Opposite Normal Side Research Articles

Comparison of bilateral eardrum temperatures measured using an infrared tympanic thermometer before and after surgery in patients with chronic otitis media.

This study aimed to investigate the effect of chronic otitis media (COM) and COM surgery on infrared tympanic thermometer measurements. We retrospectively reviewed the medical records of 192 patients (192 surgery cases) who underwent surgery for COM and whose bilateral tympanic membrane temperature was measured with an infrared tympanic thermometer the day before surgery and at 2, 3, 4, and 6 months after surgery. Patients underwent surgery for COM in 1 ear, the other eardrum was intact. Patients who underwent tympanoplasty, simple mastoidectomy, and canal wall up mastoidectomy, surgeries performed to preserve the ear canal, were included in group A, and patients who underwent canal wall down mastoidectomy, a surgery to remove the ear canal, were included in group B. There were 115 and 77 patients in groups A and B, respectively. The mean temperature on the side with COM measured the day before surgery was 37.09°C ± 0.325°C and the mean temperature on the opposite normal side was 37.03°C ± 0.330°C (P = .000). In group A, the eardrum temperature on the surgical and contralateral side was not statistically different after surgery (P = .439). The temperature difference between both sides of the eardrums (dTemp) changed from 0.056°C before surgery to 0.014°C after surgery (P = .008). However, in group B, which canal wall down mastoidectomy was performed, the eardrum temperature of the surgical side was higher than that on the other side (P = .001). The dTemp increased up to 0.15°C after surgery (P = .000). The temperature of the eardrum was slightly increased by COM. The COM surgeries, which preserve the ear canal, brought the temperature of the eardrum close to that of the normal eardrum, and the surgery to remove the ear canal raised the temperature of the eardrum.

Electrocardiographic Passing Phenomenon (Flying Phenomenon or Yasser’s Phenomenon) Conveys the Traditional Cardiovascular Management; Interpretations and Reassurance; Retrospective Observational Study

Dynamic changes during an electrocardiographic recording are common alterations. These changes were commonly reported initially as an abnormal diagnosis by cardiologists despite they are unusual taking the opposite normal side. These changes may be passing as physiological or even transient changes. An electrocardiographic dynamic change with their urgent conversion from abnormal to normal way without any medical interference is the key to the new phenomenon.

Percutaneous kirschner wire fixation of displaced colles' fracture

Introduction: Colles' fractures are one of the most common adult fractures encountered during clinical practice of an orthopaedic surgeon. It occur as the result of a fall on the outstretched hand (FOOSH). They consist of a fracture of distal redial metaphyseal region with dorsal angulation and impaction but without the involvement of the articular surface. Material and Methods: Twenty eight patients with severely displaced Colles' fractures were treated with closed reduction and percutaneous pinning with two/three kirschner wires. All the fractures healed within 3 months.Anatomical result was excellent or good in 22(80%) cases, but 6(20%) cases developed malunion. Functional results were satisfactory in all the cases. At a mean follow up of 3 years after injury, none had wrist pain. Grip strength was 95% of the opposite normal side. There were no serious complications. No patient had a significant loss of rotation of the forearm. Conclusion: The study showed that additional fixation improves both the anatomical and functional results after a Colles' fracture.Our results showed that the procedure ia a very effective treatment option for severely displaced Colles' fractures.

