Wintertime surgery increases the risk of conversion to hip arthroplasty after internal fixation of femoral neck fracture.

UNLABELLED: The study demonstrates that wintertime surgeries are associated with impaired fracture healing and increases the risk of conversion to hip arthroplasty after osteosynthesis of femoral neck fracture. Furthermore, the results raise the possibility of association between seasonal changes in vitamin D levels and impaired fracture healing of femoral neck fracture. INTRODUCTION: Although the changes of vitamin D level and calcitropic hormones influencing bone metabolism are seasonal, the effect of seasons on hip fracture healing is unknown. We assessed the effects of seasonal periodicity on conversion to hip arthroplasty after primary osteosynthesis of femoral neck fracture. METHODS: This nationwide retrospective observational cohort study involved 2779 patients aged ≥ 60 years who underwent internal screw fixation for primary femoral neck fracture and were discharged in 2000. Cases requiring conversion to arthroplasty during the 8-year follow-up derived from the Hungarian health insurance database were registered. Risk factors assessed included sex, age, fracture type, season of primary surgery and surgical delay. Competing-risks regression analysis was used for data analyses. RESULTS: During the observation period, 190 conversions to hip arthroplasty (6.8%) were identified, yielding an overall incidence of 19.5 per 1000 person-years. The crude incidence rates of conversions after osteosynthesis in winter, spring, summer and fall were 28.6, 17.8, 16.9 and 14.7 per 1000 person-years, respectively. Besides younger age, female sex and intracapsular fracture displacement, wintertime primary osteosynthesis significantly increased the risk of conversion (fall vs. winter, hazard ratio (HR): 0.50, 95% confidence interval [95% CI 0.33-0.76]; spring vs. winter, HR: 0.63, [95% CI 0.44-0.92]; summer vs. winter, HR: 0.62, [95% CI 0.42-0.91]). CONCLUSIONS: Our study demonstrate that wintertime primary osteosynthesis increases the risk of conversion surgeries. The results may help improving the outcome of primary fixation of femoral neck fractures.

Modified carpal box technique in the diagnosis of suspected scaphoid fractures.

PURPOSE: To establish and test the clinical efficacy of a new diagnostic algorithm with the extensive utilization of modified carpal box radiography (mX-CB) in the detection of scaphoid fractures. MATERIAL AND METHODS: Initial and early follow-up radiographic evaluation of 146 suspected scaphoid fractures were carried out by mX-CB. Patients with unconfirmed diagnosis were referred to CT. Patients were followed for 1 year after injury. Sensitivity, specificity and interobserver agreement of reading mX-CB images were determined statistically. RESULTS: No non-union or avascular necrosis was seen at 1 year after the injury. 90% of the fractures were diagnosed by mX-CB, only 6.8% of the patients needed referral to CT. Sensitivity of mX-CB at initial presentation was 81.6%. Interobserver agreement was very high among evaluators of mX-CB images. CONCLUSION: Extensive utilization of mX-CB as primary and early follow-up investigation resulted in high initial diagnostic accuracy and low referral rate to a more expensive diagnostic modality.

Biomechanics of the human flexor tendon sheath investigated by tenography.

Tenography has been performed on eight detached fingers and two intact hands of cadavers. Bulging and overlapping of synovial pockets between the ligamentous structures during flexion, their flattening during extension and the continuous change in expansion of the proximal cul de sac suggests a possible mixing mechanism for the synovial fluid. During flexion and extension a physiological joint-type bowstringing of the flexor tendons was observed at the PIP and DIP joints. This finding supports the theory that the flexor tendon moment arm is increased at these joints.

Complications of endoscopic sinus surgery: analysis of 2108 patients--incidence and prevention.

The incidence of complications of endoscopic sinus surgery (ESS) in a combined experience with 2108 total patients is compared to complications in 11 other series of patients (2583 total) who underwent ESS and 6 series of patients (2110 total) who underwent traditional endonasal sinus surgery. The incidence of major perioperative complications was 0.85%, with cerebrospinal fluid (CSF) leak being the most common. The most common minor complications of ESS were those related to orbital penetration and middle turbinate adhesions; minor complications occurred in 6.9% of the 2108 patients. There were no statistically significant differences in the overall incidences of major complications between this series and the other two groups. Recommendations are made for the prevention of complications during ESS.

Endoscopic sinus surgery: 4-year follow-up on the first 100 patients.

