Anatomic Osteochondral Glenoid Reconstruction for Recurrent Glenohumeral Instability With Glenoid Deficiency Using a Distal Tibia Allograft

The treatment of glenoid bone loss in the setting of recurrent shoulder instability remains a challenge. This is because of the nonanatomic nature and resultant incongruous joint resulting from most bony augmentation procedures. We present a novel technique for the management of glenoid bone deficiency by using a fresh osteochondral distal tibial allograft. We have found that the distal tibia has excellent articular conformity to unmatched humeral heads, fits nearly anatomically on the distal two thirds of the glenoid, is composed of dense weight-bearing cortical and metaphyseal distal tibia bone, and provides for a cartilaginous surface for which the humeral head to articulate. This article describes the technique, initial results, and postoperative findings with the use of a distal tibia allograft (the lateral portion of the distal tibia) for the treatment of glenoid bone deficiency (mean loss of 30%) in a series of 3 patients.     

Computed Tomography in the Headache Patient: Is Routine Evaluation Really Necessary?

SYNOPSIS
Objective . To determine the likelihood ratio of a positive computed tomogram of the brain in the routine evaluation of headache patients.
Design . Consecutive patients with a chief complaint of headache were prospectively evaluated with computed tomography of the brain. Patients with headaches complicating other clinical disorders such as trauma, postictal state or known intracranial neoplasm were excluded.
Setting . Military tertiary care center.
Patients . Consecutive sample of 350 patients with a chief complaint of headache, regardless of the presence or absence of physical or neurologic signs, were referred for computed tomography of the brain. The patients were referred from a variety of inpatient and outpatient settings.
Results . Seven (2%) of the 350 patients had computed tomographic findings that were clinically significant. An additional 25 (7%) had positive computed tomographic findings, which were clinically insignificant for findings. All of the patients with significant computed tomographic findings had an abnormal physical or neurologic exam or unusual clinical symptoms.
Conclusion . Routine computed tomography of the brain in headache patients with normal physical and neurologic exams and no unusual clinical symptoms has a low likelihood ratio for discovering significant intracranial disease.     

Mycobacterium fortuitum Infection Occurring After a Punch Biopsy Procedure

Abstract: Mycobacterium fortuitum is a rapidly growing atypical mycobacterium frequently reported as a postsurgical wound complication from a major surgical procedure. We present a unique case of M. fortuitum infection occurring in a 4-year-old boy after a minor punch biopsy surgical procedure. As far as we know there has been no published case of M. fortuitum occurring after a punch biopsy procedure.     

Outpatient management of superficial venous insufficiency at a naval medical facility

Superficial venous insufficiency is common in a young, working population. It can result in disability and lost time from work because of chronic pain, inflammation, and/or ulceration. We reviewed our experience in the management of 104 patients with superficial venous insufficiency secondary to saphenofemoral and/or perforator venous incompetence. The main treatment objective was to control venous insufficiency in a manner that would allow a rapid return to duty. The technique involved ligation of the incompetent saphenofemoral junction and/or perforating veins (i.e., point ligation) under local anesthesia. Patients returned to normal duty status the day after treatment. Six weeks later any persistent disease was controlled with compression sclerotherapy. Significant morbidity included postoperative wound complications in 4% and thrombophlebitis in 14%. Objectives of treatment, with excellent functional and cosmetic results, were achieved. True recurrence was noted in 8% of patients, whereas new disease developed in only 4%; the total recurrence rate was 12%. This mode of therapy is ideally suited to outpatient management. This study demonstrates the excellent control of venous dysfunction that is achievable with the use of selective therapy based on proximal venous ligation and staged sclerotherapy.The Chief, Bureau of Medicine and Surgery, Navy Department, Washington, D.C., Clinical Investigation Program sponsored this study No. S-94-063, as required by HSETCINST 6000.41A.Veluntary informed consent of the subjects used in this research was obtained, as required by SECNAVINST 3900.39B.The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States government.     

Olestra: A New Food Additive

In 1987, Procter and Gamble Company (Cincinnati, Ohio) petitioned the US Food and Drug Administration (FDA) to amend the food additive regulations to allow sucrose esterified with fatty acids (olestra) to be used as a replacement for conventional fats. The petitioner later restricted its request for use in savory snacks. FDA considered evidence submitted by the petitioner, the opinions of experts, proceedings from the FDA Food Advisory Committee, and public discussion and concluded on January 25, 1996, that olestra was safe for use in savory snacks (eg, salty snacks such as potato chips, corn chips). Olestra is not toxic, carcinogenic, genotoxic, or teratogenic and is neither absorbed nor metabolized by the body, but may be associated with gastrointestinal tract symptoms such as cramping or loose stools. In addition, olestra affects the absorption of fat-soluble vitamins but does not affect the absorption of water-soluble nutrients. The petitioner's studies concluded that when olestra was consumed with foods containing vitamins A, D, E, or K, the fat substitute could have an effect on the absorption of these nutrients. Therefore, FDA is requiring that fat-soluble vitamins lost through absorption be added back to olestra as follows: 170 IU vitamin A per gram olestra, 12 IU vitamin D per gram olestra, 2.8 IU vitamin E per gram olestra, and 8 μg vitamin K per gram olestra. As part of the conditions of approval FDA is requiring that the food labels of products containing olestra disclose the vitamin compensation and the potential gastrointestinal effects. FDA is also requiring that further studies examining consumption patterns and the effects of olestra on human beings be conducted. J Am Diet Assoc. 1998;98:565–569.