Total knee arthroplasty in obese patients

We examined 182 patients (257 knees) who had had a total knee arthroplasty two to five six years earlier. The patients were grouped into five weight classes. Eighteen patients (twenty-seven knees) were considered moderately obese and twelve patients (twenty-seven knees), severely obese. The results in all but four knees were rated excellent or good. One patient needed a revision procedure for late infection, and the result was rated poor. Three results were rated fair. There was no discernible difference in the over-all scores among the five weight groups. However, 30 per cent of the knees of the moderately and severely obese patients had patellofemoral symptoms, whereas the incidence was 14 per cent in the other groups (p less than 0.03). No clear-cut association was found between obesity and either thrombophlebitis or complications related to the wound.     

Psychotherapy in cases of brain damage: A possible mission

We present here a psychodynamic model for treating brain-injured patients. In contrast to the common assumption that brain-injured patients remain in an emotional vacuum, our model uses dream material to enable a direct access to the psychic inner life of the patient. It thus refutes the view that these patients can only benefit from supportive psychotherapy.     

Psychoactive substance use disorder in relatives of patients with anorexia nervosa.

We assessed the lifetime prevalence and morbid risk of psychoactive substance use disorder (SUD; alcoholism and drug use disorder) in the first- and second-degree relatives, excluding children, of 34 female patients with anorexia nervosa (AN) and 34 age- and sex-matched controls who had no history of an eating disorder. Diagnoses of relatives were made blind to probands' diagnoses. The prevalence of SUD was 9% in both anorectic and control relatives, and the figures for morbid risk were 14% and 15%, respectively; these differences were nonsignificant. These results suggest that adolescent and adult women with AN do not possess many of the familial factors that predispose to the development of psychoactive SUD.     

Combination of ABO blood group incompatibility and glucose-6-phosphate dehydrogenase deficiency: effect on hemolysis and neonatal hyperbilirubinemia

The incidence (%) of hyperbilirubinemia (serum bilirubin ≥257 μmol/l) was similar in neonates with a combination of ABO incompatibility and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency (45%), with ABO incompatibility (54%) or G-6-PD deficiency (37%), alone (ns). Carboxyhemoglobin values, corrected for inspired CO, were similarly elevated in all three groups (0.87 ± 0.32%, 0.82 ± 0.29%, 0.76 ± 0.18%, respectively, ns), but correlated with bilirubin only in those with ABO incompatibility alone. ABO-incompatible/G-6-PD-deficient neonates, compared with those with either condition alone, are not at increased risk for hemolysis or hyperbilirubinemia.     

Physical and chemical injuries of the eyes and eyelids.

Ocular trauma is not uncommon. Because the tissues associated with visual function are delicate and remarkably specialized, care of ocular injuries is best left to well-trained specialists. Initial care, however, is often simply common sense. Irrigation of chemical burns, sterile techniques, and procedures that salvage tissue are good general principles.     

Sociodemographic factors and obesity in preadolescent black and white girls: NHLBI's Growth and Health Study.

The association of sociodemographic and family composition data with obesity was studied in 1213 black and 1166 white girls, ages 9 and 10, enrolled in the National Heart, Lung, and Blood Institute''s Growth and Health Study. Obesity was defined as body mass index at or greater than age- and sex-specific 85th percentile as outlined in the Second National Health and Nutrition Examination Survey. The prevalence of obesity was higher for pubertal girls than for prepubertal girls and for girls with older mothers/female guardians. As odds ratio of 1.14 was observed for each 5-year increase in maternal age. Obesity was less common for girls with more siblings; the odds for obesity decreased by 14% for each additional sibling in the household. In blacks, the prevalence of obesity was not related to parental employment or to parental education. In whites, the odds of obesity were higher for girls with no employed parent/guardian in the household and for girls with parents or guardians with lower levels of educational attainment. Examining the associations between sociodemographic factors and risk of childhood obesity provides important clues for understanding racial differences in obesity, a major risk factor for coronary heart disease.     

Malignant melanoma associated with melanocytoma of the optic disc

A 61-year-old white man underwent enucleation because of progressive growth of a pigmented epipapillary tumor that was diagnosed 9 years earlier as an optic nerve and juxtapapillary melanocytoma. Histopathologic studies showed the tumor was a malignant melanoma of the optic disc and juxtapapillary retina and choroid. Foci of typical melanocytoma cells were within the tumor. The tumor produced segmental atrophy of the optic nerve. This is a rare example of a malignant melanoma developing in conjunction with a lesion that possessed typical clinical and histopathologic features of a melanocytoma of the optic disc.     

Ankle and foot pain

An approach that allows a consistent, thorough evaluation can be recommended by a mnemonic using the words ankle/foot. The maxim about foot and ankle pain is that "the good exam begins at the back and ends at the toe." During this exam, the cutaneous, vascular, and neural systems need careful evaluation. The exam is directed to the region of maximal discomfort where careful palpation should pinpoint the spot of greatest tenderness. Once this region has been localized and signs and symptoms collected, consider the differential diagnosis specific for that area. This will narrow the focus, make the number of potential pain sources manageable, and often provide the answer. When the diagnosis is still unclear, obtain standard x-rays of the area. A directed evaluation to probe the region is appropriate. This can mean a bone scan to detect early avascular necrosis, stress fractures or osteomyelitis; an EMG-NCS to assess the neural circuitry; and special x-ray views, CAT scan, NMR, or arthrogram to uncover the difficult fracture. At this point, fortunately, the primary physician is not alone. The diagnostic dilemma or the difficult management case can be referred for a second opinion or therapeutic assistance to a podiatrist, rheumatologist, or the orthopedist with a special interest in feet.