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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Forty primary uncemented total hip arthroplasties (THAs) were performed in 34 patients with an average age of 41.2 years (range, 21-78 years). Four hips had one component placed with cement: three femoral, one acetabular. Diagnoses included rheumatoid arthritis (30 hips), juvenile rheumatoid arthritis (seven hips), and systemic lupus erythematosus (three hips). The follow-up period averaged 3.7 years (range, two to six years). Thirty-five percent of the patients were using corticosteroids before hip replacement and throughout the follow-up period, whereas 44% of the patients had been using steroids in the past. Additionally, 79% of the patients were taking some form of antiinflammatory medications at follow-up examination. Clinical evaluation based on a ten-point rating scale indicated significant improvements from preoperative to the most recent follow-up examination for pain (from 3.1 to 9.0), walking (4.0-7.3), function (3.5-6.0), and activity (3.0-4.9). None of the hips required revision surgery, and none are pending. There was no evidence of roentgenographic failure; however, 43% of femoral and 12.8% of acetabular components showed some minor radiolucencies with sclerotic lines. None of these involved 100% of the bone-prosthesis interface. Femoral component subsidence occurred in two hips, and acetabular component migration occurred in one hip. Complications included three (8.1%) intraoperative femoral fractures, of which two required internal fixation. One patient had postoperative, culture negative, wound drainage. No deep sepsis occurred. These findings suggest that uncemented THA may be successful in the rheumatoid patient. Pain relief, walking, function, and activity levels are similar to those seen in cemented replacements with this length of follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Uncemented total hip arthroplasty in rheumatoid arthritis diseases. A two- to six-year follow-up study. 155 38

Seventy-five primary cemented total hip arthroplasties (THAs) were performed in 53 patients with rheumatoid arthritis and juvenile rheumatoid arthritis. All patients were followed for an average of 7.4 years, unless their prosthetic hips failed before that time. Clinical evaluation was based on a 10-point maximum rating scale, and ratings for pain, walking, function, and activity improved from preoperative values to the most recent follow-up examination. Revision THA was performed for aseptic acetabular loosening in four hips, and femoral loosening in one hip. Sepsis occurred in another four hips. Complications of wound healing occurred in 14 hips. Roentgenographic evidence of loosening was seen in six acetabular components, in three femoral components, and in the femoral and acetabular component of one hip; none of these hips have as yet required revision THA. The Kaplan-Meier survivorship analysis revealed a 93% survival probability at seven years, which fell to 77% at 12 years in these patients. A trend was that younger, larger patients had increased failure and component loosening rates. Cemented primary THA has been a satisfactory operation in the rheumatoid patient. The relatively high rate of wound healing problems and sepsis may be due to the systemic immune nature of rheumatoid arthritis; however, 25% of these prosthetic hips either failed or are at risk for future failure. Thus, improved techniques are still necessary to increase the long-term success of THA in the rheumatoid patient.
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PMID:Long-term follow-up of cemented total hip arthroplasty in rheumatoid arthritis. 200 52

The cases of seventeen children whose ages ranged from two to eighteen years and who were treated for a disorder of a sacro-iliac joint between 1975 and 1983 were reviewed retrospectively. Thirteen children were acutely ill, with a temperature of more than 38 degrees Celsius, and four had chronic symptoms that had persisted for three weeks to one year. Pain in the hip, thigh, and buttock was the most common symptom. Of the thirteen acutely ill patients, eleven had septic arthritis of a sacro-iliac joint, while one who had ankylosing spondylitis and one who had juvenile rheumatoid arthritis had acutely painful arthritis of a sacro-iliac joint. Of the four patients who had chronic symptoms, two had septic arthritis of a sacro-iliac joint; one, ankylosing spondylitis with sacro-iliac involvement; and one, eosinophilic granuloma of the ilium. Thus, thirteen patients had septic arthritis of a sacro-iliac joint and four had some other disorder. For the seventeen children who had acute or chronic symptoms, at admission the white blood-cell count ranged from 3,500 to 26,200 per cubic millimeter (average, 11,100 per cubic millimeter) and the sedimentation rate, as determined by the Westergren technique, ranged from twenty-two to sixty-five millimeters per hour (average, fifty millimeters per hour). Twelve of the plain radiographs of the seventeen patients were negative. The initial bone scans of all seventeen patients were positive in eleven and negative in six. Of these six, five had septic arthritis and one, juvenile rheumatoid arthritis. A computed tomographic scan was performed in four patients and was positive in all of them: three had septic arthritis and one had ankylosing spondylitis. Organisms were cultured successfully from blood, from material aspirated from the sacro-iliac joint, or from stool of all thirteen patients who had sepsis. The thirteen infections responded well to appropriate antibiotics, which were administered intravenously to seven patients and first intravenously and then orally to six.
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PMID:Disorders of the sacro-iliac joint in children. 333 71

