Surgical Challenges in Complex Primary Total Hip Arthroplasty
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Ankylosing Spondylitis
Page 1 of 4 Ankylosing Spondylitis Ankylosing spondylitis (AS) is a form of arthritis. It mainly affects the lower back. Other joints and other parts of the body are sometimes affected. Treatment includes regular exercise and anti-inflammatory drugs. The severity of AS varies from mild to severe. It is mild or moderate in most cases. What is ankylosing spondylitis? Spondylitis means inflammation of the spine. Ankylosing is a word that describes bones that tend to join together (fuse) across a joint. In ankylosing spondylitis (AS), the discs and ligaments of the lower spine become inflamed. The discs and ligaments are the strong tissues that connect the spinal bones (vertebrae) together. The joints between the lower spine and the pelvis (the sacro-iliac joints), and the small facet joints between the vertebrae are also commonly affected. Inflammation around the lower spine that persists long-term can cause scarring. This may, over time, cause some of the vertebrae in the spine to fuse together. In some cases, inflammation occurs in other joints and in other parts of the body outside of the spine (detailed below). Who gets ankylosing spondylitis? AS usually develops in teenagers or young adults. It rarely first develops after the age of 40. It is three times more common in men than women. There may be a family history with two or more members of a family being affected. About 1 in 1000 people in the UK have AS. What causes ankylosing spondylitis? The cause of AS is not known. There is a strong genetic (hereditary) part. Something may 'trigger' AS to develop in people who have an inherited tendency to have it. -
Clinical and Radiographic Features of Spondylitic Hip Disease J
Ann Rheum Dis: first published as 10.1136/ard.38.4.332 on 1 August 1979. Downloaded from Annals of the Rheumatic Diseases, 1979, 38, 332-336 Clinical and radiographic features of spondylitic hip disease J. S. MARKS AND K. HARDINGE From the Rheumatology Unit and the Centre for Hip Surgery, Wrightington Hospital, Wigan, Lancs SUMMARY The clinical and radiographic features of hip disease in 76 patients with definite anky- losing spondylitis have been studied. Symptomatic hip involvement occurred late in the course of the disease, with a mean delay after the onset of 12 years in males and 7 years in females. Patients with disease onset before the age of 20 developed hip symptoms at an earlier stage. Associated diseases included uveitis (13 %), colitis (4 %), and psoriasis (4 %). Bilateral concentric loss of hip joint space with a relatively undeformed femoral head was the commonest radiological change (61 %). Localised loss ofjoint space at the upper pole (16 %) was associated with femoral head destruction and a greater degree of osteophytosis, suggesting coincidental or secondary osteoarthrosis. Bony ankylosis of the hips (10%) was present only in women, and the absence of osteophytes, cysts, and bone lesions of the iliac crests and ischial rami suggests that it is a distinct radiographic manifestation of female ankylosing spondylitis. copyright. Ankylosing spondylitis characteristically affects Clinical details obtained from the medical records the sacroiliac joints and the spine, but peripheral included age at onset of disease, site(s) of initial joint involvement occurs in at least 50% of patients symptoms, age at initial hip symptoms, associated during the course of their disease (Polley and diseases, previous medical and surgical treatment, Slocumb, 1947; Wilkinson and Bywaters, 1958; and details of hip surgery during admission. -
Local Control of Human Umbilical Vessel Tone
