BASHH UK guidelines for the management of syphilis 2024.

The 2024 UK guidelines for the management of syphilis are in line with current evidence and practice within the UK. Key updates are detailed at the start of the article. These guidelines are accompanied by the first UK guidelines for the management of syphilis in pregnant people and children, 2024.

Ocular syphilis: the re-establishment of an old disease.

PurposeTo present the patient profiles, clinical presentations and visual outcomes in those diagnosed with ocular syphilis, attending a subspecialist uveitis service in northern England over a 15-year period.Patients and methodsRetrospective observational case series of patients presenting between January 2002 and December 2016.ResultsA total of 50 eyes of 34 patients had intraocular inflammation due to syphilis.

UK national guidelines on the management of syphilis 2015.

These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan.

Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: A radiological study of the critical shoulder angle.

We hypothesised that a large acromial cover with an upwardly tilted glenoid fossa would be associated with degenerative rotator cuff tears (RCTs), and conversely, that a short acromion with an inferiorly inclined glenoid would be associated with glenohumeral osteoarthritis (OA). This hypothesis was tested using a new radiological parameter, the critical shoulder angle (CSA), which combines the measurements of inclination of the glenoid and the lateral extension of the acromion (the acromion index). The CSA was measured on standardised radiographs of three groups: 1) a control group of 94 asymptomatic shoulders with normal rotator cuffs and no OA; 2) a group of 102 shoulders with MRI-documented full-thickness RCTs without OA; and 3) a group of 102 shoulders with primary OA and no RCTs noted during total shoulder replacement.

Imprisonment for non-intentional transmission of HIV: can it be supported using established principles for justifying criminal sentencing?

In England, Wales and Scotland, those who unintentionally transmit HIV through sexual intercourse are at risk of criminal prosecution, and furthermore may be at risk of imprisonment under the Offences Against the Person Act 1861. These sentences have ranged between 1 and 10 years. There has been a long debate on whether this is an acceptable use of the law, and indeed whether those who transmit HIV in this manner should be subjected to legal proceedings.

A comprehensive classification of proximal humeral fractures: HGLS system.

Background: This study assessed the intraobserver and interobserver reliability of a binary classification system using an easy-to-remember acronym (the HGLS system--based on the reappraisal of Codman's description by Hertel et al) and compared it with the AO and Neer systems.

Materials And Methods: Forty-seven proximal humeral fractures in 47 patients treated at the Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia, were identified in the period from July 2007 until January 2008. Fractures of the proximal humerus were examined with anteroposterior, lateral, and axillary radiographs.

Static posterior humeral head subluxation and total shoulder arthroplasty.

Background: Static posterior subluxation of the humeral head (PSH) is often associated with glenohumeral arthritis. It may persist following total shoulder arthroplasty (TSA) and lead to accelerated polyethylene wear and glenoid component loosening. The factors which lead to PSH are poorly understood.

The subcristal pelvic external fixator: technique, results, and rationale.

We report a new technique for pelvic external fixation that we have developed as an alternative to the anterosuperior (Slätis) and the anteroinferior (supra-acetabular) type pelvic external fixator configurations. The method principally differs from the other techniques by virtue of the subcristal positioning of the pins and offers advantages in terms of easier pin placement, less skin irritation, less pin tract infection and loosening, and less interference with hip flexion, while allowing dressing, sitting, and walking. Between 1992 and 2006, we successfully used subcristal pelvic external fixators as the definitive fixation device for 20 patients with pelvic ring disruptions.

Minimal invasive epiphysiodesis using a modified "Canale"-technique for correction of angular deformities and limb leg length discrepancies.

Purpose: Leg length discrepancy and angular deformities can, in contrast to adults; easily be corrected with epiphysiodesis during growth. Goal of this study was to evaluate our results of a modified Canale technique for definitive epiphysiodesis treating leg length discrepancy and also angular deformities.

Methods: Between 2000 and 2007, 22 patients (11 boys and 11 girls) were subjected to definitive epiphysiodesis.

How accurately can the acetabular rim be trimmed in hip arthroscopy for pincer-type femoral acetabular impingement: a cadaveric investigation.

Purpose: The purpose of this study was to evaluate the precision of central hip arthroscopy in the assessment and treatment of pincer-type femoroacetabular impingement (FAI) avoiding the posterolateral portal, with its close proximity to the main arterial blood supply of the femoral head, the medial circumflex femoral artery.

Methods: Seven human cadaveric hips underwent arthroscopic trimming of the acetabular labrum and rim along a preoperatively defined 105 degrees arc of resection for treatment of a presumed pincer-type lesion. After the arthroscopic procedure, all specimens were dissected and measured for evaluation of the location, quantity, and quality of the area undergoing resection.

The anterior center edge angle in Lequesne's false profile view: interrater correlation, dependence on pelvic tilt and correlation to anterior acetabular coverage in the sagital plane. A cadaver study.

Introduction: Lequesne's vertical-center-anterior margin (VCA) angle measured on the false profile view of the pelvis aims at quantifying the anterior acetabular coverage of the femoral head. The anterior delimitation of the acetabular roof is often defined on the false profile view but there are no data on its interrater reliability. Additionally, it is not known how pelvic tilt may influence this angle.

A cost-benefit analysis using contingent valuation techniques: a feasibility study in spinal surgery.

