Showing papers by "Lenox Hill Hospital published in 2002"
TL;DR: A therapeutic intervention of strengthening the adductor muscle group appears to be an effective method for preventingAdductor strains in professional ice hockey players.
Abstract: Background: Adductor strains are among the most common injuries in ice hockey. Hip adductor weakness has been identified as a strong risk factor.Hypothesis: An intervention program including muscle strengthening can reduce the incidence of adductor strains in professional ice hockey players.Study Design: Prospective risk factor prevention study.Methods: Thirty-three of 58 players from the same National Hockey League team were identified as “at risk” on the basis of preseason hip adductor strength and participated in an intervention program. The program consisted of 6 weeks of exercises aimed at functional strengthening of the adductor muscles. Injury and individual exposure data were recorded for all players.Results: There were 3 adductor strains in the 2 seasons subsequent to the intervention, compared with 11 in the previous 2 seasons (0.71 versus 3.2 per 1000 player-game exposures). All adductor strains were first-degree strains and occurred during games.Conclusions: A therapeutic intervention of stren...
193 citations
TL;DR: Real-time pulmonary ultrasonography (US) for the practicing pulmonologist supplements chest radiography and chest CT scanning and may help to diagnose conditions such as pneumothorax, hemothorAX, pleural or pericardial effusion, pneumonia, and pulmonary embolism in the critically ill patient who is in need of bedside diagnostic testing.
189 citations
TL;DR: This article focuses on the features of stent design that make a specific stent more or less suitable for a particular type of lesion or anatomy: the "average" coronary lesion, the lesion situated on a curve, the ostial lesions, the bifurcational lesion.
175 citations
TL;DR: The results indicate that persons with Parkinson's disease (PD) attain a significantly lower FAP score when ambulating at their preferred rate and demonstrate shorter step length and a longer step time than the age matched non-impaired group during both preferred and fast velocities of walking.
Abstract: Background and purpose:The purpose of this study was (1) to determine the validity of the GaitRite System in detecting footfall patterns and selected gait characteristics of person with early stage Parkinson's disease (PD) and (2) to investigate whether the Functional Ambulation Performance (FAP) scoring system is a valid tool to distinguish between selected gait characteristics of patients with early stage Parkinson's disease and similar age of non-impaired individuals. The FAP score is a quantitative means of assessing gait based on specific spatial and temporal gait parameters. Participants: 11 volunteers with idiopathic Parkinson's disease, (mean age = 74.3), and 11 age matched volunteers, (mean age = 70.3), with no history of neurological disorder participated in the study. The non-impaired control group were not matched in age and sex but of similar age and males and females were represented in the control group. Methods: Temporal and spatial parameters of gait were analyzed for both preferred- speed and fast-speed walking using the computerized GaitRite system. The system integrates specific components of locomotion to provide a single, numerical representation of gait, the Functional Ambulation Performance Score (FAP) score. Results: The most powerful and discriminating variable between Parkinson's and non-impaired groups for both walking speeds was the mean normalized velocity (MNV). Which is velocity divided by leg length. The MNV was 0.83 for PD at preferred walking speed and 1.14 at fast speed, the non-impaired group preferred-speed group walking was 1.33, while fast-speed walking MNV was 1.70. Note the fast walking of PD was slower than the preferred velocity of the non-impaired group. For preferred- speed walking, all gait variables analyzed in the study were different between the two groups beyond the p< 0.05 level of confidence with the single exception of right stance percentage. For fast-speed walking, three of the entered variables did not discriminate between the two groups: the fast walking FAP score, left fast-walking cadence, and right fast-walking single support percentage. Conclusion and discussion: Our results indicate that persons with Parkinson's disease (PD) attain a significantly lower FAP score when ambulating at their preferred rate and demonstrate shorter step length and a longer step time than the age matched non-impaired group during both preferred and fast velocities of walking. Stance duration and double support duration were increased for the Parkinson's population, whereas single support duration, mean cadence, and heel-to-heel base of support were markedly reduced for both walking speeds. The FAP score was significantly different from the non-impaired control group for preferred-speed walking. These results indicate that the GaitRite system can be useful in detecting footfall patterns and selected time and distance measurements of persons with early stage Parkinson's disease and the FAP score discriminates between the PD population and the non-impaired controls when walking at preferred rate but not at fast walking.
