Foot and ankle manifestations of Reiter's syndrome

If one were to characterize the clinical presentation of Reiter's syndrome in the feet and ankles, it would be that of pain associated with mild to moderate swelling and tenderness without significant erythema. These changes would occur most commonly at the posterior calcaneus, metatarsophalangeal joint, and phalangeal regions. The ankles will usually show an effusion. It is very uncommon for the subtalar region, midfoot region, or even the metatarsal shaft area to be involved. Roentgenographic changes were present in similar frequency as in physical findings. Erosions and soft tissue swelling affect the forefoot and ankle while "spurring" and erosions affect the hindfoot. It is readily apparent that no single clinical finding or radiographic change indicates Reiter's syndrome. The type and location of foot pain is what should prompt the physician to seek further elements allowing the diagnosis of Reiter's syndrome.

The effects of autologous bone grafting on bone healing after carpal arthrodesis in the dog

Arthrodesis was performed on the right and left carpus of eight dogs, incorporating a fresh autologous cancellous bone graft in the right carpus. Histological evaluation of each carpus after the procedure demonstrated that although the grafted bone appeared dead, healing was significantly greater (P < 0 . 01) after 12 weeks if it had been used.

Arthrodesis of the interphalangeal joint of the great toe--an improved technique

At the Mayo Clinic between 1950 and 1975, initial fusion of the interphalangeal joint of the great toe was attempted 166 times in 139 patients utilizing a Kirschner wire for stabilization. Follow-up examination of these patients disclosed an overall pseudarthrosis rate of 44%. Because of these disappointing results, a technique involving use of a longitudinal mini-cancellous bone screw was devised which provides increased stability and compression at the arthrodesis site. With this method, used 20 times in 18 patients, the pseudoarthrosis rate was decreased to 10%.

Assessment of block of the sciatic nerve in the popliteal fossa

Success of block of the sciatic nerve in the popliteal fossa in 130 patients was assessed by an anesthesiologist at the time of surgery. The patients were evaluated for complications by the anesthesiologist during postoperative rounds and by the orthopedic surgeon at the 1-month follow-up visit. Acceptance of the block by the patient was judged by answers on a questionnaire filled out by the patients after they had gone home. The questionnaire was designed to determine satisfaction with the block, discomfort associated with performance of the block, and whether sensations suggestive of paresthesias or other complications not evident at the time of discharge from the hospital had occurred. Of 119 patients responding to the questionnaire, 105 (88.2%) expressed overall satisfaction with the anesthesia. Two patients described sensations compatible with postoperative paresthesias, and two others described sensations that may have been paresthesias; in none did the sensations last longer than 1 month. Assessment of the blocks by the anesthesiologist in all 130 patients in the study revealed that anesthesia satisfactory for completion of the operative procedure was achieved in 107 (82.3%). General anesthesia was needed in eight patients (6.2%), and in 15 patients (11.5%) intravenous sedation or injection of the site of surgical incision with local anesthesia (or both) was needed.

Treatment of primary osteoporosis with fluoride and calcium. Clinical tolerance and fracture occurrence

Thirty-six patients with primary osteoporosis were treated for up to six years with sodium fluoride, calcium supplements, and, in 24 patients, vitamin D. Major adverse reactions (synovitis, painful plantar fascial syndrome, recurrent vomiting, or anemia) occurred in 15 patients (42%). New vertebral fractures occurred at a rate of 329 fractures per 1,000 years of observation. Almost half of them occurred during the first year of therapy, and they were only one sixth as frequent in 12 patients who had fluoride-induced increased trabeculation on vertebral roentogenograms. Nevertheless, until long-term safety and antifracture efficacy are better established, this regimen should continue to be restricted to investigational use.

Spatial and Temporal Use of Habitat by the Red-necked Pademelon, Thylogale thetis (Marsupialia : Macropodidae)

Use of habitat by 10 red-necked pademelons was studied by radio-tracking in an area of rain forest that adjoined pasture. They consistently moved at nightfall to pasture, where they grazed until their return to the rain forest shortly before daybreak. The time of movement between habitats was highly predictable and varied seasonally with changes in daylength. Nocturnal and diurnal range areas are described within the total area occupied by each individual. They rarely moved from the forest edge more than 70 m onto pasture or 500 m into rain forest. Animals were not nocturnal and travelled widely through the rain forest by day, seeking food and sites for basking. The nocturnal and diurnal partitioning of habitat is seen as a strategy for exploiting the rich food resource of pasture while maximizing the probability of avoiding predators.

Total joint arthroplasty. The foot

A prosthesis has been designed with which to resurface the painful, degenerated first metatarsophalangeal joint. Clinical evaluation thus far has indicated satisfactory results in 16 of 18 instances. This procedure will probably give the best results in the older patient with hallux rigidus, but the length of follow-up is as yet too short to allow firm opinions to be formed.

