Arthroscopic evaluation and treatment of the symptomatic previously operated knee

One hundred seventy-six knees in 172 consecutive patients with persistent or recurrent symptoms following a previous operative procedure were reevaluated and treated arthroscopically. Most knees had multiple findings, which are described. On the basis of these findings, four categories were defined: (a) the degenerative group; (b) the new meniscal tear group; (c) the fibroarthrosis group; (d) the minor problems group. Preoperative radiographic and clinical findings were correlated with the arthroscopically defined category. Follow-up evaluation by either comprehensive examination or detailed questionnaire was possible in 110 patients, with a mean follow-up interval of 31.4 months. A subjective rating scale relating to symptom level, functional level, and perceived surgical benefit was used. Overall, 68% of the patients were rated as satisfactory. By category, the frequencies of satisfactory results were: the degenerative group, 81%; the new meniscal tear group, 100%; the fibroarthrosis group, 75%; and the minor problems group, 47%. Workers' compensation claims correlated with a lower percentage of satisfactory results. Preoperative characteristics of those in the minor problems group were described. The poor results in this group suggest that common findings such as mild surface damage, minor adhesions, and minor meniscal lesions are often not symptomatic. Conservative management rather than arthroscopy may be more appropriate for patients in this group whereas arthroscopy is more reliable in treating symptomatic knees in the other three groups.     

Low-fat high-fiber diet decreased serum and urine androgens in men

To validate our hypothesis that reduction in dietary fat may result in changes in androgen metabolism, 39 middle-aged, white, healthy men (50-60 yr of age) were studied while they were consuming their usual high-fat, low-fiber diet and after 8 wk modulation to an isocaloric low-fat, high-fiber diet. Mean body weight decreased by 1 kg, whereas total caloric intake, energy expenditure, and activity index were not changed. After diet modulation, mean serum testosterone (T) concentration fell (P < 0.0001), accompanied by small but significant decreases in serum free T (P = 0.0045), 5 alpha-dihydrotestosterone (P = 0.0053), and adrenal androgens (androstendione, P = 0.0135; dehydroepiandrosterone sulfate, P = 0.0011). Serum estradiol and SHBG showed smaller decreases. Parallel decreases in urinary excretion of some testicular and adrenal androgens were demonstrated. Metabolic clearance rates of T were not changed, and production rates for T showed a downward trend while on low-fat diet modulation. We conclude that reduction in dietary fat intake (and increase in fiber) results in 12% consistent lowering of circulating androgen levels without changing the clearance.     

Mothers’ mental distress and parenting practices with infants and toddlers

Summary The purpose of this study was to examine whether maternal mental distress affects parenting practices related to monitoring activities (i.e. daily routines, enrichment activities). The nationally representative sample consisted of 1638 mothers. Maternal mental distress was assessed by the 5-item Mental Health Index (MHI). Logistic regression models were conducted, controlling for covariates (e.g. marital status, education level, etc.). Approximately 14% of the women reported high levels of mental distress and 25% of the women failed to engage in enrichment activities or consistent daily routines with their children. There was a significant adverse relationship between mental distress and routines, with women who were mentally distressed being more likely to not engage in daily routines. There was no significant relationship between mental distress and enrichment activities. Race differentials were evident among these relationships. These findings highlight the prevalence of maternal mental distress and its deleterious effects on select parenting behaviors.     

Analysis of renal service provision in south and mid Wales

OBJECTIVES: This paper estimates point prevalence of renal replacement therapy (RRT) utilization within population strata defined by geography and deprivation in south and mid Wales. It investigates spatial accessibility of main and satellite renal units by comparing population and patient numbers within bands of travel time. STUDY DESIGN: Prevalence study based on patient registers. METHODS: From a list of patient and renal unit locations, geocoded at the level of unit postcodes, and electoral division-level denominator population data, we calculated RRT point prevalence for the 16 unitary authorities in the study area, fifths of small area deprivation, and three bands of travel time from the nearest main renal unit and any (main or satellite) unit. RESULTS: Overall point prevalence was 633 per million population (pmp) and this varied from 256 to 780 pmp across unitary authorities. RRT prevalence was lower in more deprived areas. Sixty-nine percent of the population and 73% of patients lived within 30 min of a main renal unit. Eighty-four percent of the population and 88% of patients lived within 30 min of a main or satellite renal unit. CONCLUSIONS: The provision of satellite renal units has significantly improved spatial accessibility of RRT services. However, a substantial proportion of the population remains geographically distant from renal units. This has important implications for planning of future provision of RRT, given the inverse relationship between RRT acceptance and travel time, and the impact on quality of life of patients who travel frequently to renal units.     

Diagnosis of extracerebral fluid collections by computed tomography.

The computed tomography scans of 90 patients with extracerebral fluid collections were reviewed. Epidural hematomas, acute, subacute, and chronic subdural hematomas, convexity subarachnoid hemorrhages, subdural hygromas, and one epidural empyema were seen. The CT findings were analyzed and correlated with the time elapsed since injury (when known) and the results of radionuclide scans (when available). The overall accuracy of CT in detecting extracerebral fluid was 90% with no acute hemorrhages missed. In subacute and chronic subdural collections, six CT scans were false negative in whole or in part. Three false positive interpretations were made and are discussed.     

Markers of inflammation and their clinical significance

Inflammation plays an important role in the initiation and progression of atherosclerosis and the development of atherosclerotic events. Understanding the molecular basis of inflammation has led to the identification of markers that may also serve as new targets of therapy in the management of atherothrombotic disease. Inflammatory markers, such as C-reactive protein (CRP), have been shown to predict future cardiovascular events in individuals with and without established cardiovascular disease (CVD). Statins substantially reduce cardiovascular morbidity and mortality, and recently their anti-inflammatory properties have been investigated. In this paper, we discuss biomarkers implicated in the inflammatory process leading to atherothrombosis, including CRP, adiponectin, monocyte chemoattractant protein 1 (MCP-1), CD40 ligand and lipoprotein-associated phospholipase A(2) (Lp-PLA(2)), and the effect of statins on these markers and their potential relationship to cardiovascular events.