An evaluation of 361 patients with documented anterior cruciate tears was carried out with analysis of mechanisms, symptomatology, physical findings, and limitations. At the time of injury, patients generally heard a loud pop and felt their knee "slide apart" with a subsequent hemarthrosis. Internal tibial rotation was described as the principal mechanism of iniury in 81.6% of the patients. Less than 20% had a triad type injury. A "crossover" test enabled reproduction of the mechanism. On a 100 point scale, those with "no repair" scored a mean of 55.4, direct repairs 56.7, pes transfers 59.6, and modified MacIntosh 88.9 points. The natural course of a patient can often be projected. A Continuing comparative study of results from treatment regimens and procedures is indicated.

In the 1972, 1973, and 1974 football seasons at the University of Arkansas, 74 players sustained sprains of the ankle, producing a total of 152 missed practices and 6 missed games. Although only 18 injuries of the first metatarsophalangeal joint complex were seen, these later resulted in 92 missed practices and 7 missed games. This injury has been a significant problem for both the university and for most other major institutions, judging from a 70% response to 94 questionnaires sent to trainers of 94 large colleges and universities throughout the United States. It is the researchers opinion that the artificial turf surface, particularly as it ages, the shoes, and shoe fitting are all possible contributors to the incidence of the problem. Nonoperative treatment, whose hallmark is rest, is the treatment of first choice. Taping and splinting with a 0.51-mm spring steel splint with reinforcement, both pre- and postinjury, are beneficial. Injections of steroids or any other attempt to return the still painful athlete to activity are contraindicated. Late surgery, particularly in the event of capsular ruptures, as well as early repair, can be of benefit. The need to re-evaluate the shoes and playing surfaces in the light of this and other injuries is emphasized.

The shortage of deceased-donor organs is compounded by donation metrics that fail to account for the total pool of possible donors, leading to ambiguous donor statistics. We sought to assess potential metrics of organ procurement organizations (OPOs) utilizing data from the Nationwide Inpatient Sample (NIS) from 2009-2012 and State Inpatient Databases (SIDs) from 2008-2014. A possible donor was defined as a ventilated inpatient death ≤75 years of age, without multi-organ system failure, sepsis, or cancer, whose cause of death was consistent with organ donation. These estimates were compared to patient-level data from chart review from two large OPOs. Among 2,907,658 inpatient deaths from 2009-2012, 96,028 (3.3%) were a "possible deceased-organ donor." The two proposed metrics of OPO performance were: (1) donation percentage (percentage of possible deceased-donors who become actual donors; range: 20.0-57.0%); and (2) organs transplanted per possible donor (range: 0.52-1.74). These metrics allow for comparisons of OPO performance and geographiclevel donation rates, and identify areas in greatest need of interventions to improve donation rates. We demonstrate that administrative data can be used to identify possible deceased donors in the US and could be a data source for CMS to implement new OPO performance metrics in a standardized fashion.Abbreviations: AHRQ-NIS, agency for healthcare research and quality-nationwide inpatient sample; DCDD, donation after circulatory determination of death; DNDD, donation after neurologic determination of death; DSA, donor service area; EDCR, eligible death conversion rate; HCUP, healthcare cost and utilization project; HRSA, health resources and services administration; OPO, organ procurement organization; OTPPD, organs transplanted per possible donor; SIDs, state inpatient databases; UNOS, united network for organ sharing

Congenital saccular cysts of the larynx are unusual lesions that commonly present with respiratory obstruction in infants and children. The saccular cyst may result from an atresia of the laryngeal saccule orifice or may represent the retention of mucus in the collecting ducts of submucosal glands located around the ventricle. Traditionally, the treatment of the lesions has been endoscopic unroofing or marsupialization. Frequently, this modality requires multiple procedures as well as concomitant tracheotomy. There also have been reports of acquired subglottic stenosis. We have found that removal of the recurrent saccular cyst can be achieved relatively safely and effectively via a lateral cervical approach to the thyrohyoid membrane. We review our experience with four patients with congenital saccular cysts and detail the evaluation and surgical management of these lesions.

No abstract