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Kelley's Textbook of Rheumatology. Philadelphia, Pa. Bockenstedt LK.


  1. Il padrone di casa (Le scommesse) (Italian Edition);
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Infectious disorders: Lyme disease. Schumacher HR Jr. Synovial fluid analysis and synovial biopsy. Synovial fluid tests. What should be ordered? Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. Management of septic arthritis: a systematic review. Bacterial PCR in the diagnosis of joint infection. Identification of Neisseria gonorrhoeae in synovial fluid using the polymerase chain reaction. Concomitant septic and gouty arthritis—an analysis of 30 cases.

Rheumatology Oxford. Ultrasonography of hip joint effusions. Skeletal Radiol. The septic versus non-septic inflamed joint: MRI characteristics. Bacterial joint infections in England and Wales: analysis of bacterial isolates over a four year period. Br J Rheumatol. Gardam M, Lim S. Mycobacterial osteomyelitis and arthritis. Infect Dis Clin North Am.

Ohl CA. Infectious arthritis of native joints. Chapman SW. Blastomyces dermatitidis. Principles and Practice of Infectious Diseases. Harrington JT. Mycobacterial and fungal infections. Clinical and molecular aspects of the pathogenesis of Staphylococcus aureus bone and joint infections. J Med Microbiol. Schattner A, Vosti KL. Analysis of 23 cases and a review of the literature.

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Ross JJ, Davidson L. Methicillin-resistant Staphylococcus aureus septic arthritis: an emerging clinical syndrome. Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis.

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Acute infectious arthritis. A review of patients with nongonococcal joint infections with emphasis on therapy and prognosis. Am J Med. Reduction in osteomyelitis and septic arthritis related to Haemophilus influenzae type B vaccination. J Pediatr Orthop. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines Accessed November 16, Ytterberg SR.

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Infectious disorders: mycobacterial, fungal, and parasitic arthritis. Kohli R, Hadley S. Fungal arthritis and osteomyelitis.

Surveillance for Lyme disease—United States, — Lyme arthritis. Steere A. Borrelia burgdorferi Lyme disease, Lyme borreliosis. Acute nongonococcal infectious arthritis. Evaluation of risk factors, therapy, and outcome. Parisien JS, Shaffer B. Arthroscopic management of pyarthrosis. Clin Orthop Relat Res. Dickie AS. Current concepts in the management of infections in bones and joints. The outcome of bacterial arthritis: a prospective community-based study. The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a year prospective survey.

J Bone Joint Surg Br. Infection in total knee replacement: a retrospective review of total knee replacements. Risk factors associated with acute hip prosthetic joint infections and outcome of treatment with a rifampin-based regimen. Acta Orthop. Molecular and antibiofilm approaches to prosthetic joint infection. Antibiotic resistance of bacteria in biofilms. Bacterial biofilms: a common cause of persistent infections.

Risk factors for prosthetic joint infection: case-control study. Prosthetic joint infection due to rapidly growing mycobacteria: report of 8 cases and review of the literature. Polymicrobial prosthetic joint infections: risk factors and outcome. Risk factors for infection after knee arthroplasty. A register-based analysis of 43, cases. J Bone Joint Surg Am. Prosthetic-joint infections. N Engl J Med. In: Ochsner PE, ed. Berlin: Springer; — Zimmerli W. Infection and musculoskeletal conditions: prosthetic-joint-associated infections. Best Pract Res Clin Rheumatol. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty.

Nuclear medicine and the infected joint replacement. Semin Nucl Med. American Academy of Orthopaedic Surgeons. Information statement: antibiotic prophylaxis for bacteremia in patients with joint replacements. Accessed December 5, Dental procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study [published correction appears in Clin Infect Dis.

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Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Previous: Evaluation of Syncope. Sep 15, Issue. Approach to Septic Arthritis. C 21 — 23 In addition to antibiotic therapy, evacuation of purulent material is necessary in patients with septic arthritis; arthrocentesis and surgical methods are appropriate. C 48 Intraarticular white blood cell cutoff values for infection as low as 1, per mm 3 1.

