Read Ebook {PDF EPUB} Ache by P.J. Post Ache by P.J. Post. Quorn is the brand name of meat substitutes that are made from a vat-grown fungus. Some people have dangerous reactions to the fungus and suffer nausea, vomiting, diarrhea, and occasionally hives or difficulty breathing. Some people react the first time they eat Quorn, while some react only after building up a sensitivity. Two deaths have been linked to Quorn. The parents of an 11-year-old California boy sued the maker of Quorn in March 2015. Medical studies have proven that Quorn's fungal ingredient is an allergen, but the U.S. Food and Drug Administration and the United Kingdom's Food Standards Agency still allow its sale. All of us at CSPI have heard from more than 2,000 consumers in Europe, the United States, and Australia/New Zealand who suffered reactions to Quorn. Despite what some of the manufacturer's marketing materials indicated, the fungus used in Quorn is only distantly related to mushrooms, truffles, or morels. While all are members of the fungus kingdom, Quorn is made from a less appetizing fungus (or mold) called Fusarium venenatum ( venenatum is the Latin word for venomous). Medical Evidence Shows that Quorn Causes Adverse Reactions. The first evidence that Quorn causes severe vomiting and stomach ache came in 1977 from a clinical study conducted by the developer of Quorn. That research was never published. In subsequent years, more research has demonstrated that Quorn causes gastrointestinal and other adverse reactions, including hives and breathing difficulties. These are the key studies: RHM (unpublished 1977-78 study) This controlled clinical study was conducted by the company that developed Quorn. Ten percent of the 200 subjects who ate Quorn experienced nausea, vomiting, or stomach ache, compared to five percent of 100 subjects in a control group. This is the first known study that demonstrated that Quorn could cause adverse effects. It appears that when Marlow Foods notified the Food and Drug Administration that Quorn should be considered "Generally Recognized As Safe," it did not acknowledge the existence or results of this study. It is not known whether the study was submitted to the British government when Quorn was first used. The study was obtained from a food additive petition filed with the FDA. Udall JN, Lo CW, Young VR, Scrimshaw NS. (Am J Clin Nutr. 1984;40:285-292) This study did not find any problem in 100 college students who ate Quorn for 30 days. However, co-author Nevin Scrimshaw in 2003 told the U.S. Food and Drug Administration that "I have no doubt from the evidence currently available that the fungal product being marketed as Quorn, and that is causing an alarmingly high frequency of allergic reactions, some of them quite serious, is not the same product we tested. He added: "I am appalled that this material is allowed to stay on the market." Tee RD et al. (Clin Exper Allergy. 1993;23:257-260) This study was the first to appear in the medical literature and indicated possible safety problems with Quorn. The study involved 10 Britons who believed that Quorn caused vomiting or stomach ache. The study used classic allergy tests (like the skin-prick test) to assess the patients. There were weak indications that Quorn was allergenic, but the test methods used are considered insensitive and not highly accurate. The subjects were not fed Quorn foods, which might have elicited adverse reactions. Katona SJ, Kaminski ER. (J Clin Pathol. 2002 Nov;55(11):876-877) This letter from British researchers reported sensitivity to Quorn in a mold-allergic patient. Hoff M et al. (J Allergy Clin Immunol. 2003 May;111(5):1106-1110) These European researchers proved that Quorn caused an asthmatic reaction in a patient. They identified the particular protein that caused the allergic reaction. This paper is important. Jacobson, MF. (Allergy. 2003 May;58(5):455-456) This letter, submitted by the then executive director of the Center for Science in the Public Interest, described the adverse reactions reported by the first 284 people who contacted CSPI. It was the first item in the medical literature that indicated that Quorn caused widespread reactions, including vomiting, stomach ache, hives, and breathing difficulties. Van Durme P, Ceuppens JL, Cadot P. (J Allergy Clin Immunol. 