Importance of Vaccination Against COVID-19 in a Patient With End-Stage Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD).

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammatory polyarthritis and extra-articular involvement. Extraarticular manifestations of RA can include involvement of the skin, eye, heart, lungs, and others. RA is associated with a broad spectrum of pleuropulmonary involvement, with interstitial lung disease (ILD) and pleural disease being the most common.

Physician-scientists or celebrities? Kardashian-index of gastroenterologists.

Background: The coronavirus disease 2019 pandemic unleashed a flood of untrustworthy information on social media platforms, resulting in the unfortunate consequence of expert scientists' opinions getting lost amidst the chaotic sea of misinformation. The question of how much influence these esteemed scientists hold on social media platforms remains elusive. To address this scientific quandary, we sought to explore the concept of the Kardashian index (K-index), a term introduced by Hall in 2014.

Pyruvate Kinase Deficiency Causing Priapism.

Pyruvate kinase deficiency (PKD) is an autosomal recessive defect of the enzyme pyruvate kinase (PK) which is involved in catalyzing a reaction that produces ATP in the glycolytic pathway. It is the most common defect of the glycolytic pathway associated with congenital anemia. Patients usually present with signs of chronic hemolytic anemia such as hyperbilirubinemia, splenomegaly, reticulocytosis, and gallstones; the presentation can vary by age.

Uncontrolled Bleeding After Tongue Laceration Leading to a Difficult Airway in the Setting of Hemophilia A: A Case Report.

Bleeding in the upper airway is a potentially catastrophic event and an important cause of airway-related mortality, even in otherwise healthy patients. The bleeding airway is particularly challenging because tools used by physicians to secure a difficult airway, such as direct video and flexible video/fiberoptic laryngoscopy, may be ineffective as the camera may become soiled with blood. A 33-year-old male with hemophilia A presented with a tongue laceration after a seizure.

Towards a theory of communion-in-caring.

Background: When nursing practice assumes a fix-it view model, it limits the growing capacity of practice. The theory of communion-in-caring emerged as a hopeful response to the call to offer a new vista. This theory unifies caring and the endless potential of human care.

Early Postoperative Femur Fracture After Uncemented Collarless Primary Total Hip Arthroplasty: Characterization and Results of Treatment.

Thirty Vancouver type B periprosthetic fractures occurred within 90 days of total hip arthroplasty were identified using two institutional databases. Twenty-eight of these fractures were of a stereotyped fracture pattern consisting of a displaced fracture of the femoral neck including the lesser trochanter and a variable amount of the proximal medial femoral cortex creating a roughly triangular fragment. Time from operation until fracture was 2-88 days (mean 28).

Clevidipine in acute heart failure: Results of the A Study of Blood Pressure Control in Acute Heart Failure-A Pilot Study (PRONTO).

Background: Rapid blood pressure (BP) control improves dyspnea in hypertensive acute heart failure (AHF). Although effective antihypertensives, calcium-channel blockers are poorly studied in AHF. Clevidipine is a rapidly acting, arterial selective intravenous calcium-channel blocker.

Painful metal-on-metal total hip arthroplasty.

Two patients were evaluated for the possibility of hypersensitivity to a Metasul articulation (Centerpulse, Austin, Tex) coupled with total hip arthroplasty. Serum was tested with a lymphocyte proliferation assay, and the capsular tissues from the hip were examined for perivascular lymphocytes. The diagnosis of hypersensitivity to Metasul could not be confirmed in these patients, and ultimately, the painful hip arthroplasties were felt to be caused by a combination of musculoskeletal problems.

Metal-on-metal: articulations for the new millennium.

Implants with metal-on-metal articulations (Metasul, Sulzer Medica, Winterthur, Switzerland [now Zimmer, Warsaw, IN]) have been used in nearly 300,000 total hip replacements. In three different clinical studies, clinical success has been demonstrated using this implant as measured by Harris hip scores, patient self-assessment, and assessment of mechanical complications. Of a study group of 924 patients who received this implant, the only reported complications were mechanical, incldding two cup loosenings (0.

Fixation and osteolysis with Metasul metal-on-metal articulation.

The purpose of this study was to report the prevalence of osteolysis and loss of fixation using Metasul metal-on-metal articulation couples. Ninety-two patients with 96 hips with Metasul articulation couples were followed for 5 to 11 years. By patient self-assessment, 89 (93%) patients scored themselves as good or excellent.

Electromyography of the quadriceps in patellofemoral pain with patellar subluxation.

This study compared muscle activity and timing of gait phases during functional activities in 13 subjects with patellofemoral pain associated with lateral subluxation and in 11 subjects with healthy knees. Fine wire electromyography recorded activity in the vastus lateralis and vastus medialis oblique during walking and ascending and descending stairs. Subjects were filmed to divide the activities into phases and determine timing.

The effect of clonidine on gastrointestinal side effects associated with ultra-rapid opioid detoxification.

Clonidine, an alpha(2)-adrenergic agonist, is used to minimize withdrawal symptoms related to ultra-rapid opioid detoxification procedures. These preliminary data suggest that clonidine possesses dose-related antidiarrheal activity.

The risks of small community practice.

