Psychological factors, rehabilitation adherence, and rehabilitation outcome after anterior cruciate ligament reconstruction.

Objective: To examine prospectively the relationships among psychological factors, rehabilitation adherence, and short-term rehabilitation outcome after knee surgery. Study Design and Participants: Individuals with acute anterior cruciate ligament (ACL) tears (N?=?95) completed measures of self-motivation, social support, athletic identity, and psychological distress before reconstructive surgery. After surgery, 93 participants reported on their completion of home rehabilitation exercises and cryotherapy, and their rehabilitation practitioners indicated the patients' attendance at, and adherence during, rehabilitation sessions. Rehabilitation outcome measures were taken from 69 participants approximately 6 months postsurgery. Main Outcome Measures: Knee laxity, functional ability, and subjective symptoms were the primary outcomes assessed. Results: Self-motivation was significant predictor of home exercise completion; athletic identity and psychological distress were significant predictors of knee laxity; and attendance at rehabilitation sessions and home cryotherapy completion were significant predictors of functional ability. Rehabilitation adherence did not mediate the relationship between psychological factors and rehabilitation outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strain and age effects on egg composition from hens fed diets rich in n-3 fatty acids

The objective of this study was to compare the analgesic effects of intra-articularly administered bupivacaine with bupivacaine/morphine during and after therapeutic knee arthroscopy. In a prospective, randomized study, 50 patients with clinical signs of medial meniscal injury were allocated to two groups, A and B. The patients in group A received 40 mL of 0.25% bupivacaine while the same dose of bupivacaine combined with 1 mg of morphine sulphate was administered in group B. Pain was estimated using the visual analogue scale (VAS) during surgery and at 2, 4, 6, and 24 hours after the operation was completed. Supplementary analgesic requirements were also registered, as well as the patients' overall rating of the entire procedure. The pain scores were significantly lower in Group B throughout the whole postoperative observation period. However, no significant differences were found between the two groups in terms of intraoperative pain scores, supplementary analgesic requirements, or the overall rating of the procedure. This study provides evidence that arthroscopic surgery can be performed in a safe manner after intra-articularly administered bupivacaine with or without low-dose morphine. The combination of low-dose morphine and bupivacaine did, however, produce a superior postoperative analgesic effect during the 24 hours following knee arthroscopy compared with bupivacaine alone.     

Neuroleptic compliance among chronic schizophrenic outpatients: An intervention outcome report.

Investigated the effects of a behavioral-tailoring (BT) intervention and a psychoeducational (PE) intervention on neuroleptic medication compliance in 36 24.3–64.3 yr old male chronic schizophrenic outpatients. 12 Ss were assigned to a PE group, 12 to a BT group, and 12 to a control group. Compliance was measured by self-report, significant others' ratings, and pill count at pretreatment and at 1- and 3-mo follow-up. Results indicate that BT participants were significantly more compliant, as measured by pill count following treatment, than were the other groups. Low correlations were found between the 3 compliance measures. Results suggest that subjective ratings may have questionable validity and that behavioral techniques may be superior to other approaches in improving neuroleptic compliance among chronic schizophrenic outpatients. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of arthroscopic and open reconstruction of the anterior cruciate ligament. Early results

The purpose of this study was to determine in a prospective, randomized, blinded design whether arthroscopically assisted anterior cruciate ligament reconstruction offered any significant immediate or short-term advantages over traditional open reconstruction through a limited arthrotomy. Patients with a diagnosis of deficiency of the anterior cruciate ligament were randomly assigned to one of two treatment groups: the open group (limited open reconstruction) or the arthroscopic group (fully arthroscopic reconstruction). Postoperatively, both groups were treated identically. Intra- and postoperative observations included length of surgery, duration of hospitalization, and amount of pain medication. Follow-up evaluations were performed at 1, 6, 12, 16, 20, and 24 weeks to record crepitus, swelling, range of motion, ligament laxity, and thigh atrophy. Lysholm scores were obtained at the 16 and 24 week follow-ups. At 24 weeks, 86% of the open group and 89% of the arthroscopic group had good-to-excellent results. Intraoperative, postoperative, and follow-up findings indicated no statistically significant differences or relationships between the two groups in any of the variables measured, except that operative time was 13 minutes longer in the arthroscopic group (P < 0.001). The results do not substantiate a clinical advantage for either technique.     

