Repeat operations in patients with anal fistula, a retrospective study across England and Wales

AIM

This article reports the frequency of repeat operations including waiting times within the National Health Service (NHS) of England and Wales.

METHODS

Retrospective study on repeat operations for anal fistula (AF) performed between 1st January 2010 and 31st December 2016. Data were extracted from the national registry of data entered into Hospital Episode Statistics (HES). Patient factors (age, sex, self-declared ethnicity) and geographical location were tested for association with repeat operations and time to the second operation.

RESULTS

We analysed 36,223 patients that had an operation for AF within 148 NHS trusts. The median follow-up time was 28 months. The majority of patients (67.4%) had only one operation. Eighty-five per cent of them remained under the care of a single consultant. Six per cent of the repeat surgeries occurred in at least three different treatment sites. Young age and female sex were associated with higher rates of repeat operations. Non-declared and Black or Black British ethnicity were associated with fewer operations. The median waiting time between the first and second operations was 27.4 weeks (IQR: 14.7-55.3); between the second and third 28.0 weeks (IQR: 14.7-57.0); between the third and fourth 29.0 weeks.

CONCLUSION

This large real world population-based study shows that the majority of patients with AF undergo only one operation. Patients requiring multiple procedures tend to stay under the care of a small number of consultants but waiting times between operations are long. There is a geographical variation in the number of operations and the time between them.

Vitamin D supplementation and adverse skeletal and non-skeletal outcomes in individuals at increased cardiovascular risk: Results from the International Polycap Study (TIPS)-3 randomized controlled trial

BACKGROUND AND AIMS

Vitamin D has mostly been tested in Western populations. We examined the effect of high dose vitamin D in a population drawn predominantly from outside of Western countries.

METHODS AND RESULTS

This randomized trial tested vitamin D 60,000 IU monthly in 5670 participants without vascular disease but at increased CV risk. The primary outcome was fracture. The secondary outcome was the composite of CV death, myocardial infarction stroke, cancer, fracture or fall. Death was a pre-specified outcome. Mean age was 63.9 years, and 3005 (53.0%) were female. 3034 (53.5%) participants resided in South Asia, 1904 (33.6%) in South East Asia, 480 (8.5%) in South America, and 252 (4.4%) in other regions. Mean follow-up was 4.6 years. A fracture occurred in 20 participants (0.2 per 100 person years) assigned to vitamin D, and 19 (0.1 per 100 person years) assigned to placebo (HR 1.06, 95% CI 0.57-1.99, p-value = 0.86). The secondary outcome occurred in 222 participants (1.8 per 100 person years) assigned to vitamin D, and 198 (1.6 per 100 person years) assigned to placebo (HR 1.13, 95% CI 0.93-1.37, p = 0.22). 172 (1.3 per 100 person years) participants assigned to vitamin D died, compared with 135 (1.0 per 100 person years) assigned to placebo (HR 1.29, 95% CI 1.03-1.61, p = 0.03).

CONCLUSION

In a population predominantly from South Asia, South East Asia and South America, high-dose vitamin D did not reduce adverse skeletal or non-skeletal outcomes. Higher mortality was observed in the vitamin D group.

REGISTRATION NUMBER

NCT01646437.

Safety, Efficacy and Long-Term Outcomes of Patients Treated with the Occlutech Paravalvular Leak Device for Significant Paravalvular Regurgitation

