Abstract Introduction Simultaneous ipsilateral clavicle and acromioclavicular (AC) joint injury have been infrequently reported in the literature at this time. The purpose of this study was to assess ...incidence as well as assess risk factors for this dual injury pattern. Methods We performed a retrospective review of a prospectively collected database (Level III evidence), evaluating 383 adult patients without previous shoulder girdle injury or trauma with a minimum 1-year follow-up who sustained a displaced diaphyseal clavicle fracture. All patients in the study underwent either nonoperative management or surgical reduction and stabilization of a diaphyseal clavicle fracture with a plate and screw construct. Study subjects were followed with serial radiographs. Clavicle and shoulder radiographs, as well as chest radiographs and contralateral films in questionable cases, were used to assess for acromioclavicular joint injury in both operative and nonoperative groups. Additional data was collected on concurrent injuries, patient demographics, fracture characteristics, fixation techniques, surgical/post-operative data, and operative or nonoperative treatment. Results We found that 13/183 (7.1%) of patients undergoing fixation of a diaphyseal clavicle fracture had an ipsilateral AC joint injury, while 13/200 (6.5%) of patients undergoing conservative management had an ipsilateral AC joint injury. Critical analysis of the data revealed that presence of ipsilateral scapular body fractures, and a likely incidental association with superior plating fixation, were associated with an increased rate of this injury pattern. Conclusions Ipsilateral clavicle fracture and AC joint injury is much more common than traditionally believed, with an incidence of 6.8% overall. It is unknown how the presence of an associated AC injury influences outcome, as AC injury was not universally symptomatic.
Avec une rapidité surprenante, l'Allemagne a retrouvé son unité en 1990. Cet événement majeur de la fin du XXe siècle marquera profondément l'évolution interne du pays et l'avenir de l'Europe. Ce ...livre veut fixer des repères pour saisir la portée des vastes mutations en cours. Des spécialistes confirmés de l'Allemagne font le point sur les évolutions les plus significatives, aidant ainsi à comprendre ce qui se prépare de l'autre côté du Rhin.
L’avortement en RFA Ottomeyer-Hervieu, Christina
Les cahiers du CEDREF,
1995
Journal Article
Odprti dostop
L'unification allemande a relancé une nouvelle fois la controverse sur la législation de l'IVG. Si la polémique sur la réglementation de l'avortement a constitué la pierre d'achoppement de ...l'unification des deux Allemagnes, elle est le point focal qui a fait culminer les contradictions entre deux systèmes opposés en ce qui concerne le rôle de la femme dans la famille et dans la société, le rapport entre l'Eglise et l'Etat, la notion de la « vie en développement », bref, tous les concepts qui ...
Le Traité d’état sur l’Union monétaire, économique et sociale des deux Allemagnes, en vigueur depuis le 1er juillet 1990, constituait un pas décisif pour le processus de la réunification de la ...nation. Il ne réglait pas toutefois des problèmes politiques et juridiques fort controversés comme la législation sur l’avortement. Il s’agit là d’un débat complexe et passionnel qui a pris au cours des dernières décennies une dimension explosive au niveau politique et éthique. Les mêmes arguments sont ...
ABSTRACT
OBJECTIVES
Single case reports suggest that black blood MRI (T1‐weighted fat and blood suppressed sequences with and without contrast injection; BB‐MRI) may visualize intracranial vessel ...wall contrast enhancement (CE) in primary angiitis of the central nervous system (PACNS). In this single‐center observational pilot study we prospectively investigated the value of BB‐MRI in the diagnosis of large artery PACNS.
METHODS
Patients with suspected large artery PACNS received a standardized diagnostic program including BB‐MRI. Vessel wall CE was graded (grade 0‐2) by two experienced readers blinded to clinical data and correlated to the final diagnosis.
RESULTS
Four of 12 included patients received a final diagnosis of PACNS. All of them showed moderate (grade 1) to strong (grade 2) vessel wall CE at the sites of stenosis. A moderate (grade 1) vessel wall CE grade was also observed in 6 of the remaining 8 patients in whom alternative diagnoses were made: arteriosclerotic disease (n= 4), intracranial dissection (n= 1), and Moyamoya disease (n= 1).
CONCLUSIONS
Our pilot study demonstrates that vessel wall CE is a frequent finding in PACNS and its mimics. Larger trials will be necessary to evaluate the utility of BB‐MRI in the diagnostic workup of PACNS.
Recovery from stroke is presumed to be a function of a widespread cerebral network. Chronic white matter lesions (WML) have been proposed to be a predictor of poor outcome after acute stroke. We ...tested the hypothesis that the extent of WML has an effect on functional recovery in acute pontine stroke by disrupting the integrity of the supratentorial cerebral network.
Seventeen patients with acute unilateral pontine stroke who had received a standardized stroke workup and additional diffusion tensor imaging (DTI) were studied. After grading the extent of WML according to the Fazekas scale and semiautomated lesion volume calculation, we compared patients with acute pontine infarction and advanced WML to those with absent or minimal WML regarding baseline characteristics, stroke subtype and clinical outcome. In addition, we used tract-based spatial statistics for voxel-wise analysis of the DTI-derived parameter fractional anisotropy in the white matter tracts.
The volume of WML ranged between 0.1 and 42.1 cm³ (mean = 15.9) and was graded as follows: 0 in 5.9%, 1 in 35.3%, 2 in 41.2% and 3 in 17.6%. Both patients with Fazekas grades 2-3 (p = 0.014) as well as those with larger WML volumes (p = 0.037) had severer functional deficits at the 3-month follow-up. White matter tracts displaying a significant decrease in fractional anisotropy values were the corpus callosum, the anterior thalamic radiation and the inferior fronto-occipital fasciculus.
Chronic WML contribute to a less favorable clinical outcome after pontine stroke depending on (1) the extent of pre-existing WML and (2) the degree of disruption of cerebral connectivity as indicated by reduced tissue integrity in the white matter not affected by WML as detected by DTI and tract-based spatial statistics.
