DIALOGUE
Monday, September 29, 2008Posted by Andrew at 11:37 AM 0 comments
LEARNING from the BEST – PART B
Sunday, September 28, 2008Posted by Andrew at 3:35 AM 0 comments
DRAWING MOVEMENT- PART A
Saturday, September 27, 2008Posted by Andrew at 9:10 AM 0 comments
The ORIGINS of ANIMATION
Friday, September 26, 2008Posted by Andrew at 11:05 AM 0 comments
LEARNING from the BEST
Wednesday, September 24, 2008Posted by Andrew at 8:03 AM 0 comments
Big Mac® Sandwich
Tuesday, September 23, 2008(this is a per sandwich recipe)
1 -regular sized sesame seed bun
1 -regular sized plain bun
2 -previously frozen regular beef patties
2 -tablespoons Big Mac sauce
2 -teaspoons reconstituted onions
1 -slice real American cheese
2 -hamburger pickle slices
1/4 Cup -shredded iceberg lettuce
COOKING:
Discard the crown half of the regular bun, retaining the heel. The cooking method for the Big Mac™ is basically the same as the regular burgers, only the bun toasting method is slightly
different. In the Big Mac's case you toast the bottom (heel) first. Do this along with the extra heel. (this will be your middle bun.)
Cook the two-all-beef-patties just like the regular burgers. After the bun parts are toasted, put 1 tablespoon of "Mac sauce" on each of the heels.(toasted side.) Then add 1/8 cup shredded lettuce to each.On the true bottom bun, place one thin slice of American cheese on top of the lettuce. On the extra "heel", the middle bun, place two pickle slices on top of the lettuce. Toast the "crown" (top) of the bun also. When the meat patties are done, place them one at a time on both prepared buns. Stack the middle bun on top of the bottom bun, and put the crown on top. For proper "aging", or "Q-ing", ...wrap the finished Big Mac® in a 12"x18" sheet of waxed paper as follows:
1...Center the burger, right side up, on the waxed paper. Fold the "long" ends of the paper up over the top. (It will resemble a tube with the burger in the center.)
2...Fold the two remaining ends underneath. Wrap snug, but don't squish it like the regular burgers.
3...Let sit 5-8 minutes, allowing the flavors to "meld".
4...Microwave, still wrapped, 15 seconds on high.
....Enjoy an AWESOME Big Mac® Sandwich!
Posted by Andrew at 3:03 PM 0 comments
BIG MAC™ Special Sauce
Sunday, September 21, 2008 Ingredients:
1/4 cup KRAFT Miracle Whip
1/4 cup mayonnaise
2 Tablespoons,heaping, WISHBONE deluxe french salad dressing (the orange stuff)
1/2 Tablespoon HEINZ sweet relish
2 teaspooons, heaping, VLASIC dill pickle relish (Heinz dill relish also works)
1 teaspoon sugar
1 teaspoon dried, minced onion
1 teaspoon white vinegar
1 teaspoon ketchup
1/8 teaspoon salt
Mix everything very well in a small container. There better be no streaks! Microwave 25 seconds, and stir well again. Cover, and refrigerate at LEAST 1 hour before using.( to allow all of
the flavors to "meld". ) Makes nearly 1 cup...enough for about 8 Big Macs™.
Posted by Andrew at 1:00 PM 0 comments
ACUTE CARTILAGE INJURIES OF THE KNEE
Friday, September 19, 2008
History
. Work or recreational injury
. Mechanism
. Landing impact injury with isolated chondral defect
ligamentous injury
. Painful
. May have mechanical symptoms (e.g., locking, catching) from chondral flap
Physical exam
. Moderate effusion
. May have hemarthrosis on aspiration if osteochondral fracture
. Tender over affected condyle, plateau, or patellofemoral joint ± joint line tenderness
Studies
. Radiographs
. AP, lateral sunrise (three or four views)
. Normal
. MRI
. Will show signal changes at articular surface and possibly subchondral bone bruise
. Necessary to detect associated meniscal or ligament pathology
Differential Diagnosis
. Meniscal tear
. Osteochondritis dissecans
. Atraumatic osteonecrosis/avascular necrosis
Treatment
. Evaluate alignment
. If malalignment, consider osteotomy
. Arthroscopy to determine lesion:
. Size
. Containment
. Depth
. Depth of lesion (Outerbridge classification)
. Grade I – Softening of cartilage
. Grade II – Fibrillations
. Grade III – Fissuring
. Grade IV – Full thickness to bone
. Grade I – No treatment
. Grade II and III
. Arthroscopic debridement results in replacement with fibrocartilage
. poor wear characteristics
. Grade IV
. Mesenchymal stem cell stimulation
. Microfracture or drilling into subchondral bone results in replacement with fibrocartilage
. Substitution replacement
. Replacement of defect with autograft or allograft plug(s); also known asmosaicplasty or OATS Procedure
. Biologic replacement
. Requires two surgeries: autologous chondrocytes are harvested and cultured, then later placed into the defect and covered with periostium
. Results in hyaline cartilage – better wear characteristics
Disposition
N/A
Prognosis
. Acute cartilage injury results in release of degradative enzymes (stromelysin), which contributes to further cartilage breakdown.
. Treatment with thermal probe may cause death down to subchondral bone.
. Partial-thickness lesions do not heal without treatment
. May cause meniscal injury and cartilage injury to opposite side of joint
. Full-thickness defects 0–1 cm2 that are well contained do well with drilling or microfracture
. Full-thickness defects 1–2 cm2 that are well contained do well with drilling,microfracture, or OATS procedure
. 50–70% good results at 5 years
. Full-thickness defects >2 cm2 that are well contained do well with autologous chondrocyte implantation
. Depending on location 70–90% good results at 8–10 years
. Can be treated with OATS procedure with minimal long-term
data available
. Large poorly contained lesions have lower probability of regeneration success
. Result in lower levels of function that ultimately may require TKA
. Can be treated with large shell allografts (experimental)
Caveats and Pearls
. Early arthroscopy for classification and treatment will prevent additional chondral and meniscal injury.