Between December 2014 and March 2021, 144 patients with aortic (Ao) or mitral (Mi) paravalvular leaks (PVLs) were enrolled at 21 sites in 10 countries. Safety data were available for 137 patients, who were included in the safety analysis fraction (SAF), 93 patients with Mi PVLs and 44 patients with Ao PVLs. The full analysis set (FAS) comprised 112 patients with available stratum (aortic/mitral leak) as well as baseline (BL), 180-day or later assessments (2 years). Procedural success (implantation of the device with a proper closure of the PVL, defined as reduction in paravalvular regurgitation of ≥one grade as assessed by echocardiography post implantation) was achieved in 91.3% of FAS patients with Mi PVLs and in 90.0% of those with Ao PVLs. The proportion of patients suffering from significant or severe heart failure (HF), classified as New York Heart Association (NYHA) class III/IV, decreased from 80% at baseline to 14.1% at 2-year follow-up (FAS). The proportion of FAS patients needing hemolysis-related blood transfusion decreased from 35.5% to 3.8% and from 8.1% to 0% in Mi patients and Ao patients, respectively. In total, 35 serious adverse events (SAEs) were reported in 27 patients (19.7%) of the SAF population. The SAEs considered possibly or probably related to the device included device embolization (three patients), residual leak (two patients) and vascular complication (one patient). During follow-up, 12/137 (8.8%) patients died, but none of the deaths was considered to be device-related. Patients implanted with the Occlutech Paravalvular Leak Device (PLD) showed long-lasting improvements in clinical parameters, including NYHA class and a reduced dependency on hemolysis-related blood transfusions.

Cord blood fatty acid-binding protein-4 levels are upregulated at both ends of the birthweight spectrum

AIM

Fatty acid-binding protein-4 (FABP4) is an adipokine associated with obesity and signs of the metabolic syndrome. We aimed to investigate at birth in term neonates with normal and abnormal intrauterine growth concentrations of FABP4 and associate them with various perinatal parameters.

METHODS

Serum cord blood FABP4 levels were prospectively determined by ELISA in 80 singleton term appropriate-for-gestational-age (AGA), intrauterine growth-restricted (IUGR) and large-for-gestational-age (LGA) neonates.

RESULTS

Compared to the AGA group, cord blood FABP4 levels were increased in the IUGR and LGA groups. Additionally, they were higher in early-term than full-term neonates. A significant U-shaped correlation was recorded between serum FABP4 levels and birthweight. A significant negative correlation between cord blood FABP4 and gestational age in the whole study population was noted.

CONCLUSION

Cord blood FABP4 levels were significantly higher at the extremes of foetal growth at term and negatively correlated with gestational age, being increased in early-term versus full-term neonates. Further longitudinal studies with larger sample sizes are required to elucidate FABP4 implication in foetal growth and its association with future adverse cardiometabolic outcomes in the offspring.

Perinatal lipocalin-2 profile at the extremes of fetal growth

BACKGROUND

Lipocalin-2 (LCN-2) has been identified as an osteoblast-secreted hormone regulating immunity, inflammation and metabolic homeostasis and has emerged as a diagnostic and prognostic biomarker for acute kidney injury in neonates. We investigated the impact of fetal growth on antepartum maternal serum, cord serum and breast milk LCN-2 concentrations and the associations of the latter with perinatal parameters.

METHODS

Maternal serum, cord serum and breast milk LCN-2 concentrations were measured by ELISA in samples from 80 mothers who delivered 40 appropriate (AGA), 20 large for gestational age (LGA) and 20 intrauterine growth restricted (IUGR) neonates, classified by customized weight centiles. LCN-2 concentrations were associated with birth weight, customized centile, gender, maternal age and delivery mode.

RESULTS

Antepartum maternal serum LCN-2 concentrations were significantly higher in women delivering AGA infants compared to the other two groups. Cord blood LCN-2 concentrations were significantly higher compared to maternal ones; furthermore, they were significantly elevated in the IUGR group compared to the LGA one (p = .019). Lowest concentrations were detected in breast milk, which did not differ between the three growth groups. A negative correlation was documented between cord blood LCN-2 concentrations and customized centiles (r: -0.304, p = .007).

CONCLUSIONS

The higher cord serum LCN-2 concentrations, compared to maternal ones, may point to its fetal origin and potential role in intrauterine growth. The negative correlation of cord LCN-2 concentrations with customized centiles, possibly implies reduced nephron endowment/subclinical kidney damage in IUGR neonates. The extremely low LCN-2 breast milk concentrations could imply that the secretion of LCN-2 from maternal circulation to breast milk is not influenced by factors leading to intrauterine growth pathology.

