Nutritional status and clinical outcome in elderly female surgical orthopaedic patients

The possible relationship between nutritional status and clinical outcome following orthopaedic hip surgery was investigated. The nutritional status of 60 elderly female patients admitted for elective total hip replacement (THR) and emergency fractured neck of femur surgery (FNF) was measured over time. Specific measures of clinical outcome, including well-being and functional status, were monitored during hospital stay and at 4, 8 and 26 weeks following discharge. Patients were allocated to a high nutritional risk group where any three of the following were less than the 5th percentile value: serum albumin, haemoglobin, triceps skinfold thickness, mid-upper arm muscle circumference and body weight. Using this definition, malnutrition was present in 4% of THR patients and 41% of FNF patients. It was found that the high risk patients had significantly longer convalescence periods, (median stay 27.5 days compared with 0 days, P < 0.0009), and a greater proportion were dependent upon walking frames at 6 months (46% compared with 11%, P < 0.01). Fifty percent of the high risk patients had been living independently prior to admission, in contrast only 29% had returned to their homes at 6 months after discharge. The results indicate an apparent link between clinical outcome and nutritional status based upon the allocation procedure employed, which has the potential for ensuring cost-effective nutritional intervention.     

Ultrasound anatomy of the normal male reproductive tract

Ultrasound is being used with increasing frequency in the evaluation of the male reproductive tract. To detect abnormalities, it is important to have a comprehensive understanding of the normal anatomy and normal variations. In this article, the ultrasound anatomy of the scrotum, penis, prostate, and seminal vesicles is presented. Because ultrasound is a very visual process, the anatomy is presented not only with text, but also through the liberal use of ultrasound images and associated diagrams. Ultrasound is both an operator- and equipment-dependent procedure and, where appropriate, we have included technical discussions regarding ultrasound equipment and settings. © 1996 John Wiley & Sons, Inc.     

A Week and a Day

In an experiment conducted as part of Alcohol Alert Week, 30 employees of the New Zealand Department of Health were asked to abstain from alcohol for 8 days. Twelve abstained completely and two drank an only one occasion. Both abstainers and non-abstainers learned something about their own, and New Zealand, attitudes to alcohol during the course of the experiment.     

American Cancer Society guidelines for breast cancer screening: update 2003

In 2003, the American Cancer Society updated its guidelines for early detection of breast cancer based on recommendations from a formal review of evidence and a recent workshop. The new screening recommendations address screening mammography, physical examination, screening older women and women with comorbid conditions, screening women at high risk, and new screening technologies.     

Can immunization precipitate connective tissue disease? Report of five cases of systemic lupus erythematosus and review of the literature

OBJECTIVES: To report a series of five patients who developed systemic lupus erythematosus (SLE) after immunization and review the literature on vaccine-associated connective tissue diseases and the theoretical mechanisms that could explain such an association. METHODS: Uncontrolled retrospective analysis of cases identified sporadically over 7 years at three centers. RESULTS: In our series of 5 patients, symptoms of SLE developed within 2 to 3 weeks after secondary immunization. All patients met American College of Rheumatology (ACR) criteria for the diagnosis of SLE. In most patients, symptoms have been persistent. CONCLUSION: Although a coincidental association between vaccination and the onset of SLE cannot be excluded, the temporal relationship with the development of symptoms makes it immunologically plausible that vaccination triggered systemic autoimmunity in these rare cases. We propose that epidemiological studies be performed to examine this potential association in more detail to quantitate the risk and identify possible genetic risk factors.