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PubMedDate not supplied

[Post-traumatic infections of the musculoskeletal locomotor system; prophylaxis and treatment].

An analysis of epidemiology of the post-traumatic infections of the locomotive system, prophylaxis and treatment in presented. Infections are the most severe complications of the open bone fractures and orthopedic surgery. An incident of inflammatory complications following the open bone fractures is very high (20% according to Burrie). An incidence of complications following orthopedic surgeries is somewhat lower--0.2-9.0%. Within 1976-1986, as much as 585 patients with chronic osteitis, including 222 patients with post-traumatic infections, were treated at the Department of Orthopedic Surgery, Medical Academy in Warsaw. Therapy depended on the general and local health status, and the types of surgery were diversified. The treatment included, first of all, radical removal of crushed and necrotic tissues, stabilization of the fractured bone fragments with the external stabilizer, AO plate or the Polish original method of the stable internal osteosynthesis--ZESPOL, decompression of the crack with the aid of permanent flow or suction drainage, systemic or local antibiotic therapy, administration of vasodilating agents, and the primary skin plasty in some cases.

Bacterial Infections↗
PubMed1989

Institutionalization of the elderly and characteristics of nursing home patients.

To characterize nursing home patients and to study the prevalence of institutionalization 191 patients living in four somatic nursing homes in western Sweden were investigated. Of the total population over 65 years 7.8% were institutionalized, 2.6% in somatic nursing homes. The need for care increased markedly after 80 years of age. Most commonly (45%), the patients were admitted from emergency somatic wards. The mean age was 82.5 years, 74% were single and 60% were women. The mean period of care was 1.82 years. 87% had more than one diagnosis. The most common diseases concerned the circulatory system (51%) and the musculoskeletal system (43%). Dementia was diagnosed in 41% at admittance, but functional tests revealed a much higher frequency (72%). Conclusions. The nursing home patient was very old, was mostly single and had multiple diseases. The prevalence of dementia was high.

Age Factors↗
PubMed1994

Sarcoidosis and Wegener's granulomatosis: a comparative analysis.

Sarcoidosis and Wegener's granulomatosis (WG) share membership in the family of granulomatous diseases. Both are systemic processes that have major expressions in common sites, such as the respiratory tract, kidneys, skin, nervous system, eye and orbit, musculoskeletal system, and heart. In spite of these common features, they are sharply divergent in clinical course and pathology, sarcoidosis being a more benign, indolent disease of low mortality, in contrast to the highly lethal more dramatic course of WG. Both entities respond to glucocorticoids, but WG frequently requires cytotoxic agents such as cyclophosphamide. The current concepts of pathogenesis suggest sarcoidosis to involve mainly T-cell mediated mechanisms, whereas in the case of WG the presence of antineutrophil cytoplasmic autoantibodies (ANCA) points toward humeral mechanisms, although T-cells may also be involved.

Bone Diseases↗
PubMed1998

Long term disability rates in a cohort of Air Canada pilots.

Causes of long term disability (LTD) were collected between January 1, 1981 and December 31, 1990 among all active pilots in a cohort of Air Canada pilots. During this 10-yr period, 474 (20.9%) of the 2271 pilots had LTD; there were 1107 cases of LTD corresponding to a total duration of leave of absence of 4161 mo. Frequencies of the main diagnostic categories were: injuries: 249 (22.5%); mental disorders: 175 (15.8%); circulatory system: 157 (14.2%); digestive system: 128 (11.6%); and musculoskeletal system: 121 (10.9%). LTD rates increased with age, ranging from 1.86-9.22 per 1000 pilots per year from the younger (20-29 yr) to the older age group (50-59 yr), respectively. Several causes of LTD could be potentially preventable, in particular injuries which accounted for 63.6% of all causes in the younger age group and remained a significant condition at subsequent ages.

Absenteeism↗
PubMed2000

Musculoskeletal MRI: dedicated systems.

