Antiinflammatory mediators

Anti-inflammatory mediators have been identified - IL-4, IL-10, IL-11, IL-13, transforming growth factor-b, TNF receptors and receptor antagonist to IL-1 - the actions of which are opposed to those of the proinflammatory mediators. Unfortunately, their activities and role in sepsis remain unclear as the plasma concentration of some such as the soluble TNF receptors are also elevated in many disease entities not related to sepsis, for example rheumatoid arthritis and systemic lupus, as well as...

Shoulder pain

Shoulder pain may be referred from the cervical spine or be localized to a particular structure within the shoulder girdle. The pain may arise from the acromioclavicular joint, rotator cuff, long head of biceps or the glenohumeral joint. The diagnosis as always relies on careful clinical examination. Figure 22.34. Cervical spondylosis and C2 C4 subluxation. Figure 22.34. Cervical spondylosis and C2 C4 subluxation. Diagnosis varies according to the patient's age. In the younger age group,...

Transient synovitis of the hip

This is the commonest cause of irritable hip in the paediatric age group. It is characterized by hip pain and refusal to weight bear in a child who may be otherwise systematically well. The haematological and biochemical parameters are generally normal. Plain X-rays may reveal widening of the joint space due to an effusion or they may be normal. The child is generally apyrexial, although there may have been recent history of a concomitant viral infection. The important differential diagnosis is...

Arthritis

A simple pathological classification of arthritis is inflammatory rheumatoid arthritis (Fig. 22.10), ankylos-ing spondylitis degenerative osteoarthritis infective tuberculosis, postseptic arthritis (Fig. 22.11) post-traumatic an arthropathy may be secondary to trauma causing premature degenerative changes within the joint because of loss of bone stock, soft-tissue support or alignment idiopathic avascular necrosis (Fig. 22.12) metabolic gout and pseudo-gout secondary to inflammation resulting...

Septic arthritis

This generally refers to bacterial arthritis although it may be tuberculous. Pus is extremely chondrolytic and leads to rapid destruction of cartilage in septic arthritis. Untreated the condition can cause rapid destruction of the joint and therefore septic arthritis requires rapid decompression of the joint to preserve the articular cartilage followed by a prolonged course of antibiotics. The organisms involved are Staphylococcus aureus and S. epidermidis, Streptococcus, Pseudomonas,...