Clandestine femoral neck fractures with ipsilateral diaphyseal fractures.

We present a protocol for diagnosis of all femoral neck fractures associated with ipsilateral femoral diaphyseal fractures. A 30% incidence of delayed diagnosis has been reported by other investigators. Between 1982 and 1990, we have treated 32 patients with ipsilateral femoral neck and shaft fractures due to blunt trauma. Only 22 femoral neck fractures were diagnosed on prediaphyseal fixation radiographs. This left the 10 patients in this study who had normal prediaphyseal fixation radiographs and were subsequently found to have femoral neck fractures. The ipsilateral femoral neck fractures were found through a retrospective chart and radiographic review of all 555 femoral diaphyseal fractures identified through our trauma and fracture registries. The clinical and radiologic techniques for diagnosing the femoral neck fractures were presented. The time to union of the femoral shaft and neck was determined, and a preliminary radiologic assessment of the vascularity of the femoral head was made. Ten femoral neck fractures (31%) with normal preoperative radiographs were diagnosed after femoral diaphyseal fixation. One patient did not have a post-diaphyseal fixation radiograph. An incidental radiograph at 6 weeks showed a mildly displaced femoral neck fracture in an asymptomatic patient. At 16 weeks the patient became symptomatic, and a repeat radiograph showed the fracture. Five fractures were diagnosed in asymptomatic patients on routine post-femoral fixation radiographs. Two patients had normal post-femoral fixation radiographs, became symptomatic, and had their femoral neck fractures diagnosed on repeat radiographs at 3 and 7 days. One patient had normal pre- and postfixation radiographs, and on a 25-day routine femoral radiograph, the femoral neck fracture was diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)

MR imaging of symptomatic peripheral vascular malformations.

We performed a retrospective study of symptomatic peripheral vascular malformations to determine if MR imaging can be used to distinguish slow-flow venous malformations from high-flow arteriovenous malformations and arteriovenous fistulas. Twenty-seven MR examinations in 25 patients with malformations outside the CNS were reviewed. Sixteen venous malformations, nine arteriovenous malformations, and two arteriovenous fistulas were included. In all cases, the MR findings were correlated with the results of angiography. The distinction between slow-flow venous malformations and high-flow arteriovenous malformations and arteriovenous fistulas was made primarily on T2-weighted MR images, which showed high signal intensity in venous malformations and flow voids in high-flow lesions. In addition to the previously described MR features of venous malformations (serpentine pattern with septations, associated muscle atrophy, and typical T1 and T2 signal intensities), several new MR features were apparent. Venous malformations had a propensity for multifocal involvement (37%), orientation along the long axis of extremities or affected muscles (78%), and adherence to neurovascular distributions (64%). Prominent subcutaneous fat was commonly seen adjacent to the malformation. MR images of arteriovenous malformations and arteriovenous fistulas also commonly showed muscle atrophy and subcutaneous fatty prominence. Our results show that slow-flow venous malformations can be distinguished from high-flow arteriovenous malformations and fistulas on the basis of spin-echo MR signal characteristics. The associated imaging characteristics help in the differential diagnosis in problematic cases.

The team physician's medical bag.

A review of medications and equipment that should be included in assembling a team physician's medical bag is presented. Factors considered in these recommendations are likelihood and safety of use, cost, and convenience of handling.

Orthotic treatment of sesamoid pain.

The cause of pain and tenderness beneath the first metatarsal in an athlete is often very difficult to determine. When the symptoms originate from the sesamoid bone, exact diagnosis of the pathologic process may not be necessary in order to institute effective treatment. In this retrospective study, 8 of 10 athletes with this problem were successfully treated with custom-fitted orthoses which relieve sesamoid pain. The major benefit of this method of treatment is that it enables an athlete to continue participation without loss of valuable practice and competition time.

Bilateral lsokinetic Peak Torque, Torque Acceleration Energy, Power, and Work Relationships in Athletes and Nonathletes.