The "dedicated" MRI units have characteristics of high diagnostic accuracy and lower installation and management costs as compared with whole-body systems. The dedicated MRI units are easy to install. The low weight allows their installation also under unfavorable circumstances. In a dedicated system cost-effectiveness and ease of installation must be accompanied by the capability of providing high-quality images. In our experience, the high number of examinations performed, the most part of which provided with the surgical controls, allowed an accurate evaluation of the diagnostic potentialities of the dedicated magnet. We were not able to perform the examinations in only 3 % of cases due to the physical shape of the patient and the clinical condition of the patient which may hinder the correct positioning of the limb. The overlapping of the diagnostic accuracy of the E-scan and Artoscan units in the study of the lower limbs, compared with whole-body units and surgery, prompted us to exploit the potentialities of the E-Scan in the study of the shoulder. We had a good correlation between E-Scan, whole-body units, and surgical findings, which confirmed the high diagnostic accuracy of the dedicated system. In conclusion, in our experience carried out in the musculoskeletal system, the dedicated magnets showed promising results. Their diagnostic reliability and utility was comparable to that obtained from conventional units operating at higher magnetic fields.

Female↗
PubMed1995

Musculoskeletal complications of systemic lupus erythematosus in the Hopkins Lupus Cohort: an update.

OBJECTIVE: To determine the frequency of musculoskeletal system damage among patients in the Hopkins Lupus Cohort, over time, and to determine predictors of musculoskeletal damage (including avascular necrosis of bone, osteoporosis, and fracture) in the same cohort. METHODS: Evaluation of the cohort visit database (from 1989 or at the time of entry into the cohort if later than 1989) for the 407 patients with systemic lupus erythematosus (SLE). Musculoskeletal damage was measured by the SLICC/ACR Damage Index. RESULTS: Total damage and musculoskeletal damage accumulated from the time of diagnosis of SLE, and musculoskeletal damage continued over time, with avascular necrosis of bone being the most common form. African-Americans and SLE patients of lower socioeconomic status were more likely to experience musculoskeletal damage. Use of corticosteroids was a major risk factor for both avascular necrosis of bone and osteoporosis. CONCLUSION: Musculoskeletal damage remains one of the major sequela of SLE. Reduction of the modifiable risk factors (especially prednisone dose) is the key to both primary and secondary prevention efforts.

Adult↗
PubMed2005

Predictions of co-contraction depend critically on degrees-of-freedom in the musculoskeletal model.

In biomechanics, the calculation of individual muscle forces during movements is based on a model of the musculoskeletal system and a method for extracting a unique set of muscle forces. To obtain a unique set of muscle forces, non-linear, static optimisation is commonly used. However, the optimal solution is dependent on the musculoskeletal geometry, and single joints may be represented using one, two or three degrees-of-freedom. Frequently, a system with multiple degrees-of-freedom is replaced with a system that contains a subset of all the possible degrees-of-freedom. For example, the cat ankle joint is typically modelled as a planar joint with its primary degree-of-freedom (plantar-dorsiflexion), whereas, the actual joint has three rotational degrees-of-freedom. Typically, such simplifications are justified by the idea that the reduced case is contained as a specific solution of the more general case. However, here we demonstrate that the force-sharing solution space of a general, three degrees-of-freedom musculoskeletal system does not necessarily contain the solutions from the corresponding one or two degrees-of-freedom systems. Therefore, solutions of a reduced system, in general, are not sub-set solutions of the actual three degrees-of-freedom system, but are independent solutions that are often incompatible with solutions of the actual system. This result shows that representing a three degrees-of-freedom system as a one or two degrees-of-freedom system gives force-sharing solutions that cannot be extrapolated to the actual system, and vice-versa. These results imply that general solutions cannot be extracted from models with fewer degrees-of-freedom than the actual system. They further emphasise the need for precise geometric representation of the musculoskeletal system, if general force-sharing rules are to be derived.

Algorithms↗
PubMedDate not supplied

Pediatric orthopaedics: developmental norms.

Development of the musculoskeletal system occurs throughout childhood. This article provides an overview of normal musculoskeletal growth and development and describes some of the common variations seen in children. Knowledge of the normal patterns of growth and common problems can help nurses identify children who require further evaluation and treatment.

Adolescent↗
PubMed1981

Inspection-palpation-percussion-auscultation and an outcome-oriented alternative approach to the musculoskeletal examination.

