Giant magnon spin conductivity in ultrathin yttrium iron garnet films.

Conductivities are key material parameters that govern various types of transport (electronic charge, spin, heat and so on) driven by thermodynamic forces. Magnons, the elementary excitations of the magnetic order, flow under the gradient of a magnon chemical potential1-3 in proportion to a magnon (spin) conductivity. The magnetic insulator yttrium iron garnet is the material of choice for efficient magnon spin transport. Here we report a giant magnon conductivity in thin yttrium iron garnet films with thicknesses down to 3.7 nm when the number of occupied two-dimensional subbands is reduced from a large number to a few, which corresponds to a transition from three-dimensional to two-dimensional magnon transport. We extract a two-dimensional magnon spin conductivity around 1 S at room temperature, comparable to the (electronic) conductivity of the high-mobility two-dimensional electron gas in GaAs quantum wells at millikelvin temperatures4. Such high conductivities offer opportunities to develop low-dissipation magnon-based spintronic devices.

Percepción de residentes de pediatría en cuanto a su formación en contenidos transversales. Investigación cualitativa con grupos focales / Perception of residents in pediatrics regarding their training in cross-curricular subjects. Qualitative research in focus groups

Introducción: Los programas de residencia médica son uno de los principales sistemas de formación de especialidades básicas y posbásicas. A partir del análisis "evaluación participativa" de la OPS en 2002 y el informe de la dra. M. Rosa Borrell en 2005, el Ministerio de Salud de la Nación definió bloques transversales en las bases curriculares. Los contenidos transversales abordan problemas centrales del campo de la salud y de la atención, comunes a todas las profesiones médicas. Contextualizan y determinan el ejercicio profesional. El propósito de este trabajo es contribuir a la evaluación del programa de residencias tomando como objeto de interés a los sujetos participantes de las residencias. Objetivo comprender las percepciones de los residentes de Pediatría del Hospital Garrahan sobre la formación en contenidos transversales. Población y métodos. 4 grupos focales, con 4-6 residentes de tercer y cuarto año de pediatría del Hospital Garrahan. Con ejes de discusión previamente planificados, con un tiempo de duración (120 minutos), en un ambiente no directivo, con múltiples disparadores. Análisis: los contenidos de los grupos focales se analizaron a través de la metodología de "teoría fundamentada en los datos" asistido por el programa ATLAS. Ti (versión 8). Resultados. Participaron 20 residentes, con una mediana de edad de 27 +/- 2 años. A partir de los tres ejes de discusión planificados para los grupos focales se elaboraron núcleos temáticos: normativo institucional, programa de formación, dinámicas de aprendizaje, sectores y climas de trabajo, el paciente y su familia, displicencia. En primer lugar, se reconocieron ingresando a una institución con normas de funcionamiento, en donde "la planta" se describió como la figura normativa predominante. En cuanto al programa de formación, hubo satisfacción con las capacidades alcanzadas. Sin embargo, se debatió si el perfil de profesional alcanzado permite reconocer determinantes de salud más allá de las comorbilidades estrictamente médicas. Surgieron problemáticas vinculadas a los límites del modelo médico hegemónico y la necesidad de nuevos enfoques de aprendizaje a través de la problematización del paciente en su contexto social. Definieron los casos clínicos como la mejor forma de abordar el conocimiento sobre un tema. Surgió espontáneamente el tema de la discriminación. Conclusión: a través de los grupos focales, como espacio de escucha activa de la experiencia cotidiana de trabajo de los residentes del Hospital Garrahan surgieron problemáticas vinculadas a los límites del modelo médico hegemónico y la necesidad de enfoques de aprendizaje a través de la problematización del paciente en su contexto social (AU)

