A habitat-based framework to predict the effects of agricultural drain maintenance on imperiled fishes.

One third of the total global land viable for agricultural production has artificial drainage systems. These drainage systems can provide important habitat for fishes and, in some cases, imperiled fish species vulnerable to impact by drainage maintenance activities. A framework to provide quantitative assessments of the effects of maintenance activities on imperiled fish species is needed. In this study, a six-step habitat-based framework was developed to predict suitable habitat for two at-risk species in an agricultural drain: the Endangered Pugnose Shiner (Notropis anogenus) and the Special Concern Blackstripe Topminnow (Fundulus notatus). Using the framework, spatial models were developed to assess the effects of proposed drain maintenance on the overall amount of suitable habitat, habitat patch size, and connectivity of habitat patches. Maintenance had a significant impact on habitat connectivity, but did not significantly reduce the habitat size of isolated patches. The amount of suitable habitat available after maintenance fell below the minimum area for population viability (MAPV) for the Pugnose Shiner, but not the Blackstripe Topminnow. Future impact assessments of drain maintenance should incorporate population viability analysis, coupled with habitat patch analysis (patch size and connectivity), to quantitatively test consequences of proposed alteration to the viability of spatially structured populations.

Possible Trimethoprim-Sulfamethoxazole-Induced Hemolytic Anemia: A Case Report.

OBJECTIVE: To report a case of hemolytic anemia in a patient who received trimethoprim/sulfamethoxazole (TMP-SMX) for a urinary tract infection (UTI). SUMMARY: A 47-year-old woman recently diagnosed with uncomplicated UTI received 3 doses of TMP-SMX. She developed yellowing of the skin and eyes, lethargy, mild abdominal pain, and dry mucous membranes. Laboratory testing demonstrated significant anemia with red blood cells (RBCs) of 1.99, hemoglobin (Hgb) of 6.3 g/dL, and hematocrit (Hct) of 18.1%. TMP-SMX was immediately discontinued. The patient was given methylprednisolone 60 mg intravenously (IV) followed by oral steroids and infused with 3 units of packed RBCs over the course of a 10-day inpatient admission. On discharge, the patient continued oral steroids. Outpatient follow-up indicated Hgb of 11.0 g/dL and Hct of 32.7%, 41 days after hospital discharge. Utilizing the Naranjo adverse drug reaction probability scale, there is a probable association between the patient's hemolytic anemia and TMP-SMX. CONCLUSION: We report a case of hemolytic anemia resulting from the use of TMP-SMX. Although this is a rare adverse effect, clinicians should be aware of the signs and symptoms of hemolytic anemia, and so appropriate treatment can be administered should it occur.

Resolution of clopidogrel-associated polyarthritis after conversion to prasugrel.

PURPOSE: A case of acute polyarthritis associated with the use of clopidogrel is reported. SUMMARY: A 72-year-old retired Caucasian man arrived at the emergency department with confusion, a temperature of 101 °F, difficulty walking, leukocytosis, and diffuse joint aches. The patient reported decreased oral intake and progressive weakness. Upon questioning, he reported pain in almost all joints. The patient reported no rash, twitching, or focal numbness. Approximately two weeks earlier, the patient underwent a nonemergent percutaneous coronary intervention secondary to coronary artery disease, after which clopidogrel and aspirin were initiated. The patient had no complaints the week after his stent placement. Approximately four days before this hospital admission, the patient reported acute onset of lateral left leg pain. The symptoms progressed in the following days, necessitating admission to the hospital. The patient's symptoms markedly improved with discontinuation of clopidogrel and administration of corticosteroids. Prasugrel was initiated before hospital discharge. The patient reported no arthralgias and continued compliance with prasugrel during follow-up telephone calls by the clinical pharmacist at two and six weeks. Applying the Naranjo et al. probability scale to this case yielded a score of 5, suggesting that clopidogrel was the probable cause of the patient's adverse reaction. CONCLUSION: A patient developed acute polyarthritis evidently associated with clopidogrel therapy. Symptoms resolved after prasugrel was substituted for clopidogrel and reappeared after two doses of clopidogrel were taken inadvertently.

