Level IV, prospective study of case series.

Total knee replacementPatellar tendon length a b s t r a c t Purpose: We report our results of the effect that total fat pad excision has on patellar tendon length following total knee replacement. Method:We retrospectively reviewed radiographs of the knees of 133 patients who had Depuy LCS uncemented TKR between January 2009 to December 2009. We excluded patients who had patella resurfacing, lateral release, knee replacement for other than osteoarthritis and who had other implants used. We measured the length of the patellar tendon using the Insall-Salvati ratio.. Changes in the length of the tendon were calculated both as an absolute evaluation and as a percentage of the original length.Results: We effect of fat pad excision on patellar tendon length at 1 year and 5 years following surgery. At one year we observed no change in patellar tendon length in 81.1%, patella infera in 17.3% and patella alta in 1.6% of these 133 patients. We manage to follow up 50 of these patients at 5 years following surgery. In comparison to pre-operative length, at one year 86% showed no change, 14% had patella infera and none had patella alta. At 5 years we observed no change in 98% and patella infera in 2% of patients.Forty nine percent of our patients with patella infera developed anterior knee pain, mean flexion in those patients was 95.625 and mean oxford score was 52.31.Conclusions: In our patients following single implant design used patella infera developed in up to 18% at one year following surgery. Two percent of fifty patients who had five years follow up showed further shortening of patellar tendon after one year. We conclude that complete fat pad excision during total knee replacement does affect patellar tendon length. Level of evidence IV.

The collected works of Hippocrates describe for the first time in a systematic way a large number of oral diseases, such as ulcers, inflammations, abscesses and tumours from the epiglottis, mouth, tongue, palate, uvula and the sublingual area. Several of these case reports are remarkable for the accurate observation of clinical symptoms and signs, the aetiology, the pathogenesis and their therapeutic approach in relation to prognosis. The Hippocratic authors report cases of aphthae as part of a polysystemic disease, described many centuries later by Behçet and Adamantiades, while they associate features of splenomegaly from endemic malaria with gingivitis (ulitis). Benign lip ulcers, caused by sharp teeth bites, were distinguished from the difficult to treat herpes labialis (herpes) and from the necrotising nomae. Although staphylitis and angina (kynanche) were attributed to phlegm accumulation, they were recognised as true emergencies when they were associated with a swollen tongue and uvula. Several cases of kynanche with forward displacement of the first cervical vertebrae, atrophy of the uvula and oedema of the jaws are illustrated. A fatal outcome was anticipated in cases of phagedaenic ulcers of the teeth, causing necrosis and abscess formation. The therapeutic approach of oral diseases proceeded step by step, starting with simple regimens and progressing to invasive techniques, such as phlebotomy, surgical incisions for fluid drainage, and cauterisation. With the aim to avoid adverse events, special attention was paid to the correct timing of surgery and the maintenance of a patent airway with the insertion of small pharyngeal tubes.

The collected works οf Hippocrates include a wealth of references to emergencies and acute conditions; if the physician could treat these, he would be considered superior to his colleagues. Works most relevant to current Emergency Medicine are presented. They indicate Hippocrates' remarkable insight and attention to the value of close observation, meticulous clinical examination, and prognosis. Hippocrates and his followers disdained mystery and were not satisfied until they had discovered a rational cause to diseases. They assigned great significance to distressing signs and symptoms - the famous Hippocratic face, the breathing pattern, pain, seizures, opisthotonus - pointing to a fatal outcome, which they reported to their patient. The principles of treatment of emergencies, such as angina, haemorrhage, empyema, ileus, shoulder dislocations and head injuries, are astonishingly similar to the ones used nowadays.

Background The collected works of Hippocrates were searched for concepts on the diagnosis, prognosis, and treatment of acute and urgent respiratory diseases, with the objective to trace their origins in the Hippocratic Collection. Methods A scoping review was performed to map out key concepts of acute and severe respiratory diseases in the entire Hippocratic Collection. The digital library Thesaurus Lingua Graeca (TLG) was researched for references in the entire Hippocratic Collection regarding the epidemiology, pathophysiology, prognosis, diagnosis and treatment of acute respiratory diseases; then, the relevant texts were studied in their English translation by the Loeb Classical Library. Results Hippocratic physicians followed principles of treatment for pneumonia and pleurisy, still relevant, such as hydration, expectoration, analgesia and prompt mobilisation. Other approaches, including the inhalation of “vapours through tubes” in angina, can be considered as forerunners of modern medical practice. Thoracic empyema was diagnosed by shaking the patient and direct chest auscultation after “applying your ear to his sides”. In case of an emergency from upper airway obstruction, urgent insertion of primitive airway equipment, such as a small pharyngeal tube, was applied. Conclusions The main Hippocratic concepts on four still common acute and urgent respiratory diseases −pneumonia, pleurisy, thoracic empyema and upper airway obstruction− were identified and most of them were found to be in agreement with contemporary medical thinking and practice.