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The human skeleton is a remarkable organ that is uniquely designed to provide structural support and to house the body's hematopoietic system and mineral reservoirs. Seven concepts that will assist the clinician in understanding skeletal function are (1) material properties of bone, (2) stress and strain, (3) bending moments and torsional loads, (4) area moments of inertia, (5) fatigue and catastrophic failure, (6) Wolff's law, and (7) stress risers and open section effect. For example, as the modulus of a bone, a measure of stiffness decreases as in Padget's disease or fibrous dysplasia and the same levels of stress will cause greater deformations. The sum of these principles also explains the torus fracture (ductility), fracture of the olecranon by contracting tricep muscle (tensile loading), osteoporotic compression fracture of the spine, and the other biomechanical lesions that are encountered. Understanding these basic biomechanical principles can help physicians comprehend neoplastic processes and fractures that are the metabolic responses of the skeleton to stress and that appear on the radionuclide bone scan.
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PMID:Skeletal system: biomechanical concepts and relationships to normal and abnormal conditions. 936 41

Sixty-eight primary total hip arthroplasty in sixty-two patients (average age: 56.2 years) were followed for a minimum of five years (mean: 7.3 years). In all patients a Harris-Galante prosthesis was used. The initial diagnosis was osteoarthritis in 65 hips and avascular necrosis in 3 hips. Forty hips (58.8%) had high degree acetabular dysplasia that necessitated performing autogenous femoral head bone grafting. Preoperatively, the mean Harris hip score was 53.1 points. At last follow-up the mean hip score was 91.2 points. Twelve patients (17.6%) complained of thigh pain, which disappeared within two years in ten hips. Two patients complained of mild thigh pain of more than two years duration. There were no limitations of the activities of daily living. Radiolucency at the component-bone interface were graded 30.9% on the acetabular side, and 64.7% on femoral side. In all cases the radiolucencies were less than 2 mm in width. Two femoral components were graded as loose, but no acetabular component was graded as loose. The extrusion of the acetabular liner was seen in one hip, which is considered to be a fatigue breakage due to its design. The authors conclude that cementless total hip arthroplasty in Japan has presented excellent results.
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PMID:Clinical results of Harris-Galante total hip arthroplasty without cement. Follow-up study of over five years. 943 77

Menorrhagia--menstrual periods lasting longer than 7 days and totaling blood losses greater than 80mL--affects 9%-14% of otherwise healthy women, and it can signal cancer, an endocrinologic disorder, or gynecologic disease. Blood loss can be high enough to result in anemia, fatigue, and syncope. Most often, abnormal uterine bleeding such as menorrhagia involves a disruption in the hypothalamic-pituitary axis, the ovary, and/or the uterus. Other identified causes include medications (especially psychotropics) that cross the blood-brain barrier; chronic diseases such as cancer, diabetes, and liver and kidney dysfunction; endocrine disorders, perimenopausal anovulation, polycystic ovary disease, pituitary tumors, and abnormal estrogen cycling caused by morbid obesity; and anatomic abnormalities of the uterus. Routine tests include hematocrit or hemoglobin to detect and evaluate anemia, thyroid stimulating hormone (TSH) level to evaluate thyroid function as a possible cause, and a pregnancy test to rule out an incomplete, spontaneous abortion as a cause. A Pap test is recommended to screen for dysplasia that can suggest a gynecologic cancer cause. Additional screening for endocrine disorders that may be causing menorrhagia include tests of thyroid, liver, and kidney function, and tests of follicle stimulating hormone (FSH), prolactin, and cortisol levels. Treatment can be medical or surgical. Medical treatment includes prostaglandin inhibitors, specifically nonsteroidal antiinflammatory drugs (NSAIDs), and hormonal therapy with estrogen, progesterone, gonadotropin-releasing hormone agonists, or oral contraceptives such as medroxyprogesterone (Depo-Provera). Surgical treatment includes hysteroscopic endometrial ablation by physical agents, laser electrodiathermy, and "roller ball," or surgical, resection. Hysterectomy is the treatment of last resort.
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PMID:Treatment Decisions in the Management of Menorrhagia. 974 72

Progressive diaphyseal dysplasia (PDD), a rare disorder of bones, in recent years has been accepted as a systemic disease within the spectrum of connective tissue disorders associated with immunological abnormalities. Steroids have been used in the treatment of PDD with variable success. In this report PDD is described in a 5-year-old boy who presented with leg pain, fatigue, headache and anorexia with an onset in infancy. Physical examination revealed a waddling gait, thorax deformity and thickening in the upper extremities. The diagnosis was made by radiologic demonstration of cortical thickening and a narrowed medullary cavity of the long bones of extremities. Bone scintigraphy showed areas of increased osteoblastic activity in the diaphyseal part of the long bones of extremities and the skull. Electron microscopic examination revealed myopathic and vascular changes. Serum immunoglobulin A, G and M levels were elevated and CD4 positive T cell numbers were low. Deflazacort, a steroid with a similar anti-inflammatory effect to prednisolone but with fewer adverse effects, was started in a dose of 1.2 mg/kg/day. Deflazacort treatment resulted in clinical and radiological improvement within 12 months with no side effects. In conclusion, steroids may be recommended as an effective method of treatment in PDD and deflazacort may be a safe alternative steroid.
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PMID:Deflazacort treatment in progressive diaphyseal dysplasia (Camurati-Engelmann disease). 1045 3

