Relationship of preoperative neurologic score with intervals to regaining micturition and ambulation following surgical treatment of thoracolumbar disk herniation in dogs.

OBJECTIVE To estimate the times required for dogs to regain micturition and ambulation following surgical treatment for thoracolumbar Hansen type I intervertebral disk extrusion (IVDE) and determine whether these variables were associated with preoperative modified Frankel score (MFS). DESIGN Retrospective case series with nested cohort study. ANIMALS 54 dogs weighing < 20 kg (44 lb) that were surgically treated for Hansen type I IVDE at a referral hospital between January and December 2015. PROCEDURES Medical records and CT and MRI data were reviewed. Information was collected regarding dog signalment, type and duration of clinical signs, preoperative MFS, degree of spinal cord compression, type of medical and surgical treatment provided, and intervals from surgery to regaining micturition and ambulation (outcomes). Collected data were evaluated for correlations with outcomes. RESULTS Mean ± SD interval from surgery to regaining micturition was 4.1 ± 4.4 days, and mean interval from surgery to regaining ambulation was 13.8 ± 25.1 days. These intervals differed significantly. Significant negative correlations with MFS were identified for interval to regaining micturition (r = -0.63) and interval to regaining ambulation (r = -0.64). No other correlations with outcome were identified. CONCLUSIONS AND CLINICAL RELEVANCE The amount of time required for dogs to regain micturition and ambulation following surgery for thoracolumbar IVDE was correlated with preoperative severity of clinical signs, as reflected by preoperative MFSs. This information should be useful for pre- and postoperative decision-making and setting of expectations for owners of and clinicians treating affected dogs.

Influence of in-house rehabilitation on the postoperative outcome of dogs with intervertebral disk herniation.

OBJECTIVE: To determine the influence of in-house rehabilitation on the postoperative outcome of dogs with intervertebral disk herniation (IVDH). DESIGN: Retrospective cohort study. ANIMALS: Dogs (n = 248) under 20 kg of weight, with single site, thoracolumbar, Hansen Type I IVDH. PROCEDURES: Medical records of non-ambulatory dogs with IVDH treated via hemilaminectomy were reviewed. Dogs were classified in 2 groups depending on whether their postoperative management included an in-house rehabilitation program. Preoperative and sequential postoperative modified Frankel scores (MFSs) were recorded. Time to ambulation, time to normal conscious proprioception, final MFS, and complications were compared between the groups. RESULTS: More dogs returned to full neurologic function (final MFS of Grade 5) when in-house rehabilitation was included in the postoperative management (33% compared to 9%). Normal conscious proprioception and ambulation returned earlier in the control group (42 days and 14 days, respectively) compared to the group with rehabilitation (49 days and 28 days, respectively). The complication rate was higher in the control group (29%) compared with the group with rehabilitation (16%). CONCLUSIONS AND CLINICAL RELEVANCE: In-house rehabilitation should be included in the postoperative management in dogs after surgical treatment of IVDH to improve neurologic function and reduce postoperative complications.

Comminuted long bone fractures in children. Could combined fixation improve the results?

Comminuted diaphyseal fractures in the pediatric age group represent a major orthopedic problem. It is associated with a high incidence of complications and poor outcomes because of the instability and difficulty in treatment. The aim of this study was to evaluate the efficacy of combined external skeletal fixation and flexible intramedullary nails in reconstruction of comminuted diaphyseal fracture in skeletally immature patients. Combined external fixator and elastic stable intramedullary nails were used in the management of 27 pediatric patients (15 males and 12 females) with unstable comminuted diaphyseal fractures of the tibia and femur. There were 19 fractures of the femur and eight fractures of the tibia. The average age of the patients was 8.7 years (range 7-14 years) for the femur and 10.8 years (range 6-15 years) for the tibia. Fractures were classified according to the system of Winquist and Hansen as grade II (five cases), grade III (nine cases), and grade IV (13 cases). All cases were operated within 6 days (range 0-6 days) after injury. The mean follow-up period was 2.8 years (range 2-3.5 years). The average duration of the external fixation was 1.6 months for fractures of the tibia, whereas it was 1.4 months for fractures of the femur. The average time for tibia fracture union was 2.8 months for fractures of the tibia, whereas it was 1.9 months for fractures of the femur. Malalignment in varus less than 5° was noted in one patient. One patient had a limb-length discrepancy of 1.5 cms. There were five cases (18.5%) with pin-tract infection. According to the Association for the Study and Application of the Methods of Ilizarov evaluation system, bone results were excellent in 23 cases (85.2%), good in three cases (11.1%), and poor in one case (3.7%). Functional results were excellent in 22 (81.5%) cases and good in five (18.5%) cases. Combined use of external fixators and elastic intramedullary nails is a good method for the treatment of comminuted long bone fractures in children.

