Patellar Tendon Ruptures after Total Knee Arthroplasty.

Patellar tendon (PT) rupture following total knee arthroplasty (TKA) is a rare, but devastating complication. These injuries occur most frequently in the acute period following TKA due to trauma to the knee. PT ruptures that disrupt the extensor mechanism create a marked functional deficit, impacting every facet of daily life.

Total Knee Arthroplasty in Human Immunodeficiency Virus Patients: A Literature Review.

Background: Total knee arthroplasty (TKA) has become a common surgical intervention for human immunodeficiency virus (HIV)-positive patients who develop osteonecrosis of the knee. This paper summarized existing literature regarding the outcomes of HIV-positive patients undergoing TKA in 4 subsections: (1) complications; (2) survivorship analyses; (3) patient-reported outcomes; and (4) infections.

Methods: A review of PubMed was performed, searching for articles focused on HIV-positive patients undergoing TKA.

Total Hip Arthroplasty in Human Immunodeficiency Virus Positive Patients: A Systematic Review of Outcomes.

Background: Total hip arthroplasty (THA) has become a common intervention for human immunodeficiency virus (HIV)-positive patients who have osteonecrosis of the femoral head. This paper provides a systematic review to assess survivorships, patient-reported outcomes (PROMs), infection rates, other complications, and immune competence for patients who had THAs who did and did not have HIV.

Methods: A comprehensive and systematic review of published studies investigating the outcomes of THA in HIV-positive patients (osteonecrosis and non-osteonecrosis patients) was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Nonlinear Inverted-U Shaped Relationship Between Aging and Epidermal Innervation in the Rat Plantar Hind Paw: A Laser Scanning Confocal Microscopy Study.

Unlabelled: The under-reporting of pain and atypical manifestations of painful syndromes within the elderly population have been well documented, however, the specific relationship between pain and aging remains ambiguous. Previous studies have reported degenerative changes in primary afferents with aging. In this study, we questioned whether there is any change in the density of primary afferent endings within the epidermis of aged animals.

The National Sleep Foundation's Sleep Health Index.

Objectives: A validated survey instrument to assess general sleep health would be a useful research tool, particularly when objective measures of sleep are not feasible. Thus, the National Sleep Foundation spearheaded the development of the Sleep Health Index (SHI).

Design: The development of the SHI began with a task force of experts who identified key sleep domains and questions.

Direct Access to Physical Therapy Services Is Safe in a University Student Health Center Setting.

Objectives: The purpose of this retrospective descriptive study was to determine if direct access to physical therapy (PT) in a university health center placed patients at risk for adverse events.

Background: Direct access to PT is underutilized, even though it has been reported to reduce medical costs; however, there is a paucity of evidence on the clinical risks related to this practice.

Methods: The University of Colorado at Boulder instituted a direct access musculoskeletal injury clinic in 2000.

An observational study exploring academic mentorship in physical therapy.

Background: Health professions faculty members often come to the academy without formal training as a professor. A challenge that exists for many new professors is the expectation that they will effectively balance their tripartite roles, which include ensuring teaching excellence, research rigor, and service to the university community. Mentoring has been suggested to be a way that new faculty can be supported as they seek to meet these expectations.

Spontaneous pain-like behaviors are more sensitive to morphine and buprenorphine than mechanically evoked behaviors in a rat model of acute postoperative pain.

Background: Nonevoked spontaneous pain is most problematic for postoperative patients. Physicians assess this form of pain using the human visual analog scale or verbal numeric rating scale. Recent studies have proposed that spontaneous foot-lifting (SFL) behaviors are an expression of spontaneous pain in animals after spinal nerve injury or adjuvant-induced inflammation.

Evaluation of anxiety-like behaviour in a rat model of acute postoperative pain.

Background: Unrelieved acute postoperative pain can lead to a wide range of adverse effects, such as anxiety, depression, restlessness and sleep deprivation.

Objective: To investigate anxiety-like behaviour in a postoperative pain model.

Interventions And Main Outcome Measures: Mechanical hypersensitivity was assessed with an electronic von Frey device, whereas anxiety-like behaviour was measured with light/dark testing and elevated plus maze testing.

CT scanning in the evaluation of pulmonary hypertension.

Background: Right-heart catheterization is currently the gold standard method for detecting pulmonary hypertension (PH) and grading its severity. Our study determined the utility of computerized tomography (CT) scans for detecting PH in patients with left-sided heart disease, thereby potentially avoiding the overuse of invasive right-heart catheterization.

Methods: A retrospective review was conducted on 40 patients with left-sided cardiac pathology who had undergone both right-heart catheterization and CT scanning of the chest.

Postpneumonectomy-like syndrome presenting in a patient with treated pulmonary tuberculosis: a case report.

Introduction: Postpneumonectomy syndrome is a rare condition that is characterized by dyspnea resulting from an extreme mediastinal shift and bronchial compression of the residual lung following surgical pneumonectomy. It is even rarer for this syndrome to present in patients without a history of prior lung surgery but induced by autopneumonectomy due to parenchymal disease, an entity termed 'postpneumonectomy-like syndrome'.

Case Presentation: We present a rare case of a 91-year-old Puerto Rican man presenting with progressively worsening dyspnea with a history of pulmonary tuberculosis diagnosed 40 years earlier who developed severe unilateral lung fibrosis.

