A Functional And Radiological Outcome Of Surgical Management Of Bimalleolar And Trimalleolar Ankle Fractures

BACKGROUND: Ankle joint is one of the unstable joints in the body due to its anatomic position and is more prone to injury during daily activities. Malleolar fractures are one of the most common fractures in orthopedic traumatology. OBJECTIVES : The aim of this study was to evaluate the clinical and functional results of patients with ankle fractures treated with Open reduction and internal fixation with different modalities. Method and Materials:Aprospective study was conducted from April 2016 to April 2018 over a period of 2 years . Total 50 patients were treated by various techniques of open reduction and internal fixation. Result :According to Baird and Jackson scoring system, 23 (51 %) patients had excellent outcome, 14 (31%) had good outcome,6 (13 %) had fair outcome and 2 ( 4 %) had poor outcome. Supination External Rotation injury is the commonest mechanism of injury. CONCLUSION : We concluded that early treatment , anatomical reduction and fracture fixation, stringent postoperative mobilization and rehabilitation should help improve Functional outcome in ankle fractures.

Recuperación de pacientes en postoperatorio de drenaje de hematoma subdural crónico asociado al uso de ácidotranexámico / Recovery of patients operated with technical drain of chronic subdural hematome, associated to tranexamic acid

Con el objetivo de evaluar la recuperación de pacientes que recibieron ácido tranexámico luego del drenaje de hematoma subdural crónico (HSC), se seleccionan al azar 22 pacientes de ambos sexos en edades comprendidas de 32 a 87 años. A un grupo de 11 paciente intervenidos, se les continuó el tratamiento con la colocación de un sistema de drenaje externo tipo Jackson-Pratt (grupo A) y un segundo grupo de pacientes, se les continuó tratamiento con Ácido Tranexámico (grupo B). Ambos grupos fueron evaluados en aspectos clínicos y tomográficos una semana después de la intervención. La distribución obtenida por género representó 99,5 por ciento masculino. Del total de pacientes, la mitad presentó HSC en el lado derecho y los casos bilaterales representaron 31,8 por ciento. Los resultados funcionales postoperatorio fueron satisfactorios en el 59,1 por ciento comparado con los obtenidos en la escala Glasgow preoperatorio donde más del 50 por ciento de los casos no superaban el valor 13 de la escala. El síntoma más común fue hemiparesia izquierda (45,5 por ciento), seguido de hemiparesia derecha (22,7 por ciento). El tratamiento con Ácido Tranexámico obtuvo resultados satisfactorios en el 63,6 por ciento de los casos de manera inmediata y en el 27,3 por ciento a las 24 horas; caso contrario a los resultados obtenidos con el sistema de Jackson-Pratt, donde el 54,5 por ciento obtuvo mejoría a las 24 horas. Deigual manera la relación entre días de hospitalización y tratamiento fue significativa. Estos resultados permiten concluir que el tratamiento con Ácido Tranexámico ofrece una excelente tasa de recuperación, con menor número de complicaciones,...

The research presented as techniques to evaluate chronic subdural hematoma drainage associated with the use of tranexamic acid in the recovery of postoperative patients in IAHULA: Mérida, Venezuela. It is a descriptive, cross-sectional and retrospectivestudy. Randomly selected patients of both sexes aged 32 to 87 years old who had a diagnosis of Chronic SubduralHematoma, unilateral or bilateral. From a total of 22 patients, which will have surgery criteria: Drawing Subdural Hematoma. A group of 11 patients who underwent classic fashion, they continued the surgery with placement of an external drain JacksonPratt type. The other group of patients also underwent the classic way, they continued postoperative treatment with tranexamic acid. Both groups were evaluated clinically and tomographic week intervention. As a result it was found that most patients with surgical drainage of chronic subdural hematoma are the right area, in the group A (with A Jackson-Pratt) and group B (tranexamic acid). The present study showed male predominance (99.5 percent) and 50.0 percent of hematomas occurred on the right side, followed by bilateral cases (31.8 percent). The postoperative functional results were satisfactory in 59.1 percent compared with those obtained in the preoperative Glasgow where over 50 percent of cases did not exceed the value of the scale 13 scale. The most common symptom was left hemiparesis (45.5 percent), followed by right hemiparesis (22.7 percent). Treatment with Tranexamic Acid obtained satisfactory results in 63.6 percent of cases immediately and in 27.3 percent at 24 hours; Otherwise the results obtained with the system of Jackson-Pratt, where 54.5 percent improvement obtained by 24 hours. Similarly the relationship between days of hospitalization and treatment gave significant. These results suggest that treatment with tranexamic acid offers higher cure rate with fewer complications, mortality and sequelae, allowing also reduce hospitalization time,...

