Cauda equina lymphoma–a rare presentation of primary central nervous system lymphoma: case report and literature review.
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Cauda equina lymphoma--a rare presentation of primary central nervous system lymphoma: case report and literature review.
Br J Neurosurg. 2012 Dec;26(6):868-71
Authors: Teo MK, Mathieson C, Carruthers R, Stewart W, Alakandy L
Abstract
The spinal cord is an extremely rare site for primary central nervous system (CNS) lymphoma (< 1%). Very few cases of primary cauda equina (including conus) lymphoma were previously reported. We report such a case, and with literature review, discuss their clinical features, operative and histopathological findings. Although rare, with an increasing incidence of CNS lymphoma, they should be considered in the differential diagnosis of intradural lesions. Furthermore, with intraoperative smear to establish diagnosis, extensive surgery can be avoided. The controversial role of glucocorticoids in the management of these patients is also discussed.
PMID: 22768968 [PubMed - indexed for MEDLINE]
Aging processes and the development of osteoarthritis.
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Aging processes and the development of osteoarthritis.
Curr Opin Rheumatol. 2013 Jan;25(1):108-13
Authors: Loeser RF
Abstract
PURPOSE OF REVIEW: Aging is a primary risk factor for the development of osteoarthritis and the understanding of how aging processes contribute to the development of osteoarthritis is an important area of active research. The most recent literature in this area was reviewed in order to update investigators on the status of the field.
RECENT FINDINGS: The field is beginning to move beyond a cartilage focus to include other joint tissues relevant to osteoarthritis such as ligaments, meniscus, and bone. Synovitis also appears to play a role in osteoarthritis but has not been a focus of aging studies. Studies in small animals, including mice and rats, demonstrate age-related changes that can contribute to osteoarthritis and show that animal age is a key factor to be considered in interpreting the results of studies using surgically induced models of osteoarthritis. There is accumulating evidence that cellular processes such as damage-induced cell senescence contribute to osteoarthritis and a growing body of literature on the role of epigenetic regulation of gene expression in aging and osteoarthritis.
SUMMARY: Not all osteoarthritis is due to aging processes in joint tissues, but the age-related changes being discovered certainly could play a major contributing role.
PMID: 23080227 [PubMed - indexed for MEDLINE]
[Arthroscopic single bundle anterior cruciate ligament anatomical reconstruction with remnant preservation].
[Arthroscopic single bundle anterior cruciate ligament anatomical reconstruction with remnant preservation].
Zhongguo Gu Shang. 2013 Feb;26(2):124-7
Authors: Dong YL, Cai CY, Jiang GY, Zhang L, Jiang WH, Yang GJ
Abstract
OBJECTIVE: To investigate the feasibility and clinical effects of single bundle anterior cruciate ligament anatomical reconstruction with remnant preservation.
METHODS: From October 2007 to November 2009, 17 patients (10 male and 7 female, ranging in age from 28 to 62 years, with an average of 39.3 years) with posterior cruciate ligament injuries were treated with single bundle anatomical reconstruction with remnant preservation. Nine patients had the injuries caused by traffic accident; 6 patients caused by falling down; and 2 patients caused by sports injuries. The average time from injury to surgery was 8.5 days (ranging from 2 to 14 days). The international knee documentation committee knee evaluation form (IKDC) and Lysholm were used to analysis the effect of surgery.
RESULTS: All the patients obtained the follow-up and the average time was 29.5 months (ranging from 24 to 39 months). There were no complications such as injuries of popliteal fossa artery, tibial nerves or peroneal nerve. Twelve patients had knee joint recovering to normal; 1 patient had stiff joints and was treated with arthroscopic surgery to release after 6 months,who had postoperative flexion lack of 20 degree and straight to normal. Three patients had flexion loss of 5 to 10 degree, and 1 patient had hyperextension limitation of 5 degree. Posterior drawer test in 17 patients and the Lachman test were negative. IKDC scores of the 17 patients achieved normal(16 patients) or near normal(1 patient). IKDC overall score normal in 16 patients (94.1%), close to normal in 1 case (5.9%). The IKDC subjective score was 94.3+/-5.1 and Lysholm score was 94.7+/-3.1 at the latest follow-up.
