[Total broncho-alveolar lavage in respiratory diseases among coal mining workers].

To prevent progressive lung ventilation disorders, to lower inflammatory activity in respiratory diseases, to prevent pneumoconiosis in coal miners, total broncho-alveolar lavage was included into therapeutic and prophylactic measures system. Results are reduction of lung ventilation disorders progression over 5-year observation, lower intensity of tracheo- bronchial inflammation in miners with chronic respiratory diseases.

Maxillofacial trauma in the emergency department: a review.

OBJECTIVES: In 1978 the Advanced Trauma Life Support guidelines were first implemented and are viewed by many as the gold standard of care in the emergency setting. It may not be immediately obvious where assessment and management of maxillofacial injuries fits within these trauma guidelines. This article aims to provide a concise, contemporary guide for the treatment of maxillofacial trauma in the emergency setting. METHODS: An electronic database search was conducted in PubMed and Science Direct on articles from 1970 to the present day. The key search terms were Maxillofacial, Trauma, ATLS, Advanced Trauma Life Support, EMST, Early Management of Severe Trauma, Airway, Eye, Ophthalmic and Management. The findings were compiled into a review article. The article was then reviewed by experts in the fields of Maxillofacial Surgery and Ophthalmology to ensure content and contextual accuracy. RESULTS: Physicians are becoming increasingly exposed to major maxillofacial injuries. Resuscitative measures can be complex and require prompt decisions especially in gaining a secure airway. A proposed treatment algorithm for maxillofacial trauma patients has been devised by the authors. CONCLUSIONS: It is imperative that sight preserving assessment and interventions are not forgotten in the emergency management of maxillofacial trauma. We propose an algorithm for the management of maxillofacial trauma, and recommend the use of CT as a powerful adjunct to clinical examination in patients with maxillofacial trauma.

A study of a pre-operative intervention in patients with diabetes undergoing cardiac surgery.

BACKGROUND: Coronary heart disease is common in Type 2 diabetes and often requires cardiac surgery. However poorer outcomes have been reported including increased rates of post-operative infection and prolonged hospital stay. AIM: The aim of the study was to determine the feasibility and acceptability of a specialist consultation model (pre-operative medical and educational intervention) for type 2 diabetes in the cardiac surgery setting. METHODS: Twenty four patients were assigned usual care or to the intervention group. The intervention group were assessed by a diabetes clinical nurse consultant, dietitian, and endocrinologist during a pre-operative visit. Specific diabetes questionnaires were administered, education was delivered, and protocol-driven changes to the medical regimen were instituted. Length of stay, incidence of post-operative complications, and number of post-operative inpatient review endocrinology visits required were recorded. RESULTS: Twenty four patients with a pre-operative HbA(1c) greater than 6.5% (48 mmol/mol) were studied (17 males and 7 females). In the usual care group (n = 15), HbA(1c) pre-operatively was 7.2% (55.2 mmol/mol) compared to 10.1% (86.9 mmol/mol) in the intervention group (n = 9). Six weeks post-operatively HbA(1c) fell significantly in the intervention group by 1.9% (to 8.2% [66.1 mmol/mol]) compared to a reduction of 1.2% (to 7.0% [53 mmol/mol]) in the usual care group (p < 0.05). No significant differences were observed in length of stay in intensive care or in total hospital stay between the groups: length of ICU stay 54 h for intervention versus 47 h for usual care, total hospital stay (mean 8 days for both); or in rates of post-operative infection. Differences were seen between in the diabetes questionnaires: in the Problem Areas in Diabetes questionnaire and in the Diabetes Treatment Satisfaction Questionnaire (p = 0.048). CONCLUSION: This small pilot feasibility study suggests there is potential benefit in the acute optimisation of diabetes treatment before elective cardiac surgery.

Development and characterization of 22 polymorphic microsatellite markers for the balloon flower Platycodon grandiflorum (Campanulaceae).

The balloon flower (Platycodon grandiflorum A. DC.) is a perennial flowering plant of the Campanulaceae family; it is the only member of the genus Platycodon. Information on the genetic diversity of balloon flower populations is of great importance for the conservation and germplasm utilization of this flowering plant. Twenty-two polymorphic microsatellite loci were developed and characterized with eight balloon flower accessions collected from South Korea and China. Eighty-one alleles were detected among the eight balloon flower accessions. The number of alleles per locus ranged from two to six, with a mean of four alleles per locus. The observed and expected heterozygosity values ranged from 0.000 to 0.875 (mean = 0.355) and 0.117 to 0.766 (mean = 0.489), respectively. The polymorphic information content values ranged from 0.110 to 0.733, with a mean of 0.449. These new microsatellite markers will be useful for population and conservation genetic studies of P. grandiflorum.

