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Data from 4225 persons from the National Health and Nutrition Examination Survey (HANES) was used to determine whether obesity was associated with osteoarthritis (OA) or joint pain. Subjects were divided into four groups on the basis of sex and race. We found that obesity was associated with OA of the knee for each sex/race group (p less than 0.01). The association was strongest for women, and it was present even for subjects without evidence of knee pain on physical examination. Frame size was not significantly associated with OA of the knee. Relative weight was weakly associated with OA of the hips in white women and nonwhite men but not significantly associated with OA of the sacroiliac joint. Diabetes did not seem to be an important risk factor for OA. These results suggest that the additional mechanical stress resulting from obesity is the principal reason for the association between obesity and OA.
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PMID:The association of obesity with joint pain and osteoarthritis in the HANES data. 395 17

The authors experienced two elderly patients of megacolon associated with cerebral infarction and diabetes mellitus. The first patient was a 66-year-old female who was admitted to our hospital for rehabilitation with a complaint of knee pain. She had suffered from diabetes mellitus since she was 30 years old and multiple cerebral infarction since age 62. Two months after admission, she had an episode of abdominal distension and obstructive symptoms. The roentgenograms of her abdomen showed diffuse dilatation of the colon. The second patient was a 78-year-old female admitted to our hospital with complaints of abdominal pain, distension of the abdomen and vomiting. Her abdomen was severely distended and plain roentgenograms of the abdomen, X-ray studies of the colon with the aid of contrast medium and CT scan of the abdomen showed striking dilatation of the colon. Megacolon may be congenital or acquired, and in acquired forms the conditions are secondary to organic diseases, smooth muscle atrophy, metabolic and neurological diseases, ulcerative colitis or psychogenic origin (idiopathic). The two patients in this series were suffered from cerebral infarction and diabetes mellitus. The mechanisms of megacolon seen in these two patients are not known, but involvement of the visceral autonomic innervation is presumed. Some elderly patients have chronic constipation, and dilatation of the colon may not be uncommon due to underlying diseases or drugs. Therefore, when examining elderly patients, careful attention should be paid to their bowel movement.
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PMID:[Two elderly cases of megacolon associated with cerebral infarction and diabetes mellitus]. 836 Oct 82

Seven patients underwent primary and contralateral revision total knee arthroplasty (TKA) under one anesthetic in a sequential fashion. The average patient age was 67.6+/-6.9 years. Average blood loss was 764+/-568 cc, average operative time was 269+/-107 minutes, and average length of hospital stay was 9.6+/-3.4 days. One patient with a history of hypertension, diabetes, and coronary heart disease died from pulmonary embolism 7 days after surgery. Deep infection with enterococcus developed in the revised knee of another patient 3 months after surgery. For the six surviving patients, knee pain and function were improved by surgery. However, in this small series of patients, two major complications occurred. These results indicate that if this procedure is considered at all, it should be reserved for only healthy patients with relatively uncomplicated knee reconstructions.
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PMID:Simultaneous primary and contralateral revision total knee arthroplasty. 1032 99

We report on a case of an isolated common iliac artery aneurysm infected by Candida albicans. To our knowledge, only one other case of this condition has been reported. The patient, a 49-year-old man with diabetes mellitus and a history of fungal urinary tract infections, had recurrent right knee pain and swelling. The knee effusion grew C albicans. Mild right hydronephrosis and a 4.6-cm aneurysm of the right common iliac artery without involvement of the aorta or iliac bifurcation was revealed by means of a computed tomography scan. The aneurysm wall was inflammatory, and there was associated purulence at the time of operation. The right ureter was densely adherent to the anterior aspect of the aneurysm, but could be palpated and dissected free because of a ureteral stent that was placed before the surgical incision. The aneurysm was resected, and the proximal and distal margins were oversewn without graft placement. C albicans was found in the resected aneurysm. The patient recovered without limb-threatening ischemia or claudication, but the distance he could walk remained limited because of right knee symptoms. The aneurysm may have formed by direct extension of infection from the right ureter or by hematogenous or lymphatic spread. This case raises interesting issues about operative strategies and etiology.
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PMID:Candida infection associated with a solitary mycotic common iliac artery aneurysm. 1143 91