CONCLUSION: The single bundle anterior cruciate ligament with remnant preservation anatomical reconstruction can provide good clinical results.
PMID: 23678758 [PubMed - in process]
Could Targeted Exercise Programmes Prevent Lower Limb Injury in Community Australian Football?
Could Targeted Exercise Programmes Prevent Lower Limb Injury in Community Australian Football?
Sports Med. 2013 May 17;
Authors: Andrew N, Gabbe BJ, Cook J, Lloyd DG, Donnelly CJ, Nash C, Finch CF
Abstract
BACKGROUND: Australian football is a popular sport in Australia, at both the community and elite levels. It is a high-speed contact sport with a higher incidence of medically treated injuries when compared with most other organized sports. Hamstring injuries, ligament injuries to the knee or ankle, hip/groin injuries and tendinopathies are particularly common and often result in considerable time lost from sport. Consequently, the prevention of lower limb injuries is a priority for both community and elite Australian football organizations. There is considerable literature available on exercise programmes aimed at reducing lower limb injuries in Australian football and other running-related sports. The quality and outcomes of these studies have varied considerably, but indicate that exercise protocols may be an effective means of preventing lower limb injuries. Despite this, there has been limited high-quality and systematic evaluation of these data. OBJECTIVE: The aim of this literature review is to systematically evaluate the evidence about the benefits of lower limb injury prevention exercise protocols aimed at reducing the most common severe lower limb injuries in Australian football. METHODS: The Cochrane Central Register of Controlled Trials, the Cochrane Bone Joint and Muscle Trauma Group Specialized Register, MEDLINE and other electronic databases were searched, from January 1990 to December 2010. Papers reporting the results of randomized controlled trials (RCTs), quasi-RCTs, cohort and case-control studies were extracted. Primary outcomes were injury reduction or risk factor identification and/or modification. Secondary outcomes were adherence to any trialled interventions, injury severity and adverse effects such as secondary injuries and muscle soreness. The methodological quality of extracted manuscripts was assessed and results were collated. RESULTS: Forty-seven papers were identified and reviewed of which 18 related to hamstring injury, eight related to knee or ankle ligament injury, five related to tendon injury and four were hip or groin injury related. Another 12 papers targeted general lower limb injuries. Most (n = 27 [57 %]) were observational studies, investigating injury risk factors. Twenty reported the results of intervention trials. Of these, 15 were efficacy trials reporting the effects of an intervention in reducing injury rates, four were biomechanical interventions in which the impact of the intervention on a known injury risk factor was assessed and one reported changes in injury risk factors as well as injury rates. The strength of the evidence base for exercise programmes for lower limb injury prevention was found to be limited, primarily due to the research methods employed, low adherence to interventions by the study participants and a lack of statistical power. Limited evidence obtained from a small number of RCTs suggests that balance and control exercises might be efficacious in preventing ankle ligament injuries and a programme involving a combination of balance and control exercises, eccentric hamstring, plyometrics and strength exercises could be efficacious in preventing all lower limb injuries. CONCLUSIONS: Overall, the evidence for exercise programmes as an efficacious lower limb injury prevention strategy is predominantly restricted to studies addressing injury aetiology and mechanisms. The findings of this review highlight the need to develop and test interventions in well designed population-based trials with an emphasis on promoting intervention uptake and adherence and, hence, intervention effectiveness. The results of this review can inform the development of the components of a future lower limb injury prevention exercise protocol for community-level Australian football.
PMID: 23681448 [PubMed - as supplied by publisher]
[Intracondylar segment osteotomy : Correction of intra-articular malalignment after fracture of the tibial plateau].
[Intracondylar segment osteotomy : Correction of intra-articular malalignment after fracture of the tibial plateau].
