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Sample records for two-level cervical arthroplasty

  1. Cervical Total Disc Arthroplasty

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    Basho, Rahul; Hood, Kenneth A.

    2012-01-01

    Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc...

  2. Cervical disc arthroplasty: Pros and cons.

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    Moatz, Bradley; Tortolani, P Justin

    2012-01-01

    Cervical disc arthroplasty has emerged as a promising potential alternative to anterior cervical discectomy and fusion (ACDF) in appropriately selected patients. Despite a history of excellent outcomes after ACDF, the question as to whether a fusion leads to adjacent segment degeneration remains unanswered. Numerous US investigational device exemption trials comparing cervical arthroplasty to fusion have been conducted to answer this question. This study reviews the current research regarding cervical athroplasty, and emphasizes both the pros and cons of arthroplasty as compared with ACDF. Early clinical outcomes show that cervical arthroplasty is as effective as the standard ACDF. However, this new technology is also associated with an expanding list of novel complications. Although there is no definitive evidence that cervical disc replacement reduces the incidence of adjacent segment degeneration, it does show other advantages; for example, faster return to work, and reduced need for postoperative bracing.

  3. Two-level cervical disc replacement: perspectives and patient selection

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    Narain AS

    2017-02-01

    Full Text Available Ankur S Narain, Fady Y Hijji, Daniel D Bohl, Kelly H Yom, Krishna T Kudaravalli, Kern Singh Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA Introduction: Cervical disc replacement (CDR is an emerging treatment option for cervical degenerative disease. Postulated benefits of cervical disc replacement compared to anterior cervical discectomy and fusion include preserved motion at the operative segments and decreased motion at adjacent levels. Multiple studies have been performed investigating the outcomes of CDR in single-level pathology. The investigation of the use of CDR in two-level pathology is an emerging topic within the literature.Purpose: To critically evaluate the literature regarding two-level CDR in order to determine its utility compared to two-level cervical arthrodesis. Patient selection factors including indications and contraindications will also be explored.Methods: The PubMed database was searched for all articles published on the subject of two-level CDR up until October 2016. Studies were classified by publication year, study design, sample size, follow-up interval, and conflict of interest. Outcomes were recorded from each study, and included data on patient-reported outcomes, radiographic measurements, range of motion, peri- and postoperative complications, heterotopic ossification, adjacent segment disease, reoperation rate, and total intervention cost. Results: Fourteen studies were included in this review. All studies demonstrated at least noninferiority of two-level CDR compared to both two-level arthrodesis and single-level CDR. Patient selection in two-level CDR is driven by the inclusion and exclusion criteria presented in prospective, randomized controlled trials. The most common indication is subaxial degenerative disc disease over two contiguous levels presenting with radiculopathy or myelopathy. Furthermore, costs analyses trended toward at least noninferiority of two-level

  4. Artificial Cervical Disc Arthroplasty (ACDA): tips and tricks

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    Khadivi, Masoud; Rahimi Movaghar, Vafa; Abdollahzade, Sina

    2012-01-01

    age was 41 for females and 42 for males. Affected level was C5-C6 in 81 cases, C6-C7 in 72 cases and C4-C5 in 10 cases. The most common applied ACDA was DiscoCerv which was inserted in 127 cases followed by prodisc-c in three patients and Baguera in thirty three psatients.Ten cases had two levels involvement. Both neck and upper extremity pain improved significantly in early and late post op assessments compared to pre-op. There was only one operative complication of quadriparesis which might be attributed to the iatrogenic cervical spinal trauma. Conclusions: Cervical disc arthroplasty has been advocated to address drawbacks of fusion including loss of motion segment and adjacent level degeneration; our study along with several other reports provide considerable evidence in this regard. Cervical disc arthroplasty is a safe and effective alternative for fusion in cervical degenerative disc disease. Keywords: Cervical degenerative disc disease, Artificial cervical disc arthroplasty, Safety, Efficacy

  5. Failure of cervical arthroplasty in a patient with adjacent segment disease associated with Klippel-Feil syndrome

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    Ioannis D Papanastassiou

    2011-01-01

    Full Text Available Cervical arthroplasty may be justified in patients with Klippel-Feil syndrome (KFS in order to preserve cervical motion. The aim of this paper is to report an arthroplasty failure in a patient with KFS. A 36-year-old woman with KFS underwent two-level arthroplasty for adjacent segment disc degeneration. Anterior migration of the cranial prosthesis was encountered 5 months postoperatively and was successfully revised with anterior cervical fusion. Cervical arthroplasty in an extensively stiff and fused neck is challenging and may lead to catastrophic failure. Although motion preservation is desirable in KFS, the special biomechanical features may hinder arthroplasty. Fusion or hybrid constructs may represent more reasonable options, especially when multiple fused segments are present.

  6. Footprint mismatch in total cervical disc arthroplasty.

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    Thaler, Martin; Hartmann, Sebastian; Gstöttner, Michaela; Lechner, Ricarda; Gabl, Michael; Bach, Christian

    2013-04-01

    Cervical disc arthroplasty has become a commonplace surgery for the treatment of cervical radiculopathy and myelopathy. Most manufacturers derive their implant dimensions from early published cadaver studies. Ideal footprint match of the prosthesis is essential for good surgical outcome. We measured the dimensions of cervical vertebrae from computed tomography (CT) scans and to assess the accuracy of match achieved with the most common cervical disc prostheses [Bryan (Medtronic), Prestige LP (Medtronic), Discover (DePuy) Prodisc-C (Synthes)]. A total of 192 endplates in 24 patients (56.3 years) were assessed. The anterior-posterior and mediolateral diameters of the superior and inferior endplates were measured with a digital measuring system. Overall, 53.5 % of the largest device footprints were smaller in the anterior-posterior diameter and 51.1 % in the mediolateral diameter were smaller than cervical endplate diameters. For levels C5/C6 and C6/C7 an inappropriate size match was noted in 61.9 % as calculated from the anteroposterior diameter. Mismatch at the center mediolateral diameter was noted in 56.8 %. Of the endplates in the current study up to 58.1 % of C5/C6 and C6/C7, and up to 45.3 % of C3/C4 and C4/C5 were larger than the most frequently implanted cervical disc devices. Surgeons and manufacturers should be aware of the size mismatch in currently available cervical disc prostheses, which may endanger the safety and efficacy of the procedure. Undersizing the prosthetic device may lead to subsidence, loosening, heterotopic ossification and biomechanical failure caused by an incorrect center of rotation and load distribution, affecting the facet joints.

  7. The Mobi-C cervical disc for one-level and two-level cervical disc replacement: a review of the literature

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    Alvin MD

    2014-11-01

    Full Text Available Matthew D Alvin,1,2 Thomas E Mroz1,3,41Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA; 2Case Western Reserve University School of Medicine, Cleveland, OH, USA; 3Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; 4Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USABackground: Cervical disc arthroplasty (CDA is a novel motion-preserving procedure that is an alternative to fusion. The Mobi-C disc prosthesis, one of many Food and Drug Administration (FDA-approved devices for CDA, is the only FDA-approved prosthesis for two-level CDA. Hence, it may allow for improved outcomes compared with multilevel fusion procedures.Purpose: To critically assess the available literature on CDA with the Mobi-C prosthesis, with a focus on two-level CDA.Methods: All clinical articles involving the Mobi-C disc prosthesis for CDA through September 1, 2014 were identified on Medline. Any paper that presented Mobi-C CDA clinical results was included. Study design, sample size, length of follow-up, use of statistical analysis, quality of life outcome scores, conflict of interest, and complications were recorded.Results: Fifteen studies were included that investigated Mobi-C CDA, only one of which was a level Ib randomized control trial. All studies included showed non-inferiority of one-level Mobi-C CDA to one-level anterior cervical discectomy and fusion (ACDF. Only one study analyzed outcomes of one-level versus two-level Mobi-C CDA, and only one study analyzed two-level Mobi-C CDA versus two-level ACDF. In comparison with other cervical disc prostheses, the Mobi-C prosthesis is associated with higher rates of heterotopic ossification (HO. Studies with conflicts of interest reported lower rates of HO. Adjacent segment degeneration or disease, along with other complications, were not assessed in most studies.Conclusion: One-level Mobi-C CDA is non-inferior, but not superior, to one-level ACDF for patients

  8. Cervical arthroplasty: the beginning, the middle, the end?

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    Richards, O; Choi, D; Timothy, J

    2012-02-01

    Cervical arthroplasty has developed as an alternative to spinal fusion for the treatment of cervical radiculopathy and myelopathy. The popularity of artificial discs has grown as the evidence of complications following arthrodesis has increased, making the theoretical advantages (motion preservation, altering the natural history of disease, prevention of adjacent segment disease) of disc replacement more attractive. However, as more discs are implanted and the length of follow-up increases, reported complications such as heterotopic ossification, device migration and spontaneous fusion of arthroplasty devices are growing. As a result, surgeons and patients face a challenge when deciding between motion-preserving or fusion surgery. Currently, there is inadequate evidence to promote extensive use of artificial discs for cervical spondylosis, despite promising short-term and intermediate clinical outcomes. However, there is also insufficient evidence to cease using them completely. The use of arthroplasty over fusion in the long term can only be justified if the incidence of adjacent segment disease decreases as a result. Despite the level of investment and research into arthroplasty outcomes, long-term follow-up has yet to be completed and has not convincingly demonstrated the effect of artificial discs on adjacent segment disease. Further long-term randomised trials are necessary to determine whether cervical arthroplasty is able to reduce the incidence of adjacent segment disease and, in doing so, replace arthrodesis as the gold standard treatment for cervical spondylosis.

  9. Arthroplasty for cervical spondylotic myelopathy: similar results to patients with only radiculopathy at 3 years' follow-up.

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    Fay, Li-Yu; Huang, Wen-Cheng; Wu, Jau-Ching; Chang, Hsuan-Kan; Tsai, Tzu-Yun; Ko, Chin-Chu; Tu, Tsung-Hsi; Wu, Ching-Lan; Cheng, Henrich

    2014-09-01

    Cervical arthroplasty has been accepted as a viable option for surgical management of cervical spondylosis or degenerative disc disease (DDD). The best candidates for cervical arthroplasty are young patients who have radiculopathy caused by herniated disc with competent facet joints. However, it remains uncertain whether arthroplasty is equally effective for patients who have cervical myelopathy caused by DDD. The aim of this study was to compare the outcomes of arthroplasty for patients with cervical spondylotic myelopathy (CSM) and patients with radiculopathy without CSM. A total of 151 consecutive cases involving patients with CSM or radiculopathy caused by DDD and who underwent one- or two-level cervical arthroplasty were included in this study. Clinical outcome evaluations and radiographic studies were reviewed. Clinical outcome measurements included the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) scores, and the Neck Disability Index (NDI) in every patient. For patients with CSM, Nurick scores were recorded for evaluation of cervical myelopathy. Radiographic studies included lateral dynamic radiographs and CT for detection of the formation of heterotopic ossification . Of the 151 consecutive patients with cervical DDD, 125 (82.8%; 72 patients in the myelopathy group and 53 in the radiculopathy group) had at least 24 months of clinical and radiographic follow-up. The mean duration of follow-up in these patients was 36.4 months (range 24-56 months). There was no difference in sex distribution between the 2 groups. However, the mean age of the patients in the myelopathy group was approximately 6 years greater than that of the radiculopathy group (53.1 vs 47.2 years, p radiculopathy group and 95.8% of those in the radiculopathy group retained spinal motion (no significant difference). Evaluation of CT scans showed heterotopic ossification in 34 patients (47.2%) in the myelopathy group and 25 patients (47.1%) in the

  10. Heterotopic ossification and clinical outcome in nonconstrained cervical arthroplasty 2 years after surgery: the Norwegian Cervical Arthroplasty Trial (NORCAT)

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    Sundseth, Jarle; Jacobsen, Eva Astrid; Kolstad, Frode; Sletteberg, Ruth O.; Nygaard, Oystein P.; Johnsen, Lars Gunnar; Pripp, Are Hugo; Andresen, Hege; Fredriksli, Oddrun Anita; Myrseth, Erling; Zwart, John A.

    2016-01-01

    Purpose Heterotopic ossification is a phenomenon in cervical arthroplasty. Previous reports have mainly focused on various semiconstrained devices and only a few publications have focused on ossification around devices that are nonconstrained. The purpose of this study was to assess the occurrence of heterotopic ossification around a nonconstrained cervical device and how it affects clinical outcome 2 years after surgery. Methods Thirty-seven patients were included from a larger cohort of ...

  11. Automatic Detection of Cervical Cancer Cells by a Two-Level Cascade Classification System

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    Jie Su

    2016-01-01

    Full Text Available We proposed a method for automatic detection of cervical cancer cells in images captured from thin liquid based cytology slides. We selected 20,000 cells in images derived from 120 different thin liquid based cytology slides, which include 5000 epithelial cells (normal 2500, abnormal 2500, lymphoid cells, neutrophils, and junk cells. We first proposed 28 features, including 20 morphologic features and 8 texture features, based on the characteristics of each cell type. We then used a two-level cascade integration system of two classifiers to classify the cervical cells into normal and abnormal epithelial cells. The results showed that the recognition rates for abnormal cervical epithelial cells were 92.7% and 93.2%, respectively, when C4.5 classifier or LR (LR: logical regression classifier was used individually; while the recognition rate was significantly higher (95.642% when our two-level cascade integrated classifier system was used. The false negative rate and false positive rate (both 1.44% of the proposed automatic two-level cascade classification system are also much lower than those of traditional Pap smear review.

  12. Is Two-level Cervical Disc Replacement More Cost-effective Than Anterior Cervical Discectomy and Fusion at 7 Years?

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    Merrill, Robert K; McAnany, Steven J; Albert, Todd J; Qureshi, Sheeraz A

    2018-05-01

    Cost-effectiveness analysis. To investigate 7-years cost-effectiveness of two-level cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF). CDR and ACDF are both effective treatment strategies for managing degenerative conditions of the cervical spine. CDR has been shown to be a more-cost effective intervention in the short term, but the long-term cost-effectiveness has not been established. We analyzed 7-years follow-up data from the two-level Medtronic Prestige LP investigational device exemption study. Short-form 36 (SF-36) data were converted into health utility scores using the SF-6D algorithm. Costs were based on direct costs from the payer perspective, and effectiveness was measured as quality-adjusted life years (QALYs). The willingness-to-pay (WTP) threshold was set to $50,000/QALY. A probabilistic sensitivity analysis was conducted via Monte Carlo simulation. Two-level CDR had a 7-year cost of $176,654.19, generated 4.65 QALYs, and had a cost-effectiveness ratio of $37,993.53/QALY. Two-level ACDF had a 7-year cost of $158,373.48, generated 4.44 QALYs, and had a cost-effectiveness ratio of $35,635.72. CDR was associated with an incremental cost of $18,280.71 and an incremental effectiveness of 0.21 QALYs, resulting in an incremental cost-effectiveness ratio (ICER) of $89,021.04, above the WTP threshold. Our Monte Carlo simulation demonstrated CDR would be chosen 46% of the time based on 10,000 simulations. Two-level CDR and ACDF are both cost-effective procedures at 7-year follow up for treating degenerative conditions of the cervical spine. Based on an ICER of $89,021.04/QALY, we cannot conclude which treatment is the more cost-effective option at 7-years. CDR would be chosen 46% of the time based on 10,000 iterations of our Monte Carlo probabilistic sensitivity analysis. 3.

  13. Anterior cervical discectomy and fusion versus cervical arthroplasty for the management of cervical spondylosis: a meta-analysis.

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    Ma, Zhuo; Ma, Xun; Yang, Huilin; Guan, Xiaoming; Li, Xiang

    2017-04-01

    The aim of this study was to compare the efficacy and safety of anterior cervical discectomy and fusion (ACDF) and cervical arthroplasty for patients with cervical spondylosis. PubMed, Embase, and Cochrane Library were used to search for relevant articles published prior to April 2016 to identify studies comparing ACDF and cervical arthroplasty involving patients with cervical spondylosis. Relative risks (RR) and mean differences (MD) were used to measure the efficacy and safety of ACDF and cervical arthroplasty using the random effects model. The meta-analysis of 17 studies involved 3122 patients diagnosed with cervical spondylosis. Patients undergoing ACDF showed lower overall success rate (RR 0.84; 95 % CI 0.77-0.92; P < 0.001), higher VAS score (MD 0.36; 95 % CI 0.08-0.64; P = 0.011), and shorter mean surgical duration (MD -1.62; 95 % CI -2.80 to -0.44; P = 0.007) when compared with cervical arthroplasty. However, the association between ACDF therapy and the risk of mean blood loss (MD -0.16; 95 % CI -0.34 to 0.02; P = 0.082), mean hospitalization (MD 0.02; 95 % CI -0.31 to 0.36; P = 0.901), patient satisfaction (RR 0.96; 95 % CI 0.92-1.00; P = 0.066), neck disability index (MD 0.20; 95 % CI -0.05 to 0.44; P = 0.113), reoperation (RR 1.25; 95 % CI 0.64-2.41; P = 0.514), or complication (RR 1.17; 95 % CI 0.90-1.52; P = 0.242) was not statistically significant. Patients undergoing ACDF therapy tended to exhibit lower overall success rate, higher VAS score, and decreased mean surgical duration when compared with patients treated with cervical arthroplasty.

  14. Long Term Societal Costs of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for Treatment of Cervical Radiculopathy.

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    Ghori, Ahmer; Konopka, Joseph F; Makanji, Heeren; Cha, Thomas D; Bono, Christopher M

    2016-01-01

    Current literature suggests that anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) have comparable clinical outcomes for the treatment of cervical radiculopathy. Given similar outcomes, an understanding of differences in long-term societal costs can help guide resource utilization. The purpose of this study was to compare the relative long-term societal costs of anterior cervical discectomy and fusion (ACDF) to cervical disc arthroplasty (CDA) for the treatment of single level cervical disc disease by considering upfront surgical costs, lost productivity, and risk of subsequent revision surgery. We completed an economic and decision analysis using a Markov model to evaluate the long-term societal costs of ACDF and CDA in a theoretical cohort of 45-65 year old patients with single level cervical disc disease who have failed nonoperative treatment. The long-term societal costs for a 45-year old patient undergoing ACDF are $31,178 while long-term costs for CDA are $24,119. Long-term costs for CDA remain less expensive throughout the modeled age range of 45 to 65 years old. Sensitivity analysis demonstrated that CDA remains less expensive than ACDF as long as annual reoperation rate remains below 10.5% annually. Based on current data, CDA has lower long-term societal costs than ACDF for patients 45-65 years old by a substantial margin. Given reported reoperation rates of 2.5% for CDA, it is the preferred treatment for cervical radiculopathy from an economic perspective.

  15. Adjacent Segment Degeneration Following Anterior Cervical Discectomy and Fusion Versus the Bryan Cervical Disc Arthroplasty.

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    Yan, Suo-Zhou; Di, Jun; Shen, Yong

    2017-06-02

    BACKGROUND Anterior cervical discectomy and fusion (ACDF) is an established treatment for degenerative disease of the cervical disc, but adjacent segment degeneration or instability may develop long term. The aim of this study was to investigate the risk factors for adjacent segment degeneration following ACDF compared with the use of the Bryan artificial disc for cervical disc arthroplasty (CDA). MATERIAL AND METHODS A prospective comparative study included 93 patients who underwent ACDF or CDA with the Bryan artificial cervical disc between 2002 and 2004, and who had more than eight years of follow-up. There were 29 cases in the CDA group and 39 cases in ACDF group, with a follow-up rate of 73.12%. Clinical results and imaging data were assessed before and after surgery. RESULTS There was no significant difference between the two groups in radiographic parameters at each follow-up time point. There were 19 cases of adjacent segment degeneration (48.72%) in the ACDF group, and 13 cases of adjacent segment degeneration (44.83%) in the CDA group, with no statistically significant difference (P>0.05). Univariate analysis showed that advanced age (OR 1.271, 95% CI 1.005-1.607), low preoperative overall lordosis (OR 0.858, 95% CI 0.786-0.936) and low preoperative segmental lordosis (OR 1.185, 95% CI 1.086-1.193) were significantly correlated with adjacent segment degeneration. CONCLUSIONS Equally good clinical outcomes were achieved with both the ACDF and the Bryan CDA. Increasing patient age was associated with adjacent segment degeneration in both patient groups.

  16. Adjacent Segment Degeneration Following Anterior Cervical Discectomy and Fusion Versus the Bryan Cervical Disc Arthroplasty

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    Yan, Suo-Zhou; Di, Jun; Shen, Yong

    2017-01-01

    Background Anterior cervical discectomy and fusion (ACDF) is an established treatment for degenerative disease of the cervical disc, but adjacent segment degeneration or instability may develop long term. The aim of this study was to investigate the risk factors for adjacent segment degeneration following ACDF compared with the use of the Bryan artificial disc for cervical disc arthroplasty (CDA). Material/Methods A prospective comparative study included 93 patients who underwent ACDF or CDA with the Bryan artificial cervical disc between 2002 and 2004, and who had more than eight years of follow-up. There were 29 cases in the CDA group and 39 cases in ACDF group, with a follow-up rate of 73.12%. Clinical results and imaging data were assessed before and after surgery. Results There was no significant difference between the two groups in radiographic parameters at each follow-up time point. There were 19 cases of adjacent segment degeneration (48.72%) in the ACDF group, and 13 cases of adjacent segment degeneration (44.83%) in the CDA group, with no statistically significant difference (P>0.05). Univariate analysis showed that advanced age (OR 1.271, 95% CI 1.005–1.607), low preoperative overall lordosis (OR 0.858, 95% CI 0.786–0.936) and low preoperative segmental lordosis (OR 1.185, 95% CI 1.086–1.193) were significantly correlated with adjacent segment degeneration. Conclusions Equally good clinical outcomes were achieved with both the ACDF and the Bryan CDA. Increasing patient age was associated with adjacent segment degeneration in both patient groups. PMID:28574978

  17. Effects of cervical arthrodesis and arthroplasty on neck response during a simulated frontal automobile collision.

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    White, Nicholas A; Moreno, Daniel P; Brown, Philip J; Gayzik, F Scott; Hsu, Wesley; Powers, Alexander K; Stitzel, Joel D

    2014-09-01

    Whereas arthrodesis is the most common surgical intervention for the treatment of symptomatic cervical degenerative disc disease, arthroplasty has become increasingly more popular over the past decade. Although literature exists comparing the effects of anterior cervical discectomy and fusion and cervical total disc replacement (CTDR) on neck kinematics and loading, the vast majority of these studies apply only quasi-static, noninjurious loading conditions to a segment of the cervical spine. The objective of this study was to investigate the effects of arthrodesis and arthroplasty on biomechanical neck response during a simulated frontal automobile collision with air bag deployment. This study used a full-body, 50th percentile seated male finite element (FE) model to evaluate neck response during a dynamic impact event. The cervical spine was modified to simulate either an arthrodesis or arthroplasty procedure at C5-C6. Five simulations of a belted driver, subjected to a 13.3 m/s ΔV frontal impact with air bag deployment, were run in LS-DYNA with the Global Human Body Models Consortium full-body FE model. The first simulation used the original model, with no modifications to the neck, whereas the remaining four were modified to represent either interbody arthrodesis or arthroplasty of C5-C6. Cross-sectional forces and moments at the C5 and C6 cervical levels of the neck, along with interbody and facet forces between C5 and C6, were reported. Adjacent-level, cross-sectional neck loading was maintained in all simulations without exceeding any established injury thresholds. Interbody compression was greatest for the CTDRs, and interbody tension occurred only in the fused and nonmodified spines. Some interbody separation occurred between the superior and inferior components of the CTDRs during flexion-induced tension of the cervical spine, increasing the facet loads. This study evaluated the effects of C5-C6 cervical arthrodesis and arthroplasty on neck response

  18. Cervical arthroplasty with ROTAIO® cervical disc prosthesis: first clinical and radiographic outcome analysis in a multicenter prospective trial.

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    Obernauer, J; Landscheidt, J; Hartmann, S; Schubert, G A; Thomé, C; Lumenta, C

    2016-01-12

    Cervical Disc Arthroplasty (CDA) seems to be an alternative to Anterior Cervical Decompression and Fusion (ACDF) and was developed to minimize the risk of Adjacent Segment Disease (ASD). The ROTAIO Cervical Disc Prosthesis represents a new unconstrained implant with a variable centre of rotation which should enable physiological facet-guided movement. The aim of this current study was to evaluate the clinical outcomes after arthroplasty using ROTAIO Cervical Disc Prosthesis. Twenty-seven female and 18 male patients (n = 45) with a mean age of 43.7 ± 7.8 years were prospectively followed up for a maximum of 24 month. Clinical outcomes were assessed by Neck Disability Index (NDI), visual analogue scale (VAS) scores for neck and arm pain, patients´ overall satisfaction and the usage of analgesics. Additionally, radiographic information including ROM of the functional spinal unit (FSU) and signs of adjacent segment disease were recorded. NDI and VAS scores showed significant improvement 6 months after surgery and at last follow-up (p prosthesis and no subsidence was recorded radiographically. There were no major complications and a low rate of secondary procedures (2.2%). In the 24-months follow-up the ROTAIO Cervical Disc Prosthesis provided excellent clinical and radiographical results and seems to be safe and effective for the treatment of symptomatic single-level degenerative disc disease.

  19. Cervical disc arthroplasty for the treatment of adjacent segment disease: A systematic review of clinical evidence.

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    Wu, Ting-Kui; Liu, Hao; Ning, Ning; Hong, Ying; Deng, Ming-Dan; Wang, Bei-Yu; Rong, Xin; Meng, Yang; Chen, Hua

    2017-11-01

    The safety and efficacy of cervical disc arthroplasty (CDA) performed adjacent to previous fusion for the treatment of adjacent segment disease (ASD) remains unknown. This systematic review summarizes clinical evidence on the outcomes of CDA performed adjacent to previous cervical fusion. A systematic search of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase for literature published through March 2017 was conducted. All the studies on CDA for the treatment of ASD after cervical fusion surgery were included. Two independent reviewers searched and assessed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). A total of 5 studies were identified. The overall quality of evidence was low. All included studies demonstrated that clinical outcomes reflected by several assessment scales improved after arthroplasty. Cervical lordosis range of motion (ROM) after arthroplasty remained and was even enhanced postoperatively. The rate of complications and subsequent surgeries was low. There is a dearth of information regarding the outcomes of CDA for the treatment of ASD in the literature. In general, CDA may be a safe and effective surgical procedure to treat ASD, but this conclusion needs to be confirmed by future long-term, prospective clinical trials. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Complications and Mortality Following One to Two-Level Anterior Cervical Fusion for Cervical Spondylosis in Patients Above 80 Years of Age.

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    Puvanesarajah, Varun; Jain, Amit; Shimer, Adam L; Singla, Anuj; Shen, Francis; Hassanzadeh, Hamid

    2017-05-01

    A retrospective database review. The aim of this study was to determine the complication and mortality rates in patients 80 years of age and older who were treated with anterior cervical fusion surgery and to compare these rates against those of other elderly patients. Cervical spondylosis is frequently observed in the elderly and is the most common cause of myelopathy in older adults. With increasing life expectancies, a greater proportion of patients are being treated with spine surgery at a later age. Limited information is available regarding outcomes following anterior cervical fusion surgery in patients 80 years of age or older. Medicare data from the PearlDiver Database (2005-2012) were queried for patients who underwent primary one to two-level anterior cervical spine fusion surgeries for cervical spondylosis. After excluding patients with prior spine metastasis, bone cancer, spine trauma, or spine infection, this cohort was divided into two study groups: patients 65 to 79 (51,808) and ≥80 years old (5515) were selected. A cohort of matched control patients was selected from the 65 to 79-year-old and 90-day complication rates and 90-day and 1-year mortality rates were compared between cohorts. The proportion of patients experiencing at least one major medical complication was relatively increased by 53.4% in patients aged ≥80 years [odds ratio (OR) 1.63]. Patients 80 years of age or older were more likely to experience dysphagia (OR 2.16), reintubation (OR 2.34), and aspiration pneumonitis (OR 3.17). Both 90-day (OR: 4.34) and 1-year (OR 3.68) mortality were significantly higher in the ≥80 year cohort. Patients 80 years of age or older are more likely to experience a major medical complication or mortality following anterior cervical fusion for cervical spondylosis than patients 65 to 79 years old. Dysphagia, aspiration pneumonitis, and reintubation rates are also significantly higher in patients 80 years of age or older. Although complication rates

  1. Cervical arthroplasty versus anterior cervical fusion for symptomatic adjacent segment disease after anterior cervical fusion surgery: Review of treatment in 41 patients.

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    Lee, Sang-Bok; Cho, Kyoung-Suok

    2017-11-01

    The purpose of this study is to compare the efficacy and safety of anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement (CTDR) as revision surgeries for symptomatic adjacent segment degeneration (ASD) in cases with previous ACDF. Between 2010 and 2014, 41 patients with previous cervical fusion surgery underwent ACDF or CTDR for symptomatic ASD. Twenty-two patients in the ACDF group underwent 26 ACDFs, and 19 patients in the CTDR group underwent 25 arthroplasties for symptomatic ASD. Clinical outcomes were assessed by a visual analogue scale (VAS) for arm pain, the neck disability index (NDI) and Odom's criteria. Radiological evaluations were performed preoperatively and postoperatively to measure changes in the range of motion (ROM) of the cervical spine and adjacent segments and arthroplasty level. The radiological change of ASD was assessed in radiographs. Clinical outcomes as assessed with VAS for arm pain and Odom's criteria were significantly improved in both groups. The CTDR group showed better NDI improvement after surgery (Padjacent segment between the ACDF and CTDR groups (Padjacent segment compared with the CTDR group (Padjacent segment, and a lower incidence of adjacent segment degeneration than did the ACDF group. Copyright © 2017. Published by Elsevier B.V.

  2. Anterior cervical discectomy with arthroplasty versus arthrodesis for single-level cervical spondylosis: a systematic review and meta-analysis.

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    Fallah, Aria; Akl, Elie A; Ebrahim, Shanil; Ibrahim, George M; Mansouri, Alireza; Foote, Clary J; Zhang, Yuqing; Fehlings, Michael G

    2012-01-01

    To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA) compared to anterior cervical discectomy with fusion (ACDF) for patient-important outcomes for single-level cervical spondylosis. Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized Controlled Trials, BIOSIS and LILACS), archives of spine meetings and bibliographies of relevant articles. We included RCTs of ACDF versus ACDA in adult patients with single-level cervical spondylosis reporting at least one of the following outcomes: functionality, neurological success, neck pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD), reoperation and dysphonia/dysphagia. We used no language restrictions. We performed title and abstract screening and full text screening independently and in duplicate. We used random-effects model to pool data using mean difference (MD) for continuous outcomes and relative risk (RR) for dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each outcome. Of 2804 citations, 9 articles reporting on 9 trials (1778 participants) were eligible. ACDA is associated with a clinically significant lower incidence of neurologic failure (RR = 0.53, 95% CI = 0.37-0.75, p = 0.0004) and improvement in the Neck pain visual analogue scale (VAS) (MD = 6.56, 95% CI = 3.22-9.90, p = 0.0001; Minimal clinically important difference (MCID) = 2.5. ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary. ACDA is associated with non-statistically significant higher improvement in the Neck Disability Index Score and lower incidence of ALD requiring surgery, reoperation, and dysphagia/dysphonia. There is no strong evidence to support the routine use of ACDA over ACDF in single-level cervical spondylosis. Current trials lack long-term data required to assess safety as well as surgery for ALD. We suggest that ACDA in patients with single level

  3. [Longterm results of cervical arthroplasty with disc prosthesis. A literature review].

    Science.gov (United States)

    Fransen, P; Schils, F

    2014-01-01

    Cervical arthroplasty has now been performed for over 10 years. Despite the large number of implanted artificial discs, the quality of the published studies is weak, and very few report a follow up exceeding two years. We reviewed the literature on cervical total disc replacement, focusing on publications reporting a follow-up of more than two years. The selection of patients, the type of implant and the surgical technique seem to influence greatly the quality of the clinical and radiological results. The occurrence of heterotopic ossifications around the implant seems to be the rule rather than the exception. Wear debris are likely to be observed in the vicinity of the prosthesis. Most long term studies also report a progressive decrease in the range of motion of the prosthesis, although without influence on the clinical evolution. It seems reasonable to say that cervical disc prosthesis is not inferior to discectomy and fusion, and that these implants allow a short term preservation of cervical mobility, but the efficacy in preventing adjacent segment disease or a favourable costleffectiveness ratio have yet to be demonstrated. A more widespread use of cervical disc prosthesis can only be suggested when these questions have been answered by long term follow-up studies.

  4. Very late complications of cervical arthroplasty: results of 2 controlled randomized prospective studies from a single investigator site.

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    Hacker, Francis M; Babcock, Rebecca M; Hacker, Robert J

    2013-12-15

    Prospective, single-site, randomized, Food and Drug Administration-approved investigational device exemption clinical trials of 2 cervical arthroplasty (CA) devices. To evaluate complications with CA occurring more than 4 years after the surgical procedure in Food and Drug Administration clinical trials of the Bryan and Prestige LP arthroplasty devices. Reports of several randomized clinical studies have shown CA to be a safe and effective alternative to anterior cervical fusion in the treatment of degenerative cervical disc disorders. A majority include follow-up intervals of 4 years or less. Between 2002 and 2006, 94 patients were enrolled in Food and Drug Administration studies of the Bryan and Prestige LP cervical disc devices. Charts, imaging studies, and hospital records were reviewed for those who underwent arthroplasty and returned more than 4 years after their surgical procedure with neck-related pain or dysfunction. Excluding adjacent segment disease that occurred with a similar rate for patients who underwent fusion and arthroplasty, 5 patients, all treated with arthroplasty, returned for evaluation of neck and arm symptoms between 48 and 72 months after surgery. Four patients had peridevice vertebral body bone loss. One patient had posterior device migration and presented with myelopathy. Three required revision surgery and 2 were observed. Four patients maintained follow-up and reported stabilization or improvement in symptoms. Despite their similarities, CA and fusion are not equivalent procedures in this study in regard to very late complications. Similar to large joint arthroplasty, delayed device-related complications may occur with CA. These complications commenced well beyond the time frame for complications associated with more traditional cervical spine procedures. Both patients and surgeons should be aware of the potential for very late device-related complications occurring with CA and the need for revision surgery. 1.

  5. Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine: results of 93 patients in three prospective randomized clinical trials.

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    Jawahar, Ajay; Cavanaugh, David A; Kerr, Eubulus J; Birdsong, Elisa M; Nunley, Pierce D

    2010-12-01

    Advancements in the philosophy of "motion preservation" have led to the use of total disc arthroplasty (TDA) as an alternative to fusion for degenerative disc disease (DDD) in the cervical spine. A commonly proposed theory is that TDA could reduce the incidence of adjacent segment disease. All the published clinical studies for TDA discuss the "equal efficacy" results of different investigational device exemption (IDE) trials between TDA and anterior cervical discectomy and fusion (ACDF) but have not addressed the issue of adjacent segment disease. To present the comparison of outcome data with respect to clinical success rates, symptom-free period, and incidence of adjacent segment disease in 93 patients with one- and two-level cervical DDD treated with TDA or ACDF in three different Food and Drug Administration (FDA) investigational trials. Prospective, randomized, FDA IDE trials. Ninety-three patients with established symptomatic one-or two-level cervical disc disease who failed to respond to conservative treatment were randomized to receive TDA (59) or ACDF (34) as part of clinical trials involving three different artificial discs at our institution. Subjects were blind to the assigned group until after the surgery. Visual analog pain score (VAS), Neck Disability Index, and cervical spine radiographs were collected at 6 weeks and at 3, 6, 12, 24, 36, and 48 months after surgery. Success of the index surgery was assessed based on outcome measures at the seven data points. Success was defined as reduction by more than 30 points in both VAS and Neck Disability Index, absence of neurological deficits, and no further intervention at the index level. Adjacent segment disease was established by radiology, neurophysiology, and subsequent interventions administered to the patients. At median follow-up of 37 months (range, 24-49 months), 64 (25 ACDF and 39 TDA) patients satisfied the criteria for clinical success. Neck Disability Index was a better predictor of outcome

  6. A Comprehensive Meta-Analysis of the Adjacent Segment Parameters in Cervical Disk Arthroplasty Versus Anterior Cervical Discectomy and Fusion.

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    Dong, Liang; Wang, Dongqi; Chen, Xiujin; Liu, Tuanjing; Xu, Zhengwei; Tan, Mingsheng; Hao, Dingjun

    2017-06-15

    This is a meta-analysis of controlled trials. To assess the overall condition of adjacent segment of cervical disk arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF). With the increase in CDA and ACDF, surgeons are taking more attention to adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis). There are more and more meta-analyses comparing the efficacy of CDA with ACDF, however, there are few meta-analyses referring to adjacent segment parameters, and investigators are still unable to arrive at the same conclusion. Several important databases were searched for controlled trials comparing CDA and ACDF before February 2016 according to PRISMA guidelines. The analysis parameters included follow-up time, operative segments, cervical range of motion (ROM), adjacent segment motion, ASDeg, ASDis and adjacent segment reoperation. The risk of bias scale and Newcastle-Ottawa Scale were used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity. Forty-one controlled trials fulfilled the inclusion criteria, including 36 English papers and 5 Chinese. The average follow-up time of all included patients was 39 months. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (P0.05). CDA provided a greater cervical ROM than did ACDF (Padjacent segment ROM and the rate of ASDis in CDA compared with ACDF (Padjacent segment reoperation and adjacent segment motion; and higher cervical ROM. However, there was no statistical difference between upper and lower adjacent segment ROM/ASDeg using the same surgery.

  7. The Incidence of Adjacent Segment Degeneration after Cervical Disc Arthroplasty (CDA): A Meta Analysis of Randomized Controlled Trials

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    Yang, Baohui; Li, Haopeng; Zhang, Ting; He, Xijing; Xu, Siyue

    2012-01-01

    BACKGROUND: Cervical disc arthroplasty is being used as an alternative degenerative disc disease treatment with fusion of the cervical spine in order to preserve motion. However, whether replacement arthoplasty in the spine achieves its primary patient centered objective of lowering the frequency of adjacent segment degeneration is not verified yet. METHODOLOGY: We conducted a meta-analysis according to the guidelines of the Cochrane Collaboration using databases including PubMed, Cochrane Ce...

  8. Spondylolisthesis adjacent to a cervical disc arthroplasty does not increase the risk of adjacent level degeneration.

    Science.gov (United States)

    Kieser, David Christopher; Cawley, Derek Thomas; Roscop, Cecile; Mazas, Simon; Coudert, Pierre; Boissiere, Louis; Obeid, Ibrahim; Vital, Jean-Marc; Pointillart, Vincent; Gille, Olivier

    2018-03-31

    To understand whether a spondylolisthesis in the sub-axial spine cranial to a cervical disc arthroplasty (CDA) construes a risk of adjacent level disease (ALD). A retrospective review of 164 patients with a minimum 5-year follow-up of a cervical disc arthroplasty was performed. Multi-level surgeries, including hybrid procedures, were included. Multiple implant types were included. The two inter-vertebral discs (IVD) cranial of the CDA were monitored for evidence of radiologic degeneration using the Kettler criteria. The rate of ALD in CDA found in this series was 17.8%, with most affecting the immediately adjacent IVD (27.4 and 7.6%, respectively p = 0.000). Pre-operative mild spondylolisthesis adjacent to a planned CDA was not found to be a risk factor for ALD within 5 years. Those with a degenerative spondylolisthesis are at higher risk of ALD (33%) than those with a non-degenerative cause for their spondylolisthesis (11%). Post-operative CDA alignment, ROM or induced spondylolisthesis do not affect the rate of ALD in those with an adjacent spondylolisthesis. Patients with ALD experience significantly worse 5-year pain and functional outcomes than those unaffected by ALD. A pre-operatively identified mild spondylolisthesis in the sub-axial spine cranially adjacent to a planned CDA is not a risk factor for ALD within 5 years. These slides can be retrieved under Electronic Supplementary Material.

  9. Anterior cervical discectomy with arthroplasty versus arthrodesis for single-level cervical spondylosis: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Aria Fallah

    Full Text Available To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA compared to anterior cervical discectomy with fusion (ACDF for patient-important outcomes for single-level cervical spondylosis.Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized Controlled Trials, BIOSIS and LILACS, archives of spine meetings and bibliographies of relevant articles.We included RCTs of ACDF versus ACDA in adult patients with single-level cervical spondylosis reporting at least one of the following outcomes: functionality, neurological success, neck pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD, reoperation and dysphonia/dysphagia. We used no language restrictions. We performed title and abstract screening and full text screening independently and in duplicate.We used random-effects model to pool data using mean difference (MD for continuous outcomes and relative risk (RR for dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each outcome.Of 2804 citations, 9 articles reporting on 9 trials (1778 participants were eligible. ACDA is associated with a clinically significant lower incidence of neurologic failure (RR = 0.53, 95% CI = 0.37-0.75, p = 0.0004 and improvement in the Neck pain visual analogue scale (VAS (MD = 6.56, 95% CI = 3.22-9.90, p = 0.0001; Minimal clinically important difference (MCID = 2.5. ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary. ACDA is associated with non-statistically significant higher improvement in the Neck Disability Index Score and lower incidence of ALD requiring surgery, reoperation, and dysphagia/dysphonia.There is no strong evidence to support the routine use of ACDA over ACDF in single-level cervical spondylosis. Current trials lack long-term data required to assess safety as well as surgery for ALD. We suggest that ACDA in patients with single

  10. Comparison of two anterior fusion methods in two-level cervical spondylosis myelopathy: a meta-analysis

    Science.gov (United States)

    Huang, Zhe-Yu; Wu, Ai-Min; Li, Qing-Long; Lei, Tao; Wang, Kang-Yi; Xu, Hua-Zi; Ni, Wen-Fei

    2014-01-01

    Objective The aim of this study was to evaluate the efficacy and safety of anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF) for treating two-adjacent-level cervical spondylosis myelopathy (CSM). Design A meta-analysis of the two anterior fusion methods was conducted. The electronic databases of PubMed, the Cochrane Central Register of Controlled Trials, ScienceDirect, CNKI, WANFANG DATA and CQVIP were searched. Quality assessment of the included studies was evaluated using the Cochrane Risk of Bias Tool and the Methodological Index for Non-Randomised Studies criteria. Pooled risk ratios of dichotomous outcomes and standardised mean differences (SMDs) of continuous outcomes were generated. Using the χ2 and I2 tests, the statistical heterogeneity was assessed. Subgroup and sensitivity analyses were also performed. Participants Nine eligible trials with a total of 631 patients and a male-to-female ratio of 1.38:1 were included in this meta-analysis. Inclusion criteria Randomised controlled trials (RCTs) and non-randomised controlled trials that adopted ACCF and ACDF to treat two-adjacent-level CSM were included. Results No significant differences were identified between the two groups regarding hospital stay, the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) scores for neck and arm pain, total cervical range of motion (ROM), fusion ROM, fusion rate, adjacent-level ossification and complications, while ACDF had significantly less bleeding (SMD=1.14, 95% CI (0.74 to 1.53)); a shorter operation time (SMD=1.13, 95% CI (0.82 to 1.45)); greater cervical lordosis, total cervical (SMD=−2.95, 95% CI (−4.79 to −1.12)) and fused segment (SMD=−2.24, 95% CI (−3.31 to −1.17)); higher segmental height (SMD=−0.68, 95% CI (−1.03 to −0.34)) and less graft subsidence (SMD=0.40, 95% CI (0.06 to 0.75)) compared to ACCF. Conclusions The results suggested that ACDF has more advantages compared to

  11. Cervical disc arthroplasty for the treatment of spondylotic myelopathy and radiculopathy.

    Science.gov (United States)

    Khong, Peter; Bogduk, Nikolai; Ghahreman, Ali; Davies, Mark

    2013-10-01

    The concept of cervical disc arthroplasty (CDA) for the anterior treatment of cervical pathology has existed for approximately half a decade. In this time, multiple devices have been developed for this purpose, with the ultimate aim to provide an alternative to fusion. Fifty-five patients with cervical spondylotic radiculopathy and myelopathy underwent CDA over a 5 year period. Data was collected on 46 patients, which included Visual Analogue Scale scores for neck pain and arm pain, Neck Disability Index scores, Short Form-36 v2 (SF-36) and Nurick grades for myelopathy patients. Preoperative data and data obtained at the latest clinical follow-up (median 48 months, range, 10-76 months) were analysed to assess the intermediate term efficacy of the procedure. In patients with radiculopathy, arm pain improved by 88% (p<0.001). In those presenting with myelopathy, the Nurick grades improved from a median of 1 to 0 (p<0.001). In both groups of patients, improvements in pain and neurologic deficit were accompanied by significant improvements in multiple domains of the SF-36. Using a composite system which considered neck pain, arm pain, function and myelopathy, we arrived at an overall success rate of 73%. We concluded that CDA is an effective intervention for improving neurologic deficit, arm pain and local neck symptoms that translated into improvements in physical and social functioning in the intermediate term. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Cervical disc arthroplasty for symptomatic cervical disc disease: Traditional and Bayesian meta-analysis with trial sequential analysis.

    Science.gov (United States)

    Kan, Shun-Li; Yuan, Zhi-Fang; Ning, Guang-Zhi; Liu, Fei-Fei; Sun, Jing-Cheng; Feng, Shi-Qing

    2016-11-01

    Cervical disc arthroplasty (CDA) has been designed as a substitute for anterior cervical discectomy and fusion (ACDF) in the treatment of symptomatic cervical disc disease (CDD). Several researchers have compared CDA with ACDF for the treatment of symptomatic CDD; however, the findings of these studies are inconclusive. Using recently published evidence, this meta-analysis was conducted to further verify the benefits and harms of using CDA for treatment of symptomatic CDD. Relevant trials were identified by searching the PubMed, EMBASE, and Cochrane Library databases. Outcomes were reported as odds ratio or standardized mean difference. Both traditional frequentist and Bayesian approaches were used to synthesize evidence within random-effects models. Trial sequential analysis (TSA) was applied to test the robustness of our findings and obtain more conservative estimates. Nineteen trials were included. The findings of this meta-analysis demonstrated better overall, neck disability index (NDI), and neurological success; lower NDI and neck and arm pain scores; higher 36-Item Short Form Health Survey (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores; more patient satisfaction; greater range of motion at the operative level; and fewer secondary surgical procedures (all P  0.05). TSA of overall success suggested that the cumulative z-curve crossed both the conventional boundary and the trial sequential monitoring boundary for benefit, indicating sufficient and conclusive evidence had been ascertained. For treating symptomatic CDD, CDA was superior to ACDF in terms of overall, NDI, and neurological success; NDI and neck and arm pain scores; SF-36 PCS and MCS scores; patient satisfaction; ROM at the operative level; and secondary surgical procedures rate. Additionally, there was no significant difference between CDA and ACDF in the rate of adverse events. However, as the CDA procedure is a relatively newer operative technique, long

  13. Clinical and radiographic outcome of dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease: a minimal five-year follow-up.

    Science.gov (United States)

    Wang, Lin-Nan; Hu, Bo-Wen; Wang, Lei; Song, Yue-Ming; Yang, Xi; Liu, Li-Min; Liu, Hao

    2018-04-04

    To evaluate the mid- to long-term clinical and radiographic outcomes of anterior cervical discectomy and dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease. From April 2010 to October 2010, 38 patients with single- or double-level cervical disc herniation underwent anterior cervical discectomy and DCI arthroplasty. The clinical results and radiographic outcomes of these 38 patients (42 levels) were retrospectively evaluated. The clinical results included the visual analogue scale, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey questionnaire, and incidences of complications and neurological deterioration. Radiographic results including cervical alignment, intervertebral height, cervical range of motion (ROM), ROM of the functional spinal unit, adjacent intervertebral ROM, migration, subsidence, and heterotopic ossification (HO) were assessed on plain radiography, three-dimensional computed tomography, and magnetic resonance imaging. The mean follow-up period was 72.3 months (range 68-78 months). During follow-up, all patients showed significant improvements in the visual analogue scale score, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey physical component summary score and mental component summary score. The ROM of the functional spinal unit was partly reduced. The DCI migrated forward in 10 of 42 (23.8%) cases, and HO was detected in 24 of the 42 (57.1%) DCI segments. Subsidence was observed in 14 of 42 (33.3%) DCI segments. Two patients experienced symptom recurrence, and were treated conservatively. The clinical efficacy of DCI arthroplasty was maintained during mid- to long-term follow-up. HO formation is a common phenomenon, leading to a substantial decrease in ROM at the index level and recurrence of neurological symptoms. The incidence of implant subsidence and migration is relatively high, leaving a potential risk

  14. Impact of T1 slope on surgical and adjacent segment degeneration after Bryan cervical disc arthroplasty

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    Yang P

    2017-08-01

    Full Text Available Peng Yang,1 Yongqian Li,2,3 Jia Li,2,3,* Yong Shen2,3,* 1Department of Neurosurgery, Affiliated Hospital of North China University of Science and Technology, Tangshan, 2Department of Orthopedic Surgery, 3Key Laboratory of Orthopedic Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China *These authors contributed equally to this work Background: This retrospective study investigated an association between preoperative T1 slope and surgical and adjacent segment degeneration (SASD after Bryan cervical disc arthroplasty (BCDA in patients with cervical degenerative disc disease.Methods: Based on preoperative standing lateral radiographs, 90 patients were classified according to T1 slope that was higher or lower than the 50th percentile (high T1 or low T1, 28 and 62 patients, respectively. Patients were also classified as SASD or non-SASD (38 and 52 patients, respectively determined by radiographs at final follow-up. Visual analog scale (VAS and Neck Disability Index (NDI scores for neck and arm pain were noted, and changes in the sagittal alignment of the cervical spine (SACS, functional spinal unit (FSU angle, and FSU range of motion (ROM were also noted. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for SASD.Results: The overall rate of SASD was 42.2% (38/90. The SACS, FSU angle, FSU ROM, and SASD rates of the high T1 and low T1 slope groups were significantly different at the last follow-up. The NDI and VAS scores of the high T1 slope group were significantly greater than those of the low T1 slope. The multivariate logistic regression analysis showed that high T1 slope and endplate coverage discrepancy (ie, residual space behind the prosthesis were significant risk factors for SASD after BCDA.Conclusion: High T1 slope and endplate coverage discrepancy were associated with SASD after BCDA. Patients with a high preoperative T1

  15. Impact of T1 slope on surgical and adjacent segment degeneration after Bryan cervical disc arthroplasty.

    Science.gov (United States)

    Yang, Peng; Li, Yongqian; Li, Jia; Shen, Yong

    2017-01-01

    This retrospective study investigated an association between preoperative T1 slope and surgical and adjacent segment degeneration (SASD) after Bryan cervical disc arthroplasty (BCDA) in patients with cervical degenerative disc disease. Based on preoperative standing lateral radiographs, 90 patients were classified according to T1 slope that was higher or lower than the 50th percentile (high T1 or low T1, 28 and 62 patients, respectively). Patients were also classified as SASD or non-SASD (38 and 52 patients, respectively) determined by radiographs at final follow-up. Visual analog scale (VAS) and Neck Disability Index (NDI) scores for neck and arm pain were noted, and changes in the sagittal alignment of the cervical spine (SACS), functional spinal unit (FSU) angle, and FSU range of motion (ROM) were also noted. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for SASD. The overall rate of SASD was 42.2% (38/90). The SACS, FSU angle, FSU ROM, and SASD rates of the high T1 and low T1 slope groups were significantly different at the last follow-up. The NDI and VAS scores of the high T1 slope group were significantly greater than those of the low T1 slope. The multivariate logistic regression analysis showed that high T1 slope and endplate coverage discrepancy (ie, residual space behind the prosthesis) were significant risk factors for SASD after BCDA. High T1 slope and endplate coverage discrepancy were associated with SASD after BCDA. Patients with a high preoperative T1 slope have a smaller FSU angle and more neck pain after BCDA.

  16. The Incidence of Adjacent Segment Degeneration after Cervical Disc Arthroplasty (CDA): A Meta Analysis of Randomized Controlled Trials

    Science.gov (United States)

    Yang, Baohui; Li, Haopeng; Zhang, Ting; He, Xijing; Xu, Siyue

    2012-01-01

    Background Cervical disc arthroplasty is being used as an alternative degenerative disc disease treatment with fusion of the cervical spine in order to preserve motion. However, whether replacement arthoplasty in the spine achieves its primary patient centered objective of lowering the frequency of adjacent segment degeneration is not verified yet. Methodology We conducted a meta-analysis according to the guidelines of the Cochrane Collaboration using databases including PubMed, Cochrane Central Register of Controlled Trials and Embase. The inclusion criteria were: 1) Randomized, controlled study of degenerative disc disease of the cervical spine involving single segment or double segments using Cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion (ACDF) as controls; 2) A minimum of two-year follow-up using imaging and clinical analyses; 3) Definite diagnostic evidences for “adjacent segment degeneration” and “adjacent segment disease”; 4) At least a minimum of 30 patients per population. Two authors independently selected trials; assessed methodological quality, extracted data and the results were pooled. Results No study has specifically compared the results of adjacent segment degenerative; Two papers describing 140 patients with 162 symptomatic cervical segment disorders and compared the rate of postoperative adjacent segment disease development between CDA and ACDF treatments, three publications describing the rate of adjacent-segment surgery including 1273 patients with symptomatic cervical segments. The result of the meta-analysis indicates that there were fewer the rate of adjacent segment disease and the rate for adjacent-segment surgery comparing CDA with ACDF, but the difference was not statistically significant. Conclusions Based on available evidence, it cannot be concluded, that CDA can significantly reduce the postoperative rate of the adjacent segment degenerative and adjacent segment disease. However, due to some

  17. The incidence of adjacent segment degeneration after cervical disc arthroplasty (CDA: a meta analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Baohui Yang

    Full Text Available Cervical disc arthroplasty is being used as an alternative degenerative disc disease treatment with fusion of the cervical spine in order to preserve motion. However, whether replacement arthoplasty in the spine achieves its primary patient centered objective of lowering the frequency of adjacent segment degeneration is not verified yet.We conducted a meta-analysis according to the guidelines of the Cochrane Collaboration using databases including PubMed, Cochrane Central Register of Controlled Trials and Embase. The inclusion criteria were: 1 Randomized, controlled study of degenerative disc disease of the cervical spine involving single segment or double segments using Cervical disc arthroplasty (CDA with anterior cervical discectomy and fusion (ACDF as controls; 2 A minimum of two-year follow-up using imaging and clinical analyses; 3 Definite diagnostic evidences for "adjacent segment degeneration" and "adjacent segment disease"; 4 At least a minimum of 30 patients per population. Two authors independently selected trials; assessed methodological quality, extracted data and the results were pooled.No study has specifically compared the results of adjacent segment degenerative; Two papers describing 140 patients with 162 symptomatic cervical segment disorders and compared the rate of postoperative adjacent segment disease development between CDA and ACDF treatments, three publications describing the rate of adjacent-segment surgery including 1273 patients with symptomatic cervical segments. The result of the meta-analysis indicates that there were fewer the rate of adjacent segment disease and the rate for adjacent-segment surgery comparing CDA with ACDF, but the difference was not statistically significant.Based on available evidence, it cannot be concluded, that CDA can significantly reduce the postoperative rate of the adjacent segment degenerative and adjacent segment disease. However, due to some limitations, the results of this meta

  18. Result of the arc of movement of lower cervical spine after seven years of arthroplasty

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    Luis Claudio de Velleca e Lima

    2014-09-01

    Full Text Available OBJECTIVE: To quantify the mobility of the lower cervical spine after seven years of total cervical disc replacement at two levels. METHOD: This clinical study was designed randomly and prospectively at the spine surgery center at the Hospital Nossa Senhora das Graças, in Canoas, RS-Brazil and at the Hospital Don João Becker, in Gravataí, RS-Brazil. Seventeen patients were included in the study that was designed to compare the data obtained from annual and sequential manner until the end of seven years. A comparison was made with the prior range of motion (ROM of each patient. All patients were diagnosed with not tractable symptomatic cervical degenerative disc disease with two adjacent levels between C-3 and C-7. RESULTS: A total of patients underwent TDR in two levels and at the end of seven years, only one patient was lost to follow-up. The pre and postoperative ROM was the same in the first three years however after the fourth year there was a gradual decline with a loss of 12% of preoperative ROM in flexion, 21% in extension and 23% in the right and left lateral bending at the end of seven years. CONCLUSIONS: The clinical outcome of this study is evidence level IV in evaluating the ROM for Moby-C(r for TDR in two adjacent levels at the lower cervical spine. These results show that the ROM is maintained during the first three years, gradually declining after that.

