Total hip arthroplasty for protrusio acetabuli: a 3- to 9-year follow up of the Heywood technique

Thirty-five total joint arthroplasties (34 patients) were performed in patients who had protrusio acetabuli. Twenty-nine percent of the patients had acetabular protrusio of grade I, while 71% had grade II and grade III protrusio. The mean follow up was 4 years (range: 3 to 9). Cemented acetabular components were used in 11 hips; 24 hips received an uncemented porous coated acetabular component. The patient evaluations included preoperative and postoperative Harris Hip Ratings and standard radiographs. In all cases, the medial wall defect was reconstructed with the solid autogenous femoral head as described by Heywood. The mean preoperative Harris Hip Rating was 45 (range: 30 to 60 points), and the postoperative mean was 85 (range: 70 to 100 points). Radiographically, the preoperative protrusio measured a mean of 8.8 mm (range: 6 to 18 mm), and the mean postoperative placement of the femoral head was 10 mm lateral to Kohler's line (range: 6 to 13 mm). There were no acetabular component failures and no acetabular bone graft resorptions. All autogenous grafts were incorporated to the host radiographically by 1 year post-surgery. This study corroborates previous work which suggests that medial-placed bone grafting is not resorbed and consolidates with the host bone. We find this technique extremely useful in dealing with this technical problem.

Technical report: wire guided sialography

An improved technique for performing sialography in difficult cases is described. This is based on the passage of a cannula into the salivary duct ostium over a thin, flexible, blunt guide-wire.

Failure of oxygen radical scavengers to modify fatigue in electrically stimulated muscle

We used in situ gastrocnemius muscle of anaesthetized dogs to test the hypothesis that O2 radical production during muscle contraction contributes to fatigue. Muscle tension was measured with a force transducer and blood flow was monitored with an electromagnetic flow probe. Muscle contractions were produced by stimulating the nerve for 15 min at 20 Hz, 12 trains/min, and a duty cycle of 0.25. Three groups of seven animals were given an infusion of 0.2 mL.min-1 of either saline, low-dose oxygen radical scavengers (250 IU.mL-1 superoxide dismutase, 640 IU.mL-1 polyethylene glycol (PEG)-catalase, 0.25 mg.mL-1 deferoxamine, and 0.1 mg.mL-1 oxypurinol), or high-dose oxygen radical scavengers (3300 IU.mL-1 superoxide dismutase, 6600 IU.mL-1 PEG-catalase, 2.5 mg.mL-1 deferoxamine, and 0.1 mg.mL-1 oxypurinol). Blood flow and vascular resistance of the gastrocnemius muscle during stimulation did not differ among groups. After 15 min of stimulation, the developed tension (represented as a percentage of initial tension developed) was 66 +/- 7% in the saline treated group, 70 +/- 6% in the low-dose group, and 70 +/- 4% in the high-dose group. The change in tension during recovery was not significant in the control or low-dose groups. However, there was partial recovery in the high-dose group. In conclusion, in this preparation, oxygen radical scavengers did not delay the development of decreased muscle tension.

Receptor sub-types involved in responses of Purkinje cell to exogenous excitatory amino acids and local electrical stimulation in cerebellar slices in the rat

The effects of the NMDA receptor antagonist, 2-amino-5-phosphonovalerate (APV) and non-NMDA receptor antagonist, 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) on responses of Purkinje cells to exogenous excitatory amino acids and to electrical stimulation of the parallel fibres, were investigated in slices of the cerebellum of the rat. Glutamate, aspartate, kainate and quisqualate all induced excitation of Purkinje cells. Responses to kainate and quisqualate were blocked by CNQX (10 microM) but not by APV (10 microM). N-Methyl-D-aspartate induced biphasic excitatory-inhibitory responses, both components of which were blocked by APV but not by CNQX. The inhibitory component was less sensitive to blockade by APV but was totally blocked by bicuculline, the GABAA receptor antagonist. Parallel fibre stimulation most commonly induced inhibition of Purkinje cells, with or without preceding excitation. This inhibition was blocked by APV and excitatory responses were often revealed. A less commonly-observed predominantly excitatory response was blocked by CNQX but not by APV and inhibition tended to be revealed. These data suggest that parallel fibre-Purkinje cell synapses possess non-NMDA postsynaptic receptors, while the parallel fibre-inhibitory interneuron synapses possess functional NMDA receptors.

Magnetic resonance imaging of the knee

Magnetic resonance imaging of the knee was the first successful application of this technique to the articular system. The advantages of magnetic resonance imaging over arthrography include its noninvasive nature, the ability to evaluate the knee in multiple planes without patient repositioning, the absence of ionizing radiation, the capacity to evaluate the joint even in the presence of joint effusion, and the ability to examine the inner structure of the meniscus as well as its surface. Although magnetic resonance imaging initially was used to study the menisci and cruciate ligaments, the technique has been expanded to include the evaluation of various conditions and all the structures of the knee joint and surrounding soft tissues.

