Quantifying graft impingement in anterior cruciate ligament reconstruction.

BACKGROUND: Anterior cruciate ligament reconstructions (ACLR) fail at a rate of 10-15%, with graft impingement often a cause. In this study we investigate the prevalence and causes of impingement seen during ACLR surgery. METHODS: We reviewed consecutive primary ACLR from 2012-2018. Graft impingement was estimated intraoperatively by placing the arthroscope through the tibial tunnel and passively extending the knee, observing how much was obscured by the lateral femoral condyle from an anterior and lateral direction. Preoperative MRI scans were used to measure the intercondylar notch; Notch Width Index (NWI) and Notch Depth Index (NDI). Positioning of the tunnels was determined on postoperative radiographs. RESULTS: There were 283 ACLRs performed with 33 failures diagnosed on MRI (11.7%). 257 patients had complete imaging and follow up (91%). The mean age was 28 (±9) years and mean follow-up 5.3 (±1.8) years. The mean NWI was 0.26(±0.03), and NDI was 0.49(±0.06). The tibial tunnel aperture was located 42(±6) % of the way from anterior-posterior and 39(±6) % from medial-lateral. Impingement requiring a notchplasty was observed in 80% of cases, with lateral impingement more prominent. CONCLUSIONS: The amount of impingement did not correlate with tunnel position, which was located within the recommended area. There was a weak negative correlation between NWI and lateral impingement (rs = -0.16, p = 0.01), and NDI and anterior impingement (rs = -0.12, p = 0.04), therefore a smaller notch is associated with greater impingement. Despite optimal tunnel positioning, impingement still occurs in a significant number of cases therefore notchplasty should always be considered to keep revision rates low.

Blind-ending branch of a bifid ureter: multidetector CT imaging findings.

A bifid ureter with a blind-ending branch is a rare congenital anomaly. Although typically found incidentally, this anomaly can be symptomatic and radiologists should be aware of this important variant. To our knowledge, there has been no previous report of this anomaly as seen on multidetector CT urography. We present a patient with haematuria and review the clinical significance, radiological findings and embryological aetiology of this anomaly.

Dendrites determine the contribution of after depolarization potentials (ADPs) to generation of repetitive action potentials in hypothalamic gonadotropin releasing-hormone (GnRH) neurons.

The impact of structure in modulating synaptic signals originating in dendrites is widely recognized. In this study, we focused on the impact of dendrite morphology on a local spike generating mechanism which has been implicated in hormone secretion, the after depolarization potential (ADP). Using multi-compartmental models of hypothalamic GnRH neurons, we systematically truncated dendrite length and determined the consequence on ADP amplitude and repetitive firing. Decreasing the length of the dendrite significantly increased the amplitude of the ADP and increased repetitive firing. These effects were observed in dendrites both with and without active conductances suggesting they largely reflect passive characteristics of the dendrite. In order to test the findings of the model, we performed whole-cell recordings in GnRH neurons and elicited ADPs using current injection. During recordings, neurons were filled with biocytin so that we could determine dendritic and total projection (dendrite plus axon) length. Neurons exhibited ADPs and increasing ADP amplitude was associated with decreasing dendrite length, in keeping with the predictions of the models. Thus, despite the relatively simple morphology of the GnRH neuron's dendrite, it can still exert a substantial impact on the final neuronal output.

Fronto-parietal activation in attention-deficit hyperactivity disorder, combined type: functional magnetic resonance imaging study.

A functional magnetic resonance imaging mental rotation paradigm was used to investigate the patterns of activation of fronto-parietal brain areas in male adolescents with attention-deficit hyperactivity disorder, combined type (ADHD-CT) compared with age-, gender-, handedness- and performance IQ-matched healthy controls. The ADHD-CT group had (a) decreased activation of the 'action-attentional' system (including Brodmann's areas (BA) 46, 39, 40) and the superior parietal (BA 7) and middle frontal (BA10) areas and (b) increased activation of the posterior midline attentional system. These different neuroactivation patterns indicate widespread frontal, striatal and parietal dysfunction in adolescents with ADHD-CT.

Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws.

OBJECTIVES: To describe the technique and results of using blocking screws and intramedullary nails to treat patients with fractures of the proximal third of the tibial shaft. DESIGN: Prospective. SETTING: Level I trauma centers. PATIENTS: Twelve consecutive patients treated with intramedullary nailing and blocking screws for fractures of the proximal third of the tibial shaft. INTERVENTION: Patients were treated with intramedullary nails and blocking screws. MAIN OUTCOME MEASURE: The alignment of fractures was determined using standard anteroposterior and lateral radiographs after surgery and at each follow-up examination. One patient was lost to follow-up. All other patients were followed at regular intervals until union or establishment of a nonunion. Changes in alignment and complications were noted. RESULTS: Postoperatively, all patients had less than 5 degrees of angular deformity in the planes in which blocking screws were used to control alignment. One patient had postoperative malalignment (6 degrees of valgus), but a lateral blocking screw to control valgus deformity was not used in this patient. One patient was lost to follow-up. Eleven patients were followed up to union (n = 10) or establishment of a nonunion (n = 1). Ten of eleven patients maintained their postoperative fracture alignment at their last follow-up examination (average follow-up of thirty-three weeks). One patient progressed from 6 degrees of valgus immediately after surgery to 10 degrees of valgus at union. This patient did not have a blocking screw to control valgus angulation. CONCLUSIONS: Blocking screws are effective to help obtain and maintain alignment of fractures of the proximal third of the tibial shaft treated with intramedullary nails.

Three-dimensional ultrasonographic imaging of the neonatal brain in high-risk neonates: preliminary study.

The aim of this investigation was to compare the utility of three-dimensional ultrasonography versus two-dimensional ultrasonography in imaging the neonatal brain. Thirty patients in the neonatal intensive care unit underwent two-dimensional and three-dimensional ultrasonography. The resultant two- and three-dimensional images recorded on film and three-dimensional volumes (reviewed on a workstation) were evaluated independently. Comparable numbers of normal and abnormal studies were diagnosed by each modality. Axial images were considered useful in approximately 50% of three-dimensional cases. Image quality, overall and in the far-field, was rated higher on two-dimensional images. Three-dimensional sonographic acquisition time in the neonatal intensive care unit (1.7 min+/-0.7 standard deviation) was significantly shorter than that for two-dimensional sonography (9.0+/-4.5 min). The total time for evaluation on the three-dimensional workstation (4.4+/-1.1 min) was significantly less than that for two-dimensional images on film (10.6+/-4.7 min). In conclusion, three-dimensional ultrasonography is a promising, diagnostically accurate, and efficient imaging tool for evaluation of the neonatal brain; however, visualization must improve before it can replace two-dimensional ultrasonography.

Randomized, placebo-controlled pilot study of divalproex sodium in the treatment of acute exacerbations of chronic schizophrenia.

Experimental and clinical data suggest that GABA-ergic drugs such as valproate may have a potential role in the treatment of schizophrenia. The authors designed a 21-day prospective, double-blind, randomized, placebo-controlled pilot study of divalproex sodium as add-on treatment to haloperidol in 12 hospitalized patients with acute exacerbations of chronic schizophrenia. All patients received haloperidol 10 mg/day for 3 days and 15 mg/day for the remaining 18 days. In addition, five patients were randomly assigned to receive divalproex augmentation and seven to receive placebo. The divalproex dose was adjusted to a target serum concentration of 75 microg/mL for 2 weeks; placebo replaced divalproex during the third and last weeks to determine any carryover effect. Psychiatric rating scales were administered at baseline and on days 7, 14, and 21. Although the placebo group improved with haloperidol treatment, the divalproex group demonstrated greater improvement. On day 21, the divalproex group had greater improvement from baseline on the Clinical Global Impression Scale (p < or = 0.04), Brief Psychiatric Rating Scale (p < or = 0.13), and Schedule for Assessment of Negative Symptoms scores (p < or = 0.007). After divalproex withdrawal on day 15, a carryover effect was observed during week 3. The authors concluded that the addition of divalproex sodium to standard antipsychotic drugs may prove effective in relieving the symptoms of acute schizophrenia. Future studies may benefit from the design of this pilot study. However, it is premature to apply this augmentation strategy in the clinical setting just yet because of the small sample size and the likely heterogeneity of the disorder.

