Can aggressive treatment of diabetic foot infections reduce the need for above-ankle amputation?

We retrospectively evaluated the charts of 112 patients with diabetic foot infection to determine if early aggressive surgical intervention improves outcome. All patients were classified into two groups on the basis of the timing of surgical intervention and appropriate antimicrobial therapy. Group I included patients who underwent no surgical intervention during the first 3 days of hospitalization but received intravenous antimicrobial therapy, and group II included patients who underwent surgical intervention promptly and received intravenous antimicrobial therapy. Group II was further divided; group IIA included patients who underwent debridement, and group IIB included patients who underwent local limited amputation. A higher rate of patients in group I than in group II (27.6% vs. 13%, respectively; P < .01) required above-ankle amputation during the same hospitalization or subsequent admission. Overall, an aggressive surgical approach against foot infection in hospitalized diabetic patients reduced the need for above-ankle amputation and the length of hospital stay by at least 6 days. Treatment of diabetic foot infection requires the combination of early surgical treatment and antimicrobial therapy.

Arthroscopic excision of symptomatic medial plica. A study of 118 knees with 1-4 year follow-up.

We retrospectively reviewed 93 patients (118 knees) treated by arthroscopic excision of painful medial plica. A scoring scale 0-100 was used to evaluate the symptoms. After an average of 2 (1-4) years, 109 of 118 knees had little, if any, pain and the average improvement in the score was 41 points. Thus arthroscopic excision of a painful medial plica can provide lasting and satisfactory relief of symptoms.

A comparative study of early motion and immediate plaster splintage after internal fixation of unstable fractures of the ankle.

We reviewed 47 patients following operatively treated ankle fracture-dislocation, at an average of 15 months after injury, to assess the outcome of two different postoperative regimens. Of the 47 patients, 27 received early active and passive ankle exercises, and 20 patients received immediate plaster splintage. Patients were assessed clinically by an independent surgeon and subjective, objective and radiological criteria recorded. No significant difference was apparent between the two groups on any of the criteria, although the early movement group contained more patients who were completely pain free, had a normal gait and no radiological signs of arthrosis (P < 0.05). This was achieved at the expense of a longer stay in hospital (average 10.2 days versus 7.4 days for plaster splintage) and more ankle swelling.

Endometriosis in gluteus muscle with surgical implantation. A case report.

Intrapelvic endometriosis is a fairly common condition affecting women during their reproductive years. Extrapelvic disease is, however, very rare. We report a case where an endometrioma was found in the body of the gluteus minimus muscle, and endometrial tissue was implanted in the wound at the time of excision.

Perineural fibrosis of superficial peroneal nerve complicating ankle sprain: a case report.

The peroneal nerve is susceptible to traction injury during inversion ankle sprains. Previously, these traction lesions have been identified only at the fibular neck and popliteal fossa level. This report illustrates a previously unreported condition of perineural fibrosis of the superficial peroneal nerve at the level of the ankle following an inversion ankle sprain. Perineural fibrosis should be considered in the differential diagnosis of patients with persistent pain after ankle sprain.

Aspergillar osteomyelitis of the acetabulum. A case report and review of the literature.

An unusual case of primary osteomyelitis of the acetabulum caused by Aspergillus flavus in a presumed immunocompetent adult is presented. Review of the literature found 25 additional cases of aspergillar osteomyelitis, which occurred predominantly in hosts with either inborn or acquired immune defects. There were notable differences between the adult and the pediatric cases in causation, clinical presentation, and treatment regimens. In children, the underlying cause was usually severe immunocompromise; among adults, the majority of cases occurred in hosts presumed to be immunocompetent. In all but one case, the children were treated with antifungal chemotherapy alone, whereas the adult patients nearly always received surgical debridement in conjunction with chemotherapy.

Reconstruction for chronic anterior cruciate instability. A comparison of two methods after six years.

Forty-seven patients with disabling instability due to isolated anterior cruciate deficiency are described. None had responded to conservative measures or to attempted correction of internal derangements. Eighteen patients were treated by extra-articular MacIntosh lateral substitution alone, the other 29 were treated by the same procedure combined with carbon-fibre replacement of the anterior cruciate ligament. No statistically significant difference was found between the two groups at six years. A satisfactory outcome was found in 44% of the extra-articular group and 55% of the carbon-fibre group at last review; however, the latter group had more complications. There was a marked deterioration in the quality of results between three and six years in both groups.

