato é importante, pois os autores não têm conhecimento de caso semelhante na literatura consultada.This article reports a case of true bilateral aneurysm of the tibial posterior artery in a 57 year-old patient. The aneurysms occurred at different times. The clinical, diagnostic and therapeutic aspects of this case are discussed. This report is important because the authors did not find a similar description in the literature.

  3. Osteotomia tibial alta em pacientes com artrose do joelho High tibial osteotomy in patients with knee arthrosis

    Directory of Open Access Journals (Sweden)

    Roger Avakian

    2008-01-01

    Full Text Available OBJETIVO: Avaliar o tratamento da gonartrose medial com osteotomia tibial tipo cunha de fechamento lateral associado à liberação da articulação tibiofibular proximal. MÉTODOS: Realizamos esta técnica associado com liberação da articulação tibiofibular proximal no tratamento da gonartrose medial em 36 pacientes (41 joelhos de janeiro de 1995 a abril de 2003, com idade de 53,4 anos (média, seguidos por 51,6 meses (média. RESULTADOS: Na avaliação notamos que as osteotomias tibiais com cunha de fechamento lateral permitem correção satisfatória da deformidade fêmorotibial, com angulação femorotibial final em torno de 7º de valgo; o eixo mecânico foi desviado da região tibial medial (posição 1,2% para o centro do joelho (posição 50,5%; a inclinação tibial na incidência perfil pré-operatória de 9,8º foi corrigida para 6,5º (média; a mobilidade articular apresentou perda de 2,3º na extensão (média. CONCLUSÃO: A técnica permite correção satisfatória da deformidade em varo fêmorotibial, porém não é isenta de complicações (14,6%. O grau de satisfação (Lysholm dos pacientes teve incremento de 27,3 para 89. Assim, constitui uma parte essencial no arsenal de tratamento da gonartrose.PURPOSE: To assess medial gonarthrosis treatment with wedge-like side-closed tibial osteotomy combined with proximal tibial-fibular joint release. METHODS: we employed this technique combined with proximal tibial-fibular joint release in the treatment of medial gonarthrosis in 36 patients (41 knees, from January 1995 to April 2003, with mean age of 53.4 years, followed-up for 51.6 months (in average. RESULTS: In the assessment, we noticed that wedge-like side-closed tibial osteotomies allow for a satisfactory repair of the femorotibial deformity, with end femorotibial angle of about 7° valgus; the mechanical axis was dislocated from the medial region of the tibia (position: 1.2% to knee center (position: 50.5%; the 9.8° tibial

  4. Tibial rotational osteotomy for idiopathic torsion. A comparison of the proximal and distal osteotomy levels.

    Science.gov (United States)

    Krengel, W F; Staheli, L T

    1992-10-01

    A retrospective analysis was done of 52 rotational tibial osteotomies (RTOs) performed on 35 patients with severe idiopathic tibial torsion. Thirty-nine osteotomies were performed at the proximal or midtibial level. Thirteen were performed at the distal tibial level with a technique previously described by one of the authors. Serious complications occurred in five (13%) of the proximal and in none of the distal RTOs. For severe and persisting idiopathic tibial torsion, the authors recommend correction by RTO at the distal level. Proximal level osteotomy is indicated only when a varus or valgus deformity required concurrent correction.

  5. Preoperative Measurement of Tibial Resection in Total Knee Arthroplasty Improves Accuracy of Postoperative Limb Alignment Restoration

    Directory of Open Access Journals (Sweden)

    Pei-Hui Wu

    2016-01-01

    Conclusions: Using conventional surgical instruments, preoperative measurement of resection thickness of the tibial plateau on radiographs could improve the accuracy of conventional surgical techniques.

  6. The Tibial Slope in Patients With Achondroplasia: Its Characterization and Possible Role in Genu Recurvatum Development.

    Science.gov (United States)

    Brooks, Jaysson T; Bernholt, David L; Tran, Kevin V; Ain, Michael C

    2016-06-01

    Genu recurvatum, a posterior resting position of the knee, is a common lower extremity deformity in patients with achondroplasia and has been thought to be secondary to ligamentous laxity. To the best of our knowledge, the role of the tibial slope has not been investigated, and no studies describe the tibial slope in patients with achondroplasia. Our goals were to characterize the tibial slope in children and adults with achondroplasia, explore its possible role in the development of genu recurvatum, and compare the tibial slope in patients with achondroplasia to that in the general population. We reviewed 252 lateral knee radiographs of 130 patients with achondroplasia seen at our clinic from November 2007 through September 2013. Patients were excluded if they had previous lower extremity surgery or radiographs with extreme rotation. We analyzed patient demographics and, on all radiographs, the tibial slope. We then compared the mean tibial slope to norms in the literature. Tibial slopes >90 degrees had an anterior tibial slope and received a positive prefix. Statistical analysis included intraclass and interclass reliability, Pearson correlation coefficient, and the Student t tests (significance, Pachondroplasia than in the general population; however, this difference diminishes as patients' age. An anterior tibial slope may predispose to a more posterior resting knee position, also known as genu recurvatum. Level IV-retrospective case series.

  7. Long-nerve grafts and nerve transfers demonstrate comparable outcomes for axillary nerve injuries.

    Science.gov (United States)

    Wolfe, Scott W; Johnsen, Parker H; Lee, Steve K; Feinberg, Joseph H

    2014-07-01

    To compare the functional and EMG outcomes of long-nerve grafts to nerve transfers for complete axillary nerve palsy. Over a 10-year period at a single institution, 14 patients with axillary nerve palsy were treated with long-nerve grafts and 24 patients were treated with triceps-to-axillary nerve transfers by the same surgeon (S.W.W.). Data were collected prospectively at regular intervals, beginning before surgery and continuing up to 11 years after surgery. Prior to intervention, all patients demonstrated EMG evidence of complete denervation of the deltoid. Deltoid recovery (Medical Research Council [MRC] grade), shoulder abduction (°), improvement in shoulder abduction (°), and EMG evidence of deltoid reinnervation were compared between cohorts. There were no significant differences between the long-nerve graft cohort and the nerve transfer cohort with respect to postoperative range of motion, deltoid recovery, improvement in shoulder abduction, or EMG evidence of deltoid reinnervation. These data demonstrate that outcomes of long-nerve grafts for axillary nerve palsy are comparable with those of modern nerve transfers and question a widely held belief that long-nerve grafts do poorly. When healthy donor roots or trunks are available, long-nerve grafts should not be overlooked as an effective intervention for the treatment of axillary nerve injuries in adults with brachial plexus injuries. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  8. Intramedullary fixation of tibial shaft fractures using an expandable nail: early results of 54 acute tibial shaft fractures.

    Science.gov (United States)

    Steinberg, Ely L; Geller, David S; Yacoubian, Shahan V; Shasha, Nadav; Dekel, Shmuel; Lorich, Dean G

    2006-05-01

    To evaluate and present our experience using the expandable nail system for the treatment of acute tibial shaft fractures. Retrospective study. Two level-1 trauma centers-University teaching hospitals. Fifty-four consecutive patients were treated by this nail system for acute tibial shaft fracture. Two nail diameters were used, 8.5 mm and 10 mm. Operation, hospitalization and healing times, reaming versus nonreaming, isolated versus multiple injuries, and reoperations were recorded and analyzed statistically. Follow-up was obtained either until fracture healing or for a minimum of 1 year with an average of 14 months (12 to 24). All fractures healed in an average time of 72 days (21 to 204). The average healing times for patients treated with 8.5-mm and 10-mm nails were 77.2 days (27 to 204) and 63.4 days (21 to 121), respectively. Average operative time was 103 minutes (40 to 185) if reamed and 56 minutes (30 to 80) if unreamed. Average healing times were 65.4 days (21 to 190) if reamed and 79.5 days (42 to 204) if unreamed. There were 11 complications (20.4%) related to the nailing: 3 deep infections, 2 superficial infections, 2 bone shortenings of 1 cm secondary to nail protrusion in the knee, 1 compartment syndrome, 1 fracture propagation, 1 distal malalignment, and 1 delayed union. Hardware was removed in 6 patients (3 infections, 2 patients' request and 1 protrusion into the knee), and 1 additional patient underwent exchange nailing due to a delayed union. The expandable nail offers the theoretical advantages of improved load sharing and rotational control without the need for interlocking screws. This study demonstrates satisfactory healing and alignment for the treatment of tibial shaft fractures using this device. However, caution must be exercised when using this nail in cases of significant comminution and in cases where the fracture pattern involves the more proximal or distal aspect of the tibial shaft.

  9. Cranial nerve palsies

    International Nuclear Information System (INIS)

    Ruggieri, P.; Adelizzi, J.; Modic, M.T.; Ross, J.S.; Tkach, J.; Masaryk, T.J.

    1990-01-01

    This paper evaluates the utility of multiplanar reconstructions (MPRs) of three-dimensional (3D) MR angiography data sets in the examination of patients with cranial nerve palsies. The authors hypothesis was that 3D data could be reformatted to highlight the intricate spatial relationships of vessels to adjacent neural tissues by taking advantage of the high vessel-parenchyma contrast in high-resolution 3D time-of-flight sequences. Twenty patients with cranial nerve palsies and 10 asymptomatic patients were examined with coronal T1-weighted and axial T2-weighted imaging plus a gadolinium-enhanced 3D MRA sequence (40/7/15 degrees, axial 60-mm volume, 0.9-mm isotropic resolution). Cranial nerves II-VIII were subsequently evaluated on axial and reformatted coronal and/or sagittal images

  10. Mission roles for the Solar Electric Propulsion Stage (SEPS) with the space transportation system. Volume 1: Executive summary

    Science.gov (United States)

    Hammock, D. M.

    1975-01-01

    A study was conducted to determine the characteristics of solar electric propulsion stage (SEPS) for the space transportation system. Emphasis is placed on the rationale leading to the concepts for the development and operations program which enhances the cost effectiveness of the SEPS operating with the space transportation system. The approach in describing design concepts and configurations is concerned with the decision controlling factors and selection criteria. The mission roles for the SEPS in accomplishing proposed space activities are defined.

  11. Stress analysis of the tibial plateau according to the difference of blade path entry in opening wedge high tibial osteotomy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jun Woo; Xin, YuanZhu; Yang, Seok Jo [Chungnam National University, Daejeon (Korea, Republic of); Ji, Jong Hun; Panchal, Karnav; Kwon, Oh Soo [The Catholic University of Korea, Daejeon (Korea, Republic of)

    2015-03-15

    High tibial osteotomy (HTO) has been used to successfully treat patients with genu varus deformities that can improve mechanical function and condition in the knee joint. Clinical studies have reported that bow legs often occur with a concentrated load on the varus of the tibia. This study aimed to analyze and verify the clinical test data result by utilizing the three-dimensional (3D) static finite element method (FEM). The 3D model of lower extremities, which include the femur, tibia, meniscus, and knee articular cartilage, was created using the images from a computer tomography scan and magnetic resonance imaging. In this report, we compared changes in stress distribution and force reaction on the tibial plateau because of critical problems caused by unexpected changes in the tibial posterior-slope angle because of HTO. The results showed that the 5 .deg. wedge-angle virtual opening wedge HTO without and with the posterior-slope angle shows has a load concentration of approximately 60% and 45% in the medial region, respectively.

