Die operative Behandlung der Azetabulum-T-Fraktur über eine chirurgische Hüftluxation oder einen Stoppa-Zugang. [Operative treatment of T-type fractures of the acetabulum via surgical hip dislocation or Stoppa approach]

OBJECTIVE: Anatomic reduction and stable fixation by means of tissue- preserving surgical approaches. INDICATIONS Displaced acetabular fractures. Surgical hip dislocation approach with larger displacement of the posterior column in comparison to the anterior column, transtectal fractures, additional intraarticular fragments, marginal impaction. Stoppa approach with larger displacement of the anterior column in comparison to the posterior column. A combined approach might be necessary with difficult reduction. CONTRAINDICATIONS Fractures > 15 days (then ilioinguinal or extended iliofemoral approaches). Suprapubic catheters and abdominal problems (e.g., previous laparotomy due to visceral injuries) with Stoppa approach (then switch to classic ilioinguinal approach). SURGICAL TECHNIQUE: Surgical hip dislocation: lateral decubitus position. Straight lateral incision centered over the greater trochanter. Entering of the Gibson interval. Digastric trochanteric osteotomy with protection of the medial circumflex femoral artery. Opening of the interval between the piriformis and the gluteus minimus muscle. Z-shaped capsulotomy. Dislocation of the femoral head. Reduction and fixation of the posterior column with plate and screws. Fixation of the anterior column with a lag screw in direction of the superior pubic ramus. Stoppa approach: supine position. Incision according to Pfannenstiel. Longitudinal splitting of the anterior portion of the rectus sheet and the rectus abdominis muscle. Blunt dissection of the space of Retzius. Ligation of the corona mortis, if present. Blunt dissection of the quadrilateral plate and the anterior column. Reduction of the anterior column and fixation with a reconstruction plate. Fixation of the posterior column with lag screws. If necessary, the first window of the ilioinguinal approach can be used for reduction and fixation of the posterior column. POSTOPERATIVE MANAGEMENT: During hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with a maximum flexion of 90 degrees . No active abduction and passive adduction over the body's midline, if a surgical dislocation was performed. Maximum weight bearing 10-15 kg for 8 weeks. Then, first clinical and radiographic follow-up. Deep venous thrombosis prophylaxis for 8 weeks postoperatively. RESULTS: 17 patients with a mean follow-up of 3.2 years. Ten patients were operated via surgical hip dislocation, two patients with a Stoppa approach, and five using a combined or alternative approach. Anatomic reduction was achieved in ten of the twelve patients (83%) without primary total hip arthroplasty. Mean operation time 3.3 h for surgical hip dislocation and 4.2 h for the Stoppa approach. Complications comprised one delayed trochanteric union, one heterotopic ossification, and one loss of reduction. There were no cases of avascular necrosis. In two patients, a total hip arthroplasty was performed due to the development of secondary hip osteoarthritis.

Teaching video neuroimages: Beevor sign: when the umbilicus is pointing to neurologic disease

A 57-year-old man with genetically proven facioscapulohumeral muscular dystrophy (FSHMD 1A) demonstrated Beevor sign (video on the Neurology Web site at www.neurology.org). The upward movement of the umbilicus in a supine patient flexing the neck or sitting up is named after the British neurologist Charles Edward Beevor (1854-1908). He described a "marked elevation of the umbilicus in the act of sitting up" due to a paralyzed infraumbilical part of the rectus abdominis muscle, indicating a lesion of the spinal cord between the segments T10 and T12 or its nerve roots.(1) Beevor sign may also be present, as in our patient, in myopathies affecting the abdominal muscles, particularly in FSHMD, in which predominant involvement of the lower part of the rectus abdominis muscle is typical.(2).

Increased expression of proteasome subunits in skeletal muscle of cancer patients with weight loss

Atrophy of skeletal muscle is common in patients with cancer and results in increased morbidity and mortality. In order to design effective therapy the mechanism by which this occurs needs to be elucidated. Most studies suggest that the ubiquitin-proteasome proteolytic pathway is most important in intracellular proteolysis, although there have been no reports on the activity of this pathway in patients with different extents of weight loss. In this report the expression of the ubiquitin-proteasome pathway in rectus abdominis muscle has been determined in cancer patients with weight loss of 0-34% using a competitive reverse transcriptase polymerase chain reaction to measure expression of mRNA for proteasome subunits C2 and C5, while protein expression has been determined by western blotting. Overall, both C2 and C5 gene expression was increased by about three-fold in skeletal muscle of cachectic cancer patients (average weight loss 14.5 ± 2.5%), compared with that in patients without weight loss, with or without cancer. The level of gene expression was dependent on the amount of weight loss, increasing maximally for both proteasome subunits in patients with weight loss of 12-19%. Further increases in weight loss reduced expression of mRNA for both proteasome subunits, although it was still elevated in comparison with patients with no weight loss. There was no evidence for an increase in expression at weight losses less than 10%. There was a good correlation between expression of proteasome 20Sα subunits, detected by western blotting, and C2 and C5 mRNA, showing that increased gene expression resulted in increased protein synthesis. Expression of the ubiquitin conjugating enzyme, E214k, with weight loss followed a similar pattern to that of proteasome subunits. These results suggest variations in the expression of key components of the ubiquitin-proteasome pathway with weight loss of cancer patients, and suggest that another mechanism of protein degradation must be operative for patients with weight loss less than 10%. © 2004 Elsevier Ltd. All rights reserved.

