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The osteoporosis bandwagon has rolled inexorably forwards for years so it is interesting to note the Education and debate piece in the
BMJ (2001;323:79599
Yet another journal title has been added to Robin's stable (Arch Blind Ob, J Unsurpr Res and Excerpta Déjà Vu)the Journal of Disappointing Results, into which must go the article by Caporali et al.
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Ann Rheum Dis 2001;60:10214)
The Annals of Confusing Data are also actively considering Cosentino and colleagues' paper on extracorporeal shock wave therapy for painful plantar spurs
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Ann Rheum Dis 2001;60:10647
There is, of course, a real journal called the Annals of Improbable Research so, in the context of leeches used for osteoarthritis that I mentioned last month, it is pleasing to note that a leech study
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Baerheim and Sandvik, BMJ 1994;309:1689
Robin has seen a lot of gout (though most of what he is sent as gout is not) but has never ever heard of it affecting the temporomandibular joint ... until this week, that is ( Barthélémy et al., J Craniomaxillofac Surg 2001;29:30710[ISI][Medline]). Robin's favourite diagnostic technique of aspiration to look for crystals might be a touch difficult, he thinks. Mind you, one needs to distinguish it from pseudogout ( Berge et al., Mund Kiefer Gesichtschir 2001;5:614[Medline]), but they got the histologists involved. Both, incidentally, show as a chronic destructive arthropathy on X-ray or scan.
Gout can appear after total knee replacement, and its mis-diagnosis as sepsis may lead to unnecessary removal of the prosthesis ( Archibeck et al., Clin Orthop 2001;392:37782[Medline]). One should perhaps remind orthopaedic colleagues not up to speed with physics, that putting specimens in formalin dissolves urate, so samples should go in saline.
Now have we found the cause of fibromyalgia (or is it a consequencea nice chicken and egg scenario)? Staud and Domingo ( Pain Medicine 2001;2:20815[ISI]) have reviewed the literature and conclude that it is a neuropathic pain syndrome due to an abnormality of central pain processing. That puts it in the same stable as chronic pain syndrome and even post-traumatic stress disorder, so why don't we rationalize the terms and call the whole caboodle the same thing?
Robin does not see many patients with fibrillar collagen metabolic disorders (EhlersDanlos syndrome to you and me). But it's clearly not one disease. Schalkwijk et al. describe a recessive variant due to Tenascin-X deficiency
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N Engl J Med 2001;345:116775
Lastly Robin is keen to share with you a fascinating theory about back pain, the management of which [according to the Sunday Times (28th October 2001)] requires a holistic approach, whatever that may be. Syntax Chiropractic starts from the premise that the body becomes overloaded and unable to cope with the emotional, physical and chemical stresses in our lives and uses applied kinesiology, a technique that apparently tests muscle balance and so can detect food intolerance. Hmm. According to the piece, a failure of ileocaecal valve function creates a weakness in the main anterior muscle that stabilizes the pelvis, and in turn can create a torsion of the lumbar sacral spine. Cor. Actually the article concludes with an injunction that corsets should only be used for acute back spasm and then discarded; a sentiment with which Robin readily agrees. Back off prescribing corsets, guys.