  19. Conversion paralysis after cervical spine arthroplasty: a case report and literature review.

    Science.gov (United States)

    Boudissa, M; Castelain, J E; Boissière, L; Mariey, R; Pointillart, V; Vital, J M

    2015-09-01

    We report a case of conversion paralysis after cervical spine arthroplasty performed in a 45-year-old woman to treat cervico-brachial neuralgia due to a left-sided C6-C7 disc herniation. Upon awakening from the anaesthesia, she had left hemiplegia sparing the face, with normal sensory function. Magnetic resonance imaging (MRI) of the brain ruled out a stroke. MRI of the spinal cord showed artefacts from the cobalt-chrome prosthesis that precluded confident elimination of mechanical spinal cord compression. Surgery performed on the same day to substitute a cage for the prosthesis ruled out spinal cord compression, while eliminating the source of MRI artefacts. Findings were normal from follow-up MRI scans 1 and 15days later, as well as from neurophysiological testing (electromyogram and motor evoked potentials). The deficit resolved fully within the next 4days. A psychological assessment revealed emotional distress related to an ongoing divorce. The most likely diagnosis was conversion paralysis. Surgeons should be aware that conversion disorder might develop after a procedure on the spine, although the risk of litigation requires re-operation. Familiarity with specific MRI sequences that minimise artefacts can be valuable. A preoperative psychological assessment might improve the detection of patients at high risk for conversion disorder. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  20. The change of adjacent segment after cervical disc arthroplasty compared with anterior cervical discectomy and fusion: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Dong, Liang; Xu, Zhengwei; Chen, Xiujin; Wang, Dongqi; Li, Dichen; Liu, Tuanjing; Hao, Dingjun

    2017-10-01

    Many meta-analyses have been performed to study the efficacy of cervical disc arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF); however, there are few data referring to adjacent segment within these meta-analyses, or investigators are unable to arrive at the same conclusion in the few meta-analyses about adjacent segment. With the increased concerns surrounding adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) after anterior cervical surgery, it is necessary to perform a comprehensive meta-analysis to analyze adjacent segment parameters. To perform a comprehensive meta-analysis to elaborate adjacent segment motion, degeneration, disease, and reoperation of CDA compared with ACDF. Meta-analysis of randomized controlled trials (RCTs). PubMed, Embase, and Cochrane Library were searched for RCTs comparing CDA and ACDF before May 2016. The analysis parameters included follow-up time, operative segments, adjacent segment motion, ASDeg, ASDis, and adjacent segment reoperation. The risk of bias scale was used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity. Twenty-nine RCTs fulfilled the inclusion criteria. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (padjacent segment reoperation increases with increasing follow-up time by subgroup analysis. There was no statistically significant difference in ASDeg between CDA and ACDF within the 24-month follow-up period; however, the rate of ASDeg in CDA was significantly lower than that of ACDF with the increase in follow-up time (p.05). Cervical disc arthroplasty provided a lower adjacent segment range of motion (ROM) than did ACDF, but the difference was not statistically significant. Compared with ACDF, the advantages of CDA were lower ASDeg and adjacent segment reoperation. However, there was no statistically significant difference in ASDis and

  1. Comparison of one-level microendoscopy laminoforaminotomy and cervical arthroplasty in cervical spondylotic radiculopathy: a minimum 2-year follow-up study

    Science.gov (United States)

    2013-01-01

    Background This study aims to compare the perioperative parameters and clinical results between microendoscopy laminoforaminotomy (MELF) and cervical arthroplasty (CA) in the treatment of one-level cervical spondylotic radiculopathy in a retrospective study. Methods From 2003 to 2007, a total of 97 patients with one-level cervical spondylotic radiculopathy were treated. Forty-five patients underwent CA. Fifty-two patients underwent MELF. Patient demographics and operative data were collected with a minimum 2-year follow-up. Perioperative parameters were compared. Clinical assessment in terms of neck disability index (NDI), short form (SF)-36, and visual analogue scale (VAS) of arm pain and neck pain was performed prior to surgery and at 1.5, 3, 6, 12, and 24 months after surgery. Results Fluoroscopy time (CA, 60.3 s; MELF, 12.1 s; P  0.05). Conclusions As alternatives of anterior cervical decompression and fusion (ACDF), both CA and MELF can produce satisfactory clinical outcomes. MELF has the additional benefits of less blood loss, less surgical time, less X-ray time, and shorter hospital stay. PMID:24341633

  2. Persistent axial neck pain after cervical disc arthroplasty: a radiographic analysis.

    Science.gov (United States)

    Wagner, Scott C; Formby, Peter M; Kang, Daniel G; Van Blarcum, Gregory S; Cody, John P; Tracey, Robert W; Lehman, Ronald A

    2016-07-01

    There is very little literature examining optimal radiographic parameters for placement of cervical disc arthroplasty (CDA), nor is there substantial evidence evaluating the relationship between persistent postoperative neck pain and radiographic outcomes. We set out to perform a single-center evaluation of the radiographic outcomes, including associated complications, of CDA. This is a retrospective review. Two hundred eighty-five consecutive patients undergoing CDA were included in the review. The outcome measures were radiological parameters (preoperative facet arthrosis, disc height, CDA placement in sagittal and coronal planes, heterotopic ossification [HO] formation, etc.) and patient outcomes (persistent pain, recurrent pain, new-onset pain, etc.). We performed a retrospective review of all patients from a single military tertiary medical center from August 2008 to August 2012 undergoing CDA. Preoperative, immediate postoperative, and final follow-up films were evaluated. The clinical outcomes and complications associated with the procedure were also examined. The average radiographic follow-up was 13.5 months and the rate of persistent axial neck pain was 17.2%. For patients with persistent neck pain, the rate of HO formation per level studied was 22.6%, whereas the rate was significantly lower for patients without neck pain (11.7%, p=.03). There was no significant association between the severity of HO and the presence of neck pain. Patients with a preoperative diagnosis of cervicalgia, compared to those without cervicalgia, were significantly more likely to experience continued neck pain postoperatively (28.6% vs. 13.1%, p=.01). There were no differences in preoperative facet arthrosis, pre- or postoperative disc height, segmental range of motion, or placement of the device relative to the posterior edge of the vertebral body.However, patients with implants more centered between the uncovertebral joints were more likely to experience posterior neck pain

  3. Rate of adjacent segment degeneration of cervical disc arthroplasty versus fusion Meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Luo, Jiaquan; Wang, Hongbo; Peng, Jun; Deng, Zhongyuan; Zhang, Zhen; Liu, Shixue; Wang, Daidong; Gong, Ming; Tang, Shuo

    2018-02-27

    The concern of adjacent segment disease (ASD) has led to the development of motion-preserving technologies such as cervical disc arthroplasty (CDA). However, there is still controversy whether CDA is superior to anterior cervical decompression and fusion (ACDF) as to the incidence of ASD. The purpose of this study is to evaluate the rate of ASD between CDA and ACDF. Systematic searches of all relevant studies through November. 2017 were identified from Cochrane Library, PubMed, Embase and CNKI. Randomized controlled trials (RCTs) comparing clinical effectiveness of CDA and ACDF for cervical DDD were included. Two independent reviewers searched and assessed all literature according to the standard of Cochrane systematic review.Data extraction and quality assessment were conducted, and RevMan 5.2 was used for data analysis. The random effects model was used if there was heterogeneity between studies; otherwise, the fixed effects model was used. A total of 21 studies were included in our meta-analysis. The pooled data revealed that CDA group had significantly lower adjacent segment diseases than that in the ACDF group. Furthermore, there were fewer adjacent segment reoperations in the CDA group compared with the ACDF group. Based on this meta-analysis, we conclude that CDA was better than the ACDF in terms of ASD and adjacent segment reoperations. This suggests the HS is a superior alternative invention for the treatment of cervical DDD to preserve cervical range of motion and reduce the risk of ASD. However, this requires further validation and investigation in larger sample-size prospective and randomized studies with long-term follow-up. Copyright © 2018. Published by Elsevier Inc.

  4. Mid- to Long-Term Outcomes of Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Cervical Disc Disease: A Systematic Review and Meta-Analysis of Eight Prospective Randomized Controlled Trials

    Science.gov (United States)

    Hu, Yan; Lv, Guohua; Ren, Siying; Johansen, Daniel

    2016-01-01

    Purpose This study aimed to investigate the mid- to long-term outcomes of cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for the treatment of 1-level or 2-level symptomatic cervical disc disease. Methods Medline, Embase, and the Cochrane Central Register of Controlled Trials databases were searched to identify relevant randomized controlled trials that reported mid- to long-term outcomes (at least 48 months) of CDA versus ACDF. All data were analyzed by Review Manager 5.3 software. The relative risk (RR) and 95% confidence intervals (CIs) were calculated for dichotomous variables. The weighted mean difference (WMD) and 95%CIs were calculated for continuous variables. A random effect model was used for heterogeneous data; otherwise, a fixed effect model was used. Results Eight prospective randomized controlled trials (RCTs) were retrieved in this meta-analysis, including 1317 and 1051 patients in CDA and ACDF groups, respectively. Patients after an ACDF had a significantly lower rate of follow-up than that after CDA. Pooled analysis showed patients in CDA group achieved significantly higher rates of overall success, Neck Disability Index (NDI) success, neurological success and significantly lower rates of implant/surgery-related serious adverse events and secondary procedure compared with that in ACDF group. The long-term functional outcomes (NDI, Visual Analog Scale (VAS) neck and arm pain scores, the Short Form 36 Health Survey physical component score (SF-36 PCS)), patient satisfaction and recommendation, and the incidence of superior adjacent segment degeneration also favored patients in CDA group with statistical difference. Regarding inferior adjacent segment degeneration, patients in CDA group had a lower rate without statistical significance. Conclusions This meta-analysis showed that cervical disc arthroplasty was superior over anterior discectomy and fusion for the treatment of symptomatic cervical disc disease in

  5. The NEtherlands Cervical Kinematics (NECK Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blind randomised multicenter study

    Directory of Open Access Journals (Sweden)

    van den Akker Elske

    2010-06-01

    Full Text Available Abstract Background Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is a known entity on the long term. Recently, cervical disc prostheses are developed to maintain motion and possibly reduce the incidence of adjacent disc degeneration. A comparative cost-effectiveness study focused on adjacent segment degeneration and functional outcome has not been performed yet. We present the design of the NECK trial, a randomised study on cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in patients with cervical disc herniation. Methods/Design Patients (age 18-65 years presenting with radicular signs due to single level cervical disc herniation lasting more than 8 weeks are included. Patients will be randomised into 3 groups: anterior discectomy only, anterior discectomy with interbody fusion, and anterior discectomy with disc prosthesis. The primary outcome measure is symptomatic adjacent disc degeneration at 2 and 5 years after surgery. Other outcome parameters will be the Neck Disability Index, perceived recovery, arm and neck pain, complications, re-operations, quality of life, job satisfaction, anxiety and depression assessment, medical consumption, absenteeism, and costs. The study is a randomised prospective multicenter trial, in which 3 surgical techniques are compared in a parallel group design. Patients and research nurses will be kept blinded of the allocated treatment for 2 years. The follow-up period is 5 years. Discussion Currently, anterior cervical discectomy with fusion is the golden standard in the surgical treatment of cervical disc herniation. Whether additional interbody fusion or disc prothesis is necessary and cost-effective will be determined by this trial

  6. Differences between soft-disc herniation and spondylosis in cervical arthroplasty: CT-documented heterotopic ossification with minimum 2 years of follow-up.

    Science.gov (United States)

    Wu, Jau-Ching; Huang, Wen-Cheng; Tu, Tsung-Hsi; Tsai, Hsiao-Wen; Ko, Chin-Chu; Wu, Ching-Lan; Cheng, Henrich

    2012-02-01

    Cervical arthroplasty is a valid option for patients with single-level symptomatic cervical disc diseases causing neural tissue compression, but postoperative heterotopic ossification (HO) can limit the mobility of an artificial disc. In the present study the authors used CT scanning to assess HO formation, and they investigated differences in radiological and clinical outcomes in patients with either a soft-disc herniation or spondylosis who underwent cervical arthroplasty. Medical records, radiographs, and clinical evaluations of consecutive patients who underwent single-level cervical arthroplasty were reviewed. Arthroplasty was performed using the Bryan disc. The patients were divided into a soft-disc herniation group and a spondylosis group. Clinical outcomes were measured using the visual analog scale (VAS) for neck and arm pain and the Neck Disability Index (NDI), whereas HO grading was determined by studying CT scans. Radiological and clinical outcomes were analyzed, and the minimum follow-up duration was 24 months. Forty-seven consecutive patients underwent a single-level cervical arthroplasty. Forty patients (85.1%) had complete radiological evaluations and clinical follow-up of more than 2 years. Patients were divided into 1 of 2 groups: soft-disc herniation (16 cases) and the spondylosis group (24 cases). Their mean age was 45.51 ± 11.12 years. Sixteen patients (40%) were female. Patients in the soft-disc herniation group were younger than those in the spondylosis group, but the difference was not statistically significant (42.88 vs 47.26, p = 0.227). The mean follow-up duration was 38.83 ± 9.74 months. Sex, estimated blood loss, implant size, and perioperative NSAID prescription were not significantly different between the groups (p = 0.792, 0.267, 0.581, and 1.000, respectively). The soft-disc herniation group had significantly less HO formation than the spondylosis group (1 HO [6.25%] vs 14 Hos [58.33%], p = 0.001). Almost all artificial discs in

  7. Adjacent segment motion after anterior cervical discectomy and fusion versus Prodisc-c cervical total disk arthroplasty: analysis from a randomized, controlled trial.

    Science.gov (United States)

    Kelly, Michael P; Mok, James M; Frisch, Richard F; Tay, Bobby K

    2011-07-01

    Post hoc analysis of data acquired in a prospective, randomized, controlled trial. To compare adjacent segment motion after anterior cervical discectomy and fusion (ACDF) versus cervical total disc arthroplasty (TDA). TDA has been designed to be a motion-preserving device, thus theoretically normalizing adjacent segment kinematics. Clinical studies with short-term follow-up have yet to demonstrate a consistent significant difference in the incidence of adjacent segment disease. Two hundred nine patients at 13 sites were treated in a prospective, randomized, controlled trial of ACDF versus TDA for single-level symptomatic cervical degenerative disc disease (SCDD). Flexion and extension radiographs were obtained at all follow-up visits. Changes in ROM were compared using the Wilcoxon signed-rank test and the Mann-Whitney U test. Predictors of postoperative ROM were determined by multivariate analysis using mixed effects linear regression. Data for 199 patients were available with 24-month follow-up. The groups were similar with respect to baseline demographics. A significant increase in motion at the cranial and caudal adjacent segments after surgery was observed in the ACDF group only (cranial: ACDF: +1.4° (0.4, 2.4), P = 0.01; TDA: +0.8°, (-0.1, +1.7), P = 0.166; caudal: ACDF: +2.6° (1.3, 3.9), P adjacent segment ROM was observed between ACDF and TDA. Only time was a significant predictor of postoperative ROM at both the cranial and caudal adjacent segments. Adjacent segment kinematics may be altered after ACDF and TDA. Multivariate analysis showed time to be a significant predictor of changes in adjacent segment ROM. No association between the treatment chosen (ACDF vs. TDA) and ROM was observed. Furthermore clinical follow-up is needed to determine whether possible differences in adjacent segment motion affect the prevalence of adjacent segment disease in the two groups.

  8. Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion for Incidence of Symptomatic Adjacent Segment Disease: A Meta-Analysis of Prospective Randomized Controlled Trials.

    Science.gov (United States)

    Zhu, Yuhang; Zhang, Boyin; Liu, Haochuan; Wu, Yuntao; Zhu, Qingsan

    2016-10-01

    Meta-analysis of randomized controlled trials. To evaluate the reported rate of adjacent segment disease (ASD) of cervical disc arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF). Motion-maintaining technologies such as CDA have developed rapidly because of the concern of ASD. Till date, however, it still has been under debate whether CDA is superior to ACDF regarding the incidence of ASD. We comprehensively searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trails for prospective randomized controlled trials (RCTs) that reported the incidence of ASD between CDA and ACDF. The retrieved results were last updated on November 20, 2015 without language restrictions. Two independent authors selected qualified studies, assessed methodological quality, and extracted requisite data. Fourteen relevant RCTs involving 3235 individuals with a follow-up period of 2 to 7 years were included in the meta-analysis (1696 in CDA group and 1539 in ACDF group). The outcomes indicated that CDA was superior to ACDF considering the lower rate of ASD (risk ratio, 0.57; 95% confidence interval, 0.37 to 0.87; P = 0.009). And compared with ACDF, there were significantly fewer adjacent segment reoperations in the CDA group (risk ratio, 0.47; confidence interval, 0.32 to 0.70; P = 0.0002). Subgroup analysis stratified by different types of disc prostheses was also performed. CDA was superior to ACDF regarding fewer ASDs and relative reoperations on the basis of available evidence from a meta-analysis of 14 RCTs. CDA may be a better surgical procedure to reduce the incidence of ASD for patients with cervical disc disease compared with ACDF. Further well-designed studies should continue to pay attention to excellent patients with longer-term follow-up to evaluate the incidence of ASD of these two procedures. 1.

  9. Long-term Evaluation of Cervical Disc Arthroplasty with the Mobi-C© Cervical Disc: A Randomized, Prospective, Multicenter Clinical Trial with Seven-Year Follow-up.

    Science.gov (United States)

    Radcliff, Kris; Davis, Reginald J; Hisey, Michael S; Nunley, Pierce D; Hoffman, Gregory A; Jackson, Robert J; Bae, Hyun W; Albert, Todd; Coric, Dom

    2017-01-01

    Cervical total disc replacement (TDR) is an increasingly accepted procedure for the treatment of symptomatic cervical degenerative disc disease. Multiple Level I evidence clinical trials have established cervical TDR to be a safe and effective procedure in the short-term. The objective of this study is to provide a long-term assessment of TDR versus anterior discectomy and fusion for the treatment of one- and two-level disc disease. This study was a continuation of a prospective, multicenter, randomized, US FDA IDE clinical trial comparing cervical TDR with the Mobi-C © Cervical Disc versus ACDF through 7 years follow-up. Inclusion criteria included a diagnosis of symptomatic cervical degenerative disc disease at one or two cervical levels. TDR patients were treated using a Mobi-C © artificial disc (Zimmer Biomet, Austin TX, USA). ACDF with allograft and anterior plate was used as a control treatment. Outcome measures were collected preoperatively and postoperatively at 6 weeks, at 3, 6, 12, 18 months, annually through 60 months, and at 84 months. Measured outcomes included Overall success, Neck Disability Index (NDI), VAS neck and arm pain, segmental range of motion (ROM), patient satisfaction, SF-12 MCS/PCS, major complications, and subsequent surgery rate. The primary endpoint was an FDA composite definition of success comprising clinical improvement and an absence of major complications and secondary surgery events. A total of 599 patients were enrolled and treated, with 164 treated with one-level TDR, 225 treated with two-level TDR, 81 treated with one-level ACDF, and 105 treated with two-level ACDF. At seven years, follow-up rates ranged from 73.5% to 84.4% (overall 80.2%).The overall success rates of two level TDR and ACDF patients were 60.8% and 34.2%, respectively (p0.05). Both the single and two level TDR and ACDF groups showed significant improvement from baseline NDI scores, VAS neck and arm pain scores, and SF-12 MCS/PCS scores (p<0.0001). In the

  10. What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT.

    Science.gov (United States)

    Park, Jeong Yoon; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

    2013-05-01

    It is well known that arthrodesis is associated with adjacent segment degeneration (ASD). However, previous studies were performed with simple radiography or CT. MRI is most sensitive in assessing the degenerative change of a disc, and this is the first study about ASD by radiography, CT and MRI. We sought to factors related to ASD at cervical spine by an MRI and CT, after anterior cervical spine surgery. This is a retrospective cross-sectional study of cervical disc herniation. Patients of cervical disc herniation with only radiculopathy were treated with either arthroplasty (22 patients) or ACDF with cage alone (21 patients). These patients were required to undergo MRI, CT and radiography preoperatively, as well as radiography follow-up for 3 months and 1 year, and we conducted a cross-sectional study by MRI, CT and radiography including clinical evaluations 5 years after. Clinical outcomes were assessed using VAS and NDI. The fusion rate and ASD rate, and radiologic parameters (cervical lordosis, operated segmental height, C2-7 ROM, operated segmental ROM, upper segmental ROM and lower segmental ROM) were measured. The study groups were demographically similar, and substantial improvements in VAS (for arm) and NDI (for neck) scores were noted, and there were no significant differences between groups. Fusion rates were 95.2% in the fusion group and 4.5% in the arthroplasty group. ASD rates of the fusion and arthroplasty groups were 42.9 and 50%, respectively. Among the radiologic parameters, operated segmental height and operated segmental ROM significantly decreased, while the upper segmental ROM significantly increased in the fusion group. In a comparative study between patients with ASD and without ASD, the clinical results were found to be similar, although preexisting ASD and other segment degeneration were significantly higher in the ASD group. C2-7 ROM was significantly decreased in ASD group, and other radiologic parameters have no significant differences

  11. Design of the PROCON trial: a prospective, randomized multi – center study comparing cervical anterior discectomy without fusion, with fusion or with arthroplasty

    Directory of Open Access Journals (Sweden)

    Grotenhuis J André

    2006-11-01

    Full Text Available Abstract Background PROCON was designed to assess the clinical outcome, development of adjacent disc disease and costs of cervical anterior discectomy without fusion, with fusion using a stand alone cage and implantation of a Bryan's disc prosthesis. Description of rationale and design of PROCON trial and discussion of its strengths and limitations. Methods/Design Since proof justifying the use of implants or arthroplasty after cervical anterior discectomy is lacking, PROCON was designed. PROCON is a multicenter, randomized controlled trial comparing cervical anterior discectomy without fusion, with fusion with a stand alone cage or with implantation of a disc. The study population will be enrolled from patients with a single level cervical disc disease without myelopathic signs. Each treatment arm will need 90 patients. The patients will be followed for a minimum of five years, with visits scheduled at 6 weeks, 3 months, 12 months, and then yearly. At one year postoperatively, clinical outcome and self reported outcomes will be evaluated. At five years, the development of adjacent disc disease will be investigated. Discussion The results of this study will contribute to the discussion whether additional fusion or arthroplasty is needed and cost effective. Trial registration Current Controlled Trials ISRCTN41681847

  12. Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques?

    Science.gov (United States)

    Assietti, Roberto; Corbino, Leonardo; Olindo, Giuseppe; Foti, Pietro V.; Russo, Vittorio; Albanese, Vincenzo

    2009-01-01

    We report the clinical and radiological results on the safety and efficacy of an unusual surgical strategy coupling anterior cervical discectomy and fusion and total disc replacement in a single-stage procedure, in patients with symptomatic, multilevel cervical degenerative disc disease (DDD). The proposed hybrid, single-stage, fusion–nonfusion technique aims either at restoring or maintaining motion where appropriate or favouring bony fusion when indicated by degenerative changes. Twenty-four patients (mean age 46.7 years) with symptomatic, multilevel DDD, either soft disc hernia or different stage spondylosis per single level, with predominant anterior myeloradicular compression and absence of severe alterations of cervical spine sagittal alignment, have been operated using such hybrid technique. Fifteen patients underwent a two-level surgery, seven patients received a three-level surgery and two a four-level procedure, for a total of 59 implanted devices (27 disc prostheses and 32 cages). Follow-up ranged between 12 and 40 months (mean 23.8 months). In all but one patient clinical follow-up (neurological examination, Nurick scale, NDI, SF-36) demonstrated significant improvement; radiological evaluation showed functioning disc prostheses (total range of motion 3–15°) and fusion through cages. None of the patients needed revision surgery for persisting or recurring symptoms, procedure-related complications or devices dislocations. To the authors’ best knowledge, this is the first study with the longest available follow-up describing a different concept in the management of cervical multilevel DDD. Although larger series with longer follow-up are needed, in selected cases of symptomatic multilevel DDD, the proposed surgical strategy appears to be a safe and reliable application of combined arthroplasty and arthrodesis during a single surgical procedure. PMID:19415346

  13. Clinical report of cervical arthroplasty in management of spondylotic myelopathy in Chinese

    Directory of Open Access Journals (Sweden)

    Lu Ning

    2006-11-01

    Full Text Available Abstract Objectives To investigate clinical effects and manual operational point of Bryan cervical disc prosthesis in Chinese, to observe the stability and range of movement (ROM post-operatively. Methods and materials From 2003,12 to 2005,12, Bryan disc prosthesis replacement applied in 83 cases (102 levels of cervical spondylotic myelopathy (CSM after anterior decompression in our hospital. Clinical (JOA grade and Odom's scale and radiological (X-ray of flexion, extension; left and right bending position follow-up was performed. Systemic radiographic study about stability and ROM of replaced level post operationally were measured. CT or MRI scans were applied in all cases to evaluate the signs of the prosthesis deflexion and hetero-ossification in the replaced levels. Results At least 12 months follow-up were done in 65/83 of these paients. All of 83 patients were improved according to Odsm's scale. JOA score increased from average 8.7 to 15.5. There was no prosthesis subsidence. Replaced segment achieved stability and restored partial of normal ROM 4.73°(3.7°–5.9° early postoperation and 8.12°(5.8°–13.6° more than 12 months postoperation in flex and extension position. No obvious loss of lordosis was found. CT or MRI follow-up shows position deflexion of the prosthesis metal endplates ( Conclusion Byran cervical disc prosthesis restored motion to the level of the intact segment in flexion-extension and lateral bending in post-operative images. At the same time, it can achieve good anterior decompression treatment effect and immediate stability in replaced 1 or 2 levels, and which is a new choice for the treatment of CSM.

  14. Adjacent segment disease requiring reoperation in cervical total disc arthroplasty: A literature review and update.

    Science.gov (United States)

    Chang, Ki-Eun; Pham, Martin H; Hsieh, Patrick C

    2017-03-01

    To evaluate the difference in rate of reoperation for adjacent segment disease (ASD) between anterior cervical decompression and fusion (ACDF) and total disc replacement (TDR). A systematic review of literature was performed using PubMed, clinicaltrials.gov, and various other search engines. Nine studies met the inclusion criteria and were used to report an estimated overall rate of reoperation secondary to ASD for both ACDF and TDR. Forty-six clinical trials were identified after the initial search, and 9 studies met our inclusion criteria. Although the data was not pooled due to significant variation in level of evidence and length of follow-up, the overall rate of reoperation for ASD in the TDR cohort of patients analyzed in our review was 3.1% (range: 0-7.1%) with a follow-up between 24 and 80months. In contrast, the reoperation rate for ASD in the ACDF control was 6.0% (range: 1.0-11.9%). The average reoperation rate for ASD was 3.1% for the TDR across all studies, which was lower than the reoperation rate of 6.0% in the ACDF group. Further studies and follow-up data are still needed to determine if cervical TDR preserves adjacent segment motion more efficiently than the natural history of the disease, and if it will be a durable option when compared to the already excellent results of ACDF. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Cervicitis

    Science.gov (United States)

    ... intercourse or during a cervical exam, and abnormal vaginal discharge. However, it's also possible to have cervicitis and ... symptoms, they may include: Large amounts of unusual vaginal discharge Frequent, painful urination Pain during intercourse Bleeding between ...

  16. The NEtherlands Cervical Kinematics (NECK) Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; A double-blind randomised multicenter study

    NARCIS (Netherlands)

    M.P. Arts (Mark); R. Brand (René); B.W. Koes (Bart); W.C. Peul (Wilco); M.E. van den Akker-van Marle (Elske)

    2010-01-01

    textabstractBackground. Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is

  17. Cervicitis

    Science.gov (United States)

    ... a sexually transmitted infection, such as chlamydia or gonorrhea. Cervicitis can develop from noninfectious causes, too. Successful ... result from common sexually transmitted infections (STIs), including gonorrhea, chlamydia, trichomoniasis and genital herpes. Allergic reactions. An ...

  18. Arthroplasty-CervicalP001 - Double Crush Syndrome of the Vertebral Artery Loop and Foraminal Stenosis Causing Monoparesis

    OpenAIRE

    Rho, Young Joon; Choi, Hoon; Kurpad, Shekar; Soliman, Hesham; Heo, Dong Hwa; Park, Choon Keun; Lee, Jun Ho; Lee, Jung Hwan; Benitez, Hugo Alberto Santos; Rivera, Miguel Angel Fuentes; Moga, Amado Gonzalez; Hernandez, Gabriel Huerta; Urbina, Mizraim Castillo; Ozkunt, Okan; Sariyilmaz, Kerim

    2017-01-01

    Introduction: To report a case of monoparesis caused by a vertebral artery (VA) anomaly and foraminal stenosis treated with microvascular decompression by the posterior approach. Material and Methods: A 51-year-old man was referred because of a 4-year history of progressive left shoulder pain refractory to other forms of treatment and a 7-month history of arm weakness. Clinical and radiologic evaluation showed an abnormally tortuous loop of left C5-6 cervical foramina with foraminal stenosis ...

  19. Comparison of Hybrid Surgery Incorporating Anterior Cervical Discectomy and Fusion and Artificial Arthroplasty Versus Multilevel Fusion for Multilevel Cervical Spondylosis: A Meta-Analysis

    Science.gov (United States)

    Zang, Leyuan; Ma, Min; Hu, Jianxin; Qiu, Hao; Huang, Bo; Chu, Tongwei

    2015-01-01

    Background Few studies have reported the safety and efficacy of hybrid surgery (HS), and some of the studies comparing HS with ACDF have reported conflicting results. We conducted this meta-analysis to clarify the advantages of HS in the treatment of multilevel cervical spondylosis. Material/Methods We performed a systematic literature search in PubMed, Medline, and CNKI to identify relevant controlled trials published up to October 2015. The standardized mean difference (SMD) and 95% confidence interval (95% CI) of the perioperative parameters, visual analogue scale pain score (VAS), neck disability index (NDI), and range of motion (ROM) of C2–C7 and adjacent segments were calculated. We also analyzed complications and Odom scale scores using risk difference (RD) and 95% CI. Results In total, 7 studies were included. The pooled data exhibited significant differences in blood loss between the 2 groups. However, there was no evidence indicating significant differences in operation time, complications, VAS, NDI, or Odom scale scores. Compared with the ACDF group, the HS group exhibited significantly protected C2-C7 ROM and reduced adjacent-segment ROM. Conclusions The safety of HS may be as good as that of ACDF. Furthermore, HS is superior to ACDF in conserving cervical spine ROM and decreasing adjacent-segment ROM. However, the results should be accepted cautiously due to the limitations of the study. Studies with larger sample sizes and longer follow-up periods are required to confirm and update the results of the present study. PMID:26709008

  20. Cervicothoracic junction arthroplasty after previous fusion surgery for adjacent segment degeneration: case report.

    Science.gov (United States)

    Sekhon, Lali

    2005-01-01

    This is the first reported case of cervical arthroplasty using the Bryan Cervical Disc Prosthesis System (Medtronic Sofamor Danek, Inc., Memphis, TN) in the management of adjacent segment degeneration associated with previous fusion surgery and surgery at the cervicothoracic junction. This case report describes a 25-year-old woman who initially underwent a two-level anterior cervical fusion in 1998, 2 years after being involved in a motor vehicle accident. She was well until 18 months before presentation, when she developed bilateral shoulder pain, mechanical neck pain worse on flexion, and bilateral C8 distribution arm pain and paresthesia. On clinical examination, no focal deficits were found, although the range of motion was reduced. Preoperative cervical spine x-rays and magnetic resonance scanning confirmed accelerated degeneration of the C4-C5 and C7-T1 disc spaces, with evidence of neural compression at those levels. After careful consideration of various treatment options and failure of all conservative measures, the patient underwent an anterior C4-C5 and C7-T1 decompression with removal of the anterior cervical plate and placement of two artificial disc prostheses. After surgery, her course was uncomplicated and she was discharged from hospital well. There was complete resolution of the arm symptoms and reduction of the neck pain, with a reduction in the amount of analgesia she was taking. Seven months after surgery, she remains well with repeat x-rays confirming motion at the operated levels. This case demonstrates that cervical arthroplasty is a reasonable treatment option for patients who have had previous surgery in which interbody fusion has been performed and who have developed degeneration of adjacent levels. Despite the altered biomechanics at the cervicothoracic junction, no adverse features were noted with arthroplasty at this level.

  1. Artroplastia total de disco cervical com prótese de Bryan: resultados clínicos e funcionais Artroplastía cervical total con prótesis de Bryan: resultados clínicos y funcionales Cervical total disc arthroplasty with Bryan disc: clinical and functional outcomes

    Directory of Open Access Journals (Sweden)

    Eduardo Machado de Menezes

    2012-09-01

    resultados buenos y excelentes, 10% satisfactorios y el 7% malos. Hubo sólo una complicación (3%, que se revirtió con artrodesis anterior. CONCLUSIONES: La artroplastia discal cervical ha demostrado ser un método seguro y eficaz para el tratamiento de casos seleccionados de hernia de disco cervical asociada a la radiculopatía y/o a compresión de la médula espinal en el corto y mediano plazo.OBJECTIVE: To evaluate results of cervical disc arthroplasty with the Bryan prosthesis for treatment of cervicobrachial pain (radiculopathy and spinal cord compression (myelopathy. METHODS: From 2002 to 2007, the CECOL surgical staff has operated 65 patients. Only 28 patients were found in 2010 to a new data collection. The pre- and post-operative evaluation was conducted using the CSOQ questionnaire (Cervical Spine Outcomes Questionnaire. Odom criteria were used only in the postoperative evaluation. Both were translated and adapted to local culture. RESULTS: There was a significant symptomatic and functional improvement in most patients. The reduction of neck pain (axial and brachial pain (radicular was similar. Odom criteria showed 82.1% good and excellent results, 10% satisfactory and 7% poor. There was only one complication (3% which was reversed with anterior arthrodesis. CONCLUSIONS: The total cervical disc arthroplasty has proved to be a safe and effective method to treat selected cases of cervical disc herniation with radiculopathy and/or myelopathy in the short and medium term.

  2. Fusion around cervical disc prosthesis: case report.

    NARCIS (Netherlands)

    Bartels, R.H.M.A.; Donk, R.

    2005-01-01

    OBJECTIVE AND IMPORTANCE: Cervical arthroplasty is a relatively new method to maintain motion after cervical anterior discectomy. Two cases are presented in which bony fusion occurred around a cervical disc prosthesis. CLINICAL PRESENTATION: A 30-year-old man and a 49-year-old woman underwent a

  3. What's the best surgical treatment for patients with cervical radiculopathy due to single-level degenerative disease? A randomized controlled trial

    NARCIS (Netherlands)

    Donk, R.D.; Verbeek, A.L.M.; Verhagen, W.I.; Groenewoud, H.; Hosman, A.J.F.; Bartels, R.H.M.A.

    2017-01-01

    BACKGROUND: To investigate the efficacy of adding supplemental fusion or arthroplasty after cervical anterior discectomy for symptomatic mono-level cervical degenerative disease (radiculopathy), which has not been substantiated in controlled trials until now. METHODS: A randomized controlled trial

  4. Two-Level Semantics and Code Generation

    DEFF Research Database (Denmark)

    Nielson, Flemming; Nielson, Hanne Riis

    1988-01-01

    A two-level denotational metalanguage that is suitable for defining the semantics of Pascal-like languages is presented. The two levels allow for an explicit distinction between computations taking place at compile-time and computations taking place at run-time. While this distinction is perhaps...... not absolutely necessary for describing the input-output semantics of programming languages, it is necessary when issues such as data flow analysis and code generation are considered. For an example stack-machine, the authors show how to generate code for the run-time computations and still perform the compile...

  5. Cervical Spondylosis

    Science.gov (United States)

    ... Request an Appointment at Mayo Clinic Causes Cervical spondylosis Cervical spondylosis Cervical spondylosis is degeneration of the bones and ... Related Symptom Checker Numbness in hands Numbness Cervical spondylosis Symptoms & causes Diagnosis & treatment Doctors & departments Advertisement Mayo ...

  6. Three-level cervical disc herniation

    Directory of Open Access Journals (Sweden)

    St. Iencean Andrei

    2015-09-01

    Full Text Available Multilevel cervical degenerative disc disease is well known in the cervical spine pathology, with radicular syndromes or cervical myelopathy. One or two level cervical herniated disc is common in adult and multilevel cervical degenerative disc herniation is common in the elderly, with spinal stenosis, and have the same cause: the gradual degeneration of the disc. We report the case of a patient with two level cervical disc herniation (C4 – C5 and C5 – C6 treated by anterior cervical microdiscectomy both levels and fusion at C5 – C6; after five years the patient returned with left C7 radiculopathy and MRI provided the image of a left C6 – C7 disc herniation, he underwent an anterior microsurgical discectomy with rapid relief of symptoms. Three-level cervical herniated disc are rare in adults, and the anterior microdiscectomy with or without fusion solve this pathology.

  7. Safety and effectiveness of bone allografts in anterior cervical discectomy and fusion surgery.

    Science.gov (United States)

    Miller, Larry E; Block, Jon E

    2011-11-15

    Systematic review. The primary aim of this review was to evaluate clinical and radiographic outcomes in studies of anterior cervical discectomy and fusion (ACDF) using allograft versus ACDF with autograft, ACDF with cage devices, and cervical disc arthroplasty for the treatment of symptomatic cervical disc disease. ACDF remains the standard of care for patients with cervical radiculopathy who are unresponsive to conservative medical care. However, no known study has compared patient outcomes after ACDF with allograft, ACDF with autograft, ACDF with cage, and disc arthroplasty. After applying strict inclusion criteria, 21 comparisons from 20 studies formed the basis for this review. Patient outcomes included neck and arm pain, neck disability index (NDI), physical component summary (PCS), and mental component summary (MCS) scores from the SF-36, radiographic fusion rate, and select adverse events (e.g., wound infection, dysphagia, and adjacent segment degeneration). The four treatment groups included ACDF with allograft (allograft, n = 1341), ACDF with autograft (autograft, n = 568), ACDF with cage (cage, n = 87), and cervical disc arthroplasty (arthroplasty, n = 603). Neck pain was reduced similarly by 63% to 69% in all groups. Comparable improvements were realized in arm pain after ACDF with allograft (75%) or arthroplasty (73%) that were greater than other treatment groups (62-68%). There was notable improvement in neck disability (61-65%) with allograft and arthroplasty after treatment. PCS scores improved with allograft (42%) and arthroplasty (44%). MCS scores improved modestly (16-21%) with allograft and arthroplasty. Fusion rates were 91% for allograft and autograft and 97% for cage. Adverse events were uncommon in all groups. ACDF with allograft, ACDF with autograft, ACDF with cage, and cervical disc arthroplasty show similar improvements in pain, function, and quality of life with correspondingly low adverse event rates. All ACDF procedures result in high

  8. Outpatient Total Joint Arthroplasty.

    Science.gov (United States)

    Bert, Jack M; Hooper, Jessica; Moen, Sam

    2017-12-01

    Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program. Several studies have outlined techniques of selecting patients suitable for this type of postoperative pathway. With emerging concerns about patients who undergo outpatient arthroplasty being at increased risk of medical complications, which may lessen projected cost savings, it is important to identify value-based strategies to optimize patient recovery after OTJA. This article reviews digital techniques for patient selection and data collection, operating room efficiency systems, and provides a summary of methods to build and maintain value in outpatient total joint replacement within the framework of bundled payment reimbursement.

  9. Imaging of hip arthroplasty

    International Nuclear Information System (INIS)

    Breitenseher, M.J.; Mayerhoefer, M.; Gottsauner-Wolf, F.; Krestan, C.; Imhof, H.; Toma, C.D.

    2002-01-01

    Hip arthroplasty has become a common and still increasing procedure for the treatment of osteoarthritis, advanced head necrosis, post-inflammatory arthritis or rheumatoid arthritis.Radiography is the most important imaging modality for monitoring the normal, asymptomatic hip arthroplasty. Radiographs are obtained at the end of a surgical treatment, to exclude complications like fracture or component misplacement. In the follow-up radiographs are used for the diagnosis of loosening and infection of the hip arthroplasty as well as soft tissue ossification. Together with the history and clinical information, the analysis of morphological findings allows to find the grade of loosening. MRI has been advocated in the diagnosis of infection, in particular in the localisation of soft tissue involvement.Imaging, especially by radiographs, is used for the evaluation of the normal and complicated follow-up of hip arthroplasty. (orig.) [de

  10. Operative Techniques for Cervical Radiculopathy and Myelopathy

    Directory of Open Access Journals (Sweden)

    C. Moran

    2012-01-01

    Full Text Available The surgical treatment of cervical spondylosis and resulting cervical radiculopathy or myelopathy has evolved over the past century. Surgical options for dorsal decompression of the cervical spine includes the traditional laminectomy and laminoplasty, first described in Asia in the 1970's. More recently the dorsal approch has been explored in terms of minimally invasive options including foraminotomies for nerve root descompression. Ventral decompression and fusion techniques are also described in the article, including traditional anterior cervical discectomy and fusion, strut grafting and cervical disc arthroplasty. Overall, the outcome from surgery is determined by choosing the correct surgery for the correct patient and pathology and this is what we hope to explain in this brief review.

  11. Operative techniques for cervical radiculopathy and myelopathy.

    LENUS (Irish Health Repository)

    Moran, C

    2012-02-01

    The surgical treatment of cervical spondylosis and resulting cervical radiculopathy or myelopathy has evolved over the past century. Surgical options for dorsal decompression of the cervical spine includes the traditional laminectomy and laminoplasty, first described in Asia in the 1970\\'s. More recently the dorsal approch has been explored in terms of minimally invasive options including foraminotomies for nerve root descompression. Ventral decompression and fusion techniques are also described in the article, including traditional anterior cervical discectomy and fusion, strut grafting and cervical disc arthroplasty. Overall, the outcome from surgery is determined by choosing the correct surgery for the correct patient and pathology and this is what we hope to explain in this brief review.

  12. Cervical adjacent segment pathology following fusion: Is it due to fusion?

    OpenAIRE

    Rosenthal, Philip; Kim, Kee D

    2013-01-01

    Adjacent segment pathology affects 25% of patients within ten years of anterior cervical diskectomy and fusion (ACDF). Laboratory studies demonstrate fused segments increase adjacent level stress including elevated intradiscal pressure and increased range of motion. Radiographic adjacent segment pathology (RASP) has been associated to ACDF in multiple statistically significant studies. Randomized controlled trials (RCTs) comparing anterior cervical discectomy and arthroplasty (ACDA) and ACDF ...

  13. Arthroplasty register for Germany

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2009-10-01

    Full Text Available Scientific background: The annual number of joint replacement operations in Germany is high. The introduction of an arthroplasty register promises an important contribution to the improvement of the quality of patient’s care. Research questions: The presented report addresses the questions on organization and functioning, benefits and cost-benefits as well as on legal, ethical and social aspects of the arthroplasty registers. Methods: A systematic literature search was conducted in September 2008 in the medical databases MEDLINE, EMBASE etc. and was complemented with a hand search. Documents describing arthroplasty registers and/or their relevance as well as papers on legal, ethical and social aspects of such registers were included in the evaluation. The most important information was extracted and analysed. Results: Data concerning 30 arthroplasty registers in 19 countries as well as one international arthroplasty register were identified. Most of the arthroplasty registers are maintained by national orthopedic societies, others by health authorities or by their cooperation. Mostly, registries are financially supported by governments and rarely by other sources.The participation of the orthopedists in the data collection process of the arthroplasty registry is voluntary in most countries. The consent of the patients is usually required. The unique patient identification is ensured in nearly all registers.Each data set consists of patient and clinic identification numbers, data on diagnosis, the performed intervention, the operation date and implanted prostheses. The use of clinical scores, patient-reported questionnaires and radiological documentation is rare. Methods for data documentation and transfer are paper form, electronic entry as well as scanning of the data using bar codes. The data are mostly being checked for their completeness and validity. Most registers offer results of the data evaluation to the treating orthopedists and

  14. Radiological aspects of Arthroplasties

    International Nuclear Information System (INIS)

    Garcia, Sara Eugenia; Barragan, John Henry; Narvaez, Jorge Andres

    2008-01-01

    The development of new surgical techniques, of new prosthetic materials, and the increase in life expectancy with greater coverage of health services has ugmented the performance of hip replacements in our country. The radiologist should be familiar with the different surgical techniques and prosthetic devices, the evaluation of its components and associated complications. The most frequently performed arthroplasties are: shoulder, elbow, hip and knee replacement. This article reviews the most frequent prosthetic devices used, the radiological aspects of arthroplasties and their most common complications.

  15. [History of hip arthroplasty].

    Science.gov (United States)

    Płomiński, Janusz; Kwiatkowski, Krzysztof

    2007-02-01

    The authors present the history of hip prosthesis in treatment of coxarthrosis. Despite eighty years of experience the problem of gaining good and long-term results still exist and is difficult to solve. Even changing the way on cementless stabilization of prosthesis doesn't has result in solving the problem of aseptic loosening of hip arthroplasty. Problems of wear derbies made the producers find new to reduce particulate debris. The future of hip arthroplasty is connected with hip resurfacing. Moreover, the higher number of primary hip plasty the more prosthesis are loosening. The treatment is far more difficult and more expensive.

  16. Total knee arthroplasty

    DEFF Research Database (Denmark)

    Schrøder, Henrik M.; Petersen, Michael M.

    2016-01-01

    Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise...

  17. Elbow arthroplasty in perspective

    NARCIS (Netherlands)

    Heijink, A.

    2017-01-01

    This thesis focuses on the effect of biomechanical aspects of prosthesis design and outcome after radial head and total elbow arthroplasty. First, we examine the available evidence regarding the role of several unfavorable biomechanical conditions about the elbow in the development of

  18. Cervical Cancer

    Science.gov (United States)

    ... the place where a baby grows during pregnancy. Cervical cancer is caused by a virus called HPV. The ... for a long time, or have HIV infection. Cervical cancer may not cause any symptoms at first. Later, ...

  19. Cervical Dysplasia

    Science.gov (United States)

    ... pass through. Cervical dysplasia is detected in a pap test (pap smear), and diagnosed in a biopsy. Abnormal ... American Academy of Family Physicians (AAFP) recommends routine pap tests to diagnose cervical cancer early. You can check ...

  20. Cervical cancer

    Science.gov (United States)

    ... bleeding between periods, after intercourse, or after menopause Vaginal discharge that does not stop, and may be pale, ... Instructions Hysterectomy - abdominal - discharge Hysterectomy - laparoscopic - ... Images Cervical cancer Cervical neoplasia ...

  1. Cervical Cancer

    Centers for Disease Control (CDC) Podcasts

    2007-03-06

    Did you know that cervical cancer rates differ by race/ethnicity and region? Or that cervical cancer can usually be prevented if precancerous cervical lesions are found by a Pap test and treated? Find out how getting regular Pap tests can save a woman's life.  Created: 3/6/2007 by National Breast and Cervical Cancer Early Detection Program.   Date Released: 4/25/2007.

  2. A Comparison of Zero-Profile Devices and Artificial Cervical Disks in Patients With 2 Noncontiguous Levels of Cervical Spondylosis.

    Science.gov (United States)

    Qizhi, Sun; Lei, Sun; Peijia, Li; Hanping, Zhao; Hongwei, Hu; Junsheng, Chen; Jianmin, Li

    2016-03-01

    A prospective randomized and controlled study of 30 patients with 2 noncontiguous levels of cervical spondylosis. To compare the clinical outcome between zero-profile devices and artificial cervical disks for noncontiguous cervical spondylosis. Noncontiguous cervical spondylosis is an especial degenerative disease of the cervical spine. Some controversy exists over the choice of surgical procedure and fusion levels for it because of the viewpoint that the stress at levels adjacent to a fusion mass will increase. The increased stress will lead to the adjacent segment degeneration (ASD). According to the viewpoint, the intermediate segment will bear more stress after both superior and inferior segments' fusion. Cervical disk arthroplasty is an alternative to fusion because of its motion-preserving. Few comparative studies have been conducted on arthrodesis with zero-prolife devices and arthroplasty with artificial cervical disks for noncontiguous cervical spondylosis. Thirty patients with 2 noncontiguous levels of cervical spondylosis were enrolled and assigned to either group A (receiving arthroplasty using artificial cervical disks) and group Z (receiving arthrodesis using zero-profile devices). The clinical outcomes were assessed by the mean operative time, blood loss, Japanese Orthopedic Association (JOA) score, Neck Dysfunction Index (NDI), cervical lordosis, fusion rate, and complications. The mean follow-up was 32.4 months. There were no significant differences between the 2 groups in the blood loss, JOA score, NDI score, and cervical lordosis except operative time. The mean operative time of group A was shorter than that of group Z. Both the 2 groups demonstrated a significant increase in JOA score, NDI score, and cervical lordosis. The fusion rate was 100% at 12 months postoperatively in group Z. There was no significant difference between the 2 groups in complications except the ASD. Three patients had radiologic ASD at the final follow-up in group Z, and

  3. Primary total elbow arthroplasty

    Directory of Open Access Journals (Sweden)

    Suresh Kumar

    2013-01-01

    Full Text Available Background: Primary total elbow arthroplasty (TEA is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow. Materials and Methods: We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years. The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis. Results: In the present study, average supination was 70° (range 60-80° and average pronation was 70° (range 60-80°. Average flexion was 135° (range 130-135°. However, in 5 cases, there was loss of 15 to 35° (average 25° of extension (45° out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100. Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18% out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head

  4. Total cervical disk replacement with a prestige LP® prosthesis: clinical and functional outcomes

    Directory of Open Access Journals (Sweden)

    Rafael Osório Rocha

    2014-01-01

    Full Text Available Objective: To determine the clinical and functional results of short- and medium-term cervical arthroplasty with the Prestige LP® prosthesis for the treatment of compressive myelopathy, radiculopathy and axial pain with radiculopathty. Methods: This retrospective study, conducted from 2009 to 2012, included 18 patients. Only 16 were found for the second stage of research, conducted in 2011 and 2012. Pre- and postoperative assessments were carried out using the CSOQ (Cervical Spine Outcomes Questionnaire. Odom criteria were used only in the postoperative evaluation. Both were translated and adapted to the local culture. Results: There was no postoperative radiculopathy or other complications requiring prolonged hospitalization. In most patients, there was a significant improvement in axial pain and radiculopathy, and there was only one indication of conversion to fusion. Conclusions: In selected cases of cervical degenerative disc disease, herniated cervical disc and compressive myeolopathy, cervical arthroplasty proved to be an effective and safe treatment in the short and medium terms.

  5. Acoustic absorption by two-level systems in a superconductors

    International Nuclear Information System (INIS)

    Morozov, A.I.; Sizov, A.S.

    1991-01-01

    Contribution to sound absorption and to its rate renormalization, attributed to two-level systems, forming as a result of hydrogen capture by heavy impurities, is found. At that it is supposed that two-level system relaxation rate is defined by single-phonon processes. For superconducting niobium phase estimation for frequency range, where the given supposition is valid, is obtained

  6. Total hip arthroplasty in Denmark

    DEFF Research Database (Denmark)

    Pedersen, Alma Becic; Johnsen, Søren Paaske; Overgaard, Søren

    2005-01-01

    The annual number of total hip arthroplasties (THA) has increased in Denmark over the past 15 years. There is, however, limited detailed data available on the incidence of THAs.......The annual number of total hip arthroplasties (THA) has increased in Denmark over the past 15 years. There is, however, limited detailed data available on the incidence of THAs....

  7. The Effect of the PEEK Cage on the Cervical Lordosis in Patients Undergoing Anterior Cervical Discectomy

    Directory of Open Access Journals (Sweden)

    Salih Gulsen

    2015-03-01

    CONCLUSION: We achieved better cervical lordotic angles at the postoperative period by implanting one-level, two-level, three-level or four-level PEEK cage filled with demineralized bone matrix. Also, the causes of cervical root and or medulla spinalis impingement were different in group1 and 2. While extruded cervical disc impingement was the first pathology in group 1, osteophyte formation was the first pathology in group 2.

  8. Mortality after shoulder arthroplasty

    DEFF Research Database (Denmark)

    Amundsen, Alexander; Rasmussen, Jeppe Vejlgaard; Olsen, Bo Sanderhoff

    2016-01-01

    BACKGROUND: The primary aim was to quantify the 30-day, 90-day, and 1-year mortality rates after primary shoulder replacement. The secondary aims were to assess the association between mortality and diagnoses and to compare the mortality rate with that of the general population. METHODS: The study...... included 5853 primary operations reported to the Danish Shoulder Arthroplasty Registry between 2006 and 2012. Information about deaths was obtained from the Danish Cause of Death Register and the Danish Civil Registration System. Age- and sex-adjusted control groups were retrieved from Statistics Denmark...... common, and for fracture patients in particular, close postoperative monitoring of pulmonary, cardiac, and abdominal conditions seems important....

  9. Total knee arthroplasty

    DEFF Research Database (Denmark)

    Schrøder, Henrik M.; Petersen, Michael M.

    2016-01-01

    Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise...... surgeon seems to positively influence the rate of surgical complications and implant survival. The painful TKA knee should be thoroughly evaluated, but not revised except if a relevant indication can be established. The most frequent indications for revision are: aseptic loosening, instability, infection...

  10. Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment.

    Science.gov (United States)

    Woods, Barrett I; Hilibrand, Alan S

    2015-06-01

    Cervical radiculopathy is a relatively common neurological disorder resulting from nerve root dysfunction, which is often due to mechanical compression; however, inflammatory cytokines released from damaged intervertebral disks can also result in symptoms. Cervical radiculopathy can often be diagnosed with a thorough history and physical examination, but an magnetic resonance imaging or computed tomographic myelogram should be used to confirm the diagnosis. Because of the ubiquity of degenerative changes found on these imaging modalities, the patient's symptoms must correlate with pathology for a successful diagnosis. In the absence of myelopathy or significant muscle weakness all patients should be treated conservatively for at least 6 weeks. Conservative treatments consist of immobilization, anti-inflammatory medications, physical therapy, cervical traction, and epidural steroid injections. Cervical radiculopathy typically is self-limiting with 75%-90% of patients achieving symptomatic improvement with nonoperative care. For patients who are persistently symptomatic despite conservative treatment, or those who have a significant functional deficit surgical treatment is appropriate. Surgical options include anterior cervical decompression and fusion, cervical disk arthroplasty, and posterior foraminotomy. Patient selection is critical to optimize outcome.

  11. Stemless shoulder arthroplasty: current status.

    Science.gov (United States)

    Churchill, R Sean

    2014-09-01

    Since the original Neer humeral replacement in the 1950s, the standard primary anatomic total shoulder arthroplasty design has slowly evolved. Most recently, the humeral stem has become progressively shorter to help combat stem-related complications. Currently, there are several companies who have developed and marketed a stemless humeral arthroplasty component. Manufacturers' data for 5 stemless shoulder arthroplasty components currently on the market were analyzed and reviewed. A literature review of short-term results for stemless shoulder arthroplasty was completed. Of the stemless shoulder arthroplasty systems available on the market, 3 are currently undergoing clinical trials in the United States. The Tornier Simpliciti (Tornier, Edina, MN, USA) clinical trial began in 2011. The study with 2-year minimum follow-up results is scheduled for completion in November 2014. The Arthrex Eclipse (Arthrex, Naples, FL, USA) clinical trial was started in January 2013. The tentative study completion date is 2017. The Biomet Nano (Biomet, Warsaw, IN, USA) clinical trial began in October 2013 and also has a tentative completion date of 2017. No other clinical trial is currently under way in the United States. Early results for stemless shoulder arthroplasty indicate clinical results similar to standard stemmed shoulder arthroplasty. Radiographic analysis indicates implant stability without migration or subsidence at 2- to 3-year minimum follow-up.. Several stemless shoulder arthroplasty implants are available outside the United States. Early clinical and radiographic results are promising, but well-designed clinical studies and midterm results are lacking. Three clinical trials are currently under way in the United States with initial availability for use anticipated in 2015. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  12. Stationary states of two-level open quantum systems

    International Nuclear Information System (INIS)

    Gardas, Bartlomiej; Puchala, Zbigniew

    2011-01-01

    A problem of finding stationary states of open quantum systems is addressed. We focus our attention on a generic type of open system: a qubit coupled to its environment. We apply the theory of block operator matrices and find stationary states of two-level open quantum systems under certain conditions applied on both the qubit and the surrounding.

  13. A Comprehensive Guide to Factorial Two-Level Experimentation

    CERN Document Server

    Mee, Robert

    2009-01-01

    Statistical design of experiments is useful in virtually every quantitative field. This book focuses on two-level factorial designs that provide efficient plans for exploring the effects of many factors at once. It is suitable for engineers, physical scientists, and those who conduct experiments.

  14. Clinical and radiological results of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis.

    Science.gov (United States)

    Kan, Lisheng; Kang, Jian; Gao, Rui; Chen, Xiongsheng; Jia, Lianshun

    2014-12-01

    To date, formulation of the optimal surgical protocol for noncontiguous multilevel cervical spondylosis remains controversial, and the corresponding clinical data continue to be limited. The purpose of this study was to compare the clinical and radiological outcomes of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis (2 contiguous disc levels and 1 "skip" disc level [nonoperated level between 2 operated levels]). The incidence of adjacent-segment degeneration (ASD) was also evaluated. Sixty-three consecutive patients with noncontiguous 3-level cervical spondylosis who underwent two different hybrid methods of treatment were retrospectively reviewed. The patients were divided into 2 groups, the fusion group and the arthroplasty group. A titanium mesh cage and an anterior cervical plate were used after the anterior cervical corpectomy, and then a stand-alone cage (the fusion group) or an artificial cervical disc (the arthroplasty group) was used after the discectomy. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale score and the JOA scale score improvement rate preoperatively and during follow-up. Radiological results were assessed using global angle and global range of motion (ROM) of the cervical spine. The ASD was also evaluated. The JOA scores of the patients significantly improved postoperatively and were well maintained within the follow-up period, as did the JOA scale score improvement rate. The mean global angle of the cervical spine of the patients significantly increased postoperatively. At the last follow-up evaluation, the mean global ROM was retained by patients in the arthroplasty group (p > 0.05) but not by patients in the fusion group (p = 0.00). There was no significant difference in the incidence of ASD between the 2 groups (p = 0.114). However, at the skip levels, patients in the fusion group had a higher incidence of ASD than patients in the arthroplasty group (p = 0

  15. Cervical Cancer

    Science.gov (United States)

    ... 800-762-2264 Foundation for Women's Cancer Phone Number: 800-444-4441 Previous Page Next Page Cervical cancer fact sheet (PDF, 162 KB) Female reproductive system Related information Human papillomavirus (HPV) and genital ...

  16. Cervical Cancer

    Science.gov (United States)

    ... I find more information about cervical and other gynecologic cancers? Centers for Disease Control and Prevention: 800-CDC-INFO or www. cdc. gov/ cancer/ gynecologic National Cancer Institute: 800-4-CANCER or www. ...

  17. Cervical Cerclage

    Science.gov (United States)

    ... and Gynecology. 2014;123:372. Cervical cerclage About Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  18. Cervical Cap

    Science.gov (United States)

    ... p020041. Accessed Nov. 11, 2014. Cervical cap About Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  19. Cervical Laminoplasty

    Science.gov (United States)

    ... Nerve Tests: EMG, NCV and SEEP Alternative Medicine Acupuncture Herbal Supplements Surgical Options Anterior Cervical Fusion Artifical ... tasks. A NASS physician can perform a thorough history to evaluate your symptoms and any recent changes. ...

  20. Cervical Cap

    Science.gov (United States)

    ... weeks after delivery Can be inserted hours before sex and remain in place for up to 48 hours Doesn't require a partner's cooperation Poses few if any side effects The cervical cap isn't appropriate for everyone, ...

  1. Cervical Stenosis

    Science.gov (United States)

    ... Drug Interactions Pill Identifier Commonly searched drugs Aspirin Metformin Warfarin Tramadol Lactulose Ranitidine News & Commentary Recent News ... D May Affect Breast Cancer Survival (Video) Ectopic Pregnancy (Video) Assisted Delivery Additional Content Medical News Cervical ...

  2. Cervical Myomas

    Science.gov (United States)

    ... Drug Interactions Pill Identifier Commonly searched drugs Aspirin Metformin Warfarin Tramadol Lactulose Ranitidine News & Commentary Recent News ... D May Affect Breast Cancer Survival (Video) Ectopic Pregnancy (Video) Assisted Delivery Additional Content Medical News Cervical ...

  3. Model discrimination for dephasing two-level systems

    Energy Technology Data Exchange (ETDEWEB)

    Gong, Er-ling [Department of Automatic Control, College of Mechatronic Engineering and Automation, National University of Defense Technology, Changsha, Hunan 410073 (China); College of Science (Physics), Swansea University, Singleton Park, Swansea, SA2 8PP (United Kingdom); Zhou, Weiwei [Department of Automatic Control, College of Mechatronic Engineering and Automation, National University of Defense Technology, Changsha, Hunan 410073 (China); Schirmer, Sophie, E-mail: sgs29@swan.ac.uk [College of Science (Physics), Swansea University, Singleton Park, Swansea, SA2 8PP (United Kingdom)

    2015-02-06

    The problem of model discriminability and parameter identifiability for dephasing two-level systems subject to Hamiltonian control is studied. Analytic solutions of the Bloch equations are used to derive explicit expressions for observables as functions of time for different models. This information is used to give criteria for model discrimination and parameter estimation based on simple experimental paradigms. - Highlights: • Analytic expressions for observables of driven, dephasing two-level systems. • Distinguishability of dephasing models via Rabi-oscillation experiments. • General identifiability of model parameters and cases of failure. • Application to empirically determine of effect of driving on dephasing basis. • Importance for optimal design of coherent controls for qubits subject to dephasing.

  4. Two-level method with coarse space size independent convergence

    Energy Technology Data Exchange (ETDEWEB)

    Vanek, P.; Brezina, M. [Univ. of Colorado, Denver, CO (United States); Tezaur, R.; Krizkova, J. [UWB, Plzen (Czech Republic)

    1996-12-31

    The basic disadvantage of the standard two-level method is the strong dependence of its convergence rate on the size of the coarse-level problem. In order to obtain the optimal convergence result, one is limited to using a coarse space which is only a few times smaller than the size of the fine-level one. Consequently, the asymptotic cost of the resulting method is the same as in the case of using a coarse-level solver for the original problem. Today`s two-level domain decomposition methods typically offer an improvement by yielding a rate of convergence which depends on the ratio of fine and coarse level only polylogarithmically. However, these methods require the use of local subdomain solvers for which straightforward application of iterative methods is problematic, while the usual application of direct solvers is expensive. We suggest a method diminishing significantly these difficulties.

  5. Quantum modeling of two-level photovoltaic systems

    Directory of Open Access Journals (Sweden)

    Aram Tahereh Nemati

    2017-01-01

    Full Text Available We present a quantum formalism that provides a quantitative picture of the fundamental processes of charge separation that follow an absorption event. We apply the formalism to two-level photovoltaic cells and our purpose is to pedagogically explain the main aspects of the model. The formalism is developed in the energy domain and provides detailed knowledge about existence or absence of localized states and their effects on electronic structure and photovoltaic yield.

  6. Two-level systems driven by large-amplitude fields

    Science.gov (United States)

    Nori, F.; Ashhab, S.; Johansson, J. R.; Zagoskin, A. M.

