Synovial chondromatosis of the metacarpophalangeal joint: case report and review of the literature

Intra-articular synovial chondromatosis in the hand is rare but should be considered in the differential diagnosis of a swollen, stiff or painful joint. Other possible diagnoses include osteoarthritis, rheumatoid arthritis, gout, trauma and chronic infection, and unless enchondral ossification of loose bodies is seen the diagnosis of synovial chondromatosis may not be made preoperatively. A 69-year-old man with synovial chondromatosis of the metacarpophalangeal joint is reported. The joint was swollen and tender. He had not sustained trauma and there was no evidence of arthritis, involvement of other joints or infection. Complete synovectomy with removal of all loose bodies was successful and his symptoms resolved. Intra-articular synovial chondromatosis is a benign condition, but spontaneous resolution is the exception and surgical synovectomy remains the most effective treatment.     

Guidelines for dispensing medications

Federal and state codes exist regarding administering and dispensing medications and there is variation between the two. Recognition of the differences is imperative for the athletic trainer, who has traditionally dispensed these agents in compliance with established legal and professional guidelines. Statutes that apply to classifying, documenting, prescribing, dispensing, labeling, and housing medications by athletic trainers are presented as a baseline for this article. State and local regulations should be consulted to clarify differences existing at various governmental levels. These guidelines are provided to assist athletic trainers in properly dispensing medications.     

Characteristics of sex offenders who were sexually victimized as children

From a data bank of 479 sex offenders, a comparison was undertaken of those reporting any childhood sexual abuse versus those reporting none. A total of 201 men (42.0%) reported abuse, 261 (54.5%) did not and for 17 (3.5%), information was unavailable. The Abused and Nonabused Groups were compared on demographic information, the MMPI, Clarke Sex History Questionnaire and the Clarke Parent Child Relations Questionnaire. The Abused and Nonabused groups were similar in age, marital status, income, and criminal history, but the Abused Group had significantly less education. The Abused Group showed sexualization of their childhood, not only in the number of contacts with adults but also with age peers and siblings of both sexes. They tended to have wider ranging and more frequent sexual experiences as adults both with men and women. They more often raped. The Abused Group tended to show more emotional instability than the Nonabused Group in more frequent suicidal ideation and suicide attempts, as well as in elevated Mania Scale Scores on the MMPI. The family background of the Abused Group was more disturbed than the Nonabused Group's; especially father-son relations. They reported more alcohol use and abuse in their parents and more parent-child aggression than nonabused offenders did. Although it is unlikely that child sexual abuse causes sexual anomalies, the results of the present study suggest that childhood sexual victimization in the lives of adult sex offenders merits further investigation and has implications for treatment.     

Manpower shortage: multiple competency and cross-training.

The terms "cross training" and "multi-competency" have been much confused--Ms. Wright clearly defines the terms and gives some observations on the manpower shortage. Since cost containment will be a fact of life for the '90s, she presents thoughtful strategies to increase productivity and to combat the shortage. Her perspective on changes occurring in our profession over the past two decades provides readers with a thoughtful article.     

Transdermal scopolamine decreases nausea and vomiting following cesarean section in patients receiving epidural morphine

The authors evaluated the antiemetic properties of transdermal scopolamine (TDS) in healthy patients undergoing elective cesarean section and receiving epidural morphine for postoperative analgesia. Prior to administration of anesthesia, 203 patients had either TDS or a placebo study patch applied behind one ear. All patients were hydrated with lactated Ringer's solution iv and given 2.0% lidocaine with 1:200,000 epinephrine epidurally for surgical anesthesia. Following delivery of the infant, 4 mg of morphine sulphate was injected through the epidural catheter. After the operation patients were evaluated by "blinded" observers at 2, 4, 6, 8, 10, 24, and 48 h for nausea, vomiting, retching, pain relief, itching, and adverse effects. In addition, medications received were noted. No differences were found between the groups in terms of severity or incidence of pain, or requests for analgesic or antipruritic medication. Although there was no difference between the groups in the first 2 h, patients with TDS had significantly less nausea, vomiting, and retching than patients in the placebo group in each time interval between 2 and 10 h. Additionally, the TDS group required less antiemetic medication. There was no difference in the frequency of retching or vomiting between groups. Side effects were minimal and equal in both groups. The authors conclude that TDS results in a decreased incidence of nausea and vomiting in patients who have delivered by cesarean section and received epidural morphine. TDS appears safe for continuous antiemetic administration.     

Mental health patients in primary health care services in Nepal

Patients attending two primary care settings in Nepal (a village health post and a district hospital outpatient department) were screened for psychiatric morbidity using the Self Reporting Questionnaire. Approximately one-quarter of all patients screened were found to have psychiatric morbidity. Women presenting were found to have higher frequency of "psychiatric caseness" than men. All these psychiatric patients presented with physical complaints, none with psychological, and the most common physical symptoms presented were abdominal pain, headache and cough. Health worker recognition of these cases was 29% in the health post and 0% in the hospital. Conclusions are drawn regarding the need for sufficient and relevant psychiatric teaching in health worker curriculae.     