Introduction: Medical residency programs are one of the main systems for the training in basic and post-basic specialties. Based on the "participatory evaluation" analysis by the PAHO in 2002 and the report by dr. M. Rosa Borrell in 2005, the National Ministry of Health defined cross-curricular groups to form the basis of the curriculum. The cross-curricular contents address core subjects in the health care field, common to all medical professions. These subjects contextualize and determine the professional practice. The aim of this study was to contribute to the evaluation of the residency program focusing on the participants in the residency programs. Objective: To assess the perceptions of the residents in Pediatric Hospital Garrahan regarding the training and crosscurricular contents. Population and methods: 4 focus groups, with 4-6 residents of the third and fourth year of Pediatrics at Garrahan Hospital using previously determined lines of discussion, in a time slot of 120 minutes, in a non-directive environment, with multiple triggers. Analysis: The contents of the focus groups were analyzed using the "grounded theory data" methodology supported by the ATLAS program, Ti (version 8). Results: 20 residents, with a median age of 27 +/- 2 years, participated in the program. Based on the three discussion lines planned for the focus groups, six core topics were developed: Institutional norms, training program, learning dynamics, sectors and work environments, the patients and their families, displeasure. In the first place, the subjects recognized they entered an institution with its proper norms, in which "the staff" describes itself as the predominant normative figures. Regarding the training program, subjects were satisfied with skills obtained. However, there was debate as to whether the professional profile achieved included knowledge on determining health factors beyond the strictly medical comorbidities. Issues came up related to the limits of the hegemonic model of the physician and the need for new learning targets through the problematization of the patient in his or her social context. Clinical cases were defined as the best way to approach the knowledge on this subject. The subject of discrimination came up spontaneously. Conclusion: Through focus groups, as an active listening space for the experience in the daily practice of the residents at Garrahan Hospital Garrahan, issues appeared related to the limits of the hegemonic model of the physician the need for new learning targets through the problematization of the patient in his or her social context (AU)

Influence of tibial hybrid fixation on graft tension and stability in ACL double-bundle reconstruction.

PURPOSE: Initial graft tension in anterior cruciate ligament (ACL) reconstruction affects stability and tension loss at follow-up. This study investigated the influence of hybrid tibial fixation in 3-tunnel double-bundle ACL reconstruction on initial graft tension and tension change and stability under anterior and combined rotatory loads. METHODS: Eleven fresh-frozen cadaveric knees were reconstructed with an ACL double bundle using a 3-tunnel technique. Grafts were tightened to 80 N in 60° (AM bundle) and 15° (PL bundle) of flexion. Anterior tibial translation under 134 N of anterior shear load and translation under combined rotatory and valgus loads (10 Nm valgus stress, 4 Nm internal tibial torque) were determined at 0°, 30°, 60°, and 90° flexion. In addition, graft tension under continuous passive motion was determined. Intact, ACL-resected and ACL-reconstructed joints with either tibial extracortical graft fixation or extracortical plus supplemental aperture graft fixation (hybrid fixation) were tested. RESULTS: Hybrid fixation did not increase graft tension in either bundle during fixation or in motion without additional load. AM-bundle tension increased (p < 0.05) at 0° under combined rotatory and valgus loads and at 30° and 60° under both loading conditions without decreasing the anterior tibial translation. PL-bundle tension increased (p < 0.05) only at 90° under combined rotatory and valgus loads. CONCLUSIONS: Tibial hybrid fixation in 3-tunnel double-bundle ACL reconstruction increases time-zero AM- and PL-bundle tensions under loading conditions, generating greater construct stiffness. This could lead to a longer preservation of ACL-graft stability in clinical follow-up before bony incorporation.

Decrease in mortality of adult epilepsy patients since 1980: lessons learned from a hospital-based cohort.

