First known case of catatonia due to cyclosporine A-related neurotoxicity in a pediatric patient with steroid-resistant nephrotic syndrome.

Background: Catatonia is a neuropsychiatric syndrome characterized by diverse psychomotor abnormalities, including motor dysregulation and behavioral and affective disturbances. Once thought to occur primarily in the context of schizophrenia, recent data suggest most cases of catatonia develop in individuals with depressive or bipolar disorders. Moreover, catatonia may ensue in general medical and neurological conditions, as well as due to a variety of pharmaceuticals, drugs of abuse, and toxic agents.

Current status and future prospects for the development of substance abuse vaccines.

Substance use disorders (SUD) are a significant threat to both individual and public health. To date, SUD pharmacotherapy has focused primarily on agonist medications (i.e.

Anti-NMDA Receptor Encephalitis in a Patient with Previous Psychosis and Neurological Abnormalities: A Diagnostic Challenge.

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune disorder characterized by IgG autoantibodies directed against the NR1 subunit of the NMDA glutamate receptor. Psychiatric symptoms are common and include psychosis, mania, depressed mood, aggression, and speech abnormalities. Neurological symptoms such as seizures, decreased responsiveness, dyskinesias, and other movement abnormalities and/or autonomic instability are frequently seen as well.

Seronegative Neuromyelitis Optica Spectrum Disorder following Exposure to Hepatitis B Vaccination.

Controversy exists regarding a potential link between exposure to recombinant hepatitis B vaccine (HBV) and central nervous system demyelinating diseases. Here, we present a case of seronegative neuromyelitis optica spectrum disorder (NMOSD) following exposure to HBV. A 28-year-old man developed painful eye movements 11 days after exposure to HBV.

Development of a scale to assess performance following primary total knee arthroplasty.

Background: Quantitative assessment of postsurgical knee motion provides sensitive measurements, but results are technical and may not be meaningful to patients. Although several knee-specific instruments exist, no patient-reported outcome (PRO) measure correlates function with improved stability, motion, satisfaction, and confidence.

Objective: To address both the above limitations by developing a PRO measure to assess the phenomenon of a "normal" knee after primary total knee arthroplasty (TKA).

Joint line restoration in a contemporary revision knee system.

We investigated a new revision total knee arthroplasty device and associated instrumentation to determine if it could reduce intraoperative complexity and restore the joint line through the arc of motion. In a prospective multicenter study, a total of 95 consecutive patients undergoing a revision knee arthroplasty were evaluated. Medical history, functional health scores, and intraoperative data were collected.

Anterior referencing versus posterior referencing in total knee arthroplasty.

Appropriate femoral component positioning and sizing is essential for proper kinematic function in total knee arthroplasty (TKA). Anterior or posterior referencing (AR or PR) are two major techniques for setting center of rotation and for balancing the sagittal plane of the arthroplasty. Both techniques have advantages and disadvantages.

Incidence of bicompartmental osteoarthritis in patients undergoing total and unicompartmental knee arthroplasty: is the time ripe for a less radical treatment?

We sought to determine the incidence of bicompartmental osteoarthritis among knee replacement patients for possible bone-sparing procedures. In 259 consecutive Knee Registry subjects undergoing total or unicondylar knee arthroplasty, all three compartments of the knee joint were evaluated. Radiographic images and preoperative cruciate ligaments assessment combined with intraoperative cartilage grading using Outerbridge classification was implemented for patients' evaluations.

Mini-midvastus versus mini-medial parapatellar approach for minimally invasive total knee arthroplasty: outcomes pendulum is at equilibrium.

Comparisons between mini-midvastus (mMV) and mini-medial parapatellar approach (mMPP) for total knee arthroplasty (TKA) have reported variable results. We compared two approaches with minimum two year follow up. Forty consecutive patients who underwent staged bilateral TKA were prospectively randomized for mMPP approach in one knee and mMV approach in the other.

Function related specifications for total knee arthroplasty implant devices.

Current specifications for total knee implant devices reflect components' properties separate from each other and often in noncomparable units. We can recognize the tibial base plate thickness, size of femoral component, etc. How does it reflect the functional capabilities of the whole assembly, particularly in relation to wear and survivorship? Such approach does not take into account the fact that the individual components interact with each other, which in turn defines the final evaluation.

Effect of implant design on knee flexion.

From March 2006 to August 2008, 93 subjects (186 knees) underwent simultaneous bilateral total knee arthroplasty performed by eight surgeons at North American centers. This randomized study was conducted to determine whether non-weight-bearing passive flexion was superior for knees receiving a posterior stabilized high flexion device compared to a posterior stabilized standard device in the contra-lateral knee. Weight-bearing single leg active flexion was one secondary endpoint.

Venous thromboembolic disease management patterns in total hip arthroplasty and total knee arthroplasty patients: a survey of the AAHKS membership.

The American Association of Hip and Knee Surgeons (AAHKS) distributed a survey to its members exploring practice patterns implemented to prevent venous thromboembolic disease (VTED) in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Of 720 (33%) members, 236 responded. Prophylaxis was prescribed for 100% of patients during the course of hospitalization for THA and TKA.

Segmental limb reconstruction after tumor resection.

