Wyniki leczenia uszkodzenia nerwu strzałkowego na wysokości kolana: doświadczenie oddziału szpitala wo¡skowego

Background and purpose We investigated the management outcome of common peroneal nerve decompression at the knee level between the years 2005 and 2009. Material and methods Thirty consecutive patients with knee-level peroneal nerve injury who underwent decompression surgery and external neurolysis at our institution were evaluated preoperatively and postoperatively by electrophysiological studies and motor examination (Medical Research Council grading). Results Twenty-eight of the cases were male and 2 were female. Mean age was 31.1 for males and 57.5 for females. Physical activity during military training (overstretch/contusion) was the cause of nerve lesion in the majority of the patients (n = 28, 93%). Mean time interval between the diagnosis and the surgery was 5 months. Follow-up time ranged from 3 to 48 months (mean: 14 months). Twenty-nine of 30 (97%) patients recovered totally or near totally in foot/toe dorsiflexion. Conclusions Early decompression and neurolysis of the common peroneal nerve (CPN) at knee level after strenuous physical activity offers excellent functional recovery. Additionally, for knee-level CPN injuries, in order to minimize the postoperative scar, pain and delay in wound healing, we strictly advocate short ‘lazy S-shaped incision’ around the fibular head in supine position unlike the classical extensive opening up to the superior border of the popliteal fossa in prone position.Wstęp i cel pracy Autorzy ocenili wyniki chirurgicznego odbarczenia nerwu strzałkowego wspólnego na wysokości kolana, wykonywanego w latach 2005–2009. Materiał i metody Przedoperacyjnej i pooperacyjnej ocenie klinicznej (w skali Medical Research Council) oraz elektrofizjologicznej poddano 30 kolejnych pacjentów z uszkodzeniem nerwu strzałkowego na wysokości kolana, u których wykonano odbarczenie chirurgiczne z zewnętrzną neurolizą. Wyniki Wśród leczonych było 28 mężczyzn (średnia wieku: 31,1 roku) i dwie kobiety (średnia wieku: 57,5 roku). U zdecydowanej większości pacjentów (n = 28, 93%) przyczyną uszkodzenia nerwu była aktywność fizyczna w czasie szkolenia wojskowego (nadmierne rozciągnięcie/stłuczenie). Średnia czasu od rozpoznania do operacji wyniosła 5 miesięcy. Obserwacja po zabiegu trwała od 3 do 48 miesięcy (średnia: 14 miesięcy). U 29 na 30 chorych (97%) uzyskano pełny lub prawie pełny powrót zgięcia grzbietowego stopy/palców. Wnioski Wczesne chirurgiczne odbarczenie i neuroliza nerwu strzałkowego wspólnego na wysokości kolana w leczeniu urazu powstałego wskutek nadmiernej aktywności fizycznej daje możliwość znakomitej poprawy czynnościowej. Ponadto w przypadku uszkodzeń nerwu strzałkowego wspólnego na wysokości kolana w celu zminimalizowania blizny pooperacyjnej, nasilenia bólu i opóźnienia w gojeniu się rany pooperacyjnej autorzy usilnie zalecają krótkie cięcie w kształcie wydłużonej litery „S” wokół głowy strzałki u chorego w pozycji leżącej na plecach zamiast klasycznego otwarcia aż do górnej granicy dołu podkolanowego w pozycji leżącej na brzuchu

Identifying risk factors for blood culture negative infective endocarditis: An international ID-IRI study

Background: Blood culture-negative endocarditis (BCNE) is a diagnostic challenge, therefore our objective was to pinpoint high-risk cohorts for BCNE. Methods: The study included adult patients with definite endocarditis. Data were collected via the Infectious Diseases International Research Initiative (ID-IRI). The study analysing one of the largest case series ever reported was conducted across 41 centers in 13 countries. We analysed the database to determine the predictors of BCNE using univariate and logistic regression analyses. Results: Blood cultures were negative in 101 (11.65 %) of 867 patients. We disclosed that as patients age, the likelihood of a negative blood culture significantly decreases (OR 0.975, 95 % CI 0.963–0.987, p < 0.001). Additionally, factors such as rheumatic heart disease (OR 2.036, 95 % CI 0.970–4.276, p = 0.049), aortic stenosis (OR 3.066, 95 % CI 1.564–6.010, p = 0.001), mitral regurgitation (OR 1.693, 95 % CI 1.012–2.833, p = 0.045), and prosthetic valves (OR 2.539, 95 % CI 1.599–4.031, p < 0.001) are associated with higher likelihoods of negative blood cultures. Our model can predict whether a patient falls into the culture-negative or culture-positive groups with a threshold of 0.104 (AUC±SE = 0.707 ± 0.027). The final model demonstrates a sensitivity of 70.3 % and a specificity of 57.0 %. Conclusion: Caution should be exercised when diagnosing endocarditis in patients with concurrent cardiac disorders, particularly in younger cases

