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PubMedDate not supplied

Extensible endoprostheses for bone tumors of the proximal femur in children.

Between 1983 and 1996, nine children were treated with extensible endoprosthetic replacements of the proximal femur after resection of primary bone tumors. Four patients died of their disease. The remaining five patients were observed for an average follow-up period of 7.6 years. In these five patients, the authors performed an average of 10.2 operations per patient, including five lengthenings and a mean total extension of 69.7 mm per patient. Acetabular loosening and hip dislocations were the most frequent complications. Only two patients have not had a revision or a major complication. Despite this, four children are alive with a functioning lower limb and a mean Musculoskeletal Tumor Society functional score of 77.6%. Extensible endoprosthesis of the proximal femur is a viable alternative to hip disarticulation and in selected children offers an opportunity for near-normal development of the lower limb by allowing equalization of limb length and the ability to walk without the use of mobility aids.

Adolescent↗
PubMed2004

Disseminated Prototheca wickerhamii infection with arthritis and tenosynovitis.

Achloric algae of the Prototheca species are a rare cause of infection in humans. These infections are usually localized to the skin, olecranon bursae, and tendon sheaths of the hands and wrists. Our patient with acquired immunodeficiency syndrome and a chronic Prototheca wickerhamii skin infection of the hand developed tenosynovitis and arthritis of his ankle in the setting of a documented algemia. This is the first reported case of protothecal arthritis and tenosynovitis resulting from hematogenous dissemination. The reported musculoskeletal manifestations of protothecal infections are reviewed.

AIDS-Related Opportunistic Infections↗
PubMed2006

Work and health in Gnosjö: a longitudinal study.

This study includes women and men born between 1934 and 1953 in the municipality of Gnosjö in the south of Sweden and covers the period 1998 to 2001. Compared with the country, a large proportion of the population of the municipality of Gnosjö works in the manufacturing industry. The aim was to examine associations between physical and psychological stress factors in and outside work, sickness absence and cardiovascular and musculoskeletal diseases, from a gender perspective. Information about working conditions and other aspect of life was collected by a questionnaire in 1998, and register data about sickness absence, cardiovascular diseases and musculoskeletal diseases 1999-2001. The impact on sickness absence consisted mainly of demand and control aspects of the psychosocial working conditions, but also temporary employment and of low sense of coherence. In relation to musculoskeletal health, demand and control was important among women, but not among men. Very few physical factors in the work environment were related to musculoskeletal diseases. Low sense of coherence had an impact also on musculoskeletal diseases. Cardiovascular diseases among women were influenced by demand and control and by life style related factors. We hope that the knowledge gained from our study makes it possible to develop better tools for both the preventive work in Gnosjö and for the rehabilitation of the people already ill. Because of our holistic approach, both public health aspects and working life aspects are covered. The municipality of Gnosjö is small, and therefore foreseeable in a way that many municipalities are not. Still, we do believe that our finding, in this longitudinal study, can be of value also in the public efforts and the efforts to develop adequate and successful rehabilitation approaches.

Aged↗
PubMed2006

A web-based test of residents' skills in diagnostic radiology.

PURPOSE: To develop an objective, Web-based tool for evaluating residents' knowledge of diagnostic radiology. METHODS: We developed and tested a Web-based evaluation tool (the Diagnostic Radiology Skills Test) that consists of 3 tests, one in each of 3 domains of diagnostic radiology: chest, gastrointestinal, and musculoskeletal imaging. Each test comprises 30 cases representing a range of difficulty in the domain, including normal states, normal variants, typical cases of common diagnoses, and cases with more subtle findings. Cases are presented with a long menu of domain-specific possible diagnoses (response options), each coded for diagnostic appropriateness. Our subjects were 21 residents in postgraduate year (PGY) 2 to 5 and 11 experts in diagnostic radiology. Subjects accessed the tool via a Web site on our Web server. Residents' test results were compared for reliability and validity across domain, case, and training level. In addition, results were correlated with commonly used established and objective evaluation tools. RESULTS: The tool demonstrated consistent monotonic improvement in performance with training level. It showed acceptable reliability in discriminating between residents at different performance levels, both within and across training levels (r= 0.53 within level and 0.69 across levels). Test results also had concurrent validity against the American College of Radiology In-Training Examination, a widely accepted objective assessment tool (r = 0.65, P < 0.01), and 2 Objective Structured Clinical Examinations (OSCEs) focusing on diagnostic skills (r= 0.78 and r= 0.69, P < 0.01, respectively). CONCLUSIONS: Our study demonstrates the feasibility of a Web-based, standardized, objective assessment method for evaluating residents' performance.

Clinical Competence↗
PubMed1990

Cervical dystonia following exposure to high-G forces.