Early and high failure rates for conventional hip replacements in young and active patients are well documented. The hypothesis tested in this study is total hip articular replacement by internal eccentric shells (THARIES) resurfacing hip arthroplasty is a sufficiently durable alternative to conventional total hips in patients younger than 40 years old. Survivorship analysis techniques were applied to 106 THARIES and 98 conventional hip replacements. The primary outcome variable investigated was time to failure, as measured by the need for revision of the prosthesis in the absence of sepsis. Other definitions of prosthesis failure were also investigated. Analysis revealed that even within this young, high-risk population there were subpopulations with different risks for failure. The lowest risk patients comprised all rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA) patients, regardless of age. The intermediate risk patients comprised all non-RA, non-JRA patients older than 30 years of age and the highest-risk patients were all non-RA, non-JRA patients younger than 30 years of age. A comparison of THARIES and conventional prostheses within each of these three subpopulations revealed similar patterns of failure over time, with the conventional total hip replacement having significantly better hip function than the THARIES group only in the highest-risk population, when using a failure definition of revision surgery for aseptic loosening. A broader and more important conclusion was that all acrylic-fixed implants, THARIES or THRs are predicted to undergo early mechanical loosenings in younger-than-30, non-RA, non-JRA patients. In patients younger than 30 years age acrylic fixation of THA is inadvisable.
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PMID:Survivorship comparison of THARIES and conventional hip arthroplasty in patients younger than 40 years old. 379 52

Hip pain in children is always potentially serious. Different specialists see a different spectrum of hip diseases. Acute hip pain is usually referred to the surgeons, and the principal concern is to distinguish sepsis of the hip joint or pelvic bones from irritable hip: untreated sepsis can destroy the hip within days, but its presentation may be atypical or mild and investigations misleading. A reliable protocol for the management of acute hip pain in children is now available. Perthe's disease and slipped capital femoral epiphysis is usually evident on the initial radiograph. Hip disorders with a subacute or chronic presentation are usually referred to the paediatrician or rheumatologist. If examination shows restriction of hip movement or there are radiographic abnormalities, many will have a serious disorder requiring long-term management. The diagnosis is often apparent on the initial radiographs, although special imaging techniques may be needed. In a monoarticular presentation of juvenile arthritis, the hip radiograph will be normal but the diagnosis evident from other clinical features or blood investigations. Recognition of non-organic syndromes presenting with hip pain requires the exclusion of organic causes and an alertness to the incongruity of the physical signs.
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PMID:Differential diagnosis and management of hip pain in childhood. 788 44

Juvenile rheumatoid arthritis occurs quite rarely, but should be suspected in a child presenting with arthralgias and systemic signs of sepsis. Once diagnosed, treatment necessitates a multidisciplinary approach to address the social, medical, and surgical issues. Current research into serologic methods of diagnosis shows great promise for better classifying patients, which ultimately will facilitate treatment. Recent well-designed randomized trials are providing better objective information on pharmacologic treatment alternatives. Surgery is reserved for recalcitrant cases that fail medical and occupational therapy. The goals of surgery in children with JRA are to delay or prevent joint destruction and closure of the epiphysis, to prevent or correct deformity, to decrease pain, and to maintain growth and joint motion.
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PMID:Juvenile rheumatoid arthritis. 884 21