Chevron osteotomy for hallux valgus

The chevron osteotomy for realignment of the first metatarsal head in metatarsus primus varus deformity has been utilized at the Mayo Clinic since 1976 on 26 feet (18 patients). Follow-up evaluation disclosed excellent relief of pain, good cosmetic correction, and overall patient satisfaction. Radiographic evaluation demonstrated reduction in the angle between the phalanx and the metatarsal bone of the great toe as well as narrowing of the forefoot with a decreased angle between the first and the second metatarsal bones. The stability of the osteotomy, the technical ease, and the absence of secondary difficulties such as transfer metatarsalgia make this procedure preferable when osteotomy of the distal portion of the first metatarsal bone is used for correction of moderate deformity.

Subungual exostoses

From 1910 through 1975, forty-four patients with subungual exostoses were seen at the Mayo Clinic. Thirty-four of them had the exostosis on the great toe. Forty-three of the patients were treated by local excision and one was treated by amputation of the hallux. Five patients had local recurrence. None of the tumors underwent malignant change. Histologically, the tumors consisted of a proliferating fibrocartilaginous gap that merged into mature trabecular bone at its base. The growth in the cap was so active that is sometimes mimicked sarcoma, but no true anaplasia was seen. The subungual exostoses were uniformly benign, and local excision was the treatment of choice.

The frequency of bone abnormality in patients on anticonvulsant therapy

Biochemical and bone morphometric measurements were evaluated in 12 patients who were on long-term anticonvulsant therapy with barbiturates. Half of the patients had no symptomatic bone disease, and half presented with bone disease and pain. Serum biochemical values were normal except for a few patients who had an elevated serum level of parathyroid hormone; the concentration of serum 25-hydroxy vitamin D was decreased in the majority of patients in whom it was measured. Bone absorptiometric values were normal but proved to be misleading: the Singh Index and videodensitometric measurements indicated that bone mass was below normal in all patients. Bone morphometric data indicated that bone resorption was 3 times greater than normal, and there was no evidence of osteomalacia. Vitamin D and possibly calcium have been suggested as potentially useful agents in the treatment of the bone disease associated with chronic anticonvulsant therapy.

Intermediate states of subfragment 1 and actosubfragment 1 ATPase: reevaluation of the mechanism

The kinetics of the increase in protein fluorescence following the addition of ATP to subfragment-1 (SF-1) and acto-SF-1 have been reinvestigated. The concentration dependence of the rate obtained with SF-1 did not fit a hyperbola and at high ATP concentration, approximately 40% of the signal amplitude was lost due to a fast phase at the beginning of the transient (20 degrees C). At lower temperature (less than or equal to 10 degrees C) the fluorescence transient was biphasic, with a fast phase observed at high ATP concentration. These results indicate that there are two steps in the SF-1 pathway in which there is a change in protein fluorescence. Measurements of ATP binding and hydrolysis by chemical quench-flow methods indicate that the rate of ATP binding is correlated with the fast fluorescence step and hydrolysis is correlated with the slow fluorescence change. The SF-1 mechanism can thus be described as: (formula: see text) where M represents SF-1 and states of enhanced fluorescence are given by M (16%) and M (36% enhancement, relative to SF-1). Step 1 is a rapid equilibrium with K1 approximately 10(3) M-1. Tight binding of ATP occurs in step 2 and the loss of signal amplitude requires k2 greater than or approximately 1500--2000 s-1. The maximum observed fluorescence rate defines the rate of hydrolysis, k3 + k-3 = 125 s-1 (20 degrees C, 0.1 M KCl, pH 7.0). The steps in the mechanism correspond to the Bagshaw--Trentham scheme, with the important difference that the assignment of rate constant is altered. Formation of the acto-SF-1 complex gave a fluorescence enhancement of approximately 14% relative to SF-1. Dissociation of acto-SF-1 by ATP produced a 20--22% enhancement in fluorescence. There was no detectable fluorescence change during dissociation as evidenced by a lag in the fluorescence transient which corresponded to the kinetics of dissociation. The fluorescence change occurred at the same maximum rate as for SF-1 but there was no loss in signal amplitude at high ATP concentration. The kinetics of the fluorescence change corresponded to the rate of ATP hydrolysis, whereas tight ATP binding occurred at a much faster rate in approximate agreement with the rate of dissociation. Thus the fluorescence change in the acto-SF-1 pathway corresponds to step 3 in the SF-1 mechanism. The complete scheme can be described as follows: (formula: see text) where AM represents acto-SF-1. The tight binding step in the SF-1 pathway (k2) is sufficiently fast so that a similar step (k2') in the acto-SF-1 pathway could precede dissociation but the AM-ATP intermediate has not been detected. Following hydrolysis on the free SF-1, actin recombines with M.ADP.Pi or possibly with a second SF-1 product intermediate as proposed by Chock et al. (1976) and the fluorescence returns to the original AM level with product release.

Percutaneous biopsy of the iliac crest

By use of a percutaneous trephine, a relatively large (7.5-mm diameter), full-thickness bone sample can be obtained from the iliac crest under local anesthesia. Such a specimen can be used for histologic evaluation as well as small-volume, bone-grafting procedures. Patient acceptance has been excellent.