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Jean Collins
Jean Collins

100 Cases In Orthopaedics And Rheumatology Free

A 24-year-old woman attends rheumatology outpatients with an eight-week history of painful hands. On examination she is tearful and thin. You are the medic on duty...100 Cases in Orthopaedics and Rheumatology presents 100 scenarios commonly seen by medical students and junior doctors in orthopaedic and rheumatology clinics, or in the emergency department. A succinct summary of the patient's history, examination and initial investigations, with clinical and/or imaging photographs, is followed by questions on the diagnosis and management of each case. The answer includes a detailed discussion on each topic, with further illustration where appropriate, providing an essential revision aid as well as a practical guide for students and junior doctors. Making clinical decisions and choosing the best course of action is one of the most challenging and difficult parts of training to become a doctor. These cases will teach students and junior doctors to recognize important symptoms and signs and, where appropriate, their relationship to other medical conditions, and to develop their diagnostic and management skills.

100 Cases in Orthopaedics and Rheumatology

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Methods: A systematic search of MEDLINE and EMBASE search engines was carried out using Medical Subject Headings and keyword search terms for Systemic Lupus Erythematosus combined with incidence, prevalence and epidemiology in August 2013 and updated in September 2016. Author, journal, year of publication, country, region, case-finding method, study period, number of incident or prevalent cases, incidence (per 100 000 person-years) or prevalence (per 100 000 persons) and age, sex or ethnic group-specific incidence or prevalence were collected.

Results: The highest estimates of incidence and prevalence of SLE were in North America [23.2/100 000 person-years (95% CI: 23.4, 24.0) and 241/100 000 people (95% CI: 130, 352), respectively]. The lowest incidences of SLE were reported in Africa and Ukraine (0.3/100 000 person-years), and the lowest prevalence was in Northern Australia (0 cases in a sample of 847 people). Women were more frequently affected than men for every age and ethnic group. Incidence peaked in middle adulthood and occurred later for men. People of Black ethnicity had the highest incidence and prevalence of SLE, whereas those with White ethnicity had the lowest incidence and prevalence. There appeared to be an increasing trend of SLE prevalence with time.

A study of the first 14 cases of variant Creutzfeldt-Jakob disease in the United Kingdom, of which 13 patients had been seen by a psychiatrist early in the clinical course, revealed that all 14 patients had early psychiatric features.2 Typical presentations were depression, anxiety, and behavioural change, and two patients displayed first rank psychotic symptoms. However, the authors concluded that analysis of the psychiatric symptoms did not reveal specific features that differentiated variant Creutzfeldt-Jakob disease, at the time of presentation, from more common psychiatric disorders, although subsequent neurological and cognitive deterioration led to the eventual clinical suspicion of Creutzfeldt-Jakob disease. These psychiatric features concur with those described in subsequent case reports,3,4 and with an analysis published in the Psychiatric Bulletin.5

Subsequent to the description of the first 14 cases of variant Creutzfeldt-Jakob disease in 1997,2 the number of definite or probable cases in the United Kingdom has increased to over 100 (data supplied by National CJD Surveillance Unit, Edinburgh). Scope now exists for a much larger analysis of this relatively newly described condition and, in particular, an assessment of the early psychiatric and neurological features.

This study would not have been possible without the data collected by research staff at the National CJD Surveillance Unit (M Zeidler, G Stewart, M A Macleod, C Henry, A Lowman) and the cooperation of the relatives of patients with variant Creutzfeldt-Jakob disease. We thank clinicians throughout the United Kingdom for referring suspect cases and allowing data to be collected and D Everington for statistical advice.

Background: Arthrodesis of the first metatarsophalangeal (MTP) joint has been recommended for severe hallux valgus deformity in patients with rheumatoid arthritis (RA). However, with the progress of medical treatment of RA, joint preservation surgery has recently been performed. The aim of this study was to investigate the clinical and radiographic outcomes of modified Scarf osteotomy with medial capsule interposition for RA cases including severe destruction of the first MTP joint and to evaluate risk factors for recurrence.

