An anatomic-arthrographic study of the relationships of the lateral meniscus and the popliteus tendon.

The anatomy of the posterior lateral knee joint is studied through photography and radiography of plastic corrosion casts of the knee joint. The images thus obtained are compared to in vivo arthrograms. This anatomic-arthrographic correlation clearly demonstrates how the bursal extensions of the joint space about the popliteus tendon dictate the location and arthrographic appearance of the peripheral attachments of the posterior lateral meniscus. The casts also serve to illustrate a discussion of anatomic variation, embryology, and function of the popliteus apparatus. The largely unappreciated direct action of the popliteus muscle on the lateral meniscus is emphasized.

Eleven cases of sickle cell disease in Sydney.

Eleven cases of sickle cell disease within the Sydney area are described. Eight of these are of homozygous sickle cell anaemia, and three are of the sickle cell-thalassaemia disease. The racial origin is Lebanese Moslem in five cases, Greek from the mainland or Cyprus in four, and Portuguese, French, and Spanish in two sisters: consanguinity occurred in the latter family, and in three of the five Lebanese Moslem families. The age of patients at diagnosis ranged from five months to 22 years, and the clinical severity from very mild to very severe, with a wide spectrum of clinical manifestations. It is concluded that sickle cell disease is already a significant health problem within the Sydney area, and likely to increase in incidence with increasing migration from endemic zones.

In vitro metabolism of red blood cells from newborn and adult goats.

The erythrocytes of newborn and adult goats were studied with respect to GSH stability, GSH regeneration, levels of ATP and 2, 3-DPG, glucose consumption and activities of nine different enzymes of Embden-Meyerhof and pentose phosphate pathways of glucose metabolism. Red cells from newborn goats had significantly higher levels of ATP and 2, 3-DPG. The activities of all the enzymes measured were also significantly greater in the newborn. It is suggested that newborn goats possess red blood cells that are metabolically more active than those of adult goats.

Use of formalinized sheep erythrocytes in the rubella hemagglutination-inhibition test.

Rubella antibody determination by the hemagglutination-inhibition test was effectively simplified by substitution of formalinized sheep red blood cells for avian erythrocytes.

Nonselective angiography after intracorporal papaverine injection: an alternative technique for evaluating penile arterial integrity.

Forty patients with impotence were evaluated by means of nonselective angiography after intracorporal papaverine injection. The penile arterial network was visualized in 39 patients (97%). The technique was technically simple, and there were no complications. The most common sites of arterial disease were the arteries at the base of the penis (58%) and the internal pudendal artery (31%). In patients with advanced atherosclerotic disease, formation of collaterals within the penile arterial network appears to be important in maintaining flow to the cavernosal arteries. Asymmetry of arterial disease was frequently encountered (54%), indicating the importance of bilateral visualization of the arteries supplying the cavernosal arteries. Penile arteries were not visualized adequately in any of the patients studied nonselectively without intracorporal papaverine.

Nail-gun injuries. Accident, homicide, or suicide?

It may be difficult to distinguish industrial accidents from suicide attempts or even assaults or homicide. Nail guns are relatively new industrial tools that can produce severe or fatal injuries. The configuration of the nail on patients' radiographs after such injuries can be helpful in determining the cause of injury. Steel nails that are bent are due to a ricochet and thus indicate accidental injury. Straight-nail injuries to the co-workers of nail-gun users are most likely due to over-penetration of the substance being nailed or accidental mid-air firing; however, intentional injury cannot be ruled out. Extremity injuries caused by straight steel nails in nail gun users are the result of carelessness or poor technique, but suicide should be considered when straight nails cause wounds to the chest, head, or abdomen.

Glucose 6-phosphate dehydrogenase variants: Gd (+) Alexandra associated with neonatal jaundice and Gd (-) Camperdown in a young man with lamellar cataracts.

