Patellar taping: a radiographic examination of the medial glide technique.

The purpose of this study was to radiographically determine the effectiveness of the McConnell medial glide patellar taping technique. Twenty apparently healthy men, between ages 18 and 35, participated in this study. Subjects underwent a series of three radiographs in a modified Merchant view. First, a bilateral tangential view of the patellofemoral joints was taken to establish a baseline. Next, the same view was obtained with the experimental knees taped using the McConnell medial glide technique. Subjects then underwent a standardized exercise protocol to stress the tape and the accompanying knee structures. This was followed by a third view of the patellofemoral joints. Radiographs were measured using the Merchant congruence angle and analyzed statistically with dependent, mean difference tests. Results from this study indicate that the McConnell medial glide technique was effective in significantly moving the patella medially (P = 0.003), but that the tape was ineffective in maintaining this significance after exercise (P < 0.001). In 3 subjects (15%) of this sample, the tape was ineffective in moving the patella medially in any degree. One interesting finding was that exercise caused a statistically significant (P = 0.016) lateral shift from baseline in the control knees. This may suggest some clinical significance for patellar taping in preventing excessive lateral shift.

Occult sacral fractures in osteopenic patients.

The presentation, diagnosis, and treatment of occult sacral fractures in seventeen osteopenic patients were reviewed. Sixteen of the seventeen patients were elderly women, and the fracture usually occurred without trauma (fourteen patients). In ten patients, the sacral fracture was associated with a fracture of the pubic ramus. The sacral fractures were difficult to diagnose because nine patients also had a history of a malignant lesion of the pelvis with or without radiation treatment. Computed tomography and bone-scanning were diagnostic in all patients, but magnetic resonance imaging was not specific. Use of crutches or a walker, a reduction in activity, and use of non-narcotic analgesics allowed for the resolution of symptoms in all twelve patients who did not have mitigating conditions and permitted these patients to walk independently.

Tolerance to imidazolinone herbicides in wheat.

An imidazolinone-tolerant wheat (Triticum aestivum L. em Thell) mutant in the winter wheat cultivar Fidel has been identified and characterized. The mutant was isolated from a population derived through seed mutagenesis of the variety with an aqueous solution containing sodium azide. Imidazolinone-tolerant wheat seedlings were selected from the M(2) generation of the population in the presence of imazethapyr herbicide and identified as herbicide-insensitive individuals. The trait is inherited as a single semidominant gene and confers high levels of tolerance to imazethapyr. Acetohydroxyacid synthase activity in extracts from imidazolinonetolerant plants was less inhibited by imazethapyr than the enzyme from the wild type. The herbicide-tolerant plants have a completely normal phenotype and display no negative effects on growth and yield in either the absence or presence of imazethapyr.

Esophageal perforation following anterior cervical spine surgery.

The authors surveyed the Cervical Spine Research Society to compile a series of esophageal perforations following anterior cervical spine surgery. Twenty-two cases were assembled. Six occurred at the time of surgery, 6 in the postoperative period, and 10 weeks to months later. Eight surgeries were because of fracture. Hardware was implicated in 25% of cases occurring after surgery. Diagnosis was confirmed most often by direct vision at reexploration or esophography. Treatment usually consisted of drainage, repair, and parenteral antibiotics; 2 cases were successfully treated by enteral feeding and antibiotics alone. There was one fatality, and all patients required prolonged hospitalization. Cervical fracture and the use of hardware may be associated with this complication. Clinical suspicion and esophography are important diagnostic tools. Drainage and parenteral antibiotics are recommended treatment.

Nonunion following two-level anterior cervical discectomy and fusion.

Nonunion is a potential complication of anterior cervical discectomy and fusion (ACDF). There are reports that cite the prevalence of nonunion for two-level ACDF with various fusion techniques, but they do not recommend treatment alternatives. Pseudarthrosis after a two-level ACDF occurred in a 69-year-old man. Posterior cervical wiring and autograft resulted in a successful fusion anteriorly and posteriorly. Posterior fusion augments stability, enhances the potential for eventual anterior fusion, avoids the risks of an additional anterior procedure, and is an excellent therapeutic alternative to a second anterior attempt at stabilization.

The ST segment/heart rate slope as a predictor of coronary artery disease: comparison with quantitative thallium imaging and conventional ST segment criteria.

The ST segment shift relative to exercise-induced increments in heart rate, the ST/heart rate slope (ST/HR slope), has been proposed as a more accurate ECG criterion for diagnosing significant coronary artery disease (CAD). Its clinical utility, with the use of a standard treadmill protocol, was compared with quantitative stress thallium (TI) and standard treadmill criteria in 64 unselected patients who underwent coronary angiography. The overall diagnostic accuracy of the ST/HR slope was an improvement over TI and conventional ST criteria (81%, 67%, and 69%). For patients failing to reach 85% of their age-predicted maximal heart rate, its diagnostic accuracy was comparable with TI (77% and 74%). Its sensitivity in patients without prior myocardial infarctions was equivalent to that of thallium (91% and 95%). The ST/HR slope was directly related to the angiographic severity (Gensini score) of CAD in patients without a prior infarction (r = 0.61, p less than 0.001). The ST/HR slope was an improved ECG criterion for diagnosing CAD and compared favorably with TI imaging.