The Influence of Donor and Recipient Gender Incompatibility on Corneal Transplant Rejection and Failure.

In vascularized organ transplants, gender mismatches have higher rates of immunological rejection. We investigated the influence of gender incompatibility, including H-Y incompatibility, on corneal transplant graft rejection and failure. Patients were included who had undergone a first corneal transplant for keratoconus (KC), Fuchs endothelial dystrophy (FED), pseudophakic bullous keratopathy (PBK), infection and other indications. A Cox regression model was fitted for each indication to determine factors affecting graft failure and rejection at 5 years. The impact of gender, including H-Y, matching was analyzed after accounting for other factors, including known risk factors. Of 18 171 patients, 4314 had undergone a transplant for FED, 4783 for KC, 3669 for PBK, 1903 for infection and 3502 for other disorders. H-Y mismatched (male [M]→female [F]) corneas were at greater risk of graft failure or rejection. For FED, F→F were 40% less likely to fail (p < 0.0001) and 30% less likely to reject (p = 0.01); M→M were 20% less likely to fail (p = 0.04) and 30% less likely to reject (p = 0.01). For KC, M→M matched corneas were 30% less likely to fail (p = 0.05) and 20% less likely to reject (p = 0.01) compared with H-Y mismatches. H-Y antigen mismatched (M→F) patients were at greater risk of rejection or graft failure.

Unresolved question of the 10He ground state resonance.

The ground state of (10)He was populated using a 2p2n-removal reaction from a 59 MeV/u (14)Be beam. The decay energy of the three-body system, (8)He+n+n, was measured and a resonance was observed at E=1.60(25) MeV with a 1.8(4) MeV width. This result is in agreement with previous invariant mass spectroscopy measurements, using the (11)Li(-p) reaction, but is inconsistent with recent transfer reaction results. The proposed explanation that the difference, about 500 keV, is due to the effect of the extended halo nature of (11)Li in the one-proton knockout reaction is no longer valid as the present work demonstrates that the discrepancy between the transfer reaction results persists despite using a very different reaction mechanism, (14)Be(-2p2n).

Insufficiency stress fractures of the foot and ankle in postmenopausal women.

Eleven consecutive patients with 12 stress fractures of the foot or ankle were seen between October 1992 and July 1995. Charts were reviewed retrospectively for clinical information. The patients were all postmenopausal females. Average age was 62 years. Onset of symptoms was not associated with a specific episode of trauma. There were eight metatarsal fractures, three distal fibular fractures, and one fracture of the medial malleolus. Fractures were confirmed by radiographs, bone scan, or MRI in 9 of the 11 cases. Nonsurgical treatment utilizing rest, decreased activity, mechanical support, and analgesics resulted in successful union of the fracture except in one patient. Only four of the patients had been taking hormone or calcium supplements before injury. Just one patient had a prior bone density measurement, although four had a definite fracture previously and two had history suggestive of previous stress fracture. A careful history considering risk factors for osteoporosis should be obtained when an insufficiency type stress fracture is diagnosed. Bone density measurements should be considered for patients with this type of injury. Appropriate medical therapy directed at the treatment of the underlying osteoporosis in addition to orthopaedic management of the fracture constitute the treatment objectives. This dual approach may prevent subsequent injury.

The extra-depth toe box: a rational approach.

The conservative management of foot deformities often requires the use of a modified shoe. A higher toe box is one of the most common variations required when the abnormality is located in region of the forefoot. High toe boxes are available in a variety of footgear, including athletic sneakers, comfort shoes, and prescription footwear. A rational approach to accommodating a deformed forefoot would be to first measure the maximum height of the abnormal toes in a weightbearing position. Then, by referring to a table listing shoes and available toe box space, the physician could match the foot with a shoe. The purpose of this study was to collect and tabulate measurements of toe box height for a variety of shoes. Impressions were taken from various shoes using a moldable plastic material. Toe box height was then measured and recorded. Results were tabulated for various types of men's and women's shoes. The depth of shoes at the point 5 cm from the tip of the toe was about 44 mm for most styles. The sagittal profile (i.e., vertical height available) of extra-depth shoes, comfort shoes, and athletic shoes was similar.

The cost effectiveness of crisis intervention. Admission diversion savings can offset the high cost of service.

The authors sought to determine whether a mobile crisis intervention service can effect cost savings by diverting patients from hospital admission into community-based treatment. They followed 50 consenting adult psychiatric patients for 6 months from the first day they were seen by the crisis intervention service. At the first visit, the crisis team obtained data to assess each patient's degree of risk for hospitalization. Investigators then kept a day-by-day record of every psychiatric treatment received by each patient, in an effort to determine the cost effectiveness of crisis intervention. The authors present evidence that crisis intervention permits some patients who would otherwise have been hospitalized to remain in the community and that savings thus realized exceed the expense of crisis intervention.

Tibialis posterior: a review of anatomy and biomechanics in relation to support of the medial longitudinal arch.

The medial longitudinal arch is unique among homo sapiens. This specialization of the human foot is believed to be necessary to the habitual bipedal gait pattern. Mechanical integrity of the arch depends on static and dynamic anatomic factors. The posterior tibial tendon in particular is situated to provide dynamic support along the plantar aspect of the foot and arch. Evaluation of the phasic activity of the posterior tibial muscle appears to confirm this premise. Furthermore, changes in the longitudinal arch that occur when the posterior tibialis is deficient lend further evidence that it is important in maintenance of the normal arch.

Stabilization of ankle syndesmosis injuries with a syndesmosis screw.

A retrospective review was made of 30 patients who had disruption of the ankle syndesmosis that was treated at Santa Clara Valley Medical Center with a transfixation screw. Follow-up ranged from 3 months to 3 years. There were 21 pronation external rotation injuries and 9 Maison-neuve fractures. Screw size ranged from 3.5 cortical to 6.5 cancellous Synthes screws. Most were placed transversely from 1.5 to 3.5 cm above the joint line. Intraoperative difficulties with screw placement occurred in 2 patients, resulting in one bent screw and one screw placed directly into the ankle joint. Most patients were mobilized prior to screw removal; lucent lines developed around the syndesmosis screw before it was removed in two-thirds of the patients. No screw broke prior to removal. In 6 patients, calcification of the interosseous membrane was seen and, in 4, this progressed to a distal tibiofibular synostosis. It was found that transfixation screws provided satisfactory stability of the syndesmosis to permit stable healing of the interosseous membrane and distal ligaments after ankle fracture. Motion between the tibia and fibula developed despite screw fixation, as shown by the lytic bony changes that occurred with time.