Search

Pharmacy data reveal that 70% of patients were missing one or more days worth of drops out of five. Adopting approaches to behavior change and management skills used for people with diabetes may provide insight to improve self-management of glaucoma. Every person who is diagnosed with a chronic health condition such as glaucoma has unique life circumstances that may present barriers to behavior change. An accurate diagnosis and a treatment plan are useless if patients do not use their prescribed eye drops. Active listening and effective communication can result in persons who are more engaged in their self-care behaviors. Collaborative communication using person-centered and strengths-based messages could help eye care providers identify challenges and concerns for people with glaucoma who are experiencing inconsistencies with their eye drops. In an atmosphere where patients can discuss their challenges with treatment recommendations without judgment or fear, they are more likely to trust their provider and therefore share their situation openly and honestly. This is accomplished by choosing language that communicates mutually-agreed-upon self-management goals and addresses and strengthens individual and clinical outcomes. The eye care professional is then seen by the patient as a resource who can empathize when setbacks occur and reinforce the patient's self-management goals. Open-ended questions and tell-ask-tell approaches for identifying barriers to care are keys to more effective communication and trusting relationships. This includes recognizing that glaucoma is associated with increased rates of anxiety or depression that may be an overlooked barrier to self-management. By adopting language recommendations from diabetes care and education, eye care practitioners may be better equipped to help people with glaucoma improve their self-care.

Deep venous thrombosis and septic pulmonary embolism are known to occur in association with pediatric musculoskeletal infections. The authors of recent studies have reported an apparent increase in the incidence of this phenomenon, which appears to be related to the rising occurrence of infections caused by methicillin-resistant Staphylococcus aureus 1. Some authors have suggested that the Panton-Valentine leukocidin gene, which may be expressed by methicillin-resistant Staphylococcus aureus , is responsible for severe consequences of infection including necrotizing pneumonia, deep venous thrombosis, septic pulmonary embolism, and an enhanced local inflammatory response leading to abscess formation in tissues adjacent to the site of infection2-5. We previously reported on thirteen children with deep venous thrombosis that occurred in association with osteomyelitis (eleven), septic arthritis (one), or pyomyositis (one), and we identified characteristics of these children that may help to guide clinicians in assessing the relative propensity of a child with musculoskeletal infection to develop deep venous thrombosis6. In that report, 25% of the children above the age of eight years who had osteomyelitis caused by methicillin-resistant Staphylococcus aureus and who presented with a C-reactive protein level of >6 mg/dL were noted to have deep venous thrombosis, but none of the children with deep venous thrombosis in that report had an upper-extremity infection. The majority of the infections occurred adjacent to the knee, involving either the proximal part of the tibia or the distal part of the femur, with the deep venous thrombosis located in the popliteal or femoral vein. We present here the case of a child with acute osteomyelitis of the humerus associated with a deep venous thrombosis in the ipsilateral upper extremity and septic pulmonary embolism. The parents of the patient were informed that data concerning the case would be submitted for publication, and …

Purpose of review Total hip replacement is one of the safest and most clinically efficacious operations in orthopedic surgery. It has been extended to more and more patient populations over the past four decades. The purpose of this review is to present the contemporary data of total hip replacement in two unique patient populations: obese patients and geriatric patients older than 75 years of age. Recent findings There are unique clinical challenges in these patients. In addition, the clinical outcome and complications are different from more routine total hip replacement populations. Summary The recent research has shown that total hip replacement in the obese and elderly populations can be successful, and should not be denied solely based on these two criteria. There is a need for more research to investigate postoperative instability in the obese patient population, and perioperative mental confusion and cognitive function deterioration in the elderly patient population.

Laryngeal hemangiomas in adults are uncommon. We report four such cases seen at our clinic during an 18-month period in 1996 and 1997. All masses were detected by endoscopy, and all were biopsied and ablated uneventfully with a CO2 laser. All four patients recovered without incident. We feel that laryngeal hemangiomas that affect only the glottic area can be treated endoscopically with a CO2 laser without consequences.

Rhinophyma is an acne rosacea which primarily affects the midface of elderly men, and causes disfigurement as well as obstruction. There are numerous ways of treating this condition and, in our institution, a CO2 laser is the treatment of choice.

