Low molecular weight heparin in atrial fibrillation management: facts, fiction, future.

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia and various AF disease management strategies can be utilized.

Methods: A prospective, randomized pilot study of two AF disease management strategies was conducted at a single university hospital in patients newly diagnosed with AF. The impact of low molecular weight heparin (LMWH) on AF management strategies is discussed with respect to the current guidelines for AF management, existing data on LMWH for AF, and recent investigations pertaining to AF.

Effect of large volume infusion on left ventricular volumes, performance and contractility parameters in normal volunteers.

Objective: Characterize the normal human cardiovascular response to large volume infusion of normal saline.

Design: Prospective, interventional trial.

Setting: ICU procedure room.

The two-incision minimally invasive total hip arthroplasty: technique and results.

Minimally invasive surgery has the potential for minimizing surgical trauma, pain, and recovery time in patients having THA. This minimally invasive two-incision total hip technique was found to be safe and facilitated a rapid patient recovery. Further-more, unique instruments and fluoroscopic assistance ensure accurate component position and alignment.

Mini-incision total hip replacement using an anterolateral approach: technique and results.

The mini-incision exposure can be used in most primary THA patients. As the surgeon begins to perform mini-incision THA, he or she can gradually shorten the skin incision with improved confidence and skill. A true mini-incision THA (2.

Stress fractures of the tarsal navicular.

Tarsal navicular stress fractures present a difficult diagnostic and treatment dilemma for the orthopedic physician of an active individual. Patients often complain of diffuse, poorly-defined symptoms and have a paucity of physical findings. Initial diagnostic evaluation often.

Serum enzymes associated with cholestasis.

Alkaline phosphatase, gamma-glutamyl transferase, and 5' nucleotidase are the most common enzymes used in the evaluation of cholestasis. The present knowledge of these enzymes including their function, activity measurement, biologic variables of enzyme activity in healthy persons and disease states, and clinical significance are reviewed. Usefulness of enzymes patterns for diagnosis of specific cholestatic disorders and future directions in evaluation of cholestasis are also discussed.

Cementless acetabular reconstruction in revision total hip arthroplasty.

Reconstruction of the failed acetabular component in total hip arthroplasty (THA) can be challenging. Although there are multiple reconstructive options available, a cementless acetabular component inserted with screws has been shown to have good intermediate-term results and is the reconstructive method of choice for the majority of acetabular revisions. We reviewed the results of 138 consecutive acetabular revisions done with a hemispheric, cementless acetabular component that is sintered with Ti fiber metal mesh and was inserted with line-to-line reaming and multiple screws for fixation.

The femur in revision total hip arthroplasty evaluation and classification.

Femoral revision total hip arthroplasty is a technically demanding procedure. In addition to these technical issues, preoperative planning can be challenging and with multiple reconstructive options available, the decision-making process can be complex. The ability to preoperatively determine the most appropriate option for reconstruction greatly assists with ensuring that the appropriate implants and instruments are available at the time of surgery.

Periprosthetic sepsis.

The diagnosis of septic implant failure can be difficult to make, yet is imperative for optimal patient outcomes in revision total hip arthroplasty. In most cases, a thorough history and physical examination combined with preoperative laboratory tests and an intraoperative frozen section are sufficient to differentiate septic from aseptic failure. If preoperative laboratory test values are elevated, preoperative aspiration of the hip can be used in selected patients to confirm or exclude the diagnosis of infection.

Acetabular osteoarticular allograft after Ewing's sarcoma resection.

Ewing's sarcoma of the pelvis traditionally has been a difficult problem in orthopaedic oncology. Multiple studies have had inferior outcomes when compared with outcomes of patients with similar stage disease involving only the extremities. A major reason for this discrepancy is the difficulty associated with resection and reconstruction of pelvic tumors.

The importance of blood pressure control in the patient with diabetes.

In individuals with diabetes mellitus, higher risk for renal and cardiovascular disease is seen with blood pressure levels >130/80 mm Hg. Findings of several studies, as well as new guidelines, indicate that individuals with diabetes will benefit from more aggressive treatment of hypertension. Angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, diuretics, beta-adrenoceptor blockers, and calcium-channel blockers are effective antihypertensive agents in type 2 diabetes.

Endoscopy in eosinophilic esophagitis: "feline" esophagus and perforation risk.

Background & Aims: Idiopathic eosinophilic esophagitis is an underdiagnosed disease with typical endoscopic findings, which have not been well described.

Methods: Charts and pathology reports at two tertiary care centers from June 1993 to April 2002 were reviewed to describe the endoscopic findings of this disease and to correlate them with clinical characteristics. Eight patients were identified as having eosinophilic esophagitis based on clinical symptoms and pathology reports.

A Trilogy Case Review Highlighting the Clinical and Pharmacologic Applications of Mirtazapine in Reducing Polypharmacy for Anxiety, Agitation, Insomnia, Depression, and Sexual Dysfunction.