The Hall-Findlay mammaplasty pattern for skin-sparing mastectomy. Case report

We present an application of the Hall-Findlay mammaplasty skin pattern for skin-sparing mastectomy (SSM). This is a simplified vertical reduction mammaplasty. Vertical reduction mammaplasty is the procedure advised for patients with moderator or large ptotic breasts, who wish to have a simultaneous contra-lateral breast reduction/mastopexy at the time of SSM for cancer or prophylactic mastectomy. It is particularly suitable for breast reconstruction with autologous tissue in the form of free transverse rectus abdominis myocutaneous (TRAM), deep inferior epigastric artery perforator (DIEP) and extended latissimus dorsi (ELD) flaps.

Poster abstract : Energy-efficient rate adaptive MAC Protocol (RA-MAC) for long-lived sensor networks

This paper introduces an energy-efficient Rate Adaptive MAC (RA-MAC) protocol for long-lived Wireless Sensor Networks (WSN). Previous research shows that the dynamic and lossy nature of wireless communication is one of the major challenges to reliable data delivery in a WSN. RA-MAC achieves high link reliability in such situations by dynamically trading off radio bit rate for signal processing gain. This extra gain reduces the packet loss rate which results in lower energy expenditure by reducing the number of retransmissions. RA-MAC selects the optimal data rate based on channel conditions with the aim of minimizing energy consumption. We have implemented RA-MAC in TinyOS on an off-the-shelf sensor platform (TinyNode), and evaluated its performance by comparing RA-MAC with state-ofthe- art WSN MAC protocol (SCP-MAC) by experiments.

Validation of the Drinking Refusal Self-Efficacy Questionnaire - Revised in an Adolescent Sample (DRSEQ-RA)

Adolescent drinking is a significant issue yet valid psychometric tools designed for this group are scarce. The Drinking Refusal Self-Efficacy Questionnaire—Revised Adolescent Version (DRSEQ-RA) is designed to assess an individual's belief in their ability to resist drinking alcohol. The original DRSEQ-R consists of three factors reflecting social pressure refusal self-efficacy, opportunistic refusal self-efficacy and emotional relief refusal self-efficacy. A large sample of 2020 adolescents aged between 12 and 19 years completed the DRSEQ and measures of alcohol consumption in small groups. Using confirmatory factor analysis, the three factor structure was confirmed. All three factors were negatively correlated with both frequency and volume of alcohol consumption. Drinkers reported lower drinking refusal self-efficacy than non-drinkers. Taken together, these results suggest that the adolescent version of the Drinking Refusal Self-Efficacy Questionnaire (DRSEQ-RA) is a reliable and valid measure of drinking refusal self-efficacy.

Prediction of muscular architecture of the rectus femoris and vastus lateralis from EMG during isometric contractions in soccer players

Objectives The purpose of the study was to establish regression equations that could be used to predict muscle thickness and pennation angle at different intensities from electromyography (EMG) based measures of muscle activation during isometric contractions. Design Cross-sectional study. Methods Simultaneous ultrasonography and EMG were used to measure pennation angle, muscle thickness and muscle activity of the rectus femoris and vastus lateralis muscles, respectively, during graded isometric knee extension contractions performed on a Cybex dynamometer. Data form fifteen male soccer players were collected in increments of approximately 25% intensity of the maximum voluntary contraction (MVC) ranging from rest to MVC. Results There was a significant correlation (P < 0.05) between ultrasound predictors and EMG measures for the muscle thickness of rectus femoris with an R2 value of 0.68. There was no significant correlation (P > 0.05) between ultrasound pennation angle for the vastus lateralis predictors for EMG muscle activity with an R2 value of 0.40. Conclusions The regression equations can be used to characterise muscle thickness more accurately and to determine how it changes with contraction intensity, this provides improved estimates of muscle force when using musculoskeletal models.