Clinicians frequently assume the uninjured extremity can be used as a predictor of preinjury strength for return of the injured extremity to a normal state during rehabilitation. The purpose of this study was to examine differences in bilateral isokinetic peak torque (PT) at 60 and 180 O/sec, and torque acceleration energy (TAE), average power (AP), and total work (MI) at 180 degrees /sec during knee extension and flexion, shoulder extension and flexion, and shoulder internal and external rotation in right hand dominant pitchers, swimmers, and nonathletes. PT values were greater for the right than left sides (p < 0.05) for shoulder extension (60 and 180 degrees / sec) for all three groups. Right side internal rotation (1 80 O/sec) TAE, AP, and MI values were greater than left (p < 0.05) for pitchers but not for swimmers and nonathletes. These findings question the efficacy of assuming bilateral equivalency for PT, TAE, AP, and MI measures in the prescription of therapeutic exercise for all muscle groups in all athletic and nonathletic populations. J Orthop Sports Phys Ther 1987;9(5):184-189.

Nicotine and caffeine effects on the task-elicited blood pressure response.

Nine subjects participated in four daily sessions during which a psychomotor task was performed prior to and following drug administration. Blood pressure was reliably increased by task performance, cigarette smoking, and caffeine administration. The effect of the combination of task performance, cigarette smoking and caffeine administration was additive, resulting in a markedly increased blood pressure during task performance for subjects smoking cigarettes and receiving caffeine.

Situational suppression of cigarette smoking.

Cigarette smoking rate was observed during work and recreation while subjects participated in two long-term residential experiments. In both experiments, the smoking rate observed during work was markedly lower than the smoking rate observed during recreation. In Experiment 1, activities were performed in successive 1-hour blocks. Smoking suppression during work was not associated with an increase in smoking rate following work. Experiment 2 consisted of treatment days of alternating 30-, 60-, and 120-minute work periods and recreation and control days when no work periods were presented. Performance of work was again associated with a marked suppression of smoking. In addition, the smoking rate for days during which no work was performed was greater than the smoking rate for days during which intermittent work was performed. This effect was not related to the length of the work periods. This finding indicates that subjects failed to compensate totally for work-related decreases in smoking. All subjects exhibited partial compensation.

Cardiovascular effects of noise during complex task performance.

Ten human subjects were stimulated with intermittent pink noise during the performance of a computerized task. Each subject received 3 consecutive sessions consisting of 10 min of baseline, 30 min of task performance, and 10 min of post-task baseline. Noise stimulation was presented during minutes 10-20 of task performance. Task performance was associated with significant increases in mean blood pressure, heart rate, and respiration rate and significant decreases in digital pulse amplitude. Noise stimulation was associated with a further decrease in digital pulse amplitude and a further increase in mean blood pressure. Noise- and task-elicited blood pressure and vasomotor responses did not habituate.

Isolation of proliferating chondrocytes from bovine growth-plate cartilage by rate-zonal centrifugation in a Ficoll density gradient.

UNLABELLED: A method has been developed for the isolation of growth-plate chondrocytes with different biochemical properties by rate-zonal centrifugation in a Ficoll density gradient. Bovine calf growth plates were first incubated in F-12 medium in the presence of 3H-thymidine to label proliferating chondrocytes. The tissue was then digested with collagenase and the isolated cells were fractionated in a Ficoll density gradient. The chondrocytes, which sedimented into eleven fractions, were analyzed for 3H-thymidine and inorganic pyrophosphatase activity. Chondrocytes that were maximally labeled with 3H-thymidine and contained maximum pyrophosphatase contents were separated in the most dense, bottom fractions of the gradient. These chondrocytes, which were apparently derived from the zone of proliferating chondrocytes, remained viable. This procedure should be applicable to the study of the biochemical properties of chondrocytes from the different zones of normal and diseased growth plates. CLINICAL RELEVANCE: A procedure has been developed to separate proliferating chondrocytes from hypertrophic chondrocytes and to isolate the proliferating chondrocytes in a viable state. This procedure should make it possible to study in vitro some of te biochemical processes that are involved in normal endochondral ossification, the regulation of these processes, and the alterations that occur in these processes in the presence of growth disorders and disturbances in endochondral ossification.

