High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review.

BACKGROUND: Calcific and noncalcific tendinitis of the shoulder can be unresponsive to conventional therapies. Extracorporeal shock-wave therapy (ESWT) has been suggested as an alternative treatment. PURPOSE: To assess the efficacy of ESWT in patients with calcific and noncalcific tendinitis. DATA SOURCES: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Google Scholar were searched up to 1 November 2013. STUDY SELECTION: Randomized, controlled trials (RCTs) comparing high-energy versus low-energy ESWT or placebo for treatment of calcific or noncalcific tendinitis of the shoulder. Outcome measures included pain (visual analogue scale score), functional assessment (Constant-Murley score), and resolution of calcifications. DATA EXTRACTION: Three independent reviewers abstracted data and determined eligibility and quality by consensus. DATA SYNTHESIS: Twenty-eight RCTs met the inclusion criteria. Studies were heterogeneous. Twenty RCTs compared ESWT energy levels and placebo and consistently showed that high-energy ESWT was significantly better than placebo in decreasing pain and improving function and resorption of calcifications in calcific tendinitis. No significant difference was found between ESWT and placebo in treatment of noncalcific tendinitis. LIMITATION: The number of RCTs was small, and the studies were heterogeneous. CONCLUSION: High-energy ESWT is effective for improving pain and shoulder function in chronic calcific shoulder tendinitis and can result in complete resolution of calcifications. This therapy may be underutilized for a condition that can be difficult to manage. PRIMARY FUNDING SOURCE: None.

Fever, pain, and a limp: a case of a psoas and spinal epidural abscess caused by methicillin-resistant Staphylococcus aureus in a diabetic patient.

Psoas and spinal epidural abscesses are rare conditions that are infrequently found occurring simultaneously in the same patient. This case presents an 18-year-old female with diabetes mellitus who presented with fever and leg pain. Blood and urine cultures were positive for methicillin-resistant Staphylococcus aureus. A CT scan of the abdomen showed a large psoas abscess with loculations extending and involving the spinal canal. The abscesses were drained and the patient completed a 6-week course of intravenous antibiotics with remarkable improvement of her clinical condition. The diagnosis of psoas and epidural abscesses is difficult and can be overlooked or delayed as a result of their vague clinical manifestations and their rarity, which leads to a lack of clinical suspicion.

Health insurance and the development of diabetic complications.

BACKGROUND: Lack of health insurance can adversely affect access to medical care which leads to poor disease outcome. Few studies examine the effects of no insurance on the development of diabetes complications. The objective of this study was to determine if there is an association between health insurance status and the outcome of complications among a group of diabetic patients admitted to a teaching hospital on the Texas-Mexico border. METHODS: A retrospective case-control study was conducted over a one-year period. Multiple imputations were used to address missing values. We examined 82 diabetics who had one or more complications and 83 diabetic controls without complications. A complication was defined as a current skin or soft-tissue infection or a limb amputation. The main exposure was health insurance status, a three-level variable: no health insurance, Medicaid, and other insurance (referent). Logistic regression was used to calculate health insurance odds ratios (OR) adjusted for age, sex, and a history of recent trauma. RESULTS: Patients with no health insurance were twice as likely to have a diabetic complication as patients in the referent category: adjusted OR = 2.22, P = 0.03. An association between Medicaid status and complications was not detected (adjusted OR = 1.16, P = 0.78). CONCLUSIONS: Not having health insurance was a risk factor for developing diabetic complications in a group of predominantly Hispanic patients.

Severe bivalvular pneumococcal endocarditis and suppurative pericarditis in an immunocompetent patient.

Pneumococcal endocarditis is a very serious and rare clinical entity that results in significant morbidity and high mortality rates. It causes severe disease and is typically seen in alcoholics and immunocompromised patients. Antimicrobial therapy and timely surgery are warranted for optimal management and improving outcomes. We present a case of a previously healthy 31-year-old Hispanic man with bicuspid aortic valve who developed severe bivalvular pneumococcal endocarditis complicated by suppurative pericarditis that was promptly treated with antimicrobial therapy and subsequent aortic valve replacement with initial favorable clinical and hemodynamic improvement.