Arterial fibromuscular dysplasia (FMD) represents a collection of noninflammatory and nonatherosclerotic vascular diseases with a poorly understood etiology. Classically occurring in renal and cerebral arteries, this entity has also been reported in coronary, carotid, and other medium and small arteries. One case occurring in the pulmonary vasculature has been reported. Fatal hemothorax and lung hemorrhage have multiple causes, including other vascular malformations and connective tissue disorders; however, cases of pulmonary FMD are exceedingly rare. We report what appears to be the second such association, occurring in a 69-year-old man. The patient presented with a 3-week history of increasing dyspnea, fatigue, and productive cough; 3 days of increasing back and chest pain; and syncope. Chest radiograph showed a "white-out" of the left lung. The patient died shortly after admission from a fulminant respiratory disease of undetermined etiology. At autopsy he was found to have a massive left hemothorax resulting from an unsuspected pulmonary arterial fibromuscular dysplasia.
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PMID:Pulmonary arterial fibromuscular dysplasia: a rare cause of fulminant lung hemorrhage. 1073 31

This study examined the epidemiology and demographics of congenital hip disease in 468 (660 hips) patients who were examined between 1970 and 1996. In 356 (54%) hips, the diagnosis was secondary osteoarthritis due to congenital hip disease, and in 272 (41%) hips, the diagnosis was idiopathic osteoarthritis. In the remaining 32 (5%) hips, the diagnosis was uncertain. Of the hips with congenital hip disease, 170 (47.7%) hips were dysplastic, 85 (23.9%) had low dislocation, and 101 (28.4%) high dislocation. The majority of patients with congenital hip disease were women (338 [95%] hips). The natural history of the three types of congenital hip disease was studied in 157 patients (202 hips: 102 dysplastic, 42 low dislocation, and 58 high dislocation) who had received no treatment before the initial examination. Average length of follow-up was 17 years. In dysplastic hips, the disease remained undiagnosed until the onset of symptoms at an average age of 34.5 years. In patients with low dislocation, pain had started at an average of 32.5 years due to progressive degenerative arthritis within the false acetabulum. In patients with high dislocation, in the presence of a false acetabulum, pain started at an average age of 31.2 years, while in its absence, pain started at an average age of 46.4 years due to muscle fatigue. These findings suggest dysplasia, low dislocation, and high dislocation in adults are the results of untreated dysplasia, subluxation, and complete dislocation in infancy, respectively.
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PMID:Epidemiology, demographics, and natural history of congenital hip disease in adults. 1095 45

Human immunodeficiency virus (HIV)-infected patients experience a range of haematological complications including anaemia, neutropenia, lymphopenia and thrombocytopenia. Anaemia is a prognostic marker of future disease progression or death, independent of CD4 and viral load. Recovery from anaemia reduces the risk of disease progression to approximately the same level as seen among patients who have never had anaemia. Additionally, anaemia impacts a range of dimensions of quality of life, most commonly through fatigue. Anaemia can be caused by a range of mechanisms including infections, neoplasms, dietary deficiencies, blood loss and medication. Histologically, bone marrow hypoproliferation and dysplasia are the most commonly seen. Both AZT and d4T induce macrocytosis, however, AZT, but not d4T, has broader myelosuppressive effects both in vitro and in vivo. The management of anaemia typically includes correction of the underlying cause(s) and blood transfusion or erythropoietin. However, blood transfusions and iron supplementation may activate HIV expression and possibly worsen immunosuppression. Recombinant human erythropoietin (rHuEPO) is an effective means of improving haemoglobin and reducing transfusion requirements in patients who have low (< 500 IU/L) endogenous erythropoietin levels.
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PMID:Anaemia in persons with HIV infection: prognostic marker and contributor to morbidity. 1199 79