Arthroscopy of the knee

Arthroscopy of the knee was first performed early this century. However, it became generally accepted and grew to be a major contributor to orthopaedic surgery only during the last two decades. It has improved our understanding of numerous knee pathologies and allowed us to treat many of these disorders with considerably less morbidity. But there remain areas that warrant attention. Training in arthroscopic technique needs to be intensified and our knowledge of knee conditions should be improved if we are to avoid certain pitfalls and complications during arthroscopic surgery. Another issue that must be addressed is the inappropriate use and abuses of arthroscopic surgery of the knee. Improved audit, that insist on photographic documentation of the lesion before and after treatment is suggested to curb this latter problem.     

Behavioral interventions in asthma. Breathing training

Breathing exercises are frequently recommended as an adjunctive treatment for asthma. A review of the current literature found little that is systematic documenting the benefits of these techniques in asthma patients. The physiological rationale of abdominal breathing in asthma is not clear, and adverse effects have been reported in chronic obstructive states. Theoretical analysis and empirical observations suggest positive effects of pursed-lip breathing and nasal breathing but clinical evidence is lacking. Modification of breathing patterns alone does not yield any significant benefit. There is limited evidence that inspiratory muscle training and hypoventilation training can help reduce medication consumption, in particular beta-adrenergic inhaler use. Breathing exercises do not seem to have any substantial effect on parameters of basal lung function. Additional research is needed on the psychological and physiological mechanisms of individual breathing techniques in asthma, differential effects in subgroups of asthma patients, and the generalization of training effects on daily life.     

Subarachnoid anesthesia with minimal doses of lidocaine in ambulatory arthroscopic surgery of the knee

The objective is demonstrate that subarachnoid anesthesia with 2% isobaric lidocaine at low doses (0.5 mg/kg) is safe and effective for outpatient arthroscopic surgery of the knee. This was a prospective study of 150 ASA I-III patients undergoing arthroscopic knee surgery as outpatients under subarachnoid anesthesia. With no prior vascular filling, we provided blockade by administering 2% isobaric lidocaine at a dose of 0.5 mg/kg through a Sprotte 25G needle without vasoconstrictor. We assessed effectiveness and degree of sensory-motor blockade, cardiovascular repercussions, recovery time (until reversal of blockade, ambulation, micturition and discharge) as well as side effects observed. The mean dose of lidocaine used was 33.44 +/- 4.16 mg. The sensory-motor blockade achieved provided optimum conditions for prevention of ischemia and the practice of the surgical procedure in all cases. Surgery lasted a mean 38 +/- 10 min. Hemodynamic changes were not clinically significant and no patients additional fluids, atropine or vasopressors. Time from start of blockade until ambulation, micturition and discharge from the recovery unit were 123 +/- 8.3, 175 +/- 12.4 and 194 +/- 13.4 min, respectively. Micturition was spontaneous in all cases. Complications recorded were cephalea and backache. In conclusion, subarachnoid anesthesia at low doses of 2% isobaric lidocaine provides excellent conditions for practicing arthroscopic surgery of the knee on outpatients, with minimum side effects.     

Long-term results after arthroscopic meniscectomy. The role of preexisting cartilage fibrillation in a 13 year follow-up of 60 patients

Sixty patients with stable knees and arthroscopic menisectomy were matched into two groups according to the presence of early degenerative changes at the operation. Patients with severe cartilage changes were excluded. The patients were between 20 and 40 years of age at the operation and no patient had previous surgery on the involved knee. The intraarticular findings were documented at surgery and the patients were re-examined 12 to 15 years after the meniscectomy. Pre-existing cartilage fibrillation at the meniscectomy did not seem to influence the long-term results. At the follow-up no difference was found between the groups at the physical examination, in subjective complaints, in knee function and activity or in radiographic findings. In the total group 62% had early signs of arthrosis (Fairbank changes) and 42% narrowing of the joint space (Ahlb?ck grade 1-2) in the operated knee. No one had more severe changes. Radiographic signs of arthrosis were 4 times commoner in the operated knee compared to the non-operated knee after partial meniscectomy and 7 times commoner in the operated knee after subtotal meniscectomy. Arthrosis at the follow-up was seen three times more often in patients older than 30 years of age at surgery than in younger patients. The functional outcome was good and 70% were still active in sports compared to 90% before the operation.     