BACKGROUND AND PURPOSE: Data on mortality in patients with epilepsy have been available since the 1800s. They consistently show a 2-3-fold increase compared to the general population. Despite major advances in diagnostic tools and treatment options, there is no evidence for a decrease in premature deaths. The temporal trend of mortality in a hospital-based epilepsy cohort over three decades was assessed. METHODS: A hospital-based incidence cohort was recruited from a specialized epilepsy outpatient clinic at Innsbruck Medical University between 1980 and 2007, divided by decade into three cohorts and followed for 5 years after initial epilepsy diagnosis. Deaths and their primary causes were determined using probabilistic record linkage with the Austrian death registry. Age-, sex- and period-adjusted standardized mortality rates (SMRs) were computed in relation to the general population of the same area and grouped according to time of diagnosis. RESULTS: In all, 122 deaths in 4549.9 person-years (1954.5 women, 2595.2 men) were identified. The overall SMR was 2.2 [95% confidence interval (CI) 1.8-2.6] and decreased from 3.0 (95% CI 2.1-4.3) in 1980-1989, to 2.7 (95% CI 2.0-3.5) in 1990-1999 and to 1.4 (95% CI 1.0-2.0) in 2000-2007. CONCLUSIONS: This study indicates a decrease in mortality in newly diagnosed epilepsy patients over the last three decades. This may be due to advances in diagnosis and treatment over the past three decades, including early identification of drug resistance, introduction of new anti-epileptic drugs and establishment of a comprehensive epilepsy surgery programme in this region.

Periarticular injections with continuous perfusion of local anaesthetics provide better pain relief and better function compared to femoral and sciatic blocks after TKA: a randomized clinical trial.

PURPOSE: Combined femoral and sciatic nerve blocks for post-operative pain management following total knee arthroplasty (TKA) improve patient satisfaction, decrease narcotic consumption and improve pain. However, accompanying motoric weakness can cause falls and related complications. We wonder whether peri-capsular injections in combination with intra-articular perfusion of local anaesthetics would result in equal or less pain without the related complications of nerve blocks. The objective of the study was to verify these aspects in a prospective randomized trial comparing both treatments. METHODS: Fifty TKA patients randomly received either a femoral (continuous) and a sciatic (single-shot) nerve block (CFNB group, 25 knees) or periarticular infiltrations and a continuous post-operative intra-articular infusion (PIAC group, 25 knees). VAS for pain, pain medication consumption, functional assessment, straight leg raising as well as KSS were recorded post-operatively for 6 days. RESULTS: VAS (p < 0.001) and KSS (p = 0.05) were significantly better for PIAC. There was increased pain following CFNB compared to PIAC. Catheters stayed for 4 days, a pain 'rebound' occurred after removing in CFNB but not after PIAC. There was no difference in regard to knee function (n.s.), but straight leg raising was significant better following PIAC. There were two falls in patients with CFNB. CONCLUSION: Peri-capsular injections combined with an intra-articular catheter provide better pain control, no rebound pain with better function and might decrease the risk of complications related to motor weakness. LEVEL OF EVIDENCE: I.

Estatura final de una población de prematuros con muy bajo peso al nacer / Final height in a population of preterm infants with very low birth weight

Los niños nacidos prematuros de muy bajo peso, tienen una mayor frecuencia de baja talla a la edad adulta. En la Argentina no contamos con reportes de estatura final de estos niños. Se evaluaron el peso y estatura de 46 jóvenes de la ciudad de Buenos Aires con antecedentes de prematurez y muy bajo peso al nacer egresados de 7 unidades neonatales de la ciudad de Buenos Aires y conurbano bonaerense, entre los años 1990 y 1995. Los 46 jóvenes (27 mujeres) tenían una edad promedio de 18.97 años (16.04 - 22.93). La estatura media de las mujeres fue de -0,71 sDS (0.20) y -0.75 sDS (0.22) en varones. Se detectó baja estatura en 2 mujeres (7.4%) y 1 varón (5.3%). La incidencia global de baja estatura es de 6.5% (AU)

Infants born prematurely with a very low birth weight more often have short stature in adulthood. In Argentina there are no reports on final height in these children. We evaluated weight and height of 46 adolescents and young adults from the city of Buenos Aires with a history of prematurity and very low birth weight who were discharged from seven Departments of Neonatology in the city of Buenos Aires and Greater Buenos Aires between 1990 y 1995. The 46 youth (27 females) had a mean age of 18.97 years (16.04 ­ 22.93). Mean height of the women was -0.71 SDS (0.20) and mean height of the men was -0.75 SDS (0.22). Low stature was observed in two women (7.4%) and one man (5.3%). Overall incidence of short stature was 6.5%. (AU)

Long-term efficacy of selective laser trabeculoplasty in patients on prostaglandin therapy.