John Hughlings Jackson: um neurologista inglês / John Hughlings Jackson: a British neurologist

John Hughlings Jackson tornou-se médico e neurologista por uma via atípica e sem frequentar qualquer universidade. Entretanto, sua mente brilhante e a admirável capacidade de trabalho levaram-no a produzir conhecimentos que repercutem até os dias de hoje, nas áreas do diagnóstico neurológico, epilepsia, localização cerebral, níveis evolucionários do sistema nervoso e sua hierarquia, entre outros. Diversas das condições que descreveu foram designadas com seu nome. É admirável que essa produção médico-científica tenha sido baseada inteiramente na sua aguçada capacidade de observação clínica. Foi a personalidade que mudou a neurologia inglesa, dando-lhe um status que carecia no meio nacional e internacional. É considerado o "pai" da neurologia inglesa.

John Hughlings Jackson became a physician and neurologist through an atypical way, and without attending any university. However, his brilliant mind and amazing capacity for work led him to produce knowledge that resounds until the present days, in areas of neurological diagnosis, epilepsy, brain localization, evolutionary levels of the nervous system and their hierarchies, among others. Several conditions that he described were named after him. It is admirable that this medical-scientyphic production was founded entirely in his sharp ability of clinical observation. He was the personality that changedthe English neurology providing a status it lacked in the national and international milieu. He is considered the "father" of the English neurology.

Concordancia entre dos técnicas subjetivas para determinar la refracción en adultos jóvenes / Concordance between two subjective techniques used to determine refraction in young adults

La refracción subjetiva es una técnica que compara un lente con otro para llegar a una combinación de lentes que resulte en el máximo de agudeza visual. Estudios han evaluado la concordancia intra/inter observadora y con otras técnicas objetivas o subjetivas, principalmente para el cilindro cruzado de Jackson (JCC), pero pocas para el emborronamiento más dial astigmático (EmD). Objetivo: determinar la reproducibilidad de los métodos subjetivos EmD y JCC y la concordancia de estos con el procedimiento objetivo de retinoscopia estática. Método: se realizó un estudio descriptivo de concordancia con 190 sujetos, con medición independiente para cada técnica por dos evaluadores. En el análisis estadístico de las refracciones se usó transformación en notación Fourier. Resultados: EmD tuvo una mejor reproducibilidad para el poder esférico y cilíndrico, pero para el eje fue mejor con el método del JCC. Entre el método objetivo y los subjetivos la concordancia fue más baja en el equivalente esférico (componente M) para el JCC; se aprecia que el sesgo (exactitud) y la precisión son pobres, señalando que las mediciones hechas principalmente en el componente esférico difieren en promedio y en repetición entre estas técnicas. Conclusión: las discrepancias entre evaluadores o procedimientos en el cilindro pueden ser hasta de ±0,50 D y 10° en el eje, pero en la esfera puede ser hasta de 1,00 D; ambas técnicas son válidas para la evaluación de la refracción subjetiva en sujetos jóvenes.

