Un-united fractures of the distal radius: a report of 12 cases.

The treatment of 12 distal radius nonunions in 11 patients over a 24-year period is presented. The average age of the patients was 55 years (range, 35-72 years). The comorbid medical conditions in the patients with these fractures included diabetes mellitus, peripheral vascular disease, psychiatric disorders, alcoholism, peripheral neuropathy, scleroderma, and morbid obesity. Nine of the un-united fractures in 8 patients had insufficient metaphyseal bone to allow internal fixation; 6 of these fractures were treated with a wrist arthrodesis. Three un-united fractures in 3 patients had sufficient supporting bone to permit correction of the nonunion and preservation of the radiocarpal joint. Three nonunions in 3 patients were treated without further surgery. Bony union was achieved in all 9 nonunions managed operatively (6 wrist arthrodeses and 3 open reductions).

Syringe and needle exchange as HIV/AIDS prevention for injection drug users.

OBJECTIVE: To evaluate an all-volunteer syringe exchange program in San Francisco, Calif. DATA SOURCES: Syringe exchange program records and 11 semiannual surveys administered during a 5.5-year period, using standard questionnaires. Interviews (N = 5644) were conducted with injection drug users recruited in two 21-day drug detoxification clinics and three street settings. MAIN OUTCOME MEASURES: Use of the syringe exchange program and self-reported data regarding sources of syringes, frequency of injection, initiation into drug injection, and frequency of syringe sharing. RESULTS: In spring 1992, 45% reported "usually" obtaining injection equipment from the syringe exchange, and 61% reported using the program within the past year. During the period from December 1986 through June 1992, the median reported frequency of injection declined from 1.9 injections per day to 0.7 injection per day, the mean age increased from 36 to 42 years, and the percentage of new initiates into injection drug use decreased from 3% to 1%. In logistic regression analysis (of fall 1991 through spring 1992 interviews; n = 752), we found six independent factors associated with syringe sharing. Protective from syringe sharing were use of the syringe exchange program, having received human immunodeficiency virus (HIV) testing and counseling, condom use, older age, and African-American race. Injection of cocaine was a predictor for syringe sharing. The strength of association between use of the syringe exchange program and not sharing syringes was greatest in injection drug users younger than the median age of 40 years. CONCLUSIONS: The syringe exchange program was rapidly adopted by injection drug users. Health interventions associated with not sharing needles included use of the syringe exchange program and voluntary, confidential HIV testing and counseling. Our data did not support the hypothesis that a syringe exchange program would stimulate increased drug abuse in terms of frequency of injection or recruitment of new and/or younger users.

Neuropathy in the workplace.

Cumulative trauma disorders are frequently responsible for the development of occupational neuropathy. Predisposing factors in the workplace are identified, and ergonomic principles to minimize these risks are presented.

Optical aberration correction by real-time holography in liquid crystals.

We present results of experiments that use nematic-phase liquid crystal as a real-time holographic recording medium. Plane-wave gratings were written with as little as 10 mJ/cm(2) of incident write-beam energy from a pulsed Nd:YAG laser, and diffraction efficiencies greater than 25% were measured at 633 nm. Grating decay times were observed to fall within two distinct time regimes: a rapid-decay time of 60 to 100 microsec and a slower-decay time of 6 to 30 msec. The rapid-decay regime was used to demonstrate real-time correction of severely aberrated images by degenerate four-wave mixing.

Silicone interpositional arthroplasty of the distal interphalangeal joint.

Twenty-three female patients had silicone interpositional arthroplasty of the distal interphalangeal joint in 38 digits. The operative indications were pain and deformity of the distal interphalangeal joint. The underlying diagnosis was osteoarthritis in all but one patient who had rheumatoid arthritis. The average age at the time of operation was 58.3 years. The implants have been in place for a mean period of 72.2 months (range, 12.6 to 123.1 months). At follow-up, extension lag averaged 12.7 degrees and the range of motion of the distal interphalangeal joint had a mean value of 33.2 degrees. Compared with arthrodesis, silicone interpositional arthroplasty offers the advantage of retained motion while preserving stability.

Morning increase in onset of ischemic stroke.

The time of onset of ischemic stroke was determined for 1,167 of 1,273 patients during the collection of data by four academic hospital centers between June 30, 1983, and June 30, 1986. More strokes occurred in awake patients from 10:00 AM to noon than during any other 2-hour interval. The incidence of stroke onset declined steadily during the remainder of the day and early evening. The onset of stroke is least likely to occur in the late evening, before midnight.

Mycobacterium chelonei tenosynovitis.

