Surgery on the Hands of Musicians with Rheumatoid Arthritis

2002 ◽  
Vol 17 (3) ◽  
pp. 121-127
Author(s):  
Nikolaus Ell

The essential requisites for successful operative treatment of hands affected by rheumatoid arthritis are a thorough knowledge of the disease and experience in the applicable specialized hand surgical techniques. In musicians, decisions about the indications for surgery, the particular technique to be used, and the disadvantages of each possible procedure require additional basic knowledge about musical instruments and how they are played. This paper provides an overview of the changes in the hand and their effects on musicians in the early stages and late stages of rheumatoid arthritis as well as the special considerations that must be taken into account for operative therapy in both the early and late stages of the disease. The choice of operative procedure is often dependent on the instrument played and may vary between the right and left hands, or even from one finger to the next. If at all possible, the anticipated results of an operation should be simulated and checked preoperatively by using static or dynamic testsplints.

1996 ◽  
Vol 6 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Sylvain M. Chauvaud ◽  
Serban A. Mihaileanu ◽  
Julian A.R. Gaer ◽  
Alain C. Carpentier

AbstractEbstein's malformation is usually treated by replacing the tricuspid valve, albeit with controversial results. The “Carpentier technique,” introduced in 1980, offers both a new classification and new surgical methods for treatment of this lesion. The classification is based on the severity of the displacement of the septal and posteroinferior leaflets, with four grades of increasing severity. The surgical techniques involve mobilization of the anterosuperior leaflet, reduction of the diameter of the annulus, and longitudinal plication of the atrialized part of the right ventricle. Following this approach, 64 patients underwent consecutive surgical evaluation, with only one valvar replacement. The mean age was 26±15 years. The hospital mortality was nine percent. The mean follow-up is now 5.18±3.25 years. The actuarial survival rate was 87% at one year and 82% at five and 10 years. Of the patients, 90% were in postoperative functional class I or II. Control echocardiography revealed either no insufficiency, or minimal regurgitation in 80%. A second operation was needed in six patients because of right ventricular failure (two patients) or recurrence of valvar insufficiency (four patients). Sinus rhythm was present in 44 (88%) of the surviving patients. We conclude that repair of the malformed tricuspid valve, associated with longitudinal plication of the right ventricle, is safe and efficient. The prognosis depends on right ventricular contractility, which should be evaluated carefully before and after the operative procedure.


2020 ◽  
Vol 1 (1) ◽  
pp. 11-18
Author(s):  
M. A. Rodionov ◽  
I. V. Akimova

In the submitted study the problem of the formation of financial literacy of students at informatics lessons and relevant training of future informatics teachers is considered. Financial literacy is understood as a set of basic knowledge in the field of finance, banking, insurance, as well as budgeting for personal finances that allow a person to choose the right financial product or service, soberly assess and take risks that may arise during the use of these products, correctly accumulate savings and identify doubtful (fraudulent) investment schemes. The authors conclude that successful development of meaningful lines of the course of financial literacy requires integration of a few school subjects, such as mathematics, history, informatics, social science and literature. The role of modern informatics teacher in the formation of financial literacy of students is great. Therefore, in the training of a future informatics teacher, it should be paid the attention to issues related to the study of elements of financial literacy in informatics lessons. In order to solve the problem, the authors propose to use the special course “Basics of work in 1С:Enterprise”, which is implemented at Penza State University. The article contains a program of the course and the methodological recommendations for its implementation.


Archaeologia ◽  
1844 ◽  
Vol 30 ◽  
pp. 138-143
Author(s):  
Evan Nepean

The public curiosity has been much roused by Stevens's recent work on Central America, as well as by the late visit of Mr. Walker and Captain Caddy of the Artillery, to Palenque, and other ancient cities in that quarter.I have the honour to acquaint your Lordship, as President of the Society of Antiquaries, that, having been lately on service in the gulph of Mexico, whilst laying off the island of Sacrificios, I caused several excavations to be made there, and succeeded in digging up various articles of pottery, idols, and musical instruments; amongst other specimens, are three or four types, or signets, with hieroglyphics, which may perhaps throw some light on the origin of the Mexicans, or the still more ancient race that preceded them.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1288.1-1289
Author(s):  
I. Mcnicol ◽  
A. Bosworth ◽  
C. Jacklin ◽  
J. Galloway