Behavior analysis of cigarette smoking.

Patterns of cigarette smoking, treated as series of discrete events in time, were investigated with a variety of quantitative techniques designed to characterize individual subject smoking series and to illuminate the relationship between cigarette smoking and environmental events. Data were collected from a total of 35 subjects who were either participants in residential laboratory studies or in a smoking cessation program. Cigarette smoking events were found to be fairly irregularly distributed with respect to time within individual subject series. However, strong dependencies were found between the occurrence in time of individual acts of cigarette smoking and coffee drinking. In addition, the distribution and frequency of smoking events throughout one-hour activity sequences were found to be dependent upon the nature of the activity, and the temporal scheduling of activities was found to affect several quantitative indices of smoking patterns.

Event time-series relationship between cigarette smoking and coffee drinking.

Eight subjects resided in a programmed laboratory environment for seven to twelve successive days during which time cigarettes and coffee were freely available. An event time-series analysis based upon instances in time of each substance's use revealed a relationship between cigarette smoking and coffee drinking: a coffee-drinking event tended to occur late in the inter-cigarette interval, and a cigarette-smoking event was most probable during the twenty minutes immediately following a coffee-drinking event.

On the regularity of smoking.

The purpose of this paper is to provide fundamental information about individual subject smoking behavior when the behavior is characterized as an event time-series. Each subject's smoking series revealed a characteristic inter-cigarette interval frequency distribution but there was little evidence of sequential dependencies in the series with respect to either successive intervals or successive events in time. Several subjects exhibited possible characteristic peaks or troughs during successive 2-hour periods, a finding which was in agreement with previous studies, but even in these subjects temporal patterning accounted for only a small proportion of the total variance. The implications of these findings are discussed and recommendations for the future treatment of smoking data and for possible experimental approaches to the determinants of smoking are presented.

Time-series analysis of long-term cardiovascular response.

The purpose of this study was to illustrate the use of time-series analysis with long-term cardiovascular responding. Analyses of two successive 1000-minute mean blood pressure and heart-rate series in five chronically instrumented dogs showed that the autocorrelation function of the original series appeared highly nonstationary and that differenciation of the data produced a simple autocorrelation pattern which could be successfully modeled with stepwise autoregression. Evidence for reliable individual differences as well as change over sessions is presented and discussed.

Plasma levels and clinical improvement--a comparative study of clomipramine and amitriptyline in depression.

To see if the clinical efficacy of amitriptyline and clomipramine is related to plasma level of the active drug or its main metabolite, or to the balance between them, plasma levels and clinical progress have been studied in 48 patients taking standard dosage. Dose for dose, plasma levels of clomipramine and desmethylclomipramine are usually higher than those of amitriptyline and its main metabolite nortriptyline, but no significant relationship between plasma levels and clinical improvement was found following clomipramine administration. By contrast, optimum responses to amitriptyline therapy were obtained at plasma levels of 50--100 micrograms/l for amitryiptyline itself and 25--75 micrograms/l for nortriptyline, but when their ratio exceeded 0--7 improvement declined. Steady states were reached after two to three weeks but a crude measure could be obtained from the plasma level after four days' treatment. Clomipramine and amitriptyline appeared to be equally effective, with clomipramine taking slightly longer to relieve depression.

Lateral hamstring transfer and gait improvement in the cerebral palsy patient.

A retrospective analysis of twenty-three spastic patients who underwent forty-three transfers of the semitendinosus muscle to the lateral intramuscular septum and of the semimembranosus muscle to the biceps is presented. Decreased knee-flexion deformity as well as improved walking function were achieved in 91 per cent. An unsatisfactory result was associated with complications of the procedure. Only one knee of the forty-three that were operated on showed late genu recurvatum. This procedure appears to be both effective and relatively free of late comlications.