Evaluation of the roll over test as predictor of gestational hypertension in African women

Fifty-six primigravid women at 28-32 weeks gestation were studied prospectively to assess the roll over test (ROT) as a predictor of gestational hypertension in African women. Blood pressures were measured continuously in the supine and left lateral positions using an automated accutor machine. ROT was positive in only two women (3.6%). These two women later developed gestational hypertension but so did 18 others who had negative ROT. Measures that may be useful in increasing the predictive value of the ROT in these women are suggested.

Modulation of GABA-mediated inhibition in rat cerebellar slices by benzodiazepine receptor ligands

1. Extracellular recordings were made from the Purkinje cell layer of rat cerebellar slices. Compounds were perfused over the slice and bipolar stimulating electrodes placed in the external layer of the slice close to the recording electrode. 2. Stimulus-evoked inhibition of Purkinje layer cell activity was sensitive to bicuculline methiodide and picrotoxin, suggesting it was gamma-aminobutyric acid (GABA) mediated. The benzodiazepine ligands RU 32007 and Ro 19-0528 reversibly increased the period of inhibition, as did pentobarbital. This benzodiazepine effect was antagonised by Ro 15-1788. 3. Five inverse agonists all reduced the period of stimulated inhibition and this effect was reversed by Ro 15-1788, suggesting the involvement of benzodiazepine receptors. 4. It is concluded that this system provides a convenient physiological and possibly quantitative model for studying the action of benzodiazepine receptor ligands.

Does standing up improve the predictive value of the supine pressor test for gestational hypertension?

Fifty-six primigravid women at 28-32 weeks' gestation were studied prospectively to compare the roll-over test with the stand-up pressor test in the prediction of gestational hypertension. Blood pressures were measured in the different positions continuously using an automated machine. Twenty patients developed gestational hypertension; two of these were accurately predicted by roll-over test and six by stand-up pressor test (P less than .001). However, there was no significant difference between the tests in the rates of false negatives, specificity, and negative and positive predictive values. Concomitant measurement of blood pressures in the standing position may increase the sensitivity of the roll-over test for the prediction of gestational hypertension.

Quantitative analysis of gamma-aminobutyric acid (GABA) receptors of Purkinje cell layer from rat cerebellar slices

1. Extracellular recordings were made from Purkinje cell layer of rat cerebellar slices. Cell activity was sensitive to both magnesium and manganese ions. 2. Glutamic and aspartic acids both excited cell activity while gamma-aminobutyric acid (GABA), muscimol, taurine, beta-alanine and delta-aminolaevulinic acid all inhibited activity. 3. The sensitivity to GABA varied with depth while no such effect was observed with muscimol. 4. Bicuculline methiodide, picrotoxin and pitrazepin blocked the action of muscimol with pA2 values of 5.92, 5.97 and 5.71 respectively. 5. The benzodiazepines flurazepam and RU 32007 both potentiated the GABA inhibition and this potentiation was blocked by Ro 15-1788, a benzodiazepine antagonist.

Isradipine in Asian patients with hypertension

Isradipine, a new calcium antagonist, was administered to 51 Pakistani patients with hypertension (36 women, 15 men; mean age 47 years) over an 8-week period. Mean sitting systolic, and sitting and standing diastolic blood pressure was significantly reduced, and mean standing systolic blood pressure tended to decrease. Laboratory values, and both sitting and standing heart rates were not significantly affected by isradipine treatment. At the end of 8 weeks, 41.2% of patients were receiving isradipine 1.25mg twice daily, and 58.8% were receiving 2.5mg twice daily. Isradipine was found to be effective and well tolerated in Pakistani patients with mild to moderate hypertension.

Chemosuppression of malaria by the triple combination mefloquine/sulfadoxine/pyrimethamine: a field trial in an endemic area in Malaysia

Malaria, particularly that due to chloroquine-resistant Plasmodium falciparum, which requires management with antimalarial drugs capable of protecting against multiresistant strains, has emerged in Malaysia. A study was carried out to assess the efficacy and tolerability of 2 dosages of mefloquine/sulfadoxine/pyrimethamine (MSP; RO 13-5112) compared to Fansidar in a malaria endemic area. 914 subjects in 3 random groups were studied. Occurrence of malaria was assessed both clinically as well as by blood films. Plasma drug levels were also measured. The results showed that the low dose of MSP was completely effective in suppressing parasitaemia. 2.7% of the study population reported adverse drug reactions, the lowest incidence being in subjects on the low dose; their blood chemical profiles were also the least affected. The plasma levels of pyrimethamine and sulfadoxine achieved in the low dose group were slightly higher than expected, but there was no significant difference in bioavailability. The study showed that, for chemoprophylaxis, a low dose of MSP provided effective protection with minimal side effects.