Eccentric development of Balo's concentric sclerosis: detected by magnetic resonance diffusion-weighted imaging and magnetic resonance spectroscopy

Background: The concentricity of BCS has captured wide attention; the findings of the current study may provide useful information on the centrifugal pathogenesis of BCS. Objective: This study aims to evaluate the performance of MRI, DWI and MRS in elucidating the pathogenesis of Balo's lesions expanding. Methods: Six clinically diagnosed BCS cases were reviewed, and the findings obtained by MRI, DWI and MRS were analyzed. DWI data were available for six patients, with the DWI and ADC imaging locations being central and peripheral layers of the index lesion. At TE 144ms, we calculated metabolite ratios of MRS at different depths of the demyelinating lesions and compared with the lesion on the opposite normal side for two patients. Results: The ADC values of 18 typical concentric lesions revealed that the central lesion had the highest ADC value, followed by the internal ring, and the outermost layer had the lowest ADC value. The reduction in NAA/Cr and the increase in Cho/Cr were more evident in the central lesion than in the internal and outermost ring. Conclusion: The findings of DWI and MRS indicate Balo's concentric rings develop gradually and centrifugally. Of course, this hypothesis remains to be proved by further experimental studies.

Treatment of Static Scapholunate Instability With Modified Brunelli Tenodesis: Results Over 10 Years

To examine the long-term results of the modified Brunelli tenodesis using a strip of the flexor carpi radialis tendon as a ligament substitute to maintain reduced rotatory subluxation of the scaphoid for scapholunate instability. Between 1995 and 1998, 10 patients with scapholunate instability underwent the modified Brunelli procedure. We reviewed 8 patients with static instability with a mean follow-up of 13.8 years (range, 12-15 y). The mean age of patients was 40 years at the time of surgery. The mean period from the injury to surgical treatment was 4 months. The functional outcome according to Green and O'Brien was excellent or good in 7 of 8 patients. Postoperative Disabilities of the Arm, Shoulder, and Hand and modified Mayo scores averaged 9 and 83, respectively. At final follow-up, average total wrist motion and grip strength were 85% of the opposite normal side. Of the 8 patients, 6 were pain free; 1 patient had slight and occasional pain, and another had chronic pain. On radiographs, the average preoperative scapholunate gap was 5.1 mm. It was corrected to 2.4 mm at surgery and was 2.8 mm at final follow-up. The average scapholunate angle was 72° preoperatively, 46° postoperatively, and 63° at final follow-up. We observed degenerative osteoarthritis in 1 case. Because the number of cases is small, only a few conclusions can be made. At final follow-up there was a certain loss of scapholunate reduction. The fact that we observed arthritic changes in only 1 of 8 cases suggests that carpal stability obtained by this procedure is probably sufficient to obtain good functional long-term results. Long-term studies with more cases are required to evaluate this method, which has shown encouraging results in the present study. Therapeutic IV.

The Change in Position between the Ulnar Head and Radiusin Distal Radiounlar Joint following Distal Radius Malunion : Analysis on the Axial Planeusing Computed Tomography

Purpose : This study examined the displacement of the ulnar head with respect to the distal radius after distal radius malunion on the axial plane using computed tomography. Materials and Methods: Twenty-four patients with a residual dorsal tilt ＞10˚ or radial shortening ＞2 mm than the normal side, and no limitation in wrist rotation after radius union were enrolled in this study. The bilateral CT scans were obtained in 70˚ pronation, neutral, 70˚ supination. The radioulnar ratio was measured and the ratios of the abnormal side were compared with those of the opposite normal side. The results were statistically analyzed using a two-tailed paired t-test. Results : The ulnar head of the patients with a malunited radius had a tendency for anterior translation compared with the normal side. In patients with a dorsal tilt deformity, the anterior translation of the ulnar head with respect to the radius was significant, particularly in the supination and neutral position. However, no significant difference was found in patients with radial shortening in terms of the ulnar head translation between the normal and abnormal side. Conclusion : These results might explain the mechanism of distal radioulnar joint instability and low incidence of ulnocarpal impingement in patients with distal radius malunion.

