Anatomic and Biomechanical Evaluation of Ulnar Tunnel Position in Medial Ulnar Collateral Ligament Reconstruction.

BACKGROUND: Although numerous techniques of reconstruction of the medial ulnar collateral ligament (mUCL) have been described, limited evidence exists on the biomechanical implication of changing the ulnar tunnel position despite the fact that more recent literature has clarified that the ulnar footprint extends more distally than was appreciated in the past. PURPOSE: To evaluate the size and location of the native ulnar footprint and assess valgus stability of the medial elbow after UCL reconstruction at 3 ulnar tunnel locations. STUDY DESIGN: Controlled laboratory study. METHODS: Eighteen fresh-frozen cadaveric elbows were dissected to expose the mUCL. The anatomic footprint of the ulnar attachment of the mUCL was measured with a digitizing probe. The area of the ulnar footprint and midpoint relative to the joint line were determined. Medial elbow stability was tested with the mUCL in an intact, deficient, and reconstructed state after the docking technique, with ulnar tunnels placed at 5, 10, or 15 mm from the ulnotrochlear joint line. A 3-N·m valgus torque was applied to the elbow, and valgus rotation of the ulna was recorded via motion-tracking cameras as the elbow was cycled through a full range of motion. After kinematic testing, specimens were loaded to failure at 70° of elbow flexion. RESULTS: The mean ± SD length of the mUCL ulnar footprint was 27.4 ± 3.3 mm. The midpoint of the anatomic footprint was located between the 10- and 15-mm tunnels across all specimens at a mean 13.6 mm from the joint line. Sectioning of the mUCL increased elbow valgus rotation throughout all flexion angles and was statistically significant from 30° to 100° of flexion as compared with the intact elbow (P < .05). mUCL reconstruction at all 3 tunnel locations restored stability to near intact levels with no significant differences among the 3 ulnar tunnel locations at any flexion angle. CONCLUSION: Positioning the ulnar graft fixation site up to 15 mm from the ulnotrochlear joint line does not significantly increase valgus rotation in the elbow. CLINICAL RELEVANCE: A more distal ulnar tunnel may be a viable option to accommodate individual variation in morphology of the proximal ulna or in a revision setting.

Continuous femoral nerve blocks: varying local anesthetic delivery method (bolus versus basal) to minimize quadriceps motor block while maintaining sensory block.

BACKGROUND: Whether the method of local anesthetic administration for continuous femoral nerve blocks--basal infusion versus repeated hourly bolus doses--influences block effects remains unknown. METHODS: Bilateral femoral perineural catheters were inserted in volunteers (n = 11). Ropivacaine 0.1% was concurrently administered through both catheters: a 6-h continuous 5 ml/h basal infusion on one side and 6 hourly bolus doses on the contralateral side. The primary endpoint was the maximum voluntary isometric contraction (MVIC) of the quadriceps femoris muscle at hour 6. Secondary endpoints included quadriceps MVIC at other time points, hip adductor MVIC, and cutaneous sensation 2 cm medial to the distal quadriceps tendon in the 22 h after initiation of local anesthetic administration. RESULTS: Quadriceps MVIC for limbs receiving 0.1% ropivacaine as a basal infusion declined by a mean (SD) of 84% (19) compared with 83% (24) for those receiving 0.1% ropivacaine as repeated bolus doses between baseline and hour 6 (paired t test P = 0.91). Intrasubject comparisons (left vs. right) also reflected a lack of difference: the mean basal-bolus difference in quadriceps MVIC at hour 6 was -1.1% (95% CI -22.0-19.8%). The similarity did not reach the a priori threshold for concluding equivalence, which was the 95% CI decreasing within ± 20%. There were similar minimal differences in the secondary endpoints during local anesthetic administration. CONCLUSIONS: This study did not find evidence to support the hypothesis that varying the method of local anesthetic administration--basal infusion versus repeated bolus doses--influences continuous femoral nerve block effects to a clinically significant degree.

Modeling vadose zone processes during land application of food-processing waste water in California's Central Valley.

Land application of food-processing waste water occurs throughout California's Central Valley and may be degrading local ground water quality, primarily by increasing salinity and nitrogen levels. Natural attenuation is considered a treatment strategy for the waste, which often contains elevated levels of easily degradable organic carbon. Several key biogeochemical processes in the vadose zone alter the characteristics of the waste water before it reaches the ground water table, including microbial degradation, crop nutrient uptake, mineral precipitation, and ion exchange. This study used a process-based, multi-component reactive flow and transport model (MIN3P) to numerically simulate waste water migration in the vadose zone and to estimate its attenuation capacity. To address the high variability in site conditions and waste-stream characteristics, four food-processing industries were coupled with three site scenarios to simulate a range of land application outcomes. The simulations estimated that typically between 30 and 150% of the salt loading to the land surface reaches the ground water, resulting in dissolved solids concentrations up to sixteen times larger than the 500 mg L(-1) water quality objective. Site conditions, namely the ratio of hydraulic conductivity to the application rate, strongly influenced the amount of nitrate reaching the ground water, which ranged from zero to nine times the total loading applied. Rock-water interaction and nitrification explain salt and nitrate concentrations that exceed the levels present in the waste water. While source control remains the only method to prevent ground water degradation from saline wastes, proper site selection and waste application methods can reduce the risk of ground water degradation from nitrogen compounds.

