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Graft positioning in anterior cruciate ligament (ACL) reconstruction is usually documented from lateral postoperative radiographs. The purpose of this study was to compare 3 measurement methods for femoral graft placement in 50 patients with ACL reconstruction. Intraoperative radiographic images were obtained and divided into 2 groups. The first group showed suboptimal projections, with out-of-plane rotations causing the femoral condyles to not be perfectly overlapped. The second group showed good projection, with optimal rotation and fully overlapped femoral condyles. In our study, only the measurement technique described by Amis produced data with the least measurement error when multiple observers assessed both groups. It is recommended that Amis' method be used to measure femoral ACL graft position so that reliable data are available for comparison between medical centers.

In addition to color and pulsed Doppler sonography findings, we aimed to describe power Doppler sonography findings in Graves' disease in this study. Twenty-three patients with Graves' disease were imaged with gray-scale, color and power Doppler sonography. Twenty normal volunteers were examined by the same equipment and the same technique as a control group. A subjective grading system was used to categorize the vascularization in pulsed Doppler sonography images from normal to markedly increased vascularization. Power Doppler sonography exhibited diffuse hypervascularity in the thyroid gland in all patients. The flow was covering about all the parenchyma. Four patients showed mild, 12 patients moderate and seven patients marked vascularity. The intensity of power Doppler flow pattern was not correlated with the severity of the disease. This study demonstrated that power Doppler sonography is a convenient, time saving, inexpensive and noninvasive method as compared with isotope scan and some other laboratory tests for confirmation of Graves' disease.

Basaloid follicular hamartoma is not a well-recognized clinical entity and has often been diagnosed as trichoepithelioma or basal cell carcinoma. It is a unique benign follicular tumour which comprises a variety of clinical manifestations. We present the case of a 24-year-old male with unilateral basaloid follicular hamartoma present at birth and later misdiagnosed as basal cell carcinoma. Histological features of basaloid follicular hamartoma are not always diagnostic and clinico-pathological correlation is particularly important to distinguish this benign hamartoma from other basaloid tumours including basal cell carcinoma. Continuous follow-up of our patient did not reveal any clinical or histological malignant transformation.

We compared the reliability and validity of graft position measurements made by 4 orthopedic surgeons on intraoperative radiographs obtained using fluoroscopic control and postoperative radiographs obtained from the same 17 patients 6 weeks after ACL reconstruction. Measurements from postoperative radiographs varied significantly more than those from intraoperative radiographs. There was little agreement between the postoperative and intraoperative measurements of the tibial and femoral graft position. We conclude that postoperative radiographs are not a sufficient tool for assessing graft placement after ACL reconstruction using patellar tendon autografts. In order to consider graft position in follow-up studies and to compare results from various surgeons, we suggest intraoperative fluoroscopy to produce radiographs for accurate and reliable measurements.

Introduction: The Centers for Disease Control and Prevention's Guidelines for School Health Programs to Prevent Tobacco Use and Addiction were developed, in part, to help state and local education agencies implement effective school-based tobacco control programs. This paper: (1) reports on school tobacco policies, one facet of a larger investigation conducted to examine the consistency between WV's school-based tobacco control policies and programs and the CDC Tobacco Guidelines and (2) describes the impact this investigation had on state policy in WV., Methods: A content analysis was conducted on all (n = 55) county tobacco policies using a coding protocol developed by the authors. This protocol was designed to enable judgment about whether the county policies addressed particular elements specified in the CDC Tobacco Guidelines. Additionally, data about school-level policies, collected from a telephone survey of a sample of school principals (n = 421), are presented. Since the purpose of the needs assessment was to describe current practice, frequencies were computed for both the county and school-level analyses., Results: Both county- and school-level tobacco policies were found lacking in many of the elements recommended in CDC's Tobacco Guidelines, particularly in the areas of enforcement procedures and access to cessation programs., Conclusions: Two major outcomes resulted from this needs assessment: (1) the WV State Board of Education's Tobacco Control Policy was revised to be more consistent with CDC's Tobacco Guidelines and (2) increased attention is now being focused on providing cessation options for WV schools.

Objective: To evaluate the efficacy of power doppler ultrasonography in depicting increased vasculature and hyperemia around the superficial soft tissue abscess., Materials and Methods: 21 patients with soft tissue abscess were evaluated with gray scale imaging, color doppler sonography, power doppler sonography and computed tomography. In each case attempts were made using power doppler sonography to demonstrate any areas of increased vascularity around the lesion. The results were compared with computed tomographic findings., Results: Peripheral hyperemia and increased vasculature were demonstrated with power doppler sonography in 19 of 21 patients with soft tissue abscess. The hyperemic area demonstrated around the wall of the abscess by power doppler sonography was similar to the enhanced area shown by computed tomography performed after contrast administration., Conclusion: Power doppler sonography shows increased vasculature and hyperemia in the wall of abscesses. Therefore, power doppler sonography can be used to assist with the diagnosis of superficial soft tissue abscess., (Copyright 1998 Elsevier Science Ireland Ltd.)