    2009-03-01

    We analyze the dynamics of a two-level system subject to driving by large-amplitude external fields, focusing on the resonance properties in the case of driving around the region of avoided level crossing. In particular, we consider three main questions that characterize resonance dynamics: (1) the resonance condition, (2) the frequency of the resulting oscillations on resonance, and (3) the width of the resonance. We identify the regions of validity of different approximations. In a large region of the parameter space, we use a geometric picture in order to obtain both a simple understanding of the dynamics and quantitative results. The geometric approach is obtained by dividing the evolution into discrete time steps, with each time step described by either a phase shift on the basis states or a coherent mixing process corresponding to a Landau-Zener crossing. We compare the results of the geometric picture with those of a rotating wave approximation. We also comment briefly on the prospects of employing strong driving as a useful tool to manipulate two-level systems. S. Ashhab, J.R. Johansson, A.M. Zagoskin, F. Nori, Two-level systems driven by large-amplitude fields, Phys. Rev. A 75, 063414 (2007). S. Ashhab et al, unpublished.

  7. Cervical thymoma

    Directory of Open Access Journals (Sweden)

    Abrão Rapoport

    1999-05-01

    Full Text Available CONTEXT: Cervical thymoma is a primitive thymic neoplasia. It is very rare. This disease presents higher incidence in female patients in their 4th to 6th decade of life. We present a case report of a cervical thymoma CASE REPORT: 54-year-old female patient, caucasian, with no history of morbidity, presenting a left cervical nodule close to the thyroid gland. During the 30 months of investigation a left cervical nodule grew progressively next to the thyroid while the patient showed no symptoms, making accurate diagnosis difficult. Tests on her thyroid function did not show changes, nor were there changes in any subsidiary tests. The diagnosis of the disease was made intra-operatively through total thyroid individualization. The results were confirmed by the histological findings from the ressected material. Cervical thymoma is a very rare disease, with difficult preoperatory diagnosis. Some additional study methods which are employed today are thallium 201, technetium 99 and iodine 131 scintigraphy, magnetic nuclear resonance and especially histopathological findings and classification.

  8. Perturbation Theory for Open Two-Level Nonlinear Quantum Systems

    International Nuclear Information System (INIS)

    Zhang Zhijie; Jiang Dongguang; Wang Wei

    2011-01-01

    Perturbation theory is an important tool in quantum mechanics. In this paper, we extend the traditional perturbation theory to open nonlinear two-level systems, treating decoherence parameter γ as a perturbation. By this virtue, we give a perturbative solution to the master equation, which describes a nonlinear open quantum system. The results show that for small decoherence rate γ, the ratio of the nonlinear rate C to the tunneling coefficient V (i.e., r = C/V) determines the validity of the perturbation theory. For small ratio r, the perturbation theory is valid, otherwise it yields wrong results. (general)

  9. Two-level atom in a strong polychromatic field

    International Nuclear Information System (INIS)

    Kazakov, A.Ya.

    1991-01-01

    The quasienergy spectrium of a two-level atom in a polychromatic electromagnetic field can be expressed in terms of the Floquet indexes of a linear set of ordinary differential equations with periodic coefficients. An analytic expression for the quasienergy spectrum is obtained by the asymptotic technique for the case of a strong polychromatic field. It is shown that on deep modulation of the radiation incident on the atom forbidden bands for the quasilevels may arise. The Stark effect for the physical system under consideration is described

  10. The Danish Hip Arthroplasty Register

    DEFF Research Database (Denmark)

    Gundtoft, Per Hviid; Varnum, Claus; Pedersen, Alma Becic

    2016-01-01

    AIM OF DATABASE: The aim of the Danish Hip Arthroplasty Register (DHR) is to continuously monitor and improve the quality of treatment of primary and revision total hip arthroplasty (THA) in Denmark. STUDY POPULATION: The DHR is a Danish nationwide arthroplasty register established in January 1995...... complications. Completeness of primary and revision surgery is evaluated annually and validation of a number of variables has been carried out. DESCRIPTIVE DATA: A total of 139,525 primary THAs and 22,118 revisions have been registered in the DHR between January 1, 1995 and December 31, 2014. Since 1995....... All Danish orthopedic departments - both public and private - report to the register, and registration is compulsory. MAIN VARIABLES: The main variables in the register include civil registration number, indication for primary and revision surgery, operation date and side, and postoperative...

  11. Cervical Spondylosis and Hypertension

    OpenAIRE

    Peng, Baogan; Pang, Xiaodong; Li, Duanming; Yang, Hong

    2015-01-01

    Abstract Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully w...

  12. Atomistic study of two-level systems in amorphous silica

    Science.gov (United States)

    Damart, T.; Rodney, D.

    2018-01-01

    Internal friction is analyzed in an atomic-scale model of amorphous silica. The potential energy landscape of more than 100 glasses is explored to identify a sample of about 700 two-level systems (TLSs). We discuss the properties of TLSs, particularly their energy asymmetry and barrier as well as their deformation potential, computed as longitudinal and transverse averages of the full deformation potential tensors. The discrete sampling is used to predict dissipation in the classical regime. Comparison with experimental data shows a better agreement with poorly relaxed thin films than well relaxed vitreous silica, as expected from the large quench rates used to produce numerical glasses. The TLSs are categorized in three types that are shown to affect dissipation in different temperature ranges. The sampling is also used to discuss critically the usual approximations employed in the literature to represent the statistical properties of TLSs.

  13. A Two-Level Structure for Compressing Aligned Bitexts

    Science.gov (United States)

    Adiego, Joaquín; Brisaboa, Nieves R.; Martínez-Prieto, Miguel A.; Sánchez-Martínez, Felipe

    A bitext, or bilingual parallel corpus, consists of two texts, each one in a different language, that are mutual translations. Bitexts are very useful in linguistic engineering because they are used as source of knowledge for different purposes. In this paper we propose a strategy to efficiently compress and use bitexts, saving, not only space, but also processing time when exploiting them. Our strategy is based on a two-level structure for the vocabularies, and on the use of biwords, a pair of associated words, one from each language, as basic symbols to be encoded with an ETDC [2] compressor. The resulting compressed bitext needs around 20% of the space and allows more efficient implementations of the different types of searches and operations that linguistic engineerings need to perform on them. In this paper we discuss and provide results for compression, decompression, different types of searches, and bilingual snippets extraction.

  14. Optimizing ETL by a Two-level Data Staging Method

    DEFF Research Database (Denmark)

    Liu, Xiufeng; Iftikhar, Nadeem; Nielsen, Per Sieverts

    2016-01-01

    In data warehousing, the data from source systems are populated into a central data warehouse (DW) through extraction, transformation and loading (ETL). The standard ETL approach usually uses sequential jobs to process the data with dependencies, such as dimension and fact data. It is a non......-trivial task to process the so-called early-/late-arriving data, which arrive out of order. This paper proposes a two-level data staging area method to optimize ETL. The proposed method is an all-in-one solution that supports processing different types of data from operational systems, including early......-/late-arriving data, and fast-/slowly-changing data. The introduced additional staging area decouples loading process from data extraction and transformation, which improves ETL flexibility and minimizes intervention to the data warehouse. This paper evaluates the proposed method empirically, which shows...

  15. Conversion of failed modern unicompartmental arthroplasty to total knee arthroplasty.

    Science.gov (United States)

    Levine, W N; Ozuna, R M; Scott, R D; Thornhill, T S

    1996-10-01

    Between January 1983 and January 1991, 29 patients (31 knees) with a failed Robert Brigham metal-backed knee arthroplasty (Johnson & Johnson, Raynham, MA) underwent revision to a total knee arthroplasty (TKA). Twenty-five patients had osteoarthritis, three avascular necrosis, and one rheumatoid arthritis. The average patient age was 72.3 years (range, 49-88 years), and the average weight was 179 lb. (range, 112-242 lb.). The interval between the primary and secondary index procedures averaged 62 months (range, 7-106 months), and mean postrevision follow-up period was 45 months (range, 24-104 months). The primary mechanism of failure of the UKA was tibial polyethylene wear in 21 knees and opposite compartment progression of arthritis in 10 knees. Sixteen knees had particulate synovitis with dense metallic staining of the synovium. At revision, the posterior cruciate ligament was spared in 30 knees and substituted in 1 knee. Restoration of bony deficiency at revision required cancellous bone-graft for contained defects in seven knees, tibial wedges in four knees, and femoral wedges in two knees. No defects received structural allografts. The data suggest that failed, modern unicompartmental knee arthroplasty can successfully be converted to TKA. In most cases, the posterior cruciate ligament can be spared and bone defects corrected with simple wedges or cancellous grafts. Moreover, the results of revision of failed unicompartmental knee arthroplasty are superior to those of failed TKA and failed high tibial osteotomy and comparable to the authors' results of primary TKA with similar-length follow-up periods. Although these results are encouraging, longer-term follow-up evaluation is required to determine survivorship of these revision arthroplasties.

  16. Adjacent Segment Pathology after Anterior Cervical Fusion.

    Science.gov (United States)

    Chung, Jae Yoon; Park, Jong-Beom; Seo, Hyoung-Yeon; Kim, Sung Kyu

    2016-06-01

    Anterior cervical fusion has become a standard of care for numerous pathologic conditions of the cervical spine. However, subsequent development of clinically significant disc disease at levels adjacent to fused discs is a serious long-term complication of this procedure. As more patients live longer after surgery, it is foreseeable that adjacent segment pathology (ASP) will develop in increasing numbers of patients. Also, ASP has been studied more intensively with the recent popularity of motion preservation technologies like total disc arthroplasty. The true nature and scope of ASP remains poorly understood. The etiology of ASP is most likely multifactorial. Various factors including altered biomechanical stresses, surgical disruption of soft tissue and the natural history of cervical disc disease contribute to the development of ASP. General factors associated with disc degeneration including gender, age, smoking and sports may play a role in the development of ASP. Postoperative sagittal alignment and type of surgery are also considered potential causes of ASP. Therefore, a spine surgeon must be particularly careful to avoid unnecessary disruption of the musculoligamentous structures, reduced risk of direct injury to the disc during dissection and maintain a safe margin between the plate edge and adjacent vertebrae during anterior cervical fusion.

  17. Adjacent Segment Pathology after Anterior Cervical Fusion

    Science.gov (United States)

    Chung, Jae Yoon; Park, Jong-Beom; Seo, Hyoung-Yeon

    2016-01-01

    Anterior cervical fusion has become a standard of care for numerous pathologic conditions of the cervical spine. However, subsequent development of clinically significant disc disease at levels adjacent to fused discs is a serious long-term complication of this procedure. As more patients live longer after surgery, it is foreseeable that adjacent segment pathology (ASP) will develop in increasing numbers of patients. Also, ASP has been studied more intensively with the recent popularity of motion preservation technologies like total disc arthroplasty. The true nature and scope of ASP remains poorly understood. The etiology of ASP is most likely multifactorial. Various factors including altered biomechanical stresses, surgical disruption of soft tissue and the natural history of cervical disc disease contribute to the development of ASP. General factors associated with disc degeneration including gender, age, smoking and sports may play a role in the development of ASP. Postoperative sagittal alignment and type of surgery are also considered potential causes of ASP. Therefore, a spine surgeon must be particularly careful to avoid unnecessary disruption of the musculoligamentous structures, reduced risk of direct injury to the disc during dissection and maintain a safe margin between the plate edge and adjacent vertebrae during anterior cervical fusion. PMID:27340541

  18. Two-level tunneling systems in amorphous alumina

    Science.gov (United States)

    Lebedeva, Irina V.; Paz, Alejandro P.; Tokatly, Ilya V.; Rubio, Angel

    2014-03-01

    The decades of research on thermal properties of amorphous solids at temperatures below 1 K suggest that their anomalous behaviour can be related to quantum mechanical tunneling of atoms between two nearly equivalent states that can be described as a two-level system (TLS). This theory is also supported by recent studies on microwave spectroscopy of superconducting qubits. However, the microscopic nature of the TLS remains unknown. To identify structural motifs for TLSs in amorphous alumina we have performed extensive classical molecular dynamics simulations. Several bistable motifs with only one or two atoms jumping by considerable distance ~ 0.5 Å were found at T=25 K. Accounting for the surrounding environment relaxation was shown to be important up to distances ~ 7 Å. The energy asymmetry and barrier for the detected motifs lied in the ranges 0.5 - 2 meV and 4 - 15 meV, respectively, while their density was about 1 motif per 10 000 atoms. Tuning of motif asymmetry by strain was demonstrated with the coupling coefficient below 1 eV. The tunnel splitting for the symmetrized motifs was estimated on the order of 0.1 meV. The discovered motifs are in good agreement with the available experimental data. The financial support from the Marie Curie Fellowship PIIF-GA-2012-326435 (RespSpatDisp) is gratefully acknowledged.

  19. Cervical Spondylosis and Hypertension

    Science.gov (United States)

    Peng, Baogan; Pang, Xiaodong; Li, Duanming; Yang, Hong

    2015-01-01

    Abstract Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis. PMID:25761188

  20. Cervical Cancer Screening

    Science.gov (United States)

    ... cervical cytology (also called the Pap test or Pap smear) and, for some women, testing for human papillomavirus (HPV) . How does cervical cancer occur? Cancer occurs when cervical cells become abnormal ...

  1. Cervical Cancer Screening

    Science.gov (United States)

    ... Cancer Treatment Screening for cervical cancer using the Pap test has decreased the number of new cases of ... their chance of dying from cervical cancer . A Pap test is commonly used to screen for cervical cancer. ...

  2. Knee Arthrodesis After Failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders

    2016-01-01

    BACKGROUND: Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty in a nati......BACKGROUND: Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty...

  3. Cervical radiculopathy.

    Science.gov (United States)

    Corey, Deanna Lynn; Comeau, Douglas

    2014-07-01

    Cervical radiculopathy is the result of irritation and/or compression of nerve root as it exits the cervical spine. Pain is a common presenting symptom and may be accompanied by motor or sensory deficits in areas innervated by the affected nerve root. Diagnosis is suggested by history and corresponding physical examination findings. Confirmation is achieved with MRI. A multimodal approach to treatment helps patients improve. Medications may be used to alleviate symptoms and manage pain. Physical therapy and manipulation may improve neck discomfort. Guided corticosteroid injections and selected nerve blocks may help control nerve root pain. Most patients improve with a conservative, nonoperative treatment course. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Lateral cervical puncture for cervical myelography

    International Nuclear Information System (INIS)

    Seol, Hae Young; Cha, Sang Hoon; Kim, Yoon Hwan; Suh, Won Hyuck

    1985-01-01

    Eleven cervical myelograms were performed by lateral cervical puncture using Metrizamide. So, following results were obtained: 1. Site of lateral cervical puncture; Posterior one third of bony cervical canal at C 1-2 level. 2. Advantages as compared with lumbar puncture for cervical myelograms; 1) Small amount of contrast media 2) Excellent image 3) Less position charge 4) Short time 5) Well visualization of superior margin of obstructive lesion in spinal canal 3. Cessation of lateral cervical puncture, when; 1) Pain during injection of contrast media 2) Localized collection of contrast media

  5. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Scott M. Sporer

    2009-03-01

    Full Text Available DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Scott M. Sporer, MD. and the contributors have aimed providing the reader practical and clinically relevant information, evidence-based advices, their preferences and opinions containing current concepts for difficult and controversial clinical situations in total hip replacement surgery which are often not addressed clearly in traditional references. FEATURES The book is composed of 9 sections and 49 articles each written by a different expert designed in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected. Second section is about preoperative acetabulum questions. Third section is about preoperative femur questions. Fourth section is about intraoperative questions. Intraoperative acetabulum question is subjected in the fifth section and the intraoperative femur questions in the sixth section. The seventh section is about postoperative questions. Eighth and ninth sections are about general questions about failure and failure of acetabulum in turn. AUDIENCE Mainly practicing orthopedic surgeons, fellows and residents who are interested in hip arthroplasty have been targeted but several carefully designed scenarios of controversial and difficult situations surrounding total hip replacement surgery and the current information will also be welcomed by experienced clinicians practicing in hip arthroplasty. ASSESSMENT Scott M. Sporer

  6. Cervical Laminoplasty for Multilevel Cervical Myelopathy

    Directory of Open Access Journals (Sweden)

    Murali Krishna Sayana

    2011-01-01

    Full Text Available Cervical spondylotic myelopathy can result from degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multi-level myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Laminoplasty was major surgical advancement as laminectomy resulted in kyphosis and unsatisfactory outcomes. Hirabayashi popularised the expansive open door laminoplasty which was later modified several surgeons. Laminoplasty has changed the way surgeons approach multilevel cervical spondylotic myelopathy.

  7. Prevalence of adjacent segment disc degeneration in patients undergoing anterior cervical discectomy and fusion based on pre-operative MRI findings.

    Science.gov (United States)

    Lundine, Kristopher M; Davis, Gavin; Rogers, Myron; Staples, Margaret; Quan, Gerald

    2014-01-01

    Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical treatment for symptomatic cervical spondylosis. Some patients develop symptomatic adjacent segment degeneration, occasionally requiring further treatment. The cause and prevalence of adjacent segment degeneration and disease is unclear at present. Proponents for motion preserving surgery such as disc arthroplasty argue that this technique may decrease the "strain" on adjacent discs and thus decrease the incidence of symptomatic adjacent segment degeneration. The purpose of this study was to assess the pre-operative prevalence of adjacent segment degeneration in patients undergoing ACDF. A database review of three surgeons' practice was carried out to identify patients who had undergone a one- or two-level ACDF for degenerative disc disease. Patients were excluded if they were operated on for recent trauma, had an inflammatory arthropathy (for example, rheumatoid arthritis), or had previous spine surgery. The pre-operative MRI of each patient was reviewed and graded using a standardised methodology. One hundred and six patient MRI studies were reviewed. All patients showed some evidence of intervertebral disc degeneration adjacent to the planned operative segment(s). Increased severity of disc degeneration was associated with increased age and operative level, but was not associated with sagittal alignment. Disc degeneration was more common at levels adjacent to the surgical level than at non-adjacent segments, and was more severe at the superior adjacent level compared with the inferior adjacent level. These findings support the theory that adjacent segment degeneration following ACDF is due in part to the natural history of cervical spondylosis. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Imaging of hip joint arthroplasty

    International Nuclear Information System (INIS)

    Mayerhoefer, M.E.; Fruehwald-Pallamar, J.; Czerny, C.

    2009-01-01

    The hip joint is the largest joint in the human body and consequently, its evaluation by diagnostic imaging is highly important. This includes imaging of hip joint arthroplasty, which is used to avoid joint immobility following a wide spectrum of diseases, such as end-stage degenerative disease, avascular necrosis of the femoral head or post-traumatic fractures. Conventional radiography is still the standard imaging modality for the evaluation of hip arthroplasty both directly following surgery and for periodical follow-up. In the majority of cases conventional radiography enables adequate assessment of early and late complications that can arise following hip arthroplasty, such as loosening, prosthetic or periprosthetic fracture, luxation, infection and soft tissue calcification. If the diagnosis cannot be established by means of radiography, advanced imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), with or without injection of contrast media, may provide additional information. This is particularly true for the depiction of inflammatory processes. Regardless of the imaging modality used patients' clinical symptoms must also be taken into account in order to establish the correct diagnosis. (orig.) [de

  9. CT and MRI of hip arthroplasty

    International Nuclear Information System (INIS)

    Cahir, J.G.; Toms, A.P.; Marshall, T.J.; Wimhurst, J.; Nolan, J.

    2007-01-01

    Plain films are the initial imaging method of choice for evaluation of hip arthroplasty. Recent advances in technology and imaging techniques have largely overcome the problems of beam hardening in computed tomography (CT) and magnetic susceptibility artefact in magnetic resonance imaging (MRI). CT and MRI have now become useful imaging techniques in the assessment of hip arthroplasty

  10. Humeral windows in revision total elbow arthroplasty.

    Science.gov (United States)

    Peach, Chris A; Salama, Amir; Stanley, David

    2016-04-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery.

  11. Fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik

    2012-01-01

    thromboembolic complications in particular (V); feasibility studies showing excellent outcomes following fast-track bilateral simultaneous total knee arthroplasty (VI) and non-septic revision knee arthroplasty (VII); how acute pain relief in total hip arthroplasty is not enhanced by the use of local infiltration......Fast-track hip and knee arthroplasty aims at giving the patients the best available treatment at all times, being a dynamic entity. Fast-track combines evidence-based, clinical features with organizational optimization including a revision of traditions resulting in a streamlined pathway from...... on clinical and organizational aspects of fast-track hip and knee arthroplasty (I–IX). A detailed description of the fast-track set-up and its components is provided. Major results include identification of patient characteristics to predict length of stay and satisfaction with different aspects...

  12. Hip resurfacing arthroplasty and perioperative blood testing.

    Science.gov (United States)

    Cook, Andrew; Cook, Steven; Smith, Ian; Weinrauch, Patrick

    2014-01-01

    It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate.

  13. Hip Resurfacing Arthroplasty and Perioperative Blood Testing

    Directory of Open Access Journals (Sweden)

    Andrew Cook

    2014-01-01

    Full Text Available It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate.

  14. Headache of cervical origin

    International Nuclear Information System (INIS)

    Burguet, J.L.; Wackenheim, A.

    1984-01-01

    The authors recall cervical etiologies of headache. They distinguish on the one hand the cervico-occipital region with minor and major malformations and acquired lesions, and on the other hand the middle and inferior cervical segment. They also recall the original structuralist analysis of the cervical spine and give the example of the ''cervical triplet''. (orig.) [de

  15. Cervical Adjacent Segment Disease

    OpenAIRE

    Özbek, Zühtü; Özkara, Emre; Yağmur, İpek; Arslantaş, Ali

    2017-01-01

    Cervical adjacent segment disease; is the general name ofdisc pathologies that develop in adjacent levels after cervical surgery. If thecervical adjacent segment disease that do not require reoperation and it doesnot cause clinical signs is called radiological cervical adjacent segmentpathology, but those causing radiculopathy, myelopathy or instability is calledclinic cervical adjacent segment pathology. The incidence of cervical adjacentsegment disease in 10-year follow-up is 2.4% -2.9%. Wh...

  16. Symptomatic Adjacent Segment Disease After Anterior Cervical Discectomy for Single-level Degenerative Disk Disease.

    Science.gov (United States)

    Donk, Roland D; Verhagen, Wim I M; Hosman, Allard J F; Verbeek, Andre; Bartels, Ronald H M A

    2018-02-01

    A prospective cohort of 142 patients underwent either anterior cervical discectomy alone, anterior cervical discectomy with fusion by cage stand-alone, or anterior cervical discectomy with arthroplasty. We then followed up on their condition for a mean of 9.1±1.9 years (5.6-12.2 y) later. We aimed to evaluate the annual rate of clinically symptomatic adjacent segment disease (ASD) and to analyze predictive factors. Until recent, ASD has been predominantly evaluated radiologically. It is not known whether all patients had complaints. A frequent cited annual rate of ASD is 2.9%, but a growing number of studies report a lower annual rate. Furthermore, maintaining motion to prevent ASD is one reason for implanting a cervical disk prosthesis. However, the results of studies contradict one another. Participants took part in a randomized controlled trial that ended prematurely because of the publication of evidence that did not justify continuation of the trial. The patients were randomly allocated to 3 groups, each of which received one of the abovementioned treatments. We defined symptomatic ASD as signs and symptoms caused by degeneration of an intervertebral disk adjacent to a level of previous anterior cervical disk surgery. At the last follow-up, we were able to ascertain whether clinically symptomatic ASD was present in any of the participants. The overall annual rate of symptomatic ASD was 0.7%. We found no statistically significant correlations between any of the investigated factors and symptomatic ASD except for the surgical method used. Symptomatic ASD was seen less often in anterior cervical discectomy solely or anterior cervical discectomy with arthroplasty than in anterior cervical discectomy with fusion by plate fixation. The annual rate of symptomatic ASD after an anterior cervical discectomy procedure was estimated to be 0.7%. This seems to be related to the procedure, although firm conclusions cannot be drawn. Level 2-prospective cohort.

  17. Failure of aseptic revision total knee arthroplasties.

    Science.gov (United States)

    Leta, Tesfaye H; Lygre, Stein Håkon L; Skredderstuen, Arne; Hallan, Geir; Furnes, Ove

    2015-02-01

    In Norway, the proportion of revision knee arthroplasties increased from 6.9% in 1994 to 8.5% in 2011. However, there is limited information on the epidemiology and causes of subsequent failure of revision knee arthroplasty. We therefore studied survival rate and determined the modes of failure of aseptic revision total knee arthroplasties. This study was based on 1,016 aseptic revision total knee arthroplasties reported to the Norwegian Arthroplasty Register between 1994 and 2011. Revisions done for infections were not included. Kaplan-Meier and Cox regression analyses were used to assess the survival rate and the relative risk of re-revision with all causes of re-revision as endpoint. 145 knees failed after revision total knee arthroplasty. Deep infection was the most frequent cause of re-revision (28%), followed by instability (26%), loose tibial component (17%), and pain (10%). The cumulative survival rate for revision total knee arthroplasties was 85% at 5 years, 78% at 10 years, and 71% at 15 years. Revision total knee arthroplasties with exchange of the femoral or tibial component exclusively had a higher risk of re-revision (RR = 1.7) than those with exchange of the whole prosthesis. The risk of re-revision was higher for men (RR = 2.0) and for patients aged less than 60 years (RR = 1.6). In terms of implant survival, revision of the whole implant was better than revision of 1 component only. Young age and male sex were risk factors for re-revision. Deep infection was the most frequent cause of failure of revision of aseptic total knee arthroplasties.

  18. Cervicitis of unknown etiology.

    Science.gov (United States)

    Taylor, Stephanie N

    2014-07-01

    Cervicitis has been described by some as the female counterpart of urethritis in men. Over the years a number of clinical and microscopy-based definitions have been suggested in the literature. Clinical manifestations include mucopurulent discharge from the cervix, cervical friability (easy bleeding from the cervix with passage of a swab) and cervical ectopy. Microscopic definitions involving the use of Gram stain of cervical secretions have included either more than 10 white blood cells (WBCs) or more than 30 WBCs per high-power field. Combinations of these clinical and microscopic findings have been used in attempts to increase the accuracy of cervicitis diagnosis. When cervicitis was initially recognized as a clinical entity, several investigators reported the primary pathogens causing cervicitis as Neisseria gonorrhoeae and Chlamydia trachomatis. It is now well established that most cases of cervicitis are not caused by these two organisms. Most cases of cervicitis are of unknown etiology.

  19. Infection after primary hip arthroplasty

    Science.gov (United States)

    2011-01-01

    Background and purpose The aim of the present study was to assess incidence of and risk factors for infection after hip arthroplasty in data from 3 national health registries. We investigated differences in risk patterns between surgical site infection (SSI) and revision due to infection after primary total hip arthroplasty (THA) and hemiarthroplasty (HA). Materials and methods This observational study was based on prospective data from 2005–2009 on primary THAs and HAs from the Norwegian Arthroplasty Register (NAR), the Norwegian Hip Fracture Register (NHFR), and the Norwegian Surveillance System for Healthcare–Associated Infections (NOIS). The Norwegian Patient Register (NPR) was used for evaluation of case reporting. Cox regression analyses were performed with revision due to infection as endpoint for data from the NAR and the NHFR, and with SSI as the endpoint for data from the NOIS. Results The 1–year incidence of SSI in the NOIS was 3.0% after THA (167/5,540) and 7.3% after HA (103/1,416). The 1–year incidence of revision due to infection was 0.7% for THAs in the NAR (182/24,512) and 1.5% for HAs in the NHFR (128/8,262). Risk factors for SSI after THA were advanced age, ASA class higher than 2, and short duration of surgery. For THA, the risk factors for revision due to infection were male sex, advanced age, ASA class higher than 1, emergency surgery, uncemented fixation, and a National Nosocomial Infection Surveillance (NNIS) risk index of 2 or more. For HAs inserted after fracture, age less than 60 and short duration of surgery were risk factors of revision due to infection. Interpretation The incidences of SSI and revision due to infection after primary hip replacements in Norway are similar to those in other countries. There may be differences in risk pattern between SSI and revision due to infection after arthroplasty. The risk patterns for revision due to infection appear to be different for HA and THA. PMID:22066562

  20. Conversion total hip arthroplasty: Primary or revision total hip arthroplasty.

    Science.gov (United States)

    Schwarzkopf, Ran; Baghoolizadeh, Mahta

    2015-11-18

    Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA. This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA, primary THA, and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other, or are possibly somewhere in between. The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA. Furthermore, patients undergoing conversion THA present with poorer functional outcomes in the long run. Patients undergoing conversion THA better resemble revision THA patients than primary THA patients. As such, patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates. Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room, and for in-patient and follow-up care. We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties.

  1. Cervical cancer - screening and prevention

    Science.gov (United States)

    Cancer cervix - screening; HPV - cervical cancer screening; Dysplasia - cervical cancer screening; Cervical cancer - HPV vaccine ... Almost all cervical cancers are caused by HPV (human papilloma virus). HPV is a common virus that spreads through sexual contact. Certain ...

  2. Postoperative radiologic imaging of joint arthroplasty

    International Nuclear Information System (INIS)

    Aldinger, P.R.; Ludwig, K.

    2006-01-01

    With increased life expectancy in industrialised countries, improvement of implant design and operative technique, arthroplasty has become a routine procedure. The hip and knee joints are treated by arthroplasty most frequently. Nowadays joint replacement can be performed in many other joints. Radiologic imaging is an important tool for evaluation of the operative results and for detection of early and late complications. In the following article we describe the relevance of different imaging modalities as well as their systematic application in patients with joint arthroplasty. (orig.)

  3. Total ankle arthroplasty: An imaging overview

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Da Rae; Choi, Yun Sun; Chun, Ka Young; Jung, Yoon Young; Kim, Jin Su; Young, Ki Won [Eulji Hospital, Eulji University, Seoul (Korea, Republic of); Potter, Hollis G.; Li, Angela E. [Dept. of Radiology and Imaging, Hospital for Special Surgery, New York (United States)

    2016-06-15

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  4. [Clinical outcome of mid-term follow-up of anterior cervical non-fusion surgery versus anterior cervical discectomy and fusion for cervical spondylosis].

    Science.gov (United States)

    Guan, L; Wang, W L; Hai, Y; Liu, Y Z; Chen, X L; Chen, L

    2016-07-05

    To evaluate the clinical and radiological outcomes of artificial cervical disc replacement (Prodisc-C), dynamic cervical implant and anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylosis. From May 2011 to May 2013, a total of 44 cervical spondylosis patients that received cervical disc arthroplasty (Prodisc-C), dynamic cervical implant (DCI) or ACDF were retrospectively reviewed in Orthopedics Department, Beijing Chaoyang Hospital, Capital Medical University.The patients were divided into three groups by surgical methods.Parameters as gender, age, the operation time, blood loss and average hospital stay of three groups were compared.The patients were followed 3 months, 6 months, 12 months and 24 months postoperatively.Neck disability index (NDI), Japanese Orthopaedic Association (JOA) Score and Visual Analogue Scale (VAS) were used to evaluate the clinical outcomes of the three groups.We also measured the cervical lordosis, range of motion of surgical segment and adjacent segment and height of disc at pre-op and post-op. All the patients were got at least 24 months follow-up.The differences between postoperative JOA, NDI and VAS scores and preoperative scores were of statistical significance (P0.05) among three groups.But the operative time and intraoperative blood loss were statistically different (P0.05). There was no statistically significant difference between pre-and postoperative ROM of upper and lower levels among three groups (P>0.05), but had statistically difference in operative levels [(7.0±1.0) mm, (9.2±1.5) mm, (6.8±1.4) mm, Pfusion surgery and ACDF have received good clinical effects in the treatment of spondylotic myelopathy or radicular spondylosis.The artificial cervical disc replacement and dynamic cervical implant can not only recover cervical lordosis and keep the range of motion and stability of the surgical segment, but also reduce the incidence of compensatory motion at adjacent segments and will prevent

  5. Gemella haemolysans Infection in Total Hip Arthroplasty.

    Science.gov (United States)

    Rose, Barry; Jeer, Parminder J S; Spriggins, Anthony J

    2012-01-01

    Gemella haemolysans is a Gram-positive coccus and commensal of the upper respiratory tract and oral mucosa that rarely causes clinically important infections. There is only one previous report of this organism causing periprosthetic infection, in a total knee arthroplasty. We present a case of septic loosening of an uncemented total hip arthroplasty due to G. haemolysans, in an asplenic patient with insulin dependent diabetes mellitus. Treatment with two-stage revision has been successful at 7 years of follow-up.

  6. Hip Resurfacing Arthroplasty and Perioperative Blood Testing

    OpenAIRE

    Cook, Andrew; Cook, Steven; Smith, Ian; Weinrauch, Patrick

    2014-01-01

    It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testin...

  7. Cervical Cancer Screening

    Science.gov (United States)

    ... Cancer found early may be easier to treat. Cervical cancer screening is usually part of a woman's health ... may do more tests, such as a biopsy. Cervical cancer screening has risks. The results can sometimes be ...

  8. Cervical spondylosis (image)

    Science.gov (United States)

    Cervical spondylosis is a disorder that results from abnormal growth of the bones of the neck and degeneration and ... neck pain is a key indication of cervical spondylosis. It may be the only symptom in many ...

  9. Return to sports after shoulder arthroplasty

    Science.gov (United States)

    Johnson, Christine C; Johnson, Daniel J; Liu, Joseph N; Dines, Joshua S; Dines, David M; Gulotta, Lawrence V; Garcia, Grant H

    2016-01-01

    Many patients prioritize the ability to return to sports following shoulder replacement surgeries, including total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), and hemiarthroplasty (HA). While activity levels after hip and knee replacements have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively limited. A review of the literature regarding athletic activity after shoulder arthroplasty was performed using the PubMed database. All studies relevant to shoulder arthroplasty and return to sport were included. The majority of patients returned to their prior level of activity within six months following TSA, RTSA, and shoulder HA. Noncontact, low demand activities are permitted by most surgeons postoperatively and generally have higher return rates than contact sports or high-demand activities. In some series, patients reported an improvement in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TSA (75%-100%) are slightly higher than those reported for HA (67%-76%) and RTSA (75%-85%). Patients undergoing TSA, RTSA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six months postoperatively. TSA has been associated with higher rates of return to sports than RTSA and HA, although this may reflect differences in patient population or surgical indication. PMID:27672564

  10. Robotics in Arthroplasty: A Comprehensive Review.

    Science.gov (United States)

    Jacofsky, David J; Allen, Mark

    2016-10-01

    Robotic-assisted orthopedic surgery has been available clinically in some form for over 2 decades, claiming to improve total joint arthroplasty by enhancing the surgeon's ability to reproduce alignment and therefore better restore normal kinematics. Various current systems include a robotic arm, robotic-guided cutting jigs, and robotic milling systems with a diversity of different navigation strategies using active, semiactive, or passive control systems. Semiactive systems have become dominant, providing a haptic window through which the surgeon is able to consistently prepare an arthroplasty based on preoperative planning. A review of previous designs and clinical studies demonstrate that these robotic systems decrease variability and increase precision, primarily focusing on component positioning and alignment. Some early clinical results indicate decreased revision rates and improved patient satisfaction with robotic-assisted arthroplasty. The future design objectives include precise planning and even further improved consistent intraoperative execution. Despite this cautious optimism, many still wonder whether robotics will ultimately increase cost and operative time without objectively improving outcomes. Over the long term, every industry that has seen robotic technology be introduced, ultimately has shown an increase in production capacity, improved accuracy and precision, and lower cost. A new generation of robotic systems is now being introduced into the arthroplasty arena, and early results with unicompartmental knee arthroplasty and total hip arthroplasty have demonstrated improved accuracy of placement, improved satisfaction, and reduced complications. Further studies are needed to confirm the cost effectiveness of these technologies. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Cervical Cancer Stage IIIA

    Science.gov (United States)

    ... hyphen, e.g. -historical Searches are case-insensitive Cervical Cancer Stage IIIA Add to My Pictures View /Download : ... 1275x1275 View Download Large: 2550x2550 View Download Title: Cervical Cancer Stage IIIA Description: Stage IIIA cervical cancer; drawing ...

  12. Cervical Cancer Stage IVA

    Science.gov (United States)

    ... hyphen, e.g. -historical Searches are case-insensitive Cervical Cancer Stage IVA Add to My Pictures View /Download : ... 1575x1200 View Download Large: 3150x2400 View Download Title: Cervical Cancer Stage IVA Description: Stage IVA cervical cancer; drawing ...

  13. Cervical Cancer Stage IVB

    Science.gov (United States)

    ... hyphen, e.g. -historical Searches are case-insensitive Cervical Cancer Stage IVB Add to My Pictures View /Download : ... 1200x1305 View Download Large: 2400x2610 View Download Title: Cervical Cancer Stage IVB Description: Stage IVB cervical cancer; drawing ...

  14. Cervical Cancer Stage IIIB

    Science.gov (United States)

    ... hyphen, e.g. -historical Searches are case-insensitive Cervical Cancer Stage IIIB Add to My Pictures View /Download : ... 1425x1326 View Download Large: 2850x2651 View Download Title: Cervical Cancer Stage IIIB Description: Stage IIIB cervical cancer; drawing ...

  15. Cervical Cancer Stage IB

    Science.gov (United States)

    ... hyphen, e.g. -historical Searches are case-insensitive Cervical Cancer Stage IB Add to My Pictures View /Download : ... 1613x1200 View Download Large: 3225x2400 View Download Title: Cervical Cancer Stage IB Description: Stage IB1 and IB2 cervical ...

  16. Cervical Cancer Stage IA

    Science.gov (United States)

    ... historical Searches are case-insensitive Cervical Cancer Stage IA Add to My Pictures View /Download : Small: 720x576 ... Large: 3000x2400 View Download Title: Cervical Cancer Stage IA Description: Stage IA1 and IA2 cervical cancer; drawing ...

  17. Cervical subluxation associated with posterior cervical hemivertebra.

    Science.gov (United States)

    Otero-López, R; Rivero-Garvía, M; Márquez-Rivas, J; Valencia, J

    2016-02-01

    Hemivertebrae, associated with a failure in the formation and fusion of vertebral body ossification nuclei, are a common cause of thoracic or lumbar scoliosis. A cervical location is rare and even rarer as a cause of cervical subluxation in flexion and extension (for which only one previous case has been found). We report on the case of a 7-year-old female patient, who was examined for a cervical fusion defect, consisting of a posterior C4 hemivertebra and a left hemiblock from C5 to C7. After performing surgery consisting of a C4 corpectomy and anterior fixation with intersomatic graft and plate, adequate cervical stabilization with only a self-limiting left C6 brachialgia and ipsilateral Horner syndrome occurs in the postoperative period. Posterior cervical hemivertebra associated with instability is a very rare finding. The anterior approach with corpectomy and anterior plate enables suitable stabilization.

  18. Cryotherapy on postoperative rehabilitation of joint arthroplasty.

    Science.gov (United States)

    Ni, Sheng-Hui; Jiang, Wen-Tong; Guo, Lei; Jin, Yu-Heng; Jiang, Tian-Long; Zhao, Yuyan; Zhao, Jie

    2015-11-01

    The effectiveness of cryotherapy on joint arthroplasty recovery remains controversial. This systematic review was conducted to assess the effectiveness of cryotherapy in patients after joint arthroplasty. Comprehensive literature searches of several databases including Cochrane Library (2013), MEDLINE (1950-2013), and Embase (1980-2013) were performed. We sought randomised controlled trials that compared the experimental group received any form of cryotherapy with any control group after joint arthroplasty. The main outcomes were postoperative blood loss, adverse events, and pain. Analyses were performed with Revman 5.0. Results were shown as mean differences (MD) and standard deviations or as risk difference and 95 % confidence intervals (CIs). Ten trials comprised 660 total knee arthroplastys and three trials comprised 122 total hip arthroplastys (THAs) met the inclusion criteria. Blood loss was significantly decreased by cryotherapy (MD = -109.68; 95 % CI -210.92 to -8.44; P = 0.03). Cryotherapy did not increase the risk of adverse effect (n.s.). Cryotherapy decreased pain at the second day of postoperative (MD = -1.32; 95 % CI -2.37 to -0.27; P = 0.0003), but did not decreased pain at the first and third day of postoperative (n.s.). Cryotherapy appears effective in these selected patients after joint arthroplasty. The benefits of cryotherapy on blood loss after joint arthroplasty were obvious. However, the subgroup analysis indicated that cryotherapy did not decreased blood loss after THA. Cryotherapy did not increase the risk of adverse effect. Cryotherapy decreased pain at the second day of postoperative, but did not decreased pain at the first and third day of postoperative. II.

  19. Revision rate of Birmingham Hip Resurfacing arthroplasty: comparison of published literature and arthroplasty register data.

    Science.gov (United States)

    Schuh, Reinhard; Neumann, Daniel; Rauf, Rauend; Hofstaetter, Jochen; Boehler, Nikolaus; Labek, Gerold

    2012-07-01

    Hip resurfacing arthroplasty has gained popularity for treating young and active patients who have arthritis. There are two major data sources for assessing outcome and revision rate after total joint arthroplasty: sample-based clinical trials and national arthroplasty registers. The purpose of this study was to evaluate the outcome of the Birmingham Hip Resurfacing (BHR) arthroplasty in terms of revision rate as reported in clinical studies and recorded by national arthroplasty registers. A comprehensive literature research was performed from English-language, peer-reviewed journals and annual reports from national joint arthroplasty registers worldwide. Only publications from MEDLINE-listed journals were included. The revision rate was used as the primary outcome parameter. In order to allow for direct comparison of different data sets, calculation was based on revisions per 100 observed component years. For statistical analysis, confidence intervals (CI) were calculated. A total of 18,708 implants, equivalent to 106,565 observed component years, were analysed in the follow-up studies. The register reports contained 9,806 primary cases corresponding to 44,294 observed component years. Statistical analysis revealed a significant difference in revisions per 100 observed component years between the development team (0.27; CI: 0.14-0.40) and register data (0.74; CI: 0.72-0.76). The BHR arthroplasty device shows good results in terms of revision rate in register data as well as in clinical studies. However, the excellent results reported by the development team are not reproducible by other surgeons. Based on the results of our study, we believe that comprehensive national arthroplasty registers are the most suitable tool for assessing hip arthroplasty revision rate.

  20. Early death following revision total hip arthroplasty.

    Science.gov (United States)

    Jones, Mark D; Parry, Michael; Whitehouse, Michael R; Blom, Ashley W

    2017-12-04

    The frequency of primary total hip arthroplasty procedures is increasing, with a subsequent rise in revision procedures. This study aims to describe timing and surgical mortality associated with revision total hip arthroplasty (THA) compared to those on the waiting list. All patients from a single institution who underwent revision total hip arthroplasty or were added to the waiting list for the same procedure between 2003 and 2013 were recorded. Mortality rates were calculated at 30 and 90 days following surgery or addition to the waiting list. 561 patients were available for the survivorship analysis in the surgical group. Following exclusion, 901 and 484 patients were available for the 30 and the 90-day analysis in the revision THA waiting list group.30- and 90-day mortality rates were significantly greater for the revision THA group compared to the waiting list group (excess surgical mortality at 30 days = 0.357%, p = 0.037; odds ratio of 5.22, excess surgical mortality at 90 days = 0.863%, p = 0.045). Revision total hip arthroplasty is associated with a significant excess surgical mortality rate until 90 days post-operation when compared to the waiting list population. We would encourage other authors with access to larger samples to use our method to quantify excess mortality after both primary and revision arthroplasty procedures.

  1. [Sport activity after hip and knee arthroplasty].

    Science.gov (United States)

    Keren, Amit; Berkovich, Yaron; Berkovitch, Yaron; Soudry, Michael

    2013-11-01

    Joint arthroplasty is one of the commonest surgical procedures in orthopedic surgery. In recent years there was an increase in the number of procedures, patient satisfaction and implant survival. Originally, these operations were designed for old patients in order to relieve pain and to enable ambulation. Over the past few years, these operations have become common in younger patients which desire to return to activity, including sports activities. The importance of physical activity is a well known fact. In recent years it became clear that with the proper physical activity the outcomes of the operations are better. There are several types of arthroplasty. Many factors influence the outcome of the operation apart from the post-surgery physical activity. These factors include patient factors, surgical technique and type of arthroplasty. This review summarizes the recommendations for sports activities after hip and knee arthroplasties. These activities are evaluated according to surgeons' recommendations, stress applied on the implant and long term outcomes. The recommended sports activities after joint arthroplasties are walking, swimming and cycling. Soccer, basketball and jogging are not advised. Tennis, downhill skiing and horse riding are recommended with previous experience. There are many more sports activities that patients can participate in, and it is important that the patient discuss the different options prior to the operation. Since these operations are so common, many non-orthopedic physicians encounter these patients in their practice. They should be acquainted with the recommendations for sports activities and encourage them.

  2. Technology in Arthroplasty: Are We Improving Value?

    Science.gov (United States)

    Waddell, Bradford S; Carroll, Kaitlin; Jerabek, Seth

    2017-09-01

    Total joint arthroplasty is regarded as a highly successful procedure. Patient outcomes and implant longevity, however, are related to proper alignment and position of the prostehses. In an attempt to reduce outliers and improve accuracy and precision of component position, navigation and robotics have been introduced. These technologies, however, come at a price. The goals of this review are to evaluate these technologies in total joint arthroplasty and determine if they add value. Recent studies have demonstrated that navigation and robotics in total joint arthroplasty can decrease outliers while improving accuracy in component positioning. While some studies have demonstrated improved patient reported outcomes, not all studies have shown this to be true. Most studies cite increased cost of equipment and longer operating room times as the major downsides of the technologies at present. Long-term studies are just becoming available and are promising, as some studies have shown decreased revision rates when navigation is used. Finally, there are relatively few studies evaluating the direct cost and value of these technologies. Navigation and robotics have been shown to improve component position in total joint arthroplasty, which can improve patient outcomes and implant longevity. These technologies offer a promising future for total joint arthroplasty.

  3. Cervical epidural hematoma: Following interlaminar cervical epidural steroid injection

    Directory of Open Access Journals (Sweden)

    Dwarkadas Kanhayalal Baheti

    2015-01-01

    Full Text Available Cervical epidural steroid injection is a common procedure performed for patients with cervical radiculopathy. Cervical epidural hematoma is a rare but known complication of Intervention Pain Treatment Procedure (IPTP in healthy patients without coagulopathy. We report a case of cervical epidural hematoma as a complication of cervical epidural steroid injection in an elderly patient with cervical radiculopathy; resulting in right upper limb motor sensory deficit. Patient responded to conservative management and surgery was not performed since symptoms progressively improved.

  4. Jogging after total hip arthroplasty.

    Science.gov (United States)

    Abe, Hirohito; Sakai, Takashi; Nishii, Takashi; Takao, Masaki; Nakamura, Nobuo; Sugano, Nobuhiko

    2014-01-01

    Jogging has been classified as a high-impact sport, and jogging after total hip arthroplasty (THA) has not been well documented. To investigate the participation rate for postoperative jogging as well as jogging parameters and the influence of jogging on implant stability and bearing wear. Case-control study; Level of evidence, 3. Included in this study were 804 hips in 608 patients (85 men, 523 women) who underwent THA between 2005 and 2011 with follow-up longer than 1 year. The mean patient age was 62 years (range, 26-98 years), and mean follow-up duration was 4.8 years (range, 2.3-7.8 years). Hip resurfacing arthroplasty (HRA) was performed in 81 patients and conventional THA in 527 patients. During routine postsurgical visits, patients were given a questionnaire concerning preoperative and postoperative jogging routines. For joggers, frequency, distance, duration, and velocity of jogging were recorded. Patients who did not jog postoperatively were asked to provide reasons for not jogging. Radiographs concerning implant migration and polyethylene wear were evaluated with specialized software, and serum cobalt and chromium ion concentrations were investigated for patients with metal-on-metal articulation. A total of 33 patients (5.4%) performed jogging preoperatively, and 23 patients (3.8%) performed jogging postoperatively. Of the 23 who jogged postoperatively, conventional THA was performed in 13 patients and HRA in 10 patients. Postoperatively, joggers trained a mean of 4 times (range, 1-7 times) per week, covering a mean distance of 3.6 km (range, 0.5-15 km) in a mean time of 29 minutes (range, 5-90 minutes) per session and at a mean speed of 7.7 km/h (range, 3-18 km/h). No patient complained of pain or showed serum cobalt and chromium ion elevation greater than 7 ppb. No hip showed loosening, abnormal component migration, or excessive wear at a mean 5-year follow-up. There were 74 postoperative non-joggers with an interest in jogging. The reasons given for

  5. Reverse hybrid total hip arthroplasty

    Science.gov (United States)

    Wangen, Helge; Havelin, Leif I; Fenstad, Anne M; Hallan, Geir; Furnes, Ove; Pedersen, Alma B; Overgaard, Søren; Kärrholm, Johan; Garellick, Göran; Mäkelä, Keijo; Eskelinen, Antti; Nordsletten, Lars

    2017-01-01

    Background and purpose The use of a cemented cup together with an uncemented stem in total hip arthroplasty (THA) has become popular in Norway and Sweden during the last decade. The results of this prosthetic concept, reverse hybrid THA, have been sparsely described. The Nordic Arthroplasty Register Association (NARA) has already published 2 papers describing results of reverse hybrid THAs in different age groups. Based on data collected over 2 additional years, we wanted to perform in depth analyses of not only the reverse hybrid concept but also of the different cup/stem combinations used. Patients and methods From the NARA, we extracted data on reverse hybrid THAs from January 1, 2000 until December 31, 2013. 38,415 such hips were studied and compared with cemented THAs. The Kaplan-Meier method and Cox regression analyses were used to estimate the prosthesis survival and the relative risk of revision. The main endpoint was revision for any reason. We also performed specific analyses regarding the different reasons for revision and analyses regarding the cup/stem combinations used in more than 500 cases. Results We found a higher rate of revision for reverse hybrids than for cemented THAs, with an adjusted relative risk of revision (RR) of 1.4 (95% CI: 1.3–1.5). At 10 years, the survival rate was 94% (CI: 94–95) for cemented THAs and 92% (95% CI: 92–93) for reverse hybrids. The results for the reverse hybrid THAs were inferior to those for cemented THAs in patients aged 55 years or more (RR =1.1, CI: 1.0–1.3; p revision due to periprosthetic femoral fracture for reverse hybrids than for cemented THAs in patients aged 55 years or more (RR =3.1, CI: 2.2–4.5; p revision than cemented THAs in patients aged 55 or more. The difference in survival was mainly caused by a higher incidence of early revision due to periprosthetic femoral fracture in the reversed hybrid THAs. PMID:28095724

  6. Transfemoral Amputation After Failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Schrøder, Henrik M; Odgaard, Anders

    2016-01-01

    complications in 9 (8%). In 92 (80%) of the cases, there were ≥2 indications for amputation. CONCLUSIONS: The cumulative incidence of amputation within 15 years after primary knee arthroplasty was 0.32%, with a tendency toward a decreasing incidence in the last part of the study period. LEVEL OF EVIDENCE......BACKGROUND: Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty...... were followed by amputation. Hospital records of all identified cases were reviewed. A competing-risk model was used to estimate the cumulative incidence of amputation. Differences in cumulative incidences were analyzed with use of the Gray test. RESULTS: A total of 115 amputations were performed...

  7. Imaging patellar complications after knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Melloni, Pietro [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)], E-mail: pmelloni@cspt.es; Valls, Rafael; Veintemillas, Maite [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)

    2008-03-15

    The purpose of this study is to describe complications affecting the patella in patients with total or partial knee arthroplasty. We respectively analysed plain-film radiographs, as well as ultrasound images when acquired, in a consecutive series of 1272 patients. The mean interval from knee replacement to patellar complications was 5 years and 7 months (range, 5 months to 14 years). The complications described include fracture, instability, dislocation or luxation, necrosis of the patella, infection of the patella, erosion of the patella, patellar impingement on the prosthesis and patellar or quadricipital tendon tear. We discuss the pathological imaging findings in the patella and their differential diagnosis after knee arthroplasty. Patellar complications after knee arthroplasty are uncommon but often potentially serious.

  8. Risks of Cervical Cancer Screening

    Science.gov (United States)

    ... Cancer Treatment Screening for cervical cancer using the Pap test has decreased the number of new cases of ... their chance of dying from cervical cancer . A Pap test is commonly used to screen for cervical cancer. ...

  9. Patient selection criteria for outpatient joint arthroplasty.

    Science.gov (United States)

    Kort, Nanne P; Bemelmans, Yoeri F L; van der Kuy, P Hugo M; Jansen, Jacqueline; Schotanus, Martijn G M

    2017-09-01

    General consensus of patient selection criteria for outpatient joint arthroplasty is lacking, which is paramount to prevent prolonged hospital stay, adverse events and/or readmissions. This review highlights patient selection criteria for OJA based on the current literature and expert opinion. A search of the English and International electronic healthcare databases including MEDLINE/PubMed, EMBASE, AMED and the Cochrane library was performed in November 2015 to include studies published during the last 10 years. Furthermore, a survey of physicians from different specialties was performed. Fourteen studies described results regarding outpatient joint arthroplasty. Studies on outpatient hip and/or knee arthroplasty resulted in similar outcome in preselected patients. Patients who are able and willing to participate, with a low ASA classification (II), bleeding disorders, poorly controlled and/or severe cardiac (e.g. heart failure, arrhythmia) or pulmonary (e.g. embolism, respiratory failure) comorbidities, uncontrolled DM (type I or II), a high BMI (>30 m 2 /kg), chronic opioid consumption, functional neurological impairments, dependent functional status, chronic/end-stage renal disease and/or reduced preoperative cognitive capacity should be excluded from outpatient joint arthroplasty. The expert opinion-based selection criteria were comparable to literature with a further extension of exclusion for patients with practical issue's, urologic medical history and/or severe mobility disorders. Based on the current literature, the presented patient selection criteria provide a basis for outpatient joint arthroplasty and can be useful when selecting patients. Together with a change in mindset, a multidisciplinary approach and literature-based protocols, outpatient joint arthroplasty can be applied in daily orthopaedic practice while ensuring patients' safety. Clinical review, Level III.

  10. Shoulder arthroplasty for sequelae of poliomyelitis.

    Science.gov (United States)

    Werthel, Jean-David; Schoch, Bradley; Sperling, John W; Cofield, Robert; Elhassan, Bassem T

    2016-05-01

    Polio infection can often lead to orthopedic complications such as arthritis, osteoporosis, muscle weakness, skeletal deformation, and chronic instability of the joints. The purpose of this study was to assess the outcomes and associated complications of arthroplasty in shoulders with sequelae of poliomyelitis. Seven patients (average age, 70 years) were treated between 1976 and 2013 with shoulder arthroplasty for the sequelae of polio. One patient underwent reverse shoulder arthroplasty, 2 had a hemiarthroplasty, and 4 had total shoulder arthroplasty. Average follow-up was 87 months. Outcome measures included pain, range of motion, and postoperative modified Neer ratings. Overall pain scores improved from 5 to 1.6 points (on a 5-point scale) after shoulder arthroplasty. Six shoulders had no or mild pain at latest follow-up, and 6 shoulders rated the result as much better or better. Mean shoulder elevation improved from 72° to 129°, and external rotation improved from 11° to 56°. Average strength in elevation decreased from 3.9 to 3.4 postoperatively, and external rotation strength decreased from 3.9 to 3.3. This, however, did not reach significance. Evidence of muscle imbalance with radiographic instability was found in 4 shoulders that demonstrated superior subluxation, anterior subluxation, or both. This remained asymptomatic. No shoulder required revision or reoperation. Shoulder arthroplasty provides significant pain relief and improved motion in patients with sequelae of poliomyelitis. Muscle weakness may be responsible for postoperative instability, and careful selection of the patient with good upper extremity muscles must be made. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  11. Etiology of cervical inflammation.

    Science.gov (United States)

    Paavonen, J; Critchlow, C W; DeRouen, T; Stevens, C E; Kiviat, N; Brunham, R C; Stamm, W E; Kuo, C C; Hyde, K E; Corey, L

    1986-03-01

    We studied the relationships of selected microbial, clinical, demographic, and behavioral variables to mucopurulent cervicitis in two clinical settings, a sexually transmitted disease clinic and a student health clinic. From each clinic, we studied a group of women referred for suspected mucopurulent cervicitis and a representative sample of other women attending the clinic. After the women were stratified by patient group and summary odds ratios for all groups were obtained, mucopurulent cervicitis was most strongly associated with the isolation of Chlamydia trachomatis; other variables associated with mucopurulent cervicitis included the isolation of Ureaplasma urealyticum, Gardnerella vaginalis, and Trichomonas vaginalis, the presence of serum antibody to C. trachomatis, the clinical diagnosis of bacterial vaginosis, and oral contraceptive use (positive associations) or isolation of yeast (negative association). After adjustment for cervical culture results for C. trachomatis, mucopurulent cervicitis was positively associated with oral contraceptive use (p = 0.02) and isolation of U. urealyticum (p = 0.02) and negatively associated with isolation of yeast (p = 0.03). Among women with a positive cervical culture for C. trachomatis, isolation of U. urealyticum was significantly associated with mucopurulent cervicitis, while among the subgroup of women with a negative cervical culture for C. trachomatis and positive serum antibody to C. trachomatis, oral contraceptive use was strongly associated with mucopurulent cervicitis. These results confirm that in both clinical settings C. trachomatis is the major cause of mucopurulent cervicitis. The roles of U. urealyticum, T. vaginalis, G. vaginalis, bacterial vaginosis, and oral contraceptive use in the etiology of mucopurulent cervicitis deserve further study.

  12. Effect of posterior subsidence on cervical alignment after anterior cervical corpectomy and reconstruction using titanium mesh cages in degenerative cervical disease.

    Science.gov (United States)

    Jang, Jae-Won; Lee, Jung-Kil; Lee, Jung-Heon; Hur, Hyuk; Kim, Tae-Wan; Kim, Soo-Han

    2014-10-01

    Subsidence after anterior cervical reconstruction using a titanium mesh cage (TMC) has been a matter of debate. The authors investigated and analyzed subsidence and its effect on clinical and radiologic parameters after cervical reconstruction using a TMC for degenerative cervical disease. Thirty consecutive patients with degenerative cervical spine disorders underwent anterior cervical corpectomy followed by reconstruction with TMC. Twenty-four patients underwent a single-level corpectomy, and six patients underwent a two-level corpectomy. Clinical outcomes were assessed using a Visual Analogue Scale (VAS), the Japanese Orthopedic Association (JOA) score and the Neck Disability Index (NDI). Fusion status, anterior and posterior subsidence of the TMC, segmental angle (SA) and cervical sagittal angle (CSA) were assessed by lateral and flexion-extension radiographs of the neck. The mean follow-up period was 27.6 months (range, 24 to 49 months). The VAS, NDI and JOA scores were all significantly improved at the last follow-up. No instances of radiolucency or motion-related pseudoarthrosis were detected on radiographic analysis, yielding a fusion rate of 100%. Subsidence occurred in 28 of 30 patients (93.3%). The average anterior subsidence of the cage was 1.4 ± 0.9 mm, and the average posterior subsidence was 2.9 ± 1.2 mm. The SA and CSA at the final follow-up were significantly increased toward a lordotic angle. Anterior cervical reconstruction using TMC and plating in patients with cervical degenerative disease provides good clinical and radiologic outcomes. Cage subsidence occurred frequently, especially at the posterior part of the cage. Despite the prominent posterior subsidence of the TMC, SA and CSA were improved on final follow-up radiographs, suggesting that posterior subsidence may contribute to cervical lordosis. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Gemella haemolysans Infection in Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Barry Rose

    2012-01-01

    Full Text Available Gemella haemolysans is a Gram-positive coccus and commensal of the upper respiratory tract and oral mucosa that rarely causes clinically important infections. There is only one previous report of this organism causing periprosthetic infection, in a total knee arthroplasty. We present a case of septic loosening of an uncemented total hip arthroplasty due to G. haemolysans, in an asplenic patient with insulin dependent diabetes mellitus. Treatment with two-stage revision has been successful at 7 years of follow-up.