  12. Nerve Transfers in Tetraplegia.

    Science.gov (United States)

    Fox, Ida K

    2016-05-01

    Hand and upper extremity function is instrumental to basic activities of daily living and level of independence in cervical spinal cord injury (SCI). Nerve transfer surgery is a novel and alternate approach for restoring function in SCI. This article discusses the biologic basis of nerve transfers in SCI, patient evaluation, management, and surgical approaches. Although the application of this technique is not new; recent case reports and case series in the literature have increased interest in this field. The challenges are to improve function, achieve maximal gains in function, avoid complications, and to primum non nocere. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Standard Evaluation Procedures (SEPs) and Data Entry Spreadsheet Templates (DESTs) for Endocrine Disruptor Screening Program (EDSP) Tier 1 Assays

    Science.gov (United States)

    This page provides information and access to Standard Evaluation Procedures (SEPs) and Data Entry Spreadsheet Templates (DESTs) developed by EPA's Office of Chemical Safety and Pollution Prevention (OCSPP).

  14. Low Rates of Aseptic Tibial Loosening in Obese Patients With Use of High-Viscosity Cement and Standard Tibial Tray: 2-Year Minimum Follow-Up.

    Science.gov (United States)

    Crawford, David A; Berend, Keith R; Nam, Denis; Barrack, Robert L; Adams, Joanne B; Lombardi, Adolph V

    2017-09-01

    Total knee arthroplasty is overall a very successful surgery, but complications do occur. These complications include aseptic loosening of the tibial component, and obese patients are among the highest risk group. High-viscosity cement (HVC) has been implicated as a possible cause for aseptic loosening of the tibial component. The purpose of this study was to evaluate the incidence of aseptic loosening of the tibial component in obese patients with the use of HVC and standard tibial tray. We identified 1366 obese patients (1851 knees) with a body mass index >35 kg/m 2 and 2-year minimum follow-up who underwent primary total knee arthroplasty using HVC and a symmetrical, grit-blasted, cobalt-chrome tibial component with 40-mm stem. Preoperative and postoperative range of motion, Knee Society (KS) scores, complications, and reoperations were evaluated. Specifically, we assessed the rate of tibial aseptic loosening. At a mean 5.4 years follow-up, only 1 in 1851 knees had aseptic loosening of the tibial component for an incidence of 0.054%. There was a mean increase of 3.3 degrees of knee range of motion. KS pain level decreased by 38.6 points (50 point scale). KS clinical scores improved by 52.2, Knee Society functional scores improved by 19.5, University of California, Los Angeles, activity score improved by 0.9, and Oxford Knee Score by 15.7. All these improvements were statistically significant with P < .001. Standard tibial components and HVC can be used in most patients, including the high-risk obese group, with low rates of tibial aseptic loosening. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Specialized Nerve Tests: EMG, NCV and SSEP

    Science.gov (United States)

    ... grouped according to where they leave the spinal column. There are eight pairs of neck (cervical) nerves, 12 pairs of upper back (thoracic) nerves, five pairs of lower back (lumbar) nerves, five pairs of pelvis (sacral) nerves and ...

  16. Artroplastia total do joelho com o apoio tibial móvel: avaliação dos resultados a médio prazo Total knee arthroplasty with a mobile tibial bearing: medium-term follow-up results

    Directory of Open Access Journals (Sweden)

    Luiz Gabriel Betoni Guglielmetti

    2010-01-01

    Full Text Available OBJETIVO: Avaliações dos resultados a médio prazo da aplicação da prótese com apoio tibial móvel. MÉTODOS: Noventa e seis pacientes (107 joelhos foram submetidos a artroplastia total do joelho realizada com um modelo de prótese com mobilidade rotatória no componente tibial. Os pacientes foram avaliados após um seguimento médio de 52,7 meses - desvio padrão 21,94 (mínimo de 24 meses e máximo de 120 meses, através do protocolo de avaliação "Knee Society Clinical Rating System" (KSCRS, com uma média de 78,22 pontos. RESULTADOS: Entre as complicações transoperatórias e pós operatórias imediatas ocorreram uma deiscência de sutura, com cura espontânea, duas fraturas de patela, uma fratura do côndilo medial do fêmur, três paresias do nervo fibular lateral e uma distrofia nervosa simpático reflexa. As complicações tardias foram uma fratura da patela, uma fratura distal do fêmur, quatro solturas assépticas e quatro infecções profundas, que necessitaram de revisão. CONCLUSÃO: Excluindo-se os casos que necessitaram de uma revisão, por soltura séptica ou asséptica, os autores concluem serem bons os resultados clínicos e funcionais obtidos com a prótese com o apoio tibial móvel num seguimento a médio prazo.OBJECTIVE: Evaluation of mid-term follow up results of the application of a total knee replacement with a mobile tibial bearing design. METHODS: Ninety six patients (107 knees were submitted to total knee Arthroplasty, performed with a model of prosthesis with rotating mobility in the tibial component. The patients were evaluated after a mean follow-up of 52.7 months - standard deviation 21.94 (minimum 24 months and maximum 120 months through the Knee Society Clinical Rating System (KSCRS, with a mean outcome of 78.22 points. RESULTS: The complications that occurred immediately after or during the surgery included: one wound dehiscence with spontaneous healing, two patellar fractures, one fracture of the medial

  17. Tumors of the optic nerve

    DEFF Research Database (Denmark)

    Lindegaard, Jens; Heegaard, Steffen

    2009-01-01

    A variety of lesions may involve the optic nerve. Mainly, these lesions are inflammatory or vascular lesions that rarely necessitate surgery but may induce significant visual morbidity. Orbital tumors may induce proptosis, visual loss, relative afferent pupillary defect, disc edema and optic...... atrophy, but less than one-tenth of these tumors are confined to the optic nerve or its sheaths. No signs or symptoms are pathognomonic for tumors of the optic nerve. The tumors of the optic nerve may originate from the optic nerve itself (primary tumors) as a proliferation of cells normally present...... in the nerve (e.g., astrocytes and meningothelial cells). The optic nerve may also be invaded from tumors originating elsewhere (secondary tumors), invading the nerve from adjacent structures (e.g., choroidal melanoma and retinoblastoma) or from distant sites (e.g., lymphocytic infiltration and distant...

  18. Automated characterization of nerve fibers labeled fluorescently: determination of size, class and spatial distribution.

    Science.gov (United States)

    Prodanov, Dimiter; Feirabend, Hans K P

    2008-10-03

    Morphological classification of nerve fibers could help interpret the assessment of neural regeneration and the understanding of selectivity of nerve stimulation. Specific populations of myelinated nerve fibers can be investigated by retrograde tracing from a muscle followed by microscopic measurements of the labeled fibers at different anatomical levels. Gastrocnemius muscles of adult rats were injected with the retrograde tracer Fluoro-Gold. After a survival period of 3 days, cross-sections of spinal cords, ventral roots, sciatic, and tibial nerves were collected and imaged on a fluorescence microscope. Nerve fibers were classified using a variation-based criterion acting on the distribution of their equivalent diameters. The same criterion was used to classify the labeled axons using the size of the fluorescent marker. Measurements of the axons were paired to those of the entire fibers (axons+myelin sheaths) in order to establish the correspondence between so-established axonal and fiber classifications. It was found that nerve fibers in L6 ventral roots could be classified into four populations comprising two classes of Aalpha (denoted Aalpha1 and Aalpha2), Agamma, and an additional class of Agammaalpha fibers. Cut-off borders between Agamma and Agammaalpha fiber classes were estimated to be 5.00+/-0.09 microm (SEM); between Agammaalpha and Aalpha1 fiber classes to be 6.86+/-0.11 microm (SEM); and between Aalpha1 and Aalpha2 fiber classes to be 8.66+/-0.16 microm (SEM). Topographical maps of the nerve fibers that innervate the gastrocnemius muscles were constructed per fiber class for the spinal root L6. The major advantage of the presented approach consists of the combined indirect classification of nerve fiber types and the construction of topographical maps of so-identified fiber classes.

  19. First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up.

    Science.gov (United States)

    Gersey, Zachary C; Burks, S Shelby; Anderson, Kim D; Dididze, Marine; Khan, Aisha; Dietrich, W Dalton; Levi, Allan D

    2017-03-01

    OBJECTIVE Long-segment injuries to large peripheral nerves present a challenge to surgeons because insufficient donor tissue limits repair. Multiple supplemental approaches have been investigated, including the use of Schwann cells (SCs). The authors present the first 2 cases using autologous SCs to supplement a peripheral nerve graft repair in humans with long-term follow-up data. METHODS Two patients were enrolled in an FDA-approved trial to assess the safety of using expanded populations of autologous SCs to supplement the repair of long-segment injuries to the sciatic nerve. The mechanism of injury included a boat propeller and a gunshot wound. The SCs were obtained from both the sural nerve and damaged sciatic nerve stump. The SCs were expanded and purified in culture by using heregulin β1 and forskolin. Repair was performed with sural nerve grafts, SCs in suspension, and a Duragen graft to house the construct. Follow-up was 36 and 12 months for the patients in Cases 1 and 2, respectively. RESULTS The patient in Case 1 had a boat propeller injury with complete transection of both sciatic divisions at midthigh. The graft length was approximately 7.5 cm. In the postoperative period the patient regained motor function (Medical Research Council [MRC] Grade 5/5) in the tibial distribution, with partial function in peroneal distribution (MRC Grade 2/5 on dorsiflexion). Partial return of sensory function was also achieved, and neuropathic pain was completely resolved. The patient in Case 2 sustained a gunshot wound to the leg, with partial disruption of the tibial division of the sciatic nerve at the midthigh. The graft length was 5 cm. Postoperatively the patient regained complete motor function of the tibial nerve, with partial return of sensation. Long-term follow-up with both MRI and ultrasound demonstrated nerve graft continuity and the absence of tumor formation at the repair site. CONCLUSIONS Presented here are the first 2 cases in which autologous SCs were

  20. Nerve Transfer versus Interpositional Nerve Graft Reconstruction for Posttraumatic, Isolated Axillary Nerve Injuries: A Systematic Review.