Injuries to the cervical region have been associated with high-G loads sustained during air combat maneuvering (ACM) in high performance fighter aircraft. The spectrum of injuries ranges from mild neck pain to musculoskeletal strain, injury to the nerve roots or spinal cord, and fracture of the cervical spine. A 36-year-old fighter pilot with 2,800 h in tactical jet aircraft developed progressive cervical dystonia (spasmodic torticollis), following an ACM flight. The patient was successfully treated with local intramuscular injections of botulinum toxin into the affected cervical muscles, resulting in total relief of his spasmodic torticollis. The aeromedical considerations of this rare complication of exposure to G forces in high performance aircraft are discussed.

Adult↗
PubMed1983

Angiotensin-converting enzyme in sarcoid perivasculitis.

A young woman was treated with topical and oral steroids for sarcoidosis manifested by systemic symptoms, involvement of the respiratory and musculoskeletal systems, and anterior uveitis. Her symptoms, ocular findings, pulmonary function, and serum angiotensin-converting enzyme level all improved in response to therapy. After tapering the steroid dosage retinal perivasculitis developed associated with a small but significant elevation of the serum angiotensin-converting enzyme level. Increasing the dosage of oral steroids resulted in prompt resolution of her retinal findings but no change in the level of the serum angiotensin-converting enzyme. This suggests that changes in the serum angiotensin-converting enzyme level may not parallel the course of ocular sarcoidosis limited to the posterior segment.

Administration, Oral↗
PubMedDate not supplied

Stress fractures in 51 runners.

A prospective study was initiated in 1976 to investigate runners who are at risk for incurring stress fractures and how these fractures can be prevented. Fifty-one runners incurred 57 stress fractures. Tibial fractures were most common (25), followed by fibula (12) and metatarsal (8). Seven runners had previously sustained stress fractures, and six developed two stress fractures simultaneously. Five women over 30 years old had pelvic stress fractures. Stress fracture development was positively correlated with the presence of pes planus, weekly training distances greater than 20 miles, hard training surfaces, and training regimen modifications. The incidence did not correlate with generalized musculoskeletal laxity or tightness. Forty-four of 51 patients had initially positive roentgenograms. Five of five bone scans were positive. The average duration of rest before running was resumed was 7.4 weeks.

Adolescent↗
PubMed2000

Will the use of different prevalence rates influence the development of a primary prevention programme for low-back problems?

To determine relations to low-back problems (LBP), different prevalence rates are used. The disadvantage of using different selection criteria is that studies are not comparable, except where they provide the same results. The present aim was to establish whether different prevalence selection criteria lead to different answers on a newly formed set of questionnaires. Since this set is new, reliability tests were performed (test-retest and calculations of Cronbach's Alpha, Cohen's Kappa and the intraclass correlation). Results of the questionnaire should form the cornerstones of a primary prevention programme. Altogether 1783 nurses in four Flemish (Belgian) hospitals were questioned. Information was gathered on work circumstances, education, general health, psychosocial factors, leisure activities, family situation and musculoskeletal problems. Four different datasets with variables related to lifetime prevalence LBP, annual prevalence LBP, point prevalence LBP and a set with all related variables were constructed. The variables demonstrating a relation with LBP differed slightly depending on the kind of prevalence used (lifetime, annual, point). A factor analysis on each set of prevalence related data failed due to the lack of homogeneity of the variables. Fear avoidance, coping aspects and musculoskeletal problems in other regions then the lower back were, in all circumstances, the most discriminating variables. Their discriminating power, however, differed depending on the kind of prevalence used. The differences were too small to influence the construction of the prevention programme. It is concluded that in developing a primary prevention programme any of the prevalence rates can be used. The combination of the three types of prevalence rates studied provides the most complete and reliable image.

Adaptation, Psychological↗
PubMed1988

Evaluation of the musculoskeletal system with sonography.

Although musculoskeletal sonography historically has received little attention, its use in certain specific situations has clear advantages over use of other imaging techniques. The wide availability of sonography, its modest cost, and its lack of ionizing radiation are other reasons that its use in musculoskeletal conditions is expected to increase. We have reviewed potential applications; some of these applications are new and have been used in a small series of patients, and others, such as infant hip sonography, have already been used in thousands of cases. Additional applications may be possible [64]. Those learning the techniques of musculoskeletal sonography will find that progress is made most quickly when there is close cooperation between the sonographer and the clinician. While experience is being gained, each party must endeavor to understand what the technique is able to determine and what it cannot determine. Only through close cooperation, and with adequate opportunity to learn, will the sonographer and the clinician develop confidence in the technique to the point that it becomes the effective imaging alternative that best suits the needs of the patient.

Achilles Tendon↗
PubMed2005

The past, present, and future of bone morphometry: its contribution to an improved understanding of bone biology.