  14. Proprioception and Knee Arthroplasty: A Literature Review.

    Science.gov (United States)

    Wodowski, Andrew J; Swigler, Colin W; Liu, Hongchao; Nord, Keith M; Toy, Patrick C; Mihalko, William M

    2016-04-01

    Proprioceptive mechanoreceptors provide neural feedback for position in space and are critical for three-dimensional interaction. Proprioception is decreased with osteoarthritis of the knees, which leads to increased risk of falling. As the prevalence of osteoarthritis increases so does the need for total knee arthroplasty (TKA), and knowing the effect of TKA on proprioception is essential. This article reviews the literature regarding proprioception and its relationship to balance, aging, osteoarthritis, and the effect of TKA on proprioception. Knee arthroplasty involving retention of the cruciate ligaments is also reviewed, as well the evidence of proprioception in the posterior cruciate ligament after TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Two-Level Orthogonal Screening Designs With 24, 28, 32, and 36 Runs

    NARCIS (Netherlands)

    Schoen, E.D.; Vo-Thanh, N.; Goos, P.

    2017-01-01

    The potential of two-level orthogonal designs to fit models with main effects and two-factor interaction effects is commonly assessed through the correlation between contrast vectors involving these effects. We study the complete catalog of nonisomorphic orthogonal two-level 24-run designs involving

  16. Two-step values for games with two-level communication structure

    NARCIS (Netherlands)

    Béal, Silvain; Khmelnitskaya, Anna Borisovna; Solal, Philippe

    TU games with two-level communication structure, in which a two-level communication structure relates fundamentally to the given coalition structure and consists of a communication graph on the collection of the a priori unions in the coalition structure, as well as a collection of communication

  17. Robustness of Two-Level Testing Procedures under Distortions of First Level Statistics

    OpenAIRE

    Kostevich, A. L.; Nikitina, I. S.

    2007-01-01

    We investigate robustness of some two-level testing procedures under distortions induced by using an asymptotic distribution of first level statistics instead of an exact one. We demonstrate that ignoring the distortions results in unreliable conclusions and we propose robustness conditions for the two-level procedures.

  18. Comparison of Two-Level Preconditioners Derived from Deflation, Domain Decomposition and Multigrid Methods

    NARCIS (Netherlands)

    Tang, J.M.; Nabben, R.; Vuik, C.; Erlangga, Y.A.

    2009-01-01

    For various applications, it is well-known that a multi-level, in particular two-level, preconditioned CG (PCG) method is an efficient method for solving large and sparse linear systems with a coefficient matrix that is symmetric positive definite. The corresponding two-level preconditioner combines

  19. Resonance interaction of two-level atoms with an electromagnetic field

    International Nuclear Information System (INIS)

    Fanchenko, S.S.

    1983-01-01

    A consistent investigation of two-level atom interaction with the quantum electromagnetic field is conducted. Radiation mechanism of two-level atom relaxation is described in the framework of Keldysh diagram technique. It is shown that equilibrium state in strong fields is established at the expense of radiation transitions between quaSi-enepgetic statrs. There is no full saturation in strong fields

  20. Concomitance of fibromyalgia syndrome and cervical disc herniation.

    Science.gov (United States)

    Güler, Mustafa; Aydın, Teoman; Akgöl, Erdal; Taşpınar, Özgür

    2015-03-01

    [Purpose] Fibromyalgia syndrome (FMS) and cervical disc herniation (CDH) are a common diseases commonly encountered in physical therapy clinics. There are also patients who have both of these diseases. In this study we aim to investigated whether FMS is a risk factor for cervical disc herniation and the frequency of their coincident occurrence. [Subjects and Methods] Thirty-five patients having a primary FMS diagnosis according to the American Rheumatism Association criteria are taken into consideration and a control group were the subjects of this study. The two groups were compared with respect to cervical disc hernia using cervical region MRI. [Results] The distribution of disc hernia of 6 fibromyalgia patients who had cervical discopathy was: 16.6% C2-3, 16.6% C5-6, 16.6% C6-7, 33.3% C4-5, C5-6 (two levels in two patients) and 16.6% C4-5, C5-6, C7-1 (three levels in one patient) . The herniation directions were given as: central in 5 levels, right paramedian in 1 level, and left paramedian disc hernia in 1 level. There were 4 cervical disk hernia in the control group. The herniation direction were central in two, right paramedian in one, and left paramedian in one patient. [Conclusion] In this study, the existence of cervical disc herniation in fibromyalgia patients was found to be not different from the normal population.

  1. Concomitance of fibromyalgia syndrome and cervical disc herniation

    Science.gov (United States)

    Güler, Mustafa; Aydın, Teoman; Akgöl, Erdal; Taşpınar, Özgür

    2015-01-01

    [Purpose] Fibromyalgia syndrome (FMS) and cervical disc herniation (CDH) are a common diseases commonly encountered in physical therapy clinics. There are also patients who have both of these diseases. In this study we aim to investigated whether FMS is a risk factor for cervical disc herniation and the frequency of their coincident occurrence. [Subjects and Methods] Thirty-five patients having a primary FMS diagnosis according to the American Rheumatism Association criteria are taken into consideration and a control group were the subjects of this study. The two groups were compared with respect to cervical disc hernia using cervical region MRI. [Results] The distribution of disc hernia of 6 fibromyalgia patients who had cervical discopathy was: 16.6% C2–3, 16.6% C5–6, 16.6% C6–7, 33.3% C4–5, C5–6 (two levels in two patients) and 16.6% C4–5, C5–6, C7–1 (three levels in one patient) . The herniation directions were given as: central in 5 levels, right paramedian in 1 level, and left paramedian disc hernia in 1 level. There were 4 cervical disk hernia in the control group. The herniation direction were central in two, right paramedian in one, and left paramedian in one patient. [Conclusion] In this study, the existence of cervical disc herniation in fibromyalgia patients was found to be not different from the normal population. PMID:25931731

  2. Concomitant Total Wrist and Total Elbow Arthroplasty in a Rheumatoid Patient

    OpenAIRE

    Kane, Patrick M.; Stull, Justin D.; Culp, Randall W.

    2015-01-01

    Background Concomitant arthroplasty has been described to have several benefits over multistage procedures. Ipsilateral total elbow and total shoulder arthroplasty has been reported with good outcomes in upper extremity concomitant arthroplasty.

  3. Registration in the danish hip arthroplasty registry: completeness of total hip arthroplasties and positive predictive value of registered diagnosis and postoperative complications

    DEFF Research Database (Denmark)

    Pedersen, Alma Becic; Johnsen, Søren Paaske; Overgaard, Søren

    2004-01-01

    There are few publications regarding the validity of data in hip arthroplasty registers. The Danish Hip Arthroplasty Registry (DHR) is a nationwide clinical database of THAs and revisions in Denmark.......There are few publications regarding the validity of data in hip arthroplasty registers. The Danish Hip Arthroplasty Registry (DHR) is a nationwide clinical database of THAs and revisions in Denmark....

  4. Cervical spondylotic myelopathy

    African Journals Online (AJOL)

    Although spondylotic changes of the cervical spine occur in more than half of patients over 50, less than a ... acquired narrowing of the cervical spinal canal, with subsequent mechanical and ischaemic insults to the ... event, such as a hyperextension injury after a fall. Neck pain or stiffness and gait abnormalities are common ...

  5. Cervical Cancer Prevention

    Science.gov (United States)

    ... term pregnancies have an increased risk of cervical cancer. Using oral contraceptives for a long time Among women who are ... a 10 year period, the risk of cervical cancer returns to that of women who never used oral contraceptives. Smoking cigarettes Among women who are infected with ...

  6. SCREENING FOR CERVICAL CANCER

    African Journals Online (AJOL)

    Enrique

    CANCER SCREENING. February 2004 Vol.22 No.2 CME 63. Cervical cancer remains a major health concern worldwide, especially in devel- oping countries. It is the commonest malignancy among black women in South. Africa. The quoted incidence of cervical cancer is approximately 30/100 000 women.1 Mortality is ...

  7. SCREENING FOR CERVICAL CANCER

    African Journals Online (AJOL)

    Enrique

    Cervical cancer remains a major health concern worldwide, especially in devel- oping countries. It is the commonest malignancy ... Based on data from Cali, Colombia, the impact of starting cervical screening at different ages shows that starting .... vated blue-white light is attached to the inner aspect of the upper speculum.

  8. Postoperative pain treatment after total knee arthroplasty

    DEFF Research Database (Denmark)

    Karlsen, Anders Peder Højer; Wetterslev, Mik; Hansen, Signe Elisa

    2017-01-01

    INTRODUCTION: The aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA). METHODS: This PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-b...... of an optimal procedure-specific analgesic regimen after TKA....

  9. Total hip arthroplasty: an editiorial comment.

    Science.gov (United States)

    Peterson, L F

    1977-09-01

    Total hip arthroplasty has become an accepted method of management of severe painful problems of the hip. It has undergone some dramatic changes, the major thrust now being to more nearly match the mechanical characteristics of the implant to the bone and cartilage they replace.

  10. Design improvements in Total Knee Arthroplasty

    NARCIS (Netherlands)

    Barink, M.

    2007-01-01

    The thesis deals with three questions concerning the knee joint and total knee arthroplasty. 1. Are there parameters which can be changed to reduce bone resorption, caused by TKA, without affecting other relevant parameters? A debonded anterior flange of the femoral TKA component reduces bone

  11. Total hip arthroplasty for giant cell tumour.

    Directory of Open Access Journals (Sweden)

    Kulkarni S

    1996-07-01

    Full Text Available A 32 month follow up of an uncommon case of a Giant Cell Tumour affecting the proximal end of femur is presented. Following a wide excision, the hip was reconstructed using Charnley type of low friction total hip arthroplasty. At a 32 month review, there was no recurrence and the function was good.

  12. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery...

  13. Technical pearls in total hip arthroplasty

    NARCIS (Netherlands)

    Mulier, M.; Raaijmaakers, M.; van den Bekerom, M.

    2010-01-01

    Total hip arthroplasty (THA) has had a big impact on the quality of life of millions of patients. Primary THA has a very high success rate and implant survival time of more than 30 years have been reported. However, because of the high number of procedures performed, the small percentage of patients

  14. Knee Arthroplasty: With or Without Patellar Component?

    Directory of Open Access Journals (Sweden)

    Árpád Sólyom

    2015-09-01

    Full Text Available Arthroplasty is used when there is irreversible damage to the articular cartilage of the knee. It involves implanting a bicompartimental (femoral and tibial components or a tricompartimental (femoral, tibial and patellar components prosthesis. It is a very invasive and costly operation, so our objective was to evaluate the necessity of the patellar component.

  15. Innovations in revision total knee arthroplasty

    NARCIS (Netherlands)

    Meijer, Marrigje

    2015-01-01

    Osteoarthritis (OA) is the most common joint disorder in the world and total knee arthroplasty (TKA) is thought to be the gold standard for the surgical treatment of end-stage OA. Despite good results, a significant proportion of patients need to have their knee prosthesis replaced, and an increase

  16. POSTERIOR APPROACH FOR HIP ARTHROPLASTY: A SINGLE ...

    African Journals Online (AJOL)

    The most common indication was osteoarthritis. Two complications were encountered; surgical site infection and post-operative cerebrovascular accident. There were no dislocations. Conclusions: The posterior approach is a viable approach for hip arthroplasty for use in Kenya with low complication rates. INTRODUCTION.

  17. Sleep Disturbance and Anatomic Shoulder Arthroplasty.

    Science.gov (United States)

    Morris, Brent J; Sciascia, Aaron D; Jacobs, Cale A; Edwards, T Bradley

    2017-05-01

    Sleep disturbance is commonly encountered in patients with glenohumeral joint arthritis and can be a factor that drives patients to consider surgery. The prevalence of sleep disturbance before or after anatomic total shoulder arthroplasty has not been reported. The authors identified 232 eligible patients in a prospective shoulder arthroplasty registry following total shoulder arthroplasty for primary glenohumeral joint arthritis with 2- to 5-year follow-up. Sleep disturbance secondary to the affected shoulder was characterized preoperatively and postoperatively as no sleep disturbance, frequent sleep disturbance, or nightly sleep disturbance. A total of 211 patients (91%) reported sleep disturbance prior to surgery. Patients with nightly sleep disturbance had significantly worse (Psleep disturbance, with 186 patients (80%) reporting no sleep disturbance (Psleep disturbance group had significantly greater patient-reported outcome scores and range of motion following surgery compared with the other sleep disturbance groups for nearly all outcome measures (P≤.01). Patients have significant improvements in sleep after anatomic shoulder arthroplasty. There was a high prevalence of sleep disturbance preoperatively (211 patients, 91%) compared with postoperatively (46 patients, 20%). [Orthopedics. 2017; 40(3):e450-e454.]. Copyright 2017, SLACK Incorporated.

  18. Efficiency analysis on a two-level three-phase quasi-soft-switching inverter

    DEFF Research Database (Denmark)

    Geng, Pan; Wu, Weimin; Huang, Min

    2013-01-01

    When designing an inverter, an engineer often needs to select and predict the efficiency beforehand. For the standard inverters, plenty of researches are analyzing the power losses and also many software tools are being used for efficiency calculation. In this paper, the efficiency calculation...... for non-conventional inverters with special shoot-through state is introduced and illustrated through the analysis on a special two-level three-phase quasi-soft-switching inverter. Efficiency comparison between the classical two-stage two-level three-phase inverter and the two-level three-phase quasi-soft...

  19. Case Report: Cervical Ectopic Pregnancy presenting as Cervical ...

    African Journals Online (AJOL)

    Cervical pregnancy is a rare but serious type of ectopic pregnancy in which the implantation site is within the cervical mucosa that lines the endocervical canal. This is a rare cervical ectopic pregnancy wrongly diagnosed as a cervical fi broid by clinicoradiological examination. The actual diagnosis was revealed by ...

  20. Prevention of infection after knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2010-01-01

    Full Text Available Scientific background: Man-made joints (joint endoprostheses, including knee endoprostheses, are used in some irreversible diseases of the human joints. The implantation of joint endoprostheses (arthroplasty is associated with an increased risk for infection. To prevent infections, different interventions without and with the use of antibiotics (hygiene procedures and antibiotic prophylaxis are used. The benefits of these interventions are not clear yet. Research questions: The presented report addresses the questions regarding the medical effectiveness, the cost-effectiveness as well as the ethical, social and legal aspects related to the use of interventions to prevent infections after knee arthroplasty. Methods: A systematic literature search is conducted in the medical electronic databases MEDLINE, EMBASE, SciSearch etc. in June 2009 and has been completed by a hand search. The analysis includes publications which describe and/or evaluate clinical data from randomized controlled trials (RCT, systematic reviews of RCT, registers of endoprostheses or databases concerning interventions to prevent infections after knee arthroplasty. The conducted literature search also aims to identify health-economic studies and publications dealing explicitly with ethical, social or legal aspects in the use of interventions to prevent infections after knee arthroplasty. The synthesis of information from different publications has been performed qualitatively. Results: The systematic literature search yields 1,030 hits. Based on the predefined inclusion and exclusion criteria a total of ten publications is included in the analysis. The presented report does not find evidence of the effectiveness of different hygiene interventions with a high evidence level. Most of the unspecific interventions are recommended on the basis of results from non-RCT, from studies for other clinical indications and/or for clinically not relevant endpoints, as well as on the basis of

  1. Dispersion management for two-level optically labeled signals in IP-over-WDM networks 4

    DEFF Research Database (Denmark)

    Chi, Nan; Carlsson, Birger; Holm-Nielsen, Pablo Villanueva

    2002-01-01

    The transmission characteristics of a two-level optically labeled signal with ASK/DPSK modulation are investigated under varying dispersion management. A limitation of extinction ratio and the resilience of fiber span, compensation ratio, and power level are obtained...

  2. Controlling the optical bistability and multistability in a two-level pumped-probe system

    International Nuclear Information System (INIS)

    Mahmoudi, Mohammad; Sahrai, Mostafa; Masoumeh Mousavi, Seyede

    2010-01-01

    We study the behavior of the optical bistability (OB) and multistability (OM) in a two-level pumped-probe atomic system by means of a unidirectional ring cavity. We show that the optical bistability in a two-level atomic system can be controlled by adjusting the intensity of the pump field and the detuning between two fields. We find that applying the pumping field decreases the threshold of the optical bistability.

  3. Two-level incremental checkpoint recovery scheme for reducing system total overheads.

    Science.gov (United States)

    Li, Huixian; Pang, Liaojun; Wang, Zhangquan

    2014-01-01

    Long-running applications are often subject to failures. Once failures occur, it will lead to unacceptable system overheads. The checkpoint technology is used to reduce the losses in the event of a failure. For the two-level checkpoint recovery scheme used in the long-running tasks, it is unavoidable for the system to periodically transfer huge memory context to a remote stable storage. Therefore, the overheads of setting checkpoints and the re-computing time become a critical issue which directly impacts the system total overheads. Motivated by these concerns, this paper presents a new model by introducing i-checkpoints into the existing two-level checkpoint recovery scheme to deal with the more probable failures with the smaller cost and the faster speed. The proposed scheme is independent of the specific failure distribution type and can be applied to different failure distribution types. We respectively make analyses between the two-level incremental and two-level checkpoint recovery schemes with the Weibull distribution and exponential distribution, both of which fit with the actual failure distribution best. The comparison results show that the total overheads of setting checkpoints, the total re-computing time and the system total overheads in the two-level incremental checkpoint recovery scheme are all significantly smaller than those in the two-level checkpoint recovery scheme. At last, limitations of our study are discussed, and at the same time, open questions and possible future work are given.

  4. Coloarticular fistula: A rare complication of revision total hip arthroplasty

    OpenAIRE

    Long, Suzanne S.; Tawa, Nicholas E.; Ayres, Douglas K.; Abdeen, Ayesha; Wu, Jim S.

    2011-01-01

    Fistula formation between bowel and total hip arthroplasty or revision arthroplasty hardware is rare. We present a case of a 78-year-old woman with protrusio of left hip arthroplasty and acetabular reconstruction hardware that caused direct perforation of the sigmoid colon and fistula formation between the sigmoid colon and the left hip joint. The patient underwent several joint debridements, sigmoid colectomy, and removal of all orthopedic hardware; she ultimately died after two prolonged ho...

  5. Adverse Outcomes in Hip Arthroplasty: Long-Term Trends

    Science.gov (United States)

    Wolf, Brian R.; Lu, Xin; Li, Yue; Callaghan, John J.; Cram, Peter

    2012-01-01

    Background: Total hip arthroplasty is a common surgical procedure, but little is known about longitudinal trends in associated adverse outcomes. Our objective was to describe long-term trends in demographics, comorbidities, and adverse outcomes for older patients who underwent primary and revision total hip arthroplasty. Methods: We identified a retrospective, observational cohort of 1,405,379 Medicare beneficiaries who underwent primary total hip arthroplasty and 337,874 who underwent revision total hip arthroplasty between 1991 and 2008. The primary outcome was a composite representing the occurrence of one or more of the following adverse outcomes during the index admission or during readmission within ninety days after discharge: death, hemorrhage, infection, pulmonary embolism, sepsis, deep venous thrombosis, and myocardial infarction. Secondary outcomes included each of these outcomes assessed individually. Results: Between 1991 and 2008, the mean age and the mean comorbidity burden increased for all total hip arthroplasty patients. The length of hospital stay after primary and revision total hip arthroplasty declined by approximately 50% over the study period. However, the rate of readmission for any cause has recently increased and has surpassed 10% for primary total hip arthroplasty and 20% for revision total hip arthroplasty. The composite rate of adverse outcomes after primary total hip arthroplasty declined from 4% to 3.4% over the study period, whereas the composite adverse outcome rate after revision total hip arthroplasty slowly increased from 7% to 10.9%. We observed a steady decline in the rates of most individual adverse outcomes after primary total hip arthroplasty over the majority of the study period. Many of these rates stabilized or began to increase slightly near the end of the study period. In contrast, an increase in the rates of many adverse outcomes was observed in the revision total hip arthroplasty population even after accounting for

  6. Utilization trends of cervical artificial disc replacement after FDA approval compared with anterior cervical fusion: adoption of new technology.

    Science.gov (United States)

    Lu, Young; McAnany, Steven J; Hecht, Andrew C; Cho, Samuel K; Qureshi, Sheeraz A

    2014-02-01

    Epidemiologic study. To compare the utilization of anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) in terms of patient and hospital characteristics during the 3 years after Food and Drug Administration (FDA) approval of CDA devices in 2007. There was a surge in CDA adoption in the 3 years prior to FDA approval of CDA devices in 2007. However, utilization trends of CDA versus ACDF since the FDA approval are unknown. The Nationwide Inpatient Sample database was used to identify CDA and ACDF procedures performed in the United States in the 3 years after FDA approval of CDA devices (2008-2010). The frequencies of CDA and ACDF were estimated, stratified by patient and hospital characteristics. Average length of hospital stay and total charges and costs were estimated. Multivariable analysis was performed to identify patient and hospital characteristics associated with CDA utilization. In the 3 years after FDA approval of cervical disc devices, population-adjusted growth rates for CDA and ACDF were 4.9% and 11.8%, respectively (P = 0.6977). Female, African American and Medicaid patients were less likely to receive CDA. CDA was less likely to be performed in patients with cervical spondylotic changes and more likely to be performed in younger and healthier patients. CDA was less likely to be performed in the Midwestern United States or in public hospitals. The prevalence of CDA increased in the 3 years after FDA approval with a growth rate that is approximately twice than that for ACDF. Although there seems to be CDA adoption, CDA growth seemed to have reached a plateau and ACDF still remained the dominant surgical strategy for cervical disc disease. Possible regional, racial, and sex disparities in CDA utilization and a more strict approach in the selection of CDA over traditional ACDF may have impeded rapid adoption of CDA. 3.

  7. The Nordic Arthroplasty Register Association

    Science.gov (United States)

    Fenstad, Anne M; Salomonsson, Roger; Mehnert, Frank; Furnes, Ove; Overgaard, Søren; Pedersen, Alma B; Herberts, Peter; Kärrholm, Johan; Garellick, Göran

    2009-01-01

    Background and purpose The possibility of comparing results and of pooling the data has been limited for the Nordic arthroplasty registries, because of different registration systems and questionnaires. We have established a common Nordic database, in order to compare demographics and the results of total hip replacement surgery between countries. In addition, we plan to study results in patient groups in which the numbers are too small to be studied in the individual countries. Material and methods Primary total hip replacements (THRs) from 1995–2006 were selected for the study. Denmark, Sweden, and Norway contributed data. A common code set was made and Cox multiple regression, with adjustment for age, sex, and diagnosis was used to calculate prosthesis survival with any revision as endpoint. Results 280,201 operations were included (69,242 from Denmark, 140,821 from Sweden, and 70,138 from Norway). Females accounted for 60% of the patients in Denmark and Sweden, and 70% in Norway. Childhood disease was the cause of 3.1%, 1.8%, and 8.7% of the operations in Denmark, Sweden, and Norway, respectively. Resurfacing of hips accounted for 0.5% or less in all countries. The posterior approach was used in 91% of cases in Denmark, 60% in Sweden, and 24% in Norway. Cemented THRs were used in 46% of patients in Denmark, in 89% of patients in Sweden, and in 79% of patients in Norway. Of the 280,201 primary THRs, 9,596 (3.4%) had been revised. 10-year survival was 92% (95% CI: 91.6–92.4) in Denmark, 94% (95% CI: 93.6–94.1) in Sweden, and 93% (95% CI: 92.3–93.0) in Norway. In Denmark, 34% of the revisions were due to dislocation, as compared to 23% in Sweden and Norway. Replacement of only cup or liner constituted 44% of the revisions in Denmark, 29% in Sweden, and 33% in Norway. Interpretation This unique common Nordic collaboration has shown differences between the countries concerning demographics, prosthesis fixation, and survival. The large number of patients in

  8. Cervical intervertebral disc replacement.

    Science.gov (United States)

    Cason, Garrick W; Herkowitz, Harry N

    2013-02-06

    Symptomatic adjacent-level disease after cervical fusion has led to the development and testing of several disc-replacement prostheses. Randomized controlled trials of cervical disc replacement (CDR) compared with anterior cervical discectomy and fusion (ACDF) have demonstrated at least equivalent clinical results for CDR with similar or lower complication rates. Biomechanical, kinematic, and radiographic studies of CDR reveal that the surgical level and adjacent vertebral level motion and center of rotation more closely mimic the native state. Lower intradiscal pressures adjacent to CDR may help decrease the incidence of adjacent spinal-level disease, but long-term follow-up is necessary to evaluate this theory.

  9. Utilization rates of knee-arthroplasty in OECD countries.

    Science.gov (United States)

    Pabinger, C; Lothaller, H; Geissler, A

    2015-10-01

    The number of knee arthroplasties and the prevalence of obesity are increasing exponentially. To date there have been no published reviews on utilization rates of knee arthroplasty in OECD countries. We analysed economic, medical and population data relating to knee arthroplasty surgeries performed in OECD countries. Gross domestic product (GDP), health expenditures, obesity prevalence, knee arthroplasty utilization rates and growth in knee arthroplasty rates per 100,000 population were assessed for total population, for patients aged 65 years and over, and patients aged 64 years and younger. Obesity prevalence and utilization of knee arthroplasty have increased significantly in the past. The mean utilization rate of knee arthroplasty was 150 (22-235) cases per 100,000 total population in 2011. The strongest annual increase (7%) occurred in patients 64 years and under. Differences between individual countries can be explained by economic and medical patterns, with countries with higher medical expenditures and obesity prevalence having significantly higher utilization rates. Countries with lower utilization rates have significantly higher growth in utilization rates. The future demand for knee prostheses will increase x-fold by 2030, with exact rates dependant upon economic, social and medical factors. We observed a 10-fold variation in the utilization of knee arthroplasty among OECD countries. A significant and strong correlation of GDP, health expenditures and obesity prevalence with utilization of knee arthroplasty was found. Patients aged 64 years and younger show a two-fold higher growth rate in knee arthroplasty compared to the older population. This trend could result in a four-fold demand for knee arthroplasty in OECD countries by 2030. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  10. Nongonococcal and Nonchlamydial Cervicitis.

    Science.gov (United States)

    Nyirjesy, Paul

    2001-12-01

    Cervicitis encompasses a variety of gynecologic conditions. Although inflammation on a Papanicolaou smear may be indicative of true cervical inflammation, establishing a diagnosis of mucopurulent cervicitis (MCP) is more clinically useful. MCP seems to be analogous to nongonococcal urethritis in men. Many cases of MCP are related to Chlamydia trachomatis infection, but the majority of cases have other potential causes. Other possible pathogens include Neisseria gonorrhoeae, Trichomonas vaginalis, Ureaplasma urealyticum, Mycoplasma genitalium, herpes simplex virus, and cytomegalovirus. Many cases may be related to cervical ectopy. MCP is a marker for endometritis, salpingitis, and adverse pregnancy outcomes. Given the current shortcomings in our understanding of this disease, an empiric approach to evaluation and treatment is suggested.

  11. Immunotherapy for Cervical Cancer

    Science.gov (United States)

    In an early phase NCI clinical trial, two patients with metastatic cervical cancer had a complete disappearance of their tumors after receiving treatment with a form of immunotherapy called adoptive cell transfer.

  12. Screening for Cervical Cancer

    Science.gov (United States)

    ... cervical cancer: • Cytology: This test, also called a Pap test or Pap smear, looks for abnormal changes in ... women ages 21 to 65, screening with a Pap test every 3 years has the highest benefits with ...

  13. Two-Level Solutions to Exponentially Complex Problems in Glass Science

    DEFF Research Database (Denmark)

    Mauro, John C.; Smedskjær, Morten Mattrup

    Glass poses an especially challenging problem for physicists. The key to making progress in theoretical glass science is to extract the key physics governing properties of practical interest. In this spirit, we discuss several two-level solutions to exponentially complex problems in glass science....... Topological constraint theory, originally developed by J.C. Phillips, is based on a two-level description of rigid and floppy modes in a glass network and can be used to derive quantitatively accurate and analytically solvable models for a variety of macroscopic properties. The temperature dependence...... that captures both primary and secondary relaxation modes. Such a model also offers the ability to calculate the distinguishability of particles during glass transition and relaxation processes. Two-level models can also be used to capture the distribution of various network-forming species in mixed...

  14. Crossing rule for a PT-symmetric two-level time-periodic system

    International Nuclear Information System (INIS)

    Moiseyev, Nimrod

    2011-01-01

    For a two-level system in a time-periodic field we show that in the non-Hermitian PT case the level crossing is of two quasistationary states that have the same dynamical symmetry property. At the field's parameters where the two levels which have the same dynamical symmetry cross, the corresponding quasienergy states coalesce and a self-orthogonal state is obtained. This situation is very different from the Hermitian case where a crossing of two quasienergy levels happens only when the corresponding two quasistationary states have different dynamical symmetry properties and, unlike the situation in the non-Hermitian case, the spectrum remains complete also when the two levels cross.

  15. Thromboembolism prophylaxis practices in orthopaedic arthroplasty patients.

    LENUS (Irish Health Repository)

    Cawley, D

    2010-10-01

    Thromboembolic events are a post-operative complication of arthroplasty surgery for up to 3 months. The incidence however, is not fully known. Some form of prophylaxis should be provided to all arthroplasty patients. Clinicians are wary of side effects, compliance profile and the associated cost. The objective of this study is to investigate practice patterns and their relevance to 3 risk groups. Ninety questionnaires were sent to orthopaedic surgeons with 3 hypothetical clinical scenarios and 10 prophylaxis regimes for thromboembolism across different risk groups. The response rate was 81\\/90 (90%). The most popular options in all 3 cases were early mobilisation, thrombo-embolism deterrant (TED) stockings and low molecular weight heparin (LMWH) (51\\/81, 62% of all cases). An inconsistent relationship exists between preferred practice and relevant guidelines. Preferred practice does not correlate with each level of risk.

  16. Heterotopic bone formation following total shoulder arthroplasty

    DEFF Research Database (Denmark)

    Kjaersgaard-Andersen, P.; Frich, Lars Henrik; Sjøbjerg, J.O.

    1989-01-01

    the glenohumeral and/or the glenoacromial space. There was no correlation between shoulder pain and the development of ossification. Shoulders with grade III heterotopic bone formation had a limited range of active elevation compared with shoulders without or with only a milder lesion. Men and patients......The incidence and location of heterotopic bone formation following total shoulder arthroplasty were evaluated in 58 Neer Mark-II total shoulder replacements. One year after surgery, 45% had developed some ectopic ossification. In six shoulders (10%) the ossifications roentgenographically bridged...... with osteoarthritis of the shoulder joint were significantly disposed to the development of heterotopic bone. Heterotopic bone formation following total shoulder arthroplasty is frequent, but disabling heterotopic ossifications seem to be rare....

  17. Total hip arthroplasty: a still evolving technique

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Galia

    Full Text Available ABSTRACT It has been advocated that total hip arthroplasty (THA is probably the most successful surgical intervention performed in Medicine. In the 1960s, Sir John Charnley not only introduced, but also modified and improved the technique of cemented arthroplasties. The concepts on biological , fixation established by Pillar and Galante served as the foundation for the development of uncemented implants that are now used worldwide. Currently, THA is a worldwide widespread surgery performed on millions of people. However, keeping abreast of the large number of information available on these procedures, especially on implant fixation, designs, different tribological pairings, and the long-term results can be challenging at times. This article is a brief update on the main aspects of THA.

  18. Hyperphosphatemic Tumoral Calcinosis after Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Takeshi Mochizuki

    2017-01-01

    Full Text Available We report a case of hyperphosphatemic tumoral calcinosis (TC that occurred after total knee arthroplasty. A 64-year-old Japanese man presented with painful swellings in both shoulders, the left elbow, and the right hip that developed after he underwent total knee arthroplasty (TKA. The pathology of the patient’s bone at the time of TKA included a thick osteoid seam with calcareous deposition at the margin of the trabecular bone, which is not generally seen in osteoarthritis. Computed tomography scans of the swollen joints demonstrated leaflet and amorphous calcification masses around the joints. We diagnosed the patient with TC. The present case highlights that TC lesions are rare but should be considered in the differential diagnosis of subcutaneous soft and hard masses around the joint.

  19. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery....... Methods 29 patients were operated with 30 revision arthroplasties. Median age was 67 (34-84) years. All patients followed a standardized fast-track set-up designed for primary TKA. We determined the outcome regarding LOS, morbidity, mortality, and satisfaction. Results Median LOS was 2 (1-4) days...... undergoing revision TKA for non-septic reasons may be included in fast-track protocols. Outcome appears to be similar to that of primary TKA regarding LOS, morbidity, and satisfaction. Our findings call for larger confirmatory studies and studies involving other indications (revision THA, 1-stage septic...

  20. Dolor cervical incoercible

    Directory of Open Access Journals (Sweden)

    Adrián F Narváez-Muñoz

    2014-03-01

    Astrocytomas are relatively common glial neoplasm of the central nervous system, but only a small percentage of them are located in the spinal cord, with a predilection for the cervical and dorsal regions. In most cases, extend longitudinally, affecting several cord segments. Pain is a frequent symptom of local character bone segments involving the tumor, associated with sensory deficit and / or motor. The following is the case of a 60 year old woman with cervical cord astrocytoma extended to the brainstem.

  1. A two-level cache for distributed information retrieval in search engines.

    Science.gov (United States)

    Zhang, Weizhe; He, Hui; Ye, Jianwei

    2013-01-01

    To improve the performance of distributed information retrieval in search engines, we propose a two-level cache structure based on the queries of the users' logs. We extract the highest rank queries of users from the static cache, in which the queries are the most popular. We adopt the dynamic cache as an auxiliary to optimize the distribution of the cache data. We propose a distribution strategy of the cache data. The experiments prove that the hit rate, the efficiency, and the time consumption of the two-level cache have advantages compared with other structures of cache.

  2. Application of the postulates to some simple cases: spin 1/2 and two level systems

    International Nuclear Information System (INIS)

    Cohen-Tannoudji, Claude; Diu, Bernard; Laloe, Franck.

    1977-01-01

    Particle of spin 1/2 (quantization of kinetic momentum), illustration of the postulates of quantum mechanics on the spin 1/2 case and study of two level systems are presented. In complement are exposed: Pauli matrix; diagonalization of 2x2 hermitian matrix; fictitious spin 1/2 associated with a two level system; the two spin 1/2 system; density matrix of spin 1/2; spin 1/2 in static magnetic field and rotating field (magnetic resonance); study of the ammonia molecule by a simple model; effects of a coupling between a steady and a unsteady state [fr

  3. Interacting and self-organized two-level states in tunnel barriers

    Science.gov (United States)

    Pesenson, L.; Robertazzi, R. P.; Buhrman, R. A.; Cypher, S. R.; Hunt, B. D.

    1991-01-01

    The excess low-frequency 1/f noise and discrete two-level resistance fluctuations (TLFs) were studied in small-area NbN-MgO-NbN tunnel junctions with a high, low-temperature density of active defects. Strong and evolving interactions between large TLFs indicate that these fluctuations result from the self-organization of interacting defect elements. In the low-T tunneling regime, an unusual slowing down of the rates and a decrease in amplitude with increasing T is sometimes observed indicative of a thermally induced change in the self-organized two-level state.

  4. Endotoxins in surgical instruments of hip arthroplasty

    OpenAIRE

    Goveia, Vania Regina; Mendoza, Isabel Yovana Quispe; Guimarães, Gilberto Lima; Ercole, Flavia Falci; Couto, Bráulio Roberto Gonçalves Marinho; Leite, Edna Marilea Meireles; Stoianoff, Maria Aparecida Resende; Ferreira, José Antonio Guimarães

    2016-01-01

    Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60...

  5. Proprioception after bicruciate-retaining total knee arthroplasty is comparable to unicompartmental knee arthroplasty.

    Science.gov (United States)

    Baumann, Florian; Bahadin, Özkan; Krutsch, Werner; Zellner, Johannes; Nerlich, Michael; Angele, Peter; Tibesku, Carsten Oliver

    2017-06-01

    Rising expectations in functional performance of total knee joints are inciting further improvement of knee arthroplasty implants. From a patient-centred view, bicruciate-retaining models provide a more natural feeling knee. However, there is no evidence of functional advantage for these implants. The aim of this study was to evaluate balance ability as a measure of proprioception in patients with a bicruciate-retaining total knee arthroplasty. A prospective, controlled trial was conducted to compare balance ability in 60 patients after arthroplasty of the knee for osteoarthritis. We compared patients with a bicruciate-retaining knee arthroplasty (BCR group) to a control group of patients with a medial unicompartmental knee arthroplasty (UKA group) and another control group of patients with a posterior stabilized total knee arthroplasty (PS group). The patient population comprised 30 women (50.0 %) and 30 men in three cohorts of 20 each. The mean age was 62.1 ± 8.0 years (range 43-78). Patients were evaluated preoperatively and 9 months post-operatively. The evaluation included clinical, radiological, and balance testing-a single-leg stance with eyes closed compared to eyes open. The difference in area of sway between eyes closed and eyes open represents static balance ability after knee arthroplasty. Perioperative data showed that there was no intra-operative fracture of the intercondylar eminence. There was a decreased post-operative knee extension 9 months post-operative in the BCR group, which was not clinically relevant in any case. We recorded a lower difference in the area of sway between eyes closed and eyes open (ΔA (ec-eo) ) for the BCR group (p = 0.01) and the UKA group (p = 0.04) compared to the PS group. This study found superior static balance ability after preservation of both cruciate ligaments in arthroplasty of the knee, indicating superior proprioceptive function. Hence, BCR implants could provide improved functional properties

  6. Revision of the Failed Thumb Carpometacarpal Arthroplasty.

    Science.gov (United States)

    Papatheodorou, Loukia K; Winston, Jonathan D; Bielicka, Deidre L; Rogozinski, Benjamin J; Lourie, Gary M; Sotereanos, Dean G

    2017-12-01

    To evaluate the outcome of revision surgery for failed thumb carpometacarpal (CMC) arthroplasty. We retrospectively analyzed 32 patients with failed thumb CMC arthroplasty. The primary reason for revision was pain caused by metacarpal subsidence. Revision surgery included soft tissue interposition and distraction pinning to address the metacarpal subsidence. Additional ligament reconstruction was performed in patients with thumb instability. Eight patients required additional metacarpophalangeal joint fusion for concomitant joint hyperextension. Eleven required additional partial excision of the trapezoid for concomitant scaphotrapezoidal joint arthritis. All patients were evaluated clinically and radiographically. Mean follow-up was 57 months (range, 24-121 months). Pain levels evaluated by visual analog scale were significantly reduced in all patients after revision surgery. Mean grip strength and key pinch strength significantly increased. Twenty-seven patients achieved good functional results; those for 5 patients were fair. This study showed that revision surgery with distraction pinning and soft tissue interposition with or without ligament reconstruction was an effective treatment for failed CMC arthroplasty of the thumb. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. [Cervical discopathy, cervical migraine and vertebrobasilar arterial insufficiency: Clinical correlations].

    Science.gov (United States)

    Domzał, T; Zaleska, B; Kwasucki, J

    1978-01-01

    The pathogenesis of cervical migraine may suggest that a connection exists between it and cervical discopathy and also vertebrobasilar arterial insufficiency. This correlation was studied in a group of 103 patients subjected to clinical observations. In 83 of them cervical discopathy was found, in 69 cervical migraine and in 40 vertebrobasilar insufficiency were present. Among those with discopathy migraine was present in 63.6% of cases, and vertebrobasilar insufficiency in 31%. In patients with cervical migraine degenerative changes of the type of cervical discopathy were present in 90% of cases, although in only 56.5% of cases clinical signs were present connected with these changes. Vertebrobasilar insufficiency was present in 45% of patients with cervical migraine, that is more frequently than in discopathy. In the group with vertebrobasilar insufficiency radiological changes in the cervical spine were present in 77.5% of cases and the same proportion of patients in this group had cervical migraine. These numbers confirm the connection between cervical migraine and radiological changes and clinical manifestations of discopathy, and they indicate also that cervical migraine may be a successive stage of vascular changes leading to circulatory failure in the area supplied by vertebral arteries. This failure may have a different course and pathological mechanism. In 12.5% of patients in this group no cervical migraine or radiological changes were demonstrated. The term "cervical migraine" seems inappropriate since this type of headache has another substrate and mechanism than true migraine.

  8. Radiation Therapy Plus Cisplatin and Gemcitabine in Treating Patients With Cervical Cancer

    Science.gov (United States)

    2014-12-23

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer

  9. Distraction Arthroplasty of the Trapeziometacarpal Joint Without Trapeziectomy

    Directory of Open Access Journals (Sweden)

    Kin Weng Wong

    2011-01-01

    Conclusion: Our technique (distraction arthroplasty without trapeziectomy preserves bony and adjacent structures. It is easier and quicker than traditional arthroplasties. It serves as another effective and stable method of tendon reconstruction with a less invasive approach. A larger series is needed for further observation of validity of the procedure.

  10. Perioperative blood saving measures in total hip and knee arthroplasty

    NARCIS (Netherlands)

    Horstmann, W.G.

    2011-01-01

    This dissertation explores and discusses different aspects of blood loss and blood-saving measures in total hip and knee arthroplasty. Background: Worldwide, approximately 1 million total hip and 1 million total knee prostheses are implanted each year. Total hip arthroplasty and total

  11. Low implant migration of the SIGMA® medial unicompartmental knee arthroplasty

    DEFF Research Database (Denmark)

    Koppens, Daan; Stilling, Maiken; Munk, Stig

    2017-01-01

    The purpose of this study was to evaluate implant migration of the fixed-bearing Sigma® medial unicompartmental knee arthroplasty (UKA). UKA is a regularly used treatment for patients with medial osteoarthritis (OA) of the knee. UKA has a higher revision rate than total knee arthroplasty. Implant...... migration can be used as a predictor of implant loosening....

  12. Pulsed Rabi oscillations in quantum two-level systems: beyond the area theorem

    Science.gov (United States)

    Fischer, Kevin A.; Hanschke, Lukas; Kremser, Malte; Finley, Jonathan J.; Müller, Kai; Vučković, Jelena

    2018-01-01

    The area theorem states that when a short optical pulse drives a quantum two-level system, it undergoes Rabi oscillations in the probability of scattering a single photon. In this work, we investigate the breakdown of the area theorem as both the pulse length becomes non-negligible and for certain pulse areas. Using simple quantum trajectories, we provide an analytic approximation to the photon emission dynamics of a two-level system. Our model provides an intuitive way to understand re-excitation, which elucidates the mechanism behind the two-photon emission events that can spoil single-photon emission. We experimentally measure the emission statistics from a semiconductor quantum dot, acting as a two-level system, and show good agreement with our simple model for short pulses. Additionally, the model clearly explains our recent results (Fischer and Hanschke 2017 et al Nat. Phys.) showing dominant two-photon emission from a two-level system for pulses with interaction areas equal to an even multiple of π.

  13. Random model of two-level atoms interacting with electromagnetic field

    International Nuclear Information System (INIS)

    Kireev, A.N.; Meleshko, A.N.

    1983-12-01

    A phase transition has been studied in a random system of two-level atoms interacting with an electromagnetic field. It is shown that superradiation can arise when there is short-range order in a spin-subsystem. The existence of long-range order is irrelevant for this phase transition

  14. Approximate response of a two-level system to intense multimode radiation

    International Nuclear Information System (INIS)

    Geltman, S.

    1981-01-01

    The rotating wave solution for a two-level atom in an intense monochromatic radiation field is extended by an approximation to the case of a multimode radiation field. Expressions for the resultant average excitation probability of the upper state are presented for rectangular and triangular pulses. (orig.)

  15. Polynomial pseudosupersymmetry underlying a two-level atom in an external electromagnetic field

    International Nuclear Information System (INIS)

    Samsonov, B.F.; Shamshutdinova, V.V.; Gitman, D.M.

    2005-01-01

    Chains of transformations introduced previously were studied in order to obtain electric fields with a time-dependent frequency for which the equation of motion of a two-level atom in the presence of these fields can be solved exactly. It is shown that a polynomial pseudosupersymmetry may be associated to such chains

  16. Excitation of graphene plasmons as an analogy with the two-level system

    International Nuclear Information System (INIS)

    Fu, Jiahui; Lv, Bo; Li, Rujiang; Ma, Ruyu; Chen, Wan; Meng, Fanyi

    2016-01-01

    The excitation of graphene plasmons (GPs) is presented as an interaction between the GPs and the incident electromagnetic field. In this Letter, the excitation of GPs in a plasmonic system is interpreted as an analogy with the two-level system by taking the two-coupled graphene-covered gratings as an example. Based on the equivalent circuit theory, the excitation of GPs in the graphene-covered grating is equivalent to the resonance of an oscillator. Thus, according to the governing equation, the electric currents at the resonant frequencies for two-coupled graphene-covered gratings correspond to the energy states in a two-level system. In addition, the excitation of GPs in different two-coupled graphene-covered gratings is numerically studied to validate our theoretical model. Our work provides an intuitive understanding of the excitation of GPs using an analogy with the two-level system. - Highlights: • The excitation of graphene plasmons (GPs) in graphene-covered grating is equivalent to the resonance of an oscillator. • We establish the equivalent circuit of two-level system to analyze the resonant character. • The excitation of GPs in different two-coupled graphene-covered gratings are numerically studied to validate our theoretical model.

  17. Exact Solution of the Two-Level System and the Einstein Solid in the Microcanonical Formalism

    Science.gov (United States)

    Bertoldi, Dalia S.; Bringa, Eduardo M.; Miranda, E. N.

    2011-01-01

    The two-level system and the Einstein model of a crystalline solid are taught in every course of statistical mechanics and they are solved in the microcanonical formalism because the number of accessible microstates can be easily evaluated. However, their solutions are usually presented using the Stirling approximation to deal with factorials. In…

  18. The Effect of two levels of counselling on acceptance, uptake and ...

    African Journals Online (AJOL)

    Objective: To determine the effect of two levels of counselling on the provision of Intrauterine Contraceptive Device (IUCD) at six weeks post-partum of the postplacental intrauterine device. Setting: Embu Provincial General Hospital, Kenya. Subjects: One hundred and thirty seven pregnant women at the gestation of 36 ...

  19. Electronic decoherence of two-level systems in a Josephson junction

    Science.gov (United States)

    Bilmes, Alexander; Zanker, Sebastian; Heimes, Andreas; Marthaler, Michael; Schön, Gerd; Weiss, Georg; Ustinov, Alexey V.; Lisenfeld, Jürgen

    2017-08-01

    The sensitivity of superconducting qubits allows for spectroscopy and coherence measurements on individual two-level systems present in the disordered tunnel barrier of an Al /AlOx /Al Josephson junction. We report experimental evidence for the decoherence of two-level systems by Bogoliubov quasiparticles leaking into the insulating AlOx barrier. We control the density of quasiparticles in the junction electrodes either by the sample temperature or by injecting them using an on-chip dc superconducting quantum interference device driven to its resistive state. The decoherence rates were measured by observing the two-level system's quantum state evolving under application of resonant microwave pulses and were found to increase linearly with quasiparticle density, in agreement with theory. This interaction with electronic states provides a noise and decoherence mechanism that is relevant for various microfabricated devices such as qubits, single-electron transistors, and field-effect transistors. The presented experiments also offer a possibility to determine the location of the probed two-level systems across the tunnel barrier, providing clues about the fabrication step in which they emerge.

  20. Resonant retuning of Rabi oscillations in a two-level system

    International Nuclear Information System (INIS)

    Leonov, A.V.; Feranchuk, I.D.

    2009-01-01

    The evolution of a two-level system in a single-mode quantum field is considered beyond the rotating wave approximation. The existence of quasi-degenerate energy levels is shown to influence the essential characteristics of temporal and amplitude Rabi oscillations of the system in a resonant manner. (authors)

  1. A two-level stochastic collocation method for semilinear elliptic equations with random coefficients

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Luoping; Zheng, Bin; Lin, Guang; Voulgarakis, Nikolaos

    2017-05-01

    In this work, we propose a novel two-level discretization for solving semilinear elliptic equations with random coefficients. Motivated by the two-grid method for deterministic partial differential equations (PDEs) introduced by Xu, our two-level stochastic collocation method utilizes a two-grid finite element discretization in the physical space and a two-level collocation method in the random domain. In particular, we solve semilinear equations on a coarse mesh $\\mathcal{T}_H$ with a low level stochastic collocation (corresponding to the polynomial space $\\mathcal{P}_{P}$) and solve linearized equations on a fine mesh $\\mathcal{T}_h$ using high level stochastic collocation (corresponding to the polynomial space $\\mathcal{P}_p$). We prove that the approximated solution obtained from this method achieves the same order of accuracy as that from solving the original semilinear problem directly by stochastic collocation method with $\\mathcal{T}_h$ and $\\mathcal{P}_p$. The two-level method is computationally more efficient, especially for nonlinear problems with high random dimensions. Numerical experiments are also provided to verify the theoretical results.

  2. Reactive Power Impact on Lifetime Prediction of Two-level Wind Power Converter

    DEFF Research Database (Denmark)

    Zhou, Dao; Blaabjerg, Frede; Lau, M.

    2013-01-01

    The influence of reactive power injection on the dominating two-level wind power converter is investigated and compared in terms of power loss and thermal behavior. Then the lifetime of both the partial-scale and full-scale power converter is estimated based on the widely used Coffin-Manson model...

  3. Two-level Schwartz methods for nonconforming finite elements and discontinuous coefficients

    Science.gov (United States)

    Sarkis, Marcus

    1993-01-01

    Two-level domain decomposition methods are developed for a simple nonconforming approximation of second order elliptic problems. A bound is established for the condition number of these iterative methods, which grows only logarithmically with the number of degrees of freedom in each subregion. This bound holds for two and three dimensions and is independent of jumps in the value of the coefficients.

  4. Two-Level System Coupled to Phonons : A Discrete Path-Integral Method

    NARCIS (Netherlands)

    Raedt, Bart De; Raedt, Hans De

    1983-01-01

    A discrete path-integral representation for the partition function of a two-level tunneling system coupled to acoustic phonons is derived. This representation allows calculation of properties in the whole coupling range. As a function of the coupling there is an abrupt (ground-state) transition from

  5. Analysis of Two-Level Support Systems with Time-Dependent Overflow - A Banking Application

    DEFF Research Database (Denmark)

    Barth, Wolfgang; Manitz, Michael; Stolletz, Raik

    2010-01-01

    In this paper, we analyze the performance of call centers of financial service providers with two levels of support and a time-dependent overflow mechanism. Waiting calls from the front-office queue flow over to the back office if a waiting-time limit is reached and at least one back-office agent...

  6. Ultimate temperature for laser cooling of two-level neutral atoms

    International Nuclear Information System (INIS)

    Bagnato, V.S.; Zilio, S.C.

    1989-01-01

    We present a simple pedagogical method to evaluate the minimum attainable temperature for laser cooling of two-level neutral atoms. Results are given as a function of the laser detuning and intensity. We also discuss the use of this approach to predict the minimum temperature of neutral atoms confined in magnetic traps. (author) [pt

  7. Entanglement of a nonlinear two two-level atoms interacting with ...

    Indian Academy of Sciences (India)

    S Abdel-Khalek

    2017-12-08

    Dec 8, 2017 ... Abstract. In this paper we investigate the entanglement dynamics between two two-level atoms interacting with two coherent fields in two spatially separated cavities which are filled with a Kerr-like medium. We examine the effect of nonlinear medium on the dynamical properties of entanglement and atomic ...

  8. A Two-Level Undercut-Profile Substrate for Chemical-Solution-Based Filamentary Coated Conductors

    DEFF Research Database (Denmark)

    Wulff, Anders Christian; Lundeman, Jesper H.; Hansen, Jørn B.

    2016-01-01

    A recently developed two-level undercut-profile substrate (2LUPS), containing two levels of plateaus connected by a curved wall with an undercut profile, enables self-forming filaments in a coated conductor during physical line-of-sight deposition of buffer and superconducting layers. In the pres......A recently developed two-level undercut-profile substrate (2LUPS), containing two levels of plateaus connected by a curved wall with an undercut profile, enables self-forming filaments in a coated conductor during physical line-of-sight deposition of buffer and superconducting layers....... In the present study, the 2LUPS concept is applied to a commercial cube-textured Ni-5at.% W tape, and the surface of the 2LUPS coated with two Gd2Zr2O7 buffer layers using chemical solution deposition is examined. Except for narrow regions near the edge of upper plateaus, the plateaus are found to be covered...... by strongly textured Gd2Zr2O7 buffer layers after dip coating and sintering....

  9. Cervical syphilitic lesions mimicking cervical cancer: a rare case report

    Directory of Open Access Journals (Sweden)

    Xiaoqing Zhu

    2015-02-01

    Full Text Available A woman presented to the hospital due to postcoital vaginal bleeding. The patient was initially diagnosed with cervical carcinoma by clinicians at a local hospital. However, a biopsy of the cervical lesions revealed chronic inflammation and erosion of the cervical mucosa, and the rapid plasma reagin ratio titer was 1:256. The patient was eventually diagnosed with syphilitic cervicitis and treated with minocycline 0.1 g twice a day. The patient was cured with this treatment.

  10. January Monthly Spotlight: Cervical Health and Cervical Cancer Disparities

    Science.gov (United States)

    In January, CRCHD joins the nation in raising awareness for Cervical Health and Cervical Cancer Disparities. This month we share a special focus on NCI/CRCHD research programs that are trying to reduce cervical cancer disparities in underserved communities and the people who are spreading the word about the importance of early detection.

  11. Cervical Stenosis, Myelopathy and Radiculopathy

    Science.gov (United States)

    ... FIND A SPECIALIST Conditions Cervical Stenosis, Myelopathy and Radiculopathy Raj Rao MD Raj Rao MD Updated 5/ ... of the spinal cord within the neck. Cervical radiculopathy refers to a loss of function in a ...

  12. TOTAL HIP ARTHROPLASTY IN CHILDREN WHO HAVE UNDERGONE ARTHROPLASTY WITH DEMINERALIZED BONE-CARTILAGE ALLOCUPS

    Directory of Open Access Journals (Sweden)

    Vladimir E. Baskov

    2017-03-01

    Full Text Available Introduction. Treating children with degenerative dystrophic diseases of the hip joint has become one of the most acute problems in contemporary orthopedics. Until recently, we performed arthroplasty by demineralized bone-cartilage allocups (DBCA in the Clinic of the Hip Joint Pathology of the Turner Scientific and Research Institute for Children’s Orthopedics for patients showing clinical and radiological signs of irreversible destruction of the hip joint; we carried out this procedure to preserve the function of the lower limb. However, over the last 8 years, we have changed our protocol for children older than 12 years of age and have replaced DBCA with total hip replacement. In a number of cases, total hip replacement was performed after a previous intervention involving arthroplasty with DBCA. Objective. To determine the technical peculiarities of total hip replacement after a previous intervention involving arthroplasty with DBCA. Material and methods. We analyzed the results of treatment involving various types of hip pathology in 13 children (100% aged between 15 and 16 years [8 girls (61.5% and 5 boys (38.5%]. The medical histories of all 13 children (100% showed repeated operations on the hip joint, ultimately resulting in arthroplasty with DBCA. All 13 children (100% underwent a total hip replacement. Upon hip replacement, all 13 patients (100% showed a pronounced thinning and hardening of the edges and the bottom of the acetabulum, which created some difficulties in the process of acetabular component implantation. The transformation of DBCA was not evident in any of the 13 cases (100%. Results. During the observation period of 3–5 years following total hip arthroplasty, all 13 cases (100% showed recovery in the range of motion and absence of pain. An important criterion for evaluating the quality of care was the complete social and domestic adaptation of all 13 children (100% during the period from 6 to 9 months following total

  13. Dynamics of quantum Fisher information in a two-level system coupled to multiple bosonic reservoirs

    Science.gov (United States)

    Wang, Guo-You; Guo, You-Neng; Zeng, Ke

    2015-11-01

    We consider the optimal parameter estimation for a two-level system coupled to multiple bosonic reservoirs. By using quantum Fisher information (QFI), we investigate the effect of the Markovian reservoirs’ number N on QFI in both weak and strong coupling regimes for a two-level system surrounded by N zero-temperature reservoirs of field modes initially in the vacua. The results show that the dynamics of QFI non-monotonically decays to zero with revival oscillations at some time in the weak coupling regime depending on the reservoirs’ parameters. Furthermore, we also present the relations between the QFI flow, the flows of energy and information, and the sign of the decay rate to gain insight into the physical processes characterizing the dynamics. Project supported by the Hunan Provincial Innovation Foundation for Postgraduate, China (Grant No. CX2014B194) and the Scientific Research Foundation of Hunan Provincial Education Department, China (Grant No. 13C039).

  14. A modified two-level three-phase quasi-soft-switching inverter

    DEFF Research Database (Denmark)

    Liu, Yusheng; Wu, Weimin; Blaabjerg, Frede

    2014-01-01

    A traditional Voltage Source Inverter (VSI) has higher efficiency than a Current Voltage Source (CSI) due to the less conduction power loss. However, the reverse recovery of the free-wheeling diode limits the efficiency improvement for the silicon devices based hard-switching VSI. The traditional...... quasi-soft-switching inverter can alternate between VSI and CSI by using a proper control scheme and thereby reduce the power losses caused by the reverse recovery of the free-wheeling diode. Nevertheless, slightly extra conduction power loss of the auxiliary switch is also introduced. In order...... to reduce the extra conduction power loss and the voltage stress across the DC-link capacitor, a modified two-level three-phase quasi-soft-switching inverter is proposed by using a SiC MOSFET instead of an IGBT. The principle of the modified two-level three-phase quasi-soft-switching inverter is analyzed...

  15. Individual and community risk factors and sexually transmitted diseases among arrested youths: a two level analysis.

    Science.gov (United States)

    Dembo, Richard; Belenko, Steven; Childs, Kristina; Wareham, Jennifer; Schmeidler, James

    2009-08-01

    High rates of infection for chlamydia and gonorrhea have been noted among youths involved in the juvenile justice system. Although both individual and community-level factors have been found to be associated with sexually transmitted disease (STD) risk, their relative importance has not been tested in this population. A two-level logistic regression analysis was completed to assess the influence of individual-level and community-level predictors on STD test results among arrested youths processed at a centralized intake facility. Results from weighted two level logistic regression analyses (n = 1,368) indicated individual-level factors of gender (being female), age, race (being African American), and criminal history predicted the youths' positive STD status. For the community-level predictors, concentrated disadvantage significantly and positively predicted the youths' STD status. Implications of these findings for future research and public health policy are discussed.

  16. Revisional Surgery for Hallux Valgus with Serial Osteotomies at Two Levels

    Directory of Open Access Journals (Sweden)

    Jason B. T. Lim

    2011-01-01

    Full Text Available The aetiology and form of hallux valgus (HV is varied with many corrective procedures described. We report a 39-year-old woman, previously treated with a Chevron osteotomy, who presented with recurrent right HV, metatarsus primus varus, and associated bunion. Osteotomies were performed at two levels as a revisional procedure. This report highlights (1 limitations of the Chevron osteotomy and (2 the revisional procedure of the two level osteotomies: (i proximal opening-wedge basal osteotomy and (ii distal short Scarf with medial closing wedges. If a Chevron osteotomy is used inappropriately, for example, in an attempt to correct too large a deformity, it may angulate laterally causing a malunion with an increased distal metatarsal articular angle. Secondly, it is feasible to correct this combined deformity using a combination of proximal opening-wedge and distal short Scarf osteotomies.

  17. Geometric analysis of minimum-time trajectories for a two-level quantum system

    Science.gov (United States)

    Romano, Raffaele

    2014-12-01

    We consider the problem of controlling in minimum time a two-level quantum system which can be subject to a drift. The control is assumed to be bounded in magnitude and to affect two or three independent generators of the dynamics. We describe the time optimal trajectories in SU(2), the Lie group of possible evolutions for the system, by means of a particularly simple parametrization of the group. A key ingredient of our analysis is the introduction of the optimal front line. This tool allows us to fully characterize the time evolution of the reachable sets and to derive the worst-case operators and the corresponding times. The analysis is performed in any regime—controlled dynamics stronger than, of the same magnitude as, or weaker than the drift term—and gives a method to synthesize quantum logic operations on a two-level system in minimum time.