    Science.gov (United States)

    Koshy, John C; Agrawal, Nikhil A; Seruya, Mitchel

    2017-11-01

    The purpose of this study was to compare functional outcomes between nerve grafting and nerve transfer procedures in the setting of isolated, posttraumatic axillary nerve injuries. A systematic review was performed using the PubMed, Scopus, and Cochrane databases to identify all cases of isolated, posttraumatic axillary nerve injuries in patients aged 18 years or older. Patients who underwent axillary nerve reconstruction were included and categorized by technique: graft or transfer. Demographics were recorded, including age, time to operation, and presence of concomitant injuries. Functional outcomes were evaluated, including British Medical Research Council strength and range of motion for shoulder abduction. Ten retrospective studies met criteria, for a total of 66 patients (20 nerve grafts and 46 nerve transfers). Median time from injury to operation was equivalent across the nerve graft and nerve transfer groups (8.0 months versus 7.0 months; p = 0.41). Postoperative follow-up was 24.0 months for nerve grafting versus 18.5 months for nerve transfer (p = 0.13). Clinically useful shoulder abduction, defined as British Medical Research Council grade M3 or greater, was obtained in 100 percent of nerve graft patients versus 87 percent of nerve transfer patients (p = 0.09). Grade M4 or better strength was obtained in 85 percent of nerve graft patients and 73.9 percent of nerve transfer patients (p = 0.32). Significant differences in functional outcomes between nerve graft and transfer procedures for posttraumatic axillary nerve injuries are not apparent at this time. Prospective outcomes studies are needed to better elucidate whether functional differences do exist. Therapeutic, IV.

  1. THE TIBIAL APERTURE SURFACE ANALYSIS IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION PROCESS.

    Science.gov (United States)

    Milojević, Zoran; Tabaković, Slobodan; Vićević, Marija; Obradović, Mirko; Vranjes, Miodrag; Milankov, Miroslav Z

    2016-01-01

    The tibial tunnel aperture in the anterior cruciate ligament reconstruction is usually analyzed as an ellipse, generated as an intersection between a tibial plateau and a tibial bone tunnel. The aim of this study is to show that the tibial tunnel aperture, which utilizes 3D tibial surface bone model, differs significantly from common computations which present the tibial tunnel anterior cruciate ligament aperture surface as an ellipse. An interactive program system was developed for the tibial tunnel aperture analysis which included the real tibia 3D surface bone model generated from a series of computed tomography images of ten male patients, their mean age being 25 years. In aperture calculation, the transverse drill angle of 10 degrees was used, whereas sagittal drill angles of 40 degrees, 50 degrees and 60 degrees were used with the drill-bit diameter set to 10 mm. The real 3D and 2D tibial tunnel aperture surface projection was calculated and compared with an ellipse. According to the calculations, generated 3D aperture surfaces were different for every patient even though the same drill parameters were used. For the sagittal drill angles of 40 degrees, 50 degrees and 60 degrees, the mean difference between the projected 3D and 2D area on the tibial plateau was 19.6 +/- 5.4%, 21.1 +/- 8.0% and 21.3 +/- 9.6%, respectively. The difference between the projected 3D area on the tibial plateau and ellipse surface was 54.8 +/- 16.3%, 39.6 +/- 10.4% and 25.0 +/- 8.0% for sagittal drill angles of 40 degrees, 50 degrees and 60 degrees, respectively. The tibial tunnel aperture surface area differs significantly from the ellipse surface area, which is commonly used in the anterior cruciate ligament reconstruction analysis. Inclusion of the 3D shape of the tibial attachment site in the preoperative anterior cruciate ligament reconstruction planning process can lead to a more precise individual anatomic anterior cruciate ligament reconstruction on the tibial bone. Both

  2. Nuclear regulatory policy concept on safety, security, safeguards and emergency preparedness (3S+EP)

    International Nuclear Information System (INIS)

    Ilyas, Zurias

    2009-01-01

    Regulatory Policy is formulated in regulations that stipulate the assurance of workers and public safety and environmental protection. Legislation and regulations on nuclear energy should consider nuclear safety, security and safeguards, as well as nuclear emergency preparedness (3S+EP) and liability for nuclear damage. Specific requirements stipulated in international conventions and agreements should also be taken into account. Regulatory Policy is formulated in regulations that stipulate the assurance of workers and public safety and environmental protection. Legislation and regulations on nuclear energy should consider nuclear safety, security and safeguards, as well as nuclear emergency preparedness (3S+EP) and liability for nuclear damage. Specific requirements stipulated in international conventions and agreements should also be taken into account. By undertaking proper regulatory oversight on Safety, Security and Emergency Preparedness (3S+EP) as an integrated and comprehensive system, safe and secure use of nuclear energy can be assured. Licence requirements and conditions should fulfil regulatory requirements pertaining to 3S+EP for nuclear installation as an integrated system. An effective emergency capacity that can be immediately mobilized is important. The capacity in protecting the personnel before, during and after the disaster should also be planned. Thus, proper emergency preparedness should be supported by adequate resources. The interface between safety, security, safeguards and emergency preparedness has to be set forth in nuclear regulations, such as regulatory requirements; 3S+EP; components, systems and structures of nuclear installations and human resources. Licensing regulations should stipulate, among others, DIQ, installations security system, safety analysis report, emergency preparedness requirements and necessary human resources that meet the 3S+EP requirements.

  3. LEO to GEO (and Beyond) Transfers Using High Power Solar Electric Propulsion (HP-SEP)

    Science.gov (United States)

    Loghry, Christopher S.; Oleson, Steven R.; Woytach, Jeffrey M.; Martini, Michael C.; Smith, David A.; Fittje, James E.; Gyekenyesi, John Z.; Colozza, Anthony J.; Fincannon, James; Bogner, Aimee; hide

    2017-01-01

    Rideshare, or Multi-Payload launch configurations, are becoming more and more commonplace but access to space is only one part of the overall mission needs. The ability for payloads to achieve their target orbits or destinations can still be difficult and potentially not feasible with on-board propulsion limitations. The High Power Solar Electric Propulsion (HP-SEP) Orbital Maneuvering Vehicle (OMV) provides transfer capabilities for both large and small payload in excess of what is possible with chemical propulsion. Leveraging existing secondary payload adapter technology like the ESPA provides a platform to support Multi-Payload launch and missions. When coupled with HP-SEP, meaning greater than 30 kW system power, very large delta-V maneuvers can be accomplished. The HP-SEP OMV concept is designed to perform a Low Earth Orbit to Geosynchronous Orbit (LEO-GEO) transfer of up to six payloads each with 300kg mass. The OMV has enough capability to perform this 6 kms maneuver and have residual capacity to extend an additional transfer from GEO to Lunar orbit. This high deltaV capability is achieved using state of the art 12.5kW Hall Effect Thrusters (HET) coupled with high power roll up solar arrays. The HP-SEP OMV also provides a demonstration platform for other SEP technologies such as advanced Power Processing Units (PPU), Xenon Feed Systems (XFS), and other HET technologies. The HP-SEP OMV platform can be leveraged for other missions as well such as interplanetary science missions and applications for resilient space architectures.

  4. Contribution of myelunated fibers from spinal L4, L5 and L6 nerves to the sciatic nerve and its main branches in the adult rat Contribución de fibras mielínicas provenientes de los nervios espinales lumbares L4, L5 y L6 al nervio ciático de rata adulta y sus ramas principales

    Directory of Open Access Journals (Sweden)

    Juan D. Robles

    2000-04-01

    Full Text Available The rat sciatic nerve is composed by the L4, L5 and L6 lumbar spinal nerves. However, the contribution in myelinated fibers originating from these nerves along this nervous trunk has not yet been defined. In the present study, the L4, L5 and L4-L5 spinal nerves were selectively transected. After one week the sciatic, tibial, sural and peroneal nerves were dissected. These samples were fixed and processed for optical microscopy, and both degenerated and normal myelinated fibers were counted in toluidine blue-stained semi-thin sections. L4 contributed with myelinated fibers mainly to the peroneal nerve, and L5 to the sciatic, tibial and sural nerves. In general, the contribution of L6 was smaller and variable along the nervous trunk in comparison to the other two spinal branches. Our results give key information for further studies looking to correlate the contribution of spinal nerves making part of the sciatic nerve and its main branches with hind limb function. El nervio ciático de la rata está formado por los nervios espinales (ne lumbares L4, L5 y L6. Sin embargo, aún no se ha definido el aporte en fibras mielínicas de estos nervios espinales a lo largo del tronco nervioso. En este estudio se transectaron selectivamente los NE L4, L5 y L4-L5. Luego de una semana se disecaron los nervios ciático, tibial, sural y peroneal. Estas muestras se fijaron y procesaron para microscopía óptica y a partir de cortes coloreados con azul de toluidina se contaron las fibras mielínicas degeneradas y normales. L4 contribuyó con fibras mielínicas principalmente al nervio peroneal y L5 a los nervios ciático, tibial y sural. En general, el aporte de L6 fue menor y variable a lo largo del tronco nervioso comparado con las otras dos ramas espinales. Nuestros resultados brindan información valiosa para posteriores estudios que busquen correlacionar la contribución de los nervios espinales que componen el ciático y sus ramas principales con la funci

  5. Tumors of the optic nerve

    DEFF Research Database (Denmark)

    Lindegaard, Jens; Heegaard, Steffen

    2009-01-01

    in the nerve (e.g., astrocytes and meningothelial cells). The optic nerve may also be invaded from tumors originating elsewhere (secondary tumors), invading the nerve from adjacent structures (e.g., choroidal melanoma and retinoblastoma) or from distant sites (e.g., lymphocytic infiltration and distant...

  6. Anatomy of the trigeminal nerve

    NARCIS (Netherlands)

    van Eijden, T.M.G.J.; Langenbach, G.E.J.; Baart, J.A.; Brand, H.S.

    2017-01-01

    The trigeminal nerve is the fifth cranial nerve (n. V), which plays an important role in the innervation of the head and neck area, together with other cranial and spinal nerves. Knowledge of the nerve’s anatomy is very important for the correct application of local anaesthetics.

  7. Imaging the ocular motor nerves.

    NARCIS (Netherlands)

    Ferreira, T.; Verbist, B.M.; Buchem, M. van; Osch, T. van; Webb, A.

    2010-01-01

    The ocular motor nerves (OMNs) comprise the oculomotor, trochlear and the abducens nerves. According to their course, they are divided into four or five anatomic segments: intra-axial, cisternal, cavernous and intra-orbital and, for the abducens nerve, an additional interdural segment. Magnetic

  8. Nerve conduction and excitability studies in peripheral nerve disorders

    DEFF Research Database (Denmark)

    Krarup, Christian; Moldovan, Mihai

    2009-01-01

    PURPOSE OF REVIEW: The review is aimed at providing information about the role of nerve excitability studies in peripheral nerve disorders. It has been known for many years that the insight into peripheral nerve pathophysiology provided by conventional nerve conduction studies is limited. Nerve....... Studies of different metabolic neuropathies have assessed the influence of uremia, diabetes and ischemia, and the use of these methods in toxic neuropathies has allowed pinpointing damaging factors. Various mutations in ion channels associated with central nervous system disorders have been shown to have...

  9. Korrekturosteotomie bei lateraler Tibiakopfimpression und Valgusfehlstellung == Correction of lateral tibial plateau depression and valgus malunion of the proximal tibia

    NARCIS (Netherlands)

    Marti, René K.; Kerkhoffs, Gino M. M. J.; Rademakers, Maarten V.