Inhibitors of osteoblastogenesis in early human milk and maternal serum: evidence for protective properties of mother's milk on bone

Objective: Lactation is associated with a dramatic increase of maternal bone turnover, leading to a reversible bone loss. Early life nutrition may influence later osteoporosis risk. Proteins synthesized by the group of wingless (Wnt) genes are key mediators of osteoblastogenesis and bone formation. We aimed to investigate maternal milk and serum concentrations of the inhibitors of the Wnt signaling pathway, Dickkopf-1 (DKK-1) and sclerostin.Material and methods: In 80 women, maternal milk and serum concentrations of DKK-1 and sclerostin were determined by ELISA on the 3rd-4th day postpartum. Concentrations were associated with various maternal, gestational and neonatal characteristics.Results: DKK-1 and sclerostin were detectable in early milk [mean ± SD: 817.17 ± 259.61 pg/mL, median (range) 258.04 (2452.40-53.17) pg/mL, respectively] at significantly lower concentrations than in maternal serum [mean ± SD: 3375.36 ± 416.75 pg/mL, median (range) 16 200.54 (58 832.00-3012.60) pg/mL, respectively], (p < .000). Maternal milk sclerostin concentrations positively correlated with respective serum ones (r = 0.599, p = .000). Maternal serum and milk sclerostin concentrations positively correlated with maternal body mass index (r = 0.37, p = .001 and r  =0.38, p = .000, respectively), while maternal serum sclerostin concentrations were higher in primiparas (p = .002).Conclusion: DKK-1 and sclerostin are present in early human milk at significantly lower concentrations, compared with maternal serum, probably contributing to the short- and long-term benefits of mother's milk for bone health. Moreover, the large amounts of both substances in maternal serum may represent disruption of the Wnt cascade, contributing to the well-known lactation-associated bone loss, which seems to be greater in primiparas and obese mothers.

Diffusion with resetting inside a circle

We study the Brownian motion of a particle in a bounded circular two-dimensional domain in search for a stationary target on the boundary of the domain. The process switches between two modes: one where it performs a two-dimensional diffusion inside the circle and one where it diffuses along the one-dimensional boundary. During the process, the Brownian particle resets to its initial position with a constant rate r. The Fokker-Planck formalism allows us to calculate the mean time to absorption (MTA) as well as the optimal resetting rate for which the MTA is minimized. From the derived analytical results the parameter regions where resetting reduces the search time can be specified. We also provide a numerical method for the verification of our results.

Twins and socioeconomic factors: changes in the last 20 years

BACKGROUND

Socioeconomic factors associated with twins/multiples have been sparsely studied.

METHODS

Data, regarding twin out of total births from 1996 to 2015, were extracted from databases of the Hellenic Statistical Authority and analyzed.

RESULTS

Twinning rate in Greece has increased from 1996 and onwards, in parallel with advanced maternal age and decline in total births. Higher twin rates are associated with higher maternal education, better paid parental occupations, and thus wealthier families, married maternal status, while immigrants present a lower twinning rate than Greeks. Lastly, the years of the economic crisis, starting in the year 2008 and still continuing, are characterized by a higher percentage of twins.

CONCLUSIONS

Our findings should be mainly attributed to the postponement of fertility, as well as the treatment of infertility with transfer of multiple embryos, when assisted reproductive technologies are applied.

Role of indigenous arsenate and iron(III) respiring microorganisms in controlling the mobilization of arsenic in a contaminated soil sample

In this study two different treatment options were investigated for the release of arsenic from a contaminated soil sample. The first option was based on the "bioaugmentation" principle and involved addition of a pure Fe(III)-reducing culture, i.e. Desulfuromonas palmitatis. The second option consisted in the "biostimulation" of indigenous bacteria and involved simple addition of nutrients. Due to the strong association of As with soil ferric oxides, the reductive dissolution of soil oxides by D. palmitatis lead to 45 % arsenic release in solution (2.15 mM). When only nutrients were supplied to the soil, the same amounts of Fe and As were dissolved with slower rates and most aqueous As was found to be in the trivalent state, indicating the presence of arsenate reducing species. The arsenate reducing microorganisms were enriched with successive cultures, using Na2HAsO4 as electron acceptor. The phylogenetic analysis revealed that the enriched microbial consortium contained Desulfosporosinus species, which are known arsenate reducers.