  18. FAST COMMUNICATION: A PDE Based Two Level Model of the Masking Property of the Human Ear

    OpenAIRE

    Xin, Jack; Qi, Yingyong

    2003-01-01

    Human ear has the masking property that certain audible sound becomes inaudible in the presence of another sound. Masking is quantified by the raised threshold from the absolute hearing threshold in quiet. It is of scientific and practical importance to compute masking thresholds. Empirical models on masking have applications in low bit rate digital music compression. A first principle based two level model is developed with partial differential equation (PDE) at the periphe...

  19. Exact dynamics of a two-level atom beyond the rotating wave approximation

    Directory of Open Access Journals (Sweden)

    Semin Vitalii

    2017-01-01

    Full Text Available Interaction Hamiltonians of some models beyond the rotating wave approximation are just a product of two commuting operators. The evolution operator of such models can be transformed into product of two independent chronological exponents with the help of Hubbard-Stratonovich transformation. We use such a representation of the evolution operator to exactly describe a two-level atom in a photonic thermostat.

  20. Feedback controlled dephasing and population relaxation in a two-level system

    International Nuclear Information System (INIS)

    Wang Jin

    2009-01-01

    This Letter presents the maximum achievable stability and purity that can be obtained in a two-level system with both dephasing and population relaxation processes by using homodyne-mediated feedback control. An analytic formula giving the optimal amplitudes of the driving and feedback for the steady-state is also presented. Experimental examples are used to show the importance of controlling the dephasing process.

  1. The simulation of the non-Markovian behaviour of a two-level system

    Science.gov (United States)

    Semina, I.; Petruccione, F.

    2016-05-01

    Non-Markovian relaxation dynamics of a two-level system is studied with the help of the non-linear stochastic Schrödinger equation with coloured Ornstein-Uhlenbeck noise. This stochastic Schrödinger equation is investigated numerically with an adapted Platen scheme. It is shown, that the memory effects have a significant impact to the dynamics of the system.

  2. Urea metabolism in buffalo calves fed on rations containing two levels of crude protein

    International Nuclear Information System (INIS)

    Verma, D.N.; Singh, U.B.; Lal, M.; Varma, A.; Ranjhan, S.K.

    1974-01-01

    Urea entry rates into the body pools of Murrah Buffalo calves have been estimated using a single injection isotope dilution technique using 14 C-urea. The animals were fed two levels of crude proteins, namely, 13 percent lower and 19 percent higher than N.R.C. recommendations. Results show that the recycling of urea is significantly better in animals given low crude protein contents. (M.G.B.)

  3. Experiences of building a medical data acquisition system based on two-level modeling.

    Science.gov (United States)

    Li, Bei; Li, Jianbin; Lan, Xiaoyun; An, Ying; Gao, Wuqiang; Jiang, Yuqiao

    2018-04-01

    Compared to traditional software development strategies, the two-level modeling approach is more flexible and applicable to build an information system in the medical domain. However, the standards of two-level modeling such as openEHR appear complex to medical professionals. This study aims to investigate, implement, and improve the two-level modeling approach, and discusses the experience of building a unified data acquisition system for four affiliated university hospitals based on this approach. After the investigation, we simplified the approach of archetype modeling and developed a medical data acquisition system where medical experts can define the metadata for their own specialties by using a visual easy-to-use tool. The medical data acquisition system for multiple centers, clinical specialties, and diseases has been developed, and integrates the functions of metadata modeling, form design, and data acquisition. To date, 93,353 data items and 6,017 categories for 285 specific diseases have been created by medical experts, and over 25,000 patients' information has been collected. OpenEHR is an advanced two-level modeling method for medical data, but its idea to separate domain knowledge and technical concern is not easy to realize. Moreover, it is difficult to reach an agreement on archetype definition. Therefore, we adopted simpler metadata modeling, and employed What-You-See-Is-What-You-Get (WYSIWYG) tools to further improve the usability of the system. Compared with the archetype definition, our approach lowers the difficulty. Nevertheless, to build such a system, every participant should have some knowledge in both medicine and information technology domains, as these interdisciplinary talents are necessary. Copyright © 2018 Elsevier B.V. All rights reserved.

  4. Non-zero temperature two-mode squeezing for time-dependent two-level systems

    International Nuclear Information System (INIS)

    Aliaga, J.; Gruver, J.L.; Proto, A.N.; Cerdeira, H.A.

    1994-01-01

    A Maximum Entropy Principle density matrix method, valid for systems with temperature different from zero, is presented making it possible two-mode squeezed states in two-level systems with relevant operators and Hamiltonian connected with O(3,2). A method which allows one to relate the appearance of squeezing to the relevant operators, included in order to define the density matrix of the system is given. (author). 14 refs, 1 fig

  5. Effective Hamiltonians, two level systems, and generalized Maxwell-Bloch equations

    International Nuclear Information System (INIS)

    Sczaniecki, L.

    1981-02-01

    A new method is proposed involving a canonical transformation leading to the non-secular part of time-independent perturbation calculus. The method is used to derive expressions for effective Shen-Walls Hamiltonians which, taken in the two-level approximation and on the inclusion of non-Hamiltonian terms into the dynamics of the system, lead to generalized Maxwell-Bloch equations. The rotating wave approximation is written anew within the framework of our formalism. (author)

  6. Minimum time control of a pair of two-level quantum systems with opposite drifts

    International Nuclear Information System (INIS)

    Romano, Raffaele; D’Alessandro, Domenico

    2016-01-01

    In this paper we solve two equivalent time optimal control problems. On one hand, we design the control field to implement in minimum time the SWAP (or equivalent) operator on a two-level system, assuming that it interacts with an additional, uncontrollable, two-level system. On the other hand, we synthesize the SWAP operator simultaneously, in minimum time, on a pair of two-level systems subject to opposite drifts. We assume that it is possible to perform three independent control actions, and that the total control strength is bounded. These controls either affect the dynamics of the target system, under the first perspective, or, simultaneously, the dynamics of both systems, in the second view. We obtain our results by using techniques of geometric control theory on Lie groups. In particular, we apply the Pontryagin maximum principle, and provide a complete characterization of singular and nonsingular extremals. Our analysis shows that the problem can be formulated as the motion of a material point in a central force, a well known system in classical mechanics. Although we focus on obtaining the SWAP operator, many of the ideas and techniques developed in this work apply to the time optimal implementation of an arbitrary unitary operator. (paper)

  7. Liberal Versus Restrictive Fluid Management in Knee Arthroplasty: A Randomized, Double-Blind Study

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kristensen, Billy Bjarne; Valentiner, Lotte

    2007-01-01

    (Thrombelastograph), postoperative hypoxemia (nocturnal pulse oximetry), postoperative ileus (defecation), and subjective patient recovery (visual analog scales). Hospital stay and complications were also noted. RESULTS: Fluid guidelines were followed strictly in all patients. Liberal (median 4250 mL, range 3150......BACKGROUND: There are few data describing the relationship between amount of perioperative fluid and organ function. In this study we investigated the effects of two levels of intravascular fluid administration ("liberal" versus "restrictive") in knee arthroplasty on physiological recovery...... assessed perioperative physiological recovery variables (postoperative hypoxemia, exercise capacity or subjective patient recovery variables). No difference was found in hospital stay (median 4 days in both groups, not significant). CONCLUSION: A liberal compared to a restrictive intravascular fluid...

  8. Rapid characterization of microscopic two-level systems using Landau-Zener transitions in a superconducting qubit

    International Nuclear Information System (INIS)

    Tan, Xinsheng; Yu, Haifeng; Yu, Yang; Han, Siyuan

    2015-01-01

    We demonstrate a fast method to detect microscopic two-level systems in a superconducting phase qubit. By monitoring the population leak after sweeping the qubit bias flux, we are able to measure the two-level systems that are coupled with the qubit. Compared with the traditional method that detects two-level systems by energy spectroscopy, our method is faster and more sensitive. This method supplies a useful tool to investigate two-level systems in solid-state qubits

  9. Risk factors for blood transfusion after shoulder arthroplasty.

    Science.gov (United States)

    Padegimas, E M; Clyde, C T; Zmistowski, B M; Restrepo, C; Williams, G R; Namdari, S

    2016-02-01

    Currently, there is little information about the need for peri-operative blood transfusion in patients undergoing shoulder arthroplasty. The purpose of this study was to identify the rate of transfusion and its predisposing factors, and to establish a blood conservation strategy. We identified all patients who had undergone shoulder arthroplasty at our hospital between 1 January 2011 and 31 December 2013. The rate of transfusion was determined from the patient's records. While there were exceptions, patients typically underwent transfusion if they had a level of haemoglobin of transfusion. High- and low-risk cohorts for transfusion were identified from a receiver operating characteristic (ROC) curve. Of 1174 shoulder arthroplasties performed on 1081 patients, 53 cases (4.5%) required transfusion post-operatively. Predictors of blood transfusion were a lower pre-operative haematocrit (p transfusion. In total 48 of the 436 (11%) shoulder arthroplasties with a pre-operative haematocrit transfusion compared with five of the 738 (0.70%) shoulder arthroplasties with a haematocrit above this level. We found that transfusion was needed less frequently than previously described for shoulder arthroplasty. Patients with a pre-operative haematocrit blood transfusion, while those with a haematocrit above this level are unlikely to require transfusion. The rate of transfusion after shoulder arthroplasty is under 5%, and those with a pre-operative haematocrit greater than or equal to 39.6% have a very low likelihood (transfusion. ©2016 The British Editorial Society of Bone & Joint Surgery.

  10. Preoperative use of recombinant human erythropoietin before total joint arthroplasty.

    Science.gov (United States)

    Bezwada, Hari P; Nazarian, David G; Henry, David H; Booth, Robert E

    2003-09-01

    Previous reports have suggested that the use of recombinant human erythropoietin is effective for decreasing the need for perioperative allogeneic blood transfusion. The purpose of this study was to evaluate the efficacy of erythropoietin in combination with, and compared with, preoperative autologous donation for reducing allogeneic blood requirements for total joint arthroplasty. Two hundred and forty patients undergoing primary and revision total hip or knee arthroplasty were enrolled into three groups with different treatment regimens: (1) erythropoietin and preoperative autologous donation (Group 1), (2) erythropoietin alone (Group 2), and (3) preoperative autologous donation alone (Group 3). Patients were evaluated with regard to requirements for allogeneic transfusion, change from the baseline to the lowest postoperative hemoglobin value, postoperative complications, and adverse reactions. The rate of allogeneic transfusion was 11% in Group 1 (erythropoietin and preoperative autologous donation) compared with 28% in Group 2 (erythropoietin alone) and 33% in Group 3 (preoperative autologous donation alone). Within Group 1, patients who had a unilateral primary arthroplasty had an allogeneic transfusion rate of 4% and those who had a bilateral or revision arthroplasty had an allogeneic transfusion rate of 17%. In Groups 2 and 3, the allogeneic transfusion rates were 14% and 15%, respectively, for the patients who had a unilateral primary arthroplasty and 35% and 47%, respectively, for those who had a bilateral or revision arthroplasty. Preoperative use of erythropoietin in conjunction with preoperative autologous donation reduces the need for allogeneic blood transfusion associated with total joint arthroplasty more effectively than does either erythropoietin or preoperative autologous donation alone.

  11. Hip arthroplasty in failed intertrochanteric fractures in elderly

    Directory of Open Access Journals (Sweden)

    Javahir A Pachore

    2013-01-01

    Full Text Available Background: Failed intertrochanteric fractures in elderly patients are surgical challenge with limited options. Hip arthroplasty is a good salvage procedure even though it involves technical issues such as implant removal, bone loss, poor bone quality, trochanteric nonunion and difficulty of surgical exposure. Materials and Methods: 30 patients of failed intertrochanteric fractures where hip arthroplasty was done between May 2008 and December 2011 were included in study. 13 were males and 17 were females with average age of 67.3 years. There were 2 cemented bipolar arthroplasties, 19 uncemented bipolar, 4 cemented total hip arthroplasty and 5 uncemented total hip arthroplasties. 16 patients had a trochanteric nonunion, which was treated by tension band principles. Total hip was considered where there was acetabular damage due to the penetration of implant. Results: The average followup was 20 months (range 6-48 months. Patients were followed up from 6 to 48 months with average followup of 20 months. None of the patients were lost to followup. There was no dislocation. All patients were ambulatory at the final followup. Conclusion: A predictable functional outcome can be achieved by hip arthroplasty in elderly patients with failed intertrochanteric fractures. Though technically demanding, properly performed hip arthroplasty can be a good salvage option for this patient group.

  12. Short cervical length dilemma.

    Science.gov (United States)

    Suhag, Anju; Berghella, Vincenzo

    2015-06-01

    Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality. With research efforts, the rate of PTB decreased to 11.4% in 2013. Transvaginal ultrasound (TVU) cervical length (CL) screening predicts PTB. In asymptomatic singletons without prior spontaneous PTB (sPTB), TVU CL screening should be done. If the cervix is 20 mm or less, vaginal progesterone is indicated. In asymptomatic singletons with prior sPTB, serial CL screening is indicated. In multiple gestations, routine cervical screening is not indicated. In symptomatic women with preterm labor, TVU CL screening and fetal fibronectin testing is recommended. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Total elbow arthroplasty: a radiographic outcome study

    Energy Technology Data Exchange (ETDEWEB)

    Bai, Xue Susan [University of Washington, Department of Radiology, Box 357115, Seattle, WA (United States); Petscavage-Thomas, Jonelle M. [Penn State Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Ha, Alice S. [University of Washington, Department of Radiology, Box 354755, Seattle, WA (United States)

    2016-06-15

    Total elbow arthroplasty (TEA) is becoming a popular alternative to arthrodesis for patients with end-stage elbow arthrosis and comminuted distal humeral fractures. Prior outcome studies have primarily focused on surgical findings. Our purpose is to determine the radiographic outcome of TEA and to correlate with clinical symptoms such as pain. This is an IRB-approved retrospective review from 2005 to 2015 of all patients with semiconstrained TEA. All available elbow radiographs and clinical data were reviewed. Data analysis included descriptive statistics and Kaplan-Meier survival curves for radiographic and clinical survival. A total of 104 total elbow arthroplasties in 102 patients were reviewed; 75 % were in women and the mean patient age was 63.1 years. Mean radiographic follow-up was 826 days with average of four radiographs per patient. Seventy TEAs (67 %) developed radiographic complications, including heterotopic ossification (48 %), perihardware lucency (27 %), periprosthetic fracture (23 %), hardware subluxation/dislocation (7 %), polyethylene wear (3 %), and hardware fracture/dislodgement (3 %); 56 patients (55 %) developed symptoms of elbow pain or instability and 30 patients (30 %) underwent at least one reoperation. In patients with radiographic complications, 66 % developed elbow pain, compared to 19 % of patients with no radiologic complications (p = 0.001). Of the patients with radiographic complications, 39 % had at least one additional surgery compared to 0 % of patients without radiographic complications (p = 0.056). Radiographic complications are common in patients after total elbow arthroplasty. There is a strong positive association between post-operative radiographic findings and clinical outcome. Knowledge of common postoperative radiographic findings is important for the practicing radiologist. (orig.)

  14. A protocol avoiding allogeneic transfusion in joint arthroplasties.

    Science.gov (United States)

    Suh, You-Sung; Nho, Jae-Hwi; Choi, Hyung-Suk; Ha, Yong-Chan; Park, Jong-Seok; Koo, Kyung-Hoi

    2016-09-01

    Arthroplasties of hip and knee are associated with blood loss, which may lead to adverse patient outcome. Performing arthroplasties in Jehovah's Witness patients who do not accept transfusion has been a matter of concern. We developed a protocol, which avoids transfusion in arthroplasties of Jehovah's Witness patients, and evaluated the feasibility and safety of the protocol. The target of preoperative hemoglobin was more than 10 g/dL. When preoperative hemoglobin was lower than 10 g/dL, 4000 U erythropoietin (3 times a week) and 100 mg iron supplement (every day) were administered until the hemoglobin reached 10 g/dL. When the preoperative hemoglobin was higher than 10 g/dL, 4000 U erythropoietin and 100 mg iron supplement were administered once, before operation. During the operation, cell saver was used. Postoperatively, erythropoietin and iron supplements were administered until the hemoglobin reached 10 g/dL, similar to the preoperative protocol. We evaluated the feasibility of our protocol, perioperative complications and hematologic changes. From 2002 to 2014, 186 Witness patients visited our department. In 179 patients (96.2 %), 77 total knee arthroplasties, 69 bipolar hemiarthroplasties and 33 total hip arthroplasties were performed. The mean hemoglobin level was 12.3 g/dL preoperatively, 9.4 g/dL on postoperative day 3 and 10.3 g/dL on postoperative day 7. One patient died immediately after the arthroplasty and the remaining 178 patients survived. Total joint arthroplasty could be done without transfusion using this protocol in most of our patients. The rates of infection and mortality were similar with known infection and mortality rates of arthroplasties. In patients who do not want allogeneic transfusions, our protocol is a safe alternative to perform joint arthroplasties.

  15. Computer assisted navigation in total knee and hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Deep Kamal

    2017-01-01

    Full Text Available Introduction: Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures. Methods: A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction. Results: Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years. Conclusion: Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a

  16. People who undergo revision arthroplasty report more limitations but no decrease in physical activity compared with primary total hip arthroplasty : an observational study

    NARCIS (Netherlands)

    Stevens, Martin; Hoekstra, Tsjerk; Wagenmakers, Robert; Bulstra, Sjoerd K.; van den Akker-Scheek, Inge

    2009-01-01

    Question: Do people who have had revision arthroplasty report more limitations and less physical activity than those after primary total hip arthroplasty? Can degree of limitation and physical activity be predicted by revision arthroplasty, after adjustment for age, gender, and Charnley

  17. Computer assisted navigation in knee arthroplasty.

    Science.gov (United States)

    Bae, Dae Kyung; Song, Sang Jun

    2011-12-01

    Computer assisted surgery (CAS) was used to improve the positioning of implants during total knee arthroplasty (TKA). Most studies have reported that computer assisted navigation reduced the outliers of alignment and component malpositioning. However, additional sophisticated studies are necessary to determine if the improvement of alignment will improve long-term clinical results and increase the survival rate of the implant. Knowledge of CAS-TKA technology and understanding the advantages and limitations of navigation are crucial to the successful application of the CAS technique in TKA. In this article, we review the components of navigation, classification of the system, surgical method, potential error, clinical results, advantages, and disadvantages.

  18. Pain Management Strategies in Shoulder Arthroplasty.

    Science.gov (United States)

    Codding, Jason L; Getz, Charles L

    2018-01-01

    Pain control in total shoulder arthroplasty demands a multidisciplinary approach with collaboration between patients, surgeon, and anesthetist. A multimodal approach with preemptive medication, regional blockade, local anesthetics, and a combination of acetaminophen, nonsteroidal antiinflammatory drugs, tramadol, and gabapentinoids postoperatively leads to pain control and patient satisfaction. Assessment of patients' expectations constitutes a vital aspect of the preoperative patient evaluation. Educating and psychologically preparing patients reduces postoperative pain. Patients with anxiety and depression, preoperative narcotic use, and medical comorbidities are at an increased risk for suboptimal pain control. Minimizing narcotic use decreases opioid-related adverse effects and facilitates productive rehabilitation efforts. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Total Hip Arthroplasty in Mucopolysaccharidosis Type IH

    Directory of Open Access Journals (Sweden)

    S. O'hEireamhoin

    2011-01-01

    Full Text Available Children affected by mucopolysaccharidosis (MPS type IH (Hurler Syndrome, an autosomal recessive metabolic disorder, are known to experience a range of musculoskeletal manifestations including spinal abnormalities, hand abnormalities, generalised joint stiffness, genu valgum, and hip dysplasia and avascular necrosis. Enzyme therapy, in the form of bone marrow transplantation, significantly increases life expectancy but does not prevent the development of the associated musculoskeletal disorders. We present the case of a 23-year-old woman with a diagnosis of Hurler syndrome with a satisfactory result following uncemented total hip arthroplasty.

  20. Total knee arthroplasty in patients with extra-articular deformity

    Directory of Open Access Journals (Sweden)

    Kaushik Hazratwala, MBBS, FRACS

    2016-03-01

    Full Text Available Multiple acceptable options are available for the correction of distal femoral deformity associated with knee arthritis. The treatment modality should be chosen based on the extent of deformity and attention to preservation of the collateral ligaments. Surgical options range from osteotomy alone, arthroplasty with intra-articular correction, or arthroplasty with extra-articular correction. Different implant choices and fixation methods for the osteotomy possess advantages and disadvantages which need to be considered carefully. In addition to discussing principles of management based on current literature, this article includes a case report using a previously undescribed technique using corrective osteotomy, intramedullary nail fixation, and total knee arthroplasty with computer navigation.

  1. A technical case report on use of tubular retractors for anterior cervical spine surgery.

    Science.gov (United States)

    Kulkarni, Arvind G; Patel, Ankit; Ankith, N V

    2017-12-19

    The authors put-forth this technical report to establish the feasibility of performing an anterior cervical corpectomy and fusion (ACCF) and a two-level anterior cervical discectomy and fusion (ACDF) using a minimally invasive approach with tubular retractors. First case: cervical spondylotic myelopathy secondary to a large postero-inferiorly migrated disc treated with corpectomy and reconstruction with a mesh cage and locking plate. Second case: cervical disc herniation with radiculopathy treated with a two-level ACDF. Both cases were operated with minimally invasive approach with tubular retractor using a single incision. Technical aspects and clinical outcomes have been reported. No intra or post-operative complications were encountered. Intra-operative blood loss was negligible. The patients had a cosmetic scar on healing. Standard procedure of placement of tubular retractors is sufficient for adequate surgical exposure with minimal invasiveness. Minimally invasive approach to anterior cervical spine with tubular retractors is feasible. This is the first report on use of minimally invasive approach for ACCF and two-level ACDF.

  2. [Cervical lift: An update].

    Science.gov (United States)

    Labbé, D; Guerreschi, P

    2017-10-01

    The neck is an aesthetic unit for which a rejuvenation request is sometimes very targeted or ore often encompassed in a global surgical project of face-lift. To obtain a long lasting outcome, the plastic surgeon has to make a full, detailed, and exhaustive analysis of the neck in order to choose the best indication within the multiple surgical tools. A full clinical examination is the key point, every aspects are outlined. The numerous surgical choices are described, illustrated, and sometimes revisited in the light of targeted anatomical studies. A didactic and graduated way is used to explain the recent evolutions of the surgical tools of the cervical lifting. Complications and insufficiencies in outcomes must be identified and explained. Finally, we illustrate this development by clinical cases. The surgical improvement of the cervical region is, for us, centered on the reconstruction of a cervical retaining structure: the Cervico-Mandibular Angle Suspensor (CMAS) ligament. This element makes it possible to understand and integrate the large number of technical proposals for cervical lifting. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  3. Prevent Cervical Cancer!

    Centers for Disease Control (CDC) Podcasts

    2015-01-08

    Cervical cancer can be prevented. Listen as two friends—one a doctor—talk about screening tests and early detection. Learn what test you might need.  Created: 1/8/2015 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 1/8/2015.

  4. Preventing cervical cancer

    African Journals Online (AJOL)

    Cervical cancer remains the most common cancer diagnosed in women in southern Africa, with an estimated lifetime risk of 1 in. 26.1. Unfortunately most of these cancers are also diagnosed at a late stage, with subsequent poor prognosis for long-term survival. This very high incidence is particularly sad in an era where.

  5. Cervical Spondylotic Myelopathy (CSM)

    Science.gov (United States)

    ... to normal aging. Arthritis of the spine and spinal cord trauma can be other causes of CSM. How is cervical spondylotic myelopathy diagnosed? Your doctor will do a ... can confirm if you have spinal cord compression in your neck. It also can ...

  6. Time fractional evolution of the two-level system interacting with light field

    Science.gov (United States)

    Lu, Longzhao; Yu, Xiangyang

    2017-11-01

    In this study, we construct a generalized time fractional Schrödinger equation. By applying this equation to the two-level system, the fractional optical Bloch model is developed. With the Mittage–Leffler function, the fractional equations of motion in the absence of light field are solved analytically. We propose the fractional resonance condition and verify it based on the interaction between the system and the monochromatic light. Then we calculate the fractional Rabi frequency with respect to the order of time derivative. Finally, we propose the concept of fractional recovery area and study the resonant interaction between the system and the optical pulse.

  7. On correctness of the two-level model for description of active medium in quantum plasmonics

    Science.gov (United States)

    Chubchev, E. D.; Andrianov, E. S.; Pukhov, A. A.; Vinogradov, A. P.; Lisyansky, A. A.

    2017-09-01

    In order to simplify the theoretical description of spasers, a gain medium is commonly represented by a two-level system (TLS). A realistic model, however, should have four levels. By using the Lindblad equations we develop a description of such a system and show that depending on ratios of the Rabi frequency and the rate of relaxation of the polarization, a four-level system (FLS) may be reduced to one of two effective TLSs that reproduce the key properties of a FLS.

  8. Design of a two-level power system linear state estimator

    Science.gov (United States)

    Yang, Tao

    The availability of synchro-phasor data has raised the possibility of a linear state estimator if the inputs are only complex currents and voltages and if there are enough such measurements to meet observability and redundancy requirements. Moreover, the new digital substations can perform some of the computation at the substation itself resulting in a more accurate two-level state estimator. The objective of this research is to develop a two-level linear state estimator processing synchro-phasor data and estimating the states at both the substation level and the control center level. Both the mathematical algorithms that are different from those in the present state estimation procedure and the layered architecture of databases, communications and application programs that are required to support this two-level linear state estimator are described in this dissertation. Besides, as the availability of phasor measurements at substations will increase gradually, this research also describes how the state estimator can be enhanced to handle both the traditional state estimator and the proposed linear state estimator simultaneously. This provides a way to immediately utilize the benefits in those parts of the system where such phasor measurements become available and provides a pathway to transition to the smart grid of the future. The design procedure of the two-level state estimator is applied to two study systems. The first study system is the IEEE-14 bus system. The second one is the 179 bus Western Electricity Coordinating Council (WECC) system. The static database for the substations is constructed from the power flow data of these systems and the real-time measurement database is produced by a power system dynamic simulating tool (TSAT). Time-skew problems that may be caused by communication delays are also considered and simulated. We used the Network Simulator (NS) tool to simulate a simple communication system and analyse its time delay performance. These

  9. A two-level structure for advanced space power system automation

    Science.gov (United States)

    Loparo, Kenneth A.; Chankong, Vira

    1990-01-01

    The tasks to be carried out during the three-year project period are: (1) performing extensive simulation using existing mathematical models to build a specific knowledge base of the operating characteristics of space power systems; (2) carrying out the necessary basic research on hierarchical control structures, real-time quantitative algorithms, and decision-theoretic procedures; (3) developing a two-level automation scheme for fault detection and diagnosis, maintenance and restoration scheduling, and load management; and (4) testing and demonstration. The outlines of the proposed system structure that served as a master plan for this project, work accomplished, concluding remarks, and ideas for future work are also addressed.

  10. Properties of Two Two-level Atoms Interacting with Intensity-Dependent Coupling

    Science.gov (United States)

    Bakry, Haytham; Mohamed, Ahmed S. A.; Zidan, Nour

    2018-02-01

    We discuss some new features of the model of two two-level atoms interacting with two single-mode thermal cavity field via multi-photon transitions under intensity-dependent coupling. We examine the dynamics of quantum and classical correlations of the system initially exists in Werner states. The results show that the sudden death and sudden birth of quantum entanglement occur but the geometric measure of quantum discord remains non-zero. It is observed that, by increasing the number of photons, the periods become shorter and the quantum discord and entanglement become irregular.

  11. Aspects on entropy squeezing of a two-level atom in a squeezed vacuum

    International Nuclear Information System (INIS)

    El-Shahat, T.M.; Abdel-Khalek, S.; Abdel-Aty, M.; Obada, A.-S.F.

    2003-01-01

    The entropy squeezing and variance squeezing for the entangled state of a single two-level atom interacting with a single electromagnetic field mode in a squeezed vacuum with a broad bandwidth are studied. The exact results are employed to perform a careful investigation of the influence of the various parameters of the system on the atomic inversion as well as the entropy squeezing and variance squeezing. It is shown that features of the quantum entropy are influenced significantly by the photon number, the two-photon correlation strength, and the squeezed phase

  12. Entanglement of a nonlinear two two-level atoms interacting with deformed fields in Kerr medium

    Science.gov (United States)

    Abdel-Khalek, S.; El-Saman, Y. S.; Abdel-Aty, M.

    2018-01-01

    In this paper we investigate the entanglement dynamics between two two-level atoms interacting with two coherent fields in two spatially separated cavities which are filled with a Kerr-like medium. We examine the effect of nonlinear medium on the dynamical properties of entanglement and atomic occupation probabilities in the case of even and odd deformed coherent states. The results show that the deformed fields play important roles in the evolution of entanglement. Also, the results demonstrate that entanglement sudden death, sudden birth and long-distance can be controlled by the deformation and nonlinear parameters.

  13. Large fluctuations of radiation in stochastically activated two-level systems

    International Nuclear Information System (INIS)

    Pechersky, E; Pirogov, S; Vladimirov, A; Schütz, G M; Yambartsev, A

    2017-01-01

    We study large fluctuations of emitted radiation in the system of N non-interacting two-level atoms. Two methods are used to calculate the probability of large fluctuations and the time dependence of excitation and emission. The first method is based on the large deviation principle for Markov processes. The second one uses an analogue of the quantum formalism for classical probability problems. Particularly we prove that in a large fluctuation limit approximately half of the atoms are excited. This fact is independent on the fraction of the excited atoms in equilibrium. (paper)

  14. Fractal Two-Level Finite Element Method For Free Vibration of Cracked Beams

    Directory of Open Access Journals (Sweden)

    A.Y.T. Leung

    1998-01-01

    Full Text Available The fractal two-level finite element method is extended to the free vibration behavior of cracked beams for various end boundary conditions. A cracked beam is separated into its singular and regular regions. Within the singular region, infinite number of finite elements are virturally generated by fractal geometry to model the singular behavior of the crack tip. The corresponding numerous degrees of freedom are reduced to a small set of generalized displacements by fractal transformation technique. The solution time and computer storage can be remarkably reduced without sacrifying accuracy. The resonant frequencies and mode shapes computed compared well with the results from a commercial program.

  15. Characteristics of the 2011 Tohoku Tsunami and introduction of two level tsunamis for tsunami disaster mitigation.

    Science.gov (United States)

    Sato, Shinji

    2015-01-01

    Characteristics of the 2011 Tohoku Tsunami have been revealed by collaborative tsunami surveys extensively performed under the coordination of the Joint Tsunami Survey Group. The complex behaviors of the mega-tsunami were characterized by the unprecedented scale and the low occurrence frequency. The limitation and the performance of tsunami countermeasures were described on the basis of tsunami surveys, laboratory experiments and numerical analyses. These findings contributed to the introduction of two-level tsunami hazards to establish a new strategy for tsunami disaster mitigation, combining structure-based flood protection designed by the Level-1 tsunami and non-structure-based damage reduction planned by the Level-2 tsunami.

  16. Oscillations of Doppler-Raby of two level atom moving in resonator

    International Nuclear Information System (INIS)

    Kozlovskij, A.V.

    2001-01-01

    The interaction of the two-level atom with the quantum mode of the high-quality resonator uniformly moving by the classic trajectory, is considered. The recurrent formula for the probability of the atom transition with the photon radiation is determined through the dressed states method. It is shown, that the ratio between the Doppler shift value of the atom transition and the Raby frequency value of the atom-field system qualitatively effects the dependence of the moving atom transition probability on its position in the resonator, as well as on its value [ru

  17. Performance analysis of quantum Diesel heat engines with a two-level atom as working substance

    Science.gov (United States)

    Huang, X. L.; Shang, Y. F.; Guo, D. Y.; Yu, Qian; Sun, Qi

    2017-07-01

    A quantum Diesel cycle, which consists of one quantum isobaric process, one quantum isochoric process and two quantum adiabatic processes, is established with a two-level atom as working substance. The parameter R in this model is defined as the ratio of the time in quantum isochoric process to the timescale for the potential width movement. The positive work condition, power output and efficiency are obtained, and the optimal performance is analyzed with different R. The effects of dissipation, the mixed state in the cycle and the results of other working substances are also discussed at the end of this analysis.

  18. Quantum averaging and resonances: two-level atom in a one-mode classical laser field

    Directory of Open Access Journals (Sweden)

    M. Amniat-Talab

    2007-06-01

    Full Text Available   We use a nonperturbative method based on quantum averaging and an adapted from of resonant transformations to treat the resonances of the Hamiltonian of a two-level atom interacting with a one-mode classical field in Floquet formalism. We illustrate this method by extraction of effective Hamiltonians of the system in two regimes of weak and strong coupling. The results obtained in the strong-coupling regime, are valid in the whole range of the coupling constant for the one-photon zero-field resonance.

  19. Diagnosis of infection after total hip arthroplasty

    International Nuclear Information System (INIS)

    Itasaka, Toshio; Kawai, Akira; Sato, Toru; Mitani, Shigeru; Inoue, Hajime

    2001-01-01

    Forty-eight total hip arthroplasties for which revision surgery was performed were reviewed to determine the accuracy of laboratory tests, plain radiographs, hip aspiration, and technetium-99m MDP and gallium-67 scans in demonstrating the presence or absence of infection of the prosthesis. Six of the 48 hips were diagnosed as having an infection at the revision surgery. The erythrocyte sedimentation rate and the C-reactive protein levels were significantly higher in the patients with infected prostheses. The difference in the white blood cell count was not significant. There was no significant relationship between the presence of infection and the severity of loosening and instability of the implants diagnosed by plain radiographs. The accuracy of hip aspiration in diagnosing the infection was 83%, with a sensitivity of 40% and a specificity of 92%. The accuracy of technetium-99m MDP bone scan was 79%, with a sensitivity of 83%, and a specificity of 79%. Gallium-67 scan had an accuracy of 96%, a sensitivity of 67%, and a specificity of 100%. The findings in the present study indicated that diagnostic tests consisting of laboratory tests and plain radiography, followed by hip aspiration and sequential use of technetium-99m MDP and gallium-67 scintigraphies, are suitable for differentiation between mechanical loosening and infection of total hip arthroplasty. (author)

  20. Diagnosis of infection after total hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Itasaka, Toshio; Kawai, Akira; Sato, Toru; Mitani, Shigeru; Inoue, Hajime [Okayama Univ. (Japan). School of Medicine

    2001-07-01

    Forty-eight total hip arthroplasties for which revision surgery was performed were reviewed to determine the accuracy of laboratory tests, plain radiographs, hip aspiration, and technetium-99m MDP and gallium-67 scans in demonstrating the presence or absence of infection of the prosthesis. Six of the 48 hips were diagnosed as having an infection at the revision surgery. The erythrocyte sedimentation rate and the C-reactive protein levels were significantly higher in the patients with infected prostheses. The difference in the white blood cell count was not significant. There was no significant relationship between the presence of infection and the severity of loosening and instability of the implants diagnosed by plain radiographs. The accuracy of hip aspiration in diagnosing the infection was 83%, with a sensitivity of 40% and a specificity of 92%. The accuracy of technetium-99m MDP bone scan was 79%, with a sensitivity of 83%, and a specificity of 79%. Gallium-67 scan had an accuracy of 96%, a sensitivity of 67%, and a specificity of 100%. The findings in the present study indicated that diagnostic tests consisting of laboratory tests and plain radiography, followed by hip aspiration and sequential use of technetium-99m MDP and gallium-67 scintigraphies, are suitable for differentiation between mechanical loosening and infection of total hip arthroplasty. (author)

  1. Radiographic analysis of shoulder anatomical arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Merolla, Giovanni [Unit of Shoulder and Elbow Surgery, ' D. Cervesi' Hospital, L. Van Beethoven 46 Street, 47841 Cattolica (Italy)], E-mail: gmerolla@shouldertech.it; Di Pietto, Francesco; Romano, Stefania [Department of Diagnostic Imaging, ' A. Cardarelli' Hospital, Naples (Italy); Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe [Unit of Shoulder and Elbow Surgery, ' D. Cervesi' Hospital, L. Van Beethoven 46 Street, 47841 Cattolica (Italy)

    2008-10-15

    Arthroplasty is the standard treatment for advanced shoulder osteoarthritis. Modern prostheses designs have modular features whose size, shaft/head and body morphology can be adjusted. Total Shoulder Arthroplasty (TSA) provides better results. A complete X-ray follow-up is essential to assess the results and evaluate the survival rates of a shoulder prosthesis. Antero-posterior at 40 deg. in both internal and external rotation (true AP view) and axillary view are recommended to assess the following parameters: orientation and translation of the humeral component, offset, size and height of the humeral head, acromio-humeral distance, distribution and fixation of the cement, stress shielding and cortical resorption, radiolucent lines, subsidence and tilt, glenoid wear and 'bone stock', prostheses instability, glenoid component shift. Shoulder hemiarthroplasty can lead to glenoid wear; the true AP film at 40 deg. of internal rotation provides the best profile of gleno-humeral joint to depict glenoid erosion. Shift of the glenoid component in TSA is identified as tilting or medial migration on true AP and axillary views in the early postoperative period (1-2 months) and at minimum of 2 years. An exhaustive radiographic analysis remains essential to monitor the prosthetic implant and detect early and late complications or risk factors of prosthetic loosening.

  2. Financing in knee arthroplasty: a benchmarking analysis.

    Science.gov (United States)

    Effenberger, Harald; Rehart, Stefan; Zumstein, Marc D; Schuh, Alexander

    2008-12-01

    Flat rate payment and "diagnosis related groups" (DRG) in knee arthroplasty offer incentives to save expenses. A cost-benefit analysis exactly compares all expenses to revenues. This requires patient-related assessment of treatment costs in terms of cost-unit accounting. This study compared expenses of knee arthroplasty in Austrian, German and Swiss clinics. A survey of primary and revision surgery was conducted and data-divided into cost elements and cost centers-were collected from three Austrian, five German and one Swiss clinic. Personnel costs for medical services were lower in Austria (617 euro) than Germany (1,271 euro) and Switzerland (1,305 euro). Nursing costs amounted to 1,432 euro in Austria, 1,011 euro in Germany, 2,525 euro in Switzerland. Costs for med.-tech. services were lower in Austria (261 euro) than Germany (848 euro) and Switzerland (1,093 euro). Average costs for medication amounted to 491 euro in Austria, higher than Germany (118 euro), lower than Switzerland (506 euro). Costs for implants were higher in Austria (2,558 euro) than Germany (2,134 euro), highest in Switzerland (3,619 euro). Regarding case numbers, these cost elements showed significant differences (Pexpenses for personnel and implants must be reduced. Ultimately, the potential for hospitals to save costs can be found here.

  3. Cemented or cementless total knee arthroplasty?

    Directory of Open Access Journals (Sweden)

    Prudhon Jean-Louis

    2017-01-01

    Full Text Available Introduction: Since 1996 we have been using cementless fixation with hydroxyapatite (HA coating. The purpose of this paper is to compare survivorship of a series of 100 cemented Total Knee Arthroplasty (TKA to a similar series of 100 cementless with a follow up of 11–16 years. Material methods: Both TKA are mobile bearing total knee postero-stabilized. They can be used with cement or without cement. Among 1030 New Wave TKATM implanted from 2002 to 2015 we have identified 100 cemented TKAs and 100 cementless TKAs. All these cases were primary replacement. Differences in survival probability were determined using log-rank test. Results: Survival probabilities at 11 years of follow-up were: Cemented group: 90.2% CI95% [81.9–94.8]; Cementless group: 95.4% CI95% [88.1–98.2]. Comparison between both group showed significant difference, p = 0.32. Discussion: The advantages of cementless TKA are bone stock preservation, cement debris protection and the potential to achieve biologic fixation. Cementless implants rely on a porous or roughened surface to facilitate bone formation. HA has been shown to accelerate bone integration and to decrease micro motion of the components and to increase fixation. With a survival probability of 90.2% (cemented version and 95.4% (cementless version, this total knee prosthesis performs as intended in primary total knee arthroplasty. No statistical differences could be found between cemented and cementless implants.

  4. Footprint mismatch in lumbar total disc arthroplasty.

    Science.gov (United States)

    Gstoettner, Michaela; Michaela, Gstoettner; Heider, Denise; Denise, Heider; Liebensteiner, Michael; Bach, Christian Michael; Michael, Bach Christian

    2008-11-01

    Lumbar disc arthroplasty has become a popular modality for the treatment of degenerative disc disease. The dimensions of the implants are based on early published geometrical measurements of vertebrae; the majority of these were cadaver studies. The fit of the prosthesis in the intervertebral space is of utmost importance. An undersized implant may lead to subsidence, loosening and biomechanical failure due to an incorrect center of rotation. The aim of the present study was to measure the dimensions of lumbar vertebrae based on CT scans and assess the accuracy of match in currently available lumbar disc prostheses. A total of 240 endplates of 120 vertebrae were included in the study. The sagittal and mediolateral diameter of the upper and lower endplates were measured using a digital measuring system. For the levels L4/L5 and L5/S1, an inappropriate size match was noted in 98.8% (Prodisc L) and 97.6% (Charite) with regard to the anteroposterior diameter. Mismatch in the anterior mediolateral diameter was noted in 79.3% (Prodisc L) and 51.2% (Charite) while mismatch in the posterior mediolateral diameter was observed in 91.5% (Prodisc L) and 78% (Charite) of the endplates. Surgeons and manufacturers should be aware of the size mismatch of currently available lumbar disc prostheses, which may endanger the safety and efficacy of the procedure. Larger footprints of currently available total disc arthroplasties are required.

  5. Venous hypertensive myelopathy associated with cervical spondylosis.

    Science.gov (United States)

    Okada, Seiji; Chang, Charles; Chang, Geraldine; Yue, James J

    2016-11-01

    Venous hypertensive myelopathy (VHM) results from spinal vascular malformations of arteriovenous shunting that increases spinal venous pressure, leading to congestive edema and neurologic dysfunction. There has been no report of VHM associated with cervical spondylotic myelopathy (CSM). The aim of this study was to report an extremely rare case of VHM likely due to CSM. This study is a case report and review of the literature. The patient was a 51-year-old man with CSM exhibiting relatively rapid neurologic deterioration with an abnormal expansion of a centromedullary hyperintense lesion on T2-weighted magnetic resonance imaging (MRI) in the absence of traumatic injury. Neurologic examination and radiologic imaging were taken by various means. The patient developed a cervical radiculopathy, followed by gait disturbance and motor weakness. The MRI of the cervical spine demonstrated spinal canal stenosis due to disc bulging and flavum hypertrophy at the C5/C6 and C6/C7 levels as well as hyperintense area over the C5-C7 levels on T2-weighted images. Although decompression surgery was planned, an acute inflammatory process such as transverse myelitis or demyelinating disease other than cord compression was also considered, and the patient received intravenous steroids. His walking improved for several days. However, his symptoms then became significantly worse, and he had difficulty walking. Subsequent MRI demonstrated marked progression of the T2 hyperintense lesion over the C4-T1 vertebral levels. Flow voids were also noted on the dorsal surface of the upper cervical cord on T2-weighted MRI. His lab work, medical history, and the local enhancement on contrast-enhanced MRI indicated low probability of spinal inflammatory diseases. Therefore, the decision was made to perform anterior cervical discectomy and fusion surgery on two levels. Following surgery, his symptoms improved promptly. Our case indicates that VHM could be caused by spondylotic cord compression in the

  6. Assessment of two-level heat pump installations’ power efficiency for heat supply systems

    Directory of Open Access Journals (Sweden)

    Аlla Е. Denysova

    2015-06-01

    Full Text Available The problem of energy saving becomes one of the most important in power engineering. It is caused by exhaustion of world reserves in hydrocarbon fuel, such as gas, oil and coal representing sources of traditional heat supply. Conventional sources has essential shortcomings: low power, ecological and economic efficiencies, that can be eliminated by using alternative methods of power supply, like the considered one: low-temperature natural heat of ground waters of on the basis of heat pump installations application. The heat supply system considered provides an effective use of two-level heat pump installation operating as heat source the Odessa city ground waters during the lowest ambient temperature period. Proposed is a calculation method of heat pump installations on the basis of geothermal heat supply. Calculated are the values of electric energy consumption N by the compressors’ drive, and the heat supply system transformation coefficient µ for a source of geothermal heat from ground waters of Odessa city allowing to estimate efficiency of two-level heat pump installations.

  7. SCREENING OF MEDIUM COMPOUNDS USING A TWO-LEVEL FACTORIAL DESIGN FOR SACCHAROMYCES BOULARDII

    Directory of Open Access Journals (Sweden)

    GUOWEI SHU

    2016-04-01

    Full Text Available Even if the probiotic effect of Saccharomyces boulardii is has been reported, this yeast is rarely used in medium composition. Based on single factor experiment, two-level factorial design was employed to evaluate the effect of carbon sources (sucrose, glucose, nitrogen sources (soy peptone, beef extract, yeast extract, calf serum, malt extract and salts (K2HPO4, KH2PO4, MgSO4, Na2HPO4, NaH2PO4, CaCl2, sodium citrate, sodium glutamate on the growth of S. boulardii. At the same time, the optical density (OD in the medium was measured at 560 nm after 36 h of incubation. The result of two-level factorial design experiment showed that calf serum (p = 0.0214 and sodium citrate (p = 0.0045 are the significant growth factors of S. boulardii, sucrose (p = 0.0861 and malt extract (p = 0.0763 are important factors. In addition, sucrose and sodium citrate showed positive effect on the growth of S. boulardii. However, calf serum and malt extract showed negative effect on the growth. And we determined that the optimum medium composition for S. boulardii was as follow: 37.5 g·L-1 sucrose, 6 g·L-1 calf serum, 6 g·L-1 malt extract, 5 g·L-1 sodium citrate.

  8. Protecting quantum coherence of two-level atoms from vacuum fluctuations of electromagnetic field

    International Nuclear Information System (INIS)

    Liu, Xiaobao; Tian, Zehua; Wang, Jieci; Jing, Jiliang

    2016-01-01

    In the framework of open quantum systems, we study the dynamics of a static polarizable two-level atom interacting with a bath of fluctuating vacuum electromagnetic field and explore under which conditions the coherence of the open quantum system is unaffected by the environment. For both a single-qubit and two-qubit systems, we find that the quantum coherence cannot be protected from noise when the atom interacts with a non-boundary electromagnetic field. However, with the presence of a boundary, the dynamical conditions for the insusceptible of quantum coherence are fulfilled only when the atom is close to the boundary and is transversely polarizable. Otherwise, the quantum coherence can only be protected in some degree in other polarizable direction. -- Highlights: •We study the dynamics of a two-level atom interacting with a bath of fluctuating vacuum electromagnetic field. •For both a single and two-qubit systems, the quantum coherence cannot be protected from noise without a boundary. •The insusceptible of the quantum coherence can be fulfilled only when the atom is close to the boundary and is transversely polarizable. •Otherwise, the quantum coherence can only be protected in some degree in other polarizable direction.

  9. Two-level method for unsteady Navier-Stokes equations based on a new projection

    International Nuclear Information System (INIS)

    Hou Yanren; Li Kaitai

    2004-12-01

    A two-level algorithm for the two dimensional unsteady Navier-Stokes equations based on a new projection is proposed and investigated. The approximate solution is solved as a sum of a large eddy component and a small eddy component, which are in the sense of the new projection, constructed in this paper. These two terms advance in time explicitly. Actually, the new algorithm proposed here can be regarded as a sort of postprocessing algorithm for the standard Galerkin method (SGM). The large eddy part is solved by SGM in the usual L 2 -based large eddy subspace while the small eddy part (the correction part) is obtained in its complement subspace in the sense of the new projection. The stability analysis indicates the improvement of the stability comparing with SGM of the same scale, and the L 2 -error estimate shows that the scheme can improve the accuracy of SGM approximation for half order. We also propose a numerical implementation based on Lagrange multiplier for this two-level algorithm. (author)

  10. A novel two-level dynamic parallel data scheme for large 3-D SN calculations

    International Nuclear Information System (INIS)

    Sjoden, G.E.; Shedlock, D.; Haghighat, A.; Yi, C.

    2005-01-01

    We introduce a new dynamic parallel memory optimization scheme for executing large scale 3-D discrete ordinates (Sn) simulations on distributed memory parallel computers. In order for parallel transport codes to be truly scalable, they must use parallel data storage, where only the variables that are locally computed are locally stored. Even with parallel data storage for the angular variables, cumulative storage requirements for large discrete ordinates calculations can be prohibitive. To address this problem, Memory Tuning has been implemented into the PENTRAN 3-D parallel discrete ordinates code as an optimized, two-level ('large' array, 'small' array) parallel data storage scheme. Memory Tuning can be described as the process of parallel data memory optimization. Memory Tuning dynamically minimizes the amount of required parallel data in allocated memory on each processor using a statistical sampling algorithm. This algorithm is based on the integral average and standard deviation of the number of fine meshes contained in each coarse mesh in the global problem. Because PENTRAN only stores the locally computed problem phase space, optimal two-level memory assignments can be unique on each node, depending upon the parallel decomposition used (hybrid combinations of angular, energy, or spatial). As demonstrated in the two large discrete ordinates models presented (a storage cask and an OECD MOX Benchmark), Memory Tuning can save a substantial amount of memory per parallel processor, allowing one to accomplish very large scale Sn computations. (authors)

  11. Improved Genetic Algorithm with Two-Level Approximation for Truss Optimization by Using Discrete Shape Variables

    Directory of Open Access Journals (Sweden)

    Shen-yan Chen

    2015-01-01

    Full Text Available This paper presents an Improved Genetic Algorithm with Two-Level Approximation (IGATA to minimize truss weight by simultaneously optimizing size, shape, and topology variables. On the basis of a previously presented truss sizing/topology optimization method based on two-level approximation and genetic algorithm (GA, a new method for adding shape variables is presented, in which the nodal positions are corresponding to a set of coordinate lists. A uniform optimization model including size/shape/topology variables is established. First, a first-level approximate problem is constructed to transform the original implicit problem to an explicit problem. To solve this explicit problem which involves size/shape/topology variables, GA is used to optimize individuals which include discrete topology variables and shape variables. When calculating the fitness value of each member in the current generation, a second-level approximation method is used to optimize the continuous size variables. With the introduction of shape variables, the original optimization algorithm was improved in individual coding strategy as well as GA execution techniques. Meanwhile, the update strategy of the first-level approximation problem was also improved. The results of numerical examples show that the proposed method is effective in dealing with the three kinds of design variables simultaneously, and the required computational cost for structural analysis is quite small.

  12. Dynamical model of coherent circularly polarized optical pulse interactions with two-level quantum systems

    International Nuclear Information System (INIS)

    Slavcheva, G.; Hess, O.

    2005-01-01

    We propose and develop a method for theoretical description of circularly (elliptically) polarized optical pulse resonant coherent interactions with two-level atoms. The method is based on the time-evolution equations of a two-level quantum system in the presence of a time-dependent dipole perturbation for electric dipole transitions between states with total angular-momentum projection difference (ΔJ z =±1) excited by a circularly polarized electromagnetic field [Feynman et al., J. Appl. Phys. 28, 49 (1957)]. The adopted real-vector representation approach allows for coupling with the vectorial Maxwell's equations for the optical wave propagation and thus the resulting Maxwell pseudospin equations can be numerically solved in the time domain without any approximations. The model permits a more exact study of the ultrafast coherent pulse propagation effects taking into account the vector nature of the electromagnetic field and hence the polarization state of the optical excitation. We demonstrate self-induced transparency effects and formation of polarized solitons. The model represents a qualitative extension of the well-known optical Maxwell-Bloch equations valid for linearly polarized light and a tool for studying coherent quantum control mechanisms

  13. The Optimal Analgesic Block for Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Bendtsen, Thomas Fichtner; Moriggl, Bernhard; Chan, Vincent

    2016-01-01

    Peripheral nerve block for total knee arthroplasty is ideally motor sparing while providing effective postoperative analgesia. To achieve these goals, one must understand surgical dissection techniques, distribution of nociceptive generators, sensory innervation of the knee, and nerve topography...

  14. Total knee arthroplasty in patients with a previous patellectomy.

    Science.gov (United States)

    Maslow, Jed; Zuckerman, Joseph D; Immerman, Igor

    2013-01-01

    Post-patellectomy patients represent a specific subgroup of patients that may develop arthritis and persistent knee pain and potentially require treatment with total knee arthroplasty. This article reviews the treatment and functional outcomes following total knee arthroplasty in patients with prior patellectomy. A case report is presented as an example of the clinical management of a post-patellectomy patient with significant knee pain and disability treated with total knee arthroplasty. Emphasis will be placed in decision- making, specifically with the use of a posterior stabilized implant. In addition, postoperative strengthening of the quadriceps is essential to compensate for the lack of the patella and increase the success of total knee arthroplasty in this subgroup of patients.

  15. Resurfacing shoulder arthroplasty for the treatment of severe rheumatoid arthritis

    DEFF Research Database (Denmark)

    Voorde, Pia C Ten; Rasmussen, Jeppe V; Olsen, Bo S

    2015-01-01

    BACKGROUND AND PURPOSE: There is no consensus on which type of shoulder prosthesis should be used in patients with rheumatoid arthritis (RA). We describe patients with RA who were treated with shoulder replacement, regarding patient-reported outcome, prosthesis survival, and causes of revision......, and we compare outcome after resurfacing hemi-arthroplasty (RHA) and stemmed hemi-arthroplasty (SHA). PATIENTS AND METHODS: We used data from the national Danish Shoulder Arthroplasty Registry and included patients with RA who underwent shoulder arthroplasty in Denmark between 2006 and 2010. Patient-reported...... outcome was obtained 1-year postoperatively using the Western Ontario Osteoarthritis of the Shoulder index (WOOS), and rates of revision were calculated by checking revisions reported until December 2011. The patient-reported outcome of RHA was compared to that of SHA using regression analysis...

  16. Preoperative strength training for elderly patients awaiting total knee arthroplasty.

    NARCIS (Netherlands)

    C.J. de Ruiter; Dr. D.M. van Leeuwen; P.A. Nolte; A. de Haan

    2014-01-01

    Objective. To investigate the feasibility and effects of additional preoperative high intensity strength training for patients awaiting total knee arthroplasty (TKA). Design. Clinical controlled trial. Patients. Twenty-two patients awaiting TKA. Methods. Patients were allocated to a standard

  17. Hierarchy of stability factors in reverse shoulder arthroplasty.

    Science.gov (United States)

    Gutiérrez, Sergio; Keller, Tony S; Levy, Jonathan C; Lee, William E; Luo, Zong-Ping

    2008-03-01

    Reverse shoulder arthroplasty is being used more frequently to treat irreparable rotator cuff tears in the presence of glenohumeral arthritis and instability. To date, however, design features and functions of reverse shoulder arthroplasty, which may be associated with subluxation and dislocation of these implants, have been poorly understood. We asked: (1) what is the hierarchy of importance of joint compressive force, prosthetic socket depth, and glenosphere size in relation to stability, and (2) is this hierarchy defined by underlying and theoretically predictable joint contact characteristics? We examined the intrinsic stability in terms of the force required to dislocate the humerosocket from the glenosphere of eight commercially available reverse shoulder arthroplasty devices. The hierarchy of factors was led by compressive force followed by socket depth; glenosphere size played a much lesser role in stability of the reverse shoulder arthroplasty device. Similar results were predicted by a mathematical model, suggesting the stability was determined primarily by compressive forces generated by muscles.

  18. [PROGNOSIS OF DEEP INFECTIOUS COMPLICATIONS IN HIP ARTHROPLASTY].

    Science.gov (United States)

    Dorofeev, Yu L; Ptashnikov, D A; Tkachenko, A N; Bakhtin, M Yu; Kalimullina, A F

    2015-01-01

    The retrospective research analyzed the data of 893 patients undergoing total hip arthroplasty. There were used the data about patients undergoing hip arthroplasty without complications (the first group--808 cases) and patients with developed deep surgical site infection following total joint arthroplasty after 12 months (the second group--85 patients). It was applied as the training matrix in creation of mathematical prognosis and algorithm of prophylaxis of deep infection in patients undergoing the primary total hip arthroplasty. There were revealed 21 prognostic significant criteria of deep infection development in surgical site. The program was tested in prospective investigation (293 clinical cases) with follow-up term of 12 months after operation. The rate of development of postoperative deep infection in surgical wound reduced as compared with the rate in group of retrospective research from 1.7% to 0.7%. The efficacy of proposed program was 80%.

  19. Readmissions after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Kristian Stahl; Kristensen, Billy B

    2010-01-01

    With the implementation of fast-track surgery with optimization of both logistical and clinical features, the postoperative convalescence has been reduced as functional milestones have been achieved earlier and consequently length of stay (LOS) in hospital has been reduced. However, it has been s...... speculated that a decrease in LOS may be associated with an increase in readmissions in general, including risk of dislocation after total hip arthroplasty (THA) or manipulation after total knee arthroplasty (TKA)....

  20. [Arthroplasty registers as post-marketing surveillance systems: the Catalan Arthroplasty Register].

    Science.gov (United States)

    Allepuz, A; Serra-Sutton, V; Martínez, O; Tebé, C; Nardi, J; Portabella, F; Espallargues, M

    2013-01-01

    The aim is to present the functioning and results of the Catalan Arthroplasty Registry (RACat). The RACat arose by the initiative of the Catalan Society of Orthopaedic Surgery and Traumatology, the Catalan Health Service (CHS) and the Catalan Agency for Health Information Assessment and Quality. Publicly funded hospitals sent information through the Internet (CHS Applications website) on knee and hip arthroplasties: patient identification, hospital, joint (hip/knee), type (primary/revision), side of operation, date of surgery and prosthesis (manufacturer's name and reference number). The quality of the data is analysed regularly. We estimate the risk of replacement by the Kaplan-Meier method. A total of 52 hospitals out of 62 send data to RACat, and information on 36,951 knee and 26,477 hip arthroplasties is available. Data quality improved between 2005 and 2010. In 2010 coverage exceeded 70%, with side of operation 97%, and prostheses identification of 80%. The risk of replacement at three years was 3.3% (95% CI:3.1-3.6) for knee, 2.9% (95% CI:2.5-3.3) for total hip, and 2.5% (95% CI:2.0-3.1) for partial hip. Risk of replacement is higher than that observed in other registers, although data quality and its improvement over time should be taken into account. The information available in the RACat will help to establish a standard that will enable hospitals to compare results. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  1. Comprehensive solutions to the Bloch equations and dynamical models for open two-level systems

    Science.gov (United States)

    Skinner, Thomas E.

    2018-01-01

    The Bloch equation and its variants constitute the fundamental dynamical model for arbitrary two-level systems. Many important processes, including those in more complicated systems, can be modeled and understood through the two-level approximation. It is therefore of widespread relevance, especially as it relates to understanding dissipative processes in current cutting-edge applications of quantum mechanics. Although the Bloch equation has been the subject of considerable analysis in the 70 years since its inception, there is still, perhaps surprisingly, significant work that can be done. This paper extends the scope of previous analyses. It provides a framework for more fully understanding the dynamics of dissipative two-level systems. A solution is derived that is compact, tractable, and completely general, in contrast to previous results. Any solution of the Bloch equation depends on three roots of a cubic polynomial that are crucial to the time dependence of the system. The roots are typically only sketched out qualitatively, with no indication of their dependence on the physical parameters of the problem. Degenerate roots, which modify the solutions, have been ignored altogether. Here the roots are obtained explicitly in terms of a single real-valued root that is expressed as a simple function of the system parameters. For the conventional Bloch equation, a simple graphical representation of this root is presented that makes evident the explicit time dependence of the system for each point in the parameter space. Several intuitive, visual models of system dynamics are developed. A Euclidean coordinate system is identified in which any generalized Bloch equation is separable, i.e., the sum of commuting rotation and relaxation operators. The time evolution in this frame is simply a rotation followed by relaxation at modified rates that play a role similar to the standard longitudinal and transverse rates. These rates are functions of the applied field, which

  2. Vertebral artery injury during foraminal decompression in "low-risk" cervical spine surgery: incidence and management.

