Interfascicular reconstruction of the peroneal nerve after knee ligament injury.

Peroneal palsy is the most common lower extremity nerve injury. Although most studies emphasize particularly poor prognosis after traction injuries to the peroneal nerve, interfascicular nerve grafting has emerged as a promising technique. We describe the case of a 20-year-old man who sustained a traction injury to the peroneal nerve (0/5 foot dorsiflexion and eversion) concomitant with tears of the anterior cruciate and lateral collateral ligaments. Interfascicular sural nerve grafting (10-14 cm in length) was performed 7 months after injury and 6 months after ligament reconstruction. The patient recovered motor strength (4+/5) in both anterior and lateral compartments by 2 years' postsurgery. The results obtained indicate that interfascicular nerve grafting is a valuable technique for reconstruction of the disrupted peroneal nerve; it provides sufficient benefit to justify the time, expense, and effort involved. An aggressive approach is thus recommended in patients with peroneal nerve disruption in the setting of multiple knee ligament injuries.

Diagnosis and treatment of traumatic anterior instability of the shoulder.

Traumatic anterior glenohumeral joint dislocation is the most common type of shoulder instability. Lesions that usually result are avulsion of the anterior capsule and glenoid labrum from the glenoid rim (Bankart lesion), compression fracture of the posterosuperior humeral head (Hill-Sachs lesion), and laxity of the joint capsule. Another common lesion is a lengthwise disruption of the rotator cuff at the interval between the subcapularis and supraspinatus tendons. The shoulder that dislocates repeatedly after trauma has an excellent success rate when treated by surgical repair. The aim of the Bankart procedure is to restore stability to the shoulder by repairing the traumatic lesion of the anterior glenoid rim without altering normal anatomy.

Scintigraphic determination of patellar viability after excision of infrapatellar fat pad and/or lateral retinacular release in total knee arthroplasty.

A prospective study ascertained the effect of lateral retinacular release and/or excision of the infrapatellar fat pad on patellar vascularity after total knee arthroplasty. Fifty patients (70 knees) had postoperative technetium bone scans, which revealed a higher incidence of vascular compromise of the patella after lateral release than without lateral release. Excision of the infrapatellar fat pad, commonly performed to enhance exposure and simplify access to the proximal tibia, did not compromise patellar vascularity.

Pepsinogen--an immunoglobulin binding artefact in 'collagen' preparations.

It has previously been shown that extracts of human articular cartilage, many many of which contain type II collagen, react with heat-aggregated immunoglobulin and artificially prepared immune complexes. Sera from patients with rheumatoid arthritis and psoriatic arthritis, but not from patients with inflammatory bowel disease, react with these extracts. There are two distinct patterns of binding, either as low molecular weight immune complexes or as free antibody directed against collagen. Aggregate-binding activity identified in extracts of human articular cartilage following pepsin digestion was found to be distinct from collagen in its salt solubility. Further purification of this aggregate-binding factor by SDS gel electrophoresis has shown it to be an artefact resulting from the binding of small immune complexes to pepsinogen present in the pepsin preparation used to digest the cartilage.

Clinically unsuspected phacoanaphylaxis after extracapsular cataract extraction with intraocular lens implantation.

We describe the histopathological findings of an enucleation specimen from a clinically undiagnosed case of phacoanaphylaxis which occurred after extracapsular cataract extraction with intraocular lens implantation. Phacoanaphylaxis, a granulomatous inflammatory response to liberated lens protein, is potentially curable by prompt removal of residual lens material. This case emphasises that the diagnosis of phacoanaphylactic endophthalmitis should be considered in any case of extracapsular cataract extraction complicated by granulomatous intraocular inflammation.

Trigeminal afferents to cerebral arteries and forehead are not divergent axon collaterals in cat.

Horseradish peroxidase conjugated to wheat germ agglutinin (HRP-WGA), and bisbenzimide (a fluorescent dye) were used as retrograde axonal tracers to examine whether or not intracranial and extracranial trigeminal afferents represent divergent axon collaterals. HRP-WGA was applied to the proximal segment of the middle cerebral artery and bisbenzimide was injected into a branch of the ophthalmic nerve in 5 cats. Histologic examination of the ipsilateral trigeminal ganglion revealed HRP-labeled cell bodies located among clusters of cells exhibiting bisbenzimide fluorescence. Cells containing both labels were not observed. These results support the concept that divergent axon collaterals are probably not involved in the pathogenesis of referred pain during vascular headache.

Histopathological findings in necropsy eyes with intraocular lenses.

The histopathological findings in five post-mortem eyes with anterior chamber and iris fixation intraocular lenses (IOLS) are discussed. The interval between lens insertion and death ranged from 3 1/2 to 52 months. Clinically the lenses were well tolerated and the surgery was considered to be successful. In one case a vitrectomy was required. Prominent histopathological features included reduced corneal endothelium (five cases), central cornea guttata (one case), dislocation of an anterior chamber IOL (one case), abnormalities of the filtration angle (five cases), non-granulomatous iritis (two cases), and iris atrophy and erosion (five cases).

Histopathologic study of changes occurring in eyes with intraocular lens implantation: autopsy eyes, enucleated eyes and corneal buttons.

The clinicopathologic findings in 17 eyes which were surgically enucleated or removed at autopsy as well as the histopathology of 72 corneal buttons removed from eyes with intraocular lenses are described. In four of five autopsy eyes the intraocular lens was well tolerated; however, in all cases, changes related to the pseudophakos were found. In seven of 12 surgically enucleated eyes, postsurgical bacterial or fungal endophthalmitis had developed. On histopathological examination, one eye revealed clinically unsuspected endophthalmitis phacoanaphylactica after extracapsular cataract extraction and intraocular lens implantation. In two cases, choroidal melanoma became evident after cataract extraction and insertion of a pseudophakos. In both cases preoperative ultrasonography was limited to A-scan axial measurements. The 72 corneal buttons were removed from patients with pseudophakic bullous keratopathy; histologically the most striking findings were guttata-like changes in 50% of the specimens and retrocorneal membranes in 13.9% of the specimens.