Most atypical Mycobacterium infections of the hand are caused by Mycobacterium marinum. We are presenting a rare case of a Mycobacterium chelonei tenosynovitis. The correct diagnosis is important because the chelonei species is resistant to most antituberculosis drugs. Treatment should include surgical debridement and long-term chemotherapy after sensitivities have been determined.

Trapezium implant arthroplasty: evaluation of a semiconstrained implant.

Twenty-five patients who presented with symptoms of disabling pain secondary to arthritis at the base of thumb had 29 arthroplasties with silicone rubber trapezium implants. Stabilization was achieved with tenodesis using a strip of abductor pollicis longus as described by Eaton. All patients had relief of pain after surgery. We examined 23 hands in 19 patients for follow-up. Average follow-up was 31 months. Assessment of functional status and measurements of prehensile capabilities showed that all patients had improved after surgery. Range of motion of the thumb was measured (radial abduction averaged 40 degrees; 80% had full opposition). Average key pinch was 8 pounds. Stability of the implant was assessed with standard posteroanterior, lateral, and stress views of the trapeziometacarpal joint. Comparisons were made with previously reported results for Eaton and Swanson trapezium implants. The tenodesis effect may provide a more stable, although possibly less mobile, CMC joint of the thumb.

Volatility in the geographical structure of short-run US interstate migration.

"Migration is often thought to be a long-run phenomenon. However, it is shown here by means of labor-force migration estimates derived from the Continuous Work History Sample over the period 1958-1975, that US interstate migration is quite volatile over the short run with respect both to its adjustment to macroeconomic fluctuations and to its geographic structure. A hierarchical clustering routine is utilized to analyse yearly estimates of interstate gross in-migration and out-migration so as to identify the temporal stability and characteristics of the geographical patterns of migration. States enter the national migration linkage tree at different levels for different years, depending upon the level of short-run economic activity." It is also shown that "when national economic conditions worsen, labor-supply adjustments are more localized and the degree of interstate interdependence is less than in times of economic boom."

Combined radiocarpal intercarpal arthrodesis.

Nineteen patients with disabling radiocarpal arthritis were treated over a period of 10 years with wrist arthrodesis. Three patients died for reasons not related to their surgery, and two were lost to followup. Of the 14 patients studied, 10 were treated with a surgical technique, consisting of intercarpal fusion with cancellous bone grafts combined with inner iliac corticocancellous bone graft fixation using cancellous screws. All patients studied were evaluated using a 100 point scale evaluation system: 13 patients scored above 90 with excellent results, and the remaining one patient scored 70 with a fair result. The one patient's lower score was related to his preoperative reflex sympathetic dystrophy. All patients had solid fusion, postoperative functional improvement, and were satisfied. This combined technique also provides a short recuperation period.

The short-run dynamics of inter-state migration: a space-time economic adjustment model of in-migration to fast growing states.

"Interregional migration is analyzed with respect to its short-run responsiveness to economic fluctuations and its efficiency as a spatial labour market allocation mechanism. Using a space-time analytical framework, in-migration to four fast growing States of the United States is analyzed over the period 1958-1975. It is shown via a time-series model, employing a Koyck-distributed lag methodology, that short-run in-migration is in fact responsive to economic fluctuations." (SUMMARY IN FRE, GER)

External evaluation of regional cardiac lymph drainage in intact dogs.

After coronary occlusion, interruption of cardiac lymphatic flow reduces the proportion of creatine kinase depleted from the heart appearing in blood. Accordingly, characterization of cardiac lymph flow should be helpful in refining enzymatic estimates of infarct size. In the present study, 99mTc-sulfur colloid, a potential tracer for imaging cardiac lymphatic structures, was injected intramurally into selected regions of the heart in 17 dogs. Serial images of the chest were obtained for 24 hours with a scintillation camera, after which the animals were killed and the cardiac and other mediastinal nodes removed and assayed for radioactivity. Analysis of the images and counts in vitro demonstrated a consistent drainage pathway between the anterior left ventricular wall and the cardiac node. Other areas of the heart exhibited variable drainage patterns. After injection into the anterior left ventricular wall, in both open-chest dogs (n = 3) and in closed-chest dogs via a percutaneous, subxiphoid approach (n = 3) with a specially designed, collared needle, the cardiac node was visualized within 2 minutes. Activity in the cardiac node region reached a peak within 40 minutes in five of six dogs and accumulated greater than 1000 counts/min in five of six dogs before plateauing. In three additional dogs subjected to cardiac lymphatic occlusion five or six days prior to anterior left ventricular injection, appearance of radioactivity in the cardiac node was markedly delayed and maximum activity was far less than that in controls. Thus, regional cardiac lymph flow from the anterior left ventricular wall can be assessed semiquantitatively with a radionuclide imaging technique, potentially useful in refinement of enzymatic estimates of infarct size.