A benign psoas mass following metal-on-metal resurfacing of the hip

As metal-on-metal arthroplasty becomes more widespread, concerns are being raised about the potential dangers of metal particulate debris. We present the case of a benign psoas mass secondary to the presence of such particles. The mass was excised and the hip resurfacing subsequently revised to a total hip replacement.     

The prevalence of depression in two districts of Uganda

AbstractBackground Little information is available on the prevalence of depression in Uganda. Given the recent political history of Uganda, depression may be common.Method The aim was to estimate the point prevalence of probable clinical depressive disorder among the general population in two contrasting districts of Uganda. Translated versions (in Madi and Lusoga) of the 13-item Beck Depression Inventory (BDI) were administered to a systematic sample of adult residents in the Adjumani and Bugiri districts of Uganda.Results The overall prevalence of probably clinically significant depression (BDI score of 20–39) was 17.4%. Significantly higher rates were found in women and in Adjumani District.Conclusion Depression is common in Uganda and particularly in the more troubled and less socially cohesive district of Adjumani.     

Are self-referrers just the worried well?

BACKGROUND: Reluctance to seek formal help has been seen as a major problem in trying to reduce the prevalence of anxiety and depression. AIMS: The aims of this study were to assess the psychiatric status of those self-referring to psycho-educational Stress and Self-Confidence community workshops using a cognitive behavioural therapy (CBT) approach. METHOD: Cross-sectional analysis of 196 people who referred themselves to community workshops was carried out using the Clinical Interview Schedule (CIS-R) psychiatric interview and the Beck Depression Inventory (BDI) and Spielberger Trait Anxiety Inventory (STAI-T) scale self-report assessments. RESULTS: Over 70% of all self-referrers had an ICD-10 diagnosis. Those without diagnoses had experienced recurrent significant psychological problems and 29.7% had never consulted their General Practitioner (GP) for anxiety/depression problems. Total CIS-R scores and white ethnic group best predicted previous GP consultation. CONCLUSION: Setting up a self-referral system can enable those with diagnosable psychiatric problems, who may otherwise be reluctant to seek help, to come forward. This may have significant public mental health implications.     

Corticosteroid avoidance ameliorates lymphocele formation and wound healing complications associated with sirolimus therapy

INTRODUCTION: Sirolimus (RAPA) and corticosteroids (CS) both inhibit wound healing. To evaluate the possibility that RAPA and CS have additive effects on wound healing, we evaluated the effects of corticosteroid avoidance (CSAV) on wound healing complications in patients treated with RAPA. METHODS: One hundred nine patients treated with a CSAV regimen (no pretransplantation or posttransplantation CS) were compared with a historical control group (n = 72) that received cyclosporine (CsA), mycophenolate mofetil (MMF), and CS. The CSAV group received low-dose CsA, MMF, RAPA, and thymoglobulin induction. Complications were classified as follows: wound healing complications (WHC) or infectious wound complications (IWC). WHC included lymphocele, hernia, dehiscence, diastasis, and skin edge separation. IWC included wound abscess and empiric antibiotic therapy for wound erythema. RESULTS: The CSAV group was largely CS-free: 11% of patients received CS for rejection, 12% of patients received CS for recurrent disease, and 85% of patients are currently off CS. The CSAV group had a significantly lower incidence of WHC (13.7% vs 28%; P = .03) and lymphoceles (5.5% vs 16%; P = .02) than the control group. There was no difference in the incidence of IWC between the 2 groups. Patients who received CSAV were 18% less likely (P = .57) to develop any type of complication, 41% less likely (P = .20) to develop a WHC, and 71% less likely (P = .018) to develop a lymphocele. CONCLUSIONS: CSAV in a RAPA-based regimen results in a marked reduction in WHC and lymphoceles. Therefore, CSAV provides a promising approach for addressing WHC associated with RAPA therapy.     

Early steroid withdrawal does not increase risk for recurrent focal segmental glomerulosclerosis

Experience with early corticosteroid withdrawal (CSWD) in renal transplant recipients with focal segmental glomerulosclerosis (FSGS) has not been previously reported. Since corticosteroids are used to treat primary FSGS, concern exists as to whether early CSWD regimens will be associated with an increased risk of FSGS recurrence posttransplant. The purpose of the present study was to evaluate the results of early CSWD in FSGS recipients and compare these results to a historic control group of FSGS patients who underwent renal transplantation under corticosteroid-based immunosuppression. METHODS: Forty-three patients with FSGS underwent renal transplantation with early CSWD. Results in these patients were compared to FSGS patients that underwent renal transplantation with chronic corticosteroid therapy. All rejection episodes were biopsy proven with grading by Banff criteria. Statistical analyses included Student's t test and chi square tests. RESULTS: Results in 43 patients with a median follow-up of 569 days were analyzed and compared to control patients. There was no significant difference in recurrent FSGS, time to recurrence, or graft loss. CONCLUSION: CSWD does not increase risk for recurrence of FSGS. These observations indicate that ECSW can be achieved in FSGS patients, thereby affording them the benefits of steroid elimination.     

