Radiohumeral arthrodesis for salvage of failed total elbow arthroplasty

Ulnohumeral arthrodesis is the standard technique for elbow fusion. The geometry and surface area of the distal humerus and proximal ulna enhance the chances of fusion while maintaining some wrist motion. A case of a patient with multiple failed elbow procedures in which the standard ulnohumeral fusion was not possible is presented. A radiohumeral arthrodesis was performed in an attempt to obtain a stable, nonpainful elbow. After complete healing of the fusion, the patient was able to use the arm for most functions. This technique is presented as an option for salvage failed elbow arthroplasty in the face of significant bone loss.     

A new technique of elbow arthrodesis. A case report

Changes in body composition, somatic growth, power and strength of high school wrestlers (W, n = 8, 15.9 +/- 0.3 yrs) and controls (C, n = 6, 16.1 +/- 0.2 yrs) were studied early, mid-, late-, and 3.5-months post-season. Elbow flexion peak power (FPP), peak torque (FPT), extension peak power (EPP), and peak torque (EPT) were measured on an isokinetic dynamometer. C demonstrated normal rates of somatic growth and gains in strength and power. However, for W, significant (p < 0.05) decreases were found in: weight (WT, 61.6 +/- 2.8 to 59.2 +/- 2.8 kg), relative fat (%BF) (7.8 +/- 0.7 to 6.1 +/- 0.7 %), FPT (33.3 +/- 2.3 to 29.9 +/- 2.7 Nm), FPP (125.8 +/- 0.3 to 107.8 +/- 8.4 W), EPT (37.5 +/- 2.5 to 36.2 +/- 3.8 Nm), and EPP (132.7 +/- 8.4 to 126.7 +/- 12.3 W), between early-season and late-season and significant increases in WT (5.4 +/- 0.4 kg), fat-free mass (FFM, 4.4 +/- 0.7 kg), FPT (9.4 +/- 1.7 Nm), FPP (38.8 +/- 8.8 W), EPT (6.5 +/- 1.0 Nm), and EPP (24.4 +/- 4.7 W), between late-season and post-season. Compared to C, W had significantly (p < 0.05) smaller increases in mid-arm girth and flexed mid-arm cross-sectional muscle area (X-SECT) during the wrestling season and larger increases in shoulder girth, abdominal girth, and mid-arm girth, X-SECT, and biacromial, biilium, and anterior-posterior chest breadths during the post-season. Power and strength measures were significantly correlated with FFM, lean upper limb volume (ULV), and X-SECT (r = 0.74 to 0.93, p <0.0001). When covaried for FFM, ULV or X-SECT seasonal declines in strength and power were no longer significant while post-seasonal increases remained. In conclusion, pre- to late- season W demonstrated a lack of lean tissue accretion and reductions in strength. At post-season these variables returned to, or were above, pre-season levels. Results of analysis of covariance indicated that lean tissue changes were associated with the changes in strength and power.     

Cardiac stress testing with thallium-201 imaging reveals silent ischemia in individuals with paraplegia

The purpose of this study was to determine through noninvasive arm ergometry and radionuclide tomographic imaging the presence of latent coronary heart disease (CHD) in subjects with paraplegia. Assessment of CHD in spinal cord injury, using these methods, has not been addressed previously. Twenty asymptomatic subjects with paraplegia performed arm ergometry exercise stress testing with thallium-201 single photon emission computerized tomography (SPECT) or planar myocardial imaging studies. All subjects had normal resting electrocardiograms (ECG). Only five subjects had ECG evidence of ischemia on exercise testing, whereas 13 subjects, including the five subjects with ECG positive stress tests, had scintigraphic evidence of ischemia. Thus, eight subjects would have been undiagnosed for CHD without thallium-201 SPECT imaging. These individuals had multiple risk factors for CHD and, except for age, were without a statistically significant difference between the groups with positive or negative thallium stress imaging studies. Arm ergometry stress thallium imaging shows a high prevalence of ischemia in subjects with paraplegia.     

An achondroplastic dwarf with paraplegia

A 30-year-old female achondroplastic dwarf developed a progressive gait disturbance erroneously attributed to her hydrocephalus and deformities of both legs. Her condition deteriorated into flaccid paraplegia with anal and urinary incontinence. CT revealed extreme spinal stenosis typical in achondroplasia (shallow vertebral body, short pedicles, and hypertrophy of intervertebral joints) together with disc protrusions. Wide laminectomy of the lumbar vertebrae resulted in complete amelioration of all the neurological deficits. Progressive paraplegia is a rare complication of achondroplasia; its early recognition and surgical treatment is very rewarding.     