Subjective refraction is a technique whereby one lens is compared to another in order to find a lens combination that results in maximum visual acuity. Studies have evaluated intraobserver or interobserver concordance, along with other objective or subjective techniques, mostly for theJackson Cross Cylinder (JCC), but few for fogging and use of astigmatic dials (EmD, for its initialsin Spanish). Objective: To determine the reproducibility of subjective methods EmD and JCC, as well as their concordance with the objective procedure of static retinoscopy. Methodology: A descriptive concordance study was carried out among 190 individuals, with independent measurementfor each technique by two evaluators. Fourier transformation was used on statistical analysis of refractions. Results: EmD showed a higher reproducibility for the spherical and cylindrical power,but the JCC methodology was better for the axis. Between the objective and subjective methodologies,concordance level was lower in the spherical equivalent (component M), and for the JCC we can see that accuracy and precision are poor, pointing out that measurements made mostly in the spherical component are different on average and in technique repetition. Conclusions: Discrepancies between evaluators or procedures in the cylinder may be of up to ±0.50 D and 10°at the axis, but it can go up to 1.00 D in the sphere; both techniques are valid for the evaluationof subjective refraction in young individuals.

Henry Ey, Jackson e as ideias obsessivas / Henri Ey, Jackson and obsessive ideas / Henry Ey, Jackson et les idées obsédantes / Henry Ey, Jackson y las ideas obsesivas

O artigo destaca a importante contribuição do professor de psiquiatria Henry Ey aos estudos sobre John Hughlings Jackson. Analisa historicamente uma interface pouco conhecida de Jackson com a psiquiatria: o diálogo sobre as "ideias obsessivas" que figura nas páginas da revista Brain, entre 1894 e 1895. Discute as razões históricas que podem explicar a não influência de Jackson na psiquiatria britânica, em contraste com a ampla difusão de suas posições no campo da neurologia.

This article highlights the important contribution of the French psychiatrist Henry Ey, to studies on John Hughlings Jackson. It historically analyzes a little-known text that presents an interface between Jackson and psychiatry, namely: Dialogue on "Obsessive Ideas." This article appeared in the journal Brain, between 1894 and 1895. The author discusses historical reasons that might explain Jackson's lack of influence on British psychiatry, in contrast to the considerable spread of his ideas on neurology.

L'article souligne l'importante contribution du professeur de psychiatrie Henry Ey aux études de John Hughlings Jackson. Il analyse de façon historique une interface peu connue entre Jackson et la psychiatrie: le dialogue sur les "idées obsédantes" publié dans la revue Brain entre 1894 et 1895. Cet article discute d'ailleurs les raisons historiques qui pourraient expliquer le manque d'influence de Jackson sur la psychiatrie britannique qui contraste avec la large diffusion de ses positions en neurologie.

El artículo destaca la importante contribución del profesor de psiquiatria Henry Ey a los estúdios sobre John Hughlings Jackson. Se analisa históricamente uma interfaz poço conocida de Jackson com la psiquiatria: el diálogo acerca de las "ideas obsesivas" que figura en las páginas de la revista Brain, entre 1894 y 1895. Se discute las razones históricas que pueden explicar la ausencia de influencia de Jackson em la psiquiatria britânica, lo que contrasta con la amplia difusión de sus posiciones en la neurologia.

Concordancia de las técnicas subjetivas que miden la amplitud de acomodación / Concordance between subjective techniques that measure amplitude of accommodation

Objetivo: determinar la repetitividad inter observador y la concordancia entre las pruebas e s que miden la amplitud de acomodación (AA). Metodología: fueron evaluados setenta y nueve sujetos entre los 18 a 30 años, que presentaban un estado visual refractivo y acomodativo normales. Las pruebas clínicas realizadas fueron la técnica de Sheard (lente negativo de cerca) Jackson (lente negativo de lejos) y Donders modificada (alejamiento más un lente de -4.00D). Resultados: el Coeficiente de Correlación Intraclase (ICC) mostró que las pruebas de mostraban una alta repetitividad (>0,7); el Coeficiente de Correlación y Concordancia de Lin (ρc) reveló una pobre repetitividad y concordancia entre las pruebas (ρc≤0,9). Los límites de acuerdo para Donders, Sheard y Jackson (+/-1,22; +/-2,02, +/-3,44) revelan una menor variación de la AA entre los observadores para Donders y mayor para Jackson. Conclusión: la repetitividad inter observadora es mayor para la técnica de Donders modificada y la concordancia entre las pruebes pobre, por lo que no son intercambiables.

