Supraacetabular insufficiency fractures

Insufficiency fractures in the supraacetabular region were identified in five women, aged 55-83 years. Factors contributing to the diminished resistance of their bones included postmenopausal osteoporosis, steroid therapy, radiation therapy, and rheumatoid arthritis. The supraacetabular fractures were seen on routine radiographs as hazy bands of sclerosis located immediately above and parallel to the acetabular roof. All five patients had additional fractures in the spine or pelvis. Supraacetabular insufficiency fractures may be an unsuspected cause of hip pain, especially in older women.     

Influence of lesion of the median raphe nucleus on motility and dopamine turnover

Both the spontaneous locomotor activity and the locomotor activity stimulated by apomorphine are enhanced in raphe lesioned animals. The exploratory activity does not show clearcut differences. After unilateral microinjection of dopamine into dopaminergic areas intensity of rotation and dominance of direction are amplified in lesioned animals. Other regions fail to evoke asymmetric or enhanced motoric reactions. The sensitivity of the dopaminergic system of raphe lesioned animals is increased too against unspecific stimulation, but with less strong dominance of direction. The general enhancement of motor activity reflects the inhibitory influence of the serotonergic system. In parallel to the change of behavior we observed a moderate increase of dopamine content connected with an accelerated turnover in lesioned animals.     

Stress fracture of the clavicle in a patient with no obvious risk factors

A 28-year-old woman presented with right shoulder pain and, after a delay, a diagnosis of clavicular stress fracture was made. The patient gave no history of repetitive abnormal loading of the upper limbs which could have assisted the diagnosis. The authors wish to raise awareness of this rare diagnosis such that it can be considered in the differential for shoulder pain of unclear origin.     

Sickle cell disease: a stigmatizing condition that may lead to depression

Individuals with a chronic illness such as sickle cell disease are at risk for depression. Moreover, they are at risk for untreated depression. Depression may go untreated because of the stigma and high rates of disability associated with this chronic illness that most often affects African Americans in the United States. The purpose of this cross-sectional study was to describe depressive symptoms using the Beck Depression Inventory Fast Screen in a sample of 232 African American adults with sickle cell disease. Respondents reported higher levels of depression (26%) and depressive symptoms (32%) than did the overall United States population (9.5%). All adults with chronic illnesses need to be screened for depression in primary care practice sites where the diagnosis and treatment of depression needs to be coordinated.