Biomechanical Analysis of Two Types of Humerus Supracondylar Fracture Fixation in Anatomical Model / Análise biomecânica de dois tipos de fixação de fratura supracondiliana de úmero em modelo anatômico

Abstract Objective To analyze the stability of humerus supracondylar fracture fixation with Kirschner wires comparing intramedullary and lateral (Fi), and two parallel lateral wires (FL) fixation in experimental models, to define which configuration presents greater stability. Methods A total of 72 synthetic humeri were cross-sectioned to simulate the fracture. These bones were divided into two equal groups and the fractures were fixed with parallel Kirschner wires (FL) and with a lateral and intramedullary (Fi) wire. Then, the test specimens were subjected to stress load tests on a universal test machine, measured in Newtons (N). Each group was subdivided into varus load, valgus, extension, flexion, external rotation and internal rotation. An analysis of the data was performed comparing the subgroups of the FL group with their respective subgroups of the Fi group through the two-tailed t test. Results The two-tailed t test showed that in 4 of the 6 evaluated conditions there was no significant statistical difference between the groups (p > 0.05). We have found a significant difference between the group with extension load with a mean of 19 N (FL group) and of 28.7 N (Fi group) (p = 0.004), and also between the groups with flexural load with themean of the forces recorded in the FL group of 17.1 N and of 22.9 N in the Fi group (p = 0.01). Conclusion Fixation with one intramedullary wire and one lateral wire, considering loads in extension and flexion, presents greater stability when compared to a fixation with two lateral wires, suggesting similar clinical results.

Resumo Objetivo Analisar através de ensaios mecânicos a estabilidade da fixação da fratura supracondiliana do úmero com dois fios de Kirschner, intramedular e lateral (Fi), comparada à fixação com dois fios laterais paralelos (FL) em modelos anatômicos, de forma a se definir qual configuração apresenta maior estabilidade. Métodos Foram utilizados como corpos de prova 72 úmeros sintéticos, os quais foram seccionados transversalmente para simular a fratura. Estes ossos foram divididos em dois grupos iguais e as fraturas fixadas com dois fios de Kirschner paralelos (FL) e com um fio lateral e outro intramedular (Fi). Então os corpos de prova foram submetidos aos testes de carga em estresse em uma máquina de ensaio universal, medidos em Newtons (N). Cada grupo foi subdividido em carga em varo, em valgo, em extensão, em flexão, em rotação externa e em rotação interna. A análise dos dados foi realizada comparando os subgrupos do grupo FL, com seus respectivos subgrupos do grupo Fi através do teste t bicaudal. Resultados O teste t bicaudal demonstrou que em 4 das 6 condições aplicadas não houve diferença estatística significativa entre os grupos (p > 0,05). Encontramos uma diferença significativa entre os grupos com carga em extensão com uma média das maiores forças no grupo FL de 19 N e no grupo Fi de 28,7 N (p = 0,004), e também entre os grupos comcarga emflexão coma média de forças registradas no grupo FL de 17,1 N e no grupo Fi de 22,9 N (p = 0,01). Conclusão A fixação com fio intramedular e umfio lateral para cargas em extensão e flexão apresenta maior estabilidade quando comparada com a fixação com dois fios laterais paralelos, sugerindo resultados clínicos no mínimo semelhantes.

Hindfoot aneurysmal bone cyst: report of two cases / Cisto ósseo aneurismático do retropé: relato de dois casos

ABSTRACT Osseous tumors of the hindfoot are not usual in the literature, the diagnosis in these cases is difficult and can often go unnoticed. Besides that, surgery and reconstruction are complicated due to the complexity of the local anatomy, which makes these lesions even more challenging for the orthopedic oncological professionals. On the following article two cases of aneurysmal bone cyst of the hindfoot are reported, as well as the alternatives and peculiarities in conducting these cases according to the oncological principles. When the subject are hindfoot tumor lesions, the early diagnosis is extremely important, as well as the proper staging and the management of the case by the orthopedic oncological professional according to oncological principles.

