Search

Background: Implant arthroplasty of the wrist offers pain relief with preservation of motion to patients with rheumatoid arthritis, although few studies have investigated the long-term results of this procedure. The purpose of the present study is to report the prospective results of total wrist arthroplasty with use of the Universal wrist prosthesis in a consecutive series of patients with rheumatoid arthritis who were managed by a single surgeon. Methods: Twenty-four wrist arthroplasties in twenty patients with rheumatoid arthritis were followed prospectively. Nineteen wrists in fifteen patients were followed clinically and radiographically for a mean of 7.3 years (range, 5.0 to 10.8 years) after the index procedure. Outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) score, wrist range of motion, and standard radiographic findings. Results: The average DASH score improved from 62 points preoperatively to 40 points at the time of the latest follow-up. The mean wrist flexion and extension at the time of the latest follow-up were 42° and 20°, respectively, for a mean improvement in the total flexion-extension arc of 14°. A total of nine wrists (45%) in eight patients underwent revision surgery because of a loose carpal component at the time of the latest follow-up. One patient underwent wrist arthrodesis because of recurrent wrist instability. Two additional wrists in two patients had radiographic evidence of carpal component subsidence at the time of the latest follow-up. The implant survival rates at five and seven years for the original prosthetic components were 75% and 60%, respectively. Conclusions: The results for the Universal wrist prosthesis at a minimum of five years of follow-up include a high rate of failure, most often because of carpal component loosening, resulting in revision of ten (50%) of twenty wrists at the time of the latest follow-up (with the inclusion of one revision in a patient who died before five years). Patients with a stable prosthesis maintained a functional range of motion and had improvement in patient-reported outcome measures. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

The article elaborates the survey regarding prevalence of tinea pedis in professional and college soccer players compared to non-athletes in the United States. The objective of the study is to assess the prevalence of various risk factors and their association with tinea pedis among these three groups of people. Tinea pedis infected 69 percent professional soccer players compared with 69 percent of male college soccer players and 43 percent of female college players. The non-athletes demonstrated less tinea pedis.

Sports participation may result in myriad cutaneous manifestations, from mundane findings to life-threatening illnesses. Skin infections are among the most common dermatologic ailments in athletes; herpes simplex is clearly among the most serious for the individual athlete, and ultimately the team. Herpes simplex infection most often involves athletes with extensive skin to skin contact. For a variety of reasons, wrestlers and rugby players seem particularly prone. The keys to thwarting epidemics and reducing an athlete's disqualification period include early diagnosis, rapid institution of therapy, and routine systematic preventative measures. This clinical review examines the classification, epidemiology, diagnosis, treatment, and prevention of herpes simplex virus infection as it relates to contact sports. Attention to evidence-based medicine is paid to treatment and prevention techniques. Practical implications for all concerned parties, including athletes, parents, coaches, trainers, and physicians, are discussed. [ABSTRACT FROM AUTHOR]

The article reports on a case study associated with piezogenic pedal papules in a marathon runner. A 28-year-old woman was presented to the clinic for an unrelated condition with an incidental finding of multiple discrete, skin-colored, firm, painless papules on both heels visible only upon standing. The papules were present for many years with no new or enlarging papules. She noted that the papules were more pronounced the day after a long training run of greater than 15 miles. No biopsy was obtained, and a diagnosis of piezogenic pedal papules was made. The pain experienced in some cases of piezogenic pedal papules is thought to be caused by ischemia due to the extrusion of fat with its vasculature and associated nerves. The diagnosis of painful piezogenic pedal papules can be challenging. Clinicians may do multiple tests to identify the cause of foot pain in the athlete. Treatments of both painful and painless papules are often unsatisfactory and include surgery, heel cups, compression stockings, and acupuncture.

In this study, we show that the novel synthetic curcumin analog, EF24, induces cell cycle arrest and apoptosis by means of a redox-dependent mechanism in MDA-MB-231 human breast cancer cells and DU-145 human prostate cancer cells. Cell cycle analysis demonstrated that EF24 causes a G2/M arrest in both cell lines, and that this cell cycle arrest is followed by the induction of apoptosis as evidenced by caspase-3 activation, phosphatidylserine externalization and an increased number of cells with a sub-G1 DNA fraction. In addition, we demonstrate that EF24 induces a depolarization of the mitochondrial membrane potential, suggesting that the compound may also induce apoptosis by altering mitochondrial function. EF24, like curcumin, serves as a Michael acceptor reacting with glutathione (GSH) and thioredoxin 1. Reaction of EF24 with these agents in vivo significantly reduced intracellular GSH as well as oxidized GSH in both the wild-type and Bcl-xL overexpressing HT29 human colon cancer cells. We therefore propose that the anticancer effect of a novel curcumin analog, EF24, is mediated in part by redox-mediated induction of apoptosis.

Normal wrist motion is accomplished by a complex interaction of multiple articulations involving the radius, ulna, and carpal bones. Total wrist arthroplasty cannot duplicate this intricate system, but it can potentially produce a stable, pain-free joint with functional range of motion. Achieving a functional and durable outcome requires proper patient selection, careful preoperative planning, and accurate implantation. Because arthroplasty poses greater risks than arthrodesis, low demand patients with special needs or desires for wrist motion are the best candidates. In particular, patients with arthritis involving multiple joints of the upper limbs often find tasks of daily living easier when some wrist motion is preserved. Other patients may choose arthroplasty over arthrodesis to better maintain their ability to perform vocational and avocational activities. Regardless of a patient's desire for arthroplasty, he or she must accept the lifetime of restricted activities imposed by an artificial wrist, which are similar to any other joint replacement. Complications may include infection, imbalance, implant breakage, dislocation, and loosening. Revision arthroplasty or conversion to an arthrodesis are options for the failed total wrist.