RESUMEN
Extended-spectrum ß-lactamase and AmpC-producing Escherichia coli (ESBL/AmpC) are an emerging problem and are hypothesized to be associated with antimicrobial use (AMU), and more specifically with the use of third- and fourth-generation cephalosporins. Whether ESBL/AmpC also occur in organic dairy herds, which have restricted AMU, is not known. Additionally, it is unknown whether, in addition to restricted AMU, other factors in organic herd management are associated with ESBL/AmpC herd status. The aim of this study was to estimate the prevalence of ESBL/AmpC in organic dairy herds in the Netherlands. Subsequently, the relationships between the ESBL/AmpC herd status and AMU and between ESBL/AmpC herd status and farmers' management were assessed in organic dairy herds. For this study, 90 randomly selected, officially registered organic dairy herds were included. The ESBL/AmpC herd status was determined based on the bacteriological culture result of a slurry sample. The sensitivity of testing slurry samples for ESBL/AmpC herd status is less than 100% for detecting herds with a low ESBL/AmpC prevalence. For that reason, herds that tested positive for ESBL/AmpC in slurry were defined as positive and herds with negative slurry samples were defined as unsuspected. A comprehensive questionnaire on management practices was conducted and records on specified antimicrobials that were provided to these herds by the veterinary service providers were obtained. From the data on antimicrobial supplies by the veterinarian, the animal daily defined dose of antimicrobials per farm per year (DDDAF) was calculated. Descriptive statistics were used to describe the relation between the ESBL/AmpC herd status and DDDAF. Multivariable logistic regression models were used to evaluate management factors associated with the ESBL/AmpC herd status. We found ESBL/AmpC in 12 of the 90 (13%; 95% confidence interval=7-22%) slurry samples from organic dairy herds. The median DDDAF in organic dairy herds was 0.5, which was not significantly different between ESBL/AmpC-positive and unsuspected dairy herds. No association could be found between the use of different types of antimicrobials, such as third- and fourth-generation cephalosporins, and ESBL/AmpC herd status. Factors that were associated with higher odds of being ESBL/AmpC-positive were pig farms located within a 2-km radius of the barn, applying parental treatment for clinical mastitis, and providing milk replacer to the female calves after colostrum intake. The prevalence of ESBL/AmpC in organic dairy herds appeared lower than the prevalence in previous studies conducted in conventional dairy herds. Apparently, ESBL/AmpC are also present in herds with low AMU; this indicates that other factors than AMU are also associated with ESBL/AmpC herd status.
Asunto(s)
Escherichia coli , beta-Lactamasas , Animales , Bovinos , Países Bajos , Prevalencia , Factores de Riesgo , PorcinosRESUMEN
A cross-sectional study was conducted to evaluate the prevalence of extended-spectrum ß-lactamase (ESBL)- and plasmid-mediated AmpC-producing Escherichia coli and associated risk factors in dairy herds. One hundred dairy herds were randomly selected and sampled to study the presence of ESBL- and AmpC-producing E. coli in slurry samples. The sensitivity of testing slurry samples for ESBL/AmpC herd status is less than 100%, especially for detecting herds with a low ESBL/AmpC prevalence. Therefore, whereas herds that tested positive for ESBL/AmpC-producing E. coli in slurry were defined as positive herds, herds with negative slurry samples were defined as unsuspected. Isolates of ESBL- and AmpC-producing E. coli were further characterized by detection and typing of their ESBL/AmpC gene. At the initial sampling, a comprehensive questionnaire was conducted at the participating farms. The farmers were asked questions about management practices potentially associated with the ESBL/AMPC herd status. Also, data on antimicrobial purchases during 2011 were acquired to evaluate whether the animal-defined daily dose of antimicrobials per