Capsular synovial metaplasia mimicking silicone leak of a breast prosthesis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Synovial metaplasia around a prosthesis and in particular around silicone breast implants has been noted by various investigators, but has unknown clinical significance. We report on a patient where a large amount of synovial fluid mimicked rupture of an implant. We believe this to be an unusual clinical presentation of this phenomenon. Review of the English language literature failed to identify a comparable case.</p> <p>Case presentation</p> <p>A 25-year-old woman had undergone bilateral breast augmentation for cosmetic reasons. One implant was subsequently subjected to two attempts at expansion to correct asymmetry. The patient was later found to have a large quantity of viscous fluid around the port of that same prosthesis. Histological assessment of the implant had consequently confirmed capsular synovial metaplasia. This had initially caused the suspicion of a silicone 'bleed' from the implant and had resulted in an unnecessary explantation.</p> <p>Conclusion</p> <p>Capsular synovial metaplasia should be ruled out before the removal of breast implants where a leak is suspected. Manipulation and expansion of an implant may be risk factors for the development of synovial metaplasia.</p

Subacromial impingement in patients with whiplash injury to the cervical spine

<p>Abstract</p> <p>Background</p> <p>Impingement syndrome and shoulder pain have been reported to occur in a proportion of patients following whiplash injuries to the neck. In this study we aim to examine these findings to establish the association between subacromial impingement and whiplash injuries to the cervical spine.</p> <p>Methods and results</p> <p>We examined 220 patients who had presented to the senior author for a medico-legal report following a whiplash injury to the neck. All patients were assessed for clinical evidence of subacromial impingement. 56/220 patients (26%) had developed shoulder pain following the injury; of these, 11/220 (5%) had clinical evidence of impingement syndrome. Only 3/11 patients (27%) had the diagnosis made prior to evaluation for their medico-legal report. In the majority, other clinicians had overlooked the diagnosis. The seatbelt shoulder was involved in 83% of cases (p < 0.03).</p> <p>Conclusion</p> <p>After a neck injury a significant proportion of patients present with shoulder pain, some of whom have treatable shoulder pathology such as impingement syndrome. The diagnosis is, however, frequently overlooked and shoulder pain is attributed to pain radiating from the neck resulting in long delays before treatment. It is important that this is appreciated and patients are specifically examined for signs of subacromial impingement after whiplash injuries to the neck. Direct seatbelt trauma to the shoulder is one possible explanation for its aetiology.</p

Effect of tactile stimulus frequency on time perception: the role of working memory

In most models of interval timing, there is a central clock, which is considered to be highly protected from the effects of external stimuli. However, many studies have reported such effects and different theories are proposed to explain the observations. These include the effect of arousal, attention sharing, memory load and information processing on central clock as well as change in the speed of the pacemaker. In this study, we used regular vibro-tactile stimuli with different frequencies in a "duration reproduction task" to investigate the effect of stimulus content on interval timing. Results showed that subjects overestimated the duration as a function of test stimulus frequency. A significant correlation between increasing the test frequency and overestimation of subjective time was observed. We further investigated the effect of blank and filled gaps with various durations on time estimation. Analysis revealed that regardless of gap duration, subjective time increased in the filled gap condition, compared to the blank gap. This effect was independent from contextual stimuli and correlated to the mean number of stimuli during the temporal interval rather than rate of stimulus presentation. © 2007 Springer-Verlag

Levels of evidence in foot and ankle surgery literature:progress from 2000 to 2010?

BACKGROUND: The focus on evidence-based medicine has led to calls for increased levels of evidence in surgical journals. The purpose of the present study was to review the levels of evidence in articles published in the foot and ankle literature and to assess changes in the level of evidence over a decade. METHODS: All of the articles in the literature from the years 2000, 2005, and 2010 in Foot & Ankle International and Foot and Ankle Surgery, as well as all foot and ankle articles from The Journal of Bone and Joint Surgery (JBJS, American [A] and British [B] Volumes) were analyzed. Animal, cadaver, and basic science articles; editorials; surveys; special topics; letters to the editor; and correspondence were excluded. Articles were ranked by a five-point level-of-evidence scale, according to guidelines from the Centre for Evidence-Based Medicine. RESULTS: A total of 720 articles from forty-three different countries were analyzed. The kappa value for interobserver reliability showed very good agreement between the reviewers for types of evidence (κ = 0.816 [p &lt; 0.01]) and excellent agreement for levels of evidence (κ = 0.869 [p &lt; 0.01]). Between 2000 and 2010, the percentage of high levels of evidence (Levels I and II) increased (5.2% to 10.3%) and low levels of evidence (Levels III, IV, and V) decreased (94.8% to 89.7%). The most frequent type of study was therapeutic. The JBJS-A produced the highest proportion of high levels of evidence. CONCLUSION: There has been a trend toward higher levels of evidence in foot and ankle surgery literature over a decade, but the differences did not reach significance