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Background: A treatment algorithm and screening examination have been developed to guide patient management and prospectively determine potential for highly active individuals to succeed with nonoperative care after anterior cruciate ligament rupture.

Objective: To prospectively characterize and classify the entire population of highly active individuals over a 10-year period and provide final outcomes for individuals who elected nonoperative care.

Methods: Inclusion criteria included presentation within 7 months of the index injury and an International Knee Documentation Committee level I or II activity level before injury. Concomitant injury, unresolved impairments, and a screening examination were used as criteria to guide management and classify individuals as noncopers (poor potential) or potential copers (good potential) for nonoperative care.

Results: A total of 832 highly active patients with subacute anterior cruciate ligament tears were seen over the 10-year period; 315 had concomitant injuries, 87 had unresolved impairments, and 85 did not participate in the classification algorithm. The remaining 345 patients (216 men, 129 women) participated in the screening examination a mean of 6 weeks after the index injury. There were 199 subjects classified as noncopers and 146 as potential copers. Sixty-three of 88 potential copers successfully returned to preinjury activities without surgery, with 25 of these patients not undergoing anterior cruciate ligament reconstruction at the time of follow-up.

Conclusion: The classification algorithm is an effective tool for prospectively identifying individuals early after anterior cruciate ligament injury who want to pursue nonoperative care or must delay surgical intervention and have good potential to do so.



NAVIGATION


         

 

Gastroesophageal reflux (GER) is a common problem in mechanically ventilated patients and contributes to the development of esophageal mucosal injury and even erosive esophagitis. The relationship between percutaneous endoscopic gastrostomy (PEG) and subsequent development of GER is complex and not well understood…

 

Despite being highly effective and beneficial for many patients, unexpected consequences are emerging in patients who are prescribed proton pump inhibitors (PPIs) for reflux diseases. Physicians are warned to monitor these effects and prescribe these medications carefully, according to a new commentary published in the November 2009 issue of Otolaryngology -Head and Neck Surgery.

 

Fears about the cancer causing effects of the second most prescribed group of drugs in the Western world have been put to rest, following the largest ever study into their use. ‘Proton pump inhibitors’ (PPI) are the most commonly used treatment for chronic acid reflux, or ‘heartburn’, a painful burning sensation in the chest, neck and throat which is experienced by almost a third of people in developed countries.

 

Surgery without an incision is now possible. Yesterday Goshen General Hospital and Drs. Mark Ranzinger and Norbert Schwer, of Gerig Surgical Associates and medical staff at Goshen General Hospital, became the first hospital and surgeons in Indiana to perform an incisionless surgery to treat heartburn.

 

Patients who have gastroesophageal reflux disease (GERD) for a prolonged period have an increased risk of developing Barrett’s esophagus, a pre-cancerous condition where the tissue lining the esophagus becomes damaged by stomach acid and transformed into something like the inside of the stomach. New research finds that radiofrequency ablation — an endoscopic procedure involving targeted thermal energy — was very successful at restoring the esophagus and reducing risk for cancer.

 

A procedure that uses heat generated by radio waves to treat Barrett’s esophagus, a condition caused by acid reflux (severe heartburn), can eliminate signs of the potentially cancer-causing disorder and reduce the risk that the disease will progress. Findings from the first multicenter trial of the procedure, called radiofrequency ablation, could mean patients have an alternative to surgery for treating Barrett’s esophagus.

 

Torax Medical Inc., a medical device company focused on the minimally invasive treatment of gastroesophageal reflux disease (GERD) has commenced a pivotal clinical trial of its LINX(TM) Reflux Management System. The trial, which is being conducted at 15 leading academic and private medical centers in the U.S. and Europe, will evaluate the safety and effectiveness of the LINX System in patients suffering from GERD despite medical therapy.

 

Takeda Pharmaceutical Company Limited and its wholly-owned subsidiary, Takeda Pharmaceuticals North America, Inc., today announced that the U.S. Food and Drug Administration (FDA) approved KAPIDEX™ (dexlansoprazole) delayed release capsules for the once-daily, oral treatment of heartburn associated with symptomatic non-erosive Gastroesophageal Reflux Disease (GERD), the healing of erosive esophagitis (EE) and the maintenance of healed EE.




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