Objectives: To carry out a pilot study to demonstrate the feasibility of the contingent valuation (CV) approach to identify net benefits gained from spinal interventions; and to conduct a formal cost-benefit analysis (CBA) using a retrospective study design. The study design is a CBA feasibility study using a CV survey with ex post willingness-to-pay/willingness-to-accept (WTP/WTA) questions. The CBA study was carried out in the specialty of spinal surgery.

Clinical and structural outcomes of nonoperative management of massive rotator cuff tears.

Background: The natural history of massive rotator cuff tears is not well known. The purpose of this study was to determine the clinical and structural mid-term outcomes in a series of nonoperatively managed massive rotator cuff tears.

Methods: Nineteen consecutive patients (twelve men and seven women; average age, sixty-four years) with a massive rotator cuff tear, documented by magnetic resonance imaging, were identified retrospectively.

Reverse Delta-III total shoulder replacement combined with latissimus dorsi transfer. A preliminary report.

Background: Reverse total shoulder arthroplasty allows the restoration of active overhead elevation in patients with a massive rotator cuff tear and pseudoparesis of elevation. However, it does not restore active external rotation, the lack of which can also constitute a substantial functional handicap and compromise the outcome of this arthroplasty. Latissimus dorsi tendon transfer reliably restores control of active external rotation in rotator-cuff-deficient shoulders.

Metatarsophalangeal joint arthrodesis after failed Keller-Brandes procedure.

Background: Keller-Brandes resection arthroplasty for correction of symptomatic hallux valgus deformity can obtain early good results, but late complications, such as recurrence of the deformity and instability of the first ray, have been described. Arthrodesis of the first metatarsophalangeal, (MTP) joint can be done as a salvage procedure. The aim of this prospective study was to evaluate the clinical outcome of the arthrodesis and its effect on the biomechanics of the first ray.

Single-stage bilateral total shoulder arthroplasty: a preliminary study.

We compared six patients with a mean age of 70 years (49 to 80) with severe bilateral, painful glenohumeral joint destruction who underwent a single-stage bilateral total shoulder replacement, with eight patients of mean age 61 years (22 to 89) who underwent bilateral total shoulder replacement in two stages, at a mean interval of 18 months (6 to 43). The overall function, pain and strength improved significantly in both groups. The subjective shoulder value, relative Constant score, active external rotation and the strength were improved significantly more in the single-stage group.

Association of a large lateral extension of the acromion with rotator cuff tears.

Background: Factors predisposing to tearing of the rotator cuff are poorly understood. We have observed that the acromion of patients with a rotator cuff tear very often appears large on anteroposterior radiographs or during surgery. The purpose of this study was to quantify the lateral extension of the acromion in patients with a full-thickness rotator cuff tear and in patients with an intact rotator cuff.

Tripartite patella: late appearance of a third ossification center in childhood.

Bilateral radiographic progression of the supero-lateral fragment of a bipartite- into a tripartite patella with unilateral symptoms. An 8 year old girl presented a bilateral bipartite patella Stage III as an incidental finding after fall on the flexed right knee. Serial radiographs two years later revealed a bilateral progression of the bipartite- into a tripartite patella with complaints only on the post-traumatic right side.

Radiographic and computed tomography analysis of cemented pegged polyethylene glenoid components in total shoulder replacement.

Background: Glenoid loosening continues to be the primary reason for failure of total shoulder arthroplasty. The purpose of this study was to evaluate, with use of a sensitive and reproducible imaging method, the radiographic and clinical results of total shoulder replacement with a pegged, cemented polyethylene glenoid implant.

Methods: Forty-three patients (forty-seven shoulders) underwent a total shoulder replacement with a cemented polyethylene glenoid component with four threaded pegs.

Ocular syphilis: the new epidemic.

Aim: To present the clinical presentation, diagnosis, and management of syphilitic uveitis in the context of an epidemic of syphilis in the UK.

Method: Retrospective clinical case series.

Results: Six new cases of syphilitic uveitis presented to the Manchester Uveitis Clinic in 2004, after a 15-fold increase in the incidence of syphilis in the UK, including 615 cases in Greater Manchester in the 5 years to 2004.

Re-emerging syphilis in the UK: a behavioural analysis of infected individuals.

In-depth interviews with 27 individuals infected with syphilis in a recent UK outbreak (out of a total of 58 diagnosed between May 1999 and August 2000 in three city hospitals) were carried out to examine behaviour and attitudes. Most (23/27) participants were homosexual men, seven of whom were HIV positive. Between them, the 23 gay men had 1,494 different contacts in the twelve months prior to their awareness of having syphilis, but only 10% of these contacts could be named.

Peripheral blood T cell proliferative response to chlamydial organisms in gonococcal and non-gonococcal urethritis and presumed pelvic inflammatory disease.

Objective: To study peripheral blood mononuclear cell (PBMC) proliferative response to Chlamydia trachomatis elementary bodies in (a) controls, (b) various stages of gonococcal (c) and non-gonococcal urethritis, and (d) women with a clinical diagnosis of pelvic inflammatory disease (PID).

Methods: We categorised 102 men presenting to a GUM clinic with urethritis by organisms (C trachomatis (CT) or Neisseria gonorrhoeae (NG) (both by culture), and whether it was their first (urethritis naive) or subsequent (urethritis experienced) attack. 23 women presenting to the clinic with a clinical diagnosis of PID were also investigated.