Ag-NOR staining in the Bennett wallaby, Macropus rufogriseus: evidence for dosage compensation.

Silver staining of cells in metaphase and interphase nuclei of both sexes of the Bennett wallaby, Macropus rufogriseus, has shown that (1) the nucleolus organizer region (NOR) is located only on the X chromosome (single Ag-NOR); (2) both X chromosomes in the female cells stain with silver; (3) the amounts of silver staining of metaphase chromosomes and interphase nuclei of both sexes are very similar; (4) the single X chromosome is hyperactive in male cells to equalize the expression of rRNA genes in the female cells with two X chromosomes; and (5) the mechanism of dosage compensation for rRNA genes in this species is similar to that reported for Drosophila salivary gland cells.

The isoelastic, noncemented total hip arthroplasty. Preliminary experience with 400 cases.

The first 400 patients having cementless isoelastic total hip arthroplasties with a polyacetyl femoral component stem were assessed by independent observers with a minimum review time of two years. Six percent of the patients had died at the time of review; these were mainly elderly patients with subcapital fractures. Ninety-seven percent of the surviving patients appeared for a complete clinical and radiological review. Ninety-two percent of these patients considered that they had a good result following surgery. Six patients (1.6%) developed infection, and three patients (0.8%) required revision procedures, two for femoral loosening and one for recurrent dislocation. Two (0.5%) acetabular components were loose, one of which was associated with infection. In the initial part of the series with narrow-diameter, second-generation femoral components, some had subsided and tilted into varus, but with improved instrumentation and availability of wider diameter femoral components, this problem has been overcome. In order to obtain a more secure mechanical fixation of the femoral component in the medullary canal and to increase implant-bone interface, the third-generation femoral components were used in the latter 48 cases of the series, and clinical and radiological results were excellent with corresponding reduction in the recommended period of gait support. No component had broken. Femoral fractures incurred during surgery by dislocation or impaction had all healed with routine management. These early results are encouraging, but the effectiveness of this prosthesis must be determined by longer follow-up data.

Salivary beta-thromboglobulin: a possible marker for deep vein thrombosis following elective hip surgery.

The concentration of the platelet specific protein B-thromboglobulin, (BTG) was measured in salivary samples obtained pre and postoperatively from 30 patients without evidence of renal disease and having total hip replacement arthroplasty. When postoperative deep-vein thrombosis (DVT) was detected using percutaneous ascending phlebography there was total correlation with elevated salivary BTG levels taking 0.33 micrograms/1 or greater on 2 consecutive occasions or more as indicating a deep venous thrombus. Eight of nine patients with a positive diagnosis of DVT on urokinase scanning would have been diagnosed using the same criterion. However BTG was elevated in a further 5 patients in whom labelled urokinase failed to demonstrate a DVT. These may have been localised in the calf and thus missed by, or lysed prior to, the scanning technique.

Metastatic carcinoma presenting as a pulp space infection.

A metastasis in a terminal phalanx which presented with the clinical features of a pulp space infection is described. The primary was a carcinoma of the esophagus.

Arthroscopy and the management of the ruptured anterior cruciate ligament.

There four indications for arthroscopy in patients with ruptures of the anterior cruciate ligament: (1) assessment of the acutely injured knee, which will usually have a hemarthrosis; (2) assessment of the knee with late symptoms following ligament injury; (3) a preliminary to ligament reconstruction to assess the integrity of the menisci; (4) the assessment of patients who have symptoms following ligament reconstruction. Many patients achieve a good result after arthroscopic correction of meniscal lesions and other derangements without ligament reconstruction. Repair of all acutely ruptured anterior cruciate ligaments will result in many unnecessary ligament repairs. Assessment of acute ligament repairs is made difficult by the absence of a controlled series. The criteria for distinguishing those patients who need ligament reconstruction from those who will do well with aggressive conservative management alone have yet to be established. A prosthetic ligament can be inserted under arthroscopic control without arthrotomy, but no suitable prosthetic material is yet available.