Two male subjects are described, with unusual clinical presentations and with hitherto undescribed G6PD variants. The first, of Italian extraction, suffered from severe neonatal jaundice following maternal ingestion of fresh broad beans (Vicia fava) both prenatally and postnatally: the expression of the enzymatic defect was much more severe in the neonatal period than on retesting in adolescence, when biochemical characterization showed unique features which justify designation as a new variant Gd(+) Alexandra. The second patient, a boy of Maltese extraction who was found to have bilateral lamellar cataracts at the age of 4 years, was identified as G6PD deficient only as a result of a survey of children of Mediterranean origin with unexplained cataract formation; he has approximately 15% of normal enzyme activity, with another unique combination of biochemical characteristics which has led to its designation as Gd(-) Camperdown. Although this association may be coincidental, it prompts further attention to the possibility that under certain circumstances G6PD deficiency may favor cataract formation. The two cases illustrate the value of characterization of the mutant enzyme whenever unexpected clinical or laboratory results are obtained.

Elbow Arthrography with the Application of Tomography.

The intra-articular structure of the elbow joint was studied in 18 patients with double contrast arthrography and tomography. All tomographic examinations were made with the hypocycloid motion. The authors feel that the disadvantages of the method, i.e., getting access to tomographic equipment, the 30 to 45 minutes required to complete the examination, and the radiation from multiple exposures needed for tomographic sections are obviated by the results: the arthrographic findings were confirmed in all 7 patients who later underwent surgery.

CT of acetabular fractures: analysis of fracture patterns.

Thirty-one consecutive patients who sustained acetabular fracture or posterior femoral head dislocations were examined by computed tomography (CT). By analysis of closely spaced, thin CT images, it was possible to characterize the three-dimensional nature of these injuries. Traditional classification into anterior column, posterior column, and complex two-column fractures was facilitated. CT was especially useful in evaluation of the two-column fractures in which unique information concerning the configuration of the fracture, integrity of the acetabular dome and quadrilateral surface, and identification of the stable fragment was obtained. Surprisingly constant fracture patterns were identified. CT was also useful in determination of presence or absence of loose bodies in the joint and in evaluation of the femoral head and sacroiliac joint in all types of fracture.

CT of acetabular fractures: comparison with conventional radiography.

Computed tomography (CT) and plain radiography of the pelvis were compared in 26 adult patients in whom acetabular fractures or posterior femoral head dislocations were demonstrated or suspected on initial radiographs. The detection of abnormalities of the sacrum, sacroiliac joint, iliac wing, acetabular roof, joint space, anterior pelvic column, posterior pelvic column, posterior acetabular lip, pubic rami, and quadrilateral surface of the ilium by the two methods was compared. The ability of the two techniques to establish the stable fragment was also examined. Three independent readings of each examination for each pelvic region were tabulated, and sensitivity and specificity values were calculated. There was no significant difference between plain radiography and computed tomography in detection of fractures of the iliac wing, anterior pelvic column, posterior pelvic column, and the pubic rami, with high sensitivity and specificity for both examinations. CT was more sensitive than plain radiography in detecting fractures involving the sacrum, quadrilateral surface, acetabular roof, and posterior acetabular lip. In addition, abnormalities of the hip joint space, principally loose bone fragments, were detected more often by CT. Sensitivity of both examinations for abnormalities of the sacroiliac joint was relatively poor, but examinations were highly specific. Determination of the stable fracture fragment(s) was readily accomplished by CT scanning in all 26 patients; in five patients incorrect determinations were made with conventional radiographs alone.

Determination of rubella hemagglutination-inhibiting antibody in whole blood.

A technique is described for determination of rubella hemagglutination-inhibiting antibody in only 50 to 100 muliters of whole blood.

Treatment and traumatic hemobilia with angiographic embolization.

Hemobilia is an uncommon but devastating complication of liver trauma. The recommended treatment is surgical resection of the involved liver lobe, but this is associated with high mortality and morbidity. An alternate treatment using emboli directed selectively into the involved hepatic artery was successful in obliterating the false aneurysm and eliminating the liver cavity. Since arteriography is generally performed during the diagnostic workup of such patients, embolization may provide a simple, safe, and effective treatment for hemobilia.

