Controversies relating to the management of acromioclavicular joint dislocations.

The aim of this review is to address controversies in the management of dislocations of the acromioclavicular joint. Current evidence suggests that operative rather than non-operative treatment of Rockwood grade III dislocations results in better cosmetic and radiological results, similar functional outcomes and longer time off work. Early surgery results in better functional and radiological outcomes with a reduced risk of infection and loss of reduction compared with delayed surgery.

Speed and distance requirements for community ambulation: a systematic review.

Objective: To provide an overview of the research literature on distance and speed requirements for adults to walk outside the home.

Data Sources: We conducted a systematic review and searched PubMed, MEDLINE (Ovid), EMBASE, CINAHL, Scopus, PEDro, and The Cochrane Library from 1948 to May 2012, and other sources. Search terms included communities, walk, ambulation, and neighborhood.

Review article: is ultrasound guidance advantageous for interventional pain management? A systematic review of chronic pain outcomes.

Background: Modern ultrasound (US) is an attractive alternative to anatomical landmark-, nerve stimulation-, and fluoroscopic-guided techniques for interventional procedures performed to treat chronic pain syndromes.

Methods: In this review, we evaluated the effects of US guidance compared with traditional guidance techniques on performance, efficacy, and safety outcomes for interventional chronic pain procedures. We identified 46 studies, including 41 case series and 5 randomized trials of intermediate-to-good quality that investigated the use of US guidance for a diverse variety of chronic pain procedures.

The definition of block "success" in the contemporary literature: are we speaking the same language?

A successful nerve block is the common goal that shapes modern regional anesthesia practice and research, yet the meaning of block "success" can be open to interpretation. For this Special Article, we reviewed all applicable randomized controlled trials published over the last decade to determine the most commonly used definitions of block success. We also sought to uncover which relevant indicators of block success are routinely reported in the contemporary literature.

Trends and results of the first 5 years of Fundamentals of Laparoscopic Surgery (FLS) certification testing.

Introduction: FLS is an educational program developed by the Society of American Gastrointestinal and Endoscopic Surgeons and endorsed by the American College of Surgeons. The goal of the FLS program is to teach and assess the basic cognitive and psychomotor skills required to perform laparoscopic surgery. The purpose of this study is to review the results from the first 5 years of FLS certification testing.

Autoantibodies and liver disease: uses and abuses.

Confirming whether a patient has autoimmune liver disease is challenging, given its varied presentation and complex definitions. In the continued absence of pathognomonic serum markers, diagnosis requires evaluation of laboratory investigations and, frequently, a liver biopsy - all of which need to be interpreted in the correct clinical context, with an emphasis on exclusion of viral infections, drug toxicity and metabolic disease. However, clear diagnosis is important for appropriate and timely therapy.

Minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block.

Background And Objectives: The aim of this study was to determine the minimum effective anesthetic volume required to produce an effective supraclavicular block for surgical anesthesia using an ultrasound (US)-guided technique.

Methods: Twenty-one adults undergoing elective upper limb surgery received a US-guided supraclavicular block. The initial volume of local anesthetic (LA; 50:50 mixture of lidocaine 2% and bupivacaine 0.

Telesimulation: an effective method for teaching the fundamentals of laparoscopic surgery in resource-restricted countries.

Background: Several challenges exist with laparoscopic skills training in resource-restricted countries, including long travel distances required by mentors for onsite teaching. Telesimulation (TS) is a novel concept that uses the internet to link simulators between an instructor and a trainee in different locations. The purpose of this study was to determine the effectiveness of telesimulation for teaching the Fundamentals of Laparoscopic Surgery (FLS) to surgeons in Botswana, Africa.

Development of a virtual reality haptic Veress needle insertion simulator for surgical skills training.

The Veress needle is the most commonly used technique for creating the pneumoperitoneum at the start of a laparoscopic surgical procedure. Inserting the Veress needle correctly is crucial since errors can cause significant harm to patients. Unfortunately, this technique can be difficult to teach since surgeons rely heavily on tactile feedback while advancing the needle through the various layers of the abdominal wall.

Surgical simulation in Africa: the feasibility and impact of a 3-day fundamentals of laparoscopic surgery course.

Introduction: The use of laparoscopy in resource-restricted countries has increased in recent years. Although simulation is now considered an important adjunct to operating-room-based training for learning laparoscopic skills, there is very little literature assessing the use of simulation in resource-restricted countries. The purpose of this study was to determine the feasibility and impact of a 3-day Fundamentals of Laparoscopic Surgery (FLS) course in Botswana, Africa.

