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.     

Rupture of the posterior tibial tendon: CT and surgical findings

Computed tomography (CT) was performed in 42 patients with 49 clinically suspected tears of the posterior tibial tendon. Twenty-eight of the 49 suspected tears were subsequently surgically explored and repaired. Three patterns of tendon abnormalities were recognized on CT scans: type I-intact, hypertrophied, heterogeneous tendon; type II-attenuated tendon; and type III-absence of a portion of a tendon. Types I and II correlated with partial rupture seen during surgery, and type III correlated with complete rupture of the tendon. CT findings were accurate in 96% of the patients who underwent surgery. In four cases (14%), tendon rupture was seen on CT scans, but the extent of the injury was underestimated and the rupture was misclassified. Reactive periostitis of the distal tibia was seen in 71% of diseased tendons and may represent an important factor in the diagnosis of tendon rupture.     

Development of an <Emphasis Type="Italic">In Vitro</Emphasis> Digestion Model for Estimating the Bioaccessibility of Soil Contaminants

Soil ingestion can be a major route of human exposure to many immobile soil contaminants. The present risk assessment is based on toxicity studies in which contaminants are typically ingested in liquid or food matrices. The difference in bioavailability of contaminants ingested in a soil matrix is not taken into account. To become bioavailable, contaminants first need to become bioaccessible, i.e., they must be mobilized from the soil during digestion. Soil contaminants may be less bioaccessible than contaminants from liquid or food, so that the risks can be overestimated. This article describes the development of an in vitro human digestion model that is physiologically based. It can be used as a tool to assess bioaccessibility. We explain the rationale behind the experimental design of the model. We address the aspects of the simulated compartments of the gastrointestinal tract, temperature, soil-to-fluid ratio, ratio of digestive juices, transit times, centrifugation, pH values, mixing, constituents and their concentrations, and bile. The optimized in vitro digestion model was applied in a case study. The bioaccessibility of lead in pottery flakes with glazing was determined and compared to the bioaccessibility of lead in the soil from which the pottery flakes were removed. The data indicate that pottery flake lead is considerably less bioaccessible (0.3 ± 0.2%) than lead in soil without pottery flakes (42–66% at the same site, and 28–73% at other sites in the same town). Furthermore, bioaccessibility values of lead in soil appear to be less than calculated bioaccessibility values for dietary lead (which are based on the criterion used by the Dutch risk assessment and on literature absorption data). This indicates that accounting for the matrix of ingestion can affect the exposure assessment for lead. The in vitro digestion model is a promising tool for studying the effect of the ingestion matrix on bioaccessibility. Received: 23 December 2001/Accepted: 24 July 2002     

Clinically diagnosed axis II co‐morbidity and the short term outcome of CBT for axis I disorders

Earlier studies found that the effectiveness of CBT for anxiety disorders and depression is not negatively affected by the presence of co‐morbid axis II disorders (for reviews, see Mulder, 2002; Dreessen & Arntz, 1998). That is to say, patients with co‐morbid axis II disorders tend to have more severe complaints post‐therapy, but they already have complaints before therapy and the decrease in symptoms is not affected by axis II disorders. In these studies the presence of axis II disorders was assessed using structured interviews. Compared to the more usual open clinical interview, structured interviews tend to result in larger proportions of the patients receiving a diagnosis of one or more personality disorders. Possibly the inclusion of many relatively mild cases obscured a negative effect of personality disorders and such a negative effect might materialize if axis II disorders were assessed with a open clinical interview. In the present study, data were analyzed from 421 patients, 289 of whom received a diagnosis of one or more personality disorders. Axis I diagnoses were obsessive–compulsive disorder (n = 165), panic disorder with agoraphobia (n = 54), major depression (n = 40), eating disorders (n = 42) or other disorders (n = 120) and CBT was delivered on an in‐patient basis. When all groups were collapsed and a general measure of axis I problems was taken, the pattern was similar to the pattern from studies using structured interviews: patients with axis II problems had higher axis I problems both before and after treatment, but the decrease was parallel. When analyzed separately patients with axis II disorders did not score higher than patients without axis II disorders, while improvement in the various axis I groups was not affected by the presence of personality disorders. In the depressed subgroup a trend was observed for patients with axis II disorders to improve less. Even when personality disorders are diagnosed using an open clinical interview, their presence is largely irrelevant to the reduction of axis I problems after CBT. Copyright © 2006 John Wiley & Sons, Ltd