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1. |
Regional Musculoskeletal ExaminationWhat the Students Say |
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JCR: Journal of Clinical Rheumatology,
Volume 9,
Issue 2,
2003,
Page 67-71
David Coady,
Lesley Kay,
David Walker,
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摘要:
Confusion exists over which musculoskeletal examination skills medical students should learn. This study aimed to explore the views of third-year medical students. This was a qualitative study to allow in-depth exploration of beliefs and attitudes. Twenty students were randomly assigned to 1 of 2 focus groups. Their attitudes towards musculoskeletal examination were explored and discussed. The groups’ discussions were recorded, transcribed, and framework analysis was undertaken with the aid of NUD*IST computer software. The following themes were identified: students dislike eponymous names for clinical tests; students felt there is a need for a more structured approach to musculoskeletal examination; students appeared unaware that many clinical tests were not based on evidence; students complained of a lack of confidence in the use of musculoskeletal clinical tests. Student's confidence in their musculoskeletal examination skills may be improved by the development of an agreed set of so-called core examination skills.
ISSN:1076-1608
出版商:OVID
年代:2003
数据来源: OVID
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2. |
Lupus Pernio in SarcoidosisClinical Features and Treatment Outcomes of 14 Patients |
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JCR: Journal of Clinical Rheumatology,
Volume 9,
Issue 2,
2003,
Page 72-76
Halil Yanardaˇg,
Ömer Pamuk,
Gülsüm Pamuk,
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摘要:
Lupus pernio (LP) is the most characteristic skin lesion of sarcoidosis. In this study, we retrospectively evaluated the clinical features of sarcoidosis patients with diagnosed LP at our center. Of 516 sarcoidosis patients diagnosed within a 36-year period, 14 (2.7%) had skin lesions that were clinically and histologically diagnosed as LP. Thirteen of our LP patients were females, and one was a male (mean age: 46.3, range: 24-67). In 2 sarcoidosis patients, the initial presentation of the disease was LP. When the LP patients were compared with other sarcoidosis patients, there were more females, and the frequency of extrapulmonary involvement and the number of patients with advanced stage disease were higher (P<0.001). Oral and/or intralesional steroid therapy was the preferred treatment modality in all our patients and led to either recovery or regression in most patients with LP. As our study was an uncontrolled, retrospective one with few patients, it is difficult to say whether steroids are effective. LP runs a chronic course and spontaneous remission of lesions of more than 2 years’ duration is quite rare. Because of the unwanted side effects of steroids, the efficacy of new treatment modalities should be tested especially in sarcoidosis patients with only skin involvement.
ISSN:1076-1608
出版商:OVID
年代:2003
数据来源: OVID
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3. |
Evidence for DisseminatedMycoplasma fermentansin New Jersey Residents with Antecedent Tick Attachment and Subsequent Musculoskeletal Symptoms |
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JCR: Journal of Clinical Rheumatology,
Volume 9,
Issue 2,
2003,
Page 77-87
Eugene Eskow,
Martin Adelson,
Raja-Venkitesh Rao,
Eli Mordechai,
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摘要:
Mycoplasma species are one of nature's most abundant groups of microbes. These bacteria inhabit a wide diversity of insect, plant, and animal species, including humans. Certain mycoplasma species have been identified in blood-sucking arthropods, includingIxodesticks. Frequent human exposure to this genus of ticks led us to explore the possibility of tick-mediated transmission of these bacteria. We evaluated 7 residents of central New Jersey who developed fatigue, musculoskeletal symptoms, and cognitive disturbance after tick attachment. All 7 of these patients lacked both serological evidence and erythema migrans skin lesions characteristic of Lyme disease. We were able to amplify and quantitateMycoplasma fermentans-specific DNA from their peripheral blood lymphocytes. After antimicrobial therapy, symptoms subsided, andM. fermentansDNA could no longer be detected in their blood specimens. These findings suggest that a subset of disseminatedM. fermentansinfections may be a vector-mediated process in humans and should be considered in patients with puzzling musculoskeletal presentations.
ISSN:1076-1608
出版商:OVID
年代:2003
数据来源: OVID
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4. |
Historical Vignette: Raynaud's Phenomenon as Perceived by Musculoskeletal Specialists (1862-1957) |
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JCR: Journal of Clinical Rheumatology,
Volume 9,
Issue 2,
2003,
Page 87-87
Daniel Wallace,
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ISSN:1076-1608
出版商:OVID
年代:2003
数据来源: OVID
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5. |
Transient Renal Dysfunction with Raynaud's PhenomenonIs There a Connection? |
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JCR: Journal of Clinical Rheumatology,
Volume 9,
Issue 2,
2003,
Page 88-91
Samir Parekh,
Rajalakshmi Iyer,
Winston Sequeira,
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摘要:
We describe a patient with an episode of severe Raynaud's phenomenon and early or mild scleroderma who presented with a transient elevation of her serum creatinine that resolved spontaneously after 2 days. Vascular response to cold temperatures has been described in vascular beds other than the extremities, and a similar phenomenon in the kidney might have been responsible for the transient renal dysfunction. Possible mechanisms to explain this phenomenon are discussed. Vasospasm merits consideration as an uncommon but largely reversible cause of elevated creatinine in patients with Raynaud's phenomenon.