2003 Aug;112(2): 452-454) Belgian researchers identified a young woman who suffered a severe anaphylactic-type allergic reaction after her first ingestion of Quorn. Skin prick tests were highly positive with Quorn extracts. The researchers deduced that Quorn can be cross-reactive with inhaled mold spores. Jacobson, MF. (Am J Med 2003 Sep;115:334) This letter, submitted by the then executive director of the Center for Science in the Public Interest, described the adverse reactions received by CSPI. The letter cites a survey suggesting that mycoprotein is more likely to cause adverse reactions than shellfish, milk, peanuts, and other common food allergens. Sandhu M. (AllergyCases.org) This case report describes a 14-year-old boy who had a reaction within two minutes of eating Quorn imitation chicken. The symptoms included throat irritation followed by itchiness, difficulty breathing, and swelling of the lip, tongue, eye, and laryngeal edema. A positive skin test demonstrated a sensitivity to small amounts of Quorn (and other molds). Jacobson, MF, DePorter J. (Ann Allergy Asthma Immunol. 2018 Mar;120:626-630) This article analyzes 1,752 self-reports of adverse reactions to Quorn reported to the Center for Science in the Public Interest. Allergic reactions, including hives and anaphylaxis, occurred within 4 hours of consumption in 312 people, and gastrointestinal symptoms, including vomiting and diarrhea, occurred within 8 hours of consumption in 1,692 people. Prepatellar bursitis. Definition/ Description [ edit | edit source ] Prepatellar bursitis is also called housemaid's knee or carpenter's knee. A bursa is a fluid-filled sac which ensures there is less friction between body parts. The prepatellar bursa is located superficially between the skin and the patella. The inflammation of a bursa is called bursitis. This inflammation can take form by either an infectious nature (30%) or a non-infectious nature (70%). A direct fall on the patella, an acute trauma, repeated blows or friction on the knee may cause prepatellar bursitis. Other causes include infections or low-grade inflammatory conditions, such as gout, syphilis, tuberculosis or rheumatoid arthritis. [1] Prepatellar bursitis often occurs in specific jobs which involves a position where they work on their knees for a prolonged period of time such as miners, gardeners, carpet layers and mechanics. [1] Clinically Relevant Anatomy [ edit | edit source ] The patella is a triangular-shaped bone in front of the knee. It moves up and down in the groove of the femur when you bend and straighten your knee. The patellar tendon is a thick structure that connects the bottom of the patella with the tibia. The upper part of the patella is connected to the quadriceps, which allows the knee extension and moves the patella upwards. B ursae around the knee can be divided into two groups- those around the patella (suprapatellar bursa, the superficial and deep infrapatellar bursae & prepatellar bursa) and those that occur elsewhere (pes anserinus bursa and the iliotibial bursa) [2] [1] Epidemiology [ edit | edit source ] Prepatellar bursitis affects men more often than women and it can emerge at all ages. 80% of the people with prepatellar bursitis are men aged between 40 – 60 years. 1/3 of the prepatellar bursitis are septic and 2/3 are non-septic. [3] An infectious prepatellar bursitis emerges more often with children than grown-ups. Prepatellar bursitis occurs often, with at least an annual incidence of 10/100 000. The incidence of prepatellar bursa is probably underestimated because most of the case are non-septic and only patients with the most severe cases of prepatellar bursitis requires admission in the hospital. [4] Etiology [ edit | edit source ] Direct trauma/blow to the anterior knee Frequent falls on the knee Constant friction between the skin and the patella [1] can be a cause of this condition. By the impact, the damaged blood vessels in the knee result in inflammation and swelling of the bursa. Actually, a bacterial seeding of the bursal sac caused by a hematoma is rare, because of the limited vascular supply of the bursal tissue. Infection:Typically for a septic prepatellar bursitis is a break in the skin near the bursa, which leads to swelling and pain around this area. This happens when a bacteria (for example S. Aureus, 80% of the cases) have passed across the soft tissues from a break in the skin and begins to multiply within the bursa. [2] When a bursa is infected it can probably cause pain, fever, tenderness and an elevated amount of white blood cells. Co-existing