RESUMO Os tumores do retropé são raros na literatura, o diagnóstico é difícil e muitas vezes é feito pelo profissional menos experiente. Acrescente-se a isso o fato de o tratamento cirúrgico e a reconstrução serem complicados pela intrincada anatomia local. Essas lesões são desafiadoras para o ortopedista oncológico. Relatamos dois casos de cisto ósseo aneurismático do retropé e nossas opções e particularidades na condução deles de acordo com os princípios oncológicos. Nas lesões tumorais do retropé é importante a suspeita diagnóstica precoce, bem como o estadiamento adequado e a condução do caso de acordo com os princípios oncológicos, preferencialmente pelo ortopedista oncológico.

The efficacy of sleeve technique in primary nasolacrimal duct obstruction with a high lacrimal sac.

Purpose: To evaluate the efficacy of a sleeve technique during endoscopic dacryocystorhinostomy (DCR) i n p r i m a r y n a s o l a c r i m a l d u c t o b s t r u c t i o n ( N L D O ) p a t i e n t s w i t h a h i g h l a c r i m a l sac. Materials and Methods: The medical records of 45 patients (49 cases) undergoing endoscopic DCR for primary NLDO with a high lacrimal sac were retrospectively reviewed. In 19 patients (21 cases), the thick maxilla covering the common canalicular opening was removed using a drill and a bicanalicular silicone tube was inserted (group 1). In 26 patients (28 cases), instead of removal of the thick maxilla, a sleeve was inserted into the bicanalicular silicone tube (group 2). At 6 months postoperatively, the success rate was evaluated and the size of the intranasal mucosal ostium was measured. Results: The success rates in group 1 and 2 was 90.5% and 96.4%, respectively (P = 0.400). The intranasal mucosal ostium in group 1 and 2 measured 1.7 ± 0.7 mm and 3.1 ± 1.0 mm, respectively, and the difference was significant (P = 0.042). Conclusions: In primary NLDO patients with a high lacrimal sac, DCR inserting a silicone tube and a sleeve together had a satisfactory success rate without using a drill. In comparison with traditional surgical methods, it helped enlarge the size of the intranasal mucosal ostium.

Islet Insulin Secretion, β-Cell Mass, and Energy Balance in a Polygenic Mouse Model of Type 2 Diabetes With Obesity

Abstract Type 2 diabetes (T2D) and obesity are polygenic metabolic diseases, highly prevalent in humans. The TALLYHO/Jng (TH) mouse is a polygenic model of T2D and obesity that encompasses many aspects of the human conditions. In this study, we investigated the key metabolic components including β-cell physiology and energy balance involved in the development of diabetes and obesity in TH mice. Glucose-stimulated insulin secretion from freshly isolated islets was significantly enhanced in TH mice compared with normal C57BL/6 (B6) mice, similar to the compensated stage in human T2D associated with obesity. This increased glucose responsiveness was accompanied by an increase in total β-cell mass in TH mice. Energy expenditure and locomotor activity were significantly reduced in TH mice compared with B6 mice. Food intake was comparable between the two strains but water intake was more in TH mice. Together, obesity in TH mice does not appear to be due to hyperphagia, and TH mice may be a genetic model for T2D with obesity, allowing study of the important signaling or metabolic pathways leading to compensatory increases in insulin secretion and β-cell mass in insulin resistance.

Bilateral central serous chorioretinopathy with retinal pigment epithelium tears following epidural steroid injection.

The cause of central serous chorioretinopathy (CSC) is mostly idiopathic. Other cause such as stressful event or use of corticosteroid has been associated with severe form of CSC. Atypical presentation of CSC has widespread degeneration of retinal pigment epithelium (RPE) or bullous retinal detachment. In this report, we describe a case of bilateral CSC with RPE tear after epidural steroid injection.

Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

Purpose To study the surgical outcomes of radical nephrectomy with thrombectomy and to determine prognostic factors for survival of Korean patients with renal cell carcinoma (RCC) and venous tumor thrombus. Materials and Methods A total of 124 patients with RCC and venous tumor thrombus who underwent radical nephrectomy and thrombectomy were included in this retrospective study. Cancer-specific survival (CSS) and recurrence-free survival (RFS) rates were analyzed retrospectively according to various prognostic factors. Results The median overall follow-up period for all patients was 29.0 months; the median survival period was 50.0 months. The 2-, 5- and 10-year CSS rates for all patients were 64.2%, 47.1% and 31.7%, respectively. Those for 76 patients (pN0/xM0) without metastasis at presentation were 80.9%, 64.5% and 44.9%, respectively. For all patients, lower body mass index (BMI), higher Fuhrman grade, presence of symptoms, perinephric fat invasion, invasion of inferior vena cava (IVC) wall, lymph node (LN) involvement and distant metastasis at presentation were independent predictors for decreased CSS on multivariate analysis, while thrombus level was not. For non-metastatic patients, lower BMI, presence of symptoms and tumor size were independently associated with decreased CSS. In terms of RFS, lower BMI, presence of perinephric fat invasion were prognostic factors for recurrence. Conclusions Our data suggest that obesity is independently associated with better survival or lower risk of tumor recurrence in Korean patients undergoing radical nephrectomy with tumor thrombectomy. Also, our results indicate that Fuhrman grade, presence of symptoms, perinephric fat invasion and invasion of IVC wall, LN involvement and distant metastasis at presentation are independent predictors for survival. .

A Mediterranean Low-Glycemic-Load Diet alone or in Combination with a Medical Food Improves Insulin Sensitivity and Reduces Inflammation in Women with Metabolic Syndrome.

Aim: To determine the effects of a Mediterranean-style low-glycemic load diet alone or in combination with a medical food (MF) on insulin resistance and inflammation in women with metabolic syndrome (MetS). Study design: Two groups, Parallel study with control. Place and Duration of Study: Department of Nutritional Sciences, University of Connecticut, Storrs, CT; Department of Emergency Medicine, University of Florida, Jacksonville, FL; Department of Medicine, University of California, Irvine, CA. The study was carried out from September of 2009 to May 2010. Methodology: Eighty three women (20-75 y) with MetS. Participants were randomly allocated to consume diet alone (control group) or the diet plus the MF (MF group) for 12 wk. Body composition was measured at baseline, week 8 and week 12 by use of bioelectrical impedance in all participants while Dual-emission X-ray absorptiometry was used for 37 of the subjects. Insulin resistance, plasma insulin, leptin, adiponectin and the inflammatory cytokines, tumor necrosis factor (TNF)-α, interleukin-6 (IL-6), adhesion molecules, sICAM-1 and sVCAM-1, were measured at the same time points. Results: Independent of group allocation, women had decreases in body mass index (p < 0.0001) and body and trunk fat (p < 0.0001). Plasma insulin, insulin resistance, and leptin were also significantly decreased over time (p < 0.0001), while plasma adiponectin levels did not change. Regarding inflammatory markers, significant reductions were found in TNF-α (p < 0.0001) and sICAM-1 levels (p < 0.001), but not in IL-6 or sVCAM-1. At 12 wk, sICAM was reduced only in the MF group (p<0.05 vs control). Conclusion: A Mediterranean-style diet, in combination with a MF, are a viable option to decrease factors associated with increased risk for type 2 diabetes and coronary heart disease.

Macro-Level Factors & their Influence on Family Perceptions in Two Cultures / Factores macro y su influencia en las percepciones familiares en dos culturas

Values, political beliefs, and family perceptions are sensitive to cultural change, which embraces change in the political, economic, and other societal-level spheres. This study investigated the impact of culture-level individualism and gender on family perceptions and the interrelations between the macro-level and individual level factors in South Korea and Hungary, two countries that have undergone recent social change. The study included data from 288 university students. Cultural and gender influences on Postmodernist values, democratic beliefs, political interest, political conservatism, perceptions of family relatedness and democratisation were found, and the overall model of interrelations between all the variables was tested using SEM (structural equation modelling) analysis.

Los valores, creencias políticas y percepciones familiares son sensibles a los cambios culturales, los cuales implican modificaciones en las esferas política, económica y a otros niveles sociales. Este estudio investigó el impacto del nivel de individualismo cultural y el género en las percepciones familiares y en las inter-relaciones entre factores de nivel macro e individual en Corea del Sur y Hungría, dos países que han experimentado cambios sociales recientes. Este estudio incluyó los datos de 288 estudiantes universitarios. Se encontraron influencias culturales y del género en los valores post-modernistas, creencias democráticas, intereses políticos, conservadurismo político, percepciones de la conexión familiar y la democratización. Para probar el modelo general de relaciones entre todas las variables se usó el análisis de Ecuaciones Estructurales.

