Biomedical subjects
Publications and source records attributed to H J Haarman.
Retrosternal dislocation of the clavicle is an uncommon injury which may affect the mediastinal structures in a life-threatening way. Therefore, computed tomography is mandatory. Manipulation in the acute situation is the treatment of choice. In case of failure or old dislocation, open reduction with stabilization of the joint is required. The literature on this subject has been reviewed and an additional two cases are reported.
The effect of plasma exchange (PE) was evaluated in 4 patients with rhabdomyolysis. A single 21 PE produced a transient fall of creatinine phosphokinase and did not prevent renal failure. Theoretically PE would need to be performed very frequently to remove toxins in appropriate amounts. Since renal failure in myoglobinuira has a relative good prognosis, we do not recommend intensive PE as therapy.
A group of 474 patients was retrospectively studied to assess the value of physical examination, arthrography and arthroscopy in the diagnosis of knee pathology. In 54% of cases, the correct clinical diagnosis was made from the patient's history, physical examination and standard radiology. The diagnosis at arthrography, especially in chondropathy and synovitis, appeared to be unreliable (only 46% corresponded to the definitive diagnosis). Contrast-arthrography of the knee joint is an invasive technique which provides relatively little extra (reliable) information, and is therefore not suitable as a standard procedure. Diagnostic arthroscopy is a superior and safe technique. Apart from the essential clinical assessment of patients with acute or chronic knee complaints (patient history, physical examination and standard radiology), there is a wide range of indications for diagnostic arthroscopy.