Inhaled nitric oxide delivery and monitoring.

Inhaled nitric oxide (NO) was found to cause selective pulmonary vasodilation in the late 1980's and since then there has been a huge interest in studying its clinical benefits. The equipment used to deliver and monitor inhaled NO has gone through a dramatic evolution from simple flow meters and industrial monitors to to-days purpose built, fully integrated, NO delivery and monitoring systems that were designed specifically for the demanding area of the intensive care unit. This paper explores the evolution of inhaled NO delivery systems and identifies the design challenges, the safety and regulatory requirements and the ease of use issues that had to be solved to bring this new exciting new class of medical device in to clinical use.

Hypertrophic extensor digitorum brevis muscles simulating pseudotumors: a case report.

Pseudotumors can involve soft tissue or bone, and can lead to difficulty or uncertainty in diagnosis and treatment. The authors describe bilateral hypertrophy of the belly of the extensor digitorum that simulated ganglia.

Arthrodesis of the ankle secondary to replacement.

One hundred total ankle arthroplasties were performed in our department between 1974 and 1994, and of these, 21 have been reoperated on with arthrodesis due to septic or nonseptic failures after 6 months to 15 years (median 40 months). Immobilization using a Hoffman external fixator was the dominating method. The total ankles were of six different designs. Sixteen of the 21 patients suffered from rheumatoid arthritis. Four of the 21 ankles did not fuse whereas 17 did: 13 at the first attempt and 4 after repeat arthrodesis. At the time of the review, two patients had died. Of the remaining 15 patients whose ankles had fused, all but one were satisfied or somewhat satisfied with the result. Twelve of these 15 ankles rated excellent or good according to the Mazur and Kofoed scoring systems. We conclude that arthrodesis can be performed successfully after a failed ankle arthroplasty.

Risk analysis of occupational factors influencing the development of arthrosis of the knee.

The aim of this study was to identify occupational activities important for the development of arthrosis of the knee, taking into account the confounding factors that were suspected or could be recognized. In the archives of the Department of Diagnostic Radiology at the Malmö University Hospital all radiographs of weight-bearing knees of patients with painful knee joints from the period 1982-1986 were reassessed. We found 340 probands, i.e., subjects with arthrosis of the knee of at least grade 1 in the Ahlback classification. These probands and their age- and sex-matched controls (680) were analyzed by a validated questionnaire for details of activities at work inducing knee moment over three 15-year-periods as well as their history of knee injuries at work or in their leisure time. The questionnaire was answered by 266 (79%) arthrosis probands and 463 controls (70%). The results of the questionnaire answers and of the recorded history of knee injuries were statistically analyzed by logistic regression. The relative risk of knee arthrosis was slightly increased (RR: 1.9; CI: 1.4-2.7) in probands with weight-bearing knee bending, i.e., dynamic load of the knee joint when bending, whereas knee injuries (meniscectomies and haemarthrosis) were associated with a higher risk. Weight-bearing knee bending corrected for confounders was not a significant factor for knee arthrosis. Overweight was observed to increase the relative risk. A sedentary profession had, on the other hand, a low risk. The knee injuries (66) were, but for 9 probands, sustained in leisure activities, mainly soccer. We thus conclude that work which induces weight-bearing knee bending by itself does not significantly increase the risk of developing arthrosis of the knee - knee injuries and overweight are more important.

The natural history of idiopathic scoliosis. Incidence of treatment in 15 cohorts of children born between 1963 and 1977.

