Curr Rev Musculoskelet Med
November 2023
Purpose: To serve as a guide for non-operative physicians in the management of femoroacetabular impingement syndrome and provide an algorithm as to when to refer patients for potential surgical management.
Recent Findings: Supervised physical therapy programs that focus on active strengthening and core strengthening are more effective than unsupervised, passive, and non-core-focused programs. There is promising evidence for the use of intra-articular hyaluronic acid and PRP as adjunct treatment options.
Subchondral bone marrow lesions (BMLs) are areas of disease within subchondral bone that appear as T1 hypointense and T2 hyperintense ill-defined areas of bone marrow on magnetic resonance imaging. The most common bone marrow lesions include subchondral lesions related to osteoarthritis, osteochondral defects, and avascular necrosis. Emerging therapies include autologous biologic therapeutics, in particular mesenchymal stem cells (MSCs), to maintain and improve cartilage health; MSCs have become a potential treatment option for BMLs given the unmet need for disease modification.
View Article and Find Full Text PDFCurr Sports Med Rep
December 2019
Hypophosphatasia should be considered for any patient who presents with multiple metatarsal stress fractures and a low alkaline phosphatase.
View Article and Find Full Text PDFObjective: To determine if native English speakers (NES) perform differently compared to non-native English speakers (NNES) on a sideline-focused rapid number naming task. A secondary aim was to characterize objective differences in eye movement behaviour between cohorts.
Background: The King-Devick (KD) test is a rapid number-naming task in which numbers are read from left-to-right.
It is widely accepted that cerebral pathology can impair ocular motor and manual motor control. This is true in indolent and chronic processes, such as neurodegeneration and in acute processes such as stroke or those secondary to neurotrauma. More recently, it has been suggested that disruptions in these control systems are useful markers for prognostication and longitudinal monitoring.
View Article and Find Full Text PDFAnn Clin Transl Neurol
October 2016
Objective: The King-Devick (KD) test, which is based on rapid number naming speed, is a performance measure that adds vision and eye movement assessments to sideline concussion testing. We performed a laboratory-based study to characterize ocular motor behavior during the KD test in a patient cohort with chronic concussion to identify features associated with prolonged KD reading times.
Methods: Twenty-five patients with a concussion history (mean age: 31) were compared to control participants with no concussion history ( = 42, mean age: 32).
We present a case in which a piece of chewing gum was discovered adhering to the oral airway when it was removed after an ECT procedure. We suggest that careful examination of the patient's mouth for foreign objects be a standard part of the pre-ECT protocol.
View Article and Find Full Text PDFAs the number of patients with implantable cardiac devices increases so too does the frequency with which these individuals present for electroconvulsive therapy (ECT). The rationale for deactivating an automatic implantable cardioverter defibrillator before ECT has been made based on the concern that artifacts generated during treatment could be interpreted as a treatable rhythm by the internal device, resulting in a discharge. We believe that the risk of inappropriate discharge during ECT is very low and outweighed by the considerable benefit of an active device being able to more quickly treat a malignant dysrhythmia.
View Article and Find Full Text PDFObjective: We sought to compare the level of severity of depressive symptoms on entry into electroconvulsive therapy (ECT) clinical trials versus pharmacotherapy clinical trials.
Data Sources: English-language MEDLINE/PubMed publication databases were searched for ECT literature (search terms: ECT, electroconvulsive therapy, depression, and Hamilton) for clinical trials in which depressed patients had baseline Hamilton Rating Scale for Depression (HRSD) scores. For comparison, we used a convenience sample of 7 large pharmacotherapy trials in major depression (N = 3677).
Emergence agitation is a common complication of electroconvulsive therapy. Standard supportive and pharmacological interventions are usually effective management strategies. We report a case of severe agitation after electroconvulsive therapy that was refractory to the usual treatments but was controlled with dexmedetomidine.
View Article and Find Full Text PDFBackground: Electroconvulsive therapy (ECT) is a widely used, highly effective antidepressant treatment. Except for the most severely ill patients, right unilateral (RUL) electrode placement is the most frequent initial treatment choice. In current practice, RUL ECT is administered at several multiples of seizure threshold (ST) based on reports that lower stimulus intensity results in lower response/remission rates.
View Article and Find Full Text PDFWe report the case of a 50-year-old man who exhibited transient left hemiparesis (Todd's paralysis) after electroconvulsive therapy, which completely resolved within 10 minutes. Subsequent neurological evaluation was unremarkable for discrete etiologies for this event, other than Todd's paralysis. We review the literature of this phenomenon in association with electroconvulsive therapy.
View Article and Find Full Text PDFElectroconvulsive therapy (ECT), which has been in use for 75 years, is an important treatment for severe and treatment-resistant depression. Although it is acknowledged as the most effective acute treatment for severe mood and psychotic disorders, it remains controversial because of misperceptions about its use and lack of familiarity among health care professionals about modern ECT technique. The authors present an illustrative case of a patient for whom ECT is indicated.
View Article and Find Full Text PDFThis report compares the actual doses of methohexital and succinylcholine used for optimal anesthesia and muscle relaxation in electroconvulsive therapy with written guidelines for dosing. The initial doses of methohexital and succinylcholine in milligrams per kilogram were reviewed and compared with subsequent doses of each agent after adjustments were made for individual patient responses during treatment. The dose of methohexital required to induce general anesthesia for most patients is 1.
View Article and Find Full Text PDFImproper recording electrode placement can cause artifacts on electroconvulsive therapy tracings. This shows an example of electrocardiogram artifact in the electroencephalogram.
View Article and Find Full Text PDFInt J Geriatr Psychiatry
September 2012
A recent case reported an episode of a "stop-start-stop" phenomenon during an electroconvulsive therapy treatment. We report an example of multiple stop-start-stop episodes during several electroconvulsive therapy treatments of a 16-year-old boy.
View Article and Find Full Text PDFThe "Tap Test" is a maneuver used to test the functioning of the electroencephalogram and electromyogram leads just prior to electroconvulsive therapy. Here we present a brief case and image that reinforces the importance of this simple test.
View Article and Find Full Text PDFElectroconvulsive therapy (ECT) is the most effective and rapid treatment for severe depression; however, it should be prescribed to the limited number of patients with severe mood and psychotic disorders for whom it is clearly appropriate. We present an assessment scale that we hypothesize can be used to predict a patient's appropriateness for ECT, based on the severity, heritability, and episodic nature of their depression. This scale is offered as a tool to help the practitioner and patient gain a sense of how well the patient fits the profile of someone for whom ECT is a reasonable treatment option.
View Article and Find Full Text PDFThis report describes the electroconvulsive therapy (ECT) course of a 15-year-old male with severe bipolar disorder unresponsive to medical management. After his first treatment, the patient exhibited fever, elevated creatine phosphokinase levels, and leukocytosis. Treatment was halted although the patient reported an improvement in symptoms, which was not maintained with pharmacotherapy alone.
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