Systemic Juvenile Idiopathic Arthritis in two children; case report on clinical course, challenges in diagnosis and the role of FDG-PET/CT-scan.

Systemic juvenile idiopathic arthritis (sJIA, also called Still's disease) is a rare childhood auto-inflammatory disease with significant morbidity. This case report illustrates the clinical course and highlights diagnostic challenges. FDG-PET/CT imaging may be beneficial in the diagnostic process for some cases, in order to achieve rapid diagnosis and early treatment.

Relative torque contribution of vastus medialis muscle at different knee angles.

AIM: We investigated the relative contribution of the vastus medialis (VM) muscle to total isometric knee extension torque at 10 degrees , 30 degrees , 60 degrees and 90 degrees knee flexion. In the past a more prominent role of the VM muscle at more extended knee angles has been put forward. However, different components of the quadriceps muscle converge via a common distal tendon. We therefore hypothesized that the relative contribution of the VM to total knee extension torque would be similar across angles. METHODS: At each knee angle the EMG isometric torque relations [20%, 25%, 30%, 35% maximal voluntary contraction (MVC)] of the rectus femoris (RF), vastus lateralis (VL) and VM muscle were established in 10 healthy male subjects; rectified surface EMG was normalized to M-wave area. Subsequently, the VM was functionally eliminated by selective electrical surface stimulation with occluded blood flow. RESULTS: There was no evidence for preferential activation of VM at any of the knee angles. Following VM elimination, total knee extension torque during maximal femoral nerve stimulation (three pulses at 300 Hz) at 10 degrees , 30 degrees , 60 degrees and 90 degrees , respectively, decreased (P < 0.05) to (mean +/- SD): 75.7 +/- 12.2, 75.1 +/- 9.3, 78.2 +/- 7.2 and 76.0 +/- 5.8% (P > 0.05 among knee angles). In addition, during voluntary contractions at 20% MVC the increases in torque output of RF and VL compensating for the loss of VM function were calculated from the increases in EMG and found to be similar (P > 0.05) at 10 degrees , 30 degrees , 60 degrees and 90 degrees values (%MVC), respectively, were: 9.1 +/- 6.8, 7.5 +/- 2.9, 5.9 +/- 3.7 and 6.9 +/- 3.4. CONCLUSION: The present findings support our hypothesis that the VM contributes similarly to total knee extension torque at different knee angles.

Antenatal, neonatal and post neonatal deaths evaluated by medical audit. A population-based study in northern Norway - 1976 to 1997.

BACKGROUND: Perinatal committees evaluate deaths by medical audit to improve antenatal and neonatal care. We report data from Troms County from 1976 to 1997. SUBJECTS AND METHODS: Antenatal, neonatal and post neonatal deaths (n=472) at > or = 20 weeks of gestation have been evaluated. Data were collected from the Medical Birth Registry of Norway and from medical records. Pregnancy risk factors, mortality rates, causes of deaths, non-optimal care and avoidable deaths were recorded. RESULTS: The death rate (all deaths per thousand total births) declined from 13.8 (1976-80) to 7.7 (1992-97), (p<0.001), due to a reduced death rate in preterms > or = 24 weeks (p<0.001) and in those between 500 and 1995 g (p<0.001). Antenatal deaths decreased (p<0.001) due to reduced intrapartum deaths (p<0.001). Prelabor deaths, unexpected intrauterine pre-hospitalization deaths included, did not change. Postnatal deaths declined (p=0.01) due to reduced early neonatal mortality (p=0.002). Deaths from malformations (p<0.001), fetal and neonatal infections (p=0.03) and placental disorders (p<0.001) declined. Non-optimal care (22.5% of deaths, 2.3%o of total births), avoidable deaths (13.1% of deaths, 1.3% of total births), and maternal neglect (7.5% of cases with non-optimal care, 0.6% of total births) did not change. Death during transport was rare (n=5), and no deaths occurred at maternity homes. Non-cohabitance, smoking and undiagnosed SGA new borns declined, and the level of education increased in the study population. CONCLUSION: The improvement is due to a reduction in intrapartum deaths and early neonatal mortality in preterms. A constant high rate of unexpected intrauterine deaths in non-hospitalized patients is a challenge for antenatal health care providers.