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BACKGROUND: While hylan G-F 20 is an approved therapy for the treatment of knee osteoarthritis, there are few reports of its use in shoulder osteoarthritis. HYPOTHESIS: Hylan G-F 20 can reduce pain and improve function in patients with glenohumeral osteoarthritis. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty consecutive patients with idiopathic glenohumeral osteoarthritis who failed to respond to standard conservative measures were enrolled. Patients received 3 weekly intra-articular hylan G-F 20 injections in their affected shoulder and completed a visual analog scale for pain, the UCLA score, and the Simple Shoulder Test at baseline and at 1, 3, and 6 months after the third injection. RESULTS: Of the 30 patients, 3 withdrew during the washout period before treatment; the remaining patients (17 men and 10 women) had an average age of 62 years. The mean baseline visual analog scale score was 54, UCLA score was 15.7, and Simple Shoulder Test score was 5.7 (of 12 possible 'yes' responses). At the 6-month follow-up, hylan G-F 20 significantly improved visual analog scale (mean 30, P < .001), UCLA (mean 24, P < .001), and Simple Shoulder Test (7.6 'yes' responses, P < .001) scores. More patients slept comfortably after treatment (56%) versus before treatment (15%). Nine patients had a visual analog scale improvement >40 points after 6 months. No device-related adverse events were observed. CONCLUSION: Hylan G-F 20 may have a beneficial therapeutic effect on some symptomatic patients with glenohumeral osteoarthritis. [ABSTRACT FROM AUTHOR]

This paper reports the findings of a survey of 108 elderly heterosexual and homosexual men and women in urban Central and Southern California. The purpose of the study was to test the assumption that elderly gay men and lesbians are more depressed and socially-isolated than their heterosexual cohort. The findings indicate that there are no significant differences between older heterosexuals and homosexuals in regard to depression and social support. However, the sources of social support vary with gay men and lesbians deriving significantly more support from friends, while heterosexual elderly derive more support from family. The findings suggest a need to redefine the concept of family to include 'friendship families.' Future research which investigates the way in which these friendship families are created and maintained has the potential to benefit all elderly, especially those who have no biological families or whose biological families are unavailable for support. [ABSTRACT FROM AUTHOR]

Two boys with the clinical and radiographic picture of acute tropical pyomyositis of the short external rotators of the hip were treated surgically followed by parenteral antibiotics (Figure 1). Intraoperatively, no pus was found. Histopathology specimens from 1 patient demonstrated small foci of degenerative changes and necrosis without evidence of infection (Figure 2). Prior to decompressing the muscle in the second patient, intramuscular pressure was measured and found to be significantly elevated. Surgical decompression was performed and both patients fully recovered after a course of intravenous antibiotics. Tropical pyomyositis' clinical presentation is often insidious with a variable course accounting for its frequent missed or late diagnosis. Often the illness progresses through three stages - invasive, suppurative, and late. Patients progress from a diffuse muscle inflammation to abscess formation and sepsis. Staphylococcus aureus is responsible for the infection in >75% of the cases. The quadriceps, iliopsoas, and gluteal muscles are most commonly affected. Multiple reports addressed the optimal treatment of tropical pyomyositis. Traditionally, surgical treatment was advocated. However, there are reports of successful nonsurgical or minimally invasive treatment. Based on our experience, it is suggested that the sequence of events in the development of tropical pyomyositis is an initial insult such as vigorous exercise, leading to elevated compartment pressure, resulting in a compartment syndrome. If simultaneous bactermia occurs, the vulnerable muscle is seeded with the infectious organism and abscess formation follows. That may explain other authors' findings that early aspiration, combined with antibiotic treatment, may be sufficient to decompress the muscle, prevent abscess formation and result in full recovery. [ABSTRACT FROM AUTHOR]