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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There is disagreement in the literature as to whether responsivity to painful stimuli possesses psychometric correlates. A series of methodological and statistical factors are specified in this paper which could account for the equivocality of the literature. A series of experiments were performed in which (a) various methodological and statistical issues were first resolved and (b) psychometric correlates of pain perception were then identified by means of a stepwise multiple regression procedure. The criterion variable consisted of the psychophysical judgment of pain during a 2-min. exposure to a 3,000 gm. force on the periosteum of the left fore-finger's second digit. The predictor variables consisted of selected psychological states and traits measured by the State-Trait Anxiety Inventory, Somatic Perception Questionnaire, Depression Adjective Checklist, Profile of Mood States, Eysenck Personality Inventory, and the Embedded Figures Test. The test-retest reliability of the pain test ranged from .64 to .84 across trials separated by a 3-wk. period. In the first experiment significant multiple regressions ranging between .57 and .72 were observed and psychological traits (field dependence, extraversion and trait anxiety) accounted for the variance in these analyses. In the next experiment significant multiple Rs ranging from .62 to .68 were observed. This served as cross-validation for the first experiment. The major difference was that psychological states (depression and vigor) as well as traits entered the multiple regression equations for certain of the analyses. It was concluded that selected psychological states and traits are significantly correlated with the perception of pain.
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PMID:Psychometric correlates of pain perception. 70 52

The surgical approach to frontal sinus disease has been subject to much variation. Experimental evidence for new treatment modalities is quite limited. Frontal osteoplasty, while probably the best procedure to date, has up to a 25 percent failure rate. Possible complications include recurrent disease, incomplete bony obliteration (Macbeth technique), infection of the adipose implant, frontal bossing or depression, and laceration of the dura. Four experimental groups were designed using the canine frontal sinus model. Results indicated that stripping the mucosa in a normal sinus with intact periosteum and a patent nasofrontal duct will not consistently lead to normal mucosal regeneration. Second, the additional factor of removing the periosteum (as in osteoplasty by osteoneogenesis), leads to partial fibrous obliteration complicated by mucocele formation. Third, sinus obliteration by osteoneogenesis was much more consistent with concurrent closure of the nasofrontal duct. Fourth, intentionally leaving a strip of mucosa leads to failure of obliteration by osteoneogenesis 100 percent of the time. Finally, bony-fibrous obliteration increases with time but is still incomplete after one year. In light of these results, fat obliteration with closure of the nasofrontal duct is probably more reliable than obliteration by osteoneogenesis.
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PMID:Frontal sinus disease. III. Experimental and clinical factors in failure of the frontal osteoplastic operation. 111 98

A case report on periosteal hemangioma in the left tibia of an 11-year-old girl demonstrates roentgenographic thickening, sclerosis, and a smooth scalloping cortical depression in the bone. En block exicision of the defect, together with the markedly thickened periosteum, revealed a combination of cavernous and capillary bone hemangiomas.
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PMID:Tibial periosteal hemangioma. 112 81

After detailed examination of most products used for rehabilitation of atrophied alveolar borders, the authors describe the procedure of surgical use of hydroxylapatite blocks placed under periosteum. In a further stage, this method can be completed by a vestibuloplasty combined with a depression of the floor covered and protected by a graft.
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PMID:[Pre-prosthetic surgical ridge augmentation]. 263 Feb 1

