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Cambridge, MA, United States

Byrd J.W.,Foundation Medicine
The American journal of sports medicine | Year: 2011

Hip pathology is a significant source of pain and dysfunction among athletic individuals and femoroacetabular impingement is often a causative factor. Arthroscopic intervention has been proposed to address the joint damage and underlying impingement. Arthroscopy may be effective in the management of symptomatic femoroacetabular impingement in athletes. Case series, Level of evidence, 4. All patients undergoing hip arthroscopy at 1 institution were prospectively assessed with a modified Harris hip score obtained preoperatively and postoperatively at 3, 12, 24, 60, and 120 months. This report consists of a cohort of 200 patients identified who underwent arthroscopic management of femoroacetabular impingement, participated in athletic activities, and had achieved minimum 1-year follow up. There was 100% follow-up at an average of 19 months (range, 12-60 months). A total of 116 athletes had achieved 2-year follow-up. For the entire cohort, the average age was 28.6 years (range, 11-60 years) with 148 males and 52 females. There were 159 cam, 31 combined, and 10 pincer lesions. There were 23 professional, 56 intercollegiate, 24 high school, and 97 recreational athletes. The male:female ratio was 2.8:1 among cam lesions and 1:1 among pincer lesions. The median preoperative score was 72 with a postoperative score of 96 and the median improvement was 20.5 points, which was statistically significant (P < .001). Ninety-five percent of professional athletes and 85% of intercollegiate athletes were able to return to their previous level of competition. There were 5 transient neurapraxias (all resolved) and 1 minor heterotopic ossification. One athlete (0.5%) underwent conversion to total hip arthroplasty and 4 (2%) underwent repeat arthroscopy. For the group with minimum 2-year follow up, the median improvement was 21 points with a postoperative score of 96. The data substantiate successful outcomes in the arthroscopic management of femoroacetabular impingement with few complications and most athletes were able to resume activities.

Leishmania (Viannia) braziliensis is a parasite recognized as the most important etiologic agent of mucosal leishmaniasis (ML) in the New World. In Amazonia, seven different species of Leishmania, etiologic agents of human Cutaneous Leishmaniasis, have been described. Isolated cases of ML have been described for several different species of Leishmania: L. (V.) panamensis, L. (V.) guyanensis and L. (L.) amazonensis. Leishmania species were characterized by polymerase chain reaction (PCR) of tissues taken from mucosal biopsies of Amazonian patients who were diagnosed with ML and treated at the Tropical Medicine Foundation of Amazonas (FMTAM) in Manaus, Amazonas state, Brazil. Samples were obtained retrospectively from the pathology laboratory and prospectively from patients attending the aforementioned tertiary care unit. This study reports 46 cases of ML along with their geographical origin, 30 cases caused by L. (V.) braziliensis and 16 cases by L. (V.) guyanensis. This is the first record of ML cases in 16 different municipalities in the state of Amazonas and of simultaneous detection of both species in 4 municipalities of this state. It is also the first record of ML caused by L. (V.) guyanensis in the states of Pará, Acre, and Rondônia and cases of ML caused by L. (V.) braziliensis in the state of Rondônia. L. (V.) braziliensis is the predominant species that causes ML in the Amazon region. However, contrary to previous studies, L. (V.) guyanensis is also a significant causative agent of ML within the region. The clinical and epidemiological expression of ML in the Manaus region is similar to the rest of the country, although the majority of ML cases are found south of the Amazon River.

Schwartz A.L.,Foundation Medicine
Medicine and Science in Sports and Exercise | Year: 2010

EXPERT PANEL: Kathryn H. Schmitz, PhD, MPH, FACSMKerry S. Courneya, PhDCharles Matthews, PhD, FACSMWendy Demark-Wahnefried, PhDDaniel A. Galvão, PhDBernardine M. Pinto, PhDMelinda L. Irwin, PhD, FACSMKathleen Y. Wolin, ScD, FACSMRoanne J. Segal, MD, FRCPAlejandro Lucia, MD, PhDCarole M. Schneider, PhD, FACSMVivian E. von Gruenigen, MDAnna L. Schwartz, PhD, FAANEarly detection and improved treatments for cancer have resulted in roughly 12 million survivors alive in the United States today. This growing population faces unique challenges from their disease and treatments, including risk for recurrent cancer, other chronic diseases, and persistent adverse effects on physical functioning and quality of life. Historically, clinicians advised cancer patients to rest and to avoid activity; however, emerging research on exercise has challenged this recommendation. To this end, a roundtable was convened by American College of Sports Medicine to distill the literature on the safety and efficacy of exercise training during and after adjuvant cancer therapy and to provide guidelines. The roundtable concluded that exercise training is safe during and after cancer treatments and results in improvements in physical functioning, quality of life, and cancer-related fatigue in several cancer survivor groups. Implications for disease outcomes and survival are still unknown. Nevertheless, the benefits to physical functioning and quality of life are sufficient for the recommendation that cancer survivors follow the 2008 Physical Activity Guidelines for Americans, with specific exercise programming adaptations based on disease and treatment-related adverse effects. The advice to "avoid inactivity," even in cancer patients with existing disease or undergoing difficult treatments, is likely helpful. Copyright © 2010 by the American College of Sports Medicine.

Wan S.-H.,Foundation Medicine | Vogel M.W.,Washington University in St. Louis | Chen H.H.,Mayo Medical School
Journal of the American College of Cardiology | Year: 2014

Pre-clinical diastolic dysfunction (PDD) has been broadly defined as left ventricular diastolic dysfunction without the diagnosis of congestive heart failure (HF) and with normal systolic function. PDD is an entity that remains poorly understood, yet has definite clinical significance. Although few original studies have focused on PDD, it has been shown that PDD is prevalent, and that there is a clear progression from PDD to symptomatic HF including dyspnea, edema, and fatigue. In diabetic patients and in patients with coronary artery disease or hypertension, it has been shown that patients with PDD have a significantly higher risk of progression to heart failure and death compared with patients without PDD. Because of these findings and the increasing prevalence of the heart failure epidemic, it is clear that an understanding of PDD is essential to decreasing patients' morbidity and mortality. This review will focus on what is known concerning pre-clinical diastolic dysfunction, including definitions, staging, epidemiology, pathophysiology, and the natural history of the disease. In addition, given the paucity of trials focused on PDD treatment, studies targeting risk factors associated with the development of PDD and therapeutic trials for heart failure with preserved ejection fraction will be reviewed. © 2014 by the American College of Cardiology Foundation.

Byrd J.W.T.,Foundation Medicine
American Journal of Sports Medicine | Year: 2014

Hip disorders are increasingly recognized as a cause of dysfunction and disability among athletes. Femoroacetabular impingement (FAI) is a common source of hip problems. While FAI may sometimes be present as an incidental asymptomatic finding, substantial secondary joint damage may occur. This problem is often observed in young adult, and even adolescent, athletes. FAI morphology results in a breakdown of the labrum and articular surfaces from forces generated during sporting activities that would otherwise be well tolerated by a normal joint. A description of the pathomechanics is included. Detection of pathological FAI is important to minimize its harmful effects. The history, examination findings, and pertinent imaging studies are detailed. Nonoperative measures, including training modifications and pelvic stabilization exercises, may be of some benefit in modulating symptoms. When secondary joint damage has occurred, surgical intervention is usually necessary. While most can be managed with arthroscopic techniques, open and mini-open methods are discussed as well. With proper recognition and treatment, most athletes can expect to return to sports, although the long-term implications of high-level activities must still be considered. These results are summarized. © 2013 The Author(s).

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