Shoulder instability: impact of glenohumeral arthrotomography on treatment

We used arthrotomography to study the glenoid labrum in 114 patients. Sixty-nine of the patients had anatomic instability of the shoulder (including recurrent dislocation and subluxation of the shoulder), and 45 patients had functional instability of the shoulder (denoted by chronic pain, clicking of the joint, and the sensation that an unstable condition exists without the objective signs of it). Labral tears were revealed arthrotomographically in 86% of the patients with anatomic instability, while only 40% of the patients with functional instability had labral abnormalities, and these were primarily of minor severity. Fifty-six patients (44 of whom had anatomic instability; 12, functional instability) required surgery. The surgical findings were correlated with the arthrotomographic findings, and no false-positive results were revealed. However, arthrotomography demonstrated only part of the pathologic condition of two patients. These results confirm that there is a strong correlation between labral pathologic conditions and anatomic instability of the shoulder. Arthrotomographic studies have a great impact on the selection of therapy in cases of both anatomic and functional instability of the shoulder.     

Strength, endurance, and stability of the tongue and hand in Parkinson disease.

Weakness and fatigue in the orofacial system often are presumed to contribute to the dysarthria associated with neuromotor disorders, although previous research findings are equivocal. In this study, tongue strength, endurance, and stability during a sustained submaximal effort were assessed in 16 persons with mild to severe Parkinson disease (PD) and a perceptible speech disorder. The same measures were taken from one hand for comparison. Only tongue endurance was found to be significantly lower in these participants than in neurologically normal control participants matched for sex, age, weight, and height. Analyses of data from a larger sample comprising the present and retrospective data revealed lower-than-normal tongue strength and endurance in participants with PD. No significant correlations were found between tongue strength and endurance, interpause speech rate, articulatory precision, and overall speech defectiveness for the present and previously studied participants with PD, bringing into question the influence of modest degrees of tongue weakness and fatigue on perceptible speech deficits.     

Can we predict the outcome of a partial rupture of the anterior cruciate ligament? A prospective study of 43 cases

The concept of partial rupture of the anterior cruciate ligament (ACL) has been confirmed by arthroscopic examination and palpation. We present a prospective study of 43 patients who were diagnosed arthroscopically as suffering from a partial rupture of the ACL by the same surgeon. The patients followed a rehabilitation protocol and were examined by an independant observer after 5 years. Twenty-five patients had a stable knee, whereas 18 eventually suffered a complete ACL rupture. ACL partial rupture is easily recognizable with arthroscopy, but the quantity and state of the still intact fibres is difficult to assess. Received: 20 April 1996 Accepted: 17 December 1996     

Creating a place for population health: Interpreting the spaces of a new School in Auckland,New Zealand

Although the reconfiguring of health care within the hospital sector has gained considerable attention by social scientists, the tertiary education sector's response to new health philosophies and practices has proceeded largely unexamined. This paper considers the new School of Population Health at the University of Auckland, accounts for its origins and considers the synergies between its design and workplace organisation. The results of a thematic analysis of narratives offered by 24 employees collected in 2004 are then presented. Findings suggest that the amassing of academics from a range of health-related backgrounds is advancing interdisciplinary dialogue even if the nature and purpose of population health remains unclear to some. A key concern of respondents was the openness of the workplace which encourages a collaborative atmosphere but also generates distraction. The degree to which conduct within the new building is perceived as regulated was also of concern. Place clearly matters in the story of the new School: the form of the building (featuring an architecture of openness) complements its function (generating new collaborations and creative thinking about health). However, the question of how ‘salutogenic’ a setting it is remains contested.     

THE PSYCHOLOGICAL IMPACT OF HIP ARTHROPLASTY

The impact of total hip arthroplasty on psychological functioning was examined in 51 patients; 25 females and 26 males with a mean age of 65 years (range 42–81 years). Assessments of psychological well-being and distress were made with the Mental Health Inventory. Life satisfaction, self-rated health, and pain ratings were also obtained. Assessments were made prior to surgery, immediately after surgery, and at a 2 month follow-up. The operation produced significant improvements in psychological well-being (P < 0.001), psychological distress (P < 0.001). life satisfaction (P < 0.01), self-rated health (P < 0.001), and pain (P < 0.001). It is concluded that the changes in medical and functional status following hip arthroplasty documented in previous research are accompanied by substantial improvements in psychological state, and that the inclusion of psychological factors in hip arthroplasty research will provide a more comprehensive assessment of outcome.     

Reformulation and drop size of apraclonidine hydrochloride.

We performed a prospective, double-masked, placebo-controlled, six-period, cross-over study in which normal subjects were randomly assigned to treatment and compared three different formulations of apraclonidine hydrochloride (the present commercially available formulation, and formulations with hydroxypropylmethylcellulose or lysolecithin). We also evaluated the efficacy of a 16-microliters and 30-microliters drop size. The magnitude and duration of decrease in intraocular pressure was comparable for all formulations. Most subjects tolerated all formulations well with only a few reporting any side effects. The best-tolerated formulation was 0.5% apraclonidine hydrochloride delivered with a 16-microliters drop size. Dry mouth developed frequently with the commercially available 1% apraclonidine solution. Blurred vision complicated the use of the formulation containing hydroxypropylmethylcellulose. Both dry mouth (P less than .05) and blurred vision (P = .004) were statistically significant side effects.