    Science.gov (United States)

    Obermüller, Thomas; Wostrack, Maria; Shiban, Ehab; Pape, Haiko; Harmening, Kathrin; Friedrich, Benjamin; Prothmann, Sascha; Meyer, Bernhard; Ringel, Florian

    2015-11-01

    Vertebral artery injury (VAI) during foraminal decompression in cervical spine surgery in the absence of repositioning or screw stabilization is rare. Without immediate recognition and treatment, it may have disastrous consequences. We aimed to describe the incidence and management of iatrogenic VAI in low-risk cervical spine surgery. The records of all patients who underwent surgical procedures of the cervical spine between January 2007 and May 2012 were retrospectively consecutively evaluated. Anterior cervical discectomy and fusion or arthroplasty as well as dorsal foraminal decompression through the Frykholm approach in degenerative diseases were defined as low-risk surgeries (n = 992). VAI occurred in 0.3 % (n = 3) of 992 procedures: in one case during a dorsal foraminal decompression, and in two cases during the anterior cervical discectomy and fusion (ACDF) of two or four levels, respectively. In the first case, the VAI was intraoperatively misdiagnosed. Despite an initially uneventful course, the patient suffered hemorrhage from a pseudoaneurysm of the injured VA 1 month after surgery. The aneurysm was successfully occluded by endovascular coiling. In both ACDF cases, angiography and endovascular stenting of the lacerated segment proceeded immediately after the surgery. All three patients suffered no permanent deterioration. In a high-volume surgical center, the incidence of VAI during low-risk cervical spine surgery is extremely low, comprising 0.3 % of all cases. The major risks are delayed sequels of the vessel wall laceration. In cases of VAI, immediate angiographic diagnostics and generous indications for endovascular treatment are obligatory.

  3. Two Level Versus Matrix Converters Performance in Wind Energy Conversion Systems Employing DFIG

    Science.gov (United States)

    Reddy, Gongati Pandu Ranga; Kumar, M. Vijaya

    2017-10-01

    Wind power capacity has received enormous growth during past decades. With substantial development of wind power, it is expected to provide a fifth of world's electricity by the end of 2030. In wind energy conversion system, the power electronic converters play an important role. This paper presents the two level and matrix converters performance in wind energy conversion system employing Doubly Fed Induction Generator (DFIG). The DFIG is a wound rotor induction generator. Because of the advantages of the DFIG over other generators it is being used for most of the wind applications. This paper also discusses control of converters using the space vector pulse width modulation technique. The MATLAB/SIMULINK ® software is used to study the performance of the converters.

  4. Aeroelastic two-level optimization for preliminary design of wing structures considering robust constraints

    Directory of Open Access Journals (Sweden)

    Wan Zhiqiang

    2014-04-01

    Full Text Available An aeroelastic two-level optimization methodology for preliminary design of wing structures is presented, in which the parameters for structural layout and sizes are taken as design variables in the first-level optimization, and robust constraints in conjunction with conventional aeroelastic constraints are considered in the second-level optimization. A low-order panel method is used for aerodynamic analysis in the first-level optimization, and a high-order panel method is employed in the second-level optimization. It is concluded that the design of the abovementioned structural parameters of a wing can be improved using the present method with high efficiency. An improvement is seen in aeroelastic performance of the wing obtained with the present method when compared to the initial wing. Since these optimized structures are obtained after consideration of aerodynamic and structural uncertainties, they are well suited to encounter these uncertainties when they occur in reality.

  5. Interacting two-level defects as sources of fluctuating high-frequency noise in superconducting circuits

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, Clemens [ARC Centre of Excellence for Engineered Quantum Systems, The University of Queensland, Brisbane (Australia); Lisenfeld, Juergen [Physikalisches Institut, Karlsruhe Institute of Technology, Karlsruhe (Germany); Shnirman, Alexander [Institut fuer Theory der Kondensierten Materie, Karlsruhe Institute of Technology, Karlsruhe (Germany); LD Landau Institute for Theoretical Physics, Moscow (Russian Federation); Poletto, Stefano [IBM TJ Watson Research Centre, Yorktown Heights (United States)

    2016-07-01

    Since the very first experiments, superconducting circuits have suffered from strong coupling to environmental noise, destroying quantum coherence and degrading performance. In state-of-the-art experiments, it is found that the relaxation time of superconducting qubits fluctuates as a function of time. We present measurements of such fluctuations in a 3D-transmon circuit and develop a qualitative model based on interactions within a bath of background two-level systems (TLS) which emerge from defects in the device material. In our model, the time-dependent noise density acting on the qubit emerges from its near-resonant coupling to high-frequency TLS which experience energy fluctuations due to their interaction with thermally fluctuating TLS at low frequencies. We support the model by providing experimental evidence of such energy fluctuations observed in a single TLS in a phase qubit circuit.

  6. Bi-stability in a two-level quantum dot with attracting e–e interaction

    Energy Technology Data Exchange (ETDEWEB)

    Eskandari-asl, Amir, E-mail: amir.eskandari.asl@gmail.com

    2016-12-15

    By considering a current carrying two-level quantum dot (QD) with e–e attraction, we obtain the current and electron populations as functions of applied bias voltage using a self-consistent Hartree–Fock (HF) approximation and show that the system could be bi-stable and there exist hysteresis loops. Investigating the permanent polarization, we also show that the permanent polarization changes sign and interpret this as a quantum phase transition, since our system is at zero temperature. - Highlights: • Our system could have zero, one or two steps in its I–V curve. • Depending on the strength of the e–e attraction, there could be hysteresis loops around each step. • The polarization of the system changes sign by changing the bias voltage and this is a quantum phase transition.

  7. Phonon induced optical gain in a current carrying two-level quantum dot

    Energy Technology Data Exchange (ETDEWEB)

    Eskandari-asl, Amir, E-mail: amir.eskandari.asl@gmail.com [Department of Physics, Shahid Beheshti University, G.C. Evin, Tehran 1983963113 (Iran, Islamic Republic of); School of Nano Science, Institute for Research in Fundamental Sciences (IPM), P.O. Box: 19395-5531, Tehran, Iran (Iran, Islamic Republic of)

    2017-05-15

    In this work we consider a current carrying two level quantum dot (QD) that is coupled to a single mode phonon bath. Using self-consistent Hartree-Fock approximation, we obtain the I-V curve of QD. By considering the linear response of our system to an incoming classical light, we see that depending on the parametric regime, the system could have weak or strong light absorption or may even show lasing. This lasing occurs at high enough bias voltages and is explained by a population inversion considering side bands, while the total electron population in the higher level is less than the lower one. The frequency at which we have the most significant lasing depends on the level spacing and phonon frequency and not on the electron-phonon coupling strength.

  8. Entanglement for a Bimodal Cavity Field Interacting with a Two-Level Atom

    International Nuclear Information System (INIS)

    Liu Jia; Chen Ziyu; Bu Shenping; Zhang Guofeng

    2009-01-01

    Negativity has been adopted to investigate the entanglement in a system composed of a two-level atom and a two-mode cavity field. Effects of Kerr-like medium and the number of photon inside the cavity on the entanglement are studied. Our results show that atomic initial state must be superposed, so that the two cavity field modes can be entangled. Moreover, we also conclude that the number of photon in the two cavity mode should be equal. The interaction between modes, namely, the Kerr effect, has a significant negative contribution. Note that the atom frequency and the cavity frequency have an indistinguishable effect, so a corresponding approximation has been made in this article. These results may be useful for quantum information in optics systems.

  9. Two-Level Verification of Data Integrity for Data Storage in Cloud Computing

    Science.gov (United States)

    Xu, Guangwei; Chen, Chunlin; Wang, Hongya; Zang, Zhuping; Pang, Mugen; Jiang, Ping

    Data storage in cloud computing can save capital expenditure and relive burden of storage management for users. As the lose or corruption of files stored may happen, many researchers focus on the verification of data integrity. However, massive users often bring large numbers of verifying tasks for the auditor. Moreover, users also need to pay extra fee for these verifying tasks beyond storage fee. Therefore, we propose a two-level verification of data integrity to alleviate these problems. The key idea is to routinely verify the data integrity by users and arbitrate the challenge between the user and cloud provider by the auditor according to the MACs and ϕ values. The extensive performance simulations show that the proposed scheme obviously decreases auditor's verifying tasks and the ratio of wrong arbitration.

  10. Canyon of current suppression in an interacting two-level quantum dot

    DEFF Research Database (Denmark)

    Karlström, O; Pedersen, Jonas Nyvold; Samuelsson, P

    2011-01-01

    Motivated by the recent discovery of a canyon of conductance suppression in a two-level equal-spin quantum dot system [Phys. Rev. Lett. 104, 186804 (2010)], the transport through this system is studied in detail. At low bias and low temperature a strong current suppression is found around...... the electron-hole symmetry point independent of the couplings, in agreement with previous results. By means of a Schrieffer–Wolff transformation we are able to give an intuitive explanation to this suppression in the low-energy regime. In the general situation, numerical simulations are carried out using...... quantum rate equations. The simulations allow for the prediction of how the suppression is affected by the couplings, the charging energy, the position of the energy levels, the applied bias, and the temperature. We find that, away from electron-hole symmetry, the parity of the couplings is essential...

  11. An order level inventory model under two level storage system with fuzzy demand

    Directory of Open Access Journals (Sweden)

    Sakrar S.

    2013-01-01

    Full Text Available Deterministic inventory model with two levels of storage has been studied by numerous authors. In this paper we developed a fuzzy inventory model with two ware houses (one is the existing storage known as own warehouse (OW and the other is hired on rental basis known as rented warehouse (RW. The model allows constant levels of item deterioration in both houses. The stock is transferred from RW to OW in continuous release pattern and the associated transportation cost is taken into account. To make the model more realistic in nature, fuzzy demand has been considered. Using α-cut for defuzzification, the total variable cost per unit time is derived. Therefore, the problem is reduced to crisp annual costs. The multi-objective model is solved by Global Criteria Method supported by GRG (Generalized Reduced Gradient Technique, which is illustrated by a numerical example.

  12. Photon echo with a few photons in two-level atoms

    International Nuclear Information System (INIS)

    Bonarota, M; Dajczgewand, J; Louchet-Chauvet, A; Le Gouët, J-L; Chanelière, T

    2014-01-01

    To store and retrieve signals at the single photon level, various photon echo schemes have resorted to complex preparation steps involving ancillary shelving states in multi-level atoms. For the first time, we experimentally demonstrate photon echo operation at such a low signal intensity without any preparation step, which allows us to work with mere two-level atoms. This simplified approach relies on the so-coined ‘revival of silenced echo’ (ROSE) scheme. Low noise conditions are obtained by returning the atoms to the ground state before the echo emission. In the present paper we manage ROSE in photon counting conditions, showing that very strong control fields can be compatible with extremely weak signals, making ROSE consistent with quantum memory requirements. (paper)

  13. Thermal analysis of two-level wind power converter under symmetrical grid fault

    DEFF Research Database (Denmark)

    Zhou, Dao; Blaabjerg, Frede

    2013-01-01

    In this paper, the case of symmetrical grid fault when using the multi-MW wind turbine of partial-scale and full-scale two-level power converter are designed and investigated. Firstly, the different operation behaviors of the relevant power converters under the voltage dip will be described...... and analyzed. Simulations of different configurations regarding the loss distribution and the junction temperature of the power device are presented in respect to the various voltage dips. It is concluded that for both systems the power loss will change dramatically during the Low-Voltage Ride Through (LVRT......) condition as well as the junction temperature. For the full-scale wind turbine system, the most thermal stressed power device in the grid-side converter will appear at the grid voltage below 0.5 pu, and for the partial-scale wind turbine system, the most thermal stressed power device in the rotor...

  14. Faithful state transfer between two-level systems via an actively cooled finite-temperature cavity

    Science.gov (United States)

    Sárkány, Lőrinc; Fortágh, József; Petrosyan, David

    2018-03-01

    We consider state transfer between two qubits—effective two-level systems represented by Rydberg atoms—via a common mode of a microwave cavity at finite temperature. We find that when both qubits have the same coupling strength to the cavity field, at large enough detuning from the cavity mode frequency, quantum interference between the transition paths makes the swap of the excitation between the qubits largely insensitive to the number of thermal photons in the cavity. When, however, the coupling strengths are different, the photon-number-dependent differential Stark shift of the transition frequencies precludes efficient transfer. Nevertheless, using an auxiliary cooling system to continuously extract the cavity photons, we can still achieve a high-fidelity state transfer between the qubits.

  15. Transmission-line resonators for the study of individual two-level tunneling systems

    Science.gov (United States)

    Brehm, Jan David; Bilmes, Alexander; Weiss, Georg; Ustinov, Alexey V.; Lisenfeld, Jürgen

    2017-09-01

    Parasitic two-level tunneling systems (TLS) emerge in amorphous dielectrics and constitute a serious nuisance for various microfabricated devices, where they act as a source of noise and decoherence. Here, we demonstrate a new test bed for the study of TLS in various materials which provides access to properties of individual TLS as well as their ensemble response. We terminate a superconducting transmission-line resonator with a capacitor that hosts TLS in its dielectric. By tuning TLS via applied mechanical strain, we observe the signatures of individual TLS strongly coupled to the resonator in its transmission characteristics and extract the coupling components of their dipole moments and energy relaxation rates. The strong and well-defined coupling to the TLS bath results in pronounced resonator frequency fluctuations and excess phase noise, through which we can study TLS ensemble effects such as spectral diffusion, and probe theoretical models of TLS interactions.

  16. Thermal analysis of multi-MW two-level wind power converter

    DEFF Research Database (Denmark)

    Zhou, Dao; Blaabjerg, Frede; Mogens, Lau

    2012-01-01

    In this paper, the multi-MW wind turbine of partial-scale and full-scale two-level power converter with DFIG and direct-drive PMSG are designed and compared in terms of their thermal performance. Simulations of different configurations regarding loss distribution and junction temperature...... in the power device in the whole range of wind speed are presented and analyzed. It is concluded that in both partial-scale and full-scale power converter the most thermal stressed power device in the generator-side converter will have higher mean junction temperature and larger junction temperature...... fluctuation compared to grid-side converter at the rated wind speed. Moreover, the thermal performance of the generator-side converter in the partial-scale power converter becomes crucial around the synchronous operating point and should be considered carefully....

  17. Propagation of a videopulse through a thin layer of two-level dipolar atoms

    International Nuclear Information System (INIS)

    Elyutin, Sergei O

    2007-01-01

    The excitation of a thin layer of two-level permanent dipole moment atoms by ultimately short (less than the field oscillation period) electromagnetic pulses (videopulse) is observed. The numerical analysis of the matter equations free of the rotating wave approximation and relaxation reveals a strong influence of the local field and the Stark effect on temporal behaviour of transmitted field. Specifically, it is demonstrated that a dense film irradiated by a videopulse emits a short response with a delay much longer even than the characteristic cooperative time of the atom ensemble. It is supposed that the local field in the thin layer of permanent dipole atoms is able to re-pump the atomic subsystem. A close analogy with nonlinear pendulum motion is discussed

  18. TWO-LEVEL HIERARCHICAL COORDINATION QUEUING METHOD FOR TELECOMMUNICATION NETWORK NODES

    Directory of Open Access Journals (Sweden)

    M. V. Semenyaka

    2014-07-01

    Full Text Available The paper presents hierarchical coordination queuing method. Within the proposed method a queuing problem has been reduced to optimization problem solving that was presented as two-level hierarchical structure. The required distribution of flows and bandwidth allocation was calculated at the first level independently for each macro-queue; at the second level solutions obtained on lower level for each queue were coordinated in order to prevent probable network link overload. The method of goal coordination has been determined for multilevel structure managing, which makes it possible to define the order for consideration of queue cooperation restrictions and calculation tasks distribution between levels of hierarchy. Decisions coordination was performed by the method of Lagrange multipliers. The study of method convergence has been carried out by analytical modeling.

  19. Embedded two level direct adaptive fuzzy controller for DC motor speed control

    Directory of Open Access Journals (Sweden)

    Ahmad M. Zaki

    2018-03-01

    Full Text Available This paper presents a proposed approach based on an adaptive fuzzy logic controller for precise control of the DC motor speed. In this concern, the proposed Direct Adaptive Fuzzy Logic Controller (DAFLC is estimated from two levels, where the lower level uses a Mamdani fuzzy controller and the upper level is an inverse model based on a Takagi–Sugeno (T–S method in which its output is used to adapt the parameters of the fuzzy controller in the lower level. The proposed controller is implemented using an Arduino DUE kit. From the practical results, it is proved that the proposed adaptive controller improves, successfully both the performance response and the disturbance due to the load in the speed control of the DC motor.

  20. ARTgrid: A Two-Level Learning Architecture Based on Adaptive Resonance Theory

    Directory of Open Access Journals (Sweden)

    Marko Švaco

    2014-01-01

    Full Text Available This paper proposes a novel neural network architecture based on adaptive resonance theory (ART called ARTgrid that can perform both online and offline clustering of 2D object structures. The main novelty of the proposed architecture is a two-level categorization and search mechanism that can enhance computation speed while maintaining high performance in cases of higher vigilance values. ARTgrid is developed for specific robotic applications for work in unstructured environments with diverse work objects. For that reason simulations are conducted on random generated data which represents actual manipulation objects, that is, their respective 2D structures. ARTgrid verification is done through comparison in clustering speed with the fuzzy ART algorithm and Adaptive Fuzzy Shadow (AFS network. Simulation results show that by applying higher vigilance values (ρ>0.85 clustering performance of ARTgrid is considerably better, while lower vigilance values produce comparable results with the original fuzzy ART algorithm.

  1. Comparing return to sport activities after short metaphyseal femoral arthroplasty with resurfacing and big femoral head arthroplasties.

    Science.gov (United States)

    Karampinas, Panagiotis K; Papadelis, Eustratios G; Vlamis, John A; Basiliadis, Hlias; Pneumaticos, Spiros G

    2017-07-01

    Young patients feel that maintaining sport activities after total hip arthroplasty constitutes an important part of their quality of life. The majority of hip surgeons allow patients to return to low-impact activities, but significant caution is advised to taking part in high-impact activities. The purpose of this study is to compare and evaluate the post-operative return to daily living habits and sport activities following short-metaphyseal hip and high functional total hip arthroplasties (resurfacing and big femoral head arthroplasties). In a study design, 48 patients (55 hips) were enrolled in three different comparative groups, one with the short-metaphyseal arthroplasties, a second with high functional resurfacing arthroplasties and a third of big femoral head arthroplasties. Each patient experienced a clinical examination and evaluated with Harris Hip Score, WOMAC, Sf-36, UCLA activity score, satisfaction VAS, anteroposterior and lateral X-rays of the hip and were followed in an outpatient setting for 2 years. Statistical analysis revealed no notable differences between the three groups regarding their demographic data however significant differences have been found between preoperative and postoperative clinical scores of each group. Also, we fail to reveal any significant differences when comparing data of all three groups at the final 2 years postoperative control regarding their clinical scores. The overall outcome of all three groups was similar, all the patients were satisfied and returned to previous level of sport activities. Short metaphyseal hip arthroplasties in young patients intending to return to previous and even high impact sport activities, similar to high functional resurfacing, big femoral head arthroplasties. Short stems with hard on hard bearing surfaces might become an alternative to standard stems and hip resurfacing.

  2. Suspension Arthroplasty Combined with Ligament Reconstruction of the Thumb Carpometacarpal Joint to Salvage Two Failed Arthroplasties: A Case Report.

    Science.gov (United States)

    Kakinoki, Ryosuke; Hashimoto, Kazuhiko; Tanaka, Hiroki; Akagi, Masao

    2017-01-01

    Thumb basal joint arthroplasty with removal of the entire trapezium is often followed by proximal subsidence and impingement of the thumb metacarpal to the scaphoid, which is a common cause of post-operative thumb pain. Treatment of this impingement is a challenge among surgeons. We performed suspension arthroplasty combined with intercarpal ligament reconstruction using a strip of the extensor carpi radialis longus (ECRL) tendon on a patient suffering from pain caused by this type of the impingement and obtained a successful outcome. We treated a 52-year-old female pianist who complained of pain in her left thumb carpometacarpal (CMC) joint. She had undergone two previous ligament reconstruction and tendon interposition arthroplasty procedures on the joint, for which strips of the flexor carpi radialis tendon and the abductor pollicis longus tendon were used in the first and second operations, respectively. The pre-operative X-ray demonstrated proximal subsidence and impingement of the first metacarpal on the scaphoid. We performed suspension arthroplasty combined with intercarpal ligament reconstruction using a strip of the ECRL tendon to create the trapezial space. 3 years after surgery, despite the 3 mm subsidence of the thumb compared with immediately after surgery, her thumb pinch and grip strength had improved, and the thumb basal pain was relieved. This case shows that suspension arthroplasty with intermetacarpal ligament reconstruction using an ECRL strip can be applied in revision surgery for impingement of the first metacarpal with the scaphoid following thumb CMC joint arthroplasty after removal of the entire trapezium. This is the first report to describe the treatment of first metacarpal impingement after CMC joint arthroplasty using suspension arthroplasty combined with intercarpal ligament reconstruction.

  3. Reoperations following proximal interphalangeal joint nonconstrained arthroplasties.

    Science.gov (United States)

    Pritsch, Tamir; Rizzo, Marco

    2011-09-01

    To retrospectively analyze the reasons for reoperations following primary nonconstrained proximal interphalangeal (PIP) joint arthroplasty and review clinical outcomes in this group of patients with 1 or more reoperations. Between 2001 and 2009, 294 nonconstrained (203 pyrocarbon and 91 metal-plastic) PIP joint replacements were performed in our institution. A total of 76 fingers (59 patients) required reoperation (50 pyrocarbon and 26 metal-plastic). There were 40 women and 19 men with an average age of 51 years (range, 19-83 y). Primary diagnoses included osteoarthritis in 35, posttraumatic arthritis in 24, and inflammatory arthritis in 17 patients. There were 21 index, 27 middle, 18 ring, and 10 small fingers. The average number of reoperations per PIP joint was 1.6 (range, 1-4). A total of 45 joints had 1 reoperation, 19 had 2, 11 had 3, and 1 had 4. Extensor mechanism dysfunction was the most common reason for reoperation; it involved 51 of 76 fingers and was associated with Chamay or tendon-reflecting surgical approaches. Additional etiologies included component loosening in 17, collateral ligament failure in 10, and volar plate contracture in 8 cases. Inflammatory arthritis was associated with collateral ligament failure. Six fingers were eventually amputated, 9 had PIP joint arthrodeses, and 2 had resection arthroplasties. The arthrodesis and amputation rates correlated with the increased number of reoperations per finger. Clinically, most patients had no or mild pain at the most recent follow-up, and the PIP joint range-of-motion was not significantly different from preoperative values. Pain levels improved with longer follow-up. Reoperations following primary nonconstrained PIP joint arthroplasties are common. Extensor mechanism dysfunction was the most common reason for reoperation. The average reoperation rate was 1.6, and arthrodesis and amputation are associated with an increasing number of operations. Overall clinical outcomes demonstrated no

  4. Cetuximab, Cisplatin, and Radiation Therapy in Treating Patients With Stage IB, Stage II, Stage III, or Stage IVA Cervical Cancer

    Science.gov (United States)

    2014-12-29

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer

  5. Cisplatin and Radiation Therapy Followed by Paclitaxel and Carboplatin in Treating Patients With Stage IB-IVA Cervical Cancer

    Science.gov (United States)

    2017-05-03

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma, Not Otherwise Specified; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage IIIA Cervical Cancer; Stage IIIB Cervical Cancer; Stage IVA Cervical Cancer

  6. Cervical cancer: what's new?

    Directory of Open Access Journals (Sweden)

    José Carlos Sadalla

    2015-12-01

    Full Text Available SUMMARY Cervical cancer is the most common gynecological cancer in Brazil. Among women, it is the second most frequent, second only to breast cancer. It is the fourth leading cause of cancer death in the country, with estimated 15,590 new cases (2014 and 5,430 deaths (2013. In order to update information to improve outcomes, reduce morbidity and optimize the treatment of this cancer, this article will address the advancement of knowledge on cervical cancer. The topics covered include the role of surgery in different stages, treatment of locally advanced carcinomas, fertility preservation, the role of the sentinel lymph node technique, indications and techniques of radiotherapy and chemotherapy, and some special situations.

  7. Chronic Pseudomonas aeruginosa cervical osteomyelitis

    Directory of Open Access Journals (Sweden)

    Sujeet Kumar Meher

    2016-01-01

    Full Text Available Pseudomonas aeruginosa is a rare cause of osteomyelitis of the cervical spine and is usually seen in the background of intravenous drug use and immunocompromised state. Very few cases of osteomyelitis of the cervical spine caused by pseudomonas aeruginosa have been reported in otherwise healthy patients. This is a case presentation of a young female, who in the absence of known risk factors for cervical osteomyelitis presented with progressively worsening neurological signs and symptoms.

  8. Mucopurulent cervicitis: a clinical entity?

    OpenAIRE

    Willmott, F E

    1988-01-01

    Of 297 women attending a sexually transmitted disease clinic who were examined for the presence of mucopurulent cervicitis, 96 (32%) satisfied the diagnostic criteria. Mucopurulent cervicitis was strongly associated with the isolation of Chlamydia trachomatis and Neisseria gonorrhoeae. It was also associated with bacterial vaginosis, the use of oral contraceptives, and sexual contact with men who had non-gonococcal urethritis. Conversely, the presence of opaque cervical secretions did not sho...

  9. SUPERFICIAL CERVICAL PLEXUS BLOCK

    Directory of Open Access Journals (Sweden)

    Komang Mega Puspadisari

    2014-01-01

    Full Text Available Superficial cervical plexus block is one of the regional anesthesia in  neck were limited to thesuperficial fascia. Anesthesia is used to relieve pain caused either during or after the surgery iscompleted. This technique can be done by landmark or with ultrasound guiding. The midpointof posterior border of the Sternocleidomastoid was identified and the prosedure done on thatplace or on the level of cartilage cricoid.

  10. Case Studies - Cervical Cancer

    Centers for Disease Control (CDC) Podcasts

    2010-10-15

    Dr. Alan Waxman, a professor of obstetrics and gynecology at the University of New Mexico and chair of the American College of Obstetricians and Gynecologists (ACOG) committee for the underserved, talks about several case studies for cervical cancer screening and management.  Created: 10/15/2010 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Cancer Prevention and Control (DCPC).   Date Released: 6/9/2010.

  11. Future Directions - Cervical Cancer

    Centers for Disease Control (CDC) Podcasts

    2009-10-15

    Dr. Alan Waxman, a professor of obstetrics and gynecology at the University of New Mexico and chair of the American College of Obstetricians and Gynecologists (ACOG) committee for the underserved, talks about possible changes in cervical cancer screening and management.  Created: 10/15/2009 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Cancer Prevention and Control (DCPC).   Date Released: 6/9/2010.

  12. Traumatic cervical artery dissection.

    Science.gov (United States)

    Nedeltchev, Krassen; Baumgartner, Ralf W

    2005-01-01

    Traumatic cervical artery dissection (TCAD) is a complication of severe blunt head or neck trauma, the main cause being motor vehicle accidents. TCAD are increasingly recognized, and incidences of up to 0.86% for internal carotid and 0.53% for traumatic vertebral artery dissections (TVAD) among blunt trauma victims are reported. Diagnostic evaluation for TCAD is mandatory in the presence of (1) hemorrhage of potential arterial origin originating from the nose, ears, mouth, or a wound; (2) expanding cervical hematoma; (3) cervical bruit in a patient >50 years of age; (4) evidence of acute infarct at brain imaging; (5) unexplained central or lateralizing neurological deficit or transient ischemic attack, or (6) Horner syndrome, neck or head pain. In addition, a number of centers screen asymptomatic patients with blunt trauma for TCAD. Catheter angiography is the standard of reference for diagnosis of TCAD. Color duplex ultrasound, computed tomographic, and magnetic resonance angiography are noninvasive screening alternatives, but each method has its diagnostic limitations compared to catheter angiography. Anticoagulants and antiplatelet drugs may prevent ischemic stroke, but bleeding from traumatized tissues may offset the benefits of antithrombotic treatment. Endovascular therapy of dissected vessels, thrombarterectomy, direct suture of intimal tears, and extracranial-intracranial bypass should be considered in exceptional cases. Neurological outcome is probably worse in TCAD compared to spontaneous CAD, although it is unclear whether this is due to dissection-induced ischemic stroke or associated traumatic lesions.

  13. [Cervical spine trauma].

    Science.gov (United States)

    Yilmaz, U; Hellen, P

    2016-08-01

    In the emergency department 65 % of spinal injuries and 2-5 % of blunt force injuries involve the cervical spine. Of these injuries approximately 50 % involve C5 and/or C6 and 30 % involve C2. Older patients tend to have higher spinal injuries and younger patients tend to have lower injuries. The anatomical and development-related characteristics of the pediatric spine as well as degenerative and comorbid pathological changes of the spine in the elderly can make the radiological evaluation of spinal injuries difficult with respect to possible trauma sequelae in young and old patients. Two different North American studies have investigated clinical criteria to rule out cervical spine injuries with sufficient certainty and without using imaging. Imaging of cervical trauma should be performed when injuries cannot be clinically excluded according to evidence-based criteria. Degenerative changes and anatomical differences have to be taken into account in the evaluation of imaging of elderly and pediatric patients.

  14. Cervical spinal canal narrowing and cervical neurologi-cal injuries

    Directory of Open Access Journals (Sweden)

    ZHANG Ling

    2012-04-01

    Full Text Available 【Abstract】Cervical spinal canal narrowing can lead to injury of the spinal cord and neurological symptoms in-cluding neck pain, headache, weakness and parasthesisas. According to previous and recent clinical researches, we investigated the geometric parameters of normal cervical spinal canal including the sagittal and transverse diameters as well as Torg ratio. The mean sagittal diameter of cervical spinal canal at C 1 to C 7 ranges from 15.33 mm to 20.46 mm, the mean transverse diameter at the same levels ranges from 24.45 mm to 27.00 mm and the mean value of Torg ratio is 0.96. With respect to narrow cervical spinal canal, the following charaterstics are found: firstly, extension of the cervical spine results in statistically significant stenosis as compared with the flexed or neutral positions; secondly, females sustain cervical spinal canal narrowing more easily than males; finally, the consistent narrowest cervical canal level is at C 4 for all ethnicity, but there is a slight variation in the sagittal diameter of cervical spinal stenosis (≤14 mm in Whites, ≤ 12 mm in Japanese, ≤13.7 mm in Chinese. Narrow sagittal cervical canal diameter brings about an increased risk of neurological injuries in traumatic, degenerative and inflam-matory conditions and is related with extension of cervical spine, gender, as well as ethnicity. It is hoped that this re-view will be helpful in diagnosing spinal cord and neuro-logical injuries with the geometric parameters of cervical spine in the future. Key words: Spinal cord injuries; Spinal stenosis; Trauma, nervous system

  15. Revision for prosthetic joint infection following hip arthroplasty

    Science.gov (United States)

    Lenguerrand, E.; Whitehouse, M. R.; Beswick, A. D.; Jones, S. A.; Porter, M. L.

    2017-01-01

    Objectives We used the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to investigate the risk of revision due to prosthetic joint infection (PJI) for patients undergoing primary and revision hip arthroplasty, the changes in risk over time, and the overall burden created by PJI. Methods We analysed revision total hip arthroplasties (THAs) performed due to a diagnosis of PJI and the linked index procedures recorded in the NJR between 2003 and 2014. The cohort analysed consisted of 623 253 index primary hip arthroplasties, 63 222 index revision hip arthroplasties and 7585 revision THAs performed due to a diagnosis of PJI. The prevalence, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. Results We demonstrated a prevalence of revision THA due to prosthetic joint infection of 0.4/100 procedures following primary and 1.6/100 procedures following revision hip arthroplasty. The prevalence of revision due to PJI in the three months following primary hip arthroplasty has risen 2.3-fold (95% confidence interval (CI) 1.3 to 4.1) between 2005 and 2013, and 3.0-fold (95% CI 1.1 to 8.5) following revision hip arthroplasty. Over 1000 procedures are performed annually as a consequence of hip PJI, an increase of 2.6-fold between 2005 and 2013. Conclusions Although the risk of revision due to PJI following hip arthroplasty is low, it is rising and, coupled with the established and further predicted increased incidence of both primary and revision hip arthroplasty, this represents a growing and substantial treatment burden. Cite this article: E. Lenguerrand, M. R. Whitehouse, A. D. Beswick, S. A. Jones, M. L. Porter, A. W. Blom. Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry. Bone Joint Res 2017;6:391–398. DOI: 10.1302/2046-3758.66.BJR-2017-0003.R1. PMID:28642256

  16. Trunnionosis in total hip arthroplasty: a review.

    Science.gov (United States)

    Mistry, Jaydev B; Chughtai, Morad; Elmallah, Randa K; Diedrich, Aloise; Le, Sidney; Thomas, Melbin; Mont, Michael A

    2016-03-01

    Trunnionosis is defined as wear of the femoral head-neck interface and has recently been acknowledged as a growing cause of total hip arthroplasty failure. Some studies have reported that it accounts for up to 3 % of all revisions. The exact cause of trunnionosis is currently unknown; however, postulated etiologies include modular junction wear, corrosion damage, and metal ion release. Additionally, implant design and trunnion geometries may contribute to the progression of component failure. In order to aid in our understanding of this phenomenon, our aim was to present the current literature on (1) the effect of femoral head size on trunnionosis, (2) the effect of trunnion design on trunnionosis, (3) localized biological reactions associated with trunnionosis, and (4) gross trunnion failures. It is hoped that this will encourage further research and interest aimed at minimizing this complication.

  17. Endotoxins in surgical instruments of hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Vania Regina Goveia

    2016-06-01

    Full Text Available Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method was used. RESULT There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. CONCLUSION Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested.

  18. Postoperative pain treatment after total hip arthroplasty

    DEFF Research Database (Denmark)

    Højer Karlsen, Anders Peder; Geisler, Anja; Petersen, Pernille Lykke

    2015-01-01

    Treatment of postoperative pain should rely on results from randomized controlled trials and meta-analyses of high scientific quality. The efficacy of a particular intervention may depend on the type of surgical procedure, which supports the reporting of "procedure-specific" interventions. The aim...... of this systematic review was to document the procedure-specific evidence for analgesic interventions after total hip arthroplasty (THA). This PRISMA-compliant and PROSPERO-registered review includes randomized placebo-controlled trials (RCTs) of medication-based analgesic interventions after THA. Endpoints were......, and lumbar plexus block reduced nausea and pruritus. The GRADE-rated quality of evidence ranged from low to very low throughout the analyses. This review demonstrated, that some analgesic interventions may have the capacity to reduce mean opioid requirements and/or mean pain intensity compared with controls...

  19. Favorable results after total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E. H.; Herzberg, G.; Merser, Søren

    2013-01-01

    survival was 0.9 at 5–9 years. Interpretation The clinical results in terms of pain, motion, strength, and function were similar to those in previous reports. The implant survival was 0.9 at 9 years, both in rheumatoid and non-rheumatoid cases, which is an important improvement compared to the earlier......Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non......-rheumatoid cases) and short follow-up times. Here we report a multicenter series using a third-generation implant with a minimum follow-up time of 5 years. Methods In 2012, data were retrieved from a registry of consecutive wrist operations at 7 centers with units specialized in hand surgery, between 2003 and 2007...

  20. [Sir John Charnley and total hip arthroplasty].

    Science.gov (United States)

    Burgers, Paul T P W; van Gijn, Jan

    2011-01-01

    Sir John Charnley (1911-1982), pioneer of the total hip prosthesis, saved countless elderly people from immobility. During the Second World War he assisted Dudley Buxton, orthopaedic surgeon to the British armed forces in the Middle East, in developing new instruments and splints. After the war he first studied healing of bone fractures and the role of compression, and then completely dedicated himself to arthroplasty of the hip. Through countless experiments he found the optimal diameter for the head of the stainless steel prosthesis as well as the optimal polymer for the socket; he also advocated tight cementing of the shaft into the femur. Sir John Charnley received the Lasker Award in 1974 and was knighted in 1977.

  1. Revision of infected knee arthroplasties in Denmark

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C; Bagger, Jens

    2016-01-01

    Background and purpose - The surgical treatment of periprosthetic knee infection is generally either a partial revision procedure (open debridement and exchange of the tibial insert) or a 2-stage exchange arthroplasty procedure. We describe the failure rates of these procedures on a nationwide...... - The failure rates of 43% after the partial revision procedures and 30% after the 2-stage revisions in combination with the higher mortality outside high-volume centers call for centralization and reconsideration of surgical strategies....... ≤ 90 days postoperatively, re-revision due to infection, or not reaching the second stage for a planned 2-stage procedure within a median follow-up period of 3.2 (2.2-4.2) years. Results - The failure rate of the partial revisions was 43%. 71 of the partial revisions (67%) were revisions of a primary...

  2. Tribology of total hip arthroplasty prostheses

    Science.gov (United States)

    Rieker, Claude B.

    2016-01-01

    Articulating components should minimise the generation of wear particles in order to optimize long-term survival of the prosthesis. A good understanding of tribological properties helps the orthopaedic surgeon to choose the most suitable bearing for each individual patient. Conventional and highly cross-linked polyethylene articulating either with metal or ceramic, ceramic-on-ceramic and metal-on-metal are the most commonly used bearing combinations. All combinations of bearing surface have their advantages and disadvantages. An appraisal of the individual patient’s objectives should be part of the assessment of the best bearing surface. Cite this article: Rieker CB. Tribology of total hip arthroplasty prostheses: what an orthopaedic surgeon should know. EFORT Open Rev 2016;1:52-57. DOI: 10.1302/2058-5241.1.000004. PMID:28461928

  3. Total hip arthroplasty at the rothman institute.

    Science.gov (United States)

    Austin, Matthew S; Higuera, Carlos A; Rothman, Richard H

    2012-07-01

    Total hip arthroplasty (THA) is one of the most successful surgical interventions devised in modern times. Attempts to change the current THA procedure with unproven innovations bring the risk of increased failure rates while trying to improve the benefit of the surgery. This manuscript examines the evolution of THA at the Rothman Institute illustrating the key elements that lead the success of this procedure at this institution. These key elements include femoral stem design, use of highly crossed-linked polyethylene and use of pain and rehabilitation protocols. We attempted to describe the long-term results regarding safety, effectiveness, and durability of specific THA implant designs used at this institution drawing on reported evidence in the literature. The authors performed a review of peer-reviewed articles related to the Rothman Institute's experience with THA. Total hip arthroplasty is an efficient, safe, and durable procedure. It is a highly successful operation to restore function and improve pain. The survivorship of THA procedures at the Rothman Institute is higher than 99% at 10 years based on mechanical failure. The use of collarless, tapered wedge femoral stem, highly crossed-linked polyethylene, and improved pain rehabilitation protocols have contributed to this success. There is a well-documented long-term survivorship after THA. Future innovation in THA should address new challenges with younger and more demanding patients, rather than change current methods that have a proven good survivorship. This innovation depends mainly upon improvements in the bearing surfaces and advances in pain control and rehabilitation.

  4. Minimally invasive total hip arthroplasty: in opposition.

    Science.gov (United States)

    Hungerford, David S

    2004-06-01

    At the Knee Society Winter Meeting in 2003, Seth Greenwald and I debated about whether there should be new standards (ie, regulations) applied to the release of information to the public on "new developments." I argued for the public's "right to know" prior to the publication of peer-reviewed literature. He argued for regulatory constraint or "proving by peer-reviewed publication" before alerting the public. It is not a contradiction for me to currently argue against the public advertising of minimally invasive (MIS) total hip arthroplasty as not yet being in the best interest of the public. It is hard to remember a concept that has so captured both the public's and the surgical community's fancy as MIS. Patients are "demanding" MIS without knowing why. Surgeons are offering it as the next best, greatest thing without having developed the skill and experience to avoid the surgery's risks. If you put "minimally invasive hip replacement" into the Google search engine (http://www.google.com), you get 5,170 matches. If you put the same words in PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi), referencing the National Library of Medicine database, you get SEVENTEEN; none is really a peer-reviewed article. Most are 1 page papers in orthopedics from medical education meetings. On the other hand, there are over 6,000 peer-reviewed articles on total hip arthroplasty. Dr. Thomas Sculco, my couterpart in this debate, wrote an insightful editorial in the American Journal of Orthopedic Surgery in which he stated: "Although these procedures have generated incredible interest and enthusiasm, I am concerned that they may be performed to the detriment of our patients." I couldn't agree with him more. Smaller is not necessarily better and, when it is worse, it will be the "smaller" that is held accountable.

  5. Constraint choice in revision knee arthroplasty.

    Science.gov (United States)

    Vasso, Michele; Beaufils, Philippe; Schiavone Panni, Alfredo

    2013-07-01

    Along with the increase in primary total knee arthroplasty, there has been an increase in the number of revisions. The aim of this study was to propose a selection algorithm for the knee revision constraint according to the state of ligaments and to the bone defects Anderson Orthopaedic Research Institute Classification [AORI] classification. The hypothesis was that this algorithm would facilitate the appropriate choice of prosthesis constraint, thus providing stable components and a good long-term survivorship of the knee revisions. Sixty consecutive revision knee arthroplasties in 57 patients were prospectively evaluated. Prostheses implanted at revision included postero-stabilised, condylar constrained and rotating hinged, relative to the state of the ligaments and of the bone loss around the knee. The median follow-up was nine years (range, 4-12). The median IKS knee and function scores and HSS score were 41 (15-62), 21.5 (12-43) and 34 (23-65) points, respectively, before the operation, and 81 (48-97), 79 (56-92) and 83.5 (62-98) points (p < 0.001) at the latest follow-up evaluation. The median ROM increased from 74° (29-110°) preoperatively to 121° (98-132°) (p < 0.01) at the final follow-up. Re-revision was necessary in five (8.3%) patients. A selection algorithm for the revision implant constraint based on the state of ligaments and the bone loss AORI classification could provide stable knee reconstructions and long-term success of knee revisions.

  6. DNCON2: Improved protein contact prediction using two-level deep convolutional neural networks.

    Science.gov (United States)

    Adhikari, Badri; Hou, Jie; Cheng, Jianlin

    2017-12-08

    Significant improvements in the prediction of protein residue-residue contacts are observed in the recent years. These contacts, predicted using a variety of coevolution-based and machine learning methods, are the key contributors to the recent progress in ab initio protein structure prediction, as demonstrated in the recent CASP experiments. Continuing the development of new methods to reliably predict contact maps is essential to further improve ab initio structure prediction. In this paper we discuss DNCON2, an improved protein contact map predictor based on two-level deep convolutional neural networks. It consists of six convolutional neural networks - the first five predict contacts at 6, 7.5, 8, 8.5, and 10 Å distance thresholds, and the last one uses these five predictions as additional features to predict final contact maps. On the free-modeling datasets in CASP10, 11, and 12 experiments, DNCON2 achieves mean precisions of 35%, 50%, and 53.4%, respectively, higher than 30.6% by MetaPSICOV on CASP10 dataset, 34% by MetaPSICOV on CASP11 dataset, and 46.3% by Raptor-X on CASP12 dataset, when top L/5 long-range contacts are evaluated. We attribute the improved performance of DNCON2 to the inclusion of short- and medium-range contacts into training, two-level approach to prediction, use of the state-of-the-art optimization and activation functions, and a novel deep learning architecture that allows each filter in a convolutional layer to access all the input features of a protein of arbitrary length. The web server of DNCON2 is at http://sysbio.rnet.missouri.edu/dncon2/ where training and testing datasets as well as the predictions for CASP10, 11, and 12 free-modeling datasets can also be downloaded. Its source code is available at https://github.com/multicom-toolbox/DNCON2/. chengji@missouri.edu. Supplementary data are available at Bioinformatics online. © The Author(s) 2017. Published by Oxford University Press.

  7. Effect of one- or two-level posterior lumbar interbody fusion on global sagittal balance.

    Science.gov (United States)

    Cho, Jae Hwan; Joo, Youn-Suk; Lim, Cheongsu; Hwang, Chang Ju; Lee, Dong-Ho; Lee, Choon Sung

    2017-12-01

    Sagittal imbalance is associated with poor clinical outcomes in patients with degenerative lumbar disease. However, there is no consensus on the impact of posterior lumbar interbody fusion (PLIF) on local and global sagittal balance. To reveal the effect of one- or two-level PLIF on global sagittal balance. A retrospective case-control study. This study included 88 patients who underwent a one- or two-level PLIF for spinal stenosis with spondylolisthesis. Clinical and radiological parameters were measured pre- and postoperatively. All patients were followed up for >2 years. Clinical outcomes included a visual analog scale, Oswestry Disability Index, and EuroQol 5-dimension questionnaire (EQ-5D). Radiological parameters were measured using whole-spine standing lateral radiographs. Fusion, loosening, subsidence rates, and adverse events were also evaluated. Patients were divided into two groups according to their preoperative C7-S1 sagittal vertical axis (SVA): Group N: SVA≤5 cm vs Group I: SVA>5 cm; they were also divided according to postoperative changes in C7-S1 SVA. Clinical and radiological outcomes were compared between the groups. All clinical outcomes and radiological parameters improved postoperatively. C7-S1 SVA improved (-1.6 cm) after L3-L5 fusion, but it was compromised (+3.6 cm) after L4-S1 fusion (p=.001). Preoperative demographic and clinical data showed no difference except in the anxiety or depression domain of EQ-5D. No differences were found in postoperative clinical outcomes. Lumbar lordosis, pelvic tilt, and thoracic kyphosis slightly improved in Group N, whereas C7-S1 SVA decreased from 9.5 cm to 3.8 cm (pfusion (L3-L5 vs L4-S1, p=.033). Global sagittal balance improved after short-level lumbar fusion surgery in patients having spinal stenosis with spondylolisthesis who showed preoperative sagittal imbalance. Restoration of sagittal balance predominantly occurred after L3-L4, L4-L5, or L3-L5 PLIF. However, no such restoration was

  8. Spondilitis Tuberkulosa Cervical

    Directory of Open Access Journals (Sweden)

    Roni Eka Saputra

    2015-05-01

    Full Text Available Abstrak Spondilitis tuberkulosa servikalis adalah penyakit yang cukup jarang dijumpai, hanya berkisar 2-3% dariseluruh kasus spondilitis tuberkulosa. Gambaran klinis sangat bervariasi, mulai dari gejala ringan dan tidak spesifikhingga komplikasi neurologis yang berat. Seorang wanita berusia 29 tahun datang dengan keluhan lemah keempatanggota gerak yang semakin memberat dalam 10 hari terakhir yang didahului oleh nyeri leher yang menjalar ke bahudan lengan sejak 6 bulan sebelumnya. Nyeri awalnya dirasakan sebagai keterbatasan gerakan leher saat menolehkesamping kiri dan kanan serta menundukkan kepala. Nyeri dirasakan semakin berat dengan pergerakan danberkurang jika istirahat. Pasien mengalami penurunan berat badan sejak 2 bulan terakhir. Tidak dijumpai riwayat batukatau nyeri dada. Pemeriksaan neurologis menunjukkan kelemahan  pada keempat ekstremitas. Hasil laboratoriumditemukan peningkatan Laju Endap Darah (LED. Rontgen foto toraks dalam batas normal. Roentgen foto cervicalmenunjukkan destruksi setinggi C5. MRI cervical menunjukkan destruksi pada korpus C5-6 dengan penyempitan padadiscus intervertebrae C5-6 disertai dengan  massa/abses paravertebral dengan penekanan ke posterior. MRI Thorakaltampak destruksi corpus verebre T4,5 dengan diskus intervertebralis yang menyempit. Sugestif suatu spondilitistuberkulosa. Pasien dilakukan tindakan pembedahan anterior corpectomi melalui microscopic surgery dengan graftdari iliac sinistra, serta insersi anterior plate 1 level. Hasil pemeriksaan patologi anatomi menunjukkan spodilitis TBCkaseosa. Pada spondilitis vertebre T4,5 dilakukan laminectomi, debridement costotrasversektomi, dan stabilisasidengan pedicle screw T2, T3, dan T5. Pasien diterapi dengan obat antituberkulosis. Keadaan pasien saat ini, pasiensudah bisa beraktifitas normal dengan motorik dan sensorik baik. Spondilitis tuberkulosa merupakan bentuktuberkulosa tulang yang paling sering dijumpai. Spondilitis tuberkulosa cervical berkisar 2

  9. Evaluation Of Cervical Punch Biopsy In The Diagnosis Of Cervical ...

    African Journals Online (AJOL)

    Background: Cancer of the cervix uteri is the second leading cause of death in reproductive age women in developing countries. Its early detection and management can reduce the attendant mortality. Aim: To determine the adequacy of cervical punch biopsy technique in the diagnosis of cervical cancer. Methods: A ...

  10. Cervical intra-epithelial neoplasia and invasive cervical cancer in ...

    African Journals Online (AJOL)

    The relative incidences of cervical intra-epithelial neoplasia (CIN) and invasive cervical cancer were studied in black and white patients at the academic hospitals of the University of the Orange Free State. A statistically highly significant difference was found between black and white patients, with a higher incidence of ...

  11. Blood Transfusion Practices in Total Joint Arthroplasties in Jamaica

    Science.gov (United States)

    Rose, RE Christopher; Crichlow, Ayana; Walters, Christine; Ameerally, Andrew; Gordon-Strachan, Georgiana

    2009-01-01

    Background Major blood loss usually occurs in both hip and knee arthroplasty, frequently leading to the need for blood transfusion. This study was performed to determine blood transfusion rates and analyze the factors which affected the need for blood transfusion in patients who underwent primary unilateral total knee and hip arthroplasties at the University Hospital of the West Indies, Jamaica. Methods A prospective study of 118 patients who underwent unilateral total knee and total hip arthroplasties between January 2004 and July 2009 was undertaken. Data collected was analyzed using Microsoft Excel 2008, SPSS version 12 and Stata version 7.0. Results Of the 118 patients, 90 (70%) were females. Mean ± standard deviation (SD) age was 65.2 ± 11.5 years (range 32 - 85 years). Osteoarthritis accounted for the majority (88%) of arthroplasties. Mean ± SD estimated blood loss for all arthroplasties was 1195.0 ± 855.6 ml (range 100 - 6000 ml). Mean ± SD duration of surgery for all joint arthroplasties was 226.1 ± 63.5 minutes (range 110 - 392 minutes). Mean ± SD preoperative hemoglobin was 12.09 g/dl (range 7.3 - 15.6 g/dl). Average body mass index was 28.9 kg/m2 (range 17.9 - 68.3 kg/m2). Seventy-five (64%) patients were transfused and of these, 44 patients received allogenic blood only; 20 patients received autologous blood only, and eleven patients received both allogenic and autologous blood.  The overall blood transfusion rate was 63%. Conclusion In our study, the multivariate analysis showed a significant relationship (p = 0.000) only between postoperative transfusion and the estimated blood loss. Keywords Blood transfusion practices; Total joint arthroplasties PMID:22481988

  12. Radiation Therapy and Cisplatin With or Without Epoetin Alfa in Treating Patients With Cervical Cancer and Anemia

    Science.gov (United States)

    2017-08-08

    Anemia; Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma; Drug Toxicity; Radiation Toxicity; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer

  13. Transport of Photonic Bloch Wave in Arrayed Two-Level Atoms.

    Science.gov (United States)

    Chang, Chih-Chun; Lin, Lee; Chen, Guang-Yin

    2018-01-24

    In a quantum system of arrayed two-level atoms interacting with light, the interacted (dressed) photon is propagating in a periodic medium and its eigenstate ought to be of Bloch type with lattice symmetry. As the energy of photon is around the spacing between the two atomic energy levels, the photon will be absorbed and is not in the propagating mode but the attenuated mode. Therefore an energy gap exists in the dispersion relation of the photonic Bloch wave of dressed photon in addition to the nonlinear behaviors due to atom-light interactions. There follows several interesting results which are distinct from those obtained through a linear dispersion relation of free photon. For example, slow light can exist, the density of state of dressed photon is non-Lorentzian and is very large around the energy gap; the Rabi oscillations become monotonically decreasing in some cases; and besides the superradiance occurs at long wavelengths, the spontaneous emission is also very strong near the energy gap because of the high density of state.

  14. Two-Level Evaluation on Sensor Interoperability of Features in Fingerprint Image Segmentation

    Directory of Open Access Journals (Sweden)

    Ya-Shuo Li

    2012-03-01

    Full Text Available Features used in fingerprint segmentation significantly affect the segmentation performance. Various features exhibit different discriminating abilities on fingerprint images derived from different sensors. One feature which has better discriminating ability on images derived from a certain sensor may not adapt to segment images derived from other sensors. This degrades the segmentation performance. This paper empirically analyzes the sensor interoperability problem of segmentation feature, which refers to the feature’s ability to adapt to the raw fingerprints captured by different sensors. To address this issue, this paper presents a two-level feature evaluation method, including the first level feature evaluation based on segmentation error rate and the second level feature evaluation based on decision tree. The proposed method is performed on a number of fingerprint databases which are obtained from various sensors. Experimental results show that the proposed method can effectively evaluate the sensor interoperability of features, and the features with good evaluation results acquire better segmentation accuracies of images originating from different sensors.

  15. Spectral density of Cooper pairs in two level quantum dot–superconductors Josephson junction

    Energy Technology Data Exchange (ETDEWEB)

    Dhyani, A., E-mail: archana.d2003@gmail.com [Department of Physics, University of Petroleum and Energy Studies, Dehradun 248007, Uttarakhand (India); Rawat, P.S. [Department of Nuclear Science and Technology, University of Petroleum and Energy Studies, Dehradun 248007, Uttarakhand (India); Tewari, B.S., E-mail: bstewari@ddn.upes.ac.in [Department of Physics, University of Petroleum and Energy Studies, Dehradun 248007, Uttarakhand (India)

    2016-09-15

    Highlights: • The present work deals with the study of the electronic spectral density of electron pairs and its effect in charge transport in superconductor-quantum dot-superconductor junctions. • The charge transfer across such junctions can be controlled by changing the positions of the dot level. • The Josephson supercurrent can also be tuned by controlling the position of quantum dot energy levels. - Abstract: In the present paper, we report the role of quantum dot energy levels on the electronic spectral density for a two level quantum dot coupled to s-wave superconducting leads. The theoretical arguments in this work are based on the Anderson model so that it necessarily includes dot energies, single particle tunneling and superconducting order parameter for BCS superconductors. The expression for single particle spectral function is obtained by using the Green's function equation of motion technique. On the basis of numerical computation of spectral function of superconducting leads, it has been found that the charge transfer across such junctions can be controlled by the positions and availability of the dot levels.

  16. Two-level image authentication by two-step phase-shifting interferometry and compressive sensing

    Science.gov (United States)

    Zhang, Xue; Meng, Xiangfeng; Yin, Yongkai; Yang, Xiulun; Wang, Yurong; Li, Xianye; Peng, Xiang; He, Wenqi; Dong, Guoyan; Chen, Hongyi

    2018-01-01

    A two-level image authentication method is proposed; the method is based on two-step phase-shifting interferometry, double random phase encoding, and compressive sensing (CS) theory, by which the certification image can be encoded into two interferograms. Through discrete wavelet transform (DWT), sparseness processing, Arnold transform, and data compression, two compressed signals can be generated and delivered to two different participants of the authentication system. Only the participant who possesses the first compressed signal attempts to pass the low-level authentication. The application of Orthogonal Match Pursuit CS algorithm reconstruction, inverse Arnold transform, inverse DWT, two-step phase-shifting wavefront reconstruction, and inverse Fresnel transform can result in the output of a remarkable peak in the central location of the nonlinear correlation coefficient distributions of the recovered image and the standard certification image. Then, the other participant, who possesses the second compressed signal, is authorized to carry out the high-level authentication. Therefore, both compressed signals are collected to reconstruct the original meaningful certification image with a high correlation coefficient. Theoretical analysis and numerical simulations verify the feasibility of the proposed method.

  17. Coherent interaction with two-level fluctuators using near field scanning microwave microscopy.

    Science.gov (United States)

    de Graaf, S E; Danilov, A V; Kubatkin, S E

    2015-11-24

    Near field Scanning Microwave Microscopy (NSMM) is a scanning probe technique that non-invasively can obtain material properties on the nano-scale at microwave frequencies. While focus has been on developing room-temperature systems it was recently shown that this technique can potentially reach the quantum regime, opening up for applications in materials science and device characterization in solid state quantum information processing. In this paper we theoretically investigate this new regime of NSMM. Specifically we show that interaction between a resonant NSMM probe and certain types of two-level systems become possible when the NSMM probe operates in the (sub-) single photon regime, and we expect a high signal-to-noise ratio if operated under the right conditions. This would allow to detect single atomic material defects with energy splittings in the GHz range with nano-scale resolution, provided that individual defects in the material under study are well enough separated. We estimate that this condition is fulfilled for materials with loss tangents below tan δ ∼ 10(-3) which holds for materials used in today's quantum circuits and devices where typically tan δ microscopes operating in a high power regime.

  18. A Two-Level Task Scheduler on Multiple DSP System for OpenCL

    Directory of Open Access Journals (Sweden)

    Li Tian

    2014-04-01

    Full Text Available This paper addresses the problem that multiple DSP system does not support OpenCL programming. With the compiler, runtime, and the kernel scheduler proposed, an OpenCL application becomes portable not only between multiple CPU and GPU, but also between embedded multiple DSP systems. Firstly, the LLVM compiler was imported for source-to-source translation in which the translated source was supported by CCS. Secondly, two-level schedulers were proposed to support efficient OpenCL kernel execution. The DSP/BIOS is used to schedule system level tasks such as interrupts and drivers; however, the synchronization mechanism resulted in heavy overhead during task switching. So we designed an efficient second level scheduler especially for OpenCL kernel work-item scheduling. The context switch process utilizes the 8 functional units and cross path links which was superior to DSP/BIOS in the aspect of task switching. Finally, dynamic loading and software managed CACHE were redesigned for OpenCL running on multiple DSP system. We evaluated the performance using some common OpenCL kernels from NVIDIA, AMD, NAS, and Parboil benchmarks. Experimental results show that the DSP OpenCL can efficiently exploit the computing resource of multiple cores.

  19. Quantum driving of a two level system: quantum speed limit and superadiabatic protocols - an experimental investigation

    Science.gov (United States)

    Malossi, N.; Bason, M. G.; Viteau, M.; Arimondo, E.; Ciampini, D.; Mannella, R.; Morsch, O.

    2013-06-01

    A fundamental requirement in quantum information processing and in many other areas of science is the capability of precisely controlling a quantum system by preparing a quantum state with the highest fidelity and/or in the fastest possible way. Here we present an experimental investigation of a two level system, characterized by a time-dependent Landau-Zener Hamiltonian, aiming to test general and optimal high-fidelity control protocols. The experiment is based on a Bose-Einstein condensate (BEC) loaded into an optical lattice, then accelerated, which provides a high degree of control over the experimental parameters. We implement generalized Landau-Zener sweeps, comparing them with the well-known linear Landau-Zener sweep. We drive the system from an initial state to a final state with fidelity close to unity in the shortest possible time (quantum brachistochrone), thus reaching the ultimate speed limit imposed by quantum mechanics. On the opposite extreme of the quantum control spectrum, the aim is not to minimize the total transition time but to maximize the adiabaticity during the time-evolution, the system being constrained to the adiabatic ground state at any time. We implement such transitionless superadiabatic protocols by an appropriate transformation of the Hamiltonian parameters. This transformation is general and independent of the physical system.

  20. Vessel Delineation in Retinal Images using Leung-Malik filters and Two Levels Hierarchical Learning.

    Science.gov (United States)

    Varnousfaderani, Ehsan S; Yousefi, Siamak; Bowd, Christopher; Belghith, Akram; Goldbaum, Michael H

    2015-01-01

    Blood vessel segmentation is important for the analysis of ocular fundus images for diseases affecting vessel caliber, occlusion, leakage, inflammation, and proliferation. We introduce a novel supervised method to evaluate performance of Leung-Malik filters in delineating vessels. First, feature vectors are extracted for every pixel with respect to the response of Leung-Malik filters on green channel retinal images in different orientations and scales. A two level hierarchical learning framework is proposed to segment vessels in retinal images with confounding disease abnormalities. In the first level, three expert classifiers are trained to delineate 1) vessels, 2) background, and 3) retinal pathologies including abnormal pathologies such as lesions and anatomical structures such as optic disc. In the second level, a new classifier is trained to detect vessels and non-vessel pixels based on results of the expert classifiers. Qualitative evaluation shows the effectiveness of the proposed expert classifiers in modeling retinal pathologies. Quantitative results on two standard datasets STARE (AUC = 0.971, Acc=0.927) and DRIVE (AUC = 0.955, Acc =0.903) are comparable with other state-of-the-art vessel segmentation methods.