Maisonneuve-hyperplantarflexion variant ankle fracture.

Maisonneuve fractures are rare ankle injuries, accounting for up to 7% of all ankle fractures. They consist of a proximal third fibula fracture, syndesmotic disruption, and medial ankle injury (either a deltoid ligament disruption or a medial malleolus fracture), and are often successfully managed with nonoperative treatment of the proximal fibula fracture and open reduction and internal fixation (ORIF) of the medial ankle injury and syndesmotic disruption. The hyperplantarflexion variant ankle fracture comprises approximately 7% of all ankle fractures and features dual posterior tibial lip fractures featuring a posterolateral fragment and a posteromedial fragment. Good functional results have been reported in the literature after ORIF of both the posterolateral and posteromedial fragments of this variant fracture that is not described by the Lauge-Hansen classification. In this report, the authors present the unique case of an isolated ankle fracture demonstrating characteristics of both a Maisonneuve fracture and a hyperplantarflexion variant ankle fracture. They also highlight the diagnostic imaging characteristics, including magnetic resonance imaging (MRI) and preoperative radiograph findings, surgical treatment, and postoperative clinical outcome for this patient with a Maisonneuve-hyperplantarflexion variant ankle fracture. To the authors' knowledge, this unique fracture pattern has not been reported previously in the literature. The authors conclude that although good results were seen postoperatively in this case, the importance of ORIF of both the posteromedial and posterolateral fragments of variant fractures cannot be overstated. They also found MRI to be a particularly helpful adjunct in formulating the correct diagnosis and treatment plan.

Changes in cortical relative power in patients submitted to a tendon transfer: a pre and post surgery study.

The aim of this study is analyze possible modifications in the cerebral cortex, through quantitative electroencephalography (qEEG) in patients submitted to a tendon transfer procedure (posterior tibialis) by the Srinivasan's technique. Four subjects (2 men and 2 women), 49.25 age average (SD +/ 21.4) were studied. All subjects have been through surgical procedure due to leprosy and had, at least, two years of drop foot condition. The qEEG measured the electrocortical activity (relative power) between 8 and 25 Hz frequencies pre and post surgery. A paired t test analyzed all data (p< or =0,05). The results show significant alterations in the alpha relative power, electrodes F7 (p=0.01) and F8 (p=0.021). Altogether, based on findings of the current literature, we can conclude that the tendon transfer procedure suggests electrocortical alterations sensitive to specific qEEG bands.

Changes in cortical relative power in patients submitted to a tendon transfer: a pre and post surgery study

The aim of this study is analyze possible modifications in the cerebral cortex, through quantitative electroencephalography (qEEG) in patients submitted to a tendon transfer procedure (posterior tibialis) by the Srinivasan's technique. Four subjects (2 men and 2 women), 49.25 age average (SD±21.4) were studied. All subjects have been through surgical procedure due to leprosy and had, at least, two years of drop foot condition. The qEEG measured the electrocortical activity (relative power) between 8 and 25 Hz frequencies pre and post surgery. A paired t test analyzed all data (p<0,05). The results show significant alterations in the alpha relative power, electrodes F7 (p=0.01) and F8 (p=0.021). Altogether, based on findings of the current literature, we can conclude that the tendon transfer procedure suggests electrocortical alterations sensitive to specific qEEG bands.