BACKGROUND: Mirtazapine, a noradrenergic and specific serotonergic antidepressant (NaSSA), is characterized by a unique receptor-specific pharmacologic profile and tolerable side-effect profile in comparison to other antidepressants. It has been reported to have a low incidence of agitation, anxiety, and insomnia, which may be due to blockade of 5-HT(2) and 5-HT(3) receptors. This unique multireceptor-mediated clinical pharmacologic profile may reduce the need for polypharmacy in selected patients.

Anticholinergic syndrome after anesthesia: a case report and review.

Anticholinergic syndrome may present with a wide variety of signs and symptoms. Central manifestations range from excitatory symptoms including delirium and agitation to central nervous system depression, stupor and coma. Anticholinergic syndrome was once a common phenomenon after general anesthesia because of the frequent administration of the anticholinergic agents atropine and scopolamine.

Galanin in Alzheimer disease.

Galanin (GAL) and GAL receptors (GALR) are overexpressed in limbic brain regions associated with cognition in Alzheimer disease (AD). The functional consequences of this overexpression are unclear. Because GAL inhibits cholinergic transmission and restricts long-term potentiation in the hippocampus, GAL overexpression may exacerbate clinical features of AD.

Cytologic-histologic correlations in the diagnosis of inverted sinonasal papilloma.

We present cytologic data from multiple samples from two cases of inverted sinonasal papilloma (ISP). These samples displayed the entire spectrum of squamous cell changes, including benign squamous papilloma, variable degrees of dysplasia, and invasive squamous cell carcinoma. In all instances, the cytologic impression coincided with the final diagnosis based on frozen and/or permanent histologic sections from the same samples.

The neurologic sequelae of cardiopulmonary bypass-induced cerebral hyperthermia and cerebroprotective strategies.

Cerebral hyperthermia during the rewarming phase of cardiopulmonary bypass (CPB) is associated with adverse outcomes. Cerebral hyperthermia can exacerbate a preexisting injury prior to rewarming, and may be damaging in itself. Temperature and cerebral metabolic rate (CMRO2) play a vital role in cerebral autoregulation.

Implantation of Spheramine in advanced Parkinson's disease (PD).

Evaluation of the safety and efficacy of unilateral stereotactic implantation of cultured human retinal pigment epithelial (hRPE) cells attached to microcarriers (Spheramine) in patients with advanced PD in an open label pilot study. Six patients with advanced PD (3 males; 3 females; mean age 52.2 years; mean duration of PD 10.

Functional outcomes of bone graft substitutes for benign bone tumors.

Benign bone tumors are frequently treated surgically by intralesional excision with grafting. Due to the significant morbidity associated with autogenous graft, there is interest in bone graft substitutes. Ninety-eight consecutive patients with benign bone tumors treated by intralesional excision with bone graft substitutes were retrospectively reviewed.

Effect of elevated-rim acetabular liner and 32-mm femoral head on stability in total hip arthroplasty.

Objective: Although the theoretical attractions of the elevated rim are obvious and have been widely accepted as a mean to improve the postoperative stability, the clinical advantages have not been demonstrated. The aim of this study is to further evaluate the elevated liners contribution to stability.

Methods: Forty-six patients with 50 hips undergoing primary total hip arthroplasty (THA) were enrolled in this study, conducted in Rush Hospital, Chicago, Illinois, United State of America, between March 2001 and February 2003.

Arthroscopic biceps tenodesis.

Arthroscopic biceps tenodesis is indicated for the treatment of severe biceps tendonopathy, partial- or full-thickness tendon tears, or biceps instability typically associated with rotator cuff tear, although there has been considerable debate on tenotomy versus tenodesis. We advocate tenodesis, for the following reasons: to re-establish the resting muscle length so as to avoid scaring and spasm, to allow biceps use for complex elbow motion, and to avoid cosmetic defects in cases in which deformity can sometimes equal disability. This technical note provides illustrations and detailed descriptions of our arthroscopic tenodesis technique using a Arthrex (Naples, FL) biotenodesis system.

Biomechanical evaluation of contemporary posterior spinal internal fixation configurations in an unstable burst-fracture calf spine model: special references of hook configurations and pedicle screws.

Study Design: This study attempts to determine the most biomechanically rigid posterior spinal instrumentation configuration in a burst-fracture calf spine model.

Objectives: To compare the biomechanical stability of contemporary posterior spinal instrumentation in various hook and screw configurations in an unstable calf spine model.

Summary Of Background Data: Burst-fractures are relatively common injuries seen in the setting of spinal trauma.

Reduced cortical noradrenergic neurotransmission is associated with increased neophobia and impaired spatial memory in aged rats.

In the present study, young (5-month-old (mo)) and aged (24 mo) adult male Fischer-344 (F344) rats were assigned to experimental groups based upon their performance of a reference memory task in the Morris water maze and reactivity to a novel palatable taste in a gustatory neophobia task. Levels of norepinephrine (NE) and its metabolite 3-methoxy-4-hydroxy-phenylglycol (MHPG) were assayed via high performance liquid chromatography (HPLC) in brain regions associated with the locus coeruleus (LC)-hippocampus-cortex system and A1/A2-hypothalamic system. Binding of ligands specific for alpha-1, alpha-2, beta-1, and beta-2 receptors was assessed in hippocampus and cortex with receptor autoradiography.