153 citations
TL;DR: The VSB is a safe and effective treatment option for adults with moderate to severe sensorineural hearing loss and improvements in satisfaction, performance, and preference were statistically significant with the VSB.
Abstract: Objectives: The goal of the study was to evaluate the performance of a semi-implantable middle ear hearing device (Vibrant Soundbridge System [VSB]; Symphonix Devices, Inc). Study Design: A prospective, single-subject, repeated-measures multicenter study was conducted to determine the safety and efficacy of the VSB using analog and digital external processors. Measures included residual hearing, functional gain, speech recognition, acoustic feedback, occlusion, and patient self-assessment to determine satisfaction, perceived performance, and device preference compared with an appropriately fit acoustic hearing aid. Fifty-three adult subjects with moderate to severe sensorineural hearing loss were evaluated at 4 or more intervals after implantation. Results: Improvements in satisfaction, performance, and preference were statistically significant with the VSB, as was functional gain across all test frequencies (P < 0.001). Occlusion and feedback were virtually eliminated. Aided speech recognition was comparable between VSB and the hearing aid. Residual hearing was unchanged. Conclusion: The VSB is a safe and effective treatment option for adults with moderate to severe sensorineural hearing loss. (Otolaryngol Head Neck Surg 2002;126:97-107.)
147 citations
TL;DR: Hip-strengthening exercises were shown to be an effective method of reducing the incidence of adductor strains in one closely followed National Hockey League ice hockey team.
Abstract: An in-season adductor muscle strain may be debilitating for the athlete. Furthermore, an adductor strain that is treated improperly could become chronic and career threatening. Any one of the six muscles of the adductor group could be involved. The degree of injury can range from a minor strain (Grade I), where minimal playing time is lost, to a severe strain (Grade III) in which there is complete loss of muscle function. Ice hockey and soccer players seem particularly susceptible to adductor muscle strains. In professional ice hockey players throughout the world, ~10% of all injuries are groin strains. These injuries, which have been linked to hip muscle weakness, previous injuries to that area, preseason practice sessions and level of experience, may be preventable if such risk factors can be addressed before each season. Hip-strengthening exercises were shown to be an effective method of reducing the incidence of adductor strains in one closely followed National Hockey League ice hockey team. Despite the identification of risk factors and strengthening intervention for ice hockey players, adductor strains continue to occur throughout sport. Clinicians feel an active training programme, along with completely restoring the strength of the adductor muscle group, is the key to successful rehabilitation. Surgical intervention is available if nonoperative treatment fails for 6 months or longer. Adductor release and tenotomy was reported to have limited success in athletes.
135 citations
TL;DR: F fluoroscopy time is a poor predictor of risk because it does not correlate well with peak skin dose, and cumulative dose and DAP are not good analogues of PSD because of weak correlations for some procedures and because of wide variations in the dose index for all procedures.
135 citations
TL;DR: PCI in patients with impaired renal function, whether on dialysis or not, is associated with poor in‐hospital and 1‐year survival and high left ventricular ejection fraction and creatinine clearance were associated with decreased late mortality.
