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Clinical Director, University of Massachusetts Medical School

Reactive arthritis defined etiologies, emerging p at h op h ysiolog y, and u nresolv ed t reat ment. Is sulfasalazine effective in ankylosing spondylitis A systematic review of randomized controlled trials. Comparison of sulfasalazine and p laceb o for the t reat ment of ax ial and p erip h eral art icu lar manifestations of the seronegative spondylarthropathies a D ep art ment of Vet erans A ffairs coop erat iv e st u dy. C omp arison of su lfasalazine and p laceb o in the t reat ment of ankylosing sp ondylit is. The Cochrane review of p h ysiot h erap y int erv ent ions for ankylosing sp ondylit is. Recombinant h u man t u mor necrosis fact or recep t or (et anercep t) for t reat ing ankylosing spondylitis a randomized, controlled trial. Prevalence of spondyloarthropathies in an Italian population sample a regional community-based study. D iscov ert eb ral dest ru ct iv e lesions (so called A ndersson lesions) associat ed w it h ankylosing spondylitis. D iag nosis delay in patients with ankylosing spondylitis possible reasons and proposals for new diagnostic criteria. C linical relev ance of C-reactive protein in axial involvement of ankylosing spondylitis. The European Sp ondylart h rop at h y St u dy G rou p p reliminary crit eria for the classification of spondylarthropathy. Th e relat ionsh ip b et w een K leb siella infect ion and ankylosing spondylitis. Prevalence of Lumbar Facet Arthrosis and Its Relationship to Age, Sex, and Race An Anatomic Study of Cadaveric Specimens. Th e clinical u t ilit y of comp u t ed t omog rap h y comp ared t o conv ent ional radiog rap h y in diag nosing sacroiliitis. In iximab inhibits bone resorption by circulating osteoclast p recu rsor cells in p at ient s w it h rh eu mat oid art h rit is and ankylosing spondylitis. Treat ment of ankylosing sp ondylit is b y inh ib it ion of t u mor necrosis fact or alp h a. Long-term disab ilit y and p rolong ed sick leav es as ou t come measu rement s in ankylosing sp ondylit is. Results of surgical correct ion of kyp h ot ic deformit ies of the sp ine in ankylosing spondylitis on the basis of the modified arthritis impact measurement scales. Magnetic resonance imaging of in ammatory lesions in the spine in ankylosing spondylitis clinical trials is paramagnetic contrast medium necessary. Continuation of group physical therapy is necessary in ankylosing spondylitis results of a randomized controlled trial. A double-blind, placebo-controlled trial of low dose in iximab in ankylosing spondylitis. The appearance of the p iriformis mu scle syndrome in comp u t ed t omog rap h y and mag net ic resonance imag ing. Fatigue in ankylosing spondylitis its prevalence and relationship to disease activity, sleep, and other factors. Association between the interleukin 23 receptor and ankylosing spondylitis is confirmed by a new K case-control study and meta-analysis of published series. L at issimu s dorsi 4 5 6 2 7 1 2 6 3 9 7 6 8 10 Shoulder & Arm 9 126 Orthopedic Conditions Infraspinatus 14 13 Anterior view of right shoulder B icep s long h ead t endon Transv erse h u meral lig ament Scap u la G lenoid lab ru m A rt icu lar cap su le H u meru s Vizniak Su b scap u lar b u rsa Weak Deep neck e or Tight Pectoralis major Weak Abdominal muscles Tight Iliopsoas Scapulocostal musculature Tight Erector spinae Weak Glut. D iag nost ic accu racy of clinical t est s for su b acromial imp ing ement syndrome: a systematic review and meta-analysis. Shoulder impingement syndrome: relat ionsh ip s b et w een clinical, fu nct ional, and radiologic findings.