The dose-dependent effects of oral premedication with midazolam

OBJECTIVE: The aim of this study was to examine the psychological effects, well-being and side effects after various doses of oral midazolam medication. METHODS: After informed consent has been obtained and following the approval by the institutional ethical committee, 80 adult patients in the ASA physical status I and II were randomly assigned to one of five different premedication groups: 3.75, 7.5, 11.25, 15 mg midazolam, and placebo. The medication was given in a double-blind fashion 60 min before induction of general anaesthesia for various surgical procedures. At 3 definite stages (before premedication, 30 and 60 min after premedication), blood pressure, heart rate, transcutaneous oxygen saturation and respiratory rate were measured. Sedation and well-being were graded according to a 5-point scale, and the subjective anxiety level was assessed according a visual analogue scale (range 0-100 mm). Anterograde and retrograde amnesia were measured by recall of auditive and visual stimuli. Finally, patients were asked whether in case of future surgery they would prefer the same or a different medication. RESULTS: Demographic data were similar in all groups. There was no significant difference in respiratory rate, oxygen saturation, blood pressure or heart rate. Alertness declined only after 60 min in the groups treated with 7.5 mg and more midazolam. During the entire measurement period, anxiolysis was not different from placebo in any of the midazolam groups. In comparison to placebo, all midazolam groups showed a statistically significant and dose dependent anterograde amnesia for visual stimuli. Subjective well-being scores showed no differences between the groups. Only few side effects were seen following doses of 7.5 mg and higher, including ptosis, strabismus, diplopia, speech disorders, disorientation and vertigo. The majority of patients in all groups indicated a wish for the same medication in case of future anaesthesia for surgical interventions. CONCLUSIONS: Midazolam administered orally prior to surgical procedures showed marked interindividual variability. Sedation and amnesia were dose-dependent and were evaluated by the patients as acceptable. Anxiolysis was not significantly different from placebo. A dose of 7.5 mg midazolam showed the best relation between desirable and undesirable effects. Adequate attention given to the patient by the anaesthesiologist prior to surgery seems to be as important and beneficial as oral medication with midazolam.     

Does ice immersion influence ankle joint position sense?

The purpose of this study was to determine whether a fifteen minute ice immersion treatment influenced the normal ankle joint position sense at 40% and 80% range of inversion and to establish the length of treatment effect through monitoring the rewarming process. Forty nine healthy volunteers between the ages of 17 and 28 were tested. Subjects were screened to exclude those with a history of ankle injuries. The subject's skin temperature over antero-lateral aspect of the ankle was measured using a thermocouple device during the fifteen minutes ice intervention and thirty minutes post-intervention. Testing of ankle joint position sense using the pedal goniometer was performed before and after a clinical application of ice immersion. The testing required the subject to actively reposition their ankle at 40% and 80% of their total range of inversion. The majority of subjects experienced numbness of the foot and ankle by the fifth or sixth minute during ice immersion. One minute after immersion skin temperatures averaged 15 degrees C + 1.7 degrees C. Skin temperature was seen to rise relatively rapidly for the first ten minutes and then slowed considerably. Subjects had not returned to the pre-test skin temperatures by thirty minutes. A significant difference in ankle joint position sense (p < 0.0499) following fifteen minutes of ice immersion was found. However, the magnitude of this difference (0.5 degree) would not be deemed significant in clinical practice. The research found no significant difference in joint position sense between 40% and 80% of the range of inversion both before and after cryotherapy. These findings suggest that the clinical application of cryotherapy is not deleterious to joint position sense and assuming normal joint integrity patients may resume exercise without increased risk of injury.     

