Shoulder instability and impingement in throwing athletes.

The glenohumeral articulation maintains a fine balance between mobility and stability. In the throwing athlete, this balance is stressed from the repetitive microtrauma incurred to achieve peak performances. The presentation of shoulder pain in the throwing athlete can be confusing, and a thorough understanding of anatomy and biomechanics, in addition to the history and physical examination, are necessary to delineate the correct diagnosis. Specifically, differentiating between instability and impingement is critical to initiate appropriate nonoperative and operative interventions. This paper discusses the anatomy and biomechanics in the shoulder and provides a comprehensive approach to evaluate anterior shoulder pain in throwing athletes. In addition, treatment options will be discussed with specific emphasis or nonoperative interventions.

Laboratory parameters as predictors of operative outcome after major abdominal surgery in AIDS- and HIV-infected patients.

Surgeons throughout the country are frequently asked to consult on acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV)-infected patients experiencing abdominal pain. Disease processes vary remarkably within this population and often occur with confusing presentations and unusual pathologies related to the immunocompromised state. With the increased awareness and treatment of HIV infection, it can be anticipated that many patients will require surgery for secondary complications of AIDS, in addition to surgical problems unrelated to HIV infection. Twenty-five patients diagnosed with HIV infection underwent major abdominal surgery between 1986 and 1990 at The Mount Sinai Medical Center. Those patients classified as having AIDS had a longer post procedure hospitalization (19 days vs 9 days; P < 0.05) and a higher mortality rate (33% vs 10%). All of the patients who underwent appendectomy survived with few complications. Excluding appendectomy patients, operative mortality was predicted by low serum albumin (P < 0.001). In addition, preoperative hematocrits were considerably lower in non-survivors. Total serum protein and total WBC counts were not predictors of operative outcome.

Cerebral coenurosis. Report of a case with arteritis.

A case of the unusual clinical condition of cerebral coenurosis, the unique parasitic disease that is localized only in the CNS, is reported. The patient had repeated attacks of transient hemiparesis due to intracranial arteritis which was demonstrated by several angiographic studies. The CSF showed a discreet lymphocytosis and increased immunoglobulins. This inflammatory reaction which preceeded the manifestations of the intracranial mass can be explained by the parasitic foreign bodies, the liberation of somatic and metabolic parasitic toxins and the immunological reaction of the organism. The arteritis of the basal intracranial vessels was probably secondary to the inflammatory reaction of the leptomeninges. In presence of the rare association of meningovascular disease and an expanding intracranial lesion a parasitic condition due to a larval stage of Cestodes (Hydatidosis, Cysticercosis, Coenurosis) should be always considered.