A XAFS study of plain and composite iron(III) and chromium(III) hydroxides

Reduction of hexavalent Cr(VI) to the trivalent state is the common strategy for remediation of Cr(VI) contaminated waters and soils. In the presence of Fe the resulting compounds are usually mixed Fe(III)-Cr(III) phases, while, under iron-free conditions, reduction leads to formation of plain Cr(III) hydroxides. Environmental stability of these compounds depends on their structure and is important to understand how different precipitation conditions affect the local atomic order of resulting compounds and thus their long term stability. In current study, typical Cr(VI) environmental remediation products, i.e. plain and mixed Fe(III)-Cr(III) hydroxides, were synthesized by hydrolysis and redox reactions and their structure was studied by X ray diffraction and X ray absorption fine structure techniques. Plain Cr(III) hydroxide was found to correspond to the molecular formula Cr(OH)3·3H2O and was identified as crystalline in XRD. However, the same compound when examined by EXAFS did not exhibit any clear local order in the range of EXAFS detectable distances, i.e. between 0 and 5Å. Namely, EXAFS spectroscopy detected only contribution from the first nearest neighboring (Cr-O) shell, suggesting that CrO6 octahedra interconnection is loose, in accordance with the suggested anti-bayerite structure of this compound. Mixed Fe(III)-Cr(III) systems resembled 2-line ferrihydrite irrespective of the synthesis route. Analysis of Fe-K-EXAFS and Cr-K-EXAFS spectra indicated that FeO6 octahedra are bonded by sharing both edges and corners, while CrO6 octahedra seem to prefer edge sharing linkage. EXAFS data also suggest that Fe-Cr hydroxide produced by hydrolysis presents a better arrangement of CrO6 octahedra compared to the redox product.

Synthesis, characterization and stability of Cr(III) and Fe(III) hydroxides

Chromium is a common contaminant of soils and aquifers and constitutes a major environmental problem. In nature, chromium usually exists in the form of two oxidation states, trivalent, Cr(III), which is relatively innocuous for biota and for the aquatic environment, and hexavalent, Cr(VI) which is toxic, carcinogenic and very soluble. Accordingly, the majority of wastewater and groundwater treatment technologies, include a stage where Cr(VI) is reduced to Cr(III), in order to remove chromium from the aqueous phase and bind the element in the form of environmentally stable solid compounds. In the absence of iron the final product is typically of the form Cr(OH)3·xH2O whereas in the presence of iron the precipitate is a mixed Fe(1-x)Crx(OH)3 phase. In this study, we report on the synthesis, characterisation and stability of mixed (Fex,Cr1-x)(OH)3 hydroxides as compared to the stability of Cr(OH)3. We established that the plain Cr(III) hydroxide, abiding to the approximate molecular formula Cr(OH)3·3H2O, was crystalline, highly soluble, i.e. unstable, with a tendency to transform into the stable amorphous hydroxide Cr(OH)3(am) phase. Mixed Fe0.75Cr0.25(OH)3 hydroxides were found to be of the ferrihydrite structure, Fe(OH)3, and we correlated their solubility to that of a solid solution formed by plain ferrihydrite and the amorphous Cr(III) hydroxide. Both our experimental results and thermodynamic calculations indicated that mixed Fe(III)-Cr(III) hydroxides are more effective enhancers of groundwater quality, in comparison to the plain amorphous or crystalline Cr(III) hydroxides, the latter found to have a solubility typically higher than 50μg/l (maximum EU permitted Cr level in drinking water), while the amorphous Cr(OH)3(am) phase was within the drinking water threshold in the range 5.7<pH<11. In comparison, the mixed Fe0.75Cr0.25(OH)3 hydroxides studied were of extended stability in the 4.8<pH<13.5 range.

