HIV infection in haemophilia--a European cohort

Ten haemophilia centres in northern Europe have pooled data on 202 haemophilic children who were infected with HIV between 1979 and 1986. All cases were under 16 years of age on 1 July 1985. The age at infection ranged from 1-15 years. Thirty seven cases (18%) had progressed to AIDS by 1 July 1991 and 15 of these have died. Persistent generalised lymphadenopathy has been noted in 102 patients of whom 18 (17%) have developed AIDS. Twenty three of the remaining patients (23%) have not. CD4+ T cell counts have fallen steadily. Of 36 patients who have had shingles since seroconversion, 19 (53%) had counts below 0.2 x 10(9)/l. Thirty five out of 145 patients without shingles (24%) had similar values. The mean IgA concentration in patients with CD4+ T cell counts above 0.5 x 10(9)/l was 2.38 g/l, between 0.2 and 0.5 was 3.07 g/l, and in those with CD4+ T cell counts below 0.2 x 10(9)/l the mean IgA concentration was 4.58 g/l. Treatment patterns have altered between 1989 and 1991, with increased use of zidovudine in patients without AIDS and a marked increase in primary prophylaxis against pneumocystis pneumonia. This has been associated with a decline in the incidence of pneumocystis as an indicator disease in new AIDS cases from 56% in 1989 to 20% in 1991. These observations indicate that persistent generalised lymphadenopathy does not worsen the outlook, but shingles does. Rising IgA concentrations are markers for disease progression. Modern prophylactic regimens are delaying the onset of indicator disease, but CD4 values continue to fall steadily.     

Mineral balance and whole body bone mineral content in very low-birth-weight infants

Fat and mineral metabolic balance studies were performed in 25 normal very low-birth-weight infants ( 1500 g at birth) fed either pooled pasteurized human milk supplemented with calcium, phosphorus and magnesium, or a preterm formula. Calcium, phosphorus and magnesium intake were similar in both groups and averaged 100mg/kg/day, 72 mg/kg/day and 8 mg/kg/day, respectively. Calcium and phosphorus retention was higher in the subjects fed fortified human milk than in those receiving a preterm formula (65±14 and 62±9mg/kg/day versus 55±12 and 47±7mg/kg/day respectively). The difference was only significant for phosphorus. Magnesium retention was similar in the two groups and averaged 3 mg/kg/day. Fat intake and absorption was significantly higher in the preterm formula fed group than in the one fed fortified human milk (5.5±0.4 g/kg/day and 88±4% versus 4.2±1 g/kg/day, 79±6% respectively). Assessment of the whole body bone mineral content by dual energy X-ray absorptiometry was performed at 3 and 6 months of age in another group of 25 low-birth-weight infants fed either fortified human milk or a preterm formula. Whole body bone mineral content (BMCt) was low (43.3±30.8 g of hydroxyapatite) at 3 months of age (theoretical term) compared to normal full-term newborns at birth. There was no significant influence of the diet. At 6 months of age, BMCt reached 168.6±36.6g, a value similar to that of full-term newborns, with no significant difference between the two regimen groups. The deficit in the 12 subjects who had a BMCt under 30 g at 3 months of age had been corrected at age 6 months. Premature babies fed a pooled pasteurized human milk enriched with calcium, phosphorus and magnesium favored a better retention of calcium and phosphorus. However, no significant influence of the two diets studied was observed on the gain in BMCt over the first 6 months of life.     

Identifying error pathways during elbow and knee replacements

The aim of our study was to identify errors and error pathways during joint replacements and to propose improvements. A time-action and error analysis method was adapted for use during surgery. The error analysis consisted of identifying all possible errors, determining error paths presented in an error chart, quantifying errors, and determining the impact of errors. This method was used to evaluate joint replacements. We evaluated five knee and 11 elbow replacements done by two experienced surgeons. The main error for elbow replacements was caused by inadequate instruments. The main error for knee replacements was caused by inexperienced nurses being unfamiliar with guiding instruments. The time-action analysis showed a large variation in procedure duration. The main surgical limitations for both procedures were waiting caused by the cementing process and waiting caused by inexperienced scrub nurses. Our study identified errors and surgical limitations during joint replacements by using time-action and error analysis. Placement of both prostheses will benefit from new fixation techniques, a more experienced nursing staff, and more organized instrument tables.     

