Complications following Suture Button Use for Femoral Graft Fixation in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Understanding any potential complications that may occur in relation to the use of a suture button for femoral graft fixation in arthroscopic anterior cruciate ligament reconstruction can help raise awareness among surgeons and improve safety when using such implants. This is a systematic review of suture button related complications. A literature search was conducted using the PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases from their year of inception until January 3, 2019. We included studies reporting on suture button related complications in their outcomes of femoral graft suture button fixation in anterior cruciate ligament reconstruction. Our search identified 479 articles, of which 19 met our inclusion criteria. Suture button misplacement (initial or subsequent migration) was the most commonly reported complication. Although, in most cases, button misplacement is minimal and does not adversely affect clinical outcomes, in some cases it may lead to graft failure or local soft tissue irritation and require further surgery. Intraoperative screening or arthroscopic evaluation of the deployed suture button may reduce this complication.

Valproate in the treatment of posttraumatic bipolar disorder in a psychogeriatric patient.

The authors present an 83-year-old man who had developed posttraumatic bipolar disorder 22 years earlier. His condition was characterized by recurrent manic and depressive attacks. Valproate was found effective in controlling his symptoms.

[Neuroleptic-induced movement disorders: historical perspectives]. / Complications extrapyramidales induites par les neuroleptiques. Perspectives historiques.

Soon after the discovery of neuroleptics, neurological side effects of the extrapyramidal type were reported. The first description of neuroleptic-induced parkinsonism dates back to the "Swiss Symposium on Chloropromazine" held in 1953. Steck in 1954 vividly described the symptoms in a convincing manner. In 1955, Delay and Denicker, observing the therapeutic efficacy and extrapyramidal activity of two seemingly different compounds as chloropromazine and reserpine, used the term "neuroleptic" to characterize this common property. Two years later they proposed a definition of neuroleptics taking into account therapeutic efficacy as well as side effects. Such a definition was not accepted by American authors who preferred term like "major tranquilizers" and finally "antipsychotics". The meaning of neuroleptic parkinsonism (whether it was a side effect or part of the therapeutic action) had been discussed for a long time. The analogy with the clinical manifestations of Von Economo's encephalitis lethargica was also mentioned. Tardive dyskinesia appeared in the literature in the late 1950's. The first report was made by Schoenecker in 1957 who described bucco-oral movements persisting after the neuroleptics were diminished or discontinued. He concluded that these manifestations were different from the acute extrapyramidal side effects. Two years later Sigwald et al. reported involuntary movements of the tongue, lips and facial muscles which appeared after several years of phenothiazine treatment. In 1960 Uhrbrand and Faurbye described bucco-linguo-masticatory movements sometimes associated with trunk and foot movements. Half of these cases persisted (and a few aggravated) after neuroleptic withdrawal. In others the condition was unmasked by the neuroleptic discontinuation. In 1964 Faurbye et al. proposed the term "tardive dyskinesia" for this extrapyramidal side effect. After an initial description by Druckman et al. in 1962, the term of "tardive dystonia" was first used in 1973 by Keegan and Rajput. The patients described in the early literature were mainly of an advanced age with organic involvement. The first serious epidemiological studies were undertaken in the late 1960's, showing prevalences varying between 0.5 to 65%! Most of the predisposing factors suspected in early studies (cerebral lesions, lobotomy, ECT) were not confirmed in more recent studies that emphasized the role of an older age and a female gender. The interest in tardive dyskinesia varies from one country to another. Perhaps, dyskinesia was more severe and problematic in the USA because of more liberal indications for neuroleptic use, higher doses and smaller choice of neuroleptic medications. Medicolegal aspects have also increased the apprehension of american physicians. Tardive dyskinesia remains an enigmatic phenomenon and a therapeutic challenge. In the future, the possible discovery of antipsychotic molecules devoid of extrapyramidal side effects may discourage the research on these unresolved issues.

The prevalence of late-onset schizophrenia in a psychogeriatric population.

Of 288 patients admitted to our psychogeriatric unit during a 4-year study, seven patients were diagnosed as having symptoms of paranoid schizophrenia (2.4% of all admissions). All the patients were women. Their symptoms included bizarre delusions and auditory hallucinations. Negative symptoms were rare. Attempts to reduce the dosage of neuroleptic medication led to reappearance of the symptoms in six patients and readmission of the seventh.

Clinical characteristics of late-onset schizophrenia and delusional disorder.

We compared 20 patients with late-onset schizophrenia, 7 with delusional disorder with hallucinations (paraphrenia), and 13 with delusional disorder without hallucinations (late-onset paranoia). We found that these three categories could be distinguished from each other on some clinical parameters. Late-onset schizophrenia was characterized by bizarre delusions; auditory hallucinations; to a lesser degree, first-rank and negative symptoms; and premorbid personality of the paranoid or schizoid type. Paraphrenia was associated with predominantly nonbizarre delusions, auditory hallucinations, earlier onset of symptoms, and paranoid or schizoid personality. Paranoia (late-onset) was characterized by late onset of symptoms, nonbizarre delusions, relatively intact premorbid personality, and an underlying physical stratum.

A 10-year follow-up study of tardive dyskinesia.