Abstract: The clinical outcome of patients with chronic renal failure (CRF) who undergo percutaneous coronary intervention (PCI) has not been systematically evaluated in a large cohort of patients. We retrospectively analyzed the in-hospital and 1-year clinical outcomes of 10,076 consecutive patients who underwent PCI between January 1994 and December 1997. A total of 95 patients (0.9%) had end-stage renal disease (ESRD) on dialysis, 786 patients (7.8%) had CRF, and 9,125 patients (90.6%) had normal renal function. Despite an angiographic success rate of 97% in all three groups, in-hospital mortality was significantly higher among patients with renal disease, whether they were on dialysis or not, when compared to patients without renal dysfunction (6.8% vs. 4.2% vs. 0.9%; P < 0.0001). At 1-year follow-up, mortality rate was 48.8% for ESRD, 25.7% for patients with CRF, and 5.5%, for patients without renal dysfunction (P < 0.0001). By multivariate analysis, high left ventricular ejection fraction and creatinine clearance were associated with decreased late mortality (OR = 0.84 and 0.95; P < 0.0001), whereas ESRD (OR = 3.65; P = 0.0002), non-Q-wave myocardial infarction (OR = 2.21; P < 0.0001), diabetes mellitus (OR = 1.99; P < 0.0001), and CRF (OR = 1.74; P = 0.003) were independent correlates of increased late mortality. Therefore, PCI in patients with impaired renal function, whether on dialysis or not, is associated with poor in-hospital and 1-year survival.
133 citations
TL;DR: The harmonic scalpel, whose use was pioneered in laparoscopic surgery, offers the thyroid surgeon the ability to safely and expeditiously control the feeding vessels through a limited field.
Abstract: Objective: The purpose of this report was to evaluate the technical benefits, if any, of thyroidectomy using the harmonic scalpel versus conventional thyroidectomy. Study Design: One hundred five consecutive patients underwent thyroidectomy over 1 year with use of the harmonic scalpel. They were compared with a group of 20 patients who underwent thyroidectomy 1 year earlier using conventional techniques. Results: The incision length for those undergoing thyroidectomy with the harmonic knife averaged 4.5 cm compared with 5.5 cm for the conventional thyroidectomy group. The operating time for a hemithyroidectomy averaged 50 minutes for the harmonic scalpel group versus 80 minutes for the conventional technique. The operating time for a total thyroidectomy averaged 80 minutes for the harmonic scalpel group versus 120 minutes for the conventional thyroidectomy group. Conclusion: The use of the harmonic scalpel in thyroid surgery offers several advantages over the conventional technique. The incision length is shorter and the operating time is reduced. Bleeding is negligible and complications are few. Significance: The harmonic scalpel, whose use was pioneered in laparoscopic surgery, offers the thyroid surgeon the ability to safely and expeditiously control the feeding vessels through a limited field. (Otolaryngol Head Neck Surg 2002;127:284-8.)
121 citations
TL;DR: In this article, the authors evaluated the association between fetal gender and prolonged pregnancy and concluded that male gender significantly predisposes to the prolongation of pregnancy to the extent that, by 43 weeks of gestation, there are 3 male deliveries for every 2 female deliveries.
102 citations
TL;DR: The results of the VeGAS 2 trial further extend knowledge of the AngioJet device and demonstrate benefits in success, safety, and greater convenience to the patient and physician due to a single, combined procedure for thrombus removal and definitive intervention in this high-risk patient group.
Abstract: The results of the VeGAS 2 trial further extend knowledge of the AngioJet device and demonstrate benefits in success, safety, and greater convenience to the patient and physician due to a single, combined procedure for thrombus removal and definitive intervention in this high-risk patient group. AngioJet should be regarded as the therapy of choice for treatment of thrombotic SVGs or native coronary arteries.
TL;DR: A 61-year-old woman who was a New York City hospital employee developed fatal inhalational anthrax, but with an unknown source of anthrax exposure, and died on the fourth hospital day.