year at farm level was associated with the ESBL/AmpC herd status. Multivariable logistic regression models were used to determine the association between management practices and the ESBL/AmpC herd status. Six months after the initial slurry sampling, 10 positive herds and 10 herds that had an unsuspected ESBL/AmpC herd status during the first visit were resampled. At each farm, slurry samples and feces from 24 individual cows were collected to evaluate within herd dynamics. During the first sampling, ESBL/AmpC-producing E. coli were isolated from the slurry samples collected at 41% of the herds. In total, 37 isolates were further characterized, revealing 7 different ESBL genes (blaCTX-M-1, -2, -14, -15, -32, -55 and blaTEM-52), 1 plasmid-encoded AmpC gene (blaCMY-2), and 1 chromosomally encoded ampC gene (ampC type 3). The total animal-defined daily dose of antimicrobials per year at farm level was not significantly different between ESBL/AmpC-positive and unsuspected dairy herds. The use of third- and fourth-generation cephalosporins, however, was found to be associated with ESBL/AmpC status, with higher use of these antimicrobials resulting in a significant higher odds to be ESBL/AmpC-positive. Management factors that were associated with a higher odds of being ESBL/AmpC-positive were treatment of all cases of clinical mastitis with antimicrobials, a higher proportion of calves treated with antimicrobials, not applying teat sealants in all cows at dry off, and the use of a floor scraper. This last association, however, was considered a methodological effect rather than a true risk factor. On 5 of the 10 initially positive farms, no ESBL/AmpC-producing E. coli were cultured from the slurry or any of the individual cow samples collected during the second sampling. In 4 of the initially unsuspected farms, slurry or individual cow samples tested positive during the second sampling. In conclusion, ESBL/AmpC could frequently be cultured from slurry samples collected from Dutch dairy farms and the ESBL/AmpC genes carried by the isolates were consistent with those reported earlier. The use of third- and fourth-generation cephalosporins appeared to be associated the ESBL/AmpC herd status.
Asunto(s)
Proteínas Bacterianas/genética , Enfermedades de los Bovinos/microbiología , Infecciones por Escherichia coli/veterinaria , Escherichia coli/genética , beta-Lactamasas/genética , Animales , Antibacterianos/farmacología , Proteínas Bacterianas/biosíntesis , Técnicas de Tipificación Bacteriana , Bovinos , Enfermedades de los Bovinos/tratamiento farmacológico , Cefalosporinas/farmacología , Estudios Transversales , Industria Lechera , Relación Dosis-Respuesta a Droga , Escherichia coli/efectos de los fármacos , Escherichia coli/enzimología , Infecciones por Escherichia coli/microbiología , Heces/química , Femenino , Modelos Logísticos , Masculino , Análisis Multivariante , Plásmidos/genética , Factores de Riesgo , Sensibilidad y Especificidad , Encuestas y Cuestionarios , beta-Lactamasas/biosíntesisRESUMEN
UNLABELLED: Andreas Vesalius (1515-1564) was the first to market an illustrated text on the freshly dissected muscular anatomy of the human hand and forearm when he published his De Fabrica Corporis Humani Libri Septem, in 1543. To commemorate his 500th birthday, we searched the second of seven books composing De Fabrica, the annotated woodcut illustrations of De Fabrica, the Tabulae Sex, and Epitome, and an eyewitness report of a public dissection by Vesalius for references to the morphology and functions of these muscles. We found Vesalius to have recognized all currently distinguished muscles except the palmaris brevis and he noted occasional absence of some muscles. Generally, he limited the origin and insertion to bones, largely disregarding attachments to membranes and fascia. Functionally, he recorded the muscles as having a single vector and operating on only one joint. We conclude that Vesalius was nearly completely correct about the anatomy of the muscles of the forearm, but much less accurate about their function. LEVEL OF EVIDENCE: 5.
