Computer-assisted placement technique in hip resurfacing arthroplasty: improvement in accuracy?

Freehand positioning of the femoral drill guide is difficult during hip resurfacing and the surgeon is often unsure of the implant position achieved peroperatively. The purpose of this study was to find out whether, by using a navigation system, acetabular and femoral component positioning could be made easier and more precise. Eighteen patients operated on by the same surgeon were matched by sex, age, BMI, diagnosis and ASA score (nine patients with computer assistance, nine with the regular ancillary). Pre-operative planning was done on standard AP and axial radiographs with CT scan views for the computer-assisted operations. The final position of implants was evaluated by the same radiographs for all patients. The follow-up was at least 1 year. No difference between both groups in terms of femoral component position was observed (p > 0.05). There was also no difference in femoral notching. A trend for a better cup position was observed for the navigated hips, especially for cup anteversion. There was no additional operating time for the navigated hips. Hip navigation for resurfacing surgery may allow improved visualisation and hip implant positioning, but its advantage probably will be more obvious with mini-incisions than with regular incision surgery.

Robotic, fluoroscopic or EMG assisted pedicle screw insertion. A CT based comparative study

Introduction: In order to improve safety of pedicle screw placement several techniques have been developed. More recently robotically assisted pedicle insertion has been introduced aiming at increasing accuracy. The aim of this study was to compare this new technique with the two main pedicle insertion techniques in our unit namely fluoroscopically assisted vs EMG aided insertion. Material and methods: A total of 382 screws (78 thoracic,304 lumbar) were introduced in 64 patients (m/f = 1.37, equally distributed between insertion technique groups) by a single experienced spinal surgeon. From those, 64 (10 thoracic, 54 lumbar) were introduced in 11 patients using a miniature robotic device based on pre operative CT images under fluoroscopic control. 142 (4 thoracic, 138 lumbar) screws were introduced using lateral fluoroscopy in 27 patients while 176 (64 thoracic, 112 lumbar) screws in 26 patients were inserted using both fluoroscopy and EMG monitoring. There was no difference in the distribution of scoliotic spines between the 3 groups (n = 13). Screw position was assessed by an independent observer on CTs in axial, sagittal and coronal planes using the Rampersaud A to D classification. Data of lumbar and thoracic screws were processed separately as well as data obtained from axial, sagittal and coronal CT planes. Results: Intra- and interobserver reliability of the Rampersaud classification was moderate, (0.35 and 0.45 respectively) being the least good on axial plane. The total number of misplaced screws (C&D grades) was generally low (12 thoracic and 12 lumbar screws). Misplacement rates were same in straight and scoliotic spines. The only difference in misplacement rates was observed on axial and coronal images in the EMG assisted thoracic screw group with a higher proportion of C or D grades (p <0.05) in that group. Recorded compound muscle action potentials (CMAP) values of the inserted screws were 30.4 mA for the robot and 24.9mA for the freehand technique with a CI of 3.8 of the mean difference of 5.5 mA. Discussion: Robotic placement did improve the placement of thoracic screws but not that of lumbar screws possibly because our misplacement rates in general near that of published navigation series. Robotically assisted spine surgery might therefore enhance the safety of screw placement in particular in training settings were different users at various stages of their learning curve are involved in pedicle instrumentation.

Reliable acetabular cup orientation with a new gravity-assisted guidance system.

Acetabular cup orientation is a key factor determining hip stability, and standard mechanical guides have shown little help in improving alignment. An in vitro study was carried out to compare the accuracy and precision of a new gravity-assisted guidance system with a standard mechanical guide. Three hundred ten cups were impacted by 5 surgeons, and the final cup orientation was measured. With the new guide, the average error in anteversion was 0.4 degrees , compared with 10.4 degrees with the standard guide and 0.3 degrees and -4.7 degrees , respectively, for abduction angles. The average time required for orienting the cups was similar for both guides. The accuracy and reproducibility obtained with the new guide were better (P < .0001). These good results would require a clinical validation.

Prevalence and factors associated to the epidemic neuropathy in a population assisted by a family doctor in Cuba

With the outbreak of an epidemic neuropathy (EN) of unknown ethiology, a study of the prevalence and factors associated to the disease was carried out in the Zamora community, municipality of Marianao, Havana City. There were 11 patients identified with EN for a prevalence rate of 1.7/100. The major risk group was the one between 45 and 64 years of age, female sex, black skin. In the univaried analysis, a high prevalence ratio (PR) was found linked to beverage intake (PR=5.32 95%; confidence intervals (CI) = 1.2-24.4), frequent drugs intake (PR=6.59; CI=1.8-24.6), consumption of edible of non certified fats (PR=4.48; CI=1.2-16.7) and the smoking habit (PR=3.6; CI=1.1-12.2). More than73/100 (CI= 68.7-78.3) of the people under serologic study were infected with Coxsakie virus A-9 (strain 47) isolated from a patient still under research. It seems there are many factors like linder intake, antecedents of hemorrhagic conjuntivitis, nutritional aspects and others that, with the virus isolated were associated with this epidemiologic situation.

