"The VIHsibilite Project": HIV-positive people in the Quebec press and community responses.

The VIHsibilite Project is a community-based action-research initiative that examines newspaper coverage of HIV/AIDS issues in Quebec from 1988 to 2004. Using standard qualitative research methods, and in consultation with an advisory committee of people directly impacted by HIV/AIDS news coverage, the project discerns trends in reporting on HIV/AIDS and undertakes discursive content analysis of these, aiming to better understand in what normative ways seropositive people are represented in print media, and, ultimately, to reduce the stigma attendant upon HIV infection. Preliminary findings include indications that seropositive women tend to be represented markedly differently from men in the news.

Patella partita.

Patella partita is a malformation of the knee cap, generally characterized by one or a few vertical lines of discontinuity in sagittal planes, caused by incomplete ossification within a single ossification center. In other cases, disorder of ossification in frontal planes results in frontal subdivision of the patella. While patella partita is sometimes diagnosed as a coincidental radiographic finding, in other cases, especially in elderly individuals, it is a finding associated with symptoms which require treatment.

Parental involvement and the effectiveness of an adolescent day treatment program.

Results on an outcome study with adolescents in a partial hospitalization program reflect parental involvement during the treatment process. The study compared behavioral outcomes of adolescent patients with high parental involvement with outcomes of adolescent patients with low parental involvement. The partial hospitalization program led to improvement for adolescents aged 13-17 years with significant differences for improvement by parental involvement. Improvements were in primary function areas, school and home as perceived by the adolescent, and in a reduction in severity level and total pathology as rated by the parent. Further, adolescents with high parental involvement were less likely to need rehospitalization.

Acute bacterial arthritis in the adult.

Suppurative arthritis can be a complex and vexing problem. Formal arthrotomy is among the many successful approaches for the treatment of septic joints in the adult, however, it is not without morbidity and may not always be required. The clinical features, pathophysiology, and treatment of this disorder are reviewed.

Hypermobility in hallux valgus.

Hypermobility has been implicated as one of the etiological components in common foot problems such as hallux valgus but has not been substantiated by experimental data. Twenty patients with symptomatic untreated hallux valgus and 20 controls were evaluated with a simple hypermobility scoring system. A statistically significant correlation was found to reveal that female patients aged 20 to 40 yr with symptomatic hallux valgus have a mild generalized hypermobility when compared to a similar group of control patients. The presence of such ligamentous laxity would seem to support the need for bony correction in such patients as soft tissue procedures would have a greater propensity for malalignment due to the underlying hypermobility in combination with everyday environmental stresses of trauma and overuse.

The nature and designation of osteoarthritis determined by its histopathology.

Specimens of synovial tissue and articular cartilage removed at operations of patients with primary degenerative joint disease were scrutinized for defined histopathological parameters. The findings in the synovial membrane were subsequently compared as to frequency and intensity with identical parameters ascertained in specimens removed from patients with definite rheumatoid arthritis. These examinations disclosed the presence of synovial inflammatory features, although at lesser incidence and intensity than in rheumatoid arthritis; therefore the designation of arthritis is indicated. On the basis of the concurrently examined tissue specimens of the articular cartilage, and in consensus with the generally acknowledged start of the degenerative joint disease by disintegrating changes in the articular cartilage, the prefix of chondrosis is appropriate.

The alterations of the synovial membrane in rheumatoid arthritis treated with corticosteroids.

Sections of synovial tissue removed from patients with rheumatoid arthritis treated, for a long period of time or a brief period of time or not at all, with corticosteroids were examined for the incidence of histopathologic changes. Comparison of the quantification of these changes in the differently treated groups revealed that prolonged administration of corticosteroids had an inhibiting effect on the occurrence of lymphocytes and histiocytes in inflammatory infiltrates as well as on the hypertrophy of synoviocytes, on the proliferation both of fibroblasts and fibrocytes, and on the formation of villi and collagen fibers.

Slipped capital femoral epiphysis, unsolved adolescent hip disorder.

Slipped capital femoral epiphysis remains the unsolved adolescent hip disorder. The epidemiology, clinical signs and symptoms, pathology, and radiographic findings have been well described and are reviewed. However, since we do not know the cause of the disorder, prevention is not possible and an ideal method of treatment has not yet been found. Goals of treatment, methods of treatment, as well as results and complications of treatment are discussed.

Evaluation and diagnosis of cervical spine injuries: a review of the literature.

Cervical spine injuries pose devastating potential problems for surgeon and patient alike. This review will stress the early diagnosis of cervical spine injuries, with emphasis on early suspicion of injury. This review will focus on the radiology and types of lesions found with cervical spine injury.