Abstract: A 61-year-old woman who was a New York City hospital employee developed fatal inhalational anthrax, but with an unknown source of anthrax exposure. The patient presented with shortness of breath, malaise, and cough that had developed 3 days prior to admission. Within hours of presentation, she developed respiratory failure and septic shock and required mechanical ventilation and vasopressor therapy. Spiral contrast-enhanced computed tomography of the chest demonstrated large bilateral pleural effusions and hemorrhagic mediastinitis. Blood cultures, as well as DNA amplification by polymerase chain reaction of the blood, bronchial washings, and pleural fluid specimens, were positive for Bacillus anthracis. The clinical course was complicated by liver failure, renal failure, severe metabolic acidosis, disseminated intravascular coagulopathy, and cardiac tamponade, and the patient died on the fourth hospital day. The cause of death was inhalational anthrax. Despite epidemiologic investigation, including environmental samples from the patient's residence and workplace, no mechanism for anthrax exposure has been identified.
TL;DR: The rate of fluid intake was greater in finishers than in non-finishers, and finishers tended to more nearly meet their energy needs, which is consistent with fluid overload during a running event lasting more than 24 hours in hot and humid conditions.
Abstract: Objective: To relate changes in laboratory indices to dietary intake during extremely prolonged running and to determine if dietary intake influences the ability of runners to finish an 160 km trail race.Methods: We monitored intake and serum chemistries of 26 runners competing in an 160 km foot race in temperatures which peaked at 38°C. Blood was drawn pre-, mid- and post-race. Dietary intake and incidence of gastrointestinal distress or changes in mental status were determined by interview with runners approximately every 13 km. Twenty-three runners completed at least 88 kms and, of these 23 runners, 13 finished 160 km in a mean time of 26.2 ± 3.6 hours.Results: Finishers ingested nearly 30,000 J, 19.4 ± 8.1 L of fluid and 16.4 ± 9.5 g of sodium (Na). Sodium and fluid intake per hour was estimated to be 0.6 g/hour and 0.7 L/hour, respectively. Electrolyte intake during the first half of the race was similar between those that finished the race and those that did not. Finishers ingested fluid at a greate...
Journal Article•
TL;DR: Future developments, such as navigation-guided surgery, enhanced kinematics, and wear-resistant bearing surfaces with better fixation, promise a consistent evolution for the total knee replacement.
Abstract: In the early 1970s, the condylar knee was developed independently in the United States and overseas. The concept of replacing the tibiofemoral condylar surfaces with cemented fixation, along with preservation of the cruciate ligaments, was developed and refined. To correct severe knee deformities, the condylar knee with posterior cruciate-sacrificing design was introduced, also in the early 1970s. By 1974, replacing the patellofemoral joint and either preserving or sacrificing the cruciate ligaments had become standard practice. Subsequently, condylar knee designs were improved to include modularity and noncemented fixation, with use of universal instrumentation. Today, over 19 companies in the United States distribute total knee implants of three different types: cruciate-preserving, cruciate-substituting, and TC-III. Six major companies are actively involved in designing mobile-bearing knees. Future developments, such as navigation-guided surgery, enhanced kinematics, and wear-resistant bearing surfaces with better fixation, promise a consistent evolution for the total knee replacement.
TL;DR: Diabetics appear to have a lower risk of prostate cancer in diabetics overall, though this effect may be limited to whites.
Abstract: Background: Little is known about etiologic factors for prostate cancer. Several studies have suggested a protective effect of diabetes mellitus on the risk of prostate cancer, though a study by our group has found an elevated risk of prostate cancer following ischemic heart disease.Purpose: The purpose of this study was to investigate the association of diabetes mellitus with prostate cancer in the same setting in which we had found an elevated risk following ischemic heart disease. Our study differed from prior studies in utilizing a multi-racial population. Another purpose was to investigate stage-specific effects.Methods: We conducted a hospital-based case-control study in our University Medical Center in New York City. Cases were patients with prostate cancer seen at our Medical Center between January 1, 1984 and December 31, 1986. All cases were histologically diagnosed and had undergone a biopsy or surgical procedure at Columbia-Presbyterian Medical Center (CPMC). The controls were patients who und...
