Effect of wearing fingers rings on the behavioral and psychological symptoms of dementia: An exploratory study.

OBJECTIVE: This study was conducted to examine the effects of an approach that wears finger rings on elderly females with behavioral and psychological symptoms of dementia. METHOD: The subjects were seven Japanese dementia patients living in elderly nursing homes. A single-case experimental design was adopted for the study. Each study subject was asked to put rings on her finger (from 9:00 to 19:00) for 7 days. The Neuropsychiatric Inventory, scenes of behavioral and psychological symptoms of dementia, interest in wearing rings, self-awareness, and overall profile were determined to assess the effect on the patients of wearing rings. RESULTS: The majority of nursing care providers stated, based on their assessment, that the "irritability/lability" that was noted during the baseline period disappeared during the ring-wearing intervention period in the three patients who displayed an interest in rings. In the assessment of the self-awareness ability, these three women were aware themselves of their intellect collapsing and were capable of conjecturing their own and others' minds. It was commonly seen that the nursing staff, even though they had not been asked to do so by the researchers, told the patients, "Mrs. XX, you look so beautiful" when they found a patient wearing rings. DISCUSSION/CONCLUSION: Individuals with low self-esteem are inclined to get angry and display aggression. In subjects with low self-esteem, anger and aggression readily arise when they are slighted by others. Self-esteem is low in those women who are aware of their own status of collapsing intellect. It is concluded that the words of conjuration, "you look so beautiful," which the wearing of the ring per se by the patient elicited from the caregivers heightened the self-esteem and alleviated "irritability/lability" in the study subjects.

Modified tension band wiring fixation for avulsion fractures of the calcaneus in osteoporotic bone: a review of three patients.

Calcaneal avulsion fractures are not uncommon, and they are probably more likely in patients with osteoporosis. Closed manipulation for this type of fracture often fails to achieve acceptable reduction, and open reduction and internal fixation are usually required. However, open reduction and internal fixation with either a lag screw or Steinmann pins do not provide satisfactory fixation in patients with diabetes and elderly patients because of the presence of porotic bone. Levi described a tension band fixation system used to treat a calcaneal avulsion fracture using a simple technique performed with a transverse Kirschner wire through the os calcaneus, securing a figure-of-8 metal tension band wiring to the fragment. We report the successful treatment of 3 patients with calcaneal avulsion fractures using a modified tension band wiring technique, resulting in satisfactory recovery. Re-displacement of the fragment during the initial follow-up period was not reported, and bony union was achieved in all patients. We believe this technique is a useful surgical option for the treatment of calcaneal avulsion fractures.

Ankle valgus and subtalar varus in treated clubfoot.

UNLABELLED: The purpose of this study was to clarify whether residual subtalar varus in treated clubfoot affects the configuration of the ankle joint in the coronal plane. Radiographic characteristics of the ankle and subtalar joint in congenital clubfoot, after a minimum of 10 years of treatment, were analyzed and presented. Weight-bearing radiographs of the ankles and feet, as well as computerized tomographic images of the hindfoot, were obtained for 30 patients (41 feet), at a mean of 15.2 +/- 6.1 years after initial treatment. Subtalar varus was measured in terms of the tilting angle of the posterior facet of the talocalcaneal joint, as viewed using computerized tomographic scans, and a larger angle was indicative of greater subtalar varus. Ankle valgus was measured with anteroposterior mortise views; a larger angle was indicative of greater ankle valgus. The analyses showed that feet with greater subtalar varus also showed statistically significantly greater valgus of the ankle mortise angles (P = .003). These results suggest that the ankle compensates for residual deformity of the subtalar joint in the coronal plane in patients treated for clubfoot. It also suggests that the configuration of the ankle during the course of treatment may warrant closer attention. LEVEL OF CLINICAL EVIDENCE: 2.

Diffuse pigmented villonodular synovitis in the metatarsophalangeal joint of the hallux: a case report.

