Charcot arthropathy because of congenital insensitivity to pain in an adult

BACKGROUND: Congenital insensitivity to pain is a rare disorder that can lead to neuropathic arthropathy of any joint including the spine. Most of the case reports in the literature are in the pediatric population. PURPOSE: This case report emphasizes the importance of anterior and posterior fusion in patients with congenital insensitivity to pain. The patient was initially treated as if the deformity was postinfectious. STUDY DESIGN SETTING: The patient was treated in a university-based tertiary care center. METHODS: The patient underwent an anterior decompression and fusion with instrumentation that failed with ambulation. An anterior and posterior revision with instrumentation was then performed to stabilize the Charcot spine. RESULTS: The patient had an excellent final outcome. At 2 years postoperatively, he is solidly fused and back to his normal occupation. CONCLUSION: Anterior and posterior fusion is essential in neuropathic spinal arthropathy. Congenital insensitivity to pain can manifest problems into adulthood.     

Positive and Negative Reinforcement Underlying Risk Behavior in Early Adolescents

The goal of the current study was to examine the combined influence of positive reinforcement processes using a behavioral task measuring risk taking propensity (RTP) and negative reinforcement processes using a behavioral task measuring deficits in distress tolerance (DT) on a range of risk taking behaviors among early adolescents. Participants included a community sample of 230 early adolescents (aged 9–13) who completed two behavioral tasks assessing reinforcement processes as well as reported on past year risk behavior involvement as assessed by items from the Youth Risk Behavior Surveillance System at a baseline and a 1-year follow-up assessment. Data indicated that at the Wave 2 assessment, RTP was positively related to number of risk-taking behaviors in the past year but only for those with low DT, with this finding persisting after controlling for the significant influence of male gender and higher sensation seeking. Results of the present study highlight the importance of considering both positive and negative reinforcement processes in combination when investigating vulnerability factors for early risk behavior engagement in youth.     

Ophthalmologic examinations in children with juvenile rheumatoid arthritis

Unlike the joints, ocular involvement with juvenile rheumatoid arthritis is most often asymptomatic; yet, the inflammation can cause serious morbidity with loss of vision. Scheduled slit-lamp examinations by an ophthalmologist at specific intervals can detect ocular disease early, and prompt treatment can prevent vision loss.