TL;DR: In the initial experience, endoscopic radial artery harvesting can be performed safely, with minor, infrequent complications, and a full-length radial artery conduit can be obtained with improved esthetics and patient satisfaction and acceptance.
TL;DR: Tirofiban provided a similar level of overall protection to abciximab against the composite of death, myocardial infarction, and any target-vessel revascularisation at 6 months.
TL;DR: Finasteride significantly decreases suburethral prostatic microvessel density in patients with BPH, which may explain its efficacy for decreasing BPH associated bleeding.
TL;DR: Distal protection during SVG PCI with the FilterWire EX is associated with a low rate of peri-procedural adverse events compared to historical controls.
TL;DR: To investigate maternal perceptions of both pain and anxiety before and after genetic amniocentesis, a large number of women took part in a double-blind, placebo-controlled study.
Abstract: Objective
To investigate maternal perceptions of both pain and anxiety before and after genetic amniocentesis.
Study design
This prospective study of midtrimester, singleton pregnancies was conducted between March 2000 and July 2000. Study variables included patient demographics, medical and obstetric histories, indication for amniocentesis and a description of the source of information used by the patient regarding the procedure and technical degree of difficulty. Maternal pain and anxiety associated with performing amniocentesis were subjectively quantified with the use of the visual analog scale (VAS). Statistical analysis included Wilcoxon signed rank test, anova, and simple and stepwise regression analyses.
Results
One hundred and eighty-three women participated in the study. Perception of pain before amniocentesis was significantly higher compared to that expressed immediately after the procedure, with a mean VAS score of 3.7 ± 2.5 vs. 2.1 ± 2.0 (P < 0.0001). Similarly, perception of anxiety was significantly greater prior to the procedure, with a mean VAS score of 4.6 ± 2.8 vs. 2.8 ± 2.4 after the amniocentesis (P < 0.0001). Perceptions of pain and anxiety were significantly and positively correlated to each other both before and after the procedure (P < 0.0001). History of a prior amniocentesis was the only variable associated with reducing expected pain and anxiety (negative correlation, P < 0.001), whereas the technical degree of difficulty was the only significant variable impacting on the actual pain and anxiety (positive correlation, P < 0.005).
Conclusions
Preamniocentesis counseling should emphasize the fact that, for most women, the actual pain and anxiety experienced during the procedure are significantly lower than expected. In fact, on a scale of 0–10, the mean level of pain was only 2.1, with a slightly higher mean level of anxiety. Copyright © 2002 ISUOG
Journal Article•
TL;DR: Preliminary data does not provide evidence for a central mechanism in that an initial bout of eccentric exercise using one limb did not provide protection against damage from a repeated bout with the contralateral limb two weeks later and neither strength loss nor tenderness were significantly different between bouts.
Abstract: Individuals undergoing an unaccustomed exercise bout incorporating a high degree of eccentric muscle contractions commonly experience delayed onset muscle soreness. The damage manifests itself via tenderness, loss of strength, swelling, elevated muscle enzyme activity and loss of flexibility. Following an initial "damage bout," a repeated bout results in reduced symptoms. This protective effect is known as the repeated bout effect (RBE) and can last up to 24 weeks between bouts. The mechanism for this RBE is unclear and both central and local mechanisms have been suggested. In an attempt to test the central hypothesis, 12 subjects (mean age = 22.5± 4yrs, ht = 167±9cm, mass = 71.5±13.5kg) underwent an exercise protocol whereby one leg was exercised eccentrically and following complete recovery; the contralateral leg was exercised in the same manner. Subjects were required to step on and off a 46-cm step for 20 minutes at a cadence of 15 steps/minute. One leg was used to go up the step (concentric) while the opposite was used to go down (eccentric). Approximately two weeks later and following complete recovery, the protocol was repeated with the concentrically exercise leg now performing the eccentric contraction. Data analyses indicate that muscle damage was induced during both trials on the eccentrically exercised leg as evidenced by a change in tenderness (bout 1 P < 0.05: bout 2 P < 0.01), pain scores (bout 1 P < 0.0001; bout 2 P < 0.01), and strength loss (bout 1 P = 0.001; bout 2 P = 0.001) over the four day follow up period. No tenderness was evident on the concentrically exercised limbs when compared to baseline (Bout 1: P =0.13, Bout 2: P = .06). Pain was significantly lower in bout two versus bout one (P< 0.04), however, we attribute this to a tolerance effect. Neither strength loss nor tenderness were significantly different between bouts. In the current study, damage was induced in both bouts in the eccentrically exercised limbs. This preliminary data does not provide evidence for a central mechanism in that an initial bout of eccentric exercise using one limb did not provide protection against damage from a repeated bout with the contralateral limb two weeks later.
