According to the specimens of ulna-radius of the Cape Hare (Lepus capensie) shot in fall and winter in Shanxi province, China, the ossifications of epiphyses cartilage of ulna-radius are divided into 4 stages. With we...According to the specimens of ulna-radius of the Cape Hare (Lepus capensie) shot in fall and winter in Shanxi province, China, the ossifications of epiphyses cartilage of ulna-radius are divided into 4 stages. With weight of eye lens as a reference, it is proved that the age criterion could be used to distinguish young less than 6–7 months old from those older. This is a pragmatic method to analyze age composition of game-bag in the early period of shooting season when younger holds a large proportion in the hare population. It also is useful in judging the age of hares trapped and estimating the effects of predation on the hare population structure.展开更多
The traditional treatment of the hip with a slip of the capital femoral epiphysis has been an in situ fixation using a single screw.This has the sanctity of a long term result.Recent literature stresses the outcomes o...The traditional treatment of the hip with a slip of the capital femoral epiphysis has been an in situ fixation using a single screw.This has the sanctity of a long term result.Recent literature stresses the outcomes of failure to restore the upper femoral alignment and on the basis of the poor results makes a plea for capital realignment.This being a recent development,it lacks the support of long term follow up and it remains to be seen if this is a better alternative of managing displaced and unstable slipped capital femoral epiphysis.The authors look at some of the available literature on the subject to highlight these controversies and their implications for orthopedic surgeons.Other controversies pertain to contralateral fixation,duration of immobilization and amount of weight bearing after an in situ fixation.展开更多
AIM: To analyze the surgical results of a slipped medial rectus muscle(MRM) after hang back recession surgery for esotropia.METHODS: Twenty-one patients who underwent reexploration for diagnosed slipped muscle after h...AIM: To analyze the surgical results of a slipped medial rectus muscle(MRM) after hang back recession surgery for esotropia.METHODS: Twenty-one patients who underwent reexploration for diagnosed slipped muscle after hang back recession surgery were included in this retrospective study. Dynamic magnetic resonance imaging was performed to identify the location of the slipped muscle.Ocular motility was evaluated with assessment with prism and cover test in gaze at cardinal positions. The operations were performed by the same consultant.Intraoperative forced duction test was performed under general anesthesia. The empty sheath of the slipped MRM was resected and the muscle was advanced to the original insertion site in all patients.RESULTS: The average age of 21 patients who had consecutive exotropia with a slipped MRM at the time of presentation was 17.4±5.4y(5-50y). The average duration between the first operation and the diagnosis of the slipped muscle was 25mo(12 to 36mo). The mean follow up after the corrective surgery was 28 mo. The mean preoperative adduction limitation in the field of action of the slipped muscle was-2.26(ranging from-1 to-4). All patients had full adduction postoperatively.CONCLUSION: The diagnosis of the slipped muscle should be confirmed during the strabismus surgery. The slipped muscle may be caused due to insufficient suture and excessive rubbing of the eye. When divergent strabismus is observed after the recession of the MRM, a slipped muscle should be considered in the differential diagnosis.展开更多
Introduction: Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents. The most serious complication is avascular necrosis (AVN), which has lasting sequelae. The objective of this study was to...Introduction: Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents. The most serious complication is avascular necrosis (AVN), which has lasting sequelae. The objective of this study was to determine the rate of AVN in stable slips. Method: We reviewed retrospectively all the children treated for SCFE between 2004 and 2008 at Princess Margaret Hospital. Results: Of a total of 67 patients, 51 (76%) were stable slips and 16 (24%) unstable. Avascular necrosis developed in 3 patients with stable slip (5.9%) and in 6 with unstable slip (37.5%). There was no statistically significant association found between AVN and age, weight, slip severity, pin position, number of pins used, experience of the surgeon or side affected. Those with stable presentations can develop AVN2, males are more likely and the possibility of developing AVN increases as the time from presentation to operation increased. Conclusion: AVN can occur in stable slips without joint penetration. This combined with male sex and increased time to operation, increases the risk of AVN.展开更多
Pseudomyogenic hemangioendothelioma is a rare, recently described neoplasm that usually presents as multifocal lesions in a single extremity. The disease has demonstrated a high propensity for infiltrative growth and ...Pseudomyogenic hemangioendothelioma is a rare, recently described neoplasm that usually presents as multifocal lesions in a single extremity. The disease has demonstrated a high propensity for infiltrative growth and local recurrence but limited metastatic potential. Variations of histological appearance and immunohistochemical signatures have been described, but typically involve spindle or polygonal cells with nuclear atypia and neutrophilic infiltration. Here we present a case report of an 8-year-old female who presented with hip pain that was initially diagnosed and managed as a slipped capital femoral epiphysis (SCFE). Subsequent evaluation led to the diagnosis of pseudomyogenic hemangioendothelioma of bone. Due to the degree of osseous destruction, described patterns of local recurrence, and metastatic potential of this neoplasm, a wide resection with endoprosthetic reconstruction of the proximal femur was performed. This case highlights the importance of due diligence in the diagnoses of SCFE and bone tumors in young patients with abnormalities of the proximal femur, including consideration of the need for biopsy.展开更多
