Hoarseness and palatal petechiae as clues in identifying streptococcal throat infections.
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Biomedical subjects
Publications and source records attributed to D W Jackson.
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Bioabsorbable screws composed of poly(L-lactic acid) (PLA) were used for graft fixation and studied prospectively with serial magnetic resonance imaging (MRI) scans at 8, 16, and 24 months after autogenous patellar tendon anterior cruciate ligament (ACL) reconstruction in 10 patients. Conventional spin echo, proton density, and T2-weighted double echo sequences were obtained, as well as T2-weighted fat-saturated fast spin echo sequences. All but one of the screws (19 of 20) were evident in all serial scans. These showed minimal decrease in size over time. The one screw that had completely disappeared 8 months after reconstruction had cracked during insertion. None of the reconstructed ACL grafts showed clinical instability, persistent effusions, or detectable adverse reactions to the screws. Two patients developed abnormal signal in the tibial tunnel: one developed fluid anterior to the graft, and the other developed increased signal within the graft. The abnormal signal resolved with time in both patients. Other than the preceding changes, no abnormalities were detected on conventional sequences. Fat-saturated fast spin echo sequences showed a variable amount of increased signal around the tunnels, suggesting edema or fibrovascular marrow changes. The changes noted near the tunnels on the fat-suppressed scans most probably represent a general reaction to surgical insult rather than a reaction to the bioabsorbable screws, as similar changes were noted at the patellar harvest site.
Compromise of the space between the humeral head and the coracoacromial arch may be a source of chronic shoulder pain associated with rotator cuff impingement in the athlete participating in throwing sports. In certain carefully selected individuals, surgical decompression may alleviate these symptoms. The surgical procedure can be done under local anesthesia and may enable the athlete to return to his previous level of performance without disability.
We recommend lumbar epidural venography as a screening procedure before myelography in the young athlete. It can be done on an outpatient basis, has a low complication rate, leaves no residual contrast material, and is more pleasant to the patient than a myelogram.
Joint flexibility and laxity as measured by 5 indices among 2,300 West Point cadets demonstrated no statistical relationship to joint injuries, or the need for surgical intervention resulting from injuries sustained in general athletic competition involving the ankle, knee, shoulder, or elbow. Similarly, no relationships were seen in a high school and collegiate football team. Parameters of flexibility vary significantly among different athletic population groups as related to age, sex, and type of athletic activity in which the individual is participating. In that part of the study conducted during the 1975 football season, the 16PF showed some potential for predicting injuries. However, stronger relationships between predictor and criterion variables must be established in the future before injury predisposition counseling is a possibility. Hopefully, continuing study will bring this into being and will extend to younger and younger individuals and other population groups. This would facilitate the development of an injury profile index to assist in the counseling of athletes into sports where their individual traits are protective and beneficial, rather than detrimental.
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Preoperative psychologic test scores derived from the Minnesota Multiphasic Personality Inventory (MMPI) were evaluated as predictors of success after elective knee surgery. The patients were examined 1 to 3 years after surgery and were evaluated in terms of subjective improvement, pain, level of activity, work restrictions, swelling, and strength. Patients that had scored high on the hysteria and hypochondriasis scales of the MMPI showed less improvement after surgery than those patients scoring lower on these scales. The results indicate that personality factors may play an important part in the symptomatic success after elective knee surgery.
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The lumbar epidural cortisone injection can be a useful adjunct in the conservative management of the athlete with a symptomatic lumbar disc and associated irritated neural elements. Thirty-two young athletes (ages ranging from 17 to 30 years) with a clinical diagnosis of a symptomatic lumbar disc and sciatica were treated with lumbar epidural cortisone injections. All had had disabling symptoms persisting for a minimum of 2 weeks, with an average duration of 3.6 months. Dramatic abatement of symptoms and a significantly hastened return to competiton (a positive response) was seen in 14 (44%) of the 32 athletes following injection. Although the results were encouraging, we found the success rate of this study group to be less dramatic than larger reported series in the general population.
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A stress reaction involving the pars interarticularis of the lumbar spine was confirmed in seven young athletes with a positive technetium pyrophosphate bone scan. No pars defects were detectable on their lumbosacral roentgenograms, which included oblique views. The return to normal levels of radioactive uptake on repeat bone scans correlated closely with their clinical course. If the bony reaction is recognized early, it may heal at a subroentgenographic level and prevent the development of lumbar spondylolysis. These early lesions usually show unilateral increased uptake at one lumbar level on the bone scan and, initially, the athlete localizes the pain to the corresponding unilateral lumbar paraspinous area. The "one-legged hyperextension test" is positive on the ipsilateral side and aggravates the pain. Treatment consists of avoiding the aggravating activities and resting. The average time for return to pain-free competition was 7.3 months. These developing defects may be the source of considerable prolonged disability in the young athlete, particularly if undiagnosed and untreated.
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