RESUMEN
The present study examined age-trends and longitudinal bidirectional relations in self-esteem and prosocial behavior toward strangers, friends, and family over a four-year time period (age 11 to 14). A total of 681 adolescents were recruited in the United States (51% girls, 28% single parent families). A longitudinal panel model was conducted and the results showed that adolescent self-esteem was associated longitudinally with subsequent prosocial behavior toward strangers, and earlier prosocial behavior toward strangers promoted subsequent self-esteem. There were no such bidirectional relations between self-esteem and prosocial behavior toward friends and family. Findings also highlight the complexity of adolescent development of selfesteem and the multidimensional nature of prosocial behavior. Discussion focuses on understanding the dynamic interplay between adolescent selfesteem and prosocial behavior.
Asunto(s)
Conducta del Adolescente , Desarrollo del Adolescente , Relaciones Familiares , Amigos , Autoimagen , Conducta Social , Adolescente , Niño , Femenino , Humanos , Estudios Longitudinales , Masculino , Estados UnidosRESUMEN
Tendon and ligament injuries and degenerative conditions of these soft tissues have poor healing potential and healing is often incomplete. Biocellular and orthobiologic approaches including PRP and stem cell therapies are reviewed. A review of some of the regenerative medicine science and difficulties facing physicians exploring these methods is presented. A series of cases are reviewed demonstrating the application of these principles. Clinical experience with many of these biocellular interventions is outpacing validation in basic science studies. Clinical experience dictates the need for repeated clinical and imaging evaluation and the need for repeated intervention or change in strategies when needed.
Asunto(s)
Ligamentos/lesiones , Plasma Rico en Plaquetas/fisiología , Medicina Regenerativa , Traumatismos de los Tendones/terapia , Humanos , TendonesRESUMEN
BACKGROUND AND OBJECTIVES: Chronic low back pain related to degenerative spondylosis is commonly managed by the radiofrequency ablation of sensory nerves. Fluoroscopic guidance has been considered mandatory to ensure placement of the active tip of the cannula parallel to the nerve to provide adequate neurolysis. Conversely, analgesic (or diagnostic) blockade is usually accomplished by placing the needle perpendicular to the nerve using either fluoroscopy or ultrasound (US) guidance. The recently introduced disposable equipment of internally cooled radiofrequency allows the denervation procedure to be performed similarly to the routine diagnostic block. Consequently, US may now potentially be used for image-guided radiofrequency neurotomy. We sought to compare the accuracy using a novel US-based technique with the traditional fluoroscopy-guided placement. METHODS: The proof of concept study was performed using a magnetic positioning US-guided system. The precision of needle placements was compared with the standard fluoroscopic guidance. The primary outcome of this study was defined as the procedural accuracy. Procedural and radiation exposure time was also recorded. In addition, projected operational expenses were calculated. RESULTS: Ultrasound-guided procedural accuracy reached 97%. Both the imaging and procedure times were similar between the 2 forms of imaging guidance. Of significant importance, the US-guided approach (no radiation exposure) was quantitatively advantageous over fluoroscopy-guidance, which required an average of 170 seconds of radiation per procedure. Thus, the US method seems to be cost effective. CONCLUSIONS: A magnetic positioning system allows accurate and quick US-guided placement of radiofrequency cannula to the desired anatomical targets, sparing patients and personnel from exposure to ionized radiation.
Asunto(s)
Ablación por Catéter/métodos , Vértebras Lumbares/diagnóstico por imagen , Fenómenos Magnéticos , Ultrasonografía Intervencional/métodos , Articulación Cigapofisaria/diagnóstico por imagen , Cadáver , Humanos , Vértebras Lumbares/cirugía , Proyectos Piloto , Articulación Cigapofisaria/cirugíaRESUMEN
Persistent anterior knee pain, especially after surgery, can be very frustrating for the patient and the clinician. Injury to the infrapatellar branch of the saphenous nerve (IPS) is not uncommon after knee surgeries and trauma, yet the diagnosis and treatment of IPS neuralgia is not usually taught in pain training programs. In this case report, we describe the anatomy of the saphenous nerve and specifically the infrapatellar saphenous nerve branch; we also discuss the types of surgical trauma, the clinical presentation, the diagnostic modalities, the diagnostic injection technique, and the treatment options. As early as 1945, surgeons were cautioned regarding the potential surgical trauma to the IPS. Although many authors dismissed the nerve damage as unavoidable, the IPS is now recognized as a potential cause of persistent anterior and anteriomedial knee pain. Even more concerning, damage to peripheral nerves such as the IPS has been identified as the cause and potential perpetuating factor for conditions such as complex regional pain syndromes (CRPS). Because the clinical presentation may be vague, it has often been misdiagnosed and underdiagnosed. There is a documented vasomotor instability, but, unfortunately, sympathetic blocks will not address the underlying pathology, and therefore patients often will not respond to this modality, although the correct diagnosis can lead to rapid and gratifying resolution of the pathology. An entity unknown to the clinician is never diagnosed, and so it is important to familiarize pain physicians with IPS neuropathy so that they may be able to offer assistance when this painful condition arises.