TL;DR: The results of this multicenter, prospective registry demonstrates the safety and efficacy of a 40-mm 90Strontium/90Yttrium source train in the management of patients with in-stent restenosis and supports the continued use of beta radiation for the treatment of this disease process.
Abstract: Purpose: To evaluate the safety and efficacy of a 40-mm 90 Strontium/ 90 Yttrium source train in the management of in-stent restenosis within native coronary arteries. Methods and Materials: This multicenter, prospective registry was designed to compare the results of patients with in-stent restenosis treated with a 40-mm source train to the placebo arm of the previously reported randomized Stents and Radiation Trial (START). All patients entered in the registry were treated with repeat balloon angioplasty followed by intravascular brachytherapy. Radiation dose was prescribed based on vessel size. 18 Gy was delivered at 2 mm for vessel diameters between 2.75 and 3.35 mm, and 23 Gy was used for vessels between 3.36 and 4.0 mm. The efficacy endpoints for the START 40 registry included a reduction in the target lesion revascularization (TLR) rate, target vessel revascularization rates, and target vessel failure (TVF) at 8 months. Secondary angiographic efficacy endpoints were binary restenosis at 8 months, in-stent minimum luminal diameter (MLD), and late loss. The safety endpoints included major adverse cardiac events as well as late aneurysm formation. The registry was designed to allow a statistically valid comparison of these results to the placebo group of the START 30 trial. Quantitative angiographic analysis was performed on the 8-month follow-up examination. Rates of restenosis were evaluated for various segments of the treated vessel. A separate analysis was performed to evaluate the relationship between vessel injury length and the radiated segment. Results: A total of 207 patients were entered into the START 40 registry. The postprocedure angiographic results, including the postprocedure MLD and percent diameter stenosis, were similar between the START 40 patients and the placebo group from the START trial in the stented segment of the treated vessel. Eight-month angiographic follow-up was available on 150 patients from the registry. The TLR rate was significantly reduced when compared to the placebo group (11% vs. 22.4% respectively, p = 0.008). A similar reduction was seen in terms of target vessel revascularization (15.9% vs. 24.1%, p = 0.03). The 8-month MLD was found to be significantly larger in the START 40 patients (1.85 mm vs. 1.47 mm, p p = 0.1). Analysis of the procedural angiograms revealed mismatch between the length of vessel injured and the location of the 90% isodose in 46% of the treated cases. Angiographic analysis revealed that geographic miss was associated with a higher rate of binary restenosis (32% vs. 18% p = 0.04) in the analysis segment. Conclusions: This multicenter registry demonstrates the safety and efficacy of a 40-mm 90 Strontium/ 90 Yttrium source train in the management of patients with in-stent restenosis. Restenosis rates were lowered with the use of this longer source train when compared to the placebo arm of the START trial for lesions with a maximum vessel injury length of 20 mm. Angiographic analysis identified the importance of the accurate delineation of injury length and correct source positioning. These results support the continued use of beta radiation for the treatment of this disease process.
