Shoulder surgery in beach chair position causing perioperative stroke: Four cases and a review of the literature.

Perioperative stroke is a rare, but serious complication in shoulder-arthroscopy or arthroplasty. Recent literature suggests the beach chair position, widely used during shoulder surgery, might induce severe perioperative hypotension, and with this cerebral desaturation and ultimately perioperative stroke. In this article we report four cases of perioperative stroke in shoulder surgery. In all cases, patients underwent brief periods of hypotension, which might have caused perioperative stroke. Based on an analysis in our hospital, we think the prevalence of perioperative stroke during shoulder surgery is higher than reported. Surgeons should be aware of this risk when using the beach chair position.

Patient-reported outcome in total hip replacement. A comparison of five instruments of health status.

Our aim was to define the minimum set of patient-reported outcome measures which are required to assess health status after total hip replacement (THR). In 114 patients, we compared the pre-operative characteristics and sensitivity to change of the Oxford hip score (OHS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), the SF-36, the SF-12 (derived from the SF-36), and the Euroqol questionnaire (EQ-5D). At one year after operation, very large effect sizes were found for the disease-specific measures, the physical domains of the SF-12, SF-36 and the EQ-5Dindex (1.3 to 3.0). Patients in Charnley class A showed more change in the OHS, WOMAC pain and function, the physical domains of the SF-36 and the EQ-5Dvas (p < 0.05) compared with those in the Charnley B and C group. In this group, the effect size for the OHS more than doubled the effect sizes of WOMAC pain and physical function. We found high correlations and correlations of change between the OHS, the WOMAC, the physical domains of the SF-12 and the SF-36 and EQ-5Dindex. The SF-36 and EQ-5D scores at one year after operation approached those of the general population. Furthermore, we found a binomial distribution of the pre-operative EQ-5Dindex score and a pre-operative discrepancy and post-operative agreement between the EQ-5Dvas and EQ-5Dindex. We recommend the use of the OHS and SF-12 in the assessment of THR. The SF-36 may be used in circumstances when smaller changes in health status are investigated, for example in the follow-up of THR. The EQ-5D is useful in situations in which utility values are needed in order to calculate cost-effectiveness or quality-adjusted life years (QALYs), such as in the assessment of new techniques in THR.

[Imaging the lacrimal canaliculus with 20-MHz ultrasonography: a normal diagnosis (Part 1)]. / Examen des canalicules lacrymaux par imagerie médicale avec la sonographie à 20 MHz: cas de diagnostic normal (Partie I).

INTRODUCTION: High-frequency ultrasonography is used in ophthalmology with probes at 20, 30 and 50 MHz. The latter are used particularly for examining the anterior segments of the eye. The physical and acoustic parameters of the 20-MHz probes present an ideal compromise between resolution and penetration depth for examination of the lacrimal passages. These probes can be adapted to the I3 ultrasound diagnostic device, offering a clear financial advantage. MATERIAL AND METHODS: During the ultrasound examination, the patient is in the supine position with the head back and turned away from the eye to be examined. For proper transmission, enough gel must be applied, so that the 20-MHz probe can easily navigate on the surface to be scanned. If there is no inflammation, Healon can be applied in the canal so that it is dilated and easier to visualize. RESULTS: In all patients, we were able to visualize the canaliculi in the main cross-sections with the ultrasound. The edge of the eyelid, the lacrimal caruncle, and the medial palpebral ligament can serve as landmarks in the search for the canaliculi. CONCLUSION: The 20-MHz probes are better adapted to visualizing the presaccular lacrimal passages than conventional 10-MHz probes and the 50-MHz biomicroscope, thus enhancing the spectrum of imaging methods.

[High-frequency ultrasonography applied to disorders of the lacrimal canaliculi (Part 2)]. / Sonographie de haute fréquence appliquée aux affections des canalicules lacrymaux (Partie II).

INTRODUCTION: Thirty patients presenting disorders of the lacrimal passages were examined using high-frequency ultrasonography in the hopes that this diagnostic tool would provide better image resolution and better reproduction quality than conventional 8- to 10-MHz ultrasound examination. MATERIAL AND METHODS: To carry out this examination, we were able to combine a 20-MHz ultrasound probe to the I3 ultrasound diagnostic device. The patient was then positioned and the interior palpebral angle was filled with methylcellulose. RESULTS: In all patients, we succeeded in detecting the course and diameter of the lacrimal passages with better images than those provided by conventional ultrasound. We found that chronic canaliculitis was an important clinical domain for the 20-MHz ultrasound. Diagnosis is made easily and decisive information is provided. In all patients with this disorder (n=5), widening of the lacrimal passages, development of a diverticulum, and the presence of drusen concretions were observed. CONCLUSION: In our opinion, the use of high-frequency sonography as a noninvasive diagnostic technique is advised in cases of lacrimal passage disorders and is valuable in detecting chronic canaliculitis.

Segmental durations in the vicinity of prosodic phrase boundaries.

Numerous studies have indicated that prosodic phrase boundaries may be marked by a variety of acoustic phenomena including segmental lengthening. It has not been established, however, whether this lengthening is restricted to the immediate vicinity of the boundary, or if it extends over some larger region. In this study, segmental lengthening in the vicinity of prosodic boundaries is examined and found to be restricted to the rhyme of the syllable preceding the boundary. By using a normalized measure of segmental lengthening, and by compensating for differences in speaking rate, it is also shown that at least four distinct types of boundaries can be distinguished on the basis of this lengthening.

The use of prosody in syntactic disambiguation.

Prosodic structure and syntactic structure are not identical; neither are they unrelated. Knowing when and how the two correspond could yield better quality speech synthesis, could aid in the disambiguation of competing syntactic hypotheses in speech understanding, and could lead to a more comprehensive view of human speech processing. In a set of experiments involving 35 pairs of phonetically similar sentences representing seven types of structural contrasts, the perceptual evidence shows that some, but not all, of the pairs can be disambiguated on the basis of prosodic differences. The phonological evidence relates the disambiguation primarily to boundary phenomena, although prominences sometimes play a role. Finally, phonetic analyses describing the attributes of these phonological markers indicate the importance of both absolute and relative measures.