Indications and results of vein valve transplant.

Approximately 250,000 people are affected by postphlebitic syndrome each year in the U.S. Its pathogenesis is related to the incompetence of vein valves in the leg caused by thrombophlebitis and congenital redundancy. "Indications and results of vein valve transplant" discusses the correction of postphlebitic syndrome. Preliminary results of the vein valve transplant have been previously reported. This report updates the follow-up of 46 patients up to 3 years after the operation. The significance of muscle changes that occur with venous insufficiency is illustrated, and two new modalities of preoperative evaluation and postoperative follow-up are introduced.

Deep posterior compartment pressure in the evaluation of venous insufficiency of the lower extremity--a preliminary report.

A new method of assessing the extent of venous insufficiency in the lower extremity at the tissue level was tested on thirteen limbs with various degrees of venous insufficiency as evidenced by clinical signs and descending venography. Deep posterior compartment pressures in standing patients correlated well with standing venous pressures in these same limbs. Eighty-three percent of those limbs with deep posterior compartment pressures above 30 mmHg had objective clinical signs of venous insufficiency, namely edema, stasis dermatitis and/or stasis ulcer. Descending venography results were compared in six of these limbs, however, no correlation with compartment pressures could be found from this small sample. With further study, deep posterior compartment pressures using the slit catheter technique may prove to be a valuable aid in the diagnosis of venous insufficiency.

Sporotrichosis of the knee. A case report.

Articular infections due to the fungus Sporothrix schenkii are rare. Only 46 cases of Sporotrichosis arthritis have been well-documented in the English literature to date. The presentation may be limited to a monoarticular synovitis, hence the diagnosis may be confused with other more common causes resulting in costly delays in proper treatment. Reported is a case of Sporotrichosis of the knee misdiagnosed multiple times over a three-year period yet illustrating important clinical features that could lead to earlier diagnosis and management.

Arthroscopic surgery of the knee under local anesthesia.

This report delineates the efficacy of local anesthesia in the performance of arthroscopic surgery of the knee. A retrospective review of 500 cases revealed that only three required administration of general anesthesia to successfully complete the procedure. A prospective study comparing fentanyl, midazolam, and fentanyl/midazolam combinations as intravenous supplements was performed. Meticulous surgical technique combined with local anesthesia and some form of intravenous sedation in minimal therapeutic dosage will provide satisfactory conditions to perform surgical arthroscopy of the knee.

Arthroscopic resection of glenoid labral tears in the athlete: a report of 29 cases.

This article is a retrospective review of 28 overhead-throwing and striking athletes who underwent 29 arthroscopic partial glenoid labral resections. Indications for the procedure were a sudden inability to perform because of pain and the presence of a palpable "click" on clinical examination. At a minimum of 2 years follow-up, there was a statistically significant difference in the functional outcome between patients with stable and those with unstable glenohumral joints. In those with stable joints, there was a 91% good or excellent functional outcome. In those with unstable joints, there was a 25% good functional outcome and a 75% fair or poor functional outcome. We also noted a statistically significant difference in labral tear location between the stable and unstable glenohumeral joints. Seven of eight superior labral tears were in stable shoulders. Fourteen of 19 anterior labral tears were in stable shoulders. Both posterior labral tears were in unstable glenohumeral joints. Injury of the glenoid labrum without anatomic instability was observed in 72% of patients. Arthroscopic resection of a longitudinal labral tear in a stable shoulder can relieve the patient's discomfort and allow him or her to return to athletic competition. No patient developed clinical subluxation as a result of labral debridement, nor did any patient convert from a subluxing shoulder to a dislocating shoulder following surgery. In patients with anterior instability and labral tears, labral debridement was not a successful alternative to formal stabilization.