LOCAL CONTROL OF HUMAN UMBILICAL VESSEL TONE. Thesis submitted to the University of London for the degree of Doctor of Philosophy in the Faculty of Science. by Anita-Jane Sexton B.Sc. (Hons.) Department of Anatomy and Developmental Biology University College London. ProQuest Number: 10017796 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10017796 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 ABSTRACT This thesis examines the influence of the vascular endothelium on the local control of human feto-placental vascular tone and how these influences may vary with gestation. Electron microscopic studies have revealed that human umbilical vessels are devoid of nerves throughout gestation. Structural changes in the arterial and venous wall could be detected throughout gestation. The presence of a subpopulation of endothelial cells containing nitric oxide synthase (NOS)-like immunoreactivity was identified only in late pregnancy. The umbilical artery and vein, from both early and late pregnancy, did not relax to acetylcholine (ACh), adenosine 5-triphosphate (ATP), substance P (SP) and calcium ionophore A23187, known to be endothelium-dependent vasodilators, but did relax to sodium nitroprusside (SNP). -
Hallux Valgus
MedicalContinuing Education Building Your FOOTWEAR PRACTICE Objectives 1) To be able to identify and evaluate the hallux abductovalgus deformity and associated pedal conditions 2) To know the current theory of etiology and pathomechanics of hallux valgus. 3) To know the results of recent Hallux Valgus empirical studies of the manage- ment of hallux valgus. Assessment and 4) To be aware of the role of conservative management, faulty footwear in the develop- ment of hallux valgus deformity. and the role of faulty footwear. 5) To know the pedorthic man- agement of hallux valgus and to be cognizant of the 10 rules for proper shoe fit. 6) To be familiar with all aspects of non-surgical management of hallux valgus and associated de- formities. Welcome to Podiatry Management’s CME Instructional program. Our journal has been approved as a sponsor of Continu- ing Medical Education by the Council on Podiatric Medical Education. You may enroll: 1) on a per issue basis (at $15 per topic) or 2) per year, for the special introductory rate of $99 (you save $51). You may submit the answer sheet, along with the other information requested, via mail, fax, or phone. In the near future, you may be able to submit via the Internet. If you correctly answer seventy (70%) of the questions correctly, you will receive a certificate attesting to your earned credits. You will also receive a record of any incorrectly answered questions. If you score less than 70%, you can retake the test at no additional cost. A list of states currently honoring CPME approved credits is listed on pg. -
Adult Still's Disease
44 y/o male who reports severe knee pain with daily fevers and rash. High ESR, CRP add negative RF and ANA on labs. Edward Gillis, DO ? Adult Still’s Disease Frontal view of the hands shows severe radiocarpal and intercarpal joint space narrowing without significant bony productive changes. Joint space narrowing also present at the CMC, MCP and PIP joint spaces. Diffuse osteopenia is also evident. Spot views of the hands after Tc99m-MDP injection correlate with radiographs, showing significantly increased radiotracer uptake in the wrists, CMC, PIP, and to a lesser extent, the DIP joints bilaterally. Tc99m-MDP bone scan shows increased uptake in the right greater than left shoulders, as well as bilaterally symmetric increased radiotracer uptake in the elbows, hands, knees, ankles, and first MTP joints. Note the absence of radiotracer uptake in the hips. Patient had bilateral total hip arthroplasties. Not clearly evident are bilateral shoulder hemiarthroplasties. The increased periprosthetic uptake could signify prosthesis loosening. Adult Stills Disease Imaging Features • Radiographs – Distinctive pattern of diffuse radiocarpal, intercarpal, and carpometacarpal joint space narrowing without productive bony changes. Osseous ankylosis in the wrists common late in the disease. – Joint space narrowing is uniform – May see bony erosions. • Tc99m-MDP Bone Scan – Bilaterally symmetric increased uptake in the small and large joints of the axial and appendicular skeleton. Adult Still’s Disease General Features • Rare systemic inflammatory disease of unknown etiology • 75% have onset between 16 and 35 years • No gender, race, or ethnic predominance • Considered adult continuum of JIA • Triad of high spiking daily fevers with a skin rash and polyarthralgia • Prodromal sore throat is common • Negative RF and ANA Adult Still’s Disease General Features • Most commonly involved joint is the knee • Wrist involved in 74% of cases • In the hands, interphalangeal joints are more commonly affected than the MCP joints. -
Arthritis in Myasthenia Gravis