STUDY DESIGN: This study analyzed the incidence of treatment of scoliosis using a cross-sectional and a longitudinal technique. OBJECTIVES: To follow the incidence of treated scoliosis in Malmö, Sweden, in children born between 1970 and 1977 and compare observations with those of a study from 1988, in which the incidence of this disorder was followed in children born between 1963 to 1969. SUMMARY OF BACKGROUND DATA: During the late 1970s and early 1980s, the incidence of treated scoliosis decreased yearly in Malmö. This trend was supported by other reports. However, introduction of worldwide screening for scoliosis was a confounding factor. When cohorts of children born between 1963 and 1969 were analyzed, no change was found. In a study in Malmö in 1988, this was shown to be an effect of using a longitudinal instead of a cross-sectional technique of analyzing the data. METHODS: In a cross-sectional study, the authors registered all new treatments for idiopathic scoliosis, brace treatments, or direct surgery, for each year between 1984 and 1993. In a longitudinal study, all new treatments in each cohort of children born between 1970 and 1977 were followed. The results were compared with figures from the 1988 study. RESULTS: After the introduction of school screening in 1976, a peak in the incidence of treated scoliosis was seen in 1977. After a continuous decrease in the incidence until 1983, a steady state developed. In cohorts born between 1963 and 1977, the incidence is neither increasing nor decreasing. CONCLUSIONS: In cohorts of children followed in a longitudinal study over a 15-year period (born between 1963 and 1977), there is no support for a change in the natural history of idiopathic scoliosis.

Continuous passive motion compared to active physical therapy after knee arthroplasty: similar hospitalization times in a randomized study of 68 patients.

68 consecutive patients who had primary knee arthroplasties because of arthrosis were randomized to postoperative continuous passive motion (CPM) or active physical therapy (APT). Rehabilitation in both groups was initiated on the first postoperative day. The CPM group sustained less postoperative knee swelling with more rapid initial improvement in knee flexion than did the APT group, but there were no differences between the groups in knee flexion at discharge. Postoperative pain rating and hospitalization times were similar in the two groups.

Knee moment at work: validation of a questionnaire based on knee moment in working life.

Classifications of occupations, such as those of the International Labor Organization, have previously been constructed with respect to the physical strain and joint moment to be expected in conjunction in a profession. To detect which occupational activities specifically induce high knee moments, we designed a questionnaire to analyze walking, knee bending, climbing of stairs and ladders, and jumping during three consecutive 15-year exposure periods in the professional lives of 920 consecutive residents [329 men with a mean age of 72 (range 47-96) and 561 women with a mean age of 77 (range 47-96)] drawn from the population records of the City of Malmö. The answers, classified into three categories with respect to knee joint moment, were compared with a classification of the occupations of all probands according to the same principles by three independent specialists in industrial hygiene. The two classifications showed a high degree of agreement, with Cramer's V ranging from 0.49 to 0.6, suggesting a co-variance with a common variable, i.e. the true work-related knee moment.

Anterior ankle impingement arthropathy. The role of anterolateral arthrotomy and arthroscopy.

The choice of anterior ankle arthroplasty conducted by anterolateral arthrotomy versus arthroscopic techniques depends on the severity of the osteophytosis and the dominance type. This can be determined in most cases by conventional radiology, contrast arthrography, or MRI. Diagnostic arthroscopy may be required when noninvasive means fail to provide the answer to anterior frontier joint pain. Thorough arthroplasty must be performed and the joint placed through its end range of motion to verify reduction of all impingements. Extensive bony impingements are most effectively treated by conventional anterolateral arthrotomy. This is particularly true in posttraumatic cases with considerable arthrofibrosis infiltrate. Lesser degrees of osteophytosis confined, in particular, to the leading tibial edge are effectively reduced by arthroscopic technique. Anterior ankle arthroplasty by either technique offers symptomatic relief of pain with minimal morbidity. It can serve as a definitive treatment protocol for many patients or simply represent a temporary step along the way to more aggressive salvage surgery such as arthrodesis.

Screening for idiopathic scoliosis. Comparison of 90 cases shows less surgery by early diagnosis.

We assessed the final outcome of curve progression in 90 consecutive school children with idiopathic scoliosis. 46 children treated 1971-76 were compared with 44 treated 1978-81, after the introduction of school screening in 1977. There was a decrease in demand for surgery from 45 percent before screening to 10 percent in the screening group. When differences in subsequent brace types were accounted for, the outcome remained better in cases detected during the screening period. The most probable explanation is the earlier onset of bracing in the screened group.