Tratamento da epifisiólise proximal femoral grave com osteotomia subtrocantérica pelo método de Ilizarov / Treatment of proximal femoral epiphysiolysis with subtrochanteric osteotomy by the Ilizarov method

OBJETIVOS: Avaliar o tratamento da epifisiólise femoral proximal grave através da osteotomia subtrocantérica pelo método de Ilizarov e propor uma metodologia de cálculo para estimar a correção necessária. MÉTODOS: Foi realizado um estudo de casos de pacientes acometidos por epifisiólise do fêmur proximal grave, submetidos a osteotomia subtrocantérica com fixação externa multiplanar, avaliados no pós-operatório pela classificação modificada de Southwick. Foi desenvolvida uma metodologia de cálculo para estimar a correção angular necessária no ato cirúrgico. RESULTADOS: Foram avaliados 13 quadris, quatro à esquerda (30,8 por cento) e nove à direita (69,2 por cento), de maioria (61,5 por cento) do sexo masculino, com idade média de 14 anos. Obtiveram-se como parâmetros para dor e função 30,8 por cento de excelentes resultados, 46,2 por cento de bons e 23,0 por cento de regulares, não sendo observados resultados ruins. O arco de movimento apresentou 46,2 por cento de excelentes resultados, 30,8 por cento de bons e 23,0 por cento de regulares. Radiologicamente, foram obtidos 7,7 por cento de excelentes resultados, 69,2 por cento de bons, 15,4 por cento de regulares e 7,7 por cento de ruins. CONCLUSÕES: O tratamento percutâneo da epifisiólise proximal grave pelo método de Ilizarov como opção terapêutica apresenta bons índices de melhora da dor e função. O método de cálculo proposto auxilia de forma positiva no planejamento cirúrgico, apresentando variações entre os ângulos medidos e calculados da ordem de 3º.

OBJECTIVES: This paper evaluates the treatment of severe proximal femoral epiphysiolysis through subtrochanteric osteotomy by the Ilizarov method and propose a new method for calculating the necessary correction. METHODS: a case study was carried out with patients affected by severe proximal femoral epiphysiolysis, submitted to subtrochanteric osteotomy with external multiplanar fixation, and evaluated postoperatively by the modified Southwick classification. A method was developed for calculating the necessary angular correction at surgery procedure. RESULTS: thirteen hips were analysed, four on the left (30.8 percent) and nine to the right (69.2 percent). The majority of patients (61.5 percent) were male, with a mean age of 14 yrs. In relation to pain and function, results were excellent: 30.8 percent; good: 46.2 percent; and regular: 23.0 percent. There were no poor results in relation to these two aspects. The results for mobility were: excellent 46.2 percent; good 30.8 percent; and regular: 23.0 percent. Radiographically, the results were: excellent 7.7 percent; good: 69.2 percent; regular: 15.4 percent; and poor: 7.7 percent. CONCLUSIONS: percutaneous treatment of the severe proximal epiphysiolysis by the Ilizarov method is a good treatment option with good indices for improvement of pain and function. The proposed calculation method can help in planning surgery procedures, showing small variations between preoperative calculated angles and measured postoperative angles.

Survival and growth of Cochlodinium polykrikoides red tide after addition of yellow loess.

We examined the survival rate of Cochlodinium polykrikoides after yellow loess addition and conducted culture experiments to investigate the possibility that red tides may be caused by C. polykrikoides individuals that are precipitated when loess is added. At least 15% of the C. polykrikoides cells that precipitated to the bottom layer either by the addition of loess or no addition survived for 1 week at all growth phases, rather than disappearing immediately after precipitating. However, no live cells were observed after 20 days, regardless of phase or loess addition. In the exponential phase, the number of C. polykrikoides cells increased to >2886 cells ml-1 after loess was added. However, in the stationary phase, the number of cells did not increase until 18 days. In the exponential phase, those C. polykrikoides that survived precipitation caused by scattering loess on cultures did not appear to have the ability to cause red tides again because of the short red tide periods in the field, long lag time after loess addition, and low survival rate after loess addition.