Endoscopic sinus surgery has been reported to be successful, but lack of a standardized classification system hampers comparison of results between studies, and long-term results of surgery have not been reported in a series of consecutive patients. The results of our first 100 endoscopic sinus surgery procedures, reported previously after an average 9-month follow-up, were reviewed with the application of a new classification scheme and in light of a longer (4-year) follow-up. Surgery was successful in all patients whose sinus symptoms resulted from anatomical variations or suppurative infection, but failed in some patients with hyperplastic disease or polyps. In addition, the presence of reactive airway disease or the acetylsalicylic acid (ASA) triad was a bad prognostic sign. The overall success of the procedure in relieving sinus symptoms decreased from 98% at early follow-up to 91% at 4-year follow-up. Sixty-six percent were successful after one procedure and 25% required more than one procedure to achieve success. The decline in success since our first report in 1990 was mostly attributable to late failure in patients with recurrent symptomatic polyposis. Because symptoms may not recur in these patients for up to 3 years, long-term results of surgery for this disorder are necessary. Symptoms of recurrent polyposis can be controlled medically or by revision surgery.

[Experimental study of postoperative scarring around the tendon sheath]. / Az ínhüvely körüli posztoperatív hegesedés kísérletes vizsgálata.

Authors have compared two kind of exposures of the flexor tendons. The results were assessed by measuring the flexion oft the given finger on pulling, by light and electron microscopic examination. It was found that in fingers where the tendon sheat was detached from the subcutis the scarring was greater and its effect, limiting the motion has its maximum on the fourth postoperative week. It is raised that the role of the tendon sheat in respect of the success of the flexor tendon reconstruction is mainly mechanic and most effective if its highly integrated connection with its surrounding is not disturbed.

Cardiac tamponade in a patient with Gaucher's disease.

Gaucher's disease, a familial inborn error of metabolism associated with hepatosplenomegaly and hypersplenism, was first described by Earnest Gaucher in 1882. By 1959, Hsia found published reports on more than 300 cases. Most reports mentioned the bleeding tendencies of patients with Gaucher's, but show that major hemorrhagic complications are rare. We report a case of hemorrhagic pericarditis with cardiac tamponade in a patient with Type I Gaucher's disease.

Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy.

The hemitongue paralysis that occurs as a result of a classic hypoglossal-facial nerve crossover procedure can result in profound functional deficits in speech, mastication, and swallowing. The procedure is not an option in patients with bilateral facial paralysis or those at risk for combined cranial nerve deficits. To address some of the drawbacks and limitations of this classic procedure, we developed the hypoglossal-facial nerve interpositional jump graft (12-7 jump graft) procedure. This procedure involves interposing a nerve graft between a partially severed but functionally intact twelfth cranial nerve and the degenerated seventh cranial nerve, and is often combined with other reanimation procedures. To date, we have performed 33 12-7 jump graft procedures in 30 patients (three were treated for bilateral facial paralysis); this report describes the procedure and its indications, and details the results of 23 procedures performed in 20 patients for whom 24-month follow-up data are available. Twelfth nerve deficits occurred in only three patients in this report. Recovery of facial function began between 3 and 24 months postoperatively. Facial tone and symmetry were achieved in every patient, no patient had significant mass movement, and 13 patients (two of whom were treated for bilateral facial paralysis) had excellent and three had superb restoration of facial movement. These results show the 12-7 jump graft to be a valuable adjunct for facial reanimation in selected patients.

Gadolinium-enhanced magnetic resonance imaging of the facial nerve in herpes zoster oticus and Bell's palsy: clinical implications.

Gadolinium-enhanced magnetic resonance imaging was used in the evaluation of the facial nerve in four patients with idiopathic facial paralysis and six with herpes zoster oticus (HZO). Enhancement of the facial nerve was seen in all patients with Bell's palsy, and 50 percent of patients with HZO. The most consistent area of enhancement in both disorders involved the premeatal and labyrinthine segments. Although the images showed changes consistent with the type of viral process that is known to occur in these disorders, we found no significant correlation between the intensity or pattern of facial nerve enhancement on the images, the severity or duration of the disease, or the patient's prognosis for recovery. Nevertheless, gadolinium-enhanced MRI does have a place in the evaluation and decisions for management of select cases of facial paralysis.

[Tenodermodesis: a method for the management of inveterate extensor tendon injuries on the distal finger joint]. / Tenodermodesis: eljárás a végízület feletti inveterált extensorín sérülések kezelésére.

Authors describe the operative method of Iselin for the treatment of inveterated extensor tendon injuries over the DIP joint and their results. On the basis of favourable experiences they suggest the use of this method. No description of this procedure was found in the literature of this country.

Managing segmental facial nerve injuries by surgical repair.

