MRI in greater trochanter pain syndrome

The greater trochanter pain syndrome refers to pain on the lateral aspect of the hip joint. This is frequently attributed to trochanteric bursitis and distension of the subgluteal bursae. Associated tears of the tendons of gluteus medius and minimus have been described and may result from repetitive frictional trauma to these tendons and their associated bursae secondary to impingement beneath the tensor fascia lata. Occasionally tendinous damage may result from acute local direct trauma or a hyperadductive strain injury. We describe MRI in two patients with chronic lateral hip pain.     

Acinetobacter skin abscess in a neonate.

Although Acinetobacter is usually a species of low virulence, it is becoming increasingly more important as a cause of hospital outbreaks, particularly on intensive care units. Antibiotic resistance can develop rapidly. This organism has not been reported to cause skin abscesses previously. We describe a case of a neonate who developed an Acinetobacter abscess on our neonatal intensive care unit.     

Calcitonin gene-related peptide increases blood flow and potentiates plasma protein extravasation in the rat knee joint.

1. The effects of calcitonin gene-related peptide (CGRP) and other vasoactive mediators of inflammation on blood flow in the synovial vessels and plasma protein extravasation into the knee (femoro-tibial) joint of the pentobarbitone-anaesthetized rat were measured. 2. Changes in synovial blood flow were estimated by 133xenon clearance from the synovial cavity. CGRP (0.1 pmol and 10 pmol) and prostaglandin E1 (PGE1; 3 pmol and 300 pmol) significantly increased clearance from the knee joint measured 5 min after intra-articular injection. Substance P (10 pmol) had no effect on synovial blood flow. 3. Intra-articular perfusion of the rat knee with CGRP at concentrations up to 0.1 mM, or PGE1 at concentrations up to 10 microM, did not increase plasma extravasation into the synovial cavity measured by accumulation of intravenously injected 125I-albumin in the perfusate. 4. Plasma extravasation into the knee was significantly increased by infusion of bradykinin (0.1 microM), 5-hydroxytryptamine (1 microM) and histamine (0.1 mM), compared with the contralateral joints in the same animals which were perfused with Tyrode solution. 5. Perfusion of the knee joint with substance P did not specifically induce 125I-labelled albumin accumulation in the synovial cavity even at doses that had systemic effects as observed by marked plasma extravasation into other tissues. 6. The increase in plasma extravasation induced by histamine (0.1 mM) was potentiated by co-infusion with CGRP (0.1 microM) and PGE1 (3 microM). However the response to a submaximal dose (0.1 microM) of bradykinin, which induced similar plasma extravasation to histamine (0.1 mM), was not increased by co-infusion with CGRP or PGE1.(ABSTRACT TRUNCATED AT 250 WORDS)     

The use of the term vulnerability in acute care: why does it differ and what does it mean?

OBJECTIVE: Throughout health care literature, vulnerability is widely accepted as a potential issue for all patients yet the consensus on the meaning of and practical strategies to reduce or manage these 'harmful agents' in the clinical context are rarely offered. Three main themes emerge from the related literature which can be further refined into general terms of; social vulnerability--a person's basic statistical data in relation to their potential for illness; psychological vulnerability--the actual or potential harm to the identity of self and/or other emotional effects such as anxiety or stress caused by the ailment or treatment; and physical vulnerability--which refers to the actual physiological state where an individual is susceptible to further morbidity or mortality. SETTING: Acute care facilities. PRIMARY ARGUMENT: Although there is acknowledgment within the literature that individuals will experience some form of vulnerability when hospitalised, the complexity of what defines vulnerability for individuals causes further problems for patients and health professionals alike. CONCLUSIONS: This paper attempts to define vulnerability within the context of Western health care systems and raises the following issues: all states of vulnerability are accurate and appropriate in the context of the study or incidence alluded to, but further discussion and research is required to achieve a consensus to when, how, why and who is vulnerable. It is this recognition of the potentially differing classifications of vulnerability and the particular contexts that can be used that may assist nurses and other health care professionals with, not only problems associated with a patient's hospitalisation, but in the implementation of appropriate strategies to individual patient's cases.     