Limb salvage of large segmental and osteoarticular defects after tumor resection has become the standard of care for most patients with musculoskeletal tumors because overall survival is the same when compared with that seen in amputation patients. This study examines limb salvage for the surgical management of large segmental defects in terms of local recurrence, complications, and functional outcome in both primary and metastatic lesions. We retrospectively identified 32 patients with benign or malignant tumors of bone who underwent resection and limb salvage reconstruction by means of a custom or modular metal implant between 1985 and 1995.

Arthroscopic release for lateral epicondylitis: a cadaveric model.

At least 10 different surgical approaches to refractory lateral epicondylitis have been described, including an arthroscopic release of the extensor carpi radialis brevis tendon. The advantages of an arthroscopic approach include an opportunity to examine the joint for associated pathology, no disruption of the extensor mechanism, and a rapid return to premorbid activities with possibly fewer complications. A cadaveric study was performed to determine the safety of this procedure.

The porous-coated anatomic total hip prosthesis, inserted without cement. A prospective study with a minimum of ten years of follow-up.

One hundred consecutive primary total hip arthroplasties performed with use of a porous-coated anatomic total hip prosthesis, fixed without cement, in ninety-one patients were followed prospectively for a minimum of ten years. At the time of the most recent follow-up, twenty patients (twenty-three hips) had died and seventy-one patients (seventy-seven hips) were living. The average age of the living patients was sixty-six years (range, thirty-two to ninety-two years), and their average Harris hip score was 84 points (range, 33 to 100 points).

A review of total joint replacement in active duty soldiers.

Thirty-two active duty soldiers (36 total joint replacements) were followed from 9 months and 18 years (average 4.1 years) to evaluate the outcome of total joint replacement in active duty soldiers. Follow-up consisted of clinical assessment and radiographic evaluation at 6 weeks, 3 months, 6 months, 1 year, and yearly thereafter.

Fractures through cystic lesions of the greater trochanter. A cause of late pain after cementless total hip arthroplasty.

Four patients who presented with sudden onset of hip pain 7 to 11 years after successful porous-coated cementless hip arthroplasty are described. These four patients were all diagnosed to have fractures through osteolytic cysts in the greater trochanter. One patient was seen initially with a displaced fracture of the greater trochanter.

Parachuting injuries among Army Rangers: a prospective survey of an elite airborne battalion.

Injuries are common in sports and military parachuting. This paper presents results of a prospective survey of parachuting injuries in an airborne Ranger battalion. The Ranger regiment is the U.

The diagnostic accuracy of history, physical examination, and radiographs in the evaluation of traumatic knee disorders.

We prospectively looked at the diagnostic accuracy of clinical examination of the knee in patients with arthroscopically documented knee injuries. The study included 156 patients with 156 knee injuries (72 acute and 84 chronic) who were seen during 1 year at Martin Army Hospital at Fort Benning Georgia. All patients were given a primary diagnosis based on their history, physical examination, and routine radiographs.

Structural bulk allografts in acetabular reconstruction. Analysis of two grafts retrieved at post-mortem.

Two acetabula which contained large bone allografts introduced at revision arthroplasty were obtained at post-mortem. The allografts had been placed in superior defects to support cementless acetabular components, and both hips were functioning well at the time of death. Clinical radiographs demonstrated apparent healing of graft to host bone, no graft collapse and stability of the acetabular components.

Morselized allograft in acetabular reconstruction. A postmortem retrieval analysis.

Contained acetabular defects often are repaired at revision surgery using morselized bone allograft. The extent to which this graft becomes incorporated is unknown, and the value of radiographs for predicting allograft incorporation is unclear. To better understand the effectiveness of morselized allograft in revision hip arthroplasty, the authors studied postmortem specimens from 3 patients treated with this type of graft.

Osteolysis around an uncemented cobalt chrome total hip arthroplasty.

One hundred consecutive uncemented Porous Coated Anatomic total hip arthroplasties performed in 91 patients who obtained prospective serial clinical and radiographic evaluation during a minimum 7-year followup period were studied for the occurrence, extent, and progression of localized periprosthetic bone loss (osteolysis). Periprosthetic bone loss occurred around the femoral component in 11 hips, the acetabular component in 2 hips, and both components in 2 hips during the followup interval. The bone loss was progressive in 6 hips (2 of 11 femoral cases, 2 of 2 acetabular cases, and 2 of 2 both component cases).

The porous-coated anatomic total hip prosthesis, inserted without cement. Results after five to seven years in a prospective study.

The results of 100 primary arthroplasties with a porous-coated anatomic total hip prosthesis that were performed consecutively in ninety-one patients were followed prospectively for five to seven years after the operation or until death. Clinical Harris hip ratings and anteroposterior and lateral radiographs were made preoperatively, several times in the first postoperative year, and at annual intervals thereafter. Average sequential hip ratings were maintained between 92 and 93 points during the follow-up interval.

Evaluation of the learning curve associated with uncemented primary porous-coated anatomic total hip arthroplasty.

The results of the first and second groups of 50 consecutive primary, uncemented porous-coated anatomic arthroplasties were analyzed to evaluate the learning curve associated with the procedure. Femoral fit, acetabular cup angle, femoral fracture rate, minimum two-year clinical hip ratings, and clinical symptoms were compared between the two groups. Significant improvement in achieving better femoral canal filling with the prosthesis and lower acetabular cup angle placements was documented in the second 50 cases.