Evidence-based analysis of odontoid fracture management.

Object: The management of odontoid fractures remains controversial. Evidence-based methodology was used to review the published data on odontoid fracture management to determine the state of the current practices reported in the literature.

Methods: The Medline literature (1966-1999) was searched using the keywords "odontoid," "odontoid fracture," and "cervical fracture" and graded using a four-tiered system.

Critical evaluation of Mirels' rating system for impending pathologic fractures.

This project examined the hypothesis that Mirels' rating system for impending pathologic fractures is reproducible, valid, and applicable across various experience levels and training backgrounds. Twelve true clinical histories and corresponding radiographs for patients with femoral metastatic lesions were reviewed by 53 participants from five experience levels: orthopaedic residents, musculoskeletal radiologists, orthopaedic attendings, fellowship-trained practicing orthopaedic oncologists, and radiation or medical oncologists. Each examiner provided individual and total Mirels' scores and independent determination of impending fracture using clinical judgment.

Self-organization and the dynamical nature of ventricular fibrillation.

This article reviews recent data supporting the conjecture that, in the structurally and electrophysiologically normal heart, cardiac fibrillation is not a totally random phenomenon. Experimental and numerical studies based on the theory of excitable media suggest that fibrillation in the mammalian ventricles is the result of self-organized three-dimensional (3-D) electrical rotors giving rise to scroll waves that move continuously (i.e.

Spiral drift and core properties.

We consider the drift of a stable, nonmeandering rotating spiral wave in a singly diffusive FitzHugh-Nagumo medium with generic reaction functions; the drift is assumed to be caused by a weak time-independent diffusivity gradient or convection term in the fast-variable equation. We address, to first order in the perturbation, the standard problem whose statement reads, "Given the unperturbed solution, as well as the model's parameters, predict the speed and direction of the drift in terms of the strength and direction of the perturbation." Our main results are as follows: First, we establish a mathematical equivalence between true gradients and convective perturbations; second, a variety of numerical examples, taken from computer simulations, are presented as a reference base for testing drift theories; and third, we propose a semiempirical solution to the drift problem, requiring only two quantities to be measured off the unperturbed spiral, namely, its period of rotation and the value of the fast variable at its center; good agreement with numerical simulations is found for moderately sparse spirals.

Biomechanical evaluation of thumb opposition transfer insertion sites.

The optimal location for insertion of the transferred tendon in opposition transfer is controversial. The purpose of this study was to examine 4 commonly used insertion sites into the thumb and determine which maximizes thumb opposition. The flexor digitorum superficialis of the ring finger was used as a donor tendon and was attached in random order to the abductor pollicis brevis (APB) tendon, the APB and extensor pollicis longus, the flexor pollicis brevis (FPB) and dorsal radial extensor hood, and the ulnar extensor hood at the base of the proximal phalanx.

Diffuse lamellar keratitis induced by trauma 6 months after laser in situ keratomileusis.

This case report illustrates an unusual presentation of diffuse lamellar keratitis triggered by a foreign body striking the eye 6 months after laser in situ keratomileusis (LASIK). The etiology of diffuse lamellar keratitis is unclear. The infiltrate within the plane of the flap after removal of the foreign body supports the theory that diffuse lamellar keratitis is an inflammatory reaction.

Predicting filament drift in twisted anisotropy.

Excitable media with twisted anisotropy have recently been attracting significant interest because of their applicability to wave propagation in heart tissue. Here we consider the dynamics of an intramural scroll wave whose filament lies initially within an arbitrary layer of mutually parallel cardiac fibers, and drifts parallel to itself from layer to layer. Earlier simulations have demonstrated that such a filament stabilizes in a layer whose fiber direction is the same as its own.

Systemic inflammation induced by cardiopulmonary bypass: a review of pathogenesis and treatment.

The acute respiratory distress syndrome (ARDS) is a severe alteration in lung structure and function that develops secondary to a traumatic stimulus. When ARDS develops following cardiopulmonary bypass (CPB) it is know as postpump syndrome (PPS). ARDS can be caused by a single massive insult ("hit"); however, sequential minor insults ("hits") are more common clinically.

Neuroleptic malignant syndrome associated with amoxapine and lithium in an older adult.

This report describes the presentation of neuroleptic malignant syndrome (NMS) in the primary care setting in an older adult with major depression with psychosis. This patient had been stable on a regimen of amoxapine, lithium carbonate, lorazepam, and benztropine. The patient had rigidity, altered sensorium, diaphoresis, autonomic instability, elevated WBC count and urine myoglobin, and creatine phosphokinase (CPK) reaching 1331 U/I.

Sparing of radiation-induced damage to the physis: fractionation alone compared to amifostine pretreatment.

Purpose: The purpose of this study was to determine the relative benefits of sparing longitudinal bone growth by fractionation alone compared to pretreatment with amifostine, a chemical that provides differential radioprotection of normal tissues.

