Toxic leukoencephalopathy versus delayed post-hypoxic leukoencephalopathy after oral morphine sulphate overdose.

Toxic leukoencephalopathy (TLE) is a rare pathology caused by various substances including opioids (notably heroin), immunosuppressants, chemotherapy agents, cocaine, alcohol and carbon monoxide. However, although heroin is metabolised by the body into morphine, there is a striking paucity in cases of primary oral morphine-induced TLE, especially in the adult population. We present the case of a man in his 40s admitted to hospital in respiratory depression with a Glasgow Coma Scale (GCS) score of 6 after taking an overdose of oral morphine sulphate.

Physical Activity After Transient Ischemic Attack or Mild Stroke Is Business as Usual.

Background And Purpose: Regular, sustained moderate-to-vigorous physical activity (MVPA) is a recommended strategy to reduce the risk of recurrent stroke for people who have had transient ischemic attack (TIA) or mild stroke. This study aimed to explore attitudes toward, and experience of engaging in physical activity by adults following a TIA or mild stroke.

Methods: Constructivist grounded theory methodology informed data collection and analysis.

Participants' Perspective of Engaging in a Gym-Based Health Service Delivered Secondary Stroke Prevention Program after TIA or Mild Stroke.

People who have had a transient ischemic attack (TIA) or mild stroke have a high risk of recurrent stroke. Secondary prevention programs providing support for meeting physical activity recommendations may reduce this risk. Most evidence for the feasibility and effectiveness of secondary stroke prevention arises from programs developed and tested in research institute settings with limited evidence for the acceptability of programs in 'real world' community settings.

Leigh syndrome caused by mutations in is associated with a better prognosis.

Objectives: Mitochondrial methionyl-tRNA formyltransferase (MTFMT) is required for the initiation of translation and elongation of mitochondrial protein synthesis Pathogenic variants in have been associated with Leigh syndrome (LS) and mitochondrial multiple respiratory chain deficiencies. We sought to elucidate the spectrum of clinical, neuroradiological and molecular genetic findings of patients with bi-allelic pathogenic variants in .

Methods: Retrospective cohort study combining new cases and previously published cases.

Early, specialist vocational rehabilitation to facilitate return to work after traumatic brain injury: the FRESH feasibility RCT.

Background: Up to 160,000 people incur traumatic brain injury (TBI) each year in the UK. TBI can have profound effects on many areas of human functioning, including participation in work. There is limited evidence of the clinical effectiveness and cost-effectiveness of vocational rehabilitation (VR) after injury to promote early return to work (RTW) following TBI.

Facilitating return to work through early specialist health-based interventions (FRESH): protocol for a feasibility randomised controlled trial.

Background: Over one million people sustain traumatic brain injury each year in the UK and more than 10 % of these are moderate or severe injuries, resulting in cognitive and psychological problems that affect the ability to work. Returning to work is a primary rehabilitation goal but fewer than half of traumatic brain injury survivors achieve this. Work is a recognised health service outcome, yet UK service provision varies widely and there is little robust evidence to inform rehabilitation practice.

Campaign best practice in intravenous therapy.

Intravenous therapy is an integral part of nursing care but is associated with a high risk of infection. This article outlines a campaign that aimed to increase awareness of best practice for IV therapy and reduce the risks of healthcare-associated IV infections in hospital and community settings.

The Oxford Medial Partial Knee Replacement. The rationale for a femur first technique.

Background: The Oxford Medial Partial Knee Replacement (PKR) has been in clinical use for more than 20 years. The current surgical technique requires a number of judgements to be made, and even in the most experienced hands surgery can be challenging. We present an alternative surgical technique, which we believe addresses the unpredictability of the current method.

Botulinum Toxin in the management of hitchhiker's toe.

Introduction: Hyperextension of the extensor hallucis longus (EHL) muscle is a well recognised disabling sequel of either pyramidal or extrapyramidal lesions causing what is known as striated or hitchhiker's toe. Surgery was the only effective strategy to manage EHL hyperextension before botulinum toxin's use to manage muscular dystonia and spasticity became widely popular.

Methods: A multicentre retrospective study.

Flexion after total knee replacement. A comparison between the Medial Pivot knee and a posterior stabilised implant.

A comparison was made between 261 knees replaced with the Medial Pivot arthroplasty and 288 replaced with the 913 posterior stabilised arthroplasty (PS knee). There was no significant difference in the flexion obtained at 12 months after surgery (111 degrees and 109 degrees , respectively). When the knees were grouped into preoperative flexion ranges, there was no significant difference between the two implants.

