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The number of colons used in titles increased significantly in the BMJ and the Lancet between 1970 and 1995 keflex 250 mg on-line, but not in the New England Journal of Medicine. Writers often use punctuation to add a qualifying subtitle even though subtitles that describe the study design are often unnecessary or can detract from the title’s impact. For example, in the title Risk factors for birth defects in premature babies: a case–control study, the study design could be removed. While study design is of fundamental importance for any clinical or epidemiological research study, it is better described in the Abstract and the Methods rather than in the title, unless the journal suggests otherwise. The classic way of writing a title is to begin with a word that describes the main topic or the independent variable in your analyses. If the paper is submitted to a respiratory journal, either of the first two titles in Box 4. The problem with these types of titles is that they can be boring, especially if they are not short and concise. Titles that give the answer to the question: Asthma is negatively associated with growth in height during adolescence Linear growth deficit in asthmatic children There is an increasing tendency to use questions in titles. Questions that reiterate the aim of the paper may attract readers who want to know the answer. However, such titles are frowned on, perhaps because they tend to suggest a positive result and are therefore misleading if the findings are negative. Fashions rarely last and question titles are probably best reserved for abstracts and talks, which can be more immediate and interactive. Journal articles need to be more conservative in the ways in which results are conveyed, and their titles need to withstand the tests of time. The “assertive sentence title” has grown in popularity but should be avoided at all costs for journal articles.

In our own investigation we observed that the spine purchase keflex 500mg with mastercard, the aim of preservation of mobility probably cannot Harrington instrumentation increases the rotation, par- be reached. The staples stiffen the spine and they hardly ticularly if compression rods are used. They also produce a growth distur- is the rotating effect if the two rods are connected with bance. Since segmental Luque wires pull on the verte- temporary continuous growth stimulation at the concave bral arches on the concave side, they produce a derotating side. With such a method preservation of mobility should effect, though this is only slight. Much has been writ- ten about the derotating effect of the Cotrel-Dubousset Supplementary remarks system. During the operation the rod is turned through The sagittal plane and the extent of the rotation must be approx. In children under 12 or for very severe scolioses (over The most efficient method in terms of derotation is 60°), we always perform an anterior (thoracoscopic) disk ventral derotation spondylodesis (Zielke procedure). We sup- the anterior longitudinal ligament and the intervertebral plement the (lumbar) ventral derotation spondylodesis disks are removed during this procedure, the strongest (because of the risk of additional kyphosing) with poste- forces of resistance to the derotation are eliminated. As we ourselves have discovered, aver- > In almost all idiopathic thoracic scolioses we routinely age derotations of 20° to 30° are perfectly possible. Long-term results Genuine long-term results are available, particularly after Results of surgical scoliosis treatment Harrington procedures: Several studies have reported on Frontal plane (correction of the Cobb angle) follow-up periods of over 20 years [17, 18, 42, 75, 94]. A Corrections of between 28% and 55% have been correction loss of 5–10° occurs over time [17, 42]. How- achieved with the Harrington instrumentation, while cor- ever, the functional result is generally very good and the rections of 55% have been calculated for the use of the frequency of back pain is no greater than in a healthy Harrington-Luque technique.

If significant joint space narrowing is present on the 45° flexion PA radiograph generic keflex 250 mg fast delivery, MRI is not indicated. An and chondroitin sulfate potentially offer some relief MRI is valuable in assessing the status of the knee lig- in subjective symptoms. Glucosamine is thought to aments and menisci, but generally tends to underesti- stimulate chondrocyte and synoviocyte activity, and mate the degree of cartilage abnormalities seen at the chondroitin is thought to inhibit degradative enzymes time of arthroscopy (Khanna et al, 2001). The role of and prevent fibrin thrombi formation in periarticular the bone scan remains controversial: isolated articular tissues (Gosh, 1992; Bucci, 1994; Muller-Fassbender surface defects that do not penetrate subchondral bone et al, 1994). Recent studies indicate that pain, joint may not be identified by bone scan. Arthroscopy con- line tenderness, range of motion, and walking speed tinues to remain the gold standard for the diagnosis of may be improved with these medications (Barclay, articular cartilage injuries. Tsourounis, and McGart, 1998; DaCamara and The Outerbridge classification system (Outerbridge, Dowless, 1998). However, there are no clinical data 1961) was initially developed for macroscopic grad- showing that these oral agents affect the formation of ing of chondromalacia patellae and has since been cartilage (Tomford, 2000). A recent modifica- with high-molecular weight hyaluronans remains an tion by the International Cartilage Repair Society option despite the lack of well-controlled studies (ICRS) (Brittberg, 2000; Brittberg and Peterson, demonstrating efficacy. Suggested indications for referral to an orthopedic surgeon with expertise in cartilage NONSURGICAL MANAGEMENT restoration techniques are presented in Table 9-5. Acute motion loss Gross deformity Traditional methods for treatment of chondral lesions Acute neurovascular deficit include the judicious use of nonsteroidal anti-inflam- Mechanical symptoms (catching, locking, sensation of a loose body) matory drugs combined with activity modification. Failed nonsurgical management greater than 3 months in duration Oral chondroprotective agents such as glucosamine Repeated giving way or complaints of instability 50 SECTION 1 GENERAL CONSIDERATIONS IN SPORTS MEDICINE SURGICAL MANAGEMENT quality and volume of repair tissue (fibrocartilage) is variable. These procedures are used in low demand patients with larger lesions (>2 cm2) or in higher Various surgical modalities exist for the treatment of demand patients with smaller lesions (<2 cm2). The goals are to reduce symptoms, and abrasion arthroplasty for several reasons: (1) it is improve joint congruence by restoring the articular sur- less destructive to the subchondral bone because it cre- face with the most normal tissue (i.