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   Table of Contents - Current issue
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October-December 2018
Volume 11 | Issue 4
Page Nos. 143-197

Online since Friday, November 9, 2018

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EDITORIAL  

Editorial p. 143
Jamal Al Saleh
DOI:10.4103/HMJ.HMJ_91_18  
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REVIEW ARTICLES Top

Hope for escape from a prison of bone: Cellular and molecular targets for fibrodysplasia ossificans progressiva p. 144
Frederick S Kaplan
DOI:10.4103/HMJ.HMJ_78_18  
The progressive pathological metamorphosis of one normal organ system into another is unique to fibrodysplasia ossificans progressiva and unveils a pathophysiologic process that can be exploited for therapy of disabling extraskeletal ossification. Here, we review the recent remarkable insight from medical research and the potential of targeted therapy for this rare condition as well as for many common forms of heterotopic ossification.
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The shoulder-pacemaker treatment for functional posterior shoulder instability p. 151
Philipp Moroder, Victor Danzinger
DOI:10.4103/HMJ.HMJ_79_18  
Functional posterior shoulder instability (Polar Type III) can lead to posterior subluxation and/or dislocation during shoulder movement. Disturbed activation of external rotators and periscapular muscles generating a force imbalance in the shoulder can result in instability, weakness and pain as the leading symptoms patients present. Recommended conservative treatment is often ineffective, alternative surgical treatment may diminish function even further and aggravate pain. The implementation of the Shoulder-Pacemaker was evaluated in a prospective clinical trial. Patients suffering from functional posterior shoulder instability refractory to previous treatment options should regain glenohumeral shoulder stability after our conservative therapeutic training regime with the Shoulder-Pacemaker. 19 cases with therapy-resistant functional posterior shoulder instability had been included in the Shoulder-Pacemaker therapy-concept. Previously all patients were treated unsuccessfully with at least 3 months of regular physiotherapy. Failed surgical stabilization attempts were not an exclusion criterion. Prior to treatment, a fluoroscopy was performed for diagnosis assurance as well as the evaluation of current MR-Imaging for excluding structural defects. The Shoulder-Pacemaker therapy consisted of a 3- to 6- weeks conservative treatment regime with electric muscle stimulation and regular physiotherapy. For longitudinal evaluation of shoulder function, a specifically developed questionnaire including SSV, ROWE and WOSI score was assessed. After treatment, all patients were very satisfied and fully recommended the Shoulder-Pacemaker therapy. All cases improved in all scores assessed and patients had been able to return to physically demanding and even sporting activities. Patients with completed 3-month follow-up achieved a Rowe score of 92 ± 14, SSV of 95 ± 6%, and WOSI score of 372 ± 181 [Figure 1]. In 2 out of 19 cases the training was not completed because of lack of compliance. No complications were observed. The Shoulder-Pacemaker therapy is a very effective treatment option in patients with functional posterior shoulder instability. Even if previous conservative or surgical stabilization attempts failed, the Shoulder-Pacemaker therapy successfully re-established glenohumeral stability and seems to have a long-lasting effect. Because of the short time of follow up, these results remain preliminary.
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Enthesitis and synovitis on magnetic resonance imaging are frequently found in psoriatic patients without arthritic symptoms: Clinical considerations of this finding p. 155
Johannes J Rasker
DOI:10.4103/HMJ.HMJ_80_18  
Patients with skin psoriasis often perceive complaints such as fatigue and vague aches and pains in the joints, often diagnosed as fibromyalgia or psychogenic. We showed in psoriasis patients, without complaints or signs of arthritis on knee magnetic resonance imaging, evidence of subclinical inflammation at the attachments of tendons (enthesitis) and of the joints. These findings indicate that enthesitis may be an early sign (perhaps the earliest) of subclinical psoriatic arthritis and may, for example, explain a lot of problems these psoriatic patients perceive. We discussed our findings in the light of recent literature regarding enthesitis as an early sign in spondyloarthropathies like psoriatic arthritis and also in early osteoarthritis and the possible clinical implications. Our findings may change the paradigm regarding arthritis complicating this skin disease and lead to a different treatment approach of these patients.
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Analyses of undesirable clinical outcomes and supportive biomechanical data for a device are essential for the evolution of disruptive device technology in spine p. 159
Deniz U Erbulut, Koji Matsumoto, Anand Agarwal, Joseph Zavatsky, Vijay K Goel
DOI:10.4103/HMJ.HMJ_81_18  
Assumptions, inevitable part of engineering solution, lead to the disparities between positive biomechanical data and undesirable long- and short-term clinical outcomes for a given surgical procedure or device. Consequently, high-quality biomechanical data may not necessarily lead to desirable clinical outcomes. This review article discusses such issues for devices that provide ‘“stability/enhanced environment for fusion or restore motion”’ for the spinal segment (s) with goal of improving patient satisfaction.
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Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome p. 166
