Histologic anatomy of the triangular fibrocartilage.

The collagen arrangement of the triangular fibrocartilage complex was studied in 20 fresh cadaver wrists by means of standard and polarized light microscopy and scanning electron microscopy. The collagen fibres in the articular disk are arranged in undulating sheets oriented at oblique angles to each other. The fibers of the radioulnar ligaments are oriented longitudinally from the radial origin to the ulnar insertion. The origin of the articular disk from the radius is characterized by thick fibers 1 to 2 mm in length radiating from the radius into the articular disk. Five specimens were also injected with india ink. The radioulnar ligaments and the peripheral 15% to 20% of the articular disk are well vascularized, whereas the central 80% of the articular disk is avascular.

Clinical comparison of freeze-dried and fresh frozen patellar tendon allografts for anterior cruciate ligament reconstruction of the knee.

The aim of this study was to evaluate the clinical outcome of freeze-dried compared to fresh frozen allograft tissue used as a substitute for a ruptured ACL of the knee. In addition, the incidence of any graft rejection phenomena was recorded. Forty-one patients with ACL deficient knees underwent reconstructive surgery using a patellar bone-tendon-bone allograft that had been freeze-dried (Group 1, N = 14) or fresh frozen (Group 2, N = 27). All patients underwent the same implant technique and rehabilitation program. Followup ranged from 24 to 36 months. The evaluation consisted of subjective, objective, and instrumented laxity testing (KT-1000, MEDmetric, San Diego, CA; and Genucom, FARO Medical Technologies, Inc., Montreal, Canada). There were 31 males and 10 females. Eleven (79%) patients in Group 1 thought their knee was "normal" or "improved," and 25 (93%) in Group 2 thought the same. In addition, 10 (71%) patients in Group 1 denied any "giving way," compared to 26 (96%) in Group 2. The mean Lysholm knee score in Group 1 was 86/100 (range, 22 to 100) compared to 92/100 (range, 59 to 100). Clinical examination included the Lachman test and tests for anterior drawer sign and pivot shift. Postoperatively, Group 1 patients had the following results: Lachman test--seven Grade 0, six Grade 1, one Grade 2; anterior drawer sign--eight Grade 0, five Grade 1, one Grade 2; and pivot shift--seven Grade 0, five "trace," and two "present."(ABSTRACT TRUNCATED AT 250 WORDS)

Direct coronal computed tomography arthrography of osteochondritis dissecans of the talus.

Although radiographs, arthrography, tomography, and computed tomography can all be used to diagnose osteochondritis dissecans of the talus, these imaging methods may not demonstrate whether an undisplaced osteochondral fragment has any attachment to the articular cartilage or bony bed of the talus. As lack of such attachment is a relative indication for surgery, we studied the feasibility of using coronal computed tomography (CT) after double contrast arthrography to demonstrate attachment in four patients with osteochondritis dissecans seen on radiographs. Direct coronal CT arthrographic images showed intact articular cartilage in three patients. In the fourth patient, overlying cartilage was virtually absent and contrast tracked beneath the fragment, an appearance that correlated with arthroscopic findings of partial articular cartilage attachment and no union at the osteochondral fracture line. Our initial experience suggests that direct coronal CT arthrography clearly shows the state of attachment of the osteochondritic fragment to the talus.

A perspective of lesions associated with ACL insufficiency of the knee. A review of 100 cases.

A retrospective study was conducted to survey the extent of intracapsular damage associated with ACL insufficient knees in both the acute and chronic situation. Previously unoperated knees were studied to assess the effect that reinjury had on the knee joint. One hundred patients with confirmed anterior cruciate ligament damage, both clinically and under general anesthesia, were examined arthroscopically and the findings recorded on video tape. Both anterolateral and posteromedial approaches were used to well visualize the entire intra-articular structures of the knee joint. The incidence of meniscal tears increased from 77% in the acute injury to 91% in the chronically reinjured knee (p less than .06). Furthermore, articular surface disease increased from 23% in the acute injury to 54% in the chronically ACL lax knee (p less than .002). The majority of meniscal tears were medial and amenable to peripheral suture repair (63%). Irrespective of how one approaches ACL insufficiency of the knee acutely, one cannot ignore the likelihood of finding these significant associated lesions. Reinjury to the knee will likely enhance the incidence of meniscal tears and articular changes.