European Society of Cardiology quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity in cancer treatment.

AIMS: To develop quality indicators (QIs) for the evaluation of the prevention and management of cancer therapy-related cardiovascular toxicity. METHODS AND RESULTS: We followed the European Society of Cardiology (ESC) methodology for QI development which comprises (i) identifying the key domains of care for the prevention and management of cancer therapy-related cardiovascular toxicity in patients on cancer treatment, (ii) performing a systematic review of the literature to develop candidate QIs, and (iii) selecting of the final set of QIs using a modified Delphi process. Work was undertaken in parallel with the writing of the 2022 ESC Guidelines on Cardio-Oncology and in collaboration with the European Haematology Association, the European Society for Therapeutic Radiology and Oncology and the International Cardio-Oncology Society. In total, 5 main and 9 secondary QIs were selected across five domains of care: (i) Structural framework, (ii) Baseline cardiovascular risk assessment, (iii) Cancer therapy related cardiovascular toxicity, (iv) Predictors of outcomes, and (v) Monitoring of cardiovascular complications during cancer therapy. CONCLUSION: We present the ESC Cardio-Oncology QIs with their development process and provide an overview of the scientific rationale for their selection. These indicators are aimed at quantifying and improving the adherence to guideline-recommended clinical practice and improving patient outcomes.

Effectiveness and core components of infection prevention and control programmes in long-term care facilities: a systematic review.

BACKGROUND: Infection prevention and control (IPC) is a measure to prevent healthcare-associated infections in healthcare settings. There is limited evidence of the effectiveness of IPC programmes in long-term care facilities (LTCFs). AIM: To review and analyse the effectiveness and the components of IPC programmes in LTCFs for older adults. METHODS: Electronic databases (PubMed, EMBASE, CINAHL and Cochrane CENTRAL) were searched systematically for English-language articles assessing IPC interventions in LTCFs, published over the last decade (2007-2016). The components of IPC programmes were analysed based on the World Health Organization (WHO) manuals for improving IPC activities. Two reviewers independently assessed the quality of studies using the Cochrane risk-of-bias tool and the risk-of-bias assessment tool for non-randomized studies. FINDINGS: Seventeen studies met the eligibility criteria; 10 studies were randomized trials (58.8%) and the others were non-randomized trials to examine the impact of IPC programmes on infection and/or performance outcomes of healthcare workers. None of the included studies implemented all of the WHO core components. Behavioural change strategies using education, monitoring and feedback were reported to be successful interventions for reducing the threat of healthcare-associated infections. Generally, studies using four or more elements of the WHO multi-modal strategy reported significant reductions in infection rates. CONCLUSIONS: There is some evidence for the effectiveness of IPC interventions using education, monitoring, feedback and four or more elements of the WHO multi-modal strategy to control healthcare-associated infections in LTCFs.

Influence of aging on the in vivo properties of human patellar tendon.

Tendons are important for optimal muscle force transfer to bone and play a key role in functional ability. Changes in tendon properties with aging could contribute to declines in physical function commonly associated with aging. We investigated the in vivo mechanical properties of the patellar tendon in 37 men and women [11 young (27 +/- 1 yr) and 26 old (65 +/- 1 yr)] using ultrasonography and magnetic resonance imaging (MRI). Patella displacement relative to the tibia was monitored with ultrasonography during ramped isometric contractions of the knee extensors, and MRI was used to determine tendon cross-sectional area (CSA) and signal intensity. At peak force, patellar tendon deformation, stress, and strain were 13 (P = 0.05), 19, and 12% less in old compared with young (P < 0.05). Additionally, deformation, stiffness, stress, CSA, and length were 18, 35, 41, 28, and 11% greater (P < 0.05), respectively, in men compared with women. After normalization of mechanical properties to a common force, no age differences were apparent; however, stress and strain were 26 and 22% higher, respectively, in women compared with men (P < 0.05). CSA and signal intensity decreased 12 and 24%, respectively, with aging (P < 0.05) in the midregion of the tendon. These data suggest that differences in patellar tendon in vivo mechanical properties with aging are more related to force output rather than an age effect. In contrast, the decrease in signal intensity indirectly suggests that the internal milieu of the tendon is altered with aging; however, the physiological and functional consequence of this finding requires further study.