UNLABELLED: A 60-year-old woman presented to our institution with a 2-month history of swelling and unrelieved pain on walking, localized to the right hallux. Magnetic resonance image scans revealed a multinodular soft tissue mass with low signal intensity on both T1- and T2-weighted images. Microscopic examination of a specimen procured using fine-needle biopsy revealed multinucleated giant cells, hemosiderin deposition, and foaming histiocytes, indicative of pigmented villonodular synovitis. Thereafter, excision of the mass and a thorough synovectomy were carried out using 2 separate longitudinal incisions. Although pigmented villonodular synovitis of the first metatarsophalangeal joint is not unheard of, it is relatively rare and physicians should consider it in the differential diagnosis when treating patients with prolonged chronic arthritis of the first pedal ray. This case, moreover, clearly depicts the diagnostic value of magnetic resonance imaging combined with fine-needle biopsy in regard to making the diagnosis of pigmented villonodular synovitis. LEVEL OF CLINICAL EVIDENCE: 4.

Septic arthritis of the atlantoaxial joint: case report.

Bacterial epidural abscess formation of cervical spine was rarely seen and all these cases were associated with osteomyelitis of the odontoid process. To the author's knowledge, only 1 case of septic arthritis of the C1-C2 lateral facet joint has been reported in the English literature. A 76-year-old woman presented with progressive neck pain and stiffness in the left side of her neck with fever. Coronal computed tomography clearly demonstrated destructive change of the atlantoaxial joint. Contrast magnetic resonance imaging demonstrated infection of the atlantoaxial joint resulting in epidural abscess formation. Because of lack of neurologic deficit, we treated her with halo-fixation together with appropriate antibiotics administration. The patient was successfully treated with antibiotics and immobilization. Septic arthritis of the lateral atlantoaxial joint should be added to the differential diagnosis of severe neck pain with fever, although it is very rare clinical entity. Early analysis of computerized tomography and magnetic resonance imaging although maintaining a high suspicion for this disease is mandatory to avoid delayed diagnosis and subsequent morbidity.

Symptomatic anomalous insertion of the medial meniscus.

We report a case of a young athlete with a symptomatic anomaly of the medial meniscus. An anomalous portion in conjunction with the anterior horn of the medial meniscus extended to the intercondylar notch of the femur through the surface of the anterior cruciate ligament. This anomalous band was arthroscopically resected and the symptoms completely disappeared. Histologic examination showed fibrocartilaginous tissue compatible with meniscus.

Coalition of bilateral first cuneometatarsal joints: a case report.

The most common types of tarsal coalition are talocalcaneal and calcaneonavicular coalition. This report presents a case of a patient with middle foot pain who was diagnosed as having first cuneometatarsal coalition.

Pseudogout attack of the lumbar facet joint: a case report.

STUDY DESIGN: A case of acute low back pain caused by pseudogout attack of the lumbar facet joint is reported. OBJECTIVE: To report a new cause of acute low back pain previously unreported in the literature. SUMMARY OF BACKGROUND DATA: There have been some reports of lumbar spinal stenosis caused by calcium pyrophosphate dihydrate crystal deposition. However, there are no known reports of pseudogout attack of the lumbar facet joint. METHODS: An axial magnetic resonance imaging scan demonstrated joint effusion at the level of the bilateral L4-L5 facet joint. Aspiration of the left L4-L5 facet joint yielded 1.5 mL of pus-like synovial effusion. Multiple cultures of synovial fluid tested negative for bacteria and fungi, whereas compensated polarized light microscopy revealed monoclinic or triclinic crystals with a positive birefringence. RESULTS: The symptoms of acute low back pain lasted for 3 days. Local and systemic inflammatory signs, as well as symptoms, gradually improved after joint aspiration. A follow-up evaluation 8 months after lumbar facet joint aspiration showed complete resolution of pain and no neurologic deficit. CONCLUSIONS: Pseudogout attack of the lumbar facet joint is rare, but this clinical entity should be added to the differential diagnosis of acute low back pain.