Naltrexone-assisted rapid methadone discontinuation : a pilot study

Rapport de Synthèse : Un sevrage lent comme méthode élective pour l'interruption de la méthadone est coûteux en termes de temps, le plus souvent associé à un taux élevé d'abandon. Bien que les méthodes ultrarapides de désintoxication des opiacés aient gagné en popularité récemment, elles sont chères et posent les problèmes spécifiques liés aux patients traités par la méthadone. Méthodologie: ont été inclus dans l'étude dix patients en traitement de substitution avec de la méthadone. La dernière dose de méthadone a été administrée le matin même du jour de l'admission, en préalable à l'hospitalisation. Les médicaments suivants ont été administrés le jour suivant l'admission: ondansetron 36mg, ranitidine 40mg, loperamide 8m., clonazepam 4m., promazine 1OOmg, metoclopramide 70mg, naltrexone 5Omg. L'échelle objective de sevrage des opiacés (Objective Opiate Withdrawal Scale) a été appliquée au deuxième, troisième et quatrième jour d'hospitalisation, deux fois par jour, à 8h00 et 18h00. Un suivi a été réalisé sous la forme d'entretiens téléphoniques pendant une semaine, respectivement six mois après la date de sortie de l'hôpital, faisant suite à la désintoxication. Un autre entretient téléphonique a été réalisé dans les six mois suivant le "post-sevrage", avec pour objectif d'investiguer la continuité du traitément, une éventuelle rechute dans l'abus de drogues et une possible réintroduction de la méthadone. Résultats: nous avons pu déterminer quatre groupes de symptômes, sur la base d'une observation de trois jours d'évolution: 1) Les signes typiques du syndrome de sevrage de retrait des opiacés, symptôme de froid et chaud, pilo-érection, anxiété caractérisée par une intensité initiale élevée et une disparition relativement continue. 2) Hyperactivité neurovégétative caractérisée par une intensité initiale élevée et une rapide disparition. 3) Phénomènes neurovégétatifs dont l'intensité s'est maintenue durant toute la période d'observation. 4) Contractions musculaires, insomnies et anorexie, manque d'appétit, réapparaissant chez certains patients au 2ème et au début du 3ème jour. Conclusions: une procédure courte de désintoxication utilisant une dose unique de naltrexone s'avère être une méthode alternative valable pour un sevrage de la méthadone. Cette méthode semble accélérer et écourter la symptomatologie associée au sevrage. Le cours des symptômes peut être interprété comme biphasique. Une première phase de retrait est éminemment caractérisée par tous les symptômes typiques eux-mêmes et probablement induits par la naltrexone. La seconde phase, pour un plus petit nombre de patients, peut être interprétée comme en corrélation avec une concentration de méthadone en diminution significative ultérieurement.

Power laws and scaling of rain events and dry spells in the Catalonia region

We analyze the statistics of rain-event sizes, rain-event durations, and dry-spell durations in a network of 20 rain gauges scattered in an area situated close to the NW Mediterranean coast. Power-law distributions emerge clearly for the dryspell durations, with an exponent around 1.50 ± 0.05, although for event sizes and durations the power-law ranges are rather limited, in some cases. Deviations from power-law behavior are attributed to finite-size effects. A scaling analysis helps to elucidate the situation, providing support for the existence of scale invariance in these distributions. It is remarkable that rain data of not very high resolution yield findings in agreement with self-organized critical phenomena.

Universality of rain event size distributions

We compare rain event size distributions derived from measurements in climatically different regions, which we find to be well approximated by power laws of similar exponents over broad ranges. Differences can be seen in the large-scale cutoffs of the distributions. Event duration distributions suggest that the scale-free aspects are related to the absence of characteristic scales in the meteorological mesoscale.

A Mitochondrial DNA Phylogeny Indicates Close Relationships between Populations of Lutzomyia whitmani (Diptera: Psychodidae, Phlebotominae) from the Rain-forest Regions of Amazônia and Northeast Brazil

Phylogenetic analysis of all 31 described mitochondrial (cytochrome b) haplotypes of Lutzomyia whitmani demonstrated that new material from the State of Rondônia, in southwest Amazônia, forms a clade within a lineage found only in the rain-forest regions of Brazil. This rain-forest lineage also contains two other clades of haplotypes, one from eastern Amazônia and one from the Atlantic forest zone of northeast Brazil (including the type locality of the species in Ilhéus, State of Bahia). These findings do not favour recognizing two allopatric cryptic species of L. whitmani, one associated with the silvatic transmission of Leishmania shawi in southeast Amazônia and the other with the peridomestic transmission of Le. braziliensis in northeast Brazil. Instead, they suggest that there is (or has been in the recent past) a continuum of inter-breeding populations of L. whitmani in the rain-forest regions of Brazil.

