Intracerebral hemorrhage and phenylpropanolamine use.

Two patients developed intracerebral hemorrhage within hours from first-time ingestion of phenylpropanolamine-containing medications. One patient had marked hypertension, presented with three intracerebral hematomas, and developed a fourth hemorrhage 10 days later. Angiogram in one patient revealed "beading" of intracranial arteries, an abnormality also detected in a third patient who developed severe headache, vomiting, and acute hypertension following a single dose of phenylpropanolamine. These cases and others reported in the literature strongly suggest an association between phenylpropanolamine ingestion and hemorrhagic stroke. Direct questioning of use of this medication in cases of unexplained intracranial hemorrhage in previously healthy young individuals may reveal an unsuspected high frequency of this association.

A retrospective study of cervical spine injuries in American rugby, 1970 to 1994.

We undertook a retrospective study to document and analyze the occurrence of cervical spinal injuries in rugby in the United States from 1970 to 1994. We studied 59 cases (average, 2.36 per year). Thirty junior-level players (50.8%) (college or high school), 28 (47.5%) men's club players, and 1 (1.7%) woman player were injured. Fifty-seven injuries (97%) occurred during games. The incidence of cervical spine injuries is well documented in the United Kingdom and South African literature. However, no study in United States literature discusses the incidence or cause of cervical spine injury in rugby. We found that coaching is less consistent in the United States. Players with more weight and less experience are playing positions that require significant skill. Many players in the United States learn skills in games rather than in practice. In our study, 52.5% (31 of 59) of the injured players were junior-level players. Conversely, in world competition junior-level athletes sustained only 30% to 40% of the cervical spine injuries. Understanding the factors that contribute to cervical spine injuries is paramount in injury prevention. Through this study, we hope to promote change in rugby laws and regulations, as has been done in football, to enhance the safety and pleasure of the sport for players, coaches, and spectators.

The thermal properties of bovine joint capsule. The basic science of laser- and radiofrequency-induced capsular shrinkage.

Orthopaedic surgeons have recently adapted the holmium: yttrium-aluminum-garnet (YAG) laser for the shrinkage of capsular tissues for treatment of glenohumeral instability. The molecular mechanism of capsular shrinkage has not been documented to date. This study examined the effects of heating on bovine calf knee capsule and subsequent shrinkage of the capsule. Capsule specimens were placed in a saline bath at temperatures ranging from 55 degrees to 75 degrees C for 1, 3, 5, and 10 minutes. Shrinkage was quantified by digital imaging, and the tissue was examined by light and polarized light microscopy. Tissue contraction was not measurable at or below 57.5 degrees C. At 60 degrees C, tissue shrinkage occurred with corresponding basophilic staining and loss of birefringence in collagen fibers. For specimens heated at 60 degrees C and 62 degrees C, shrinkage directly correlated with duration of thermal exposure. Maximal shrinkage of approximately 50% in length occurred at and above 65 degrees C with thermal exposures of 1 minute or greater. This study demonstrates that thermal shrinkage of bovine knee capsule correlates with denaturation of collagen fibers and depends on both time and temperature. Capsular shrinkage treatments may be performed with any energy source that is capable of well-controlled heating of capsular tissue and does not depend on the special properties of laser light.

The preparticipation sports examination for high school and college athletes.

The PSE can be used as a tool to allow athletes to participate safely in sports. The goal of the PSE is not to disqualify athletes but to ensure that their participation in sports does not unnecessarily increase their risk of injury. The PSE is most effectively conducted by the station method with multiple examiners, one of whom should have specialty training in musculoskeletal disorders. The examination should be conducted 6 weeks prior to the beginning of the season and at the beginning of each new level of competition, unless directed differently by local laws. The correct use of the PSE should screen for signs and symptoms of pathological states that may lead to a nontraumatic death while participating in sports. An effective musculoskeletal examination should detect any postinjury deficits that may lead to subsequent reinjury later in the season. It is our hope that a PSE, based on the literature, can be used to prevent some of the nontraumatic deaths and musculoskeletal injury associated with sports participation.

