New and Interesting Fungi. 3.

Seven new genera, 26 new species, 10 new combinations, two epitypes, one new name, and 20 interesting new host and / or geographical records are introduced in this study. New genera are: Italiofungus (based on Italiofungus phillyreae) on leaves of Phillyrea latifolia (Italy); Neolamproconium (based on Neolamproconium silvestre) on branch of Tilia sp. (Ukraine); Neosorocybe (based on Neosorocybe pini) on trunk of Pinus sylvestris (Ukraine); Nothoseptoria (based on Nothoseptoria caraganae) on leaves of Caragana arborescens (Russia); Pruniphilomyces (based on Pruniphilomyces circumscissus) on Prunus cerasus (Russia); Vesiculozygosporium (based on Vesiculozygosporium echinosporum) on leaves of Muntingia calabura (Malaysia); Longiseptatispora (based on Longiseptatispora curvata) on leaves of Lonicera tatarica (Russia). New species are: Barrmaelia serenoae on leaf of Serenoa repens (USA); Chaetopsina gautengina on leaves of unidentified grass (South Africa); Chloridium pini on fallen trunk of Pinus sylvestris (Ukraine); Cadophora fallopiae on stems of Reynoutria sachalinensis (Poland); Coleophoma eucalyptigena on leaf litter of Eucalyptus sp. (Spain); Cylindrium corymbiae on leaves of Corymbia maculata (Australia); Diaporthe tarchonanthi on leaves of Tarchonanthus littoralis (South Africa); Elsinoe eucalyptorum on leaves of Eucalyptus propinqua (Australia); Exophiala quercina on dead wood of Quercus sp., (Germany); Fusarium californicum on cambium of budwood of Prunus dulcis (USA); Hypomyces gamsii on wood of Alnus glutinosa (Ukraine); Kalmusia araucariae on leaves of Araucaria bidwillii (USA); Lectera sambuci on leaves of Sambucus nigra (Russia); Melanomma populicola on fallen twig of Populus canadensis (Netherlands), Neocladosporium syringae on branches of Syringa vulgarishorus (Ukraine); Paraconiothyrium iridis on leaves of Iris pseudacorus (Ukraine); Pararoussoella quercina on branch of Quercus robur (Ukraine); Phialemonium pulveris from bore dust of deathwatch beetle (France); Polyscytalum pinicola on needles of Pinus tecunumanii (Malaysia); Acervuloseptoria fraxini on Fraxinus pennsylvanica (Russia); Roussoella arundinacea on culms of Arundo donax (Spain); Sphaerulina neoaceris on leaves of Acer negundo (Russia); Sphaerulina salicicola on leaves of Salix fragilis (Russia); Trichomerium syzygii on leaves of Syzygium cordatum (South Africa); Uzbekistanica vitis-viniferae on dead stem of Vitis vinifera (Ukraine); Vermiculariopsiella eucalyptigena on leaves of Eucalyptus sp. (Australia).

Does batch operation enhance oxidation in subsurface constructed wetlands?

Two side-by-side experimental sub-surface flow systems allowed direct comparison of wetland performance under batch and continuous-flow operation. One system consisted of microcosm "columns" operated in 20-day batch mode while the second consisted of continuous-flow "cells" operated at a five-day residence time. Both systems treated identical synthetic domestic wastewater for two years and then treated identical synthetic mine-impacted water for one year. Each system had replicates planted with Typha latifolia, Scirpus acutus and unplanted controls. Temperature was cycled annually between 4 to 24 degrees C. Results indicated that plant species, season, and mode of operation interacted strongly in controlling dynamics of COD, nitrogen species, phosphate, sulfate, and redox potentials. In batch-loaded columns, between-species differences in oxidation and COD removal were large in winter, during plant dormancy, but absent in summer; COD removal, sulfate concentration, and redox potentials were closely correlated, suggesting that variation in root-zone oxygenation due to seasonal plant growth patterns and temperature-dependent plant and microbial respiration may explain observed differences. In the continuous-flow cells, species and seasonal differences were minimal or non-existent, indicating that under continuous-flow operation plants either did not influence root zone oxidation or that this influence had no effect on wetland performance for COD and nutrient removal or sulfate reduction.

The effects of chlorhexidine irrigation solution on contaminated bone-tendon allografts.

