Proximal interphalangeal joint replacement in patients with arthritis of the hand: a meta-analysis.

We systematically reviewed all the evidence published in the English language on proximal interphalangeal joint (PIPJ) replacement, to determine its effectiveness on the function of the hand and the associated post-operative complications. Original studies were selected if they reported clinical outcome with a minimum of one year's follow-up. Quality was assessed using the Cowley systematic review criteria modified for finger-joint replacements. Of 319 articles identified, only five were adequately reported according to our quality criteria; there were no randomised controlled trials. PIPJ replacements had a substantial effect size on hand pain of -23.2 (95% confidence interval (CI) -27.3 to -19.1) and grip strength 1.2 (95% CI -10.7 to 13.1), and a small effect on range of movement 0.2 (95% CI -0.4 to 0.8). A dorsal approach was most successful. Post-operative loosening occurred in 10% (95% CI 3 to 30) of ceramic and 12.5% (95% CI 7 to 21) of pyrocarbon replacements. Post-operative complications occurred in 27.8% (95% CI 20 to 37). We conclude that the effectiveness of PIPJ replacement has not been established. Small observational case studies and short-term follow-up, together with insufficient reporting of patient data, functional outcomes and complications, limit the value of current evidence. We recommend that a defined core set of patients, surgical and outcome data for this intervention be routinely and systematically collected within the framework of a joint registry.

Percutaneous chemical myotomy using botulium neurtoxin A under local anaesthesia in the treatment of cricopharyngeal dysphagia following laryngectomy.

OBJECTIVE: The purpose of this study was to evaluate the outcome of the use of percutaneous injection of botulinum neurotoxin A under local anaesthesia in the management of cricophayngeus dysphagia in post-laryngectomy patients. METHODS: Fifteen post-laryngectomy patients (6 males, 9 females, age range 48-72 years) with surgery performed not less than five years with post-operative radiotherapy were recruited. Under video-fluoroscopic control and the attachment of a metal safety pin to the neck as a topographical marker for the cricopharyngeus muscle, botulinum neurotoxin was injected after local anaesthesia infiltration. Patients were followed up for a 4 months period with repeated video-fluoroscopy and telephone self-assessment and weight change. RESULTS: Eighty seven percent of patients noticed some improvement in their dysphagia. One patient reported an adverse reaction of pain at the site of injection. CONCLUSION: Percutaneous local injection of botulinum neurotoxin A is a simple, safe and cost-effective means of improving cricopharyngeal dysphagia in post-laryngectomy patients when general anaesthesia is contra-indicated.

A prospective cohort study of arm pain in primary care and physiotherapy--prognostic determinants.

OBJECTIVE: To investigate outcome and prognostic determinants for arm pain presenting to primary care and physiotherapy services. METHODS: Patients with arm pain were recruited as they presented to primary care and physiotherapy services, and were followed for 12 months. At baseline, they were classified by diagnosis using a validated examination schedule. Depression, somatizing tendency, health anxiety, fear-avoidance beliefs and chronic pain outside the arm were ascertained using standard definitions. Three outcomes were considered: same-site pain during the final month of follow-up (continuing pain); pain present on most days of that month; and pain present without a break of 7 days over follow-up ('unremitting' pain). Associations were explored in multi-level logistic regression models and summarized as odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS: Altogether, 313 (83%) of 375 subjects completed follow-up, including 53% with 'continuing' and 24% with 'unremitting' pain. 'Continuing' pain was predicted most strongly by male sex (OR 1.9, 95% CI 1.2-3.2) (this association was restricted largely to the elbow), higher frequency of pain in the past month at baseline (OR 2.5, 95% CI 1.1-5.6), chronic pain at sites outside the arm (ORs 1.6-2.4 for different sites) and current smoking (OR 3.3, 95% CI 1.6-6.6). There were also indications that mental health and fear-avoidance beliefs influenced prognosis. Predictors for the other two adverse outcomes were similar. CONCLUSION: Arm pain often persists in patients who consult medical services. Predictors of persistence include male sex (elbow only), frequency of pain at baseline, chronic pain at other sites and smoking.

Common iliac artery occlusion: treatment with pull-through angioplasty.

A technique was developed to traverse an occlusion of the common iliac artery when approach from an ipsilateral puncture has been unsuccessful. The technique involves an antegrade approach to the occlusion and allowed successful passage in seven cases. At 2-year follow-up, only one of the seven occlusions had recurred.

Interactions between dermatophyte fungi and staphylococci or Brevibacterium in vitro.

Interactions between dermatophyte fungi and staphylococci or brevibacteria on a new skin-based culture medium are described. Penicillin production by the fungus selects penicillin resistant S. aureus or B. epidermidis. Fungi are inhibited by brevibacteria but not by the staphylococci. "Keratolysis" by fungi may contribute to the growth nutrients of staphylococci.

Distribution of chromobacteria in a lowland river.

A selective medium was used to estimate the numbers of purple pigmented bacteria in the River Wey. Chromobacteria were never isolated from the springs at the source of the river, but they appeared within a short distance and their numbers generally increased over the first 30 km. Counts were always low but were much higher during the winter than during the summer.Records of water temperature and turbidity, as well as daily rainfall, were maintained during the sampling period. An unweighted multiple regression analysis of some of the results has shown that much of the variability in the counts of chromobacteria was correlated with turbidity (r=0.67,P<0.001). After turbidity was allowed for, a significant inverse correlation with temperature (r=0.60,P < 0.001) became apparent and these two factors together accounted for 64.7% of the variation in counts. Allowing for these two factors revealed a significant correlation with rainfall during the previous 4 days (r=0.27,P<0.05), and the three factors together accounted for 67.2% of the variability in counts.In an attempt to discover the source of chromobacteria, samples of silt, soil, and storm overflow effluents were studied. In general, chromobacteria were present in highest numbers in soil or silt containing substantial quantities of organic material.