Incidence of ocular surface epithelial dysplasia in metropolitan Brisbane. A 10-year survey.

The ocular histologic records of all hospital and private pathologic laboratories in metropolitan Brisbane, Australia, were surveyed from 1980 through 1989. One hundred thirty-nine cases of histologically proven dysplasia, carcinoma in situ, and invasive carcinoma of the cornea and conjunctiva were identified. The incidence of these conditions in the area surveyed is estimated to be 1.9 per 100,000 per year averaged for 10 years.

Ocular surface squamous neoplasia.

Ocular surface squamous neoplasia presents as a spectrum from simple dysplasia to carcinoma in situ to invasive squamous cell carcinoma involving the conjunctiva as well as the cornea. It is a distinct clinical entity, although it has been known by a variety of different names throughout the literature. Most commonly it arises in the limbal region, occurring particularly in elderly males who have lived in geographic areas exposed to high levels of ultraviolet-B radiation. Symptoms range from none to severe pain and visual loss. The development of preoperative diagnostic techniques, such as impression cytology, are of value in clinical decision making and follow-up management. Simple excision with adequate margins is currently the best established form of treatment despite trials of other modalities. The course of this disease may be evanescent, but is more frequently slowly progressive and may require exenteration and occasionally may lead to death.

Comparison of a space shuttle flight (STS-78) and bed rest on human muscle function.

The purpose of this investigation was to assess muscle fiber size, composition, and in vivo contractile characteristics of the calf muscle of four male crew members during a 17-day spaceflight (SF; Life and Microgravity Sciences Spacelab Shuttle Transport System-78 mission) and eight men during a 17-day bed rest (BR). The protocols and timelines of these two investigations were identical, therefore allowing for direct comparisons between SF and the BR. The subjects' age, height, and weight were 43 +/- 2 yr, 183 +/- 4 cm, and 86 +/- 3 kg for SF and 43 +/- 2 yr, 182 +/- 3 cm, and 82 +/- 4 kg for BR, respectively. Calf muscle strength was examined before SF and BR; on days 2, 8, and 12 during SF and BR; and on days 2 and 8 of recovery. Muscle biopsies were obtained before and within 3 h after SF (gastrocnemius and soleus) and BR (soleus) before reloading. Maximal isometric calf strength and the force-velocity characteristics were unchanged with SF or BR. Additionally, neither SF nor BR had any effect on fiber composition or fiber size of the calf muscles studied. In summary, no changes in calf muscle strength and morphology were observed after the 17-day SF and BR. Because muscle strength is lost during unloading, both during spaceflight and on the ground, these data suggest that the testing sequence employed during the SF and BR may have served as a resistance training countermeasure to attenuate whole muscle strength loss.

Corneoscleral transplantation for end stage corneal disease.

AIM: To describe the prognosis and complications of corneoscleral transplantation in the management of end stage eye disease. METHODS: A case series is presented of 23 patients who have undergone corneoscleral transplantation (> or = 11 mm). Patients were examined for visual acuity, intraocular pressure, recurrence of disease process, epithelialisation of the graft, signs of rejection, and other potential complications. RESULTS: 14 patients retained their eye, with six maintaining a clear graft. Vision ranged from 6/30 to no perception of light. 13 patients developed glaucoma (range 25-69 mm Hg), with six patients requiring surgical intervention. 12 patients required tarsorrhaphy to promote epithelialisation. Only two grafts resulted in typical rejection. CONCLUSIONS: The technique of corneoscleral transplantation can salvage otherwise end stage eye disease, but the results are poor with respect to maintenance of vision. These patients need careful follow up because of potential complications of glaucoma, epithelial defects, rejection, and recurrence of disease.

Effects of lamellar keratotomy on postkeratoplasty astigmatism.