BACKGROUND: The aim of the study was to analyse the efficacy of selective laser trabeculoplasty in patients on medical therapy and to evaluate a possible influence of prostaglandin therapy on intraocular pressure reduction. PATIENTS AND METHODS: A retrospective chart review was undertaken of patients with ocular hypertension or open angle glaucoma who underwent selective laser trabeculoplasty between 3/2008 and 12/2010. Data were collected preoperatively, on the day of intervention, 1 day, 1 month and then every 3 months post selective laser trabeculoplasty. The main outcome measure was mean intraocular pressure reduction. RESULTS: 109 eyes (76 on prostaglandins) were included. Mean preoperative intraocular pressure was 22.3 ± 4.5 mmHg (prostaglandin naïve) and 19.2 ± 4.8 mmHg (on prostaglandin) (p=0.003). Up to 1 year follow-up, intraocular pressure was statistically significantly reduced in both groups (p ≤ 0.019). Eyes with a higher preoperative intraocular pressure had a greater pressure reduction (Spearman rho=0.387, p=0.002). Eyes naïve to prostaglandins initially had a greater reduction in intraocular pressure, although after 1 year of follow-up the difference was no longer statistically significant. CONCLUSIONS: Selective laser trabeculoplasty significantly reduces intraocular pressure in patients already on medical therapy. A sustained influence of prostaglandin therapy on the efficacy of selective laser trabeculoplasty was not found.

Long-term efficacy of selective laser trabeculoplasty in pseudophakic patients - a "real-life" analysis.

BACKGROUND: The aim of this study was to report on the course and long-term effect of selective laser trabeculoplasty on intraocular pressure of pseudophakic patients suffering from open angle glaucoma or ocular hypertension with insufficient intraocular pressure lowering despite maximally tolerated topical and systemic intraocular pressure lowering medication. PATIENTS AND METHODS: A retrospective chart review of patients who underwent selective laser trabeculoplasty (360°) between 2008 and 2010 at the University hospital Zurich was undertaken. Intraocular pressure values before intervention, on the day of the intervention, 1 day, 1 month, 3 months and every 3 months up to 43 months after the intervention were analysed with respect to lens status. RESULTS: Out of 153 treated eyes of 111 patients (mean age 70.6 years ± 11.13 SD) 40 were pseudophakic. Mean baseline intraocular pressures were 19.00 mmHg ± 4.61 in the pseudophakic group and 20.12 mmHg ± 4.89 in the phakic group. One month after selective laser trabeculoplasty intraocular pressure reduction measured between -0.33 and -4.10 mmHg (CI 95%) in the pseudophakic group and between -3.64 and -5.58 mmHg (CI 95%) in the phakic group, the difference at this time point was significant (p=0.01). Beyond one month after selective laser trabeculoplasty there was no statistically significant difference in intraocular pressure reduction between pseudophakic and phakic patients. The mean decrease in intraocular pressure from baseline to the last follow-up of 43 months was 0.67 mmHg in the pseudophakic group and 0.25 mmHg in the phakic group (p=0.72). CONCLUSIONS: One month after selective laser trabeculoplasty pseudophakic patients showed a statistically significant diminished reduction of intraocular pressure compared to phakic patients. Later on there was no statistically significant difference in intraocular pressure reduction between pseudophakic and phakic patients. Therefore we conclude that there was no clinically relevant influence of pseudophakia on the long-term effect of selective laser trabeculoplasty.

Cutaneous fibroma in a captive common snapping turtle (Chelydra serpentina).

An adult female common snapping turtle (Chelydra serpentina) had a mass on the plantar surface of the right forelimb that was removed surgically. Microscopical examination revealed many spindle cells with mild anisocytosis and anisokaryosis and a surrounding collagenous stroma. There were no mitoses. Immunohistochemistry showed that the spindle cells expressed vimentin, but not desmin. A diagnosis of cutaneous fibroma was made. Tumours are reported uncommonly in chelonian species. Cutaneous fibroma has been diagnosed in an alligator snapping turtle (Macrochelys temminckii), but not previously in a common snapping turtle.

