Physiotherapist-led suprascapular nerve blocks for persistent shoulder pain: Evaluation of a new service in the UK.

INTRODUCTION: This service evaluation explored and reported findings from a new physiotherapist-led service offering suprascapular nerve blocks (SSNBs) to patients with persistent shoulder pain. METHODS: We collected data before the SSNB injection and at the 6-weeks and 6-month follow-up from consecutive patients with persistent shoulder pain being treated by physiotherapists or an anaesthetist. Outcomes were patient-reported pain (numerical rating scale [NRS 0 to 10]), patient-specific functional score (PSFS) and health-related quality of life [the EuroQol five dimensions questionnaire (EQ5D-5 L)]. Exploratory analyses compared baseline and follow-up scores within each clinician delivery group (physiotherapists, anaesthetist). RESULTS: Forty patients (mean age 57 years [standard deviation {SD} 12]; 63% female) received an SSNB from a physiotherapist, eight patients (mean age 59 years [SD 11]; female 88%) received an SSNB from an anaesthetist. At the 6-week follow-up, the physiotherapy group showed a mean reduction in pain (on the NRS): 2.2 (95% confidence interval [CI] 1.3 to 3.0) and an improvement in function (on the PSFS): -1.3 (95% CI -1.9 to -0.4). Similar changes were found in those treated by the anaesthetist (pain: 1.3 [95% CI -1.18 to 3.80]; function: -1.4 (95% CI -3.18 to 0.35]). Very small changes, that were not statistically significant, were found in EQ5D-5 L scores. At the 6-month follow-up, the mean reduction in pain (NRS) was maintained at 2.0 (95% CI 0.99 to 2.95) for the physiotherapy group. CONCLUSION: The results provide early, exploratory evidence that patients with persistent shoulder pain treated by physiotherapists using palpation-guided SSNBs achieve clinically important changes in pain and function in the short and medium term

A role for the histone variant HTZ1 in meiotic chromosome segregation

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Biology, 2008.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Includes bibliographical references (leaves 36-42).In Eukaryotic cells, the packaging of genomic DNA into chromatin has important consequences for all DNA-dependent transactions. Chromatin structure is highly regulated by a variety of complex processes that are not well understood. These include nucleosome remodeling and post-translational modification of histone proteins (Dunn & Kingston, 2007; Kouzarides, 2007; Workman, 2006). An additional mechanism for chromatin regulation is the replacement of conventional histones with specific non-allelic variants. H2AZ, a highly conserved variant of histone H2A, is of particular interest because it is essential for viability in multicellular organisms and it has been implicated in many distinct and even contradictory functions. Despite extensive evidence implicating H2AZ in maintenance of genome stability, centromere structure and function, and chromosome segregation, a role for H2AZ in meiosis has not been investigated. The budding yeast Saccaromyces cerevisiae, a classical model for cell division studies, constitutes a highly amenable system in which to approach this question. In this study, deletion of the S. cerevisiae H2AZ homologue, Htz1, resulted in classical meiotic defect phenotypes such as reduced sporulation efficiency, impaired spore viability, and displayed a reduced ability to progress through meiosis. Htz1 deletion strains also showed an increase in chromosome nondisjunction during both meiosis I and II and premature sister chromatid separation during meiosis I. These results suggest a novel role for H2AZ in regulating meiotic chromosome segregation and possibly in centromeric protection and kinetochocore co-orientation and further illustrate how defects in H2AZ function may contribute to human diseases such as cancer.by Shlomo Hogla Meislin.S.M

Infected Peri-Pancreatic Necrosis Causing Gallbladder Necrosis by Direct Extension

Acute acalculous cholecystitis may develop in patients suffering from necrotizing pancreatitis. Conversely, acute pancreatitis may complicate acute gallbladder disease. We present a case that lends support to the existence of another possibility: gallbladder necrosis caused by direct extension of the necrotizing pancreatitic process

Rupture of the Distal Biceps Tendon Combined with a Supinator Muscle Tear in a 51-Year-Old Woman: A Case Report

Distal biceps tendon rupture is a relatively uncommon occurrence in the general female population, and to our knowledge, has not been reported in association with a supinator muscle tear. We report a case of 51-year-old woman who experienced sharp pain in her forearm and elbow after lifting a heavy object. History and physical examination raised suspicion for a distal biceps tendon rupture. MRI imaging determined a combined distal biceps tendon tear with a supinator muscle tear with subsequent confirmation at surgery. Surgical repair was performed for the distal biceps tendon only through a single incision approach using the Endobutton technique

Integrating Tendinous Pathophysiology Into Rotator Cuff Tears And Greater Trochanteric Pain Syndrome: A Narrative Review

This narrative review aims to use the similarities between the shoulder and hip joints to better understand why rotator cuff (RC) tendinopathy and hip abductor tendinopathy occur and inform about diagnosis and treatment of both orthopedic complaints. A search of the literature was conducted using GoogleScholar and Pubmed and initially followed a systematic review protocol, but the nature of the topic, current literature and data necessitated a narrative review. Reports that discussed pathomechanics of RC and gluteal tendinopathy individually, together and with other muscles groups were reviewed. It was found that the methods measuring and describing the processes of tendinopathy differ significantly, for each individual joint and between all joints. A review of a large body of quantifiable measures and theoretical ideas regarding tendinopathy was performed to address this lack of consensus in current literature. Initial literature yielded 74 articles. After review, only 43 articles were used from a broad range of approaches and methodologies. The review found a body of evidence suggesting that fibrocartilage overgrowth and compressive forces over bony structures cause tendonous pathology of the RC and hip abductor tendons. These findings support the idea that tendinopathy is often caused by intrinsic factors rather than the traditional view of external factors. Earlier treatment and improved outcomes without surgery are possible using current imaging technology to identify these intrinsic factors that affect tendinous properties

