Loss of passive external rotation at 90 degrees abduction is predictive of a medially healed Bankart lesion.

Purpose: This prospective study correlates passive range of external rotation with arthroscopic findings in patients with anterior instability for the purpose of defining criteria that can be used to detect a medially healed Bankart lesion.

Methods: External rotation at 90 degrees abduction (ER90) was assessed on examination with the patient under anesthesia in bilateral shoulders of 46 consecutive patients with unidirectional, anterior glenohumeral instability. Arthroscopy was used to identify 22 patients with a detached Bankart lesion (group I) and 24 patients with a medially healed Bankart lesion (group II).

Nonexercise models for estimating VO2max with waist girth, percent fat, or BMI.

Unlabelled: Previously published nonexercise models using either percent fat or body mass index (BMI) as body composition measures provided valid estimates of VO2max.

Purpose: This study was conducted to investigate the use of waist girth (WG) as a body composition surrogate in the nonexercise models and to compare the accuracy of nonexercise models that include WG, %fat, or BMI.

Methods: A total of 2417 men and 384 women were measured for VO2max by indirect calorimetry (RER > 1.

Single-dose fluconazole for vulvovaginal candidiasis: impact on prothrombin time in women taking warfarin.

Objective: To estimate the effect of a single oral 150-mg dose of fluconazole on the prothrombin time of women on long-term warfarin therapy.

Methods: Women on warfarin therapy for 6 months or more with no change in dose within 4 weeks of the study, and a prothrombin time (PT) with an International Normalized Ratio (INR) between 2 and 3 were invited to participate. Two consecutive baseline PTs were obtained (days -1 and 0), and women were given 150 mg of fluconazole.

The difficult task of delivering bad news.

Maintaining straightforward communication with the patient and family regarding all possibilities lays a foundation of trust and understanding between the patient and the health care team. In this kind of setting the patient is more likely to receive comfort measures and palliative care at the appropriate time in the process, not as a last resort or an afterthought to care.

Zonisamide monotherapy in a multi-group clinic.

Objective: Reports on zonisamide monotherapy are limited despite favourable preliminary data, and typically restricted to tertiary referral centres. The goal of this study is to report clinical experience with zonisamide monotherapy in a large, multi-group clinic setting.

Methods: We reviewed the charts of patients treated with zonisamide monotherapy in the Neurology Department of the Kelsey-Seybold Clinic (Houston, Texas) during an 18-month period.

Intra-instrument reliability of 4 goniometers.

Background: Cervical spine ROM movements taken accurately with reliable measuring devices are important in outcome measures as well as in measuring disability.

Objective: To compare the active cervical spine ROM in healthy young adult population using 4 different goniometers.

Methods: Subjects were tested during active cervical spine ROM.

Persistent leg ulcers in an obese patient with venous insufficiency and elephantiasis.

Options in Practice presents different management approaches to the same clinical situation. You are invited to submit a brief case description, including the specialty nursing care provided, and several glossy color photographs of the clinical situation. The case material will then be sent to another wound, ostomy, or continence care nurse, who will also address management concerns.

A biophysical model for estimating the frequency of radiation-induced mutations resulting from chromosomal translocations.

Gene mutations can be induced by radiation as a result of chromosomal translocations. A biophysical model is developed to estimate the frequency of this type of mutation induced by low-LET radiation. Mutations resulting from translocations are assumed to be formed by misrejoining of two DNA double strand breaks (DSB), one within the gene and one on a different chromosome.

Probabilities of radiation-induced inter- and intrachromosomal exchanges and their dependence on the DNA content of the chromosome.

A biophysical model has been developed that is based on the assumptions that an interphase chromosome occupies a spherical territory and that chromosome exchanges are formed by the misrejoining of two DNA double-strand breaks induced within a defined interaction distance. The model is used to explain the relative frequencies of inter- and intrachromosomal exchanges and the relationship between radiation-induced aberrations in individual chromosomes and the DNA content of the chromosome. Although this simple model predicts a higher ratio of inter- to intrachromosomal exchanges for low-LET radiation than for high-LET radiation, as has been suggested by others, we argue that the comparison of the prediction of the model with experimental results is not straightforward.

Anterior-inferior capsular shift of the shoulder: a biomechanical comparison of glenoid-based versus humeral-based shift strategies.