    2007-01-01

    OBJECTIVE: Improvement of joint congruency in malunited lateral tibial plateau fractures, reduction of pain, prevention of osteoarthritis. INDICATIONS: Valgus malalignment of the proximal tibia combined with intraarticular depression of the tibial plateau. CONTRAINDICATIONS: Patients in poor general

  10. Optic nerve oxygen tension

    DEFF Research Database (Denmark)

    Kiilgaard, Jens Folke; Pedersen, D B; Eysteinsson, T

    2004-01-01

    The authors have previously reported that carbonic anhydrase inhibitors such as acetazolamide and dorzolamide raise optic nerve oxygen tension (ONPO(2)) in pigs. The purpose of the present study was to investigate whether timolol, which belongs to another group of glaucoma drugs called beta...

  11. Optic nerve oxygen tension

    DEFF Research Database (Denmark)

    Kiilgaard, Jens Folke; Pedersen, D B; Eysteinsson, T

    2004-01-01

    The authors have previously reported that carbonic anhydrase inhibitors such as acetazolamide and dorzolamide raise optic nerve oxygen tension (ONPO(2)) in pigs. The purpose of the present study was to investigate whether timolol, which belongs to another group of glaucoma drugs called beta block...

  12. Optic nerve sheath meningiomas

    NARCIS (Netherlands)

    Saeed, Peerooz; Rootman, Jack; Nugent, Robert A.; White, Valerie A.; Mackenzie, Ian R.; Koornneef, Leo

    2003-01-01

    To study the natural history and growth of optic nerve sheath meningiomas and evaluate their management outcome. Clinicopathologic retrospective noncomparative case series. A retrospective study of 88 patients who were treated between 1976 and 1999 at the University of British Columbia and the

  13. Significance of the position of the proximal tip of the tibial nail: An important factor related to anterior knee pain

    OpenAIRE

    Tahririan, Mohammad Ali; Ziaei, Ehsan; Osanloo, Reza

    2014-01-01

    Background: Intramedullary nailing is the treatment of choice for the majority of tibial shaft fractures and anterior knee pain is the most common complication of this surgery; however, its etiology is still unknown. The purpose of this study was to assess the predicting factors related to anterior knee pain following tibial nailing. Materials and Methods: Patients with isolated, unilateral tibial shaft fracture who had undergone tibial nailing were identified retrospectively. Data includ...

  14. Proximal tibial varus osteotomy. Indications, technique, and five to twenty-one-year results

    NARCIS (Netherlands)

    Marti, R. K.; Verhagen, R. A.; Kerkhoffs, G. M.; Moojen, T. M.

    2001-01-01

    Although high tibial osteotomy has been proved effective for the treatment of painful osteoarthritis of the medial compartment of the knee, the role of proximal tibial varus osteotomy for the treatment of painful osteoarthritis of the lateral compartment still remains controversial. From 1974 to

  15. The effect of posterior tibial slope on simulated laxity tests in cruciate-retaining TKA

    NARCIS (Netherlands)

    Marra, Marco A.; Strzelczak, Marta; Heesterbeek, Petra J.C.; van de Groes, Sebastiaan; Janssen, Dennis; Koopman, Bart F.J.M.; Wymenga, Ate B.; Verdonschot, Nico

    2017-01-01

    INTRODUCTION: Tibial slope can affect the outcomes of Total Knee Arthroplasty (TKA). More posterior slope potentially helps releasing a too tight flexion gap and it is generally associated with a wider range of post-operative knee flexion. However, the mechanism by which tibial slope affects the

  16. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... uncemented prosthesis. 888.3590 Section 888.3590 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be implanted...

  17. Tibial component with and without stem extension in a trabecular metal cone construct

    NARCIS (Netherlands)

    Meijer, Marrigje F.; Boerboom, Alexander L.; Stevens, Martin; Reininga, Inge H.F.; Janssen, Dennis W.; Verdonschot, N.; Bulstra, Sjoerd K.

    2017-01-01

    Purpose: The purpose of this study was to investigate stability and strain distribution of a tibial plateau reconstruction with a trabecular metal cone while the tibial component is implanted with and without a stem, and whether prosthetic stability was influenced by bone mineral density. Trabecular

  18. Tibial component with and without stem extension in a trabecular metal cone construct

    NARCIS (Netherlands)

    Meijer, Marrigje F; Boerboom, Alexander L; Stevens, Martin; Reininga, Inge H F; Janssen, Dennis W; Verdonschot, N; Bulstra, Sjoerd K

    2017-01-01

    PURPOSE: The purpose of this study was to investigate stability and strain distribution of a tibial plateau reconstruction with a trabecular metal cone while the tibial component is implanted with and without a stem, and whether prosthetic stability was influenced by bone mineral density. Trabecular

  19. Immediate weight-bearing after osteosynthesis of proximal tibial fractures may be allowed

    DEFF Research Database (Denmark)

    Haak, Karl Tobias; Palm, Henrik; Holck, Kim

    2012-01-01

    Immediate weight-bearing following osteosynthesis of proximal tibial fractures is traditionally not allowed due to fear of articular fracture collapse. Anatomically shaped locking plates with sub-articular screws could improve stability and allow greater loading forces. The purpose of this study...... was to investigate if immediate weight-bearing can be allowed following locking plate osteosynthesis of proximal tibial fractures....

  20. Effect of referencing technique for the tibial slope in cruciate-retaining total knee arthroplasty

    NARCIS (Netherlands)

    Marra, Marco Antonio; Heesterbeek, Petra J.C.; van de Groes, Sebastiaan A.W.; Janssen, Dennis W.; Koopman, H.F.J.M.; Wymenga, A.B.; Verdonschot, N.J.J.

    2017-01-01

    Introduction: Tibial slope was shown to majorly affect the outcomes of Total Knee Arthroplasty (TKA). More slope of the tibial component could help releasing a too tight flexion gap in cruciate-retaining (CR) TKA and is generally associated with a wider range of post-operative knee flexion. However,

  1. Metachronous Bilateral Posterior Tibial Artery Aneurysms in Ehlers-Danlos Syndrome Type IV

    International Nuclear Information System (INIS)

    Hagspiel, Klaus D.; Bonatti, Hugo; Sabri, Saher; Arslan, Bulent; Harthun, Nancy L.

    2011-01-01

    Ehlers-Danlos syndrome type IV is a life-threatening genetic connective tissue disorder. We report a 24-year-old woman with EDS-IV who presented with metachronous bilateral aneurysms/pseudoaneurysms of the posterior tibial arteries 15 months apart. Both were treated successfully with transarterial coil embolization from a distal posterior tibial approach.

  2. Posterior cruciate ligament reconstruction by means of tibial tunnel: anatomical study on cadavers for tunnel positioning

    Directory of Open Access Journals (Sweden)

    Antônio Altenor Bessa de Queiroz

    2014-08-01

    Full Text Available Objective:To determine the reference points for the exit of the tibial guidewire in relation to the posterior cortical bone of the tibia.Methods:Sixteen knees from fresh cadavers were used for this study. Using a viewing device and a guide marked out in millimeters, three guidewires were passed through the tibia at 0, 10 and 15 mm distally in relation to the posterior crest of the tibia. Dissections were performed and the region of the center of the tibial insertion of the posterior cruciate ligament (PCL was determined in each knee. The distances between the center of the tibial insertion of the PCL and the posterior tibial border (CB and between the center of the tibial insertion of the PCL and wires 1, 2 and 3 (CW1, CW2 and CW3 were measured.Results:In the dissected knees, we found the center of the tibial insertion of the PCL at 1.09 ± 0.06 cm from the posterior tibial border. The distances between the wires 1, 2 and 3 and the center of the tibial insertion of the PCL were respectively 1.01 ± 0.08, 0.09 ± 0.05 and 0.5 ± 0.05 cm.Conclusion:The guidewire exit point 10 mm distal in relation to the posterior crest of the tibia was the best position for attempting to reproduce the anatomical center of the PCL.

  3. Effect of triple tibial osteotomy on femorotibial stability in canine cranial cruciate ligament deficient stifles

    DEFF Research Database (Denmark)

    Kristiansen, S.; Vedel, T.; Jensen, Bente Rona

    ° (± 8.5°). Two different complications were observed during TTO. These were fracture of the caudal tibial cortex and fracture of the distal tibial tuberosity. The complication rate was respectively 100% and 44%. Conclusion: TTO significantly reduced CTS in this CrCl and medial meniscus deficient stifle...

  4. Pathology of the vestibulocochlear nerve

    Energy Technology Data Exchange (ETDEWEB)

    De Foer, Bert [Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: bert.defoer@GZA.be; Kenis, Christoph [Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: christophkenis@hotmail.com; Van Melkebeke, Deborah [Department of Neurology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: Deborah.vanmelkebeke@Ugent.be; Vercruysse, Jean-Philippe [University Department of ENT, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: jphver@yahoo.com; Somers, Thomas [University Department of ENT, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: Thomas.somers@GZA.be; Pouillon, Marc [Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: marc.pouillon@GZA.be; Offeciers, Erwin [University Department of ENT, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: Erwin.offeciers@GZA.be; Casselman, Jan W. [Department of Radiology, AZ Sint-Jan AV Hospital, Ruddershove 10, Bruges (Belgium); Consultant Radiologist, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium); Academic Consultent, University of Ghent (Belgium)], E-mail: jan.casselman@azbrugge.be

    2010-05-15

    There is a large scala of pathology affecting the vestibulocochlear nerve. Magnetic resonance imaging is the method of choice for the investigation of pathology of the vestibulocochlear nerve. Congenital pathology mainly consists of agenesis or hypoplasia of the vestibulocochlear nerve. Tumoral pathology affecting the vestibulocochlear nerve is most frequently located in the internal auditory canal or cerebellopontine angle. Schwannoma of the vestibulocochlear nerve is the most frequently found tumoral lesion followed by meningeoma, arachnoid cyst and epidermoid cyst. The most frequently encountered pathologies as well as some more rare entities are discussed in this chapter.

  5. ß-TCP bone substitutes in tibial plateau depression fractures.

    Science.gov (United States)

    Rolvien, Tim; Barvencik, Florian; Klatte, Till Orla; Busse, Björn; Hahn, Michael; Rueger, Johannes Maria; Rupprecht, Martin

    2017-10-01

    The use of beta-tricalciumphospate (ß-TCP, Cerasorb®) ceramics as an alternative for autologous bone-grafting has been outlined previously, however with no study focusing on both clinical and histological outcomes of ß-TCP application in patients with multi-fragment tibial plateau fractures. The aim of this study was to analyze the long-term results of ß-TCP in patients with tibial plateau fractures. 52 patients were included in this study. All patients underwent open surgery with ß-TCP block or granulate application. After a mean follow-up of 36months (14-64months), the patients were reviewed. Radiography and computed-tomography were performed, while the Rasmussen score was obtained for clinical outcome. Furthermore, seven patients underwent biopsy during hardware removal, which was subsequently analyzed by histology and backscattered electron microscopy (BSEM). An excellent reduction with two millimeters or less of residual incongruity was achieved in 83% of the patients. At follow-up, no further changes occurred and no nonunions were observed. Functional outcome was good to excellent in 82%. Four patients underwent revision surgery due to reasons unrelated to the bone substitute material. Histologic analyses indicated that new bone was built around the ß-TCP-grafts, however a complete resorption of ß-TCP was not observed. ß-TCP combined with internal fixation represents an effective and safe treatment of tibial plateau depression fractures with good functional recovery. While its osteoconductivity seems to be successful, the biological degradation and replacement of ß-TCP is less pronounced in humans than previous animal studies have indicated. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Prolonged operative time increases infection rate in tibial plateau fractures.