Arthroscopy: possibilities and limitations in the diagnosis and therapy of meniscus lesions

The menisci consist of fibrocartilage and are an important supporting structure of the knee joint. They are poorly vascularized and have to withstand a high mechanical strain and load; therefore, lesions are common, especially on the medial side. Meniscal lesions are among the most frequent surgical procedures in orthopedic surgery. Meniscal lesions are diagnosed by a careful clinical examination in 80% of all cases in spite of modern imaging techniques such as magnetic resonance imaging (MRI). In the last 15 years, arthroscopic meniscectomy has become the 'golden standard' of therapy. Arthroscopy provides a powerful tool to precisely locate and classify the type of meniscus injury and to perform arthroscopic meniscectomy at the same time. This means less morbidity, reduced hospitalization time and earlier return to work and hence reduced costs. The endoscopic technique allows to exactly remove the damaged parts of the meniscus with precision instruments (partial meniscectomy). Former open techniques only allowed the complete removal of the meniscus. The arthroscopic techniques used nowadays allow a preservation of the functionally important edge of the meniscus, which is responsible for the stability and the biomechanics of the knee joint and can thus prevent an early onset of arthrosis. In rare cases of peripheral meniscal tears in young patients, arthroscopic refixation is an advantageous treatment option. Partial arthroscopic meniscectomy and arthroscopic meniscus refixation are challenging therapeutic procedures that require a trained and experienced orthopedic surgeon. Today diagnostic arthroscopy is more and more abandoned in favour of noninvasive and reliable MRI techniques. MRI is also useful in cases of previous knee surgery and clinically unclear findings, but should not be used on a routine basis. In differential diagnosis, the orthopedic surgeon always has to evaluate the MRI findings as to their impact. Today, arthroscopic knee surgery is a reliable, technically sophisticated and standardized technique to treat meniscal damages of all patients. There is a relatively low rate of complications, provided that the indication for the procedure is critically applied and restricted to patients with sufficient clinical and MRI findings.     

Effect of nabumetone on hemostasis during arthroscopic knee surgery

The known effects of commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) on hemostatic parameters have led to concern over their use in the perioperative period. Nabumetone, unlike other NSAIDs, has little effect on collagen-induced platelet aggregation. To evaluate the effect of nabumetone 2000 mg daily on other hemostatic parameters (e.g., bleeding time, prothrombin time, and partial thromboplastin time) in the clinical setting, this double-masked study was conducted in patients with osteoarthritis undergoing arthroscopic knee surgery. After a 1-week placebo washout period, 58 patients were randomized to receive nabumetone and 53 were randomized to receive placebo. They were assessed before surgery (after 1 to 2 weeks of treatment) and again after surgery (after an additional 3 weeks of treatment). The study was designed to have 90% power to show equivalence in bleeding time to within 1.5 minutes, a difference assumed to be of no clinical importance. No meaningful differences were observed between the groups in any of the measured hemostatic parameters. Before surgery, the bleeding time increased by only 0.3 minutes with nabumetone and decreased by 0.2 minutes with placebo. The mean (+/- SD) difference between the groups in change from baseline was 0.5 +/- 0.3 minutes. After surgery, the changes were 0.1 minutes and 0.0 minutes, respectively, and the difference between groups was 0.2 +/- 0.3 minutes. These differences were neither statistically nor clinically significant, and maximum individual increases were similar in each group. Furthermore, there were no reports of abnormal bleeding in the operative knees. The results of this study show that nabumetone had little or no effect on hemostasis and suggest that this drug can be used safely in the perioperative period.     

The holmium YAG laser in office based arthroscopy of the knee: comparison with standard interventional instruments in patients with arthritis

OBJECTIVE: To confirm the feasibility of laser assisted technology in an office based rheumatology practice and to compare selected outcome variables with those of conventional arthroscopic cutting tools. METHODS: A prospective analysis of 70 office based arthroscopies on 70 patients with knee arthritis over an 8 month period. All patients met specific criteria for office based arthroscopy. Thirty-six patients had interventions with conventional cutting tools and 34 patients had interventions with a 40 watt holmium YAG laser. Variables assessed included procedure time, length of recuperative period, and postprocedural pain. RESULTS: Laser assisted arthroscopy was performed in 34 cases without side effects or complications. Patients who received laser treatment had a shorter recuperative period, less postprocedural pain, and fewer hemarthroses than patients treated with conventional methods. CONCLUSION: While recognizing the shortcomings and possible complications associated with laser surgery, we conclude that laser use in an office setting is not only feasible but may in the future be an excellent method for office based arthroscopic treatment of the arthritic knee.     

