Vascular injuries in knee dislocations: the role of physical examination in determining the need for arteriography

BACKGROUND: Popliteal artery injury is frequently associated with knee dislocation following blunt trauma, an injury that is being seen with increasing frequency. The primary purpose of the present study was to evaluate the use of physical examination to determine the need for arteriography in a large series of patients with knee dislocation. The secondary purpose was to evaluate the correlation between physical examination findings and clinically important vascular injury in the subgroup of patients who underwent arteriography. METHODS: One hundred and thirty consecutive patients (138 knees) who had sustained an acute multiligamentous knee injury were evaluated at our level-1 trauma center between August 1996 and May 2002 and were included in a prospective outcome study. Four patients (four knees) were lost to follow-up, leaving 126 patients (134 knees) available for inclusion in the study. The results of the physical examination of the vascular status of the extremities were used to determine the need for arteriography. The mean duration of follow-up was nineteen months (range, eight to forty-eight months). Physical examination findings, magnetic resonance imaging findings, and surgical findings were combined to determine the extent of ligamentous damage. RESULTS: Nine patients had flow-limiting popliteal artery damage, for an overall prevalence of 7%. Ten patients had abnormal findings on physical examination, with one patient having a false-positive result and nine having a true-positive result. The knee dislocations in the nine patients with popliteal artery damage were classified, according to the Wascher modification of the Schenck system, as KD-III (one knee), KD-IV (seven knees), and KD-V (one knee). CONCLUSIONS: Selective arteriography based on serial physical examinations is a safe and prudent policy following knee dislocation. There is a strong correlation between the results of physical examination and the need for arteriography. Increased vigilance may be justified in the case of a patient with a KD-IV dislocation, for whom serial examinations should continue for at least forty-eight hours.     

Immunogenicity of influenza and HSV-1 mixed antigen ISCOMs in mice

Summary Immunostimulating complexes (ISCOMs) were prepared with mixtures of antigens from influenza A virus (A/PR/8/34 or A/Sichuan/2/87) and herpes simplex virus type 1 (HSV-1), and were characterised by enzyme linked immunosorbent assay (ELISA) and electron microscopy using double-labelling immunogold techniques employing monoclonal antibodies to influenza or HSV-1 glycoproteins. The immunogenicity of the mixed antigen ISCOMs was evaluated in mice, following administration by the subcutaneous route, by measuring the total and subclass IgG antibody responses. Protection of these animals against challenge with live influenza A/Sichuan virus or live HSV-1, was compared with that induced by immunization with aqueous mixed antigen preparations. It was found that relatively high humoral responses to both influenza and HSV antigens, and increased levels of protection to both influenza and HSV viruses were elicited in mice receiving the mixed antigen ISCOM preparation compared to those observed in animals receiving the mixed aqueous subunit preparation. The findings also indicate that antigens from more than one virus can be used in an ISCOM formulation to produce immunity and protection.     

Ligamentary structure of the base of the nail

Summary The authors report the results of 115 dissections of the base of the distal phalanx of fingers and toes. In 85% of cases including hypoplastic supernumerary digits, there is a connective ligament-like structure. It is a dorsal expansion of the lateral ligament of the distal inter-phalangeal joint arising from the intermediate phalanx and ending in the matrix and the lunula. This ligament may have a role in biomechanical strains on the nail. It can explain some dystrophic nails associated with some malpositioned joints in fingers or toes.

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Structure ligamentaire de la base de l'ongle

Résumé Les auteurs rapportent les résultats de 115 dissections portant sur la base de la phalange distale des doigts ou des orteils. Ils retrouvent dans 85 % des cas, y compris sur des doigts hypoplasiques surnuméraires, une formation conjonctive de type ligamentaire. Il s'agit d'une expansion dorsale du ligament latéral de l'articulation interphalangienne distale, naissant de l'extrémité distale de la phalange intermédiaire et se terminant au sein de la matrice et sur la lunule. Ce ligament ostéomatriciel peut jouer un rôle dans la transmission des contraintes biomécaniques sur l'ongle et expliquer les dystrophies unguéales stéréotypées associées à certaines malpositions articulaires des doigts ou des orteils.

     

Cavernous haemangioma of the head and neck in the adult.

This paper reviews a personal experience of 51 cases seen over a 30 year period. Patients were treated in either a combined Head and Neck clinic or a Combined Ophthalmology clinic and a balanced view is thus represented. A method of grading the severity of the disease is described as well as a method of assessing response. This approach has not been proposed hitherto. It is generally concluded that the preferred treatment for small lesions is excisional surgery and for larger lesions carefully planned and highly localized radiation.