Effect of n-3 polyunsaturated fatty acids on Barrett's epithelium in the human lower esophagus.

Background: Epidemiologic studies suggest a reduced risk of esophageal adenocarcinoma in populations with a high consumption of fish, and n-3 fatty acids inhibit experimental carcinogenesis. One possible explanation is the suppression of eicosanoid production through inhibition of cyclooxygenase 2 (COX-2).

Objective: The objective was to determine the effects of dietary supplementation with the n-3 fatty acid eicosapentaenoic acid (EPA) on a number of biological endpoints in Barrett's esophagus.

Ipsilateral patellofemoral arthroplasty and autogenous osteochondral femoral condylar transplantation.

The aim of this study was to report the results of ipsilateral patellofemoral arthroplasty and autologous osteochondral transplantation for patellofemoral arthritis and focal full-thickness chondral defects of the femoral condyles. The size of the condylar cartilage defects ranged from as small as 10 x 9 mm to as big as 24 x 7 mm. The mean Knee Society function score improved from 49 to 93, and the clinical score improved from 47 to 95.

Impact of surgeon handedness and laterality on outcomes of total knee arthroplasties: should right-handed surgeons do only right TKAs?

In this study, we examined the impact of surgeon handedness on total knee arthroplasty (TKA) outcomes. From 1997 to 2001, a right-handed surgeon performed 728 primary TKAs while standing on the side of the operative extremity--377 on the right and 351 on the left. Extension and Knee Society Function and Pain scores were significantly better for right knees than for left knees 1 year after surgery.

Comparison of lateral release versus lateral release with medial soft-tissue realignment for the treatment of recurrent patellar instability: a systematic review.

Purpose: The purpose of this report is to present a systematic review of the literature to compare surgical success of lateral retinacular release (LRR) or LRR with medial soft-tissue realignment (MR) for recurrent lateral patellar instability.

Methods: We searched MEDLINE and PubMed databases for all English-language studies reporting surgical management of recurrent lateral patellar instability with LRR or with LRR and MR. Exclusion criteria included a minimum follow-up <2 years, mean age <18 years old, bony realignment procedures, surgical treatment of an initial patellar instability episode, or surgical treatment of patellofemoral pain without instability.

Measuring the attitudes and impact of the eighty-hour workweek rules on orthopaedic surgery residents.

Background: The literature on graduate medical education contains anecdotal reports of some effects of the new eighty-hour workweek on the attitudes and performance of residents. However, there are relatively few studies detailing the attitudes of large numbers of residents in a particular surgical specialty toward the new requirements.

Methods: Between July and November 2004, a survey created by the Academic Advocacy Committee of the American Academy of Orthopaedic Surgeons was distributed by mail, fax, and e-mail to a total of 4207 orthopaedic residents at the postgraduate year-1 through year-6 levels of training.

Current issues in health policy: a primer for the orthopaedic surgeon.

Political, social, and economic forces occupy an increasingly larger role in health care. It is essential that orthopaedic surgeons become familiar with the ever-changing landscape within which they practice. Greater comprehension of the current issues in health policy will enable practitioners to appreciate these issues and understand the importance of the involvement of the AAOS in the political process.

Surgery for morbid obesity.

The prevalence of morbid obesity in the UK population is rising, bringing with it increased levels of cardiovascular disease, diabetes, arthritis and early mortality. The overall cost to the health service is high, and is set to increase over the coming decades as the overweight population ages. Dietary, lifestyle and pharmacological interventions offer at best reasonable, short-term weight reduction and often fail.

Posterior cervical arthrodesis for subacute odontoid fracture in a patient with osteopetrosis: case report.

Study Design: A case of subacute odontoid fracture in a patient with osteopetrosis treated with posterior cervical arthrodesis using transarticular screws and interspinous wiring.

Objectives: To report the first successful cervical arthrodesis in a patient with osteopetrosis and to highlight the potential perioperative pitfalls in this rare surgical population.

Summary Of Background Data: Osteopetrosis is a group of skeletal dysplasias characterized by osteoclast dysfunction, impaired bone resorption, and poor bone remodeling.

Prospective trial of laparoscopic nissen fundoplication versus proton pump inhibitor therapy for gastroesophageal reflux disease: Seven-year follow-up.

Laparoscopic Nissen fundoplication and proton pump inhibitor (PPI) therapy are both established treatments for gastroesophageal reflux disease (GERD). We have performed a prospective randomized study comparing these two treatments and now have long-term follow-up data. Between July 1997 and August 2001, 183 patients in Norwich took part in a randomized controlled trial comparing laparoscopic Nissen fundoplication and PPI therapy for the treatment of GERD.

Sacral fractures.