It was not until the 1950s that a better paradigm for bone biology evolved, which led to the birth of bone histomorphometry. Two clinicians, Harold Frost (1958-1964) and Lent Johnson (1964), were responsible for the paradigm stating that the primary function of bone is mechanical load bearing with subsidiary function to participate in plasma calcium homeostasis to support hematopoesis. Dynamic bone histomorphometry was born when Milch et al. (1958) discovered bone localization of tetracycline and Frost generated the methodology to study tetracycline-based dynamic histological analysis of cortical bone remodeling (1961-1965). Dynamic bone histomorphometry did not blossom until Frost, while a Sun Valley Workshop participant, developed it to address trabecular bone dynamics. The combination of Arnold (1948) producing thin sections of plastic-embedded undecalcified bone and Frost's (1977-1983) modification of dynamic cortical bone histology for cancellous bone made it possible to study tetracycline-based dynamic histomorphometry of cancellous bone. It led to the better understanding of basic metabolic unit (BMU) remodelling and to Frost's mechanostat hypothesis, and characterized the rat model to accelerate the development of several drugs in the treatment of bone diseases. Currently, dynamic bone histomorphometry has contributed to studies in bone's mechanical usage windows, mechanical usage setpoint hypothesis, muscle-bone relations, marrow-bone relations, the Utah paradigm of musculoskeletal physiology, apoptosis, genetics (transgenic mice) and bone structure, bone quality, the lacunocanalicular network and bone modelling, and remodeling hypothesis, osteocyte role as mechanosensory, chemosensory, and regulatory in bone maintenance, targeted and untargeted remodeling, the role of permissive agents, etc., items in bone biology expounded briefly by Lent Johnson (1965) and continuously by Harold Frost at the Sun Valley Workshop (1965-2003). Finally, "What's next?" covers how to improve and perpetuate the employing of qualitative histomorphometry in research opportunities in hard tissue research.

Animals↗
PubMed2006

Reduction of musculoskeletal injuries in intensive care nurses using ceiling-mounted patient lifts.

The musculoskeletal injury (MSI) rate in the Richmond Hospital Intensive Care Unit (ICU) increased significantly in 2000 and 2001 by 130%. As part of a quality initiative program, the problem was identified, assessed, and a plan was developed that involved the installation of ceiling-mounted patient lifts (CMPL) and the incorporation of a patient positioning sling. The evaluation process included a survey given to the ICU nursing staff prior to the implementation of the CMPL and repeated three, six, and 18 months after implementation. The survey included questions about discomfort, fatigue, and frustration levels before and after a 12-hour shift, as well as any medical interventions such as use of medications, physician visits, physiotherapy, and massage therapy for work-related issues. The use of the lifts contributed to lower scores in fatigue, pain and frustration in addition to a reduction in medical visits. The results also demonstrated a significant reduction in work-related time loss claims while promoting a positive workplace environment.

Absenteeism↗
PubMed2004

Do physical leisure time activities prevent fatigue? A 15 month prospective study of nurses' aides.

OBJECTIVE: To test the hypothesis that physical leisure time activities reduce the risk of developing persistent fatigue. METHODS: The hypothesis was tested in a sample that was homogeneous with respect to sex and occupation, with a prospective cohort design. Of 6234 vocationally active, female, Norwegian nurses' aides, not on leave because of illness or pregnancy when they completed a mailed questionnaire in 1999, 5341 (85.7%) completed a second questionnaire 15 months later. The main outcome measure was the prevalence of persistent fatigue-that is, always or usually feeling fatigued in the daytime during the preceding 14 days. RESULTS: In participants without persistent fatigue at baseline, reported engagement in physical leisure time activities for 20 minutes or more at least once a week during the three months before baseline was associated with a reduced risk of persistent fatigue at the follow up (odds ratio = 0.70; 95% confidence interval 0.55 to 0.89), after adjustments for age, affective symptoms, sleeping problems, musculoskeletal pain, long term health problems of any kind, smoking, marital status, tasks of a caring nature during leisure time, and work factors at baseline. CONCLUSION: The study supports the hypothesis that physical leisure time activities reduce the risk of developing persistent fatigue.

Adult↗
PubMed1985

Hypophysectomy mitigates skeletal muscle fiber damage in hamster dystrophy.

Ablation of the pituitary gland by a radiofrequency lesion markedly retarded the musculoskeletal growth of young dystrophic hamsters. The prevalence of centronucleated muscle fibers, which is a reliable cumulative index of the microscopic pathological expression of dystrophy, was drastically reduced in quadriceps muscles of 35- and 45-day-old hypophysectomized dystrophic hamsters, compared with sham-operated controls. Mitigation of skeletal muscle fiber damage by musculoskeletal growth retardation may also occur in human dystrophy.