The nature of the shamanic state of consciousness: a review

A review of the literature suggests that a common psychobiological process is associated with various altered states of consciousness (ASC) utilized by shamans, meditators, and mediums. However, the shamanic state of consciousness (SSC) can be differentiated physiologically from possession trance states. The psychophysiological literature on different types of trances and on seizure conditions associated with the temporal lobe discharge syndrome is reviewed. On this basis, it is hypothesized that while both the SSC and possession trances involve hippocampal-septal stimulation, the difference between the SSC and the possession states includes the amygdala involvement associated with the latter. This criterion and others establish a basis for differentiating between the terms "shamanic," "shamanistic," and "mediumistic." The physiological concomitants of the SSC make it appear to be both physiologically and psychologically beneficial as well as indicating that it is most likely that there is a genetic component affecting one's ability to enter the SSC and other ASC.     

Recovery from short term intense exercise: Its relation to capillary supply and blood lactate concentration

Summary Muscle force recovery from short term intense exercise was examined in 16 physically active men. They performed 50 consecutive maximal voluntary knee extensions. Following a 40-s rest period five additional maximal contractions were executed. The decrease in torque during the 50 contractions and the peak torque during the five contractions relative to initial torque were used as indices for fatigue and recovery, respectively. Venous blood samples were collected repeatedly up to 8 min post exercise for subsequent lactate analyses. Muscle biopsies were obtained from m. vastus lateralis and analysed for fiber type composition, fiber area, and capillary density. Peak torque decreased 67 (range 47–82%) as a result of the repeated contractions. Following recovery, peak torque averaged 70 (47–86%) of the initial value. Lactate concentration after the 50 contractions was 2.9±1.3 mmol·l⁻¹ and the peak post exercise value averaged 8.7±2.1 mmol·l⁻¹. Fatigue and recovery respectively were correlated with capillary density (r=−0.71 and 0.69) but not with fiber type distribution. A relationship was demonstrated between capillary density and post exercise/peak post exercise blood lactate concentration (r=0.64). Based on the present findings it is suggested that lactate elimination from the exercising muscle is partly dependent upon the capillary supply and subsequently influences the rate of muscle force recovery. Dr. Tesch was on leave from Department of Clinical Physiology, Karolinska Hospital, Stockholm, Sweden     

Socioeconomic position and cardiovascular and neuroendocrine responses following cognitive challenge in old age

Social disparities in health persist into old age, and differences in psychophysiological responsivity may contribute to this pattern. We assessed whether higher socioeconomic status (SES) is associated with attenuated cardiovascular and neuroendocrine responses elicited by cognitive tasks in old age. We tested 132 community-dwelling men and women aged 65-80 years, divided on the basis of educational attainment into higher and lower SES groups, and compared them with 26 higher educated participants aged 27-42 years. Blood pressure, hemodynamic variables and salivary cortisol were assessed in response to the performance of three cognitive tasks, and then during recovery. Older groups showed smaller heart rate and larger cortisol changes than younger participants. Post-task recovery in heart rate, stroke volume, pre-ejection period, and systolic blood pressure was greatest in the younger group, least in the older/lower education group, and intermediate in the older/higher education group. SES did not influence the increased cortisol responsivity of older participants. The results are consistent with the notion that higher SES protects against age-related changes in cardiovascular response profiles, particularly during recovery.     

Switching from a restricted to an effective CD4 T cell response by activating CD8+ murine dendritic cells with a Toll-like receptor 9 ligand

Freshly isolated quiescent splenic dendritic cell (DC) subtypes differ in their capacity to activate naive CD4 T cells in culture. The CD8+ DC showed a reduced capacity to stimulate T cell proliferation compared to either of the CD8- DC subsets, regardless of antigen and DC dose. In contrast to CD8- DC, the quiescent CD8+ DC did not induce IFN-gamma production from CD4 T cells. The difference between the DC subtypes appeared to be at the level of initial surface molecule interactions, but could not be attributed to differences in expression of MHC class II or B7 family molecules, or to the expression of Fas ligand on DC. However, when activated by inclusion of the Toll-like receptor 9 ligand CpG in culture, CD8+ DC became potent stimulators of both CD4 T cell proliferation and IFN-gamma production. In contrast, similar activation of CD8- DC produced a more modest increase in capacity to stimulate CD4 T cell proliferation and no increase in capacity to stimulate IFN-gamma production. The difference between a quiescent and an activated state is therefore more extreme for CD8+ than for CD8- DC. The especially tight regulation of the activity of CD8+ DC may be essential for the maintenance of self tolerance.