Background:NRAS follows best practice, evidence-based standards in all we do. Whilst huge strides have been made in the diagnosis and treatment of RA, the impact on quality of life can be significant and for many this disease remains hard to come to terms with. NRAS services and resources can improve the outcomes of people with RA/Adult JIA through a framework of supported self-management resources tailored to individual need. It is particularly important to provide the right support at the beginning of a person’s journey with RA, when unhelpful health beliefs, anxiety and incorrect information can influence how someone responds to prescribed medication and treatment thus impeding their ability to achieve the best outcomes. We know, for example, that many people do not take their medication as prescribed which reduces their chances of achieving remission or low disease activity state.Objectives:To demonstrate that by referring patients online as part of a quality improvement programme to NRAS Right Start Service, we can show improved outcomes for patients with early RA when measured by the MSKHQ. Referred patients will benefit by: a) Better understanding what RA is; b) knowing how it can affect them; c) getting the right support; d) feeling more in control; receiving a tailored pack of information that meets their personal needs; e) be able to talk to a like-minded person who has lived with RA. It’s a 4 step process which starts with the health professional referring their patient to NRAS on line. NICE Quality Standard 3 states that “Adults with rheumatoid arthritis are given opportunities throughout the course of their disease to take part in educational activities that support self-management.” Our service enables health professionals to meet their responsibilities against this national quality standard.Methods:In preparation for the introduction of this service at BSR congress 2019, an audit of the NRAS helpline service was undertaken at the end of 2018 and remains on going. Currently we have 224 responses which have been analysed against specific criteria. An Advisory Board comprising 7 clincians, from different hospitals was appointed to work with NRAS on this important research.Results:In the helpline audit, when asked ‘how concerned are you about your disease’?, alarmingly, 78% of those surveyed scored their level of concern about their disease at 7 or higher out of 10, while only 8% scored it at 5 or below. When asked about the emotional effects of their RA, 62% scored it as 7 or more where 10 was the worst possible impact. 94% of survey respondents said that they would definitely or very likely recommend NRAS and its services to another person. These results led to the development of New2RA Right Start launched in 2019, whereby health professionals across the UK can refer their patients directly to NRAS via a consented online referral which is fully GDPR compliant. To date (31stJan, 2020), we have made calls to 101 patients, from 24 referring hospitals of which 55 have been successfully completed, 34 have had information sent through the post although our helpline team were unable to speak to them, and 12 remain open. Data analysis on the service is being carried out by King’s College Hospital London, comparing the results of patients who have been referred to Right Start within the national audit who have completed a baseline and 3 month follow up MSKHQ and patients in the audit who have not participated in Right Start.Conclusion:Anecdotally, we have had a tremendous response to this service from both patients and referring health professionals. We await data from King’s on the above figures, which we will have within the next 2 months and further data, should this abstract be accepted, will be available prior to June 2020. Right Start enables health professionals to comply with QS3 above, of the NICE Quality Standards in RA, one of the key standards against which they are being audited in the NEIAA national audit. Once data and write up in a peer review journal has been published we plan to roll this service out to people with more established disease.References:[1]To be done, not included in word count.Acknowledgments:I would like to thank Ailsa Bosworth MBE, Clare Jacklin, and James GallowayDisclosure of Interests:Iain McNicol Shareholder of: GSK, Ailsa Bosworth Speakers bureau: a number of pharmaceutical companies for reasons of inhouse training, advisory boards etc., Clare Jacklin Grant/research support from: NRAS has received grants from pharmaceutical companies to carry out a number of projects, Consultant of: I have been paid a speakers fee to participate in advisory boards, in house training of staff and health professional training opportunities, Speakers bureau: Various pharma companies, James Galloway: None declared


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 526.1-526
Author(s):  
L. Nacef ◽  
H. Riahi ◽  
Y. Mabrouk ◽  
H. Ferjani ◽  
K. Maatallah ◽  
...  

