Septic arthritis of the glenohumeral joint: a review of 23 cases

Infection of the glenohumeral joint is an uncommon yet devastating condition. The objective of this study was to review the incidence, risk factors, presentation, and treatment for this disorder. Twenty-three culture-positive cases of septic arthritis of the glenohumeral joint were identified and treated at the authors' institution between 1986 and 2000. Eighty-seven percent of patients had at least one serious systemic illness, and on average had two. Fifty-two percent had a different primary site of infection identified. Staphylococcus aureus was identified as the infectious organism in 70% of cases, 17% of which were found to be methicillin-resistant S. aureus. Patients admitted to the orthopedic service were more likely to undergo surgical treatment. Patients treated surgically had shorter hospital stays than those treated with serial aspirations alone. Shoulder infections affect patients who are older and have multiple systemic diseases. Surgical treatment of shoulder infections, when compared to aspiration alone, is associated with a shorter hospital stay. Glenohumeral infection is a debilitating affliction even when control of the infection can be achieved.     

Effects of three groin compression methods on patient discomfort, distress, and vascular complications following a percutaneous coronary intervention procedure

BACKGROUND: Incidence of vascular complications (VCs) after sheath removal following a percutaneous coronary intervention procedure (PCIP) vary widely by the compression method used to achieve femoral artery hemostasis. OBJECTIVE: To determine if one groin compression method causes the least discomfort and distress for patients and results in fewer VCs. METHODS: Patients (n = 306, mean age = 62.3 years, 77% male, 96.4% Caucasian) undergoing PCIPs at a tertiary care center in the urban Midwest participated in this three-group experimental design study. They were randomly assigned to Femostop, C-clamp, or manual compression and rated level of groin discomfort and distress on a 0-10 Numeric Rating Scale (NRS) prior to, during, and after arterial compression was released. The groin area was assessed for any VCs (oozing, ecchymosis, hematoma) prior to sheath removal, after compression released, and 12 and 24 hr after sheath removal. RESULTS: No significant differences were found by compression method for discomfort, distress, or VCs. Regardless of method, not having a VC prior to femoral sheath removal contributes to less oozing (z = -3.1, p = .0019), hematoma (z = -9.4, p < .0001), and ecchymosis(z = -10.1, p < .0001). C-clamp contributes to less oozing when hemostasis time is < 30 min (z = -2.2, p = .03), and Femostop is superior when time to hemostasis is >30 min (z = -2.3, p = .02). Not receiving eptifibatide (Integrilin) contributes to less ecchymosis (z = -2.9, p = .004). CONCLUSIONS: Nurses need to be vigilant when caring for patients who have a VC prior to femoral sheath removal and have received antiplatelet medications. Further research is needed to identify patient characteristics that may contribute to VCs.     

Reduction in normalized bone elasticity following long-term bisphosphonate treatment as measured by ultrasound critical angle reflectometry

Using an improved version of ultrasound critical angle reflectometry, the bone quality of cortical and trabecular bone was assessed in vivo by measuring elastic moduli (normalized for bone density) at both principal axes, referred to as the minimum and maximum normalized elasticities. The measurements were made in 30 normal premenopausal women, 30 normal postmenopausal women, 22 untreated postmenopausal women with osteoporosis, 74 postmenopausal women with osteoporosis or osteopenia on bisphosphonate treatment, and 32 patients with renal transplantation (16 women and 16 men) taking steroids. Cortical elasticity was higher than trabecular elasticity; both declined slightly and non-significantly with age in normal women. Among untreated postmenopausal women with osteoporosis, cortical maximum normalized elasticity (E_cmax) remained within 95% prediction intervals of normal women. Among patients on bisphosphonate, E_cmax was low in the majority of patients. E_cmax was significantly more depressed among those taking the drug 3 years than <3 years (22.1% below normal premenopausal women versus 17.2%, P =0.001), and among those with incident non-spinal fractures than without (75.9 vs. 81.5%, P =0.008). E_cmax was independent of bone mineral density at the calcaneus. Most patients with renal transplantation had low E_cmax, with a mean 20.8% below the normal premenopausal mean. Qualitatively similar findings were found with cortical minimum elasticity and with trabecular minimum and maximum elasticities. Thus, the material bone quality of cortical and trabecular bone may be impaired following bisphosphonate treatment, as in renal transplantation on steroids.     

Prävalenz und Korrelate der Osteoarthrose in der BRD

ZusammenfassungHintergrund Zielsetzung der Arbeit ist die Ermittlung aktueller und repräsentativer Prävalenzdaten der Osteoarthrose innerhalb einzelner Bevölkerungsgruppen sowie die Identifizierung möglicher Risikofaktoren.Material und Methoden Im Rahmen einer Querschnittstudie, dem Ersten Bundesgesundheitssurvey für die BRD, wurden zwischen Oktober 1997 und März 1999 die Arthroseprävalenz, die Komorbidität und gesundheitsrelevante Verhaltensweisen der gesamtdeutschen Bevölkerung mittels eines ärztlichen Interviews und medizinischer Untersuchungen erfasst. Die zugrunde liegende Nettostichprobe umfasst insgesamt 6205 Personen im Alter von 18–79 Jahren.Ergebnisse Die 3 bedeutendsten Korrelate der Osteoarthrose sind das Alter, Adipositas und berufliche Belastungsfaktoren. Arthrosepatienten weisen häufiger Osteoporose, Schilddrüsenerkrankungen, chronische Bronchialerkrankungen sowie Hypertonie und erhöhte Blutfette, nicht aber Diabetes mellitus auf.Schlussfolgerung Unsere Daten unterstreichen die Wichtigkeit verhaltenspräventiver Maßnahmen wie eine Gewichtskontrolle und eine gelenkschonende Arbeitsplatzgestaltung.Gefördert durch den Forschungsfonds der Stiftung Orthopädische Universitätsklinik Heidelberg (Projektnummer F04–0026).     