Asunto(s)
Anatomía/historia , Mano/anatomía & histología , Ilustración Médica/historia , Músculo Esquelético/anatomía & histología , Europa (Continente) , Historia del Siglo XVI , Humanos , Músculo Esquelético/fisiología , Obras Médicas de ReferenciaRESUMEN
BACKGROUND: Neoadjuvant chemotherapy is gaining acceptance as an option for breast cancer treatment, particularly in young women. These women may seek immediate breast reconstruction after mastectomy even though it is not known whether such preoperative chemotherapy may be detrimental to post-reconstruction wound healing. Therefore, we set out to assess the influence of neoadjuvant chemotherapy for invasive breast cancer on the short-term complications after skin sparing mastectomy and immediate prosthetic reconstruction. METHODOLOGY: The short-term surgical outcome of 48 immediate breast reconstructions in 37 women treated with neoadjuvant chemotherapy from 2006 through 2009 was prospectively compared to that of 215 immediate reconstructions in 176 women who were operated in the same period without neoadjuvant chemotherapy. RESULTS: The overall rate of short-term postoperative complications was significantly less among neoadjuvantly treated women (15% vs. 29%; p = 0.042) but this did not result in a reduction of loss of prostheses (8% vs. 11%; p = 0.566). CONCLUSION: Because neoadjuvant chemotherapy is not associated with an increase in short-term complications after skin sparing mastectomy and immediate prosthetic reconstruction in patients with invasive breast cancer, such combined surgical therapy may be offered as treatment option for this particular group of patients also.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/cirugía , Mamoplastia/efectos adversos , Mastectomía Simple , Terapia Neoadyuvante/métodos , Adulto , Anciano , Implantes de Mama/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/patología , Quimioterapia Adyuvante , Femenino , Humanos , Mamoplastia/métodos , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Radioterapia Adyuvante , Proyectos de Investigación , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de Heridas/efectos de los fármacosRESUMEN
The effect of bluetongue virus serotype 8 (BTV-8) infections was quantified on milk production and udder health. From July 2008 to December 2008, 1,074 seronegative cows in 15 herds that were not vaccinated against BTV-8 were tested every 3 wk for BTV-8 antibodies. Sampling stopped when cows seroconverted. Test-day records were provided and 3 traits were defined to evaluate the effect of BTV-8 on milk production and udder health: 1) the difference between observed and predicted fat- and protein-corrected milk production; 2) the natural logarithm of the somatic cell count (lnSCC); and 3) the occurrence of a new high SCC. In the default model, the variables were assumed influenced by BTV-8 when the test-day record of the seroconverted cow was taken within 30 d before seroconversion, thus, in the period in which the cow was infected. In sensitivity analyses, the time intervals were varied in which BTV-8 was assumed to affect milk production and udder health. During the study, 185 cows (17%) had a subclinical infection and seroconverted and 77 had a test-day result within 30 d before seroconversion. In this period, in cows that seroconverted, the fat- and protein-corrected milk production was 52 (95% confidence interval: 26 to 77) kg less than in the period before and after seroconversion and was 51 (95% CI: 26 to 76) kg less than in cows that remained seronegative. When the time interval was increased to within 42 d before seroconversion, the milk production in BTV-8-seroconverted cows decreased by 61 (95% CI: 28 to 94) kg compared with the period before and after seroconversion and decreased by 59 (95% CI: 27 to 92) kg compared with cows that remained BTV-8 seronegative. No significant effect of BTV-8 was found on SCC and odds for a high SCC. Subclinical BTV-8 infection in dairy cattle results in a decreased milk production.