Population biology and feeding habits of the nephropid lobster Metanephrops thomsoni (Bate, 1888) in the East China Sea.

Population biology and feeding habits of the nephropidlobsterMetanephrops thomsoni (Bate) was studied from a field survey sampled with bottom trawls in the East China Sea. The female/male ratio was 1.06:1. Three size-class groups were discriminated for both sexes, which may correspond to one to three year-old cohorts. The average stage fecundity was 471 in each brood. Larger than two-year-size-class females are multi broods during the breeding season. Gut analysis showed that this lobster is a common camivore and mainly consume crustaceans and fishes, regardless of sex and carapace length size.

Tratamento da pseudartrose infectada da tíbia pelo método de Ilizarov: técnica do encurtamento agudo com subseqüente alongamento / Treatment of infected pseudoarthrosis of the tibia by Ilizarov's method: technique using acute compression and subsequent distraction

OBJETIVO:Comprovar a eficácia do tratamento da pseudartrose infectada da tíbia pelo método de Ilizarov, utilizando a técnica do encurtamento agudo do foco da pseudartrose com posterior alongamento ósseo. MÉTODOS: Foram estudados 20 pacientes adultos portadores de pseudartrose unilateral infectada da tíbia, tratados no período entre novembro de 1993 e setembro de 2000. No pós-operatório, os pacientes foram avaliados quanto a dor, necessidade de órtese, avaliação da mobilidade articular, retorno às atividades normais do dia-a-dia e/ou do trabalho, consolidação da pseudartrose, cura da infecção, existência de deformidades ósseas, discrepância no comprimento dos membros e consolidação óssea na área do regenerado ósseo. RESULTADOS: Os resultados funcionais foram: excelentes em 10 pacientes (50 por cento), bons em oito (40 por cento), regulares em um (5 por cento) e ruins em um paciente (5 por cento). O tempo de consolidação da pseudartrose, do segmento ósseo alongado e o tempo de uso do fixador foram proporcionais à extensão da perda óssea. CONCLUSÃO: O método de Ilizarov, associado ao encurtamento agudo com subseqüente alongamento ósseo, mostrou-se eficaz para o tratamento da pseudartrose infectada da tíbia.

OBJECTIVE: To verify the effectiveness of treating the infected pseudoarthrosis of the tibia by Ilizarov's method using the technique of acute compression of the focus of pseudoarthrosis with later bone distraction. METHODS: 20 adult patients with unilateral infected pseudoarthrosis of the tibia treated from November 1993 to September 2000 were studied. In the postoperative period, the patients were evaluated for pain, orthesis requirement, joint mobility, return to daily life activities and/or to work, union of the pseudoarthrosis, cure of the infection, presence of bone deformities, discrepancy in limb length, and bone union in the bone regenerate area. RESULTS: Functional results were: excellent in 10 patients (50 percent), good in eight (40 percent), regular in one (5 percent), and poor in one patient (5 percent). The time to achieve union of the pseudoarthrosis of the distracted bone segment and the time of use of the fixator were proportional to the extension of bone loss. CONCLUSION: Ilizarov's method associated to acute compression followed by bone distraction showed to be effective to treat infected pseudoarthrosis of the tibia.

Tumor necrosis factor-á signaling cascades in apoptosis, necrosis, necroptosis and cell proliferation

Tumor necrosis factor-á (TNF-á) is a multifunctional cytokine involved in host defense, inflammation, apoptosis, autoimmunity, organogenesis and lymphoid microarchitecture. Many of these activities may be explained by the ability of this cytokine to induce distinct signal transduction pathways that recruit regulatory proteins involved in differentiation, cell death or cell proliferation. In this review, we discuss the contribution of caspases -3, -6, -7 and -8, and of cyclin-dependent kinases (CDKs), cyclin B and cyclin-dependent kinase inhibitors (CKI p21 and p27), as well as retinoblastoma tumor suppressor in the signaling cascades triggered by TNF-á to induce apoptosis, necrosis and cellular proliferation in the murine cell lines NIH3T3 and WEHI-164 and the human cervical carcinoma cell line HeLa-S3. Based on the findings of many literature reports and our own data, we discussed a model in which caspases are continuously activated throughout the cell cycle and kept at a critical threshold level by IAP (inhibitor of apoptosis) antagonists. Following the release of Smac/Diablo and HtrA2/OMI from mitochondria in response to diverse stimuli, this threshold is overcome and results in amplified caspase activation and cell death. An alternative, caspase-independent mechanism of cell death is induced in NIH3T3 fi broblasts by a combination of TNF and the pan-caspase inhibitor z-VADfmk. This cell death phenotype, known as necroptosis, displays some morphological features of apoptosis and necrosis. Although caspases are critical regulators of the TNF signaling pathway during cellular life and death, the mechanisms involved in the fine regulation of their dual effects remain to be fully elucidated.

