Correlation of intra-articular osseous measurements with posterior cruciate ligament length on MRI scans.

Six patients with a clinical diagnosis of chronic posterior cruciate ligament (PCL) rupture, based on a positive posterior drawer test, had a normal appearance of the PCL on an MRI scan. It is postulated that the PCL had been ruptured but healed in a lengthened state. 12 volunteers with no history of knee trauma underwent an MRI scan of the knee. In this control group (n = 12), there was a close correlation between the lateral femoral condylar width in the sagittal plane and the PCL length, with a ratio of 2:1 (95% confidence interval (CI) = 1.817-2.095). In the clinically abnormal group (n = 6), the ratio was 1.49:1 (95% CI = 1.206-1.782) (p< 0.0005). In conclusion, the ratio of the lateral femoral condylar width in the sagittal plane to the PCL length is a useful index for diagnosing PCL attenuation and lengthening in the presence of a normal morphological MR appearance.

Epidemiology of sporting and recreational injuries in a paediatric orthopaedic outpatients department.

Knowledge of the number and type of injuries attending the paediatric orthopaedic outpatients is crucial in the future planning of any new paediatric hospital. We prospectively collected data on all new patients attending two paediatric orthopaedic out-patients departments, over a four month period. There were a total of 1,791 completed questionnaires. Sporting and recreational injuries represented 270% and 28% of the total attending, respectively. The new use of heelies represented 11% of the recreational injuries. The upper limb injuries represented 74% of the total, with the lower limb accounting for 25%. Treatment was nonoperative or operative. The number of patients, and the types of injuries presenting demonstrates the workload involved in diagnosing and treating these injuries. A total of 827 casts were applied. With almost half of those attending the clinic requiring a cast, the workload on the plaster technicians is substantial, and has implications for future service planning.

Measurement of coronary artery calcification by electron beam computerized tomography in persons with chronic spinal cord injury: evidence for increased atherosclerotic burden.

BACKGROUND/OBJECTIVE: Individuals with spinal cord injury (SCI) have been reported to have an increased prevalence of premature cardiovascular disease. Whether the increased risk of disease is owing to clustering of traditional cardiac risk factor or is over and above that predicted by risk factors was addressed. METHODS: Ninety-one persons with chronic SCI were studied for subclinical atherosclerosis. Cardiac risk factors and coronary artery calcium (CAC) was compared to matched non-SCI controls. The 273 controls were 3:1 matched for age, gender, ethnicity and risk factors and were drawn from a national database of over 30,000 asymptomatic persons undergoing coronary scanning. RESULTS: Seventy-six men and 15 women were studied. Average age was 49.7+/-12 years. Duration of injury was 19.7+/-10 years. The ethnicity of the study cohort included 36% Caucasian, 49% Latino, 10% African American, and 5% other. The mean calcium score of the SCI group was significantly greater than the control group (75+/-218 versus 28+/-104, P<0.001). The prevalence of any CAC score was greater in the SCI population than the control population (51 versus 39%, P<0.05), as was CAC score >100 (16 versus 7%, P<0.01). Women with SCI had a significantly lower CAC score than men (mean score: 12 versus 86, P<0.01). CONCLUSION: Patients with SCI were shown to have greater atherosclerotic burden than able-bodied controls. Of note, and unexplained, this finding is beyond that explained by the clustering of traditional risk factors. On the basis of these findings, increased attention should be directed toward the prevention of coronary heart disease in those with SCI.

Association of white blood cell count with systolic blood pressure within the normotensive range.