This study compared the biomechanical effects of an anterior-inferior capsular shift based at the humeral side with one on the glenoid side of the joint on resultant multidirectional glenohumeral translation and rotation. Nine matched pairs of fresh cadaveric shoulders were placed in a testing apparatus that constrained 3 rotations but allowed simultaneous free translation of the humeral head with respect to the glenoid. The right and left shoulders of each of the matched pairs were randomized to undergo either a glenoid-based or humeral-based anterior capsular shift.

Relationship between radiation-induced aberrations in individual chromosomes and their DNA content: effects of interaction distance.

Purpose: To study the effect of the interaction distance on the frequency of inter- and intrachromosome exchanges in individual chromosomes with respect to their DNA content. Assumptions: Chromosome exchanges are formed by misrejoining of two DNA double-strand breaks (DSB) induced within an interaction distance, d. It is assumed that chromosomes in G(0)/G(1) phase of the cell cycle occupy a spherical domain in a cell nucleus, with no spatial overlap between individual chromosome domains.

Comparison of F ratios generated from interphase and metaphase chromosome damage induced by high doses of low- and high-LET radiation.

Although biophysical models predict a difference in the ratio of interchromosomal to intrachromosomal interarm exchanges (F ratio) for low- and high-LET radiations, few experimental data support this prediction. However, the F ratios in experiments to date have been generated using data on chromosome aberrations in samples collected at the first postirradiation mitosis, which may not be indicative of the aberrations formed in interphase after exposure to high-LET radiations. In the present study, we exposed human lymphocytes in vitro to 2 and 5 Gy of gamma rays and 3 Gy of 1 GeV/nucleon iron ions (LET = 140 keV/micrometer), stimulated the cells to grow with phytohemagglutinin (PHA), and collected the condensed chromosomes after 48 h of incubation using both chemically induced premature chromosome condensation (PCC) and the conventional metaphase techniques.

Management of clinical side effects of DMPA.

This edition of Tips for Clinicans tackles a common patient complaint: side effects of depot medroxyprogesterone acetate (DMPA). If perception is reality, patient compliance can be greatly enhanced by addressing perception of DMPA side effects proactively. As clinicians, we can educate teens on actual as well as perceived side effects, anticipating problems and providing solutions when problems arise.

Productivity of radiologists in 1997: estimates based on analysis of resource-based relative value units.

Objective: Productivity of radiologists was quantified using the resource-based relative value scale for examining trends in workload.

Materials And Methods: Staffing and workload data for 1997 were collected in a survey of radiology departments in multispecialty clinics. Workload ratios were calculated and were compared with prior surveys of the same clinics and with published data.

Case discussions on the pathophysiology and clinical features of near-fatal asthma episodes.

This article reviews the definition of near-fatal asthma. The slow-onset, late arrival group and the sudden-onset groups of near-fatal asthma patients are discussed. Risk factors for near-fatal asthma and the pathologic differences between the two groups are elucidated.

Late-stage emphysema: when medical therapy fails.

Although most patients with emphysema are managed medically, a small subset of severely disabled patients may become candidates for surgery. This paper discusses for the internist who works with emphysema patients the risks, benefits, patient selection criteria, and outcome data for three procedures in current use: bullectomy, lung transplantation, and a new procedure which provides an alternative to transplantation--lung volume reduction.

Transbronchial needle aspiration. An underused diagnostic technique.

Despite its proven usefulness, TBNA is not widely used. An American College of Chest Physicians (ACCP) survey showed that only 11.8% of pulmonologists use TBNA.

Permanent pacing for asystole of the donor heart after heterotopic heart transplantation.

A 41-year-old woman presented with shortness of breath and decreased exercise tolerance 1 year after heterotopic heart transplantation. She was found to have an ejection fraction of less than 20% for the native heart and severely depressed left ventricular systolic function of the donor heart. A left ventriculogram of the donor heart showed no systolic contractility.

Changes in aerobic power of women, ages 20-64 yr.

This study quantified and compared the cross-sectional and longitudinal influence of age, self-report physical activity (SR-PA), and body composition (%fat) on the decline of maximal aerobic power (VO2peak) of women. The cross-sectional sample consisted of 409 healthy women, ages 20-64 yr. The 43 women of the longitudinal sample were from the same population and examined twice, the mean time between tests was 3.

Comparison of supine versus prone tomographic myocardial imaging. Effect on false-positive rate.

As in most other nuclear medicine facilities, tomographic myocardial imaging was started here with the patients in the supine position. However, previous planar imaging experience indicated a high number of false-positive results using the supine position for left lateral views of the myocardium. Evaluating the accuracy of supine position SPECT imaging was considered necessary.