Translation, adaptation and validation of the Shoulder Rating Questionnaire (SRQ) into the Dutch language

OBJECTIVE: To translate and adapt the original English version of the Shoulder Rating Questionnaire (SRQ) into the Dutch language (SRQ-DLV) and evaluate its internal consistency, reliability, validity and responsiveness to clinical changes. DESIGN: Prospective study. SETTING: Outpatient departments of orthopaedics, radiology and physical therapy of an academic and a non-academic hospital. SUBJECTS: One hundred and seven patients treated for unilateral shoulder disorder (adhesive capsulitis 68, calcifying tendinitis 22, impingement syndrome or rotator cuff tear 17). METHODS: The original SRQ was translated and adapted following international guidelines. The SRQ-DLV was used among other measures of body function and structure, activities and societal participation in order to determine reliability, internal consistency, validity and responsiveness. Assessments were done at baseline and three months after treatment, with the SRQ-DLV being re-administered within one week before the baseline measurement and the start of the treatment for testing reliability. RESULTS: Cronbach's alpha for internal consistency was 0.89 for the total questionnaire and 0.81, 0.80, 0.72 and 0.84 for the domains pain, daily activities, sports/recreational activities and work, respectively. Test-retest reliability of the SRQ-DLV and its subscales ranged from 0.63 to 0.86. The summary score of the SRQ-DLV correlated with measures of shoulder function, daily activities and quality of life. Except for the work subscale of the SRQ-DLV, large effect sizes, reflecting its responsiveness to clinical changes after treatment, were found for both the summary and the subscales scores. CONCLUSIONS: Empirical data support that the SRQ-DLV is a reliable, valid and responsive measure to be used in clinical trials including Dutch patients with various shoulder disorders.     

Relapsing polychondritis studied by computed tomography

Computed tomographic findings in a patient with relapsing polychondritis are described. Collapse of the cartilage of the nose and calcification in cartilages of the ears were clearly demonstrated. CT scanning was also helpful in evaluating the tracheobronchial tree for airway compromise, which could prove fatal in this condition.     

Quantitative assessment of fatty degeneration in rotator cuff muscles determined with computed tomography

OBJECTIVES: Reliable assessment of fatty degeneration of rotator cuff muscles is desirable to predict the outcome of shoulder surgery. Currently used qualitative assessments are limited by relatively high inter- and intraobserver variability. It was hypothesized that a quantitative measurement of muscle density using computed tomography (CT) was more reliable and reproducible. MATERIALS AND METHODS: Thirty shoulders from patients with rheumatoid arthritis were analyzed using parasagittal multiplanar reconstructions acquired from a 16-slice CT scanner. Three observers visually rated the severity of fatty degeneration and independently outlined the rotator cuff muscles, after which the mean density was calculated. Inter- and intraobserver agreement on both measurements was expressed by the interclass correlation coefficient (ICC) and the standard deviation of the differences (SDD) between the measurements. RESULTS: A strong correlation was found between the quantitative measure and the visual rating (R2 = 0.94; P < 0.0001). The SDD in muscle density did not exceed 2.3 Hounsfield units, and the mean rotator cuff ICC (0.98) was substantially greater than that of the visual rating (0.63). CONCLUSIONS: This study describes a reproducible method to quantify fatty degeneration of the rotator cuff muscles in CT images, with a higher interobserver agreement than the visual score, and may prove a reliable tool to evaluate the quality of the rotator cuff muscles.