Treatment of distal femoral fractures with early weight-bearing. A preliminary report.

Ten patients with 11 supracondylar fractures of the femur were treated with early weight-bearing and early knee motion. All fractures united. A good functional range of painless knee motion was restored in each case. No deformity or shortening developed during treatment in the cast-brace.     

Scintigraphic diagnosis of tricuspid regurgitation

The authors describe a simple technique for diagnosis of tricuspid regurgitation. Red blood cells were labeled in vivo with 99mTc and 22 patients were studied with ECG-gated blood-pool imaging of the liver. A single region of interest was manually drawn around the liver and a time-activity curve obtained. The per cent change in liver counts during the cardiac cycle was found to be significantly higher in the 12 patients with tricuspid regurgitation (Group I) (mean, 4.04 +/- 1.6%; range, 1.3-21.4%) compared with the 10 controls (Group II) (mean, 0.35 +/- 0.16%; range, 0.013-1.3%) (p less than 0.05). Using a 1% change in liver counts as the criterion of a positive study, all 12 cases in Group I were diagnosed correctly, but there was one false positive in Group II; thus the sensitivity was 100% and the specificity 90%.     

A computerized mass spectrometer and flowmeter system for respiratory gas measurements

Instrumentation systems for breath-to-breath analysis of respiratory gas exchange have been faulted by phase lags between various flow and composition signals and by difficulties in gathering and processing large amounts of data. The system described here represents an attempt to overcome these problems. Phase delays have been minimized by using a direct, piezoelectrically operated mass spectrometer inlet rather than an inlet capillary, by locating the mass spectrometer inlet and flow sensors in the same plane, and by incorporating design features which enhance the mass spectrometer response. Convenience in system operation and data analysis has been enhanced by integrating a computer into the system design so that the computer performs on-line data analysis and control functions and provides the primary interface between the experimenter and the instruments. Miniaturization of the instruments permits close coupling to an exercising subject.     

The effect of intravenous pyelography and cystoscopy on the staging of cervical cancer.

Intravenous pyelography and cystoscopy were performed in 583 patients with invasive cervical cancer at the University of Kentucky Medical Center. Eighty-six patients were found to have ureteral obstruction, which occurred most commonly at or near the ureterovesical junction. The incidence of ureteral obstruction varied from 2.2% in patients with pelvic findings consistent with Stage I disease to 36% in patients with Stage IV disease. No patient with Stage I or II disease on pelvic examination was found to have invasive cervical cancer in the bladder. However, bladder invasion occurred in 27 patients initially thought to have Stage IIIB disease.Intravenous pyelography should be performed as part of staging in all patients with cervical cancer, whereas cystoscopy can be reserved for those initially thought to have Stage III or IV disease.     

Health-related quality of life following operative treatment of unstable ankle fractures: a prospective observational study

BACKGROUND: Although Weber type B ankle fractures are often considered benign with a good prognosis, evidence from observational studies suggests that 17% to 24% of such patients may have less satisfactory outcomes. Although the explanation for variability in outcomes remains unclear, previous studies of other surgical procedures have suggested nonsurgery-related causes account for much of the variability in outcomes. METHODS: We conducted a prospective observational cohort study to evaluate health-related quality of life in 30 patients with unstable ankle fractures who were otherwise healthy. Only patients from 2 university-affiliated hospitals sustaining unstable type B Weber injury patterns requiring surgery were eligible. Patients provided detailed baseline information regarding alcohol consumption, smoking habits, and educational level. Patients completed the short form 36 questionnaire and a visual analogue pain scale at regular follow-up intervals. RESULTS: The average patient age was 51.6 years (SD 15.2 years), and 57% (17 out of 30) were male. The majority of fractures were the result of a fall (67%, 20 out of 30), and all were closed injuries. Almost half of all patients were smokers (47%, 14 out of 30), whereas 43% consumed alcohol on a weekly basis (13 out of 30). Forty-three percent of patients (13 out of 30) had obtained an elementary or high school level of education. Patients experienced significant improvements in all domains of the SF-36 questionnaire (P < 0.001), except general health, which remained essentially normal over the 24-month period. Study patients achieved scores similar to age-matched U.S. normative data across 6 of the 8 domains (Role Emotional, Social Function, Mental Health, Bodily Pain, Vitality, and General Health). However, patients' physical function and role physical scores remained significantly lower than US norms at 24 months (21.8 and 20.7 points lower on a 100-point scale, respectively; P < 0.001). Smoking history (P = 0.02), presence of a medial malleolar fracture (P = 0.02), and lower levels of education (P = 0.01) were significant independent predictors of lower physical function up to 3 months postoperation. Lower mental health domain scores were significantly associated with alcohol use (P = 0.02) and increasing age (P = 0.04). CONCLUSIONS: As is the case in many other areas, social factors may be important determinants of outcome in patients with traumatic fractures. Optimal orthopedic care may involve attention to modifiable risk factors, including smoking and alcohol consumption.