Background:Hypertension, diabetes, and dyslipidemia are traditional risk factors of cardiac events. Carotid ultrasonography is an available way to detect subclinical atherosclerosis.Objectives:This study aimed to compare the intima-media thickness in RA patients based on their personal cardiovascular (CV) history of hypertension (hypertension), diabetes, and dyslipidemia.Methods:The present study is a prospective study conducted on Tunisian RA patients in the rheumatology department of Mohamed Kassab University Hospital (March and December 2020). The characteristics of the patients and those of the disease were collected.The high-resolution B-mode carotid US measured the IMT, according to American Society of Echocardiography guidelines. The carotid bulb below its bifurcation and the internal and external carotid arteries were evaluated bilaterally with grayscale, spectral, and color Doppler ultrasonography using proprietary software for carotid artery measurements. IMT was measured using the two inner layers of the common carotid artery, and an increased IMT was defined as ≥0.9 mm. A Framingham score was calculated to predict the cardiovascular risk at 10-year.Results:Forty-seven patients were collected, 78.7% of whom were women. The mean age was 52.5 ±11.06 [32-76]. The rheumatoid factor (RF) was positive in 57.8% of cases, and anti-citrullinated peptide antibodies (ACPA) were positive in 62.2% of cases. RA was erosive in 81.6% of cases. Hypertension (hypertension) was present in 14.9% of patients, diabetes in 12.8% of patients, and dyslipidemia in 12.8% of patients. Nine patients were active smokers. The mean IMT in the left common carotid (LCC) was 0.069 ±0.015, in the left internal carotid (LIC) was 0.069 ±0.015, in the left external carotid (LEC) was 0.060 ±0.023. The mean IMT was 0.068 ±0.01 in the right common carotid (RCC), 0.062 ±0.02 in the right internal carotid (RIC), and 0.060 ±0.016 in the right external carotid (REC). The IMT was significantly higher in the left common carotid (LCC) in patients with hypertension (p=0.025). There was no significant difference in the other ultrasound sites (LIC, LEC, RCC, RIC, and REC) according to the presence or absence of hypertension. The IMT was also significantly increased in patients with diabetes at LCC (p=0.017) and RIC (p=0.025). There was no significant difference in the IMT at different ultrasound sites between patients with and without dyslipidemia.Conclusion:Hypertension was significantly associated with the increase in IMT at the LCC level in RA patients. Diabetes had an impact on IMT in LCC and RIC. However, dyslipidemia did not affect the IMT at the different ultrasound sites.References:[1]S. Gunter and al. Arterial wave reflection and subclinical atherosclerosis in rheumatoid arthritis. Clinical and Experimental Rheumatology 2018; 36: Clinical E.xperimental.[2]Aslan and al. Assessment of local carotid stiffness in seronegative and seropositive rheumatoid arthritis. SCANDINAVIAN CARDIOVASCULAR JOURNAL, 2017.[3]Martin I. Wah-Suarez and al, Carotid ultrasound findings in rheumatoid arthritis and control subjects: A case-control study. Int J Rheum Dis. 2018;1–7.[4]Gobbic C and al. Marcadores subclínicos de aterosclerosis y factores de riesgo cardiovascular en artritis temprana. Subclinical markers of atherosclerosis and cardiovascular risk factors in early arthritis marcadores subclínicos de aterosclerose e fatores de risco cardiovascular na artrite precoce.Disclosure of Interests:None declared


1980 ◽  
Vol 3 (1) ◽  
pp. 24-29
Author(s):  
H. Fukumasu ◽  
D.B. Olsen ◽  
J.H. Lawson ◽  
A. Mochizuki ◽  
N. Daitoh ◽  
...  

Two surgical techniques have been developed in our laboratory to deal with identifiable problems in long-term artificial heart experiments. A right thoracotomy is used to deal with problems such as extensive bleeding, which occur in the immediate postoperative stage of the experiment, while a left thoracotomy is used in cases in Which the original implantation is preceded by more than one week, since extensive adhesions complicate the right thoracotomy at that stage. Pulmonary problems have been eliminated as a primary cause of difficulties after reoperation, but infection remains a serious problem.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1117.3-1118
Author(s):  
L. Nacef ◽  
H. Ferjani ◽  
H. Riahi ◽  
K. Maatallah ◽  
Y. Mabrouk ◽  
...  

Background:Rheumatoid arthritis (RA) is chronic inflammatory rheumatism characterized by an independent cardiovascular (CV) risk. The screening of carotid intima-media thickness (IMT) in the common carotid artery appears to be a marker of atherosclerosis and is used as a specific tool for CV risk assessment.Objectives:The main of this study was to determine the most associated US sites with CV risk in RA.Methods:The present study is a prospective study conducted on Tunisian RA patients in rheumatology department of Mohamed Kassab University Hospital (March and December 2020). The characteristics of the patients and those of the disease were collected. The measurement of cIMTwas done using high-resolution B-mode carotid US with a Philips machine with the patient in supine position, according to AmericanSociety of Echocardiography guidelines.The carotid bulb below itsbifurcation and the internal and external carotid arteries were evaluated bilaterally with gray scale, spectral and color Doppler ultra-sonography using proprietary software for carotid arterymeasurements.IMT was measured using the two inner layers of the commoncarotid artery and an increased IMT was defined as ≥0.9 mm. The CV risk at 10 years was calculated by the SCORE index.Results:Forty-seven patients were collected, of which 78.7% were women. The mean age was 52.5 ±11.06 years. The rheumatoid factor (RF) was positive in 57.8% of cases, and anti-citrullinated peptide antibodies (ACPA) were positive in 62.2% of cases. RA was erosive in 81.6% of cases. Hypertension (hypertension) was present in 14.9% of patients and diabetes in 12.8% of patients. Nine patients were active smokers. The mean IMT in the left common carotid (LCC) was 0.069 ±0.015, in the left internal carotid (LIC) was 0.069 ±0.015, in the left external carotid (LEC) was 0.060 ±0.023. The mean IMT was 0.068 ±0.01 in the right common carotid (RCC), 0.062 ±0.02 in the right internal carotid (RIC), and 0.060 ±0.016 in the right external carotid (REC). The mean SCORE index of CV risk was 2±2.81 [0-11.6]. CV risk was significantly associated with the IMTs for LIC (p=0.029; r=0.374), LEC (p=0.04; r=0.480), and REC (p=0.016; r=0.408). No association was found between the IMT in the LCC (p=0,361; r=0,162), neither in the RCC (p=0,438; r=0,140) nor the RIC (p=0,670; r=0,077).Conclusion:In our study, IMT is strongly associated with score index, especially in carotid bifurcation. However, IMT measured in common carotid does not reflect a cardiovascular risk at 10-years.References:[1]S. Gunter and al. Arterial wave reflection and subclinical atherosclerosis in rheumatoid arthritis. Clinical and Experimental Rheumatology 2018; 36: Clinical E.xperimental.[2]Aslan and al. Assessment of local carotid stiffness in seronegative and seropositive rheumatoid arthritis. SCANDINAVIAN CARDIOVASCULAR JOURNAL, 2017.[3]Martin I. Wah-Suarez and al, Carotid ultrasound findings in rheumatoid arthritis and control subjects: A case-control study. Int J Rheum Dis. 2018;1–7.Disclosure of Interests:None declared


