[Total hip arthroplasty with the cementless spiron femoral neck prosthesis]. / Hüftgelenkersatz mit der zementfreien Spiron-Schenkelhalsprothese.

OBJECTIVE: Cementless total hip arthroplasty with preservation of femoral neck and natural load transmission. Restoration of joint function and alleviation of pain. INDICATIONS: Osteoarthritis of the hip or femoral head necrosis in younger patients. CONTRAINDICATIONS: Patients biologically > 65 years. Destructed or discontinued femoral neck. Pathologic hip formation: short femoral neck, severe enhanced or reduced CCD angle. Body mass index (BMI) > 30 (relative contraindication). Manifest osteoporosis. Necessity of immediate full weight bearing. Heavy smoking (relative contraindication). Ongoing chemotherapy. SURGICAL TECHNIQUE: Anterolateral approach to the hip joint. Exposition of the femoral neck and resection of the femoral head at its lateral margin. Preparation of the acetabulum and insertion of a common acetabular component. Positioning of the center pin into the femoral neck. Face milling of the femoral neck butt. Preparation of the femoral neck with the Spiron drill bit. Insertion of the Spiron prosthesis. Trial reduction with a trial head. Substitution by the definitive head (cone 12/14 mm). Wound closure. POSTOPERATIVE MANAGEMENT: Low centred X-ray of the pelvis and cross table view of the hip joint. Physiotherapy and partial weight bearing for 6 weeks. Prevention of deep vein thrombosis until achievement of full weight bearing. RESULTS: A total of 28 Spiron prosthesis were implanted in 26 patients (15 men, 11 women, mean age 51 years [range 34-64 years], mean BMI 28 kg/m(2) [range 21-39 kg/m(2)]) from August 2009 to January 2012. Diagnoses: 13 cases of primary osteoarthritis, 8 cases of secondary osteoarthritis, 5 cases of femoral head necrosis, and 2 cases of posttraumatic osteoarthritis. The mean surgery length was 93 min (range 70-121 min), the mean hospital stay was 9 days (range 6-16 days). Blood transfusion was not necessary in any of the cases. There were no immediate complications such as deep vein thrombosis, surgery requiring secondary bleeding, wound infection, nerve palsy, or dislocation of the hip. Postoperative radiologic examinations showed an average leg lengthening of 3 mm (range -10-19 mm). No varus deviation of the prosthesis was observed. The Harris Hip Score improved from 55.4 points (range 33.5-76.9 points) preoperative to 90.5 points (range 75.7-99.9 points) 3 months postoperative. In 1 case with aseptic loosening, replacement surgery was performed without complications.

Visual exploration of isotope labeling networks in 3D.

Isotope labeling networks (ILNs) are graphs explaining the flow of isotope labeled molecules in a metabolic network. Moreover, they are the structural backbone of metabolic flux analysis (MFA) by isotopic tracers which has been established as a standard experimental tool in fluxomics. To configure an isotope labeling experiment (ILE) for MFA, the structure of the corresponding ILN must be understood to a certain extent even by a practitioner. Graph algorithms help to analyze the network structure but produce rather abstract results. Here, the major obstruction is the high dimension of these networks and the large number of network components which, consequently, are hard to figure out manually. At the interface between theory and experiment, the three-dimensional interactive visualization tool CumoVis has been developed for exploring the network structure in a step by step manner. Navigation and orientation within ILNs are supported by exploiting the natural 3D structure of an underlying metabolite network with stacked labeled particles on top of each metabolite node. Network exploration is facilitated by rotating, zooming, forward and backward path tracing and, most important, network component reduction. All features of CumoVis are explained with an educational example and a realistic network describing carbon flow in the citric acid cycle.

Polyaxially-locked plate screws increase stability of fracture fixation in an experimental model of calcaneal fracture.

