Plexiform neurofibroma of the submandibular gland in patient with von Recklinghausen's disease

Plexiform neurofibroma of the submandibular gland is an extremely rare tumor. Herein, we report a case of plexiform neurofibroma in a patient with a von Recklinghausen's disease (NF-1) who presented with a submandibular mass mimicking a submandibular gland tumor. Complete surgical excision provides the best treatment and final diagnosis. A neurofibroma should be considered in the differential diagnosis for submandibular mass

A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions.

BACKGROUND: Assistive products are items which allow older people and people with disabilities to be able to live a healthy, productive and dignified life. It has been estimated that approximately 1.5% of the world's population need a prosthesis or orthosis. OBJECTIVE: The objective of this study was to systematically identify and review the evidence from randomized controlled trials assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions. METHODS: Literature searches, completed in September 2015, were carried out in fourteen databases between years 1995 and 2015. The search results were independently screened by two reviewers. For the purpose of this manuscript, only randomized controlled trials which examined interventions using orthotic or prosthetic devices were selected for data extraction and synthesis. RESULTS: A total of 342 randomised controlled trials were identified (319 English language and 23 non-English language). Only 4 of these randomised controlled trials examined prosthetic interventions and the rest examined orthotic interventions. These orthotic interventions were categorised based on the medical conditions/injuries of the participants. From these studies, this review focused on the medical condition/injuries with the highest number of randomised controlled trials (osteoarthritis, fracture, stroke, carpal tunnel syndrome, plantar fasciitis, anterior cruciate ligament, diabetic foot, rheumatoid and juvenile idiopathic arthritis, ankle sprain, cerebral palsy, lateral epicondylitis and low back pain). The included articles were assessed for risk of bias using the Cochrane Risk of Bias tool. Details of the clinical population examined, the type of orthotic/prosthetic intervention, the comparator/s and the outcome measures were extracted. Effect sizes and odds ratios were calculated for all outcome measures, where possible. CONCLUSIONS: At present, for prosthetic and orthotic interventions, the scientific literature does not provide sufficient high quality research to allow strong conclusions on their effectiveness and cost-effectiveness

Prevention of post-coccygectomy infection in a series of 136 coccygectomies

Postoperative infection is a regular complication in coccygectomy. The authors propose the use of a topical skin adhesive on the postoperative wound as a contribution to the prevention of this complication. It was used on the first 56 patients in this study. The rate of infection was 3.6% compared with the 14% rate of infection in a previous study. The 80 following patients had, in addition to the skin adhesive, two prophylactic antibiotics for 48 hours (cefamandole and ornidazole), a preoperative rectal enema, and closure of the incision in two layers. The rate of infection dropped to 0.0%. Topical skin adhesive constitutes a significant contribution in the prevention of infection after coccygectomy

Underneath the cerclage: an ex vivo study on the cerclage-bone interface mechanics

Cerclages regain interest due to a rising number of periprosthetic fractures. The contact distribution at the circumferential cerclage-bone interface is still unknown. Local interface pressure depends on the amount of contact area. Cortical damage at the interface would provoke cerclage loosening. Therefore, the contact area, the bone pressure along the interface and the cortical resistance underneath loaded cerclages were determined in an ex vivo model

Coccygectomy with or without periosteal resection

The purpose of this study was to compare the clinical outcomes and wound complications in coccygectomy with or without subperiosteal resection. This retrospective study included 25 patients who underwent coccygectomy. Resection of all mobile coccygeal segments including the periosteum was performed in 11 patients (group 1) and resection was performed subperiostally sparing the periosteum in the remaining 14 patients (group 2). A visual analogue scale was used for pain assessment before and after the surgery both in sitting and standing positions. A questionnaire to evaluate subjective patient satisfaction was also used. The two groups were statistically similar in terms of age, sex, aetiology, duration of symptoms before surgery and follow-up time. Both surgical techniques resulted in a statistically similar clinical outcome. Overall, 84% of patients who underwent coccygectomy benefited from surgery. We observed four wound infections (two superficial and two deep) that caused delayed wound healing in group 1. The rate of infection in group 1 was statistically higher than in group 2. The results of this study suggest that periosteal preservation and closure are related to low risk of infection

Avaliação da confiabilidade do Método Merle d'Aubigné e Postel Modificado Evaluation of the reliability of the Modified Merle d·Aubigné and Postel Method

OBJETIVO: Avaliar a confiabilidade inter-avaliadores do Método Merle d'Aubigné e Postel Modificado. MÉTODO: Participaram do estudo 45 pacientes, com média de idade de 57,93(+13,35), submetidos à artroplastia total de quadril. Todos foram avaliados por três pesquisadores, os quais receberam treinamento para uniformizar seus critérios. Realizou-se a avaliação pelo Método Merle d'Aubigné e Postel Modificado (associação dos prefixos A, B e C), no mesmo dia de forma aleatória, e os pesquisadores não se comunicaram durante as avaliações. Para avaliação da mobilidade, foram realizados movimentos passivos do quadril e mensurados pelo goniômetro universal. A análise estatística foi tratada com o Teste de Cronbach (p<0,05 e 0,7<&#945;<1,0). RESULTADOS: Análise estatística demonstrou elevadas significância e confiabilidade inter-avaliadores para os itens: prefixo (p<0,001; &#945;=0,961), dor (p<0,001; &#945;=0,892), marcha (p< 0,001; &#945;=0,898), mobilidade (p<0,001; &#945;=0,810) e pontuação total (p<0,001; &#945;=0,917). CONCLUSÃO: Verificou-se elevada significância e confiabilidade entre os três avaliadores para todos os itens do Método Merle d'Aubigné e Postel Modificado, sugerindo que esse Método é confiável, desde que seja parametrizado seus itens e realizado o treinamento prévio dos avaliadores. Nivel de evidência II, Estudo diagnóstico.<br>OBJECTIVE: To assess the inter-evaluator reproducibility of the Modified Merle d'Aubigné and Postel Method. METHOD: Forty-five patients took part in the study, with a mean age of57.93 (±13,35) who underwent total hip arthroplasty. All were evaluated by three researchers, who received training to standardize their criteria. The evaluation was held by the Modified Merle d'Aubigné and Postel Method (association of prefixes A, B and C) the same day at random, and the researchers did not report to one another throughout the evaluations. For mobility assessment, passive hip movements were performed and measured with the universal goniometer. The statistical analysis was carried out by the Cronbach Test (p<0,05 and 0,7<&#945;<1,0). RESULTS: The statistical analysis showed significantly high inter-evaluators reliability for the items: prefix (p<0,001; &#945; = 0,961), pain (p <0,001; &#945;= 0,892), gait (p<0,001; &#945;= 0,898), mobility (p<0,001; &#945;=0,810) and total score (p <0,001; &#945;=0,917). CONCLUSION: There was high significance and reliability among the three evaluators for all items of the Modified Merle d'Aubigné and Postel Method, suggesting that this method is reliable, provided its items are parameterized and previous training of evaluators is carried out. Level of Evidence II, Diagnostic Study