A comprehensive approach to outpatient total hip arthroplasty.

Minimally invasive surgery (MIS) techniques for total hip arthroplasty (THA) have the potential for reduced tissue trauma, leading to more rapid recovery and return to function than with traditional approaches to THA. However, to achieve these potential benefits, all other aspects of patient care need to be modernized. Development and implementation of these newer anesthetic and rehabilitation protocols allow MIS-THA to be done safely on an outpatient basis in select patients.

Middle turbinate medialization with bovine serum albumin tissue adhesive (BioGlue).

Middle turbinate (MT) medialization without resection is an approach designed to both preserve the MT and prevent lateralization, which may cause obstruction of the outflow of the ethmoid, maxillary, and frontal sinuses after endoscopic sinus surgery. Many techniques for medialization have been described. We present a quick and easy technique that involves using the microdebrider to create small areas of denuded mucosa on opposite surfaces of the MT and the nasal septum followed by an application of a bovine serum albumin tissue adhesive to promote the formation of controlled synechiae without the need for nasal packing.

Arthroscopic synovectomy in haemophilia: indications, technique and results.

Recurrent spontaneous haemarthrosis are commonly seen in patients affected by haemophilia. The knee and the elbow are most commonly affected and both are amenable to arthroscopic treatment. Arthroscopic synovectomy is indicated after failure of appropriate medical management with recurrent bleeding.

Addressing severe bone deficiency: what a cage will not do.

Managing severe acetabular bone loss in total hip arthroplasty revision can be a tremendous challenge. Osteolysis and migration of the acetabular component can lead to large uncontained defects. Traditionally, these deficiencies have been treated with allograft with or without the support of a cage.

The ugly underbelly of the MIS movement: in opposition.

The relatively high complication rates associated with early prostheses and techniques eventually led to the improvement of implants and refinement of the surgical procedures. Almost all surgical techniques improve over time by leading to less invasive approaches. The modern era's communications technologies, coupled with more sophisticated marketing techniques, has dramatically influenced the speed with which new techniques are recognized, popularized, and thus demanded by an easily influenced public.

Reducing blood loss in total joint surgery with a saline-coupled bipolar sealing technology.

Despite the availability of a number of techniques to reduce blood loss in patients undergoing total joint arthroplasty, many patients remain at risk of receiving blood transfusions postoperatively. We have used a new technology that couples bipolar radiofrequency energy with saline to reduce blood loss in patients undergoing total joint surgery. The use of this technology has been shown to effectively minimize the risk of transfusion and reduce intraoperative and postoperative bleeding-related complications.

Surgery of the palate and oropharynx.

Progress in successful surgical treatment of the obstructive sleep apnea/hypopnea syndrome (OSAHS) has been based on adjunctive treatment of the hypopharynx. Still the palate and oropharynx are the major areas of intervention, and certainly the most commonly operated upon. To ensure a successful outcome, appropriate surgical candidates must be identified.

Hypnotics should not be considered for the initial treatment of chronic insomnia. Con.

Analysis of the use of hypnotic medication versus CBT for insomnia using an established model for ethical medical decision making leads to the conclusion that hypnotics are not appropriate as the initial treatment in cases of chronic insomnia. Instead, CBT should be considered as the initial treatment for chronic insomnia. This decision is based on empirical data demonstrating that CBT is equally effective in the short-term treatment of insomnia and is superior to pharmacologic treatment in the long-term management of insomnia.

Impaction affects cell viability in osteochondral tissues during transplantation.

Symptomatic full-thickness defects of articular cartilage are increasingly treated with osteochondral allografts. The present study focused on the viability of cells in cartilage that had been impact loaded by the instruments used in preparation of the cartilage for transplantation. Osteochondral plugs were removed and reimplanted using a plastic tamp device fitted with a load cell.

Severity of burn injury and sepsis determines the cytokine responses of bone marrow progenitor-derived macrophages.

Background: Although thermal injury and sepsis result in enhanced monocytopoiesis, the functional characteristics of macrophages that develop in the microenvironment of burn and sepsis are unknown. Here we compare cytokine responses of bone marrow progenitor-derived macrophages (BMO) and peritoneal macrophages (PMO) after graded levels of thermal injury and sepsis.

Methods: Mice were randomly divided into sham (S), burn (B), and burn sepsis (BS) groups.

Revision uvulopalatoplasty by Z-palatoplasty.

Objective: To study the effectiveness of Z-palatoplasty (ZPP) for patients with persistent obstructive sleep apnea/hypopnea syndrome (OSAHS) after previous uvulopharyngopalatoplasty (UP3).

Setting: Prospective study of 31 subjects who sought revision surgery in university-affiliated medical center.

Study Design: In accord with Institutional Review Board approval, 40 consenting adult patients with persistent, progressive, or recurrent OSAHS of moderate/severe severity despite previous UP3 surgeries were enrolled.