Hypertension and inflammation promote cardiovascular disease (CVD). Even high normal systolic blood pressure (SBP) is associated with increased CVD risk. We assessed the relationship of elevated SBP within the normotensive range and white blood cell (WBC) count. This is a cross-sectional study of 3484 white asymptomatic individuals (mean age: 43+/-8 years, 79% males) without hypertension with SBP<140 mm Hg. White blood cell count >or=75th percentile (8.35 x 10(9) cells/l) was considered cutoff for elevated WBC. Subjects were classified into three levels of SBP (first: <120 mm Hg, n=1,176, 34%; second: 120-129 mm Hg, n=1,654, 47%; third: 130-139 mm Hg, n=654, 19%). Mean WBC count increased linearly across SBP categories (first: 6.14+/-1.54, second: 6.20+/-1.52, third: 6.41+/-1.62, P=0.02 for trend). There was a linear increase in prevalence of elevated WBC across higher SBP categories (22, 24 and 28%, P=0.02). As compared to those with SBP<120 mm Hg, in multivariate linear regression analyses (adjusting for age, gender, smoking status, diabetes, body mass index, physical activity, cholesterol/high-density lipoprotein cholesterol ratio) WBC count was significantly higher among participants with SBP 130-139 mm Hg (regression coefficient: 2.64, 95% confidence interval: 1.04-4.24, P=0.001). Odds ratio for prevalence of elevated WBC with SBP<120 mm Hg as reference group was 1.14 (0.92-1.41) for SBP 120-129 mm Hg and 1.50 (1.15-1.92) for SBP 130-139 mm Hg. In conclusion, Higher SBP within the normotensive range is also associated with elevated WBC count. Further studies are needed to clarify the role of inflammation in high normal SBP and associated CVD risk.

Nail-gun limb injuries.

We present four cases and a review of the literature regarding nail-gun related limb injury. Nail guns have significant potential to cause limb and other major injuries. In most cases improper use of the nail-gun is the single most important factor in causing such types of injuries. Treatment of these injuries requires careful assessment of the limb and the type of nail involved in order to enable safe extraction. We recommend the introduction of training in the workforce to encourage awareness of the danger of such devices. We also emphasize the continuing requirements for improved workplace safety and adequate safety equipment when working with such dangerous devices.

The prevalence and pattern of liver disease in infants and children in Hazara Division.

BACKGROUND: The pattern of the liver disease may vary in different geographical locations. These reported variations are attributable to the differences in environmental factors, eating habits, socio-economic factors and other reasons. We studied the pattern of liver diseases in infants and children of Hazara Division of Pakistan. METHODS: 200 inpatient and outpatient infants and children in Ayub Teaching Hospital were studied from June, 1998 to October, 1999. RESULTS: The spectrum of defect in the subjects, suffering from liver diseases showed that viral hepatitis was more common (relative frequency of 60%), followed by enteric hepatitis (26%), drug induced liver injury (7.5%), biliary atresia (5.0%) and Criglar-Najjar Syndrome (1.5%). Although both sexes were affected, however, the spectrum of liver disease was more common in males. Moreover, viral hepatitis and enteric hepatitis were found in children aging 6 to 8 years, biliary atresia in 6 months to 2 years, and drug induced liver injury in 3 to 5 years old subjects.

Serum proteins electrophoresis in infants and children.

Total serum proteins and its fractions were estimated in 468 infants and children from birth to 4 years in relation to age, sex and dietary pattern. The mean values of total serum proteins and its fractions showed some changes with age, especially in gamma globulins, which was high at birth and showed a decrease at the age of 3 months, after which it increased and attained an adult level at the age of 18 months. No difference was noted between the two sexes. Completely breast fed infants had a significantly higher protein and albumin levels at 3 months than completely weaned infants but no such difference was observed in other protein fractions in the same age groups.

Inactivation of alpha- and beta-thrombin by antithrombin-III, alpha 2-macroglobulin and alpha 1-proteinase inhibitor.

Inactivation of alpha- and beta-thrombin by alpha 2-macroglobulin, by alpha 1-proteinase inhibitor and by antithrombin-III and heparin was studied. The amount of alpha- and beta-thrombin inactivated by antithrombin-III was proportional to the concentration of the inhibitor, but the inactivation rates of the two forms of thrombin were different. Heparin facilitated complex-formation between alpha-thrombin and antithrombin-III, whereas inactivation of beta-thrombin by antithrombin was only slightly influenced, even at a heparin concentration two orders of magnitude higher. alpha 2-Macroglobulin inhibited both alpha- and beta-thrombin activity similarly, i.e. the amount of alpha- and beta-thrombin inactivated as well as the rates of their inhibition were the same. alpha 1-Proteinase inhibitor also formed a complex with alpha- and beta-thrombin, similarly to antithrombin-III, although the inactivation of the enzyme needed high inhibitor concentration and long incubation time. These results suggest that the inactivation of beta-thrombin, if it occurs in the plasma, is also controlled by plasma inhibitors.