Successfully treated intractable pruritus with rifampin in a case of benign recurrent intrahepatic cholestasis.

A 56-year-old gentleman with benign recurrent intrahepatic cholestasis (BRIC) suffered from recurrent episodes of pruritus for over 40 years. The treatment prescribed, namely cholestyramine, was minimally effective. However, rifampin 150 mg b.

Presentation and diagnosis of primary biliary cirrhosis in the 21st century.

Primary biliary cirrhosis is a slowly progressive, cholestatic, and chronic liver disease in which the epithelium of the intrahepatic biliary tree is destroyed by a chronic inflammatory process. The origin of this disease, which mainly affects middle-aged women, is unknown but has characteristics favoring an autoimmune etiology. This article reviews the presentation and diagnosis of PBC in the 21st century.

Primary biliary cirrhosis.

Primary biliary cirrhosis (PBC) is a chronic and slowly progressive cholestatic liver disease of autoimmune etiology characterized by injury of the intrahepatic bile ducts that may eventually lead to liver failure. Affected individuals are usually in their fifth to seventh decades of life at time of diagnosis, and 90% are women. Annual incidence is estimated between 0.

Ultrasound-guided brachial plexus block in a patient with multiple glomangiomatosis.

Background And Objectives: Glomangiomas are rare, vascular tumors consisting of an afferent artery, arteriovenous canal, neuro-reticular elements, collagen, and efferent veins, and are most often located in the soft tissue of the upper extremities. We describe how the use of ultrasound-guided nerve blockade altered the anesthetic management of a patient with multiple glomangiomatosis undergoing elective forearm surgery.

Ultrasound Findings: A 32-year-old man was scheduled for excision of painful glomangiomas from the ulnar aspect of his right wrist, with exploration of his ulnar nerve.

Predictors of functional outcome two years following revision hip arthroplasty.

Background: Little is known about factors that might predict functional outcome following revision hip arthroplasty. The purpose of this study was to identify predictors of pain and physical function at two years following revision total hip arthroplasty and to evaluate whether the time that the patient waited for the surgery and whether the patient had complications were significant predictors of outcome.

Methods: One hundred and twenty-six patients (126 hips) were entered prospectively into the study when their name was placed on the waiting list for surgery.

Antidepressants in the treatment of psychosis with comorbid depression in Parkinson disease.

Psychotic symptoms are commonly associated with Parkinson disease and can be a source of significant morbidity. Depression has been reported as a comorbidity in patients with psychosis. We describe a patient with Parkinson disease with psychotic symptoms and comorbid depression whose treatment refractory delusions and hallucinations improved markedly only after antidepressant monotherapy was initiated.

Effects of peripheral sensory input on cortical inhibition in humans.

Cortical inhibitory systems play an important role in motor output. The motor cortex can be inhibited by intracortical mechanisms and by peripheral sensory inputs. We examined whether cortical inhibition from peripheral sensory input is mediated through previously identified intracortical inhibitory systems and how these inhibitory systems interact.

Can we alter physician behavior by educational methods? Lessons learned from studies of the management and follow-up of hypertension.

Introduction: As expectations for effective continuing medical education (CME) grow, so, too, does the need to identify relationships among educational methods, physician performance, and patient outcomes associated with specific disease entities. Thus, we set out to review the literature on the effectiveness of physician educational interventions in the management and follow-up of hypertension.

Method: We searched PubMed and the Research and Development Resource Base in Continuing Medical Education for randomized controlled trials of physician educational interventions.

Common bile duct stones: the role of preoperative, intraoperative, and postoperative ERCP.

The indications for endoscopic retrograde cholangiopancreatography (ERCP) to demonstrate the presence of common bile duct stones has changed in the era of laparoscopic cholecystectomy. Preoperative ERCP is indicated when there is strong evidence of common bile duct stones, ie, jaundice, cholangitis, ultrasound demonstration of a common bile duct stone, and specific enzyme elevations. Preoperative ERCP is not indicated in mild gallstone pancreatitis.

Novel analgesic adjuncts for brachial plexus block: a systematic review.

This article reviews current evidence for the efficacy of adding novel analgesic adjuncts to brachial plexus block, the goal of which is to prolong analgesic effect without the disadvantage of systemic side effects or prolonged motor block. It may also allow for a reduction in the total dose of local anesthetic used. Novel adjuncts studied to date include opioids, clonidine, neostigmine, and tramadol.