Olecranon and prepatellar bursitis: treating acute, chronic, and inflamed.

Elbow and knee bursitis is common in both athletes and nonathletes and has three basic presentations: acute, chronic nonseptic, and chronic infected. Most acute swellings occur after trauma and can be treated with early aspiration, compression, and padding. Chronic, nonseptic bursitis can usually be treated with conservative therapy and, occasionally, aspiration or corticosteroid injection. Inflamed bursae should be aggressively evaluated and treated. Some may require aspiration and decompression, and oral or intravenous antibiotics should be started to prevent septicemia. Incision and drainage is rarely needed but may be indicated for injuries that do not respond. Surgical excision of the bursa is recommended only for recalcitrant cases.

Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus.

OBJECTIVE: To identify predictors of hypoglycemic and hyperglycemic episodes in hospitalized patients with diabetes with special attention to the effectiveness of sliding scale insulin regimens. DESIGN: Prospective cohort study. SETTING: Urban university hospital. PARTICIPANTS: One hundred seventy-one adults with diabetes mellitus as a comorbid condition admitted consecutively to medical inpatient services during a 7-week period. MEASUREMENTS: Demographic, clinical, and laboratory data from inpatient medical records. MAIN OUTCOMES: Rates of hypoglycemic (capillary blood glucose, < or = 3.3 mmol/L [< or = 60 mg/dL]) and hyperglycemic (capillary blood glucose, > or = 16.5 mmol/L [> or = 300 mg/ dL]) episodes. RESULTS: Of the patients, 23% experienced hypoglycemic episodes, and 40% experienced hyperglycemic episodes. The overall rates of hypoglycemic and hyperglycemic episodes were 3.4 and 9.8 per 100 capillary blood glucose measurements, respectively. Independent predictors of hypoglycemic episodes included African American race (relative risk [RR], 2.13) and low serum albumin level (RR, 1.92 per 100-g/L decrease); corticosteroid use was associated with a reduced risk of hypoglycemic episodes (RR, 0.32; P < .05). Independent predictors of hyperglycemic episodes included female gender (RR, 1.67), severity of illness (RR, 1.22 per 10 Acute Physiology and Chronic Health Evaluation III units), severe diabetic complications (RR, 2.32), high admission glucose level (RR, 1.33 per 5.5 mmol/L), admission for infectious disease (RR, 2.14), and corticosteroid use (RR, 3.74; P < .05). Of 171 patients, 130 (76%) were placed on a sliding scale insulin regimen. When used alone, sliding scale insulin regimens were associated with a 3-fold higher risk of hyperglycemic episodes compared with individuals following no pharmacologic regimen (RRs, 2.85 and 3.25, respectively; P < .05). CONCLUSIONS: Suboptimal glycemic control is common in medical inpatients with diabetes mellitus. The risk of suboptimal control is associated with selected demographic and clinical characteristics, which can be ascertained at hospital admission. Although sliding scale insulin regimens are prescribed for the majority of inpatients with diabetes, they appear to provide no benefit; in fact, when used without a standing dose of intermediate-acting insulin, they are associated with an increased rate of hyperglycemic episodes.

Instrumented examination of knee laxity in patients with anterior cruciate deficiency: a comparison of the KT-2000, Knee Signature System, and Genucom.

Knee ligament arthrometers are used during rehabilitation to assess changes in knee laxity after anterior cruciate ligament injury. This study investigated the reliability and error associated with measurements of knee laxity using three different instrumented devices: the KT-2000, the Knee Signature System (KSS), and the Genucom Knee Analysis System to aid in the interpretation of instrumented laxity measurements during rehabilitation. Ten subjects with unilateral anterior cruciate deficiency were examined by two testers on two separate days. Measurement error was calculated as the minimum difference required to assume a true change in laxity between two measurements (p < 0.05). Between-day reliability was relatively high for both the KSS and the KT-2000 (.95 and .83, respectively) but substantially lower for the Genucom (.22). Intertester reliability was slightly lower for the KT-2000 and the KSS (.92 and .78, respectively) and slightly higher but still low for the Genucom (.27). When monitoring changes in anterior laxity of an anterior-cruciate-deficient knee, the following error values were determined to be needed in order to assume a true difference between successive measurements: KT-2000, 2.0 mm; KSS, 4.2 mm; and Genucom, 5.9 mm. The results of this study suggest that measurements of anterior laxity taken by a single examiner using the KT-2000 provide the most reliable measurements.

Characterization of the human interleukin-2 receptor beta-chain gene promoter: regulation of promoter activity by ets gene products.

The interleukin-2 receptor (IL-2R) beta chain (IL-2R beta) is an essential signaling component of high- and intermediate-affinity IL-2Rs. Our laboratory previously reported that a DNA fragment containing 857 bp of 5'-flanking sequence of the human IL-2R beta gene exhibited promoter activity. We have now further characterized the promoter and delineated cis-acting regulatory regions. The region downstream of -363 is critical for basal and phorbol myristate acetate-inducible IL-2R beta promoter activity and contains at least three enhancer-like regions. Among them, the -56 to -34 enhancer was the most potent and had high-level activity in two T-cell lines but not in nonlymphoid HeLaS3 and MG63 cells. This enhancer contains a GGAA Ets binding site which bound two Ets family proteins, Ets-1 and GA-binding protein in vitro. Mutation of the Ets motif strongly diminished both promoter and enhancer activities. We conclude that this Ets binding site plays a key role in regulating basal and phorbol myristate acetate-inducible IL-2R beta promoter activity and may also contribute to tissue-specific expression of the IL-2R beta gene.