Integrity and full coding sequence of B19 virus DNA persisting in human synovial tissue.

Primary infection by human parvovirus B19 is often accompanied by arthropathy of varying duration, of which the most severe cases can be indistinguishable from rheumatoid arthritis (RA). While this might seem to imply a role in RA pathogenesis, recent studies have verified long-term persistence of B19 DNA in synovial tissue not only in patients with rheumatoid or juvenile arthritis, but also in immunocompetent, non-arthritic individuals with a history of prior B19 infection. However, the latter data are based on PCR amplification of short segments of DNA, with little sequence information. We determined the nucleotide sequence and examined the integrity of the protein-coding regions of B19 genomes persisting in synovial tissue and compared the results with data from synovial tissues of recently infected patients. In synovium of both previously and recently infected subjects, the viral coding regions were found to be present in an apparently continuous, intact DNA molecule. Comparison with sequences reported from blood or bone marrow showed that the synoviotropism or persistence of the B19 virus DNA was not due to exceptional mutations or particular genotype variants. The synovial retention of full-length viral genomes may represent a physiological process functioning in long-term storage of foreign macromolecules in this tissue.

Persistence of parvovirus B19 DNA in synovial membranes of young patients with and without chronic arthropathy.

BACKGROUND: Human parvovirus B19 replicates in erythroid precursors of the bone marrow, and several diseases have been attributed to this virus including some cases of juvenile chronic arthropathy. METHODS: Tissue samples from children with juvenile arthritis and from healthy young adults with recent joint trauma were examined for B19 DNA by PCR. We also studied the timing of the parvovirus infection serologically. FINDINGS: All samples of synovial fluid, bone marrow, and blood were negative for B19 DNA. Eight (28%) of the 29 children with chronic arthritis had B19 DNA in synovial tissues. However, an even higher proportion of the non-arthropathy controls were positive for B19 DNA in synovial membranes (13 [48%] of 27). All the individuals with B19 DNA in synovial membrane had serum IgG antibodies to B19. INTERPRETATION: Genomic B19 DNA can persist in the synovial membranes not only in patients with chronic arthropathy but also in healthy immunocompetent individuals. The diagnostic criteria for parvovirus arthropathy must be reevaluated.

Carbon fiber for repair of the rotator cuff. A 4-year follow-up of 14 cases.

Thirteen patients with 14 large rotator cuff tears were operated on using carbon fiber to cover the defect. The median follow-up time was 4 years. In 11, 1, and 2 cases the results were respectively excellent or good, fair, and poor. In 2 cases where the carbon fiber was anchored to the major tuberosity, a bone cyst was seen, but it did not influence the result. A carbon fiber tow application combined with Neer's anterior acromioplasty seems useful in the reconstruction of large tears of the rotator cuff.

Outcome of closed injuries exceeding 20-unit blood transfusion need.

A series of 129 patients with closed injuries receiving more than 20 units (1 unit = 500 ml) of blood within the first 48 h of accident was analysed. The transfusion policy included type-specific crossmatched whole blood stored with citrate phosphate-adenine as the main replacement. One unit of fresh whole blood was transfused for every 5 to 6 units of stored blood. Also platelet concentrates and fresh frozen plasma were in routine use. The patients required 340 surgical procedures, on average 2.6 per patient. Thrombocytopenia with a lowest recorded platelet count of less than 100,000/mm3 occurred in 81 patients (63 per cent) of whom 18 had disseminated intravascular coagulation. This serious complication seemed to be associated with large retroperitoneal blood accumulations, the latter possibly acting as an enhancing factor. The mortality rate in the whole series was slightly lower than recorded previously in the literature. Among patients receiving 21 to 39 blood units the mortality was 25 per cent and among those receiving 40 units or more the mortality was 52 per cent.

Maxillofacial trauma in fatally injured victims of motor vehicle accidents.

A survey of 84 victims of maxillofacial injuries sustained in road traffic accidents is presented. The material was based on the files of the Finnish National Board of Traffic Accident Investigation of the Insurance Companies, comprised the years 1972-1983 and covered the whole country. 86% of the victims were occupants of motor cars; only 24% had worn seat belts. Similarly only two of the eight motor-cyclists had worn a helmet. The majority of all victims also had other head injuries but only 24% had brain injuries; over 50% had a chest injury. In 20 cases the facial injury was thought to be the definitive fatal trauma. In the remaining cases the other injuries could have been responsible for the fatal outcome. However, aspiration of blood from the facial wounds, unconciousness and an injured thorax probably all contributed to death which in 87% was immediate. Thirty-six of the 64 victims who had not used a seat-belt or helmet could certainly, or probably, have been saved by either the belt or the helmet. The possibilities of preventing fatal maxillofacial injuries in road traffic are discussed.

Fatal cervical spinal injuries in road traffic accidents.