The purpose was determinate reliability test retest and concordance between clinical techniques that measure amplitude of accommodation. Methods: seventy nine students who had normal visual function, refractive and accommodative skills participated. The techniques were: minus lens (near), minus lens (far) and push down modified (-4.00D lens). Results: Intraclass Correlation Coefficient (ICC) show that test retest was high three techniques (>0,7); Concordance correlation coefficient of Lin (ρc) showed that agreement was poor for all of them (ρc≤0,9). Limits of agreement (95%) were push down modified +/-1,22; minus lens near +/-2,02; minus lens far +/- 3,44. Conclusion: reliability test retest was higher for push down modified and concordance between the techniques was poor so, these are not interchangeable.

Concordancia de las técnicas subjetivas que miden la amplitud de acomodación / Concordance between subjective techniques that measure amplitude of accommodation

Objetivo: determinar la repetitividad inter observador y la concordancia entre las pruebas clínicas que miden la amplitud de acomodación (AA). Metodología: fueron evaluados setenta y nueve sujetos entre los 18 a 30 años, que presentaban un estado visual refractivo y acomodativo normales. Las pruebas clínicas realizadas fueron la técnica de Sheard (lente negativo de cerca) Jackson (lente negativo de lejos) y Donders modificada (alejamiento más un lente de -4.00D). Resultados: el Coeficiente de Correlación Intraclase (ICC) mostró que las pruebas demostraban una alta repetitividad (>0,7); el Coeficiente de Correlación y Concordanciade Lin (pc) reveló una pobre repetitividad y concordancia entre las pruebas (pc<0,9). Los límites de acuerdo para Donders, Sheard y Jackson (+/-1,22; +/-2,02, +/-3,44) revelan una menor variación de la AA entre los observadores para Donders y mayor paraJackson. Conclusión: la repetitividad inter observadora es mayor para la técnica de Donders modificada y la concordancia entre las pruebas es pobre, por lo que no son intercambiables.

The purpose was determinate reliability test retestand concordance between clinical techniques that measure amplitude of accommodation. Methods: seventy nine students who had normal visual function, refractive and accommodative skills participated.The techniques were: minus lens (near), minus lens (far) and push down modified (-4.00D lens). Results: Intraclass Correlation Coefficient (ICC) show that test retest was high three techniques(>0,7); Concordance correlation coefficient of Lin (pc) showed that agreement was poor for all of them(pc<0,9). Limits of agreement (95 percent) were push down modified +/-1,22; minus lens near +/-2,02; minus lens far +/- 3,44. Conclusion: reliability test retest was higher for push down modified and concordance between the techniques was poor so, these are not interchangeable.

The effect on respiratory mechanics when using a Jackson surgical table in the prone position during spinal surgery / 대한마취과학회지