The size and location of articular cartilage wear was assessed on 106 varus and 37 valgus osteoarthritic tibial plateaus resected during total knee arthroplasty. Anterior cruciate ligament integrity was assessed intraoperatively, and calibrated digital images were used to measure the wear patterns. Complete anterior cruciate ligament deficiency was seen in 25% of the varus and 24% of the valgus knees. Wear patterns on anterior cruciate ligament intact and attenuated varus tibial plateaus occurred in the middle to anterior aspect of the medial plateau. Anterior cruciate ligament deficient varus plateaus had significantly larger wear areas located more posterior on the medial plateau. In contrast, anterior cruciate ligament intact and deficient valgus tibial plateaus had wear located posterior to the center of the lateral plateau. Anterior cruciate ligament integrity is a discrete feature of advanced osteoarthritis that strongly influences the articular wear patterns. The anterior cruciate ligament deficient wear patterns show a wear mechanism that is consistent with the posterior femoral subluxation and posterior tibiofemoral contact observed after acute anterior cruciate ligament rupture. These observations provide insight into the altered knee mechanics that exist in osteoarthritic knees and the resulting mechanical factors that contribute to degenerative changes.

The purpose of this study was to investigate the epidemiological features of pityriasis rosea (PR) in the Eastern Anatolia, Turkey. Three hundred ninety-one patients (214 females, 177 males) with PR seen during the years 1992-1995 were analyzed for annual incidence among dermatologic outpatients, sex, age, and distribution by month and year. The average annual incidence was 0.75 per 100 dermatologic patients. PR was reported to be slightly more common in women by margin of 1.2:1.0. Eighty-seven percent of the cases were between the ages of 10 and 39 years, with a peak in the 20-29 age group. The incidence of the disease was much higher in the rainy and snowy months. No declining incidence was observed over the years. Changes in incidence from year to year, though not great, were statistically significant.

Mycosis fungoides rarely involves the oral cavity. To our knowledge only 29 cases of oral cutaneous T-cell lymphoma have been described up to 1994. This report presents a case of mycosis fungoides with involvement of the oral cavity in a 57-year-old man who died from septicemia 7 months after the onset of oral involvement.

There is increasing interest in using surface modification technology to improve the wear properties of titanium alloy and limit articular surface wear of metal and polyethylene components. This report details the in vivo wear performance of titanium nitride coating on a retrieved hip implant obtained postmortem from a low demand patient 1 year after total hip arthroplasty. Analysis of the well-functioning implant revealed that wear debris can originate from a titanium nitride coated femoral head, as delaminated surface asperities, and manifest as adhesive wear on the articular surface. The wear observed on this implant indicates that rigorous testing and evaluation of titanium nitride coating technology should be conducted prior to widespread use on total joint implants.

The difficulty in quantitatively assessing the inherent variables of surgical stem insertion and interfemur differences continues to be a problem in experimental methodologies which assess hip stem stability. An in-vitro torsional stability protocol was developed which limited the mechanical testing variability and provided a reproducible micromotion measurement of an uncemented stem in synthetic composite femurs. Using a controlled mechanical stem insertion resulted in less interfemur variability within each group with the coefficient of variation being reduced from 35% overall to less than 20%. Femurs with shallow stem insertion depths had significantly larger micromotion than femurs having deep stem insertion depths. The sensitivity of the experimental protocol and the synthetic composite femurs to the varied functional behaviour of three different stem designs was demonstrated. The stem with a hollowed anterior-to-posterior proximal section experienced significantly more motion than the two stems with full proximal sections, reinforcing the need for proximal contact to ensure minimal micromotion in torsional loading.

In this study, we compared Hispanic and Caucasian college students identified as adult children of alcoholics in terms of psychological adjustment using the Diagnostic Inventory of Personality and Symptoms (DIPS; Vincent, 1985). Results of the study suggested that, among college students, Caucasian men seem to be at a greater risk for using alcohol and drugs than Caucasian women or Hispanic men and women.

Data from Exner's 1985 and 1989 normative samples on nonpatient adults and comparison samples of patients with schizophrenia, depression, and character problems were reanalyzed using a standard of clinical significance appropriate for N = 1. The 1989 norms, which exclude Rorschach protocols with less than 14 responses, alter not only the number of significant variables, but also alter the ability of most variables that relate to form quality to differentiate among the patient comparison groups. The Exner Rorschach is judged to be a valid test for schizophrenia, but to have demonstrated little differential utility for depression and character disorders. It is recommended that the scoring of nonsignificant variables be abandoned.

A recently described scoring system designed to assess the individual risk of finding serious pathology in patients referred for upper gastrointestinal investigation has been prospectively tested in 1279 patients undergoing first-time endoscopy and 321 patients undergoing radiologic examination. The scoring system has been confirmed to give a reasonable prediction of the likelihood of finding serious pathology in two hospitals with differing endoscopic practice, and also to be applicable to patients attending for radiology. The system works best at defining a low-risk group (score less than 412, 26% of total) in which the incidence of serious pathology was 3%. All cases of malignancy (n = 55) occurred in patients scoring greater than 464 (50% of total). A simple table is described that allows for the easy calculation of score at a glance without the use of a computer. We believe that this scoring system, which can be implemented in seconds, is the simplest yet described and that it could prove to be a useful educational aid.