Unfallchirurg. 2013 May;116(5):413-26
Authors: Krettek C, Hawi N, Jagodzinski M
Abstract
Intracondylar deformities after tibial plateau fractures are intra-articular deformities which present within the medial and/or lateral knee compartments. They exist either isolated or in combination with other extra-articular deformities and/or ligament problems. These deformities are complex problems and difficult to treat. While many treatment concepts exist for extra-articular deformities there is limited information available for intra-articular or even intracondylar deformities. Selecting the appropriate procedure for the approach, osteotomy, management of bone defects and cartilage damage is crucial. The authors describe the analysis, planning, treatment and clinical outcome for these rare but difficult problems and present step by step details of the surgical technique.
PMID: 23681487 [PubMed - in process]
Neuromuscular ultrasound in common entrapment neuropathies.
Neuromuscular ultrasound in common entrapment neuropathies.
Muscle Nerve. 2013 May 16;
Authors: Cartwright MS, Walker FO
Abstract
Neuromuscular ultrasound involves the use of high-resolution ultrasound to image the peripheral nervous system of patients with suspected neuromuscular diseases. It complements electrodiagnostic studies well by providing anatomic information regarding nerves, muscles, vessels, tendons, ligaments, bones, and other structures that cannot be obtained with nerve conduction studies and electromyography. Neuromuscular ultrasound has been studied closely over the past 10 years and has been used most often in the assessment of entrapment neuropathies. This review focuses on the use of neuromuscular ultrasound in 4 of the most common entrapment neuropathies: carpal tunnel syndrome, ulnar neuropathy at the elbow and wrist, and fibular neuropathy at the knee. © 2013 Wiley Periodicals, Inc.
PMID: 23681885 [PubMed - as supplied by publisher]
Aseptic lymphocyte dominated vasculitis-associated lesion resulting from trunnion corrosion in a cobalt-chrome unipolar hemiarthroplasty.
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Aseptic lymphocyte dominated vasculitis-associated lesion resulting from trunnion corrosion in a cobalt-chrome unipolar hemiarthroplasty.
J Arthroplasty. 2013 Jan;28(1):196.e11-4
Authors: Khair MM, Nam D, DiCarlo E, Su E
Abstract
Most of the published descriptions of adverse soft tissue reactions that have been reported in the context of a metal-on-metal articulation have been in cases of total hip arthroplasty or resurfacing arthroplasty. Recently, several case reports have been published describing aseptic lymphocyte dominated vasculitis-associated lesions (ALVAL) in metal-on-polyethylene. To our knowledge, there has not been a description of a similar, aggressive reaction secondary to metal debris from the head-neck junction of a unipolar hemiarthroplasty component. In this case report, we describe a patient with a catastrophic failure of a unipolar hip hemiarthroplasty, secondary to aggressive osteolysis and an inflammatory mediated immunological reaction to metal debris.
PMID: 22795878 [PubMed - indexed for MEDLINE]
Mortality among third age patients with hip fracture and high cardiac risk.
Mortality among third age patients with hip fracture and high cardiac risk.
Med Arh. 2013;67(1):42-4
Authors: Dedovic Z, Talic-Tanovic A, Resic H, Vavra-Hadziahmetovic N
Abstract
INTRODUCTION: Mortality after hip fracture remains high in spite of the progress of medicine. Due to the trend toward longer life, the problem of hip fracture is getting more significant. The aim of this study is to determine the effects of surgical treatment in patients with high risk of hip fracture on mortality reduction.
METHODS: In the retrospective-prospective study, 66 patients aged 65-92 with a hip fracture and a high cardiac risk have been analyzed. The risk estimation was based on the Lee index. The patients with three or more risk factors were considered high-risk. The first group consisted of surgically treated patients with a hip fracture and at high cardiac risk, and in the second group were conservatively treated patients with a hip fracture and high cardiac risk.