The present study analyses fatal road traffic accidents involving private cars and vans in Finland during the period 1972-1982, in which an injury to the cervical spine was the main cause of death. The material consists of 289 victims; this being 10.5 per cent of all the fatalities in this category of road traffic accidents. Front seat and rear seat passengers seem to have an equal risk of sustaining a fatal cervical spinal injury. However, front seat passengers have a significantly greater chance (P less than 0.001) of having fatal cervical spinal injuries than the drivers. Of the victims 21.1 per cent had worn safety belts but there was no statistical difference between those who did and those who did not wear safety belts. Increasing age seems to increase the risk of fatal cervical spinal injuries. Patients between 16 and 25 years of age had the lowest risk and patients over the age of 60 had the highest risk of sustaining a fatal cervical spinal injury (P less than 0.001). In 48.1 per cent of the cases, the victims were multiply injured and this is similar to other main causes of death in road traffic accidents. Wearers of safety belts had significantly (P less than 0.001) more multiple injuries. Of the patients who died of cervical injury, only 8.8 per cent survived transportation to hospital and 1.4 per cent survived longer than 24 hours. A direct blow was the most common mechanism of the cervical injury (47.1 per cent) and deceleration was found in 13.1 per cent of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthroscopic volume of the knee joint in young male adults.

'Arthroscopic volume' and resorption of normal saline was measured in 35 young males during routine arthroscopic examination. The average mean volume of the knee joint cavity was 103.4 ml and this volume was observed to correlate with the midpatellar circumference of the knee and the height of the patients. Mean resorption of normal saline was 4.1 ml/min, this resorption correlating with the volume of the joint cavity. No correlation with the underlying disease of the knee was observed.

Outcome of sports injuries treated in a casualty department.

The present investigation analyses 2493 patients with a sports injury treated in a casualty department during a one-year period. Of the patients 73% were men, the age of the patients averaging 26 years and the mean follow-up time was 24 months. Soccer and indoor ball games caused 24% and 23% of the injuries respectively, these being followed by injuries in ice hockey in 14%. Track and field injuries scored low with 2% out of all injuries. Injuries to the lower extremity predominated. At follow-up, ligamentous injuries of the lower extremity were the major cause of discomfort. Further, in the group of patients with persistent discomfort 36% had suffered a fracture or a dislocation, 13% a contusion and 10% a wound. The mean period of sports incapacity after a sustained injury was 3 weeks. In track and field events the injury seldom disturbed training for more than one week, but in soccer, indoor ball games, skiing and skating the mean sports incapacity period varied between 6 and 3 weeks. Out of the total injured, 2% had to give up their sports activity completely. An injury of the lower extremity demanded on average 4 weeks' rest, an injury of the upper extremity and the trunk 2 weeks and injuries of the head and neck one week's rest. According to the present investigation sports injuries were in the majority of cases of a relatively benign nature and sick leave from work seldom exceeded 2 weeks.

Postero-lateral spine fusion. A 1-4-year follow-up of 80 consecutive patients.

We analysed 80 consecutive patients with postero-lateral spine fusion performed during the years 1972-1976. Thirty-seven were women and 43 men, the mean age being 30 (14-54) years. In 73 cases the fusion was performed because of spondylolysis and spondylolisthesis and in seven because of some other form of painful instability. Preoperatively, all patients had pain in normal activities and 63 at rest. At the 1-5-year follow-up, eight patients were pain-free, while 69 had stress pain and 35 pain at rest. The reduction of pain was significant; 51 patients considered themselves improved, 18 unchanged and 10 worse. Twelve fusions united in less than 2 months, eight after more than 4 months, and two failed to unite. Patients under 20 years did better than older patients. The result was better when the fusion united within 4 months and also when the bone transplants were properly placed. We conclude that postero-lateral spine fusion can be advocated as treatment of painful spondylolisthesis and sometimes in low-back instability in younger patients.

Acute soccer injuries in Finland in 1980.

The present investigation analyses all the acute soccer injuries recorded in Finland during one year (1980). The mean follow-up time was 18 months. The calculated yearly injury incidence was 5.8%. No significant difference in the injury incidences between the two sexes could be detected. A major part, 64% of the injuries were located in the lower extremities. Fractures and dislocations accounted for 11% of all injuries. One quarter of the injuries were classified as mild, causing a playing disability shorter than a week. Most injuries occurred through physical contact with another player (p less than 0.001). The calculated median time of absence from practice after injury was 4 weeks.

Surgical repair of subcutaneous rupture of the Achilles tendon.

The present study analyses 70 consecutive patients who were operatively treated for a rupture of the Achilles tendon, the mean follow-up time being 6 years (range 3-8). The injury was sustained in 70% of the cases during sport exercise. Direct suturation was applied in 18 cases and various types of tenoplasty in 52 cases. Postoperative plaster immobilization after surgery lasted 6-8 weeks. The median sick leave was 57 days, 70% of the sick leaves ranging from 1 to 3 months. At the follow-up, 48 patients showed excellent results (as good as before the accident), 20 good (no distress other than when running), and two fair (distress while walking). Statistically, the operative techniques did not differ from one another with regard to the final clinical result. The injured Achilles tendon was found to have increased thickness and the girth of the calf to have decreased in thickness, both at a statistically highly significant level (P less than 0.001). The plantar flexion of the ankle was limited at a statistically significant level (P less than 0.01). The location of the scar did not influence the final clinical result. Recurrence of the rupture was experienced in two cases, this being doe to another accident. The authors recommend that ruptured Achilles tendons should be operatively treated at the acute stage.