Animals↗
PubMed1993

Trapezius muscle load as a risk indicator for occupational shoulder-neck complaints.

Upper trapezius muscle activity was quantified by electromyographic (EMG) recordings using surface electrodes to study occupational muscle load as a risk indicator for the development of shoulder-neck complaints. Thirty-nine female production workers and thirty-two female office workers showed much larger interindividual differences than the mean difference in muscle activity between the two groups. By comparison with the production workers, the muscle activity patterns of the office workers were characterized by more short pauses and a lower static load. The median load level was similar for the two groups. For the office workers, but not for the production workers, weak correlations were found between symptoms of pain in the shoulder-neck region and some of the EMG parameters (static level and frequency of micropauses > 0.6 s. Current techniques for measuring shoulder muscle load by EMG recordings seem inadequate as screening methods to predict future risk of development of muscle pain symptoms.

Adult↗
PubMed1995

Death before birth: clues from gene knockouts and mutations.

A survey of mouse gene knockouts, transgene insertions and spontaneous mutations that are lethal prenatally reveals that surprisingly few developmental disturbances lead to death of the embryo and early foetus. These disturbances include failure to establish and maintain a vascular circulation, and failure to make the transition from yolk-sac-based to liver-based haematopoiesis. The embryo must also establish gestation-dependent routes of nutritional interaction with the mother, including implantation, formation of a yolk-sac vascular circulation, and formation of a chorioallantoic placenta. A number of embryonic organ and body systems, including the central nervous system, gut, lungs, urogenital system and musculoskeletal system, appear to have little or no survival value in utero.

Animals↗
PubMed2001

The effect of bone morphogenetic protein-2 expression on the early fate of skeletal muscle-derived cells.

The identification of bone morphogenetic proteins (BMPs) has stimulated intense interest in BMP delivery approaches. Ex vivo BMP-2 gene delivery has recently been described using skeletal muscle-derived cells. Skeletal muscle-derived cells, because of proven efficient transgene delivery and osteocompetence, represent an attractive cell population on which to base ex vivo BMP-2 gene delivery. However, the early in vivo fate of BMP-2-expressing muscle-derived cells is unknown. This study investigates the in vivo effects of BMP-2 secretion on skeletal muscle-derived cells in terms of cell survival and cell differentiation. The first experiment compared survival of BMP-2-expressing cells with control cells during the first 48 h after in vivo implantation. The results demonstrate that BMP-2 secretion did not adversely affect cell survival 8, 24, or 48 h after intramuscular implantation. The second experiment histologically compared the fate of BMP-2-expressing muscle-derived cells to the same cells not expressing BMP-2. The results show that BMP-2 expression prevented in vivo myogenic differentiation and promoted osteogenic differentiation of the transduced cells. This study further supports the existence of osteoprogenitor cells residing within skeletal muscle. Moreover, it is demonstrated that BMP-2 secretion does not adversely affect early cell survival of muscle-derived cells. These data are important for future investigations into BMP-2 gene delivery approaches to the musculoskeletal system.

Animals↗
PubMedDate not supplied

Patient-practitioner perceptions: can chiropractors assume congruence?

BACKGROUND: Advances in mind-body medicine have resulted in the realization that beliefs can modulate pathophysiologic processes. Because symbolic interaction affects health status, perceptions and the congruence between the perceptions of chiropractors and their patients become a relevant clinical consideration. OBJECTIVE: A case study to explore the congruence of health-relevant perceptions of chiropractors and their patients was undertaken. METHOD: This Australian case study was undertaken to explore the concurrence of patient-practitioner perceptions with respect to the patient's stress levels, the importance of injury as a causative factor in the presenting symptom and the responsibility the patient should take "in getting themselves well." Purposive sampling of practitioners and convenience sampling of patients was undertaken. Data were collected by means of a patient questionnaire and a practitioner questionnaire and interview. Data were analyzed to determine the congruence of patient-practitioner perceptions within each of 173 consultations. RESULTS: A total of 9 practitioners and 173 patients participated. Within each patient-practitioner dyad, congruence of perceptions was <50% in each of 3 dimensions examined. Most patients believed they should take a high level of responsibility for "getting well." DISCUSSION: Although the results of a case study cannot be extrapolated to the chiropractic patient population, this study does suggest that it may be prudent for chiropractors to ascertain the extent to which their patients share their perceptions of the presenting clinical problem. "Thinking hats" are proposed as a helpful perception management tool. CONCLUSION: This exploratory study suggests that practitioners should not assume that their patients share their perceptions. Given that each patient-practitioner encounter is unique, it may be prudent for chiropractors to actively ascertain the patient's opinions. A patient's perception of his or her responsibility for "getting well" should be harnessed in developing management plans with high compliance.

Chiropractic↗