O objetivo deste estudo é analisar possíveis modificações no córtex cerebral, através da electrencefalografia quantitativa (EEGq), em pacientes submetidos a um procedimento de transferência de tendão (tibial posterior) pela técnica de Srinivasan. Quatro sujeitos (2 homens e 2 mulheres), com média de idade de 49,25 anos (±21,4 DP) foram estudados. Todos os sujeitos realizaram o procedimento cirúrgico devido a hanseníase e tinham, pelo menos, dois anos de pé caído. O EEGq mediu a atividade electrocortical (potencia relativa) entre freqüências de 8 e 25 Hz, no pré e pós-operatório. Um teste t pareado analisou todos os dados (p<0,05). Os resultados mostram alterações significativas na potência relativa em alfa, nos elétrodos F7 (p=0,01) e F8 (p=0,021). Baseados em recentes achados na literatura, podemos concluir que o procedimento de transferência de tendão sugere alterações eletrocorticais sensíveis às freqüên-cias específicas do EEGq.

[EEG spectral coherence at patients submitted to tendon transfer surgery: study pre- and post-surgery]. / Coerência espectral do eletrencefalograma em pacientes submetidos a transposição tendinosa: estudo pré e pós-operatório.

Tendon transfer of the tibiliais posterior muscle is a surgical intervention widely employed in orthopedics for the correction of drop foot caused by leprosy. However, few models have proposed a thorough investigation of the brain plasticity phenomenon during tendon transfer. Thus, the present study aimed at analyzing EEG spectral coherence (SC) in patients submitted to tendon transfer of the tibiliais posterior muscle by Srinivasan's technique and quantitative EEG (EEGq). The sample consisted of four subjects with drop foot caused by leprosy. The SC parameter was evaluated in two experimental moments: pre and post-surgery. Results demonstrated a main moment effect for the C3-CZ electrode pair. Specifically, a significant increase in coherence values was observed. However, the ANOVA did not indicate a significant band/moment interaction. It can be assumed that coherence augmentation indicates that functional rehabilitation promoted by this specific surgery yields cortical alterations.

Coerência espectral do eletrencefalograma em pacientes submetidos a transposição tendinosa: estudo pré e pós-operatório / EEG spectral coherence at patients submitted to tendon transfer surgery: study pre and post surgery

A transferência tendinosa do músculo tibial posterior é intervenção cirúrgica bastante utilizada na ortopedia para correção do pé caído por seqüela de hanseníase. Poucos modelos propuseram investigações mais significativas sobre os fenômenos plásticos cerebrais nas transferências tendinosas. O presente estudo teve como objetivo analisar a coerência espectral (CE) na Eletroencefalografia (EEG) em pacientes submetidos a transferência do tendão do tibial posterior pela técnica de Srinivasan através da EEG quantitativa (EEGq). A amostra foi composta de quatro sujeitos com pé caído devido a seqüela de hanseníase. Os parâmetros de CE do EEG foram quantificados no momento pré e pós-operatório. Os resultados mostraram que houve efeito principal para o fator momento, significativo, no par de eletrodos C3-CZ, com aumento da coerência. Entretanto, os achados da ANOVA não revelaram interação significativa entre bandas versus momento. A recuperação funcional promovida por tal cirurgia parece gerar alterações corticais.

Systemic suppression of interferon-gamma responses in Buruli ulcer patients resolves after surgical excision of the lesions caused by the extracellular pathogen Mycobacterium ulcerans.

Buruli ulcer (BU), caused by Mycobacterium ulcerans, is the third most common mycobacterial infection in immunocompetent humans besides tuberculosis and leprosy. We have compared by ex vivo enzyme-linked immunospot analysis interferon-gamma (IFN-gamma) responses in peripheral blood mononuclear cells (PBMC) from BU patients, household contacts, and individuals living in an adjacent M. ulcerans nonendemic region. PBMC were stimulated with purified protein derivative (PPD) and nonmycobacterial antigens such as reconstituted influenza virus particles and isopentenyl-pyrophosphate. With all three antigens, the number of IFN-gamma spot-forming units was reduced significantly in BU patients compared with the controls from a nonendemic area. This demonstrates for the first time that M. ulcerans infection-associated systemic reduction in IFN-gamma responses is not confined to stimulation with live or dead mycobacteria and their products but extends to other antigens. Interleukin (IL)-12 secretion by PPD-stimulated PBMC was not reduced in BU patients, indicating that reduction in IFN-gamma responses was not caused by diminished IL-12 production. Several months after surgical excision of BU lesions, IFN-gamma responses of BU patients against all antigens used for stimulation recovered significantly, indicating that the measured systemic immunosuppression was not the consequence of a genetic defect in T cell function predisposing for BU but is rather related to the presence of M. ulcerans bacteria.