Impacto de la inmunoprofilaxis en una población de lactantes prematuros con y sin displasia broncopulmonar / Impact of immunoprophylaxis in a population of preterm infants with and without bronchopulmonary dysplasia

Con el fin de objetivar el impacto de la infección por Virus Sincicial Respiratorio (VSR) se analizó una cohorte de prematuros (PT) atendidos en nuestro consultorio de seguimiento de alto riesgo (CSAR) entre los años 1998 y 2004. A par tir del año 2006 el Hospital incorpora el anticuerpo monoclonal Palivizumab (PVZ) para la profilaxis de VSR en esta población vulnerable. Objetivo: analizar el impacto de la profilaxis con PVZ en la población de lactantes PT con y sin displasia broncopulmonar (DBP). Población: PT atendidos en el CSAR del Hospital Garrahan entre los años 1998- 2004 y 2006-2010. Diseño y Método: estudio longitudinal y observacional mediante comparación de riesgo de hospitalización por VSR entre la cohor te retrospectiva que no recibió PVZ (SP) vs una cohor te prospectiva que recibió profilaxis (CP) Resultados: SP: 154 pacientes, CP: 99 pacientes. La tasa de internación en el grupo SP fue 26% (21% en el grupo sin DBP y 28% para el grupo con DBP); la tasa de internación en el grupo CP disminuyó a 6% (5% y 6,3% para los PT sin y con DBP). Estas diferencias resultaron significativas (RR 0,22 IC95% 0,10 a 0,51); el NNT (número necesario a tratar) fue de 5. Conclusiones: la incorporación de inmunoprofilaxis en este grupo de riesgo produjo un impor tante descenso de la tasa de internación. El impacto en nuestra población fue mayor que el repor tado, incluso en la población de pacientes mas graves como los lactantes con DBP...

[Arthroscopic treatment strategies for the long head of the biceps tendon]. / Arthroskopische Versorgungsstrategien der langen Bizepssehne.

Shoulder pain is a common issue in orthopedic clinics and the advancement and progress in shoulder arthroscopy has brought new knowledge into the anatomy, pathology and treatment. Affection of the long head of the biceps tendon (LHBT) may be the cause of these disorders. Pathologies of the LHBT are comorbidities of rotator cuff tears or shoulder instability. The following article gives an overview of diseases of the LHBT as well as arthroscopic treatment options.

Hippocampal abnormalities in malformations of cortical development: MRI study.

OBJECTIVES: Hippocampal abnormalities may coexist with malformations of cortical development (MCD). This cross-sectional MRI study aimed at categorizing hippocampal abnormalities in a large group of MCD and comparing MCD patients with (group W) and without (group W/O) hippocampal abnormalities. METHODS: Hippocampal anatomy, rotation, size, internal structure, and MRI signal alterations were assessed visually by 3 independent raters in patients with MCD and epilepsy. Four types of hippocampal abnormalities were examined in 220 patients (116 women, mean age 31 +/- 16.6, range 2-76 years): partially infolded/hypoplastic hippocampus (HH), hippocampal sclerosis (HS), malrotated hippocampus (MH), and enlarged hippocampus (EH). The commonest MCD in the cohort were focal cortical dysplasia (27%), polymicrogyria (PMG) (21%), developmental tumors (15%), and periventricular nodular heterotopia (PNH) (14%). RESULTS: Hippocampal abnormalities were seen in 69/220 (31%) patients: HH in 34/69 (49%); HS in 18/69 (26%); MH in 15/69 (22%); and EH in 2/69 (3%). PNH (21/30 [70%]) and PMG (22/47 [47%]) were most commonly associated with hippocampal abnormalities. Compared to the W/O group, patients in the W group had a higher rate of learning disability (W 41/69 [59%] vs W/O 56/151 [37%]; p = 0.003) and delayed developmental milestones (W 36/69 [52%] vs W/O 53/151 [35%]; p = 0.025); groups did not differ otherwise with regard to clinical presentation. HH was associated with symptomatic generalized epilepsies (11/34 [32%]) and high rate of learning disability (27/34 [79%]), neurologic deficits (25/34 [73%]), and delayed developmental milestones (23/34 [68%]). CONCLUSIONS: About a third of patients with malformations of cortical development had hippocampal abnormalities. Patients with hypoplastic hippocampus had the most severe clinical phenotype.

