Competitive water polo. Upper extremity injuries.

Water polo is a contact sport combining the skills of swimming, swim conditioning, throwing and, occasionally, the elements of wrestling and boxing. As such, the athletes frequently sustain upper extremity injuries involving the shoulder, the elbow, or the hand and fingers; moreover, injuries may result from either overuse or acute trauma. Successful treatment of these injuries requires an understanding of the peculiarities of the game and the likely mechanisms of injury, and the experience to properly recognize when they occur.

Legionella pneumophila serogroup Lansing 3 isolated from a patient with fatal pneumonia, and descriptions of L. pneumophila subsp. pneumophila subsp. nov., L. pneumophila subsp. fraseri subsp. nov., and L. pneumophila subsp. pascullei subsp. nov.

Previous DNA relatedness and enzyme electrophoretic mobility studies indicated heterogeneity among strains of Legionella pneumophila serogroups 1, 4, 5, and Lansing 3 (a new, as yet unnumbered serogroup). In this study 60 L. pneumophila strains were studied by DNA hybridization (hydroxyapatite method) to assess their genomic relatedness. These strains were also studied biochemically and serologically to determine whether they formed one or more phenotypic groups. DNA relatedness studies identified three groups. DNA group 1 contained the type strain Philadelphia 1 and strains from serogroups 1 through 14 of L. pneumophila. The average relatedness of DNA group 1 strains was 88% at 60 degrees C with 1.1% divergence in related sequences and 85% at 75 degrees C. DNA group 2 contained strain Los Angeles 1, the reference strain of serogroup 4, and strains of serogroups 1, 4, 5, and Lansing 3, an unnumbered serogroup. Average relatedness of DNA group 2 strains was 84% at 60 degrees C with 0.7% divergence and 87% at 75 degrees C. Reciprocal relatedness of DNA groups 1 and 2 was approximately 67% at 60 degrees C with 6.0% divergence and 48% at 75 degrees C. DNA group 3 strains were in serogroup 5. They were 98% related at 60 degrees C with 0.5% divergence and 97% related at 75 degrees C. Reciprocal relatedness of DNA group 3 and DNA group 1 was approximately 74% at 60 degrees C with 5.3% divergence and 43% at 75 degrees C, and reciprocal relatedness of DNA groups 3 and 2 was 66% at 60 degrees C with 5.7% divergence and 55% at 75 degrees C. The DNA groups could not be separated biochemically or serologically or by cell wall fatty acid and isoprenoid quinone composition. Three subspecies of L. pneumophila are proposed to accommodate the three DNA groups: L. pneumophila subsp. pneumophila subsp. nov. for DNA group 1, L. pneumophila subsp. fraseri subsp. nov. for DNA group 2, and pneumophila subsp. pascullei subsp. nov. for DNA group 3.

Posteromedial dislocation of the ankle without fracture.

We report the results of treatment in eight patients who had posteromedial dislocation of the ankle without fracture. The ages of seven of the eight patients ranged from twenty-three to thirty-six years. Four patients had increased generalized ligamentous laxity. One-half of the injuries were sustained during athletic competition. The mechanism of injury appeared to be forced inversion of the foot when it was maximally plantar flexed and axially loaded. Five of the eight patients had an open injury, and four of the five patients had an associated injury to the anterolateral neurovascular structures. No patient had an injury to the distal tibiofibular ligaments or to the syndesmosis. The three patients who had a closed dislocation achieved good long-term functional and roentgenographic results after closed reduction and immobilization. The patients who had an open injury that was treated by anatomical repair of the disrupted lateral ligaments at the time of initial débridement also achieved good long-term functional and roentgenographic results. It does not appear to be necessary to repair the deltoid ligament. In one patient who had an open dislocation and in whom the lateral ligaments were not repaired, moderate instability of the ankle resulted and degenerative changes developed in the joint.

Reasonable expectations following arthroscopic surgery.

The primary determinant of the ultimate outcome of surgery is the nature of the underlying disease. The current applications of arthroscopic surgery to various disease entities are reviewed and the results that can reasonably be expected with each are summarized. As time goes on, the number of diseases that can be treated arthroscopically and the efficacy of treatment will continue to improve.