Methods And Materials: Twenty-four weanling 4-week-old male Sprague-Dawley rats were randomized into 2 overall treatment groups: fractionation alone (n = 12) and amifostine pretreatment (n = 12). The distal femur and proximal tibia in the right leg of each animal were exposed to a therapeutic X-irradiation dose (17.

Ventricular fibrillation: mechanisms of initiation and maintenance.

Ventricular fibrillation (VF) is the major immediate cause of sudden cardiac death. Traditionally, VF has been defined as turbulent cardiac electrical activity, which implies a large amount of irregularity in the electrical waves that underlie ventricular excitation. During VF, the heart rate is too high (> 550 excitations/minute) to allow adequate pumping of blood.

Prenatal ultrasound evaluation of fetal diastematomyelia: two cases of type I split cord malformation.

Isolated diastematomyelia is a rare form of spinal dysraphism characterized by a sagittal cleft in the spinal cord, conus medullaris and/or filum terminale with splaying of the posterior vertebral elements. This condition is the result of the presence of an osseous or fibrocartilaginous septum producing a complete or incomplete sagittal division of the spinal cord into two hemicords. It may be isolated or associated with other segmental anomalies of the vertebral bodies.

Identification of a protein kinase activity that phosphorylates connexin43 in a pH-dependent manner.

The carboxyl-terminal (CT) domain of connexin43 (Cx43) has been implicated in both hormonal and pH-dependent gating of the gap junction channel. An in vitro assay was utilized to determine whether the acidification of cell extracts results in the activation of a protein kinase that can phosphorylate the CT domain. A glutathione S-transferase (GST)-fusion protein was bound to Sephadex beads and used as a target for protein kinase phosphorylation.

Matrix metalloproteinase inhibitor: differential effects on pulmonary neutrophil and monocyte sequestration following cardiopulmonary bypass.

Unlabelled: Acute respiratory distress syndrome (ARDS) following cardiopulmonary bypass (CPB), also known as "post-pump" or "post-perfusion syndrome" (PPS), results from sequential priming and activation of neutrophils. We hypothesized that chemically modified tetracycline (CMT-3) an inhibitor of neutrophil matrix metalloproteinase (MMP) and elastase, would prevent PPS. We performed histometric analysis of lung tissue from our porcine PPS model to correlate cellular sequestration and histologic injury with CMT-3 treatment.

Thoracic radiology: the past 50 years.

The radiology of 50 years ago was a primitive science compared with the radiology of today. Hospital departments were small and radiologists few in number. Night call was uncommon.

Binocular three-dimensional perception through stereoscopic generation from rotating images.

Rationale And Objectives: The authors evaluated the clinical utility and potential applications of a binocular three-dimensional (3D) image display in diagnostic radiology.

Materials And Methods: Rotating video displays of computed tomographic (CT), magnetic resonance (MR) angiographic, and digital subtraction angiographic (DSA) image data were used to generate stereoscopic image displays with a 3D appearance. Eight physicians viewed and scored eight skeletal and eight vascular-interventional studies with a planar display mode and a cathode ray tube.

Chest radiographic features of engraftment syndrome.

About the time of hematopoietic engraftment, patients undergoing autologous hematopoietic stem cell transplantation in the form of peripheral blood stem cell transplantation (PSCT) may develop an "engraftment syndrome" that includes fever, skin rash, and capillary leak. This condition is usually self-limited, as opposed to other early complications of bone marrow transplantation such as infection and drug reactions. This article describes the chest radiographic manifestations of engraftment syndrome.

Diagnosis of papillary carcinoma in a thyroglossal duct cyst by fine-needle aspiration biopsy.

The incidence of papillary thyroid carcinoma arising in a thyroglossal duct cyst is rare and occurs in about 1 % of thyroglossal duct cysts. Only 17 such cases diagnosed with fine-needle aspiration biopsy have been previously reported in the English-language literature, with a diagnostic rate of 53%. In this article, the cytologic features of the current case are emphasized and those of the previous reported cases are briefly reviewed.

Invasive aspergillosis diagnosed by fine-needle aspiration of the thyroid gland.

Invasive aspergillosis has been increasingly recognized as causing significant morbidity and mortality in immunocompromised patients but has never been diagnosed by fine-needle thyroid aspiration. A 24-year-old female with systemic lupus erythematosus presented with cough, shortness of breath, and fever of unknown origin unresponsive to broad-spectrum antibiotics. History and physical examination failed to indicate a source of infection.

Orbital volume expansion of dysthyroid ophthalmopathy by surgical placement of lateral rim implants: a case study.

Purpose: To measure the increase in orbital volume expansion effected by surgical placement of a lateral rim implant.

Methods: Computed tomography was used to obtain 1-mm axial sections of a normal human cadaver skull. A computer program was used to measure the orbital area of each section and integrate the sum of the areas to obtain the total orbital volume.