[Results of a prospective multicenter trial for treatment of acromioclavicular dislocation]. / Ergebnisse einer prospektiven Multicenterstudie zur Behandlung der Schultereckgelenksprengung.

OBJECTIVE AND METHODS: The treatment of the acromioclavicular joint dislocation is a topic of constant debate. Objective of the study was to analyze if operative treatment of Rockwood types 3 and 5 acromioclavicular joint dislocations is superior to nonoperative treatment. Treatment outcomes of 100 patients (91 male, 9 female, median age 33.7 +/- 8.6) from 4 different hospitals/departments of trauma surgery were analyzed. Clinicofunctional, radiological, as well as subjective parameters were taken into consideration. RESULTS: Clinicofunctional outcome of the operative treatment of acromioclavicular joint dislocation was very good in 91.2 % of patients. 87.7 % of the operated patients had a subjectively stable joint. The patients operated on for the acromioclavicular joint dislocation were capable of exercising after 13 weeks post surgery. versus 25.3 weeks in nonoperatively treated patients. The operated patients had a Rowe score and Constant score as high as 90.7 and 91.8 respectively, reflecting an excellent treatment outcome. CONCLUSION: Operative anatomic reconstruction of the injured acromioclavicular joint leads to very good clinicofunctional outcomes. The operative technique plays only a minor role in achieving these outcomes. The rate of complications is low for all operative techniques listed here. Demanding patients and multimedia education of patients are the reasons for a majority of operated patients in this study (97 %).

[Treatment of acute AC joint dislocation by transosseal acromioclavicular and coracoclavicular fiberwire cerclage]. / Versorgung der Schultereckgelenksprengung mittels akromioklavikulärer und korakoklavikulärer FiberWire-Cerclage.

AIM: Many different procedures are used for the operative treatment of acute AC joint dislocations type Rockwood III - VI. We discuss the clinical results for an exact anatomical reconstruction of the AC-joint by transosseal acromioclavicular and coracoclavicular FiberWire cerclage. METHOD: 56 patients with acute AC joint dislocations type Rockwood III and V underwent operative treatment, using an exact anatomical reconstruction of the AC joint by transosseal acromioclavicular and coracoclavicular FiberWire cerclage. A clinical and radiological follow-up examination was performed. Clinical complications, objective results, radiological results, Constant and Rowe scores were evaluated. RESULTS: 43 patients could be examined on average 15.4 months after surgery. 24 patients (56 %) showed radiological signs of ossification of the acromioclavicular and coracoclavicular ligaments. Minimal postoperative clavicular displacement was observed in 14 patients (33 %). 2 patients (5 %) needed a second surgery due to complications, in one case because of reduction in the range of motion, in the other case due to abacterial inflammation. The advantage of this type of surgery is a minimal rate of complications and a good objective result with a high Constant score of 94 and Rowe score of 93, without the need for a second surgery. CONCLUSION: This procedure for an exact anatomic AC joint reconstruction shows good objective results with a high Constant and Rowe scores for shoulder function. Postoperative ossifications of the AC joint ligaments are common, but seem to have no influence on the clinical results.