The purpose of this study was to determine an expedient and effective method for disinfecting contaminated human bone-tendon allografts. The first part of this study used beef muscle and cadaveric human tissues to determine the most effective solution and volume to decontaminate tissues inoculated with four different organisms: Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Of the solutions tested (benzalkonium chloride, castile soap, castile soap followed by benzalkonium chloride, triple antibiotic, chlorhexidine gluconate, and chlorhexidine gluconate/triple antibiotic), only the 4% chlorhexidine power irrigation solution and 4% chlorhexidine/triple antibiotic bath completely disinfected all tissues. Work in part 2 revealed that a 2% chlorhexidine irrigation solution was equally effective as the 4% solutions. Part 3 of the study involved human Achilles tendon-calcaneus allografts. We found similar results: 3 liters of 2% chlorhexidine power irrigation solution thoroughly removed all microorganisms from the contaminated tissues. All control allografts irrigated with normal saline solution alone revealed positive bacterial growth for all four organisms after 72 hours' growth on sheep blood agar. Total decontamination time was 10 to 12 minutes. Two percent chlorhexidine irrigation solution may be an effective method for decontaminating human bone-tendon allografts challenged with a polymicrobial inoculum. This method of disinfecting bone-tendon allografts is at least five times more expeditious than methods in previously reported studies.

Polycaprolactone/glass bioabsorbable implant in a rabbit humerus fracture model.

Research in improved materials and methods for internal fixation has centered on internal fixators made of bioabsorbable materials such as polylactic acid, polyglycolic acid, and polyparadioxanone. These materials have two problems: the first is a postoperative complication related to a delayed inflammatory response; and the second is low strength characteristics. An alternative material developed to alleviate these problems is a composite of phosphate glass fibers embedded in the polymer polycaprolactone, referred to as PCL. In this study, intramedullary pins made of PCL were compared to stainless steel pins in a rabbit humerus osteotomy model. Specimens were harvested at 0, 6, and 12 weeks postoperatively, radiographs and mechanical testing to failure were performed at each time interval, and tissue was examined microscopically at 6 and 12 weeks. Histologic results showed PCL pins to be well tolerated with minimal inflammation around the pin. Mechanical testing revealed the PCL fixation to be weaker initially than the stainless steel fixation. There was significant stress shielding of stainless-steel-healed rabbit humeri when compared to the PCL/bone humeri. All osteotomies immobilized with PCL healed with abundant periosteal callus production.

Endometrial carcinoma presenting with an isolated osseous metastasis: a case report and review of the literature.

Endometrial carcinoma, the fourth most common cancer in women, is primarily a disease afflicting postmenopausal women and usually presents with vaginal bleeding or vaginal discharge. A slender, athletic 44-year-old woman was diagnosed with endometrial carcinoma after presenting with an isolated, solitary femoral bone metastasis. She had no symptoms except for progressive left knee pain. An open biopsy of the lesion in the proximal left femur revealed metastatic adenocarcinoma compatible with an endometrial primary. An endometrial biopsy subsequently revealed moderately differentiated endometrioid adenocarcinoma. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, and adjuvant chemotherapy. An aggressive metastatic workup revealed no other sites of metastatic disease. The femoral metastasis was treated with radiation. On chronic progestin therapy, the patient is clinically free of disease 2 years following diagnosis. Patients with endometrial carcinoma (with otherwise early stage disease) who present with an isolated skeletal lesion may represent an unusual group with perhaps a better prognosis. This patient received aggressive multi-disciplinary therapy and has had a two year progression-free interval.

Closed reduction and percutaneous stabilization of tibial plateau fractures.

Twenty-eight patients with tibial plateau fractures treated by closed reduction using forceful traction and percutaneous stabilization with pins or screws were reviewed. For six bicondylar fractures, transfixion pins with an external fixation device were used. In six cases, an arthroscopic exam was also done. For 21 patients, external support was used postoperatively. Twenty-one patients were followed an average of 26 months. All fractures healed. Functional ratings were: 14 excellent, 6 good, and 1 poor. Radiographic ratings were: 11 excellent, 9 good, and 1 fair. For fractures with large fragments without excessive comminution or severe central depression, this technique yields good results with minimal surgical morbidity.

High-performance liquid chromatographic analysis of glycoamines in serum.

This report describes the development of an HPLC-UV method for studies of glycoamines and glycoamine-like compounds in normal human serum and osteosarcoma patients serum as potential biological markers of cancer. The glycoamines, a newly recognized class of endogenous, low-molecular-mass biopolymers, are conjugates of amino acids and sugar units, containing 5 to 29 amino acid and 1 to 17 sugar units. After ultrafiltration of serum samples, reversed-phase HPLC separation with diode-array detection was used to obtain standard profiles of serum ultrafiltrates below M(r) 10,000 in healthy subjects. These highly reproducible profiles utilized two-dimensional peak identification and were used to develop a statistical profile of the major glycoamine peaks in normal serum. This newly developed analytical method was subsequently used to address a key question: whether or not there is a single tumor-specific glycoamine or a family of tumor-specific glycoamines in cancer patient serum. Preliminary results suggest that this method can separate and detect glycoamines and glycoamine-like compounds in various types of cancer patients serum with a high degree of reproducibility on the basis of comparative two-dimensional identification of natural compounds and a panel of synthetic glycoamine analogs. Moreover, the method is useful for following the relative changes in the amount of a given glycoamine over an extended clinical time course. Initial results suggest that a glycoamine or glycoamine-like compound, GA-4.63, may have clinical utility in human osteosarcoma studies.