Sacral fractures most commonly occur after pelvic ring injuries but occasionally in isolation. Although the true incidence of sacral fractures is unknown, an estimated 30% are identified late. Sequelae of inappropriately treated or untreated sacral fractures include persistent pain, decreased mobility, and neurologic compromise.

The effect of intraperitoneal local anesthesia in laparoscopic cholecystectomy: a systematic review and meta-analysis.

Intraperitoneal administration of local anesthesia is often used to improve pain relief after laparoscopic cholecystectomy. We have conducted a meta-analysis to establish the efficacy of this technique in reducing early postoperative abdominal pain. A systematic literature search revealed 24 randomized, controlled trials assessing intraperitoneal local anesthetic use in laparoscopic cholecystectomy that met inclusion criteria.

Nucleus implant parameters significantly change the compressive stiffness of the human lumbar intervertebral disc.

Nucleus replacement by a synthetic material is a recent trend for treatment of lower back pain. Hydrogel nucleus implants were prepared with variations in implant modulus, height, and diameter Human lumbar intervertebral discs (IVDs) were tested in compression for intact, denucleated, and implanted condition. Implantation of nucleus implants with different material and geometric parameters into a denucleated IVD significantly altered the IVD compressive stiffness.

Modern surgical treatment of primary aneurysmal bone cyst of the spine in children and adolescents.

Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor-like condition. Treating children with spinal involvement poses special hazards due to the proximity of the lesion to the spinal cord and the need to preserve spinal stability and balance after surgery. Twelve children with ABC treated between 1990 and 2002 at a tertiary pediatric musculoskeletal tumor center using modern surgical techniques and technology were retrospectively reviewed.

Effect of bracing on paralytic scoliosis secondary to spinal cord injury.

Background: The incidence of paralytic scoliosis subsequent to acquired spinal cord injury (SCI) has been reported to range from 46% to 97% in patients injured before the adolescent growth spurt.

Objective: The purpose of this report is to review early bracing of children with SCI as a means of preventing or delaying surgical fusion.

Methods: Patient records from January 1996 to December 2001 from the Shriners Hospitals for Children-Philadelphia were retrospectively reviewed; 123 patients met the inclusion criteria of cervical or thoracic SCI prior to skeletal maturity.

The relationship between required medical school instruction in musculoskeletal medicine and application rates to orthopaedic surgery residency programs.

Background: Orthopaedic residency programs lack gender and race diversity. This study examines the hypothesis that exposure to a required course in musculoskeletal medicine in medical school is associated with a higher rate of application to orthopaedic surgery residency programs by underrepresented groups.

Methods: All 122 medical schools in the United States were surveyed in 2001 to determine whether they required dedicated course work in musculoskeletal medicine, defined as a preclinical module or clinical clerkship in orthopaedic surgery, rheumatology, or physiatry.

The tension required at repair to reappose the supraspinatus tendon to bone rapidly increases after injury.

Rotator cuff tears occur frequently and can cause significant pain and reduced shoulder function. A high percentage of patients are satisfied after surgical repair of rotator cuff tears, but a smaller percentage of patients with chronic tears continue to have pain and poor shoulder function. This may be partly attributable to an increase in the repair tension, the force required at repair to reappose the tendon to its original insertion site on the humerus.

Langerhans cell histiocytosis of the spine in children. Long-term follow-up.

Background: Langerhans cell histiocytosis causes destructive lesions in a child's spine. Few large, long-term studies have evaluated the clinical and radiographic presentation, natural history, outcomes of modern treatment approaches, and maintenance of normal spinal growth and stability after the diagnosis of this disease in children.

Methods: Twenty-six children with biopsy-proven Langerhans cell histiocytosis involving the spine were treated at our institution between 1970 and 2003.

Neuro-orthopedic management of shoulder deformity and dysfunction in brain-injured patients: a novel approach.

Shoulder problems are common in patients with traumatic brain injury. Very little has been written about the evaluation and neuro-orthopedic management of these problems. This is largely because there have not been surgical treatments available other than release of contracted, nonfunctional shoulders.

Supraspinatus tendon organizational and mechanical properties in a chronic rotator cuff tear animal model.

Rotator cuff tears of the shoulder are a common cause of pain and disability. The successful repair of rotator cuff tendon tears depends on the time from onset of injury to the time of surgical repair. However, the effect of time from injury to repair remains poorly understood.

An atypical presentation of Langerhans cell histiocytosis of the cervical spine in a child.

Study Design: A case report of a child with Langerhans cell histiocytosis of the posterior elements of the cervical spine treated conservatively and with long-term follow-up is described.

Objectives: To describe the unique diagnostic and therapeutic challenges of treating Langerhans cell histiocytosis located atypically in the posterior elements of the spine.

Summary Of Background Data: Langerhans cell histiocytosis involves the spine in approximately 20% of children with the disease.