Effects of flooding and temperature on Aedes albifasciatus development time and larval density in two rain pools at Buenos Aires University City

Aedes albifasciatus is a floodwater mosquito that breeds in temporary waters. This semi-domestic species, widely distributed in Argentina, is a competent vector of the western equine encephalitis. The present study was carried out in two rain pools of the city of Buenos Aires, from April 1998 through March 1999. Samples were taken twice a week during the cold season and daily during the warmer months, starting from October. Immature mosquitoes were collected with a dipper, being the number of dippers proportional to the flooded area. The estimated rainfall thresholds to initiate cohorts of Ae. albifasciatus were: 16-17 mm in the fall-winter period, 25 mm in the spring, and 30 mm in the summer. The development time of the different cohorts and the mean air temperature of their respective periods were estimated in all seasons, ranging from six days (at 24ºC) to 32 days (at 13ºC). The equation that best expresses the relationship between development time and mean air temperature is dt =166,27.e-0,1435.T (R²=0,92). Significantly shorter development times were recorded for larvae of the first three stages as compared to the fourth larval stage and pupae.

The Phlebotominae sand fly (Diptera: Psychodidae) fauna of two Atlantic Rain Forest Reserves in the State of Rio de Janeiro, Brazil

During two consecutive years, studies on the sand fly fauna in Poço das Antas and Fazenda Bom Retiro, two Atlantic Rain Forest Reserves from the State of Rio de Janeiro, were performed using Shannon traps, CDC light traps and human bait collections. Eleven species were identified; Lutzomyia longipalpis, L. migonei, L. edwardsi, L. intermedia, L. whitmani, L. fischeri, L. shannoni, L. ayrozai, L. hirsuta, L. monticola and L. misionensis (first occurrence in the State of Rio de Janeiro). L. intermedia and L. whitmani were the predominant anthropophilic species around houses, while L. hirsuta predominated in the forest.

Low-pressure, water-assisted anatexis of basic dykes in a contact metamorphic aureole, Fuerteventura (Canary Islands): oxygen isotope evidence for a meteoric fluid origin

Migmatites produced by low-pressure anatexis of basic dykes are found in a contact metamorphic aureole around a pyroxenite-gabbro intrusion (PX2), on Fuerteventura. Dykes outside and inside the aureole record interaction with meteoric water, with low or negative delta O-18 whole-rock values (+0.2 to -3.4 parts per thousand), decreasing towards the contact. Recrystallised plagioclase, diopside, biotite and oxides, from within the aureole, show a similar evolution with lowest delta O-18 values (-2.8, -4.2, - 4.4 and -7.6 parts per thousand, respectively) in the migmatite zone, close to the intrusion. Relict clinopyroxene phenocrysts preserved in all dykes, retain typically magmatic delta O-18 values up to the anatectic zone, where the values are lower and more heterogeneous. Low delta O-18 values, decreasing towards the intrusion, can be ascribed to the advection of meteoric water during magma emplacement, with increasing fluid/rock ratios (higher dyke intensities towards the intrusion acting as fluid-pathways) and higher temperatures promoting increasing exchange during recrystallisation.

Ochlerotatus albifasciatus in rain pools of Buenos Aires: seasonal dynamics and relation to environmental variables

The immature stages of Ochlerotatus albifasciatus develop in temporary pools. The present study aims at evaluating the seasonal dynamics of the aquatic stages of this mosquito, also analyzing the relationship among their presence and breeding success to some relevant climatic and environmental variables in the ephemeral rain pools of an urban park. Nineteen cohorts of O. albifasciatus that developed synchronously after rain events were recorded in all seasons. The proportions of mosquito-positive pools were significantly higher during the fall-winter period than in the spring-summer months (p < 0.001). The presence of this mosquito species was positively related to the amount of rain (p < 0.001), whereas negatively correlated to air temperature (p < 0.05) within a 5.2 to 29.7ºC range. The distribution of the number of cohorts per pool throughout the year was grouped (variance/mean: 3.96), indicating that these habitats were not equally suitable as breeding sites. The immature stages of O. albifasciatus were detected in pools belonging to all of the categories of surface area, depth, duration, vegetation cover, and insolation. However, the proportion of pools where immature mosquitoes were detected was positively and significantly related to surface, depth, duration, and vegetation cover. On the other hand, the proportion of mosquito-positive pools was higher at an intermediate insolation degree. Our results suggest that although preimaginal stages were present in all seasons, high temperatures may be unfavorable to larval development, and substrate vegetation may regulate water temperature. The positive relationship between the proportion of mosquito-positive pools and pool size and duration might reflect a strategy of O. albifasciatus to accomplish immature development.