The effect of intercurrent diarrhoea on relapse of ulcerative colitis was investigated. Diarrhoea resulting from travel abroad, gastroenteritis or antibiotic usage resulted in an approximately 50% relapse rate. With regard to colonoscopy and barium enema, only the latter was followed by relapse and this may reflect differences in the preparation for the procedure.

The prevalence of symptoms suggestive of a motility disturbance similar to the irritable bowel syndrome was investigated in 98 patients with ulcerative colitis in remission, and a similar number of age- and sex-matched healthy controls. Thirty-three per cent of patients compared with 7% of controls fulfilled the criteria for such a syndrome (p<0.01). Contrary to expectations these symptoms were not confined to patients with distal disease. Other symptoms such as constipation were also very common in the colitic group (31%).

To assess the validity of the present subdivision of patients with inflammatory bowel disease into those with Crohn's disease of the small bowel or of the colon and those with ulcerative colitis, 252 patients with inflammatory bowel disease have been studied by questionnaire and case note review. One hundred and seventy-two variables concerning the nature and frequency of symptoms in remission and relapse, the incidence of complications and results of investigation have been analysed by computer. As expected, there were many highly significant variables between patients with ulcerative colitis and those with Crohn's disease of the small bowel. The latter showed evidence of a more severe disease course with more complications. There were similar, although less marked, differences between patients with Crohn's disease of the colon and those with Crohn's disease of the small bowel. There were very few differences in disease course between patients with Crohn's disease of the colon and those with ulcerative colitis. The results suggest that while separate classification of patients with Crohn's disease of the small bowel is justified on clinical grounds, the present separation of patients with disease confined to the colon into groups labelled ulcerative colitis or Crohn's disease of the colon is not. Alternative methods of classification should therefore be investigated.

The introduction of an open access general practitioner endoscopy service may result in many unnecessary examinations being performed. In an attempt to prevent this, 235 patients attending for endoscopy were interviewed and the results analysed to determine which factors best discriminated between those with major disease (ulcers, cancers, oesophageal strictures; n = 48) and those without (n = 187). The six characteristics which best discriminated between the two groups were increasing age, history of vomiting, male sex, smoking, and a past history of peptic ulcer or hiatus hernia. With the use of these six features a scoring system was devised, designed to give an indication of the likelihood of finding such disease in an individual patient. This was assessed prospectively in a further 356 patients. The results showed that by utilising this scoring system it would be possible to reduce the number of examinations performed by 30% yet still detect 98% of serious disease. If confirmed in further prospective studies, this scoring system (or a modification) could more accurately assess individual priority for endoscopy and enable optimum use to be made of limited resources.

The conceptual framework and empirical basis of the distribution model are examined, and it is concluded that a more satisfactory model is required.

This prospective investigation was undertaken to determine whether routine ultrasound visualization of the gravid uterus shortly before cesarean section would provide useful information in determining the site for uterine incision. Complete data were gathered on 124 pregnancies using a portable real-time ultrasound machine. Determination of the placenta and umbilical cord locations, fetal presentation, and amniotic fluid volume were reliable. Compared with a matched group without ultrasonic visualization, the eventual site for uterine incision and morbidity to the mother and fetus were not significantly different. Although routine visualization of the intrauterine contents before surgery is not necessary, worthwhile information may be gained in select cases to confirm a previously suspected noncephalically presenting fetus or a low anterior placenta.

To assess the relation of ventricular arrhythmias to myocardial K(+) movement during ischemia, we placed an electrode catheter in the left anterior descending coronary artery for thrombus production in intact anesthetized dogs. (85)Kr injections distal to the thrombus permitted serial coronary blood flow measurements. Animals of Group I with a moderate flow reduction exhibited no arrhythmia or myocardial egress of K(+). In Group II, marked flow reduction was accompanied by an injury potential and loss of K(+) from the ischemic site, before and during ventricular tachycardia. Therapeutic interventions were performed in animals having the same degree of ischemia as Group II. Systemic procaine amide in Group III interrupted the tachycardia and egress of K(+), despite persistent ischemia. Group IV did not respond to intracoronary insulin with K(+) uptake, as did normal dogs, and progressed to fibrillation. During the production of hyperglycemia in Group V, myocardial loss of K(+) ceased with maintenance of sinus rhythm. Hemodynamic factors did not appear to have a major role in the genesis of the arrhythmia.Since intracoronary infusion of K(+) in normal dogs similarly altered repolarization and produced fibrillation, it would appear that during ischemia egress of K(+) before development of the arrhythmia indicates a major role of the ion in pathogenesis. This view is supported by the myocardial loss of K(+) and arrhythmia induced in normal dogs by strophanthidin and by the fact that pharmacologic regulation of K(+) loss is associated with correction of the arrhythmia, despite persistence of low blood flow.