[Diagnostic ultrasound imaging in municipal health care centers].
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Abdominal Pain↗
Biomedical subjects
I Kunnamo
Publications and source records attributed to I Kunnamo.
Are smokers a risk group for delayed healing of tibial shaft fractures?
A total of 135 patients with a fresh tibial shaft fracture and with no other significant injuries underwent primary conservative treatment. Data on their smoking habits were obtained from hospital records and by questionnaire. Although the smokers had better prospects for healing of the fracture at the outset than non-smokers (lower mean age and less fractures caused by high-energy injuries), the smokers were found to have a significantly longer mean time to clinical union and a higher incidence of delayed union. According to a crude calculation, smokers had a 4.1-fold risk of tibial shaft fracture caused by low-energy injury, compared with non-smokers. An accelerated failure time model showed that the more comminuted or open the fracture, the higher the number of cigarettes smoked and the older the patient, the longer was the time to clinical union of the tibial shaft fracture. Female sex appeared to be a further risk factor for delayed healing. A logit model indicated that comminution of the fracture, smoking and female sex were associated with delayed union and non-union. If a patient has a markedly raised probability of delayed union of tibial shaft fracture because of many risk factors as reported in the previous literature or in this study, operative treatment should be considered as the primary alternative instead of conservative treatment. Stopping smoking during healing of tibial shaft fracture could also promote the union of the fracture.
Adolescent↗
Anticoagulant treatment as a risk factor for primary intracerebral haemorrhage.
Forty one (14.2%) of 288 patients with primary intracerebral haemorrhage occurring between September 1985 and December 1989 in Central Finland were on anticoagulant treatment at the onset of symptoms. In a sample of 29,000 subjects from the same population the prevalence of anticoagulant treatment was 1.6% in those aged 40 years or older. The estimated age adjusted odds ratio of being on anticoagulant treatment at the time of primary intracerebral haemorrhage was 6.7 (95% CI from 4.5 to 9.9). The risk was highest during the first year of anticoagulation. Overtreatment (thrombotest value < 5%) was slightly more common among the patients. The haematoma volumes measured from the CT scans were similar in patients on anticoagulant treatment and those not anticoagulated. The case fatality rate during the first week and the mortality during follow up of 32 months were slightly higher, and the functional outcome slightly worse in the anticoagulated group.
Adult↗
Synovial fluid lymphocytes in different subtypes of juvenile rheumatoid arthritis.
We studied the subsets of synovial fluid (SF) lymphocytes and their activation states in 4 subtypes of juvenile rheumatoid arthritis. The expression of lymphocyte differentiation antigens and activation markers (Ia and Tac) appeared to be similar in these subgroups. Tac + DNA-synthesizing T blasts represented, at most, 5% of all SF mononuclear cells. This finding was in clear contrast to the high proportion of Ia-positive SF mononuclear cells. There were no differences in Ia and Tac expression or DNA synthesis among the different juvenile rheumatoid arthritis subgroups. This finding suggests that the cell-mediated immune response may represent secondary features of the disease that are involved as a final common pathogenetic pathway.
Arthritis, Juvenile↗
Life changes related to the onset of juvenile rheumatoid arthritis.
Life changes preceding the onset of juvenile rheumatoid arthritis (JRA) were studied in 49 children with prolonged arthritis, and in 58 children with temporary arthritis. In addition, the frequency of changes experienced by patients during their life was compared with the expectancy scores for healthy children. The frequency of changes during the year prior to the onset of the disease did not differentiate children with JRA from children with temporary arthritis. During their lives, the children of both groups had experienced a higher frequency of life changes requiring considerable readjustment than healthy children of the same age.
Adaptation, Psychological↗
[Is urinalysis necessary in physical examinations?].
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Humans↗
Clinical signs and laboratory tests in the differential diagnosis of arthritis in children.
To develop a scheme for primary diagnosis, we analyzed the clinical findings and laboratory test results in 278 children with arthritis by using univariate analysis and multivariate logistic regression analysis. An elevated C-reactive protein (CRP) value, a temperature above 38.5 degrees C, and a high white blood cell count were independent predictors for the diagnosis of septic joint infection in patients with acute monoarthritis. The presence of either of the first two signs had a sensitivity of 100% and a specificity of 87% for septic arthritis. Sixty-seven percent of all patients with arthritis were cured within two weeks from the onset of joint symptoms. In patients whose disease duration exceeded two weeks, a low CRP value, the absence of fever, and an elevated IgG value were independent predictors for the diagnosis of juvenile arthritis. Antinuclear antibodies had a specificity of 100% and a sensitivity of 25% for juvenile arthritis or other connective tissue diseases. We recommend that laboratory tests indicated for all children with joint symptoms include determinations of the erythrocyte sedimentation rate and the CRP value, both total and differential leukocyte counts, urinalysis, and a bacterial culture of a throat smear. When arthritis is prolonged or when enteroarthritis is suspected, tests for antinuclear antibodies and serum immunoglobulins, serologic tests for Yersinia and Salmonella, and stool bacterial cultures should be included.
Adolescent↗
Infections and related risk factors of arthritis in children. A case-control study.
We used a parent-completed questionnaire to record the clinical signs of infection preceding the onset of joint symptoms by 1 month or less in 334 children with arthritis or other joint disease. An upper respiratory tract infection (URTI) often preceded the onset of arthritis (51%) but also arthralgia (56%) and even trauma or orthopedic disease (43%). The results of a case-control analysis of 165 patients and community controls matched for age and sex were in favour of a preceding URTI having an etiologic or triggering role in acute transient arthritis of other joints than the hip only (odds ratio of preceding URTI, 7.0), juvenile rheumatoid arthritis (odds ratio 3.3) and transient synovitis of the hip (odds ratio 3.0). The form of day-care differed significantly from that of controls only in patients with transient synovitis of the hip who attended a day-care centre more often than controls (odds ratio 3.5).