Diagnosis of osteomyelitis in the presence of soft-tissue infection and radiologic evidence of osseous abnormalities: value of leukocyte scintigraphy.

To evaluate the usefulness of 111In-leukocyte scintigraphy for identifying osteomyelitis in the presence of soft-tissue infection, we prospectively studied 45 bone sites adjacent to soft-tissue infection in patients with abnormal findings on radiographs and 99mTc bone scans that were suggestive of osteomyelitis. 111In-leukocyte scans were analyzed in terms of the intensity of abnormal uptake and its location relative to bone. The diagnosis of osteomyelitis was established from results of percutaneous bone biopsy culture (n = 35), histologic examination of surgical specimens (n = 8), and clinical follow-up (n = 2). Osteomyelitis was present at 22 sites, including 16 of 18 sites with increased leukocyte uptake in bone, resulting in a sensitivity of 73%, specificity of 91%, and positive predictive value of 89% for this finding. Osteomyelitis was present at four of 17 sites with predominantly soft-tissue localization of leukocyte activity in the region of bone, none of seven sites with normal leukocyte scans, and two of three sites with diminished leukocyte uptake in bone. Although not helpful in distinguishing infectious from noninfectious bone abnormalities, 3- and especially 24-hr bone scans viewed in conjunction with leukocyte studies provided important correlation to aid in estimating the location of focal abnormal leukocyte uptake. The finding of soft-tissue infection with increased uptake of labeled leukocytes that extends to involve adjacent bone strongly suggests concurrent osteomyelitis. When the presence of abnormal leukocyte uptake in bone is uncertain, additional imaging and possibly biopsy may be required to establish or exclude the diagnosis of osteomyelitis.

Treatment of acute renal artery occlusion after percutaneous transluminal angioplasty.

Four patients with occlusive complications after percutaneous transluminal renal artery angioplasty (PTA) have been treated from July 1, 1984, to March 14, 1988. During this interval such renal artery angioplasties were performed in 44 patients. Two resulted in complete main renal artery occlusion, one angioplasty resulted in occlusion of a stenotic renal artery bypass graft, and one renal PTA resulted in segmental branch renal artery narrowing, which was thought to represent a dissection. The latter segmental renal artery narrowing was treated expectantly with good long-term results. One of the main renal artery occlusions was treated by radiologic means by reentry and repeat transluminal dilation. The other two acute complete occlusions, one of an autogenous artery and the other of an aortorenal bypass graft, were treated by aortorenal or ileorenal bypass grafting, respectively. The overall incidence of main renal artery occlusion (including the bypass graft occlusion) after PTA requiring operative intervention was 4.5% (2/44). Revascularization was accomplished after 6 and 8 hours of renal ischemia time for the two surgical procedures. Despite this, the bypass grafts done emergently remain patent, and the involved kidneys appear to be functional. The incidence of main renal artery occlusion after PTA is not as low as would be apparent from a review of the literature. It is proposed that main renal artery occlusion after PTA can be treated successfully by surgical and interventional radiologic techniques because of the presence of protective renal collateral circulation whose formation was stimulated by the renal artery lesion that prompted PTA.

Preliminary report: penile vein occlusion therapy: selection criteria and methods used for the transcatheter treatment of impotence caused by venous-sinusoidal incompetence.

Penile vein occlusion therapy is a fluoroscopic guided technique developed for treating venous-sinusoidal incompetence in patients with erectile dysfunction. We report our experience with 22 patients who have been followed for greater than 1 year. Catheterization of the veins draining the penis was technically possible in 20 of 22 patients (91%). Of these 20 patients 5 (25%) were cured and 9 (45%) had significantly improved erectile function. All 5 patients (100%) with venous-sinusoidal incompetence plus normal cavernous arterial flow, no glans or corpus spongiosal shunts, and bilateral complete coil occlusion of the crural and common crural veins were cured. No deterioration of function was noted at 1 and 2 years. Patient selection and bilateral occlusion of the penile veins are essential to achieve successful penile vein occlusion therapy.