Results of Arthroscopic Treatment of Chronic Patellar Tendinopathy.

BACKGROUND: The surgical treatment of chronic patellar tendinopathy could be open or arthroscopic. A general agreement on the best surgical treatment option is still lacking. PURPOSE: The aim of our study was to evaluate the clinical results after a minimally invasive arthroscopic treatment of chronic patellar tendinopathy including a resection of the lower patellar pole. METHODS: The study included 14 patients with a mean age of 26 years and chronic patellar tendinopathy refractory to non-operative treatment of more than 6 months. All patients underwent arthroscopic debridement of the adipose tissue of the Hoffa's body posterior to the patellar tendon, debridement of abnormal patellar tendon and resection of the lower patellar pole. Preoperative and postoperative evaluation was undertaken using clinical examination, magnetic resonance imaging (MRI) and the Lysholm and Victorian Institute of Sport Assessment-Patella (VISA-P) scores. Return to sports and postoperative complications were also assessed. The mean follow-up was 12.2 ± 0.9 months. RESULTS: All 14 patients continued with sport activities, but only 12 of them (85.7%) achieved their presymptom sporting level. The median time to return to preinjury level of activity was 3.9 ± 0.8 months. Patients showed a major improvement in the mean Lysholm score from 51.1 ± 3.8 to 93.4 ± 4.2 (p=0.001) and in the mean VISA-P score from 42.1 ± 3.5 to 86.7 ± 8.4 (p=0.001) There were no postoperative complications. CONCLUSION: We found that this arthroscopic technique gives reduced morbidity and satisfactory outcome resulting in significantly faster recovery and return to sports in patients with chronic patellar tendinopathy.

The Influence of Anterior Cruciate Ligament Remnant on Postoperative Clinical Results in Patients with Remnant Preserving Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Anterior Cruciate Ligament (ACL) remnants have important biomechanical, vascular and proprioceptive function. AIM: To determine the influence of the ACL residual remnants after partial and complete ACL ruptures on postoperative clinical results in patients with remnant preserving ACL reconstruction. PATIENTS AND METHODS: The study included 66 patients divided into two groups. In patients from the investigation group remnant preserving ACL reconstruction was performed, in patients from the control group single bundle ACL reconstruction was performed. The results were assessed by Rolimeter measurements, Lysholm and Tegner scores and proprioception evaluation. RESULTS: The mean side-to-side difference of anterior tibia displacement (mm) was improved from 4.4 ± 1.06 to 0.4 ± 0.7 in the investigation group, and from 4.6 ± 0.68 to 1.9 ± 0.64 in the control group (p < 0.001). Difference in the angles in which the knee was placed by the device and the patient has improved from 1.5 ± 0.96° to 0.5 ± 0.53° in the investigation group and from 1.8 ± 0.78° to 1.3 ± 0.97° in the control group (p < 0.05). Tegner and Lysholm scores showed no difference between the groups. CONCLUSION: Preservation of the ACL residual bundle provides a better knee stability and proprioceptive function.

An audit of basic record keeping standards: lessons learnt from the Royal College of Physicians.

This paper describes an audit of the basic standard of record keeping for inpatient clinical records. Following an initial audit, the Royal College of Physicians' inpatient record keeping standards 6 and 7 were adopted. The standard was then reassessed in a second audit. During the first audit, 189 medical entries were assessed and 274 were assessed on repeat audit. A significant improvement was achieved in many areas including recording of time (19-82%), name of author (60-89%), location of patient (58-94%) and identity of the most senior doctor present (68-89%), (p<0.001). The Royal College of Physicians' record keeping standards through the use of audit can lead to considerable improvement in the standard of record keeping within psychiatric practice.

Matrix metalloproteinases (MMP-1, -8, -13) in chronic periapical lesions.

BACKGROUND/AIM: Matrix metalloproteinases (MMPs) are proteolytic enzymes capable of degrading almost all extracellular matrix and basement membrane components in many destructive pathological processes, such as chronic inflammation and bone-destructive lesions. The aim of this study was to determinate the correlation between concentration of collagenases (MMP-1, -8, -13) in chronic periapical lesions and their dimension calculated with software predilection through X-ray. METHODS: Chronic periapical tissues were collected by periapical surgery from 60 teeth with clinically and radiographically verified different chronic periapical lesions (20 granulomas, 20 diffuse periapical lesions, 10 cysts). Ten normal pulps used as controls were obtained by extirpation of the pulp of impacted third molars after their surgery. For rapid analysis of MMP-1, -8, -13 collagenase activities in the examined material Chemicon Collagenase Activity Assay Kit were used. From the X-ray trough software predilection (Image Tool3 Program) of the volume of chronic periapical tissue, correlation between concentration of MMPs in the periapical lesions and their dimension was confirmed. RESULTS: Different concentrations of collagenases (MMP-1, -8 and -13) in chronic periapical process from different inflammation types showed different activity of MMPs. The obtained results showed the highest values of collagenases concentration (MMP-1, -8, -13) in chronic diffuse lesions (5.39 ng/ml). Low values of concentration of MMPs accompanied less serious lesions, whereas chronical periapical lesions of large dimension had high concentration of MMPs, which was proportional to progression of the lesion and destruction of bone tissue. CONCLUSIONS: This study confirmed the destructive role of collagenases (MMP-1, -8 and -13) in inflammation process, which directly depends on the concentration of MMPs in pathologically changed tissue.

Clinicians' attitudes to spirituality in old age psychiatry.

BACKGROUND: The aim of this survey is to investigate professional attitudes to the presence and value of spiritual care from Old Age Psychiatrists. METHOD: All registered members of the Faculty of the Psychiatry of Old Age in the United Kingdom were asked to complete a 21-question semi-structured questionnaire. The first mail shot took place in 2002 and the second mail shot to non-respondents in 2003. Quantitative and qualitative analyses were carried out on the answers received. RESULTS: The response rate was 46%. The majority of respondents (92%) recognize the importance of spiritual dimensions of care for older people with mental health needs and about a quarter of respondents appear to consider referring patients to the chaplaincy service. In contrast, integration of spiritual advisors within the assessment and management of individual cases is rare. CONCLUSIONS: Opinions vary as to whether provision of spiritual care should become widely available to older people with mental health needs who are admitted to hospital. Old age psychiatrists recognize that awareness of spiritual dimensions may be important for their patients. They seem less clear about the role of spiritual advisors and how NHS multidisciplinary clinical teams and spiritual and pastoral care services can be best integrated. Much work needs to be done on developing effective training and operational policies in this area.