The role of stress radiographs for the severe ankle sprain: A 7-year prospective study

Ankle sprains are common. They are the most common musculoskeletal injury in athletes and account for about 2 million emergency department visits annually in the United States. Although ankle radiographs are often indicated to rule out fractures of the acutely sprained ankle, the need for additional imaging work-up, such as stress radiographs, to evaluate the severity of ligamentous injury is not clear. One hundred five patients with severe ankle sprains diagnosed by stress radiographs were randomized into three conservative modes of therapy (Schantz wrap, cast brace, cast) and followed prospectively for 7 years. There was no statistically significant difference among treatment groups for mechanical outcome at 1 year (P=0.27) or for functional outcome at 5 years (P=0.39) and 7 years (P=0.27) after injury. We conclude that: (a) there currently is no recommendation for stress radiographs in the setting of the acutely sprained ankle, and (b) a larger multicenter study is needed to confirm these findings.     

Core decompression for avascular necrosis of the femoral head: correlation between long-term results and preoperative MR staging

A long-term radiographic follow-up study was conducted on 24 patients (34 hips) who underwent core decompression of the femoral head for avascular necrosis (AVN). The purpose of the study was to assess the potential correlation between the extent of AVN, as determined with preoperative magnetic resonance (MR) imaging, and development of collapse. The preoperative MR results were classified into four categories: group A, no AVN; group B, less than 25% involvement of the weight-bearing portion of the femoral head; group C, 25%-50% involvement; and group D, more than 50% involvement. Histologic evidence of AVN was found in all 34 hips. Collapse occurred in none of the hips in groups A and B (n = 12), in three of seven hips (43%) in group C, and in 13 of 15 hips (87%) in group D. It is concluded that MR estimation of the extent of femoral head involvement with AVN may help in predicting which femoral heads will collapse shortly after core decompression, so that this invasive procedure can be avoided in patients at risk.     

Ueber das Verhältniss der Phosphorsäure zum Stickstoff im Urin

Ohne Zusammenfassung(Schluss von S. 251.)     

Interrelationship of erythrocyte blood group substances A,B, and H studied with immunofluorescence

Summary. Adult O cells generally showed strong anti-H reactions; A cells showed an inverse relationship between A and H reactivity; B cells often lacked the expected inverse relationship, showing both weak and strong anti-H reactions. Newborn O cells usually reacted weakly with anti-H; A cells generally lacked a reciprocal relationship, and reacted weakly with both anti-A and anti-H; B cells reacted strongly with anti-B and weakly with anti-H. All this suggests a special property of B that produces strong reactions regardless of the number of antigenic molecules. Seemingly, the high reactivity of the B antigen accounts for the behavioral divergence between erythrocytes and soluble substances. The findings in groups A, 4B, and O support the Watleins and Morgan theory.     

Anti-s Hemolytic Disease: A Case Report

A case of hemolytic disease due to anti-s in a mother apparently sensitized by previous pregnancy is reported. The antibody was of the incomplete type and the clinical manifestations were those of a compensated hemolytic anemia with minimal icterus.     

The knee: surface-coil MR imaging at 1.5 T1

Seven normal knees (in five volunteers) and seven injured knees (in seven patients) were examined by high-resolution magnetic resonance (MR) imaging at 1.5 T with a surface coil. Seven medial meniscal tears, three anterior cruciate ligament tears, one posterior cruciate ligament avulsion, an old osteochondral fracture, femoral condylar chondromalacia, and one case of semimembranous tendon reinsertion were identified. MR images correlated well with recent double-contrast arthrograms or results of surgery. All tears were identified in both the sagittal and coronal planes. Because of its ability to demonstrate small meniscal lesions and ligamentous injuries readily, MR imaging with a surface coil may eventually replace the more invasive arthrography.