Fractures of the talus.

A total of 35 patients treated in the years 1970 to 1977 for fractures of the talus were investigated for an analysis of the long-term clinical end results. Falling from height was the most common cause of injury (15 patients), the next most common being road traffic accidents (13 patients). The mean followup time was 8 years. At followup, 19 patients were free of any discomfort and none had pain at rest. The incidence of pain was correlated significantly (p less than 0.01) with the grade of dislocation both before and after reduction. In severely dislocated fractures open reduction and osteosynthesis with a compression screw are recommended.

The effects of vehicle mass, speed and safety belt wearing on the causes of death in road traffic accidents.

The present investigation was based on the files of the Boards of Traffic Accident Investigation of insurance companies with regard to those fatal motor-car accidents in Finland during the period 1972-1979, where the driver or front seat passenger had died. The analysis concerned a total of 1197 fatalities. In collisions where the other vehicle had been clearly heavier (mass distribution smaller than 1/5) head injuries were significantly (p less than 0.001) more often found as the main cause of death (57.3%) than was the case when colliding vehicles had approximately the same weight (mass distribution 2/3-3/2), in which case head injuries were found in 37.8% of the cases to be the main cause of death. When the speed was over 80 kph , the number of head injuries as the main cause of death increased significantly (p less than 0.001) in collisions where the vehicles had approximately the same weight (mass distribution 2/3-3/2) and in single accidents of motor-cars. The wearing of seat belts had an effect on the distribution of causes of death in single accidents of motor-cars and in collisions where the vehicles had approximately the same weight but did not effect the distribution of causes of death in collisions where the other vehicle was clearly heavier. In single accidents of motor-cars where the victims had not used seat belts, there were more head injuries (54.2%) as the main cause of death than in victims who had used seat belts (head injuries in 36.8% as the main cause of death). In collisions where the vehicles had approximately the same weight, cervical spine injuries were more common causes of death in victims who had used seat belts than in those who had not (21.3%/13.7%). The mechanism of fatal cervical spine injuries in victims who had used seat belts was the rapid bending of the neck due to maximal deceleration in 38% of cases.

Proximal tibial osteotomy in the treatment of osteoarthritis of the knee.

A long-term follow-up study is presented of 162 patients who were treated for knee arthrosis with proximal tibial osteotomy, 10 of whom had undergone a bilateral operation. The average follow-up time was 8 years. Pre-operatively, varus deformity was found in the knees of 117 patients; 45 of them had valgus knees. In 142 knees curved osteotomy was performed and wedge osteotomy in 30. At follow-up, 33% of the patients were found to have no pain. Significant long-term improvement was achieved, as registered at the time of follow-up, in 80% of the patients, whereas in 11% pain remained unchanged. Better results were recorded in women than in men (P less than 0.01). In the present study, slightly better results were obtained statistically using curved osteotomy (P less than 0.05). Postoperative plaster sleeve immobilisation for approximately 6 weeks (10 weeks at the most) gave the best results. Internal fixation seemed unnecessary.

Fractures of the patella treated by operation.

A retrospective analysis of 93 operatively treated fractures of the patella is presented. Tension band fixation was used in 14, circumferential wire in 15 and screw fixation in 19 patients. Partial patellectomy was performed in 35 cases and total patellectomy in 10 cases. The result was considered excellent in 27% of the patients, good in 49%, fair in 16% and poor in 8%. Patients under 30 years of age had better results than the older ones (p less than 0.01). Tension band fixation gave results superior to screw fixation (p less than 0.05) and partial patellectomy superior to total patellectomy (p less than 0.02). The length of the immobilization time in plaster showed no statistical significance. As a result of this investigation tension band fixation and partial patellectomy seem to be the methods of choice in the management of those fractures of the patella which need operative treatment.

Comminuted displaced fractures of the patella.

A series of 64 comminuted displaced fractures of the patella is reviewed. Morphologically the fractures can be classified into three groups reflecting the mechanism of injury and the degree of soft tissue damage. All fractures were operated on. Tension band wire was used in 21, partial patellectomy in 33 and total patellectomy in patients. The problem of the management of these fractures is often in making the choice between excision and internal fixation. In this retrospective analysis the results of anterior tension band wire fixation were acceptable even in severe comminuted fractures. Partial excision showed satisfactory results provided that at least three-fifths of the patella could be preserved. Total excision is sometimes clearly unavoidable but should be preceded by sober contemplation whenever considered as the alternative to internal fixation.