Actinomyces meyeri: from "lumpy jaw" to empyema.

While the most common presentation of actinomycosis is cervicofacial disease, or "lumpy jaw syndrome," Actinomyces meyeri has a predilection for pulmonary disease as well as dissemination to distant organs. We describe a 61-year-old Caucasian male with a relapsing-remitting mandibular sinus tract who would go on to develop weight loss, dyspnea, and a cough productive of malodorous sputum. Imaging revealed a right lower lobe pneumonia and a large left sided empyema.

Immune reconstitution inflammatory syndrome involving the central nervous system in a patient with HIV infection: a case report and review of literature.

IRIS is described as a paradoxical deterioration of clinical status upon initiation of combined anti-retroviral therapy (cART) in patients with HIV infection. Immune reconstitution inflammatory syndrome (CNS-IRIS) involving the central nervous system is rarely reported. We describe the case of 57-year-old man who developed a fatal case of CNS- IRIS.

Effect of therapeutic horseback riding on balance in community-dwelling older adults with balance deficits.

Objectives: Falls are an important cause of morbidity in older adults. Equine-assisted activities including therapeutic riding (TR) benefit balance and neuromuscular control in patients with neurological disabilities but have not been systematically studied in older adults at greater risk for falls due to balance deficits. The effect of an 8-week TR program on measures of balance and quality of life in community-dwelling older adults with established balance deficits was evaluated.

Free vascularized fibular grafting preserves athletic activity level in patients with osteonecrosis.

Athletic patients with osteonecrosis of the femoral head have few desirable therapeutic options that preserve athletic ability. Because these patients are usually young and healthy, any procedure that avoids total hip arthroplasty would be most desirable. This study prospectively evaluated 15 patients (19 hips) who presented with an average age of 28.

Perioperative pain control in pediatric patients undergoing orthopaedic surgery.

Management of perioperative pain is critical in the pediatric patient undergoing orthopaedic surgery. A variety of modalities can be used to manage pain and optimize recovery and patient satisfaction, including nonopioid and opioid analgesia; local anesthetic injection; and regional analgesia such as intrathecal morphine, epidural therapy, and peripheral nerve blocks. Acute pain management can be tailored based on the needs of the patient, the surgical site, and the anticipated level of postoperative pain.

Pancreatic extra-gastrointestinal stromal tumour masquerading as a bleeding duodenal mass.

We describe a 55-year-old man presenting to our institution with a gastrointestinal bleed. He was found to have a 5 cm pancreatic extra-gastrointestinal stromal tumours (EGISTs) eroding into the duodenum and ampulla of Vater. Pancreaticoduodenectomy was performed and the tumour was noted to be positive for CD117 and CD34 with six mitotic figures per 50/high-powered field.

Leonardo da Vinci's foot: historical evidence of concept.

Introduction: Leonardo da Vinci (1452-1519), world-renowned Italian renaissance master, is known for his contributions to, and broad interests in science and art. The objective of this work is to demonstrate the extent of his science by applying the use of his concepts to current models of foot and ankle mechanics.

Methods: The art and science of Leonardo Da Vinci were extensively analyzed by reviewing his original drawings and hand written notebooks as well as their English translation.