Knee dislocation: treatment of high-velocity knee dislocation

BACKGROUND: We report the outcomes of patients treated with a new arthroscopic treatment modality for knee dislocation after high-velocity trauma. METHODS: Twenty-three patients (12 men, 11 women; 25 knees) with traumatic knee dislocation were treated with this technique. Under arthroscopy with gravity inflow irrigation, the ruptured posterior cruciate ligament was reconstructed with a patellar bone-tendon-bone graft, and the anterior cruciate ligament was debrided subacutely. The collateral ligament, meniscus, and capsules were repaired through additional incisions. RESULTS: The average interval between injury and surgery was 11.1+/-5 days (range, 5 to 25 days). After a mean follow-up period of 27.2+/-7.86 months, the mean extension was 1+/-2 degrees and the average flexion was 129.6+/-4.91 degrees. The mean Lysholm score was 84. There were no major complications. CONCLUSION: Arthroscopic posterior cruciate ligament reconstruction seems to be an effective treatment for traumatic knee dislocation.     

周围型肺癌阻塞性病变的CT表现

目的：确定ＣＴ 图像上周围型肺癌之肺部阻塞性病变的诊断作用。方法：１８ 例周围型肺癌和１２ 例良性肺肿块对照者均经常规ＣＴ 扫描,绝大多数病人经肿块部位及其上下一层的深呼吸时相ＣＴ 扫描。结果：周围型肺癌的肺部阻塞性病变计有肺不张、阻塞性肺炎、阻塞性肺气肿及肺静脉癌栓。结论：注重ＣＴ 图像上周围型肺癌的各种肺部阻塞性病变,可为肺癌确诊提供重要的诊断依据。     

科玛嘉培养基与沙氏培养基分离酵母菌的比较

目的应用科玛嘉显色培养基(Chromagar)对120份妇科门诊病人分泌物标本进行念珠菌的分离培养.与常用的沙氏培养基(Sabourand's Agar)比较.方法用接种环分别将标本接种于两种培养基上,37℃培养,24 h和48 h各观察一次,并记录菌落生长时间、大小及颜色.结果①科玛嘉显色培养基菌落的不同颜色可筛选出不同的念珠菌,如绿色菌落为白色念珠菌、蓝灰色菌落为热带念珠菌、粉红色菌落为克柔氏假丝酵母菌、白色菌落为其它念珠菌;②科玛嘉显色培养基菌落大小明显较沙氏培养基菌落大;③科玛嘉显色培养法具有操作简便、快速等优点.结论新培养基(科玛嘉显色培养基)在分离诊断致病性酵母菌方面优于沙氏培养基.     

Development and regulation of substance P expression in neurons of the tadpole optic tectum.

Activity-dependent synaptic plasticity is characteristic of developing visual systems. Using the frog retinotectal system, we investigated the extent to which afferent input affects neurotransmitter expression in a target structure. We have concentrated on a particular subpopulation of tectal cells that is immunoreactive to substance P (SP). Early in development, SP expression in tectal neurons was restricted to the anterior lateral region of the tectum. As tadpoles developed, this expression expanded into progressively more posterior and medial regions in a manner that closely followed the gradient of tectal maturation. At all times, however, anterior and lateral tectal regions had a greater percent of SP-like immunoreactive (SP-ir) cells than posterior and medial ones. Horseradish peroxidase (HRP) labeling of the retinal ganglion cell projection in conjunction with SP immunocytochemistry demonstrated that innervation by retinal ganglion cell terminals preceded the expression of SP by tectal cells. This suggested that the optic nerve may influence SP differentiation and/or expression. In support of this idea, transection of the optic nerve resulted in a decrease in SP expression in the deafferented tectal lobe of tadpoles. This result, opposite to that seen previously in the adult, also indicates that optic nerve-dependent regulation of SP expression in the developing and mature systems occurs through different pathways.     

Cervical Cancer among Asian American Women: A Neglected Publica Health Problem?