Global assessment of pain relief (none, mild, moderate, or excellent or 0 = no pain relief, 1 = slight improvement, 2 = moderate improvement, 3 = complete pain relief, depending on the protocol or the report) None of the reports explicitly state which was the primary outcome. Withdrawals Due to Adverse Events: G = 4/53, P = 4/53 Denominators not apparent, as no version of report shows how many patients were randomized to P or G in "phase 1" vs. Initial report sent to Phil Magistro at Parke-Davis Pharmaceuticals August 23rd, 1997. The other two articles do not list baseline characteristics, only mean change in pain scores. This is also implied in both the Aug denominator 40, because it is impossible to know any other denominators from this report. Further on the reports, however, it is stated that 19 patients were randomized to the active drug and 21 to placebo during first treatment period. Narcotics were allowed throughout this trial (10 patients continued to use throughout the trial) and no apparent calculations to account for the possible interaction between narcotics and Gabapentin. Gabapentin in the treatment of painful diabetic neuropathy: a placebo controlled, double blind, crossover trial. The report also states that 19 were randomized to active drug while 21 to placebo in phase one, what about the other 13? With regard to baseline characteristics, the protocol states that "The subjects will also provide a verbal rating scale of global assessment of pain at baseline and every 2 weeks during the out whatsoever. Our results suggest that further studies evaluating higher dosages of Gabapentin are warranted. The protocol states that "Subjects will be assessed every 3 weeks for efficacy, safety, and compliance. Also, compliance is not reported anywhere in the reports except to say that 5 people withdrew due to non-compliance or personal/other reasons. The updated/altered report states "At the end of each treatment period patients provided a global assessment of pain relief: none, mild, moderate, or excellent, as compared to the level of pain preceding each pain period. The protocol states that "The subjects will also provide a verbal rating scale of global assessment of pain at baseline and every 2 weeks during the treatment period as follows: 0 = no pain relief, 1 = slight improvement. Also with regard to the Global Assessment of Pain Relief, patients rated their improvement as none, mild, moderate, or excellent. Because of multiple comparisons, we used the Bonferroni correction and a p-value of < 0. Global Assessment of Pain Relief: None / Mild Pain Relief Gabapentin Placebo 23 31 Moderate / Excellent Pain Relief 17 9 withdrew. Diarrhea, tremulousness, ankle swelling, and cramps G = 2, P = 2 (Assume this is what is meant by ". None of the reports clearly detail the adverse effects suffered by those on placebo. The above makes it very likely that many patients taking Gabapentin were unblinded. Validated measures of improvement in global function the p-value for above table is 0. For example, the letter to the editor states that 12 in the Gabapentin group and 1 in the placebo group suffered adverse effects. Furthermore, different tests were used to assess the incidence of adverse effects with Gabapentin and placebo. Although the data for this indicator was not significant, one wonders about post-hoc analysis, i. We know 126 patients were screened, 53 were randomized and 13 dropped out, while 40 completed the trial. No numbers are given and it is never stated whether or not this deviation from baseline is statistically significant, my feeling is that if it were significant, than this would have been stated.

There is no medical indication to excise the cutaneous neurofibromas as, unlike subcutaneous or plexiform neurofibromas, they are not associated with malignant transformation. The priority for this patient is to identify the cause of her high blood pressure and initiate appropriate treatment. This patient should have urgent assessment for renal artery stenosis (including duplex ultrasonography) and 24-hour urinary catecholamine collection to rule out phaeochromocytoma. It is reassuring that her renal function is normal on routine biochemistry, but a protein/creatinine ratio on a random void urine specimen should be performed to assess the level of renal dysfunction and identify any mild to moderate proteinuria which is frequently seen in association with renal vascular disease. Its protein product, called neurofibromin, is widely expressed particularly in the nervous system. Approximately 50 per cent of affected individuals have new mutations, however the family of this patient should be examined for any suggestive features. She is complaining of skin changes affecting her neck, which have been progressively worsening over the past 18 months. She is a very quiet girl and there is little eye contact through the consultation. Her mother has type 2 diabetes, hypertension and is also overweight, her father suffers from asthma. She has symmetrical hyperpigmented velvety thickened papillomatous plaques associated with scattered skin tags (acrochordons) around her neck, especially posteriorly and laterally, as well as in her axillae. It is thought to be caused by factors that stimulate epidermal keratinocyte and dermal fibroblast proliferation. The most common association with acanthosis nigricans in young patients is insulin resistance. In older patients with new-onset acanthosis nigricans, an associated (usually aggressive) internal malignancy (particularly gastrointestinal) must be considered. Many syndromes share common features, including obesity, hyperinsulinaemia and craniosynostosis. It predisposes to insulin resistance and type 2 diabetes, hypertension, hyperlipidaemia, liver and renal