Malignant hyperthermia associated with exercise-induced rhabdomyolysis or congenital abnormalities and a novel RYR1 mutation in New Zealand and Australian pedigrees.

Malignant hyperthermia (MH) is rarely associated with specific myopathies or musculoskeletal abnormalities. Three clinical investigations of MH associated with either non-specific myopathies or congenital disorders in three separate families are presented. Two of these cases also show evidence of exercise-induced rhabdomyolysis. In each case MH susceptibility was confirmed by in vitro contracture testing of quadriceps muscle. DNA sequence analysis of each kindred revealed the presence of a common novel mutation that results in an arginine401-cysteine substitution in the skeletal muscle ryanodine receptor gene (RYR1). Haplotype analysis using chromosome 19q markers indicated that the three families are likely to be unrelated, providing confirmation that the MH/central core disease region 1 of RYR1 is a mutation hot spot.

Stanmore compared with Charnley total hip replacement. A prospective study of 413 arthroplasties.

From 1982 to 1987, we randomised prospectively 413 patients requiring primary total hip replacements to receive either a Stanmore or Charnley prosthesis. They were reviewed by an independent observer in an attempt to correlate a number of factors including femoral head size with longevity. There were 213 Stanmore hips and 200 Charnley prostheses. At five to ten years (mean 6.5) 76 patients had died and 16 arthroplasties had required revision. Seven were radiologically loose in asymptomatic patients. There was only one case of deep infection. We found no difference statistically in the clinical outcome or in the revision rate of 4% in the two types of prosthesis. The revision rate was greater for trainees than for senior operating surgeons, and there were recognisable technical errors in seven of the nine Stanmore, and four of the seven Charnley replacements which required revision. Retrospective radiological analysis of a random subset of 51 Charnely and 57 Stanmore femoral components showed no difference in femoral subsidence, but in 14 patients who had had bilateral replacements with one femoral component of each type, there was greater early subsidence of the Stanmore prosthesis. Our results confirm that conventional cemented total hip replacements give acceptable results in a general teaching unit, and we found no evidence of any effect of the size of the femoral head on wear or loosening at five to ten years.

Late presentation of bilateral habitual dislocation of the patella on flexion.

We describe the case of a 56-year-old woman who, despite having bilateral habitual dislocation of the patella, remained asymptomatic until an injury to her left knee. We suggest that there is a need for a randomized study to evaluate the results of surgical and nonsurgical treatment.

Extra-articular tenodesis for anterior cruciate deficient knees: a review of the Ellison repair.

Twenty-two patients who underwent an Ellison extra-articular tenodesis for anterolateral instability of the knee, performed by one surgeon (SCC), have been reviewed after a mean follow-up of 59 months. Seventy-seven per cent had a good or excellent result enabling them to return to their pre-injury level of sport. These results compare very favourably with intra-articular repair but are not associated with such severe complications.

Employees' views of their work experience in private hospitals.

Employees in 10 private for-profit hospitals responded to questionnaires regarding their work experiences, hospital facilities, and employer. Replicated results identified themes of employee opinions, including: Supervision, The Employer, Role Significance, Hospital Image, Competitiveness, Benefits, Cohesiveness, and Work Load. Only scores on the Role Significance scale differed between clinical and non-clinical respondents, with the former scoring higher. Survey methodology can be used to define an organization's culture from the employee's viewpoint. Their perception of this culture helps determine their behavior at work and their conveying the image of their facility in the community. The recent emphasis on quality improvement and 'bottom-up' management presents a particularly well-suited opportunity for the effective use of surveys. Quality improvement efforts involve employee groups which empower workers as active diagnosticians, internal consultants, and decision markers. Survey defined 'action levers' portray avenues along which such constructive efforts might be directed. Also, surveys identify themes through which management can evaluate organizational performance overall and department by department, building in means by which those responsible for units of the hospital can be accountable for achieving measurable results.

Synovial cyst of a lumbar facet joint: a rare cause of back pain and sciatica. Report of two cases.

Intraspinal synovial cysts, sometimes referred to as ganglion cysts, are uncommon lesions which may present as acute or chronic low back pain, with or without radicular symptoms. We present two patients who presented with back pain and radicular symptoms attributable to the unusual pathology of an intraspinal synovial cyst.

