Arthroscopy of traumatic hemarthrosis following sports injuries. A 5 year analysis

This retrospective study was made to evaluate the significance of different sports activities that cause variable haemarthrosis with intraarticular lesions of the knee joint. Throughout 1984 to 1988 arthroscopy was performed in 337 patients with acute haemarthrosis. The average time between trauma and arthroscopy was 8 days. ACL rupture was diagnosed in most of these cases. Regarding the different types of sport activities ACL lesions were found in skiers (74%), other winter sports (47%), soccer (53%), tennis and squash (58%), athletics (41%) and indoor (61%). Peripheral meniscus tears associated with haemarthrosis were found in 36% and patellar dislocations in 8%. Isolated MCL ruptures were diagnosed clinically and arthroscopy was not performed in these cases. Throughout 1987 isolated ACL ruptures were fixed by reattachment. This technique was not continued any longer and ACL replacement by patellar tendon as bone-ligament-bone was performed routinely since 1988 in those patients, who required surgery. 56 patients required ACL reconstruction following conservative treatment because of ACL deficiency, when they went back to sports activities. Longitudinal peripheral meniscus tears were fixed by the scape in inside-out technique.     

Knee joint hemarthrosis--differential diagnostic considerations for planning an operation

From 1980 to the end of 1988, arthroscopy has been performed on 620 patients with acute hemarthrosis of the knee joint. Of all the intraarticular lesions, 89.4% required surgery. Arthroscopy has changed in the last decade from diagnostic screening to invasive instrumentation for exact operative planing and alternative operative techniques. Hemarthrosis in stable knee joints was caused by minor lesions (7.84%) that did not require surgical procedures. Seventy-three patients had traumatic patellar dislocations--in 33 cases associated with chondral or osteochondral fractures. In 54.8% of the isolated medial retinacular ruptures, simple suture was performed in 14 cases--3 times arthroscopically and 11 times open, combined with lateral retinacular release without redislocation following. Associated chondral fracture indicated surgery in all cases. Isolated meniscus pathology (12.48%) was treated by arthroscopy alone, and refixation of the medial meniscus was carried out using the inside-out technique in 27 cases. Arthroscopic elevation of lateral tibia plateau fracture--indicated by type II fracture according to the AO classification--was performed in 3 cases with excellent results, and was associated with screw fixation and image intensification in 2 patients. Intercondylar eminence fracture is an excellent indication for arthroscopic refixation in the presence of the mono- or two-fragment type of fracture. ACL rupture is the main intra-articular pathology (64.8%) for hemarthrosis of the knee joint, which was diagnosed as an acute injury within the 1st week following trauma (51.04%). Anterior instability can be detected clinically if a careful examination with the Lachman test, combined with the missing end-point and pivot-shift test, is performed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Syndesmosis transfixation screw

Instability of the distal tibia-fibular joint necessitates the implant of a fibular tibial transfixation screw. The screw should be placed 2 cm above the anterior syndesmosis. The angle of insertion is 30 degrees upwards from dorsal in relation to the frontal plane. If tibiofibular stability cannot be maintained following anatomical reconstruction of the fibula the transfixation screw must engage the medial tibial cortex. This is imperative, since the transfixation screw cannot withstand the biomechanical forces during motion and bearing of load if the screw penetrates only three corticals.     

Predictivity of Plasma Prolactin Levels in Differentiating Epilepsy from Pseudoseizures: A Prospective Study

The predictivity of raised plasma prolactin (PRL) concentrations in differentiating seizure from syncopal attack was prospectively assessed in all patients consecutively admitted to the Clinica Neurologica of Brescia, Italy in a 12-month period who fulfilled the criteria for either a seizure or syncopal attack. Postictal plasma prolactin concentration (P1) was assessed as soon as possible after the event. Three further assessments were performed: P2 was sampled 1 h after P1, P3, and P4 were sampled in the morning for the next 2 days. Patients who had had a seizure showed significantly increased P1 concentrations, when P1 was sampled within 60 min of the attack. In seizure patients assessed >1 h after the event, P1 was not significantly different from either P2, P3, or P4. In patients who had had a syncopal attack, PRL concentration never increased. In patients assessed ≤60 min after the seizure, cutoff criterion of P1 exceeding by + 3 SD the mean calculated on P2, P3, and P4 yielded a positive predictive value of 89% and a negative predictive value of 61%. These findings confirm that plasma prolactin concentration is highly predictive of true epilepsy but barely predictive of pseudoseizures.     

Pathophysiology of urinary dysfunction in multiple sclerosis

Neurological Sciences - Bladder and urethra are innervated peripherally by pelvic parasympathetic, lumbar sympathetic and pudendal nerves; but a complex of brain networks is involved in the...     

Stable preference for high ethanol concentrations after ethanol deprivation in Sardinian alcohol-preferring (sP) rats.

Results of a recent study have demonstrated that exposure to multiple ethanol concentrations and repeated ethanol deprivation periods in Indiana ethanol-preferring (P) rats resulted in the development of an alcohol deprivation effect (ADE; the temporary increase in voluntary ethanol intake after a period of deprivation from ethanol) characterized by consumption of intoxicating amounts of ethanol. The current study was designed to possibly extend these results to Sardinian alcohol-preferring (sP) rats, generated with the same selective program previously used for P rats. To this aim, ethanol-naive sP rats were exposed initially to the home cage four-bottle choice [10%, 20%, and 30% (vol./vol.) ethanol solutions and water] for eight consecutive weeks. Subsequently, rats were divided into two groups: The first group had continuous access to the four-bottle regimen (nondeprived rats), and the second group was exposed to five cycles of 14-day periods of deprivation from ethanol and 14-day periods of reexposure to the four-bottle regimen. An ADE developed after each deprivation period. However, the extra intake of ethanol was limited to the first hour of each reaccess period. Magnitude of ADE did not change with repeated periods of deprivation. However, a shift in preference toward the two highest concentrations of ethanol solutions was evident from the first reexposure to ethanol and was maintained throughout the study. These results provide further evidence on the heterogeneity of ethanol-drinking behavior among rat lines selectively bred for high ethanol preference and consumption.