Remembering the Peel Island Lazaret through re-imagining the Teerk Roo Ra forest

This paper discusses my current research which aims to re-member the site of the Peel Island Lazaret through re-imagining the Teerk Roo Ra forest as a series of animated artworks. Teerk Roo Ra National Park (formally known as Peel Island) is a small island in Moreton Bay, Queensland and is visible on the ferry journey from Cleveland to Stradbroke Island. The island has an intriguing history, and is the site of a former Lazaret and quarantine station. The Lazaret treated patients diagnosed with Hansen’s disease (or Leprosy), and operated between 1907 and 1959. In this paper I will discuss conceptions of the non-indigenous historical context of the Peel Island Lazaret and the notion of the liminal state (Turner,1967). Through this discussion conceptions of place from Australian cultural theorist Ross Gibson are also examined. The concept of two overlapping realms is then explored through the clues and shared stories about the people who inhabited the site. There is then an explanation of my own approach to re-member this place through re-imagining the forest that witnessed the events of the Lazaret. I then draw on theories of the uncanny from German Psychiatrist Ernst Jentsch, Austrian Neurologist Sigmund Freud and South African animation theorist Meg Rickards to argue that my experience of the forest of Teerk Roo Ra was an uncanny experience where two worlds or states of mind existed simultaneously and overlapped, causing a viscerally unsettling uncanny experience. Through an analysis of Czech Surrealist Animator Jan Švankmajer’s cinematic narrative Down to the cellar (1982), my creative work Structure #24(2011), and Australian Artist Patricia Piccinini’s cinematic artwork The Gathering (2007), I discuss the situation of the inanimate and the animate co-existing simultaneously. Using this approach I propose an understanding of the uncanny as an intellectual uncertainty as outlined by Jentsch (1906). I also develop the notion of the familiar being concealed and becoming unfamiliar through mimicry (Freud, 1919). These discussions form an introduction to my creative work Nocturne #5(2014) which re-members the forests of Teerk Roo Ra as an uncanny place primarily expressed through animation.

Zapys zemelʹnyĭ Na pravo korystovanni︠a︡ zemli︠u︡, shcho znakhoditʹsi︠a︡ v Odeskoï guberni Peryletravenʹsʹkyĭ okruzi Kantakuzenʹsʹy raʹoni pid nazvoi︠u︡ Trudovyshyĭ artilʹ Slava

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Zapys zemelʹnyĭ Na pravo korystovanni︠a︡ zemli︠u︡, shcho znakhoditʹsi︠a︡ v Odeskoï guberni Peryletravenʹsʹkyĭ okruzi Kantakuzenʹsʹy raʹoni pid nazvoi︠u︡ Trudovyshyĭ artilʹ Slava

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Hizkuntza idatziaren i(ra)kaskuntza Urtxintxa metodoari jarraituz

Lan hau, Ikastolen Elkarteak sortutako Urtxintxa metodoaren 5 urteko irakaslearen gidaliburuen idazten eta irakurtzen irakasteko atalaren analisian oinarritzen da. Proiektu hau ikuspegi konstruktibista batetik eratu da, beraz, honetan idazten eta irakurtzen irakasteko erabiltzen den materialek teoria konstruktibistari jarraitzen diote. Material hau aztertu da Haur Hezkuntzako 5 urteko gelan idazketa eta irakurketa lantzeko zein neurritan erabilgarria den ezagutzeko helburuarekin. Ikerketaren ondorioek agerian utzi dute Urtxintxa modu eraikitzailean eta globalizatuan hizkuntza idatzia lantzeko gida erabilgarria dela. Idazketa-irakurketaren inguruan proposatzen diren jarduerek hizkuntza idatziaren erabilera funtzionala sustatzen dute eta horrela, haurren ikasketa esanguratsua ziurtatzen dute.

Contribución de las comunidades bentónicas en la dieta del róbalo (Eleginops maclovinus) en la Ría Deseado (Santa Cruz, Argentina)

