A Reliable Method for Intraoperative Evaluation of Syndesmotic Reduction.

A reliable method for intraoperative evaluation of syndesmotic reduction.

J Orthop Trauma. 2013 Apr; 27(4): 196-200
Summers HD, Sinclair MK, Stover MD

: To determine the accuracy of a technique for intraoperative assessment of syndesmotic reduction in ankle fractures.: Prospective, case series.: University hospital.: Eighteen consecutive patients with suspected syndesmotic injuries were enrolled between 2007 and 2009. The diagnosis of syndesmotic injury was based on static ankle radiographs. The study group consisted of 12 male and 6 female patients with an average age of 32 years (range 19-56 years).: All patients had mortise and talar dome lateral fluoroscopic images obtained of the uninjured ankle in the operating room. The injured ankle underwent operative reduction and provisional fixation using the uninjured ankle radiographs as a template for comparison. An intraoperative computed tomography (CT) scan was obtained to verify the syndesmotic reduction before syndesmotic fixation. If the reduction was not anatomic, the reduction was revised using fluoroscopy and the CT repeated.: Accuracy of syndesmotic reduction performed using fluoroscopy and confirmed by intraoperative CT scan.: Using the technique described, intraoperative CT confirmed anatomic reduction initially in 17 of the 18 fractures. The 1 case where CT did change the course of treatment, revision of fibular fracture reduction resulted in an anatomic reduction of the syndesmosis on repeat CT.: Accurate evaluation of the syndesmotic reduction can be determined intraoperatively using comparison mortise and talar dome lateral fluoroscopic images. Direct visualization of the syndesmosis or CT may not be necessary to achieve an accurate reduction in these injuries. HubMed – rehab


Survival following spinal cord infarction.

Spinal Cord. 2013 Mar 26;
New PW, McFarlane CL

Study design:Retrospective open cohort.Objectives:To calculate the survival of patients with spinal cord infarction and to compare the cause of death in patients with different mechanisms of ischaemic injury.Setting:Spinal Rehabilitation Unit, Melbourne, Victoria, Australia.Methods:Consecutive admissions between 1 January 1995 and 31 December 2008 with recent onset of spinal cord infarction. Linkage to the Registry of Births, Deaths and Marriages (Victoria) was used to determine survival following discharge from in-patient rehabilitation and cause of death.Results:A total of 44 patients were admitted (males=26, 59%), with a median age of 72 years (interquartile range (IQR) 62-79). One patient died during their in-patient rehabilitation programme. In all, 14 patients (n=14/44; 33%) died during the follow-up period. The median survival after diagnosis was 56 months (IQR 28-85) and after discharge from in-patient rehabilitation was 46 months (IQR 25-74). The 1- and 5-year mortality rates were 7.0% (n=3/43; 95% confidence interval (CI)=2.4-18.6%) and 20.9% (n=9/43; 95% CI=11.4-35.2%). There was no statistically significant difference in survival between patients with the different aetiologies of spinal cord infarction (other vs idiopathic: ?(2)=0.6, P=0.7; other vs vascular: ?(2)=1.9, P=0.3). There was no relationship between survival and gender (?(2)=0.2, P=0.6), age (?(2)=3.0, P=0.08), level of injury (?(2)=0.0, P=1) or American Spinal Cord Society Impairment Scale grade of spinal cord injury (?(2)=0.02, P=0.9).Conclusion:Patients with spinal cord infarction appear to have a fair survival after discharge from in-patient rehabilitation, not withstanding the occurrence of risk factors of vascular disease in many patients.Spinal Cord advance online publication, 26 March 2013; doi:10.1038/sc.2013.14. HubMed – rehab


Comfort care, withdrawal of life-support treatment, and nonconsensual euthanasia in the ICU.

Crit Care Med. 2013 Apr; 41(4): e35-6
Rady MY, Verheijde JL

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[Plasma citrulline concentration as a biomarker of intestinal function in short bowel syndrome and in intestinal transplant.]

An Pediatr (Barc). 2013 Mar 22;
Vecino López R, Andrés Moreno AM, Ramos Boluda E, Martinez-Ojinaga Nodal E, Hernanz Macías A, Prieto Bozano G, Lopez Santamaria M, Tovar Larrucea JA

INTRODUCTION: Citrulline is a non-essential amino acid produced solely in the enterocyte. The aim of this study was to analyse the role of serum citrulline as a biomarker of enterocyte load in children with intestinal failure due to short bowel syndrome (SBS) and its relationship to enteral adaptation. MATERIAL AND METHODS: Plasma citrulline concentration was determined by chromatography (normal value>15?mol/L) in 57 patients (age 0.5-18 years) admitted to our Intestinal Rehabilitation Unit with intestinal failure. Those who were dehydrated, with renal insufficiency, or other conditions able to modify the results were excluded. Patients were divided into 4 groups: group i: SBS totally dependent on parenteral nutrition (PN); group ii: SBS under mixed enteral-parenteral nutrition; group iii: IF weaned from PN after a rehabilitation period; group iv: small bowel transplanted patients weaned from PN and taking a normal diet. RESULTS: The mean±SD plasma citrulline values were: group i (n=15): 7.1±4.1; group ii (n=11): 15.8±8.9; group iii (n=13): 20.6±7.5; group iv (n=25): 28.8±10.1. Values were significantly lower in group i in comparison with groups ii-iii-iv (P<.001), and in group ii in comparison with groups iii-iv (P<.001). A low citrulline was associated with remnant small bowel length (P<.001, r=0.85). In group iv citrulline levels decreased >50% in 3 patients who developed moderate-severe rejection, and in one patient who developed viral enteritis. CONCLUSIONS: 1. Plasma citrulline could be a sensitive and specific biomarker of the residual functional enterocyte load. 2. It is related to enteral feeding tolerance. 3. Its prognostic value in the process of intestinal adaptation and as a rejection marker in small bowel transplanted patients needs to be confirmed. HubMed – rehab