A Randomized Trial of Autologous Chondrocyte Implantation Versus Alternative Forms of Surgical Cartilage Management in Patients With a Failed Primary Treatment for Chondral or Osteochondral Defects in the Knee.

Background: There are limited randomized controlled trials with long-term outcomes comparing autologous chondrocyte implantation (ACI) versus alternative forms of surgical cartilage management within the knee.

Purpose: To determine at 5 years after surgery whether ACI was superior to alternative forms of cartilage management in patients after a failed previous treatment for chondral or osteochondral defects in the knee.

Study Design: Randomized controlled trial; Level of evidence, 1.

Case report: delayed response after electroconvulsive therapy in a patient with major depressive disorder.

Background: Major depressive disorder and associated mood syndromes are amongst the most common psychiatric disorders. To date, electroconvulsive therapy (ECT) is considered the most effective short-term treatment for patients with severe or treatment-resistant depression. In clinical practice, there is considerable variation in the ECT dosing schedule, with the number of sessions typically ranging from 6 to 12, with early antidepressant effects being predictive of increased positive outcomes.

Managing the overlap between mental and physical health.

The interface between the Mental Capacity Act 2005 and the Mental Health Act 1983 can be complex, particularly in patients with co-existing mental and physical illnesses. The management of these patients requires the involvement of patients, relatives and multidisciplinary teams. This article presents four illustrative patient cases, all of whom suffered from co-existing mental and physical illnesses.

Peripheral nerve blocks for hip fractures.

Background: Various nerve blocks with local anaesthetic agents have been used to reduce pain after hip fracture and subsequent surgery. This review was published originally in 1999 and was updated in 2001, 2002, 2009 and 2017.

Objectives: This review focuses on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anaesthesia for hip fracture surgery.

Treatment adherence in multiple sclerosis: a survey of Belgian neurologists.

Background: Poor treatment adherence is common among patients with multiple sclerosis (MS). This survey evaluated neurologists' perception of treatment adherence among MS patients.

Materials And Methods: This questionnaire-based survey of Belgian neurologists treating MS patients was conducted between June and July 2014.

Levothyroxine pseudomalabsorption and thyroxine absorption testing with use of high-dose levothyroxine: case report and discussion.

Objective: To report the case of a 55-year-old woman who had been prescribed a daily dose of 1,000 μg of levothyroxine for the treatment of hypothyroidism but still had severe biochemical hypothyroidism and to discuss the use of thyroxine absorption testing to diagnose pseudomalabsorption.

Methods: The patient was admitted to the hospital for supervised thyroxine absorption testing. Baseline thyroid function tests were performed.

Magnetic resonance imaging for low back pain: indications and limitations.

Magnetic resonance imaging (MRI) is the preferred investigation for most spinal diseases and is increasingly requested for people with low back pain (LBP). However, determining the cause of back pain is complicated as it is often multifactorial and anatomical abnormalities are common in the spine and may not necessarily translate into clinical symptoms. Thus, national guidelines discourage the use of MRI in non-specific LBP and recommend reserving it for the investigation of severe or progressive neurological deficits or for those cases in which serious underlying pathology is suspected.

The prevalence of oilseed rape hypersensitivity in a mixed cereal farming population.

Background: Oilseed rape production is widespread in cereal growing areas. Many patients attending our clinics for seasonal allergy claim that they are allergic to it.

Aim: To determine the prevalence of oilseed rape allergy in our population.

Magnetic resonance imaging for low back pain: indications and limitations.

Magnetic resonance imaging (MRI) is the preferred investigation for most spinal diseases and is increasingly requested for people with low back pain (LBP). However, determining the cause of back pain is complicated as it is often multifactorial and anatomical abnormalities are common in the spine and may not necessarily translate into clinical symptoms. Thus, national guidelines discourage the use of MRI in non-specific LBP and recommend reserving it for the investigation of severe or progressive neurological deficits or for those cases in which serious underlying pathology is suspected.

Cutaneous sensory loss following primary total knee arthroplasty. A two years follow-up study.

We examined 32 patients for skin flap numbness around their scars after primary total knee arthroplasty (TKA). All 32 patients were reviewed six weeks following surgery and two years thereafter. The aims of our study were to determine the natural history of cutaneous sensory loss, to identify the relationship with scar length and scar location, as well as the relationship between the size of the numb area and the severity of numbness and its recovery pattern.

Fibroepithelial polyp of the tonsil: case report of a rare, benign tonsillar lesion.

Objective: We report the case of a man presenting with a tonsillar mass causing difficult breathing, snoring and disturbed sleep.

Method: Case report.

Results: The patient was found to have a fibroepithelial polyp of the left tonsil.

Effect of dressing choice on outcomes after hip and knee arthroplasty: a literature review.