Intestinal neuronal dysplasia type B in adults: a controversial entity

Intestinal neuronal dysplasia (IND) is a well-defined entity which raises controversy among authors, described as a congenital malformation of gastrointestinal innervation and caused by dysplastic embryonal development of the enteric nervous system. It is potentially associated with mild and chronic gastrointestinal motility disturbances. IND is rarely reported in adults and especially elderly patients. The present study reports on the case of a 71-year-old man suffering from longstanding idiopathic constipation and who was misdiagnosed for more than 60 years, despite several hospital admissions and a sigmoidectomy in the meantime. On the last admission, the patient presented with megacolon, abdominal pain and X-ray finding of bowel obstruction. Due to massive large bowel dilatation, an exploratory laparotomy failed to reveal any obvious mechanical cause, and a subtotal colectomy and Hartmann's procedure was performed. Bowel continuity was performed 3 months later. Analysis of full-thickness biopsies revealed enlarged myenteric and submucosal neurons as well as an increased number of giant cells and increased acetylcholinesterase activity in the mucosa. The diagnosis of IND was established. The main diagnostic criteria, the underlining pathophysiology and the recommended therapeutic approach of this rare entity are extensively reviewed.

Splenic infarction due to septic emboli from bacterial endocarditis: A previously unreported cause of hyperamylasaemia

We present what maybe the only case of splenic infarction causing hyperamylasaemia in a patient with bacterial endocarditis. A 49-year-old gentleman presented a 24 hour history of vomiting, abdominal pain and fever. Clinical examination showed diffuse upper abdominal tenderness, a mild tachycardia and a low grade pyrexia. Blood investigations showed a hyperamylasaemia. His failure to improve on treatment for a provisional diagnosis of alcohol induced pancreatitis lead to a CT abdomen, which showed a splenic infarct and an echo showing aortic valve vegetation's as a source of emboli. He underwent urgent aortic valve replacement with a tissue valve following which he made an uncomplicated recovery.

Murine typhus in Cyprus: a 9-year survey

Epidemiological and clinical data of 193 human cases of murine typhus in Cyprus were recorded and analysed during a 9-year period (2000-2008). The incidence rate was estimated at 24.5 cases/100,000 population/year. The incidence rate varied considerably between rural, urban and semi-urban areas, with residents in rural areas accounting for 79.3% of the total cases. Most (72.5%) of the cases occurred in late summer (July and August) and early autumn (September to October) with a peak in September. Well-established persistent endemic foci with clusters of cases were identified and characterised as 'high risk' areas. Presence of or contact with rats and fleas, presence of domestic/peridomestic animals and residence in rural areas, especially locations near the 'green line' (a narrow zone patrolled by UN forces that separates the northern and southern parts of the island), increased the possibility of murine typhus infection. The results of the current study enhance the belief that murine typhus is a serious public health problem in Cyprus.

Isolated right atrial metastasis of malignant melanoma mimicking a myxoma

Malignant melanoma is the malignancy with the highest propensity for cardiac metastasis. Metastasis to the heart usually occurs in the setting of disseminated disease and is therefore commonly associated with a poor prognosis. We report the case of a 51-year-old woman with a previous history of cutaneous malignant melanoma who presented with a symptomatic, isolated right atrial metastasis attached via a narrow stalk to the interatrial septum, thus resembling a myxoma. The lesion was completely resected, rendering the patient symptom and, potentially, disease-free. The case illustrates the importance of cardiac evaluation in the management of patients with melanoma.