inflammatory disease- rheumatoid arthritis, gout etc. Characteristics/Clinical Presentation [ edit | edit source ] Pain Swelling [5] Differential warmth around the knee Painful and limited ROM at the knee If bursitis is caused by an infection, pain is associated with fever and chills. Differential Diagnosis [ edit | edit source ] Prepatellar bursitis is often confused with other causes of knee pain including: [6] Diagnostic Procedures [ edit | edit source ] [7] Bursitis can be diagnosed through a detailed history (about the onset of symptoms, the pattern of knee pain and swelling and how the symptoms affect their lifestyle) [8] and a physical examination, however, X-ray, MRI and CT-scan can be done to rule out the possibility of a fracture or soft tissue injury. If it is uncertain whether or not the bursa is infected, an arthrocentesis can be done. It is typically done for three reasons: necessary information is needed to make a diagnose, to relieve the pressure in the joint and will help alleviate the pain and excess fluid also needs to be removed before a therapeutic injection is given. [9] Outcome Measures [ edit | edit source ] Physical Examination [ edit | edit source ] Physical examination involves checking for: Differential warmth around the knee Erythema Tenderness Swelling Pain Range of motion. When there is a limited range of motion or swells, a doctor may recommend using a needle and syringe to remove the fluid from the joint. This fluid can be send to labs for testing whether or not the bursa is infected. Common tests for infection are gram stain, white blood cell count (an elevated number of white blood cells in the synovial fluid indicates infection) and glucose levels tests (when the levels are significantly lower than normal it may indicate an infection). Gram stain is used to determine if there are certain troublesome bacteria present. Not all bacteria’s can be identified. Even when the test comes back negative, septic bursitis cannot be completely ruled out. [9] Medical Management [ edit | edit source ] The treatment for prepatellar bursitis depends primarily on the cause of the bursitis and secondarily on the pathological changes in the bursa. [12] The primary goal of treatment is to control the inflammation. Conservatively, the R.I.C.E regime[1] in the first 72 hours after the injury or when the first signs of inflammation appear. Medications including non-steroidal anti-inflammatory drugs, topical medications- creams, sprays, gels and patches can provide pain relief when those are directly applied to the skin over the knee. To reduce the gastrointestinal side effects that can be caused by oral medications, topical medications may be a good choice. Also, for cases of septic prepatellar bursitis, antibiotics are used to treat the infection. Corticosteroid injections. Surgical Management [ edit | edit source ] When conservative treatments have failed for chronic/post-traumatic prepatellar bursitis, outpatient arthroscopic bursectomy under local anaesthesia is an effective procedure. Arthroscopic or endoscopic excision of the bursa has more recently been reported to have satisfactory results with less trauma than open excision. [13] [14] Operative Technique [ edit | edit source ] The patients are placed in a supine position and the tourniquet will be routinely applied on the thigh and not inflated until necessary. The skin will be prepared in an aseptic manner over the whole lower extremity. A solution will be infiltrated at the portal site and into the cavity, respectively a 1% xylocaine solution with a 1:100,000 epinephrine. For monitoring a 2.7-mm, 30-degree endoscope will be used and a 2.7-motorised shaver to remove thickened synovium. Two or three 2mm portals will be made; an anterior medial portal and anterior lateral portal are routinely used and if necessary a superior lateral portal. To make a 2mm incision for each portal, a no. 11 scalpel will be used. After this, the trochar will be inserted into the cavity and the other instruments will follow. The bursa cavity and synovial thickening are directly visible by the endoscopy. The motorized shaver inserts through the other portal and total synovectomy including the bursa will be performed until all the pathological lesions are removed. When all the procedures are completed, the portals will be closed with adhesive tape without any suture. The anterior knee area is dressed with loosely unfolded