The purpose of the study is to evaluate influences of the introduction of 30% co-payments on potential visit behavior using a questionnaire in order to determine whether "employment state of the spouse" and "number of dependent children", as indicators of economic backgrounds, affect visits to physicians in a health insurance society. The subjects were 1,674 insured consisting of 1,165 males and 509 females, who underwent a regular health examination in July 2002, in a health insurance society. In the survey, they were asked whether the subject "will reduce" or "will not reduce" visits to physicians due to the increase in co-payments in the health insurance system scheduled in 2003. Multivariate analyses showed that "employment state of the spouse" was significantly related to the reduction in visits for myocardial infarction or stroke, cancer or heart disease, and hypertension and diabetes mellitus. Concerning "number of dependent children", it was related to the risk of reducing visits to physicians for myocardial infarction or stroke, trauma or fracture, cancer or heart disease, and low back pain or knee pain. Finally, upper limit expenditures of co-payments of physicians to visits due to hypertension and diabetes mellitus were related to "number of dependent children". The study results suggest that "employment state of the spouse" and "number of dependent children" are significant factors to affect potential visits to physicians after the introduction of 30% co-payments.
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PMID:A study on a reduction in visits to physicians after introduction of 30% co-payments in the employee health insurance in Japan. 1496 18

The burden of obesity on patients' everyday life is high; obese subjects perceive a poor Health-Related Quality of Life (HRQL) in both physical and mental dimensions. We aimed to identify the areas of everyday life limited by health status and factors mainly responsible for perceived problems. The Nottingham Health Profile questionnaire (NHP) was used in 274 obese subjects seeking treatment at a university-based obesity center. Values were compared with normative Italian data, corrected for age and sex. Anthropometric and clinical data were also recorded, and correlated with health status. All domains of NHP were significantly impaired in obesity, the effect size ranging from 0.14 (Emotional Reactions; p = 0.02) to 0.99 (Physical Mobility; p < 0.0001), and varying in relation to gender, age and obesity class. Female subjects reported a higher-than-expected prevalence of problems in most areas of daily life [from 20% (Paid Employment) to 44% (Jobs around the home), compared with 14-26% in controls]. Males reported a high prevalence of problems in Sex life (31%), Holidays (37%) and Hobbies (49%), compared with 14, 14, and 16% in controls, respectively. Logistic regression analysis identified osteoarticular pain (knee and hip pain) and respiratory diseases as major factors predicting a poor HRQL in its physical dimensions, or perceived problems in everyday life. The relative importance of knee pain was higher than that of hip pain. Osteoarticular and respiratory diseases are major determinants of poor HRQL in obesity. Prevention strategies and treatment of somatic diseases are mandatory for a comprehensive approach to obesity.
Diabetes Nutr Metab
PMID:The burden of obesity on everyday life: a role for osteoarticular and respiratory diseases. 1500 Apr 39

We report on a young female who had presented with fatigue, bilateral knee pain and gait disturbance. Primary hyperparathyroidism was diagnosed together with splenomegaly and anemia. Bone marrow biopsy revealed myelofibrosis. A parathyroid adenoma was excised during surgical intervention. As early as three months after the operation, hematologic parameters improved along with bone markers without any other intervention. The control bone marrow biopsy demonstrated well marked regression in marrow fibrosis. Her spleen has also gradually decreased in size. These findings indicate that her myelofibrosis was the result of primary hyperparathyroidism. Anemia associated with primary hyperparathyroidism may be due to bone marrow fibrosis.
Exp Clin Endocrinol Diabetes 2004 Mar
PMID:Myelofibrosis secondary to hyperparathyroidism. 1505 31

