The effect of a cardiac rehabilitation program on the joints and spine: subjective evaluation.

To examine the effects of a cardiac rehabilitation exercise program on the joints of patients just recovered from a coronary disease episode, a questionnaire was distributed to such patients entering the program. Of 171 patients who completed the questionnaire, 76 indicated they had pain in some joints, most frequently in the back. Sixty-six patients were available to complete follow-up questions after participating in the exercise program for a minimum of 3 months. Pain, or lack thereof, remained unchanged in 35 participants. A decrease in pain was noted by 27, and more pain by 4.

Avascular necrosis in systemic lupus erythematosus: clinical associations and a 47-year perspective.

Twenty-six of 488 (5%) patients with systemic lupus erythematosus followed in a private practice developed clinically evident, symptomatic avascular necrosis. Avascular necrosis was significantly associated with hypertension, pleural effusions, cerebritis, nephritis, anemia, and earlier age of disease onset. No association with anticardiolipin antibodies or thromboembolic disease was observed. Avascular necrosis is usually observed in active, severe lupus.

Knock-knee deformity in children. Congenital and acquired.

The causes of knee valgus in children are multiple and complex. Physiologic knock knee, trauma, poliomyelitis, dysplasias, and infection all can be causative. One of the most interesting examples is the valgus that sometimes follows an undisplaced proximal tibial metaphyseal fracture. Treatment for all these entities can vary from doing nothing to corrective osteotomies, stapling of the medial epiphyseal plate, and bracing of the leg.

Posterior fracture dislocation of the hip with fractures of the femoral head.

In general, all traumatic dislocations of the hip must be treated as surgical emergencies. Multiple attempts at closed reduction are contraindicated, particularly in Type V dislocations. Every effort must be made to recognize the dislocation, particularly in patients with other severe lower extremity trauma. Reduction within 24 hours gives better results than late reductions. Roentgenograms of the pelvis must include both hips after closed or open procedures as a check for a concentric reduction of the hip. Any abnormality, or failure to reduce the avulsed head fragment, demands an immediate hip arthrotomy. The good results, after primary open reduction, although under 50%, were better than closed or closed followed by open reduction. Our approach is to discard the avulsed head fragment. No conclusions can be made regarding screw fixation of the avulsed fragment because there was an insufficient follow-up period in this procedure. Long-term follow-up examination is necessary in Type V fracture dislocations because one can anticipate that arthritic changes will develop in more than 50% of patients. Anterior approaches to excise head fragments in Type V dislocations are contraindicated. Early intervention is indicated in all dislocations with sciatic or peroneal nerve paralysis. Because most dislocations in this series were due to automobile accidents, the routine use of seat belts could have prevented many of these injuries.

Closed needle biopsy of the lumbar spine: a safe and easy method.

Numerous articles have been written about methods of closed biopsy of the spine. One of the most recent is by Moore et al,1 who describes his method as used at the Los Angeles General Hospital. The method described in this report is a simple and safe method for closed biopsy of the lumbar vertebra.

Infection after knee replacement surgery.

Vigorous treatment is not always necessary to eradicate late postoperative infection after total knee implantation. Aspiration of the pus and intravenous antibiotic administration was enough to eradicate the infection in the case reported.