PURPOSE OF THE PAPER: Relatively little attention has been paid to cervical cancer control in Asian American populations. We summarize available cervical cancer incidence and mortality dat, present information on levels of Pap testing use, and review factors that may be associated with cervical cancer screening participation. METHODS: We reviewed the literature pertaining to cervical cancer and Pap testing among Asian populations in North America. PRINCIPAL FINDINGS: Cancer registry data suggest that women from Southease Asia have a nearly five­fold increased risk of invasive cervical cancer (when compared to non­Hispanic White women). Filipino and Korean populations also have elevated risks. The excess invasive cervical cancer burden appears to be concentrated among women aged 40 and older. Pap testing use by Asians is less than for all toher racial/ethnic groups in the U.S., and recent studies suggest that over one­third of Vietnamese immigrants have never been screened. Barriers to Pap testing participation by less acculturated Asian women include a lack of familiarity with Western preventive concepts, a lack of knowledge concerning cervical cancer, embarrassment in association with gynecologic exams, the role of women in some Asian cultures, the cost of health care, and language difficulties. CONCLUSIONS: There is a considerable need for ethnoculturally appropriate cervical cancer control programs targeting Asian American populations. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: This paper is relevant to Asian American women from East, South, Southeast, and Island Asia.     

Clinical Measurement of Testicular Volume in Adolescents: Comparison of the Reliability of 5 Methods

Purpose

Measurement of the testis is a more readily available method of estimating spermatogenesis. Doubt remains about the best instrument for measuring testicular volume. Lack of bias or accuracy of instruments has received too much emphasis in some studies, while to our knowledge no one has yet appropriately compared reliability statistically. We propose a simple new method for measuring testicular size based on visual comparison with graphic models, and describe the reliability and bias of this and 4 traditional methods.

Materials and Methods

Measurements of 42 adolescent testes were made in a certain sequence: graphic method, dimensional measurement, Prader orchidometer, ring orchidometer and ultrasound with ultrasound assumed to be the standard. Statistical analysis was based on the linear structural model.

Results

Statistical tests indicated that all 5 methods are equally reliable (R greater than 0.9). Although they are not equally accurate, actual testicular size can be calculated using each of these 5 methods and the equations of the linear structural model.

Conclusions

The new graphic method proposed in this study is as reliable as other well-known methods for measuring testicular size. Actual testicular volume can be estimated without bias and with equal reliability from any of the 5 methods using the equations of the linear structural model. This statistical approach is more relevant than the sole comparison of lack of bias or accuracy, which has been the main concern of previous studies.     

Effects of pesticide seed treatments onRhizobium japonicum and its symbiotic relationship with soybean

Summary SeventeenRhizobium japonicum cultures isolated from soybean nodules induced formation of nodules on taproots of soybean plants. All isolates reduced acetylene to ethylene to different extentsin vitro. Paper disc assay indicated that two insecticides, lindane (-1,2,3,4,5,6-hexachlorocyclohexane), chlorpyrifos (O,O-diethyl O-3,5,6-trichloro-2-pyridyl phosphorothioate), and a fungicide, thiram (tetramethylthiuratn disulphide) individually or in combination caused significant inhibition of the growth ofR. japonicum No. 16.The effects of insecticide-fungicide seed treatments on the nitrogenase activity of soybean plants in nitrogen-fixing capacity, weights of leaves, stems, and nodules were determined. Thiram, singly or in combination with lindane and/or chlorpyrifos, significantly delayed growth of the plants and affected the activity of nitrogenase in the fixation of nitrogen 3 weeks after treatments. No drastic effect of any of the pesticide treatments on soybean plant growth was observed after 8 weeks.Contribution No., Research Institute, Agriculture Canada, London, Ontario.     

