Goniometric techniques for range-of-motion assessment

The authors hope that this article promotes greater understanding of the methodology available for measuring and recording joint ROM and fosters movement towards the eventual adoption of a single integrated goniometric system for the evaluation and recording of musculoskeletal impairment and disability. Towards this end, the authors have focused on applications of the Neutral-Zero Measuring Method and SFTR documentation and Recording System, and have highlighted the advantages of this system when compared to more conventional approaches. Examination and recording procedures have been described briefly, and examples of appropriate instruments and their applications have been illustrated. The reader is referred to more extensive discussions elsewhere of the measurement techniques themselves.     

Management Strategies for Hormone-Refractory Prostate Cancer

There are a range of therapeutic options for the management of prostate cancer in patients in whom the disease has progressed despite hormone-deprivation therapy. These include second- and third-line hormone maneuvers, cytotoxic chemotherapy, systemic isotopes, bisphosphonates, biologically targeted agents, and palliative treatments such as external-beam radiotherapy. Optimal care requires clarity of purpose and experienced judgment of potential benefits and risks. The field has grown rapidly, and there is recent evidence of significant benefit from chemotherapy, in terms of both prolongation of life and symptom relief, using a regimen well tolerated in relatively elderly and infirm patients. The combination of docetaxel with prednisone has a clear role in patients with symptomatic hormone-refractory prostate cancer; however, a number of controversies exist, for example, the dose, cycle interval, duration of treatment, whether to combine docetaxel with other cytotoxic or biologically targeted agents, and its role in patients with asymptomatic disease. The overall benefit of bisphosphonate therapy is less clear in prostate cancer than in other malignancies. As our understanding of the biochemical basis of relative androgen-independence grows, development of targeted agents will become more appropriate and efficient. This is an active field of research and currently there are trials addressing both new cytotoxic agents, such as satraplatin and the epothilones, and a range of biological targets, including the vitamin D receptor, the endothelin A receptor, an augmented prostatic acid phosphatase antigen, as well as tumor angiogenesis.     

Uvular edema secondary to snoring under deep sedation

A 57-year-old male with a documented history of obstructive sleep apnea with loud snoring received deep intravenous sedation with midazolam, fentanyl, ketamine, and propofol infusion and a left interscalene brachial plexus nerve block for a left biceps tendon repair. Loud snoring during the case was noted. On the second postoperative day, he was observed to have significant uvular edema. After due consideration of the various elements in the differential diagnosis, it was concluded that negative pressure trauma from deep snoring during the sedation was the most likely etiology.     

The interaction of selected semiconducting biomaterials with platelet-rich plasma and whole blood

Copper and silicon are used as biomaterials in various forms. Silicon is a well-known semiconductor and has two distinct types (n-type and p-type), depending on the dopants used. The oxides (e.g., CuO and Cu2O) on the copper surface also behave as semiconductors. The electrochemical properties of these two selected semiconducting biomaterials were investigated by cyclic voltammetry, electrochemical impedance spectroscopy (EIS), and open-circuit potential (OCP) in an aerated Ringer's solution at 37 degrees C. Platelet-rich plasma (PRP) and whole blood from a healthy human donor were used to determine the degree of interaction with the selected semiconducting materials in vitro. Morphologies of adherent platelets and blood on these two biomaterials were examined by scanning electron microscopy (SEM). Experimental results indicated that the degree of interaction is a function of the electrochemical properties of these two biomaterials. Platelets and blood were found to react strongly with p-type biomaterials while little or no sign of interaction with n-type biomaterials was demonstrated. The difference in PRP and whole blood reactions between p-type and n-type semiconductors was quantified to be significant as p<0.05.     

An association between Emergency Medicine residencies and improved trauma patient outcome

A study was done to compare trauma patient outcome at American College of Surgeons (ACS) Level l Trauma Centers with Emergency Medicine residency programs (EMRP+) to those without (EMRP-). Ten Level l Trauma Centers were reviewed from the ACS National Trauma Database (5 centers with and 5 without EM residency programs). Of 18,591 trauma patient records, 8679 were identified as EMRP-, and 9912 as EMRP+. After deleting incomplete data sets, 6621 EMRP- and 6150 EMRP+ records remained. Comparisons between patient age, gender, TRISS, complications, deaths, hospital, ICU and ventilator days, and numbers of burns, penetrating and blunt trauma were performed using t-test and chi-square analysis. Despite having a statistically significant older patient population, with more burn and penetrating trauma patients requiring longer ICU stays and longer ventilatory support (p < 0.0001), Emergency Medicine Residency program hospitals had a significantly lower complication rate (5.14% vs. 11.04%, respectively, p < 0.0001), death rate (4.704% vs. 5.479%, respectively, p = 0.0013), and shorter overall hospital stays (Mean 4.94 days, SD +/- 8.74 vs. 6.35 days, SD +/- 11.22, respectively, p < 0.0001) than EMRP- hospitals. The presence of Emergency Medicine residency programs at ACS Level I Trauma Centers is associated with improved trauma patient outcomes.