Investigación de mercado del programa Administración en Salud con énfasis en Gestión de Servicios de Salud, Antioquia, 2004 / Marketing investigation of the health administration with emphasis in health services management academic program, Antioquia, 2004

A semejanza de lo que ocurre en las empresas, las instituciones educativas y sus programas académicos deben conocer las necesidades y requerimientos de sus clientes potenciales para satisfacerlas y ser más competitivos en el mercado. Esta investigación identifica esos factores con el fin de que el programa de administración en salud con énfasis en gestión de servicios de salud (AES GSS) cumpla con esa exigencia. Se partió de una muestra representativa de egresados de este programa, de la Facultad Nacional de Salud Pública, y se halló que un poco más de la mitad laboran en el sector salud; no obstante, manifiestan que sus cargos son de nivel administrativo, pero que se encuentran desempeñando funciones operativas. También expresaron que el ingreso al campo laboral es difícil, lo que atribuyen principalmente a la falta de conocimiento del perfil y de la formación que hay en el medio. Señalaron además las fortalezas y debilidades del programa académico y recomendaron acciones que podrían mejorar, tanto el programa como el perfil del profesional y su imagen en el mercado laboral. Se tomaron también empleadores del sector salud (instituciones públicas y privadas), que destacaron su buen concepto del nivel académico de los estudiantes de la facultad. Se advirtió que los mismos empleadores conocen poco el programa, lo que se relaciona con la poca utilización de los servicios del administrador egresado de esta especialidad.

[Intraoperative endoscopic surveillance in laparoscopic surgical treatment of achalasia]. / Endoscopía Transoperatoria en la Cirugía Laparoscópica de la Acalasia.

We study the utility of intraoperative endoscopic control, in laparoscopic surgical treatment of the typical Achalasia of Esophagus. 81 patients were intervened surgically in Centro de Cirugia Endoscopica. Hospital Universitario Calixto Garcia in a five year-old period. All patients received intraoperative endoscopic evaluation to guarantee the effectiveness and integrity of the esophago-cardiomyotomy. The average time of surgical procedure was of 144,7 minutes. The transendoscopic complication in relation with endoscopic procedure was seen in one case but it didn't modify the morbi-mortality of the study. According to Vantrappen classification, 79 patients were considered with a evolution between excellent and good. The use of endoscopic intraoperative control is recommended in the surgical interventions of the patients with achalasia.

Anatomical and functional cardiac abnormalities in type I diabetes.

To analyse the anatomy and systolic and diastolic cardiac function in a group of type I diabetics with no other abnormality and to correlate it with the duration of the disease, the presence of complications, the control of the diabetes and the abnormalities in the autonomous nervous system, 125 type I diabetics and 50 age- and sex-matched healthy controls were studied. In 112 diabetics, an echocardiographic image which enabled us to calculate the thickness, cavity dimensions and systolic function rates was obtained. A Doppler echocardiograph was done in all patients to measure 9 parameters of diastolic function. The autonomic nervous system was evaluated by the response to 4 cardiovascular reflexes. Two control groups and 4 study groups were established, based on duration and on the presence and number of microangiopathic complications. The results showed a significant increase in the septal and posterior wall thickness, although without differences between the study groups. There were no differences in the analysis of systolic function. The abnormalities in diastolic function were significant in all the groups, but greater in the groups with microangiopathy. Overall, for groups 1-4, respectively, the incidence of anatomical abnormalities was 9.6%, 17%, 28% and 57% (average 22%); systolic 0%, 0%, 4% and 4.7% (average 2.2%); and diastolic 15%, 21%, 60% and 80% (average 44%). Only 13 diabetics from group 4 presented with cardiac autonomic neuropathy. No correlation between these alterations and the glycaemic control or the duration of the disease was found, although there was a correlation between the presence or absence of complications and the anatomic and diastolic abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiac anatomical and functional changes in a group of young type I diabetics with microangiopathy]. / Alteraciones anatómicas y funcionales cardíacas en un grupo de jóvenes diabéticos tipo I con microangiopatía.