Two clinical tests for assessing lateral compartment arthritis.

Two clinical tests, the valgus tap test and the valgus skid test, are described which detect bone contact in the lateral compartment of the knee. They are useful in planning surgical intervention.

Can the epicondylar axis be defined accurately in total knee arthroplasty?

As part of a study on rotational alignment of the femoral component in knee replacement, the surgical epicondylar axis was identified in 74 knees and marked with pins. An alternative technique was employed to achieve rotational alignment and in each case the distance between the pins and the cut surface of the posterior condyles was measured. The alignment of the femoral component was measured postoperatively by axial CT scans of the distal femur, allowing an assessment to be made of what would have been achieved if the epicondylar pins had been used for guidance.

Accuracy of implantation of components in the Oxford knee using the minimally invasive approach.

Screened postoperative X-rays of 224 Oxford knees implanted through the minimally invasive approach were analysed using 16 criteria. The technique was as recommended by the Oxford Group except that the femoral intramedullary rod was used only as a guide to flexion/extension of the femoral component. All femoral components were within the recommended range for varus/valgus and mediolateral position.

Achieving ligament stability and correct rotational alignment of the femur in knee arthroplasty: a study using the Medial Pivot knee.

In a series of 90 Medial Pivot arthroplasties rotational alignment of the femur was achieved by provisionally reconstructing the lateral side of the joint and tensioning the medial side with feeler gauges. Axial CT scans were employed to measure the rotational alignment relative to surgical epicondylar axis. In valgus knees the cutting block was externally rotated to adjust for posterolateral bone loss.

Patellar instability-can the TT-TG distance be measured clinically?

The horizontal distance between the tibial tubercle and the centre of the groove (TT-TG) is an important determinant in the treatment of patellar instability. We set out investigate whether it could be measured in the outpatient setting using a length of string lined up between a proximal reference point, the centre of the patello-femoral groove and the tibial tubercle. The technique was employed in 24 knees of patients awaiting patellar realignment and the results compared with linked MRI slices through the trochlear and tibial tubercle.

The influence of the tibial sagittal cut on component position in the Oxford knee.

The alignment of the components of the Oxford knee replacement were analysed before and after modification of technique for performing the sagittal cut. In the 126 knees prior to the change, there was wide variation in the apparent femoral rotation on screened X-rays centred on the tibial component. In the 40 knees after the change, the variability was markedly reduced (traditional technique, mean femoral rotation 7.

The effect of aprotinin on blood loss in bilateral total knee arthroplasty.

Twenty-five patients undergoing bilateral total knee arthroplasty were given aprotinin (1-2 million units) in doses adjusted for weight, infused at the end of the first arthroplasty. Blood management was compared with our previous series of 68 patients who were not treated with aprotinin. Blood drained and re-transfused in the first 6 h was significantly less in the aprotinin group (323 ml, S.

Accuracy of patellar resection in total knee replacement. A study using the medial pivot knee.

A series of 80 patellae were randomly allocated to osteotomy by sawing or milling while implanting the medial pivot knee. Three landmarks were used to control the plane of the cut in the coronal plane. The lateral edge of the patellar tendon distally, and both medial and lateral edges of the quadriceps tendon proximally.

Varus/valgus alignment of the femur in total knee arthroplasty. Can accuracy be improved by pre-operative CT scanning?

In a series of 80 consecutive knee replacements, pre-operative scout scans of the femur were taken and the angle between the slope of the worn femur and the mechanical axis was measured. At surgery the angle of the distal femoral cut was adjusted to make it perpendicular to the mechanical axis. Post-operative scans revealed that 97.

Patellar subsidence in heavy patients undergoing bilateral knee arthroplasty.

A retrospective review of 40 patients undergoing simultaneous bilateral total knee replacement was undertaken to investigate the link between patient body weight and patellar subsidence. Of the 40 patients, three (five knees) had collapse or fracture of the patellar bone and four (five knees) had developed radiolucent lines around the patellar implant. None of these patients were symptomatic and their Knee Society and Oxford functional scores were satisfactory.

Unicondylar arthroplasty of the knee--cheap at half the price?

Between June 1999 and October 2002 we performed 355 total knee replacements (75 bilateral cases) and 135 medial unicondylar arthroplasties (27 bilateral cases). The cases were not randomised with the result that those undergoing total knee replacement had more severe disease though not enough to account for the differences observed. The total knees were in hospital 4 days longer than the unicondylar knees (8.