Sex differences and similarities in the management and outcome of stroke patients

BACKGROUND AND PURPOSE: Previous studies have documented sex differences in the management and outcome of patients with cardiovascular disease. However, little data exist on whether similar sex differences exist in stroke patients. We conducted a study to determine whether sex differences exist in patients with acute stroke admitted to Ontario hospitals. METHODS: Using linked administrative databases, we performed a population-based cohort study. The databases contained information on all 44 832 patients discharged from acute-care hospitals in Ontario between April 1993 and March 1996 with a most responsible diagnosis of acute stroke. The main outcomes measured consisted of sex differences in comorbidities, the use of rehabilitative services, the use of antiplatelet therapy and anticoagulants (in elderly stroke survivors aged > or =65 years only), discharge destination, and mortality. RESULTS: Male stroke patients were more likely than female stroke patients to have a history of ischemic heart disease (18.1% versus 15.3%, respectively; P<0.001) and diabetes mellitus (20.1% versus 18. 7%, respectively; P<0.001), whereas female patients were more likely than male patients to have hypertension (33.8% versus 30.0%, respectively; P<0.001) and atrial fibrillation (12.9% versus 10.2%, respectively; P<0.001). There were no sex differences in the usage of in-hospital rehabilitative services. The overall 90-day postdischarge use of aspirin and ticlopidine was similar in stroke survivors aged 65 to 84 years. However, among stroke survivors aged > or =85 years, men were more likely than women to receive aspirin (36. 0% versus 30.7%, respectively; P<0.001) and ticlopidine (9.2% versus 6.8%, respectively; P=0.007). Use of warfarin was similar for the two sexes. Men were more likely than women to be discharged home (50. 6% versus 40.9%, respectively; P<0.001) and less likely to be discharged to chronic care facilities (16.8% versus 25.2%, respectively; P<0.001). The risk of death 1 year after stroke was somewhat lower in women than men (adjusted odds ratio 0.939, 95% CI 0.899 to 0.980; P=0.004). The mortality differences were greatest among elderly stroke patients. CONCLUSIONS: Elderly men are more likely than elderly women to receive aspirin and ticlopidine and equally like to receive warfarin after a stroke. Despite these differences, elderly women have a better 1-year survival after a stroke.     

Rate of stroke recurrence in patients with primary intracerebral hemorrhage

BACKGROUND AND PURPOSE: Primary intracerebral hemorrhage (PICH) is a devastating illness with high early mortality. Hypertension is a major risk factor both for ischemic cerebrovascular disease and for intracranial hemorrhage. Survivors of PICH are at risk for both recurrent hemorrhage and ischemic cerebrovascular disease. We sought to determine the rate of recurrence of ICH or cerebral ischemia in a cohort of PICH patients at the Toronto Hospital, Toronto, Canada. METHODS: A retrospective search of computerized hospital records from 1986 to 1996 for patients with a discharge diagnosis of intracerebral hemorrhage (International Classification of Diseases, Ninth Revision-Clinical Modification [ICD-9-CM] code 431) was conducted to identify the index cases. Charts were abstracted for demographic and clinical characteristics. CT scans, MR scans, or radiologist reports were reviewed. To determine recurrence, the database was linked to the Ontario Provincial Government Vital Statistics Registry and to the Canadian Institute for Health Information database of hospital discharge abstracts. Logistic regression analysis was used to identify predictive factors for mortality after PICH. A Cox proportional hazards model was fitted to identify predictive factors for recurrent ICH or stroke. RESULTS: A total of 746 charts were identified by computer search. After abstraction, 423 index patients with PICH were identified. Of these, 27.4% died in the first 30 days of their admission. Predictors of death were age, intraventricular rupture of hemorrhage, and trilobar hemorrhage. The recurrence rate for PICH was 2.4% (95% CI 1.4% to 3. 9%) per year, whereas the recurrence rate for ischemic cerebrovascular disease was 3.0% (95% CI 1.8% to 4.7%) per year. The only significant predictor of readmission for ICH was lobar location of the index hemorrhage, with a hazard ratio of 3.8 (95% CI 1.2 to 12.0). CONCLUSIONS: PICH has a high 30-day mortality rate. Survival from the initial insult portends a moderate risk of recurrence of 2. 4% per year for PICH and 3.0% per year for ischemic cerebrovascular disease. Patients with PICH are at risk for both ischemic stroke or TIA and recurrent hemorrhage; thus, PICH may be a marker for ischemic stroke. Patients with lobar hemorrhage have a 3.8-fold increased risk of recurrent ICH.