Self-evaluation of unintended biases and prejudices.

A scale for measuring self-assessment of factors, which might lead to unintended biases and prejudices, was tested with 39 professionals working with adolescents on probation. The scale has 10 items (e.g., "Would feel comfortable providing clinical services to [e.g., African Americans]." Each item was rated on a 3-point scale so as summated scores increase across items the probability of unintended biases and prejudices against five culturally diverse groups (African American, American Indian, Asian, Hispanic, and White) would also increase. The coefficient alpha was .87. Participants' mean unintended bias and prejudices across items were always lower toward clients from their own racial or ethnic group. For example, Hispanic and White participants tended to be more prompt to display these attitudes against African Americans, relative to African-American participants. White participants, however, reported lower scores leading to unintended biases in the case of White clients, relative to African-American and Hispanic participants. Overall, participants' mean unintended bias and prejudices against American Indian and Asian clients tended to be higher with these groups, relative to clients from the African-American, Hispanic, and White communities. Results are discussed in terms of further development of the scale in the design of cross-cultural training in various working environments with culturally diverse clients.

Knowledge of laws regulating issues related to HIV and AIDS: development of the HIV/AIDS and the law scale.

42 middle-aged and older adults, ranging in age from 51 to 85 years, completed 10 items dealing with the assessment of knowledge regarding laws regulating issues related to HIV and AIDS. Participants also completed 40 items involving knowledge of risks for HIV infection. The Cronbach coefficient alpha and test-retest reliability coefficient on the HIV/AIDS and the Law Scale were .74 and .83, respectively. Over-all, the grand mean for correct answers was 46.9%, whereas the grand means for incorrect answers and "don't know" responses were 13.6% and 39.5%, suggesting substantial lack of knowledge of laws regulating issues related to HIV and AIDS. Women (50%) and younger participants (51 to 66 years old; 48.2%) showed more of this knowledge (50%) than men (43.0%) and older participants (46.2%). The sample reported a substantial amount of knowledge regarding HIV transmission assessed with factual (92.2% correct) and misconception (87.5% correct) items. The correlation between this knowledge and knowledge of laws regulating issues related to HIV and AIDS was .42 (p < .01). Research with this scale using adolescents and young adults as well as the utility of the scale in areas of clinical, legal, and policy development are discussed.

Critical review of GABA-ergic drugs in the treatment of schizophrenia.

GABA-ergic medications may have a potential role in the treatment of schizophrenia. Laboratory evidence has generally supported the ability of gamma-aminobutyric acid (GABA) to reduce dopaminergic activity and has suggested that GABA may be effective in combating hypofrontality by acting on mesoprefrontocortical tracts in patients resistant to treatment with antipsychotic drugs. Although the results of clinical trials of several GABA-ergic compounds have been inconclusive because of methodologic limitations and drug toxicity, benzodiazepines and valproate seem to be associated with favorable treatment outcomes, especially when combined with typical antipsychotic agents. This study concludes that further investigation of the use of GABA in schizophrenia is likely to improve the understanding of the psychopathology of this illness and to expand our treatment alternatives. Also provided are suggestions to enhance the design of future studies, improve the potential for favorable treatment outcomes, and assist in predicting patients' responses to GABA-ergic medications.

HIV/AIDS education survey for mental health professionals.

