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INTRODUCTION: Internationally, musculoskeletal conditions are a major morbidity issue for Indigenous populations and the social and economic burden imposed by musculoskeletal complaints is significant. However, little is known about the prevalence and associated pain and impairment of musculoskeletal conditions among rural Indigenous Australians. METHODS: The study was conducted between January 2001 and July 2002. DESIGN: A cross-sectional research design was used. SAMPLE: Participants included 189 Indigenous members of the community, 80 of whom were randomly selected and 109 were recruited using a convenience sample. The sample included 87 males (46%) and 102 females (53%). Participants' mean age was 44 years (+/-14.8). MEASURES: The main outcome measures were sites of current pain, self-reported levels of pain, limitations to activities of daily living, and barriers to managing these conditions. PROCEDURE: Following a screening survey participants underwent a clinical examination conducted by musculoskeletal health professional trained in standardised, clinical assessment procedures. RESULTS: Lower back pain, followed by neck, head and shoulder pain were the most common conditions. Approximately 57% of participants suffered from 2 to 4 musculoskeletal conditions. The most commonly endured level of pain was 'high'. There were no significant differences between male and female participants in terms of reported levels of pain. The level of pain reported was relatively high compared with the level of associated limitation of activities of daily living. A majority of participants had suffered from their principal condition for 7 weeks or more, indicating high levels of chronicity in the community. CONCLUSION: The majority of people living in this large rural, Indigenous community have learnt to live with chronic levels of pain affecting multiple anatomical sites. Strategies such as community musculoskeletal health promotion and appropriately trained community health workers can assist the community manage this chronic burden of disability. There is scope for further study into the musculoskeletal health of both rural and urban Indigenous populations.

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BACKGROUND: A prospective, randomized controlled trial was used to compare the efficacy of the arteriovenous (AV) impulse system and aspirin in reducing venous thrombosis after fracture to the femoral neck. METHODS: A total of 143 patients underwent hemiarthroplasty, after which 70 patients were treated with the AV pump and a second group of 73 patients were commenced on 325 mg of aspirin. Duplex ultrasound was used to assess both proximal and distal venous thrombi on days 7 to 10. Calf and thigh circumferences were also measured. RESULTS: Thrombi developed in seven of the patients treated with aspirin and in four patients treated with the AV pump. No statistically significant difference could be established (p = 0.109). There was a significant reduction in both calf (p = 0.003) and thigh (p = 0.002) swelling in the group treated with the AV pump. Neither treatment group was a significant predictor of a poorer outcome by using logistical regression analysis (p = 0.258). CONCLUSIONS: Both aspirin and the AV pump are effective in reducing thromboembolic events after hemiarthroplasty of the hip.

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We retrospectively reviewed 75 total hip arthroplasties to examine the effect of acetabular component position. In group A, 38 of the components were implanted according to manufacture's instructions with all peripheral fins in contact with acetabular bone; as such, the acetabular components were in a relatively vertical position with a mean angle of inclination of 61.9 degrees. Three of these patients developed recurrent dislocations necessitating revision of the acetabular component. In group B, 37 hips, a more horizontal orientation was used despite the fact that all of the peripheral fins of the acetabular component did not engage acetabular bone; in this group the mean angle of inclination was 49.7 degrees. Only one of these hips recurrently dislocated and required revision. There were no problems in this group associated with provisional component stability caused by inadequate peripheral fixation. Radiographs of all patients were obtained at 4 years after surgery (range, 4.0-4.3 years). Pelvic osteolysis had occurred in 24% of hips in group A and 13% of group B. Asymmetric polyethylene wear was observed in 5.1% of the hips in group A; no hip in group B showed wear asymmetry. Acetabular component migration developed in 19% of group A hips and 5% of group B hips. The Mayo clinical hip score was excellent in both groups: group A 71/80, group B 73/80. At an intermediate follow-up it is clear that significant problems can be encountered when this component is positioned in a relatively vertical position to facilitate engaging all four peripheral fins in bone. We have addressed this problem by placing the cup in a more anatomic position of inclination while maintaining provisional rim fixation. This has resulted in a decreased incidence of pelvic osteolysis and fewer complications overall.

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PURPOSE: This pilot, open-label study evaluates the antiemetic efficacy and safety of a single 20-mg intravenous (IV) dose of dexamethasone combined with a single IV dose of ondansetron (32, 24, or 8 mg) in patients receiving highly emetogenic (HE), moderately high emetogenic (MHE), or moderately emetogenic (ME) chemotherapy, respectively. PATIENTS AND METHODS: One hundred forty-six patients received a single 20-mg IV dose of dexamethasone over 15 minutes beginning 45 minutes before chemotherapy and either a single 32-, 24-, or 8-mg IV dose of ondansetron over 15 minutes beginning 30 minutes before chemotherapy. Patients were evaluated for emetic episodes, extent of nausea, and adverse events for 24 hours after chemotherapy. RESULTS: Complete response (no emetic episodes) was noted in 72% (95% confidence interval [CI], 60% to 84%), 88% (95% CI, 79% to 97%), and 77% (95% CI, 63% to 92%) of patients in the HE, MHE, and ME categories, respectively. The proportion of patients who experienced no nausea on the posttreatment assessment was 51% (95% CI, 37% to 64%), 69% (95% CI, 56% to 81%), and 47% (95% CI, 29% to 65%), respectively. The antiemetic regimens were all well tolerated. The proportion of patients with any drug-related adverse events did not vary across the three study groups despite the range of ondansetron doses and variety of chemotherapy regimens. Mild headache was noted in 28% of patients. Other adverse events, all of which were noted in fewer than 10% of patients, included lightheadedness, fatigue, dizziness, and constipation. CONCLUSION: A single IV dose of either 8, 24, or 32 mg of ondansetron combined with a single 20-mg IV dose of dexamethasone resulted in good control of acute emesis across a wide spectrum of chemotherapy regimens. Nausea control proved somewhat more difficult, with approximately 50% of patients in the HE and ME emetogenic categories experiencing some degree of nausea. The results of our pilot study suggest that adjusting the dose of ondansetron to the intrinsic emetogenicity of the chemotherapy regimen permits a more efficient use of ondansetron while maintaining good antiemetic control. Such an approach appears worthy of further investigation.

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We present a case of significant envenomation from a severed, preserved rattlesnake head in a 22-year-old man. The patient was treated successfully with 15 vials of Crotalidae polyvalent antivenin despite a history of severe immediate hypersensitivity reaction to antivenin. The patient developed a mild case of serum sickness five days after antivenin infusion that was treated successfully with a course of steroids. The patient experienced complete recovery. This case demonstrates the hazard of even preserved snake heads and fangs.

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