Correlates with comfort and function after total shoulder arthroplasty for degenerative joint disease.

Although most patients are improved after shoulder arthroplasty, the degree of improvement is variable. The factors contributing to this variability are not well understood. In particular, little information is available regarding the preoperative characteristics of the patient that may influence the quality of the result. This study correlated patient demographics, preoperative health status, and preoperative shoulder function with 3 outcome metrics: comfort, physical role function, and shoulder-specific function. One hundred thirty-four shoulders having total shoulder arthroplasty for degenerative glenohumeral joint disease had an average follow-up of 3.4 +/- 1.8 years. The SF-36 Comfort score improved from 39 to 61 (P < .0001). The SF-36 Physical Role Function score improved from 30 to 52 (P < .0001). The average number of Simple Shoulder Test functions performable (out of 12) improved from 4 to 9 (P < .0001). The strongest correlates with postoperative comfort included preoperative physical function (P < .0001), general health (P < .0001), and social function (P < .001). The strongest correlates with postoperative physical role function included preoperative physical function (P < .0001) and general health (P < .001). The strongest correlates with postoperative shoulder function included male gender (P < .0001), and preoperative physical function (P < .0001), social function (P < .0001), mental health (P < .0001) and shoulder function (P < .0001). These data indicate that the overall well-being of the patient before surgery is strongly correlated with the quality of the outcome from total shoulder arthroplasty for degenerative glenohumeral joint disease.

The correlation of comorbidity with function of the shoulder and health status of patients who have glenohumeral degenerative joint disease.

We studied the effect of comorbidities on function of the shoulder and health status in a group of eighty-five consecutive patients who had glenohumeral degenerative joint disease of sufficient severity to meet one surgeon's criteria for the performance of shoulder arthroplasty. A questionnaire was used to identify the comorbidities, such as other diseases, social factors, or a work-related injury, for each patient. The number of functions on the Simple Shoulder Test that the patient could perform had a significant negative correlation with the number of comorbidities (r = -0.32, intercept = 4.6 per cent, slope = -0.6, and p = 0.0031). Each parameter on the Short Form-36 (except for physical role function) had a significant negative correlation with the number of comorbidities (p < 0.05). This negative relationship was strongest for general health perception (r = -0.42) and vitality (r = -0.35). We concluded that the number of comorbidities has a quantitative effect on function of the shoulder. In the evaluation of the functional status of patients and the effectiveness of treatment, the effects of comorbidity must be controlled. The results of the present study demonstrate that the scores on the Short Form-36 are quantitatively related to the number of comorbidities. The six parameters that are unrelated to function of the shoulder (physical function, social function, emotional role function, mental health, vitality, and general health perception) may provide a practical way to integrate the effects of all potential comorbidities on individual patients. Future clinical research will be strengthened by efforts to measure the impact of comorbidities and by strategies to control for their effects.

Melorheostosis.

Melorheostosis is a rare, benign connective-tissue disorder characterized by a cortical thickening of bone with irregular dense hyperostosis that appears to flow along the cortex. We review the literature to date, etiology, clinical aspects, roentgenographic features, histology, and treatment of melorheostosis.

Pelvic mass secondary to polyethylene and titanium alloy wear debris resulting in recurrent deep vein thrombosis.

External venous compression can be a cause of deep vein thrombosis (DVT). This is an unusual case of acetabular component failure and resultant polyethylene and titanium alloy wear debris that presented as a pelvic mass and resulted in iliac vein compression and subsequent DVT.

Pediatric osteomyelitis masquerading as skeletal neoplasia.

Osteomyelitis has many forms of presentation in the pediatric age group. From neonatal osteomyelitis, with a paucity of clinical symptoms and signs, to the more typical acute hematogenous form or even the subacute or chronic presentations, a high index of suspicion is needed to institute appropriate investigations and treatment.

Fatal pulmonary embolus after knee arthroscopy.

We report a case of fatal pulmonary embolus after arthroscopy of the knee to heighten awareness of this potentially fatal complication. A literature search was conducted to review the reported complications of knee arthroscopy.

Blunt needle infusion of local anesthetics or narcotic analgesics into operative wounds or joints.

Local anesthetics or narcotic analgesics introduced into surgical wounds have been noted to provide pain relief. These agents are typically infused into the postoperative joint or wound using a standard beveled needle or by pressing the syringe hub against the incision without a needle. We present an alternative method of administering these agents to provide pain relief in the orthopedic patient. A blunt needle is used to infiltrate the postoperative joint or wound with local anesthetics or narcotic analgesics.

The role of melatonin and serotonin in aging: update.

It has been proposed that aging occurs because of a failure of the pineal gland to produce melatonin from serotonin each day beginning at sunset and throughout the night. This lack leads to a nighttime deficiency of melatonin both absolutely and also relatively to serotonin. As melatonin has wide-spread integrative and regenerative effects, its lack may lead to disturbances normally associated with aging. The present paper reviews the pertinent literature which appeared since our first publication, but earlier articles are also included. Evidence is presented for a role of melatonin and serotonin in controlling the neuroendocrine and immune networks and in inhibiting the development of ischemic heart and Alzheimer's disease, tumor formation and other degenerative processes associated with aging. The possible role of melatonin in the favourable effects of dietary restriction on aging is also discussed. This paper provides additional evidence that a melatonin deficiency, especially in relation to serotonin, may be responsible for the promotion of aging in the organism.

The role of melatonin and serotonin in aging.

The hypothesis presented in this paper defines aging as a pathological process originating in the pineal gland. This results in a diminished output of melatonin, along with a diminished melatonin to serotonin ratio, leading to a decline in adaptive processes and a predictable syndrome manifested by the "diseases of the aged" (DOA) and subsequent death of the organism. That is, aging is a syndrome of relative melatonin deficiency resulting from the gradual failure of the pineal gland.