RESULTS: In the group of conservatively treated patients, 75% were women and in operatively treated group 67.6%. Patient in both group are similar in relation to the participation of risk factor. A difference has been noticed in terms of renal insufficiency (RI). There was 18.8% conservatively treated patient with RI and 2.9% in operatively treated group.
CONCLUSION: Patients with hip fracture and at high cardiac risk have lower mortality when treated surgically.
PMID: 23678838 [PubMed - in process]
Health care performance comparison using a disease-based approach: The EuroHOPE project.
Health care performance comparison using a disease-based approach: The EuroHOPE project.
Health Policy. 2013 May 13;
Authors: Häkkinen U, Iversen T, Peltola M, Seppälä TT, Malmivaara A, Belicza E, Fattore G, Numerato D, Heijink R, Medin E, Rehnberg C
Abstract
This article describes the methodological challenges associated with disease-based international comparison of health system performance and how they have been addressed in the EuroHOPE (European Health Care Outcomes, Performance and Efficiency) project. The project uses linkable patient-level data available from national sources of Finland, Hungary, Italy, The Netherlands, Norway, Scotland and Sweden. The data allow measuring the outcome and the use of resources in uniformly-defined patient groups using standardized risk adjustment procedures in the participating countries. The project concentrates on five important disease groups: acute myocardial infarction (AMI), ischemic stroke, hip fracture, breast cancer and very low birth weight and preterm infants (VLBWI). The essentials of data gathering, the definition of the episode of care, the developed indicators concerning baseline statistics, treatment process, cost and outcomes are described. The preliminary results indicate that the disease-based approach is attractive for international performance analyses, because it produces various measures not only at country level but also at regional and hospital level across countries. The possibility of linking hospital discharge register to other databases and the availability of comprehensive register data will determine whether the approach can be expanded to other diseases and countries.
PMID: 23680074 [PubMed - as supplied by publisher]
Implementing the National Hip Fracture Database: An audit of care.
Implementing the National Hip Fracture Database: An audit of care.
Injury. 2013 May 13;
Authors: Patel NK, Sarraf KM, Joseph S, Lee C, Middleton FR
Abstract
BACKGROUND: Hip fractures are common injuries in the elderly, with significant associated morbidity and mortality rates. The National Hip Fracture Database (NHFD) was implemented to audit care according to national standards thus improving its clinical and cost-effectiveness. PATIENTS AND METHODS: We retrospectively examined the care pathway for all hip fractures after its introduction at our centre over 1 year, with an audit of care according to the BOA-BGS 'Blue Book' guidelines. Data between the first (period 1: initial audit) and second (period 2: re-audit) six months of the study period were compared. RESULTS: There were 372 patients (28% male, 72% female) in total with 190 in period 1 and 182 in period 2. For all patients, the median age was 85 years (range 33-101) and the median time to surgery was 24.5h (1-519.3), with 251 (67.5%) within 36h. Surgical delay was mainly due to lack of theatre space (37.6%) and medical reasons (54.7%). The median length of stay was 11 days (2-92) and the inpatient mortality rate was 6.2% (23). When comparing the two study periods, there were significantly more patients undergoing falls (p<0.01) and bone protection (p<0.01) assessments in period 2. Lack of theatre space was a significantly less common (p<0.01), with a significantly shorter median time to surgery (p=0.01) and length of stay (p<0.01) in period 2. More patients were discharged to rehabilitation units and the mortality rate was non-significantly lower in period 2 (7.4% vs. 5%). The best practice tariff was met in 45.3% and 70.3% (p<0.001) of patients in periods 1 and 2 respectively providing a total income of £95230.00 (GBP). CONCLUSIONS: Implementing the NHFD has led to an improvement the quality of hip fracture care according to national guidelines. More patients were assessed by an orthogeriatrician, with a shorter time to surgery and length of stay following re-audit. There is potential for an improvement in mortality rates as well as significant financial income for hospitals.
PMID: 23680283 [PubMed - as supplied by publisher]
D5 Creation