December, 2004

Dear Readers,

In this month’s Evidence Corner, Dr. Laura Bolton reviews and comments on two articles addressing variables that affect spinal-cord injury outcomes. The first article by Bagnall, et al., assessed the benefits and shortcomings of spinal fixation, referral to a spinal-injury unit (SIU), and steroid treatment. It would appear that early referral to a SIU is an important consideration for these patients. The second article by Hicks, et al., is a report of a prospective, randomized, controlled study on the effects of a nine-month course of exercise on patient s

Presentation

A 25-year-old African American woman with a four-year history of dermatomyositis (DM) presented with an ulcer in the right popliteal fossa of five weeks duration. Initially, the patient was diagnosed with DM based on typical heliotrope rash, photosensitivity, high creatinine kinase (CK), and interstitial lung disease. Her serology for other connective tissue diseases was negative. She was initially treated with oral prednisone 1mg/Kg/d. After normalization of CK levels, prednisone was tapered to 10mg/d but never discontinued. Two years later, she developed calcium deposits on

C hronic wounds are caused by a variety of etiologies, including diabetic neuropathy, venous and/or arterial insufficiency, and prolonged pressure.1 In addition to significant morbidity and both financial and emotional costs, chronic wounds have been associated with an increased risk of osteomyelitis and limb amputation and increased mortality.2 At present, despite addressing the underlying pathophysiology of the wound and employing adjuvant therapies, such as growth factors and tissue-engineered skin, a need exists for additional options in the therapeutic arsenal. In t