TL;DR: Only by understanding the particular cystometric characteristics of patients with OAB can the authors determine the appropriate treatment, and Urodynamic testing should serve as an essential part of therapy and guide future research in diagnosis and management.
TL;DR: It is the impression that the fundamental problem in the current healthcare system is a lack of meaning, which will be defined as the underlying beliefs, guiding principles, and defining philosophies that make up the professional ethic of medicine.
Abstract: FOR SOME TIME, I have taught communication and relational skills to medical students and physicians-in-training in an internal medicine residency program in the United States. What became apparent to me early on was that the humanistic, relationship-centred attitudes and behaviours being fostered in the classroom were not always finding their way into the clinic or onto the hospital floors. Sadly enough, this observation is supported by studies on patient–physician communication.1,2 In discussing this phenomenon with my students and colleagues, a common response emerged. They believe the relational behaviours taught in the classroom are not wholly credible in the “real world” of medical practice. Empathic attitudes and behaviours make little sense in terms of survival in residency training or success in practice. It seems as if these compassionate behaviours are being extinguished by a lack of incentive or reward in the system. Valued and rewarded instead are academic acumen, technical knowledge and skill, business savvy, and financial success. To better understand this situation, I began to study the “real world” of medicine more intently. Based on this examination, it is my impression that the fundamental problem in the current healthcare system is a lack of meaning. For the purpose of this article, “meaning” will be defined as the underlying beliefs, guiding principles, and defining philosophies that make up the professional ethic of medicine. What follows are my observations and thoughts, as well as a brief outline of my recommendations. Over the past century, there has been an insidious decline in attention to the philosophy of medicine. We have become less interested in or aware of the age-old values and ethical traditions of our healing profession. This claim is supported by the many studies demonstrating that medical training and professional socialisation, rather than developing and fostering humanistic attitudes and behaviours, actually erode them.3,4 As a result, the core meanings of medicine have been subsumed by the current, dominating societal paradigms of business,5 consumerism,6 the information age,7 technology,8 and the legal system. Clearly, these paradigms are integral and necessary to world culture and modern healthcare, but problems arise when they control the healthcare system, directing the way we care for patients and relate to clinicians. Patient-care surveys reveal a steady decline in public satisfaction with medical care. Research studies repeatedly demonstrate a lack of communication, empathy, and trust in the doctor–patient relationship.9 Although a significant percentage of patients are satisfied with their individual physicians, they and their families are largely displeased with the overall healthcare experience.10 Escalating discontent and distrust are evidenced weekly in newspaper articles and bestselling books.11,12 This widespread public discontent with mainstream medical care is further evidenced by the large and growing movement to seek alternative avenues of medical treatment by turning, literally, to “alternative” practitioners.13 Dangling on the other end of the stethoscope, physicians and other clinicians increasingly find themselves frustrated and demoralised by a work environment devoid of respect and compassion for its employees.14 Morale within the healthcare work environment is at an all-time low.15 Physicians, emotionally exhausted and burned-out, are claiming disabilities and leaving the practice of medicine in unprecedented numbers.16 Loss of autonomy in medical decisionmaking, burdensome and time-consuming administrative hurdles, fear of malpractice litigation, and financial disincentives threaten physicians’ livelihood and their sense of responsibility and professionalism.17 Clinicians, entering the profession with an expectation of providing humanistic medical care, quickly become disappointed and disillusioned.18 The present healthcare system, embedded in the principles of the marketplace, has become a caustic and dehumanising environment for patient and physician alike. Physicians are reduced to interchangeable “providers” and patients to generic “consumers”. Clinicians, now treated like factoryline workers, are forced to process patients as if they were items on a conveyor belt. And so we find ourselves entangled in the paradox of modern healthcare19 — despite astounding scientific achievements and dazzling technological sophistication over the past few decades, societal satisfaction with the healthcare system is declining.20 The question we return to is why. One of the greatest tragedies of the 20th century is that in developing the means we have forgotten the “meaning”.21 Our society has forgotten that the practice of medicine is primarily a humanistic endeavour, not a scientific one.22 We have forgotten that medicine is a healing profession, not a technological one, and that the contribution of a doctor adds up to more than the sum of his or her knowledge and skill. We have forgotten that the patient, as a person, is far more important than the illness; that the illness is far more than the presence of a disease; and that when the cure of Reclaiming the lost meanings of medicine
TL;DR: A prospective, randomized, intermediate-term study comparing proximally hydroxyapatite (HA)-coated and non-HA-coated surfaces of identical stem design confirmed comparable outcomes in both groups according to the Postel--d'Aubigne Hip Rating System.