A three-dimensional computer simulation of the basilar crescentic osteotomy has been presented. The bunion deformity consists of hallux valgus, an increased first and second intermetatarsal angle, pronation of the great toe, and elevation of the first metatarsal head. Every foot is different and some may have more or less of each of the above noted components. Because the deformity is multiplanar, at least two roentgenograms are needed to evaluate the deformity. The weight-bearing, anterior-posterior roentgenogram is the principle radiograph used in preoperative planning. The use of a weight-bearing, sesamoid roentgenogram is recommended to quantify the anterior-posterior deflection and rotation of the first metatarsal head. A computer model (based on a cylinder) of the first metatarsal has been formulated. The osteotomy then was performed in a variety of scenarios in order to simulate the surgical correction. A great deal of flexibility is afforded by this osteotomy. The surgeon needs to be aware of the coupled motions that occur. That is, closure of the intermetatarsal angle may also cause head rotation, depression, or elevation. If the osteotomy is performed in an oblique multiplanar direction, then it is possible for the metatarsal head to elevate, pronate, and significantly shorten as the intermetatarsal angle is closed. If this scenario should occur, a poor surgical outcome will result. Excision of the medial eminence is recommended after the osteotomy has been completed and secured with stable fixation because of these rotational changes. The basilar crescentic osteotomy is an excellent method for correction of a marked metatarsus primus varus. It is important to pay close attention to a variety of anatomic considerations. The osteotomy must not be made in the diaphysis because of potential nonunion. There should be little dissection of the periosteum because of possible delayed union. As in any bunion surgery, it is essential to perform an adequate, distal, soft-tissue repair. Three dimensional preoperative planning is essential in obtaining correction of all components of a bunion. Specific guidelines, based on a three-dimensional computer model, are now available. An interactive computer program also is available to aid the surgeon in preoperative planning. We hope there will be better understanding of this technically difficult but highly versatile osteotomy.
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PMID:Basilar crescentic osteotomy. A three-dimensional computer simulation. 279 52

The periosteal chondroma (juxtacortical chondroma) is an unusual tumor which usually occurs on the surface of tubular bones in the metaphyseal area. In this study, we reviewed the clinicopathologic features of 22 patients representing 23 instances of periosteal chondroma and discuss the radiologic and histologic features necessary for accurate diagnosis. The characteristic radiologic appearance is of a single cartilaginous mass in the metaphyseal periosteum causing well-defined depression or "saucerization" of the adjacent cortex. The radiologic differential diagnoses include soft-tissue tumors compressing bone, fibrous cortical defect, and periosteal chondrosarcoma or osteosarcoma. Histologic features include lobules of hyaline cartilage with frequent areas of hypercellularity, binucleate chondrocytes, and focal mild cytologic atypia. The histologic features clearly identify the tumor as chondrogenic; however, familiarity with the x-rays may be necessary to recognize the tumor as benign.
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PMID:Periosteal chondroma. A clinicopathologic study of 23 cases. 718 Sep 62

The coronal incision used for brow lift procedure has a high rate of localized alopecia, widening, and depression of the scar at the suture line. Other sequelae of the standard coronal brow lift incision procedure are "stretch-back" with a recurrent brow ptosis, poor brow elevation, and numbness beyond the incision line. Factors causing alopecia are tension, use of a monopolar cautery, use of key sutures with undue tension, one-layer closure, and sutures left too long. Recurrent brow ptosis may be due to anterior displacement of the posterior scalp flap, stretching of the anterior frontal skin flap, or insufficient power of the weakened frontalis muscle. Poor brow elevation may be due to unsatisfactory dissection on the glabella and orbital rims. Numbness and itching beyond the incision line are due to a low coronal incision. To avoid these problems, the following principles were followed: (1) If not contraindicated, the incision is made high on the vertex of the head, posterior to a biauricular line. (2) The pericranium is included in the frontal flap starting at the incision lines. (3) The subperiosteal dissection is continued down to the orbital rims and nasal bones. (4) The release of the periosteum at the arcus marginalis or just above allows repositioning of the brow structures. (5) The inelastic pericranium maintains the position of the elevated structures and avoids stretching of the frontal skin. (6) The integrity of the frontalis muscle is maintained completely. (7) Two large triangles of scalp resected in the posterior flaps allow fixing the position of the posterior scalp and match better the length of the anterior flap. (8) The galea periosteal rim flap allows anchoring of the frontal flap to the undersurface of the posterior scalp flap. This stabilizes the closure with minimal tension on the hair-bearing portion of the scalp. The wide surface of contact avoids depression and widening at the suture line. (9) Closure with skin staples avoids constriction of the hair follicles. (10) Hemostasis is done with a bipolar cautery. (11) No through-and-through key sutures are used. Some of these principles were introduced to the endoscopic subperiosteal forehead lift. The modifications mentioned above have been used in 92 open brow/face lift procedures with excellent aesthetic and functional results and minimal complications.
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PMID:The anchor subperiosteal forehead lift. 1130 18