    Science.gov (United States)

    Colman, Matthew; Wright, Adam; Gruen, Gary; Siska, Peter; Pape, Hans-Christoph; Tarkin, Ivan

    2013-02-01

    Fractures of the tibial plateau present a treatment challenge and are susceptible to both prolonged operative times and high postoperative infection rates. For those fractures treated with open plating, we sought to identify the relationship between surgical site infection and prolonged operative time as well as to identify other surgical risk factors. We performed a retrospective controlled analysis of 309 consecutive unicondylar and bicondylar tibial plateau fractures treated with open plate osteosynthesis at our institution's level I trauma centre during a recent 5-year period. We recorded operative times, injury characteristics, surgical treatment, and need for operative debridement due to infection. Operative times of infected cases were compared to uncomplicated surgical cases. Multivariable logistic regression analysis was performed to identify independent risk factors for postoperative infection. Mean operative time in the infection group was 2.8h vs. 2.2h in the non-infected group (p=0.005). 15 fractures (4.9%) underwent four compartment fasciotomies as part of their treatment, with a significantly higher infection rate than those not undergoing fasciotomy (26.7% vs. 6.8%, p=0.01). Open fracture grade was also significantly related to infection rate (closed fractures: 5.3%, grade 1: 14.3%, grade 2: 40%, grade 3: 50%, pinfection rates (13.9% vs. 8.7%, p=0.36). Multivariable logistic regression analysis of the entire study group identified longer operative times (OR 1.78, p=0.013) and open fractures (OR 7.02, psite infection. Operative times approaching 3h and open fractures are related to an increased overall risk for surgical site infection after open plating of the tibial plateau. Dual incision approaches with bicolumnar plating do not appear to expose the patient to increased risk compared to single incision approaches. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. A phase 3, placebo controlled study of the safety and efficacy of avanafil for the treatment of erectile dysfunction after nerve sparing radical prostatectomy.

    Science.gov (United States)

    Mulhall, John P; Burnett, Arthur L; Wang, Run; McVary, Kevin T; Moul, Judd W; Bowden, Charles H; DiDonato, Karen; Shih, Winnie; Day, Wesley W

    2013-06-01

    We evaluated the safety and efficacy of 100 and 200 mg avanafil for the treatment of adult males with erectile dysfunction after bilateral nerve sparing radical prostatectomy. This was a double-blind, placebo controlled, parallel group, phase 3 study in males age 18 to 70 years with a history of erectile dysfunction of 6 months or more after bilateral nerve sparing radical prostatectomy. Patients were randomized to 100 or 200 mg avanafil or placebo (taken 30 minutes before sexual activity) for 12 weeks. Primary end points included successful vaginal insertion (Sexual Encounter Profile [SEP] question 2), successful intercourse (SEP3) and change in score on the erectile function domain of the International Index of Erectile Function (IIEF-EF) questionnaire. A total of 298 patients were randomized and 84.6% completed the study. At baseline 16.1% were age 65 years or older and 71.5% had severe erectile dysfunction (mean overall IIEF-EF domain score 9.2). After 12 weeks there were significantly greater increases in SEP2 and SEP3 and change in mean IIEF-EF domain score with 100 and 200 mg avanafil vs placebo (p erectile function after prostatectomy. Results suggest a rapid onset of action and sustained duration of effect, with all 3 primary end points being achieved at both dose levels. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  8. Return to Sport After Tibial Shaft Fractures: A Systematic Review.

    Science.gov (United States)

    Robertson, Greg A J; Wood, Alexander M

    2016-07-01

    Acute tibial shaft fractures represent one of the most severe injuries in sports. Return rates and return-to-sport times after these injuries are limited, particularly with regard to the outcomes of different treatment methods. To determine the current evidence for the treatment of and return to sport after tibial shaft fractures. OVID/MEDLINE (PubMed), EMBASE, CINAHL, Cochrane Collaboration Database, Web of Science, PEDro, SPORTDiscus, Scopus, and Google Scholar were all searched for articles published from 1988 to 2014. Inclusion criteria comprised studies of level 1 to 4 evidence, written in the English language, that reported on the management and outcome of tibial shaft fractures and included data on either return-to-sport rate or time. Studies that failed to report on sporting outcomes, those of level 5 evidence, and those in non-English language were excluded. Systematic review. Level 4. The search used combinations of the terms tibial, tibia, acute, fracture, athletes, sports, nonoperative, conservative, operative, and return to sport. Two authors independently reviewed the selected articles and created separate data sets, which were subsequently combined for final analysis. A total of 16 studies (10 retrospective, 3 prospective, 3 randomized controlled trials) were included (n = 889 patients). Seventy-six percent (672/889) of the patients were men, with a mean age of 27.7 years. Surgical management was assessed in 14 studies, and nonsurgical management was assessed in 8 studies. Return to sport ranged from 12 to 54 weeks after surgical intervention and from 28 to 182 weeks after nonsurgical management (mean difference, 69.5 weeks; 95% CI, -83.36 to -55.64; P Fractures treated surgically had a return-to-sport rate of 92%, whereas those treated nonsurgically had a return rate of 67% (risk ratio, 1.37; 95% CI, 1.20 to 1.57; P displaced fractures and to attempt nonsurgical management for undisplaced fractures. Primary surgical intervention of undisplaced

  9. Outcomes of The Isolated Closed Tibial Shaft Fractures Treated Nonsurgically

    Directory of Open Access Journals (Sweden)

    Dawood Jafari

    2011-05-01

    Full Text Available Background: Fractures of the tibia are important for their commonness and controversy in their management. Both conservative and surgical techniques have been introduced in an effort to speed time to union while minimizing the occurrence of complications. Standard treatment for low-energy tibial shaft fractures includes closed reduction and cast immobilization.The purpose of our study was to analyze retention of reduction after cast immobilization of simple isolated closed tibial fractures.Methods:All cases of the diagnosed isolated closed tibial shaft fracture treated non-surgically at Shafa Yahyaeian Hospital, between 2006 and 2009 were retrieved from medical records. We reviewed all medical records and radiographs of these patients to inquire about the patients’ demographic data used to analyze the outcomes of the non-surgical treatment.Results:Of the 26 patients examined, males were more commonly affected. The mean age was 27.46   (SD=7.58.The most common causes of injury were direct blow and motorcycle to pedestrian accident. Followup duration for each patient had an average of 9.12 months (SD=2.36. Using AO/OTA classification, distributed as 38.5% A1.1, 26.9% A2.1 and 34.6% A3.1 fractures. Most fractures were sustained in the lower third of the tibia (53.85%. All fractures eventually healed in an average of 13.7 weeks (SD=3.24. There was one case of delayed union in the 22nd week. In 92.3% of patients, shortening of bone was less than 1 cm, while in 7.7% patients, was more than 1.5 cm. We observed an anterior or posterior angulation > 10 ° in 2 (7.69% patients. Moreover, in 4 (15.38% patients we found varus angulation > 5°. Therefore, final deformity was observed in 8 (30.77% patients. No patient had non-union, rotational malalignment of more than 10 degrees, an infection, or a compartment syndrome.Conclusion : Our non-surgical treatment’s outcomes were not satisfactory, despite applying all principles for conservative treatment and

  10. Age variations in the properties of human tibial trabecular bone

    DEFF Research Database (Denmark)

    Ding, Ming; Dalstra, M; Danielsen, CC

    1997-01-01

    We tested in compression specimens of human proximal tibial trabecular bone from 31 normal donors aged from 16 to 83 years and determined the mechanical properties, density and mineral and collagen content. Young's modulus and ultimate stress were highest between 40 and 50 years, whereas ultimate...... amount of collagen) varied with failure energy. Collagen concentration was maximal at younger ages but varied little with age. Our results suggest that the decrease in mechanical properties of trabecular bone such as Young's modulus and ultimate stress is mainly a consequence of the loss of trabecular...

  11. External tibial torsion and the effectiveness of the solid ankle-foot orthoses.

    Science.gov (United States)

    Vankoski, S J; Michaud, S; Dias, L

    2000-01-01

    The aims of this study were to determine the influence of external tibial torsion on the effectiveness of the ankle-foot orthoses (AFO) in children with lumbosacral myelomeningocele. Forty patients with normal tibial rotation and 18 patients with excessive external tibial torsion were evaluated with three-dimensional gait analysis at their comfortable walking speed. The group with normal tibial rotation showed significantly greater knee extension and lower mean extension moment compared with the group with external tibial torsion (p 20 degrees demand close inspection as candidates for derotation osteotomy. The AFO will continue to stabilize the ankle-foot complex, but improved knee motion, knee-extensor activity, and ultimately walking efficiency may be compromised.

  12. A Patient with Unilateral Tibial Aplasia and Accessory Scrotum: A Pure Coincidence or Nonfortuitous Association?

    Directory of Open Access Journals (Sweden)

    Zoran Gucev

    2010-01-01

    Full Text Available Tibial aplasia is an uncommon lower limb malformation that can occur isolated or be part of a more complex malformation pattern. We describe a 9-year-old boy born after uneventful pregnancy and delivery. Family history was negative for maternal diabetes and other malformations. The patient presented with left tibial aplasia and homolateral prexial foot polydactyly. He also displayed enamel dysplasia and bifid scotum with cryptorchidism. Literature review failed to identify a significant syndromic association between lower limb defects of the tibial type and the genital anomalies reported here. The combination of tibial aplasia with midline genital malformations further supports the hypothesis that the tibial ray development mirrors the morphogenetic process of the radial structures. Accordingly, the malformation pattern observed in the present patient may be pathogenetically explained by an insult occurring during late blastogenesis.

  13. SeP, ApoER2 and megalin as necessary factors to maintain Se homeostasis in mammals.

    Science.gov (United States)

    Krol, Magdalena Beata; Gromadzinska, Jolanta; Wasowicz, Wojciech

    2012-10-01

    Selenoprotein P (SeP) is an extracellular protein containing ten selenium atoms in the form of selenocysteine, secreted mainly from the liver. About 60% of the whole plasma selenium level is present in SeP, which makes it a useful biomarker of selenium nutritional status. The main functions of SeP are transport and storage of selenium in plasma. It is especially an important protein for the brain, testes and kidneys where the supplementation of the proper amount of Se ensures the synthesis of selenoenzymes with antioxidant properties.Recently, it has been found that SeP uptake in kidneys, testes and brain depends on the apolipoprotein receptor 2 (ApoER2) and lipoprotein megalin receptor (Lrp2). Megalin receptor represents a physiological SeP receptor in kidneys, mediating the re-uptake of secreted SeP from the primary urine. The absence of a functional megalin receptor causes a significant reduction of plasma selenium and the SeP levels as a result of Se excretion. ApoER2 is a SeP receptor in the brain and testes which uptakes Se from the extracellular fluid. Deletion of ApoER2 in mice leads to a lowered selenium level in the brain and testes, neurological dysfunction, production of abnormal spermatozoa, infertility and even death when the subjects are fed a low-selenium diet. Copyright © 2012 Elsevier GmbH. All rights reserved.

