Biomedical subjects
Publications and source records attributed to J J Weiss.
In 12 cases of septic bursitis seen during 11 years, 11 patients were men and one patient was a woman, with a mean age of 51.3 years. The olecranon bursa was involved in nine cases. Staphylococcus aureus was grown from nine of ten culture-positive fluids. Bursal fluid WBC counts ranged from 1,550/cu mm to 165,000/cu mm, associated with low glucose levels in two cases, but not in three. Treatment with antibiotics and needle aspiration or surgical drainage was successful.
Following shoulder arthrography to establish the diagnosis of adhesive capsulitis, we injected steroids via the in situ arthrogram needle. Subsequent intraarticular steroids, if needed, were given at the outpatient clinic using landmarks established at the time of arthrography. Out of 18 patients treated, function sufficient to permit resumption of usual work and self-care activities returned to 16. In 11 patients, recovery was associated with painless total shoulder movement gather than a return to glenohumeral motion. This therapy appears perferable to other forms of intraarticular injection and is an alternative to surgery when physical therapy has failed.
We observed hyperuricemia, acute gouty arthritis, and renal medullary cystic disease in three members of a family over two generations. Two of these individuals were women who developed gout by age 20 years. Two teenage sons of one of these patients had severe hyperuricemia, which appeared due to underexcretion of uric acid. To our knowledge the occurrence of hyperuricemia, gout, and renal medullary cystic disease has not been reported previously.
With the exception of the arthritis associated with rubella, acute wrist conditions have no pathognomonic physical findings. The primary physician can diagnose and treat the majority of wrist problems presented. Referral to a rheumatologist is necessary only when confronted with an anxious patient or an individual having persistent wrist pain and swelling of obscure etiology. This article focuses on rheumatologic problems of the wrist that are most likely to come to the attention of the primary physician.
Arthrograms of the shoulder were evaluated in 10 patients with rheumatoid arthritis. The arthrographic findings common to all joints consisted of nodular filling defects, irregular capsular attachments, bursal filling defects and visualized lymphatic drainage. Findings unique to the shoulder joint consisted of rotator cuff tear, frozen shoulder, and biceps sheath dilatation. Since the agents used to treat patients with rheumatoid arthritis have profound side effects, it is important to exclude an associated rotator cuff tear and/or confirm the presence of glenohumeral rheumatoid involvement.
Rotator cuff tear secondary to chronic synovitis eroding the rotator cuff tendon is a complication of rheumatoid arthritis that has received little attention. Patients with such tears have a long history of active rheumatoid disease preceding the sudden onset of increased unilateral shoulder pain and immobility. The physician may interpret this change as indicating a joint infection or rheumatoid flare, and initiate a drastic change in the patient's therapy. Shoulder arthrography reveals the correct diagnosis. Appropriate treatment consists of heat, rest, range of motion exercises, and repeated intra-articular injection of steroids.