Asunto(s)
Virus de la Lengua Azul/aislamiento & purificación , Lengua Azul/virología , Enfermedades de los Bovinos/virología , Glándulas Mamarias Animales/virología , Leche/metabolismo , Animales , Anticuerpos Antivirales/sangre , Lengua Azul/fisiopatología , Virus de la Lengua Azul/inmunología , Bovinos , Enfermedades de los Bovinos/fisiopatología , Recuento de Células/veterinaria , Grasas de la Dieta/análisis , Femenino , Lactancia/fisiología , Leche/química , Leche/citología , Proteínas de la Leche/análisis , Países Bajos , Factores de TiempoAsunto(s)
Neoplasias de Cabeza y Cuello/terapia , Arterias Mamarias/cirugía , Músculo Esquelético/trasplante , Procedimientos de Cirugía Plástica/métodos , Trasplante de Piel/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Anciano , Femenino , Estudios de Seguimiento , Cabeza , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/irrigación sanguínea , Cuello , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
In 2007, BTV-8 re-emerged for the second year in the Netherlands and caused morbidity and increased mortality in cattle herds. In addition, cattle farmers reported reduced fertility in their cows. For this study, fifteen herds that were not vaccinated were selected. These were matched to 10 vaccinated herds by geographic region. At the start of the study, in July 2008, all cattle in the non-vaccinated herds >1 year old were sampled. All seronegative cows entered the study program and blood samples from these cows were tested for antibodies against BTV-8 in an ELISA. Cows were sampled at intervals of three weeks and sampling was stopped once a cow tested seropositive. Sampling ceased in all remaining cows in December 2008. Newborn calves originating from infected dams or from vaccinated dams were tested by PCR for BTV-8. Fertility data were obtained from the Royal Dutch Cattle Syndicate (CRV). Multi-level generalized latent and linear models were used for analyses. In 2008, 185 (17.2%) out of 1,074 initially seronegative non-vaccinated cattle seroconverted and were assumed to be infected with BTV-8. Infected cows were 5 (95% CI: 1.9-14.3) times more likely to return for insemination within 56 days after first insemination. In addition, these cows needed 1.7 (95% CI: 1.4-2.0) times more inseminations for an assumed pregnancy, and needed 2.5 (95% CI: 2.4-2.6) times more days between first and last insemination compared to the period prior to seroconversion and compared to cows not infected by BTV-8 in 2008. No association between BTV-8 infection and the chance to abort between 100 and 260 days after last insemination was found. In total, 48 calves originating from infected cows were tested by PCR for the presence of BTV-8. Ten (20.8%) out of these 48 calves were born PCR-positive. None of 256 calves from vaccinated dams tested PCR-positive. Further, cows infected during the second half of gestation had a 15.5 times (95% CI: 1.3-190.4) higher chance of a PCR-positive newborn calf compared to cows infected in the first half of gestation. This study showed that BTV-8 has a negative effect on fertility of dairy cattle.
Asunto(s)
Virus de la Lengua Azul/aislamiento & purificación , Lengua Azul/complicaciones , Enfermedades de los Bovinos/virología , Transmisión Vertical de Enfermedad Infecciosa/veterinaria , Infertilidad/veterinaria , Animales , Animales Recién Nacidos/virología , Lengua Azul/prevención & control , Lengua Azul/transmisión , Virus de la Lengua Azul/inmunología , Bovinos , Enfermedades de los Bovinos/prevención & control , Enfermedades de los Bovinos/transmisión , Femenino , Infertilidad/virología , Embarazo , Factores de Tiempo , Vacunación/veterinaria , Vacunas Virales/uso terapéuticoRESUMEN
The first laparoscopic sliding knot to be described was the Roeder knot; it has been used for a variety of procedures in all surgical disciplines. It was surmised that the introduction of new modifications in the geometry of the knot paralleled the introduction of its new indications, and that not all modifications improved its security. Therefore, a geometrical review was made of all modifications and all data on knot security and loop security of the knot were analyzed. The introduction of the original knot and its 14 applicable modifications paralleled the increase in minimally invasive techniques and the spread of these techniques in all the medical specialties. Roeder loop security depends predominantly on the number of initial turns around the standing part. Its knot security depends on the additional half hitches used to backup the knot after it has been tightened. Only a few of the modifications improved the security of the knot or its previous modifications.