AIM: To determine the changes in postkeratoplasty astigmatism induced by lamellar keratotomy. METHODS: A prospective, non-randomised comparative trial of patients undergoing a hinged lamellar corneal flap for treatment of significant astigmatism after penetrating keratoplasty. Uncorrected visual acuity, best corrected visual acuity, refraction, and corneal topography were assessed at 1 and 3 months after the lamellar keratotomy. RESULTS: 17 eyes in 16 patients (13 M, 3F) were included in the study (mean age 48.2 years; range 20-86 years). Six of 17 eyes (35.3%) changed more than 1 dioptre (D) in spherical equivalent by 3 months. Nine of 17 eyes (52.9%) changed more than 1 D in sphere by 3 months. 12 of 17 eyes (70.6%) changed more than 1 D in refractive cylinder. Seven patients of 15 (46.7%) changed more than 1 D in corneal power as measured topographically. Five of 17 eyes (29.4%) changed in refractive cylinder axis more than 15 degrees and this was similar to the change measured topographically of four of 15 eyes (26.7%). Vector analysis showed 60% of eyes had a surgically induced astigmatism (SIA) vector of more than 1 D, including a net corneal astigmatism decrease of more than 1 D in four eyes and increase of more than 1 D in two eyes at 3 months after surgery. Complications of the lamellar keratotomy included two partial buttonholes and one partial wound dehiscence. CONCLUSIONS: The creation of a lamellar flap alone can have significant effects on the astigmatism following penetrating keratoplasty. LASIK for correction of postkeratoplasty astigmatism may be more accurately performed as a two stage procedure rather than a single stage, after the corneal effects of the lamellar keratotomy have stabilised.

Knowledge of sunlight effects on the eyes and protective behaviors in adolescents.

The knowledge of the effects of sunlight on the eyes and protective behaviors were studied in an adolescent population. A group of 652 systematically sampled students aged between 13 and 17 years was surveyed with a standardized questionnaire in Brisbane, Australia in October-November, 1995. Survey data on the knowledge of sunlight effects on the eyes, ultraviolet light, eye and body protection as well as risk factors for ultraviolet (UV) exposure were relatively ranked and totalled to give overall scores. Of the 652 subjects, 330 (51%) were female. Most subjects (568 or 88%) were aged between 15 and 16 years. Overall, this group of subjects demonstrated a moderate level of knowledge with respect to UV, sunlight and the eyes. The knowledge of the effects of sunlight and body protection was higher than the knowledge of the effects of sunlight and eye protection. Almost three-quarters (462 or 71%) of the subjects owned a pair of sunglasses. The mean age at which subjects started to wear sunglasses was 10.4 years. However, most subjects (528 or 81%) only wore sunglasses occasionally or not at all. The reported frequency of wearing sunglasses was significantly related to personal, family and peer attitudes to such use, but not to media advertizing. Assessment of adolescent knowledge is important in the formulation of health promotion strategies designed to prevent excessive UV exposure at this young age.

Knowledge of sunlight effects on the eyes and protective behaviors in the general community.

The knowledge of sunlight effects on the eyes and protective behaviors was assessed in the general community of Brisbane, Australia. Five hundred people were systematically sampled and surveyed via a telephone questionnaire. Of the participants, 279 (56%) were female and 258 (52%) were aged 40 years or less. Levels of knowledge were found to be lower in the older subjects, those with dark complexions and outdoor workers. Most were unaware of specific ultraviolet light related eye diseases such as cataract, pterygium and eye cancer. Three hundred and ninety (78%) wore sunglasses > 10% of the time while outdoors during the day; the most common reasons for wearing included protection from glare in 254 (65%) and driving in 60 (15%). Ninety-six (19%) never wore sunglasses, the most common reasons being inconvenience in 16 (17%), thought unnecessary in 16 (17%) and uncomfortable in 13 (14%). Promotion of sun protection to prevent ultraviolet light related diseases should include information on the eye. This information is important for establishing preventative behaviors and the selection of optimal eye protective measures.

Biomechanical properties of anterior thoracolumbar multisegmental fixation: an analysis of construct stiffness and screw-rod strain.