gauze, padding and bandage are applied. [1] Physical Therapy Management [ edit | edit source ] The Rest, Ice, Compression and Elevation method [15] (level of evidence 2a) is commonly used treatment for prepatellar bursitis. The ‘rest-phase’ consists of a short period of immobilization. This period should be limited to the first days after the trauma. Resting will reduce the metabolic demands of the injured tissue and will avoid increased blood flow. The use of ice will cause a decrease of the temperature of the tissues in question, inducing vasoconstriction and a limitation of the bleeding. Also, the pain will decrease because cold will cause increasing threshold levels in the free nerve endings and at synapses. Don’t place the ice too long on your knee (maximum 20 minutes at a time with an interval of 30-60 minutes). The compression will decrease the intramuscular blood flow to the affected area and will also reduce the swelling. At lastly there is the elevation. This ensures that the hydrostatic pressure will decrease and it will also reduce the accumulation of interstitial fluid. This part of the Rice- principle also decreases the pressure in local blood vessels and helps to limit the bleeding. However, the effectiveness of this RICE-method has not been proven in any randomized clinical trial. [16] Once the initial inflammation has reduced a program of stretching and light strengthening will be initiated to restore full motion and improve strength to reduce stress on the tendons and knee joint. Therapeutic exercises to strengthen and stretch the muscles of the knee. This includes static contraction of the quadriceps [17] . This should be an exercise that the patient can do at home 1 to 3 times a day. The objective of the rehabilitation is that the patient can resume their everyday activities. To see if the exercise is working you have to put your fingers on the inner side of the quadriceps, you will feel the muscle tighten during the contraction of the muscle. The patient has to hold his contraction for 5 seconds; the exercise can be repeated 10 times as hard as possible. It is important not to forget this exercise must be pain-free. Also, the stretching of the quadriceps is a good exercise for the patient, it reduces the friction between the skin and the patella tendon. There is less friction when the patella tendon is more flexible. The physiotherapist can also help the patient by using electrotherapy modalities and patient education on the use of knee pads for kneeling activities. Prevention [ edit | edit source ] In order to prevent prepatellar bursitis you should avoid injury or an overload of your muscles. It is very important to do an appropriate warm-up and cool down, while playing sports. For example, if you play volleyball, it is advisable to wear knee pads. This will prevent falling on the kneecap. Also when you spent a lot of time on your knees is it advisable to wear knee pads. Another important thing to avoid prepatellar bursitis is to check if the flexibility of the knee and the strength and endurance of the leg muscles stays optimal. [2] Key Research [ edit | edit source ] Yu-Chih H, et al. Endoscopic treatment of prepatellar bursitis. Int Orthop 2011; 35(3): 355–358.(2) Hurkmans E.J., et al. KNGF-guideline for Physical Therapy in patients with rheumatoid arthritis. 2008; 118 (5): 13-16.(1) Infectious olecranon and patellar bursitis: short-course adjuvant antibiotic therapy is not a risk factor for recurrence in adult hospitalized patients http://apps.isiknowledge.com.ezproxy.vub.ac.be:2048/full_record.do? product=UA&search_mode=GeneralSearch&qid=1&SID=S24LCBd8ahiI4bB3hJ7&page=1&doc=2&colname=WOS Cloxacillin-based therapy in severe septic bursitis: Retrospective study of 82 cases http://apps.isiknowledge.com.ezproxy.vub.ac.be:2048/full_record.do? product=UA&search_mode=GeneralSearch&qid=1&SID=S24LCBd8ahiI4bB3hJ7&page=1&doc=3&colname=WOS Ossifying Bursitis Praepatellaris of the Knee Joint http://apps.isiknowledge.com.ezproxy.vub.ac.be:2048/full_record.do? product=UA&search_mode=GeneralSearch&qid=1&SID=S24LCBd8ahiI4bB3hJ7&page=1&doc=4&colname=WOS Hemorrhagic prepatellar bursitis: a rare case report and review of the literature http://apps.isiknowledge.com.ezproxy.vub.ac.be:2048/full_record.do? product=UA&search_mode=GeneralSearch&qid=1&SID=S24LCBd8ahiI4bB3hJ7&page=1&doc=8&colname=WOS Prepatellar Septic Bursitis: A Case Report of Skin Necrosis Associated With Open Bursectomy