Fractures of the femur treated by intramedullary nailing using the fluted rod. A report of 193 consecutive cases.

One hundred ninety-three of 196 acute nonpathologic femoral shaft fractures were treated consecutively with intramedullary nailing using the fluted rod. Closed intramedullary nailing was used in 126 fractures, and an open technique was used in 67. This series includes 58 open fractures and 104 comminuted fractures. All fractures treated with the fluted rod united. Complications included three superficial infections (1.5%). Malrotation greater than 20 degrees was noted in six patients (3.1%). Significant shortening (5 cm), which required treatment, occurred in one patient. After initial resuscitation and evaluation, routine treatment included preoperative traction and a first-generation cephalosporin followed by accurate reduction and nailing of the fracture. The results of this series suggest that the fluted rod may be ideal for the treatment of most femoral shaft fractures.

A bone biopsy procedure for neonatal pigs.

Neonatal pigs were used to develop a surgical biopsy procedure to remove bone tissue from the ilium of small animals, with potential application for infants and small children. While the neonatal pig was under general anaesthesia, a scalpel was used to make a punch incision down to the ilium. Then a Craig Biopsy Trephine was used to remove a core sample of the bone. The samples ranged from 5 to 15 mm in length and 2 to 3 mm in diameter, with an average dry weight of 34.4 mg. The samples were adequate for mineral (calcium and zinc) analysis in our laboratory and may be equally suitable for histological or biochemical analyses. Surgical trauma was minimal, which permitted each pig to be biopsied every 7 days for 5 weeks without adverse consequences.

A comparison of transfusion requirements after total knee arthroplasty using the Solcotrans autotransfusion system.

Twenty-five consecutive total knee arthroplasties were performed with the Solcotrans unit for scavenging postoperative drainage (study group) and were compared with the previous 25 arthroplasties performed without the Solcotrans unit (control group). Mean preoperative hematocrits, estimated blood loss, and fluid replacement for both control and study groups were nearly identical. When the autotransfusion system was not used, 10 patients in the control group required transfusion of a total of 20 units of packed red blood cells, while only two patients utilizing the Solcotrans unit required transfusion of five units of packed red blood cells (P less than .01). The total amount autotransfused in the study group averaged 607.9 mm, and the hematocrit of the scavenged drainage was 29.3%. Samples from all autotransfusions were sent to the microbiology lab for routine culture and were finalized as no growth after 14 days. Serial postoperative hematocrits, platelet counts, prothrombin, partial thromboplastin, blood urea nitrogen, and creatinine values were compared between the two groups. No significant differences were found, and no evidence of coagulopathy, thrombocytopenia or renal dysfunction was found in the study group.

Disseminated intravascular coagulation complicating Ender's nailing of a pathologic fracture in prostatic carcinoma. A case report.

Disseminated intravascular coagulation (DIC) occurred after closed Ender's pinning of a pathologic fracture of the humerus in a 58-year-old man with metastatic prostatic carcinoma. A review of the oncologic and urologic literature revealed that coagulopathy can be associated with prostatic carcinoma. This association seems not to have been previously reported in the orthopedic literature.

Surgical correction of the snapping iliopsoas tendon.

Eighteen patients with 20 symptomatic hips underwent lengthening of the iliopsoas tendon for persistent painful snapping of this "internal" variety of snapping hip. We referred to the pathologic, painful snapping of the iliopsoas in the deep anterior groin as the "internal" snapping hip. This is in contrast to the more common and better-known "external" snapping that involves the greater trochanter and its overlying soft tissues. The results of our iliopsoas lengthening procedure are presented here. Lengthening of the iliopsoas tendon was accomplished by step cutting of the tendinous portion of the iliopsoas. The pathoanatomy of this poorly understood symptom complex was described in 1984 paper from this institution and is reviewed here. Iliopsoas bursography demonstrated a sudden jerking movement of the iliopsoas tendon between the anterior inferior iliac spine and iliopectineal eminence, synchronous with the patient's pain and often accompanied by an audible snap. The average preoperative duration of symptoms was 2.9 years, and the average length of postoperative followup was 25 months. All patients, except one, had a marked reduction in the frequency of snapping after tendon lengthening, and 14 of 20 hips had no snapping postoperatively. Of the six patients who had recurrence of snapping, all but one stated that this occurred much less frequently and was much less painful compared to the preoperative state. Two hips required reoperation. Postoperatively, only three patients complained of subjective weakness, and most patients were unlimited in physical activity with return to activities such as competitive football, pole vaulting, and long-distance running.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship between residency programs and fellowships in the educational setting.