STUDY DESIGN: Three types of anterior thoracolumbar multisegmental fixation were biomechanically compared in construct stiffness and rod-screw strain. OBJECTIVES: To investigate the effects of rod diameter and rod number on construct stiffness and rod-screw strain in anterior thoracolumbar multisegmental instrumentation. SUMMARY OF BACKGROUND DATA: No studies have been undertaken to investigate the biomechanical effects of rod diameter and rod number in thoracolumbar anterior instrumentation. METHODS: Ten fresh-frozen calf spines (T13-L5) were used. After intact analysis, a total discectomy and transection of the ALL and PLL were performed at L1-L2, L2-L3, and L3-L4 with intervertebral reconstruction using carbon fiber cages. Three types of anterior fixation were then performed at L1-L4: 1) 4.75-mm diameter single-rod, 2) 4.75-mm dual-rod, and 3) 6.35-mm single-rod systems. Single screws at each vertebra were used for single-rod and two screws for dual-rod fixation. These systems share the same basic design except rod diameter. Nondestructive biomechanical testing was performed and included compression, torsion, flexion-extension, and lateral bending. Construct stiffness and rod-screw strain of the three reconstructions were compared. RESULTS: The 6.35-mm single-rod fixation significantly improved construct stiffness compared with the 4.75-mm single rod fixation only under torsion (P < 0.05). The 4. 75-mm dual rod construct resulted in significantly higher stiffness than did both single-rod fixations (P < 0.05), except under compression. No statistical differences were observed in rod-screw strain between the two types of single rods, whereas dual-rod reconstruction exhibited less rod-screw strain (P < 0.05). CONCLUSIONS: For single-rod fixation, increased rod diameter neither markedly improved construct stiffness nor affected rod-screw strain, indicating the limitations of a single-rod system. In thoracolumbar anterior multisegmental instrumentation, the dual-rod fixation provides higher construct stiffness and less rod-screw strain compared with single-rod fixation.

Proximal kyphosis after posterior spinal fusion in patients with idiopathic scoliosis.

STUDY DESIGN: For this retrospective study, preoperative and postoperative radiographs of posterior spinal fusions for idiopathic scoliosis were reviewed. OBJECTIVES: To determine the prevalence and possible causes of proximal kyphosis after posterior spinal fusion for idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Proximal kyphosis has been anecdotally noted after the insertion of Harrington rods and after use of the new posterior multisegmented hook/rod systems. In this study no attempt was made to determine whether this condition is painful or an adverse outcome for the patient or just a radiographic abnormality; however, it is suspected that this may be a problem in the long term, and it may be worthwhile to try to avoid it if predictive values can be ascertained. METHODS: Patients with adolescent idiopathic scoliosis who had undergone posterior spinal fusion not extending above T3 with good-quality radiographs of the proximal thoracic spine and a minimum 2-year follow-up were studied. Of the 106 patients who underwent posterior spinal fusion from 1990 through 1994, 69 met the inclusion criteria. Abnormal kyphosis from T2 to the proximal level of the instrumented fusion was defined as kyphosis of more than 5 degrees above the summed normal angular segments. RESULTS: Of 69 patients, 37 (54%) had normal proximal kyphosis, and 32 (46%) of the 69 were defined as having abnormal proximal kyphosis. In the 32 patients with abnormal proximal kyphosis, the measurement from T2 to the fusion was 10.3 degrees before surgery and 21.2 degrees after surgery. The normal group had kyphosis measuring 2.7 degrees from T2 to fusion before surgery and 5.3 degrees after surgery (P < 0.00001). Junctional kyphosis in the kyphosis group measured 6.5 degrees before surgery and 12.6 degrees after surgery, compared with normal kyphosis of 1.7 degrees and 2.6 degrees, respectively (P < 0.00001). When analyzing who would develop proximal kyphosis, preoperative one-level junctional kyphosis of more than 5 degrees above the proposed proximal instrumented vertebrae was shown to have the highest sensitivity (78%) and specificity (84%). CONCLUSIONS: In this study, 32 (46%) of 69 patients had abnormal proximal kyphosis after undergoing posterior spinal fusion. A preoperative junctional kyphosis of more than 5 degrees above the proposed proximal instrumented vertebrae indicates that extending the fusion to a higher level in the thoracic spine would be beneficial in avoiding this problem.

Biomechanical comparison of five different atlantoaxial posterior fixation techniques.

STUDY DESIGN: Five different reconstructions of the atlantoaxial complex were biomechanically compared in vitro in a nondestructive test. OBJECTIVES: To determine whether non-bone graft-dependent one-point fixation affords stability levels equivalent to three-point reconstructions. SUMMARY OF BACKGROUND DATA: Previous investigations have demonstrated that three-point fixation, using bilateral transarticular screws in combination with posterior wiring, provide the most effective resistance to minimize motion around C1-C2. However, placement of transarticular screws is technically demanding. Posterior wiring techniques affording one-point fixation have failure rates of approximately 15%, with failure considered to be secondary to structural bone graft failures. One-point, non-bone graft-dependent fixations have not been tested. METHODS: Eight human cervical specimens, C0-C3 were loaded nondestructively. Unconstrained three-dimensional segmental motion was measured. The reconstructions tested were two one-point fixations, one two-point fixation, and two three-point fixations. RESULTS: Under axial rotation two and three-point reconstructions provided better stiffness than the one-point reconstructions (P < 0.05). During flexion-extension, higher stiffness levels were observed in one- and three-point fixations when compared with the intact spine (P < 0.05). In lateral bending no significant differences were observed among the six groups, although the trend was that reconstructions including transarticular screws provided greater stability than one-point fixations. CONCLUSION: The current findings substantiate the use of three-point fixation as the treatment of choice for C1-C2 instability. [l: atlantoaxial fixation, biomechanics, cervical spine, instability, spinal instrumentation, transarticular screws]

Revision strategies for salvaging or improving failed cylindrical cages.