Treatment of spinal fractures with paraplegia

Of 206 patients with vertebral fractures in the thoraco-lumbar spine with spinal cord injuries, an antero-lateral decompression with stabilization of the injured segment of the vertebral column was undertaken in 56 cases. In all these cases there was a compression of the spinal cord from the front. 8 patients made a complete recovery, 31 a good recovery, and 6 were improved. In 8 patients no improvement was noted. 2 patients developed pressure sores later and 1 patient died one year after the operation of uraemia. 22 patients out of 55 got a normal function of the bladder and 25 patients out of 54 a normal function of the anal sphincter. 16 patients out of 17 made a complete or good recovery after removal of a displaced rotated vertebral bony fragment from the spinal canal, and 7 patients out of 9 with wedge shaped fractures. In our clinic today, in cases of vertebral fractures with neural involvement, reduction and internal fixation with Harrington rods and fusion of the injured segment is undertaken as soon as possible, also during the night. If narrowing of the neural canal and compression of the spinal cord are verified, a decompression operation with interbody fusion is undertaken during the next days.     

Hereditary spastic paraplegia with dementia

OBJECTIVE: Hereditary spastic paraplegia (HSP) with dementia is a very rare condition. The aim of the paper is to present the first report of HSP in a Fijian Indian family. METHOD: A psychiatrist and a general physician examined the affected members of the family on five occasions over three years. RESULTS: There are three affected individuals in a sibship of seven. The parents are without symptoms and the marriage is non-consanguineous. The course of the disease has been remarkably similar. All subjects were healthy and performing well in the early years of school. In two, symptoms of cognitive loss preceded difficulty with ambulation and in the third, these symptoms appeared concurrently. All subjects had both symptoms by 13 years of age; they were unable to ambulate independently by the mid to late teens, at which time there was dysarthria spastic paraplegia and dementia. One subject suffered a three month episode of hypomanic behaviour. Over the three-year study period deterioration was slight but noticeable. CONCLUSIONS: It is possible that HSP is more commonly associated with pre-senile dementia than is currently recognised. HSP with dementia is a very rare cause of failing school performance. Physical examination of the patient and other family members is indicated if this diagnosis is being considered.     

Limited arthrodesis for scaphoid nonunion

A new surgical technique is described for the treatment of longstanding scaphoid nonunions with established degenerative changes and carpal malalignment. The technique is based on natural history and biomechanical studies and includes the excision of the distal scaphoid fragment and a limited arthrodesis that incorporates the proximal pole of the scaphoid, the lunate, and the capitate. Six men were treated with the procedure for symptomatic chronic scaphoid nonunions, and all limited arthrodeses fused. Pain relief was good to excellent, and range of motion averaged 50% of the contralateral side.     

Triple arthrodesis with lateral column lengthening for treatment of severe planovalgus deformity

The occurrence of abnormal nuclear DNA content in major salivary gland adenomas is not well known and its correlation with tumor recurrence has not been documented previously. From 1987 to 1991, 119 consecutive major salivary gland adenomas were operated on at Turku University Central Hospital. These tumors were analyzed by flow cytometry and 100 (84%) were found to be diploid, 12 (10%) near-diploid and 7 (6%) aneuploid with DNA indexes > 1.15. The mean proliferation rate measured as a percentage of cells in the S-phase fraction was 2.5 +/- 1.6%. The histological slides were then blindly reclassified according to current World Health Organization classification. As a result histological classification was changed in 3 tumors: malignant cells were found in 2 aneuploid tumors and 1 diploid neoplasm. Preoperative cytological fine-needle aspiration biopsy had been considered as possibly malignant in 2 of these cases. Among all case material 10 specimens were recurrent tumors; although the tendency to recur depended on the extent and adequacy of the surgery performed, multiple recurrences were associated with non-diploid tumors.     

Ankle arthrodesis in patients with rheumatoid arthritis

The results of 26 ankle arthrodeses performed for rheumatoid arthritis on 21 patients were reviewed. Tibiotalar arthrodesis was performed in 14 ankles, and tibiotalocalcaneal arthrodesis was performed in 12. External fixation was used in 20 ankles, and internal fixation was used in six. Followup was available in 24 of 26 ankles (19 patients), and averaged 5 years (range, 2-8 years). There was no pain experienced in 19 ankles; mild, occasional pain was experienced in four ankles; and moderate, daily pain was experienced in one ankle. Daily activities were limited in five patients and recreational activities were limited in 11. All patients reported some difficulty walking on uneven terrain. Nearly all patients were satisfied; two were satisfied with reservations and two were dissatisfied. Union was achieved in 25 of 26 (96%) ankles. Ankle arthrodesis is an effective operation in patients with rheumatoid arthritis. Unlike previous reports, union and complication rates in this series were comparable with rates for arthrodesis for posttraumatic and degenerative arthritis.     