BACKGROUND: Respiratory dynamics may be monitored and evaluated indirectly by measuring the peak inspiratory pressure and plateau pressure. In this study, the respiratory dynamics of patients undergoing spinal surgery using a Jackson surgical table were observed with a device after converting their position from supine to prone. The effects of the dynamic compliance and airway resistance were observed from the changes in peak inspiratory pressure and plateau. METHODS: Twenty five patients were selected as subjects scheduled to undergo lumbar spine surgery. After intubation, the patients were ventilated mechanically with a tidal volume of 10 ml/kg and a respiration rate of 10/min. Anesthesia was maintained with sevoflurane 1.5%, nitrous oxide 2 L/min and oxygen 2 L/min. The peak inspiratory pressure, plateau pressure, resistance, compliance, arterial oxygen tension, carbon dioxide tension, heart rate and arterial blood pressure were measured at 10 minutes after the induction of anesthesia. These parameters were measured again 10 minutes after placing the patient in the prone position. RESULTS: The prone position did not significantly affect the arterial oxygen tension, carbon dioxide tension, blood pressure and heart rate, but significantly increased the peak inspiratory pressure and resistance and decreased the dynamic compliance. CONCLUSIONS: The peak inspiratory pressure was increased using a Jackson surgical table to minimize the abdominal pressure when converting from the supine to prone position. This might be due to a decrease in lung and chest compliance as well as an increase in airway resistance.

A influência de Hughlings Jackson sobre a teoria freudiana da memória e do aparelho psíquico / Hughlings Jackson’s influence on the Freudian theory on memory and the psychic apparatus

No texto 'Sobre a concepção das afasias' (1891), a influência das ideias do neurologista inglês Hughling Jackson sobre as hipóteses elaboradas por Freud é bastante evidente, sendo reconhecida pelo próprio autor. Em seus textos psicanalíticos posteriores, em momento algum Freud volta a se referir explicitamente a Jackson. No entanto, a influência deste neurologista sobre Freud parece ter se mantido ao longo de sua obra metapsicológica. Os objetivos deste artigo são retomar algumas das hipóteses de Jackson e apontar como essas ideias influenciaram as sucessivas elaborações da teoria freudiana do aparelho psíquico, fornecendo o modelo pelo qual Freud pensou tanto a gênese deste aparelho, como o seu funcionamento normal e patológico.

In Freud’s text On Aphasia (1891), the influence of the British neurologist Hughlings Jackson’s ideas on the hypotheses formulated is very clear, and was acknowledged by Freud himself. In his later psychoanalytic texts, Freud no longer explicitly refers to Jackson. However, Jackson’s influence would appear to persist throughout the development of Freud’s meta-psychological work. The objective of this paper is to discuss some of Jackson’s ideas and try to show the impact on the elaboration of the Freudian theory of the psychic apparatus, providing the model used by Freud to conceive the source of such apparatus, as well as its normal and pathological workings.

The Brain-MR Studies in the Brain Death Patient: Report of 3 Cases: The Utility of the Anesthetic Mapleson Circuit-F System

Brain-MR studies are sensitive to intracranial ischemia and vascular flow. However, brain MR study for brain death is clinically limited because keeping the ventilation is difficult during study. In our hospital, three 'brain death patients' brain-MR studies were performed under the anesthetic Mapleson's circuit-F system. Three patients' clinical states were not changed after the studies. We confirmed that brain herniation, absent intracranial flow void, no intracranial contrast enhancement, poor gray/white matter differentiation, and prominent nasal enhancement findings. The value of brain-MR study for brain death may be possible.

Personal reflections on Jackson Pollock's fractal paintings

The art world changed forever when Jackson Pollock picked up a can and poured paint onto a vast canvas rolled across the floor of his windswept barn. Fifty years on, art theorists recognize his patterns as being a revolutionary approach to aesthetics. A significant step forward in understanding Pollock's aesthetics occurred in 1999 when my scientific analysis showed that his paintings are fractal. Fractals consist of patterns that recur at finer and finer magnifications, building up shapes of immense complexity. Significantly, many natural patterns (for example, lightning, clouds, mountains, and trees) are also fractal. In this essay, I will present some personal reflections on this relationship between the fractal patterns of Pollock and those of nature, and also on the interactions between art and science as the project evolved.