Men with learning disabilities who have sex with men in public places: mapping the needs of services and users in South East London

This survey investigated the prevalence of men with learning disabilities who have sex with men in public places in three south east London boroughs. The work was administered through contact with providers of services for people with leaming disabilities and was commissioned by the local health authority. It represents the first example of needs assessment work on this theme. Service responses to risk assessment and risk management in relation to HIV and the sexual behaviour of male service users were explored. The survey identified 13 services where this was a management or practice issue, and 16 and 18 men for whom this behaviour definitely or possibly applied. This paper reports the findings of the survey and identifies issues relevant to commissioning and providing services for people with learning disabilities.     

Detection of T cells responsive to a vascular growth factor in rheumatoid arthritis

The primary lesion in rheumatoid arthritis (RA) is a destructive synovitis characterized by proliferation of endothelial cells, fibroblasts, and vascular smooth muscle cells, and with perivascular lymphocyte aggregates. A nonhematopoietic growth factor, acidic fibroblast growth factor (aFGF), may induce many of the biological features found in rheumatoid synovium, including T cell activation. To determine if aFGF-responsive T cells are increased in RA, we developed an assay to measure the frequency of peripheral blood T cells that are costimulated by aFGF. The data indicate that the frequency of aFGF-responsive T cells is increased in RA and may change with disease activity and treatment.     

Production of serum antibodies that recognise epitopes located on the R3 region of Escherichia coli core lipopolysaccharides by patients infected with strains of enterohaemorrhagic E. coli

Antibody-antigen cross-reactions were examined with sera from patients with Escherichia coli O157 infection and lipopolysaccharide (LPS) purified from a range of enterohaemorrhagic E. coli (EHEC) including those belonging to serogroups O26, O103, O111, O145 and O157. Six of 10 patients infected with an O157 EHEC produced serum antibodies that cross-reacted with common LPS-core epitopes, which were expressed by 23 of 33 strains of EHEC examined. These common LPS-core epitopes were also present on strains of E. coli O26 which did not produce verocytotoxin. These cross-reacting antibodies did not influence the basic immunoblotting procedures used for the routine serodiagnosis of infections with E. coli O157.     

Unusual Enterobacteriaceae: a Salmonella cubana that is Urease Positive

This is the first report of a naturally occurring Salmonella that is urea positive. The strain was identified as Salmonella cubana and it was typical in all biochemical, serological, and bacteriophage reactions, except that is produced urease strongly.     

Z-line structural diversity in frog single muscle fiber in the passive state

The structural changes of the Z-line between small square net (ss) and basket weave (bw) cross-sectional patterns were examined using intact single fibers and mechanically skinned fibers in the passive state to determine if the pattern is related to the sarcomere length (SL) and if the pattern undergoes a reversible transition in low- and high-osmotic medium.Frog single fibers were isolated from the anterior tibial muscle in Ringer's solution. Entirely or partially skinned single fibers were prepared in relaxing solution (also called low-osmotic medium).The high osmotic medium contained 10% polyvinylpyrrolidone (PVP) in relaxing solution.The sarcomere length (SL) of each fiber was measured directly by use of a laser beam or indirectly from electron micrographs with use of a correction factor. The ss and bw forms in cross sections were quantified by analysis of electron micrographs. The results show that the structural change of Z-line occurs around bw 2.3–2.4m ss (n = 25) and bw 3.1–3.2m ss (n = 13) in intact single fibers and skinned fibers, respectively. With the quick freeze-freeze substitution method, an intact single fiber with a SL of 2.35m showed almost 100% of ss form. The structural transition in cross section was also confirmed in four partially skinned fibers, where patterns went from mostly ss form (intact portion) to mostly bw form (skinned portion) at the SL between 2.40 to 3.20m.The reversibility of the change between ss and bw was proved by using low- and high-osmotic medium. The transition and reversion of cross-sectional patterns both occur in the passive state.