Thirty-two university-based doctors and sixty-seven medical students used a visual analogue scale (VAS) to estimate the usefulness of the inspection-palpation-percussion-auscultation (IPPA) approach. Doctors considered IPPA less useful in the examination of the musculoskeletal system than in other systems, both in clinical practice (P less than 0.01) and as an aid in teaching (P less than 0.01). Students rated IPPA less useful in the musculoskeletal examination than in other systems as a learning aid (P less than 0.001). Based on these findings, an alternative model for physical examination of the musculoskeletal system was devised, using inspection, palpation and other clinical methods only when required to reach a diagnosis. The model focused on the outcome of the diagnostic process (aetiological, anatomical/pathophysiological and functional diagnoses) rather than on the process itself. Thirteen students taught this method found it a useful learning aid. Those familiar with both methods preferred the outcome-oriented to the IPPA method (P less than 0.001).

Auscultation↗
PubMed2004

A review of fibromyalgia.

Characterized by chronic widespread joint and muscle pain, fibromyalgia is a syndrome of unknown etiology. The American College of Rheumatology's classification criteria for fibromyalgia include diffuse soft tissue pain of at least 3 months' duration and pain on palpation in at least 11 of 18 paired tender points. Symptoms are often exacerbated by exertion, stress, lack of sleep, and weather changes. Fibromyalgia is primarily a diagnosis of exclusion, established only after other causes of joint or muscle pain are ruled out. The initial workup for patients who present with widespread musculoskeletal pain should include a complete blood count, erythrocyte sedimentation rate, liver function tests, hepatitis C antibody, calcium, and thyrotropin. The musculoskeletal system, the neuroendocrine system, and the central nervous system, particularly the limbic system, appear to play major roles in the pathogenesis of fibromyalgia. The goal in treating fibromyalgia is to decrease pain and to increase function without promoting polypharmacy. Brief interdisciplinary programs have been shown to improve subjective pain. Fibromyalgia is a complex syndrome associated with significant impairment on quality of life and function and substantial financial costs. Once the diagnosis is made, providers should aim to increase patients' function and minimize pain. This can be accomplished through nonpharmacological ahd pharmacological interventions. With proper management, the rate of disability appears to be significantly reduced.

Central Nervous System↗
PubMed1986

Exercise prescriptions for the elderly.

The decline in physical function that occurs with aging affects all systems, especially the cardiovascular and musculoskeletal systems. Exercise may improve cardiovascular fitness, increase bone density, improve flexibility and enhance mental outlook. Exercise of adequate intensity should be performed three to five times per week. Elderly persons require longer periods of activity because of their inability to tolerate intense levels of exertion.

Aged↗
PubMed1996

A survey of red cell use in 45 hospitals in central Ontario, Canada.

BACKGROUND: The purpose of this survey was to establish baseline information on blood component use in relation to patient diagnoses, procedures, and demographics and to identify patterns of blood use that may be used for blood program planning and transfusion audits. STUDY DESIGN AND METHODS: A cross-sectional survey of the transfusion of blood components in teaching and nonteaching hospitals in central Ontario between September 1991 and August 1992 was carried out. Coders of hospital medical records routinely record demographics, procedures, diagnoses, and other relevant information. A protocol was created by which medical records coders could add the components transfused to the discharge abstract for this study. Red cell use is reported here. RESULTS: Of the 61 hospitals invited to participate, from which 547,279 patients were discharged during the 12-month period of the study, 45 (74%) agreed to participate. Information was collected on 439,373 discharged patients. Of these, 26,611 (6.1%) received at least 1 unit of red cells. Of a total of 101,116 red cell units transfused, more than 74 percent were used in patients discharged with neoplasms, gastrointestinal diseases, circulatory system diseases, and trauma. High-transfusion-use procedures included operations and procedures on the digestive and cardiovascular systems, diagnostic and therapeutic procedures, musculoskeletal system, and hemic or lymphatic system procedures. CONCLUSION: This survey provides baseline blood transfusion information for a specific period that can help determine the need for hospital audits and maximum surgical blood-order schedule guideline reviews. This information is relevant to current recommendations to reduce patient's exposure to blood components. These transfusion data will assist in blood program planning based on known disease trends, demographics, and population changes.

Cross-Sectional Studies↗
PubMed1998

Intestinal and extraintestinal symptoms in functional gastrointestinal disorders.