Enhanced release from proactive interference in nonamnesic alcoholic individuals: Implications for impaired associative binding.

Proactive interference (PI) occurs when previously learned information reduces the ability to acquire new, related information. Given that PI is modulated by the cholinergic system in rats (E. De Rosa & M. E. Hasselmo, 2000) and that chronic alcohol dependence disrupts cholinergic function in rats and humans, associative properties of PI in patients with alcoholism were examined. It was hypothesized that normal PI contingencies would be disrupted in alcoholic participants. When tested with a paired-associate simultaneous discrimination paradigm, analogous to that used in the rat model, alcoholic participants showed significantly less PI than controls yet performed comparably on a control response reversal task. The absence of PI in alcoholic participants may reflect impaired configural binding of paired-associate stimuli while sparing the elemental ability to process each stimulus component. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Talonavicular arthrodesis for rheumatoid arthritis of the hindfoot

In recent years there has been an increased interest in the development of neuropsychological tests that can diagnose accurately brain damage. The most successful of these test are represented in the Halstead-Reitan Neuropsychological Battery, which has been shown to be 90% or more effective in the diagnosis of brain damage. However, this battery is not available to many psychologists or clients because of its length, cost, and the considerable background required to use it properly. The present study tested 121 Ss (30 normal, 91 brain-damaged) to develop an abbreviated version of the battery that is relatively brief (1 hour) and inexpensive, but accurate. It was found by discriminant analysis that the abbreviated battery is capable of diagnosing brain damage equally as well as the full battery 93% of the time. The limitations and advantages of the abbreviated battery are discussed.     

Wrist arthrodesis for failed wrist implant arthroplasty

Thirteen wrist arthrodeses were performed for failed wrist implant arthroplasties between 1984 and 1992. Twelve patients were available for review, with an average follow-up period of 28 months. The original arthroplasties consisted of 8 silicone implants and 4 metal-plastic total wrist implants. The surgical method involved a tricortical iliac bone graft and an intramedullary Steinmann pin. There were 7 excellent results, 4 good results, and 1 poor result. All but 1 patient had markedly improved function with no or mild pain. Seven patients had solid fusions and 5 patients had pseudarthroses. Four pseudarthroses occurred at the graft-metacarpal junction and 1 occurred at the graft-radius junction. Each patient with a solid fusion had an excellent result. All graft-metacarpal pseudarthroses were painless and did not limit the patients' activities. There were 17 complications in 9 patients. Wrist arthrodesis can be a successful salvage procedure for failed wrist implant arthroplasty in patients with rheumatoid arthritis. However, the complication rate can be high. Owing to the high incidence of distal graft-metacarpal pseudarthrosis, we recommend using more rigid fixation techniques in patients with failed wrist arthroplasties.     

Reversible symmetric polyneuropathy with paraplegia after heart transplantation

BACKGROUND: Neurotoxicity is a well-recognized side effect of cyclosporine therapy in transplant recipients. Cyclosporine can cause a wide range of adverse effects on both the central and peripheral nervous systems. METHODS: We present a case history of symmetric polyneuropathy with flaccid paraplegia, a rare neurological complication of cyclosporine administration. RESULTS: Blood levels of the drug above the therapeutic range accompanied the neurological manifestations. The syndrome subsided fully with dose reduction. Patients' symptoms were attributed to axonal degeneration of the peripheral nerves, according to electromyography findings. CONCLUSIONS: Cyclosporine neurotoxicity should always be considered in patients with neurological complications following transplantation. The case presented in this article illustrates an additional potential mechanism of this adverse effect, namely, axonal degeneration of the peripheral nerves, causing symmetric polyneuropathy.     

Talonavicular arthrodesis for the painful adult acquired flatfoot

Twenty-seven consecutive patients with posterior tibial tendon insufficiency were treated with talonavicular arthrodesis as the primary stabilizing procedure. Twenty-six patients were followed a minimum of 12 and an average of 27 months. Twenty-four patients had either no pain or pain only after heavy usage. Eleven patients were completely satisfied with postoperative foot function, 13 were satisfied, with minor reservations, and 2 were satisfied, with major reservations. Results were rated as excellent in 10 patients, good in 14 patients, and fair in 2 patients. Successful arthrodesis was achieved in all patients, although one patient required two additional bone grafts. Progressive arthrosis in adjacent joints was noted in five patients, four of whom had arthrosis preoperatively. No deterioration of foot position was seen in any patient with follow-up as long as 5 years. An isolated talonavicular arthrodesis seems to offer patients with this disorder both reliable pain improvement and lasting stability.     

