Proximal hamstring tendinosis and partial hamstring origin ruptures are painful conditions of the proximal thigh and hip that may occur in the acute, chronic, or acute on chronic setting. Few publications exist related to their diagnosis and management. This systematic review discusses the incidence, treatment, and prognosis of proximal hamstring tendinosis and partial hamstring ruptures. Conservative treatment measures include nonsteroidal anti-inflammatory drugs, physical therapy, rest, and ice. If these measures fail, platelet-rich plasma or shockwave therapy may be considered. When refractory to conservative management, these injuries may be treated with surgical debridement and hamstring reattachment. [Orthopedics. 2017; 40(4):e574-e582.].

Background Many hospitalized patients with acute elevations in blood pressure are treated with intravenous (IV) antihypertensive medications without evidence of benefit. This study investigated the effects of IV as-needed (PRN) antihypertensives on blood pressure, hospital length of stay, and mortality. Methods We included hospitalized patients with an order for an IV PRN antihypertensive medication. We excluded patients with target organ damage. We performed multivariate analysis to assess whether the medication was independently associated with outcomes. Results 1784 out of 5680 patients (31%) had an administration of the PRN medication. Patients who received the medication had a longer hospital stay compared to patients with an order for the medication who did not receive it (4.9 ± 6.1 vs. 3.1 ± 4.1 days, p <0.001). This remained statistically significant after adjusting for covariates. In-hospital mortality was higher in the group that received the medication (3.3 vs. 1.6%, p <0.001), but this was not statistically significant on multivariate analysis. Intravenous hydralazine caused the most significant reduction in blood pressure and led to a shorter length of stay when compared to enalapril and labetalol. A total of 62% of patients received the medication for a systolic blood pressure lower than 180 mmHg. Conclusion Treating hypertension in the in-patient setting remains complex. Rapid lowering of blood pressure can cause harm to patients, and this study showed that antihypertensive medication increased hospital length of stay. Once assuring no target organ damage, a strategic approach should be to treat modifiable factors and gradually reduce blood pressure.

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ILEUS has been defined as a retention of the intestinal contents. I wish at once to make a clear distinction between ileus from a mechanical obstruction and ileus from a paralysis of the musculature of the intestine; in this paper I will deal only with the latter, and the two must not be confused with each other. Paralytic ileus is wholly a retention from complete muscular atony and not from an organic obstruction; yet many authors will speak of a paralytic obstruction. In this there is no onward movement of the intestinal contents and no attempts at the same, therefore, there can be no obstruction unless something is being prevented from passing on. However, McLean claims that the clinical picture is the same in both conditions; with this we cannot agree, as our observations have shown them to be most unlike clinically. This will be described more fully later on.This serious post-operative complication has not received the attention it deserves. Although much has been written upon the subject, it is really not well understood and we believe not recognized readily by us. Relatively little is known as to its etiology and there has been but little research work upon the subject, and what has been done has been mostly to determine the cause of death, by showing which portion of the intestinal secretion and contents were more poisonous; however, the research has been of distinct therapeutic value. We know better what to do in case it arises than we do what causes it or how to prevent it. Our text-books are peculiarly silent upon the subject or have it jumbled up with all kinds of mechanical intestinal obstruction.There is a certain amount of paralytic ileus after every abdominal incision as is evidenced by the usual accumulation of gas with which we are familiar and which gives us no grave concern.Occurrence.-It may occur after any abdominal operation or even after only the administration of an anaesthetic; however, it is said by some to occur more frequently after certain operations, e.g., after resection of the omentum, rough handling of the intestines in any operation in the abdomen, or following an operation for relief of volvulus or intussusception, where the mesentery is more or less injured. Lack of pelvic drainage is claimed by Mr. Hicks as a causative factor. The same author says that it has occurred in his practice five times in three hundred abdominal operations; in my own experience it has occurred four times in approximately seven hundred operations. Rather oddly it has occurred to me three times in the last year, and I trust 184

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