Molecular alterations as target for therapy in metastatic osteosarcoma: a review of literature

Treating metastatic osteosarcoma (OS) remains a challenge in oncology. Current treatment strategies target the primary tumour rather than metastases and have a limited efficacy in the treatment of metastatic disease. Metastatic cells have specific features that render them less sensitive to therapy and targeting these features might enhance the efficacy of current treatment. A detailed study of the biological characteristics and behaviour of metastatic OS cells may provide a rational basis for innovative treatment strategies. The aim of this review is to give an overview of the biological changes in metastatic OS cells and the preclinical and clinical efforts targeting the different steps in OS metastases and how these contribute to designing a metastasis directed treatment for OS

Design, Performance, and Calibration of the CMS Hadron-Outer Calorimeter

The CMS hadron calorimeter is a sampling calorimeter with brass absorber and plastic scintillator tiles with wavelength shifting fibres for carrying the light to the readout device. The barrel hadron calorimeter is complemented with an outer calorimeter to ensure high energy shower containment in the calorimeter. Fabrication, testing and calibration of the outer hadron calorimeter are carried out keeping in mind its importance in the energy measurement of jets in view of linearity and resolution. It will provide a net improvement in missing \et measurements at LHC energies. The outer hadron calorimeter will also be used for the muon trigger in coincidence with other muon chambers in CMS

Design, Performance and Calibration of the CMS Forward Calorimeter Wedges

We report on the test beam results and calibration methods using charged particles of the CMS Forward Calorimeter (HF). The HF calorimeter covers a large pseudorapidity region (3\l |\eta| \le 5), and is essential for large number of physics channels with missing transverse energy. It is also expected to play a prominent role in the measurement of forward tagging jets in weak boson fusion channels. The HF calorimeter is based on steel absorber with embedded fused-silica-core optical fibers where Cherenkov radiation forms the basis of signal generation. Thus, the detector is essentially sensitive only to the electromagnetic shower core and is highly non-compensating (e/h \approx 5). This feature is also manifest in narrow and relatively short showers compared to similar calorimeters based on ionization. The choice of fused-silica optical fibers as active material is dictated by its exceptional radiation hardness. The electromagnetic energy resolution is dominated by photoelectron statistics and can be expressed in the customary form as a/\sqrt{E} + b. The stochastic term a is 198% and the constant term b is 9%. The hadronic energy resolution is largely determined by the fluctuations in the neutral pion production in showers, and when it is expressed as in the electromagnetic case, a = 280% and b = 11%

Design, Performance, and Calibration of CMS Hadron-Barrel Calorimeter Wedges

Extensive measurements have been made with pions, electrons and muons on four production wedges of the Compact Muon Solenoid (CMS) hadron barrel (HB) calorimeter in the H2 beam line at CERN with particle momenta varying from 20 to 300 GeV/c. Data were taken both with and without a prototype electromagnetic lead tungstate crystal calorimeter (EB) in front of the hadron calorimeter. The time structure of the events was measured with the full chain of preproduction front-end electronics running at 34 MHz. Moving-wire radioactive source data were also collected for all scintillator layers in the HB. These measurements set the absolute calibration of the HB prior to first pp collisions to approximately 4%

Synchronization and Timing in CMS HCAL

The synchronization and timing of the hadron calorimeter (HCAL) for the Compact Muon Solenoid has been extensively studied with test beams at CERN during the period 2003-4, including runs with 40 MHz structured beam. The relative phases of the signals from different calorimeter segments are timed to 1 ns accuracy using a laser and equalized using programmable delay settings in the front-end electronics. The beam was used to verify the timing and to map out the entire range of pulse shapes over the 25 ns interval between beam crossings. These data were used to make detailed measurements of energy-dependent time slewing effects and to tune the electronics for optimal performance