O mundo da arte mudou para sempre quando Jackson Pollock apanhou uma lata e despejou tinta em uma enorme tela esticada sobre o chão de seu celeiro castigado pelo vento. Cinqüenta anos depois, os teóricos da arte reconhecem que seu estilo constitui uma abordagem estética revolucionária. Um passo importante na compreensão da estética de Pollock se deu em 1999, quando, de acordo com a minha análise científica, suas pinturas eram fractais. Fractais são padrões que recorrem em sucessivos desdobramentos, construindo formas de imensa complexidade. Sugestivamente, muitos padrões naturais (como raios, nuvens, montanhas e árvores) também são fractais. No presente trabalho, apresento algumas reflexões pessoais sobre essa relação entre os padrões fractais de Pollock e os da natureza, assim como sobre as interações entre arte e ciência.

A Case of FGFR2 Exon lllc Mutation in Crouzon Syndrome

Crouzon syndrome, an autosomal dominant disorder, has characteristic features of craniosynostosis, hypertelorism, exophthalmos, maxillary hypoplasia and relative mandibular prognathism. Mutations of fibroblast growth factor receptor 2 (FGFR2) gene are associated with craniosynostotic conditions, such as Crouzon syndrome, Jackson-Weiss syndrome, Pfeiffer syndrome, Apert syndrome and Beare-Stevenson cutis gyrata. We found one child with common morphological features of Crouzon syndrome. Interestingly, she was found to have Cys342Ser mutation in FGFR2 exon lllc which has been previously observed in Jackson-Weiss syndrome. This finding supports the variable expression of FGFR2 in human and allelic heterogeneity in these apparently clinically distinct craniosynostotic conditions.

The Clinical Study of Two Modified Methods for Pediatric Anesthesia / 대한마취과학회지

During the last decade, nonrebreathing systems have been used most extensively for neonate and small children, but these systems can lead to alveolar hyperventilation when it was used manually because these systems have not volumometer to measure the tidal volume of patients. Therefore, the author devised two modified methods that is able to estimate the tidal volume of patients using the volumometer in the adult circle system for pediatric anesthesia. One method is modified Jackson Rees system. The Y-piece of the adult circle system was removed and the inspiratory gas tube of the Jackson Rees system was connected to the inspiratory corrugated tube of the adult circle system and the expiratory reservoir tube of the Jackson Rees system was connected to the expiratory corrugated tube of the adult circle system, then was ventilated with reservoir bag of the adult circle system. The other method is modified Y-piece system. The deadspace of Y-piece of the adult circle system was reduced by set up of short cannula in the inspiratory side of the Y-piece, then was ventilated with reservoir bag of the adult circle system. Using above two modified methods, study was undertaken in 25 cases to determine whether adequate alveolar ventilation could be maintained for pediatric anesthesia. The ventilation was carried out as the discretionary manual ventilation, and as the estimated tidal volume of patients using the volumometer in the adult circle system, respectively. In the latter method, tidai volume was 8 ml/kg and respiratory rate was 35 breaths/min under 5 kg of body weight, 30 breaths/min weighing 5 kg-10 kg and 20 breaths/min over 10 kg. Total gas flow of these systems was 2.5 times minute volume of patients. Arterial blood gas tension was measured 30 minutes after the induction of anesthesia. The following results were obtained. 1) In the method of the original Jackson Rees system, when it was ventilated manually and discretionary in 5 cases, PaCO2 level was 21.0+/-1.65mmHg. 2) In the method of the modified Jackson Rees system, when it was ventililated manually and discretionary in 5 cases, PaCO2 level was 25.1+/-0.52mmHg, and was ventilated as estimated tidal volume of patients in 5 cases, PaCO2, level was 37.6+/-0.45 mmHg. 3) In the modified Y-piece system, when it was ventilated manually and discretionary in 5 cases, PaCO2, level was 21.3+/-1.37 mm Hg, and was ventilated as estimated tidal volume in 5 cases, PaCO2 level was 36.2+/-1.01mmHg. Therefore, it could be assumed that these two modified methods are a good device to maintain an appropriate alveolar ventilation for pediatric anesthesia.