Small community practice has risks not present in a metropolitan practice. The practice is general orthopaedics and subspecialization does not thrive. The quality of consulting physicians and the community hospital may not be of the level desired.

The risk of product liability: orthopaedic surgeons can be trapped.

Orthopaedics has become the specialty that it is because of the technologic advancements of medicine in designing successful implants. However, the use of implants introduces a new risk of product failure. The orthopaedic surgeon needs to be aware of the potential consequences of the risks of use of devices in treating patients.

Self-inflicted risks of orthopaedic surgery.

The advancements in medicine, including orthopaedic treatment, since 1960 have so greatly improved quality of life that human nature has changed in its social goals. These technological innovations, especially the products created, have resulted in a self-inflicted increase in risk of practice. This risk will not be leveled until society recognizes that it expects that the physician not only be a healer, but able to fulfill the social goals of the patient.

Intraoperative monitoring for safety of bilateral total knee replacement.

Cardiopulmonary hemodynamics in 79 consecutive patients who had one-stage bilateral total knee replacements were monitored prospectively with a pulmonary artery catheter. The pulmonary vascular resistance, wedge pressure, pulmonary artery pressure, and systemic vascular resistance were measured before skin incision, 5 to 10 minutes after implanting the first total knee replacement, and after the second knee replacement. The second knee replacement was cancelled in five patients because the pulmonary vascular resistance after the first knee replacement was more than double the baseline, or above 200 dyne/second/cm(5).

Comparison of preoperative radiographs and intraoperative findings of fixation of hemispheric porous-coated sockets.

Background: The radiographic criteria for identification of loose cementless acetabular components have not been well established. The purpose of this study was to compare the radiographic appearance of a hemispheric porous-coated cementless cup fixed with screws with the intraoperative findings with regard to the fixation status.

Methods: The quality of the cup fixation was evaluated at fifty-two hip revisions that were performed, for reasons other than infection, at an average of 89.

Electromyographic analysis of the deltoid and rotator cuff muscles in persons with subacromial impingement.

The purpose of this study was to compare subjects with subacromial impingement and subjects with normal shoulders with respect to muscle activity. Fifteen subjects in each group were studied by means of fine-wire electromyography. The middle deltoid and rotator cuff muscles were evaluated during isotonic scaption from 30 to 120 degrees.

A modification of the relocation test: arthroscopic findings associated with a positive test.

Thirteen overhand-throwing athletes who failed at least 3 months of physical therapy while restricted from throwing and who demonstrated a positive modified relocation test at 90 degrees, 110 degrees, and/or 120 degrees were clinically and arthroscopically examined. On arthroscopic examination, all patients demonstrated articular surface pathology. Eleven patients had fraying of the undersurface of the rotator cuff, and 10 patients had fraying of the posterosuperior labrum.

The painful shoulder in the swimming athlete.

Given the popularity of swimming and the high risk of injury associated with the sport, many clinicians come into contact with the swimmer's shoulder. This article describes the mechanism of injury, diagnostic tools, and subtle signs of injury for swimmer's shoulder. It focuses on conservative treatment for the injury, including methods for stretching and strengthening and eliminating acute inflammation.

Electromyographic analysis of deltoid and rotator cuff function under varying loads and speeds.

The purpose of this study was to compare the effect of increasing loads and doubling speed on the deltoid and rotator cuff muscles during isotonic scapular plane abduction (scaption) with neutral humeral rotation. These muscles were studied in 16 volunteers with asymptomatic shoulders with the use of fine wire electromyography. The addition of load to the arm during scaption caused an increase in electromyographic activity during the first 90 degrees of motion.

Anatomy of provocative tests for impingement syndrome of the shoulder.

The purpose of this study was to describe the extra- and intra-articular anatomic relationships present during the Neer and Hawkins tests. Nine fresh-frozen cadaveric shoulders were positioned in the impingement position described by Neer (n = 5) or that described by Hawkins (n = 4), embedded in polyurethane, and studied with the use of a cross-sectional technique. All shoulders placed in the Neer position demonstrated soft tissue contact with the medial acromion and contact between the articular surface of the rotator cuff tendons and the anterosuperior glenoid rim.

Arthroscopic findings in the overhand throwing athlete: evidence for posterior internal impingement of the rotator cuff.

The purpose of this article is to describe the outcome of an arthroscopic examination and the pathology in symptomatic shoulders of 41 professional overhand throwing athletes. With the arm in the position of the relocation test, 100% of the subjects had either contact between the rotator cuff undersurface and the posterosuperior glenoid rim or osteochondral lesions. Other key findings included undersurface cuff fraying in 93%, posterosuperior labral fraying in 88%, and anterior labral fraying in 36% of the subjects.

Shoulder reaction time and muscle-firing patterns in response to an anterior translation force.

The primary restraint preventing humeral head translation is the capsuloligamentous system. Muscle forces can also decrease translation; however, the timing and magnitude of muscle response has not been previously reported. Fine wire electromyographic analysis of the biceps long head, anterior deltoid, pectoralis major, latissimus dorsi, and rotator cuff muscles was performed after an anterior translation force was applied to 15 normal shoulders.