Citations

Abstract Purpose Recent advancements in the understanding of hip biomechanics have led to the development of techniques to remove bony impingement and repair and/or preserve the labrum during hip arthroscopy. Although much attention in the literature is devoted to diagnosis and treatment, there is little information about post‐operative rehabilitation. Therefore, the purpose of this review is to (1) provide a five‐phase rehabilitation protocol following arthroscopic treatment for FAI and (2) report clinical and functional outcomes of patients following this protocol at minimum 1‐year follow‐up, in order to provide the surgeon and therapist with a protocol that is supported by clinical data. Methods All consecutive patients undergoing hip arthroscopy and subsequent five‐phase rehabilitation protocol at a single institution from 1 April 2011 to 1 April 2012 were analysed. Inclusion criteria were as follows: no prior ipsilateral hip surgery, completion of the five‐phase rehabilitation protocol, minimum 1‐year follow‐up, and documented outcome scores. Prospective outcomes were assessed with modified Harris hip score (MHHS) and hip outcome score (HOS). Results Fifty‐two patients (19 male and 33 female) met the inclusion criteria with a median age of 42 (range 16–59) years. Mean MHHS, HOS‐ADL, and HOS‐sport scores at a mean 12.5 (range 12–15) months were 80.1 ± 19.9 (0–100), 83.6 ± 19.2 (13.2–100), and 70.3 ± 27.0 (0–100), respectively. Conclusion This five‐phase rehabilitation programme provides a framework where progression from surgery to increasing post‐operative activity level can take place in a predictable manner. Patients following this rehabilitation protocol after hip arthroscopy demonstrated satisfactory clinical and functional outcomes, validating its implementation. Level of evidence Case series, Level IV.

Although compulsive hoarding may pose health, social, and developmental impairment for children, there are few phenomenological and treatment studies to guide assessment and treatment. Current evidence-based questions the link between hoarding and obsessive compulsive disorder (OCD) and the effectiveness of cognitive behavioral therapy protocols for OCD to adequately address the unique challenges of poor insight, poor emotion regulation, and increased family accommodation in children with compulsive hoarding. This case study seeks to illustrate a family-based behavioral approach to outpatient treatment of compulsive hoarding with a 9-year-old girl (pseudonym Lily). Treatment included psychoeducation, exposure to discarding items, exposure to acquiring cues, and parent behavior management techniques.

Shapiro syndrome and periodic hypothermia have been reported approximately fifty times in the literature. Shapiro syndrome is defined as the constellation of periodic hypothermia and hyperhidrosis along with agenesis of the corpus callosum by Shapiro et al. in 1969. Periodic hypothermia is a more broad diagnosis with a number of proposed mechanisms; it occurs in patients without structural brain abnormalities. Hematologic abnormalities beyond iron-deficiency anemia have not been documented in any of the reported cases of Shapiro syndrome or periodic hypothermia. Though accidental and therapeutic hypothermia have been associated with thrombocytopenia, this is, to our knowledge, the first reported case of periodic intrinsic hypothermia causing bicytopenia. In this report, we present the case of a patient with Shapiro syndrome who experienced cyclic bicytopenia mirroring hypothermic episodes. We address the differential diagnosis of bicytopenia, review the mechanisms proposed for cytopenias related to hypothermia, and propose possible mechanisms for the finding in this case.

Systemic lupus erythematosus (SLE) patients frequently have high circulating tumor necrosis factor alpha (TNF-α) levels. We explored circulating TNF-αlevels in SLE families to determine whether high levels of TNF-αwere clustered in a heritable pattern. We measured TNF-αin 242 SLE patients, 361 unaffected family members, 23 unaffected spouses of SLE patients, and 62 unrelated healthy controls. Familial correlations and relative recurrence risk rates for the high TNF-αtrait were assessed. SLE-affected individuals had the highest TNF-αlevels, and TNF-αwas significantly higher in unaffected first degree relatives than healthy unrelated subjects(P=0.0025). No Mendelian patterns were observed, but 28.4% of unaffected first degree relatives of SLE patients had high TNF-αlevels, resulting in a first degree relative recurrence risk of 4.48(P=2.9×10-5). Interestingly, the median TNF-αvalue in spouses was similar to that of the first degree relatives. Concordance of the TNF-αtrait (high versus low) in SLE patients and their spouses was strikingly high at 78.2%. These data support a role for TNF-αin SLE pathogenesis, and TNF-αlevels may relate with heritable factors. The high degree of concordance in SLE patients and their spouses suggests that environmental factors may also play a role in the observed familial aggregation.