Selecting the right dressing for these wounds can prevent blistering, maceration and the risk of infection. Ideally, the dressing should be permeable, waterproof, transparent, absorbent and flexible enough to withstand joint movement.

The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies.

Introduction: Postoperative hypocalaemia commonly occurs after extensive thyroid surgery and may require calcium and/or vitamin D supplements to alleviate or prevent the symptoms. In this study, we determined the risk factors for developing hypocalcaemia and whether early serum calcium levels can predict the development of or differentiate between temporary or permanent hypocalcaemia.

Patients And Methods: A total of 162 patients who either had a completion or total thyroidectomy formed the basis of this prospective study.

Pleomorphic adenoma of the nasal septum: a case report.

Introduction: Pleomorphic adenomas are the most common benign tumour of the major salivary glands. In addition, they may also occur in the minor salivary glands of the hard and soft palate. Intranasal pleomorphic adenomas are unusual and may be misdiagnosed because they have greater myoepithelial cellularity and fewer myxoid stromata compared to those elsewhere.

Resection of pyriform aperture: a useful adjunct in nasal surgery.

Objective: The aim of this paper is to describe a novel technique of improving the nasal airflow in patients in whom, despite reduction surgery to the inferior turbinates (either alone or with septal surgery), the nasal airways remain compromised because of obstruction occurring anterior to the inferior turbinate, due to a prominent nasal process of the maxilla at the pyriform aperture.

Method: We describe a novel approach to resection of the nasal process of the maxilla, a technique performed in 40 patients with either: residual obstructive symptoms following septal surgery with or without turbinate surgery; and significant inspiratory alar collapse. The same technique was also used in two patients to improve the intranasal approach to the medial and anterior maxilla during endoscopic medial maxillectomy for recurrent inverted papilloma.

Dysphagia and other manifestations of oesophageal involvement in the musculoskeletal diseases.

Oesophageal dysfunction can occur in a variety of musculoskeletal conditions, most notably the autoimmune connective tissue diseases. However, correlation between oesophageal symptoms and investigations is frequently poor. It is often uncertain whether symptoms are caused by the underlying disease or by its treatment.

A novel use of photo messaging in the assessment of nasal fractures.

We evaluated a new method of assessing patients referred to the otolaryngology department with nasal injury. Patients possessing a mobile phone with built-in camera took an image of their face and sent it to the department for assessment. A decision was then made as to whether the patient needed further consultation or treatment.

Posterior nasal septal abscess in a healthy adult patient.

Objective: We report an extremely rare case of bilateral posterior nasal septal abscess in an otherwise healthy adult patient.

Method: Case report and a review of the world literature concerning atraumatic nasal septal abscess and its management.

Results: The development of an atraumatic nasal septal abscess is rare, but it has been reported in association with acute sinusitis, in patients with poor immunity and in children.

'Boil and Bite' mouth guards for direct laryngoscopy.

'Boil and Bite' mouth guards are an alternative to conventional silicone guards in direct laryngoscopy. These guards are less likely to displace. They are cheap and easy to prepare.

Pneumopericardium: a rare complication of laparoscopic varicocoele ligation.

Although symptomatic pneumopericardium post-laparoscopic varicocoele ligation procedure is rare, numerous cases have been reported and identified pneumopericardium as a complication of laparoscopic surgery. Pneumopericardium after other urological procedures has been previously reported when diagnosed incidentally on chest X-ray but there are no reports of symptomatic presentation. We hereby present the first symptomatic pneumopericardium case after a routine procedure for the ligation of varicocoele.

Emphysematous pyelonephritis.

Background: A 54-year-old nondiabetic male presented with high fever, vague lower abdominal pain and leakage of urine around his long-standing suprapubic catheter. Examination revealed pyrexia and tenderness in the right renal angle. White cell count was 22.

Lignocaine as a topical analgesia for post-operative nasal pack removal: a prospective, randomized, double-blind, controlled trial.

The objective of this study was to assess the efficacy of topical lignocaine in reducing the pain of pack removal after nasal surgery. Fifty-eight patients with Merocel nasal packs in situ after nasal surgery were randomized to receive 10 ml of either 2 per cent lignocaine or 0.9 per cent saline on the packs 10 minutes prior to their removal and the pain experienced on their removal was recorded on a visual analogue scale.

Pleural effusion and thickening due to cabergoline use in a patient with Parkinson's disease.

A 62-year-old Caucasian man with a history of Parkinson's disease developed bilateral pleural thickening and a large, right-sided, exudative pleural effusion. Further investigations revealed a chronic inflammatory process involving the pleura as a result of exposure to cabergoline used to treat the Parkinson's disease. The inflammatory process reversed after the discontinuation of cabergoline.