Rickettsia typhi and Rickettsia felis in Xenopsylla cheopis and Leptopsylla segnis parasitizing rats in Cyprus

Fleas collected from rats during a three-year period (2000-2003) in 51 areas of all provinces of Cyprus were tested by molecular analysis to characterize the prevalence and identity of fleaborne rickettsiae. Rickettsia typhi, the causative agent of murine typhus, was detected in Xenopsylla cheopis (4%) and in Leptopsylla segnis (6.6%). Rickettsia felis was detected in X. cheopis (1%). This is the first report of R. typhi in X. cheopis and L. segnis from rats, in Cyprus, and the first report of R. felis in X. cheopis in Europe. The role of fleas (mainly X. cheopis) was confirmed in the epidemiologic cycle of murine typhus in Cyprus by interrelation of current results with those of previous studies. The geographic distribution of fleas coincided with the geographic distribution of the pathogen they can harbor, which emphasizes the potential risk of flea-transmitted infections in Cyprus.

Structure and coherence of reasoning ability in Down Syndrome adults and typically developing children

The present study investigates the ability of Down Syndrome (DS) adults to reason: (a) deductively with transitivity (linear and reverse relations) and categorical syllogisms (all-some relations); (b) inductively with classical verbal analogies and non-verbal analogical reasoning (Raven's Coloured Progressive Matrices); and (c) to retain information in short-term memory. The results have shown that: (i) The Down Syndrome adults did not differ from typically developing children, matched on expressive and verbal ability, in transitivity and non-verbal analogical thinking; (ii) they differed in categorical reasoning, classical verbal analogies and short-term memory. Application of a structural model demonstrated that, despite differences in slope means in the three measures, the structure of functioning within-and-across all domains of cognition tests and its growth pattern, equally reliable and coherent, goes in parallel for the Down Syndrome adults and the typically developing children. The results are discussed within the context of the two-group developmental and difference approach.

Perception, representation and recognition: a holistic view of recognition

It is clear that humans have mental representations of their spatial environments and that these representations are useful, if not essential, in a wide variety of cognitive tasks such as identification of landmarks and objects, guiding actions and navigation and in directing spatial awareness and attention. Determining the properties of mental representation has long been a contentious issue (see Pinker, 1984). One method of probing the nature of human representation is by studying the extent to which representation can surpass or go beyond the visual (or sensory) experience from which it derives. From a strictly empiricist standpoint what is not sensed cannot be represented; except as a combination of things that have been experienced. But perceptual experience is always limited by our view of the world and the properties of our visual system. It is therefore not surprising when human representation is found to be highly dependent on the initial viewpoint of the observer and on any shortcomings thereof. However, representation is not a static entity; it evolves with experience. The debate as to whether human representation of objects is view-dependent or view-invariant that has dominated research journals recently may simply be a discussion concerning how much information is available in the retinal image during experimental tests and whether this information is sufficient for the task at hand. Here we review an approach to the study of the development of human spatial representation under realistic problem solving scenarios. This is facilitated by the use of realistic virtual environments, exploratory learning and redundancy in visual detail.

Perturbation study of shading in pictures

Pictorial relief was measured for a series of pictures of a smooth solid object. The scene was geometrically identical for all pictures, but the rendering was different. Whereas all pictures were monochrome full-scale photographs, they were taken under different illuminations of the scene, the source being frontal and displaced towards either the upper left, the upper right, the lower right, or the lower left. It was found that different illuminations led to significantly different, systematic alterations of pictorial relief. It is concluded that though shape constancy under changes in illumination might be said to rule in the first rough approximation, the deviations from true constancy are indeed both significant and systematic. Different from either stimulus-reduction or cue-conflict paradigms, this 'perturbation analysis' shows that shading is used as an important source of information even if the particular illumination appears to be ignored at first blush. For all subjects, brighter parts in the stimulus were consistently interpreted as being nearer in pictorial space, both for the global layout and for the subsidiary relief.