STUDY DESIGN: This is a review of 20 patients who experienced failure of threaded interbody fusion cages and underwent surgical correction. OBJECTIVE: To review the causes and possible treatment strategies for failed cylindrical cages. SUMMARY OF BACKGROUND DATA: Intraoperative complications have been described in the past; however, management of the postoperative patient with failure of interbody fusion devices has not been described. METHODS: In 20 patients with failed threaded titanium fusion cages (18 Bagby and Kuslich Devices [BAK; Sulzer-Spine Tech, Minneapolis, MN], 2 Ray Threaded Fusion Cages [Ray TFC; Surgical Dynamics, Norwalk, CT) who underwent revision surgery, all had failure before successful arthrodesis was achieved. Eight of the original titanium cages had been inserted anteriorly (7 laparoscopically), and 12 had been inserted for posterior interbody lumbar fusion. Before the revision surgery, five of the implants were thought to be solid by the referring surgeon, but pseudarthrosis was clearly present in all. In addition, 14 other explanted BAK devices were subjected to undecalcified histologic preparation, quantitative histomorphometry, and histopathologic analysis. RESULTS: The average length of time before revision surgery (implant duration) was 31.8 weeks (range, 1-156 weeks). The most common revision procedure was posterior exploration of the symptomatic nerve root with foraminotomy for unrecognized lateral recess stenosis (11 cases) or excision of iatrogenically herniated intervertebral disc fragments (4 cases). However, four cages inserted through posterior exposure during an interbody lumbar fusion procedure had to be removed because of migration into the spinal canal. In nine cases posterior pedicle screw instrumentation was necessary in addition to posterolateral fusion using iliac crest bone grafting. CONCLUSIONS: All 20 cages failed because of surgical technique rather than an intrinsic defect in fusion cage technology. The factors associated with failure of the original insertion procedure were failure to achieve adequate distraction of the anulus fibrosis; undersized cages, especially when placed through the posterior interbody lumbar fusion approach; cerebrospinal fluid leakage or pseudomeningocele; Type 2 diabetes mellitus; the use of local bone graft rather than iliac crest inside the cage; anterior insertion in an excessively lateral position resulting in symptoms of a far lateral disc herniation; and failure to identify the spinal midline during an anterior approach.

Elbow valgus stress radiography in an uninjured population.

Valgus instability of the elbow joint is a clinical diagnosis. However, many authors describe valgus stress radiographs as an aid in making this diagnosis. We studied valgus stress radiographs of 20 men (40 elbows) and 20 women (40 elbows), none with a history of elbow trauma or instability. The medial ulnohumeral distance was measured with no stress, valgus stress by gravity, and an applied valgus stress of 25 N (approximately 5 pounds). Measurements were made with the elbow positioned in extension and in 30 degrees of flexion. The increase in medial ulnohumeral gapping with either gravity or 5 pounds of stress was statistically significant at both extension and 30 degrees of flexion compared with the unstressed condition. The difference in ulnohumeral gapping between gravity stress and 5 pounds of valgus stress in extension and in 30 degrees of flexion was also significant. We found no differences with regard to hand dominance or sex. We conclude that uninjured elbows have significant medial ulnohumeral gapping on valgus stress radiography. Although this is an important tool in diagnosing valgus instability of the elbow, it may yield a false-positive assessment of valgus instability. Valgus stress radiographs comparing contralateral elbows may reduce the false-positive rate since there appears to be no significant difference in medial ulnohumeral gapping between the two elbows.

Angle-closure glaucoma after laser treatment for retinopathy of prematurity.

Laser photocoagulation has become the standard for treatment of retinopathy of prematurity. In general, it has been found to be a safe and effective means of retinal ablation. We report a case of angle-closure glaucoma in an infant after diode laser treatment for retinopathy of prematurity, which required bilateral surgical peripheral iridectomies.