Comparative functional analysis of the Bristow, Magnuson-Stack, and Putti-Platt procedures for recurrent dislocation of the shoulder

Literature on anterior shoulder instability deals most often with elimination of recurrence following reconstruction. We analyzed the subjective function, loss of motion and shoulder strength of three operative procedures: Magnuson-Stack, Bristow, and Putti-Platt. A retrospective review of 27 patients, 9 in each surgical group, with no postoperative dislocations or on-going pain was performed. All patients were male, right hand dominant with the right shoulder affected. Average time of followup was 6.75 years (range, 4.2 to 10.3 years). All patients completed a questionnaire and had their range of motion measured by a hand-held goniometer and their shoulder strength tested on the Cybex II Dynomometer. Peak torque as a percent of body weight and side-to-side differences were calculated for six arm positions and compared to nine right hand dominant controls of similar age and recreational activity. Sixty percent returned to throwing sport. One Magnuson-Stack and Bristow patient felt full functional return to preinjury level. Three patients in each of these two groups returned to unmodified throwing sport whereas no Putti-Platt patient attained this level. Deficit of external rotation at shoulder neutral measured 4.7 degrees, Magnuson-Stack; 12.2 degrees, Bristow; and 21.8 degrees, Putti-Platt. At 90 degrees shoulder abduction, similar deficits in external rotation measured 6.4 degrees, 11.6 degrees, and 28.8 degrees respectively. These values were statistically significant employing analysis of variance. We compared the operative groups as a whole to the controls and compared the operative groups to each other.(ABSTRACT TRUNCATED AT 250 WORDS)     

Smoking habits and blood carbon monoxide levels

The carboxyhemoglobin concentrations (COHb) of 97 meat porters, 77 office workers, and 200 pregnant women have been determined. Individuals were questioned on smoking habits including numbers normally smoked per day, numbers already smoked on day of sampling, and time since last cigarette. The number of cigarettes smoked per day appears to allow the best prediction of COHb concentration. Individuals whose occupation involved them in physical exertion (meat porters) accumulated less carbon monoxide (CO) for numbers of cigarettes smoked per day than individuals smoking whilst sedentary. Pregnant women were seen to accumulate CO in a similar way to the active meat porters. In all groups, smokers had significantly higher COHb concentrations than nonsmokers. The effects of activity on CO uptake and elimination are discussed in relation to cigarette smoking, and it is suggested that the effect of activity on COHb is related more to elimination in the nonsmoking periods rather than uptake in the smoking periods.     

Corticosteroids in airway management

Adrenal corticosteroids exert a strong suppressive influence on the basic inflammatory response that leads to tissue swelling. The corticosteroid effect is nonspecific. In upper airway obstruction caused by edema from infection, allergy, or trauma, corticosteroids will exert some degree of suppressive effect. The steroid effect is local and directly proportional to the concentration of steroids in the inflamed tissue. In upper airway obstruction steroids should be delivered to the inflamed tissue in high concentration with the least delay. Dexamethasone and methylprednisolone produce high blood levels within 15 to 30 minutes of intramuscular injection. Recommended initial doses for acute airway obstruction are dexamethasone, 1.0 to 1.5 mg/kg, or methylprednisolone, 5 to 7 mg/kg. The risk of harm from steroid therapy of 24 hours or less is negligible.     

Skeletal trauma in skateboard injuries

Thirty fractures resulting from skateboarding have been treated in the past six months at the Henry Ford Hospital, Detroit. Although there have been no serious or unusual injuries, this represents a substantial increase over the previous year. Awareness of the hazards of this sport is the first step in reducing the frequency and seriousness of these injuries. As a result of our experience, safety guidelines for skateboarding are recommended for the parents of enthusiasts. We hope adherence to these guidelines will greatly reduce the number of injuries.     

Nosological coding of cause of death

Death certificates representing 766 decedents who had participated in the Hypertension Detection and Follow-up Program (1973-1979) at one of 14 US centers were given to three nosologists for purposes of coding underlying cause of death. Analyses examined interobserver variability among the three nosologists as well as intraobserver variability for each of the three nosologists. All three nosologists agreed on a three-digit International Classification of Diseases, Adapted (ICDA) code in 90.2% of the cases and at least two out of three agreed in 99.7% of the death certificates examined. Agreement rates improved when disease codes were collapsed into broader categories utilized in the Hypertension Detection and Follow-up Program. When particular disease classifications (e.g., cerebrovascular, ischemic heart disease, myocardial infarction, and neoplasms) were examined, three out of three agreement rates were highest for neoplasms (97.8%) and lowest for myocardial infarction (86.5%). Similarly, two out of three agreement was highest for neoplasms (98.5%) and lowest for myocardial infarction (88.0%). Intranosologist agreement rates were based on a recoded 20% sample of death certificates. Agreement rates for three-digit ICDA codes ranged from 94.8% to 96.1% for the three nosologists. The agreement rates for the general disease categories ranged from 96.7% to 97.4%.     

The role of psychiatry in Western European medical education.

During 1976-77 the authors studied psychiatric education in Western Europe, visiting university centers in 10 countries. Medical education in various European countries has developed out of different traditions. The significance of these for the present educational systems are discussed and the differences from the U.S. curriculum clarified. Psychiatry until recently in Europe has been dominated by a phenomenological approach. It has not assumed the same importance in the curriculum as in the United States. However, since the student revolts of 1968, there have been major reforms in teaching, including changes in the role of psychiatry in medical education and increased attention to social and psychological factors in health and disease.