BACKGROUND Slipped capital femoral epiphysis(SCFE)occurs in adolescents and has an incidence of around 10 per 100000 children.Children presenting with a unilateral SCFE are 2335 times more likely to develop a contrala...BACKGROUND Slipped capital femoral epiphysis(SCFE)occurs in adolescents and has an incidence of around 10 per 100000 children.Children presenting with a unilateral SCFE are 2335 times more likely to develop a contralateral SCFE than the general population.Prognostic factors that have been suggested to increase the risk of contralateral slip include a younger patient,an underlying endocrine disorder,growth hormone use and a higher radiographic posterior sloping angle.However,there is still much debate on the advantages and disadvantages of prophylactic fixation of the unaffected side in an otherwise healthy patient.AIM To investigate the risk rate of contralateral SCFE and assess the(dis)advantages of prophylactic fixation of the contralateral hip.METHODS A systematic literature search was performed in the Embase,Medline,Web of Science Core Collection and Cochrane databases.Search terms included‘slipped capital femoral epiphysis,’‘fixation,’‘contralateral,’and derivatives.The eligibility of the acquired articles was independently assessed by the authors and additional relevant articles were included through cross-referencing.Publications were considered eligible for inclusion if they presented data about otherwise healthy children with primarily unilateral SCFE and the outcomes of prophylactically pinning their unaffected side,or about the rates of contralateral slips and complications thereof.The study quality of the included articles was assessed independently by the authors by means of the methodological index for non-randomized studies criteria.RESULTS Of 293 identified unique publications,we included 26 studies with a total of 12897 patients.1762 patients(14%)developed a subsequent symptomatic contralateral slip.In addition,38%of patients developed a subsequent slip on the contralateral side without experiencing clinical symptoms.The most outspoken advantage of prophylactic fixation of the contralateral hip in the literature is prevention of an(asymptomatic)slip,thus reducing the increased risk of avascular necrosis(AVN),cam morphology and osteoarthritis.Disadvantages include an increased risk of infection,AVN,peri-implant fractures,loss of fixation as well as migration of hardware and morphologic changes as a consequence of growth guidance.These risks,however,appeared to only occur incidentally and were usually mild compared to the risks involved with an actual SCFE.CONCLUSION The advantages of prophylactic pinning of the unaffected side in otherwise healthy patients with unilateral SCFE seem to outweigh the disadvantages.The final decision for treatment remains to be patient-tailored.展开更多
BACKGROUND Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient setting.Two recent examples include slipped capital femoral epiphysis(SCFE)and Bloun...BACKGROUND Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient setting.Two recent examples include slipped capital femoral epiphysis(SCFE)and Blount’s disease.Surgical indications are well-studied for each pathology,but to our knowledge,there is an absence in literature analyzing safety and efficacy of inpatient vs outpatient management of either condition.We believed there would be no increase in adverse outcomes associated with outpatient treatment of either conditions.AIM To investigate whether outpatient surgery for SCFE and Blount’s disease is associated with increased risk of adverse outcomes.METHODS The 2015-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric Registries were used to compare patient characteristics,rates of complications,and readmissions between outpatient and inpatient surgery for SCFE and Blount’s disease.RESULTS Total 1788 SCFE database entries were included,30%were performed in an outpatient setting.In situ pinning was used in 98.5%of outpatient surgeries and 87.8%of inpatient surgeries(P<0.0001).Inpatients had a greater percent of total complications than outpatients 2.57%and 1.65%respectively.Regarding Blount’s disease,outpatient surgeries constituted 41.2%of the 189 procedures included in our study.The majority of inpatients were treated with a tibial osteotomy,while the majority of outpatients had a physeal arrest(P<0.0001).Complications were encountered in 7.4%of patients,with superficial surgical site infections and wound dehiscence being the most common.1.6%of patients had a readmission.No differences in complication and readmission risks were found between inpatients and outpatients.CONCLUSION The current trend is shifting towards earlier discharges and performing procedures in an outpatient setting.This can be safely performed for a large portion of children with SCFE and Blount’s disease without increasing the risk of complications or readmissions.Osteotomies are more commonly performed in an inpatient setting where monitoring is available.展开更多
A series of perylenetetracarboxylic diimides (PDIs) dimers with slipped “face-to-face” stacked structure and different substituents at the bay positions have been synthesized and the molecular structures are charact...A series of perylenetetracarboxylic diimides (PDIs) dimers with slipped “face-to-face” stacked structure and different substituents at the bay positions have been synthesized and the molecular structures are characterized by 1H NMR, MALDI-TOF and elemental analysis. And different substituents at the bay positions of the PDI ring bring about various steric hindrances. These different steric hindrances have caused significant differences on the absorption and emission spectra. The correlation between the photophysical properties and the molecular structure is discussed.展开更多
文摘According to the specimens of ulna-radius of the Cape Hare (Lepus capensie) shot in fall and winter in Shanxi province, China, the ossifications of epiphyses cartilage of ulna-radius are divided into 4 stages. With weight of eye lens as a reference, it is proved that the age criterion could be used to distinguish young less than 6–7 months old from those older. This is a pragmatic method to analyze age composition of game-bag in the early period of shooting season when younger holds a large proportion in the hare population. It also is useful in judging the age of hares trapped and estimating the effects of predation on the hare population structure.