Different calcaneal plates with locked screws were compared in an experimental model of a calcaneal fracture. Four plate models were tested, three with uniaxially-locked screws (Synthes, Newdeal, Darco), and one with polyaxially-locked screws (90 degrees +/- 15 degrees ) (Rimbus). Synthetic calcanei were osteotomised to create a fracture model and then fixed with the plates and screws. Seven specimens for each plate model were subjected to cyclic loading (preload 20 N, 1000 cycles at 800 N, 0.75 mm/s), and load to failure (0.75 mm/s). During cyclic loading, the plate with polyaxially-locked screws (Rimbus) showed significantly lower displacement in the primary loading direction than the plates with uniaxially-locked screws (mean values of maximum displacement during cyclic loading: Rimbus, 3.13 mm (sd 0.68); Synthes, 3.46 mm (sd 1.25); Darco, 4.48 mm (sd 3.17); Newdeal, 5.02 mm (sd 3.79); one-way analysis of variance, p < 0.001). The increased stability of a plate with polyaxially-locked screws demonstrated during cyclic loading compared with plates with uniaxially-locked screws may be beneficial for clinical use.

Predictors of nonrecovery in acute traumatic sixth nerve palsy and paresis.

PURPOSE: To evaluate whether nonrecovery from acute traumatic sixth nerve palsy could be predicted from demographic factors or palsy characteristics. DESIGN: Prospective, observational case series SETTING: Multicenter (academic and private practices). OUTCOME MEASURE: Nonrecovery, defined as the presence of diplopia in primary position or more than 10 prism diopters of distance esotropia in primary position at 6 months after onset. METHODS: Using data from a previously described cohort of 84 eligible patients with acute traumatic sixth nerve palsy, we performed multivariate analyses of demographic factors and palsy characteristics. RESULTS: Nonrecovery at 6 months after onset was associated with a complete palsy (adjusted risk ratio, 9.11; 95% confidence interval [CI], 2.77-14.84) and with a bilateral palsy or paresis (adjusted risk ratio, 2.53; 95% CI, 0.98-4.29). The choice of conservative management (observation, prism, or patch) versus acute injection of Botulinum toxin (within 3 months of injury) did not influence final recovery. CONCLUSIONS: In acute traumatic sixth nerve palsy or paresis, failure to recover by 6 months after onset was associated independently with inability to abduct past midline at presentation and bilaterality. Although the overall recovery rate is high in acute traumatic sixth nerve palsy or paresis, a complete or bilateral case has a poor prognosis and is more likely to need strabismus surgery.

Botulinum toxin treatment versus conservative management in acute traumatic sixth nerve palsy or paresis.

PURPOSE: Botulinum toxin (BTX), injected into the ipsilateral medial rectus muscle, has been advocated for the management of acute traumatic sixth nerve palsy or paresis. We conducted a multicenter, nonrandomized, data collection study to evaluate recovery rates of patients treated with either conservative measures or BTX. METHODS: All members of the American Association for Pediatric Ophthalmology and Strabismus and the North American Neuro-Ophthalmology Society were invited to enroll patients with acute traumatic sixth nerve palsy or paresis during a 2-year period (between March 1996 and February 1998). The BTX group was defined as patients who received a BTX injection within 3 months of injury. Recovery at 6 months from injury was defined as absence of diplopia in the primary position and a distance esotropia of no more than 10 PD in the primary position. Nonrecovered patients with less than 6 months of follow-up (n = 15) were excluded. RESULTS: Eighty-four eligible patients were enrolled by 46 investigators. Sixty-two patients (74%) were treated conservatively and 22 (26%) with BTX. Sixty-two patients (74%) had unilateral palsy, and 22 (26%) had bilateral palsy. Recovery rates were similar between BTX and conservatively treated patients (overall: 73% vs 71%, P = 1.0; unilateral: 81% vs 83%, P = 1.0; bilateral: 50% vs 38%, P = 0.66, respectively). CONCLUSIONS: In this prospective multicenter study of acute traumatic sixth nerve palsy or paresis, patients treated with either BTX or conservative measures had similar high recovery rates.

Non-ossifying fibromas and giant cell reparative granulomas in a child with ocular-ectodermal syndrome.

We report on a patient with ocular-ectodermal syndrome who was previously described in 1993 [Am J Med Genet (1993) 45:764-766]. This boy has now developed additional manifestations, including giant cell granulomas and non-ossifying fibromas. This adds to the list of phenotypic manifestations of this condition.

Long-term postoperative results of a consecutive series of stages 4 and 5 retinopathy of prematurity.