http://apps.isiknowledge.com.ezproxy.vub.ac.be:2048/full_record.do? product=UA&search_mode=GeneralSearch&qid=1&SID=S24LCBd8ahiI4bB3hJ7&page=1&doc=7&colname=WOS Olecranon and prepatellar bursitis - Treating acute, chronic, and inflamed http://apps.isiknowledge.com.ezproxy.vub.ac.be:2048/full_record.do? product=UA&search_mode=GeneralSearch&qid=1&SID=S24LCBd8ahiI4bB3hJ7&page=1&doc=30&colname=WOS. Resources [ edit | edit source ] Clinical Bottom Line [ edit | edit source ] The prepatellar bursa is located under the skin and occurs in most people. When a bursa is inflamed, it's called bursitis. The inflammation can be of an infectious nature or a non-infectious nature. Many different aetiologies have been proposed as the cause of prepatellar bursitis. Chronic inflammation of prepatellar bursa after repetitive minor trauma is called ‘housemaid’s knee’. It can be seen in those who have to kneel very often, such as carpet layers and housemaids. Also a fall directly on the patella, an acute trauma, may cause patellar bursitis. Treatment for prepatellar bursitis depends primarily on the cause of bursitis and secondarily on the pathological change in the bursa. A surgical procedure is in most cases not required, but if needed, the surgical procedures involved are (1) aspiration and irrigation with a suitable drug, (2) incision and drainage in cases of acute suppurative bursitis, and (3) excision of chronically infected and thickened bursa. [1] Ache by P.J. Post. Please note that Internet Explorer version 8.x is not supported as of January 1, 2016. Please refer to this support page for more information. Download PDF Download. International Journal of Surgery. Add to Mendeley. Abstract. The term postcholecystectomy syndrome (PCS) comprises a heterogeneous group of symptoms and findings in patients who have previously undergone cholecystectomy. Although rare, these patients may present with abdominal pain, jaundice or dyspeptic symptoms. Many of these complaints can be attributed to complications including bile duct injury, biliary leak, biliary fistula and retained bile duct stones. Late sequelae include recurrent bile duct stones and bile duct strictures. With the number of cholecystectomies being performed increasing in the laparoscopic era the number of patients presenting with PCS is also likely to increase. We briefly explore the syndrome and its main aetiological theories. Keywords. Recommended articles. Citing articles. Article Metrics. We use cookies to help provide and enhance our service and tailor content and ads. By continuing you agree to the use of cookies . International Stores. Offers good for a limited time at participating U.S. Papa John's restaurants. Prices may vary. Not valid with any other coupons or discounts. All beverage related trademarks are registered Trademarks of PepsiCo, Inc. Some offers require the purchase of multiple pizzas. Some offers may be available online only. No triple toppings or extra cheese. Certain toppings may be excluded from special offer pizzas or require additional charge. Additional toppings extra. Limit seven toppings to ensure bake quality. Limited delivery area. Delivery fee may apply and may not be subject to discount. Minimum purchase may be required for delivery. Customer responsible for all applicable taxes. No purchase necessary. MSG and Data rates may apply. Click here for SMS term and conditions for terms and conditions. Text HELP for help. Six (6) message per month. Text CANCEL to cancel. Customer Care Team Contact Us. ©2021 Papa John's International, Inc. All Rights Reserved. Canada: Adults and youth (ages 13 and older) need an average of 2,000 calories a day, and children (ages 4 to 12) need an average of 1,500 calories a day. However, individual needs vary. n-webnc-p03-18.4.1.0 18.4.0.2. Nuggets’ Michael Porter Jr. makes “Showtime” debut, P.J. Dozier raises bar: “I know what I’m capable of” Credit Monte Morris with the assist. The nickname he bestowed upon Nuggets rising star Michael Porter Jr. was more than fitting. “’Showtime,’” Porter said with a knowing grin. “We went with it.” No one else on the Nuggets has the flair or charisma necessary to match that nickname. And even though Nikola Jokic’s cerebral approach to basketball is every bit as astounding, his understated personality wouldn’t fit. Whereas Porter, who drained and rained a career-high 39 points on eight 3-pointers in Saturday’s bounce-back win over Houston, was