Treatment of flexor tenosynovitis of the hand (''trigger finger'') with corticosteroids: a prospective study of the response to local injection

Article Abstract:

The use of corticosteroids to treat local muscle and bone problems is still controversial because clinicians fear localized reactions to the drug, while remaining unconvinced that it will resolve the condition. Information on corticosteroid treatment is scarce in the medical literature, making an informed choice about drug therapy, and the decision between corticosteroids and surgery, difficult. Flexor tenosynovitis of the hand, often called ''trigger finger'' although it may affect any of the fingers or the thumb, is caused by an inflammation of the tendon sheath. The inflammation may be due to calcium deposits, repeated strain, injury, high cholesterol, rheumatoid arthritis, gout, or gonorrhea. This study of 58 patients with a total of 77 episodes of flexor tenosynovitis evaluated the effectiveness of the long-acting corticosteroid depo-methylprednisolone acetate. A single injection was effective in 61 percent of the cases, and a second injection brought the success rate up to 88 percent, comparable to that of surgical treatment. There were no serious adverse reactions, and only 38 percent of injections caused limited pain, swelling, stiffness, bruising, or wasting of the fat under the skin. No infections or tendon ruptures were reported in this study. No systemic effects were noted, as expected with a low, long-acting dosage. Corticosteroids are recommended for initial treatment of trigger finger, and other treatment such as rest or nonsteroidal anti-inflammatory drugs (such as aspirin) should not delay corticosteroid treatment for long. Only long-acting corticosteroids should be used, and a second injection should be given if symptoms continue after six weeks. Surgery is indicated if symptoms continue or recur, or if fingers are locked. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Drug therapy, Corticosteroids, Adrenocortical hormones, Dosage and administration, Tenosynovitis

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Intrauterine infection and miscarriage following trans-abdominal chorionic villus sampling. Case report

Article Abstract:

Chorionic villus sampling is a diagnostic procedure for obtaining a sample from the chorion, a membranous tissue layer surrounding a developing fetus and which shares the same genetic make-up as the fetus. A catheter (a tube) is inserted into the cervix, the opening of the uterus, and into the membranes surrounding the fetus. The chorionic villus sample is used to detect the genetic composition of the fetus before birth, as a method of screening for fetal abnormalities. The procedure can be performed in early pregnancy, but may be associated with an increased risk of miscarriage and possibility of harming the fetus. The chorionic villus may also be sampled by a needle inserted through the abdominal wall (transabdominal chorionic villus sampling). While avoiding the possibility of infection associated with the catheter, this method may also produce infection when the bowel is inadvertently pierced during the procedure. A case is described of a 36-year-old woman who requested transabdominal chorionic villus sampling because her age and her history of genital herpes. Although the procedure was performed without problems, the patient felt faint and vomited following the procedure. She later developed malaise, headache, pelvic pain, and a bloodstained water discharge. Her blood pressure dropped and heart rate became faster. The patient had a miscarriage due to infection with the bacteria, Clostridium perfringens and Streptococcus faecalis, which are both normally found within the bowel. Transabdominal chorionic villus sampling should be performed using ultrasound to prevent puncture of the bowel during the procedure. Ultrasound is an imaging technique in which sound waves are used to visualize internal structures. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Miscarriage, Chorionic villus sampling

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Prospective study of candida endophthalmitis in hospitalized patients with candidemia

Article Abstract:

Endophthalmitis, an inflammation of the inside of the eye, occurs in 9.9 to 37 percent of adults, particularly those hospitalized for candidemia, a condition in which a yeast-like fungus infects the skin's mucous membrane, often becoming localized in nails, mouth, vagina, bronchi, lungs and sometimes the blood, a condition known as fungemia. Researchers evaluated 32 hospitalized patients suffering from fungemia to determine the risk factors that led to involvement of the eye. The study also evaluated the use of weekly multiple ophthalmologic examinations as a means of providing clinical data on the care and treatment of patients with candidemia. No visual symptoms were noted even in those patients diagnosed as having endophthalmitis, nor were any hospital-acquired risk factors (e.g, use of central venous catheters) identified. Laboratory findings, such as white blood cell count, were not able to predict which patients infected with Candida would develop endophthalmitis. Given the absence of clinical or laboratory means by which to distinguish patients at risk for endophthalmitis, an early ophthalmoscopic examination was judged to be crucial for the diagnosis of Candida eye infection among the patients in the study. In nine of the 32 patients, indirect ophthalmoscopy detected eye lesions. In those patients follow-up examinations provided useful information that helped outline antifungal therapy. The encouraging results obtained from the evaluation of the small group of 32 patients suggests that a larger study should be conducted.

Infection, Candidiasis, Eye

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