Ipsilateral free semitendinosus tendon graft transfer for reconstruction of chronic tears of the Achilles tendon

<p>Abstract</p> <p>Background</p> <p>Many techniques have been developed for the reconstruction of the Achilles tendon in chronic tears. In presence of a large gap (greater than 6 centimetres), tendon augmentation is required.</p> <p>Methods</p> <p>We present our method of minimally invasive semitendinosus reconstruction for the Achilles tendon using one para-midline and one midline incision.</p> <p>Results</p> <p>The first incision is a 5 cm longitudinal incision, made 2 cm proximal and just medial to the palpable end of the residual tendon. The second incision is 3 cm long and is also longitudinal but is 2 cm distal and in the midline to the distal end of the tendon rupture. The distal and proximal Achilles tendon stumps are mobilised. After trying to reduce the gap of the ruptured Achilles tendon, if the gap produced is greater than 6 cm despite maximal plantar flexion of the ankle and traction on the Achilles tendon stumps, the ipsilateral semitendinosus tendon is harvested. The semitendinosus tendon is passed through small incisions in the substance of the proximal stump of the Achilles tendon, and it is sutured to the Achilles tendon. It is then passed beneath the intact skin bridge into the distal incision, and passed from medial to lateral through a transverse tenotomy in the distal stump. With the ankle in maximal plantar flexion, the semitendinosus tendon is sutured to the Achilles tendon at each entry and exit point</p> <p>Conclusion</p> <p>This minimally invasive technique allows reconstruction of the Achilles tendon using the tendon of semitendinosus preserving skin integrity over the site most prone to wound breakdown, and can be especially used to reconstruct the Achilles tendon in the presence of large gap (greater than 6 centimetres).</p

Less invasive Achilles tendon reconstruction

<p>Abstract</p> <p>Background</p> <p>The optimal management of chronic ruptures of the Achilles tendon is surgical reconstruction. Reconstruction of the Achilles tendon using peroneus brevis has been widely reported. Classically, these procedures involve relatively long surgical wounds in a relatively hypovascular area which is susceptible to wound breakdown.</p> <p>Results</p> <p>We describe our current method of peroneus brevis reconstruction for the Achilles tendon using two para-midline incisions.</p> <p>Conclusion</p> <p>This technique allows reconstruction of the Achilles tendon using peroneus brevis preserving skin integrity over the site most prone to wound breakdown, and can be especially used to reconstruct the Achilles tendon in the presence of previous surgery.</p

Protective effects of N-acetylcysteine on acetic acid-induced colitis in a porcine model

BACKGROUND: Ulcerative colitis is a chronic inflammatory disease and involves multiple etiological factors. Acetic acid (AA)-induced colitis is a reproducible and simple model, sharing many characteristics with human colitis. N-acetylcysteine (NAC) has been widely used as an antioxidant in vivo and in vitro. NAC can affect several signaling pathways involving in apoptosis, angiogenesis, cell growth and arrest, redox-regulated gene expression, and inflammatory response. Therefore, NAC may not only protect against the direct injurious effects of oxidants, but also beneficially alter inflammatory events in colitis. This study was conducted to investigate whether NAC could alleviate the AA-induced colitis in a porcine model. METHODS: Weaned piglets were used to investigate the effects of NAC on AA-induced colitis. Severity of colitis was evaluated by colon histomorphology measurements, histopathology scores, tissue myeloperoxidase activity, as well as concentrations of malondialdehyde and pro-inflammatory mediators in the plasma and colon. The protective role of NAC was assessed by measurements of antioxidant status, growth modulator, cell apoptosis, and tight junction proteins. Abundances of caspase-3 and claudin-1 proteins in colonic mucosae were determined by the Western blot method. Epidermal growth factor receptor, amphiregulin, tumor necrosis factor-alpha (TNF-α), and toll-like receptor 4 (TLR4) mRNA levels in colonic mucosae were quantified using the real-time fluorescent quantitative PCR. RESULTS: Compared with the control group, AA treatment increased (P < 0.05) the histopathology scores, intraepithelial lymphocyte (IEL) numbers and density in the colon, myeloperoxidase activity, the concentrations of malondialdehyde and pro-inflammatory mediators in the plasma and colon, while reducing (P < 0.05) goblet cell numbers and the protein/DNA ratio in the colonic mucosa. These adverse effects of AA were partially ameliorated (P < 0.05) by dietary supplementation with NAC. In addition, NAC prevented the AA-induced increase in caspase-3 protein, while stimulating claudin-1 protein expression in the colonic mucosa. Moreover, NAC enhanced mRNA levels for epidermal growth factor and amphiregulin in the colonic mucosa. CONCLUSION: Dietary supplementation with NAC can alleviate AA-induced colitis in a porcine model through regulating anti-oxidative responses, cell apoptosis, and EGF gene expression

