Medication noncompliance: a significant problem and possible strategies.

Medication noncompliance is a significant public health problem with both economic and quality of life dimensions. The physician should be aware of the frequency of the occurrence and develop strategies to reduce its incidence. This includes simplification of prescription practice, patient education and adequate instructions. The physician has to accept the role of a motivator as a part of the education process.

Computerized blood flow analysis for decision making in the treatment of osteochondritis dissecans.

Patients presenting the radiologic appearance of osteochondritis dissecans (OCD) require a decision as to further treatment. This often requires an invasive procedure. The noninvasive technique of computerized blood flow analysis (CBFA) has been used in 13 patients with OCD. In clinically early disease (four patients), there is always decreased flow in the area distal to the OCD lesion. Patients with intermediate OCD (four patients) showed characteristics of healing reflected in increased flow to the OCD lesion. These patients were left under observation and underwent spontaneous healing. Patients who showed no increase in flow or had decreased flow in the area of involvement (four patients) were clinically found to be nonviable OCD and required surgical intervention. The technique of CBFA therefore holds promise for decision making in the management of this disease.

Dynamic bone scintigraphy in osteochondritis dissecans.

We report a retrospective study of eighteen patients with pain in the knee or ankle, eleven of whom had osteochondritis dissecans. In these patients the bone-flow time-activity curves were observed after an intravenous injection of a bolus of 99mTc MDP. The curves varied according to the severity of the clinical signs and symptoms. The diagnosis rate was 29% with static scintigraphy and this improved to 57% when dynamic flow studies were used. A positive pattern in the dynamic study together with radiographs and static scintigraphs raised the diagnosis rate to 100%; the sensitivity was 90%. These preliminary results show that dynamic bone scintigraphy holds promise as a technique for identification and management of this condition.

Computerized blood-flow analysis in osteochondritis dissecans.

A retrospective review of static images and computerized blood flow studies (CBFS) in patients with osteochondritis dissecans (OCD) suggests that CBFS maybe useful in following the clinical course of this disease.

Compartment syndrome associated with Staphylococcus endotoxin.

A case is presented of a 23-year-old athletic male student who developed right knee pain after a weekend of strenuous activity. The patient failed to respond to conservative measures; pain increased and within 24 hours he developed fever, chills and swelling of the involved knee. On admission to the hospital, the patient appeared toxic. Efforts to establish a diagnosis, particularly with the use of computerized axial tomography are described. It was surgical decompression of muscular swelling of the distal thighs, revealed by CT scanning, that led to the diagnosis and the successful treatment that followed.

Slipped capital femoral epiphysis: factors affecting shear forces on the epiphyseal plate.

Very little is known regarding the magnitude of physiological shear forces in the normal capital femoral epiphyseal plate. Changes in these forces related to deformities in the proximal femur have been postulated to increase significantly the shear forces and predispose to slipped epiphysis. By force analysis techniques, a three-dimensional model has been developed to study the change in shear forces that might be expected from abnormal angulation in the frontal and sagittal planes. This study suggests that within the range of normal activity, shear forces on the epiphyseal plate are well below the critical values required to cause a slip. Angular deformities of up to 30 degrees in either the frontal or sagittal planes, by themselves, are unlikely to raise these forces to a critical value.

Surgical correction of spastic thumb-in-palm deformity.

A series of 31 operations on 27 patients for correction of the spastic thumb-in-palm deformity is reported. 19 patients were followed four years or longer post-operatively; the remainder have been followed for at least one year. In approximately 70 per cent of the operations, supplementary procedures were performed on the hand or forearm, as the deformity is usually only one facet of a complex spastic disability of the upper extremity. The surgical technique and illustrative cases are presented. Augmentation of a markedly weak extensor-abductor motor function is necessary, otherwise the spastic thumb-in-palm deformity will recur, as in two cases in the present series which required a second operation. The remainder of the patients were classified as improved, indicating that the thumb was no longer clenched in the palm, could be used in gross grasping activities, and the hand had become more useful. In no instance did the spastic hand become the primary functioning hand post-operatively.