Preeclampsia and long-term coronary artery disease: How to minimize the odds?

Preeclampsia (PE) is a hypertensive disorder of pregnancy that can cause detrimental obstetric outcomes if not managed properly. Current evidence demonstrates higher risk for long-term cardiovascular disease in preeclamptic women. Even in uncomplicated pregnancies, the heart work overload often reveals subtle cardiac defects or abnormalities, which otherwise remain undiagnosed in women without a history of pregnancy. Pathophysiologic patterns occurring in PE patients resemble biochemical responses observed in cases of cardiovascular disease. It has been estimated that women with an obstetric history of PE are more likely to develop coronary artery disease in the long run. Currently, additionally to whether any approach could actually contribute to minimizing mortality and morbidity among these affected populations, there is no consensus regarding management for these patients. In this review we summarized the current scientific evidence regarding the correlation between PE and long-term coronary artery disease. Based on this knowledge, we propose postpartum and lifetime management for these high-risk patients in order to minimize morbidity and mortality within this population.

Advances in the management of traumatic anterior and atraumatic multidirectional shoulder instability.

Dislocation of the shoulder is a common and often disabling injury to an athlete. Most shoulder dislocations are traumatic in origin, occur in the anterior direction and result in stretching and detachment of the anterior capsule and labrum. The most frequent adverse sequel of shoulder dislocation is recurrence--an event that occurs most commonly in active individuals and less frequently with age. In the past, many operative procedures failed to address the anatomical disruptions of shoulder instability. Recently, an enhanced understanding of shoulder instability pathoanatomy and significant technological advances have resulted in surgical procedures for shoulder instability that are less interventional and have focused on restoring disrupted static constraints.

Shoulder instability. Diagnosis and management.

BACKGROUND: The shoulder is the most commonly dislocated joint in the body. The most frequent complication of shoulder dislocation is recurrence, occurring most often in young athletes. OBJECTIVE: To summarise the functional anatomy of the shoulder joint, the structures damaged following shoulder dislocation and the methods to evaluate and treat shoulder instability. DISCUSSION: Clinical history is effective for diagnosing obvious shoulder instability. The O'Brien's sign (for superior labral lesions), the sulcus sign (for capsular laxity) and the apprehension sign (for anterior instability) are helpful clinical tests for more subtle instabilities. Labral disruptions and capsular laxity can often be restored by minimally invasive (arthroscopic) methods. Rehabilitation aims to enhance the dynamic muscular and proprioceptive restraints to shoulder instability.