Purpose The purpose of this study was to compare elite athletes who underwent hip arthroscopy with and without microfracture with respect to their ability to return to sport at the professional level. Methods All elite male athletes who underwent hip arthroscopy between 1999 and 2010 were identified. Inclusion criteria were hip arthroscopy with treatment of labrum, femoroacetabular impingement, cartilage, ligamentum teres, capsule, and/or loose body removal. Exclusion criteria were diffuse degenerative joint disease, previous surgery, plans to retire, labral reconstruction, soft tissue release, and concomitant lower extremity injury. Thirty-nine athletes underwent hip arthroscopy with microfracture and were assigned to the microfracture treatment group. Eighty-one elite athletes (94 hips) underwent hip arthroscopy without microfracture and were assigned to the control group. Sports played included hockey, soccer, football, baseball, tennis, and golf. Results Seventy-seven percent (30 of 39) of athletes in the microfracture treatment group and 84% (79 of 94) in the control group returned to play. There was no statistical difference in rate of return to play between groups (odds ratio = 1.6; 95% confidence interval, 0.633 to 4.049). Those players who did return were followed for an average of 3 years (range, 2 to 12). Athletes in the microfracture treatment group who returned have averaged 3 seasons thus far, and 73% are still playing. We found no significant difference in the microfracture group in age, time from injury to surgery, number of seasons played preoperatively, or size of lesion for return versus no return. We also found no increased risk of not returning because of contact sport, multiple lesions, or lesion on weightbearing surface. Conclusions There was no detectable statistically significant difference in return to play rate after hip arthroscopy with microfracture and hip arthroscopy without microfracture. Professional athletes who underwent hip arthroscopy with microfracture procedure were able to return to the same high level of competition after surgery at a high rate. Level of Evidence Level III, retrospective comparative study.

This is case report of extramedullary plasmacytoma occurring in the nasal cavity. These are unusual tumors especially in the nasal area. Patients present mainly with nasal symptoms on the same side of the tumors. The treatment consists of surgery resection, or, radiation, or both. There is a fifty percent survival rate in five years.

Objectives: Hypertropic lingual tonsils are a known obstruction in the upper airway. Enlarged linguals are responsible for obstructive sleep apnea, potential infections, and difficult intubations for routine surgeries. In our institution all patients were treated with protection of the airway, and ablation of lingual tonsils with a CO 2 laser. Methods: The patients were diagnosed with direct visualization and a CT scan of the neck. All patients were intubated with a laser reinforced endotracheal tube and fire precautions were taken when draping patient. One patient had a tracheotmy performed before being treated for hypertrophic lingual tonsils. A wide funnell larynscope was suspended. The CO 2 laser was used at 15 watts continuous along with an operating microscope to ablate the tissue. Results: All patients were admitted for a 23-hour stay. Postoperatively, no patient required intubation to protect the airway. Three of the 50 patients required a revision surgery to completely ablate all the lingual tonsils. The patient with the tracheotomy was decannulated. All patients were relieved and asymptomatic after surgery. Conclusion: CO 2 laser is a safe and acceptable method for lingual tonsillectomy. All patients in our institution had no complications and were free of all symptoms. The laser compleletly ablated the lingual tonsils removing the obstruction in the airway.

(Editorial Comment: The authors describe a rare entity that may mimic a common benign parotid neoplasm. The clinical presentation, work-up, and treatment are summarized.) Preauricular masses are usually parotid tumors. Rarely, they are temporomandibular joint cysts. These cysts are divided between ganglion cysts and synovial cysts. Twelve temporomandibular joint cysts have been reported. Eight have been ganglion cysts and 4 have been synovial cysts. 1 This is the 5th synovial cyst reported as a temporomandibular joint cyst. Treatment is uncertain; however, surgical excision of the temporomandibular joint cyst has the highest success rate. CASE REPORT A 47-year-old woman presented to the Ear, Nose, and Throat Clinic with a preauricular mass. She admitted to the mass growing slowly and being present for approximately 1 year. She had left preauricular pain and discomfort when chewing. The pain had become worse before her visit. She had a history of temporomandibular joint dysfunction and was being treated by her dentist. Her past medical history was basically unremarkable. Her physical examination showed a 2-cm mass in the left preauricular region. The mass was tender to the touch and mobile. There was no facial nerve paralysis or paresis. The rest of her head and neck examination was unremarkable. A fine-needle aspiration was performed. The results were nondiagnostic. Epithelial cells were obtained, but we could not make a diagnosis. She was offered an additional fine-needle aspiration, even with the use of ultrasound needle-guided aspiration, but she refused. Therefore, a computed tomography (CT) scan was obtained, which showed a cystic lesion near the parotid gland but did not involve the parotid gland (Fig 1). Because the pain was becoming unbearable and there was no diagnosis of this cystic lesion, she was offered surgery. She was taken to the operating room where a superficial parotidectomy was performed for exposure. The cystic lesion involved the left temporomandibular joint. The cystic lesion was removed, and the entire joint and capsule of the temporomandibular joint was reconstructed at the time of surgery. Pathological examination showed that this was a synovial ganglion cyst of the left temporomandibular joint. She was followed up in 1 week with no complications. She admitted her pain was gone. Postoperatively, she had no pain on chewing. Six months postoperatively, she only complained of occasional temporomandibular joint problems, which were very mild compared with her past history.