Acute calcific tendonitis in the hand

Calcific tendonitis in the hand is an uncommon entity with a clinical presentation that is very similar to that of infection. Because of the similarity, the potential for misdiagnosis and mismanagement is high. An awareness of calcific tendonitis in the hand and the associated clinical and radiographic findings will aid in its early diagnosis and treatment.

Guidelines for the use of digital tourniquets based on physiological pressure measurements

A potential complication of a digital tourniquet is neurovascular damage due to excessive tissue pressure. A technique for measuring digital tourniquet pressures was developed in our laboratory and was tested on fresh cadaver hands in order to establish guidelines for proper application of tourniquets. A saphenous vein from a fresh cadaver was laid subcutaneously along the neurovascular bundle of the test finger. Digital tourniquets consisting of Penrose drains or rolled surgical gloves were then applied in a standardized fashion. Saline solution was injected through the saphenous vein in a quasi-static fashion using a Harvard pump, and the pressure within the vein was monitored with a pressure transducer. When the pressure within the vein reached the closing pressure generated by the tourniquet, the pressure stabilized due to leakage of fluid beyond the tourniquet. Digital tourniquets applied in customary fashion by selected physicians and surgeons produced a wide range of closing pressures that did not exceed 360 millimeters of mercury. Rolled surgical gloves produced closing pressures ranging from 113 to 363 millimeters of mercury, depending on the relationship between the size of the glove and that of the hand. Penrose drains produced closing pressures of more than 800 millimeters of mercury, depending on the amount of stretch applied.

Posterior stabilization of pelvic fractures by use of threaded compression rods. Case reports and mechanical testing

Threaded compression rods were placed between the posterior-superior spines as a means of posterior stabilization of pelvic fractures. To document the increase in sacroiliac stability afforded by this technique, biomechanical testing was performed. Malgaigne-type fractures with sacroiliac disruptions were created in four cadaver pelvises. The fractures were stabilized with anterior frames of the Slatis or Pittsburgh type and subjected to longitudinal and torsional loading patterns on an Instron machine. The anterior fixation was then augmented with threaded compression rods placed between the posterior-superior spines to compress the disrupted sacroiliac joints, and repeat testing was conducted. Anterior frames alone were found to provide little stabilization of the disrupted sacroiliac joints with either longitudinal or torsional loading. Markedly improved stabilization in both loading modes was achieved with posterior augmentation. Two typical cases are presented to demonstrate that posterior stabilization is as efficacious in clinical practice as in the biomechanics laboratory.

The relationship between tourniquet pressure and underlying soft-tissue pressure in the thigh

Soft-tissue pressures in specimens of the lower extremities of cadavera, obtained following hip disarticulation, were measured directly beneath a pneumatic thigh tourniquet to establish the relationship between the tourniquet pressure and underlying soft-tissue pressure. It was found that the tissue pressure was consistently lower than the tourniquet pressure and that the percentage of tourniquet pressure reflected in the underlying tissue varied inversely with the circumference of the thigh. It was also found that the pressure decreased with increasing depth of the soft tissue.

CLINICAL RELEVANCE

the use of a pneumatic tourniquet is potentially associated with injury to underlying muscles, vessels, and nerves if excessive pressure occurs beneath the tourniquet. In order to minimize the risk of soft-tissue injury, the lowest tourniquet pressure that maintains a bloodless field should be used. A nomogram based on data generated in this experiment is provided as a guide to determining appropriate tourniquet pressures.

Determinants of acquiescence and naysaying of mentally retarded persons

Social desirability and intellectual limitations were investigated as possible determinants of two response biases--acquiescence and naysaying--among mentally retarded respondents. Results clearly indicated that naysaying and acquiescence occur more frequently among lower IQ individuals and naysaying occurs more frequently concerning prohibited behavior, whereas respondents acquiesce regarding desirable behavior. These results suggest that intellectual limitations predispose people to biased responding, whereas social desirability factors determine the type of bias.

Treatment of depression in alcoholics

The authors compared two groups of depressed alcoholics given either placebo or chlordiazepoxide-imipramine in a double-blind study. Although depression decreased in both groups, there were no significant differences between them on any of three pre- and posttreament measures. The Zung scale showed that medication decreased depression significantly, however, this finding was not supported by the Beck Depression Inventory or by the Minnesota Multiphasic Personality Inventory, indicating the necessity for use of multiple assessment instruments.

Treatment of falciparum malaria from Vietnam with a phenanthrene methanol (WR 33063) and a quinoline methanol (WR 30090)

Two new investigational antimalarial drugs developed by the U.S. Army Malaria Research Program were tested in patients with multi-drug-resistant falciparum malaria from Vietnam. WR 33063, a phenanthrene methanol, cured 13 patients treated in the United States. All of these patients had suffered multiple recrudescences after treatment with standard antimalarial drugs. In addition, 23 of 25 patients with acute attacks of falciparum malaria treated in Vietnam were cured. The rate of clinical response was prompt. WR 30090, a quinoline methanol, similarly cured eight patients with multiple recrudescences in the United States and 23 of 26 patients in Vietnam. Adverse effects associated with the drugs were not seen. These drugs signify a major advance in the chemotherapy of drug-resistant falciparum malaria.