Internal impingement: concurrent superior labral and rotator cuff injuries

Internal impingement is a general term usually applied to the pathologic combination of a superior labral anterior-posterior injury and a partial thickness rotator cuff injury that is commonly seen in the disabled throwing shoulder. Clinical presentation varies but involves a combination of internal derangement (popping, clicking, catching, sliding) and rotator cuff weakness. Evaluation should be precise to delineate all components of the injury. Treatment must be directed toward both of the components and any other coexisting pathology. Labral repair should aim at restoring all aspects of the roles of the labrum. Rotator cuff treatment should take into account the need for optimal rotation and may not include complete take down and repair. Pitfalls in diagnosing and treating internal impingement should be known and avoided. Comprehensive rehabilitation emphasizing kinetic chain principles and full ranges of motion should be used.     

Bleeding peptic ulcer: An evolving role for surgical intervention

Abstract Early surgical intervention was previously advocated in patients > 60 years with bleeding peptic ulcer presenting with haemodynamic instability or ongoing transfusion requirements. It is, however, well recognized that emergency surgical intervention with its inherent risks must be reserved for highly selected patients in whom endoscopy initially fails to control exsanquinating haemorrhage or in whom life-threatening bleeding recurs. Therapeutic endoscopy for bleeding ulcer has led to a remarkable decline in rebleeding rates, the need for emergency surgery and mortality. Octogenarians are at risk, particularly when ulcer size exceeds 2 cm. Poor surgical candidates make up two-thirds of patients with major ulcer bleeding and operation is to be avoided if at all possible. Medical therapy with proton pump inhibitor and subsequent eradication of Helicobacter pylori following endoscopic treatment has been shown to be beneficial to outcomes. Should surgery be deemed necessary, it is likely that laparoscopic techniques to control bleeding, with or without the addition of an acid-reducing procedure, will find a role in haemodynamically stable patients undergoing operation on an early elective basis.     

Carcinoma of the breast: detection with MR imaging versus xeromammography

Detectability of breast cancer with magnetic resonance (MR) imaging versus xeromammography was quantitatively compared. MR images were obtained of breasts of 120 women who underwent xeromammography. T1 values were determined for masses larger than 2 cm. Cancer was histologically confirmed in 39 breasts and was considered excluded from 81 due to results of biopsy, cyst aspiration, or sonography or absence of change in xeromammographic findings over time. Images were blindly interpreted by three observers, and results were expressed as receiver operating characteristic curves. Detectability of breast cancer was substantially better with xeromammography than with MR imaging for all observers (P less than .03, 10(-6), and .001). On MR images, spiculation of a mass, distorted architecture, skin thickening, and nipple or skin retraction were specific but relatively insensitive indicators of cancer. Masses with smooth, distinct margins and signal intensity greater than that of fat on T2-weighted images were always benign. Other findings and T1 values were not diagnostically useful. The authors conclude that xeromammography is superior to MR imaging in detection of breast cancer.     

The larger bronchi in cryptogenic fibrosing alveolitis: a morphometric study

In a morphometric study of the main, lobar, and segmental bronchi of the left lung in nine cases of cryptogenic fibrosing alveolitis the quantity of gland was found to be significantly greater than in a group of normal controls, and similar to that of a group of patients with chronic bronchitis. The quantity of muscle was also increased, amounts in the segmental bronchi being higher than in the bronchitic patients. The cause of these changes is uncertain, but they seem likely to be due to proximal extension of repeated and persistent infection of the lung parenchyma.     

ANTIBODY STUDIES IN RABBIT ENCEPHALOMYELITIS INDUCED BY A WATER-SOLUBLE PROTEIN FRACTION OF RABBIT CORD

A water-soluble protein fraction of nervous tissue was prepared by extraction of rabbit spinal cord with sodium citrate at pH 4.3. Characterization by nitrogen content and paper electrophoresis showed it to be a mixture of basic proteins. This extract demonstrated encephalitogenic activity when injected into rabbits. The most suitable technique for the measurement of serum antibody to the rabbit cord antigen proved to be the precipitation of antigen-antibody complexes by 40 per cent saturated ammonium sulfate. Antibody could not be demonstrated by the techniques of complement fixation, quantitative precipitation, and Ouchterlony plates. The early appearance of circulating antibody occurred almost exclusively in rabbits that subsequently developed EAE. Specificity of the antibodies for nervous tissue was demonstrated by appropriate blocking and adsorption experiments.