Displasia condroectodérmica (Síndrome de Ellis-van Creveld): relato de dois casos / Chondroectodermal dysplasia (Ellis-van Creveld Syndrome): report of two cases

The authors report two patients with chondroectodermal dysplasia, also called Ellis-van Creveld Syndrome. This rare, inherited disease of autossomal-recessive trait was diagnosed in two brothers. Both presented clinically with dwarfism, postaxial hand polydactyly, fingernail dysplasia, shortened limbs, heart and teeth problems, and other associated deformities. One of the children evolved to death from cardiac arrest, and the other is sound at 5 years of age. The main purpose of the orthopedic approach in this syndrome is to improve the function and appearance of affected hands.

Transfixação da placa de crescimento com fios metalicos lisos e rosqueados: estudo experimental em coelhos / Growth plate transfixation with smooth and threaded pins: an experimental study

Realizou-se estudo experimental na placa epifis ria de crescimento distal do femur de 50 coelhos com cinco semanas de vida. A placa epifisaria foi transfixada com pinos metalicos lisos e rosqueados, introduzidos perpendicular ou obliquamente ao seu eixo longitudinal. Os animais foram divididos em cinco grupos, de acordo com a técnica de transfixação e implante metalico empregado. Os cinco grupos foram subdivididos em 10 subgrupos de cinco animais cada, de acordo com a época em que foram mortos. As alterações no crescimento longitudinal, na angulação dos candilos femorais e na microestrutura da placa de crescimento foram analisadas por meio de mensuração do comprimento longitudinal do femur, por radiografias de controle e estudo histol¢gico, apos oito e 12 semanas. A placa epifis ria distal do femur de coelhos com cinco semanas de vida foi transfixada por um pino metalico liso de 1,5mm de diametro que atravessou a placa epifisaria perpendicularmente e foi retirado em seguida no mesmo ato cir£rgico. Esse procedimento não alterou o crescimento longitudinal do osso e tampouco modificou a estrutura morfologica da placa de crescimento. Entretanto, quando o pino foi deixado no local, provocou lesõe definitiva na rea lesada. Os pinos metalicos lisos cruzados em relação à placa epifisaria produzem lesão definitiva na placa de crescimento, com substituição do tecido cartilaginoso por tecido osseo no local da lesão. A maior incidencia de retardo de crescimento e alterações fisarias ocorreram apos 12 semanas, no grupo em que a placa epifisaria foi transfixada com pinos intramedulares ou pino rosqueado. Esses achados experimentais sugerem que se deve ter cuidados quando os pinos que transfixam a placa epifisaria são utilizados no tratamento de fraturas, pois podem produzir lesão permanente da placa epifisaria

Cem entless Revision of total hip arthroplasty / 대한정형외과학회잡지

Forty-six patients (fifty hips) underwent revisions of a total hip arthroplasty that had failed but was not associated with infection, Three of these patients had a third revision. The mean length of follow-up was approximately two years. Thirty patients reported that their condition was improved. On final roentgenographic examination showed, two loosening of the acetabular components and five of the femoral components in which there was one sympto matic loosening (moderate severe pain and probable roentgengraphic loosening) noted. The extralong stems are not necessary in all revision cases, cortical defects at the tip of standard stem obviously should require bypass the stress riser with a longer stem. If the stability can be achieved with host bone, Revision may be carried out with a relatively short stem. Significant postoperative complications as subsidence and progressive loosening were noted in seven out of the forty-six patients. We consider that extensive porocoated cementless stem or standard flute stem seem to be a better outcome in revision arthroplasty.