Asunto(s)
Laparoscopía/métodos , Técnicas de Sutura/instrumentación , Suturas , Endoscopía/métodos , Humanos , Procedimientos Quirúrgicos OperativosRESUMEN
The aim of this study was to objectively assess the relationship between impaired forearm rotation and movement patterns of the upper arm and trunk in patients with hemiplegic cerebral palsy. For this purpose, 'extrinsic forearm rotation' was introduced as a parameter to quantify the cumulative result of all movements that supplement forearm rotation. The results of three-dimensional video analysis of the upper extremity and trunk in different reaching tasks in eight male and two female patients (mean age, 16 years and 2 months) were compared to those of 10 case-matched controls. The active forearm rotation impairment in the patient group as compared to the controls was combined with a significantly higher value for 'extrinsic forearm rotation'. In this way, we objectively measured compensatory movement patterns associated with impaired forearm rotation and, consequently, we advocate assessment of the overall movement strategy rather than just the forearm deformity in patients with hemiplegic cerebral palsy.
Asunto(s)
Parálisis Cerebral/fisiopatología , Hemiplejía/fisiopatología , Movimiento/fisiología , Rotación , Extremidad Superior/fisiología , Abdomen/fisiología , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Femenino , Humanos , Masculino , Tórax/fisiología , Grabación en VideoRESUMEN
Injectable filler materials can be valuable to aesthetic surgeons. To date, hardly any short-term and no long-term complications of polyalkylimide injections (Bio-Alcamid) have been reported. We present and discuss the history of 18 patients who had such complications. The patients were between 31 and 55 years of age. The time between injection and the onset of complications of polyalkylimide ranged from 1 month to 3 years. Additional invasive therapy at, or near, the site of injections triggered the onset of infection in 10 patients. By use of T2-weighted MRI with fat suppressing spectro-presaturation inversion recovery (SPIR) the filler material can be visualised. Once infection or migration of the permanent filler occurs, the therapeutic options are limited to surgical removal by a direct approach. Polyalkylimide should be handled under strict antiseptic circumstances. This does not only apply at the time of initial injections, but even more during any subsequent invasive treatment such as evacuation of surplus deposits or additional surgical procedures at, or near, the site of injection.
Asunto(s)
Resinas Acrílicas/efectos adversos , Extravasación de Materiales Terapéuticos y Diagnósticos/etiología , Síndrome de Lipodistrofia Asociada a VIH/terapia , Adulto , Extravasación de Materiales Terapéuticos y Diagnósticos/diagnóstico , Extravasación de Materiales Terapéuticos y Diagnósticos/cirugía , Femenino , Reacción a Cuerpo Extraño/etiología , Reacción a Cuerpo Extraño/patología , Humanos , Infecciones/etiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Ritidoplastia/efectos adversosRESUMEN
The effect of surgical correction of impaired forearm rotation on associated body movement patterns was studied prospectively by comparison of preoperative and postoperative three-dimensional video analysis of the upper extremity and trunk in eight male and two female patients with hemiplegic cerebral palsy (CP; mean age 16y 2mo [SD 4y 11mo]; range 11-27y). A customized parameter, 'extrinsic forearm rotation', was used to quantify associated movements supplementing forearm rotation. After surgical correction of the pronation deformity, active forearm supination during a functional reaching task had improved by a mean of 37 degrees in combination with significantly decreased extrinsic forearm rotation by a mean of 13 degrees . In addition, an average loss of 16 degrees of active pronation in combination with increased extrinsic forearm rotation (mean 8 degrees ) was observed. On the basis of these results we conclude that successful surgical correction of a pronation deformity in patients with CP directly affects related movement patterns of the upper extremity and trunk.
