Comparative concurrent validities of five alcoholism measures in a psychiatric hospital.

The concurrent validities of five self-report alcoholism measures were compared in a psychiatric hospital population using Diagnostic Interview Schedule (DIS) alcohol dependence module outputs as criterion. The Michigan Alcohol Screening Test was the most accurate identifier of alcohol dependence at some point in the subjects' life, while the CAGE interview best identified alcohol dependence in the previous year. The correlations of a quantity-frequency measure, the Clinical Signs checklist, and the Medical History questionnaire with DIS alcohol dependence module outputs were generally weaker. The data also suggested that cutting scores based on local norms may offer better hit rates in psychiatric settings than those proposed by the instruments' authors, but additional cross-validations are needed to confirm that possibility.

Arthroscopic management of transchondral talar-dome fractures (osteochondritis dissecans) and anterior impingement lesions of the ankle joint.

Transchondral talar-dome fractures can be disabling conditions requiring surgical management. Arthroscopic surgery of the ankle offers a means of correcting these problems with low morbidity. A technique for performing this surgery utilizing a new noninvasive distraction device is reviewed in this article.

Treatment of osteoid osteoma by computed tomography guided excision in the pediatric patient.

An osteoid osteoma is a benign lesion that can occur in any bone. Controversy exists regarding treatment of this condition. This study demonstrates that the nidus of an osteoid osteoma can be disrupted and removed by use of the CORB biopsy system guided by computed tomography (CT) scan. Of nine patients followed for an average of 42.5 months (range 18-76 months), seven have had complete resolution of their pain after this procedure. The technique failed in two patients, who each required two separate en bloc excisions with bone grafting to resolve each lesion. CT-directed CORB appears to be useful in localization and removal of the nidus of an osteoid osteoma.

Ankle arthroscopy: neurovascular and arthroscopic anatomy of standard and trans-achilles tendon portal placement.

Ankle arthroscopy is an accepted method of evaluating ankle disorders. Accurate arthroscopic portal placement is essential because of the proximity of superficial and deep neurovascular and tendinous structures of the ankle. In order to define this anatomy as it pertains to safe portal placement, five fresh frozen cadaver ankles were dissected after standard arthroscopic portals were placed anteriorly and posteriorly. All structures were identified. The distances to these structures from the most lateral portals were recorded. Five other ankles were arthroscoped using standard portals and evaluated. In addition, a trans-achilles tendon (TAT) approach was evaluated for portal use. Ankle arthroscopy can be performed in a safe, reproducible manner when the following recommendations are followed: (a) outline tendinous structures, and remain parallel to them with the knife blade to avoid laceration of underlying structures; (b) penetrate only the skin with the knife to avoid laceration of superficial nerves in the subcutaneous tissue; (c) perform pre- and postneurovascular examination; and (d) understand that anterocentral and posteromedial portals are potentially hazardous to their respective neurovascular bundles. The TAT approach, based only on cadaver studies, appears anatomically safe and offers the potential advantage of an additional posterior portal.

The Total Life Concept Transplanted from AT&T to Sandia National Laboratories.

Abstract This study illustrates how the Total Life Concept (TLC) program originated by AT&T was successfully transplanted to another work site, Sandia National Laboratories. Demographics of the participants at A T&T and Sandia differ and make comparisons difficult, but it is possible to assess program impact in terms of participation rates for each program. The original AT&T TLC pilot study had three major components: orientation, testing, and risk interpretation; lifestyle-improvement courses; and activities to promote health. Sandia kept the three major components of the AT&T TLC concept and made some modifications to meet Sandia's needs. Sandia's experience of adopting a model program and tailoring it to local needs worked well, demonstrating that an existing model can be successfully altered to meet the needs of different companies in varied settings.

Arthroscopic surgical management of osteochondritis dissecans of the knee.

Surgical management of osteochondritis dissecans of the knee is indicated when the ununited fragment remains persistently ununited and the knee becomes symptomatic and does not respond to conservative measures of rest and immobilization. Traditionally, arthrotomy was done and either bone peg grafts, with or without fixation, or excision of the fragment and drilling of the base of the crater were performed. This paper presents a series of 29 patients who were treated surgically for symptomatic osteochondritis dissecans using arthroscopic techniques. In this series of patients, excision of fragment and drilling or abrasion of the crater were done. In the instances when the fragment had become a loose body, the loose body was simply excised and the crater was then either drilled or left alone. The plan of this study is to follow up these patients for a long time to determine the ultimate result. To our knowledge, this paper is the first report of the early results of this form of surgery in the treatment of this difficult lesion of the knee. The early follow-up indicates a 72% satisfactory result rate when both subjective and objective means of measuring the results are considered. An interesting finding during the study was the high incidence of significant intra-articular pathology (51%) other than the osteochondritis discovered when arthroscopic techniques are used. There were no complications from the arthroscopic surgery.

