Calcific tendonitis of the quadriceps.

The case reported is of a 46 year old male who presented with a history of acute on chronic knee pain. The clinical features and investigations suggested a tear of the quadriceps tendon, with pre-existing chronic calcific enthesopathy. The operative findings were of an acute collection of calcific material within the quadriceps tendon. This acute presentation and calcific collection have not previously been reported in the quadriceps tendon.

Distribution of sonographically detected tendon abnormalities in patients with a clinical diagnosis of chronic achilles tendinosis.

PURPOSE: We conducted a retrospective study of the distribution of sonographically detected abnormalities in the heels of patients who had a clinical diagnosis of Achilles tendinosis. METHODS: One hundred eighteen symptomatic heels in 73 patients who had a clinical diagnosis of chronic Achilles tendinosis were examined over a 12-month period by the same experienced sonologist. The distribution of altered tendon architecture and features suggesting retrocalcaneal bursitis or Achilles paratendinosis were evaluated. RESULTS: Sonograms of 118 symptomatic heels demonstrated that 96 (81%) had abnormalities confined to the proximal two thirds of the Achilles tendon, 9 (8%) had abnormalities in the distal third alone, and 13 (11%) had abnormalities at both sites. Of the 109 heels with proximal two-third Achilles tendon disease, 99 (91%) had medial tendon involvement; 22 of the 99 showed diffuse tendon changes. Lateral tendon segment changes were seen in 22 (19%) of the 118 symptomatic heels. No lateral tendon segment was involved in isolation. Of the 22 heels with distal third abnormalities, 14 (64%) had sonographic evidence of Achilles paratendinitis, and 13 (59%) had sonographic evidence of Achilles tendinosis. Eighteen of the 22 had sonographic evidence of retrocalcaneal bursitis. In all cases of distal third tendinosis, the deep surface of the tendon was primarily involved. In the heels with both proximal and distal changes, superficial segment involvement of the mid-Achilles tendon was present. CONCLUSIONS: Sonography provides information that helps to accurately diagnose clinical Achilles tendinopathy and may help to determine the biomechanical processes involved in the injury.

Sonographic incidence of tendon microtears in athletes with chronic Achilles tendinosis.

OBJECTIVE: To assess the number and distribution of tendon microtears in asymptomatic controls and athletes with chronic Achilles tendinitis or partial thickness tears using high resolution ultrasound. METHODS: The mean number of microtears in three random tendon cross sections were recorded per tendon third in 19 asymptomatic volunteers, 16 athletes with symptomatic chronic Achilles tendinitis, and eight athletes with partial Achilles tendon rupture. RESULTS: Microtears were most numerous in the middle third section of the Achilles tendon. Some 67% of tendons in the control group had no microtears, and 28% showed a single microtear. Only 18% of the athletes with chronic Achilles tendinitis and none of the athletes with partial tendon rupture were without microtears in the middle third of their Achilles tendon. Of the tendons with chronic tendinitis, 13% had more than three microtears per section which increased to 87% in tendons exhibiting partial rupture. CONCLUSIONS: There appears to be an association between microtear formation and Achilles tendon rupture.

Revision hip surgery in the elderly: is it worthwhile?

We prospectively analyzed the outcome in 103 consecutive patients undergoing revision hip replacement, dividing the patients into 2 groups according to their age at the time of surgery. There were 45 patients aged 75 years or older and 58 patients aged younger than 75 years. The results of revision hip replacement in terms of pain relief, functional improvement, and patient satisfaction did not differ between the 2 groups. There was a significantly higher death rate among the elderly patients (13.3% versus 1.7%; P = .0202) and a significantly higher rate of dislocation (20% versus 1.7%; P = .0019). We conclude that revision hip replacement is an effective operation in the elderly, but that patient and surgeon must be aware of the risks that such surgery entails.

A prospective evaluation of the modified Alvarado score for acute appendicitis in children.

The accuracy of the modified Alvarado score was assessed prospectively in the preoperative diagnosis of acute appendicitis in children. A consecutive series of 118 patients (54 boys, 64 girls) with acute abdominal pain was studied prospectively over a 6 month period. Appendicitis was confirmed in 38 of 43 children undergoing appendicectomy, giving a false-positive appendicectomy rate of 11.6%. No child under active observation was subsequently found to have a perforated appendix. The overall sensitivity of a modified Alvarado score of > or = 7 was 76.3% and its specificity was 78.8%. Current clinical practice is more accurate than the modified Alvarado score in the diagnosis of acute appendicitis in children.

Cytocortical organization during natural and prolonged mitosis of mouse 8-cell blastomeres.

Late 8-cell blastomeres were harvested within the first 45 min after entering mitosis. Some mitotic cells were analysed within the ensuing 2 h for the organization of their surface in relation to their progress through mitosis. Whereas in most late interphase cells microvilli were restricted to a discrete polar region, in mitotic cells at all stages from early metaphase to immediately postcytokinesis microvilli were found to be present over more of the cell surface. Other mitotic cells were placed in nocodazole to arrest them in M-phase for up to 10 h. They were found to show an even more extensive distribution of microvilli over the whole surface, the longer periods of incubation yielding more extended coverage such that many cells no longer appeared to have any residual surface polarity. Removal from nocodazole at all time points from 1 to 10 h resulted in most cells completing mitosis to yield pairs of cells which, in most cases, resembled pairs derived from nonarrested blastomeres and in which a defined polar area of microvilli was restored. However, the percentage of differentiative divisions decreased after 6 h arrest. If, instead of removing cells from nocodazole, they were placed in both nocodazole and cytochalasin D (CCD) for periods of up to 3 h, most microvilli retracted to reveal a tight polar zone of CCD-resistant microvilli. This result suggests that a heterogeneity of cytocortical organization may still exist within the arrested mitotic cell. We propose a model to explain the origin of this heterogeneity of organization and its relationship to the generation of cell diversity.