Influence of educational programs on perceived barriers toward living donor kidney exchange programs

Living donor kidney exchange programs (LDKEPs) provide significant advantages toward addressing ABO and crossmatch incompatibility in living donor kidney transplantation, however, they have not yet realized their potential. The aim of this study was to examine the effect of an educational conference on perceived barriers toward living donor kidney transplantation and LDKEPs. METHODS: Between 2002 and 2004, a state-wide living donor/living donor kidney exchange program was established by the Ohio Solid Organ Transplant Consortium (OSOTC). Prior to initiating the OSOTC LDKEP, an educational conference was held and its effect on transplant professional attitudes toward LDKEP barriers were assessed prior to and following the conference using a questionnaire. Questions were answered using a Likert scale (LS) (1 = strongly agree, 5 = strongly disagree). RESULTS: Forty-eight participants completed questionnaires prior to and following the conference. The conference was judged to increase understanding of KEPs. The complementary web-based computer matching program was also felt to be an important component for the LDKEP. The conference did not affect the state of decision making regarding KEPs, however. Perceived barriers to LDKEPs not influenced by the educational conference included (1) concerns about donor travel costs, (2) concern about potential medical legal problems, (3) lack of perceived superiority of LDKEPs over desensitization protocols, and (4) concern about donation to strangers. Although numeric trends existed for each of these barriers, none were statistically significantly influenced by the education conference. CONCLUSIONS: These results suggest that interventions other than large scale educational conferences will be needed to address the barriers to LDKEP.     

Multimodal therapy including neoadjuvant methotrexate,vinblastine, doxorubicin,and cisplatin (MVAC) for stage IIB to IV cervical cancer

OBJECTIVE: The purpose of this study was to determine the survival rates and toxicity levels that are associated with multimodal therapy (including neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin [MVAC]) in patients with stage IIB to IVB cervical cancer. STUDY DESIGN: We retrospectively reviewed the cases of 49 patients who were treated between 1989 and 1997 with neoadjuvant MVAC for advanced cervical cancer. RESULTS: The clinical response rate was 90% (27 partial responders, 17 complete responders). Grade 3 or greater toxicity was mostly limited to neutropenia; no deaths were attributed to MVAC. Combined therapy after MVAC included operation in 34 patients (69%) and radiation in 41 patients (84%). Twenty-one patients (43%) had <2 cm residual tumor at histologic evaluation. Pelvic control was achieved in 86% of patients. Five-year disease-specific survival for patients with stage III disease was 60%. CONCLUSION: For patients with advanced cervical cancer, neoadjuvant MVAC had a high response rate (90%) and an acceptable toxicity level. Compared with historic control subjects, multimodal treatment may be associated with improved rates of pelvic control.     

Clinical predictors of cervical intraepithelial neoplasia 2 or greater in women with mildly abnormal Pap smears

OBJECTIVE: To evaluate clinical predictors of cervical intraepithelial neoplasia (CIN) 2 or greater in women with mildly abnormal Pap smears. STUDY DESIGN: Using a computerized colposcopy database of 2,200 women, we identified 1,494 with atypical squamous cells of undetermined significance (ASCUS) or low grade squamous intraepithelial lesions (LSILs). Of the 1,494, 1,016 (68%) underwent biopsy and formed the cohort for this retrospective review. Clinical variables associated with CIN 2 or greater in a univariate analysis (P < .10) were included in a multivariate regression analysis. RESULTS: Of the 1,016 women biopsied, 195 (19%) had CIN 2 or greater. In the initial analysis, age (< 35 years), race (Caucasian and African American), marital status (unmarried) and smoking status (current and former) were found to be significantly associated with more severe histologic disease. In the regression analysis, a history of smoking remained a statistically significant clinical predictor of CIN 2 or greater (odds ratio 1.57, 95% confidence intervals 1.09-2.27). CONCLUSION: A significant predictor of CIN 2 or greater in a large cohort of women with mildly abnormal Pap smears was a history of current or former smoking.