Disease activity level, remission and response in established rheumatoid arthritis: Performance of various criteria sets in an observational cohort, treated with anti-TNF agents

Background  

Most composite indices of disease activity and response criteria in RA have been validated and compared in clinical trials rather than routine care. We therefore wanted to compare the performance of the DAS28, SDAI and CDAI activity indices, their activity states, their response criteria, and also compare with the ACR response criteria in an observational clinical setting.     

Changing clinical presentation of angiosarcomas after breast cancer: from late tumors in edematous arms to earlier tumors on the thoracic wall

Angiosarcoma is a rare complication of breast cancer treatment. In order to define predictors, clinical presentation, and outcome, we characterized a population-based 50-year cohort of angiosarcomas after breast cancer. Clinical data were collected from all females with previous breast cancer who developed angiosarcomas/lymphangiosarcomas on the thoracic wall/upper extremity between 1958 and 2008 in the Southern Swedish health care region. In total, 31 angiosarcomas developed at a median age of 71 years. The patients formed two distinct groups; 14 females treated for breast cancer with radical mastectomy and radiotherapy 1949–1988 developed angiosarcomas in edematous arms (Stewart–Treves syndrome) after median 11 years, and 17 females treated by segmental resection, anti-hormonal treatment and radiotherapy 1980–2005 developed angiosarcomas in the irradiated field on the thoracic wall after median 7.3 years. The clinical presentations were heterogeneous and included hematoma-like lesions, multiple bluish-reddish nodules, and asymptomatic lumps. The overall 5-year survival was 16%. In this population-based cohort, the early angiosarcomas developed in edematous arms after radical mastectomies, whereas more recent cases occurred after a shorter time period in the irradiated fields following breast conserving surgery. We conclude that the clinical presentation of angiosarcomas has changed, parallel with altered treatment principles for breast cancer.     

What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics?

Background and purpose An acetabular labral tear is a diagnostic challenge. Various clinical tests have been described, but little is known about their diagnostic sensitivity and specificity. We investigated the diagnostic validity of clinical tests and ultra-sound as compared with MR arthrography.Patients and methods We examined 18 patients (18 hips, 2 men, median age 43 (32–56) years) with impingement test, FABER test, resisted straight leg raise test, ultrasound, and MR arthrography. They had had previous periacetabular osteotomies due to symptomatic, acetabular dysplasia. All hips showed no or only slight signs of osteoarthritis (Tönnis grade 0–1).Results MR arthrography identified labral tears in 17 of the 18 hips. Ultrasound had a sensitivity of 94%, a positive predictive value of 94%, and was false negative in only 1 case compared to MR arthrography. The impingement test had the best diagnostic ability of the clinical tests, with a sensitivity of 59% and a specificity of 100%. The positive predictive value was 100% while the negative predictive value was 13%.Interpretation The impingement test is helpful in identifying acetabular labral tears. If this test is negative and if a labral tear is still suspected, ultrasound can reliably diagnose most tears of the acetabular labrum. MR arthrography is indicated in cases where ultrasound is negative, but the patient suffers continued, specific symptoms.     

Navigated versus conventional drilling of the knee in a model of obesity

Core decompression by exact drilling into ischemic lesions of the femoral condyle stays a challenging procedure, particularly in obese patients. The precision of fluoroscopically-based drilling compared to conventional drilling was evaluated in an in-vitro model for obesity. 40 sawbones were prepared mimicking osteonecrosis in obese patients. 20 sawbones were drilled by guidance of an intraoperative navigation system VectorVision® (BrainLAB, Munich, Germany); the other 20 sawbones were conventionally drilled by fluoroscopic control only. Regarding the distance to the desired mid-point of the lesion, a statistically significant difference with 0.55 mm in the navigated group and 1.19 mm in the control group could be stated (p<0.001). Significant differences were further found for the number of drilling corrections (p<0.001) and radiation time needed (p<0.001). Even in difficult circumstances as in obese patients, the drilling guided by the VectorVision®-navigation system shows high precision with simultaneous enormous reduction of radiation time.     

Nurse-led medication reviews and the quality of drug treatment of elderly hospitalized patients

Purpose  

To evaluate if nurses after receiving training in clinical pharmacology can improve the quality of the drug therapy in elderly hospitalized patients.     

Empirically derived subclassification of the autistic syndrome

A method is presented for empirical subclassification of autistic and autisticlike children, based on observations of current behavior. The advantage of the method is that it identifies profiles of cooccurring behaviors and accordingly assigns children to subtypes. The subtypes are more clinically homogeneous than the overall sample of autistic children. Preliminary findings are presented, including an effort to validate the subclasses by suggesting possible relationships between subtype membership and perinatal markers, developmental milestones, and independent measures of concurrent behavior.This work was supported by postdoctoral training grants MH-15147 and MH-16744 from the National Institute of Mental Health (Siegel), by the Scottish Rite Foundation (Anders, Siegel), by the John Merck Fund (Ciaranello), and by the National Institute of Mental Health grant MH-38064 (Anders, Ciaranello). A portion of this work was presented at the Annual Meeting of the National Society for Children and Adults with Autism, Salt Lake City, July 1983.