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.38.11.1048 on 1 November 1975. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry, 1975, 38, 1048-1055 Arthritis in myasthenia gravis J. A. AARLI1, E.-J. MILDE, AND S. THUNOLD From the Departments of Neurology and Pathology, School of Medicine, University of Bergen, and the Rheumatic Disease Unit, The Deaconesses' Hospital, Bergen, Norway SYNOPSIS Seven patients with myasthenia gravis developed clinical signs of arthropathy. In two patients, the symptoms were due to a deforming rheumatoid arthritis and the myasthenic symptoms appeared as a transitory phase during the course of the disease. Muscle antibodies of IgG class were demonstrated with sera from both patients. Autoreactivity between muscle antibodies and rheuma- toid factor was detected in one patient. Both patients died from sudden cardiac failure. Necropsy was performed in one and revealed a spotty myocardial necrosis. One patient had juvenile rheumatoid arthritis. Two patients had mild articular symptoms with indices of multivisceral disease and sero- logical findings indicating a systemic lupus erythematosus. One patient had classical ankylosing spondylitis, and one, unspecified arthropathy. guest. Protected by copyright. The concept of myasthenia gravis as a pure cate a clinical overlap (Oosterhuis and de Haas, disorder of the neuromuscular transmission has 1968). The aim of the present paper is a re- probably been an obstacle to the full delineation appraisal ofthe relationship between myasthenia of the clinical picture of this disease. Thus, care- gravis and arthritis. Seven patients are described ful clinical examination has revealed a series of and the data compared with relevant literature. -
Non-Cardiac Manifestations of Marfan Syndrome
Keynote Lecture Series Non-cardiac manifestations of Marfan syndrome Anne H. Child Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London, UK Correspondence to: Dr. Anne H. Child, MD, FRCP. Reader in Cardiovascular Genetics, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London SW17 0RE, UK. Email: [email protected]. Because of the widespread distribution of fibrillin 1 in the body, Marfan syndrome (MFS) affects virtually every system. The expression of this single dominantly inherited gene is variable within a family, and between families. There is some genotype-phenotype correlation which is helpful in guiding long-term prognosis, and management. In general gene mutations have been reported in clusters, with those having mainly ocular manifestations occurring in exons 1 to 15 of this 65-exon gene; those causing cardiac problems often involving cysteine replacement in a calcium binding EGF-like sequence; the most severe mutations occurring in exons 25–32, causing neonatal MFS diagnosed at birth, and severe enough to cause death frequently before the age of 2. Other correlations will certainly be found in future. This condition is progressive, and the manifestations unfold according to age. For example, if the lens is going to dislocate this usually occurs by age 10; scoliosis usually presents itself between the ages of 8 and 15; height should be monitored carefully between the onset of puberty and cessation of growth approximately age 17 or 18. Holistic care should be offered by one doctor who oversees the patient’s welfare. This should be a paediatrician, paediatric cardiologist, or general practitioner in the case of an affected child. -
Tonic and Rhythmic Spinal Activity Underlying Locomotion
Send Orders for Reprints to [email protected] Current Pharmaceutical Design, 2017, 23, 1-11 1 REVIEW ARTICLE Tonic and Rhythmic Spinal Activity Underlying Locomotion Yury P. Ivanenkoa,*, Victor S. Gurfinkelb, Victor A. Selionovc, Irina A. Solopovac, Francesca Sylos-Labinid, Pierre A Guertine and Francesco Lacquanitia,d,f aLaboratory of Neuromotor Physiology, Santa Lucia Foundation, 00179 Rome, Italy; bBiomedical Engineering Department, Oregon Health and Science University, Portland, Oregon, USA; cLaboratory of Neurobiology of Motor Control, Institute for Information Transmission Problems, Moscow 127994, Russia; dCentre of Space Bio-medicine, University of Rome Tor Vergata, 00133 Rome, Italy, City, Country; eDepartment of Psychiatry and Neurosciences, Laval University, Québec