Risk Factors for Septic Arthritis Contiguous spread Skin infection, cutaneous ulcers 8 , 9 Direct inoculation Previous intraarticular injection 8 , 10 Prosthetic joint: early and delayed 8 Table 6 Recent joint surgery 8 , 10 Hematogenous spread Diabetes mellitus 8 , 10 Human immunodeficiency virus infection 11 Hematogenous spread Immunosuppressive medication 9 , 11 Intravenous drug abuse 11 Osteoarthritis 9 Other cause of sepsis 9 Prosthetic joint: late 8 Table 6 Rheumatoid arthritis 8 , 9 Sexual activity specifically for gonococcal arthritis 12 Other factors Age older than 80 years 8 Information from references 8 through Table 1.

Table 2. Table 3. Clinical Presentations of Septic Arthritis Clinical history or exposure Joint involvement Pathogen Cleaning fish tank 7 , 31 Small joints fingers, wrists Mycobacterium marinum Dog or cat bite 7 , 32 Small joints fingers, toes Capnocytophaga species, Pasteurella multocida Ingestion of unpasteurized dairy products 7 , 32 Monoarticular: sacroiliac joint Brucella species Intravenous drug use 7 , 18 , 32 Axial joints, such as sternoclavicular or sacroiliac Pseudomonas aeruginosa, Staphylococcus aureus Nail through shoe 20 Foot P. Table 4.

Table 5. Table 6. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close. Best Value! To see the full article, log in or purchase access. Are you sure? More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue.

Sign up for the free AFP email table of contents. Navigate this Article. Contiguous spread. Direct inoculation. Hematogenous spread. Osteoarthritis 9. Other factors. Crystal-induced arthritis. Calcium oxalate, gout, cholesterol, pseudogout, hydroxyapatite crystals. Bacteria, fungi, mycobacteria, spirochetes, viruses.

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Inflammatory arthritis. Bacterial endocarditis, human immunodeficiency virus infection. Metastasis, pigmented villonodular synovitis. Inflammatory: crystalline disease. Inflammatory: noncrystalline disease. Infectious: Lyme disease. Positive 85 percent. Infectious: gonococcal. Positive 25 to 70 percent. Infectious: nongonococcal. Positive 60 to 80 percent. Small joints fingers, wrists. Mycobacterium marinum. Small joints fingers, toes.

Monoarticular: sacroiliac joint. Brucella species. Axial joints, such as sternoclavicular or sacroiliac. Pseudomonas aeruginosa, Staphylococcus aureus. Tenosynovial component in hands, wrists, or ankles. Neisseria gonorrhoeae. Monoarticular: knee, hand, or wrist. Monoarticular: knee, ankle, or elbow. Coccidioides immitis.

Ceftriaxone Rocephin. Vancomycin plus either ceftazidime or an aminoglycoside. Less than three months. Staphylococcus aureus , gram-negative bacilli. Educated guesswork — and not-so-educated guesswork — has a long history in geology. While Kepler, Galileo and others were establishing the foundations of modern astronomy in the 17th century, the study of Earth itself remained a medieval science, mired in myth and fantastic imaginings. A map published in by Jesuit scholar Athanasius Kircher depicts a cavernous Earth riddled with chambers — some filled with air, some with water, some with fire.

Ducts flowing with flames warmed hot springs, fed volcanoes and tormented the damned. Whatever his faults as a theoretician, Kircher was no armchair scholar. He once had an assistant lower him into the active and smoking crater of Mount Vesuvius so he could take temperature measurements. Even the best astronomers of the day stumbled when they turned their attentions Earthward.

In a paper published in , Edmond Halley, later famed for charting the orbit of his eponymous comet, argued that Earth was mostly hollow, consisting of three concentric shells rotating around a core. He estimated that the outermost shell — the one we live on — was miles thick. Atmospheres of glowing gas separated the shells, each of which had its own magnetic poles.

Halley believed the inner shells might even be inhabited and lit by subterranean suns. The Lick Observatory in California was home to North America's first time-recording seismograph, shown here in a drawing. By the early 20th century, a global network of the instruments allowed researchers to record seismic waves that had traveled from one side of the planet to the other. An earthquake powerful enough to be felt occurs somewhere in the world about once every 30 minutes. Each releases a variety of seismic waves.