. Meniscal pathology, ligamentous instability, and significant malalignment, if untreated, will all result in chondral injury.
. Advances in imaging technology are not yet sufficient to detect and classify these injuries.
Posted by Andrew at 2:11 PM 0 comments
TREATMENT FOR ACROMIOCLAVICULAR SEPARATION
Sunday, September 14, 2008. Classification system based on injury to AC and CC ligaments and
severity and direction of displacement of clavicle
I: Sprain of AC ligaments; CC ligaments intact; no increase in CC
distance
II: Disruption of AC ligaments and sprain of CC ligaments;
increase in CC distance <25%; weighted views would show equal CC distances .
III: Disruption of AC and CC ligaments; CC distance 25–100%; deltotrapezial fascia is intact . IV:Disruption of AC and CC ligaments; clavicle is posteriorly displaced into deltotrapezial fascial may not have significant superior displacement .
V: Disruption of AC and CC ligaments; marked superior displacement of clavicle with CC distance of 100–300%; torn deltotrapezial fascia .
VI: Disruption of AC ligaments +/- CC ligaments; inferior displacement of clavicle in either subacromial (CC ligaments intact) or subcoracoid (CC ligaments disrupted) location; subcoracoid dislocation associated with severe injury, rib fractures, and clavicle fracture .
Types I and II
. Ice and sling for comfort for 1–2 weeks
. Return to activity when full pain-free range ofmotion present
. May take longer in type II injuries
. Kenny Howard brace – presses down on clavicle and pushes armupwards
. Must be worn 24 hours a day
. Can cause skin breakdown over clavicle and anterior interosseous nerve palsy
. Pts w/ type II may develop persistent symptoms in future secondary to posttraumatic degeneration, osteolysis of distal clavicle, loose cartilage fragments, or unstable meniscus
. Treat with distal clavicle excision +/- CC stabilization
. Distal clavicle excisions fare poorly if grade II injury present .
Type III
. Operative vs. nonoperative treatment remains controversial
. Literature unclear on the matter, but careful review reveals that recent trend is to opt for nonoperative treatment
. Patients treated nonoperatively recover sooner,with no difference in strength or pain . .Exceptions to this are in overhead laborers and perhaps throwing athletes
. Nonoperative treatment
. Sling for 2–4 weeks
. Early pendulum and ROMexercises
. Begin strengthening at 4–6 weeks
. Avoid contact sports for 4–8 weeks .
Types IV and V
. Operative treatment recommended
. Early (first 2 weeks) surgery results are better than late surgery
. Type IV tends to bemore painful
. Type V symptomatology generally relative to degree of displacement .
Posted by Andrew at 12:04 PM 0 comments
ACROMIOCLAVICULAR SEPARATION
Tuesday, September 9, 2008
History
. Direct force by far most commonmechanism
. Fall onto point of shoulder
. Acromion gets driven downward and clavicle is stabilized by sternoclavicular
(SC) ligaments
. Sequence of ligamentous injuries: acromioclavicular (AC) ligaments,
coracoclavicular (CC) ligaments, deltoid and trapezial muscle
attachments, skin
. Inferior dislocation (type VI separation) likely caused by downward
force on clavicle
. Injury may also be caused by indirect forcewith humeral head being
driven into acromion
. Will cause no damage to CC ligaments
. A common athletic injury
. Football
. Hockey
. Lacrosse
. Bicycling (esp. mountain biking)
. Snowboarding
. Motorcycle accidents
. Tend to be complex with associated injuries
. Patients report pain, swelling at AC
. Chronically may have deformity, clicking, pain
Physical exam
. Inspection of deformity
. Rule out posterior buttonholing of clavicle through deltotrapezial
fascia
. Neurovascular and rotator cuff strength exam
. Palpation of AC and CC regions
. Cross-body adduction
. Injuries to rule out acutely
. Clavicular shaft fracture
. Acromion and coracoid fractures
. Brachial plexus injuries
. SC joint injuries
. Pneumothorax
. Scapulothoracic dissociation
. Chronically must rule out other sources of pain
. SLAP tear
. Cervical radiculopathy
. Rotator cuff tear
Studies
. Preferably done standing
. AP (Zanca view)
. cephalic tilt to avoid superimposition of AC joint on scapula
. Reduced exposure needed as in AP view of glenohumeral joint
. Axillary view
. Rule out posterior displacement of clavicle
. Rule out coracoid and acromion fractures
. Film other side if questionable
. Standing AP view of both shoulders
. Measure CC distances and calculate % increase on affected side
. CC distance normally 1.0–1.3 cm
. Weighted views
. Help distinguish type II from type III
. Not needed, as they seldom change treatment plan or decision
to perform surgery
. MRI
. Can delineate ligamentous injury and arthritis, useful for surgical
planning
Differential Diagnosis
. Lateral clavicle fracture
. Periosteal sleeve fracture
. Bipolar AC separation + SC joint injury
. Combined AC separation + coracoid process fracture
. Glenohumeral joint dislocation
Posted by Andrew at 4:35 AM 0 comments
COLOR and TEXTURE
Sunday, September 7, 2008Posted by Andrew at 7:28 AM 0 comments
SETTING the STAGE
Wednesday, September 3, 2008Posted by Andrew at 6:26 AM 0 comments
