Reprocessing flexible gastrointestinal endoscopes after a period of disuse: is it necessary?

BACKGROUND: Gastrointestinal endoscopy is an integral tool in the evaluation and management of many gastrointestinal and hepatobiliary conditions. Although rare, media reports of infectious complications following gastrointestinal endoscopy persist in this new millennium. With only limited data available, society guidelines continue to suggest that endoscopes undergo a reprocessing cycle before the first patient of the day. This preliminary study aimed to assess the microbiological stability of gastrointestinal endoscopes after high-level disinfection. METHODS: In this multiphase study, four endoscopic retrograde cholangiopancreatography (ERCP) scopes and three colonoscopes were evaluated. In phase 1, endoscopes were assayed after initial high-level disinfection and daily for a period of 2 weeks. In phase 2, this procedure was repeated to confirm phase 1 results. In phase 3, endoscopes were assayed after high-level disinfection and again following a 7-day storage period. RESULTS: In phase 1, 6 of 70 (8.6 %) assays were positive. This involved 4 of 7 (57 %) endoscopes (2 colonoscopes and 2 ERCP scopes) and was limited to the first 5 days of the study. No cultures were positive in phase 2. In phase 3, one endoscope had a positive culture. Positive cultures grew only STAPHYLOCOCCUS EPIDERMIDIS, a low-virulence skin organism. DISCUSSION: With proper disinfection and storage, it appears that reprocessing of gastrointestinal endoscopes is unnecessary after periods of disuse of at least 7 days and possibly up to 2 weeks. Despite recent media reports of infectious complications, society guidelines that recommend more frequent reprocessing seem to lack scientific merit and need to be revisited.

Sagittal plane translations of the knee in anterior cruciate deficient subjects and controls.

Static anterior-posterior (AP) laxity is one of the commonly used criteria in selecting patients for cruciate ligament reconstructions, but in reality dynamic AP laxity plays a more important role. The aim of this in vivo study was to compare the sagittal translation of the knee during active and passive motion, signifying dynamic AP laxity, with static AP laxity in healthy subjects (controls) and patients with anterior cruciate ligament deficiency. The sagittal plane knee translations were recorded and compared in both knees of nine healthy subjects (Controls) and seven patients with confirmed unilateral ACL deficiency during dynamic and static situations with an electrogoniometer system. In all groups during the ascents the tibia moved anteriorly in relation to the femur, whereas during the descents it moved posteriorly. The static anterior-posterior translation was significantly smaller in the control knee than in both healthy and injured knees of the ACL deficient group (P < 0.05). The injured knee showed the same laxity (92%) as the uninjured knee during dynamic activities, but it was 46% of static laxity. Also in the injured knees, the dynamic active laxity was larger during descents than ascents (P < 0.05). The results indicate that there is also a change in mechanics of the noninjured knee following injury to the contralateral knee and that this population of patients with ACL deficiency had good control over their abnormal anterior-posterior laxity.

Sagittal plane translation of the knee during stair walking. Comparison of healthy and anterior cruciate ligament--deficient subjects.

With an electrogoniometer system, we made bilateral measurements of the maximal sagittal plane anterior-posterior knee translations in 15 healthy subjects (controls) and 14 patients with arthroscopically confirmed unilateral anterior cruciate ligament deficiency during two types of ascents and descents (straight and side). In both groups, during the ascent cycle the tibia moved anteriorly in relation to the femur, whereas during the descent cycle it moved posteriorly. There was wide individual variation in maximal translation in both the control and anterior cruciate ligament-deficient groups (range, 1 to 12 mm; mean, 7 mm). The maximal translations were similar in both groups (P > 0.05), but they occurred at a significantly smaller flexion angle in the injured knees (38 degrees +/- 8 degrees) than in the control and non-injured knees (44 degrees +/- 8 degrees) (P < 0.05). The translation during step ascent and descent did not differ between the injured and control knees. These findings indicate that patients with anterior cruciate ligament injuries are able to control abnormal anterior translation during normal activity.

Sagittal plane translation of the knee during stair walking in healthy volunteers measured by an electrogoniometer chain.

Maximal sagittal plane knee translation during stair walking was investigated in 5 healthy male subjects without any previous history of knee joint trauma during 2 types of ascents and descents (straight and side) using an electrogoniometer system (CA-4000, OS Inc., Hayward CA, USA). During the ascents, the tibia moved anteriorly in relation to femur, whereas during the descents it moved posteriorly. The maximum translations occurred within the range of 39 degrees to 51 degrees of knee flexion and were significantly larger during the ascents than during descents, but there was no difference between straight and side activities. There were significant interindividual differences in the maximum translations during the ascent or descent cycles but no differences between trials or the right or left limbs. The mean difference between repeated trials was 1.2 mm and the 95% confidence interval was +/- 0.6 mm.

Graft failure in intra-articular anterior cruciate ligament reconstructions: a review of the literature.

There exists a substantial group of patients with unsatisfactory results following anterior cruciate ligament (ACL) reconstructions. This may be attributable to graft failure. Revision surgery, for the correction of abnormal anterior translation of laxity, requires a careful analysis of the causes of failure to ensure the success of the salvage procedure. This review attempts to present an overview of some of the important studies in the literature pertaining to the intraoperative and postoperative factors that probably cause graft failure. It was done by initial identification of the articles from a Medline database followed by the use of cross references. It shows that failures can be minimised by adhering to the correct operative and post-operative techniques wherein proper attention to the factors, such as: adequate notchplasty, proper tunnel placements, proper tensioning, adequate fixation, optimal selection and harvest of the graft, and rehabilitation, are ensured.

Neck injuries from skate blades in ice hockey: a report of three cases.

This article describes three neck slash injuries in amateur ice hockey players, with a fatal outcome in two. One player died of asphyxation secondary to hemorrhage into the respiratory passage, but the other died of hemorrhage from the main blood vessels in the neck, severed by the skate blade. All three were not wearing any neck protecting device. Neck slash injury from skate blades, as a preventable sports-related injury, and the need for neck protective equipment in preventing such injuries are discussed.

An unusual case of vascular abnormality mimicking a lateral meniscal cyst.

An unusual case of a vascular abnormality mimicking a lateral meniscal cyst is reported. The patient was a 31-year-old active sportsman who presented with intermittent pain over the lateral aspect of the left knee joint line, occurring only during activities involving twisting motions such as playing soccer. He did not experience local tenderness or swelling, clicking, locking, or giving way. The magnetic resonance imaging, which was done after a diagnostic arthroscopy with normal intra-articular findings, showed a cyst formation of approximately 4-mm diameter adjacent to the lateral meniscus periphery, but no meniscal tissue degeneration. Exactly at the preoperatively marked site of most intensive pain sensation during twisting motions, surgical exposure showed a venous-aneurysm-like tumor, which was removed. The operation resulted in complete relief of symptoms and undisturbed sporting activities including soccer.