Retinopatía del prematuro / Retinopathy of Prematurity

La retinopatía del prematuro (RDP) es una complicación frecuente en los egresados de las UCIN y una causa importante de ceguera. Su prevención primaria depende de una tención reacional que respete límites de saturación en la oxigenoterapia. Su prevención secundaria requiere controles oftalmológicos oportunos y reiterados hasta completarse la vascularización de la retina. Estudios epidemiológcios realizados en el 2002 encontraron una situación alarmante por la frecuente afectación de pacientes de bajo riesgo (PN > 1500 g) y controles oftalmológicos tardíos. A partir del 2003 se conformó un grupo colaborativo multicéntrico para revertir esta situación. Objetivo: analizar las modificaciones de las características de los RN derivados por RDP al hospital JP Garrahan durante los períodos 1996-1999, 2000-2003 y 2004-2007. Métodos: diseño retrospectivo. Las variables analizadas fueron: PN, edad gestacional (EG), tiempo de tratamiento con 02 y ARM, edad de consulta, severidad de RDP, lugar dederivación (> o < a 70 Km). Resultados: el nº de consultas fue de 190, 613 y 489 respectivamente. La proporción de pacientes derivados de > 70 Km disminuyó del 50 al 35 por ciento. Los pacientes del último período han tenido > tiempo de ARM (P 0.04) y oxigenoterapia (p 0.001) pero no varió significativamente su PN ni EG. La proporción de pacientes con RDP severa aumentó del 56 por ciento al 67 por ciento. conclusión: ha disminuido la frecuentcia de derivaciones y las mismas coresponden a pacientes más graves. Continúa siendo la inaceptable la proporción de pacientes de bajo riesgo y la severidad de la RDP al momento de consulta.

[First traumatic anterior shoulder dislocation: postoperative results 6 months and 2 years after arthroscopic stabilization in young patients]. / Die traumatische Schultererstluxation : Ergebnisse 6 Monate und 2 Jahre postoperativ nach arthroskopischer Stabilisierung beim jungen Patienten.

BACKGROUND: The purpose of this prospective clinical trial was to report about results of primary or early secondary arthroscopic stabilization after first traumatic anterior dislocation of the shoulder. PATIENTS AND METHODS: Within 2 weeks or in the 7th to 12th week post trauma, 51 subjects between 16 and 30 years received arthroscopic stabilization and rehabilitation. The patients were followed-up 6 months and 2 years post operation and assessed with the Rowe and the Constant scores. RESULTS: At a mean follow-up of 27.9+/-4.3 months all patients returned to work in their profession. Of the patients, 79.2% were satisfied with the result of the operation; 91.7% returned to their sports. During the follow-up period five patients (10.4%) suffered redislocation. There was no difference in the result comparing the time of operation. The Rowe and Constant scores showed excellent results. CONCLUSIONS: Arthroscopic stabilization after first traumatic anterior shoulder dislocation of the young patient is an appropriate approach and regardless of whether it is performed as a primary or early secondary operation it significantly lowers the redislocation rate. The method leads to quick reintegration into professional life and sports activities.

Electroclinical and imaging findings in ulegyria and epilepsy: a study on 25 patients.

PURPOSE: Ulegyria refers to cerebral cortex scarring, which results from a perinatal ischaemic brain injury. It presents with a characteristic gyral pattern: small circumvolutions with atrophy at sulci bottom and spared apex. Ulegyria is frequently associated with epilepsy, cerebral palsy and mental disability. We analysed electroclinical and MRI features in patients with ulegyria and epilepsy. PATIENTS AND METHODS: We reviewed 25 patients (14 males/11 females) with ulegyria and epilepsy from the database (about 5000 patients with epilepsy) of our unit. Patients were examined clinically, underwent high resolution MRI, EEG recordings, positron emission tomography, single photon emission computed tomography and neuropsychological testing. Two patients with refractory seizures underwent epilepsy surgery. RESULTS: Mean age of patients was 34 years (5-66) at the reassessment time. The majority (16/25, 64%) had a history of perinatal asphyxia. 15 patients had delayed developmental milestones; 20 had learning disabilities and five patients were severely disabled. Mean age at seizure onset was 4.2 years (1-18). 17 patients (68%) had medically intractable epilepsy. 11 patients (44%) had occipital lobe seizures. The majority (n = 24, 96%) had parieto-occipital lesions on MRI. In 13 patients (52%), ulegyria was bilateral. 12 patients (48%) had hippocampal sclerosis. Two patients underwent epilepsy surgery with an excellent postoperative outcome (Engel class IA and IC). CONCLUSION: Patients with ulegyria often have a history of perinatal asphyxia and present with pharmacoresistant seizures. Their presurgical assessment is complicated because of frequent dual pathology (hippocampal sclerosis) and bilateral lesions.