  14. 29 CFR 2520.104-48 - Alternative method of compliance for model simplified employee pensions-IRS Form 5305-SEP.

    Science.gov (United States)

    2010-07-01

    ... retirement account or individual retirement annuity (IRA) for that year. (c) If the employer establishing and... employee pensions-IRS Form 5305-SEP. 2520.104-48 Section 2520.104-48 Labor Regulations Relating to Labor... compliance for model simplified employee pensions—IRS Form 5305-SEP. Under the authority of section 110 of...

  15. 78 FR 19489 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-04-01

    ... Increase Breast and Cervical Cancer Population--Based Prevention Activities SIP13-066, Panel A, initial... Colorectal Cancer Screening, SIP13-065; and Using Small Media to Increase Breast and Cervical Cancer..., Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting...

  16. 77 FR 5026 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-02-01

    ..., Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting... Series among Adolescent Females, IP12-004, and Intervention Study to Increase Use of Standing Orders... Series among Adolescent Females, FOA IP12-004; and Intervention Study to Increase Use of Standing Orders...

  17. 77 FR 21778 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-04-11

    ..., Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Development and Testing of a Clinic-Based Intervention to Increase Dual Protection... applications received in response to ``Development and Testing of a Clinic-Based Intervention to Increase Dual...

  18. 77 FR 12844 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Development...

    Science.gov (United States)

    2012-03-02

    ..., Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Development and Evaluation of a Clinic-Based Screening and Brief Intervention for Changing Behaviors Related to Cytomegalovirus... ``Development and Evaluation of a Clinic-Based Screening and Brief Intervention for Changing Behaviors Related...

  19. 76 FR 24031 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2011-04-29

    ..., Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting... Intervention to Promote a Targeted Vaccination program in the Obstetrician- Gynecologist Setting, FOA IP11-009... Population-Based Immunization Information Systems, FOA IP11-008; Effectiveness in an Intervention to Promote...

  20. 77 FR 39497 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-07-03

    ..., Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting... Intervention to Increase Fruit and Vegetable Intake in Middle and High School Students, SIP12-063, Panel F... Intervention to Increase Fruit and Vegetable Intake in Middle and High School Students, SIP12-063, Panel F...

  1. 76 FR 4703 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Pregnancy...

    Science.gov (United States)

    2011-01-26

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Pregnancy Risk Assessment Monitoring System (PRAMS), DP11-001 Panel...

  2. 77 FR 61756 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-10-11

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Occupational...

  3. 77 FR 19018 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-03-29

    ... [Federal Register Volume 77, Number 61 (Thursday, March 29, 2012)] [Notices] [Page 19018] [FR Doc No: 2012-7545] DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The...

  4. 78 FR 37542 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-06-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns NIOSH...

  5. 78 FR 19490 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-04-01

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review Notice of Cancellation: A notice was published in the...

  6. 78 FR 17410 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panels (SEP): Initial review

    Science.gov (United States)

    2013-03-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panels (SEP): Initial review The meeting announced below concerns Epi-Centers for...

  7. 76 FR 28790 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2011-05-18

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Member Conflict...

  8. 78 FR 75923 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-12-13

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Clinical...

  9. 78 FR 732 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-01-04

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Identification...

  10. 76 FR 52330 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2011-08-22

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Member Conflict...

  11. 77 FR 4048 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-01-26

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Evaluation of...

  12. 77 FR 5257 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-02-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Detecting...

  13. 77 FR 14806 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-03-13

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Epidemiology...

  14. 76 FR 18766 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2011-04-05

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Epidemiologic...

  15. 77 FR 36544 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-06-19

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Coordinating...

  16. 77 FR 7164 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-02-10

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Member Conflict...

  17. 77 FR 28393 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-05-14

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Research to...

  18. 78 FR 25743 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-05-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Member Conflict...

  19. 77 FR 25180 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-04-27

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Conducting...

  20. 78 FR 9926 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-02-12

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Medicaid...

  1. 77 FR 12844 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-03-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Detecting...

  2. Studies on UV/NaOCl/TiO2/Sep photocatalysed degradation of Reactive Red 195.

    Science.gov (United States)

    Karaoğlu, M Hamdi; Uğurlu, Mehmet

    2010-02-15

    The photocatalytic degradation of Reactive Red 195 (RR195) has been investigated in aqueous suspensions by using ultraviolet (UV), sodium hypochlorite (NaOCl) and TiO(2)/Sep nanoparticles together. To get the TiO(2)/Sep nanoparticle, the nanocrystalline TiO(2) anatase phase on sepiolite was obtained using a sufficient thermal treatment by gradually increasing the temperature from 300, 400 and 500 degrees C for 3h. Then, TiO(2)/Sep materials were characterized using different spectral and technical structural analyses with scanning electron microscopy (SEM) and X-ray diffraction (XRD). The influence of pH, catalyst amount, oxidant and initial dye concentration was investigated in all the experiments. Maximum colour and chemical oxygen demand (COD) removal were 99.9% and 78% respectively, at a dye concentration of 250 mg L(-1), NaOCl dosage of 50.37 mM, 0.1 g L(-1) weight of TiO(2)/Sep and pH of 5.45 in 3h. In addition, the pseudo-first order model was applied and r(2) values were noted from 0.92 to 0.99.

  3. 77 FR 48986 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-08-15

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Member Conflict...

  4. 77 FR 27460 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-05-10

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Conducting...

  5. 76 FR 39879 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2011-07-07

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Human...

  6. 76 FR 28438 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2011-05-17

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns ``Affordable...

  7. 78 FR 19269 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-03-29

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review Notice of Cancellation: This document corrects a...

  8. 77 FR 44618 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-07-30

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns the World Trade...

  9. 77 FR 22326 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-04-13

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Extension of the...

  10. 78 FR 60878 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-10-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Health Promotion...

  11. 77 FR 25181 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-04-27

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Research...

  12. 78 FR 17412 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-03-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Strengthening...

  13. 77 FR 28392 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-05-14

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Alcohol-related...

  14. 78 FR 17411 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-03-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Monitoring and...

  15. 76 FR 13413 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP); Meeting

    Science.gov (United States)

    2011-03-11

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP); Meeting Studies at the Animal-Human Interface of Influenza and Other...

  16. 76 FR 56461 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2011-09-13

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Emerging...

  17. 77 FR 20822 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-04-06

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Detecting...

  18. 77 FR 4047 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-01-26

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Epidemiology...

  19. 76 FR 49771 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2011-08-11

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Special Interest...

  20. 78 FR 56236 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-09-12

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns NIOSH Member...

  1. 78 FR 36785 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-06-19

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Centers for...

  2. 78 FR 60877 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-10-02

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Occupational...

  3. 77 FR 31018 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-05-24

    ... [Federal Register Volume 77, Number 101 (Thursday, May 24, 2012)] [Notices] [Pages 31018-31019] [FR Doc No: 2012-12675] DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial...

  4. 76 FR 29756 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2011-05-23

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Centers for...

  5. 76 FR 78263 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2011-12-16

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Occupational...

  6. 78 FR 60875 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-10-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Occupational...

  7. 75 FR 27561 - Disease, Disability, and Injury Prevention and Control; Special Emphasis Panel (SEP): A...

    Science.gov (United States)

    2010-05-17

    ... HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control; Special Emphasis Panel (SEP): A Prospective Birth Cohort Study Involving Environmental Uranium... Control and Prevention (CDC), announces the aforementioned meeting: Times and Date: 1 p.m.-4 p.m., July 8...

  8. 76 FR 10908 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Maternal...

    Science.gov (United States)

    2011-02-28

    ... HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Maternal Vitamin D Status and Preterm Birth, DP11-002, Initial... and other committee management activities, for both the Centers for Disease Control and Prevention and...

  9. 75 FR 78999 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Maternal...

    Science.gov (United States)

    2010-12-17

    ... HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Maternal Vitamin D Status and Preterm Birth, DP11-002, Initial... Centers for Disease Control and Prevention (CDC) announces the aforementioned meeting: Time and Date: 11 a...

  10. 78 FR 6329 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-01-30

    ... HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Birth Defects... Section 10(a)(2) of the Federal Advisory Committee Act (Pub. L. 92-463), the Centers for Disease Control...

  11. 75 FR 13559 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Long Term...

    Science.gov (United States)

    2010-03-22

    ... Control Special Emphasis Panel (SEP): Long Term Outcomes of Infants Identified With Congenital Cytomegalovirus (CMV) Infection, Funding Opportunity Announcement (FOA) IP10-006, Initial Review In accordance... in response to ``Long Term Outcomes of Infants Identified with Congenital CMV Infection, FOA IP10-006...

  12. 78 FR 78966 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-12-27

    ... with High HIV Prevalence, Funding Opportunity Announcement (FOA) IP14-002, initial review. In... Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Epidemiology.... Matters To Be Discussed: The meeting will include the initial review, discussion, and evaluation of...

  13. 76 FR 45575 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2011-07-29

    ... Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Human Immunodeficiency Virus (HIV) Prevention Projects for Young Men of Color Who Have Sex with Men and Young Transgender Persons of Color, Funding Opportunity Announcement (FOA) PS11-1113, initial review. Correction: The notice...

  14. 76 FR 32213 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP); Initial Review

    Science.gov (United States)

    2011-06-03

    ... Control Special Emphasis Panel (SEP); Initial Review The meeting announced below concerns Human Immunodeficiency Virus (HIV) Prevention Projects for Young Men of Color, Funding Opportunity Announcement (FOA) PS11-1113, initial review. Correction: The notice was published in the Federal Register on February 22...

  15. 77 FR 28393 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-05-14

    ... Earthquake Reconstruction, Cholera and HIV/AIDS Response, FOA GH12-002, initial review.'' Contact Person for... Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Research and..., Cholera and HIV/AIDS Response, FOA GH12-001, and Research and Technical Assistance for Public Health...

  16. 77 FR 39498 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-07-03

    ... Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Special Interest Project (SIP): Assessing the Pregnancy Prevention Needs of HIV-Infected Young Women of Reproductive Age and Effects of Contraception, SIP12-064, Panel G, initial review. In accordance with Section 10(a)(2...

  17. 78 FR 6329 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-01-30

    ... with Duchenne Muscular Dystrophy (DMD), FOA DD13-002, initial review.'' Contact Person for More... Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Evaluation of Treatments and Services Provided to People with ] Duchenne Muscular Dystrophy (DMD), FOA DD13-002, initial...

  18. 76 FR 71568 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2011-11-18

    ... Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns National HIV Behavioral Surveillance For Young Men Who Have Sex With Men, Funding Opportunity Announcement (FOA), PS11-0010201SUPP12, initial review. In accordance with Section 10(a)(2) of the Federal Advisory Committee Act (Pub. L...