A total of 6804 mental health professionals, e.g., licensed and certified psychologists, licensed professional counselors, in Arkansas, Louisiana, New Mexico, Oklahoma, and Texas were mailed a questionnaire regarding HIV/AIDS topics professionals might recommend for educational programs. Participants were asked to rate how strongly they would recommend each topic. The return rate was 31% (2121). The percentage of participants who did not recommend the topics was low (0.7%-10.9%). Most topics were either recommended (6.5%-50.2%) or strongly recommended (29.0%-92.8%). Topics with ratings of 80% of participants endorsing the strongly recommended rating included psychological crises associated with learning one is HIV positive, psychosocial issues, and counseling dying clients regarding grief, loss, and legal issues. The results are discussed in terms of continuing to develop educational programs targeting mental health professionals.

Suicide attempts, substance abuse, and personality.

The prevalence and relevance of a positive suicide attempt history among 103 subjects who had entered a substance abuse program and participated in a study of personality was examined. Twenty subjects had a positive suicide attempt history. Women were more likely to attempt suicide. Attempters were more likely to have additional psychiatric diagnoses, such as major depression. Attempters had higher addiction severity scores, abused more substances, and were more likely to have abused alcohol and sedative hypnotics than were nonattempters. DSM-III-R and Eysenck personality measures were compared across groups. Attempters had significantly higher neuroticism and borderline scores. Impulse dysregulation may predispose this group to more severe addictions.

Cortical distribution of EEG activity for component processes during mental rotation.

Alpha power (8-12 Hz) was monitored over the frontal, temporal, parietal and occipital lobes of the left and right cerebral hemispheres while participants mentally rotated three-dimensional shapes to match a specified target. By comparing the activational patterns generated during three experimental conditions, each designed to systematically isolate the involvement of the various subcomponents comprising this mental rotation task, it was suggested that the right frontal lobe mediates encoding and comparison/decision processes, while the left parietal and the left temporal region appear most involved in the generation of images and their mental rotation. A preliminary model describing the cooperative interaction of these cortical regions during mental rotation tasks is proposed.

Personality structure of elderly drivers.

This paper reports the factor structure of a 37-item personality questionnaire intended to be predictive of driving performance in elderly persons. Subjects were 191 persons 63 years of age of older, about half of whom also were given perceptual/cognitive tasks and drove on a closed driving course. Although the personality questionnaire did not predict driving skill, the factor structure of the questionnaire is of interest. Of several factor analyses, the most satisfactory was a 2-factor solution. We interpreted the approximately orthogonal factors as measuring what we labeled Competence and Emotionality.

Students' perception of a difficult case in psychotherapy.

Paniagua, et al. suggested that the definition of a "difficult" case in psychotherapy implies a relational definition involving the characteristics of the patient, the case, and the therapist. This study concerned this hypothesis with 44 graduate students in social work who received the Difficult Case Questionnaire representing examples of variables across each domain, e.g., motivation of the client, nature of the disorder, generic factors, and orientation of the therapist. The results were compared with the 1993 findings reported by Paniagua, et al., for a group of professionals in mental health practice. As in the earlier study, the present sample also agreed that, although all such domains are important in the formulation of that definition, their importance is not equal. Whereas professionals rated patient's, case's, and therapist's characteristics as the most important order of domains in that definition, students in this study agreed on the order of therapist's, patient's, and case's characteristics.

Comorbidity of gender dysphoria and other major psychiatric diagnoses.