Yasser Emad, Yasser Ragab, Alaaabou-Zeid , Johannes J Rasker
DOI:10.4103/HMJ.HMJ_82_18  
In fibromyalgia (FM) a combination of symptoms frequently exists, including impaired cognition, memory changes, widespread pain, and disrupted sleep rhythm, with no sufficient explanations for these bizarre symptoms. Many theories have been developed and it is still not clear whether FM is a chronic stress syndrome caused by many factors, including society or just a part of the spectrum of chronic pain. FM is the second most common rheumatic disorder behind osteoarthritis and, though still widely a puzzling syndrome, is now considered to be a central nervous system disorder, which is responsible for amplified and intensive pain. Over the years, three main ideas of hippocampal function have dominated the literature: Response inhibition, episodic memory, and spatial cognition. Given that the hippocampus plays integral roles in memory, cognition, and sleep regulations the later functions may be influenced by prolonged stress know to exist in FM syndrome. Moreover the hippocampus is an integral component of the limbic system, and as such may contribute to the negative affect and avoidance motivation experienced during pain experience and chronic stress. The aim of the current review is to focus on the physiological roles of the hippocampus and its relation to symptoms production in FM syndrome.
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Hughes syndrome antiphospholipid syndrome p. 169
Graham Robert Vivian Hughes
DOI:10.4103/HMJ.HMJ_83_18  
Hughes Syndrome is now recognised world-wide as a common, major illness, impacting on specialties including neurology, cardiology and surgery. It is the commonest, treatable cause of recurrent miscarriage, and has had a profound impact on the practice of obstetrics.
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Advancements in the treatment of degenerative disc disease p. 175
Hassan Serhan
DOI:10.4103/HMJ.HMJ_85_18  
Low back pain is number one reason for disability in patients under the age of 45 year and the number two reason to see a doctor after flue in the USA. Early intervention for the treatment of patients with Degenerative Disc Disease (DDD) using regenerative medicine or ultra-minimal invasive approaches have gained traction over the past 20 years as alternatives to invasive, costly, and complicated surgical interventions. This review article discusses the pathophysiology of DDD and summarizes the literature encompassing the use of biologic-based therapies for DDD. Articles and patents published in the past 40 years were reviewed, cell-based, bimolecular or gene therapies, as well as companies investigating the utility of allogeneic and tissue-engineered intervertebral discs were included. Additionally, published and unpublished ongoing clinical trials were also included. These exciting non-invasive therapies have encouraging initial positive results across multiple strategies paving the road for a potentially thriving regenerative techniques and increase in the number of DDD clinical trials.
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Orthoplastic extremity reconstruction – From replantation to transplantation p. 184
Lawrence Scott Levin
DOI:10.4103/HMJ.HMJ_86_18  
For more than a half century, the use of the operating microscope for extremity surgery has led to remarkable advances in the management of orthopaedic trauma, tumours, infections and congenital differences. The microsurgical reconstructive ladder ascends from basic microsurgical procedures such as digital artery or nerve repair, to more complex procedures such as autologous tissue transplantation (free tissue transfer). Tissue transfers have also become more sophisticated with the evolution from simple myocutaneous flaps to perforator-based flaps. Functional muscle transfers, toe-to-hand transfers, and recently vascularised composite allotransplantation make up the highest rungs on this ladder. The development of the orthoplastic approach simultaneously integrates principles and practices of both orthopaedic surgery and plastic surgery for optimal care of extremities based heavily on the application of microsurgical techniques. We will describe our contributions and innovations in orthopaedic clinical practice using microsurgical techniques as well as highlight our clinical, anatomic and basic science research in reconstructive microsurgery that have led to improvements in limb salvage, reconstruction and restoration during the last 25 years.
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A biomechanical approach to advances in sacropelvic reconstruction p. 193
Peter S Rose, Michael J Yaszemski, Franklin H Sim
DOI:10.4103/HMJ.HMJ_88_18  
The sacrum is the only mechanical connection between the spine and pelvis/lower extremities. In the setting of a primary, or in select patients a locally advanced recurrent malignancy, curative treatment requires en-bloc sacrectomy. In addition to the surgery in this area being challenging due to the complexity of the pelvic anatomy, adjacent visceral and vascular structures; spinal-pelvic continuity is often lost. Historically following sacral resection patients were left “un-reconstructed” and the spinal column floated between the remaining pelvis, forming a soft-tissue sling which can become painful and lead to a poor patient outcome. Our institution has pioneered a means to reconstruct these defects following high sacral resection in order to restore continuity between the spine, pelvis and femur which has been shown to improve patient outcomes. The purpose of this article is to describe a biomechanical approach to sacral reconstruction.
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