Open Bankart Repair

Background The potential weakness of the open Bankart procedure is the takedown and repair of the subscapularis tendon. It is not known to what extent this part of the procedure affects the final result. Hypothesis The function of the subscapularis muscle after surgery will be related to the patient's perception of surgical success. Study Design Cohort study; Level of evidence, 2. Methods A total of 30 patients with traumatic anterior instability had an open Bankart repair by a single surgeon. These patients were observed for a mean of 4 years. At final follow-up, the patients filled out 3 self-assessment forms: the American Shoulder and Elbow Surgeons scale, the Western Ontario Shoulder Instability Index, and the Constant and Murley scale. An independent physician performed a complete physical examination. Strength testing of all muscle groups was performed and compared with the opposite normal side. Results Multiple factors were related to the patient's perception of the result. Only subscapularis function was found to have a statistically significant correlation. Of the patients, 23% had an incompetent subscapularis with a mean of 27% strength as compared with the opposite side. These patients had a positive lift-off test result and reported 57% good and excellent results; only 57% would have the surgery again. Of the patients, 77% had a normal functioning subscapularis with at least 80% strength as compared with the opposite side. These patients had a negative lift-off test result and had 91% good and excellent results; 100% would have the surgery again. The Western Ontario Shoulder Instability Index was the only scale that differentiated between a patient with subscapularis function and a patient without subscapularis function. Conclusion Postoperative subscapularis function was the most critical factor in determining the patient's perception of surgical success. Clinical Relevance It is likely that handling of the subscapularis tendon during surgery and protection of the subscapularis in the first weeks after surgery are critical to the success of the open Bankart repair.

In vivo proton MR spectroscopy of chorea-ballismus in diabetes mellitus.

The most common cause of chorea-ballismus (CB) is a vascular lesion; it is also associated with nonketotic hyperglycaemia in diabetes mellitus (DM) and may be the first manifestation of this disorder. We describe the CT, MRI and proton MR spectroscopy (1H-MRS) of CB in eight patients. Six had hemichorea-hemiballismus (HC-HB) and two bilateral CB. Single-voxel (SV) 1H-MRS was performed using point-resolved spectroscopy (PRESS). Voxels were positioned in the basal ganglia of the patients and control subjects. PRESS was also used to obtain spectroscopic imaging (1H-MRSI) of the slice of interest in two patients. CT showed a slightly dense striatum in all the patients with CB, and T1-weighted images revealed high signal. The CB correlated well with the neuroimaging findings. SV 1H-MRS showed the mean (+/- SD) N-acetylaspartate (NAA)/ creatine (Cr) ratio to be 1.45 +/- 0.19 in HC-HB and 1.82 +/- 0.06 on the opposite normal side (P = 0.01). The choline (Cho)/ Cr ratio was 1.3 +/- 0.12 in HC-HB and 1.11 +/- 0.13 on the opposite normal side (P = 0.005). A lactate peak was seen in seven patients. The NAA/Cr ratio was 1.44 +/- 0.15 in bilateral CB and 1.74 +/- 0.16 in the controls (P = 0.017); the Cho/Cr ratios were 1.36 +/- 0.1 and 1.19 +/- 0.07 (P = 0.015). The low NAA/Cr suggests neuronal loss or damage and the high Cho/Cr probably indicates gliosis. The presence of lactate may suggest mild ischaemia due to acute vascular events during hyperglycaemia and underlying chronic focal cerebrovascular diseases in DM.

Scapholunate ligament repair and capsulodesis for the treatment of static scapholunate dissociation

Twenty-four patients were treated with scapholunate ligament repair and dorsal capsulodesis for scapholunate dissociation. Seventeen patients were available for follow-up at an average of 30 months. The average interval between injury and surgery was 3 months. At final follow-up, no patients were pain-free. Average total wrist motion was 60% and grip strength 70% of the opposite normal side. The average preoperative scapholunate angle was 78 degrees and was corrected to a normal 47 degrees at surgery. The average final scapholunate angle was 72 degrees, which was not significantly different from the preoperative value. The scapholunate gap likewise was not significantly changed postoperatively. Only two patients had an excellent or good outcome using a clinical grading system, and six out of 17 scored good or excellent using a radiographic grading system. In conclusion, repair of the scapholunate ligament with dorsal capsulodesis failed to provide consistent pain relief and maintain carpal alignment in patients with static scapholunate instability.