ISSN:1076-1608
出版商:OVID
年代:2003
数据来源: OVID
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6. |
Relapsing Polychondritis With Involvement of Posterior Inferior Cerebellar Artery Causing Acute Lateral Medullary Syndrome |
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JCR: Journal of Clinical Rheumatology,
Volume 9,
Issue 2,
2003,
Page 92-95
K. Topalkara,
E. Kaptanoˇglu,
A. Akyüz,
S. Yurtçu,
V. Akman,
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摘要:
We present a patient with relapsing polychondritis who presented with findings of lateral medullary syndrome, known as the syndrome of Wallenberg, produced by infarction of a wedge of lateral medulla lying posterior to the inferior olivary nucleus. Angiographic examination showed complete occlusion of the right posterior inferior cerebellar artery and segmental narrowings in the basilar artery. We believe that the angiographic findings were based on an underlying vasculitis because of his relapsing polychondritis. This is the first case of relapsing polychondritis with angiographically demonstrated posterior inferior cerebellar artery involvement. Although this syndrome is usually a result of atherosclerosis, our case suggests that vasculitis must also be considered because it may respond to treatment with corticosteroids.
ISSN:1076-1608
出版商:OVID
年代:2003
数据来源: OVID
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7. |
Successful Treatment With Low-Dose Thalidomide in a Patient With Both Behçet's Disease and Complex Regional Pain Syndrome Type ICase Report |
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JCR: Journal of Clinical Rheumatology,
Volume 9,
Issue 2,
2003,
Page 96-98
Daniel Ching,
Alan McClintock,
Frances Beswick,
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摘要:
Thalidomide is a recognized treatment of Behçet's disease. Low-dose thalidomide seems to be effective in the treatment of orogenital ulcers and is potentially safer with a lower incidence of adverse effects than higher doses. We wish to report a case of Behçet's disease in a 33-year-old woman who responded well to thalidomide 50 mg 2 to 4 times per week. Her disease manifestations (severe orogenital ulceration, pseudofolliculitis, mild thrombophlebitis, positive pathergy response, and fatigue) were previously resistant to courses of prednisone, dapsone, colchicine, various types of mouthwash, and topical steroid preparations. She also gave a history of complex regional pain syndrome type I (CRPS 1) over her left patella (severe pain, intermittent edema, hyperalgesia, allodynia, cold skin, and loss of movement) after a fall onto her left knee 6 years previously. This had only partially responded to a variety of treatment modalities.After starting thalidomide for her Behçet's disease, the pain in her left knee unexpectedly disappeared. There are rat experiments showing that thalidomide improves neuropathic pain, probably by selectively blocking tumor necrosis factor-alpha production in activated macrophages. We believe this is the first report of successful use of thalidomide in a human being with CRPS 1, and we therefore recommend that thalidomide should be considered in the treatment of CRPS 1.
ISSN:1076-1608
出版商:OVID
年代:2003
数据来源: OVID
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8. |
When Thought Leaders Mislead: “Discoid Lupus is Not Related to SLE” |
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JCR: Journal of Clinical Rheumatology,
Volume 9,
Issue 2,
2003,
Page 98-98
Daniel Wallace,
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ISSN:1076-1608
出版商:OVID
年代:2003
数据来源: OVID
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9. |
Differentiating the New Rheumatoid Arthritis Biologic Therapies |
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JCR: Journal of Clinical Rheumatology,
Volume 9,
Issue 2,
2003,
Page 99-114
Arthur Weaver,
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摘要:
Current understanding of the mechanisms behind the pathogenesis of rheumatoid arthritis (RA) has led to the development of therapies involving biologic agents that target specific mediators of the disease process. Although the biologic agents used to treat RA share the ability to alter the cytokine cascade, they differ in ways that are clinically important. For example, they vary with regard to how they block cytokine activity (ie, as receptors, as receptor blockers, or as anticytokine antibodies) and the particular cytokine they target (eg, tumor necrosis factor [TNF] versus interleukin-1). Biologic therapies for RA also differ in mode of administration. Several are administered subcutaneously, whereas others are given intravenously. They also have molecular dissimilarities that result in differences in pharmacokinetics (ie, long versus medium half-life) and that may influence their safety profiles.Some biologic agents, such as the TNF inhibitors etanercept and infliximab, have been rigorously examined for long-term safety and efficacy, whereas other agents, like the TNF inhibitor adalimumab, have not. Differences between the various biologic agents may relate to the usefulness of each individual drug as a long-term treatment in RA. For example, the need for physician visits may impact the practicality of drugs that are administered intravenously. Also, physicians should be aware that use of cytokine inhibitors increases the risk of infection. The prevalence of tuberculosis during therapy with infliximab exceeds the background rate in patients with RA. Accordingly, physicians should be familiar with the updated warnings in the package inserts that accompany these drugs.
ISSN:1076-1608
出版商:OVID
年代:2003
数据来源: OVID
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10. |
Examination of the Risk of Continuous Leflunomide Treatment on the Incidence of Infectious Complications After Joint Arthroplasty in Patients With Rheumatoid Arthritis |
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JCR: Journal of Clinical Rheumatology,
Volume 9,
Issue 2,
2003,
Page 115-118
Nobuyuki Tanaka,
Hisashi Sakahashi,
Eiichi Sato,
Kazuya Hirose,
Takumi Ishima,
Seiichi Ishii,
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摘要:
Synopsis: To determine whether the risk of infectious complications after total joint arthroplasty is increased in rheumatoid arthritis patients who are treated continuously with leflunomide, the incidences of infectious complications in 41 rheumatoid arthritis patients who received continuous leflunomide treatment (leflunomide group) and in 41 patients who did not receive leflunomide within 4 weeks of surgery (nonleflunomide group) were compared. The incidence (6.1%) of local infection after surgery in the leflunomide group (82 procedures) was slightly lower than that (6.3%) in the nonleflunomide group (79 procedures). There were no systemic or deep infections. None of the other variables analyzed were identified as risk factors for postoperative complications. The results indicate that there is no dramatically increased risk of postoperative infectious complications in rheumatoid arthritis patients who continue to be treated with low doses of leflunomide perioperatively.
ISSN:1076-1608
出版商:OVID
年代:2003
数据来源: OVID
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