Alcohol-related hand injuries: an unnecessary social and economic cost.

Severe hand injuries constitute the largest number of acute referrals to this plastic surgery unit, the admission of these patients often displacing routine admissions due to bed shortages, thus increasing waiting list time. This study showed that a high percentage of these injuries were alcohol-related and were therefore preventable. The economic cost to the unit is discussed.

The combination of liquid crystal thermography and duplex scanning in the diagnosis of deep vein thrombosis.

One hundred patients with clinically suspected deep vein thrombosis (DVT) were studied by liquid crystal thermography (LCT), duplex scanning and venography. Liquid crystal thermography was found to have a negative predictive value of 97% if performed within 1 week of the onset of symptoms. Duplex scanning had a sensitivity of 93% and specificity of 91% for all thrombi (proximal and calf). On the basis of these results a plan of investigation has been formulated that would avoid duplex scanning and venography in 39 of the 100 patients. Duplex scanning alone would be appropriate in 56 of the remaining 61 patients. Only six patients would be unsuitable for duplex scanning because of a very tense tender leg and require venography. The plan would miss one calf thrombus and result in treating three patients unnecessarily. This policy would be not only effective but also cost-effective.

Levels and sources of fat in the U.S. food supply.

The amount of fat in the U.S. food supply increased one-third between 1909-13 and 1984, from 124 grams to 166 grams per capita per day. Also, the proportion of food energy provided by fat increased from 32 to 43 percent. The gain in fat in the food supply was due to an increase in fat from vegetable sources. The share of fat from vegetable sources increased from 17 to 42 percent between 1909-13 and 1984. Although animal fats provided the largest share of fat, their proportionate contribution declined from 83 to 58 percent between 1909-13 and 1984. Three food groups--fats and oils; meat, poultry, and fish; and dairy products--provided about 90 percent of the fat in the food supply throughout the past 75 years. However, the shares of fat provided by these groups changed. The share from the fats and oils group increased from 37 to 44 percent between 1909-13 and 1984, while the share from the meat, poultry, and fish group declined from 37 to 34 percent, and the share from the dairy products group declined from 15 to 12 percent. Fat from the fats and oils group increased 59 percent between 1909-13 and 1984. Most of the gain in fat from this group was due to increased use of edible oils. Margarine replaced much of the butter and shortening replaced much of the lard as sources of fat. Fat from the meat, poultry, and fish group increased 24 percent between 1909-13 and 1984. Pork accounted for the largest proportion of fat from this group and beef ranked second. The share of fat from poultry, although much smaller than either pork or beef, almost tripled. Fat from dairy products was about the same in 1984 as in 1909-13. Cheese was the leading source of fat from dairy products by 1984. Until recent years, whole milk was the leading source, although its share declined substantially after the late 1950's. Despite their low fat content, the share of fat from skim and lowfat milks increased as use increased, particularly in the past 25 years. The proportion of fat provided by frozen desserts increased over the years, while that from creams decreased. Among the fatty acids in the food supply, the quantity of TSFA increased by 10 percent between 1909-13 and 1984. Quantities of oleic and linoleic acid increased by 39 and 189 percent, respectively, between 1909-13 and 1984.(ABSTRACT TRUNCATED AT 400 WORDS)

Review of trends in food use in the United States, 1909 to 1980.

A review of per capita food use in this country between 1909 and 1980 indicates increased use of some food groups--meat, poultry, and fish; dairy products; fats and oils; fruits; vegetables; and sugars and other sweeteners--and decreased use of eggs, potatoes, and grain products. Use of foods in other groups--dry beans, peas, nuts, and soy products and the miscellaneous group which includes coffee, tea, and chocolate products--remained relatively low and stable. Changes in the use of foods are reflected in the nutrient levels of the food supply. The food energy level was slightly higher in 1980 than in 1909-13, but the proportion of energy from fat increased from 32 to 42 percent; the proportion from carbohydrate decreased from 56 to 46 percent; the proportion from protein remained about 12 percent. Between 1909-13 and 1980, large increases occurred in the levels of niacin, thiamin, and riboflavin in the food supply. Smaller increases occurred for ascorbic acid, iron, vitamin B12, calcium, and vitamin A. The levels of phosphorus and zinc were almost unchanged, while the levels of vitamin B6 and magnesium decreased.