Girdlestone arthroplasty for infected total hip arthroplasty.

Results of a previous study of 21 patients who underwent conversion of infected total hip arthroplasties to Girdlestone resection arthroplasties suggested that Girdlestone resection arthroplasty provides a functionally poor salvage technique and is often painful. The present study was undertaken to assess further the salvage value of Girdlestone arthroplasties for the treatment of infected total hips. Fourteen additional cases were reviewed, summarizing the clinical experience of the past three years. These more recent data support the conclusion that resection arthroplasty provides a poor functional result when used as a salvage procedure following removal of infected total hip components. Of the 14 patients reviewed, only one obtained an acceptable functional result. The initial 21 patients studied were re-reviewed to obtain further follow-up data. The functional results obtained were essentially unchanged and are comparable with those from the series of 14 patients reviewed in this study. In some cases of infected total hip arthroplasty, resection arthroplasty is the best method of treatment available, but the results are often far from ideal. Direct or indirect prothesis exchange is an alternative in some cases. Total hip arthroplasty should not be recommended for the young patient who has one or two joint diseases and no limiting systemic factors, with the expectation that when the total hip fails, it can be converted to a resection arthroplasty and the patient improved as compared with the pre-total hip status. It may be wiser to utilize another procedure, e.g., fusion, resection arthroplasty, or osteotomy, primarily, and then revise to a total hip, if necessary, when the patient is older.

Studies on acid lipase, and E 600-resistant acid esterase activities in human tissue homogenates.

Detailed comparison of acid lipase and acid esterase activities of human spleen, liver and kidney homogenates has been carried out by means of the following substrates: 14C-tripalmitin, alpha-naphthyl acetate, alpha-naphthyl butyrate, alpha-naphthyl laurate, p-nitro-phenyl acetate, butyrate and laurate. In addition, homogenates of the three tissues were subjected to isoelectric focusing in polyacrylamide gels and histochemical staining with the above mentioned naphthyl substrates in the presence and absence of the organophosphate esterase inhibitor diethyl-p-nitrophenyl phosphate (E 600). These studies provide extensive support for the proposal that E 600-resistant acid naphthyl butyryl and lauryl esterase activities in human tissues derive largely from the enzyme acid lipase. The studies suggest that the most specific chromogenic substrate for this enzyme at a biochemical and histochemical level is alpha-napthyl laurate in the presence of E600 (3 X 10(-6) M).

Therapeutic trial of aniline mustard in patients with advanced cancer. Comparison of therapeutic response with cytochemical assessment of tumor cell beta-glucuronidase activity.

Seventy-eight patients with advanced cancer received an adequate therapeutic trial with aniline mustard (NSC 18429). Significant anticancer activity with clinical benefit was demonstrated in five patients with cancer of the prostate and one patient with renal cancer. beta-glucuronidase levels in aspirate and imprint preparations of tumor cells were assessed by a timed cytochemical technique. A partial correlation appeared to exist between very intense glucuronidase staining and tumor regression in prostate and kidney lesions; however, these high levels were observed only rarely. Sequential observations in two patients demonstrated loss of enzymatic activity concomitant with development of clinical relapse.

Use of cationic disc electrophoresis near neutral pH in the evaluation of trace proteins in human plasma.

Cationic discontinuous electrophoresis can be carried out at pH 6.0 With excellent resolution in urea-containing acrylamide gels with potassium as the leading ion, 3-picoline as the trailing ion, and cacodylic acid as the buffer. This analytic technique has consistently demonstrated trace protein abnormalities in plasma or serum from febrile patients. It has made possible the detection of three protein bands that were obscured in similar electrophoretic assays at pH 3.8 A rough parallelism is found in the plasma (or serum) content of the five protein bands regardless of the apparent clinical cause of the febrile state.