Disorders of the gut-brain interaction (DGBIs) are presently classified into mutually exclusive anatomical area-related symptom-based categories according to the Rome IV criteria. The pathophysiology of visceral nociception, which contributes to the wide range of symptoms of DGBIs, involves complex psychobiological processes arising from the bidirectional interactions of multiple systems at the gut and brain levels, which affect symptom expression and illness behaviors. The attitude toward an illness and expression of pain and bowel habit vary across cultures with variable interpretation based on sociocultural beliefs, which may not tally with the medical definitions.Thus, psychological factors impact DGBI definitions, their severity and health care utilization. Due to the poor localization and multisegment referral of visceral pain, the anatomical site of pain may not correspond to the affected segment, and there may be a variable degree of overlap among symptoms. The somewhat restrictively defined Rome IV criteria assume one-to-one correlation of symptoms with underlying pathophysiology and ignore overlapping DGBIs, nonstandardized symptom categories, and change or shift in category over time. The microorganic nature of DGBIs resulting from systemic, metabolic or motility disorders, gut dysbiosis and inflammation are not addressed in the Rome IV criteria. Although there is a multidimensional clinical profile that does address these factors, it is not followed rigorously in practice. Threshold changes for diagnostic criteria or addition/deletion of symptoms leads to wide variation among different DGBI criteria resulting in uncertain comparability of results. Although the Rome IV criteria are excellent for research studies and therapeutic trials in homogenous populations, further improvement is needed for their wider applicability in clinical practice.

PURPOSE: The purpose of this prospective study was to determine correlation between coronal mechanical alignment measured on preoperative standing full-length radiographs and navigation during total knee arthroplasty (TKA) in the presence of an associated sagittal deformity (hyperextension and flexion deformity). MATERIALS AND METHODS: Coronal mechanical alignment measured on preoperative, standing, full-length, hip-to-ankle anteroposterior radiographs was compared with intraoperative measurements recorded with computer navigation in 200 primary navigated TKAs. RESULTS: The mean difference in mechanical alignment between the two techniques was significantly greater (p=0.001) in patients with an associated flexion deformity >10° when compared to knees with associated flexion deformity ≤10°; 48% of knees with a flexion deformity >10° had a difference of ≥3° between the full-length radiograph and navigation alignment measurements. There was a strong correlation between the radiographic and navigation measurement techniques. CONCLUSIONS: The mean difference in coronal mechanical alignment between the two techniques was significantly higher in patients with an associated flexion deformity >10°. Hence, surgeons should take caution when relying on preoperative full-length radiographs for determining coronal mechanical alignment in patients with an associated flexion deformity >10° where using navigation may be more reliable.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Humans ; Knee ; Prospective Studies ; Surgeons ; Surgery, Computer-Assisted

BACKGROUND: Brennan’s rodent paw incision model has been extensively used for understanding mechanisms underlying postoperative pain in humans. However, alterations of physiological parameters like blood pressure and heart rate, or even feeding and drinking patterns after the incision have not been documented as yet. Moreover, though eicosanoids like prostaglandins and leukotrienes contribute to inflammation, tissue levels of these inflammatory mediators have never been studied. This work further investigates the antinociceptive effect of protein C after intra-wound administration. METHODS: Separate groups of Sprague–Dawley rats were used for quantitation of cyclooxygenase (COX) activity and leukotriene B4 level by enzyme-linked immunosorbent assay, as well as estimation of cardiovascular parameters and feeding and drinking behavior after paw incision. In the next part, rats were subjected to incision and 10 μg of protein C was locally administered by a micropipette. Both evoked and non-evoked pain parameters were then estimated. RESULTS: COX, particularly COX-2 activity and leukotriene B4 levels increased after incision. Hemodynamic parameters were normal. Feeding and drinking were affected on days 1 and 3, and on day 1, respectively. Protein C attenuated non-evoked pain behavior alone up to day 2. CONCLUSIONS: Based upon current observations, Brennan’s rodent paw incision model appears to exhibit a prolonged period of nociception similar to that after surgery, with minimal interference of physiological parameters. Protein C, which is likely converted to activated protein C in the wound, attenuated the guarding score, which probably represents pain at rest after surgery in humans.
Animals ; Blood Pressure ; Drinking ; Drinking Behavior ; Eicosanoids ; Enzyme-Linked Immunosorbent Assay ; Heart Rate ; Hemodynamics ; Humans ; Inflammation ; Leukotriene B4 ; Leukotrienes ; Nociception ; Pain, Postoperative ; Prostaglandin-Endoperoxide Synthases ; Prostaglandins ; Protein C ; Rats ; Rodentia ; Wounds and Injuries

OBJECTIVE: Auricular perichondritis refers to inflammation involving the perichondrium of the external ear. It is a very serious disease which may lead to permanent deformity of the pinna. We describe the predisposing factors, pathogenic organisms, interventions and residual deformities in a prospective consecutive sample of patients.

METHODS:
Design: Prospective Cohort Study
Setting: Tertiary Rural Government Teaching Hospital
Participants: All patients presenting with auricular perichondritis for a period of one year between March 2011 and February 2012 were consecutively enrolled and a clinical history and demographic details were obtained. Routine hematologic, blood biochemical examinations and culture / sensitivity of discharge from the pinna were conducted, and empiric intravenous ciprofloxacin was administered and continued if confirmed by culture and sensitivity. Those sensitive to co-amoxiclav, ceftazidime or amikacin were shifted to those medications. Medications were shifted to oral forms when available and indicated by resolution of acute inflammation, wound healing and no growth on cultures. Parenteral medications were maintained until the same parameters were achieved. Surgical incision and drainage was also performed when indicated, followed by a standardized wound care regimen. Follow up was for six months ending with assessment of pinna deformity.

RESULTS: Of the total study population of 50, 76% were male and 24% were female; 15-75 years of age (range 60 years) displaying male predominance and clustering in the fourth decade of life. The most common predisposing factors were trauma from motor vehicle accidents (30%) followed by high ear piercing (22%). Pseudomonas aeruginosa (48%) followed by Staphylococcus aureus (20%) were the most common organisms isolated. All were managed with intravenous antibiotics but 76% also required surgical intervention. Sixty-eight percent developed residual deformities of the pinna with 50% being total and 18% being partial.

CONCLUSION: Auricular perichondritis is a frightening disease which requires early management. As Pseudomonas aeruginosa is the most common organism, antipseudomonal antibiotics should be started as early as possible. Despite medical and surgical intervention, residual deformities may ensue.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Wounds and Injuries ; Ear, External