more than willing to embrace his new moniker — and his elevated role within the offense. “They know when they throw it to me, if I’m open, I’m probably gonna shoot it,” he said with a smile. “It’s a chance they might get an assist, so I don’t know if they’re looking out for me or looking out … nah, I’m playing.” For at least one night, Porter helped ease the pain of losing Jamal Murray to a season-ending ACL tear and dual hamstring strains to starting guards Monte Morris and Will Barton. But aside from his personal best, the reason Porter’s night was so tantalizing was that nothing he did seemed especially surprising or difficult. “I definitely don’t see anybody when I shoot just because I’m 6-foot-10,” Porter said. His jaw-dropping talent, on devastating 13-of-21 efficiency, showed within the flow of the offense. He moved without the ball, made himself available in transition chances and even gave the ball up on certain sequences only to find it later in possessions in more dangerous positions. “When you’re on balance and you take your time, you’re a deadly shooter,” Nuggets coach Michael Malone told him. That’s why, as long as Porter’s shots aren’t forced, Malone is encouraging the volume. In the six games since Murray went down, Porter’s averaging nearly 25 points per game on over 15 shots per game, including 55% from the 3-point line. “You’re talking about ‘Showtime,’” combo guard P.J. Dozier said. “We call him ‘Showtime.’ He’s definitely ready.” But the Nuggets aren’t going to survive, or make a serious postseason run, on a diet of just Jokic and Porter for however long Morris and Barton remain out. That’s why Dozier’s career-high 23 points on 10-of-13 shooting from the field were equally as intriguing. In his first career start, Dozier’s impact was immediate. He opened the game with three consecutive 3-pointers, yet Malone naturally cited the defensive highlight reel. Barely three minutes into the game, Dozier rotated over from the weakside and swatted Jae’Sean Tate’s layup attempt. Dozier’s defensive length has turned him into an invaluable chess piece for Malone to deploy. Assuming defense is the constant, Dozier’s offense may make him a more than adequate Barton replacement for the time being. On Saturday, Dozier went 3-of-5 from 3-point range. Before a hamstring injury cost Dozier most of February, he was shooting over 40% on 3s to start the season. “I’ve been playing this way for a long time,” Dozier said. “Early on, shots haven’t really been falling. But like I said, I’m gonna have confidence in myself. I know what I’m capable of. The coaching staff knows what I’m capable of and ultimately, my teammates know.” Malone has been a huge fan of Dozier’s since he proved he could hold his own defensively in last season’s playoffs. That underlying trust is why Dozier was a safe bet to replace Barton in the starting lineup. “Nothing surprised me to be honest,” Malone said. “Every time P.J.’s been given an opportunity, he’s shown these flashes. … For him to go 3 for 5 (from 3), that’s not eye-popping. I expect P.J. to make shots. The seven rebounds, as big and strong as he is, he should be a hell of a rebounder from the guard position. The three assists, he’s a playmaker. He can get to places on the court that a lot of guys can’t. I’m not expecting the same numbers like this from him every night, but nothing he did was really surprising in my eyes.” Dozier didn’t need one, but that’s as strong an endorsement as Malone has offered on the 6-foot-6 hybrid guard. Jokic called his starting debut “amazing” and Porter reiterated the team’s confidence in him. “Will, that hurts, but P.J. and Will kind of have similar games in the way they can create, playmake for others, get downhill, get their own shot,” Porter said. “He’s going to fill that Will Barton role while Will’s out for a couple weeks pretty well. We all trust P.J.” Malone has said often in the past two weeks how much they’re going to need production by committee. Career nights from Porter, Dozier and even a career-high 13 assists from Facundo Campazzo were all encouraging responses to a devastating turn of events. The question that will ultimately determine whether the Nuggets can stay afloat is whether it’s sustainable. All three career nights felt like more a product of opportunity than anything uniquely remarkable. With Denver’s injuries, the minutes are going to available. In the final 12 games, it’s about seizing their chance.