disease, reproductive dysfunction and orthopaedic problems. Anecdotal evidence suggests that depression and eating disorders are common in children and adolescents referred to obesity clinics. Prejudice and discrimination against individuals with obesity are ubiquitous within youth culture; even very young children have been found to regard their peers who have obesity in negative ways. Acanthosis nigricans is not a skin disease per se, but rather a sign of an underlying problem. If associated with insulin resistance, the most common cause, treatment of the metabolic abnormality may lead to improvement of the appearance of the skin. Dietary changes and weight loss may cause the acanthosis nigricans to regress almost completely. Identification and treatment of the underlying disorder will improve the appearance of the skin changes. Three weeks previously she had sustained a lower leg laceration at work and had attended the accident and emergency department where the wound was cleaned and sutured. Two days later, with an enlarging ulcer and increasing pain, she attended the A&E once more. The concern was of potential extending necrotic infection, such as necrotizing fasciitis and she was taken to theatre for urgent debridement and commenced on intravenous vancomycin and gentamicin. In theatre the ulcer was debrided but the base, surrounding skin and fascia were all noted to be healthy. There was no growth from any of the swabs or samples sent for microbiological, atypical mycobacterial, viral or mycological analysis. Over the next 10 days the ulcerated areas have continued to extend associated with extreme pain. Examination There is marked erythema and swelling of the distal third of the right lower leg, ankle and proximal foot. There are two areas of ulceration: a smaller regularly shaped ulcer anteromedially, and a more irregularly shaped and larger ulcer extending posteriorly from the medial malleolus. The surrounding skin (particularly distal to the ulceration) is erythematous and there is marked swelling. Pedal pulses are difficult to palpate on the affected side due to pain and swelling, however bedside Doppler studies confirm good flow.

Dose reduction is not required in patients with impaired liver and/or renal dysfunction. Patients should be advised to avoid heat exposure, as prochlorperazine may interfere with thermoregulatory mechanisms. Use with caution in patients under the age of 35 years, as there is an increased risk of dystonic reactions. Patients should be advised to avoid sun exposure to prevent photosensitivity reactions. Toxicity 2 Extrapyramidal reactions in the form of motor restlessness, tremor, akathisia, dystonia, pseudoparkinsonism, and tardive dyskinesia. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting 657 6. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting 659 Table 1. Level 1:,10% of patients experience acute (,24 hours after chemotherapy) emesis without antiemetic prophylaxis. With regard to combination regimens, the emetogenic levels are determined by identifying the most emetogenic agent in the combination and then assessing the relative contribution of the other agents based on the following: 1. The presence of one or more level 2 agents increases the emetogenic potential of the combination by one level greater than the most emetogenic agent in the combination. The presence of level 3 or level 4 agents increases the emetogenic potential of the combination by one level per given agent. In this updated version of Essentials, there are new chapters focusing on current popular topics in plastic surgery, including lymphedema, gender affirmation surgery and composite tissue allotransplantation. The book was written primarily for medical students and other students of plastic surgery to obtain a brief introduction into the specialty and provide references for further reading. It is not designed to be a comprehensive text, but rather an outline that can be read in the limited time available in a burgeoning curriculum. Plastic surgery had its beginning nearly 3000 years ago, when Sushruta, an Indian surgeon, reconstructed the nose by transferring a flap of cheek and then forehead skin. It is a modern field, stimulated by the challenging reconstructive problems of the unfortunate victims of the World Wars. The advent of the operating microscope has thrust the plastic surgeon of today into the forefront of advances in small vessel and nerve repair, culminating in the successful replantation of amputated parts as small as distal fingers and bypassing of lymphatic vessels, only a few millimeters in diameter. Furthermore, these techniques have been utilized to perform the first composite tissue transplantations of both hands and partial faces. The American Society of Plastic Surgeons is proud to provide complimentary online copies of the Plastic Surgery Essentials for Students handbook to all medical students in the United States and Canada. Unlike many other fields, it is not confined to a single organ system, region of the body, or patient population. The Greek term "plastikos" means to mold or to shape, and this is where our specialty derives its name and underlying principles. By reshaping, remolding, and manipulating both soft and hard tissues, plastic and reconstructive surgeons help patients with a myriad of issues. The goal of our specialty is to restore form and function, and to do so in an aesthetic fashion. Since, plastic surgery has come a long way and now is integral to the treatment of patients with disfigurement due to trauma, burns, scarring, cancer, infection, and more. As opposed to treating specific conditions with a limited set of procedures, plastic surgeons use skills and principles based on anatomy, physiology, and tissue transfer when managing patients.