From diagnosis to treatment of gluteus medius tendon tear of the hip: a case report]

OBJECTIVE: To report a case of spontaneous gluteus medius tear repaired surgically in a 42-year-old woman patient without any other antecedent other than diabetes. PATIENT AND METHODS-RESULTS: Trochanteric pain evolving for 7 months led to scintigraphy objectifying a hyperfixation of the trochanter and ultrasonography showing an inflammatory gluteus medius tendon. These examinations were supplemented by magnetic resonance imaging and tomodensitometry visualising the tendon rupture but no marked fat degeneration of the muscle despite atrophy of this one. Surgical exploration confirmed the presence of a major rupture of the gluteus medius tendon, which was reinserted through an osseous trench. Rehabilitation involved protecting the tendon, by an installation of the member in abduction and passive mobilization from the third postoperative day, with a move to partial support on day 45. The result after 16 months was excellent, the patient returning to work 8 months after the surgery without any residual pain. CONCLUSION: The spontaneous rupture of the gluteus medius, often ignored, can occur in young subjects and induce limited function, often well corrected by reinsertion surgery.     

Quality of life is predictive of relapse in schizophrenia

Background

Obese and overweight people have a higher risk of both chronic physical illness and mental illness. Obesity is reported to be positively associated with psychiatric disorders, especially in people who seek obesity treatment. At the same time, obesity treatment may be influenced by psychological factors or personality characteristics. This study aimed to understand the prevalence of mental disorders among ethnic Chinese who sought obesity treatment.

Methods

Subjects were retrospectively recruited from an obesity treatment center in Taiwan. The obesity treatments included bariatric surgery and non-surgery treatment. All subjects underwent a standardized clinical evaluation with two questionnaires and a psychiatric referral when needed. The psychiatric diagnosis was made thorough psychiatric clinic interviews using the SCID. A total of 841 patients were recruited. We compared the difference in psychiatric disorder prevalence between patients with surgical and non-surgical treatment.

Results

Of the 841 patients, 42% had at least one psychiatric disorder. Mood disorders, anxiety disorders and eating disorders were the most prevalent categories of psychiatric disorders. Females had more mood disorders and eating disorders than males. The surgical group had more binge-eating disorder, adjustment disorder, and sleep disorders than the non-surgical group.

Conclusion

A high prevalence of psychiatric disorders was found among ethnic Chinese seeking obesity treatment. This is consistent with study results in the US and Europe.     

Core Discrete Event Simulation Model for the Evaluation of Health Care Technologies in Major Depressive Disorder

ObjectiveA review of existing economic models in major depressive disorder (MDD) highlighted the need for models with longer time horizons that also account for heterogeneity in treatment pathways between patients. A core discrete event simulation model was developed to estimate health and cost outcomes associated with alternative treatment strategies.MethodsThis model simulated short- and long-term clinical events (partial response, remission, relapse, recovery, and recurrence), adverse events, and treatment changes (titration, switch, addition, and discontinuation) over up to 5 years. Several treatment pathways were defined on the basis of fictitious antidepressants with three levels of efficacy, tolerability, and price (low, medium, and high) from first line to third line. The model was populated with input data from the literature for the UK setting. Model outputs include time in different health states, quality-adjusted life-years (QALYs), and costs from National Health Service and societal perspectives. The codes are open source.ResultsPredicted costs and QALYs from this model are within the range of results from previous economic evaluations. The largest cost components from the payer perspective were physician visits and hospitalizations. Key parameters driving the predicted costs and QALYs were utility values, effectiveness, and frequency of physician visits. Differences in QALYs and costs between two strategies with different effectiveness increased approximately twofold when the time horizon increased from 1 to 5 years.ConclusionThe discrete event simulation model can provide a more comprehensive evaluation of different therapeutic options in MDD, compared with existing Markov models, and can be used to compare a wide range of health care technologies in various groups of patients with MDD.     