Auricular Repair with Autogenous Rib Cartilage Grafts

The purpose of this paper is twofold: to present a sound approach to auricular construction using methods that have evolved through two decades of my personal experience with 600 cases and to discuss pertinent information I have gleaned from a questionnaire sent to my operated patients. This series comprises 546 completed ears in 500 microtia patients (46 bilateral) and 75 completed ears in acquired deformities. Follow-up ranges from 1 to 17 years. Major complications such as infection, hematoma, or skin loss with cartilage exposure occurred in only 1.6 percent of cases and were limited to the perioperative period of 12 days. None have occurred in the last 9 years (481 frameworks). This paper describes the evolution and rationale for my current management of total ear repair and covers preoperative planning, how to fabricate the rib cartilage framework, how to modify the framework for specific deformities, and how to cover the framework, i.e., how to assess and use local skin and vestiges or when to supplement the coverage by recruiting fascial flaps or using tissue expansion. When considering fascial flaps, patient selection was found to be particularly important because of long-term effects on the donor scalp; expansion was found to be most useful intraoperatively. This paper also covers how to manage the hairline, how to stage the surgery, when to combine procedures, and how to manage bilateral microtia in a team approach. The survey revealed that autogenous cartilage frameworks grow, are durable, retain their detail over the years, and withstand trauma well. More than 40 severe traumas occurred in surgically constructed ears, and all healed without incident. Ears constructed in young patients generally grew to keep pace with the opposite normal side; 41.6 percent actually overgrew by several millimeters. Emotional and psychological benefits were universal, and patient satisfaction was high. Among patients who were classified as "severely affected" by the original deformity, 100 percent were pleased with the result. When considered "moderately disturbed" by the microtic defect and operated on by age 14, 95.5 percent of patients were satisfied with the surgical repair; 83.3 percent of adolescents between the ages of 15 and 20 who did not consider themselves "severely affected" by the deformity were pleased with the outcome, and the rest were "undecided."

Echographic study of Tietze's syndrome

An echographic study of Tietze's syndrome was carried out. Three patients with clinical evidence of Tietze's syndrome were examined. Ten normal volunteers were studied as controls. In Tietze's syndrome a dishomogeneous increase of the echogenicity in pathological cartilage and an increased thickness vs. the opposite normal side were observed. A moderate thickness and a decreased echogenicity of surrounding soft tissues was observed in one case.

Sonography of the musculoskeletal system.

Improved technology and the development of high-resolution transducers have made sonography of the structures of the musculoskeletal system possible. The vast majority of scientific reports on the value of sonography for imaging musculoskeletal abnormalities have been written only in the last decade. Sonography has several inherent advantages: it is relatively inexpensive, allows comparison with the opposite normal side, uses no radiation, and can be performed at bedside or in the operating room if necessary. The advent of MR imaging has revolutionized musculoskeletal imaging and may be used in many instances rather than sonography for evaluating the same abnormalities or anatomic structures. It is important, however, to keep in perspective what the different imaging techniques have to offer, and, if one is just as efficacious as the other, the least invasive and least expensive should be chosen whenever possible. The goal of this article is to review the applications of sonography to the evaluation of musculoskeletal disorders including tendon disease, soft-tissue masses, identification of foreign bodies, osteomyelitis, cellulitis, and certain joint abnormalities.

Cerebellar corticogram in extra cerebellar astrocytoma

1. 1. A case of extra-cerebellar astrocytoma is reported in which corticography of the cerebellum showed a striking difference between the two cerebellar hemispheres 2. 2. The record from the side on which the tumour lay showed suppression of activity and much less fast activity than the opposite normal side. 3. 3. It is suggested that corticography of the cerebellum in man may be a useful diagnostic measure, as it is of the cerebral hemispheres.