Asunto(s)
Parálisis Cerebral/fisiopatología , Parálisis Cerebral/cirugía , Antebrazo/fisiopatología , Antebrazo/cirugía , Trastornos de la Destreza Motora/fisiopatología , Cuidados Posoperatorios , Postura/fisiología , Cuidados Preoperatorios , Rotación , Adolescente , Adulto , Parálisis Cerebral/epidemiología , Niño , Femenino , Humanos , Masculino , Trastornos de la Destreza Motora/diagnóstico , Trastornos de la Destreza Motora/epidemiología , Pronación/fisiología , Manguito de los Rotadores/fisiopatología , Manguito de los Rotadores/cirugía , Supinación/fisiología , Extremidad Superior/fisiopatologíaRESUMEN
Trauma, oncological resections and pressure sores can cause major soft tissue defects. The evolution of cutaneous, myocutaneous, and fasciocutaneous flaps currently makes possible the restoration of contour and, in many cases, function. This evolution was closely related to the increased understanding of the vascular anatomy of the skin and subcutis and has led to the development of perforator flaps. A perforator flap is a large flap of skin that survives on a single vascular stalk that perforates the muscle, referred to in briefas a 'perforator'. This has its origin in a larger vascular stalk that runs beneath the muscle. The vascular stalk of such a perforator flap can be lengthened by dissecting the perforator from the muscle in continuity with the vessels running beneath the muscle. Moreover, the larger diameter of these vessels facilitates the creation of a vascular anastomosis in the receptor area. By the use of such perforator flaps, proper innervation and a good blood supply to the flap can be combined with less morbidity at the donor site. Important possibilities include the filling of a dorsal (decubitus) defect and breast reconstruction.
Asunto(s)
Músculo Esquelético/irrigación sanguínea , Procedimientos de Cirugía Plástica , Piel/irrigación sanguínea , Colgajos Quirúrgicos/irrigación sanguínea , HumanosAsunto(s)
Granuloma de Cuerpo Extraño/inducido químicamente , Bases Oleosas/análisis , Enfermedades del Pene/inducido químicamente , Vaselina/efectos adversos , Escroto/cirugía , Adulto , Granuloma de Cuerpo Extraño/diagnóstico , Granuloma de Cuerpo Extraño/patología , Granuloma de Cuerpo Extraño/cirugía , Humanos , Hipertrofia , Masculino , Bases Oleosas/administración & dosificación , Enfermedades del Pene/diagnóstico , Enfermedades del Pene/patología , Enfermedades del Pene/cirugía , Vaselina/administración & dosificación , Escroto/patologíaRESUMEN
BACKGROUND: In three cases of chronic scrotal lymphedema, histological and immunohistochemical changes were observed that were strikingly similar to an exceedingly rare lesion reported previously under the name of acquired smooth-muscle hamartoma (ASMH) of the scrotum. The clinical context indicated that the cases were reactive rather than hamartomatous in nature. MATERIALS AND METHODS: The histological and immunohistochemical findings of the three cases were compared to macroscopically normal scrotal specimens obtained during sex reassignment surgery in seven male-to-female transsexuals. RESULTS: Compared to the seven controls, the three cases of chronic scrotal edema revealed a marked increase of dartos smooth-muscle tissue and of connective tissue of the scrotal skin and underlying soft tissues. Still, even the normal amount of scrotal smooth-muscle tissue may easily be misinterpreted as smooth-muscle hyperplasia. CONCLUSIONS: Chronic scrotal lymphedema may induce hyperplasia of the dartos muscle, resulting in a histological appearance previously described as ASMH. This indicates that ASMH may not always represent a later onset of abnormality similar to congenital smooth-muscle hamartoma but, rather, may constitute a histological simulator.
