Improved perioperative analgesia with ultrasound-guided ilioinguinal/iliohypogastric nerve or transversus abdominis plane block for open inguinal surgery: a systematic review and meta-analysis of randomized controlled trials.

[Purpose] Ultrasound-guided ilioinguinal/iliohypogastric (II/IH) nerve and transversus abdominis plane (TAP) blocks have been increasingly utilized in patients for perioperative analgesia. We conducted this meta-analysis to evaluate the clinical efficacy of ultrasound-guided II/IH nerve or TAP blocks for perioperative analgesia in patients undergoing open inguinal surgery. [Subjects and Methods] A systematic search was conducted of 7 databases from the inception to March 5, 2015. Randomized controlled trials (RCTs) comparing the clinical efficacy of ultrasound-guided vs. landmark-based techniques to perform II/IH nerve and TAP blocks in patients with open inguinal surgery were included. We constructed random effects models to pool the standardized mean difference (SMD) for continuous outcomes and the odds ratio (OR) for dichotomized outcomes. [Results] Ultrasound-guided II/IH nerve or TAP blocks were associated with a reduced use of intraoperative additional analgesia and a significant reduction of pain scores during day-stay. The use of rescue drugs was also significantly lower in the ultrasound-guided group. [Conclusion] The use of ultrasound-guidance to perform an II/IH nerve or a TAP block was associated with improved perioperative analgesia in patients following open inguinal surgery compared to landmark-based methods.

The Impact of the Immediate Postoperative Prosthesis on Patient Mobility and Quality of Life after Transtibial Amputation.

BACKGROUND: The immediate postoperative prosthesis has been purported to allow early mobilization with potential physical and psychologic benefits to patients. This study used accelerometers and validated questionnaires to prospectively examine activity level and quality of life data for patients receiving an immediate postoperative prosthesis after transtibial amputation. METHODS: A total of 10 patients were included in the study. Mean age was 58 yrs (range, 22-69 yrs), there were 9 men and 1 woman, and reason for amputation was nonhealing gangrenous ulcer in 9 patients and ischemic limb in 1 patient. Patients were followed for 6 wks. Activity data were collected on ActiGraph GT3X accelerometers and analyzed using ActiLife 6 Data Analysis Software. At the 6-wk postoperative visit, an Amputee Mobility Predictor clinician-rated performance evaluation was conducted and a Short Form-36 questionnaire was completed. RESULTS: Patients in the cohort spent an average of 88% (range, 83%-92%) of their time sedentary, 11.5% (range, 7.6%-16.9%) of their time in light physical activity, and 0.3% (range, 0.12%-1.36%) of their time in moderate to vigorous physical activity. No statistically significant relationships were observed between expected level of function and recorded activity level. Patients had low physical and emotional Short Form-36 component scores. CONCLUSIONS: Patients with transtibial amputations were extremely sedentary in the early postoperative period despite their immediate postoperative prosthesis dressings.

Pain Catastrophizing and Anxiety are Associated With Heat Pain Perception in a Community Sample of Adults With Chronic Pain.

BACKGROUND: The principle aim of this study was to investigate the associations between heat pain (HP) perception, pain catastrophizing, and pain-related anxiety in a heterogenous cohort of community-dwelling adults with chronic pain admitted to a 3-week outpatient pain rehabilitation program. METHODS: All adults consecutively admitted to an outpatient pain rehabilitation program from July 2009 through January 2011 were eligible for study recruitment (n=574). Upon admission, patients completed the Pain Catastrophizing Scale (PCS), the short version of the Pain Anxiety Symptoms Scale (PASS-20), and HP perception was assessed using a standardized quantitative sensory testing (QST) method of levels. RESULTS: Greater PCS scores were significantly correlated with lower standardized values of HP threshold (HP 0.5) (P=0.006) and tolerance (HP 5) (P=0.003). In a multiple variable model adjusted for demographic and clinical factors known to influence HP perception, every 10-point increase in the PCS was associated with a -0.124 point change in HP 0.5 (P=0.014) and a -0.142 change in HP 5 (P=0.014) indicating that participants with higher PCS scores had lower HP thresholds and tolerances, respectively. Similarly, greater PASS-20 scores significantly correlated with lower standardized values of HP 0.5 and HP 5. In a multiple variable model, every 10-point increase in the PASS-20 was associated with a -0.084 point change in HP 0.5 (P=0.005) and a -0.116 point change in HP 5 (P=0.001) indicating that participants with higher PASS-20 scores had lower HP thresholds and tolerances, respectively. CONCLUSIONS: The findings of this study extend the use of a standardized method for assessing HP in a heterogenous sample of adults with chronic pain. Although pain catastrophizing shares significant variance with pain-related anxiety, our findings suggest that either measure would be appropriate for use in future studies that incorporate the QST method of levels.

Wrestlers with Limb Deficiencies: A Descriptive Study.

OBJECTIVE: The objective of this study was to determine if wrestling is a safe, positive athletic option for limb-deficient individuals. DESIGN: This descriptive study consisted of an opportunity sample of limb-deficient wrestlers, aged 5 yrs and older with at least 1 yr of experience. Participants completed a questionnaire regarding health, satisfaction, and achievements. Descriptive statistics were used for analysis. RESULTS: Sixteen male wrestlers reported nine below-the-knee, five above-the-knee, and three below-the-elbow limb deficiencies. There were nine congenital deficiencies and seven amputations acquired during childhood. Two individuals won National Collegiate Athletic Association championships, and seven competed collegiately. All reported a positive impact on quality-of-life, 87% reported no difficulty finding acceptance with the team, and 50% experienced wrestling-related residual limb complications. Associations between (1) residual limb complications before and during wrestling and (2) skin breakdown before and during wrestling did not demonstrate statistical significance (P = 0.30 and 0.1189, respectively). CONCLUSIONS: This study suggests that wrestling is a safe, positive sport for limb-deficient individuals, that it fosters competitive equality between impaired and nonimpaired participants, and that it has a positive impact on health and quality-of-life. The incidence of residual limb complications warrants monitoring.