Abstract: A prospective, randomized, intermediate-term study of 174 patients (199 hips) comparing proximally hydroxyapatite (HA)-coated and non-HA-coated surfaces of identical stem design is presented. Clinical and radiographic data from 152 patients (174 hips) confirmed comparable outcomes in both groups according to the Hospital for Special Surgery modification of the Postel–d'Aubigne Hip Rating System. The non-HA group showed significantly higher ( P =.03) activity-related thigh pain, however. There were no significant radiographic differences, with all stems showing bone ongrowth. The use of HA-coated stems resulted in early recovery of function and reduced activity-related trochanteric and thigh pain. A possible explanation for the difference is most likely early superior osseointegration. HA as a biologic adjuvant should gain widespread acceptance because of rapid recovery of function and lesser trochanteric and thigh pain. Copyright 2002, Elsevier Science (USA). All rights reserved.
TL;DR: The first case report of acalculous eosinophilic cholecystitis in a young man secondary to the use of a muscle-building herbal medicine containing L-tryptophan is presented, and the literature regarding the adverse effects of herbal medicines in surgical patients is reviewed.
TL;DR: Although Doppler velocimetry is the newest modality to assess fetal wellbeing, it has been the subject of more randomized controlled trials than any other test of fetal well-being.
Abstract: Doppler ultrasound is a noninvasive technique that is commonly used to evaluate maternal and fetal hemodynamics. This testing modality is based on the premise that an insufficient uterine, placental, or fetal circulation results in an adverse pregnancy outcome and that these abnormalities can be defined with the use of Doppler velocimetry. Doppler techniques have been used in obstetrics since the initial report of successful recording of blood flow signals from the umbilical artery by Fitzgerald and Drumm in 1977. Although Doppler velocimetry is the newest modality to assess fetal wellbeing, it has been the subject of more randomized controlled trials than any other test of fetal well-being.
TL;DR: A consecutive series of five patients who developed facial paralysis following cranial surgery for acoustic neuroma are described, each underwent successful cross-facial nerve grafting during the first week following their initial surgery.
Abstract: Facial nerve repair is a dynamic reanimation technique Direct nerve repair by suturing or grafting can provide good results within a specific time frame Immediate nerve repair has been successful in cases of laceration injuries, but nerve grafting techniques are typically delayed when it is clear that direct suturing to the nerve trunk cannot be achieved without tension Delayed nerve grafting is also employed following ablative procedures and in cases of trauma that cause segmental nerve deficits Cross-facial nerve grafting is particularly useful when the peripheral branches are intact and the main trunk of the facial nerve is inaccessible This method is also typically performed in a delayed fashion Rehabilitation of the facial nerve and subsequent reinnervation of the mimetic motor endplates are achieved through axonal growth In this article, we describe a consecutive series of five patients who developed facial paralysis following cranial surgery for acoustic neuroma Each underwent successful cross-facial nerve grafting during the first week following their initial surgery Each received a sural nerve graft to at least two main divisions of the VII th cranial nerve We discuss our operative technique and the degree of restored nerve function
TL;DR: The acute management of soft tissue injuries of the knee requires knowledge of the injury mechanism, physical findings, and results of adjunctive tests.