Protective effect of sensory denervation in inflammatory arthritis (evidence of regulatory neuroimmune pathways in the arthritic joint)

OBJECTIVE: To investigate the direct effect of joint innervation on immune mediated joint inflammation in a patient with psoriatic arthritis (PsA).Case report: The patient developed arthritis mutilans in all digits of both hands with the exception of the left 4th finger, which had prior sensory denervation following traumatic nerve dissection. Plain radiography, ultrasonography and nerve conduction studies of the hands confirmed the absence of articular disease and sensory innervation in the left 4th digit. METHODS: This relationship between joint innervation and joint inflammation was investigated experimentally by prior surgical sensory denervation of the medial aspect of the knee in six Wistar rats in which carrageenan induced arthritis was subsequently induced. Prior sensory denervation--with preservation of muscle function--prevented the development of inflammatory arthritis in the denervated knee. DISCUSSION: Observations in human and animal inflammatory arthritis suggest that regulatory neuroimmune pathways in the joint are an important mechanism that modulates the clinical expression of inflammatory arthritis.     

Autotransfusion--a technique for the trauma patient.

The use of autotransfusion--the retrieval and reinfusion of shed blood--has been demonstrated to be a beneficial therapeutic modality for the trauma patient. The use of autotransfusion is indicated for major blood losses of the patient who experiences blunt or penetrating trauma and has an external or a cavitational bleeding source. Advantages and disadvantages are numerous. It does appear that because of the low incidence of complications and the many advantages, autotransfusion will become a widespread resuscitative technique for use with the trauma patient. The procedure also has clinical application for those other than trauma patients. The nursing implications suggested by this new modality are many, including legal considerations, safety factors, protocol adoption, and new nursing roles. Perhaps the most positive benefit to nursing is the opportunity for clinical nursing staff (ER and OR) to become involved in nursing research that they can apply directly to their clinical setting.