Bilateral simultaneous achilles tendon ruptures. A case report and review of the literature.

Bilateral simultaneous Achilles tendon ruptures are rare, with only ten cases reported in the English literature. Our case is that of a 44-year-old woman, along with a review of the literature. Affected persons usually are on chronic steroid treatment and in the fifth to seventh decades of life. The patient may have concomitant systemic disease, and the injury occurs with relatively mild trauma. The goals of treatment are mainly preventative, i.e., cessation of steroids as soon as possible and protective bracing of the remaining intact Achilles tendon.

Functional evaluation of nonsensate free flaps to the sole of the foot.

Free flap transfer for soft tissue defects involving the sole of the foot have been important in limb salvage. The functional capacity of 16 patients is documented. From our data, free flaps to weightbearing surfaces of the foot give satisfactory results in patients less than 40 years old and salvage is rewarding. Older patients had less than satisfactory results. When the only alternative is an amputation, free flap salvage may still be indicated.

[Spondylolisthesis and related conditions; pathology, clinical aspects and treatment]. / Spondylolisthese und verwandte Zustände; Pathologie, Klinik und Behandlung.

Close pathogenetic and morphologic relationships exist between the alterations of the lumbosacral spine designated as spondylolysis, spondylolisthesis and praespondylolisthesis. The initial management of 105 patients with such conditions was conservative. However, of this group 34 patients with persistent instability and/or intractable neurologic symptoms were subsequently treated surgically, and the majority of them obtained lasting benefits.

Spondylolisthesis and related disorders. A correlative study of 105 patients.

A close relation exists among the alterations in the lumbosacral spine designated as spondylolysis, isthmic spondylolisthesis, degenerative spondylolisthesis, and prespondylolisthesis. While the former two conditions are probably caused by faulty development and subsequent minor traumata or repeated stresses, the third condition is caused by degenerative changes associated with anatomic variations; the fourth condition is a static insufficiency leading to faulty alignment. In 105 patients, the initial preferred management of these conditions was conservative. Thirty-four patients who developed persistent symptoms of spinal instability and/or intractable neurologic deficits were treated surgically. The results were generally successful.

Total knee arthroplasty in 1984.

In total knee arthroplasty, as little bone as possible should be removed, all intact ligaments should be saved, and fixation by biologic ingrowth, rather than methylmethacrylate, should result in the lowest incidence of loosening.

Heterotopic ossification. Incidence and relation to trochanteric osteotomy in 100 total hip arthroplasties.

Heterotopic ossification can impair the functional results of total hip arthroplasty. The causative role of trochanteric osteotomy in heterotopic ossification is uncertain. Postoperative radiographs of 100 total hip arthroplasties were analyzed for incidence of heterotopic ossification. Forty procedures were performed with trochanteric osteotomy and 60 without. There was a 17% overall incidence of clinically significant heterotopic ossification, 22% with osteotomy and 13% without. High- and low-risk categories revealed clinically significant heterotopic ossification in 25% of the high-risk group and in 8% of the low-risk group. In the high-risk group there was a 32% incidence with trochanteric osteotomy and 22% without osteotomy. In the low-risk group there was a 16% incidence without trochanteric osteotomy and a 3% incidence with trochanteric osteotomy. The increase in clinically significant heterotopic ossification in the high-risk group over that of the low-risk group was statistically significant. The present study showed that trochanteric osteotomy tended to increase the incidence and severity of clinically significant heterotopic ossification. These data suggest that trochanteric osteotomy should be avoided, if possible, during total hip arthroplasty to decrease the risk of heterotopic ossification.

Acute traumatic fibular bowing associated with tibial fractures.

Acute traumatic fibular bowing associated with angular fracture of the tibia was observed in three young adults. The fibular bowing may have had a negative effect on the healing of the tibial fracture by transmitting tension through the interosseous membrane, thereby preventing proper reduction of the tibial fracture fragments and delaying the union.

The impact of CT in clinical management of pelvic and acetabular fractures.

Thirty-eight consecutive patients admitted to the hospital with pelvic and acetabular fractures underwent CT examination. The axial plane of CT is shown to be the most suitable for evaluation of these fractures. The fracture pattern is readily demonstrated, facilitating fracture classification. The degree of fracture fragment displacement and rotation, hip joint stability, and intra-articular osseous fragments can be determined. A number of unsuspected fractures were detected, including five sacral and four anterior acetabular wall fractures; the latter were due to extension of superior ramus fractures. Soft tissue injuries included several hematomas, serosanguinous cysts in one patient, and bladder laceration in one patient. It is concluded that in patients with pelvic fracture CT examination is the method of choice following preliminary radiographic evaluation, if further radiographic investigation is deemed necessary.