OBJECTIVE: The purpose of the study was to assess the long-term, anatomic, and functional results of a consecutive series of stages 4 and 5 retinopathy of prematurity (ROP) eyes after surgical management. DESIGN: A retrospective analysis of 42 eyes of 21 children yielded 34 eyes of 19 children who were operated on for stages 4 and 5 ROP. PARTICIPANTS: In 33 of 34 eyes, it was possible to have age-appropriate vision testing. The children were followed for a mean of 44 months. RESULTS: Seventy-six percent of eyes (25 of 33) in which vision testing was possible had partial or complete attachment of the posterior pole. Fifteen percent of all eyes achieved 20/300 or better visual acuity. Thirty percent of all eyes achieved 20/800 or better visual acuity. Forty-eight percent of eyes achieved ambulatory vision of 20/ 1900 visual acuity or better, and 72% of eyes achieved light perception or better vision. All eyes were managed similarly for their preoperative screening, surgical therapy, and postoperative refractive correction by one vitreoretinal surgeon and one pediatric ophthalmologist. CONCLUSION: Timely surgical intervention and appropriate postoperative care can result in useful vision in stages 4 and 5 ROP.

The natural history of acute traumatic sixth nerve palsy or paresis.

BACKGROUND: Spontaneous resolution of traumatic sixth nerve palsy or paresis has been reported to range between 12% and 54%. However, previous studies have been based in tertiary referral centers, have been retrospective in nature, have included a heterogeneous group of patients, and have included patients with long-standing palsies. To provide a more accurate estimate of the true recovery rate, we performed a prospective natural history study. METHODS: All members of the American Association for Pediatric Ophthalmology and Strabismus and the North American Neuro-Ophthalmology Society were invited to enroll patients with acute traumatic sixth nerve palsy or paresis between March 1996-February 1997. Recovery at 6 months after injury was defined as absence of diplopia in primary position and less than or equal to 10 PD distance esotropia in primary position. Patients who had been treated with botulinum toxin (n = 8) within 6 months after injury and patients with <6 months of follow-up (n = 3) were excluded. RESULTS: Thirty-three eligible patients were enrolled by 27 investigators. Twenty-five (76%) of the palsies were unilateral and 8 (24%) were bilateral. The overall spontaneous recovery rate was higher than previously reported (73%, 95% CI 54%-87%). Spontaneous recovery was more frequent in unilateral cases (84%, 95% CI 64%-95%) than in bilateral cases (38%, CI 9%-76%; P = .02). CONCLUSIONS: In this prospective multicenter study of acute traumatic sixth nerve palsy or paresis, the overall spontaneous recovery rate, particularly in unilateral cases, was much higher than previously reported. Our results have important sample size implications for the planning of any randomized treatment trial and may help guide early treatment decisions.

Measurement of low vision in advanced cicatricial retinopathy of prematurity.

This study evaluates functional vision in visually impaired children with stage IV to V cicatricial retinopathy of prematurity (CROP) by comparing results derived from the Teller acuity cards and a battery of behavioral tasks, the visual function battery (VFB). Vision was evaluated in 26 eyes of 15 children ages 6 months to 14 years, who underwent retinal reattachment procedures for active stage IV and stage V retinopathy of prematurity. Results showed that 10 of 26 eyes (38%) had a recordable grating acuity to Teller acuity card assessment. Twenty-five of 26 eyes (96%) showed a response to the VFB. Sixteen of 26 eyes (62%) showed recordable scores with the VFB but no corresponding scores with the Teller acuity cards. The VFB may be more reliable than the Teller acuity cards in measuring visual function in the very low acuity range.

Measurement of low vision in children and infants.

The authors evaluated a preferential looking technique (Teller acuity cards) and a set of gross behavioral indicators (visual function battery) for the ability to rank visually impaired children and infants on the basis of their visual function. Fourteen older children with a diagnosis of cicatricial retinopathy of prematurity who were capable of giving Snellen acuities and a group of 31 preverbal infants with decreased vision due to a variety of causes were tested. Teller acuity card and visual function battery findings were highly correlated with each other (and with Snellen acuities in the older group); however, the Teller acuity cards provided better discrimination in the moderately visually impaired range, whereas the visual function battery was better in the severely impaired range. It is concluded that, in children and infants, visual function over the entire spectrum of low vision can be characterized by using a combination of the Teller acuity cards and the visual function battery.

Linear subcutaneous fat atrophy after corticosteroid injection of periocular hemangiomas.

Two children developed evidence of subcutaneous fat atrophy after corticosteroid injection of periocular hemangiomas. The atrophy appeared at the site of injection and followed the expected course of lymphatic channels to the vicinity of regional lymph nodes.