Outcome of adult patients with temporal lobe tumours and medically refractory focal epilepsy.

BACKGROUND: Tumours are a well-recognized cause of medically intractable epilepsies. Tumours represent the primary pathology in 10%-30% of patients undergoing surgical treatment for chronic epilepsy. This study examines the surgical and epileptological outcome of adults with temporal lobe tumoural epilepsy treated within a comprehensive epilepsy surgery programme. METHODS: Between 1999 and 2004, 99 consecutive patients have been operated for intractable temporal lobe epilepsy (TLE). Among these, 14 adult patients exhibited temporal lobe neoplasms associated with TLE. Every patient underwent a comprehensive presurgical evaluation including video-EEG monitoring, MRI, interictal PET scan, ictal SPECT and neuropsychological testing. Surgical strategies were determined in an interdisciplinary seizure conference and tailored to the findings of the presurgical evaluation. All patients were available for follow up at regular intervals after 3, 6, 12 months and yearly thereafter. Epileptological outcome was classified according to Engel [10] and the ILAE (International League Against Epilepsy)/systems [33]. FINDINGS: The surgical procedures performed were temporal lobe resection in 3 patients, extended lesionectomy in 4 and extended lesionectomy with resection of the temporomesial structures in 7. One patient with an astrocytoma grade III underwent a second and third operation for recurrent disease. Histological results: Astrocytoma 5 patients, ganglioglioma/gangliocytoma 5, oligodendroglioma 2, ependymoma 1 and dysembryoplastic neuroepithelial tumour (DNET) 1. Postoperative follow-up was performed after 12-74 months (mean 31). The outcome according to the Engel classification indicated class IA in 9 patients, class IC in 3, and 1 each in classes IIIA and IVA. Epileptological outcome according to the ILAE classification indicated class 1 (12 patients) and class 4 (2 patients). Surgical mortality was zero and mild permanent neurological deficits due to surgery were seen in 2 patients. Postoperatively 3 patients showed a homonymous quadrantanopia. CONCLUSIONS: Patients with drug resistant epilepsy and temporal lobe tumours should undergo evaluation in dedicated epilepsy surgery programmes.

[Computer-assisted open-wedge osteotomy]. / Computerassistierte valgisierende Tibiakopfosteotomie.

AIM: The open-wedge high tibial osteotomy is an established procedure for the treatment of the unicompartimental gonarthrosis in young patients. An adequate correction of osseous malalignment is crucial for a sufficient reduction of stress in a diseased compartment. We have examined reliability and precision of an intraoperatively used computer-assisted navigation system for high tibial osteotomy. The aim of the study is to show the equivalent safety and effectiveness of high tibial osteotomies carried out with the computer-assisted navigation system. It is assumed that a good correlation between the mechanical tibio-femoral axis as measured by radiography and by the navigation system can be achieved. METHOD: 40 medial open-wedge osteotomies were performed with computer-assisted navigation on 39 patients (27 males, 12 females) between 1/2004 and 8/2006. The average age was 46.3 years (range: 26 - 64 years), the average weight was 83.2 kg (range: 54 - 118 kg). RESULTS: A good correlation between radiographic data and the data acquired with the navigation system was found for the tibio-femoral axis: preoperative data (8.0 +/- 2.5 degrees, radiographic; 7.8 +/- 2.1 degrees navigated) for varus alignment. The postoperative correlation was lower than the preoperative one (postoperative data (0.6 +/- 3.2 degrees radiographic; - 0.7 +/- 1.0 degrees navigated) for valgus alignment. In 2 patients a loss of correction occurred and had to be treated operatively. CONCLUSION: High tibial osteotomy is an established therapy procedure for unicompartmental gonarthrosis. It can be improved in its precision and reliability by computer-assisted navigation.