Methods: A retrospective observational study of 76 cases (60 patients) followed for a mean of 35.3 months (range, 24 to 56 months) after a modified Scarf osteotomy was performed. Scores on the Japanese Society for Surgery of the Foot (JSSF) RA foot and ankle scale, the JSSF hallux scale, and a self-administered foot evaluation questionnaire (SAFE-Q) were determined along with preoperative and postoperative radiographic parameters.

Conclusions: The modified Scarf osteotomy with medial capsule interposition for hallux valgus deformity improved clinical and radiographic outcomes in RA cases with severe destruction of the first MTP joint. Increased preoperative M1M2A and M1M5A; incomplete reduction of the sesamoid bone; and the HVA, M1M2A, and M1M5A at 3 months after surgery should be evaluated as they are associated with recurrence of the deformity. The preoperative DAS28-CRP score was associated with the clinical and radiographic outcomes after surgery.

Arthroscopic surgery is not often used to treat arthritis of the knee. In cases where osteoarthritis is accompanied by a degenerative meniscal tear, arthroscopic surgery may be recommended to treat the torn meniscus.

Most of the cases included are common problems but the book also includes more unusual cases to illustrate specific points and to emphasize that rare things do present. The first 20 cases are arranged by systems; the next 80 are in random order because symptoms such as breathlessness and pain may relate to many different clinical problems in various systems.

These true-to-life cases will teach students and junior doctors to recognize important clinical symptoms and signs and to develop the diagnostic and management skills needed for the cases they will encounter on the job.

The majority of patients described in the case reports were living in Europe (49 cases) followed by Asia (24), North America (16), Africa (4), South America (4) and Australasia (3). The majority of patients were from the United Kingdom (30 cases) followed by the United States of America (14), Germany (5), Japan (5), Iran (4), Italy (4) and Pakistan (4).

The continent where the first author was based was Europe (51 cases), Asia (21), North America (21), Australasia (3), South America (3) and Africa (1). The majority of first authors were working in the United Kingdom (30), followed by the United States of America (17), Germany (5), Japan (5), Iran (4), Italy (4) and Pakistan (4).

31 cases were claimed by the author(s) to be the first ever report in the accessible medical literature of such a case. This demonstrates the contribution that case reports can make to the expansion of medical knowledge.

34 cases involved a person with an infection, 23 involved a person with cancer, 21 involved a person with a vascular condition, 14 involved a person with one or more malformations, 14 involved a person with a metabolic condition and 9 involved a person who had experienced trauma. 31 cases involved iatrogenic problems and 6 cases involved the death of the patient.

43 cases described a relatively common presentation of a rare condition, 27 cases described a rare presentation of a rare condition, 18 cases described a rare presentation of a common condition, and 12 cases described a relatively common presentation of a common condition but with specific features which made the case suitable for publication.

16 cases described unreported or unusual side effects or adverse interactions involving medications. 16 cases described unexpected or unusual presentations of a disease, 6 cases described new associations or variations in disease processes, 16 cases described presentation, diagnosis and/or management of new and emerging diseases, 20 cases described an unexpected association between diseases or symptoms, 24 cases described an unexpected event in the course of observing or treating a patient, and 2 cases described findings that shed new light on the possible pathogenesis of a disease or an adverse effect.

This analysis shows the great diversity in the cases being published in this journal with cases contributed from most areas of clinical medicine, from many different parts of the world and describing patients from infancy to old age.

Many are high-volume centers where surgeons annually perform hundreds, and in some cases thousands, of total joint replacements, in addition to less complex musculoskeletal surgeries. These programs highlighted have rich histories of innovation and have won grants to research musculoskeletal treatments. The centers also include robust nonoperative services and provide care to professional and elite athletes in their communities.

Children's Medical Center Dallas - Texas Scottish Rite Hospital for Children. Texas Scottish Rite Hospital for Children is dedicated to pediatric orthopedic cases as well as children with neurological disorders. The hospital includes six centers of excellence known for providing innovative solutions to spine care, limb lengthening and other disorders. The hospital is also committed to research to develop new solutions for scoliosis treatment, concussion management and other conditions. U.S. News & World Report ranked the hospital among the top five in the nation for pediatric orthopedics in 2019-20. 041b061a72


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