Primary waves, or P-waves, compress the layers of rock or liquid they pass through. They move at more than 16, feet per second through granite. Secondary waves, or S-waves, pull rocks apart as they undulate through the planet, creating what scientists call shear forces. The speeds and paths of both types of waves vary with the density and elasticity of the materials they encounter. Whenever the waves reach a boundary between regions differing in density or other properties, they are deflected from their trajectories.

Until well into the 20th century, most scientists believed Earth had a liquid iron core. The first hint that Earth actually had a solid iron core beneath a liquid layer came in , after a magnitude But only one scientist noticed anything unusual. Inge Lehmann, a Danish seismologist, made meticulous notes on seismic activity, including the arrival time of P-waves, at various seismographic stations.

Lehmann kept her notes on cards that she stored in empty oatmeal boxes. She found P-waves in what should have been P-wave shadow zones.

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In a paper published in , she argued that the anomalous P-waves must have been deflected from some denser structure within the liquid core, sending them on trajectories into the shadow zones. Lehmann concluded that Earth must have a solid inner core. Lehmann, who published her last scientific paper when she was 98, died in at the age of Or so it seemed until recently. New research has uncovered a flaw in our understanding of the core — specifically, about the manner in which heat energy flows from the core and through the overlying mantle.

The problem raises important questions about the age of the inner core, and about how Earth generates its magnetic field, a phenomenon crucial for the existence of life. Based on the radioactive dating of ancient rocks, scientists estimate that Earth formed about 4. As the molten proto-Earth cooled, its outermost layer hardened into a thin crust. The inner core, once entirely liquid, is slowly solidifying from the inside out, increasing its diameter by about half a millimeter per year, according to some estimates. Under slightly less pressure, the outer core — a 1,mile-deep, 8,degree ocean of iron and nickel — is still hot enough to be fluid.

Convection occurs when heat from below creates motion in the layers above — heated material rises, then falls back again as it cools, only to be heated once more. Convection is what roils a pot of boiling soup. Deep inside Earth, slow-motion convection of rocky minerals in the mantle and heat loss from the cooling solid inner core cause convection in the liquid outer core. Heat also makes its way through the Earth by conduction — the transfer of thermal energy by molecules inside a material from hotter areas to colder ones — without causing any motion.

To continue the soup example, heat is conducted through the bottom of the metal pot. The same is true inside the Earth: In addition to convection currents moving heated material through the outer core and mantle, heat is conducted through liquids and solids without roiling them. As the molten iron flows, it creates electric currents, which generate local magnetic fields.

Those fields in turn give rise to more electric currents, an effect that results in a self-sustaining cycle called a geodynamo. Two years ago, a team of scientists from two British universities discovered that liquid iron, at the temperatures and pressures found in the outer core, conducts far more heat into the mantle than anyone had thought possible. In other words, there would be no heat-driven convection in the outer core. If a pot of soup conducted heat into the surrounding air this effectively, convection would never start, and the soup would never boil.

We would not have a geodynamo without convection. By first principles, they mean that they solved a set of complex equations that govern the atomic states of iron. The British researchers spent several years developing the mathematical techniques used in the equations; only in recent years have computers become powerful enough to solve them. Stevenson and other researchers have previously proposed a second mechanism besides heat flow that could produce the required convection in the outer core. The inner core, although composed almost entirely of pure iron, is thought to contain traces of lighter elements, primarily oxygen and silicon.

As the iron in the inner core cools and solidifies, the researchers hypothesize, some of those light elements would be squeezed out, like the salt extruded from ice crystals when seawater freezes. Those light elements would then rise into the liquid outer core, creating convection currents.

This so-called compositional convection would be another way to power the geodynamo. But compositional convection would work only once an inner core had already formed. In a purely liquid core, the light elements would be evenly distributed throughout the liquid, so there would be no compositional convection. How did the geodynamo manage to function for at least a couple of billion years before the inner core existed? Some people are saying maybe the Earth was a lot hotter in the past. What could have provided the extra heat?

The idea that a Mars-size body smashed into Earth roughly 4. Moon rocks are unique in that regard. Meteorites, for example, have chemical and elemental profiles that mark them as distinctly otherworldly. Protoplanet collisions with a young Earth may have led to the birth of our moon and could have kick-started the geodynamo that makes life here possible. Some of the debris from one of these impacts eventually coalesced to form the moon. Earth itself was left so hot that it would have glowed like a small star for a thousand years.