  1. Acoustic interactions between inversion symmetric and asymmetric two-level systems

    International Nuclear Information System (INIS)

    Churkin, A; Schechter, M; Barash, D

    2014-01-01

    Amorphous solids, as well as many disordered lattices, display remarkable universality in their low temperature acoustic properties. This universality is attributed to the attenuation of phonons by tunneling two-level systems (TLSs), facilitated by the interaction of the TLSs with the phonon field. TLS-phonon interaction also mediates effective TLS–TLS interactions, which dictates the existence of a glassy phase and its low energy properties. Here we consider KBr:CN, the archetypal disordered lattice showing universality. We calculate numerically, using conjugate gradients method, the effective TLS–TLS interactions for inversion symmetric (CN flips) and asymmetric (CN rotations) TLSs, in the absence and presence of disorder, in two and three dimensions. The observed dependence of the magnitude and spatial power law of the interaction on TLS symmetry, and its change with disorder, characterizes TLS–TLS interactions in disordered lattices in both extreme and moderate dilutions. Our results are in good agreement with the two-TLS model, recently introduced to explain long-standing questions regarding the quantitative universality of phonon attenuation and the energy scale of ≈1–3 K below which universality is observed. (paper)

  2. A distributed monitoring system for photovoltaic arrays based on a two-level wireless sensor network

    Science.gov (United States)

    Su, F. P.; Chen, Z. C.; Zhou, H. F.; Wu, L. J.; Lin, P. J.; Cheng, S. Y.; Li, Y. F.

    2017-11-01

    In this paper, a distributed on-line monitoring system based on a two-level wireless sensor network (WSN) is proposed for real time status monitoring of photovoltaic (PV) arrays to support the fine management and maintenance of PV power plants. The system includes the sensing nodes installed on PV modules (PVM), sensing and routing nodes installed on combiner boxes of PV sub-arrays (PVA), a sink node and a data management centre (DMC) running on a host computer. The first level WSN is implemented by the low-cost wireless transceiver nRF24L01, and it is used to achieve single hop communication between the PVM nodes and their corresponding PVA nodes. The second level WSN is realized by the CC2530 based ZigBee network for multi-hop communication among PVA nodes and the sink node. The PVM nodes are used to monitor the PVM working voltage and backplane temperature, and they send the acquired data to their PVA node via the nRF24L01 based first level WSN. The PVA nodes are used to monitor the array voltage, PV string current and environment irradiance, and they send the acquired and received data to the DMC via the ZigBee based second level WSN. The DMC is designed using the MATLAB GUIDE and MySQL database. Laboratory experiment results show that the system can effectively acquire, display, store and manage the operating and environment parameters of PVA in real time.

  3. Non-redundant patent sequence databases with value-added annotations at two levels

    Science.gov (United States)

    Li, Weizhong; McWilliam, Hamish; de la Torre, Ana Richart; Grodowski, Adam; Benediktovich, Irina; Goujon, Mickael; Nauche, Stephane; Lopez, Rodrigo

    2010-01-01

    The European Bioinformatics Institute (EMBL-EBI) provides public access to patent data, including abstracts, chemical compounds and sequences. Sequences can appear multiple times due to the filing of the same invention with multiple patent offices, or the use of the same sequence by different inventors in different contexts. Information relating to the source invention may be incomplete, and biological information available in patent documents elsewhere may not be reflected in the annotation of the sequence. Search and analysis of these data have become increasingly challenging for both the scientific and intellectual-property communities. Here, we report a collection of non-redundant patent sequence databases, which cover the EMBL-Bank nucleotides patent class and the patent protein databases and contain value-added annotations from patent documents. The databases were created at two levels by the use of sequence MD5 checksums. Sequences within a level-1 cluster are 100% identical over their whole length. Level-2 clusters were defined by sub-grouping level-1 clusters based on patent family information. Value-added annotations, such as publication number corrections, earliest publication dates and feature collations, significantly enhance the quality of the data, allowing for better tracking and cross-referencing. The databases are available format: http://www.ebi.ac.uk/patentdata/nr/. PMID:19884134

  4. Induced absorption and stimulated emission in a driven two-level atom

    International Nuclear Information System (INIS)

    Mavroyannis, C.

    1992-01-01

    We have considered the induced processes that occur in a driven two-level atom, where a laser photon is absorbed and emitted by the ground and by the excited states of the atom, respectively. In the low-intensity limit of the laser field, the induced spectra arising when a laser photon is absorbed by the ground state of the atom consist of two peaks describing induced absorption and stimulated-emission processes, respectively, where the former prevails over the latter. Asymmetry of the spectral lines occurs at off-resonance and its extent depends on the detuning of the laser field. The physical. process where a laser photon is emitted by the excited state is the reverse of that arising from the absorption of a laser photon by the ground state of the atom. The former differs from the latter in that the emission of a laser photon by the excited state occurs in the low frequency regime and that the stimulated-emission process prevails over that of the induced absorption. In this case, amplification of ultrashort pulses is likely to occur without the need of population inversion between the optical transitions. The computed spectra are graphically presented and discussed. (author)

  5. Testing a Quantum Heat Pump with a Two-Level Spin

    Directory of Open Access Journals (Sweden)

    Luis A. Correa

    2016-04-01

    Full Text Available Once in its non-equilibrium steady state, a nanoscale system coupled to several heat baths may be thought of as a “quantum heat pump”. Depending on the direction of its stationary heat flows, it may function as, e.g., a refrigerator or a heat transformer. These continuous heat devices can be arbitrarily complex multipartite systems, and yet, their working principle is always the same: they are made up of several elementary three-level stages operating in parallel. As a result, it is possible to devise external “black-box” testing strategies to learn about their functionality and performance regardless of any internal details. In particular, one such heat pump can be tested by coupling a two-level spin to one of its “contact transitions”. The steady state of this external probe contains information about the presence of heat leaks and internal dissipation in the device and, also, about the direction of its steady-state heat currents. Provided that the irreversibility of the heat pump is low, one can further estimate its coefficient of performance. These techniques may find applications in the emerging field of quantum thermal engineering, as they facilitate the diagnosis and design optimization of complex thermodynamic cycles.

  6. Risk Analysis of a Two-Level Supply Chain Subject to Misplaced Inventory

    Directory of Open Access Journals (Sweden)

    Lijing Zhu

    2017-06-01

    Full Text Available Misplaced inventory is prevalent in retail stores and may lead to the overall poor performance of the supply chain. We explore the impact of misplaced inventory on a two-level supply chain, which consists of a risk-neutral supplier and a risk-averse retailer. The supplier decides the wholesale price to maximize her profit, whereas the retailer decides the order quantity to maximize his utility. Under the Conditional Value-at-Risk (CVaR criterion, we formulate the problem as a Stackelberg game model and obtain the equilibrium solutions in three cases: (i information asymmetry about inventory errors exists; (ii the retailer shares information about inventory errors with the supplier; and (iii in order to reduce misplaced inventory, the supply chain deploys Radio-Frequency Identification (RFID technology. The benefits of information sharing and RFID implementation are explored. A revenue and cost sharing contract is proposed to coordinate the supply chain and to allocate the cost savings from RFID implementation among supply chain participants. Finally, we provide managerial insights for risk-averse decision makers that are considering investing in the RFID technology.

  7. Flexion/extension cervical spine views in blunt cervical

    Directory of Open Access Journals (Sweden)

    Nasir Sadaf

    2012-06-01

    Full Text Available 【Abstract】Objective: To examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma, who show loss of cervical lordosis and neck pain. Methods: All patients who presented to our emer-gency department following blunt trauma were enrolled in this study, except those with schiwora, neurological defi-cits or fracture demonstrated on cross-table cervical spine X-rays, and those who were either obtunded or presented after cervical spine surgery. Adequacy of flexion and exten-sion views was checked by the neurosurgery and radiology team members. All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain. Results: A total of 200 cases were reviewed, of whom 90 (45% underwent repeat X-rays because of either inadequate exposure or limited motion. None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability. Conclusions: Our results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma, flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis. We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled. Key words: X-rays; Cervical vertebrae; Lordosis

  8. Practical aspects of cervical cancer

    NARCIS (Netherlands)

    Tillaart, Sabrina Ada Hendrika Maria van den

    2013-01-01

    The thesis describes studies on practical aspects of cervical cancer, concering surgical considerations, and aspects of tumour behaviour and tumour spread. The thesis comprises studies on: the comparison of nerve-sparing and non-nerve-sparing radical hysterectomy for cervical cancer; a new surgical

  9. Radiology of the cervical spine

    International Nuclear Information System (INIS)

    Wackenheim, A.

    1989-01-01

    The author describes some particularities seen in the abnormal or pathological image of the cervical spine: The osteolysis of the cortical bone in the spinous processes, the 'Y' shaped course of the corporeal veins, the notch in interspinous bursitis, and the main forms of constitutional stenosis of the cervical canal. (orig.) [de

  10. CERVICAL LYMPHADENOPATHY IN IBADAN, NIGERIA

    African Journals Online (AJOL)

    of life. Conclusion: This study shows that metastatic tumours, Hodgkins lymphoma and Non Hodgkins lymphoma constituting 52.4% of all cases of cervical lymphadenopathy are common in this environment therefore highlighting the need for early and proper evaluation of patients. Keywords: Lymph node, Cervical region, ...

  11. Outcome of Revision Total Hip Arthroplasty in Management of Failed Metal-on-Metal Hip Arthroplasty.

    Science.gov (United States)

    Rahman, Wael A; Amenábar, Tomás; Hetaimish, Bandar M; Safir, Oleg A; Kuzyk, Paul R; Gross, Allan E

    2016-11-01

    This is a retrospective review of the functional outcomes and complications of revision total hip arthroplasty (THA) of failed metal-on-metal (MoM) hip arthroplasty. A total of 20 revision THAs were performed in 19 patients. Of them, 2 cases were failed hip resurfacing, and 18 cases were failed (MoM) THA. The mean age at revision (THA) was 59.35 years (standard deviation [SD] 9.83). The mean follow-up was 45 months (SD 13.98). The indications of revision were aseptic loosening of acetabular component without adverse local tissue reaction (ALTR; 10 hips), aseptic loosening of the acetabular and femoral components without ALTR (1 hip), painful hip associated with ALTR (6 hips), iliopsoas impingement associated with a large-diameter femoral head or malpositioned acetabular component (3 hips). The acetabular components were revised in 18 hips using Trabecular Metal Modular cups. The femoral components were revised in 3 hips. A constrained acetabular liner was used in 5 hips. The Harris hip score significantly improved from 48.4 (SD 12.98) to 83.25 (SD 10.08). There were 2 complications (1 foot drop and 1 superficial infection) and 1 failure (recurrent dislocation) that required revision to a constrained liner. Early results of revision THA of failed MoM hip arthroplasty showed improvement in pain and functional outcome. No case of failed bone ingrowth was noted with the use of Trabecular Metal Modular cups. Extensive soft tissue and abductor muscles dysfunctions were common. A constrained acetabular component with repair of the hip abductors might be beneficial. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. The Biomechanics of Cervical Spondylosis

    Directory of Open Access Journals (Sweden)

    Lisa A. Ferrara

    2012-01-01

    Full Text Available Aging is the major risk factor that contributes to the onset of cervical spondylosis. Several acute and chronic symptoms can occur that start with neck pain and may progress into cervical radiculopathy. Eventually, the degenerative cascade causes desiccation of the intervertebral disc resulting in height loss along the ventral margin of the cervical spine. This causes ventral angulation and eventual loss of lordosis, with compression of the neural and vascular structures. The altered posture of the cervical spine will progress into kyphosis and continue if the load balance and lordosis is not restored. The content of this paper will address the physiological and biomechanical pathways leading to cervical spondylosis and the biomechanical principles related to the surgical correction and treatment of kyphotic progression.

  13. Mucopurulent cervicitis: a clinical entity?

    Science.gov (United States)

    Willmott, F E

    1988-06-01

    Of 297 women attending a sexually transmitted disease clinic who were examined for the presence of mucopurulent cervicitis, 96 (32%) satisfied the diagnostic criteria. Mucopurulent cervicitis was strongly associated with the isolation of Chlamydia trachomatis and Neisseria gonorrhoeae. It was also associated with bacterial vaginosis, the use of oral contraceptives, and sexual contact with men who had non-gonococcal urethritis. Conversely, the presence of opaque cervical secretions did not show these associations, and the results indicated no difference in genital infections in women with clear cervical secretions whether or not more than 10 polymorphonuclear leucocytes per field (at a magnification of x 1000) were present. The findings support the suggestion that mucopurulent cervicitis is a definite clinical entity that requires investigation and treatment.

  14. Therapy of cervical chlamydial infection.

    Science.gov (United States)

    Brunham, R C; Kuo, C C; Stevens, C E; Holmes, K K

    1982-08-01

    The treatment of cervical Chlamydia trachomatis infection in nonpregnant women was evaluated in a double-blind randomized study. Objective criteria were used to assess the response of cervicitis to therapy. Fifty patients were treated with tetracycline hydrochloride, 500 mg orally four times daily, and 50 patients were treated with rosaramicin, 250 mg orally four times daily, both for 7 days. Both agents were highly effective in eradicating C trachomatis. Both produced significant improvement in objective signs of cervicitis: eliminating mucopurulent endocervical discharge and edema of ectopy, and decreasing the clinical severity score of cervicitis. This trial shows that the 1-week course of tetracycline hydrochloride currently recommended for treatment of chlamydial urethritis in men is also highly effective for the treatment of chlamydial cervical infection in women. Rosaramicin, a macrolide antibiotic, was equally effective but produced a higher rate of gastrointestinal side effects.

  15. The Biomechanics of Cervical Spondylosis

    Science.gov (United States)

    Ferrara, Lisa A.

    2012-01-01

    Aging is the major risk factor that contributes to the onset of cervical spondylosis. Several acute and chronic symptoms can occur that start with neck pain and may progress into cervical radiculopathy. Eventually, the degenerative cascade causes desiccation of the intervertebral disc resulting in height loss along the ventral margin of the cervical spine. This causes ventral angulation and eventual loss of lordosis, with compression of the neural and vascular structures. The altered posture of the cervical spine will progress into kyphosis and continue if the load balance and lordosis is not restored. The content of this paper will address the physiological and biomechanical pathways leading to cervical spondylosis and the biomechanical principles related to the surgical correction and treatment of kyphotic progression. PMID:22400120

  16. Two Levels of Waviness Are Necessary to Package the Highly Extensible Nerves in Rorqual Whales.

    Science.gov (United States)

    Lillie, Margo A; Vogl, A Wayne; Gil, Kelsey N; Gosline, John M; Shadwick, Robert E

    2017-03-06

    Peripheral nerves are susceptible to stretch injury [1-4] and incorporate structural waviness at the level of the axons, fascicles, and nerve trunk to accommodate physiological increases in length [5, 6]. It is unknown whether there are limits to the amount of deformation that waviness can accommodate. In rorqual whales, a sub-group of baleen whales, nerves running through the ventral groove blubber (VGB) associated with the floor of the mouth routinely experience dramatically large deformations. In fact, some of these nerves more than double their length during lunge feeding and then recoil to a short, compressed state after each lunge [7-9]. It is unknown how these nerves have adapted to operate in both extended and recoiled states. Using micro-CT and mechanics, we have discovered that the VGB nerves from fin whales require two levels of waviness to prevent stretch damage in both extended and recoiled states. The entire nerve core itself is highly folded when recoiled and appears buckled. This folding provides slack for extension but unavoidably generates large stretches at the bends that could damage nerve fascicles within the core. The strain at the bends is minimized by the specific waveform adopted by the core [10, 11], while the existing bending strains are accommodated by a second level of waviness in the individual fascicles that avoids stretch of the fascicle itself. Structural hierarchy partitions the waviness between the two length scales, providing a mechanism to maintain total elongation while preventing the stretching of fascicles at the bends when recoiled. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Quantum thermalization of two coupled two-level systems in eigenstate and bare-state representations

    International Nuclear Information System (INIS)

    Liao Jieqiao; Huang Jinfeng; Kuang Leman

    2011-01-01

    We study analytically the quantum thermalization of two coupled two-level systems (TLSs), which are connected with either two independent heat baths (IHBs) or a common heat bath (CHB). We understand the quantum thermalization in eigenstate and bare-state representations when the coupling between the two TLSs is stronger and weaker than the TLS-bath couplings, respectively. In the IHB case, we find that, when the two IHBs have the same temperatures, the two coupled TLSs in eigenstate representation can be thermalized with the same temperature as those of the IHBs. However, in the case of two IHBs at different temperatures, just when the energy detuning between the two TLSs satisfies a special condition, the two coupled TLSs in eigenstate representation can be thermalized with an immediate temperature between those of the two IHBs. In bare-state representation, we find a counterintuitive phenomenon that, under some conditions, the temperature of the TLS connected with the high-temperature bath is lower than that of the other TLS, which is connected with the low-temperature bath. In the CHB case, the coupled TLSs in eigenstate representation can be thermalized with the same temperature as that of the CHB in nonresonant cases. In bare-state representation, the TLS with a larger energy separation can be thermalized to a thermal equilibrium with a lower temperature. In the resonant case, we find a phenomenon of antithermalization. We also study the steady-state entanglement between the two TLSs in both the IHB and CHB cases.

  18. A two level mutation-selection model of cultural evolution and diversity.

    Science.gov (United States)

    Salazar-Ciudad, Isaac

    2010-11-21

    Cultural evolution is a complex process that can happen at several levels. At the level of individuals in a population, each human bears a set of cultural traits that he or she can transmit to its offspring (vertical transmission) or to other members of his or her society (horizontal transmission). The relative frequency of a cultural trait in a population or society can thus increase or decrease with the relative reproductive success of its bearers (individual's level) or the relative success of transmission (called the idea's level). This article presents a mathematical model on the interplay between these two levels. The first aim of this article is to explore when cultural evolution is driven by the idea's level, when it is driven by the individual's level and when it is driven by both. These three possibilities are explored in relation to (a) the amount of interchange of cultural traits between individuals, (b) the selective pressure acting on individuals, (c) the rate of production of new cultural traits, (d) the individual's capacity to remember cultural traits and to the population size. The aim is to explore the conditions in which cultural evolution does not lead to a better adaptation of individuals to the environment. This is to contrast the spread of fitness-enhancing ideas, which make individual bearers better adapted to the environment, to the spread of "selfish" ideas, which spread well simply because they are easy to remember but do not help their individual bearers (and may even hurt them). At the same time this article explores in which conditions the adaptation of individuals is maximal. The second aim is to explore how these factors affect cultural diversity, or the amount of different cultural traits in a population. This study suggests that a larger interchange of cultural traits between populations could lead to cultural evolution not improving the adaptation of individuals to their environment and to a decrease of cultural diversity

  19. Eigenstate-specific temperatures in two-level paramagnetic spin lattices

    Science.gov (United States)

    Masthay, Mark B.; Eads, Calley N.; Johnson, Amber N.; Keil, Robert G.; Miller, Philip; Jones, Ross E.; Mashburn, Joe D.; Fannin, Harry B.

    2017-12-01

    Increasing interest in the thermodynamics of small and/or isolated systems, in combination with recent observations of negative temperatures of atoms in ultracold optical lattices, has stimulated the need for estimating the conventional, canonical temperature Tcc o n v of systems in equilibrium with heat baths using eigenstate-specific temperatures (ESTs). Four distinct ESTs—continuous canonical, discrete canonical, continuous microcanonical, and discrete microcanonical—are accordingly derived for two-level paramagnetic spin lattices (PSLs) in external magnetic fields. At large N, the four ESTs are intensive, equal to Tcc o n v, and obey all four laws of thermodynamics. In contrast, for N Tcc o n v, and violate each of the thermodynamic laws. Hence, in spite of their similarities to Tcc o n v at large N, the ESTs are not true thermodynamic temperatures. Even so, each of the ESTs manifests a unique functional dependence on energy which clearly specifies the magnitude and direction of their deviation from Tcc o n v; the ESTs are thus good temperature estimators for small PSLs. The thermodynamic uncertainty relation is obeyed only by the ESTs of small canonical PSLs; it is violated by large canonical PSLs and by microcanonical PSLs of any size. The ESTs of population-inverted eigenstates are negative (positive) when calculated using Boltzmann (Gibbs) entropies; the thermodynamic implications of these entropically induced differences in sign are discussed in light of adiabatic invariance of the entropies. Potential applications of the four ESTs to nanothermometers and to systems with long-range interactions are discussed.

  20. Multiphoton-resonance-induced fluorescence of a strongly driven two-level system under frequency modulation

    Science.gov (United States)

    Yan, Yiying; Lü, Zhiguo; Luo, JunYan; Zheng, Hang

    2018-03-01

    We study the fluorescence spectrum of a strongly driven two-level system (TLS) with modulated transition frequency, which is a bichromatically driven TLS and has multiple resonance frequencies. We are aiming to provide a reliable description of the fluorescence in a regime that is difficult to tackle with perturbation theory and the rotating-wave approximation (RWA), and illustrate the spectral features of the fluorescence under off- and multiphoton-resonance conditions. To go beyond the RWA, we use a semianalytical counter-rotating-hybridized rotating-wave method that combines a unitary transformation and Floquet theory to calculate the two-mode Floquet states and quasienergies for the bichromatically driven TLS. We then solve the master equation accounting for the spontaneous decay in the bases of the two-mode Floquet states, and derive a physically transparent fluorescence spectrum. In comparison with the numerically exact spectrum from the generalized Floquet-Liouville approach, the present spectrum is found to be applicable in a wide range of the parameters where the RWA and the secular approximation may break down. We find that the counter-rotating (CR) terms of the transverse field omitted in the RWA have non-negligible contributions to the spectrum under certain conditions. Particularly, at the multiphoton resonance the width of which is comparable with the Bloch-Siegert shift, the RWA and non-RWA spectra markedly differ from each other because of the CR-induced shift. We also analyze the symmetry of the spectrum in terms of the transition matrix elements between the two-mode Floquet states. We show that the strict symmetry of the spectrum cannot be expected without the RWA but the almost symmetric spectrum can be obtained at the single-photon resonance that takes the Bloch-Siegert shift into account if the driving is moderately strong and at the multiphoton resonance with a sufficiently weak transverse field.

  1. A two level hierarchical model of protein retention in ion exchange chromatography.

    Science.gov (United States)

    Salvalaglio, Matteo; Paloni, Matteo; Guelat, Bertrand; Morbidelli, Massimo; Cavallotti, Carlo

    2015-09-11

    Predicting protein retention in ion exchange chromatography (IEX) from first principles is a fascinating perspective. In this work a two level hierarchical modeling strategy is proposed in order to calculate protein retention factors. Model predictions are tested against experimental data measured for Lysozyme and Chymotrypsinogen A in IEX columns as a function of ionic strength and pH. At the highest level of accuracy Molecular Dynamics (MD) simulations in explicit water are used to determine the interaction free energy between each of the two proteins and the IEX stationary phase for a reference pH and ionic strength. At a lower level of accuracy a linear response model based on an implicit treatment of solvation and adopting a static protein structure is used to calculate interaction free energies for the full range of pHs and ionic strengths considered. A scaling coefficient, determined comparing MD and implicit solvent simulations, is then introduced in order to correct the linear response model for errors induced by the adoption of a static protein structure. The calculated free energies are then used to compute protein retention factors, which can be directly compared with experimental data. The possibility to introduce a third level of accuracy is explored testing the predictions of a semiempirical model. A quantitative agreement between the predicted and measured protein retention factors is obtained using the coupled MD-linear response models, supporting the reliability of the proposed approach. The model allows quantifying the electrostatic, van der Waals, and conformational contributions to the interaction free energies. A good agreement between experiments and model is obtained also using the semiempirical model that, although requiring parameterization over higher level models or experimental data, proves to be useful in order to rapidly determine protein retention factors across wide pH and ionic strength ranges as it is computationally inexpensive

  2. Lambda-Based Data Processing Architecture for Two-Level Load Forecasting in Residential Buildings

    Directory of Open Access Journals (Sweden)

    Gde Dharma Nugraha

    2018-03-01

    Full Text Available Building energy management systems (BEMS have been intensively used to manage the electricity consumption of residential buildings more efficiently. However, the dynamic behavior of the occupants introduces uncertainty problems that affect the performance of the BEMS. To address this uncertainty problem, the BEMS may implement load forecasting as one of the BEMS modules. Load forecasting utilizes historical load data to compute model predictions for a specific time in the future. Recently, smart meters have been introduced to collect electricity consumption data. Smart meters not only capture aggregation data, but also individual data that is more frequently close to real-time. The processing of both smart meter data types for load forecasting can enhance the performance of the BEMS when confronted with uncertainty problems. The collection of smart meter data can be processed using a batch approach for short-term load forecasting, while the real-time smart meter data can be processed for very short-term load forecasting, which adjusts the short-term load forecasting to adapt to the dynamic behavior of the occupants. This approach requires different data processing techniques for aggregation and individual of smart meter data. In this paper, we propose Lambda-based data processing architecture to process the different types of smart meter data and implement the two-level load forecasting approach, which combines short-term and very short-term load forecasting techniques on top of our proposed data processing architecture. The proposed approach is expected to enhance the BEMS to address the uncertainty problem in order to process data in less time. Our experiment showed that the proposed approaches improved the accuracy by 7% compared to a typical BEMS with only one load forecasting technique, and had the lowest computation time when processing the smart meter data.

  3. How Do Preoperative Medications Influence Outcomes After Total Joint Arthroplasty?

    Science.gov (United States)

    Zarling, Bradley J; Sikora-Klak, Jakub; Bergum, Chris; Markel, David C

    2017-09-01

    Recent health care policy changes require hospitals and physicians to demonstrate improved quality. In 2012, a prospective database was formed with the Blue Cross and Blue Shield of Michigan to improve quality of care. The purpose of this study was to analyze patient preoperative medication as predictors of outcomes after total joint arthroplasty. Data were collected on patient's preoperative medications from 2012 to 2015 using a total joint arthroplasty database. Medications were categorized as antiplatelet, antimicrobial, anticoagulant, narcotic, steroid, insulin, or oral diabetes medication. Outcomes included hospital length of stay (LOS), discharge disposition/destination, and 90-day readmission. Univariate and multivariate regression analyses were performed. A total of 3959 patients were studied. Eighty percent (3163 patients) were discharged home. The remainder (795) went to an extended-care facility (ECF). Patients discharged to an ECF were taking more medications (1.13 vs 0.80 in total knee arthroplasty; 1.18 vs 0.83 in total hip arthroplasty; P Patients who were readmitted took more medications (1.0 vs 0.85; P diabetes medication users. Patients taking anticoagulants, narcotics, insulin, and antiplatelets had greater readmission rates. There was a significant correlation between the number of medications and an increased LOS. Patients taking more medications were more frequently discharged to an ECF and had increased LOS and readmission rates. Narcotics and diabetic medications had the greatest influence. Category and quantity of preoperative medications can be used as predictors of outcomes after arthroplasty surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Sports Activity Following Cementless Metaphyseal Hip Joint Arthroplasty.

    Science.gov (United States)

    Czech, Szymon; Hermanson, Jacek; Rodak, Piotr; Stołtny, Tomasz; Rodak, Łukasz; Kasperczyk, Sławomir; Koczy, Bogdan; Mielnik, Michał

    2017-12-01

    An adequate level of physical activity has a substantial effect on both mental and physical human health. Physical activity is largely dependent on the function of the musculoskeletal and articular system. One of the most frequent diseases of this system is degenerative joint disease. Due to the changing and more demanding lifestyles and patients' willingness to be involved in sports activity, the expectations of hip joint arthroplasty are becoming increasingly high. Alleviating pain ceases to be the only reason for which patients choose surgical interventions, while the expectations often include involvement in various sports. Only few studies contain recommendations concerning the frequency, type and intensity of sports activity which are acceptable after hip joint arthroplasty. The aim of the study was to evaluate function and physical activity of people following cementless short-stem hip joint arthroplasty in the observation of at least five years. The study group comprised 106 patients who underwent total hip arthroplasty due to degenerative joint diseases, chosen according to inclusion criteria. Patients underwent routine physical examinations following the Harris Hip Score protocol, responded to the UCLA scale and questionnaires concerning pre-surgical and current physical activity. Our results demonstrated that hip joint arthroplasty in people suffering from degenerative joint diseases has a beneficial effect on their level of functioning and physical activity. Although physical activity and the level of functioning obviously reduced as a person aged, the level of physical activity continued to be very high in both groups, with function of the hip joint evaluated as very good.

  5. Readmission Rates, Reasons, and Risk Factors Following Anterior Cervical Fusion for Cervical Spondylosis in Patients Above 65 Years of Age.

    Science.gov (United States)

    Puvanesarajah, Varun; Hassanzadeh, Hamid; Shimer, Adam L; Shen, Francis H; Singla, Anuj

    2017-01-15

    A retrospective database review. The aim of this study was to determine readmission reasons and rates following primary, elective anterior cervical spinal fusion surgery for cervical spondylosis and determine risk factors predicting increased risk of 30-day readmission in an exclusively elderly population. In the United States, there were almost 190,000 cervical spine procedures in 2009. Many cervical spine surgery patients are elderly, a demographic increasingly requiring surgery for degenerative cervical spine pathology. Unfortunately, this patient population is poorly studied, particularly concerning readmission rates. Medicare data from 2005 to 2012 were queried for elderly patients (65-84 years) who underwent primary one to two and ≥three-level anterior cervical spine fusion surgeries for cervical spondylosis. Forty-five thousand two hundred eighty-four patients treated with one to two-level and 12,103 patients with ≥three-level anterior cervical fusion (ACF) were identified and included in two study cohorts. Reasons for and rates of readmission were determined within 30 days, 90 days, and one-year postoperatively. Risk factors for medical, surgical, and all 30-day readmissions were also determined, selecting from various comorbidities, demographics, and surgical variables. Readmission rates of 1.0% to 1.4%, 2.7% to 3.6%, and 13.2% to 14.1% were observed within 30 days, 90 days, and one year. Within 30 days, over 30% of patients from both study cohorts were readmitted for surgical reasons. Of surgical reasons for 30-day readmission, hematoma/seroma diagnoses were the most frequent (11.4%-15.4% of all readmissions). Male gender, diabetes mellitus, chronic pulmonary disease, obesity, and smoking history were all found to be predictive of all-cause readmissions. Unplanned 30-day readmission rates following primary, elective ACF in elderly patients is low and often due to medical reasons. Frequent surgical reasons for 30-day readmission include hematoma

  6. Inferior outcome after hip resurfacing arthroplasty than after conventional arthroplasty. Evidence from the Nordic Arthroplasty Register Association (NARA) database, 1995 to 2007

    DEFF Research Database (Denmark)

    Johanson, Per-Erik; Fenstad, Anne Marie; Furnes, Ove

    2010-01-01

    The reported outcomes of hip resurfacing arthroplasty (HRA) vary. The frequency of this procedure in Denmark, Norway, and Sweden is low. We therefore determined the outcome of HRA in the NARA database, which is common to all 3 countries, and compared it to the outcome of conventional total hip...

  7. Cervical radiculopathy combined with cervical myelopathy: prevalence and characteristics.

    Science.gov (United States)

    Choi, Byung-Wan; Kim, Sung-Soo; Lee, Dong-Hyun; Kim, Ji-Wan

    2017-10-01

    Patients with cervical myelopathy may experience symptoms of radiculopathy, and it is not easy to determine whether these symptoms are caused by the myelopathy itself or by a radiculopathy accompanied by root compression. Therefore, we aimed to investigate the prevalence of radiculopathy combined with cervical myelopathy and to evaluate the characteristics of cervical myelopathy with or without radiculopathy. We enrolled 127 patients with cervical myelopathy in this retrospective study and reviewed their medical records and magnetic resonance imaging findings. They were divided into two groups according to the presence of cervical radiculopathy, and their age, sex, involved spinal segment, cord signal change, surgical method, clinical status were compared, and postsurgical recovery was compared using four clinical questionnaires. The incidence and level of radiculopathy combined with myelopathy were investigated. Combined cervical radiculopathy and myelopathy was diagnosed in 66 patients (51.9%, group 1), whereas 61 patients did not have radiculopathy (group 2). There was no difference in sex, age, cord signal change, preoperative Japanese Orthopedic Association score, neck disability index, and neck visual analogue scale (VAS) between the two groups, but group 1 showed higher preoperative arm VAS score (p = 0.001). Postoperative arm and neck VAS scores were significantly improved in group 1 (p = 0.001 and 0.009). Half of the patients had combined cervical myelopathy and radiculopathy. A high preoperative arm VAS score was a characteristic of radiculopathy combined with myelopathy.

  8. Joint Arthroplasties other than the Hip in Solid Organ Transplant Recipients

    Science.gov (United States)

    Sayed-Noor, Arkan S

    2009-01-01

    Transplantation Surgery has undergone a great development during the last thirty years and the survival of solid organ recipients has increased dramatically. Osteo-articular diseases such as osteoporosis, fractures, avascular bone necrosis and osteoarthritis are relatively common in these patients and joint arthroplasty may be required. The outcome of hip arthroplasty in patients with osteonecrosis of the femoral head after renal transplantation has been studied and documented by many researchers. However, the results of joint arthroplasties other than the hip in solid organs recipients were only infrequently reported in the literature. A systematic review of the English literature was conducted in order to investigate the outcome of joint arthroplasties other than the hip in kidney, liver or heart transplant recipients. Nine pertinent articles including 51 knee arthroplasties, 8 shoulder arthroplasties and 1 ankle arthroplasty were found. These articles reported well to excellent results with a complication rate and spectrum comparable with those reported in nontransplant patients. PMID:19572036

  9. 10-year follow-up after implantation of the Bryan Cervical Disc Prosthesis.

    Science.gov (United States)

    Dejaegher, Joost; Walraevens, Joris; van Loon, Johannes; Van Calenbergh, Frank; Demaerel, Philippe; Goffin, Jan

    2017-04-01

    Cervical arthroplasty is being used as an alternative for cervical fusion, but long-term follow-up results have rarely been reported. In this paper, we present 10-year follow-up results after implantation of the Bryan Cervical Disc Prosthesis in a single center. 89 patients underwent implantation of a single-level Bryan Cervical Disc Prosthesis to treat radiculopathy and/or myelopathy. Clinical (Neurological Success, Neck Disability Index (NDI), Neck- and Arm-Pain, and SF-36) and radiological follow-up was prospectively organized up to 10 years after surgery. Adverse events and second surgeries were recorded and evaluated. Ten-year follow-up data were available for 72 (81%) patients. Maintenance or improvement of the neurological state was seen in 89% of patients after 10-year follow-up. SF-36 PCS scores improved significantly at all follow-up points. SF-36 MCS improvement was significant at 4 and 6 year, but not at 8- and 10-year follow-up. Significant improvement for NDI, and Neck- and Arm-Pain scores was found for the subgroup of patients in whom these data were available. Mean angular motion of the prosthesis at 10-year follow-up was 8.6°. Mobility of the device, defined as >2° of angular motion, was reached in 81% of patients. During the study period, 21 patients (24%) developed new or recurrent radiculopathy or myelopathy, the majority of these being treated conservatively. Seven patients (8%) required 8 additional spine surgeries to treat persistent or recurrent symptoms. Of these, 2 patients (2%) were reoperated at the index level and at 5 (6%) an adjacent level. In this study, favorable long-term clinical outcome after implantation of the Bryan Cervical Disc Prosthesis was seen, with the majority of prostheses remaining mobile after 10-year follow-up. However, still 6% of patients required adjacent level surgery.

  10. Pain and Function Recovery Trajectories following Revision Hip Arthroplasty: Short-Term Changes and Comparison with Primary Hip Arthroplasty in the ADAPT Cohort Study.

    Directory of Open Access Journals (Sweden)

    Erik Lenguerrand

    Full Text Available Patients report similar or better pain and function before revision hip arthroplasty than before primary arthroplasty but worse results are reported after revision surgery than after primary surgery. The trajectory of post-operative recovery during the first months and any differences by type of surgery have received little attention. We explored the trajectories of change in pain and function after revision hip arthroplasty to 12-months post-operatively and compare them with those observed after primary hip arthroplasty.This study is a prospective cohort study of patients undergoing primary (n = 80 with 92% for an indication of osteoarthritis and revision (n = 43 hip arthroplasties. WOMAC pain and function scores and walking speed were collected pre-operatively, at 3 and 12-months post-operatively. Multilevel regression models were used to chart and compare the trajectories of change (0-3 months and 3-12 months between types of surgery.The improvements in pain and function following revision arthroplasty occurred within the first 3-months with no evidence of further change beyond this initial period. While the pattern of recovery was similar to the one observed after primary arthroplasty, improvements in the first 3-months were smaller after revision compared to primary arthroplasty. Patients listed for revision surgery reported lower pre-operative pain levels but similar post-operative levels compared to those undergoing primary surgery. At 12-months post-operation patients who underwent a revision arthroplasty had not reached the same level of function achieved by those who underwent primary arthroplasty.The post-operative improvements in pain and function are larger following primary hip arthroplasty than following revision hip arthroplasty. Irrespectively of surgery type, most of the improvements occur in the first three post-operative months. More research is required to identify whether the recovery following revision surgery could be

  11. Matthews device arthroplasty presents superior long-term mouth opening than interpositional arthroplasty in the management of temporomandibular joint ankylosis.

    Science.gov (United States)

    Denadai, Rafael; Raposo-Amaral, Cassio Eduardo; Buzzo, Celso Luiz; Raposo-Amaral, Cesar Augusto

    2016-08-01

    The aim of this study is to describe the surgical outcomes of a single-institution experience in the surgical management of temporomandibular joint ankylosis, comparing interpositional arthroplasty with autogenous tissue and Matthews device arthroplasty. A retrospective analysis of temporomandibular joint ankylosis patients (n = 15), who underwent interpositional arthroplasty or Matthews device arthroplasty, was conducted. The surgical outcomes (preoperative, recent [4-6 weeks], intermediate [1 year], and late [3 years] postoperative maximal incisal opening, hospital stay, and complication, relapse, and reoperation rates) were compared. Significant (all p  0.05) in preoperative (4.8 ± 2.9 vs. 4.9 ± 2.9 mm) and recent (35 ± 4 vs. 37 ± 4 mm) postoperative maximal incisal opening, hospital stay (3.5 ± 0.8 vs. 3.6 ± 0.8 days), and surgery-related complications (13% vs. 14%). Both surgical procedures evaluated were successful in initial management of temporomandibular joint ankylosis, but the Matthews device arthroplasty avoided postoperative relapse. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Two levels decision system for efficient planning and implementation of bioenergy production

    International Nuclear Information System (INIS)

    Ayoub, Nasser; Martins, Ricardo; Wang, Kefeng; Seki, Hiroya; Naka, Yuji

    2007-01-01

    When planning bioenergy production from biomass, planners should take into account each and every stakeholder along the biomass supply chains, e.g. biomass resources suppliers, transportation, conversion and electricity suppliers. Also, the planners have to consider social concerns, environmental and economical impacts related with establishing the biomass systems and the specific difficulties of each country. To overcome these problems in a sustainable manner, a robust decision support system is required. For that purpose, a two levels general Bioenergy Decision System (gBEDS) for bioenergy production planning and implementation was developed. The core part of the gBEDS is the information base, which includes the basic bioenergy information and the detailed decision information. Basic bioenergy information include, for instance, the geographical information system (GIS) database, the biomass materials' database, the biomass logistic database and the biomass conversion database. The detailed decision information considers the parameters' values database with their default values and the variables database, values obtained by simulation and optimization. It also includes a scenario database, which is used for demonstration to new users and also for case based reasoning by planners and executers. Based on the information base, the following modules are included to support decision making: the simulation module with graph interface based on the unit process (UP) definition and the genetic algorithms (GAs) methods for optimal decisions and the Matlab module for applying data mining methods (fuzzy C-means clustering and decision trees) to the biomass collection points, to define the location of storage and bioenergy conversion plants based on the simulation and optimization model developed of the whole life cycle of bioenergy generation. Furthermore, Matlab is used to set up a calculation model with crucial biomass planning parameters (e.g. costs, CO 2 emissions), over

  13. [Primary cervical cancer screening].

    Science.gov (United States)

    Vargas-Hernández, Víctor Manuel; Vargas-Aguilar, Víctor Manuel; Tovar-Rodríguez, José María

    2015-01-01

    Cervico-uterine cancer screening with cytology decrease incidence by more than 50%. The cause of this cancer is the human papilloma virus high risk, and requires a sensitive test to provide sufficient sensitivity and specificity for early detection and greater interval period when the results are negative. The test of the human papilloma virus high risk, is effective and safe because of its excellent sensitivity, negative predictive value and optimal reproducibility, especially when combined with liquid-based cytology or biomarkers with viral load, with higher sensitivity and specificity, by reducing false positives for the detection of cervical intraepithelial neoplasia grade 2 or greater injury, with excellent clinical benefits to cervical cancer screening and related infection of human papilloma virus diseases, is currently the best test for early detection infection of human papillomavirus and the risk of carcinogenesis. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

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

    Science.gov (United States)

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

    2013-01-01

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

  15. Transfusion practice in hip arthroplasty - a nationwide study

    DEFF Research Database (Denmark)

    Jans, Øivind; Kehlet, H; Hussain, Zubair Butt

    2011-01-01

    ) in Denmark. Materials and Methods We performed a retrospective cohort study of all patients undergoing THA or RTHA in Denmark in 2008. Primary outcomes were intercentre variation in red blood cell (RBC) transfusion rates and the timing of transfusion related to surgery. Results Six thousand nine hundred......Background and Objectives The optimal transfusion strategy in hip arthroplasty remains controversial despite existing guidelines. The aim of this study was to evaluate the transfusion practice in patients undergoing primary total hip arthroplasty (THA) or revision total hip arthroplasty (RTHA...... thirty-two THA patients and 1132 RTHA patients were included for analysis of which 1674 (24%) THA and 689 (61%) RTHA patients received RBC transfusion. Of these, 47% of THA and 73% of RTHA patients received transfusion on the day of surgery. Transfusion rates between centres varied from 7 to 71...

  16. Shoulder arthroplasty. Part 1: Prosthesis terminology and classification

    Energy Technology Data Exchange (ETDEWEB)

    Sheridan, B.D., E-mail: bdsheridan@hotmail.com [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom); Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P. [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom)

    2012-07-15

    Shoulder arthroplasty is the third most common joint replacement procedure in the UK, and there are a number of different implant options available to surgeons to treat a variety of shoulder disorders. With an increasing burden placed on clinical follow-up, more patients are remaining under the care of their general practitioners and musculoskeletal triage assessment services and are not necessarily being seen by specialists. Referrals to orthopaedic specialists are therefore often prompted by radiological reports describing evidence of implant failure. This article is the first of two reviews on shoulder arthroplasty, concentrating on implant features and the indications for their use. The second article will address the modes of failure of shoulder arthroplasty and describe the relevant associated radiological features.

  17. The association between metal allergy, total knee arthroplasty, and revision

    DEFF Research Database (Denmark)

    Münch, Henrik J; Jacobsen, Stig; Olesen, Jens T

    2015-01-01

    BACKGROUND AND PURPOSE: It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction...... to common metal allergens, and revision surgery in patients who underwent knee arthroplasty. PATIENTS AND METHODS: The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test......, the prevalence of cobalt and chromium allergy was markedly higher. Metal allergy that was diagnosed before implant surgery appeared not to increase the risk of implant failure and revision surgery. INTERPRETATION: While we could not confirm that a positive patch test reaction to common metals is associated...

  18. Shoulder arthroplasty. Part 1: Prosthesis terminology and classification

    International Nuclear Information System (INIS)

    Sheridan, B.D.; Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P.

    2012-01-01

    Shoulder arthroplasty is the third most common joint replacement procedure in the UK, and there are a number of different implant options available to surgeons to treat a variety of shoulder disorders. With an increasing burden placed on clinical follow-up, more patients are remaining under the care of their general practitioners and musculoskeletal triage assessment services and are not necessarily being seen by specialists. Referrals to orthopaedic specialists are therefore often prompted by radiological reports describing evidence of implant failure. This article is the first of two reviews on shoulder arthroplasty, concentrating on implant features and the indications for their use. The second article will address the modes of failure of shoulder arthroplasty and describe the relevant associated radiological features.

  19. Radiographic and scintigraphic evaluation of total knee arthroplasty

    International Nuclear Information System (INIS)

    Schneider, R.; Soudry, M.

    1986-01-01

    Various radiographic and scintigraphic methods are used to supplement clinical findings in the evaluation of total knee arthroplasty and its complications. Serial roentgenograms offer reliable information for diagnosing mechanical loosening. Wide and extensive radiolucency at the cement-bone interface and shift in position and alignment of prosthetic components can be seen in almost all cases by the time revision is necessary. Radiographic abnormalities are usually not present in acute infection, but are often present in chronic infection. Bone scanning has a high sensitivity for diagnosis of infection or loosening, but is nonspecific because increased uptake is often present around asymptomatic total knee arthroplasties with normal radiographs. Differential bone and Gallium scanning and scanning with Indium 111-labeled leukocytes have a greater specificity for diagnosis of infection than does bone or Gallium scanning alone. Routine radiographic and scintigraphic studies have shown a high incidence of deep vein thrombosis in the calf after total knee arthroplasty. Clinically significant pulmonary embolization is infrequent

  20. More than 95% completeness of reported procedures in the population-based Dutch Arthroplasty Register

    Science.gov (United States)

    van Steenbergen, Liza N; Spooren, Anneke; van Rooden, Stephanie M; van Oosterhout, Frank J; Morrenhof, Jan W; Nelissen, Rob G H H

    2015-01-01

    Background and purpose A complete and correct national arthroplasty register is indispensable for the quality of arthroplasty outcome studies. We evaluated the coverage, completeness, and validity of the Dutch Arthroplasty Register (LROI) for hip and knee arthroplasty. Patients and methods The LROI is a nationwide population-based registry with information on joint arthroplasties in the Netherlands. Completeness of entered procedures was validated in 2 ways: (1) by comparison with the number of reimbursements for arthroplasty surgeries (Vektis database), and (2) by comparison with data from hospital information systems (HISs). The validity was examined by conducting checks on missing or incorrectly coded values in the LROI. Results The LROI contains over 300,000 hip and knee arthroplasties performed since 2007. Coverage of all Dutch hospitals (n = 100) was reached in 2012. Completeness of registered procedures was 98% for hip arthroplasty and 96% for knee arthroplasty in 2012, based on Vektis data. Based on comparison with data from the HIS, completeness of registered procedures was 97% for primary total hip arthroplasty and 96% for primary knee arthroplasty in 2013. Completeness of revision arthroplasty was 88% for hips and 90% for knees in 2013. The proportion of missing or incorrectly coded values of variables was generally less than 0.5%, except for encrypted personal identity numbers (17% of which were missing) and ASA scores (10% of which were missing). Interpretation The LROI now contains over 300,000 hip and knee arthroplasty procedures, with coverage of all hospitals. It has a good level of completeness (i.e. more than 95% for primary hip and knee arthroplasty procedures in 2012 and 2013) and the database has high validity. PMID:25758646

  1. Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants.

    Science.gov (United States)

    Holschen, M; Franetzki, B; Witt, K-A; Liem, D; Steinbeck, J

    2017-08-01

    Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants. Due to humeral or glenoid bone-loss and rotator cuff insufficiency reverse total shoulder arthroplasty often means the only remaining treatment option in revision shoulder arthroplasty. This study investigates the clinical outcome of patients treated with a reverse total shoulder in revision cases with special regard to stemless and stemmed primary implants. From 2010 to 2012 60 failed shoulder arthroplasties were converted to reverse total shoulder arthroplasty. Forty-four patients were available for follow-up after a mean of 24 months. Patients were assessed with X-rays, Constant- and ASES Score and a questionnaire about their subjective satisfaction. The total number of observed complications was seven (16%). Ninety-eight percent of the patients were satisfied with their clinical result. Patients achieved a mean normalized constant score of 70.2% and a mean ASES Score of 65.3. Patients with stemless primary implants achieved a higher normalized constant score than patients with stemmed primary implants (82 vs. 61.8%; p = 0009). Reverse total shoulder arthroplasty provides satisfactory clinical results and a high patient satisfaction in revision shoulder arthroplasty. The complication rate needs to be considered and discussed with the patient prior to surgery. Presence or absence of a stem of revised shoulder arthroplasties interferes with the outcome. LEVEL OF EVIDENCE IV: (Retrospective study).

  2. Tuina treatment in cervical spondylosis

    Directory of Open Access Journals (Sweden)

    Florin Mihai Hinoveanu

    2010-12-01

    Full Text Available Cervical spondylosis is a common, chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck as well as the contents of the spinal canal. Common clinical syndromes associated with cervical spondylosis include cervical pain, cervical radiculopathy and/or mielopathy. This study show the main principles, indication and side effects of tuina in cervical spondylosis´ treatment; tuina is one of the external methods based on the principles of Traditional Chinese Medicine (TCM, especially suitable for use on the elderly population and on infants. While performing Tuina, the therapist concentrates his mind, regulates his breathing, and actuates the Qi and power of his entire body towards his hands. For a better result is recommended to try to combine acupuncture with tuina treatment. Tuina can help relieve the pain associated with spondylosis. After this kind of treatment, the symptomes produced by irritated nerves and sore muscles can find some relief. Tuina helps patients with cervical spondylosis regain muscle control, nerve function and flexibility, all through the restoration of the life force flow.

  3. What Factors Drive Inpatient Satisfaction After Knee Arthroplasty?

    Science.gov (United States)

    Peres-da-Silva, Ashwin; Kleeman, Lindsay T; Wellman, Samuel S; Green, Cynthia L; Attarian, David E; Bolognesi, Michael P; Seyler, Thorsten M

    2017-06-01

    The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, developed by the Centers for Medicare & Medicaid Services, is directly tied to hospital reimbursement. The purpose of this study is to analyze survey responses from patients who underwent primary knee arthroplasty in order to identify factors that drive patient dissatisfaction in the inpatient setting. HCAHPS responses received from patients undergoing elective total and unicompartmental knee arthroplasty at our institution between January 1, 2013 and January 1, 2016 were obtained and expressed as a percentage of overall satisfaction. Satisfaction scores were correlated to patient demographics. Overall, responses from 580 patients were obtained (554 total knee arthroplasties, 26 unicompartmental knee arthroplasties). There was a statistically significant difference in overall satisfaction when comparing sex (P = .034), race (P = .030), and socioeconomic status (P = .001). Men reported a higher average satisfaction score than women (77.8% vs 74.2%). Patients in the 1st quartile of socioeconomic status reported a higher average satisfaction than those in the 4th quartile (81.3% vs 71.3%). African American patients reported a higher satisfaction than Caucasian and other races (81.6% vs 75.3% vs 66.3%, respectively). There was an inverse relationship between increased length of stay and reported satisfaction (r = -0.113, P = .006). Our data indicate that patients who are likely to report higher levels of inpatient satisfaction after knee arthroplasty are male, African American, of lower socioeconomic status, and with shorter length of stay. To our knowledge, this is the first reported analysis of the HCAHPS survey in relation to total joint arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Avulsive axillary artery injury in reverse total shoulder arthroplasty.

    Science.gov (United States)

    Wingert, Nathaniel C; Beck, John D; Harter, G Dean

    2014-01-01

    In addition to neurologic injuries such as peripheral nerve palsy, axillary vessel injury should be recognized as a possible complication of reverse total shoulder arthroplasty. Limb lengthening associated with Grammont-type reverse total shoulder arthroplasty places tension across the brachial plexus and axillary vessels and may contribute to observed injuries. The Grammont-type reverse total shoulder arthroplasty prosthesis reverses the shoulder ball and socket, shifts the shoulder center of rotation distal and medial, and lengthens the arm. This alteration of native anatomy converts shearing to compressive glenohumeral joint forces while augmenting and tensioning the deltoid lever arm. Joint stability is enhanced; shoulder elevation is enabled in the rotator cuff–deficient shoulder. Arm lengthening associated with reverse total shoulder arthroplasty places a longitudinal strain on the brachial plexus and axillary vessels. Peripheral nerve palsies and other neurologic complications of reverse total shoulder arthroplasty have been documented. The authors describe a patient with rotator cuff tear arthropathy and a history of radioulnar synostosis who underwent reverse total shoulder arthroplasty complicated by intraoperative injury to the axillary artery and postoperative radial, ulnar, and musculocutaneous nerve palsies. Following a seemingly unremarkable placement of reverse shoulder components, brisk arterial bleeding was encountered while approximating the incised subscapularis tendon in preparation for wound closure. Further exploration revealed an avulsive-type injury of the axillary artery. After an unsuccessful attempt at primary repair, a synthetic arterial bypass graft was placed. Reperfusion of the right upper extremity was achieved and has been maintained to date. Postoperative clinical examination and electromyographic studies confirmed ongoing radial, ulnar, and musculocutaneous neuropathies.

  5. Multimodal Pain Management in Older Elective Arthroplasty Patients.

    Science.gov (United States)

    Brooks, Elaine; Freter, Susan H; Bowles, Susan K; Amirault, David

    2017-09-01

    Pain management after elective arthroplasty in older adults is complicated due to the risk of undertreatment of postoperative pain and potential adverse effects from analgesics, notably opioids. Using combinations of analgesics has been proposed as potentially beneficial to achieve pain control with lower opioid doses. We compared a multimodal pain protocol with a traditional one, in older elective arthroplasty patients, measuring self-rated pain, incidence of postoperative delirium, quantity and cost of opioid analgesics consumed. One hundred fifty-eight patients, 70 years and older, admitted to tertiary care for elective arthroplasty were prospectively assessed postoperative days 1-3. Patients received either traditional postoperative analgesia (acetaminophen plus opioids) or a multimodal pain protocol (acetaminophen, opioids, gabapentin, celecoxib), depending on surgeon preference. Self-rated pain, postoperative delirium, and time to achieve standby-assist ambulation were compared, as were total opioid doses and analgesic costs. Despite receiving significantly more opioid analgesics (traditional: 166.4 mg morphine-equivalents; multimodal: 442 mg morphine equivalents; t = 10.64, P < .0001), there was no difference in self-rated pain, delirium, or mobility on postoperative days 1-3. Costs were significantly higher in the multimodal group ( t = 9.15, P < .0001). Knee arthroplasty was associated with higher pain scores than hip arthroplasty, with no significant difference in opioid usage. A multimodal approach to pain control demonstrated no benefit over traditional postoperative analgesia in elective arthroplasty patients, but with significantly higher amounts of opioid consumed. This poses a potential risk regarding tolerability in frail older adults and results in increased drug costs.

  6. Shoulder arthroplasty. Part 2: Normal and abnormal radiographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Sheridan, B.D., E-mail: bdsheridan@hotmail.com [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom); Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P. [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom)

    2012-07-15

    Frequently, the decision made by general practitioners or musculoskeletal triage assessment services to refer patients for specialist review is initiated by a radiological report. Following shoulder arthroplasty it is important to ensure that any patient with asymptomatic evidence of a failing prosthesis is referred for review so that revision surgery can be contemplated and planned before the situation becomes unsalvageable. The first paper in this series described the various types of shoulder arthroplasty and indications for each. This follow-up paper will concentrate on their modes of failure and the associated radiographic features, and is aimed at radiology trainees and non-musculoskeletal specialist radiologists.

  7. Shoulder arthroplasty. Part 2: Normal and abnormal radiographic findings

    International Nuclear Information System (INIS)

    Sheridan, B.D.; Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P.

    2012-01-01

    Frequently, the decision made by general practitioners or musculoskeletal triage assessment services to refer patients for specialist review is initiated by a radiological report. Following shoulder arthroplasty it is important to ensure that any patient with asymptomatic evidence of a failing prosthesis is referred for review so that revision surgery can be contemplated and planned before the situation becomes unsalvageable. The first paper in this series described the various types of shoulder arthroplasty and indications for each. This follow-up paper will concentrate on their modes of failure and the associated radiographic features, and is aimed at radiology trainees and non-musculoskeletal specialist radiologists.

  8. Avascular necrosis of the trapezoid bone following carpometacarpal arthroplasty.

    Science.gov (United States)

    Kane, Patrick; Waryasz, Greg; Katarincic, Julie

    2014-03-03

    A 58-year-old female developed avascular necrosis of her trapezoid approximately 3 months after undergoing carpometacarpal arthroplasty. The patient was treated conservatively with immobilization and had complete resolution of her clinical symptoms during her year of follow-up. Additionally, radiographic examination showed complete restoration of the height of her trapezoid approximately 1 year after the index procedure. Avascular necrosis of the trapezoid is extremely rare with very few cases described in the literature. This is the first description of avascular necrosis following carpometacarpal arthroplasty.

  9. Wear particles and osteolysis in patients with total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Toxværd, Anders; Bansal, Manjula

    2014-01-01

    tissue, the level of chrome and cobalt ions in the blood, and the possible role of infectious or rheumatoid activity in the development of PPO. METHODS: Biopsies were taken from the implant-bone interphase in 13 consecutive patients with total wrist arthroplasty and with at least 3 years' follow...... of the radiolucent zone. The blood levels of chrome and cobalt ions were normal. There was no evidence of infectious or rheumatoid activity. CONCLUSIONS: Polyethylene wear has been accepted as a major cause of osteolysis in total hip arthroplasty, and metallic debris has also been cited to be an underlying cause...

  10. Does knee awareness differ between different knee arthroplasty prostheses?

    DEFF Research Database (Denmark)

    Thomsen, Morten G; Latifi, Roshan; Kallemose, Thomas

    2016-01-01

    BACKGROUND: Low knee awareness after Total Knee Arthroplasty (TKA) has become the ultimate goal in trying to achieve a natural feeling knee that meet patient expectations. To accommodate this manufacturers of TKAs have developed new prosthetic designs that potentially could give patients a more n...... a standard CR TKA, indicating that the use of this newer prosthetic design facilitate less knee awareness and better function after TKA.......BACKGROUND: Low knee awareness after Total Knee Arthroplasty (TKA) has become the ultimate goal in trying to achieve a natural feeling knee that meet patient expectations. To accommodate this manufacturers of TKAs have developed new prosthetic designs that potentially could give patients a more...

  11. History and factors of survival of total hip arthroplasty.

    Science.gov (United States)

    Kolundžić, Robert; Trkulja, Vladimir; Orlić, Dubravko

    2012-02-01

    Since the 1960s total hip arthroplasty (THA) has represented one of the greatest accomplishments in orthopedic surgery. It improves the functionality, working ability and quality of life of patients with non-functional hip joint due to various reasons. This article reviews general and regional history of THA, current knowledge and concepts regarding the long-term outcomes of the procedure and emphasizes the need for establishing national (and international) THA registries as an essential way of gathering data critical for decision making in daily practice as well as in defining national healthcare policies in respect to arthroplasty procedures.

  12. ARTHROPLASTY FEATURES IN OVERWEIGHT PATIENTS (REVIEW

    Directory of Open Access Journals (Sweden)

    A. I. Yousef

    2017-01-01

    Full Text Available The paper represents a review of modern foreign literature dedicated to joint replacement in patients with increased body mass index. The authors  examine the epidemiology,  pathogenesis features  of osteoarthritis (arthrosis in obesity. The majority  of experts  consider  the increased  body mass index an aggravating factor in the surgical treatment of large joints arthrosis.  There is also the opposite point of view, confirmed by many orthopedic surgeons.The analysis of publications in foreign scientific literature regarding the risk of intraand postoperative complications after arthroplasty in obese patients yields controversial results. The authors  regret  availability of only a few studies  on such an interesting and important topic  carried  out  in Russia. The  need for a detailed  study  of the  issues related  to treatment of patients with obesity is prompted by our time.

