The role of arthroscopic surgery in the evaluation of acute traumatic hemarthrosis of the knee

Eighty patients presented for evaluation with an acute traumatic hemarthrosis of the knee and negligible instability on clinical examination. All had an examination under general anesthesia followed by arthroscopy. Anatomical lesions were demonstrated in 71 of 80 knees (89%) including anterior cruciate ligament (ACL) disruption in 50 (62%). Twenty-nine of 50 patients (58%) with arthroscopically-demonstrated ACL injuries had associated meniscal tears. Fifteen (19%) demonstrated isolated meniscal tears and nine (11%) osteochondral fractures not detected by conventional roentgenograms. The frequent occurrence of injuries to other joint structures in conjunction with ACL injuries was remarkable. An acute traumatic hemarthrosis of the knee often masks significant lesions. Arthroscopy aids the orthopedic surgeon in determining the full extent of the intraarticular damage.     

Event-related Potentials as Markers for Alcoholism Risk in High Density Families

One hundred sixty-eight adult siblings and parents from affected and control families were tested for ERP characteristics using two tasks involving an auditory oddball paradigm. Significant within family differences among affected families suggest that risk for developing alcoholism may be seen even in adult subjects who have had experience consuming alcohol. Further, analysis of quantity and recency of drinking in the past seven days were not correlated with either amplitude or latency of P300, suggesting that the within-family differences observed reflect relative risk for developing alcoholism rather than experience with alcohol.     

Natural history and treatment of anorectal strictures complicating Crohn's disease

Forty-four patients seen between 1975 and 1985 with anorectal strictures complicating Crohn's disease have been reviewed to determine the natural history and outcome of surgical treatment. Proctitis was present in 98 per cent, and 93 per cent of patients had sever perianal disease. The site of strictures was rectal in 22, anal in 15 and anorectal in 11 (4 patients had a stricture at 2 sites). Initial treatment was by rectal excision alone in 6, dilatation in 33, and 5 needed no treatment at all. Single dilatation was effective in 15, 8 required two dilatations and in 10 repeated dilatation was necessary. Proctocolectomy was eventually required in 19 patients, 2 have a loop ileostomy and 1 has an ileostomy with a rectal stump in situ. Only 21 remain asymptomatic while 3 continue to need dilatation. Perineal wound healing was delayed in 9 of 19 patients having a proctocolectomy and in 3 the perineal wound has never healed.     

Sarcoidosis and primary biliary cirrhosis

Summary An unusual case of a woman with primary biliary cirrhosis and cutaneous sarcoidosis is described. The factors that allow a specific diagnosis of each condition are presented and the literature pertaining to such complex and unusual cases is presented.This work was supported in part by a grant from the Gastroenterology Medical Research Foundation of Southwestern Pennsylvania.     

Strangulation of the Colon Complicating Acute Pancreatitis

We report a patient with alcohol-induced necrotizing pancreatitis who developed a severe ileus followed by incarceration of a portion of the transverse colon within a ventral hernia. Laparotomy 9 days after the onset of symptoms revealed infarction of the transverse colon and infection of the pancreas. This is the first report of a case of acute pancreatitis that led to a strangulated ventral hernia of the colon. We believe that the enteric organisms that infected the pancreas originated in the incarcerated transverse colon.     

Consultation letters as a method for assessing in-training performance in a department of medicine.

This study examined the feasibility of using outpatient consultation letters as a means of assessing the clinical performance of clerks and house staff in a large teaching hospital. A total of 222 assessments were obtained based on samples of consultation problems from two clinical services. The method involved a two-stage rating scale based on the performance areas of Data Base, Problem Formulation, Diagnostic Tests, Management and Overall Assessment. The technique was investigated in terms of the objectivity, reliability, validity and efficiency of the performance ratings. Product-moment coefficients were used to assess inter- and intrarater agreement in scoring the consultation letters. These analyses identified a consistent difficulty in assessing the category of Data Base. For the remaining performance categories, interrater coefficients in the range .19-.76 and intrarater coefficients in the range .23-.96 were obtained. Other preliminary findings indicated good potential for a reliable and valid assessment. The method is technically feasible, and is based on a novel and reasonably unobtrusive approach to assessing trainee performance in a clinical setting.     

Platelet transfusions are not associated with increased morbidity or mortality in cardiac surgery

PURPOSE: To determine the independent relationship between leukoreduced platelet transfusions and adverse events in cardiac surgery. METHODS: In this observational study, detailed baseline and perioperative data were prospectively collected on consecutive patients who underwent cardiac surgery at a single institution from 1999 to 2004. The independent associations of platelet transfusion with clinical outcomes (low output syndrome, myocardial infarction, stroke, renal failure, sepsis, and death) were determined by multivariable logistic regression analysis and propensity score case-control analysis. RESULTS: Of the 11,459 patients analyzed, 2,174 (19%) received (leukoreduced) platelets - 1,408 received 5 U, 471 received 10 U, 140 received 15 U, and 155 received 20 or more units. Although all measured adverse event rates were higher in those who received platelets, in neither the logistic regression analyses nor the propensity score analyses was there any association between platelet transfusion and any of the adverse events. CONCLUSIONS: Transfusion of leukoreduced platelets in cardiac surgery is not associated with adverse clinical outcomes when adjustments are made for important confounders.