The Veterans Health Study (VHS) was designed to produce patient-based measures of health status suitable for monitoring the health of men served by the Veterans Health Administration. This article summarizes the objectives, conceptual framework, and results of 6 substudies of the VHS that were designed to develop disease-focused measures of illness severity, that is, patient-perceived, clinically significant manifestations of disease processes that are associated with decrements in health-related quality of life. Developmental psychometric studies used cross-sectional survey data from the baseline comprehensive evaluations conducted in the VHS. Patients who screened positive for the 6 study medical conditions in the VHS (osteoarthritis of the knee, n = 511; type 2 diabetes, n = 425; chronic lung disease, n = 352; hypertension, n = 996; chronic low-back pain, n = 574; and alcohol-related disorder, n = 175) were administered structured interview modules that assessed symptoms and complications of these chronic diseases. Psychometric analyses were conducted to identify internally coherent and reliable indices, which were validated with respect to their correlations with measures of health-related quality of life (eg, Short Form-36) and the utilization of health services. We constructed 6 indices of illness severity. The severities of osteoarthritis of the knee and chronic lung disease were defined by brief (12 and 6 items, respectively) assessments of symptoms (eg, knee pain and dyspnea). Since diabetes and hypertension are largely asymptomatic, illness severity for these conditions was assessed by ascertaining complications such as angina and vascular disorders. Alcohol-related disorder, which involves both behavioral symptoms and physical complications, was assessed by separate scales for these 2 dimensions of its severity. Chronic low-back pain required a unique solution. Rather than assessing the intensity of back pain, it is more productive to construct a measure that focuses on manifestations of radiculopathy, that is, whether back pain radiated down the leg to below the knee. The 5 symptoms or complication indices and the assessment of radiculopathy in chronic low-back pain were significantly correlated with Short Form-36 scores and intensity of recent use of health services. The 6 measures may complement measures of health-related quality of life in providing more comprehensive assessments of health status in Veterans Affairs patients.
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PMID:Patient-based measures of illness severity in the Veterans Health Study. 1596 20

Anserine bursitis is a frequent cause of medial knee pain. Despite its name, the structure at fault causing the symptoms remains unknown. Diabetes mellitus is a known predisposing factor leading to the condition. Overweight and knee osteoarthritis are possible additional risk factors, but their role has yet to be assessed. Anserine bursitis is diagnosed clinically based on medial knee pain and localized tenderness at the inferomedial knee. Current treatment of anserine bursitis includes nonsteroidal anti-inflammatory dugs, physiotherapy, and local glucocorticoid injections. Of these, only the latter has been shown effective in clinical trials. Knowledge gaps in the epidemiology, pathology, and pathogenesis of anserine bursitis should lead to additional research efforts on this common and perplexing condition.
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PMID:Evidence-Based Soft Tissue Rheumatology IV: Anserine Bursitis. 1704 9

We present a 45 year old female who was initially seen by Rheumatologist with long standing knee pain affecting her mobility. She was found to be severely hypercalcaemic and exhibited features suggestive of parathyroid carcinoma (palpable neck mass, extremely high parathyroid hormone, high alkaline phosphatase, concomitant presence of renal disease and skeletal involvement). Hence she was referred for parathyroidectomy. Postoperatively she developed profound hypocalcaemia with markedly raised serum alkaline phosphatase, requiring intensive intravenous calcium and oral vitamin D supplements, consistent with the development of hungry bone syndrome (HBS). HBS is a complication of parathyroid surgery where the correction of primary hyperparathyroidism is associated with rapid bone remineralisation, causing severe and prolonged hypocalcaemia. HBS is relatively rare but has to be considered in the differential diagnosis of postoperative hypocalcaemia particularly in severe cases. In the current report, we discuss pathogenesis, clinical course and management of HBS.
Exp Clin Endocrinol Diabetes 2008 Aug
PMID:A case of parathyroid carcinoma with severe hungry bone syndrome and review of literature. 1809 36


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