Surface gradients, contours and the perception of surface attitude in images of complex scenes

Sophisticated computer graphics were used to generate images of three-dimensional blocks-world scenes to investigate the perception of surface attitude. Three types of surface primitive (planar blocks, cylinders, and ellipsoids) were combined to form structured settings. The experiments were designed to investigate whether surface-based information such as gradients in shading and texture provide any significant advantage in attitude judgments over information derived from object contours. Images of shaded, textured, and line-drawn surfaces formed the stimulus set. The subjects' task consisted of setting an attitude probe on different parts of the scene so that the probe appeared to be locally coplanar with the perceived surfaces. Analysis of settings according to attitude components, slant and tilt, shows remarkable agreement in slant settings for the shaded and line-drawn scenes but poor correlation between shaded and textured scenes. Similarly, tilt was also easily judged in shaded and line-drawn scenes and the experiments indicate that explicit surface boundaries are important for stable tilt perception. In general, the results suggest that, for the simple surfaces employed here, surface cues provide little extra information beyond that which is derived from contours.

Shape constancy in pictorial relief

Pictorial relief was measured for a series of pictures of a smooth solid object. The scene was geometrically identical (ie the perspective of the three-dimensional scene remained the same) for all pictures, the rendering different. Some of the pictures were monochrome full-scale photographs taken under different illumination of the scene. Also included were a silhouette (uniform black on uniform white) and a 'cartoon'-style rendering (visual contour and key linear features rendered in thin black line on a uniform white ground). Two subjects were naive and started with the silhouette, saw the cartoon next, and finally the full-scale photographs. Another subject had seen the object and did the experiment in the opposite sequence. The silhouette rendering is impoverished, but has considerable relief with much of the basic shape. The cartoon rendering yields well-developed pictorial relief, even for the naive subjects. Shading adds only small local details, but different illumination produces significant alterations of relief. It is concluded that shape constancy under changes in illumination is dominant throughout, but that the (small) deviations from true constancy reveal the effect of cues such as shading in a natural setting. Such a ¿perturbation analysis' appears more promising than either stimulus-reduction or cue-conflict paradigms.

The triggering role of physical injury in the onset of peripheral arthritis in seronegative spondyloarthropathy

Three more cases of B27-positive patients who developed peripheral arthritis immediately after trauma are reported. The first had an exacerbation of arthritis in the right hip after falling from her motor-bike. The second had arthritis of the distal interphalangeal (DIP) joint of the right forefinger after shutting his finger in the door of his car. The third had arthritis of the right sternoclavicular joint after a road-accident while fastening her safety belt.

Differential diagnosis between osteitis condensans ilii and sacroiliitis

Sacroiliitis of seronegative spondyloarthropathy may sometimes show on pelvis plain films findings indistinguishable from those of osteitis condensans ilii. Computed tomography (CT) can differentiate earlier than plain radiography between the 2 conditions; furthermore, it should also be possible to make this differentiation clinically. The aim of our study was to verify whether the criteria recently proposed by the European Spondylarthropathy Study Group (EESG) for the classification of spondyloarthropathy are useful. CT scans through the synovial part of the sacroiliac joints of 7 consecutive patients meeting the ESSG criteria and showing typical findings of osteitis condensans ilii on plain films were mixed with those of 15 consecutive patients with osteitis condensans ilii not meeting the ESSG criteria. Scans were examined for joint space and surface abnormalities blindly and independently by 2 observers. Six patients in the spondyloarthropathy group and one in the osteiitis condensans ilii group showed clear erosions and/or joint space narrowing of less than 2 mm in at least one joint. The difference was statistically significant (p less than 0.001). Our results suggest that by using criteria valid for the whole group of seronegative spondyloarthropathies, it is possible to differentiate clinically between seronegative spondyloarthropathies with sacroiliitis mimicking osteitis condensans ilii and "true" osteitis condensans ilii.

Trauma and seronegative spondyloarthropathy: report of two more cases of peripheral arthritis precipitated by physical injury

Two more cases of B27 associated peripheral arthritis triggered by physical injury are reported. One patient developed arthritis after a minor insult and in the other Reiter's syndrome occurred after the injury. Possibly, trauma causes release of self antigens from the injured joints.