Lasso procedure to correct finger-clawing in leprosy using index or middle finger flexor digitorum superficialis split into four tails--a long-term follow-up study.

For obvious reasons, the use of flexor digitorum superficialis (FDS) from the ring finger, for correction of finger-clawing, is usually not recommended in leprosy. Hence, one has to choose either index or middle finger FDS for correction of finger-clawing. No significant differences could be made out when follow-up data of claw-finger correction by modified lasso procedure, using FDS either from index or middle finger, were compared. In some hands post-operative problems, such as stiffness, superficialis minus deformities of proximal interphalangeal joints (PIPJ) and distal interphalangeal joints (DIPJ), were noted. As revealed by finger dynamography, the working space of the hand was not found to be fully restored, the donor finger showing distortion of its working space.

Validity of scoring systems to predict risk of prolonged mechanical ventilation after coronary artery bypass graft surgery

STUDY OBJECTIVE: Two scoring systems, (the Spivack scoring system [SSS] and the cardiac risk score [CRS]), have been proposed to predict the risk of prolonged mechanical ventilation (PMV) after coronary artery bypass graft surgery (CABG). The primary objective of this study was to validate the efficacy of these scoring systems to predict the risk of PMV. DESIGN: Prospective observational study. SETTING: Cardiovascular surgical ICU. PATIENTS: Three hundred forty-eight patients underwent CABG. Following surgery, patients were extubated by a standardized respiratory weaning protocol. MEASUREMENTS AND RESULTS: Forty-nine percent of patients had SSS > 0 and had significantly longer duration of mechanical ventilation. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the SSS for failure to extubate at 48 h are 80, 49, 9 per cent, and 98 per cent, respectively. Two hundred thirty-two patients (67.5 per cent), 101 patients (29 per cent), and 12 patients (3.5 per cent) had a CRS of 0 to 4, 5 to 8, and > 8, respectively. Patients with lower scores had shorter duration of mechanical ventilation. The sensitivity, specificity, PPV, and NPV of the CRS for failure to extubate at 10 h are 42, 73, 47 per cent and 69 per cent, respectively. CONCLUSION: The SSS may be used as a preoperative screening tool. A simple questionnaire that includes history of unstable angina, diabetes, congestive heart failure, and smoking prior to hospital admission can be used to calculate the SSS. Patients with SSS .

Results of thumb correction in leprosy using different techniques.

Forty-four hands of 42 leprosy patients with paralysis of intrinsic muscles of the hand were treated by opponensplasty using ring finger superficialis (FDS4) or extensor indicis proprius (EIP). Superficialis tendon of middle finger was also used in these hands for lumbrical replacement by "direct lasso" operation. Low ulnar paralysis with Froment's sign was corrected by transfer of radial half of flexor pollicis longus (FPL) to extensor pollicis longus (EPL). Results of thumb correction were assessed and analysed in 37 hands of 35 patients. The mean follow-up period was 19 months. Best results were found with transfer of half FPL to EPL. Results of FDS transfer was good in 12 out of 16 manual workers. EIP transfer worked well, but the power of the thumb and patients' satisfaction was less.

Characteristics and operative management of supination external rotation ankle fractures.

Identification and management of the acutely fractured ankle is discussed by the authors. The Lauge Hansen classification system, and in particular, supination-external rotation injuries, is evaluated. Intraoperative technique, perioperative considerations, and generalized management of these pathologic conditions are reviewed, according to the authors' experiences.

Restoration of plantar sweat secretion in the feet of leprosy patients.

As part of the studies on nerve damage and its consequences in leprosy, the status of sweat gland function in the anaesthetic sole of the feet of leprosy patients was investigated qualitatively and semi-quantitatively, before and after surgical decompression of the posterior tibial neurovascular bundle. Sweat prints of the feet of the patients were obtained pre-operatively and postoperatively on Whatman's No. 1 filter paper. The paper was treated with one percent Ninhydrin and the intensities of the Ninhydrin positive areas were quantitated. Forty one feet of thirty six patients have been studied in this manner. Sweat print analysis of twenty normal people have also been done, and included for comparison. This operative procedure has been found to effect an improvement in the sweat gland function in the feet of more than fifty percent of leprosy patients studied so far.