文摘The traditional treatment of the hip with a slip of the capital femoral epiphysis has been an in situ fixation using a single screw.This has the sanctity of a long term result.Recent literature stresses the outcomes of failure to restore the upper femoral alignment and on the basis of the poor results makes a plea for capital realignment.This being a recent development,it lacks the support of long term follow up and it remains to be seen if this is a better alternative of managing displaced and unstable slipped capital femoral epiphysis.The authors look at some of the available literature on the subject to highlight these controversies and their implications for orthopedic surgeons.Other controversies pertain to contralateral fixation,duration of immobilization and amount of weight bearing after an in situ fixation.
文摘AIM: To analyze the surgical results of a slipped medial rectus muscle(MRM) after hang back recession surgery for esotropia.METHODS: Twenty-one patients who underwent reexploration for diagnosed slipped muscle after hang back recession surgery were included in this retrospective study. Dynamic magnetic resonance imaging was performed to identify the location of the slipped muscle.Ocular motility was evaluated with assessment with prism and cover test in gaze at cardinal positions. The operations were performed by the same consultant.Intraoperative forced duction test was performed under general anesthesia. The empty sheath of the slipped MRM was resected and the muscle was advanced to the original insertion site in all patients.RESULTS: The average age of 21 patients who had consecutive exotropia with a slipped MRM at the time of presentation was 17.4±5.4y(5-50y). The average duration between the first operation and the diagnosis of the slipped muscle was 25mo(12 to 36mo). The mean follow up after the corrective surgery was 28 mo. The mean preoperative adduction limitation in the field of action of the slipped muscle was-2.26(ranging from-1 to-4). All patients had full adduction postoperatively.CONCLUSION: The diagnosis of the slipped muscle should be confirmed during the strabismus surgery. The slipped muscle may be caused due to insufficient suture and excessive rubbing of the eye. When divergent strabismus is observed after the recession of the MRM, a slipped muscle should be considered in the differential diagnosis.
文摘Introduction: Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents. The most serious complication is avascular necrosis (AVN), which has lasting sequelae. The objective of this study was to determine the rate of AVN in stable slips. Method: We reviewed retrospectively all the children treated for SCFE between 2004 and 2008 at Princess Margaret Hospital. Results: Of a total of 67 patients, 51 (76%) were stable slips and 16 (24%) unstable. Avascular necrosis developed in 3 patients with stable slip (5.9%) and in 6 with unstable slip (37.5%). There was no statistically significant association found between AVN and age, weight, slip severity, pin position, number of pins used, experience of the surgeon or side affected. Those with stable presentations can develop AVN2, males are more likely and the possibility of developing AVN increases as the time from presentation to operation increased. Conclusion: AVN can occur in stable slips without joint penetration. This combined with male sex and increased time to operation, increases the risk of AVN.
文摘Pseudomyogenic hemangioendothelioma is a rare, recently described neoplasm that usually presents as multifocal lesions in a single extremity. The disease has demonstrated a high propensity for infiltrative growth and local recurrence but limited metastatic potential. Variations of histological appearance and immunohistochemical signatures have been described, but typically involve spindle or polygonal cells with nuclear atypia and neutrophilic infiltration. Here we present a case report of an 8-year-old female who presented with hip pain that was initially diagnosed and managed as a slipped capital femoral epiphysis (SCFE). Subsequent evaluation led to the diagnosis of pseudomyogenic hemangioendothelioma of bone. Due to the degree of osseous destruction, described patterns of local recurrence, and metastatic potential of this neoplasm, a wide resection with endoprosthetic reconstruction of the proximal femur was performed. This case highlights the importance of due diligence in the diagnoses of SCFE and bone tumors in young patients with abnormalities of the proximal femur, including consideration of the need for biopsy.