Se analiza el aporte de la comunidad bentónica de la ría Deseado a la dieta del róbalo (Eleginops maclovinus), para contribuir al conocimiento de la trama alimentaria costera en la Patagonia austral. Entre la primavera 2005 y otoño 2006 se estudiaron las comunidades bentónicas submareales en áreas de pesca de E. maclovinus y paralelamente, se analizaron los contenidos alimentarios estomacales de róbalos provenientes de la pesca deportiva. La comunidad bentónica de planicies areno-fangosas fue dominada por poliquetos, representados principalmente por las familias Onuphidae, Orbiniidae y Maldanidae. Los crustáceos constituyeron el segundo grupo en importancia y estuvieron representados principalmente por los anfípodos gamáridos Heterophoxus sp. y Ampelisca sp. La comunidad submareal de fondos de rodados estuvo dominada por poliquetos de las familias Nereididae, Cirratulidae y Polynoidae, y los moluscos Perumytilus purpuratus y Margarites violacea. E. maclovinus presentó una dieta bentónica de tipo oportunista y generalista, con una tendencia hacia la ingesta de anfípodos gamáridos y algas clorofíceas. Durante la marea baja, la mayor contribución a su dieta la realizó la comunidad de planicies areno-fangosas submareales. Durante la marea alta, E. maclovinus se alimentó también en el intermareal rocoso, donde preda preferentemente las clorofíceas Enteromorpha spp. ENGLISH: The role of the benthic communities at Ría Deseado in the diet of the Patagonian blenny (Eleginops maclovinus) was analyzed in order to increase the understanding of the coastal food web in southern Patagonia. Subtidal benthic communities were surveyed between spring 2005 and autumn 2006 in areas of E. maclovinus sport fishing. Simultaneously, the stomach contents of patagonian blenny specimens caught during sport fishing were analyzed. The benthic community over flat sandy-muddy bottoms was dominated by polychaetes, mainly from the families Onuphidae, Orbiniidae and Maldanidae, followed by crustaceans, which were mainly represented by the gammarid amphipods Heterophoxus sp. and Ampelisca sp. The subtidal benthic community over pebbly bottoms was dominated by polychaetes from the families Nereididae, Cirratulidae and Polynoidae and the mollusks Perumytilus purpuratus and Margarites violacea. The diet of E. maclovinus was benthic opportunist and generalist, with a preference to feed on gammarid amphipods and chlorophycea algae. During low tide, the main dietary contribution came from the subtidal community over flat sandy-muddy bottoms whereas, during high tide, E. maclovinus also preyed on rocky intertidal species, mainly the Chlorophycea Enteromorpha spp.

El alga invasora Undaria pinnatifida (Harvey) Suringar en la Ría Deseado (Patagonia austral, Argentina): ciclo del esporofito y factores ambientales determinantes de su distribución

Undaria pinnatifida was registered in Ría Deseado (47º45´S, 65º55´W _ southern Patagonia) by the first time in spring 2005, colonizing the intertidal and shallow subtidal. A seasonal survey in 2006 showed that U. pinnatifida was established in a sheltered zone inside the estuary, along a coastal fringe of 8 km between Punta Cascajo and Cañadón del Puerto. This continuous distribution was only interrupted in the mouth of canyons that flow into Ría Deseado, where the bottom is conformed by mud and sand. The sporophytes were mainly found colonizing the rocky bottom in the lower intertidal, bordering the Macrocystis pyrifera population. The highest density and biomass of sporophytes (12.13 ind. m-2; 254.60 g m-2) were registered during spring, when the population was mainly conformed by individuals of medium sizes. The lowest density and biomass (0.33 ind. m-2; 5.69 g m-2) were registered in autumn. Juvenile sporophytes recruited throughout the year, but presented the highest percentage in the population during autumn and winter. First mature sporophytes appeared in spring and attained their maximum size in summer. After this, the sprophytes decayed and disappeared. Environmental factors such as rocky bottoms availability and water transparency may be the main factors determining the sporophytes distribution in Ría Deseado. The field experiment point out that M. pyrifera population is an important factor controlling the dispersion of U. pinnatifida towards the subtidal. SPANISH: Undaria pinnatifida fue registrada en la Ría Deseado (47º45´ S, 65º55´ W _ Patagonia austral) durante la primavera de 2005, colonizando el intermareal y submareal somero. Los relevamientos estacionales realizados durante el 2006, revelaron que U. pinnatifida se encontró establecida en una zona protegida en el interior de la ría, ocupando una franja costera de aproximadamente 8 km de largo entre Punta Cascajo y el Cañadón del Puerto. Esta distribución casi continua sólo presentó algunas interrupciones en la boca de los cañadones que desembocan en la ría, donde el fondo predominante es de tipo areno-fangoso. Los esporofitos de U. pinnatifida ocuparon preferentemente el fondo rocoso del intermareal inferior, limitando con la población de Macrocystis pyrifera. La densidad y biomasa más altas de esporofitos (12,13 ind. m-2; 254,60 g m-2) fueron registradas en primavera, cuando la población se encontró compuesta principalmente por individuos de tallas intermedias. La densidad y biomasa más bajas (0,33 ind. m-2; 5,69 g m-2) fueron registradas durante el otoño. Los esporofitos juveniles se reclutaron a lo largo de todo el año, pero alcanzaron su mayor proporción en la población durante el otoño y el invierno. Los esporofitos reproductivamente maduros aparecieron durante la primavera y alcanzaron su talla máxima durante el verano, luego del cual comenzaron a deteriorarse y a desaparecer. Factores como la disponibilidad de fondos rocosos y la transparencia de las aguas podrían actuar como los principales factores determinantes de su distribución en la ría. El experimento de campo realizado revela que los bosques de M. pyrifera actúan también como un importante factor de control, limitando la dispersión de U. pinnatifida hacia el submareal.