City, Canada G1V 4G2; fDepartment of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy Abstract: In recent years, many researches put significant efforts into understanding and assessing the functional state of the spinal locomotor circuits in humans. Various techniques have been developed to stimulate the spinal A R T I C L E H I S T O R Y cord circuitries, which may include both diffuse and quite specific tuning effects. Overall, the findings indicate that tonic and rhythmic spinal activity control are not separate phenomena but are closely integrated to properly initiate and sustain stepping. The spinal cord does not simply transmit information to and from the brain. Its Received: November 2, 2016 Accepted: January 20, 2017 physiologic state determines reflex, postural and locomotor control and, therefore, may affect the recovery of the locomotor function in individuals with spinal cord and brain injuries. This review summarizes studies that exam- ine the rhythmogenesis capacity of cervical and lumbosacral neuronal circuitries in humans and its importance in DOI: 10.2174/1381612823666170125 developing central pattern generator-modulating therapies. -
Cerebral Palsy
Cerebral Palsy Cerebral palsy encompasses a group of non-progressive and non-contagious motor conditions that cause physical disability in various facets of body movement. Cerebral palsy is one of the most common crippling conditions of childhood, dating to events and brain injury before, during or soon after birth. Cerebral palsy is a debilitating condition in which the developing brain is irreversibly damaged, resulting in loss of motor function and sometimes also cognitive function. Despite the large increase in medical intervention during pregnancy and childbirth, the incidence of cerebral palsy has remained relatively stable for the last 60 years. In Australia, a baby is born with cerebral palsy about every 15 hours, equivalent to 1 in 400 births. Presently, there is no cure for cerebral palsy. Classification Cerebral palsy is divided into four major classifications to describe different movement impairments. Movements can be uncontrolled or unpredictable, muscles can be stiff or tight and in some cases people have shaky movements or tremors. These classifications also reflect the areas of the brain that are damaged. The four major classifications are: spastic, ataxic, athetoid/dyskinetic and mixed. In most cases of cerebral palsy, the exact cause is unknown. Suggested possible causes include developmental abnormalities of the brain, brain injury to the fetus caused by low oxygen levels (asphyxia) or poor circulation, preterm birth, infection, and trauma. Spastic cerebral palsy leads to increased muscle tone and inability for muscles to relax (hypertonic). The brain injury usually stems from upper motor neuron in the brain. Spastic cerebral palsy is classified depending on the region of the body affected; these include: spastic hemiplegia; one side being affected, spastic monoplegia; a single limb being affected, spastic triplegia; three limbs being affected, spastic quadriplegia; all four limbs more or less equally affected. -
Back-To-Basics: the Intricacies of Muscle Contraction
Back-to- MIOTA Basics: The CONFERENCE OCTOBER 11, Intricacies 2019 CHERI RAMIREZ, MS, of Muscle OTRL Contraction OBJECTIVES: 1.Review the anatomical structure of a skeletal muscle. 2.Review and understand the process and relationship between skeletal muscle contraction with the vital components of the nervous system, endocrine system, and skeletal system. 3.Review the basic similarities and differences between skeletal muscle tissue, smooth muscle tissue, and cardiac muscle tissue. 4.Review the names, locations, origins, and insertions of the skeletal muscles found in the human body. 5.Apply the information learned to enhance clinical practice and understanding of the intricacies and complexity of the skeletal muscle system. 6.Apply the information learned to further educate clients on the importance of skeletal muscle movement, posture, and coordination in the process of rehabilitation, healing, and functional return. 