Patellar tracking problems in athletes.

Problems of the patellofemoral joint have long been recognized as a source of knee dysfunction. They range in spectrum from pain alone to recurrent instability, yet all are related in origin by congenital predisposition. Problems of the extensor mechanism are prevalent in any and all populations. Most patellofemoral problems respond readily to conservative rehabilitation efforts. Because of its chronic, recurrent nature, satisfactory results remain elusive in some syndromes. In our practice, the newer McConnell techniques have proved to be a positive addition to the extensor mechanism armamentarium, allowing pain-free return to function for most patients.

Cimetidine versus ranitidine: single-dose, oral regimen for reducing gastric acidity and volume in ambulatory surgery patients.

This placebo-controlled trial compared the efficacy of single oral doses of cimetidine or ranitidine in maintaining intragastric pH and volume greater than 2.5 and less than 25 ml, respectively, in ambulatory surgery patients requiring general anesthesia. Patients were randomized to receive either placebo, ranitidine HCl 150 mg, or cimetidine HCl 400 mg upon rising on the morning of surgery. At induction, the cimetidine and ranitidine groups had significantly higher (p less than 0.05) gastric pH values than the placebo group. At extubation, the ranitidine group had a significantly higher (p less than 0.05) gastric pH than either the cimetidine or placebo group. Both H2-blocker groups had lower volumes when compared with the placebo group at extubation (p less than 0.05). There were more patients at risk for aspiration pneumonitis (pH less than 2.5 and/or volume greater than 25 ml) in the cimetidine group (46 percent) than in the ranitidine group (15 percent). All placebo-treated patients were at risk for aspiration pneumonitis. We did not find subjective clinical evidence of aspiration pneumonitis in our patients. We conclude that both ranitidine and cimetidine are superior to placebo, but ranitidine may be the preferred agent because of its more consistent effect on gastric pH and volume.

Thermal biofeedback and the treatment of tinnitus.

Thermal biofeedback and general relaxation procedures were employed to treat 32 patients with subjective tinnitus. Each patient received eight 1-hour biofeedback sessions over an eight-week period, while listening to standard Jacobsonian type relaxation tapes. Sixty-five percent of the patients experienced a reduction of their symptoms. While none reported worsening of their symptoms, only two reported total symptom abatement. Findings suggest relaxation and peripheral vascular circulation are inversely related to the intensity of tinnitus symptoms. The probability that an individual will benefit from biofeedback appears related to his/her ego strength (Es). No differences were noted between the performance of male and female patients. Although not fail-safe, biofeedback and relaxation treatment are excellent management tools in the treatment of tinnitus.

Shoulder strength following acromioclavicular injury.

The acromioclavicular (AC) joint enjoys the dubious distinction of being one of the few joints in the body whose total dislocation is routinely treated by simply leaving the joint dislocated. Adherents of both conservative and operative treatment have presented reasons for their viewpoints. Residual shoulder weakness has been offered as a sequela of untreated acromioclavicular injury and a reason for repairing the joint. An objective evaluation of shoulder strength would be valuable in determining the optimum treatment for this injury. The purpose of our study was to quantitate, using the Cybex II, the residual shoulder weakness following various modes of treatment. Seventeen patients with Grade III AC separations and eight patients with Grade II AC sprains were reviewed. Nine of the Grade III injuries were treated and eight nonoperatively. All Grade II injuries were treated nonsurgically. All patients were tested on the Cybex II isokinetic dynamometer at both slow and fast speeds through various ranges of motion. Grade III injuries treated nonoperatively showed no significant strength deficits. Surgically treated Grade III injuries had a significant strength deficit in vertical abduction at fast speeds (19.8%) when compared to the uninjured shoulder. Interestingly, the Grade II injuries led to a significant weakness in horizontal abduction (24.3%) at fast velocity. Evaluation of subjective results showed that Grade III injuries treated conservatively had the most pain and stiffness, despite their strong shoulders. Patients with Grade III injuries treated operatively rated their overall outcome below that of those treated conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Exercise for stress management. Program design and troubleshooting.

Exercise is undoubtedly an important facet of stress reduction, and patients should be encouraged in every way possible to use exercise as part of stress-management programs. However, exercise may itself create a set of disorders, usually overuse, inflammatory syndromes. Physicians should have a firm understanding of the methods available for treating such problems and returning the patient to his or her exercise program. While it is not reasonable for a patient to cling to an "exercise-at-all-costs" attitude, neither is it reasonable for a physician to treat all exercise-related problems by the simple advice to stop exercising.

Computer-aided emergency telecommunications for the deaf.

Computer-aided telecommunications provide deaf teletypewriter users with 24-hour toll-free access to emergency services. An interface and software link the deaf caller's teletypewriter (TDD) with a microprocessor by reducing and inverting voltage levels between the two devices. This system facilitates rapid transmission of linguistically controlled triage questions to meet the communication needs of deaf patients.

Anteromedial rotatory instability of the knee: present state of the art of surgery.

Anteromedial rotatory instability normally is not difficult to diagnose and therefore to repair during the acute stage. Posterior oblique ligament advancement is useful in treating both acute and chronic cases. Advancement of the capsular arm of the semimembranosus and advancement of the semitendinosus may both be added in cases of severe chronic instability. The outlook for anteromedial rotary instability, while best for repairs of acute cases, is still favorable for reconstruction of chronic cases.

Proximal and distal reconstruction of the extensor mechanism for patellar subluxation.

Proximal and distal reconstruction of the leg extensor mechanisms has been developed and performed in 346 cases over a period of 25 years. Proximal extensor mechanism reconstruction produces very satisfactory results in over 70% of cases and continues to be the basic principle of surgical treatment for patellar subluxation. In patients with Q angles (angle between line of the quadriceps force and the direction of the patellar tendon) greater than 10 degrees distal reconstruction (patellar tendon transfer) is done in addition to, not in lieu of, the dynamic proximal reconstruction. Treatment of the chondromalacia developing secondary to altered extensor mechanism mechanics can be by simple chondrectomy provided that the causal mechanical abnormalities are modified.

Prevention of ankle sprains.

Ankles are sprained when supported on an unstable foundation, while too rididly fixed to the playing surface, or when forced into unnatural positions by extrinsic muscle tightness. The unstable foundation may be the shoe itself, a chuck-hole, or another player's foot. Undue fixation may be by 1-inch mud cleats, baseball spikes, or a modern wrestling mat. When these circumstances occur, heel cord tightness may alter the ankle's response. Thus, prevention of ankle sprains may be by modification of any of these factors.