In our institution lateral ankle ligament injuries are classified into three grades according to the extent of instability found on physical examination and/or stress X-rays. Grade I and II lesions are taped, while treatment of grade III lesions consists of operative reconstruction of the ruptured ligaments. In 1989 we published the results of 1012 patients after 9 months' follow-up. About 30% had residual complaints. The nature and frequency of the complaints were equally divided among the three groups. To examine the long-term follow-up results, we conducted a retrospective study with the same group of patients after 6.5 years. Although ankle ligament injuries are still considered rather innocent lesions, we conclude that even after 6.5 years patients can still have residual complaints (pain, fear of giving-way, actual instability, swelling), which interfere with daily living and/or sport activities. The result deteriorated with time. This was especially prominent in the grade II group, where the percentage of poor and fair results doubled. The overall percentage of residual complaints was 39%. We conclude that there is no such thing as "a simple sprain".

By means of a questionnaire, an inventory was made of the residual complaints and possible handicaps 9 months post-injury in 1012 patients who had been treated for distortion or lateral ankle ligament injury. The response rate was 81% and responses were equally distributed among the various grades of distortion. Residual complaints were reported by 30% of the patients. The injuries were classified into three grades. For all grades, the nature and frequency of the residual complaints were the same. Explanations for the study results or guidelines for treatment cannot be derived from this study.

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The natural sausage casings industry is large and worldwide, and casings prepared from the small intestine of sheep form a large part of it. Food safety authorities in several countries have been concerned about the risk to consumers from the bovine spongiform encephalopathy (BSE) agent. Although this agent could enter the European small ruminant population via infected feed, there is no evidence that it has. Because the BSE agent introduced experimentally into sheep and goats has a tissue distribution very similar to that found in animals with natural cases of scrapie, the agent would likely be found in the intestine and lymph nodes of some infected sheep from an early age. When natural casings are prepared from the intestine, the ileum (known to be infected in animals with natural cases of scrapie) is removed and the intestine is cleaned such that the inner (tunica mucosa) and outer (tunica serosa and tunica muscularis) layers are removed, leaving only the submucosa. There are two main methods for cleaning the intestine: manual and mechanical. The cleaning efficiency of these two methods was examined in the commercial environment as practiced on healthy sheep considered fit for human consumption in Turkey and Great Britain. The investigation involved a qualitative and quantitative histological approach. There was no significant difference in cleaning efficiency between the two methods, although there was some variation. No Peyer's patches or residues of them were found in any part of the cleaned casings. This finding is important because in sheep infected with transmissible spongiform encephalopathies (TSEs) Peyer's patches are likely to contain a major part of the intestinal infectivity. No serosa was found in any casing, but some residual mucosa and muscularis was retained, with more of the former than the latter. The results indicate that the cleaning efficiency of the two methods was broadly equivalent, that there was significant removal of tissue that could promote TSE infection, and that TSE risk reduction likely would be achieved by both methods, although this probability could not be quantified by the methods used in this study.

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