Reactive haemophagocytic syndrome is characterized by activation and uncontrolled non-malignant proliferation of T lymphocytes and macrophages, leading to a cytokine overproduction, which accounts for the main biological signs. Children usually present with an acute febrile illness, fulminant pancytopenia and hepatosplenomegaly, posing a problem of differential diagnosis with severe sepsis. Hemopoietic cells are actively ingested by monocytes/macrophages in various organs, including lymph nodes, bone marrow, liver and spleen. This exarcerbation of the histiocytic system is currently classified among the reactional histiocytoses. It reflects an inappropriate host immune response. Most patients have a known underlying disease (hemopathy, lupus, systemic juvenile arthritis, HIV infection). In the few cases that occur in the apparent absence of any risk factors, investigations should be made to look for predisposing inherited diseases, such as familial lymphohistiocytosis or Purtilo's disease in boys. The treatment rests on immunosuppressive agents, followed by bone marrow transplantation, which can provide a definitive cure in genetic forms.
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PMID:[Reactive hemophagocytic syndrome in children]. 1076 6

Chronic inflammatory arthritis in childhood could be due to an obvious cause (e.g. sepsis, rheumatic fever, systemic lupus erythematosus etc.), or it could be idiopathic. After excluding those with obvious cause there still remains a large group of chronic inflammatory arthritis in childhood. This category has been variously called 'juvenile rheumatoid arthritis', 'juvenile arthritis', 'juvenile chronic arthritis', and more recently, 'idiopathic arthritis of childhood', The present article reviews the various classification criteria used for defining this group of disorders with emphasis on the common features as well as the major differences between these criteria. The major classes within this group with their characteristic clinical and laboratory features are also discussed.
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PMID:Juvenile rheumatoid arthritis--clinical manifestations. 1083 2

We analyzed the clinical and laboratory features, treatment, and course of twenty-one children with systemic-onset juvenile rheumatoid arthritis (S-JRA) encountered at our institution over the past ten years. There were eleven boys and ten girls. The mean age at onset was 11.6 +/- 4.2 years. The mean duration of symptoms prior to diagnosis was 5.5 +/- 1.7 months, and the mean follow-up period was 45.7 +/- 9.5 months. The clinical and laboratory features at presentation were similar to previous reports, except that peripheral blood smear revealed toxic granulation of neutrophils in 60% of our patients. Although systemic manifestation could be readily controlled by non-steroidal anti-inflammatory drugs (NSAIDs) with or without additional steroids, nine patients suffered from chronic arthritis (duration > 6 months) requiring disease-modifying anti-rheumatic drugs (DMARDs). Of the nine children with chronic arthritis, six (67%) had a monocylic systemic course, and seven (78%) had polyarticular disease (five or more joints affected) at the disease onset. Five patients developed severe destructive polyarthritis, with persistent anemia, thrombocytosis, elevated serum C-reactive protein (CRP) levels, and marked functional limitation during follow-up. One of the five patients with severe arthritis developed systemic lupus erythromatosis after 8-year follow-up, and died of sepsis. Our study indicated significant morbidity in children with S-JRA in Taiwan.
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PMID:A follow-up study of systemic-onset juvenile rheumatoid arthritis in children. 1091 Jun 10

The acute flare of joint inflammation in the child with known juvenile rheumatoid arthritis causes concern primarily regarding the need for additional or modified medical treatment. Acute joint inflammation in an otherwise healthy child creates concern regarding the existence of joint infection. In the early phase of disease, the clinical findings and symptoms of an inflamed joint attributable to juvenile rheumatoid arthritis or infection may be similar and difficult to differentiate from the other. Juvenile rheumatoid arthritis usually is well controlled by medical interventions, however, the initiation of specific treatment is more urgent in children with joint sepsis. The following case report is presented to emphasize the difficulty in evaluation of patients with known juvenile rheumatoid arthritis and coexistent septic arthritis, and to discuss the methods used to differentiate between the two conditions.
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PMID:Septic arthritis in a patient with juvenile rheumatoid arthritis. 1504 20


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