Analysis of event-related potentials (ERP) by damped sinusoids

Several researchers propose that event-related potentials (ERPs) can be explained by a superposition of transient oscillations at certain frequency bands in response to external or internal events. The transient nature of the ERP is more suitable to be modelled as a sum of damped sinusoids. These damped sinusoids can be completely characterized by four sets of parameters, namely the amplitude, the damping coeffcient, the phase and the frequency. The Prony method is used to estimate these parameters. In this study, the long-latency auditory-evoked potentials (AEP) and the auditory oddball responses (P300) of 10 healthy subjects are analysed by this method. It is shown that the original waveforms can be reconstructed by summing a small number of damped sinusoids. This allows for a parsimonious representation of the ERPs. Furthermore, the method shows that the oddball target responses contain higher amplitude, slower delta and slower damped theta components than those of the AEPs. With this technique, we show that the differentiation of sensory and cognitive potentials are not inherent in their overall frequency content but in their frequency components at certain bands

Epileptic source localization using wavelet prefiltering and MUSIC scanning

The epileptic focus localization in the 3-D brain structure is performed using integer spline wavelet prefiltering and source localization. The forward and inverse problems are solved by Boundary Element Method (BEM) and MUSIC (Multiple Signal Classification) Scanning algorithm, respectively. The realistic head model is obtained by using an average human MRI data released by the Montreal Neurological Institute (MNI). 19 Channel EEG data from three different patients are collected. The technique is tested on these three clinical cases with secondary epileptic seizures based on morphological lesions that could be depicted in the anatomical MRI examinations of the patients. The estimated locations of the generators of interictal epileptiform signals correspond well to the surrounding neural tissue of the lesions. Especially, the disappearance of the seizures in two operated patients after the removal of the astrocytomas verifies the results. The wavelet prefiltering facilitates the visual inspection and detection of the interictal epileptic spikes and the BEM based on a realistic head model gives a more accurate anatomical localization for the focus. A focal source model is widely accepted in many cases of epilepsy and the MUSIC scanning seems to be very suitable for localizing these type of sources

The orthopaedic aspects of multiple epiphyseal dysplasia

PubMed ID: 10093815Five cases of multiple epiphyseal dysplasia (MED) were treated from 1985-1996 at the Orthopaedics and Trauma Department of SSK Izmir Educational Hospital. Four patients were female and one was male. The pedigrees of the first two female patients had the same features of inter-related marriages. The patients have been followed up for 5.5-11 years (average of 7.5 years). Surgical operations were mostly required in the lower limbs. Problems in the hips required adductor myotomy, the Soutter procedure, total hip replacement, and pertrochanteric extension osteotomy. Management of the knees required supracondylar shortening and extension osteotomy of the femur, high tibial extension osteotomy, debridement of the knee joint with removal of osteophytes, ogleotomy of the patellar lengthening of the knee flexors and posterior capsulotomy. Interphalangeal arthrodesis for hammer toes, extension osteotomy of the head of the first metatarsals, and Kellers operation were carried out in the foot. In the upper limb decompression and arterior transposition of the ulnar nerve, debridement of the elbow joint, extension and valgus osteotomy of the distal radius, and extension osteotomy of the head of the first metacarpal were required

Analysis of functional components of P300 by wavelet transform

The wavelet transform (WT) was applied to event-related potentials (ERPs) elicited in oddball paradigm to investigate the presence of several functional components occuring in the P300 latency range. Quadratic B-spline WT was used to decompose the single-sweep ERPs into four octaves. The analysis demonstrates that several delta, theta, and alpha frequency components in the P300 latency range differ in latency and amplitude between target and nontarget processing. These findings indicate that P300 is composed of multiple functional components and the WT is a powerful technique to help study them