Bone soft tissue remodelling at the femoral and tibial insertions of the medial collateral ligament (MCL) of the rat knee was monitored at regular intervals from birth to 120 days of age in 40 Sprague Dawley rats. At birth the femoral insertion originated from the perichondrium of the epiphysis. By day 8 the perichondrium within the insertion had turned into fibrocartilage. Secondary ossification of the femoral epiphysis had progressed in the region near to the insertion site by day 15. The epiphyseal cartilage was entirely replaced by bone by day 40 except for the fibrocartilage within the insertion. After that stage, no qualitative change in zonal insertion characteristics was observed, but only increase in size and decrease in cellularity. At birth, the tibial ligament inserted onto the thin cortical bone of the metaphysis via periosteum. At day 8, osteoclasts started to resorb the thin cortical bone at the ligament insertion, thus forming a metaphyseal depression between days 10 and 20. From days 20 to 120, the insertion remained qualitatively unchanged, showing three zones, the ligament, periosteum, and metaphyseal trabecular bone. The deep periosteal layer showed osteoclastic activity in the proximal part and osteoblastic activity in the distal part. The migration-mechanism of the ligament insertion during growth seems to be caused by this growth-related osteoclastic resorption of the proximal metaphyseal bone and by simultaneous osteogenic activity, which successively cements the distal part of the ligament to bone. The persistence of the periosteal layer and the metaphyseal depression for up to 120 days may be regarded as a sign of continuing growth in this animal model. This is the first investigation showing that the formation of the metaphyseal depression is a purely postnatal event, and suggests that this process might be initiated by the change in mode of growth and joint biomechanics after birth, enabling ligament development and migration in a growing and increasingly loaded weight-bearing joint. The mainly resorptive process, which takes place during development of the tibial MCL insertion, may account for the tensile failure of this ligament that commonly occurs at this site during growth. The pronounced morphological differences between the chondral femoral and the periosteal tibial attachment of the adult MCL are apparently caused by the different postnatal development processes at epiphyses and metaphyses.
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PMID:The postnatal development of the insertions of the medial collateral ligament in the rat knee. 883 96

Fractures of the humeral head are very common in elderly people, with 70% of all such fractures being seen at an age of more than 60 years. For the radiological examination of the fracture, x-rays from two levels are mandatory. The number and position of the fragments, assessment of intact or ruptured periosteum between the fragments and muscle forces acting on the fragments have to be determined from the x-rays. A 3-D CT scan can be very useful for better understanding of the character of the fracture. The remaining displacement between fragments after reduction have to be evaluated according to their location. Even small incongruities between fragments in the subacromial space will impair the gliding mechanism, whereas remaining displacements between the head and shaft can be accepted to a much larger extent. According to the fracture mechanism, we can basically differentiate between avulsion fractures and depression fractures. The avulsion fractures are characterised by a varus tendency of the humeral head,whereas the depression fractures are characterised by a valgus position of the head fragment. This has to be taken into consideration when choosing the implant for fixation. The indication for reconstructive surgery or prosthetic replacement depends on the type of fracture, on the quality of bone and on the familiarity of the surgeon with the treatment of humeral head fractures. The implants currently used for fixation can basically be differentiated between rigid and semi-rigid. The indication for the one or the other depends on the fracture type and the bone quality. In general, for simple fractures and in case of poor bone quality semi-rigid implants are indicated. Despite the fact that an understanding of the character of the fractures and implants has improved over the last few years, there are still types of fractures which need primary prosthetic replacement.
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PMID:[Fractures of the humeral head]. 1295 31

Cephalhematoma is a collection of blood beneath the periosteum of the bones in the cranial vault. The treatment strategy of most cephalhematoma is conservative. However, in cases of ossified cephalhematoma causing deformities of skull, surgical management is indicated. From 1996 to 2002, the authors treated three cases of ossified cephalhematoma with the suggested pathogenesis of ossification, which cephalhematoma goes to ossification process, rather than calcification. Surgical treatment, which is bony shaving with a burr on the irregular margin site, was performed in one case in which the thickness of the skull in the bulging area was the same as in the normal area in preoperative computed tomography (CT) scan, and a depression did not exist in the operative field. In two cases in which there was any difference in bony density in the preoperative CT scan and depression after removal of cephalhematoma, the bony cap was remodeled into multiple pieces and the depressed region was reconstructed with a remodeled bone cap as an onlay bone graft. There was no evidence of complications and recurrence, and there was good reconstitution of the skull contour in all cases.
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PMID:Surgical treatment of ossified cephalhematoma. 1534 17


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