Retrotendinous calcification of the infrapatellar tendon: unusual cause of anterior knee pain syndrome.

Bilateral anterior knee pain is a common presentation to the orthopaedist. Correct diagnosis is based on careful history and physical examination aided by proper radiographs. Erroneous diagnosis may lead to improper treatment. This report describes a case of bilateral anterior knee pain syndrome of 3 years' duration. The teenaged patient was believed to be suffering from seronegative rheumatoid arthritis. Her pain persisted despite numerous antirheumatoid medications as well as a single injection of steroids into each infrapatellar tendon. The management of her case by means of arthroscopic surgical intervention is described.

Use of a low-profile thigh holder to facilitate high tibial osteotomy for varus gonarthrosis.

In the performance of a proximal tibial osteotomy, the maintenance of proper leg positioning on a standard operating table can be cumbersome. A low-profile thigh holder commonly used for arthroscopic knee surgery effectively positions the limb and simplifies the performance of high tibial osteotomy.

Giant intraarticular loose bodies of the knee. Cases demonstrate spectrum of the lesion.

Synovial chondromatosis is a well-known, well-described clinical and histopathologic entity. Occasionally, loose bodies in the knee joint can continue to grow and become large enough to impinge on joint motion. Extremely large synovial chondromata are relatively rare in the knee joint and have only been described in singular case reports in the orthopaedic literature. We describe two cases representing the spectrum of this disease process occurring in the popliteal fossa, simulating bony and/or soft tissue neoplasm. Case 1 demonstrates a large ossified chondroma, while Case 2 demonstrates a large chondroma without much calcification and with no ossification present. Because of the rarity of these lesions, preoperative staging studies, including CT scan, bone scan, and angiography, are usually warranted to help in the preoperative planning. Open biopsy with adequate tissue sampling is necessary to make an accurate histopathologic diagnosis. Once diagnosis is made, local excision for removal of the mechanical block to motion results in "cure"; local recurrence has not been noted.

Arthroscopic meniscal repair evaluated with repeat arthroscopy.

Arthroscopic meniscal repair is a technically feasible approach to the treatment of meniscal tears in young active individuals. To evaluate this premise, we repaired 29 minisci in 27 patients and then arthroscoped their knees 3 months later. Repairs were limited to displaceable longitudinal tears. In 16 patients ligaments were intact. Eleven patients were anterior cruciate ligament deficient, six of whom underwent concomitant ACL reconstructions. In two patients, bicompartmental tears were encountered. Under arthroscopic control, using curved cannulae, horizontal mattress sutures of absorbable monofilament were placed across the tear, out through the capsule, and tied over the fascia, deep to the skin. No arthrotomies were performed, and all portions of the menisci could be reached with this method. Twenty-four of 29 repairs healed completely; 5 healed partially (30 to 50% healing). Four of the five failed repairs occurred in unstable anterior cruciate ligament deficient knees.

Intra-articular pressures during arthroscopic knee surgery.

Arthroscopic surgery of the knee requires effective joint distention. No reports exist in the literature relating to optimal fluid pressure and dynamics of joint distention during arthroscopic knee surgery. Static and dynamic laboratory studies were performed on a knee model to establish an accurate method of measuring pressures from the arthroscopic cannula. A prospective study of 107 subjects who underwent arthroscopic surgery by one surgeon (J.W.E.) was then performed using saline distention from a saline bag wrapped with a pneumatic cuff. Intra-articular pressures ranged from 0 to 750 mm Hg, but usually fell into the zone from 70 to 120 mm Hg. A minimum pressure of 30 mm Hg was required for visualization. Variations in pressure magnitudes as well as flow rates during the procedures were studied. Technical suggestions based upon these data include maintenance of pressure between 70 and 100 mm Hg; avoidance of abrupt changes in position of the distended knee; and maintenance of lower pressure levels (35-50 mm Hg) if the synovium has been violated as in the performance of a lateral release procedure.

Angiographic assessment and control of potential operative hemorrhage with pathologic fractures secondary to metastasis.

Two cases are reported, which demonstrate the contribution of angiography to the operative management of neoplastic, pathologic fractures. The degree of fracture site neovascularity was assessed by pre-operative arteriography. Selective trans-catheter gelatin-foam embolization was then employed to markedly reduce or obliterate the arterial supply to lesions shown to be richly vascular. Open reduction and internal fixation was subsequently accomplished with minimal operative hemorrhage.

Pasteurella multocida peritonitis in hepatic cirrhosis with ascites.

Two patients with spontaneous Pasteurella multocida peritonitis in association with cirrhosis and ascites are described. Both patients had close contact with domestic animals, but neither had been bitten. Both patients died, but only one as a result of his infection. We are aware of only one previous report of cirrhosis with spontaneous peritonitis caused by this organism. P. multocida should be considered as a possible cause of peritonitis in cirrhotic patients with a history of close contact with animals, particularly cats.