文摘BACKGROUND Slipped capital femoral epiphysis(SCFE)occurs in adolescents and has an incidence of around 10 per 100000 children.Children presenting with a unilateral SCFE are 2335 times more likely to develop a contralateral SCFE than the general population.Prognostic factors that have been suggested to increase the risk of contralateral slip include a younger patient,an underlying endocrine disorder,growth hormone use and a higher radiographic posterior sloping angle.However,there is still much debate on the advantages and disadvantages of prophylactic fixation of the unaffected side in an otherwise healthy patient.AIM To investigate the risk rate of contralateral SCFE and assess the(dis)advantages of prophylactic fixation of the contralateral hip.METHODS A systematic literature search was performed in the Embase,Medline,Web of Science Core Collection and Cochrane databases.Search terms included‘slipped capital femoral epiphysis,’‘fixation,’‘contralateral,’and derivatives.The eligibility of the acquired articles was independently assessed by the authors and additional relevant articles were included through cross-referencing.Publications were considered eligible for inclusion if they presented data about otherwise healthy children with primarily unilateral SCFE and the outcomes of prophylactically pinning their unaffected side,or about the rates of contralateral slips and complications thereof.The study quality of the included articles was assessed independently by the authors by means of the methodological index for non-randomized studies criteria.RESULTS Of 293 identified unique publications,we included 26 studies with a total of 12897 patients.1762 patients(14%)developed a subsequent symptomatic contralateral slip.In addition,38%of patients developed a subsequent slip on the contralateral side without experiencing clinical symptoms.The most outspoken advantage of prophylactic fixation of the contralateral hip in the literature is prevention of an(asymptomatic)slip,thus reducing the increased risk of avascular necrosis(AVN),cam morphology and osteoarthritis.Disadvantages include an increased risk of infection,AVN,peri-implant fractures,loss of fixation as well as migration of hardware and morphologic changes as a consequence of growth guidance.These risks,however,appeared to only occur incidentally and were usually mild compared to the risks involved with an actual SCFE.CONCLUSION The advantages of prophylactic pinning of the unaffected side in otherwise healthy patients with unilateral SCFE seem to outweigh the disadvantages.The final decision for treatment remains to be patient-tailored.
文摘BACKGROUND Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient setting.Two recent examples include slipped capital femoral epiphysis(SCFE)and Blount’s disease.Surgical indications are well-studied for each pathology,but to our knowledge,there is an absence in literature analyzing safety and efficacy of inpatient vs outpatient management of either condition.We believed there would be no increase in adverse outcomes associated with outpatient treatment of either conditions.AIM To investigate whether outpatient surgery for SCFE and Blount’s disease is associated with increased risk of adverse outcomes.METHODS The 2015-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric Registries were used to compare patient characteristics,rates of complications,and readmissions between outpatient and inpatient surgery for SCFE and Blount’s disease.RESULTS Total 1788 SCFE database entries were included,30%were performed in an outpatient setting.In situ pinning was used in 98.5%of outpatient surgeries and 87.8%of inpatient surgeries(P<0.0001).Inpatients had a greater percent of total complications than outpatients 2.57%and 1.65%respectively.Regarding Blount’s disease,outpatient surgeries constituted 41.2%of the 189 procedures included in our study.The majority of inpatients were treated with a tibial osteotomy,while the majority of outpatients had a physeal arrest(P<0.0001).Complications were encountered in 7.4%of patients,with superficial surgical site infections and wound dehiscence being the most common.1.6%of patients had a readmission.No differences in complication and readmission risks were found between inpatients and outpatients.CONCLUSION The current trend is shifting towards earlier discharges and performing procedures in an outpatient setting.This can be safely performed for a large portion of children with SCFE and Blount’s disease without increasing the risk of complications or readmissions.Osteotomies are more commonly performed in an inpatient setting where monitoring is available.
文摘A series of perylenetetracarboxylic diimides (PDIs) dimers with slipped “face-to-face” stacked structure and different substituents at the bay positions have been synthesized and the molecular structures are characterized by 1H NMR, MALDI-TOF and elemental analysis. And different substituents at the bay positions of the PDI ring bring about various steric hindrances. These different steric hindrances have caused significant differences on the absorption and emission spectra. The correlation between the photophysical properties and the molecular structure is discussed.
