Laterally hypertrophic adenoids as a contributing factor in otitis media.

Adenoidectomy has been demonstrated in randomized controlled studies to be effective in the prevention of otitis media with effusion (OME). Despite an apparent lack of correlation between adenoid size and outcome, it has been suggested that the role of adenoid tissue in the pathophysiology of OME relates either to obstruction of the Eustachian tube (ET) with impairment of its function, or to adenoid tissue serving as a reservoir of infection. The aim of this study was to further delineate the relationship between adenoid hypertrophy and OME. This prospective survey was performed in an ambulatory care setting of a tertiary care pediatric hospital, where data was collected on 273 consecutive adenoidectomy patients. At the time of surgery, adenoid position in relation to the ET orifice was recorded as well as concurrent procedures performed (e.g. pressure equalization tubes; PET). Sixty percent of patients undergoing simultaneous PET insertion were found to have laterally hypertrophic adenoid tissue encroaching upon the ET orifice versus only 22% for those undergoing adenoidectomy alone. Thus, a strong correlation was found to exist between OME, requiring the placement of PET and lateral adenoids abutting the torus tubarius (chi2 = 39.12; P < 0.001). The clinical relevance of this finding is that it may allow the prediction of children with OME, who will benefit most from undergoing adenoidectomy. Patients with OME requiring PET insertion, who are found to have lateral adenoid hypertrophy encroaching upon the ET orifice, could be selected for adenoidectomy, thus allowing a more judicious application of this surgical procedure in the setting of OME.

Adenoidectomy: indirect visualization of choanal adenoids.

A retrospective review of adenoidectomies was carried out at the Montreal Children's Hospital, Montreal, Quebec. From April 1, 1990, to November 14, 1992, the senior author (JJM) was involved in 330 adenoidectomies with or without concurrent tonsillectomy or pressure equalization tube (PET) insertion. In all cases, adenoid surgery was performed with proper soft palate retraction and indirect visual inspection using laryngeal mirrors. A subgroup of 31 patients (9.4%) was identified as having adenoid tissue extending from the nasopharynx into the choanae and posterior nasal cavity: "choanal adenoids." The characteristics of this subgroup are outlined in the hope that features may be useful in identifying potential choanal adenoids preoperatively. Furthermore, the use of indirect visualization, as opposed to the traditional "blind adenoidectomy," is proposed so that no significant residual adenoid tissue remains post-adenoidectomy.

Pre-operative localization of 25 consecutive parathyroid adenomas: a prospective imaging/surgical correlative study.

The successful diagnosis and surgical treatment of primary hyperparathyroidism due to parathyroid adenoma benefits significantly, in our experience, from a process of pre-operative imaging localization of the parathyroid adenoma. This prospective study evaluates a window of 25 consecutive patients who underwent pre-operative imaging localization prior to successful unilateral parathyroidectomy for parathyroid adenoma. All parathyroid adenomas were successfully localized by imaging, and subsequently documented photographically in surgical correlation, and pathologically confirmed. All patients were cured biochemically. Ultrasound accurately localized 92% of adenomas (100% in the neck and extrathyroidal) while radionuclide subtraction scanning identified 60% of a smaller subset. Both DSA and CT were successful in the two cases utilized, and MRI demonstrated four of five adenomas. The high yield of these pre-operative localization studies should make them an important consideration in the routine evaluation of patients undergoing surgery for possible parathyroid adenoma. Their usefulness in directing a conservative unilateral operation may result in time and cost savings, as well as reduced surgical exposure.

Pigmented villonodular synovitis presenting as a subcutaneous mass at the knee.

We describe a 45-year-old man who developed a painful mass about his knee. Magnetic resonance imaging demonstrated a well defined lesion, and biopsy confirmed a diagnosis of pigmented villonodular synovitis. Our case exemplifies a primary synovial process presenting as a subcutaneous tumor. Such diagnostic possibilities, although rare, should be more widely known.

A Bizarre Risk of Barefoot Waterskiing.

In brief A boat driver who was pulling a barefoot waterskier suffered a blinding injury when the towrope snapped forward and hit him after the skier lost his grip. The impact produced a ruptured right globe with multiple inferior and medial orbital rim fractures.

A review of computerized tomography evaluation of acetabular fractures--part 1.

Computerized tomography is an established modality for use in the evaluation of acetabular fractures. As open reduction and internal fixation of acetabular fractures becomes more common, the need for an accurate understanding of the fracture anatomy is critical. An anatomic study of the innominate bone is reported and the relevant standard radiographic landmarks as seen with computerized tomography are illustrated.

Results of total knee arthroplasty using the posterior stabilized condylar prosthesis. A report of 137 consecutive cases.

One hundred thirty-seven consecutive posterior stabilized total knee arthroplasties (TKAs) were reviewed. Average age of the patient was 61.1 years and length of postoperative follow-up period was 29.2 months. Patients were evaluated using the Hospital for Special Surgery (HSS) knee rating scores. Average preoperative scores improved from 52 to 92, postoperatively. Ninety-eight percent of patients had no pain or mild occasional pain postoperatively compared with 99% of patients experiencing severe to disabling pain preoperatively. Complications included one myocardial infarction, two deep venous thrombosis, one urinary tract infection, one patellar dislocation, and four wound problems. There were two incidences of seroma, one hematoma, and one deep infection requiring revision after joint debridement and systemic antibiotics. Also noted was one incidence of ligamentous laxity and one patella fracture.

Anterior compartment syndrome: a case report.

The chronic form of the anterior compartment syndrome can be overlooked if the symptoms of leg pain are attributed to shin splints. Herein is presented a case report which I feel represents an acute exacerbation of the chronic form of anterior compartment syndrome in a long-distance runner secondary to bleeding into the extensor digitorum longus muscle. Chronic anterior compartment syndrome can be a disabling injury which may require a fasciotomy, depending upon the severity and duration of the patient's symptoms and the intracompartmental pressures. The lay term "shin splints" should be separated from medical use, and a more reliable assessment of the etiology of the patient's symptoms should be made. The term shin splints should be utilized only for pain localized to the posterior medial border of the tibia at the origin of the posterior tibialis muscle.

Neck motion in the high school football player. Observations and suggestions for diminishing stresses on the neck.

In a group of 40 high school athletes (height: 166.37 to 189.57 cm, average, 174.40 cm; neck circumference: 35.56 to 41.91 cm, average, 39.12 cm), the neck motions were studied in flexion and extension, clinically, radiographically, and cineoradiographically. Flexion ranged from 34 to 84 degrees (average 72 degrees) and extension from 21 to 64 degrees (average 45 degrees) without helmet and shoulder pads. In well-fitting equipment flexion ranged from 36 to 86 degrees (average 73 degrees) and extension from 12 to 56 degrees(average 34 degrees). No correlation was determined between the size of the athlete's neck and the range of motion. The size of the athlete's neck was important in the determination of maximum stresses in the neck. The helmets impinged on the shoulder pads or interscapular region; this impingement diminished tension on the anterior portion of the cervical spine in extension. The face masks impinged on the shoulder pads in flexion of the neck; this impingement diminished stress on the posterior musculature. Proper fitting equipment, conditioning neck exercises, and changes in the rules of the game so that abuse of the head and neck is not encouraged are some of the aspects that may reduce the risk of injury to the cervical region in football players.