Estimating mechanical blood trauma in a centrifugal blood pump: laser Doppler anemometer measurements of the mean velocity field

There are different opinions on the duration of post-operative shoulder immobilisation following arthroscopic repair of labrum tears. Between 1993 and 1994 at our department arthroscopic repairs of the glenoid labrum as described by Habermeyer (15, 16) have been performed in 38 patients. In 20 of these patients postoperative treatment included immobilisation of the operated shoulder in a Gilchrist-bandage for 3 weeks, while in the remaining 18 patients this postoperative immobilisation period was decreased to only 1 or 2 weeks. Physiotherapy started the day after the operation, using a device for passive-motion exercises. The mean follow-up time of our examinations was 15.4 month. The mean score by Rowe rose significantly from 20.0 preoperatively to 82.6 at the follow-up examination. Results were excellent or good in 89.4% of all cases, new shoulder dislocations did not occur in any case. Patients having their shoulders immobilised for 3 weeks reached significantly higher Rowe-scores at our follow-up than those patients, whose shoulders were immobilised for only 1 or 2 weeks. Therefore, postoperative management following arthroscopic repair of labrum tears should include immobilisation of the operate shoulder for 3 weeks and an early start of passive-motion exercises.     

Comparison of three methods of ulnar fixation in horses

BACKGROUND: This study was done to determine whether the difference in duration of action of the long-acting angiotensin-converting enzyme (ACE) inhibitor spirapril compared with the short-acting ACE inhibitor captopril affects clinical efficacy in patients with congestive heart failure. METHODS AND RESULTS: The effects on exercise capacity, neurohumoral status, and quality of life were studied in 20 patients with mild to moderate congestive heart failure in a double-blind, randomized, comparative study in parallel groups with a duration of 12 weeks. All assessments during the study were performed in the morning, before intake of the study medication, to avoid the expected peak effect of the ACE inhibitors used. Mean peak oxygen consumption (peak Vo2) was 17.4 mL/min/kg (range, 14.2-19.9 mL/min/kg) and mean left ventricular ejection fraction was 28% (range, 13-40%). Exercise duration in the captopril group showed a significant increase after 12 weeks (P < .05) of treatment compared with the spirapril group. Peak oxygen consumption tended only to increase in the captopril-treated patients compared with the spirapril-treated patients. Serum ACE activity was significantly different between the two treatment groups during treatment (P < .0001) and showed only a significant decrease in the spirapril group. There was no difference in improvement of quality of life between the two treatment groups. CONCLUSIONS: This study showed that the effects of the ACE inhibitors spirapril and captopril on exercise capacity are not related to the degree of inhibition of serum ACE activity.     

Refractive outcome in eyes with retinopathy of prematurity treated with cryotherapy or diode laser: 3 year follow up

AIMS: To compare the refractive error 1 to 3 years after cryotherapy or diode laser treatment for threshold retinopathy of prematurity. METHODS: Twenty six infants treated with diode laser and 17 infants treated with cryotherapy underwent cycloplegic refraction during follow up. RESULTS: After 3 years of follow up, 94.1% of patients had myopia (right eye if bilateral) following cryotherapy and 45.5% of patients had myopia following diode laser treatment. The difference between the two proportions was 48.7% (95% confidence interval 17.8 to 80.1, p = 0.004). In the cryotherapy group 55% of patients were highly myopic (> -6.00 dioptres) while in the laser group there were no high myopes. CONCLUSIONS: In the diode laser group there were significantly fewer myopes than in the cryotherapy group up to 3 years after the procedure. There was no trend towards increasing myopia in the laser treated group and the refraction in these eyes stabilised after 1 year. In the cryotherapy group there was a significant increase in the degree of myopia between year 1 and year 3 of follow up (p = 0.02). Diode laser treatment is thought to be as effective as cryotherapy, and has the added benefit of reducing myopia, in the treatment of ROP.     

