A systematic review of the management of acute pyogenic flexor tenosynovitis.

UNLABELLED: Pyogenic flexor tenosynovitis (PFT) is an aggressive closed-space infection that can result in severe morbidity. Although surgical treatment of pyogenic flexor tenosynovitis has been widely described, the role of antibiotic therapy is inadequately understood. We conducted a literature review of studies reporting on acute pyogenic flexor tenosynovitis management. A total of 28 case series articles were obtained, all of which used surgical intervention with varied use of antibiotics. Inconsistencies among the studies limited summative statistical analysis. Our results showed that use of antibiotics as a component of therapy resulted in improved range of motion outcomes (54% excellent vs. 14% excellent), as did using catheter irrigation rather than open washout (71% excellent vs. 26% excellent). These studies showed benefits of early treatment of pyogenic flexor tenosynovitis and of systemic antibiotic use. As broad-spectrum antibiotics have changed the management of other infectious conditions, we must more closely evaluate consistent antibiotic use in pyogenic flexor tenosynovitis management. LEVEL OF EVIDENCE: Therapeutic, Level III.

Osteocalcin is independently associated with body mass index in adolescent girls.

OBJECTIVE: Osteocalcin is a bone-related protein, recently found to correlate with body mass index (BMI), waist circumference, fat percentage and metabolic syndrome in adults. The aim of this study was to determine the relationship between osteocalcin and BMI in adolescence, a time of significant bone accrual, while considering possible confounders related to bone and body composition. METHODS: We analyzed data from 160 female adolescents (mean age 15.1 ± 0.7 years), which were divided into tertiles by osteocalcin levels. Across these three groups, we examined the differences in BMI with relation to age, total daily energy intake, calcium intake, physical activity (PA), total body bone mineral density, parathyroid hormone (PTH), 25(OH)-vitamin D, bone alkaline phosphatase and body fat percentage. RESULTS: Mean BMI values differed significantly between participants in the three osteocalcin tertiles, including after adjustment for age, PA, PTH, energy and calcium intakes. Post-hoc analysis revealed that girls in the highest osteocalcin tertile, had a significantly lower BMI than those in the two lower ones (19.3 ± 2.2 vs. 20.6 ± 3.0 and 20.7 ± 2.9 kg m(-2), respectively, P = 0.018). There was no significant difference in energy and calcium intakes, bone mineral density, 25(OH)-vitamin D levels and PTH between study groups. CONCLUSIONS: In female adolescents, BMI is inversely related to osteocalcin, even after consideration of several factors that may affect bone and fat mass. As bone mineral density, 25(OH)D and PTH did not differ between groups, it is possible that the relation between osteocalcin and BMI could be unrelated to bone tissue itself.

Assessment of body composition in ballett dancers: correlation among anthropometric measurements, bio-electrical impedance analysis, and dual-energy X-ray absorptiometry.

Ballet dancers tend to restrict caloric intake and/or to use inappropriate compensatory behavior (e.g. self-induced vomiting, use of laxatives) in order to maintain a low body weight. Therefore careful assessment of body composition and determination of minimal body weight for maintenance of a desirable percent fat may reduce unnecessary weight loss and decrease the use of a potentially dangerous weight-control behavior. The purpose of this study was to determine body fat in a homogenous group of 59 adolescent, female ballet dancers (age range 14-17 y). Body composition was assessed using three different techniques: skinfold thickness measurements, bio-electrical impedance analysis (BIA), and dual energy X-ray absorptiometry (DXA). Percent body fat and the sum of skinfold thickness were calculated from measurements of four sites (i.e. triceps, biceps, subscapular, and suprailiac). All eumenorrheic dancers were examined in the early follicular phase of the menstrual cycle whereas amenorrheic dancers (or pre-menarcheal) at random. Significant positive correlations were found between skinfold measurements and assessments of body fat by BIA (r=0.48, p<0.001); and between skinfold measurements and assessments of body fat by DXA (r=0.80, p<0.00001). Assessment of body fat by BIA was significantly correlated with assessment of body fat by DXA (r=0.63, p<0.001). The correlation coefficient of percent body fat by skinfolds with DXA (r=0.8, p<0.00001) was significantly higher than the correlation coefficient of body fat by BIA with body fat DXA (p<0.01). In addition the agreement between measurements of body fat by DXA and skinfolds was higher than measurements of body fat by DXA and BIA. This study demonstrates that a simple, inexpensive, field-based method such as skinfold measurements can be successfully used to determine body fat in a homogeneous group of female ballet dancers. This may help to determine a minimal body weight of female dancers based on their percent body fat and as a result may reduce excessive weight loss and prevent the use of a risky weight-reducing behavior.