  19. 77 FR 291 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2012-01-04

    ... Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns National HIV Behavioral Surveillance For Young Men Who Have Sex With Men, Funding Opportunity Announcement (FOA), PS11-0010201SUPP12, initial review. Correction: The notice was published in the Federal Register on November 18, 2011...

  20. book reviews.PDF | sep252000 | currsci | Indian Academy of Sciences

    Indian Academy of Sciences (India)

    Home; currsci; sep252000; book reviews.PDF. 404! error. The page your are looking for can not be found! Please check the link or use the navigation bar at the top. YouTube; Twitter; Facebook; Blog. Academy News. IAS Logo. Theory Of Evolution. Posted on 23 January 2018. Joint Statement by the Three Science ...

  1. 75 FR 13560 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Knowledge...

    Science.gov (United States)

    2010-03-22

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Knowledge Synthesis Center for... to ``Knowledge Synthesis Center for Evaluating Genomic Application in Practice and Prevention, GD 10...

  2. 76 FR 3909 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Family...

    Science.gov (United States)

    2011-01-21

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Family History and Diamond..., discussion, and evaluation of ``Family History and Diamond Blackfan Anemia, DD11-010, initial review...

  3. 75 FR 41872 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Surveillance...

    Science.gov (United States)

    2010-07-19

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Surveillance, Natural History... evaluation of ``Surveillance, Natural History, Quality of Care and Outcomes of Diabetes Mellitus with Onset...

  4. 78 FR 1212 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Science.gov (United States)

    2013-01-08

    ..., Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review The meeting announced below concerns Natural History and Prevention of Viral Hepatitis Among Alaska Natives, Funding... initial review, discussion, and evaluation of applications received in response to ``Natural History and...

  5. 75 FR 13560 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Surveillance...

    Science.gov (United States)

    2010-03-22

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Surveillance, Natural History... evaluation of ``Surveillance, Natural History, Quality of Care and Outcomes of Diabetes Mellitus With Onset...

  6. 76 FR 13621 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Family...

    Science.gov (United States)

    2011-03-14

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Family History and Diamond Blackfan Anemia, DD11- 010, Initial Review Correction: This notice was published in the Federal Register on...

  7. 75 FR 29561 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Surveillance...

    Science.gov (United States)

    2010-05-26

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Surveillance, Natural History, Quality of Care and Outcomes of Diabetes Mellitus with Onset in Childhood and Adolescence, RFA DP 10-001...

  8. Varus femoral and tibial coronal alignments result in different kinematics and kinetics after total knee arthroplasty.

    Science.gov (United States)

    Watanabe, Mutsumi; Kuriyama, Shinichi; Nakamura, Shinichiro; Tanaka, Yoshihisa; Nishitani, Kohei; Furu, Moritoshi; Ito, Hiromu; Matsuda, Shuichi

    2017-11-01

    Abnormal knee motion under various conditions has been described after total knee arthroplasty (TKA). However, differences in kinematics and kinetics of knees with varus femoral versus varus tibial alignment have not been evaluated. It was hypothesized that varus femoral and tibial alignments have the same impact on knee motion. A musculoskeletal computer simulation was used. Femoral and tibial alignment in the coronal plane was each varied from neutral to 5° of varus in 1° increments. Lift-off, defined as an intercomponent distance of >2 mm, and tibiofemoral contact forces were evaluated during gait up to 60° of knee flexion. Knee kinematics and contact stresses were also examined during squat, with up to 130° of knee flexion. During gait, lift-off occurred readily with more than 3° of varus tibial alignment and slight lateral joint laxity. In contrast, lift-off did not occur with varus femoral or tibial alignment of up to 5° during squat. Peak medial contact forces with varus femoral alignment were approximately twice those observed with varus tibial alignment. The lowest points of the femoral condyles moved internally with varus femoral alignment, contrary to the kinematics with neutral or varus tibial alignment. On the other hand, there was femoral medial sliding and edge loading against the tibia in mid-flexion with varus tibial alignment. Varus femoral alignment affects the non-physiological rotational movement of the tibiofemoral joint, whereas varus tibial alignment causes medial-lateral instability during mid-flexion. Varus femoral and tibial alignments might lead to post-TKA discomfort and unreliability.

  9. Percutaneous tibial physeal fracture repair in small animals: technique and 17 cases.

    Science.gov (United States)

    von Pfeil, Dirsko J F; Glassman, Mathieu; Ropski, Meaghan

    2017-07-20

    To retrospectively describe cases treated via percutaneous tibial physeal fracture repair (PTPFR), using intra-operative fluoroscopy (IFL) or digital radiography (DR). To describe a technique ("spiking"), used to treat tibial tuberosity avulsion fractures. Clinical data of 14 dogs and three cats were included. The "spiking" technique was described. Intra-operative fluoroscopy (n = 11) and DR (n = 6) were successfully used in 11 tibial tuberosity avulsion fractures, one combined proximal physeal and tibial tuberosity avulsion fracture, and five distal tibial/fibular physeal fractures. Surgery times ranged from eight to 54 minutes. The "spiking" technique was successfully applied in six tibial tuberosity avulsion fracture cases. Return to function was at a mean (± standard deviation) of 1.9 (± 1.6) weeks. Long-term (>12 months; n = 17) follow-up was available at a mean of 40.6 (± 13.4) months. Major complications consisted of skin irritation from a pin (distal tibia / fibula physeal fracture case; 8 weeks post-PTPFR), and a bilateral grade II medial patella luxation (tibial tuberosity avulsion fracture case; 1.5 years post-PTPFR). One case developed a mild tibial tuberosity avulsion fracture re-avulsion. All conditions in these three cases were not of clinical concern at follow-up and final outcome was graded as good in these and excellent in the other 14 cases. Percutaneous tibial physeal fracture repair can be considered as a technique to treat tibial physeal fractures. The "spiking" technique was successfully applied in six dogs. A larger, prospective case series is indicated to provide additional clinical information.

  10. Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review.

    Science.gov (United States)

    Panni, Alfredo Schiavone; Ascione, Francesco; Rossini, Marco; Braile, Adriano; Corona, Katia; Vasso, Michele; Hirschmann, Michael T

    2017-12-15

    The aim of this systematic review is to analyze the effect of tibial rotational alignment after total knee arthroplasty (TKA) on clinical outcomes and assess the eventual cut-off values for tibial TKA rotation leading to poor outcomes. A detailed and systematic search from 1997 to 2017 of the Pubmed, Medline, Cochrane Reviews, and the Google Scholar databases was performed using the keyword terms "total knee arthroplasty", "total knee replacement", "tibial alignment", "tibial malalignement", "tibial rotation", "rotational error", "axis", "angle", "tibial malrotation", "clinical outcome", in several combinations. The modified Coleman scoring methodology (mCMS) was used. All the primary TKAs studies analyzing correlation between clinical results and tibial rotation were included. Five articles met the inclusion criteria. A total of 333 arthroplasties were included in this review; 139 had tibial component malalignment, while 194 were in control groups. The mean age of patients was 67.3 (SD 0.57) years. The mean average postoperative follow-up delay was 34.7 months (range 21-70). The mean mCMS score was 59.2 points indicating good methodological quality in the included studies. Functional outcomes were assessed through KSS, OKS, KOOS and VAS, negatively related to tibial internal rotation. Our review confirmed that excessive internal rotation of the tibial TKA component represents a significant risk factor for pain and inferior functional outcomes after TKA (> 10° of internal rotation demonstrated the common value), since external rotation does not affect the results. However, a universal precise cut-off value has not been found in the available literature and there remains a debate about CT rotation assessment and surgical intra-operative landmarks. III.

  11. Standing balance in people with trans-tibial amputation due to vascular causes: A literature review.

    Science.gov (United States)

    Seth, Mayank; Lamberg, Eric

    2017-08-01

    Balance is an important variable to consider during the rehabilitation process of individuals with trans-tibial amputation. Limited evidence exists on the balance abilities of people with trans-tibial amputation due to vascular causes. The purpose of this article is to review literature and determine if standing balance is diminished in people with trans-tibial amputation due to vascular causes. Literature review. Data were obtained from PubMed, Google Scholar, OandP.org , CINHAL, and Science Direct. Studies were selected only if they included standing balance assessment of people with unilateral trans-tibial amputation due to vascular causes. The review yielded seven articles that met the inclusion criteria. The general test methodology required participants to stand still on force platforms, with feet together, while center of pressure or postural sway was recorded. According to the findings of this review, individuals with trans-tibial amputees due to vascular causes have diminished balance abilities. Limited evidence suggests their balance might be further diminished as compared to individuals with trans-tibial amputation due to trauma. Although the evidence is limited, because of the underlying pathology and presence of comorbidities in individuals with trans-tibial amputation due to vascular causes, one cannot ignore these findings, as even a minor injury from a fall may develop into a non-healing ulcer and affect their health and well-being more severely than individuals with trans-tibial amputation due to trauma. Clinical relevance Individuals with trans-tibial amputation due to vascular causes have diminished balance abilities compared to healthy individuals and individuals with trans-tibial amputation due to trauma. This difference should be considered when designing and fabricating prostheses. Prosthetists and rehabilitation clinicians should consider designing amputation cause-specific rehabilitation interventions, focussing on balance and other

  12. Proximal tibiofibular joint dislocation associated with tibial shaft fractures - 7 Cases.

    Science.gov (United States)

    Haupt, Samuel; Frima, Herman; Sommer, Christoph

    2016-04-01

    Lower leg fractures of the tibia with or without fracture of the fibula are very common. Proximal tibiofibular joint (PTFJ) dislocation is a very rare injury that can occur together with a tibia shaft fracture. As there is only scarce literature about this injury available, we would like to present our experience with the treatment of this entity. We present a small case series of seven patients. In most cases, the tibia fracture was nailed in a closed technique. After distal locking the proximal fibula was exposed by a lateral approach exposing and preserving the peroneal nerve. After anatomical reduction into the corresponding articular facet of the proximal tibia, the fibula was transfixed to the tibia with a positioning screw. This indirectly provided a correct length and rotation of the tibia, which could finally be locked to the nail by inserting the proximal locking bolts. The positioning screw was removed after six weeks prior to full loading. Six of seven patients had been followed up by at least 7 months post-treatment. Out of 663 prospectively collected tibia shaft fractures treated at our institution from 1/2001 to 7/2014, we found seven patients with associated PTFJ dislocation. All except one had been caused by a high energy trauma. After one year, five patients showed excellent results with full range of motion and returning to their sporting activities as before the accident. Two patients have impaired function due to associated injuries. None complained of persistent pain or instability of the PTFJ. PTFJ dislocation with tibia shaft fracture can easily be overlooked if one is not familiar with this injury. It is important to diagnose and treat this uncommon dislocation anatomically to achieve good results. Otherwise, as the literature shows, it can lead to chronic instability of the proximal fibula with snapping, proximal fibular pain and even peroneal nerve palsy. Furthermore in complex tibial fractures correct length and rotation only can be