Autoantibodies to ribosomal P proteins in systemic lupus erythematosus

Autoantibodies to ribosomal P proteins (anti-P) are directed against three ribosomal phosphoproteins (P0, P1, and P2) and are believed to be specific markers for systemic lupus erythematosus (SLE), particularly with neuropsychiatric manifestations. The objective of this study was to determine the rate of occurrence and clinical significance of anti-P in Tunisian patients. METHODS: We included 100 Tunisian patients with SLE whose sera were received between January 1998 and December 2000 by the immunology laboratory of the Charles Nicolle Teaching Hospital in Tunis, Tunisia, and were tested for anti-P. An immunodot technique based on a synthetic protein shared by all ribosomal phosphoproteins was used. RESULTS: Sera from 22 (22%) patients were positive for anti-P. This rate is consistent with the literature. We found no statistically significant associations between anti-P and specific manifestations of SLE. CONCLUSION. We found that anti-P were significantly associated with anti-Sm and anti-RNP, as reported previously. The significance of these associations remains debatable.     

Nasal localization of the Crohn's disease

Crohn's diseases is a chronic granulomatous inflammatory disease of the gastrointestinal tract. Any part of the gastrointestinal tract may be affected, and 9% of cases have oral lesions (1). Nasal involvement is exceptionally rare. We report a case of nasal involvement revealed by chronic atrophic rhinitis in a patient with known Crohn's disease.     

Concomitant alar and apical ligament avulsion in atlanto-axial rotatory fixation. Case report and review of the literature

The authors report a case of Fielding type II acute atlanto-axial rotatory fixation (AARF). The CT scan with coronal reconstruction showed an avulsion of the apical and right alar ligament. These findings are exceptionally reported in the literature, especially concerning the apical ligament which might be a stabiliser in flexion and extension of the occipitocervical joint.     

Prognosis of traumatic head injury in South Tunisia: a multivariate analysis of 437 cases

BACKGROUND: This study aimed to determine predictive factors of mortality after posttraumatic brain injury. METHODS: A retrospective study conducted over a 3-year period (1997-1999) involved 437 adult patients with head injury admitted to the intensive care unit of a university hospital in Sfax, Tunisia. Basic demographic, clinical, biologic, and radiologic data were recorded at admission and during the intensive care unit stay. RESULTS: This study included 393 men (90%) and 44 women with a mean age of 36 +/- 17 years. Traffic accidents were the main cause of trauma (85.6%). In 58% of the cases, the injury was serious (Glasgow Coma Score, <8). The mean simplified acute physiology score was 39 +/- 15, and the mean Injury Severity Score was 34.5 +/- 17. Of the 437 patients, 127 (29.1%) died. According to multivariate analysis, the factors that correlated with a poor prognosis were age older than 40 years (p < 0.01), simplified acute physiology score exceeding 40 (p < 0.001), Glasgow Coma Score lower than 7 (p = 0.03), intracranial mass lesion (p = 0.02), a cerebral herniation (p < 0.001), diabetes insipidus (p < 0.001), and blood sugar level higher than 10 mmol/L (p < 0. 001). CONCLUSIONS: In Tunisia, head injury is a frequent cause of hospitalization, comprising 14.4% of all adult admissions. It is observed most often among young patients involved in traffic accidents. The short-term prognosis is poor, with a high (29%) mortality rate, and determined by demographic, clinical, radiologic, and biologic factors. Prevention is highly advised.     

Systemic lupus erythematosus with celiac disease: a report of five cases

Systemic lupus erythematosus and celiac disease (CD) are rarely reported in combination. We report five cases seen over a 4-year period. The two conditions occurred concomitantly in one patient, whereas the CD antedated the lupus in one patient and postdated the lupus in the remaining three patients. Villous atrophy on duodenal biopsy specimens with a favorable response to a gluten-free diet was noted in all five patients. Only four patients had positive serological tests for CD and only three had abdominal symptoms.