Inhibition of 5-fluorouracil-cisplatin-induced stomatitis by oral cryotherapy: use of an ice-bar containing fibrinolysin and deoxyribonuclease combine (Elase)

Stomatitis caused by a combined chemotherapy with 5-fluorouracil (5-FU) and cisplatin (CDDP) is a serious problem in the course of treatment for patients with oral carcinoma. In the present study, we proposed a form of cryotherapy using an ice-bar containing fibrinolysin and deoxyribonuclease (Elase) to inhibit the stomatitis. The therapeutic effect of the ice-bar cryotherapy was evaluated in 20 patients with oral squamous cell carcinoma who were undergoing 5-FU-CDDP chemotherapy. Nine of the 20 patients were given the ice-bar cryotherapy while the remaining patients were not. As a result, although there was no significant difference between the incidence of stomatitis in the groups with and without the ice-bar cryotherapy, the incidence of severe stomatitis with ulcers and/or eating disturbance in the 11 cases without the ice-bar cryotherapy (90%) was significantly higher than that in the 9 cases with the cryotherapy (44%) (p < 0.05). However, no significant difference in the clinical response rate of the 5-FU-CDDP chemotherapy was observed between the two groups.     

Enlarged cerebrospinal fluid spaces in opiate-dependent male patients: a stereological CT study

Total knee arthroplasty was evaluated in 10 patients with post-traumatic osteoarthrosis secondary to work-related knee injuries (age- and sex-matched with 10 controls who had total knee arthroplasties for nonwork-related osteoarthrosis) to determine if Workers' Compensation status influenced treatment outcome. Using the Hospital for Special Surgery Knee Rating System (maximum possible score: 100), most recent follow-up scores averaged 64.1 for Workers' Compensation patients and 91.9 for controls. Subjective indices (pain, function) were significantly different between groups (p < 0.05), but objective indices (range of motion, strength, deformity, instability) were not. No significant differences were noted between groups on either immediate postoperative or most recent follow-up radiographs (which were assessed for alignment and radiolucencies at implant surfaces, respectively). Suboptimal outcomes can be anticipated in total knee arthroplasties performed on Workers' Compensation patients, particularly in cases where claims have not been settled at the time of surgery.     

Osteonecrosis of the knee following arthroscopic laser meniscectomy

An unusual case of osteonecrosis of the knee following an arthroscopic laser meniscectomy is presented. The unusual presentation of the osteonecrosis and the chronology suggest that the osteonecrosis of the knee resulted from damage to the articular cartilage and subchondral bone at the time of the arthroscopic laser meniscectomy.     

Hormone replacement therapy does not augment gains in muscle strength or fat-free mass in response to weight-bearing exercise

Lower extremity strength and fat-free mass were examined in 58 postmenopausal women aged 60-72 yr. Subjects were studied before and after an 11-mo control period (n = 16) or before and after an 11-mo weight-bearing exercise training program designed to generate relatively high ground reaction forces (n = 42). Twenty-two of the exercisers initiated hormone replacement therapy (HRT) at the outset of exercise and continued HRT for 11 mo. Hip extension and abduction strength were assessed using a hand-held dynamometer. Force production during knee extension and flexion was evaluated on an isokinetic dynamometer at 60, 90, and 180 degrees/s. Simultaneous knee and hip extension strength was also assessed on a leg press machine. Total body and lower extremity fat-free mass were determined using dual-energy x-ray absorptiometry. There were no significant changes in muscle strength or body composition in control subjects. Both exercise groups had significant increases in fat-free mass and in all strength measures. Fat-free mass increased from 38.8 +/- 4.3 to 39.7 +/- 4.3 kg in the exercise group and from 37.7 +/- 3.9 to 38.9 +/- 4.6 kg in the exercise-plus-HRT group. The average relative increase in strength was 16.2 +/- 11.0% in the exercise group and 17.0 +/- 13.0% in the exercise-plus-HRT group. Women receiving HRT did not have a gain in fat-free mass or in strength over and above that demonstrated by the women not on HRT. Our results provide evidence that HRT does not augment the increases in muscle mass or strength that occur in response to weight-bearing exercise in older women.