In 1981, the Advisory Council for Orthopaedic Education published a list of 175 orthopedic postgraduate fellowships. Since that time, several groups within orthopedics have discussed various methods for enhancing the educational nature of fellowships as they related to orthopedic residency programs. The orthopedic community as a whole has concurred about the concept of accrediting fellowships, ensuring a minimum standard educational quality, and keeping the growth of fellowships in some areas from adversely affecting the educational quality of a residency program. When fellowships are accredited, standards are created, such as the requirement that a fellowship must last at least one year, and depending on the area of specialization, include both research and clinical work. Certification and accreditation are separate issues. Certification is the process of credentialing individual physicians as specialists and is the responsibility of a specialty board. Accreditation is the process of identifying residency and fellowship programs that meet published educational standards and is the responsibility of the Accreditation Council for Graduate Medical Education and the corresponding Residency Review Committee. There is little question that the educational process that occurs during a fellowship can have a beneficial effect on the learning process of residents and vice versa.

Primary iliopsoas bursography in the diagnosis of disorders of the hip.

The iliopsoas bursa is a well-defined anatomic structure that has been involved in various diseases about the hip, including osteoarthritis, rheumatoid arthritis, pigmented villonodular synovitis, and synovial chondromatosis. Demonstration of the iliopsoas bursa using contrast material has been reported during hip arthrography and inadvertently during angiography, but no direct or primary methods of iliopsoas bursography have been reported. A technique of primary bursography under fluoroscopy is described wherein filling of the bursa with contrast material allowed the observation of movement of the iliopsoas musculotendinous unit across the front of the pelvis during motion of the hip. This technique, which was of significant benefit in determining the etiology of two cases of the snapping hip syndrome of the internal variety, is simple, easily reproducible, and has clinical application.

The snapping hip syndrome.

The snapping hip syndrome is a symptom complex characterized by hip pain and an audible snapping of the hip with exercise typically seen in young individuals. "External" and "internal" etiologies have been described, although the "internal" etiology is poorly understood. A clinical, radiographic, and anatomical study of eight patients with this disorder, secondary to an internal etiology, was undertaken to aid in the diagnosis and surgical treatment. Iliopsoas bursography with cineradiography revealed subluxation of the iliopsoas tendon to be an apparent cause of the snapping hip. The anatomy of the hip in relationship to the iliopsoas tendon is defined with the anterior inferior iliac spine, iliopectineal eminence, and lesser trochanter assuming a significant role in the syndrome. An operative approach involving a partial release and lengthening of the iliopsoas tendon, with minimal resection of a lesser trochanteric bony ridge, if involved, is described.

Biomechanics of the spine in the polevaulter as related to spondylolysis.

An athlete was filmed at high speed to anatomically plot the position of the vertebrae during several pole vaults. A computer analysis adapted from a previously described program (Gainor, BJ, et al: The kick: Biomechanics and collision injury. Am J Sports Med 6: 185-193, 1978) was used to quantify the kinematic data. The thoracic and lumbar vertebrae of the polevaulter began in a neutral position but rapidly hyperextended 40 degrees during pole plant. The spine subsequently flexed 130 degrees in 0.65 seconds as the pole uncoiled and the athlete was propelled towards the bar. Angular velocities of the spine reached a maximum of 6 radians/sec during both extension and flexion. More significantly, angular accelerations of 150 radians/sec2 occurred in hyperextension, and 180 radians/sec2 in hyperflexion. Torque about the spine was estimated to be 1,500 inch-pounds during extension and 1,800 inch-pounds during flexion. The maximum kinetic energy in the athlete's body was calculated to be 36,000 inch-pounds. We believe the magnitude of these torques and accelerations predispose the back to injury. These results were correlated with several cases of spondylolysis in competing polevaulters.

Gait analysis with reference to chondromalacia patellae.

This study analyzed the gait of women exhibiting symptoms of chondromalacia patellae, and compared them with a group of women without chondromalacia symptoms. High speed cinematography was used to film the subjects walking on a level surface and a 15 downhill slope. Flexion of the knee on both surfaces during the single support phase was significantly less for the chondromalacia subjects (P < 0.05). increased external femoral rotation was detected in chondromalacia patellae subjects (P < 0.05) during swing phase on level and sloping surfaces. A radical inward femoral rotation occurred immediately preceding heel strike (P < 0.001). We conclude that significant differences in gait are apparent in females exibiting chondromalacia patellae symptoms as compared with apparently normal female knees.J Orthop Sports Phys Ther 1983;5(3):127-131.