Child witnesses in Oklahoma.

Children are often required to testify in court about physical and sexual abuse. This article examines the literature related to their testifying and reports the experiences of children who were interviewed regarding those experiences. In general, the children did not appear to be unduly traumatized by their court experiences.

Operative management of distal femoral fractures.

Fractures of the distal femur can be managed successfully with surgery. A good result depends on identification of all fragments, adequate repair of soft tissue, appropriate bone grafting, meticulous intrafragmentary compression, and complete reduction of the joint space. Instrumentation may include condylar blade plates, condylar screws, or locked intramedullary rods. Anatomic reconstruction with stable fixation permits early rehabilitation and recovery of full function after fracture.

Bicondylar tibial plateau fractures: principles of treatment.

The management of intraarticular fractures such as tibial plateau fractures in weightbearing joints is inherently complex. Bicondylar tibial plateau fractures resulting from high energy trauma are particularly difficult to treat successfully. The objectives in managing these fractures are to obtain adequate reduction and appropriate stabilization while allowing early range of motion and limiting potential morbidity. The incidence of complications and long-term sequelae is relatively high in cases treated with traditional open reduction and internal fixation. From 1986 through 1993, 32 bicondylar tibial plateau fractures were treated at our institution. Of these, 26 were treated operatively using various methods of open reduction and internal fixation, and, more recently, indirect reduction techniques with percutaneous screw and/or external fixation. These newer techniques include arthroscopically-assisted reduction with percutaneous screw fixation or applications of a hybrid circular external fixator with or without limited internal fixation. These techniques provide adequate reduction and fixation while limiting the complications associated with traditional open methods. This retrospective study was conducted to compare these newer techniques with more traditional methods of open reduction and internal fixation (ORIF).

Photodynamic modulation of wound healing with BPD-MA and CASP.

BACKGROUND AND OBJECTIVE: Wound healing is an intricate process requiring the orchestration of cells, growth factors, cytokines, and the extracellular matrix. Cytokines, specifically TGF-beta, are believed to be instrumental in sustaining the fibrotic process, which leads to scarring. Photodynamic therapy (PDT) uses potent photosensitizers, which induce a wide range of effects on cells and the extracellular matrix. The influences of PDT on wound healing are not well known. STUDY DESIGN/MATERIALS AND METHODS: Seven full-thickness incisional wounds were placed on each of 24 hairless Sprague Dawly rats, three wounds on one flank serving as dark controls and four on the contralateral side treated with PDT. Wounds were created two days before, one hour before, or one hour after red light exposure with an argon ion pumped dye laser. Twelve rats were injected with 0.25 mg/kg or 0.5 mg/kg of the PDT drug, BPD-MA, and the other 12 with 5 mg/kg or 10 mg/kg of the PDT drug, CASP, 3 and 24 hours prior to irradiation of light, respectively. At low doses of both photosensitizers, animals were irradiated with 1, 5, 10, and 20 J/cm2. At higher doses of BPD-MA and CASP animals were treated with 10, 20, 50, and 100 J/cm2 of light. Wounds were examined each day for 14 days and noted for edema, erythema, inflammation, necrosis, and quality of scarring. Wounds were also photographed at day 0, 2, 5, 8, and 14 post-irradiation. All animals were sacrificed 14 days after irradiation and the wounds were evaluated by light microscopy. RESULTS: Grossly, animals treated with 0.25 mg/kg BPD-MA showed no effect with PDT. Animals treated with 0.5 mg/kg BPD, and 5 and 10 mg/kg CASP showed responses that varied with both light and drug dose. Erythema, edema, inflammation, and necrosis attributed to PDT were all observed, but there was no apparent influence of PDT on either the rate or final appearance of wound healing. Histologically, there were no apparent differences between treated and untreated sites, regardless of the drug, dose of light, or time of irradiation. CONCLUSION: A single PDT treatment given before or after skin wounds does not apparently alter wound healing even when PDT caused brisk inflammatory reactions. PDT may have effects that were not detected. We conclude that PDT does not greatly influence incisional skin wound healing in the rat model.