Arthrolysis for post-traumatic stiffness of the elbow

Twelve of 14 patients who underwent arthrolysis of the elbow for post-traumatic stiffness were re-examined after a mean of 62 months. Pain and subjective stiffness were improved. The mean function of the elbow improved from 73 degrees to 112 degrees. Those operated on within a year of their injury improved twice as much as those who had been operated on after a longer period. Arthrolysis may be very rewarding when conservative treatment fails, especially when it is carried out within a year of the injury.     

Salvage surgery for lateral tennis elbow

We undertook a retrospective analysis of 34 patients (35 elbows) who had prior failed surgical intervention for lateral tennis elbow. Revision surgeries were performed between 1979 and 1994. Each patient's non-operative and operative history was recorded before our salvage revision surgery. At revision surgery, findings included residual tendinosis of the extensor carpi radialis brevis tendon in 34 of 35 elbows. In 27 elbows, the pathologic changes in the extensor carpi radialis brevis tendon had not been previously addressed at all, and in 7 elbows the damaged tissue had not been completely excised. Salvage surgery included excision of pathologic tissue in the extensor carpi radialis brevis tendon origin combined with excision of excessive scar tissue and repair of the extensor aponeurosis when necessary. Based on a 40-point functional rating scale proposed here, 83% of the elbows (29 of 35) had good or excellent results at an average followup of 64 months (range, 17 months to 17 years). To prevent failure of surgical treatment for tennis elbow, the pathologic tissue usually present in the extensor carpi radialis brevis tendon should be resected. Release operations, which weaken the extensor aponeurosis but fail to address the pathoanatomic changes, are not recommended.     

Meta-analyses comparing theory of mind abilities of individuals with autism, individuals with mental retardation, and normally developing individuals

A deficit in theory of mind (ToM) abilities has been described as the core deficit in autism. The authors performed 3 meta-analyses, comparing ToM abilities of individuals with autism, individuals with mental retardation (MR), and normally developing individuals. Results indicated that individuals with autism and MR have impaired ToM abilities. The etiology associated with MR (i.e., Down syndrome, undifferentiated etiology) was found to be an important moderator variable. Chronological age (CA) and verbal mental age (VMA) of the normally developing children and CA, VMA, and performance mental age of individuals with MR, and type of matching between the groups were also found to be moderator variables. Discussion focuses on the implication of the findings and emphasizes the need to consider the specific etiology of comparison groups when studying abilities and impairments of individuals with autism and MR.     

Work values: a comparison of non-disabled persons with persons with paraplegia

A number of studies focus on factors that might explain the low level of employment of persons with paraplegia without questioning the social representations connected to work. Being employed is considered a priori as beneficial, constituting an important objective for rehabilitation. However sociologists have recently pointed out that work, as a means of self fulfilment, is a 'constructed' rather than a 'natural' category. The comparisons of the representations of work given by two groups: persons with paraplegia (n = 350), and non-disabled persons (n = 327) show that persons with paraplegia are more likely than non-disabled persons to consider work as a source of personal fulfilment and social recognition and less likely to positively value the fact of not-working. In addition, a demonstrated satisfaction with not working, among persons of working age, is clearly more significant among non-disabled persons than among persons with paraplegia. Among these, some of them who have generally made up their mind about not working declare that they feel satisfied being unoccupied. This satisfaction is explained, in part, by expressed representations of work. The authors suggest a reflection on the place of work in rehabilitation programmes.     

Short-term memory scan in normal individuals and individuals with aphasia

Ten matched pairs of normal adults and adults with aphasia participated in a short-term memory, visual recognition paradigm wherein each determined whether or not a probe digit appeared in a subset of digits previously presented. Reaction times, measured in milliseconds from onset of probe digits until completion of visual-motor responses, were analyzed as a function of increasing subset size (two, four, and six digits) and the positive versus the negative response condition. Reaction times were significantly slower for the subjects with aphasia. Both groups of subjects demonstrated linear increases in reaction time across levels of subset size. For both groups, increases in reaction time were similar in the positive vs the negative-response conditions. Resulting parallel slopes suggested that both groups of subjects used a serial exhaustive scan of short-time memory. Results from this study did not support results obtained by others in previous studies which may have been confounded by group differences in visual retention spans.