A comparison of nefopam and flurbiprofen in the treatment of osteoarthrosis

A double-blind cross-over study was undertaken comparing the analgesic nefopam with the NSAID flurbiprofen in the treatment of osteoarthritis of the knees. Thirty patients entered the study and 18 completed the full trial protocol of one month on each drug. There was no significant difference in efficacy between the two treatments, although there were more side effects during the nefopam period. These must be balanced against the known gastrotoxicity of NSAIDs when choosing symptomatic treatment for osteoarthrosis.     

Fatal systemic arterial air embolism following lung needle aspiration

Fatal systemic arterial air embolism occurred as a complication of percutaneous fine-needle aspiration of the lung, immediately following cytologic sampling of a vasculitic lesion of Wegener granulomatosis. This complication is extremely rare, and it may have been caused by the biopsy of abnormal veins, in which transmural inflammation prevented the normal vasoconstrictive responses to injury.     

Traction bow for acute reduction of fracture and/or dislocation of the thoracic or thoracolumbar spine

Treatment of acute fractures and/or fracture dislocations of the thoracic or thoracolumbar spine has traditionally involved bedrest or the use of traction devices with external hanging weights, until surgical correction can be accomplished. A fiberglass tubular traction bow with continuous adjustable elastic tension has been designed for the application of skeletal traction. When used to treat thoracic or thoracolumbar fractures and/or dislocations, it can maintain distraction forces in an uninterrupted fashion. Ten patients with acute fractures and/or dislocations of the thoracic or thoracolumbar spine were treated with this traction bow. All of the spinal deformities showed dramatic improvement within the first 3 h of treatment. The patients all showed immediate lessening of acute severe pain, and those with incomplete neurologic loss showed improvement of their neurologic function. The patients all tolerated the device well and were able to undergo radiologic examination and, ultimately, spinal fusion while they were stabilized in the traction bow. We believe this device is especially valuable for immediate reduction of spine and care of patients with fractures or fracture dislocations of the thoracolumbar spine.     

Sonography of full-thickness supraspinatus tears: comparison of patient positioning technique with surgical correlation

OBJECTIVE: Sonography has become a popular technique for the assessment of musculoskeletal disorders. Patient positioning is crucial to a thorough and accurate assessment of rotator cuff tendons. Two positions, the Crass and modified Crass, have been routinely used in the research and clinical settings to examine the supraspinatus tendon. Our study was a prospective trial to determine whether the Crass or the modified Crass position affords the most accurate measure of supraspinatus tears when compared with surgical findings. SUBJECTS AND METHODS: Twenty-one patients with full-thickness supraspinatus tears underwent shoulder sonography in both the Crass and the modified Crass positions. Measurements of supraspinatus tears were performed in the sagittal and transverse dimensions. Patients subsequently underwent either arthroscopic or open supraspinatus repair. Intraoperative measurements were made in two dimensions and were compared with sonographic findings. RESULTS: Sonography had 100% specificity in detecting full-thickness supraspinatus tears. No statistically significant difference was seen between the size of supraspinatus tears in the Crass and modified Crass positions and surgical findings in the transverse plane (p = 0.55 and 0.61, respectively). In the sagittal dimension, no statistically significant difference was seen between surgical findings and the Crass position (p = 0.14); however, a difference existed when the modified Crass position was used (p = 0.03). CONCLUSION: Sonography reliably detects and quantifies supraspinatus tears. Both the Crass and the modified Crass positions reflected the true size of supraspinatus tears in the transverse plane. In the sagittal plane, the Crass position is the more useful to quantify supraspinatus tears because the modified Crass position overestimates the size of such tears.     

Asymptomatic total hip prosthesis: natural history determined using Tc- 99m MDP bone scans

A prospective study was performed with 97 patients who had undergone total hip replacement surgery and who were not experiencing pain or other symptoms or problems. The study was intended to determine the normal postoperative appearance of radionuclide scans of the hip following administration of technetium-99m methylene diphosphonate. Five areas of the prostheses were evaluated. Results showed that 6 months after implantation activity around the lesser trochanter and prosthesis shaft became insignificant. Activity around the acetabulum, greater trochanter, and prosthesis tip stabilized approximately 2 years after surgery; approximately 10% of patients in the study had persistent activity in these areas. Familiarity with this normal progression is fundamental to interpretation of postoperative bone scans in patients with total hip prosthesis.