Stress Views should be Standard of Care for all ACL Deficient Knees with Asymmetric Varus Laxity on Examination.

A small degree of increased varus laxity in acute anterior cruciate ligament (ACL) disrupted knees can often be felt on initial examination. Why this occurs is not always clear and is usually felt to be related to some degree of fibular collateral ligament (FCL) injury. However, there may be another structure that demands our attention in an ACL-deficient knee with more laxity than isolated ACL injuries, but less laxity than combined ACL and FCL injuries. That structure is the anterolateral complex (ALC), including the anterolateral ligament (ALL), the iliotibial band, and quite importantly, Kaplan's fibers.

Little League Shoulder and Subsequent Proximal Humeral Fracture in the Setting of Human Growth Hormone Use: A Case Report.

CASE: A 16-year-old right-hand dominant male baseball player presented with little league shoulder in the setting of recombinant growth hormone utilization for growth hormone deficiency. After a prolonged treatment course, including physical therapy and throwing programs, the patient returned to baseball but suffered an ipsilateral proximal humerus fracture around the growth plate. CONCLUSION: The occurrence of such an injury in the context of human growth hormone treatment merits consideration in youth athletes undergoing similar treatment regimens. Clinically, we recommend screening pediatric patients with sports-related epiphysiolysis for current or previous growth hormone use because of the possible prognostic implications of such treatment.

Bilateral vocal cord paralysis caused by accidental button battery ingestion in children: A case report and literature review.

Button battery ingestion in pediatric populations is a common occurrence with severe sequelae. Multiple case reports have established the occurrence of death, fistula formation, mucosal erosion, esophageal perforation, and bleeding post-ingestion of button batteries. However, there is a gap in the literature on the occurrence of bilateral vocal cord paralysis post-lithium battery ingestion. We present a case in which a 12-month-old male developed bilateral vocal cord paralysis following ingestion of a button battery. We compare our case to eleven other reports that exist in the literature based on age, sex, time until removal, clinical presentation, day upon which vocal cord paralysis developed, anatomic location, and post-operative course. We conclude that bilateral vocal cord paralysis is a time-sensitive complication which requires prompt diagnosis. Any child with stridor following button battery ingestion should undergo consultation with pediatric otolaryngology immediately. In addition, long-term follow-up is necessary to evaluate return of normal vocal cord function.

Effects of Common Ear Drops on Tympanic Membrane Healing in Rats.

Objective Ciprofloxacin + dexamethasone ear drops have been associated with higher rates of tympanic membrane perforations than ofloxacin. This was thought to be an effect of the steroid; however, ciprofloxacin (sans steroid) has been found to be more toxic to tympanic membrane fibroblasts than ofloxacin in vitro. This study aimed to compare the effect of these agents on tympanic membrane healing in vivo. Study Design Controlled animal study. Setting Academic research laboratory. Methods Perforations were created in 54 rats with a carbon dioxide laser. Rats were randomized to 6 groups (9/group), with 1 ear receiving ofloxacin, ciprofloxacin, dexamethasone, ofloxacin + dexamethasone, ciprofloxacin + dexamethasone, or neomycin, and the contralateral ear receiving saline twice daily for 10 days. Healing was assessed over 40 days. Results Ofloxacin did not delay healing relative to saline. All other treatments delayed healing relative to ofloxacin at day 10 ( P < .0001). Dexamethasone and ofloxacin + dexamethasone delayed healing up to day 14 ( P < .0001). Neomycin and ciprofloxacin + dexamethasone further delayed healing up to day 28 ( P = .009) and day 35 ( P = .043), respectively. All eardrums healed by day 10 with ofloxacin, day 20 with ciprofloxacin, day 28 for dexamethasone, and day 35 for ofloxacin + dexamethasone. At day 40, 2 of 9 ciprofloxacin + dexamethasone-treated eardrums had not healed. All saline-treated eardrums in the ofloxacin, ciprofloxacin, dexamethasone, and ofloxacin + dexamethasone groups were healed by day 14, but this was delayed to day 20 in the ciprofloxacin + dexamethasone group ( P = .007). Conclusions Ototopical quinolones delay rat tympanic membrane healing in a drug-specific manner, with ciprofloxacin having a greater impact than ofloxacin. This effect is potentiated by steroids.