Previous studies suggest that many transsexuals evidence an Axis I diagnosis according to the DSM-IV classification (e.g., psychoses, major affective disorder). The current study examined retrospectively the comorbidity between gender dysphoria and major psychopathology, evaluating the charts of 435 gender dysphoric individuals (318 male and 117 female). All had undergone an extensive evaluation, addressing such areas as hormonal/surgical treatment, and histories of substance abuse, mental illness, genital mutilation, and suicide attempts. In addition, a subgroup of 137 individuals completed the MMPI. Findings revealed over two thirds were undergoing hormone reassignment, suggesting a commitment to the real-life cross-gender process. One quarter had had problems with substance abuse prior to entering treatment, but less than 10% evidenced problems associated with mental illness, genital mutilation, or suicide attempts. Those completing the MMPI (93 female and 44 male) demonstrated profiles that were notably free of psychopathology (e.g., Axis I or Axis II criteria). The one scale where significant differences were observed was the Mf scale, and this held true only for the male-to-female group. Psychological profiles as measured by the MMPI were more "normal" in the desired sex than the anatomic sex. Results support the view that transsexualism is usually an isolated diagnosis and not part of any general psychopathological disorder.

Sex differences in matching circles and arcs: a preliminary EEG investigation.

Alpha wave (8-12 Hz) activity was monitored over the four lobes of the left and right cerebral hemispheres while 12 male and 12 female participants mentally manipulated circles and arcs to determine size matches. Four task conditions were tested, each designed to tap into the visual encoding, image generation, mental rotation, and comparison/decision subcomponents comprising this task. Males were more accurate than females in making such matches, and in all conditions they exhibited a significant alpha power reduction asymmetry, with the right frontal lobe being more active than the left frontal lobe. Females showed a pattern of activation that was bilaterally distributed, primarily to the frontal and temporal regions. These findings suggest a difference in the functional organisation of the male and female brain which may contribute to the reported sex difference in the performance of some spatial tasks.

Developmentally advanced EEG alpha power in gifted male and female adolescents.

An electroencephalographic (EEG) study of gifted and average ability male and female adolescents, as well as college students of both sexes, was conducted to investigate further the relative contributions the left and right cerebral hemispheres during an eyes open (baseline) task in all groups. A total of 90 subjects had baseline EEG recorded in three groups with equal numbers of males and females: 30 gifted adolescents, 30 average ability adolescents, and 30 college-age subjects. Overall alpha power (8-12 Hz resting potential) was significantly greater in average ability subjects compared to both college-age subjects. Moreover, there were no significant differences in overall alpha power between college-age and gifted adolescent subjects. However, college-age and gifted adolescent subjects had different RH/LH patterns of activation such that at temporal and parietal locations college-age and gifted adolescent subjects had greater LH alpha power levels whereas gifted adolescents had greater RH alpha power. These findings suggest that gifted adolescents may have a developmentally enhanced state of brain activity, one that more closely resembles that of college-age adults to whom they also resemble in terms of cognitive development.

Digital tapping of the superficial temporal artery: significance in carotid duplex sonography.

To determine whether tapping on the superficial temporal artery correctly identifies the ECA during carotid sonography, prospective evaluation of the reflection of the temporal tap on the spectral waveform was recorded and graded as 3+, 2+, 1+, or 0 in each ECA, ICA, and CCA, with 3+ being the most brisk response in each carotid system (ipsilateral CCA, ICA, and ECA). The pattern of response was evaluated in patients with and without hemodynamically significant (> than 50% diameter) stenoses in CCA, ICA, and ECA. The most frequent pattern of response to tapping on the superficial temporal artery was 3+ in the ECA, 2+ in the CCA, and 1+ or 0 in the ICA. This pattern was found in 41% (82/200) of systems overall. Whether or not stenoses were present in any branch of the extracranial carotid system, the strongest response (3+) was found in the ECA (58/200 [87%] with stenosis; 119/200 [89%] without stenosis, and lesser responses in the other arteries: 2+ in the CCA 31/200 [46%] with stenosis; 63/200 [47%] without stenosis, and 1+ or 0 in the ICA 58/200 [87%] with stenosis and 103/200 [77%] without stenosis). This pattern was unaltered by the degree of stenosis in the ECA or in the ICA. In 92.5% of the systems interrogated, the response was greater in the ECA than in the ICA. Tapping on the superficial temporal artery may be used as a reliable method of identifying the ipsilateral ECA even in instances of significant atherosclerotic disease in the ECA, CCA, or ICA.