1. Epithelial Four Basic Tissue Categories 2. Muscle 3. Nervous 4. Connective A. Loose Connective B. Bone C. Cartilage D. Blood Introduction There are 3 types of muscle tissue in the muscular system: . Skeletal muscle: Attached to bones of skeleton. Voluntary. Striated. Tubular shape. Cardiac muscle: Makes up most of the wall of the heart. Involuntary. Striated with intercalated discs. Branched shape. Smooth muscle: Found in walls of internal organs and walls of vascular system. Involuntary. Non-striated. Spindle shape. 4 Structure of a Skeletal Muscle Skeletal Muscles: Skeletal muscles are composed of: • Skeletal muscle tissue • Nervous tissue • Blood • Connective tissues 5 Connective Tissue Coverings Connective tissue coverings over skeletal muscles: .Fascia .Tendons .Aponeuroses 6 Fascia: Definition: Layers of dense connective tissue that separates muscle from adjacent muscles, by surrounding each muscle belly. -
1 Human Resting Muscle Tone
Human Resting Muscle Tone (HRMT): Narrative Introduction and Modern Concepts Alfonse T. Masi, MD, DR.P.H. * Professor of Medicine and Epidemiology University of Illinois College of Medicine at Peoria One Illini Drive, Peoria, IL 61656, USA Tel: +1 309 671 8428 Fax: +1 309 671 8513 Email: [email protected] John Charles Hannon, DC Certified Feldenkrais Practitioner 1141 Pacific Suite B San Luis Obispo, CA 93401, USA Tel: +1 805 542 9925 Fax: +1 805 541 2391 Email: [email protected] Key Words: passive tone or tonus; viscoelastic; skeletal muscle; fascia; myofascial, biotensegrity *Correspondence to: Dr. AT Masi 1 Abstract Human resting muscle studies have been performed to establish (myofascial) tone (HRMT) is the passive normal frequency distributions of degrees of tonus or tension of skeletal muscle that myofascial tone. Clinical experience derives from its intrinsic (EMG-silent) indicates that persons with certain molecular viscoelastic properties. The word symptomatic musculoskeletal conditions tone has been used to convey varying may have palpably increased resting muscle clinical and physiological features that have firmness or hardness (EMG-silent), such as led to confusion and controversy. HRMT is that of the upper trapezius in tension-type the vital low-level, passive tension, and headache, and the lumbodorsal extensors resistance to stretch that contributes (hartspann) in degenerative lumbar disc importantly to maintaining postural stability disease and ankylosing spondylitis. in balanced equilibrium positions. In contrast, co-contraction of muscle is an In summary, resting skeletal muscle tone is active neuromotor control that provides an intrinsic viscoelastic tension exhibited greater levels of tonus for increased within the body’s kinematic chains. -
Thieme: Teaching Atlas of Musculoskeletal Imaging
Teaching Atlas of Musculoskeletal Imaging Teaching Atlas of Musculoskeletal Imaging Peter L. Munk, M.D., C.M., F.R.C.P.C. Professor Departments of Radiology and Orthopaedics University of British Columbia Head Section of Musculoskeletal Radiology Vancouver General Hospital and Health Science Center Vancouver, British Columbia, Canada Anthony G. Ryan, M.B., B.C.H., B.A.O., F.R.C.S.I., M.Sc. (Engineering and Physical Sciences in Medicine), D.I.C., F.R.C.R., F.F.R.R.C.S.I. Consultant Musculoskeletal and Interventional Radiologist Waterford Regional Teaching Hospital Ardkeen, Waterford City, Republic of Ireland Radiologic Tutor and Clinical Instructor in Radiology The Royal College of Surgeons in Ireland Dublin, Republic of Ireland Thieme New York • Stuttgart [email protected] 66485438-66485457 Thieme Medical Publishers, Inc. 333 Seventh Ave. New York, NY 10001 Editor: Birgitta Brandenburg Assistant Editor: Ivy Ip Vice President, Production and Electronic Publishing: Anne T. Vinnicombe Production Editor: Print Matters, Inc. Vice President, International Marketing: Cornelia Schulze Sales Director: Ross Lumpkin Chief Financial Officer: Peter van Woerden President: Brian D. Scanlan Compositor: Compset, Inc. Printer: The Maple-Vail Book Manufacturing Group Library of Congress Cataloging-in-Publication Data Munk, Peter L. Teaching atlas of musculoskeletal imaging / Peter L. Munk, Anthony G. Ryan. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-58890-372-3 (alk. paper) ISBN-10: 1-58890-372-9 (alk. paper) ISBN-13: 978-3-13-141981-1 (alk. paper) ISBN-10: 3-13-141981-4 (alk. paper) 1. Musculoskeletal system—Diseases—Imaging—Atlases. 2. Musculoskeletal system—Diseases—Case studies.