Severe gastrointestinal bleeding of obscure origin.
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The objective of this study is to assess the effectiveness of the endoscopic capsule for the diagnosis of bleeding of the small bowel and of Crohn's disease. A systematic review was performed. Studies with more than 10 patients, using the capsule and some other procedure for diagnostic purposes, and published in peer reviewed journals, were included. In order to evaluate the papers, a quality scale was created. The diagnostic yield of the capsule for small-bowel bleeding was approximately 55-75%. With other procedures, the diagnostic yield was around 30%. For Crohn's disease, the diagnostic yield of the capsule was between 43-70% while it was 0-50% with other procedures. The reviewed studies have methodological limitations, yet they seem to point to the fact that the capsule may have a better diagnostic yield than other diagnostic procedures for small-bowel bleeding and Crohn's disease.
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The application of laser/thermal energy in arthroscopic shoulder surgery remains controversial. Laser proponents tout the benefits of coagulation and vaporization of tissue, whereas opponents cite costs, complications, and the fact that the laser has not yet shown results superior to presently available mechanical techniques. A lack of basic science studies and the aversion of many physicians to the marketing aspects of laser technology have undermined the widespread orthopaedic acceptance of laser techniques. Newer applications, such as capsular shrinkage are just now being evaluated as to effect and efficacy. Orthopaedists should be assured that, at present, they are not compromising patient care by not using laser techniques.
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Like most surgical procedures, the results of arthroscopic Bankart repair can probably be improved by meticulous attention to surgical detail. Some of these aspects include the orientation of the suture holes in bone anchors to facilitate smooth gliding of the sutures. Using the outside strand as the post strand optimises soft tissue approximation to the glenoid especially when using a ratchet type of slip knot.
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Using traditional techniques in novel ways often can improve management of common surgical problems. Additionally, established products may find new utility when deployed in a slightly different fashion to enhance patient care in a clinically relevant way. This article describes endoscopic placement of radiopaque markers into the proximal small intestine as a means to evaluate motility in a focused fashion. A method to delineate the location of dysmotility in a patient with several potential sites is described. This technique is safe, feasible, reasonably inexpensive, and is easily performed by a skilled endoscopist. Moreover, this technique has the added benefit of providing functional data in a timely fashion.
The acromioclavicular (AC) joint may be affected by a number of pathologic processes, most commonly osteoarthritis, posttraumatic arthritis, and distal clavicle osteolysis. The correct diagnosis of a problem can usually be deduced from a thorough history, physical examination, and radiologic evaluation. Asymptomatic AC joint degeneration is frequent and does not always correlate with the presence of symptoms. Selective lidocaine injection enhances diagnostic accuracy and may correlate with surgical outcome. Nonoperative treatment is helpful for most patients, although those with osteolysis may have to modify their activities. In appropriately selected patients, open or arthroscopic distal clavicle resection is necessary to relieve symptoms. Recent biomechanical and clinical data emphasize the importance of capsular preservation and minimization of bone resection; however, the optimal amount of distal clavicle resection remains elusive. Patients with AC joint instability have poor results after distal clavicle resection.
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Surgery of the TMJ is a useful tool in Temporo Mandibular Disorders (TMD). After have been identified what is part of TMD and what isn't, this article lay stress upon the fact that surgery of the TMJ is the appropriate treatment only when the nonsurgically therapy had failed. Indications, danger and complications are discussed. Procedures of arthrotomy and arthroscopy are explained. Various surgical procedures and staging of TMD are discussed.