Functional gastrointestinal disorders such as irritable bowel syndrome or functional dyspepsia have traditionally been regarded as syndromes limited to the digestive system. However, both clinical experience and published evidence show that patients with such disorders also report a series of other symptoms of physical distress, such as fibromyalgia and irritable bladder and alterations in vital functions, such as sleep, libido, appetite and energy level. Some of these extraintestinal symptoms can be explained in the context of an evolving comprehensive disease model which views functional gastrointestinal disorders as manifestations of alterations in the interactions between the nervous system, the viscera and the musculoskeletal system. Alterations in central circuits concerned with arousal, attention and fear, cognitions about bodily symptoms and possible alterations in the hypothalamic pituitary adrenal (HPA) axis may all contribute to the wide range of symptoms reported by affected patients.

Colonic Diseases, Functional↗
PubMed2001

Community health profile of Windsor, Ontario, Canada: anatomy of a Great Lakes area of concern.

The rates of mortality, morbidity as hospitalizations, and congenital anomalies in the Windsor Area of Concern ranked among the highest of the 17 Areas of Concern on the Canadian side of the Great Lakes for selected end points that might be related to pollution in this relatively highly industrialized city. Mortality and morbidity rates from all causes were higher than in the rest of the province. Anomalously high rates of diseases included various cancers; endocrine, nutritional, metabolic, and immunity disorders; diseases of the blood and blood-forming organs, nervous system and sense organs, circulatory and respiratory systems, digestive system, genitourinary system, skin and subcutaneous tissue, musculoskeletal system and connective tissues; congenital anomalies, and infant mortality. Of particular concern was the early onset of the elevated rates of many of these diseases and conditions. Comparison of these incident rates with those in Hamilton, another industrial municipality in southern Ontario, suggested that in addition to a variety of local sources of industrial pollution from automobile manufacturing and use, transboundary air and water pollution from Detroit, Michigan, should be investigated as potentially important causes of these health outcomes in the Windsor Area of Concern. Some of the institutional and political trends of the past decade may need to be reversed before effective remedial programs are implemented for cleaning up contaminated sediments and for containment of leaking hazardous waste sites. This pilot project would seem to be a useful preliminary method of integrating human health concerns and of priority setting for the administration of the Great Lakes Water Quality Agreement and the Canada-United States Air Quality Agreement.

Adolescent↗
PubMed2005

Burnout as a predictor of medically certified sick-leave absences and their diagnosed causes.

Stress-related illnesses, such as mental, behavioral, and cardiovascular diseases, are common causes for sick-leave absences. It is generally assumed that burnout, the chronic stress syndrome, also leads to absenteeism and poor health, but this assumption has rarely been tested. The authors investigated the prospective effect of burnout on registered sick leaves and their causes in industrial employees. We collected the number of medically certified (> 3 days) absence episodes and their causes (according to the International Statistical Classification of Diseases-10 diagnostic categories) of 3,895 industrial employees from a company register during 1995 to 1998. Burnout was measured in 1996 with the Maslach Burnout Inventory-General Survey, which defines burnout as a 3-dimensional syndrome consisting of components of exhaustion, cynicism, and lack of professional efficacy. In Poisson regression models, the total burnout score increased the risk for future all-cause absences after adjustment for age, sex, occupation, and baseline absence. Burnout increased the risk of future absences because of mental and behavioral disorders, diseases of the circulatory system, diseases of the respiratory system, and diseases of the musculoskeletal system. Of the separate components of burnout, exhaustion was strongly related to future diseases of the circulatory system, whereas cynicism was strongly related to future diseases of the digestive system. Other differentiated effects were also found. The results of this study show that burnout is related to increased risk of future illness. This implies that burnout prevention can reduce future absenteeism and has a major economic impact on work life and health care.

Absenteeism↗
PubMed1976

Men with disability pension.

In 1964, temporary or permanent disability pension was granted to 2.9 per thousand of all men in Malmö aged 16 to 66 years. The figure for 1974 was 10.6 per thousand, i.e. 3.7 times as high. The 235 men who in 1964 for the first time had been granted temporary or permanent disability pension by the Regional Social Insurance Office were compared with 235 men chosen at random from the 893 who in 1974 had been granted these benefits for the first time. The relation between temporary and permanent disability pension in the 1964 material was 1:2, and in the 1974 material, 1:4. In the 1964 material, the average age was 54.9 years; in the latter 57.4. The main diagnoses mental disorders, diseases of circulatory system, and diseases of the musculoskeletal system represent about 70% of the cases in each of the materials.

Age Factors↗