Can local corticosteroid injection in the retrocalcaneal bursa lead to rupture of the Achilles tendon and the medial head of the gastrocnemius muscle?

PURPOSE: The purpose of the study is to explain the cause-effect relationship in three patients who reported combined ruptures of the Achilles tendon and the gastrosoleus complex 6 months after they had received corticosteroids injections for the management of retrocalcaneal bursitis. METHODS: Three cryopreserved cadavers (three men, three left legs) were examined to assess the anatomic connection between the retrocalcaneal bursa and the Achilles tendon (distal and anterior fibers). Blue triptan medium contrast was injected. RESULTS: An unexpected connection between the retrocalcaneal bursa and the anterior fibers of the Achilles tendon was found in all instances. CONCLUSIONS: Local corticosteroid injection of the retrocalcaneal bursa may help the symptoms of retrocalcanear bursitis, but pose a risk of Achilles tendon rupture. This risk-benefit has to be taken into account when corticosteroid injections are prescribed to professional and high-level athletes.

Evaluating screening tests for dementia and cognitive impairment in a heterogeneous population in the presence of verification bias.

This article reviews two potentially serious sources of error in the evaluation of screening tests, namely, verification bias and the influence of demographic covariates. It demonstrates how to deal with these problems statistically. Verification bias arises when not all subjects receive a definitive diagnosis following a screening test. If only a small proportion of those who screen negative are sent for diagnosis, the calculated test sensitivity is an overestimate and the calculated specificity an underestimate. The methodology outlined in this article may be extended to psychological and medical screening tests in general.

Screening for nutritional risk among community-dwelling elderly on Prince Edward Island.

The purpose of this survey was to estimate the prevalence of nutritional risk among a group of community-dwelling older persons on Prince Edward Island, aged 70 years and over, and to examine the relationships between health-related factors and nutritional risk. Subjects (n = 215) were interviewed as part of the 1996 Canadian Study of Health and Aging. The prevalence of nutritional risk, as measured by the DETERMINE checklist, in PEI seniors was 37.1% (95% CI = 36.3, 37.9). The prevalence was estimated at 47% after adjusting for the sensitivity and specificity of the checklist. Only pain was a significant predictor of the presence or absence of nutritional risk (logistic regression, p = 0.05). The only predictor to discriminate between the three categories of no nutritional risk, moderate risk, and high risk was depression (Kruskal-Wallis, p = 0.035). Several limitations were identified with the use of the DETERMINE checklist.