Efficacy of intervertebral disc regeneration with stem cells - a systematic review and meta-analysis of animal controlled trials.

Management of intervertebral disc (IVD) degenerative disease is challenging, as it is accompanied by irreversible loss of IVD cells. Stem cell transplantation to the disc has shown promise in decelerating or arresting the degenerative process. Multiple pre-clinical animal trials have been conducted, but with conflicting outcomes. To assess the effect of stem cell transplantation, a systematic review and meta-analysis was performed. A comprehensive literature search was conducted through Week 3, 2015. Inclusion criteria consisted of controlled animal trials. Two reviewers screened abstracts and full texts. Disagreements were resolved by a third reviewer. Random effects models were constructed to pool standardized mean difference (SMD). Twenty two studies were included; nine of which were randomized. Statistically significant differences were found with the stem cell group exhibiting increased disc height index (SMD=3.64, 95% confidence interval (CI): 2.49, 4.78; p<0.001), increased MRI T2 signal intensity (SMD=2.28, 95% CI: 1.48, 3.08; p<0.001), increased Type II collagen mRNA expression (SMD=3.68, 95% CI: 1.66, 5.70; p<0.001), and decreased histologic disc degeneration grade (SMD=-2.97, 95% CI: -3.97, -1.97; p<0.001). There was statistical heterogeneity between studies that could not be explained with pre-planned subgroup analyses based on animal species, study designs, and transplanted cell types. Stem cells transplanted to the IVD in quadruped animals decelerate or arrest the IVD degenerative process. Further studies in human clinical trials will be needed to understand if such benefit can be translated to bipedal humans.

Secondary parathyromatosis in a patient with normal kidney function: review of diagnostic modalities and approaches to management.

OBJECTIVE: To present a patient with secondary parathyromatosis, a rare complication of parathyroidectomy, and to discuss issues currently pertinent to its diagnosis and management. METHODS: Data were derived from clinical and pathologic observations obtained during patient care. RESULTS: The index patient developed intractable hyperparathyroidism and hypercalcemia that has persisted after 4 surgical procedures and has remained largely resistant to medication, albeit with partial amelioration with combined bisphosphonate and cinacalcet. CONCLUSION: Despite the rarity of this difficult complication of parathyroidectomy, its iatrogenic basis emphasizes a need for heightened awareness and caution among surgeons and endocrinologists. Herein we report an instance of intractable secondary parathyromatosis in a patient with normal kidney function, and we review current approaches to diagnosis and management.

Evaluation, treatment, and outcomes of suprascapular neuropathy: a 5-year review.

OBJECTIVE: To report our diagnostic and treatment experiences, and patient outcomes, in patients with suprascapular neuropathy (SSN). DESIGN: Retrospective cohort study. SETTING: A tertiary medical center. PATIENTS: 65 patients with electromyographically (EMG)-confirmed SSN. METHODS: A 5-year retrospective chart review of patients with EMG-confirmed SSN. MAIN OUTCOME MEASURES: Descriptive statistics were used to summarize demographics, risk factors, causes, EMG findings, diagnostic evaluation, treatments, and self-reported outcomes. Exact Mantel-Haenszel χ(2) tests and Fisher exact tests were used to assess correlation between these measures. RESULTS: The 3 most common causes of SSN were trauma (32 patients), an inflammatory process (ie, brachial neuritis) (14), and the presence of a cyst (13). Remaining cases were related to a rotator cuff tear or were due to overuse. No cases were attributed to notch abnormalities. At the time of follow-up (a mean of 50 months [range, 15-84 months] after EMG), 50% of subjects returned to activity with no restrictions (excellent outcome) and 40% returned to activity with restrictions (good outcome), regardless of cause and treatment. EMG findings, specifically the presence/absence of fibrillation potentials, did not predict recovery. CONCLUSIONS: SSN should be considered in patients with shoulder pain and weakness. Magnetic resonance imaging and ultrasound help to exclude a structural process. Identifying a structural cause, specifically a cyst or rotator cuff tear, is important because it appears that these patients have improved recovery with return to normal activities when treated surgically. Although EMG data did not have prognostic value in this study, the data were limited and further study is warranted. Regardless of cause or treatment, most patients with SSN returned to activities in some capacity.

Sport-related performance anxiety in young female athletes.

The prevalence of anxiety disorders in adolescents range from 6% to 20%, and it is much higher for anxiety symptoms not meeting criteria for a specific anxiety disorder. The prevalence is much higher in females. Athletes participating in sports experience different levels of stress from competitive sports. For most young athletes (generally 13 to 24 years old, i.e., high-school and college age group) sport participation is reported to be no more stressful than many other activities of daily student or work life in general where competition is involved and performance is measured. Some level of sport related performance anxiety is considered to be normal and healthy; however, extreme anxiety in athletes can be detrimental in these performance situations. A number of factors may contribute to the development, severity, and persistence of performance anxiety related to sport participation. This article reviews the definitions, theories, clinical presentation, evaluation, and management principles of performance anxiety symptoms in young athletes.