  13. Surgical approaches for total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Vincent M Moretti

    2017-01-01

    Full Text Available Total hip arthroplasty (THA has become one of the most reliable and patient-requested surgical interventions in all medicine. The procedure can be performed using a variety of surgical approaches, but the posterior approach, direct lateral approach, and direct anterior approach are by far the most common across the globe. This article highlights the history and technique for each of these common approaches. A review of outcomes and complications for each approach are also provided. Each approach has its own unique advantages and disadvantages, but all can be safely and successful utilized for THA. Strong, convincing, high-quality studies comparing the different approaches are lacking at this time. Surgeons are therefore recommended to choose whichever approach they are most comfortable and experienced using. Though not described here, THA can also be done using the anterolateral approach (also known as the Watson Jones approach as well as the two-incision approach. In addition, recently, some surgeons are utilizing the so-called direct superior approach for THA. While these approaches are far less commonly utilized, they are recognized as viable alternatives to traditional approaches.

  14. The off-resonant aspects of decoherence and a critique of the two-level approximation

    International Nuclear Information System (INIS)

    Savran, Kerim; Hakioglu, T; Mese, E; Sevincli, Haldun

    2006-01-01

    Conditions in favour of a realistic multilevelled description of a decohering quantum system are examined. In this regard the first crucial observation is that the thermal effects, contrary to the conventional belief, play a minor role at low temperatures in the decoherence properties. The system-environment coupling and the environmental energy spectrum dominantly affect the decoherence. In particular, zero temperature quantum fluctuations or non-equilibrium sources can be present and influential on the decoherence rates in a wide energy range allowed by the spectrum of the environment. A crucial observation against the validity of the two-level approximation is that the decoherence rates are found to be dominated not by the long time resonant but the short time off-resonant processes. This observation is demonstrated in two stages. Firstly, our zero temperature numerical results reveal that the calculated short time decoherence rates are Gaussian-like (the time dependence of the density matrix is led by the second time derivative at t = 0). Exact analytical results are also permitted in the short time limit, which, consistent with our numerical results, reveal that this specific Gaussian-like behaviour is a property of the non-Markovian correlations in the environment. These Gaussian-like rates have no dependence on any spectral parameter (position and the width of the spectrum) except, in totality, the spectral area itself. The dependence on the spectral area is a power law. Furthermore, the Gaussian-like character at short times is independent of the number of levels (N), but the numerical value of the decoherence rates is a monotonic function of N. In this context, we demonstrate that leakage, as a characteristic multilevel effect, is dominated by the non-resonant processes. The long time behaviour of decoherence is also examined. Since our spectral model allows Markovian environmental correlations at long times, the decoherence rates in this regime become

  15. Comparative pooled survival and revision rate of Austin-Moore hip arthroplasty in published literature and arthroplasty register data.

    Science.gov (United States)

    Sadoghi, Patrick; Thaler, Martin; Janda, Wolfgang; Hübl, Michael; Leithner, Andreas; Labek, Gerold

    2013-09-01

    The aim was to evaluate the pooled survival and revision rate of Austin-Moore hip arthroplasty (AMHA) in published literature and arthroplasty register data. A comprehensive literature analysis of clinical publications and register reports was conducted with the main endpoints revision surgery and revision rate. Sixteen relevant clinical studies have been found to significantly underestimate revision rates by a ratio of 2.15 compared to register data sets. The medium-term outcome of AMHA showed significantly worse outcomes than the use of other bipolar implants, or modular cervicocephalic prostheses and data of journal publications on revision rates deviate significantly from data of arthroplasty registers. Copyright © 2013. Published by Elsevier Inc.

  16. LEAK study : design of a nationwide randomised controlled trial to find the best way to treat wound leakage after primary hip and knee arthroplasty

    NARCIS (Netherlands)

    Löwik, Claudia A M; Wagenaar, Frank-Christiaan; van der Weegen, Walter; Poolman, Rudolf W; Nelissen, Rob G H H; Bulstra, Sjoerd K; Pronk, Yvette; Vermeulen, Karin M; Wouthuyzen-Bakker, Marjan; van den Akker-Scheek, Inge; Stevens, Martin; Jutte, Paul C

    2017-01-01

    INTRODUCTION: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are highly successful treatment modalities for advanced osteoarthritis. However, prolonged wound leakage after arthroplasty is linked to prosthetic joint infection (PJI), which is a potentially devastating complication. On

  17. Is it feasible to merge data from national shoulder registries? A new collaboration within the Nordic Arthroplasty Register Association

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe V.; Brorson, Stig; Hallan, Geir

    2016-01-01

    Background The Nordic Arthroplasty Register Association was initiated in 2007, and several papers about hip and knee arthroplasty have been published. Inspired by this, we aimed to examine the feasibility of merging data from the Nordic national shoulder arthroplasty registries by defining a common...... in case of revision (date, reason for revision, and new arthroplasty brand). From 2004 to 2013, there were 19,857 primary arthroplasties reported. The most common indications were osteoarthritis (35%) and acute fracture (34%). The number of arthroplasties and especially the number of arthroplasties...... for osteoarthritis have increased in the study period. The most common arthroplasty type was total shoulder arthroplasty (34%) for osteoarthritis and stemmed hemiarthroplasty (90%) for acute fractures. Conclusion We were able to merge data from the Nordic national registries into 1 common data set; however, the set...

  18. Cervical tissue engineering using silk scaffolds and human cervical cells.

    Science.gov (United States)

    House, Michael; Sanchez, Cristina C; Rice, William L; Socrate, Simona; Kaplan, David L

    2010-06-01

    Spontaneous preterm birth is a frequent complication of pregnancy and a common cause of morbidity in childhood. Obstetricians suspect abnormalities of the cervix are implicated in a significant number of preterm births. The cervix is composed of fibrous connective tissue and undergoes significant remodeling in preparation for birth. We hypothesized that a tissue engineering strategy could be used to develop three-dimensional cervical-like tissue constructs that would be suitable for investigating cervical remodeling. Cervical cells were isolated from two premenopausal women undergoing hysterectomy for a benign gynecological condition, and the cells were seeded on porous silk scaffolds in the presence or absence of dynamic culture and with 10% or 20% serum. Morphological, biochemical, and mechanical properties were measured during the 8-week culture period. Cervical cells proliferated in three-dimensions and synthesized an extracellular matrix with biochemical constituents and morphology similar to native tissue. Compared to static culture, dynamic culture was associated with significantly increased collagen deposition (p < 0.05), sulfated glycosaminoglycan synthesis (p < 0.05), and mechanical stiffness (p < 0.05). Serum concentration did not affect measured variables. Relevant human tissue-engineered cervical-like constructs constitute a novel model system for a range of fundamental and applied studies related to cervical remodeling.

  19. CURBSIDE CONSULTATION IN KNEE ARTHROPLASTY: 49 CLINICAL QUESTIONS

    Directory of Open Access Journals (Sweden)

    Craig J. Della Vale

    2008-12-01

    Full Text Available A user- friendly reference for decision making in complicated cases of knee arthroplasty desingned in a question and answers format composed of articles containing current concepts and preferences of experts in total knee replacement surgery, enhanced by several images, diagrams and references and written in the form of a casual advice by Craig J. Della Vale, MD. and his collaborators. PURPOSE By this practical reference of knee arthroplasty, the editor and the contributors have aimed providing straightforward and brief answers, evidence-based advices, their preference and opinions containing current concepts for unanswered questions about complicated cases in total knee replacement surgery which are often controversial and not addressed clearly in traditional knee arthroplasty references. FEATURES There are 49 subjects each written by a different expert designed in 4 sections in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected including indications, unicompartmental osteoarthritis of the knee, patient with vascular problems, donating blood, bilateral arthroplasty, patellar resurfacing, range of motion, bearing surface, contraindications, teaching class for patients prior surgery. The second section is about intraoperative questions including skin incision, patella femoral maltracking, femoral component rotation, tibial component rotation, lateral release, femoral component sizing, flexion instability, varus deformity, and valgus deformity, tightness in extension, iatrogenic MCL injury, antibiotic-loaded cement, and perioperative pain. The third section subjects postoperative questions including wound drainage, preventing tromboembolic events, vascular complications, foot drop, manipulation under anesthesia, patella fractures, supracondylar femur fractures, acute extensor mechanism disruptions. In the fourth

  20. Tuberculosis ganglionar cervical

    Directory of Open Access Journals (Sweden)

    Osmany Leonel Mendoza Cruz

    2014-08-01

    Full Text Available La tuberculosis es una enfermedad reemergente en la actual sociedad globalizada y puede presentarse prácticamente ante cualquier especialista. Las formas extrapulmonares pueden representar hasta la cuarta parte de los casos, y entre ellos la afectación ganglionar se ubica entre las más frecuentes. Se reportan dos pacientes estudiados y tratados en el Servicio de Otorrinolaringología del Hospital General de Bata, Litoral de Guinea Ecuatorial, África Central, afectados por tumoraciones laterocervicales subagudas, con escasos síntomas y excelente evolución, tras su diagnóstico de tuberculosis ganglionar cervical y terapéutica antibiótica. Aunque la punción y aspiración con aguja fina no fue concluyente, ambos casos resultaron positivos por medio de la tinción de Ziehl-Neelsen

  1. Hemangiopericytoma of the cervical spine

    Directory of Open Access Journals (Sweden)

    Raghvendra V Ramdasi

    2014-01-01

    Full Text Available A 28-year-old male presented with neck pain and dysesthesias in the right upper limb. On examination, he had a firm, well-defined midline posterior cervical mass discernible on palpation at the mid-cervical level. He had no neurological deficit. Neuroradiology revealed a variegated enhancing cervical mass is arising from C3 lamina. The mass extended into the right extradural space eroding the C3 lamina and posteriorly into the intermuscular plane. The tumor was excised totally. Histopathology of the tumor showed features of hemangiopericytoma (HPC. The patient underwent postoperative radiotherapy. Primary osseous spinal HPC are rare malignant extra-axial tumors that tend to recur and metastasize. Only two cases of primary osseous HPC have been reported earlier to involve the cervical spine. The clinical presentation and management of the present case with a review of the literature is presented.

  2. Hemangiopericytoma of the cervical spine

    Science.gov (United States)

    Ramdasi, Raghvendra V.; Nadkarni, Trimurti D.; Goel, Naina A.

    2014-01-01

    A 28-year-old male presented with neck pain and dysesthesias in the right upper limb. On examination, he had a firm, well-defined midline posterior cervical mass discernible on palpation at the mid-cervical level. He had no neurological deficit. Neuroradiology revealed a variegated enhancing cervical mass is arising from C3 lamina. The mass extended into the right extradural space eroding the C3 lamina and posteriorly into the intermuscular plane. The tumor was excised totally. Histopathology of the tumor showed features of hemangiopericytoma (HPC). The patient underwent postoperative radiotherapy. Primary osseous spinal HPC are rare malignant extra-axial tumors that tend to recur and metastasize. Only two cases of primary osseous HPC have been reported earlier to involve the cervical spine. The clinical presentation and management of the present case with a review of the literature is presented. PMID:25210342

  3. Cervical cancer screening at crossroads

    DEFF Research Database (Denmark)

    Lynge, Elsebeth; Rygaard, Carsten; Baillet, Miguel Vazquez-Prada

    2014-01-01

    Cervical screening has been one of the most successful public health prevention programmes. For 50 years, cytology formed the basis for screening, and detected cervical intraepithelial lesions (CIN) were treated surgically to prevent progression to cancer. In a high-risk country as Denmark......, screening decreased the incidence of cervical cancer from 34 to 11 per 100,000, age-standardized rate (World Standard Population). Screening is, however, also expensive; Denmark (population: 5.6 million) undertakes close to half a million tests per year, and has 6-8 CIN-treated women for each prevented...... cancer case. The discovery of human papillomavirus (HPV) as the cause of cervical cancer dramatically changed perspectives for disease control. Screening with HPV testing was launched around 1990, and preventive HPV vaccination was licensed in 2006. Long-term randomized controlled trials (RCT...

  4. Get Tested for Cervical Cancer

    Science.gov (United States)

    ... Basics: Cervical Screening Tests What happens during a Pap test? A Pap test takes about 2 to 5 minutes. It may ... uterus, ovaries, and other organs. Learn more about Pap tests. What happens if I’m also having an ...

  5. Cervical Dysplasia: Is It Cancer?

    Science.gov (United States)

    Cervical dysplasia: Is it cancer? I had a Pap test recently, and my doctor said the results showed ... the appearance of the abnormal cells. On the Pap test report, this will be reported as a low- ...

  6. Current Cervical Carcinoma Screening Guidelines

    Directory of Open Access Journals (Sweden)

    Megan J. Schlichte

    2015-05-01

    Full Text Available A formidable threat to the health of women, cervical carcinoma can be prevented in many cases with adequate screening. The current guidelines for cervical carcinoma screening were created as joint recommendations of the American Cancer Society (ACS, the American Society for Colposcopy and Cervical Pathology (ASCCP and the American Society for Clinical Pathology (ASCP in 2012, and later accepted and promoted by the American Congress of Obstetricians and Gynecologists (ACOG. The 2012 recommendations underscore the utility of molecular testing as an adjunct to cytology screening for certain women and provide guidance to clinicians based on different risk-benefit considerations for different ages. This manuscript will review screening techniques and current recommendations for cervical cancer screening and human papilloma virus (HPV testing, as well as possible future screening strategies.

  7. Adjacent Segment Disease in the Cervical and Lumbar Spine.

    Science.gov (United States)

    Tobert, Daniel G; Antoci, Valentin; Patel, Shaun P; Saadat, Ehsan; Bono, Christopher M

    2017-04-01

    Adjacent segment disease (ASD) is disappointing long-term outcome for both the patient and clinician. In contrast to adjacent segment degeneration, which is a common radiographic finding, ASD is less common. The incidence of ASD in both the cervical and lumbar spine is between 2% and 4% per year, and ASD is a significant contributor to reoperation rates after spinal arthrodesis. The etiology of ASD is multifactorial, stemming from existing spondylosis at adjacent levels, predisposed risk to degenerative changes, and altered biomechanical forces near a previous fusion site. Numerous studies have sought to identify both patient and surgical risk factors for ASD, but a consistent, sole predictor has yet to be found. Spinal arthroplasty techniques seek to preserve physiological biomechanics, thereby minimizing the risk of ASD, and long-term clinical outcome studies will help quantify its efficacy. Treatment strategies for ASD are initially nonoperative, provided a progressive neurological deficit is not present. The spine surgeon is afforded many surgical strategies once operative treatment is elected. The goal of this manuscript is to consider the etiologies of ASD, review its manifestations, and offer an approach to treatment.

  8. The association between metal allergy, total hip arthroplasty, and revision

    DEFF Research Database (Denmark)

    Thyssen, Jacob Pontoppidan; Jakobsen, Stig Storgaard; Engkilde, Kåre

    2009-01-01

    BACKGROUND AND PURPOSE: It has been speculated that the prevalence of metal allergy may be higher in patients with implant failure. We compared the prevalence and cause of revisions following total hip arthroplasty (THA) in dermatitis patients suspected to have contact allergy and in patients in ...

  9. 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

  10. Blood Loss and Influencing Factors in Primary Total Hip Arthroplasties

    African Journals Online (AJOL)

    Introduction: Orthopaedic surgery results in significant blood loss. There are no studies that can aid the surgeon in the African region estimate the expected blood loss after total hip replacement. We conducted a study to quantify the blood loss following total hip arthroplasty and to determine the factors associated with this ...

  11. bladder injury during infected total hip arthroplasty prosthesis

    African Journals Online (AJOL)

    Severe intrapelvic protrusions after total hip arthroplasty may occur in cases of chronic infection. During hip surgery, the components threating the neighboring organs were most often cement and screws than the cup itself. As expected, infection is another problem related to all implant surgeries. Bach et al (8) suggested that.

  12. High-volume infiltration analgesia in bilateral hip arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Ø; Otte, Niels Kristian Stahl; Husted, Henrik

    2011-01-01

    Background and purpose High-volume infiltration analgesia may be effective in postoperative pain management after hip arthroplasty but methodological problems prevent exact interpretation of previous studies. Methods In a randomized, double-blind placebo-controlled trial in 12 patients undergoing...

  13. How to quantify knee function after total knee arthroplasty?

    NARCIS (Netherlands)

    Boonstra, M.C.; Waal Malefijt, M.C. de; Verdonschot, N.J.J.

    2008-01-01

    Total knee arthroplasty (TKA) is being undertaken in a younger population than before and as a result the functional demands on the knee are likely to be increasing. As a consequence, it is important to define quantitative functional knee tests that can monitor any increase. A valuable functional

  14. A vascular complication in computer navigated total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Sandesh Gulhane

    2013-01-01

    Full Text Available The use of computer navigation has the potential to improve implant position in total knee arthroplasty (TKA, but pin fixation of reference arrays introduces an additional potential source of complications. We report a case of vascular injury related to the insertion of a femoral pin during navigated TKA.

  15. A vascular complication in computer navigated total knee arthroplasty

    Science.gov (United States)

    Gulhane, Sandesh; Holloway, Ian; Bartlett, Mathew

    2013-01-01

    The use of computer navigation has the potential to improve implant position in total knee arthroplasty (TKA), but pin fixation of reference arrays introduces an additional potential source of complications. We report a case of vascular injury related to the insertion of a femoral pin during navigated TKA. PMID:23531499

  16. Alpine Skiing With total knee ArthroPlasty (ASWAP)

    DEFF Research Database (Denmark)

    Koesters, A.; Poetzelsberger, B.; Dela, F.

    2015-01-01

    The aim of this study was to monitor the long-term effects of skiing on health-related parameters and implant related factors like loosening and wear in patients with total knee arthroplasty. This paper describes the overall study design, general demographics, and physiological demand of the inte...

  17. Prospective psychometric characterization of hip and knee arthroplasty patients

    DEFF Research Database (Denmark)

    Gylvin, Silas Hinsch; Fink-Jensen, Anders; Kehlet, Henrik

    2018-01-01

    BACKGROUND: Psychiatric conditions and psychopharmacological treatments have been demonstrated to be important risk-factors for prolonged hospital length of stay, readmission and morbidity, following fast-track total hip (THA) and total knee arthroplasty (TKA). AIMS: The aim of the study was to p...

  18. Increasing risk of prosthetic joint infection after total hip arthroplasty

    DEFF Research Database (Denmark)

    Dale, Håvard; Fenstad, Anne M; Hallan, Geir

    2012-01-01

    The study was based on the Nordic Arthroplasty Register Association (NARA) dataset. 432,168 primary THAs from 1995 to 2009 were included (Denmark: 83,853, Finland 78,106, Norway 88,455, and Sweden 181,754). Adjusted survival analyses were performed using Cox regression models with revision due to infection...

  19. Low manipulation prevalence following fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Jørgensen, Christoffer C.; Gromov, Kirill

    2015-01-01

    BACKGROUND AND PURPOSE: Postoperative joint stiffness following total knee arthroplasty (TKA) may compromise the outcome and necessitate manipulation. Previous studies have not been in a fast-track setting with optimized pain treatment, early mobilization, and short length of stay (LOS), which ma...

  20. Individualized assessment of post-arthroplasty recovery by actigraphy

    DEFF Research Database (Denmark)

    Engelund Luna, Iben; Peterson, Barry; Kehlet, Henrik

    2017-01-01

    Previous studies using actigraphy to monitor recovery after total knee arthroplasty (TKA) have reported activity as maximum and average count/min, but not utilized the full potential of the data by stratifying activity into various intensities or analysed the individual development in activity ov...

  1. ANALYSIS OF LONG-TERM RESULTS OF SHOULDER ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    D. V. Nenashev

    2012-01-01

    Full Text Available The retrospective analysis of 97 shoulder arthroplasties during 1998 to 2009 was performed. The hemiarthroplasty were fulfilled in 92 patients and total shoulder replacement in 5 patients. Total rate good and satisfactory results consists 32,0%, poor results - 68,0% (66 patients, include 5 patients with total shoulder arthroplasty. The lower level of good results was revealed in patients with chronic fractures and fracture-dislocations of shoulder. It related with changes bones of shoulder and muscles of shoulder (rotator cuff. In the studied group of patients there was no proper pre-operative diagnostics of the rotator cuff, articular surface of the scapula, which shows the need for careful preoperative examination to determine the indications for shoulder arthroplasty and select the type of prosthesis. Unsatisfactory results of total arthroplasty related to screw migration (in case of the transacromion approach and to the development of subacromial impingement. The conclusion about the need to narrow the indications for use of the scapular component «Ortho-P». The authors showed preference to cemented implants without a metal base. It is necessary to introduce in practice the anatomic implants of the third generation allowing the fullest play the anatomy and biomechanics of the shoulder joint.

  2. Importance of attenuating quadriceps activation deficits after total knee arthroplasty.

    Science.gov (United States)

    Thomas, Abbey C; Stevens-Lapsley, Jennifer E

    2012-04-01

    Total knee arthroplasty (TKA) is associated with persistent quadriceps dysfunction. Because quadriceps dysfunction impairs functional performance, minimizing quadriceps dysfunction by attenuating central activation deficits early after surgery may improve function later in life. Rehabilitation strategies incorporating neuromuscular electrical stimulation and early, aggressive quadriceps strengthening may prove beneficial. Furthermore, surgical approaches, such as minimally invasive TKA, may minimize postoperative quadriceps dysfunction.

  3. Fast-track knee arthroplasty – status and future challenges

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Thienpont, Emmanuel

    2013-01-01

    Fast-track programs have been developed for different surgical procedures leading to higher patient satisfaction and lower morbidity. This concept has been extended to knee arthroplasty in recent years. The purpose of this narrative review was to discuss the different aspects of fast-track knee a...

  4. Recovery of gait after short-stay total hip arthroplasty

    NARCIS (Netherlands)

    van den Akker-Scheek, Inge; Stevens, Martin; Bulstra, Sjoerd K.; Groothoff, Johan W.; van Horn, Jim R.; Zijlstra, Wiebren

    Objective: To describe recovery of gait after total hip arthroplasty (THA) based on the assessment of spatiotemporal gait parameters determined with an ambulatory system. Design: A 6-month inception cohort study. Setting: Inpatient and outpatient setting in an academic hospital. Participants:

  5. Calcaneal Insufficiency Fracture after Ipsilateral Total Knee Arthroplasty

    OpenAIRE

    Jeong, Min; Jin, Jin Woo; Shin, Sung Jin; Kang, Byoung Youl

    2016-01-01

    Insufficiency fracture of the calcaneus is a rare entity. In the absence of trauma, evaluating a painful ankle in an elderly patient can be difficult and also it might be overlook the insufficiency fracture. We experienced a case of insufficiency calcaneus fracture that occurred after ipsilateral total knee arthroplasty. Here, we report our case with a review of literatures.

  6. CUSTOMIZED ACETABULAR COMPONENTS IN REVISION HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    G. M. Kavalersky

    2016-01-01

    Full Text Available In recent years, there is a trend of increasing demand for revision hip arthroplasty. Among these patients there are many with complex acetabular defects, including patients with pelvic discontinuity. To ensure stability for revised acetabular components in such cases becomes a challenging or unachievable task. Such defects give indications for printing customized tri-flange acetabular component. The authors analysed own experience of creating and applying custom made acetabular components in 3 patients with complex acetabular defects. Material and methods. Among the patients there were 2 women and 1 man. Average age was 60,3±19,4 years (38 to 78 years. Two patients had III B defects with pelvic discontinuity and one patient had III A defect by Paprosky classification. As the first step, the authors in collaboration with engineers printed a plaster full size pelvic 3D model, as the second step a customized tri-flange acetabular component was designed and printed. Harris Hip Score was evaluated preoperatively and 3 months postoperatively. Results. Average follow-up period was 5,3±2,5 months (3 to 8 months. The authors observed no cases of implant loosening, dislocation or deep periprosthetic infection. Average Harris Hip Score before surgery was 27,13 and after surgery – 74,1 indicating a significant improvement in 3 months postoperatively. Conclusion. Indications for use of individual acetabular components in reported patients correspond to indications formulated by Berasi et al. The authors obtained encouraging early follow-up outcomes that correspond to data of other authors. In one patient certain difficulties were reported due to insufficient pelvic distraction. Component’s flanges prevented achieving adequate pelvic distraction. Nevertheless, good primary stability was achieved. Modern software and 3D metal printers can significantly reduce the production cost of customized acetabular components. Application of this technology can be

  7. Infected total knee arthroplasty treatment outcome analysis

    Directory of Open Access Journals (Sweden)

    Radoičić Dragan

    2012-01-01

    Full Text Available Background/Aim. Infected total knee arthroplasty (TKA is a topic of great importance, because its diagnosing and treatment requires a lot of resources, and often has an unsatisfactory outcome. The aim of this study was to analyze the outcome of the treatment of infection developed following TKA. Methods. This retrospective study of infected TKAs was performed in the period from 1998 to 2008 in the Orthopedics & Traumatology Clinic of the Military Medical Academy (MMA in Belgrade. A total of 654 primary and revised TKAs were performed in the said period. We registered and surgically treated 28 infected TKAs (primary TKAs: MMA - 22, other institutions - 6. The incidence of TKA infection in the MMA was 3.36%. The most common pathogens were: Staphylococcus aureus - 14 (50% cases, and Staph. epidermidis - 3 (10.7% cases. Other isolated pathogens were: Enterococcus faecalis, Klebsiella pneum., Klebsiella spp., Streptoccocus viridans, Seratia spp, Micrococcus luteus and Peptostreptococcus spp. In one case we had mixed anaerobic flora, and in 3 cases cultures were negative. We analyzed diagnostic challenges, risk factors (such as age and previous viscosupplementation and treatment outcomes in our series of infected TKAs. Results. In our series 2 infections healed after iv antibiotics and debridement, 1 patient responded to open debridement with component retention, 4 patients responded fully to one-stage reimplantation, 10 cases responded fully to two-stage reimplantation, 11 patients ended with arthrodesis and we had 1 patient with above knee amputation. Conclusion. Two-stage reimplantation remains gold standard for treatment of infected TKA, and we recommend it as treatment of choice for eradication of infection. The antibiotic loaded spacer prothesis concept in most cases allows infection eradication, good function and high patient satisfaction.

  8. Total knee arthroplasty in elderly osteoporotic patients.

    Science.gov (United States)

    Spinarelli, Antonio; Petrera, Massimo; Vicenti, Giovanni; Pesce, Vito; Patella, Vittorio

    2011-04-01

    Often in daily practice the choice of a prosthesis does not rise out of considerations about literature evidences, but it seems to be related to the personal experience and "surgical philosophy" of surgeon. The choice of prosthesis in total joint replacement is usually justified by biological and mechanical parameters that the surgeon considers before surgery. Osteoporosis is a disease characterized by a reduced bone mass and a degeneration of the bone tissue; it leads to bone fragility, so to a higher risk of fractures. Bone resistance, as all the changes in the microarchitecture of the bone tissue, is linked to bone density. Because of the bone density variation and/or the changes in the bone micro-architecture, as the bone strength decreases, the risk of fractures increases. It is important to understand all the factors taking part in both normal and abnormal bone remodelling. Osteoporosis does not imply a concrete bone loss, but a change of the bone micro-architecture itself. In these cases the choice of the patient and implant design are very important. In the period between March 1997-July 2002, we implanted 100 consecutive TKA (total knee arthroplasty) Genesis II in 97 subjects (79 female); mean age was 77.1 years old. All TKA were performed because of primary osteoarthritis of the knee. All patients had complete pain relief and excellent knee score. The surgical and medical complications were in accordance with the published literature. We must consider all existing medical conditions, the state of the knee and local needs of the elderly patient. Thus, within these limits, the total knee can improve the ability of patients to manage the activities of daily living and improve their quality of life.

  9. Congenital spondylolysis of the cervical spine with spinal cord compression: MR and CT studies

    International Nuclear Information System (INIS)

    Martinez, M.J.; Marti-Bonmati, L.; Molla, E.; Poyatos, C.; Cerda, E. de la; Urrizola, J.

    1997-01-01

    Spondylolysis of the cervical spine is a rare disorder that is characterized by a defect in the articular mass between the superior and inferior facets of a cervical vertebra. It is considered to be congenital because it is usually associated with dysplastic changes, especially involving the posterior arch of the vertebra, which differentiates it from its traumatic equivalent. We present two cases of spondylolysis of the cervical spine without spondylolisthesis, which were studied by means of magnetic resonance (MR) and computerized tomography (CT). One patient showed contralateral involvement at two levels and the other had a single lesion presenting canal stenosis with chronic spinal cord compression, an unusual association in previously reported series. the combination of MR and CT makes it possible to limit the spectrum of bone changes and their impact on the spinal cord in these patients. (Author) 12 refs

  10. Habitual physical activity and sports participation after total ankle arthroplasty.

    Science.gov (United States)

    Naal, Florian D; Impellizzeri, Franco M; Loibl, Markus; Huber, Martin; Rippstein, Pascal F

    2009-01-01

    There is a lack of detailed information about habitual physical activity levels and the sports participation of patients after total ankle arthroplasty. The proportion of sports active patients increases after total ankle arthroplasty, and the majority of patients will meet current recommendations for health-enhancing physical activity. Case series; Level of evidence, 4. The authors assessed the pre- and postoperative participation in sports and recreational activities of 101 patients at a mean of 3.7 years after total ankle arthroplasty. Activity levels were determined with use of the University of California at Los Angeles (UCLA) activity scale. The International Physical Activity Questionnaire (IPAQ) was used to quantify habitual physical activity levels and to calculate the proportion of patients meeting current guidelines for health-enhancing physical activity. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was used as the clinical outcome measure. Radiographs were studied for tibial and talar radiolucencies, and any association between radiolucencies, activity levels, and sports participation was determined. Preoperatively, 62.4% of the patients were active in sports; 66.3% were active after surgery (P=.56). The patients were active in 3.0 +/- 1.8 different sports and recreational activities preoperatively and in 3.0 +/- 1.6 activities after surgery (P =1.0). The sports frequency remained unchanged, with 2.0 +/- 1.6 sessions per week before total ankle arthroplasty and 2.3 +/- 1.7 sessions per week postoperatively (P=.19). Overall, the patients were active in sports and recreation for 3.9 +/- 3.8 hours per week pre-operatively, and for 4.7 +/- 3.9 hours per week after surgery (P=.14). The most common disciplines after total ankle arthroplasty were swimming, cycling, and fitness/weight training. Sixty-five percent of the patients stated that surgery had improved their sports ability. The UCLA activity levels increased significantly from

  11. Two-Stage Cementless Revision Total Hip Arthroplasty for Infected Primary Hip Arthroplasties.

    Science.gov (United States)

    Camurcu, Yalkin; Sofu, Hakan; Buyuk, Abdul Fettah; Gursu, Sarper; Kaygusuz, Mehmet Akif; Sahin, Vedat

    2015-09-01

    The main purpose of the present study was to analyze the clinical features, the most common infective agents, and the results of two-stage total hip revision using a teicoplanin-impregnated spacer. Between January 2005 and July 2011, 41 patients were included. At the clinical status analysis, physical examination was performed, Harris hip score was noted, isolated microorganisms were recorded, and the radiographic evaluation was performed. The mean Harris hip score was improved from 38.9 ± 9.6 points to 81.8 ± 5.8 points (Phips. Radiographic evidence of stability was noted in 37 acetabular revision components, and all femoral stems. Two-stage revision of the infected primary hip arthroplasty is a time-consuming but a reliable procedure with high rates of success. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Endovascular Management of Recurrent Spontaneous Hemarthrosis After Arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Kolber, Marcin K.; Shukla, Pratik A.; Kumar, Abhishek; Zybulewski, Adam; Markowitz, Todd; Silberzweig, James E., E-mail: jsilberzweig@chpnet.org [Mount Sinai Beth Israel, Division of Vascular and Interventional Radiology, Department of Radiology (United States)

    2017-02-15

    PurposeRecurrent spontaneous hemarthrosis is an infrequent but debilitating late complication of joint replacement, affecting up to 1.6% of patients with arthroplasty of the affected joint. Repeated episodes of bleeding result in an inflammatory cascade that further propagates bleeding events. Open and arthroscopic synovectomy are often performed when conservative treatments fail. Transarterial embolization is increasingly utilized as a less invasive option; however, its role is not widely established. We performed a systematic literature review to report the safety and efficacy of transarterial embolization in treating recurrent hemarthrosis in the setting of prior arthroplasty.Materials and MethodsA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, Embase, and SCOPUS databases of patients undergoing embolization for recurrent hemarthrosis after arthroplasty. Patients immediately post-operative, those embolized at first bleeding episode, and those with hemophilia were excluded. Demographic data, clinical information, angiographic findings, treatment, and outcomes were tabulated.ResultsThe search identified 119 titles of which 24 were deemed relevant, comprising 91 patients undergoing 99 embolization procedures. Mean time from prosthesis implantation was 32.2 months. Technical success was 99%. Mean follow-up time was 24.9 months. There were 10 recurrences (10%). Two cases were complicated by joint infection requiring arthroplasty revision.ConclusionsTransarterial embolization for recurrent spontaneous hemarthrosis may be safe and effective in patients having undergone arthroplasty of the affected joint.

  13. Endovascular Management of Recurrent Spontaneous Hemarthrosis After Arthroplasty

    International Nuclear Information System (INIS)

    Kolber, Marcin K.; Shukla, Pratik A.; Kumar, Abhishek; Zybulewski, Adam; Markowitz, Todd; Silberzweig, James E.

    2017-01-01

    PurposeRecurrent spontaneous hemarthrosis is an infrequent but debilitating late complication of joint replacement, affecting up to 1.6% of patients with arthroplasty of the affected joint. Repeated episodes of bleeding result in an inflammatory cascade that further propagates bleeding events. Open and arthroscopic synovectomy are often performed when conservative treatments fail. Transarterial embolization is increasingly utilized as a less invasive option; however, its role is not widely established. We performed a systematic literature review to report the safety and efficacy of transarterial embolization in treating recurrent hemarthrosis in the setting of prior arthroplasty.Materials and MethodsA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, Embase, and SCOPUS databases of patients undergoing embolization for recurrent hemarthrosis after arthroplasty. Patients immediately post-operative, those embolized at first bleeding episode, and those with hemophilia were excluded. Demographic data, clinical information, angiographic findings, treatment, and outcomes were tabulated.ResultsThe search identified 119 titles of which 24 were deemed relevant, comprising 91 patients undergoing 99 embolization procedures. Mean time from prosthesis implantation was 32.2 months. Technical success was 99%. Mean follow-up time was 24.9 months. There were 10 recurrences (10%). Two cases were complicated by joint infection requiring arthroplasty revision.ConclusionsTransarterial embolization for recurrent spontaneous hemarthrosis may be safe and effective in patients having undergone arthroplasty of the affected joint.

  14. Effect of total hip arthroplasty on recreational and sporting activity.

    Science.gov (United States)

    Chatterji, Urjit; Ashworth, Mark J; Lewis, Peter L; Dobson, Peter J

    2004-06-01

    Common concerns of patients undergoing total hip arthroplasty are whether they can continue with certain recreational and sporting activities or even commence new ones after the procedure. The present paper describes preoperative and postoperative activities, the numbers participating and the time to resume these activities. Between 1 and 2 years after total hip arthroplasty, 216 patients, who had undergone a total of 235 arthroplasties, were surveyed by postal questionnaire to ascertain how the arthroplasty had affected their recreational and sporting ability. Their preoperative and postoperative activity along with the time to resume was recorded. A general hip score and estimate of physical activity was also collected. The number of patients participating in sport increased from 188 preoperatively to 196 postoperatively. Patients stated that the surgery had a beneficial effect on their performance of sporting activities although the number of sporting events decreased. By multiplying individuals by the number of sports they participated in, there were 434 occurrences of sport preoperatively giving a mean for the group of 1.9 sports per patient. Postoperatively this had reduced to 382, giving a mean of 1.7. Five sports showed a significant change for individual patients from pre to postoperation. Those which showed an increase were exercise walking, where 38 patients (16.8%) who did not walk before surgery took up walking afterwards (P aqua aerobics, where 15 took up this activity postoperatively for the first time (P = 0.002). There were three sports which decreased significantly from pre to postoperation. They were, golf where 13 out of 39 (P = 0.005), tennis 13 out of 14 (P = 0.01) and jogging where six out of seven (P = 0.01) patients stopped participating. This study has shown that patients are adopting lower impact activities to participate in after total hip arthroplasty. The total number of patients performing a sport increases postoperatively but the

  15. Sports Activity Following Cementless Metaphyseal Hip Joint Arthroplasty

    Directory of Open Access Journals (Sweden)

    Czech Szymon

    2017-12-01

    Full Text Available An adequate level of physical activity has a substantial effect on both mental and physical human health. Physical activity is largely dependent on the function of the musculoskeletal and articular system. One of the most frequent diseases of this system is degenerative joint disease. Due to the changing and more demanding lifestyles and patients’ willingness to be involved in sports activity, the expectations of hip joint arthroplasty are becoming increasingly high. Alleviating pain ceases to be the only reason for which patients choose surgical interventions, while the expectations often include involvement in various sports. Only few studies contain recommendations concerning the frequency, type and intensity of sports activity which are acceptable after hip joint arthroplasty. The aim of the study was to evaluate function and physical activity of people following cementless short-stem hip joint arthroplasty in the observation of at least five years. The study group comprised 106 patients who underwent total hip arthroplasty due to degenerative joint diseases, chosen according to inclusion criteria. Patients underwent routine physical examinations following the Harris Hip Score protocol, responded to the UCLA scale and questionnaires concerning pre-surgical and current physical activity. Our results demonstrated that hip joint arthroplasty in people suffering from degenerative joint diseases has a beneficial effect on their level of functioning and physical activity. Although physical activity and the level of functioning obviously reduced as a person aged, the level of physical activity continued to be very high in both groups, with function of the hip joint evaluated as very good.

  16. Outpatient anterior cervical discectomy and fusion for cervical disk disease: a prospective consecutive series of 96 patients.

    Science.gov (United States)

    Lied, B; Rønning, P A; Halvorsen, C M; Ekseth, K; Helseth, E

    2013-01-01

    To evaluate surgical complications and clinical outcome in a consecutive series of 96 patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical disk degeneration (CDD) in an outpatient setting. Pre-, per-, and postoperative data on patients undergoing single- or two-level outpatient ACDF at the private Oslofjord Clinic were prospectively collected. This study includes 96 consecutive patients with a mean age of 49.1 years. 36/96 had a two-level ACDF. Mean postoperative observation time before discharge was 350 min, and 95/96 were successfully discharged either to their home or to a hotel on the day of surgery. The surgical mortality was 0%, while the surgical morbidity rate was 5.2%. Two (2.1%) patients developed postoperative hematoma, 2 (2.1%) patients experienced postoperative dysphagia, and 1 (1%) experienced deterioration of neurological function. Radicular pain, neck pain, and headache decreased significantly after surgery. 91% of patients were satisfied with the surgery, according to the NASSQ. ACDF in carefully selected patients with CDD appears to be safe in the outpatient setting, provided a sufficient postoperative observation period. The clinical outcome and patient satisfaction of outpatients are comparable to that of inpatients. © 2012 John Wiley & Sons A/S.

  17. Periacetabular Bone Mineral Density Changes After Resurfacing Hip Arthroplasty Versus Conventional Total Hip Arthroplasty. A Randomized Controlled DEXA Study

    NARCIS (Netherlands)

    Smolders, J.M.H.; Pakvis, D.F.; Hendrickx, B.W.; Verdonschot, Nicolaas Jacobus Joseph; van Susante, J.L.C.

    2013-01-01

    A randomized controlled trial was performed to evaluate acetabular bone mineral density (BMD) changes after hip resurfacing (RHA) versus an established conventional total hip arthroplasty (THA). A total of 71 patients were allocated randomly to receive either an RHA press-fit cobalt–chromium cup (n

  18. Long-term results of patellofemoral arthroplasty - A report of 56 arthroplasties with 17 years of follow-up

    NARCIS (Netherlands)

    Kooijman, HJ; Driessen, APPM; van Horn, [No Value

    We studied retrospectively the outcome of patellofemoral arthroplasty (PFA) using the Richards prosthesis in 51 patients (56 knees). Their mean age was 50 years (30 to 77). In 43 patients (45 knees), the American Knee Society score and the patients' subjective judgement were assessed. Excellent or

  19. Revision to reverse shoulder arthroplasty with retention of the humeral component

    OpenAIRE

    Werner, Birgit S; Boehm, Dorota; Gohlke, Frank

    2013-01-01

    Background Revision in failed shoulder arthroplasty often requires removal of the humeral component with a significant risk of fracture and bone loss. Newer modular systems allow conversion from anatomic to reverse shoulder arthroplasty with retention of a well-fixed humeral stem. We report on a prospectively evaluated series of conversions from hemiarthroplasty to reverse shoulder arthroplasty. Methods In 14 cases of failed hemiarthroplasty due to rotator cuff deficiency and painful pseudopa...

  20. Changes in collagen metabolites in serum after cemented hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Joerring, S; Jensen, L T

    1993-01-01

    Markers of types I and III collagen turnover were measured in serial blood samples collected preoperatively and 60 days after surgery in 13 patients undergoing cemented total hip arthroplasty and 11 patients undergoing cemented total knee arthroplasty. The markers were the carboxyterminal extension....... We suggest that the changes in serum PICP and serum PIIINP reflect collagen formation in healing soft connective tissue 60 days after cemented hip or knee arthroplasty....

  1. The risk of venous thromboembolism with aspirin compared to anticoagulants after hip and knee arthroplasty.

    Science.gov (United States)

    Chu, Janet N; Maselli, Judith; Auerbach, Andrew D; Fang, Margaret C

    2017-07-01

    Recent guidelines include aspirin as an option to prevent venous thromboembolism (VTE) in selected patients undergoing hip or knee replacement surgery. However, the efficacy of aspirin after arthroplasty has not been well-defined, particularly in more contemporary patient populations. We compared rates of post-operative VTE between patients who received aspirin-only versus anticoagulants after hip or knee arthroplasty, using data from a large US-based administrative database. We conducted a retrospective cohort study of 231,780 adults who underwent total knee arthroplasty and 110,621 who underwent total hip arthroplasty in 2009-2012 and who received pharmacologic VTE prophylaxis (aspirin or anticoagulant) within the first 7days after surgery. We compared the risk of post-operative VTE between patients receiving aspirin-only vs. anticoagulants, controlling for clinical and hospital characteristics using multivariable logistic regression with propensity score adjustment. Aspirin-only prophylaxis was administered to 7.5% of patients after knee arthroplasty and 8.0% after hip arthroplasty. Post-operative VTE was diagnosed in 2217 (0.96%) patients after knee arthroplasty and 454 (0.41%) after hip arthroplasty. Compared to anticoagulants, aspirin was not associated with a higher risk for post-operative VTE either after knee arthroplasty (adjusted odds ratio and 95% confidence interval [OR] 0.34 [0.24-0.48]) or hip arthroplasty (OR 0.82 [0.45-1.51]). Aspirin was uncommonly administered as the sole prophylactic agent after hip or knee arthroplasty in this study. However, patients who received aspirin-only had similar rates of post-operative VTE compared to patients who received anticoagulants. Further research should focus on distinguishing which patients benefit more from anticoagulants versus aspirin after arthroplasty. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Constraints in total knee arthroplasty: current status and review of literature

    OpenAIRE

    Saubhik Das; Arkesh M.; Rajkumar Selvanayagam

    2017-01-01

    Appropriate selection of prosthesis is critical for success of total knee arthroplasty. It is a daunting task of arthroplasty surgeon to choose from a wide array of implant design for a given situation to confer optimal stability, which translates into satisfactory outcome. Contemporary evolution of prosthetic design with various levels of constraints has revolutionized the approach to total knee arthroplasty. This paper deals with the succinct review of the level of constrained prosthesis av...

  3. Quiste dermoide cervical

    Directory of Open Access Journals (Sweden)

    Yurian Gbenou Morgan

    Full Text Available Los quistes dermoides presentan una incidencia de 1,6 hasta 6,9 % en la región de cabeza y cuello. Se realiza el siguiente reporte de caso clínico con el objetivo de enfatizar en la importancia de un adecuado manejo diagnóstico preoperatorio, para establecer una acertada planificación quirúrgica en la exéresis de este tipo de lesiones de la región cervicofacial. Se presenta el caso clínico de un paciente masculino, de 13 años de edad, quien hacía 3 años se notaba un crecimiento redondeado en región submentoniana, lo cual le ocasionaba molestias al hablar y ligera afectación de su estética facial. Una vez realizados los estudios complementarios preoperatorios, se decide tratamiento quirúrgico, empleando una cervicotomía medial para la extirpación de la lesión quística, dada la ubicación anatómica por debajo del músculo milohiodeo y su gran dimensión. El diagnóstico histopatológico se corresponde con un quiste epidérmico. Se concluye que resulta imprescindible realizar un exhaustivo examen físico e imagenológico, para lograr resultados satisfactorios en el tratamiento quirúrgico del quiste dermoide cervical.

  4. Computer aided decision support system for cervical cancer classification

    Science.gov (United States)

    Rahmadwati, Rahmadwati; Naghdy, Golshah; Ros, Montserrat; Todd, Catherine

    2012-10-01

    Conventional analysis of a cervical histology image, such a pap smear or a biopsy sample, is performed by an expert pathologist manually. This involves inspecting the sample for cellular level abnormalities and determining the spread of the abnormalities. Cancer is graded based on the spread of the abnormal cells. This is a tedious, subjective and time-consuming process with considerable variations in diagnosis between the experts. This paper presents a computer aided decision support system (CADSS) tool to help the pathologists in their examination of the cervical cancer biopsies. The main aim of the proposed CADSS system is to identify abnormalities and quantify cancer grading in a systematic and repeatable manner. The paper proposes three different methods which presents and compares the results using 475 images of cervical biopsies which include normal, three stages of pre cancer, and malignant cases. This paper will explore various components of an effective CADSS; image acquisition, pre-processing, segmentation, feature extraction, classification, grading and disease identification. Cervical histological images are captured using a digital microscope. The images are captured in sufficient resolution to retain enough information for effective classification. Histology images of cervical biopsies consist of three major sections; background, stroma and squamous epithelium. Most diagnostic information are contained within the epithelium region. This paper will present two levels of segmentations; global (macro) and local (micro). At the global level the squamous epithelium is separated from the background and stroma. At the local or cellular level, the nuclei and cytoplasm are segmented for further analysis. Image features that influence the pathologists' decision during the analysis and classification of a cervical biopsy are the nuclei's shape and spread; the ratio of the areas of nuclei and cytoplasm as well as the texture and spread of the abnormalities

  5. Effect of Kerr-like medium on a two-level atom in interaction with bimodal oscillator

    Czech Academy of Sciences Publication Activity Database

    Abdalla, M. S.; Křepelka, Jaromír; Peřina, Jan

    2006-01-01

    Roč. 39, - (2006), s. 1563-1577 ISSN 0953-4075 R&D Projects: GA MŠk(CZ) OC P11.003 Institutional research plan: CEZ:AV0Z10100522 Keywords : kerr-like medium * two-level atom * bimodal oscillator Subject RIV: BH - Optics, Masers, Lasers Impact factor: 2.024, year: 2006

  6. Dynamics of a two-level system in a classical field. A description in different observation levels

    International Nuclear Information System (INIS)

    Heiner, E.; Steinbeck, L.

    1992-01-01

    Effects of contraction in the description of a two-level quantum system coupled to a classical electromagnetic field are studied. Different observation levels are introduced and the corresponding nonlinear equations of motion are obtained. The solutions are discussed with respect to stability, constants of motion and evolution of relevant entropies. (orig.)

  7. Quantum driving protocols for a two-level system: From generalized Landau-Zener sweeps to transitionless control

    DEFF Research Database (Denmark)

    Malossi, Nicola; Bason, Mark George; Viteau, Matthieu

    2013-01-01

    We present experimental results on the preparation of a desired quantum state in a two-level system with the maximum possible fidelity using driving protocols ranging from generalizations of the linear Landau-Zener protocol to transitionless driving protocols that ensure perfect following of the ...

  8. Algebraic analysis of the electromagnetic wave interaction with the two-level system with two-fold degenerated states

    International Nuclear Information System (INIS)

    Rustamov, K.A.

    1988-11-01

    Algebraic properties of the analytical model, describing electro-magnetic weak interaction with the two-level system with two-fold degenerate state are considered. The expressions for the coherent states and Green function of the system are obtained. (author). 9 refs

  9. Open quantum systems and the two-level atom interacting with a single mode of the electromagnetic field

    International Nuclear Information System (INIS)

    Sandulescu, A.; Stefanescu, E.

    1987-07-01

    On the basis of Lindblad theory of open quantum systems we obtain new optical equations for the system of two-level atom interacting with a single mode of the electromagnetic field. The conventional Block equations in a generalized form with field phases are obtained in the hypothesis that all the terms are slowly varying in the rotating frame.(authors)

  10. CDC Vital Signs: Cervical Cancer is Preventable

    Science.gov (United States)

    ... Digital Press Kit Read the MMWR Science Clips Cervical Cancer is Preventable Language: English (US) Español (Spanish) Recommend ... 000 More than 4,000 women die of cervical cancer each year. 93% As many as 93% of ...

  11. Preventing Cervical Cancer with HPV Vaccines

    Science.gov (United States)

    Cervical cancer can be prevented with HPV vaccines. NCI-supported researchers helped establish HPV as a cause of cervical cancer. They also helped create the first HPV vaccines, were involved in the vaccine trials, and contribute to ongoing studies.

  12. Serial transvaginal sonographic measurement of cervical ...

    African Journals Online (AJOL)

    length and width were measured. The gestational age at delivery was recorded. Cervical changes were analysed using student – t test with three classifying factors; gestational age (23). Percentile charts were established for cervical length and ...

  13. Post laminoplasty cervical kyphosis—Case report

    Directory of Open Access Journals (Sweden)

    D.E. Dugoni

    2014-01-01

    CONCLUSION: The anterior approach is a good surgical option in flexible cervical kyphosis. It is of primary importance the sagittal alignment of the cervical spine in order to decompress the nervous structures and to guarantee a long-term stability.

  14. Results of infected total knee arthroplasty treated with arthroscopic debridement and continuous antibiotic irrigation system

    Directory of Open Access Journals (Sweden)

    Che-Wei Liu

    2013-01-01

    Conclusion: Arthroscopic debridement combined with continuous antibiotic irrigation and suction is an effective treatment for patients with acute presentation of late infected total knee arthroplasty.

  15. Cervical spondylosis in Nepalese porters.

    Science.gov (United States)

    Bista, P; Roka, Y B

    2008-01-01

    Neck pain with or without radiculopathy and myelopathy is a very common problem in clinical practice. The incidence is believed to be higher in subgroups carrying load on their head. It has been reported in literature that radiographic spondylosis is appreciable in 25% to 50% of population by the age of 50 years and 75% to 85% by the age of 65 years. One hundred and nineteen lateral X-rays of cervical spine were analyzed as case-control study in patients between 40 and 50 years age with the objective of finding out proportion of cervical spondylosis in this age group and difference in the prevalence between porters and non-porters. Out of the 119 cases 54 (45.4.2%) were porters and 65 (54.6%) were non-porters. There were 98 (82.4%) males and 21 (17.6%) females. The overall prevalence of radiological cervical spondylosis was 69 (58%). The prevalence of cervical spondylosis was significantly lower (x2=14.795, p=0.0001) in porters in comparison to non-porters. The odds ratio was found to be 0.23 (0.10, 0.53) at 95% confidence interval indicating that portering significantly prohibited development of spondylosis. This study concludes that the overall prevalence of cervical spondylosis in the Nepalese population is slightly higher than in the Caucasian and contrary to other studies there is significantly lower prevalence of such degeneration among the Nepalese porters.

  16. Course prognosis of cervical osteochondrosis

    Directory of Open Access Journals (Sweden)

    Kolesov V.N.

    2012-06-01

    Full Text Available

    Today we can state that in spite of a considerable number of cervical osteochondrosis studies, there is a lack of research devoted to analysis of its course. There is no correlation between initial expert evaluations of cervical osteo-chondrosis cases and further course of pathological process. Goal of the research is to develop system of course prognosis of cervical osteochondrosis taking into account environmental infuence, heredity, living conditions, psychological profle of patient’s personality. Materials and methods. Dynamics of degenerative-dystrophic changes progressing of cervical vertebrae in 236 patients was analyzed. Results. Received data demonstrated that probability of stage I changing to stage II, III and IV depended on patients’ sex, age and type of labour activity, frequent supercooling and stress. Probability of fast progression of cervical osteochondrosis (5-year cycle of stage I changing to stage III and IV was to a great extent associated with heredity, urban living, presence of endocrine system diseases, syndrome of nonspecifc dysplasia of connective tissue and low indices of quality of life. Conclusion. Proposed system allows making prognosis of morphologic changes in spinal cord, and is based on radiation methods of verifcation without taking into consideration dynamics of neurological symptomatology.

  17. Endotoxins in surgical instruments of hip arthroplasty.

    Science.gov (United States)

    Goveia, Vania Regina; Mendoza, Isabel Yovana Quispe; Guimarães, Gilberto Lima; Ercole, Flavia Falci; Couto, Bráulio Roberto Gonçalves Marinho; Leite, Edna Marilea Meireles; Stoianoff, Maria Aparecida Resende; Ferreira, José Antonio Guimarães

    2016-01-01

    To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method) was used. There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested. Investigar endotoxinas em instrumentais cirúrgicos esterilizados empregados em artroplastias do quadril. Estudo exploratório, descritivo, desenvolvido em um hospital público de ensino. Foram selecionados seis tipos de instrumentais, a saber: raspa acetabular, raspa femural, saca-cabeça de fêmur, formão box, fresa de fêmur e cabeça de prova de fêmur. A seleção foi feita a partir da análise da dificuldade para a remoção de resíduos de sangue e osso durante a limpeza. A amostra foi constituída por 60 instrumentais cirúrgicos, que foram testados para endotoxinas em três momentos distintos. Foi utilizado o método de gel-clot pelo Limulus Amebócito Lisado (LAL) Endosafe(tm). Houve formação de gel consistente com análise positiva em oito instrumentais, o que corresponde a 13,3%, sendo quatro raspas de fêmur e quatro fresas de fêmur. Foram detectadas endotoxinas em quantidade ≥0,125 UE/mL em 13,3% dos instrumentais testados.

  18. Gait during hydrokinesitherapy following total knee arthroplasty.

    Science.gov (United States)

    Giaquinto, Salvatore; Ciotola, Elena; Margutti, Ferdinando

    2007-05-15

    To obtain gait parameters during hydrotherapy (HT) in patients who were referred for rehabilitation after primary total knee arthroplasty (TKA). The study had a cohort prospective design. Patients who had undergone TKA followed a HT rehabilitation programme. Twenty-two consecutive patients were enrolled. Four of them dropped out for various reasons, independently of HT. Therefore 18 patients could be evaluated (5 men and 13 women). Eighteen age-matched healthy volunteers were the control subjects. Nine patients had a right TKA and nine a left TKA. On the average HT duration was 18.4 days (SD 1.4). The patients presented with a mean speed of 912 (SD 275) meters per hour (m/h) at the baseline. At the last session the mean speed was 1330 (SD 416) m/h. The mean stance duration was 1.75 s (SD 0.34) on the operated side and 1.83 s (SD 0.41) on the non-operated side. By contrast, the mean swing duration was 1.10 s (SD 0.25) on the operated side and 1.13 s (SD 0.34) on the non-operated side. The step duration was the same on both sides. At the beginning of HT the mean stance/swing ratio was 1.94 on the operated side, whereas it was 1.77 on the non-operated side. In the controls the ratio was 1.46. At the beginning the mean stride length was 0.526 m (SD 0.147) and the value became 0.556 (SD 0.138) after 18 training sessions. At the individual level, recovery occurred in a non-linear fashion (Best Fitting, 7th-grade Fourier finite series). The study design permits accurate definition of stride parameters during rehabilitation which allows optimization of the programme. Increase in speed and regain of balance are the main targets of a HT programme and are monitored on a daily basis.

  19. Gait during hydrokinesitherapy following total hip arthroplasty.

    Science.gov (United States)

    Giaquinto, Salvatore; Ciotola, Elena; Margutti, Ferdinando; Valentini, Fabio

    2007-05-15

    To obtain gait parameters during hydrotherapy (HT) in patients who were referred for rehabilitation after total hip arthroprostheses. The study had a cohort prospective design. Patients who underwent primary total hip arthroplasty (THA) followed a HT rehabilitation program. Twenty-one consecutive patients were enrolled. Five of them dropped out for various reasons, independently of HT. Therefore 16 patients could be evaluated (5 men and 11 women). Sixteen age-matched healthy volunteers were the control subjects. Nine patients had a right THA and 7 a left THA. On average HT duration was 15.7 days (SD 3.8). The patients presented with a mean speed of 749 meters per hour (SD 146) at the baseline. At the last session the mean speed was 1175 meters per hour (SD 396). The mean stance duration was 1.59 s (SD 0.28) on the operated side and 1.67 (SD 0.27) on the non-operated side. By contrast, the mean swing duration was 1.02 s (SD 0.20) on the operated side and 0.95 s (SD 0.16) on the non-operated side. The differences in balance were statistically significant. The step duration was the same on both sides. At the beginning of HT the stance/swing ratio was 1.62 (SD 0.40) on the operated side, whereas it was 1.74 (SD 0.42) on the non-operated side. In the controls the ratio was 1.45. During HT both values fluctuated but the trend was toward a better coherence over time. At the beginning the mean stride length was 0.484 meters (SD 0.116) and the value became 0.628 (SD 0.131) after 15 training sessions. At the individual level, recovery occurred in a non-linear fashion, but the mean regression line had a coefficient of 27.1 and the intercept was at 560.3. The study design permits accurate definition of stride parameters during rehabilitation which allows optimization of the programme. Increase in speed and regain of balance are monitored on a daily basis and they appear as the targets of a HT programme.

  20. Femoral component loosening after hip resurfacing arthroplasty

    International Nuclear Information System (INIS)

    Zustin, Jozef; Sauter, Guido; Hahn, Michael; Morlock, Michael M.; Ruether, Wolfgang; Amling, Michael

    2010-01-01

    Before the re-introduction of the current generation of total hip resurfacing arthroplasty, component loosening and osteolysis were of great concern to the orthopaedic community. Early, mid- and long-term clinical results are encouraging, but component loosening still exists. Macroscopic, contact radiographic and histopathological analyses after undecalcified preparation of bone tissue specimens were performed. To investigate the frequency and morphological patterns of the loosening of the femoral component, we analysed a series of 190 retrieved femoral remnants that were revised for aseptic failures. Thirty-five (18.4%) hips were revised for clinical and/or radiographic loosening of the femoral component. Pseudoarthrosis (n = 17; median in situ time: 16 weeks, interquartile range [IQR]: 9 to 34), collapsed osteonecrosis (n = 5; median in situ time: 79 weeks, IQR: 63 to 97), cement-socket debonding (n = 3; median in situ time: 89 weeks, IQR: 54 to 97) and at later follow-up bone-cement loosening (n = 10; median in situ time: 175 weeks; IQR 112 to 198; p =0.005) were distinct patterns of the femoral remnant-implant loosening. Fibrocartilaginous metaplasia of interface bone trabeculae (n = 38; median in situ time: 61 weeks, IQR: 32 to 138) was strongly associated with femoral component loosening (p = 0.009). Both the trabecular hyperosteoidosis (n = 32; median in situ time: 71 weeks, IQR 50 to 129) and excessive intraosseous lymphocyte infiltration (n = 12; median in situ time: 75 weeks, IQR 51 to 98) at the bone-cement interface correlated strongly with fibrocartilaginous metaplasia (p = 0.001 and p = 0.016 respectively) and all three lesions were associated with the female gender (p = 0.021, p = 0.009, and p = 0.051). Femoral component loosening at early follow-up was mostly caused by pathological changes of the femoral remnant bone tissue: pseudoarthrosis and collapsed osteonecrosis. Fibrocartilaginous metaplasia was frequently observed in hips with femoral