The myelodysplastic syndromes (MDS) are clonal disorders characterized by dysplasia in at least two myeloid cell lines. Fatigue is one of the most significant symptoms. MDS patients are treated with blood transfusions to improve their health-related quality of life (HRQoL). A cross-sectional pilot study was performed for psychometric evaluation of three internationally established HRQoL measures in MDS patients, and for investigation of the association between the severity of chronic anaemia and HRQoL. Fifty consecutive MDS patients completed the Short Form 36, the Multidimensional Fatigue Inventory and the EuroQoL-5D Visual Analogue Scale. Hb level was measured during the same visit. Psychometric analysis focused on feasibility, construct validity and reliability. The questionnaires showed a high feasibility, reliability and validity. MDS patients had worse HRQoL scores than the age- and sex-matched general population. We found a positive correlation between haemoglobin (Hb) level and HRQoL. This study provides insights into the suitability of established HRQoL measures for the evaluation of interventions in MDS patients. Hb value and HRQoL are complementary variables for evaluation of the severity of chronic anaemia in patients with MDS.
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PMID:Quality of life measurement in patients with transfusion-dependent myelodysplastic syndromes. 1269 48

The purpose of rehabilitation is to restore good physical, mental emotional, social condition and if at all possible efficiency at work in a patient with an obstructive pulmonary disease. The most important aspect of rehabilitation is an individual attitude to each patient. A patient with chronic disease and different degree of failure of the respiratory tract struggles with abnormal lung function i.e. with dyspnoea and general physical weakness. Obviously, a slight disturbance in the function of the respiratory system is almost imperceptible in daily activities, thus patients complain about slight fatigue that recedes after a short rest. The values of basic spirometric indexes FVC, FEV1 are within normal. Only disturbances of the function of peripheral air passages MEF50%VC, MEF25%VC indicate the onset of failure in the distribution of inspired gas and alveolar hypoventilation as well as violation of normal air flow in the peripheral bronchioles whose diameter is less than 2 mm. Anxiety and concern for health appear with increased dyspnoea while doing exercises and within years dyspnoea will accompany daily domestic routine activities. It is known that such factors as pollution of the environment, smoking tobacco, viral infections in childhood, bacterial infections of the respiratory system, prematurity, respiratory distress syndrome (RDS) and different degree of bronchi-pulmonary dysplasia favour the development of chronic obstructive pulmonary disease. The decrease of FEV1 more than 40 ml per year shows the increased respiratory failure. Ventilatory reserves of the respiratory system systematically diminished exceeding the predicted limit 80%. COPD is a chronic progressive disease causing irreparable obstruction of the bronchi. Then changes in the structure of the bronchial tree are seen as well as the increased tension of the smooth muscles which depend on the parasympathetic system. Does the progression of the disease indicate the lack of effective treatment? The sick patient starts doubting about the right diagnosis, medicines, rehabilitation and medical team. It is necessary to analyse and update again therapeutic treatment and rehabilitation. Movement and respiratory rehabilitation, regardless of the degree of COPD severity, has in principle five major tasks: 1. The control, alleviation, delay of pathological processes causing the increased pulmonary failure. 2. Improvement of physical condition. 3. The study of physiotherapy and coping with stress in patients with dyspnoea and progressive disease. 4. Improvement of the standard of life and prolonging lifespan. 5. The decrease of medical care expenses.
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PMID:[Movement rehabilitation, psychotherapy and respiratory rehabilitation in patients with chronic obstructive pulmonary disease]. 1500 10

Various kinds of surgical treatments have been reported for varus deformity of the proximal femur due to fibrous dysplasia. We report a case of two-stage corrective osteotomy for severe varus-retroversion deformity of the femoral neck due to monostotic fibrous dysplasia. The patient was an 18 year-old man. On initial examination, the spina malleollar distance was 88 cm on the right side and 83 cm on the left. Plain radiography showed prominent varus deformity of his left proximal femur. The morphology was 130 degrees on the right side and 85 degrees on the left. Computed tomography revealed 60 degree retroversion of the femoral neck. A two-stage surgery was performed, consisting of curettage and bone grafting followed by corrective osteotomy 16 months later. A 55 degree valgus osteotomy was performed in the subtrochanteric region. After osteotomy and 40 degree internal rotation of the shaft, a 130 degree angle plate was used for osteosynthesis. Postoperative radiological examination showed a morphology of 140 degrees and computed tomography revealed a 20 degree retroversion of the femoral neck. No recurrence or varus deformity was seen at four years after surgery. Although the leg length discrepancy was 2.5 cm, the patient had no difficulty in one foot standing and no restriction of ADL (activity of daily living). The well-known progressive varus Shepherd's crook deformity in the polyostotic form of fibrous dysphasia is associated with limb shortening, limping, and occasionally chronic fatigue fractures with disabling pain. Various kinds of surgical treatments have been reported for this type of varus deformity. Curettage and bone grafting is one of the most common and simple treatments. However, this method often gives bad results as the grafted bones are absorbed and that the progress of varus deformity van not to be prevented. We report a case of two-stage corrective osteomy forsevere varus-retroversion deformity of the femoral neck due to monostotic fibrous dysplasia.
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PMID:A two- stage surgery for severe femoral neck deformity due to fibrous dysplasia: a case report. 1525 49


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