2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Mustafa Erkan Sari ◽  
Ozhan Ozdemir ◽  
Pinar Kadirogullari ◽  
Funda Arpaci Ertugrul ◽  
Cemal Resat Atalay

Background. Mature cystic teratomas of the fallopian tube are extremely rare and only 54 cases have been reported in the literature. In this paper, we report a mature cystic teratoma of the fallopian tube in a postmenopausal woman and we report the review of literature of tubal cystic teratomas.Case. A 62-year-old, gravida 4 postmenopausal woman presented with pain in the right lower abdominal region for a long time. An 88 × 72 × 95 mm heterogeneous mass which contained calcifications and lipoid components was detected in the right adnexal region by transvaginal ultrasonogram (TV-USG). Serum tumour markers, namely, CA125, CA15-3, and CA19-9, were within normal range. A laparotomy revealed a 9 × 10 cm cystic mass within the fimbrial region in the right fallopian tube, and right salpingoopherectomy was performed consequently. Microscopic examination revealed squamous epithelium with sebaceous glands and hair follicles, and pseudostratified ciliated respiratory epithelium with cartilage and mucous glands. Because the frozen section resulted in a benign dermoid cyst, no further operative procedure was performed. The postoperative follow-up was uneventful and the patient was discharged on the second postoperative day.Conclusion. In cases of undetermined pelvic or abdominal masses, a teratoma of the fallopian tube should be considered.


2005 ◽  
Vol 62 (12) ◽  
pp. 931-933
Author(s):  
Novak Milovic ◽  
Pero Janjic ◽  
Vladimir Bancevic ◽  
Srdjan Kupresanin

Background. Any large missing part of the ureter may be replaced by transureteroureterostomy, psoas hitch, Boari flap, nephrectomy, renal autotransplanation or by the implementation of an intestinal graft. Case report. A patient with a defect of the lumbal- pelvic portion of the right ureter, after the management of a penetrating and perforating gun shot wound was presented. The missing part of the ureter was successfully replaced with an appendix. The technique of uretero-transappendixcystoneostomy complete with a Boari flap and a psoas hitch was used. Conclusion. By the use of an original combination of surgical techniques, a large defect of the ureter and the defect of the bladder, as well as the preservation of the renal function was achieved in a more successful manner.


2021 ◽  
Vol 1 (2) ◽  
pp. 225-233
Author(s):  
Ari Patma Sari ◽  
Dwi Prasetiyawati Diyah Hariyanti ◽  
Purwadi Purwadi

Musical intelligence is musical intelligence which is characterized by a person's ability in the field of music, both sensitivity and mastery of tones, rhythms, rhythm patterns, instruments, and musical expressions, so that a person can play musical instruments or sing songs. This study aims to analyze the musical intelligence of early childhood with angklung musical instruments in Hidayatullah Islamic Kindergarten Semarang. The benefit of this research is knowing how to apply the angklung musical instrument correctly so that it can develop children's musical intelligence. The method used is descriptive qualitative research with data collection methods, namely observation, interviews, and documentation. Based on the results of research that has been done that the activity of playing angklung musical instruments can play an active role in stimulating children's musical intelligence. This can be seen when playing angklung musical instruments, children have skills in playing angklung musical instruments, the ability to adjust the tempo, adjust the tone, adjust the rhythm/rhythm, and the ability to sing short songs with the right rhythm. The results of the study showed that the musical intelligence of children in group B of Hidayatullah Islamic Kindergarten Semarang through playing the angklung musical instrument developed as expected.


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