BACKGROUND: There are conflicting data concerning the alteration of cardiac function in diabetics without another type of accompanying pathology. Therefore this study was designed with the aim to analyze the anatomical and functional changes and relate them with the time and control of diabetes. METHODS: Fifty-four type I diabetics with a mean age of 33.5 years and 25 healthy controls paired by age and sex were studied. The patients were rigourously selected excluding any disease or treatment other than insulin and the presence of demonstrated microangiopathy was required. M-mode and bidimensional echocardiographic studies were carried out in 46 patients to calculate thickness, cavity dimension and systolic function rates. Doppler-echo studies analyzing 9 parameters of diastolic function were performed in all the 54 patients studied. RESULTS: The results obtained demonstrated significant differences in the thickness of the posterior wall and the septum in the diabetics in comparison with the normal subjects. No differences were observed in the parameters of systolic function with the diastolic parameters being significant. Considered globally 41% of the patients demonstrated structural alterations, 4% systolic and 70% diastolic. The only significant correlation was established between the diastolic alteration and the time of evolution of the diabetes. The autonomic alteration which some patients presented did not vary the results obtained. CONCLUSIONS: In this group of selected diabetic structural and cardiac diastolic alterations appeared being attributed only to the diabetes itself in relation to the length of time of the same and possibly to the microangiopathy.

[The cardiac anatomical and functional changes in a group of young type-1 diabetics without microangiopathy]. / Alteraciones anatómicas y functionales cardíacas en un grupo de jóvenes diabéticos tipo I sin microangiopatía.

We study 71 type I diabetics and 25 controls, trying to analyze the anatomical and functional changes due to diabetes. The diabetics, with a mean age of 18.4 +/- 8.2 years, were strictly selected excluding any disease and treatment besides insulin. In 66, and echocardiographic M mode and 2D study was done to calculate wall thickness, cavity dimensions and systolic function indexes; in all, Eco-Doppler analyzing 9 diastolic function indexes. The results showed an increase in septal thickness in diabetics (p less than 0.01 in diastole and less than 0.001 in systole). There was no difference in systolic function or posterior wall thickness, having the diabetics a significant increase of the T 1/2 (p less than 0.001), a decrease of the deceleration of E and the ratio E/A (p less than 0.001). As a group, 12.5% of the diabetics had anatomical abnormalities, and 18.3% diastolic abnormalities at least in two indexes. The only significant correlation was established between the evolution time and the T 1/2 (p less than 0.01). We conclude that in this group of selected diabetics, the anatomical and functional abnormalities found were only imputable to the diabetic abnormality.

Reappraisal of intracutaneous tests in the diagnosis of reaginic allergy.

In an attempt to determine the clinical relevance of positive intracutaneous tests when epicutaneous tests are negative, 34 patients with symptoms of perennial rhinitis who had negative epicutaneous but positive intracutaneous tests were evaluated by radioallergosorbent (RAST) test, nasal provocation (NP) tests and leukocyte histamine release (LHR) assay. Nineteen patients with perennial rhinitis who had positive epicutaneous tests and 13 normal healthy volunteers were also studied as positive and negative controls, respectively. None of the 34 patients with negative epicutaneous but positive intracutaneous tests had positive RASTs or LHR assays, but 1 patient had a positive NP test. In contrast, of the 19 patients with positive epicutaneous tests, 12 patients had positive RASTs, 17 had positive LHR assays, and 17 had positive NP tests. In the negative control group of 13 subjects, none had positive RAST, LHR assays, or NP tests, although 3 subjects showed positive intracutaneous tests. These results indicate that when epicutaneous tests are negative in patients with perennial rhinitis, positive intracutaneous tests are not likely to indicate the presence of reaginic allergy.

Agreement between radioallergosorbent test and skin test.

A total of 4,260 RAST results were compared with the same number of prick and intracutaneous skin test results. Intracutaneous test was done only when the prick test was negative. The mean agreement between positive RAST and positive prick test was 81.3% for five grasses, 45.1% for seven weeds, 42.2% for two trees, 42.6% for two molds, and 45.8% for two environmental antigens. The mean agreement between positive RAST and positive intracutaneous test ranged from 0 to 4.9% for the same antigens.

Lymphocyte response to grass pollen antigens: a correlation with radioallergosorbent test and effect of immunotherapy.

The deoxyribonucleic acid (DNA) synthetic response of cultured lymphocytes to grass pollen antigens was significantly higher in 66 untreated atopic patients than in 15 non-atopic subjects (p less than 0.05). There was no correlation between the DNA synthetic response and the specific IgE antibody level as measured by radioallergosorbent test in the 81 subjects (r= 0.13; p greater than 0.2). The effect of immunotherapy on proliferative lymphocyte response and specific IgE antibody response to grass pollen antigens was evaluated prospectively in 22 atopic patients. The DNA synthetic response to grass pollen antigens was significantly reduced after immunotherapy (p less than 0.01) but the specific IgE antibody level did not change significantly.