Dysbiosis in pouchitis: evidence of unique microfloral patterns in pouch inflammation.

Background & Aims: Pouch inflammation after surgery for ulcerative colitis can significantly alter quality of life and thus ideally should be prevented. Dysbiosis or altered microflora is suspected to be the key pathogenic factor for pouchitis. However, dysbiosis in pouchitis has not been characterized carefully because of a lack of available sensitive microbiological technology suitable for in vivo studies in human beings.

Optimizing therapy of seizures in children and adolescents with developmental disabilities.

Children and adolescents with intellectual and developmental disabilities and epilepsy are a unique patient population that offers significant challenges. They are more likely to suffer lifelong intractable epilepsy with multiple seizure types than other patients with epilepsy. In addition, these patients often cannot clearly express their complaints about antiepileptic drug (AED) side effects, and the caregiver's role becomes all-important as an advocate for the patient.

Reduction of C-reactive protein with surgical treatment of obstructive sleep apnea hypopnea syndrome.

Objectives: To determine whether surgical treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) has an impact on C-reactive protein (CRP) level.

Study Design: Prospective study of 34 consecutive subjects undergoing surgical treatment for OSAHS. CRP levels were evaluated preoperatively and 2 months postoperatively.

Effects of an oral contraceptive (norgestimate/ethinyl estradiol) on bone mineral density in adolescent females with anorexia nervosa: a double-blind, placebo-controlled study.

Purpose: To evaluate the effect of an oral contraceptive (OC) on bone mineral density (BMD) in adolescent females with anorexia nervosa (AN) or eating disorder not otherwise specified (EDNOS).

Methods: Females 11-17 years of age with AN or EDNOS entered the study. Subjects were randomized equally to treatment with a triphasic OC containing norgestimate (NGM) 180-250 microg and ethinyl estradiol (EE) 35 microg or placebo for 13 28-day cycles.

Arthroscopic reduction and repair of a locked posterior shoulder dislocation.

Locked posterior shoulder dislocations are an uncommon but difficult problem for the orthopaedic clinician. Furthermore, they are often missed on initial presentation, resulting in significant delays in treatment. Traditional treatment has involved formal open reduction, most commonly from an anterior approach, followed by transfer of the lesser tuberosity or subscapularis tendon into the anterior humeral head defect.

Efficacy and safety of torcetrapib, a novel cholesteryl ester transfer protein inhibitor, in individuals with below-average high-density lipoprotein cholesterol levels.

Objectives: This study was designed to evaluate the efficacy and safety of torcetrapib, a cholesteryl ester transfer protein (CETP) inhibitor, in subjects with low high-density lipoprotein cholesterol (HDL-C) levels.

Background: Evidence suggests HDL-C is atheroprotective. A proven mechanism for increasing the level of HDL-C is the inhibition of CETP.

Peripheral vascular surgery: does anesthetic management affect outcome?

Several recent articles have examined the effect of anesthetic technique on outcome in patients undergoing peripheral vascular surgery. This review examines the recent literature and evaluates the role of new data in advancing current understanding of the impact of anesthetic management on outcome in this high-risk population.

Expanding the definition of hypertension to incorporate global cardiovascular risk.

Recent epidemiologic analyses have changed the way that hypertension is viewed. Cardiovascular risk has been found to be elevated at levels of blood pressure previously believed to be normal and not imparting additional risk. Furthermore, the approach to hypertension has been shifted from viewing and treating it in isolation to a more comprehensive approach that incorporates a focus on global cardiovascular risk and the risk factors commonly associated with having an elevated blood pressure.

Contrast ultrasound imaging of the carotid artery vasa vasorum and atherosclerotic plaque neovascularization.

Cardiovascular disease is associated with the aging of the population, obesity, metabolic syndrome, and diabetes. Therefore, it is important to develop non-invasive imaging systems to detect "at-risk" populations. New data suggest that contrast-enhanced ultrasound (CU) imaging of the carotid arteries enhances luminal irregularities (i.

Hip arthroscopy.

With adequate patient screening and attention to complications specific to the hip joint, hip arthroscopy can be performed safely and effectively. When used in appropriately selected patients, the reduced recovery and rehabilitation time is significant. In the past decade, the indications for hip arthroscopy have evolved to include a variety of pathologies, which has lead to a dramatic rise in its use.

The clinical response to brain death: a policy proposal.

The ethical and scientific literature reflects a certain amount of controversy and confusion surrounding the concept of death by neurological criteria, or brain death. The issues surrounding brain death occur with limited frequency for those working in acute critical care settings. Even so, the literature and our own experiences evidence the discomfort of caregivers and policymakers when dealing with brain-dead patients and their family and loved ones.