Are complications in cruciate ligament replacement operations with patellar tendon transplantation dependent on surgical technique and surgical timing?

HYPOTHESIS: In a retrospective study we analyzed our results of ACL reconstructions with a patellar tendon graft. We wanted to know if the complications were dependent upon timing and technique of surgery. METHOD: We reviewed 283 patients after ACL-reconstruction, who underwent an operation with bone patellar tendon graft between 1984-1993. In our study we particularly looked for complications. The overall rate of complications was 21.6% dependent on the applied technique. Infections, DVTs, limitations of movement and graft failures were the most common complications. Furthermore we analyzed the timing of operation. Arthrofribrosis was less common in the group with delayed reconstruction (6.1%) whereas in the primary reconstruction group the rate was 17.6%. For this reason we changed our management with regard to the timing of operation. Meniscal injuries were the most common additional injuries in both groups. Conservatively treated ACL-ruptures showed a high rate of mensical ruptures in combination with cartilage injuries. CONCLUSION: Because of these results we put more emphasis on patient information to achieve the optimal result and to meet the individual needs for every patient.     

Uncertainty in the information provided during genetic counseling

Clients seek genetic counseling in order to become informed, to make better decisions, and, if possible, to be reassured. Genetic knowledge, however, is fragmentary and incomplete and therefore it may involve more uncertainty than is desirable. In a cohort of 30 counseling sessions we studied the genetic information that was actually conveyed in terms of its predictability, controllability and novelty. With regard to predictability it emerged to be rather the rule than the exception that clients of genetic counseling were confronted with (1) an inconclusive diagnosis, (2) the chance or an estimate of the chance of the occurrence or recurrence of a genetic disorder, and (3) ambiguity about the severity of the disease. In case of bad news, possibilities for control (therapeutic or preventive measures) were minimal. In a few cases, clients were confronted with completely unexpected findings, i.e., information of high novelty. It is concluded that the high degree of uncertainty in the information provided during genetic counseling--reflecting the true state of the art--is in direct contrast to the needs of clients.     

Self-reported stressors, symptom complaints and psychobiological functioning-II: Psychoneuroendocrine variables

Hydroxamate siderophores of virulent Bordetella pertussis and Bordetella bronchiseptica strains were purified using a simple large-scale isolation procedure, and identified by various spectroscopic techniques as the macrocyclic dihydroxamate siderophore trivially known as alcaligin, 1,8(S),11,18(S)- tetrahydroxy-1,6,11,16-tetraazacycloeicosane-2,5,12,15-tetrone+ ++, which was previously isolated from the taxonomically-related bacterial species Alcaligenes denitrificans subsp. xylosoxydans. Alcaligin purified from iron-depleted cultures of B. pertussis and B. bronchiseptica exhibited specific growth-promoting activity under iron-restricted conditions for Bordetella indicator strains, and ere active in [55Fe]ferric alcaligin transport assays. Evidence suggests that several C2-symmetric conformations of alcaligin exist simultaneously in both methanolic and aqueous solution.     

Recent update on the PPAR alpha-null mouse

The most important commercially available nitro- and aminobenzenes and the explosive trinitrobenzene were tested for mutagenicity in the Salmonella typhymurium TA 98 and TA 100 both in the absence and presence of S 9. Ten of the 14 compounds tested (71%) were mutagenic. All the substances showed positive results in TA 98 and 4 substances were also mutagenic in TA 100. The three diaminobenzenes and 4-nitroaniline were mutagenic only with metabolic activation. All other compounds did not require the addition of S 9. Only nitrobenzene, 1,2-dinitrobenzene, aniline and 2-nitroaniline were negative in both strains. In summary, all substances that are derived from nitrobenzene or aniline by addition of a nitro group in the meta- or para-position were mutagenic, whereas nitrobenzene and aniline themselves and their ortho-derivates were nonmutagenic. The possible relationships between the position of the substituents and the mutagenicity are discussed.     

Pregnant women's perceptions of prenatal care

PROBLEM: To describe pregnant women's perceptions in two specific areas: expectations about prenatal care and satisfaction with prenatal care. METHOD: A focus group technique using a semi-structured interview format. Three focus groups (N = 22) were conducted in the third trimester of pregnancy. Data were transcribed from the taped sessions and studied using content analysis. FINDINGS: Three major dimensions of satisfaction were identified: satisfaction with health care provider(s); satisfaction with support staff; and satisfaction with the prenatal care, including the desire for continuity of provider, clear explanations, and accessible quality care. CONCLUSIONS & IMPLICATIONS FOR NURSING: The provider relationship was identified as having the greatest influence on the women's satisfaction with prenatal care. Satisfaction with prenatal care can be enhanced through positive provider-patient interactions.