MR imaging of the shoulder after an impingement test: how long to wait.

OBJECTIVE: The purpose of this study was to determine the appropriate minimum waiting time between an impingement test with subacromial injection and subsequent MR imaging to avoid misinterpretation if the injected fluid is still present. CONCLUSION: MR imaging should be delayed a minimum of 24 hr after a subacromial injection. Fluid in the subacromial space 24 hr after subacromial injection is unrelated to an impingement test.

Anterior cruciate ligament reconstruction as an outpatient procedure.

During a 27-month period, 222 patients with 227 anterior cruciate ligament-deficient knees underwent arthroscopically assisted reconstructions as outpatient procedures. Bone-tendon-bone autografts were used for 169 of these reconstructions; the other 58 were done with bone-tendon-bone allografts. Additional procedures were performed on 180 of the patients. The interval from injury to reconstruction averaged 29 months. The protocol developed at our clinic employs a general anesthetic administered with the intent of same-day discharge, infiltration of the skin and joint with bupivacaine, a cold compressive dressing, and the use of both ketorolac tromethamine and a Schedule III narcotic (acetaminophen with codeine or with propoxyphene) for postoperative pain control. At an average followup of 10 months, no readmissions in the immediate postoperative period had been required and no short- or long-term postoperative complications could be attributed to the protocol. This safe and effective technique offers the patient the advantage of anterior cruciate ligament reconstruction as a same-day procedure and allows the surgeon to implement its use in any outpatient setting without additional discharge planning.

Mortality after fracture of the hip in patients who have end-stage renal disease.

Thirteen fractures of the hip in twelve patients who had end-stage renal disease were treated over a ten-year period; these injuries included one intertrochanteric fracture, seven non-displaced fractures of the femoral neck, and five displaced fractures of the femoral neck. Twelve of the thirteen fractures were treated with an operation. Six patients (who had a total of six fractures) died within one year after the fracture. Two patients died as the result of sepsis related to the wound; the other four deaths were not directly related to the operation. Although the mortality rate in this group of patients was higher than that in a group of matched patients who had a fracture of the hip but who did not have end-stage renal disease, we were not able to demonstrate that this difference was significant, perhaps because of the small size of the sample. The mortality rate in these twelve patients was significantly higher, however, than that in matched patients who had end-stage renal disease but who did not have a fracture of the hip (p = 0.01).

Analysis of the quantity of antiviral antibodies from mink infected with different Aleutian disease virus strains.

Mink persistently infected with Aleutian disease virus (ADV) develop hypergammaglobulinaemia and immune complex disease. Radiolabelled antibodies from mink infected with ADV-G, DK, Pullman , and Utah I strains of ADV were reacted against all four ADV strains in radioimmunoassay (RIA). The amount of anti-ADV antibody in two equally hypergammaglobulinaemic serum pools varied from 13% (anti- Pullman ) to 57% (anti-Utah I). Serum pools from two other sources (anti-DK and anti-ADV-G), although less hypergammaglobulinaemic , had 5% and 13%, respectively, indicating that 43-95% of the Ig in the sera of mink with AD was not specific antibody to ADV structural antigens. The possibility of a general polyclonal activation of the humoral immune system is being discussed. Comparison of plateau RIA binding levels for the four serum pools against the four viral antigens suggested three patterns of reactivity: DK and Utah I reacted similarly, but Pullman and ADV-G reacted serologically different.