Aesthetic Acceptance Equals to Nature’s Compensation Plus Surgical Correction.

Aesthetic acceptance equals to nature’s compensation plus surgical correction.

BMJ Case Rep. 2013; 2013:
Vadgaonkar V, Gangurde P, Karandikar A, Mahajan N

Orthognathic surgery has become an acceptable treatment plan for patients with various maxillofacial deformities. The rehabilitation of severe class III adult patients requires a complex interdisciplinary orthodontic and orthognathic approach. This presentation aims to show a case of combination of camouflage and bilateral sagittal split osteotomy (BSSO).Camouflage in maxillary arch was accepted after analysing visual treatment objective (VTO) and pleasing soft tissue compensation which gave us the clue to go ahead for surgical correction of excess mandibular length to achieve best aesthetic outcome while maintaining nature’s compensation in upper arch. HubMed – rehab

Difficulty with learning of exercise instructions associated with ‘working memory’ dysfunction and frontal glucose hypometabolism in a patient with very mild subcortical vascular dementia with knee osteoarthritis.

BMJ Case Rep. 2013; 2013:
Takeda K, Meguro K, Tanaka N, Nakatsuka M

We present a patient with no dementia, depression or apathy, who had difficulty in learning self-exercise instructions. The patient was an 80-year-old right-handed woman who was admitted to a rehabilitation unit to receive postoperative rehabilitation after a femoral neck fracture. She was instructed quadriceps isometric exercises to perform 10 repetitions and to hold each stretch for 10 s. She performed the exercise correctly with motivation, but she had difficulty in learning the number of repetitions and the duration of each stretch. She had no history of cerebrovascular accident and the neurological examination was normal. Neuropsychological testing, MRI and (18)F-fluoro- D-glucose-positron emission tomography (FDG-PET) were performed to examine the neural mechanisms associated with this difficulty in learning instructions. Neuropsychological tests revealed dysfunction of working memory while other cognitive domains were relatively preserved. Her neuropsychological tests scores were (1) Mini-Mental State Examination: 24 (mild cognitive impairment), (2) Geriatric Depression Scale-15: 2 (no depression), (3) Apathy Scale: 2 (no apathy), (4) digit span forward: 5 (normal), (5) digit span backward: 2 (impaired), (6) visuospatial span forward: 4 (normal), (7) visuospatial span backward: 2 (impaired), (8) frontal assessment battery: 11 (normal), (9) Weigl test: 0 (impaired), (10) trail making test A: 52 s (normal), (11) train making test B: failed (impaired). T2-weighted and fluid-attenuated inversion recovery MRI showed high signal-intensity lesions in the cerebral deep white matter. FDG-PET revealed hypometabolic areas in the bilateral frontal lobes, particularly in the bilateral dorsolateral frontal area, anterior cingulate cortex and orbitofrontal cortex. One of the possible neural mechanisms underlying the learning difficulties in this patient may have been partial blockage of the cingulofrontal network by deep white matter lesions. HubMed – rehab

Sonographically guided deep plantar fascia injections: where does the injectate go?

J Ultrasound Med. 2013 Aug; 32(8): 1451-9
Maida E, Presley JC, Murthy N, Pawlina W, Smith J

Objectives- To determine the distribution of sonographically guided deep plantar fascia injections in an unembalmed cadaveric model. Methods- A single experienced operator completed 10 sonographically guided deep plantar fascia injections in 10 unembalmed cadaveric specimens (5 right and 5 left) obtained from 6 donors (2 male and 4 female) aged 49 to 95 years (mean, 77.5 years) with a mean body mass index of 23.2 kg/m(2) (range, 18.4-26.3 kg/m(2)). A 12-3-MHz linear array transducer was used to direct a 22-gauge, 38-mm stainless steel needle deep to the plantar fascia at the anterior aspect of the calcaneus using an in-plane, medial-to-lateral approach. In each case, 1.5 mL of 50% diluted colored latex was injected deep to the plantar fascia. After a minimum of 72 hours, study coinvestigators dissected each specimen to assess injectate placement. Results- All 10 injections accurately placed latex adjacent to the deep side of the plantar fascia at the anterior calcaneus. However, the flexor digitorum brevis (FDB) origin from the plantar fascia variably limited direct latex contact with the plantar fascia, and small amounts of latex interdigitated with the FDB origin in 90% (9 of 10). In all 10 specimens, latex also covered the traversing first branch of the lateral plantar nerve (FBLPN, ie, Baxter nerve) between the FDB and quadratus plantae muscles. No latex was found in the plantar fat pad or plantar fascia in any specimen. Conclusions- Sonographically guided deep plantar fascia injections reliably deliver latex deep to the plantar fascia while avoiding intrafascial injection. However, the extent of direct plantar fascia contact is variable due to the intervening FDB. On the contrary, the traversing FBLPN is reliably covered by the injection. Deep plantar fascia injections may have a role in the management of refractory plantar fasciitis, particularly following failed superficial perifascial or intrafascial injections, in cases of preferential deep plantar fascia involvement, or when entrapment/irritation of the distal FBLPN is suspected. HubMed – rehab

Pain, Sleep Disturbances, and Functional Limitations in People Living with HIV/AIDS-Associated Distal Sensory Peripheral Neuropathy.

J Int Assoc Provid AIDS Care. 2013 Jul 25;
Sandoval R, Roddey T, Giordano TP, Mitchell K, Kelley C

Background:Pain, sleep, and functional disturbances are a common occurrence in people living with HIV/AIDS-related distal sensory peripheral neuropathy (PLWHA-DSPN) yet lack group classification and quantification.Methods:A total of 46 PLWHA-DSPN were recruited, as part of a 2-group intervention study, to complete the Neuropathic Pain Scale and the Pittsburgh Sleep Quality Index (PSQI) questionnaires. The participant’s performance during a forward reach task and walking distance in 6 minutes was recorded as a measure of function.Results:The pain (60.77 ± 17.85) and sleep (14.62 ± 4.28) scores denote marked pain and sleep disturbances, compared to sero-negative, age-matched individuals. The ambulation distance was limited (243.99 ± 141.04 m) and inversely associated with the PSQI-sleep efficiency subscale (rs = -.35, P < .05). The average reaching distances measured (36.07 ± 7.37 cm) were similar to sero-negative, age-matched individuals. Pain, sleep, and functional measures exhibited significant associations.Conclusions:The data collected suggest that PLWHA-DSPN report moderate-to-severe pain and significant sleep disturbances and exhibit limited ambulation distances. HubMed – rehab

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