Treatment of labial fusion with topical estrogen therapy

Twenty girls with labial fusion that covered at least 50% of the vaginal opening were treated with a topical estrogen cream. The cream was precisely applied to the fused area twice a day until the adhesions were totally lysed. After separation of the adhesions, a petroleum ointment (Vaseline) was applied twice a day to the labia minora for at least 1 month. The introital area was carefully rinsed twice each day before application of either the estrogen cream or the petroleum ointment. The mean age of the studied population was 13.2 months (range, 2 to 38 months). The mean duration of estrogen treatment was 2.4 months (range, 1 to 3.5 months). All patients were successfully treated. Five patients developed vulval pigmentation, which lasted for a mean of 1.5 months. One patient developed breast enlargement, which lasted for 1 month. The mean duration of follow-up was 3.1 months, and there was no recurrence of labial fusion during the period of follow-up. We conclude that treatment of labial fusion with topical estrogen therapy is safe and effective.     

R (+) etomidate and the photoactivable R (+) azietomidate have comparable anesthetic activity in wild-type mice and comparably decreased activity in mice with a N265M point mutation in the gamma-aminobutyric acid receptor beta3 subunit

A photoactivable diazirine derivative of etomidate, azietomidate, shares many actions of etomidate, including a capacity to abolish the righting reflexes in tadpoles and enhance gamma-aminobutyric acid (GABA)-induced currents. Azietomidate's usefulness in studies of mechanisms of anesthesia depends on the assumption that it shares a site of action with etomidate. Mice bearing an N265M beta3 subunit point mutation in GABA(A) receptors have a markedly decreased sensitivity to loss of righting reflexes induced by etomidate over a range of doses. Accordingly, in the present study we measured the time to recovery of righting reflexes of wild type and mutant mice as a function of dose given as an IV bolus. Analysis of the data for azietomidate yielded mean times to recovery of righting reflexes at a dose of 7.5 mg/kg of 10.0 +/- 0.9 min and 3.0 +/- 1.6 min for wild type and mutant mice, respectively (mean +/- sd). A similar analysis for etomidate yielded mean times to recovery of righting reflexes at a dose of 7.5 mg/kg of 12.0 +/- 1.3 min and 4.0 +/- 0.7 min for wild type and mutant mice respectively. Thus, at this dose a single mutation, N265M on the beta3 subunit of the GABA(A) receptor, approximately halved the time to recovery of righting reflexes for both etomidate and azietomidate (by 7.6 +/- 1.5 min and 7.2 +/- 1.8 min, respectively), emphasizing the contribution of this residue as a determinant of a behavioral response of azietomidate in mice.     

Inequalities in influenza vaccine uptake among people aged over 74 years in Britain

BACKGROUND: In the UK, payments to providers (General Practitioners) for vaccinating all people aged over 64 years old against influenza commenced in 2000. Little information exists on the relationship between uptake and need. We assessed factors influencing uptake and equity in uptake in over 74 year olds. METHODS: We analysed cohort data from 5572 subjects in a community-based trial. Analyses took into account clustering and location of general practices in terms of Underprivileged Area (UPA) Score and area Standardised Mortality Ratio (SMR). RESULTS: Vaccine uptake in practices in the most deprived tertile was 0.88 (95% CI 0.80-0.96) that of the least deprived and mid tertile, adjusted for confounding. Within each deprivation tertile, uptake in the mid and highest SMR tertile was 0.86 (95% CI 0.79, 0.94) and 0.87 (95% CI 0.81, 0.95) that of the lowest respectively. Uptake was 10% lower at the most in individuals with poorer quality housing. Higher uptake if married or with respiratory conditions and lower uptake if smoked had cognitive impairment or depression did not explain the socioeconomic differentials. CONCLUSIONS: Lower uptake in practices in deprived areas supports targeting of resources. At the individual level, those who are more isolated require support to access influenza vaccination.     

Urinary proteome of steroid-sensitive and steroid-resistant idiopathic nephrotic syndrome of childhood

The response to steroid therapy is used to characterize the idiopathic nephrotic syndrome (INS) of childhood as either steroid-sensitive (SSNS) or steroid-resistant (SRNS), a classification with a better prognostic capability than renal biopsy. The majority (approximately 80%) of INS is due to minimal change disease but the percentage of focal and segmental glomerulosclerosis is increasing. We applied a new technological platform to examine the urine proteome to determine if different urinary protein excretion profiles could differentiate patients with SSNS from those with SRNS. Twenty-five patients with INS and 17 control patients were studied. Mid-stream urines were analyzed using surface enhanced laser desorption and ionization mass spectrometry(SELDI-MS). Data were analyzed using multiple bioinformatic techniques. Patient classification was performed using Biomarker Pattern Software and a generalized form of Adaboost and predictive models were generated using a supervised algorithm with cross-validation. Urinary proteomic data distinguished INS patients from control patients, irrespective of steroid response, with a sensitivity of 92.3%, specificity of 93.7%, positive predictive value of 96% and a negative predictive value of 88.2%. Classification of patients as SSNS or SRNS was 100%. A protein of mass 4,144 daltons was identified as the single most important classifier in distinguishing SSNS from SRNS. SELDI-MS combined with bioinformatics can identify different proteomic patterns in INS. Characterization of the proteins of interest identified by this proteomic approach with prospective clinical validation may yield a valuable clinical tool for the non-invasive prediction of treatment response and prognosis.