The Drake Superfund site in Clinton County, Pennsylvania, has been contaminated with the carcinogens beta-naphthylamine, benzidene, and benzene. The authors reviewed county-wide, age-adjusted, sex-, race-, and site-specific cancer mortality rates for the years 1950-1959, 1960-1969, and 1970-1979, and type-specific birth defects incidence rates for 1973-1978. During the 1970s, a significantly increased number of bladder cancer deaths occurred among white males in Clinton County, and a significantly increased number of other cancer deaths occurred in the general population of Clinton and three surrounding counties. There were no statistically significant clusters of any specific birth defect or of all birth defects. County-wide data on cancer and birth defects can be used for initially screening counties with Superfund sites, but more definitive studies are needed to assess the actual health effects caused by these sites.

Age Factors↗

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Residential health study of families living near the Drake Chemical Superfund site in Lock Haven, Pennsylvania.

The Pennsylvania Department of Health conducted a health survey of a group of residents in the Lock Haven area who live in the immediate vicinity of the Drake Superfund site. A control group of residents were selected randomly from the remaining areas of Lock Haven. The study did not indicate the presence of any serious chronic health conditions in the exposed group of residents when compared with the control group. Significantly more individuals in the exposed group than the control group experienced skin problems and sleepiness for at least 1 month prior to the survey, indicative of a possible association between direct human exposure to toxic chemicals from the site and the manifestation of symptoms. The increased prevalence of the two symptoms may also have been caused by factors other than contaminants at the Drake site, e.g., stress, occupational exposure, or other etiologic agents, or it may be a spurious finding due to chance or biased reporting.

Adolescent↗

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The patient's view of the pes anserinus transfer operation for rotatory instability of the knee.

A review of 82 patients was performed to ascertain their subjective evaluations of the pes anserinus transfer procedure for rotatory instability of the knee. Analysis demonstrated a slow improvement in symptoms which occurred over a 12-month period. At that time, 62% of the patients had regained 90% of their preinjury confidence in knee stability.

Evaluation Studies as Topic↗

PubMedDate not supplied

Rupture of the biceps tendon in gymnastics: a case report.

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Adult↗

PubMedDate not supplied

Multiphasic view of medial meniscectomy.

In a retrospective study, the records of a group of 816 patients who had tears of the medial meniscus alone were selected for review from a total of 6,000 records of patients who had had knee surgery (1966 to 1976). According to the operative reports, these 816 patients had no other structural or pathologic findings at the time of medical meniscectomy. In an average of 2.0 years after initial surgery to the knee, 210 patients required subsequent surgical procedures for progressive meniscal pathology (38), articular cartilage damage (64), or ligamentous instability (108). The recognition of the possiblility for future surgery after medial meniscectomy is an important finding which must be acknowledged by the treating physician and to the patient. The evidence from the review suggests that others should review series of patients with tears of the medial meniscus and should attempt to gain understanding of the basic pathologic processes.

Humans↗

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Arthroscopy of the knee under general anesthesia: an aid to the determination of ligamentous instability.

During a 34-month period (March 1976 through December 1978), 790 patients underwent arthroscopic examination of the knee under general anesthesia. Preoperative assessment of ligementous instability was compared with the ligamentous examination while under general anesthesia. Eight percent of the patients with no preoperative instability first demonstrated ligamentous instability under general anesthesia. Thirty-six percent of the patients with preoperative instability and 27% of the patients with previous surgery had either an increased grade or additional component of instability found when examined under general anesthesia. Information gained from arthroscopy without a comprehensive ligament examination under anesthesia may result in an incomplete diagnosis and ineffective treatment. Patients at high risk include those with acute injuries, preoperative instability, or previous surgery.

Adult↗

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Intraarticular substitution for anterior cruciate insufficiency. A clinical comparison between patellar tendon and meniscus.

Forty two patients with functionally incapacitating 2+ or 3+ anterior instability underwent anterior cruciate ligament substitution using a meniscus (25 patients) or central third of the patellar tendon (17 patients). Subjective and objective evaluations were personally performed on all patients with an average followup of 15 months. Seventy-nine percent of the patients were objectively graded successful. Objective results were primarily based on the surgeon's technical ability to correct completely all components of anterior instability at the time of surgery. Subjective results were multifactorial and were correlated primarily with patient expectations, the presence or absence of continued buckling and the ability to return to recreational activities. The only observed difference between the two types of cruciate substitutions was the average loss of 6 degrees of flexion in the central third of the patellar tendon group. Both the patellar tendon and meniscus clinically appeared to be successful intraarticular cruciate substitutes which can predictably correct moderate to severe anterior instability of the knee in a high percentage of patients.

Adolescent↗

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Acute posterior cruciate ligament injuries.

One hundred and two posterior cruciate ligament injuries were reviewed (43 chronic and 59 acute repairs). The 59 acute repairs were profiled as to cause and site of injury, associated ligamentous damage, clinical examination, patient position at surgery, and reoperation rate. Twenty-two patients were followed up. Motor vehicle accidents and athletics were the usual causes of injury. In the 59 acute repairs, the posterior cruciate avulsion site was femoral in 21, midsubstance in 13, and tibial in 25. The high incidence of associated injuries included medial collateral ligament tears, capsular damage, lateral knee component damage, and anterior cruciate ligament ruptures. Thirteen of 59, believed to have isolated tears, had surgery in the prone position. Twelve were subsequently reoperated. Eight of 12 reoperations were done prone initially for an "isolated" tear. Our acute knees with poor results all had the most supposed "isolated" and midsubstance tears, and the most popliteal surgery. The posterior cruciate ligament tear is due to major violence with associated ligament injuries and has no single universal physical sign. Arthroscopy and examination under anesthesia are recommended to prevent the missed diagnosis (chronic case) or to clarify a suspected "isolated" tear prior to prone popliteal surgery.

Accidents, Traffic↗

PubMedDate not supplied

Fracture of the patella due to overuse syndrome in a child. A case report.

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Athletic Injuries↗

PubMedDate not supplied

Triceps tendon avulsion in a professional body builder. A case report.

We have reported a case of triceps tendon avulsion in a professional body builder, treated successfully by delayed repair, allowing him to return to competition. Triceps tendon ruptures, besides being rare injuries, differ from tendon ruptures in other locations. First, the injury can occur through healthy tissue. Second, the time of delay, from injury to repair, seems to have little effect on the functional outcome, as we demonstrated in our patient.

Adult↗

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Arthroscopic "second look" at the GORE-TEX ligament.

We performed an arthroscopic "second look" in 21 knees (20 patients) that had arthroscopic implantation of the GORE-TEX prosthesis for chronic ACL insufficiency. Arthroscopy was done on eight knees at the time of screw removal, eight for knee pain, two for giving way, and three for recurrent effusions. The degree of synovial joint reaction, graft synovial ingrowth, and graft rupture was graded. Microscopic examination was carried out on all biopsies of the GORE-TEX ligament. The average patient age was 30 years and the average time interval from original implantation to second look was 11 months. The GORE-TEX was intact in 11 knees, 10% ruptured in 6, and completely ruptured in 4. There was no correlation between number of GORE-TEX strands ruptured and synovial reaction. No particles of the graft were noted in the synovium if the implant was intact, but particles were noted with graft rupture. We conclude that the intact GORE-TEX ligament is an inert substance and does not cause significant joint reaction. Impingement in the intercondylar notch appeared to be the most common cause of graft failure. Further study is critical to determine the natural history of the GORE-TEX ligament and the knees' response to this prosthetic device.

Arthroscopy↗