Faculty Bibliography

Post-operative pain continues to be one of the most common complications in ambulatory surgery. Uncontrolled pain prolongs hospitalization, hinders recovery and contributes to patient dissatisfaction. Current pain therapies, such as opioids, have several debilitating side effects that include nausea, constipation, and drowsiness, which impact the patient's functional recovery. The objective was to assess Lidoderm (lidocaine 5%) patch effectiveness in reducing pain and opioid use in post-operative unilateral knee replacement patients. This was a randomized, double-blind, placebo-controlled trial. One Lidoderm or placebo patch was cut in half and placed on either side of the incision of the operated knee, for 12-hours on and 12-hours off each day. Both groups continued to receive their regular pain medication as needed, which included acetaminophen/codeine, acetaminophen/hydrocodone, acetaminophen 325mg/oxycodone5 mg (Percocet), hydromorphone, tramadol, and celecoxib. Pain levels were based on a 10-point numerical analog scale and were assessed daily for a total of 7-days. Data from 87 participants were included, 44 in Lidoderm and 43 in placebo group: the mean amount of Percocets used was 24.76 (SD=16.45) in the Lidoderm and 27.76 (SD=22.35) in the placebo group (p=0.64). The mean amount of Percocet use per day was 3.53 (SD=2.34) in the Lidoderm and 3.90 (SD=3.21) in the placebo group (p=0.71). The mean decrease in pain scale for the Lidoderm was 3.01 (SD=2.42) and 2.08 (SD=1.70) for the placebo group, and was significant (p=0.003). No side effects reported. Providing post-operative analgesia is difficult yet imperative to recovery. Patients with lidoderm patches had an overall lower pain level that was statistically significant over a 7-day post-operative period. The average total and daily Percocet use was also lower in the Lidoderm group. Based on our results, we found that placing a topical Lidoderm patch provides an effective adjunct treatment in post-operative pain management

An 84-yr-old man presented with right posterior shoulder pain and growing mass. Shoulder range of motion was limited in forward elevation and abduction; result of the neurologic testing was normal. Radiologic workup showed an irregular mass resembling Paget's disease or sarcoma. On surgical inspection, a 16-cm hemorrhagic mass, occupying the entire scapula, was identified. Patient underwent tumor resection and scapulectomy. Postoperatively, he started a rehabilitation program. With attempted ambulation, patient exhibited strong tendencies to lean rightward, walked in circles, and risking fall. The gait abnormality could not be corrected and acute inpatient rehabilitation admission was recommended. A unique rehabilitation program was developed to correct gait deviation, improve balance, and compensate for deficits. After a comprehensive inpatient rehabilitation, the patient was successfully discharged home. We present a review of scapulectomy, postoperative care, and a recommended rehabilitation program

Adult limb lengthening occurs via distraction osteogenesis and traditionally involves use of an external fixator. Complications after placement of hardware often disrupt rehabilitative efforts and hinder patients' progress. A completely internal limb-lengthening device has been developed and increasingly used, and it may more commonly be seen by a physiatrist in consultation for postoperative rehabilitation. We present two cases of patients who underwent implantation of the intramedullary skeletal kinetic distractor and required acute inpatient rehabilitation. One patient had previously suffered a malunion deformity with a resultant limb shortening, and the second patient was born with a congenital leg-length inequality. Both patients had successful femoral intramedullary skeletal kinetic distractor implantation and were transferred for acute inpatient rehabilitation. Distraction occurred daily, based on the patient's level of physical activity in therapy, and was measured using a hand-held monitor. Both patients were successfully discharged home, without complications throughout the hospital stay. Knowledge of the theory and mechanism of action of the device is important to guide both the amount and type of therapy prescribed and to follow patient progress. We present general guidelines during the acute rehabilitation of a patient after intramedullary skeletal kinetic distractor surgery

A detailed knowledge of the consumer's preferences for the different classes of common bean is useful to define objectives in bean breeding and quality projects in a given region or country and it is also a valuable tool to design marketing strategies. The present work consisted on the application of a survey to 1514 common bean consumers in 14 states of Mexico. To facilitate the interpretation of the results the country was divided in four regions: North East, North West, Center and South. In the North West region, 98% of the surveyed individuals eat the "Azufrado" types (sulphur yellow); in the North East, 70% of the consumers prefer "pinto" (beige with brown mottles) and "Bayo" (cream) types; in the South, 90% of the consumers prefer the "Black" type; and in the Center of the country, all commercial classes are consumed. Within a commercial class, specific characteristics are demanded. For instance, in the black type, small and opaque seeds are preferred while in the "Flor de mayo" (Beige with pink mottles) type medium to large seeds having bright seed coat are preferred. The main characteristics utilized by consumers to select a given bean type are cooking time and flavor. It was observed that preferential classes are well established among the consumers since 70% responded that they would not change the preferred class even if the alternative class was sold to a lower price. Consumers do not soak the beans, because it changes the flavor and the aspect of the cooked beans and they do not add salt at the beginning of the cooking process due to the same reason. Organoleptic studies conducted in the laboratory confirmed that soaking of beans or addition of salts in the soaking water or at the beginning of the cooking process negatively affected acceptability of cooked beans by panelists. In this paper aspects related to ways of processing and consuming common beans as well as marketing aspects are discussed.

Brainstem auditory evoked potential (BAEP) and visual evoked potential (VEP) studies were undertaken in 8 patients with chronic cervical pain associated with auditory and visual symptoms of more than 6 months duration. The purpose of the study was to ascertain possible central abnormalities, including posterior cervical sympathetic syndrome (Barre-Lieou syndrome), in their auditory and/or visual pathways. Patients who had been treated surgically for cervical pain were excluded from the study group. All patients had normal cervical radiographs and electromyographic findings. Six also had normal CT scans and myelograms. A criterion of the study was that abnormal results would be considered significant only if ophthalmological and/or otolaryngological work-ups failed to reveal an underlying organic abnormality. The TECA-TE 42 was used throughout the study, as well as the international Ten-Twenty System of Electrode Placement. The results showed no abnormalities in the latency, amplitude, or waveform morphology of the evoked potentials. BAEP and VEP studies do not appear to reveal central abnormalities of the auditory and visual pathways in this group of patients. However, in view of the small number of patients included in the study, no conclusions can be made with certainty and the study is continuing