In a 10-year follow-up study of 44 patients with tardive dyskinesia (TD), the majority (22 or 50%) had no change in their TD severity, 9 (20%) had an improvement and 13 (30%) had a worsening of their TD. Little difference was noted in those patients whose medication was decreased (n = 12) and those whose medication remained unchanged (n = 32). Of the women, 26% showed improvement as compared with 11% of the men. Also, patients whose TD improved had lower present neuroleptic dose than those whose TD worsened. These two factors should be studied in larger patient cohorts.

Tardive dyskinesia in elderly psychiatric patients: a 5-year study.

OBJECTIVE: The authors investigated the prevalence of tardive dyskinesia among elderly psychiatric patients who had never received neuroleptic medication before their first hospitalization. METHOD: The study was performed in the geriatric psychiatry unit of a university-affiliated hospital in Canada and involved all first-admission patients admitted from September 1984 through August 1989 who had never taken neuroleptic drugs. In September and October 1989, the patients who were available for follow-up were examined and given ratings on the Abnormal Involuntary Movement Scale to establish the presence or absence of tardive dyskinesia. The patients' records were reviewed for information on age, diagnosis, duration of hospitalization, neuroleptic treatment received after admission, anticholinergic drugs received, and drug-free periods. RESULTS: Of the 162 patients who were available and whose data were analyzed, a total of 99 had been treated with neuroleptics, and 35 (35.4%) of these were found to have tardive dyskinesia. Two of the 35 also had tardive dystonia. Significantly more patients with major depression than patients with primary degenerative dementia or delusional psychosis had tardive dyskinesia. CONCLUSIONS: This study confirms the higher vulnerability of elderly psychiatric patients treated with neuroleptics to the development of tardive dyskinesia. The authors stress that caution is especially necessary when neuroleptics are prescribed for older patients with major affective disorders.

Gender differences in tardive dyskinesia: a critical review of the literature.

We analyzed data from 76 selected studies on prevalence of tardive dyskinesia (TD), published through 1989. The primary focus was on gender differences. The overall prevalence of TD in the 39,187 patients included in these reports was 24.2 percent, and prevalence was significantly higher in women (26.6%) than in men (21.6%). The gender difference in TD prevalence appeared to narrow intriguingly in more recent studies. Overall, the TD prevalence seemed to reach its peak in the 50-70-year-old age group in men and continued to rise after age 70 in women. Also, women tended to have more severe TD than men. Spontaneous dyskinesia too was found to be more common in women. The material was also analyzed for cultural differences by comparing studies in four continents: North America, Europe, Africa, and Asia. Although grouping together studies from different countries in a continent into a single group is somewhat problematic, we found that Asian patients had lower prevalence of TD than North American, European, and African patients. Limitations of our review (including differences among studies in diagnostic criteria, observer bias, etc.) as well as possible explanations for the reported differences in the risk for TD are discussed.

The course of tardive dyskinesia in newly treated psychogeriatric patients.

The author reports on the course of tardive dyskinesia in 10 newly treated psychogeriatric patients. Of the 5 whose medication was discontinued, 3 improved; TD continued unchanged in the other 5 patients whose neuroleptics were not discontinued. The author recommends that neuroleptics be discontinued whenever possible in this patient population.

Factors in the development of severe forms of tardive dyskinesia.

The authors evaluated 558 patients for tardive dyskinesia. They found that the prevalence of tardive dyskinesia was 34%. There were no differences between men and women in prevalence of tardive dyskinesia. However, severe tardive dyskinesia was found to occur more in male patients 40 years old or younger and in female patients 71 years old or older. Patients with mild tardive dyskinesia received more neuroleptics than did patients with moderate and severe forms. However, patients with moderate tardive dyskinesia had significantly more drug-free periods in their drug histories than did patients with mild tardive dyskinesia.

Mild tardive dyskinesia: an 8-year follow-up study.

The authors re-examined 20 patients who were found to exhibit mild tardive dyskinesia (TD) involving only one body area in 1980. Of these, 11 still showed TD of the same degree, whereas 4 had no TD and 5 aggravated TD. The authors conclude that mild TD involving one body area should be included in prevalence studies and that Schooler & Kane's definition of minimal manifestation of TD should be extended to include these patients.

The Effect of Electroconvulsive Therapy on Tardive Dyskinesia: A Prospective Study.

In a prospective study of the effect of electroconvulsive therapy (ECT) on tardive dyskinesia, one patient (of nine) showed dramatic improvement following her fourth treatment. While ECT was effective in only one patient, further studies are warranted to elucidate the mechanism of action of ECT on this movement disorder.

A comparison of severe tardive dystonia and severe tardive dyskinesia.

The authors present a demographic study comparing tardive dystonia with severe tardive dyskinesia (TD) patients. Tardive dystonia was more common among young men, while severe TD was more common in older women. Neuroleptics were distributed equally in both groups before the onset of the movement disorders. Drug-free periods were common in the history of severe TD than in tardive dystonia patients.

Functional impairment in tardive dyskinesia: medical and psychosocial dimensions.

The author presents 22 patients with tardive dyskinesia who were referred to him through consultation. Several patients had functional impairment caused by their movement disorder. Impaired gait was noted in 6 patients, speech impediment in 3 and thoughts of suicide in 1. Psychosocial difficulties were reported in 12 patients. The author concludes that tardive dyskinesia can lead to difficulties in patients who are suffering from the severe form.