Poor outcome after a surgically treated chondral injury on the medial femoral condyle: early evaluation with dGEMRIC and 17-year radiographic and clinical follow-up in 16 knees

Background and purpose — The optimal treatment for traumatic cartilage injuries remains unknown. Contrast-enhanced MRI of cartilage (dGEMRIC) evaluates cartilage quality and a low dGEMRIC index may predict radiographic osteoarthritis (OA). The purpose of this study was (a) to explore the results 17 years after surgical treatment of an isolated cartilage knee injury and (b) to evaluate the predictive value of dGEMRIC.

Patients and methods — 16 knees with an isolated traumatic cartilage injury of the medial femoral condyle had cartilage repair surgery either by microfracture or autologous cartilage implantation. dGEMRIC of the injured knee was performed 2 years after surgery and radiographic examinations were performed 17 years after the operation.

Results — Radiographic OA was present in 12 of 16 knees. Irrespective of surgical method, the dGEMRIC index was lower in repair tissue compared with adjacent cartilage in the medial compartment, 237?ms vs. 312?ms (p < 0.001), which in turn had lower value than in the non-injured lateral cartilage, 312?ms vs. 354?ms (p < 0.008). The dGEMRIC index in the cartilage adjacent to the repair tissue correlated negatively with radiographic osteophyte score, r = –0.75 (p = 0.03).

Interpretation — A traumatic cartilage injury is associated with a high prevalence of OA after 17 years. The low dGEMRIC index in the repair tissue 2 years postoperatively indicates fibrocartilage of low quality. The negative correlation between the dGEMRIC index in the adjacent cartilage and future OA suggests that the quality of the surrounding cartilage influences outcome after cartilage repair surgery.     

Physiologic Effects of the TASER After Exercise

Objectives: Incidents of sudden death following TASER exposure are poorly studied, and substantive links between TASER exposure and sudden death are minimal. The authors studied the effects of a single TASER exposure on markers of physiologic stress in humans. Methods: This prospective, controlled study evaluated the effects of a TASER exposure on healthy police volunteers after vigorous exercise, compared to a subsequent, identical exercise session that was not followed by TASER exposure. Subjects exercised to 85% of predicted heart rate (HR) on an ergometer and then were given a standard 5-second TASER activation. Measures before and for 60 minutes after the TASER activation included minute ventilation, tidal volume, respiratory rate, end-tidal pCO₂, oxygen saturation, HR, blood pressure (systolic BP/diastolic BP), 12-lead electrocardiogram, and arterialized blood for pH, pO₂, pCO₂, and lactate. Each subject repeated the exercise and data collection session on a subsequent data, without TASER activation. Data were analyzed using paired Student’s t-tests with differences and 95% confidence intervals (CIs). Statistical significance was adjusted for multiple comparisons. Results: A total of 25 officers (21 men and 4 women) completed both portions of the study. After adjusting for multiple comparisons, the TASER group was significantly higher for systolic BP at baseline (difference of 14.1, 95% CI = 8.7 to 19.5, p < 0.001) and HR at 5, 30, and 60 minutes with the largest difference at 30 minutes (difference of 7.0, 95% CI = 2.5 to 11.5, p = 0.004). There were no other significant differences between the two groups in any other measure at any time. Conclusions: A 5-second exposure of a TASER following vigorous exercise to healthy law enforcement personnel does not result in clinically significant changes in ventilatory or blood parameters of physiologic stress.     

Percutaneous fluoroscopic removal of a knotted Swan–Ganz catheter in a patient with a persistent left‐sided superior vena cava

Knotting of intravascular catheters is an uncommon but a well‐recognized occurrence. The Swan–Ganz catheter (SGC) is the one that knots most commonly. A case of a knotted SGC is described in a patient with a persistent left‐sided superior vena cava, and we propose that the presence of a left‐sided superior vena cava is a risk factor for knot formation not previously reported. We review the published work on the risk factors for knot formation and on the techniques used to remove knotted SGC. We describe a technique using a gooseneck snare and Omni Flush catheter (Angiodynamics, Queensbury, NY, USA) to loosen and untie a knotted SGC.     

Fertility before and after surgery for primary ovarian pregnancy

Primary ovarian pregnancy usually occurs in parous fertile women. It is an accidental event probably related to the presence of the IUD affecting implantation rather than an indicator of altered fertility. Reproductive performance postoperatively remains unmodified.     

Superior vena cava syndrome associated with lymphoma.

OBJECTIVE--To evaluate the workup and treatment of children with lymphoma and superior vena cava syndrome. DESIGN--A retrospective survey. SETTING--State hospital serving as a secondary and tertiary referral center for pediatric oncology and pediatric cardiac surgery. PARTICIPANTS--Eleven children aged 11 months to 12 years diagnosed as having lymphoma or T-cell acute lymphoblastic leukemia who presented with superior vena cava syndrome during an 11-year period. INTERVENTIONS--Lymph node biopsy (two patients), thoracenthesis (five patients), bone marrow aspiration (two patients), and thoracenthesis in addition to bone marrow aspiration (two patients). All aspirates were evaluated with immunohistochemical studies. Chemotherapy was the only management intervention. RESULTS--T-cell lymphoma or leukemia accounted for nine cases and Hodgkin's disease for two cases. Respiratory symptoms occurred in 10 patients, including tracheal compression in six patients (compression was life-threatening in one patient). Diagnosis of superior vena cava syndrome was achieved in eight patients using surface-marker analysis of aspirates. The syndrome disappeared within 2 to 10 days. Seven of nine children whose conditions were diagnosed more than 1 year before this writing were alive and free of disease after mean follow-up of 37 months. CONCLUSIONS--(1) A specific diagnosis can be achieved in most children with superior vena cava syndrome and lymphoma; (2) Thoracic computed tomographic scans are essential, identifying minute pleural effusions that can aid diagnosis; (3) Anesthetic hazard is related only to severe tracheal compression; (4) Chemotherapy achieves excellent symptomatic relief; and (5) Long-term survival, without disease, is achievable.     

Colposuspension for urinary stress incontinence in premenopausal and postmenopausal women

Sixty-nine premenopausal and 53 postmenopausal women had a colposuspension operation for urinary stress incontinence. A significant postoperative reduction (p less than 0.001) of symptoms of frequency, nocturia, urgency and urge incontinence was obtained in both groups. Postoperatively, 88.4 per cent of the premenopausal women were found to be dry compared with 66 per cent in the postmenopausal group (p less than 0.01). No differences were found preoperatively and postoperatively in the cystometric values or in the urethral pressure profiles at rest in both groups and between the groups. The pressure transmission ratios were significantly improved postoperatively in both groups. The postoperative transmission ratios in the premenopausal women were found to be significantly higher than those in the postmenopausal group, at the middle two-quarters of the urethra. Although surgical treatment for urinary stress incontinence in postmenopausal women results in lower cure rates than in younger women, it should be considered.