[Three patients with a fracture during methotrexate use, possibly due to methotrexate osteopathy]. / Drie patiënten met een botfractuur tijdens het gebruik van methotrexaat, mogelijk door methotrexaatosteopathie.

Three female patients, aged 76, 64 and 74 years old, who were treated with low-dose methotrexate due to an inflammatory joint disorder, developed severe pain in a lower extremity. The pain increased on weight bearing and could not be explained by arthritis. Conventional x-ray investigation showed a fracture in the second patient. In the other two patients insufficiency fractures were visualized by MRI and bone scan. Because methotrexate osteopathy was suspected, treatment with methotrexate was stopped. All three patients made a rapid recovery after discontinuation. Methotrexate osteopathy is characterized by pain, osteoporosis and microfractures, and was first reported in children treated with high-dose methotrexate for a malignancy. Similar clinical features are reported in the literature in patients with chronic joint inflammation treated with low-dose methotrexate. The causal relationship between the insufficiency fractures and the use of methotrexate is still under debate. Although the clinical picture fits with methotrexate osteopathy, these patients often also have other risk factors for osteoporotic insufficiency fractures.

[Nasolacrimal stent for epiphora caused by obstruction of the nasolacrimal duct]. / Nasolacrimale stent voor epiphora door obstructie van de ductus nasolacrimalis.

A 71-year-old patient with severe epiphora due to a subtotal obstruction of the nasolacrimal duct was initially treated with balloon dilatation. After failure of this procedure a nasolacrimal stent was placed under fluoroscopic control in an outpatient setting. After stenting there was complete resolution of the epiphora during a follow-up of six months. Outpatient treatment of complete nasolacrimal duct obstruction or obstruction after failure of balloon dilatation with a nasolacrimal stent appears to be a good alternative to surgery.

An irreducible superior dislocation of the glenohumeral joint.

The clinical features of a superior dislocation of the glenohumeral joint are described. Reposition, even under general anaesthesia, cannot be achieved. Associated supraspinatus tear, acromioclavicular separation and the dislocated position of the humeral head can be clearly visualized.

AIDS epidemic, emotional strain, coping and psychological distress in homosexual men.

This study examined the process by which emotional strain imposed by the threat of AIDS may manifest itself as psychological distress, assessed by depressive symptomatology, in a sample of homosexual men. Specifically, the study examined the extent to which the perceived threat of AIDS is related to depression, and how coping resources, such as locus of control and social support, influence this process. Results highlight the role of social support and locus of control. These factors were found to be the strongest correlates of depression, and appear to exert a considerable influence on the associations between strain measures and depressive symptomatology.

Detecting changes in functional ability in women with premenstrual syndrome.

There has been a lack of objective assessment of the disruptive effect that the symptomatology of premenstrual syndrome has on the functional performance of affected women. This study assessed the functional performance of women with premenstrual syndrome at four phases of the menstrual cycle. Twelve women with premenstrual syndrome and nine asymptomatic women were tested on four functional instruments at the menstrual, early follicular, early luteal, and late luteal phases. Two tests of a paper-and-pencil type measured perceptual parameters, and two tests involving manipulation of objects measured manual dexterity. Mean performance on the Crawford Small Parts Dexterity Test--Part II, which tests fine motor function, was better at the late luteal testing, compared to the early follicular testing, in asymptomatic women but was worse in the women with premenstrual syndrome. This difference was statistically significant (p = 0.015). No significant differences between groups in performance changes were observed for the other functional tests. The Crawford Small Parts Dexterity Test-Part II is an objective measure that is potentially valuable in therapeutic trials involving patients with premenstrual syndrome.

Examination of selection criteria for a program in occupational therapy.

The purpose of this study was to determine if the results of preselection interviews in combination with preselection academic performance offer better predictions of academic performance in occupational therapy than either of these criteria taken singly. The sample consisted of 48 high school students and 31 university students admitted to the program in occupational therapy at the University of Western Ontario from 1978 to 1980. The results indicated that for university students, previous academic performance alone was the best predictor for their performance in first-year occupational therapy. For high school students, the combination of 5 of the 12 interview items with previous academic performance produced the best predictor of successful academic performance in occupational therapy. This implies that for high school students at least, the interview and previous academic performance should both be considered as important selection criteria.

Academic performance and job satisfaction.

This paper investigates the possible relationship between job satisfaction and academic performance of occupational therapists who have graduated from the University of Western Ontario in the years 1975 to 1978. Fifty-four percent of the graduates of this time period filled out questionnaires eliciting information on their satisfaction with their jobs as occupational therapists and with the profession of occupational therapy. This information was analyzed with the therapists' academic performance of Grade XIII and their four years in the Occupational Therapy Program. The results indicated that although job satisfaction related significantly to three individual academic courses it did not relate to overall performance as measured by grade average.