Asunto(s)
Enfermedades de los Genitales Masculinos/patología , Hamartoma/patología , Linfedema/patología , Músculo Liso/patología , Escroto/patología , Adulto , Antígenos CD34/metabolismo , Estudios de Casos y Controles , Diagnóstico Diferencial , Enfermedades de los Genitales Masculinos/metabolismo , Humanos , Linfedema/metabolismo , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To prove that fibrous restoration of the continuity of a cut tendon may cause recurrence of flexion deformity of the wrist after mere tenotomy of the spastic flexor carpi ulnaris muscle. BACKGROUND: Mere tenotomy of the flexor carpi ulnaris tendon is insufficient to prevent recurrence of acquired spastic flexion deformity of the wrist. Subsequent restoration of the continuity of the tendon by fibrous interposition may result in the recurrence. We examined whether a previously tenotomised muscle is strong enough to cause the deformity. METHODS: Active and passive force-length characteristics of the flexor carpi ulnaris muscle were measured intraoperatively in a patient with recurrent spastic flexion wrist deformity. The observed characteristics were compared with the average in vivo force-length characteristics of 14 spastic flexor carpi ulnaris muscles that had not previously been operated. RESULTS: The previously tenotomised flexor carpi ulnaris muscle was able to maximally exert 110 N force. Its active force-length curve and passive force at maximal extension were similar to those of non-operated spastic flexor carpi ulnaris muscles. CONCLUSIONS: A previously tenotomised flexor carpi ulnaris muscle is strong enough to cause recurrence of spastic flexion deformity of the wrist in case functional fibrous restoration of the tendon occurs after mere tenotomy. RELEVANCE: The surgical routine of mere tenotomy should probably be modified by including the dissection of the distal muscle belly and the excision of a segment of the tendon to avoid its restoration.
Asunto(s)
Contracción Isométrica , Espasticidad Muscular/fisiopatología , Espasticidad Muscular/cirugía , Músculo Esquelético/fisiopatología , Procedimientos Ortopédicos/efectos adversos , Tendones/fisiopatología , Tendones/cirugía , Articulación de la Muñeca/fisiopatología , Adolescente , Parálisis Cerebral/complicaciones , Parálisis Cerebral/fisiopatología , Parálisis Cerebral/cirugía , Estimulación Eléctrica , Femenino , Humanos , Espasticidad Muscular/etiología , Espasticidad Muscular/prevención & control , Músculo Esquelético/inervación , Prevención Secundaria , Estrés Mecánico , Articulación de la Muñeca/cirugíaRESUMEN
The effect of combined pronator teres rerouting and flexor carpi ulnaris transfer on forearm rotation was prospectively studied by comparison of pre- and postoperative three-dimensional analysis of forearm range of motion in ten patients with cerebral palsy. One year postoperatively, surgery had improved maximal supination of the forearm in all patients by an average of 63 degrees, but there was also a mean loss of 40 degrees pronation. Forearm range of motion increased by a mean of 23 degrees. The centre of the range of motion on average shifted 52 degrees in the direction of supination. Based on these results of objective forearm range of motion analysis, we conclude that the common combination of pronator teres rerouting and flexor carpi ulnaris transfer in patients with cerebral palsy effectively facilitates active supination but impairs active pronation.
Asunto(s)
Articulación del Codo/fisiología , Antebrazo/fisiología , Adolescente , Adulto , Niño , Femenino , Humanos , Imagenología Tridimensional , Masculino , Rango del Movimiento Articular , Rotación , Supinación/fisiologíaRESUMEN
Our aim was to determine whether the length and function of the flexor carpi ulnaris muscle were affected by separating it from its soft tissue connections. We measured the length of flexor carpi ulnaris before and after its dissection in ten patients with cerebral palsy. After tenotomy, tetanic contraction shortened the muscle by a mean of 8 mm. Subsequent dissection to separate it from all soft tissue connections, resulted in a further mean shortening of 17 mm (p < 0.001). This indicated that the dissected connective tissue had been strong enough to maintain the length of the contracting muscle. Passive extension of the wrist still lengthened the muscle after tenotomy, whereas this excursion significantly decreased after subsequent dissection. We conclude that the connective tissue envelope, which may be dissected during tendon transfer of flexor carpi ulnaris may act as a myofascial pathway for the transmission of force. This may have clinical implications for the outcome after tendon transfer.
