Does primary brachial plexus surgery alter palliative tendon transfer surgery outcomes in children with obstetric paralysis?

<p>Abstract</p> <p>Background</p> <p>The surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed. Tendon transfers are the mainstay of palliative surgery. Occasionally, surgeons are required to utilise already denervated and subsequently reinnervated muscles as motors. This study aimed to compare the outcomes of tendon transfers for residual shoulder dysfunction in patients who had undergone early nerve surgery to the outcomes in patients who had not.</p> <p>Methods</p> <p>A total of 91 patients with obstetric paralysis-related shoulder abduction and external rotation deficits who underwent a modified Hoffer transfer of the latissimus dorsi/teres major to the greater tubercle of the humerus tendon between 2002 and 2009 were retrospectively analysed. The patients who had undergone neural surgery during infancy were compared to those who had not in terms of their preoperative and postoperative shoulder abduction and external rotation active ranges of motion.</p> <p>Results</p> <p>In the early surgery groups, only the postoperative external rotation angles showed statistically significant differences (25 degrees and 75 degrees for total and upper type palsies, respectively). Within the palliative surgery-only groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. The significant differences between the early surgery groups and the palliative surgery groups with total palsy during the preoperative period diminished postoperatively (p < 0.05 and p > 0.05, respectively) for abduction but not for external rotation. Within the upper type palsy groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles.</p> <p>Conclusions</p> <p>In this study, it was found that in patients with total paralysis, satisfactory shoulder abduction values can be achieved with tendon transfers regardless of a previous history of neural surgery even if the preoperative values differ.</p

Dynamic amplification factor concept of soil layers: a case study in İzmir (Western Anatolia)

Dynamic soil amplification factor (DAF) defining which ratio earthquake acceleration will reach the soil surface by changing is one of the most important factors in seismic risk studies. When computing the value of DAF at a point without a strong motion station, peak horizontal acceleration values (PGA) at the bedrock and soil transfer function are needed. PGA value at the bedrock can be obtained by using either real seismic records or the earthquake scenario. However, the soil transfer function (soil transfer function) can be computed observationally and theoretically. Observational soil transfer function is defined by microtremor horizontal/vertical spectral ratio. In case of theoretical computation, the density belonging to the soil layers between the bedrock and the soil surface is used together with the change of P-S wave rates with the depth and the damping factor. In this study, the dynamic amplification factor (DAF) has been computed and mapped for 57 points by using observational soil transfer functions obtained by microtremor horizontal/vertical spectral ratio as well as the earthquake scenario at a new city center located within the metropolitan area of Izmir. Also, theoretical soil transfer function at 1 point was obtained through spatial autocorrelation method (SPAC) study and determined to be compatible with observational result. It was observed that both peak period values are higher than 1 s and DAF values are higher than 2 throughout the area. Also, according to the soil profile obtained from the SPAC study, S wave rate changes up to a depth of 1300 m showing that acoustic impedance differences may occur in the frequencies and the magnitudes of the earthquake waves. The fact that peak period values obtained from microtremor studies are higher than 2 s supports this result. This means that acoustic impedance differences likely to occur in these depths should also be taken into consideration while computing the dynamic amplification factor

Protective role of heparin in the injury of the liver and kidney on the experimental model of ischemia/reperfusion

PubMed ID: 24533613Background: Surgery of thoracoabdominal aortic aneurysms (TAAA) is associated with high incidence of serious complications. Ischemia/reperfusion (I/R) injury may be responsible for these complications. We investigated the effect of degree of anticoagulation on remote organ I/R injuries and whether heparin is protective against I/R injury in addition to its anticoagulant properties.Methods: Spraque Dawley rats were used to determine both liver and kidney concentrations of HSP-70,IL-6, MPO in four groups: ischemic control (operation with cross-clamping and intraperitoneal administration of 0.9% saline, n = 7), sham (operation without cross-clamping, n = 7), heparin (ACT level about 200), and high dose heparin (ACT level up to 600). Histological analyses of the organs were performed.Results: Histopathological evaluation of kidney presented significant differences between groups with regards to the cytoplasmic vacuole formation, hemorrhage, tubular cell degeneration and tubular dilatation while heparinized group had best results. The kidney MPO and HSP-70 levels significantly decreased (p 0.05) in heparinized group when compared to ischemic control group. No statistically significant intergroup differences were detected in the tissue samples of liver. Immunohistochemical markers of the liver were compared and no statistically significant difference was found among the groups.Conclusion: Heparin is an important anticoagulation agent in TAAA surgical procedures but the use of higher levels of heparin in the present study revealed no beneficial effects. Bleeding complications is much less when heparin is used in the real-world clinical practice as ACT levels of 200. © 2014 Yener et al.; licensee BioMed Central Ltd