Orthostatic hypotension in stroke patients

To assess the incidence of orthostatic hypotension [OH] in stroke patients undergoing rehabilitation and to determine clinical variables associated with it. Thirty patients with a first clinical stroke who underwent rehabilitation within one month of stroke onset were included in this study. They were 17 males and 13 females. Their age ranged from 49 to 68 years [mean +/- SD= 58.1 +/- 6.3]. Patients were subjected to full history taking, thorough clinical examination and investigations. Patients' blood pressure was measured in the supine position and on tilting at 90[0]. OH was defined as a drop in systolic blood pressure [SBP] of 20 mmHg or more. OH was present in 14 [46.7%] patients. Age was highly significantly associated [p<0.001] with OH and admission modified Barthel Index [MBI] score was significantly associated [p<0.05] with OH. There was a non-significant correlation with the site of stroke or the use of anti-hypertensives. OH was common in stroke patients undergoing inpatient rehabilitation especially in older patients who have a lower functional status

Mast cells in rheumatoid synovial tissue with electron microscopy

The aim of this study was to search for the presence of mast cells in the synovial tissues of rheumatoid arthritis [RA] with electron microscopy in a trial to understand the pathogenesis of the disease. Synovial tissues were obtained from 10 RA patients. The presence of mast cells was examined with electron microscopy. The presence of mast cells was not demonstrated in the synovial tissues of RA with electron microscopy. Electron microscopy is not a suitable method for demonstrating the presence of mast cells in the synovial tissue of RA patients

Serum and synovial fluid levels of MMP-3 and TIMP-1 in rheumatoid arthritis and osteoarthritis

Matrix metalloproteinases [MMPs] are cytokine-modulated enzymes that play an important role in the pathogenesis of RA by inducing bone resorption and cartilage destruction. Tissue inhibitors of metalloproteinases [TIMPs] are naturally occurring MMPs inhibitors. In rheumatoid arthritis [RA], there is a disturbed balance between MMPs and TIMPs favoring proteolysis. This study was performed to evaluate the significance of measuring the serum and synovial fluid [SF] levels of MMP-3 and TIMPs in RA and osteoarthritis [OA] patients in an attempt to provide more insight in their role in the pathogenesis of those two diseases. Serum levels of MMP-3 and TIMP-1 were measured from 30 RA, 20 OA patients and 20 healthy controls using double-antibody ELISA. Also, their levels were measured in the SF of 14 RA and 9 OA patients. RA disease activity was assessed using the Multivariate Analysis of Mallya and Mace and joint erosions were assessed using Larsen score. Serum and SF levels of MMP-3 and TIMP-1 were significantly higher in RA than OA patients and in OA patients than controls. Their levels were significantly higher in the SF than in the serum. Serum and SF TIMP-1: MMP-3 ratio was significantly lower in RA as compared to OA patients and normal controls and this ratio was significantly lower in the SF than in the serum of RA patients. Serum levels of MMP-3 and TIMP-1 correlated strongly with clinical and laboratory parameters of rheumatoid disease activity, and the serum levels of MMP-3 showed a significant positive correlation with the number of joint erosions but TIMP-1 levels did not show this positive correlation. Serum and SF MMP-3 and TIMP-1 levels were significantly higher in RA than OA patients and normal controls. They appear to play a critical role in joint inflammation and destruction, especially MMP-3, which may serve as an additional marker for assessment of RA disease activity and severity

Role of extended field of view ultrasonography in musculoskeletal disorders

Real time ultrasound [U/S] scanning is useful to detect abnormalities of musculo-skeletal system [MSK] and shows the effect of movement. However, documentation is best with the extended field of view [Fov] ultrasonography. This new imaging technique identifies identical structures on two successive images for position registration to display a large area in real time without position sensors. To evaluate the usefulness of extended Fov U/S in displaying and documenting on a single, static image a more panoramic depiction of MSK abnormality and its relationship to adjacent structures. Abnormalities of tendons, muscles, and soft tissue infection and masses are examples of lesions documented by high frequency extended Fov U/S. The study was monitored for 24 months period and included 18 patients [7 males and 11 females] of variable age groups. Six patients with tendon pathology, three with muscle pathology, eight with soft tissue masses, and one with a bony lesion. Large resolution preserved composite images of up to 30 cm were obtained. The display of the relationship of abnormalities to surrounding structures is very important and allows for better interpretation of findings and appreciation of the diagnosis on a static image. In addition, easily useful applicable comparative measurements on follow up scanning were done. Extended Fov U/S allowed: [a] better appreciation of MSK disorders [b] sizing of large masses on a single global image [c] relating the lesion to surrounding structures [d] greater measurement reproducibility at follow up scanning in circumstances under which conventional real time scans could not provide this information

Combined ligamentotaxis and kirchner wires fixation for intraarticular fractures of the distal radius

Forty-two unstable intra-articular distal radius fractures were treated with primary external fixator augmented with Kirschner wires fixation. An external fixator was inserted between the radius and the second metacarpal, and ligamentotaxis was maintained for 4 weeks. A supervised physiotherapy regimen was started from day one postoperative. The external fixation was removed at 4 weeks and Kirschner wires were removed at an average of 7.1 weeks. Seventy patients were females and 25 were males, with an average age of 47.3 years. In 39 patients [92.9%] the anatomical result was good or excellent, but three fractures healed with malunion. All patients made a satisfactory functional recovery, at a mean follow-up of 28 months after injury. None had pain in the wrist and all were satisfied with the result. The average grip strength was 96% of normal. External fixation supplemented with Kirschner wires fixation with early removal of the external fixator and mobilization is an effective method for the treatment of unstable intra-articular distal radius fractures. It could give better functional results than the use of an external fixator alone

association between rheumatoid arthritis and hepatitis C virus infection

To study the association between rheumatoid arthritis and HCV infection. The study included 40 RA patients diagnosed according to the ACR criteria [group I]. It also included 20 inflammatory arthritis patients with RF positive but not fulfilling the criteria for diagnosis of RA [group II]. Ten age and sex matched subjects were taken as controls. Anti HCV antibodies were detected in the sera of these patients. 0.5% of the patients of group I had anti HCV antibodies while 20% of patients of group II had anti HCV antibodies. As regards the control group, none was anti HCV antibody positive. There is a strong association between the presence of anti HCV antibodies and rheumatoid factor that is stronger than the association between anti HCV antibodies and rheumatoid arthritis. Patients with anti HCV antibodies may have rheumatoid factor positive in their serum, but the picture may not fulfill the criteria of RA. Thus in any case of inflammatory arthritis, hepatitis C virus must be put in consideration

Treatment of chronic rotator-cuff impingement with arthroscopic subacromial decompression

We made a prospective study on 29 patients who had arthroscopic subacromial decompression for chronic rotator-cuff impingement. All patients were diagnosed as having chronic rotator-cuff impingement on the basis of clinical and sonographic examination. All patients were assessed pre-operatively and at 3, 6 and 12 months post-operatively using the shoulder-rating scale of the University of California at Los Angeles [UCLA]. The dominant arm was affected in 24 patients. There were 26 males and only three females. Before operation, the UCLA shoulder score was poor or fair in all patients. After three months of the operation 48% of patients had satisfactory relief of symptoms but at one year 93% of patients examined had a good or excellent result We concluded that arthroscopic subacromial decompression is an effective form of treatment, but full recovery of function and relief of symptoms could take long time