Impact of patient education on quality of bowel preparation in outpatient colonoscopies.

Background: High-quality bowel preparation is essential for successful outpatient colonoscopy. Currently, the rate of adequate bowel preparation for outpatient colonoscopy in the USA is low. Patients often fail to adhere to recommended preparation instructions.

Selection criteria for expander/implant breast reconstruction following radiation therapy.

Purpose: Breast reconstruction with expander/implants is generally discouraged in patients who have undergone radiation therapy. However, not every patient treated with radiation develops sequelae severe enough to preclude the use of prostheses. To date, there have been no studies that have established criteria for selecting which patients may still be considered for expander/implant reconstruction.

Review of the possible relationship and hypothetical links between attention deficit hyperactivity disorder (ADHD) and the simple sleep related movement disorders, parasomnias, hypersomnias, and circadian rhythm disorders.

Recent evidence has been accumulating that the sleep of individuals with attention deficit hyperactivity disorder (ADHD) is not only disrupted in a nonspecific way but that ADHD has an increased association with simple sleep related movement disorders such as restless legs syndrome/periodic limb movements in sleep (RLS/PLMS), rhythmic movement disorder (body rocking and head banging), and parasomnias, such as disorders of partial arousal (sleep walking, sleep terrors, and confusional arousals). In addition increased associations have been reported between ADHD and hypersomnias such as narcolepsy and sleep apnea as well as circadian rhythm disorders, such as delayed sleep phase syndrome. These relationships are reviewed and the implications for such associations are explored.

23-hour stay outcomes for laparoscopic Roux-en-Y gastric bypass in a small, teaching community hospital.

The goal of every surgery is a successful outcome with the shortest hospital stay. Morbidly obese patients with their myriad of comorbidities have confounded surgeons over the years, usually leading to an increased length of hospital stays after complicated surgeries. Laparoscopic Roux-en-Y gastric bypass (LRYGB) has proven to be an effective treatment for the morbidly obese with a usual length of stay of 3 days.

Psychiatric and psychological aspects of chronic pain.

To gain a better understanding and a more complete assessment of chronic pain syndrome, the psychosocial, psychological, psychodynamic, and psychiatric aspects of this condition should be included in patient evaluation. As illustrated in the two case studies presented, this approach leads to clearer recognition of the biological and psychosocial needs of patients, and allows for more effective treatment measures to be taken.

Management and pharmacotherapy of chronic pain syndromes including opioid pharmacotherapy.

Emphasizing the importance of an interdisciplinary approach in the treatment and management of patients with chronic pain syndromes (CPS), this article reviews, first, nonpharmacologic approaches and modalities for CPS patients, and next, pharmacologic approaches for CPS patients. Flexibility and the use of multiple modalities are emphasized. The article concludes with the controversial subject of the use of long-term analgesic opioid pharmacotherapy in patients with chronic benign pain syndromes.

Diagnosis and clinical management of headaches.

In this article, we will first present an overview of the epidemiology and classification of headaches, distinguishing between primary headaches (in which the headache itself is the primary disorder) and secondary headaches (ie, headaches due to an underlying condition, such as a neoplastic and/or space-occupying lesion, a cerebrovascular accident, or other type of structural brain lesion). We will use the current classification system of the International Headache Society, focusing on primary headache disorders (migraine, tension-type headache, cluster headache), which we will discuss from the practical clinical perspectives of diagnosis and clinical management. Throughout this article, we will emphasize the chronicity and periodicity of headaches as a type of chronic pain syndrome.

Lower blepharoplasty with capsulopalpebral fascia hernia repair for palpebral bags: a long-term prospective study.

Background: In December of 1998, the authors published a prospective study in Plastic and Reconstructive Surgery (102: 2459, 1998) comparing standard lower blepharoplasty with lipectomy on one side and fat-preserving capsulopalpebral fascia hernia repair on the contralateral side; comparable aesthetic outcomes were demonstrated after 6 months of follow-up. In the present study, the authors report their findings on the original patient cohort with an average follow-up of 11.3 years.

Role of arthroscopy in treating anterior instability of the athlete's shoulder.

Introduction: Shoulder arthroscopy continues to use minimally invasive techniques to diagnose and treat the athlete's shoulder. Instability can result from trauma or repetitive forceful movements. Arthroscopy stabilization includes multiple quadrant surgery, proper capsular tensioning, and allows dynamic evaluation of the anatomic repair without disruption of the subscapularis.

Rise of blood pressure with periodic limb movements in sleep and wakefulness.

Objective: To measure changes in blood pressure and pulse rate associated with periodic limb movements in sleep (PLMS) in patients with restless legs syndrome (RLS).

Methods: We measured autonomic activation as indicated by a rise in blood pressure and pulse rate during periodic limb movements in sleep (PLMS) in 8 patients (6 women average age 57.6+/-16.

The scoring of movements in sleep.

The International Classification of Sleep Disorders (ICSD-2) has separated sleep-related movement disorders into simple, repetitive movement disorders (such as periodic limb movements in sleep [PLMS], sleep bruxism, and rhythmic movement disorder) and parasomnias (such as REM sleep behavior disorder and disorders of partial arousal, e.g., sleep walking, confusional arousals, night terrors).