Asunto(s)
Tejido Conectivo/fisiopatología , Deformidades Adquiridas de la Articulación/cirugía , Músculo Esquelético/cirugía , Transferencia Tendinosa/métodos , Articulación de la Muñeca/cirugía , Adolescente , Adulto , Fenómenos Biomecánicos , Parálisis Cerebral/complicaciones , Parálisis Cerebral/fisiopatología , Niño , Disección/métodos , Femenino , Humanos , Deformidades Adquiridas de la Articulación/complicaciones , Deformidades Adquiridas de la Articulación/fisiopatología , Masculino , Movimiento/fisiología , Músculo Esquelético/fisiopatología , Resultado del Tratamiento , Articulación de la Muñeca/fisiopatologíaRESUMEN
Transmission of bovine herpesvirus 1 (BHV1) within and between herds was studied on the island of Ameland, The Netherlands. There were 50 herds with 3300 head of cattle on the island. Herds were divided into three groups: (1) only containing seronegative cattle, (2) containing seronegative cattle and vaccinated seropositive cattle, and (3) containing only vaccinated cattle. All 23 herds in groups 1 and 2 were monitored. Three major outbreaks of BHV1 infections were observed due to the introduction of infectious cattle. Another major outbreak was most likely induced by reactivation of latent BHV1 in seropositive cattle. The basic reproduction ratio within these herds was estimated at least 4. Only one of these outbreaks led to three secondary outbreaks in susceptible herds in which all cattle were seronegative. These outbreaks were most likely due to respectively, direct animal contact, human transmission, and aerogenic transmission. The basic reproduction ratio between herds in this study was estimated to be 0.6.
Asunto(s)
Enfermedades de los Bovinos/transmisión , Brotes de Enfermedades , Infecciones por Herpesviridae/veterinaria , Herpesvirus Bovino 1 , Animales , Bovinos , Enfermedades de los Bovinos/epidemiología , Enfermedades de los Bovinos/prevención & control , Brotes de Enfermedades/prevención & control , Susceptibilidad a Enfermedades , Infecciones por Herpesviridae/transmisión , Países Bajos , Dinámica Poblacional , Prevalencia , Estudios SeroepidemiológicosRESUMEN
OBJECTIVE: To present a historical appraisal of the use of anthropological and cephalometrical facial soft tissue measurements in cleft patients. DESIGN: The McDowell Indexes and a Medline search were used to trace references up to 1999. Also, references listed with chapters and articles on facial clefts were searched for anthropometrical studies. Twenty-six retrieved articles and book chapters on soft tissue anthropometry and 12 cephalometric publications on soft tissue measurements on radiographs and plaster casts of cleft patients were reviewed. RESULTS AND CONCLUSIONS: Since 1931, the facial soft tissue appearance of cleft patients has been evaluated by means of anthropometric and cephalometric techniques. Not all of the older studies were performed in a statistically correct fashion. Many of the conclusions of the studies overlap despite differences in technique of assessment. Most studies demonstrate the deficient growth of the maxilla and the deformities of the facial profile in cleft patients.
Asunto(s)
Antropometría/historia , Cefalometría/historia , Fisura del Paladar/historia , Cara/anatomía & histología , Historia del Siglo XX , HumanosRESUMEN
In male-to-female trans-sexuals in whom the hormonal treatment has not resulted in sufficient growth of the breasts, augmentation mammaplasty may be considered. Mammaplasty is performed in two-thirds of our patients who have had vaginoplasties. We present our experience of 201 patients operated on at the Academisch Ziekenhuis Vrije Universiteit in Amsterdam up to 1997. The patients' mean age was 34 years (range 17-76) and the mean follow-up was four years (range 2 weeks to 16 years). In keeping with our protocol, most patients had had oestrogen therapy and a successful real-life experience for a minimum of 1.5 years. The mean size of implants has nearly doubled over the years. Male-to-female trans-sexuals often request large breasts and repeated augmentation mammaplasties were required, mainly in cases where the result of initial augmentation was not outspoken.