Lupus nephritis in Chinese children--a territory-wide cohort study in Hong Kong

We report a multicenter study of Chinese children in Hong Kong with systemic lupus erythematosus (SLE) nephritis. Children were included if: they fulfilled the ACR criteria, had significant proteinuria or casturia, were Chinese and younger than 19 years and had been diagnosed with SLE between January 1990 and December 2003. Investigators in each center retrieved data on clinical features, biopsy reports, treatment and outcome of these patients. There were 128 patients (eight boys, 120 girls; mean age: 11.9+/-2.8 years). About 50% presented with multisystem illness and 40% with nephritic/nephrotic symptoms. Negative anti-dsDNA antibodies were found in 6% of the patients. Renal biopsy revealed WHO Class II, III, IV and V nephritis in 13 (10%), 22 (17%), 69 (54%) and 13 (10%) patients, respectively. The clinical severity of the nephritis did not accurately predict renal biopsy findings. The follow-up period ranged from 1 to 16.5 years (mean+/-SD: 5.76+/-3.61 years). During the study five patients died (two from lupus flare, one from cardiomyopathy, two from infections). Four patients had endstage renal failure (ESRF) (one died during a lupus flare). All deaths and end-stage renal failure occurred in the Class IV nephritis group. Chronic organ damage was infrequent in the survivors. The actuarial patient survival rates at 5, 10 and 15 years of age were 95.3, 91.8, and 91.8%, respectively. For Class IV nephritis patients, the survival rates without ESRF at 5, 10, and 15 years were 91.5, 82.3 and 76%, respectively. The survival and chronic morbidity rates of the Chinese SLE children in the present study are comparable to those of other published studies.postprin

Case Report Rupture of the Distal Biceps Tendon Combined with a Supinator Muscle Tear in a 51-Year-Old Woman: A Case Report

Distal biceps tendon rupture is a relatively uncommon occurrence in the general female population, and to our knowledge, has not been reported in association with a supinator muscle tear. We report a case of 51-year-old woman who experienced sharp pain in her forearm and elbow after lifting a heavy object. History and physical examination raised suspicion for a distal biceps tendon rupture. MRI imaging determined a combined distal biceps tendon tear with a supinator muscle tear with subsequent confirmation at surgery. Surgical repair was performed for the distal biceps tendon only through a single incision approach using the Endobutton technique

Intra-articular knee haemangioma originating from the anterior cruciate ligament: a case report

<p>Abstract</p> <p>Introduction</p> <p>Synovial haemangioma is a rare intra-articular benign tumour, which may arise from any synovium-lined surface, but particularly in the knee joint. Synovial haemangioma originating from the anterior cruciate ligament has not been reported previously.</p> <p>Case presentation</p> <p>A 34-year-old man presented with a history of intermittent knee pain, locking and swelling.</p> <p>Conclusion</p> <p>Knee intra-articular haemangioma, a very rare benign tumour, is often misdiagnosed. Magnetic resonance imaging is effective in detecting this lesion and should be performed in cases of persistent knee swelling and pain.</p

Differential analysis of the impact of lesions’ location on clinical and radiological outcomes after the implantation of a novel aragonite-based scaffold to treat knee cartilage defects

Purpose: There is limited comparative evidence on patient outcomes following cartilage repair in various knee compartments. The aim of this study was to compare clinical and imaging outcomes after treating cartilage defects in femoral condyles and trochlea with either an aragonite-based scaffold or surgical standard of care (SSoC, i.e., debridement/microfractures) in a large multicentre randomized controlled trial. Methods: 247 patients with up to three knee joint surface lesions (ICRS grade IIIa or above) in the femoral condyles, trochlea or both (“mixed”), were enrolled and randomized to surgery with either a cell-free aragonite scaffold or SSoC. Patients were followed for up to 48 months by analysing subjective scores (KOOS and IKDC), radiological outcomes (defect filling on MRI), as well as treatment failure rates and adverse events. A differential analysis of outcomes for condylar, trochlear and mixed lesions was performed. Results: The scaffold group significantly outperformed the SSoC group regardless of lesion location with statistically significantly better KOOS Overall scores at 24 months (all p ≤ 0.0009) and 48 months (all p ≤ 0.02). Similar results were observed for KOOS subscales and IKDC scores. For KOOS responder rates, superiority of the implant group was demonstrated at 24, 36, and 48 months (all p ≤ 0.004). Higher defect filling on MRI for implants was observed for all locations. Lower treatment failure rates for the implant were observed in condylar and mixed lesions. Conclusion: The aragonite-based scaffold was safe and effective regardless of the defect location, providing superior clinical and radiological outcomes compared to SSoC up to four years follow-up. Level of evidence: I – Randomized controlled trial

A skin abscess model for teaching incision and drainage procedures

<p>Abstract</p> <p>Background</p> <p>Skin and soft tissue infections are increasingly prevalent clinical problems, and it is important for health care practitioners to be well trained in how to treat skin abscesses. A realistic model of abscess incision and drainage will allow trainees to learn and practice this basic physician procedure.</p> <p>Methods</p> <p>We developed a realistic model of skin abscess formation to demonstrate the technique of incision and drainage for educational purposes. The creation of this model is described in detail in this report.</p> <p>Results</p> <p>This model has been successfully used to develop and disseminate a multimedia video production for teaching this medical procedure. Clinical faculty and resident physicians find this model to be a realistic method for demonstrating abscess incision and drainage.</p> <p>Conclusion</p> <p>This manuscript provides a detailed description of our model of abscess incision and drainage for medical education. Clinical educators can incorporate this model into skills labs or demonstrations for teaching this basic procedure.</p