University of Vermont

About: University of Vermont is a education organization based out in Burlington, Vermont, United States. It is known for research contribution in the topics: Population & Poison control. The organization has 17592 authors who have published 38251 publications receiving 1609874 citations. The organization is also known as: UVM & University of Vermont and State Agricultural College.

Adolescent idiopathic scoliosis.

Abstract: Adolescent idiopathic scoliosis (AIS) is the most common form of structural spinal deformities that have a radiological lateral Cobb angle - a measure of spinal curvature - of ≥10(°). AIS affects between 1% and 4% of adolescents in the early stages of puberty and is more common in young women than in young men. The condition occurs in otherwise healthy individuals and currently has no recognizable cause. In the past few decades, considerable progress has been made towards understanding the clinical patterns and the three-dimensional pathoanatomy of AIS. Advances in biomechanics and technology and their clinical application, supported by limited evidence-based research, have led to improvements in the safety and outcomes of surgical and non-surgical treatments. However, the definite aetiology and aetiopathogenetic mechanisms that underlie AIS are still unclear. Thus, at present, both the prevention of AIS and the treatment of its direct underlying cause are not possible.

Minimal-access surgery for staging of malignant melanoma.

Abstract: Objective: To develop a simple, minimally invasive technique of determining whether regional node metastasis has occurred in patients with melanoma. Setting: Teaching hospital tertiary care and private practice settings. Patients: Between February 1993 and October 1994, 121 patients with invasive malignant melanoma and clinically negative lymph nodes were enrolled in this clinical trial. Design: Consecutive sample clinical trial. Within 24 hours prior to lymph node resection, a radioactive tracer was injected into the dermis around the site of the primary melanoma. Forty-four patients also had blue dye injected immediately prior to surgical resection. Measurement of radioactivity in the lymph nodes and surgical localization were made using a handheld gamma detector. Radiolabeled nodes were selectively removed with the least dissection possible. In patients with pathologically positive radiolabeled nodes, regional lymphadenectomy was performed. Outcome Measures: Successful identification of radiolabeled sentinel lymph nodes, correlation of radiolabeling with injection of blue dye, and regional node recurrence rate. Results: Surgeons successfully resected the radiolabeled sentinel lymph nodes in 118 (98%) of 121 patients. One hundred percent of blue-stained lymph nodes were successfully radiolabeled. Fifteen patients had pathologically positive sentinel lymph nodes. In 10 patients, the sentinel node was the only node with metastasis. Two systemic and one regional node recurrences occurred during a mean follow-up of 220 days. Conclusions: Selective gamma probe—guided resection of the radiolabeled sentinel lymph node is possible in over 95% of patients with melanoma. This technique offers a simple and reliable method of staging of regional lymph nodes in these patients without performing a regional lymphadenectomy. (Arch Surg. 1995;130:654-658)

Anterior Cruciate Ligament Strain Behavior During Rehabilitation Exercises In Vivo

Abstract: Before studying the biomechanical effects of rehabilitation exercises on the reconstructed knee, it is important to understand their effects on the normal anterior cruciate ligament. The objective of this investigation was to measure the strain behavior of this ligament during rehabilitation activities in vivo. Participants were patient volunteers with normal anterior cruciate ligaments instrumented with the Hall effect transducer. At 10 degrees and 20 degrees of flexion, ligament strain values for active extension of the knee with a weight of 45 N applied to a subject's lower leg were significantly greater than active motion without the weight. Isometric quadriceps muscle contraction at 15 degrees and 30 degrees also produced a significant increase in ligament strain, while at 60 degrees and 90 degrees of knee flexion there was no change in ligament strain relative to relaxed muscle condition. Simultaneous quadriceps and hamstrings muscles contraction at 15 degrees produced a significant increase in ligament strain compared with the relaxed state but did not strain the ligament at 30 degrees, 60 degrees, and 90 degrees of flexion. Isometric contraction of hamstrings muscles did not produce change in ligament strain at any flexion angle. Exercises that produce low or unstrained ligament values, and would not endanger a properly implanted graft, are either dominated by the hamstrings muscle (isometric hamstring), involve quadriceps muscle activity with the knee flexed at 60 degrees or greater (isometric quadriceps, simultaneous quadriceps and hamstrings contraction), or involve active knee motion between 35 degrees and 90 degrees of flexion.

Three-dimensional terminology of spinal deformity. A report presented to the Scoliosis Research Society by the Scoliosis Research Society Working Group on 3-D terminology of spinal deformity.

Abstract: Conventional terminology of three-dimensional description of spinal deformity is ambiguous and mostly tied to either a frontal or sagittal plane view of the spine. The article proposes a rationalized system for describing the shape of the spine. The spine is viewed as a line in space ('vertebral body line') with three 'angulations' specifying the orientation of each vertebra. Four axis systems are defined for the whole body, the spine, curve regions, and individual vertebrae, respectively. These in turn define the principal planes of the body, spine, curve regions, and vertebrae. Curvature can be defined as a local measure at a point on the vertebral body line, or as a regional measure between specified end vertebrae. Torsion is defined both as a local geometric property of the vertebral body line, and as measure of the relative axial plane angulations between specified vertebrae. Linear distance measures define the deviations of specified vertebrae from the local, regional, spinal, and global axis systems. Practical recommendations for positioning patients are made. This new system of terminology recognizes the 3-dimensional nature of scoliosis and other spinal deformities and is intended to rationalize communication in both research and clinical practice.

Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates

Abstract: OBJECTIVE: We designed a multicenter randomized trial to compare 3 approaches to the initial respiratory management of preterm neonates: prophylactic surfactant followed by a period of mechanical ventilation (prophylactic surfactant [PS]); prophylactic surfactant with rapid extubation to bubble nasal continuous positive airway pressure (intubate-surfactant-extubate [ISX]) or initial management with bubble continuous positive airway pressure and selective surfactant treatment (nCPAP). DESIGN/METHODS: Neonates born at 26 0 7 to 29 6 7 weeks9 gestation were enrolled at participating Vermont Oxford Network centers and randomly assigned to PS, ISX, or nCPAP groups before delivery. Primary outcome was the incidence of death or bronchopulmonary dysplasia (BPD) at 36 weeks9 postmenstrual age. RESULTS: 648 infants enrolled at 27 centers. The study was halted before the desired sample size was reached because of declining enrollment. When compared with the PS group, the relative risk of BPD or death was 0.78 (95% confidence interval: 0.59–1.03) for the ISX group and 0.83 (95% confidence interval: 0.64–1.09) for the nCPAP group. There were no statistically significant differences in mortality or other complications of prematurity. In the nCPAP group, 48% were managed without intubation and ventilation, and 54% without surfactant treatment. CONCLUSIONS: Preterm neonates were initially managed with either nCPAP or PS with rapid extubation to nCPAP had similar clinical outcomes to those treated with PS followed by a period of mechanical ventilation. An approach that uses early nCPAP leads to a reduction in the number of infants who are intubated and given surfactant.