This report describes our experiences and evolving philosophy with regard to managing segmental facial nerve injuries. We present the results of 13 facial nerve repairs of traumatic injury to a segment of the facial nerve. All peripheral facial nerve branches contribute essential elements to normal mimetic facial movement; therefore, we recommend early, appropriate repair of the nerve segment. This recommendation is based on principles established for managing disruptions of the main trunk of the facial nerve. It offers the patient the chance for complete recovery of facial function.

Early facial reanimation following radical parotid and temporal bone tumor resections.

A retrospective study of 35 patients who underwent early facial reanimation following extirpative parotid and temporal bone surgery requiring facial nerve sacrifice was performed. Regional facial reanimation performed immediately or within several days included 16 patients who underwent temporalis muscle transposition and 27 who underwent gold weight or eyespring lid reanimation with lower lid tightening. Simultaneous nerve grafts or nerve crossover procedures were performed in 22 patients. The authors' favored approaches to facial reanimation are discussed, with an emphasis on the value of early reanimation using properly selected techniques.

Grading facial nerve function: House-Brackmann versus Burres-Fisch methods.

Many systems for reporting results of facial function tests have been proposed, but after five International Facial Nerve Symposia, a perfect system for reporting has yet to be developed. In 1985 the American Academy of Otolaryngology-Head and Neck Surgery adopted the House-Brackmann (H-B) six-point subjective grading scale as a universal standard. This decision was based on the recommendation of the Facial Nerve Disorders Committee. The next year, 1986, Burres and Fisch proposed the Linear Measurement Index (B-F LMI) as an alternative, objective grading system. To determine the ability of each system to grade the facial function of patients with facial palsy, and the relative merits of each system, 41 patients with facial weakness and one normal patient were studied. The H-B grading system is easy to use and provides simple, concise criteria for each separate grade of facial function. The B-F LMI grading system is time-consuming and labor-intensive, and requires a complex calculation to derive a percentage value that represents facial function. The most important finding of this study was the high degree of correlation between the two systems, in spite of the fact that the H-B system is subjective and qualitative while the B-F LMI system is objective and quantitative. Until the perfect grading system is developed, the authors favor combining the H-B and B-F LMI systems as the best method available at the moment to evaluate facial function.

Video telescopic sinus surgery technique for teaching.

Video-endoscopic sinus surgery is a team approach which has evolved from classic, endoscopic sinus surgery in treating over 500 patients. Unlike classic endoscopic sinus surgery which has the surgeon viewing and operating through the endoscope, this technique permits the surgeon to operate while viewing the T.V. monitor using two hands for instrumentation. This technique greatly facilitates hands-on teaching and learning, while simultaneously providing a reproducible method of documentation.

[Current observations on the morphology and biomechanics of the human flexor tendon sheath]. / Ujabb megfigyelések az emberi hajlítóínhüvely morfológiájáról és biomechanikájáról.

Authors give a short description, based on own experimental work and literary data, of the tendon sheat biomechanics of the long fingers. The importance of the integrity of the tendon sheat--subcutis--skin unit is presented. Starting from this, a new possibility of exposing the flexor tendons, a laterobasal exposure is shown. The experimental character of their work is stressed, it is however underlined that clinical importance is attached to their aspect.

[Restoration of movement after irreparable nerve damage caused by injury]. / A mozgás helyreállítása a kéz irreparábilis idegsérülései után.

Authors made a late follow-up of their motion improving operations, performed on the Department of Traumatology of the I Department of Surgery, Pésci University of Medical Science. The indication and technique of these operations in case of paralysis of the opponens, interosseal-lumbrical muscles and of the extensors of the hand are described in details.

Studies on the structure of rat liver messenger ribonucleoprotein. I. Isolation and characterization.

Messenger ribonucleoprotein (mRNP) was released from 0.5 M KCl washed rat liver polyribosomes after mild pancreatic ribonuclease (EC 3.1.27.5) and EDTA treatment and separated by sucrose gradient centrifugation from ribosomal subunits. The method yielded partially fragmented mRNP, which, however, was free from ribosomal contaminants. In CsCl gradient the mRNP banded at 1.46 g/cm3, indicating a protein content of about 65%. Treatment of mRNP with 0.25 M or 0.5 M KCl resulted in loss of the proteins. Urea/sodium dodecyl sulfate polyacrylamide gel electrophoresis of mRNA bound proteins showed that the most prominent polypeptides found in the mRNP fractions exhibited molecular weights of 29 000 (P29), 31 000 (P31), 38 000 (P38), 44 000 (P44), 50 000 (P50), 54 000 (P54), 63 000 (P63) 76 000 (P76) and 105 000 (P105). Three polypeptides, P38, P44 and P63 were most sensitive to high salt treatment.