Acute Disease↗
The value of biopsy in patients with monarticular juvenile rheumatoid arthritis of recent onset.
The histopathology of arthroscopic biopsy material from the knees of 8 patients with monarticular juvenile rheumatoid arthritis (JRA) of recent onset and of 4 control patients was examined using a histochemical method for acid alpha-naphthyl acetate esterase and an avidin-biotin-peroxidase complex method for different cell subtype-specific surface antigens. According to results of our prospective, single-blind study, nonspecific synovitis was observed in those biopsy samples obtained early in the course of disease. The samples were also characterized by cellular changes that are quite distinct from those described in patients with chronic rheumatoid synovitis. JRA must be considered the cause of symptoms if no orthopedic or infectious disease is found at arthroscopy in children with monarticular symptoms of recent onset and if nonspecific synovitis is observed in the histopathologic specimen. This pathologic description, however, does not correspond to that of classic rheumatoid synovitis. In our studies, we found that mononuclear cells displaying diffuse cytoplasmic esterase and surface Ia formed a large proportion of all inflammatory cells in situ. There were comparatively few activated Ia+ T cells and plasma cells. These observations suggest that exudative features and nonspecific cellular inflammation are prominent at onset of JRA. The immune response, in the form of immunocompetent T and B cells, seems to be more extensively involved in chronic JRA and may represent secondary features of the disease.
Adolescent↗
Incidence of arthritis in urban Finnish children. A prospective study.
The incidence of various types of arthritis in children was estimated by a prospective 1-year study in the greater Helsinki area (population under 16 years of age: 148,362). Patients were sought from primary care physicians, and 71% of the patients studied were seen within 1 week of the onset of symptoms. All patients received followup care for at least 3 months; patients whose symptoms were prolonged received followup care for a minimum of 2 years. The incidence per 100,000 children under 16 years of age was as follows: 108.5 for all cases of arthritis, 6.7 for septic arthritis, 5.4 for enteropathic arthritis, 51.9 for transient synovitis of the hip, 18.9 for prolonged arthritis (duration greater than 3 months), and 25.8 for acute transient arthritis. The incidence of juvenile rheumatoid arthritis was 19.6. Oligoarticular disease was prevalent (76%) among the juvenile rheumatoid arthritis patients.
Adolescent↗
Serum-sickness-like disease is a common cause of acute arthritis in children.
Among 283 children in a prospective study of arthritis we found 15 patients with a self-limited serum-sickness-like disease consisting of urticaria or joint erythema and mostly polyarticular arthritis. The mean duration of joint symptoms was 5.9 days. A preceding infection was reported in 12 patients and 12 had received drugs, the therapy starting on average 12.8 days before the onset of joint symptoms. In 9 cases the drug was penicillin. Four patients had recurrent attacks. Circulating immune complexes were detected in the serum of 12 patients, but specific IgE antibodies to penicillin only in 3 patients. The estimated annual incidence of the condition was 4.7/100,000 children under age 16.
Adolescent↗
Transient synovitis and Perthes' disease. Is there an aetiological connection?
A prospective study was made of 119 children with transient synovitis or any other cause for synovial effusion and elevated intra-articular pressure. During a follow-up of one year not one case of Perthes' disease was diagnosed and the late clinical and radiographic changes were minimal with moderate overgrowth of the femoral head in 33% and widening of the joint space in 14.2%. Our results do not support the widely accepted concept that Perthes' disease develops as a result of the period of elevated intra-articular pressure found in transient synovitis. Further research into this and Perthes' disease should follow the premise that they are two different diseases without any aetiological connection.
Acute Disease↗
Routine analysis of synovial fluid cells is of value in the differential diagnosis of arthritis in children.
Results of synovianalysis are reported in 129 children, 91 with juvenile rheumatoid arthritis (JRA), 13 with septic arthritis, 12 with enteroarthritis, 12 with acute transient arthritis and 1 with bacillus Calmette-Guerin arthritis. Mononuclear cells were dominant in the patients with oligoarticular JRA (mean 64%, median 74%), and among these, significantly lower proportions of polymorphonuclear (PMN) cells were found in patients with early onset disease with antinuclear antibodies or chronic uveitis than in those with late onset with HLA-B27. PMN cells were dominant in polyarticular and systemic onset JRA, septic arthritis and enteroarthritis. The sensitivity and specificity of a white cell count above 40,000/mm3 exceeded 90% in differentiating septic arthritis from the other kinds of arthritis. Measurement of total protein, glucose and lactate in synovial fluid was of limited diagnostic value.
Arthritis↗
Ultrasonography in hip disease in children.
Intra-articular synovial effusion was visualized in different juvenile hip diseases by ultrasonography; 166 hips from 149 children were examined. Joint aspiration of 97 hips confirmed that ultrasonography was more sensitive than conventional radiography in diagnosing effusion. The magnitude of the ultrasonic joint space correlated well with the clinical severity of the disease, the volume of synovial fluid, and the intra-articular pressure. Considerable widening of the ultrasonic joint space was seen in transient synovitis, septic arthritis, reactive arthritis and arthritis with urticaria; moderate widening was seen in some patients with Perthes disease, and symmetrical joint space in patients with nonspecific arthralgia. We conclude that ultrasonography is valuable in the diagnosis and follow-up of synovial effusion of the hip in children.
Adolescent↗
PDRD--a computer-based primary care decision support system.
This article identifies the current stage of development and assessment of computer-assisted decision support systems in the domain of general practice. Physician's Desk Reference and Database (PDRD), an electronic medical database, is presented, and a plan for assessment of PDRD is briefly discussed.
Artificial Intelligence↗