  13. Dependence of large SEP events with different energies on the associated flares and CMEs

    Science.gov (United States)

    Le, Gui-Ming; Zhang, Xue-Feng

    2017-12-01

    To investigate the dependence of large gradual solar energetic particle (SEP) events on the associated flares and coronal mass ejections (CMEs), the correlation coefficients (CCs) between peak intensities of E> 10 {MeV} (I 10), E> 30 {MeV} (I 30) and E> 50 {MeV} (I 50) protons and soft X-ray (SXR) emission of associated flares and the speeds of associated CMEs in the three longitudinal areas W0-W39, W40-W70 (hereafter the well connected region) and W71-W90 have been calculated. Classical correlation analysis shows that CCs between SXR emission and peak intensities of SEP events always reach their largest value in the well connected region and then decline dramatically in the longitudinal area outside the well connected region, suggesting that they may contribute to the production of SEPs in large SEP events. Both classical and partial correlation analyses show that SXR fluence is a better parameter describing the relationship between flares and SEP events. For large SEP events with source location in the well connected region, the CCs between SXR fluence and I 10, I 30 and I 50 are 0.58±0.12, 0.80±0.06 and 0.83±0.06 respectively, while the CCs between CME speed and I 10, I 30 and I 50 are 0.56±0.12, 0.52±0.13 and 0.48±0.13 respectively. The partial correlation analyses show that in the well connected region, both CME shock and SXR fluence can significantly affect I 10, but SXR peak flux makes no additional contribution. For E> 30 {MeV} protons with source location in the well connected region, only SXR fluence can significantly affect I 30, and the CME shock makes a small contribution to I 30, but SXR peak flux makes no additional contribution. For E> 50 {MeV} protons with source location in the well connected region, only SXR fluence can significantly affect I 50, but both CME shock and SXR peak flux make no additional contribution. We conclude that these findings provide statistical evidence that for SEP events with source locations in the well connected

  14. Unilateral sixth nerve palsy.

    Science.gov (United States)

    Sotoodehnia, Mehran; Safaei, Arash; Rasooli, Fatemeh; Bahreini, Maryam

    2017-06-01

    The diagnosis of cerebral venous sinus thrombosis still remains a real challenge. Seizure, unusual headache with sudden onset, unexplained persistently unilateral vascular headache and neurologic deficit-which is difficult to be attributed to a vascular territory are some of the suggestive symptoms. An isolated sixth nerve palsy is discussed as a rare presentation for cerebral venous thrombosis. Following the extensive investigation to rule out other possible diagnoses, magnetic resonance venogram revealed the final etiology of sixth nerve palsy that was ipsilateral left transverse sinus thrombosis; therefore, anticoagulant treatment with low molecular weight heparin was administered. Rapid and accurate diagnosis and treatment cause to achieve excellent outcomes for most patients. Considering different clinical features, risk factors and high index of suspicion are helpful to reach the diagnosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Does the combination of erythropoietin and tapered oral corticosteroids improve recovery following iatrogenic nerve injury?

    Science.gov (United States)

    Bernstein, Derek T; Weiner, Bradley K; Tasciotti, Ennio; Mathis, Kenneth B

    2016-08-01

    The reported prognosis for recovery after peripheral nerve injury is remarkably poor. Deficits may persist for years, resulting in significant functional disability. Both corticosteroids and Erythropoietin have been investigated as neuroprotective agents; however, their efficacy in total hip and knee arthroplasty is not known. The purpose of this study was to evaluate the effect of systemically-administered Erythropoietin and tapered oral corticosteroids on the recovery of postoperative nerve palsies in the setting of total hip and knee arthroplasty. Eleven patients sustaining postoperative peripheral nerve injuries after total hip or knee arthroplasty were treated acutely with Erythropoietin and tapered oral steroids. Motor and sensory function was assessed clinically pre- and postoperatively until complete motor recovery or for a minimum of 1 year. Motor loss was complete in seven (64%) patients and partial in four (36%). Seven (64%) patients' symptoms affected the common peroneal nerve distribution and four (36%) had concomitant tibial nerve involvement. Eight (73%) patients experienced full motor recovery at an average of 39 days (range: 3-133 days), and three (27%) had near-complete motor recovery. At final follow up, no patient required assistive devices for ambulation. Administration of Erythropoietin coupled with oral tapered steroids for patients sustaining iatrogenic nerve injuries in total hip and knee arthroplasty demonstrated faster and more complete recovery of motor and sensory function compared to previous reports in the literature. This study highlights the importance of further investigation to define the role of each in the setting of acute postoperative nerve palsies. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Optic nerve hypoplasia

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    Savleen Kaur

    2013-01-01

    Full Text Available Optic nerve hypoplasia (ONH is a congenital anomaly of the optic disc that might result in moderate to severe vision loss in children. With a vast number of cases now being reported, the rarity of ONH is obviously now refuted. The major aspects of ophthalmic evaluation of an infant with possible ONH are visual assessment, fundus examination, and visual electrophysiology. Characteristically, the disc is small, there is a peripapillary double-ring sign, vascular tortuosity, and thinning of the nerve fiber layer. A patient with ONH should be assessed for presence of neurologic, radiologic, and endocrine associations. There may be maternal associations like premature births, fetal alcohol syndrome, maternal diabetes. Systemic associations in the child include endocrine abnormalities, developmental delay, cerebral palsy, and seizures. Besides the hypoplastic optic nerve and chiasm, neuroimaging shows abnormalities in ventricles or white- or gray-matter development, septo-optic dysplasia, hydrocephalus, and corpus callosum abnormalities. There is a greater incidence of clinical neurologic abnormalities in patients with bilateral ONH (65% than patients with unilateral ONH. We present a review on the available literature on the same to urge caution in our clinical practice when dealing with patients with ONH. Fundus photography, ocular coherence tomography, visual field testing, color vision evaluation, neuroimaging, endocrinology consultation with or without genetic testing are helpful in the diagnosis and management of ONH. (Method of search: MEDLINE, PUBMED.

  17. Thrombosed Popliteal Artery Pseudoaneurysm as Herald of Tibial Osteochondroma

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    A.M. Ruales Romero

    Full Text Available Background: Osteochondroma is the most common non-malignant tumour of bone, accounting for approximately one third of benign lesions in the skeleton. They often develop around the knee in the distal femur and in the proximal tibia and fibula. They present as a painless slow growing mass during adolescence and have been reported to cause damage to adjacent structures such as blood vessels; arterial damage is more common than venous injury and is usually a result of compression, stretching, and rubbing of the arterial wall. Such lesions include stenosis, thrombosis, and pseudoaneurysm formation possibly causing lower limb claudication or acute limb ischemia. Methods: An 18 year old male patient with a 4 week history of pain, hematoma, and oedema of the left calf without previous trauma is reported. A computed tomography scan (CT revealed a large popliteal artery pseudoaneurysm and its close relationship to a protrusion of the proximal tibia. Results: The popliteal artery was repaired by an external saphenous patch and the exostosis was removed. The patient had palpable popliteal and distal pulses after surgery and during the first year follow-up. Conclusions: Tibial osteochondroma should be considered in the differential diagnosis in young patients, among the potential causes of pseudoaneurysm of the femoral or popliteal artery. Surgical repair should be performed to restore normal blood flow with resection of the exostosis to prevent recurrence. Keywords: Popliteal artery, Pseudoaneurysm, Tibial exostosis, Osteochondroma

  18. Outcome of intramedullary interlocking SIGN nail in tibial diaphyseal fracture

    International Nuclear Information System (INIS)

    Khan, I.; Javed, S.; Khan, G.N.; Aziz, A.

    2013-01-01

    Objective: To determine the outcome of intramedullary interlocking surgical implant generation network (SIGN) nail in diaphyseal tibial fractures in terms of union and failure of implant (breakage of nail or interlocking screws). Study Design: Case series. Place and Duration of Study: Orthopaedics and Spinal Surgery, Ghurki Trust Teaching Hospital, Lahore Medical and Dental College, Lahore, from September 2008 to August 2009. Methodology: Fifty patients aged 14 - 60 years, of either gender were included, who had closed and Gustilo type I and II open fractures reported in 2 weeks, whose closed reduction was not possible or was unsatisfactory and fracture was located 7 cm below knee joint to 7 cm above ankle joint. Fractures previously treated with external fixator, infected fractures and unfit patients were excluded. All fractures were fixed with intramedullary interlocking SIGN nail and were followed clinically and radiographically for union and for any implant failure. Results: Forty one (88%) patients had united fracture within 6 months, 5 (10%) patients had delayed union while 4 (8%) patients had non-union. Mean duration for achieving union was 163 + 30.6 days. Interlocking screws were broken in 2 patients while no nail was broken in any patient. Conclusion: Intramedullary interlocking nailing is an effective measure in treating closed and grade I and II open tibial fractures. It provides a high rate of union less complications and early return to function. (author)

  19. Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures

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    Sandeep Gurung

    2016-06-01

    Full Text Available Introduction: Tibia fractures in the skeletally immature patient can usually be treated with above knee cast or patellar tendon bearing cast. The purpose of our study was to evaluate epidemiology and outcome of Elastic stable intramedullary nailing fixation of pediatric tibial shaft fractures treated at our institution. Methods: Over a period of one year, fifty pediatric patients of tibial shaft fractures, with average age of 9.68 yr (SD=2.37, were treated with elastic stable intramedullary nail. Demographic data, union and complication rate were evaluated. Results: There were 36 closed and 14 open fractures. The average time to union was 11.6 weeks  (SD=2.65 for close and  14.3 weeks (SD=2.62 for open fracture. There were no instances of growth arrest, remanipulations, or refracture. Conclusion: We conclude that flexible intramedullary fixation is an easy and effective method of management of both open and closed unstable fractures of the tibia in children.

  20. Posterior coronal plating for tibial fractures: technique and advantages

    Directory of Open Access Journals (Sweden)

    Montu Jain

    2014-04-01

    Full Text Available Objective:Tibial shaft fractures are straightforward to treat but when associated with soft tissue injury particularly at the nail entry/plate insertion site or there is significant comminution proximally or a large butterfly fragment/a second split component in the posterior coronal plane, it is a challenge to the treating surgeon. The aim of the present report is to describe the technique of posterior coronal plating in such a scenario and its advantages. Methods:Between July 2008 and June 2011, 12 patients were pro spectively treated by this approach using 4.5 mm broad dynamic compression plates. Results:The time of bony consolidation and full weight bearing averaged 21.7 weeks (range, 16-26 weeks. Patients were followed up for at least 24 months (range, 24-48 months. At 1 year postoper atively, no loss in reduction or alignment was observed. Mean Hospital for Lower Extremity Measurement Functional Score was 72.8 (range, 64-78. All patients were satisfied with their treatment outcomes. Conclusion:Direct posterior approach and fixation using prone position helps to visualise the fracture fragments and provide rigid fixation. The approach is simple and extensile easily, apart from advantages of less soft tissue and hardware problems compared to standard medial or lateral plating. Key words: Tibial fractures; Bone plates; Orthopedic procedures