Penetrating atherosclerotic ulcers of the thoracic aorta

Penetrating ulcer of the thoracic aorta is defined as an atherosclerotic lesion of the descending thoracic aorta with ulceration that penetrates the internal elastic lamina, allowing hematoma formation in the media. There is controversy whether this lesion differs from classic acute type III aortic dissection, based on its location, radiographic findings, natural history, and recommended therapeutic approach. Of 47 patients with a diagnosis of aortic dissection seen at our hospital during a 2-year period, five patients had clinical and radiographic findings of penetrating ulcer. Each of the five patients had characteristic computerized tomographic (CT) findings and two patients had angiographic confirmation. In all patients CT showed subintimal hemorrhage, aortic wall enhancement, absence of a double lumen, and contrast extravasation through the ulceration. In both patients who underwent angiography, ulceration, subintimal hematoma, and absence of a false lumen were demonstrated. The clinical presentation in four patients simulated acute aortic dissection or expanding thoracic aneurysm. The other patient, who was normotensive, did not have symptoms referable to the thoracic aorta but was studied because of an abnormal chest x-ray film. None of these five patients required surgical intervention. All five patients were alive and free of symptoms at 6 months, 8 months, 14 months (two patients), and 30 months after the original diagnosis. Follow-up CT scans in four patients showed resolution of subintimal hematoma and some dilatation of the lumen but no progression to rupture or aneurysm. Other authors stress the importance of differentiating symptomatic penetrating atherosclerotic ulcers from acute type III aortic dissection because of the higher incidence of rupture of penetrating ulcers and therefore recommend early surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

Host response to autologous endothelial seeding

Dacron and expanded polytetrafluoroethylene grafts, seeded with autologous venous endothelial cells at the time of implantation, subsequently develop endothelial linings. However, it has not been shown whether the endothelial cells in these linings are derived from the seeded cells, or whether the seeding process itself stimulates host endothelial cells to proliferate and cover the grafts. As a first step in testing this hypothesis, bilateral end-to-side aortoiliac expanded polytetrafluoroethylene grafts with an internal diameter of 6 mm, an internodal distance of 22 microns, and an average length of 9.2 cm were placed in 10 adult mongrel dogs weighing 20 to 25 kg; the aorta was ligated just distal to the origin of the grafts. The graft on one side, chosen at random, was seeded with autologous endothelium that was harvested by enzyme single-stage technique from external jugular veins; the other side was not seeded. After 4 weeks the animals were anesthetized and heparinized, and the grafts were fixed by perfusion in vivo with 2.5% glutaraldehyde solution before they were removed. Both grafts occluded in two animals, and both grafts were patent in five animals. In two animals the seeded grafts were open and the unseeded grafts were occluded. In one the seeded graft was occluded and the unseeded graft was patent. There was no significant difference in clot-free surface area between seeded (29% +/- 18%) and unseeded (31% +/- 11%) grafts. Scanning electron microscopy showed the presence of an endothelial monolayer that averaged 39% +/- 20% and 36% +/- 26% coverage, respectively, in the clot-free midgraft portions of all seeded and unseeded patent grafts.(ABSTRACT TRUNCATED AT 250 WORDS)

Interposition of extensor digitorum tendon in distal radius fracture mimicking a compartment syndrome

A 14-year-old boy sustained a dorsally displaced Salter-Harris Type II fracture of the distal radius. A single attempt at closed reduction failed. After this closed reduction, the patient was unable to passively or actively extend or flex his fingers. He had increasing pain and compartment pressures were abnormally elevated. Dorsal fasciotomy was done, and during the open reduction, entrapment of the dorsal extensor retinaculum and extensor digitorium communis within the fracture was found. After removal of these structures, fracture reduction was easily accomplished and his fingers had a full range of motion. Postoperative recovery was uneventful.

A user evaluation of four Kodak Ektachem slide assays

Evaluations of magnesium, theophylline, creatinine, and creatine kinase isoenzyme MB assays by the Kodak Ektachem multilayer-film technique are reported.

A user evaluation of four Kodak Ektachem slide assays

Evaluations of magnesium, theophylline, creatinine, and creatine kinase isoenzyme MB assays by the Kodak Ektachem multilayer-film technique are reported.

Incidentally discovered mass of the adrenal gland

Increasing numbers of asymptomatic masses of the adrenal gland are being discovered by high resolution computed tomography (CT) scanning. The significance of these masses and the question of further evaluation or treatment, or both, have posed a dilemma. From 1976 to 1983, an incidental finding of adrenal gland mass was identified in 88 patients undergoing abdominal CT scanning for unrelated problems. Adrenelectomy was performed upon 23 patients (26 per cent), including three adenomas (2.5, 3.0 and 6.5 centimeters), five carcinomas of the adrenal gland (6 to 20 centimeters), two hyperplasias and three adenocarcinomas of unknown origin. Thirty-eight (43 per cent) of the nonfunctioning masses were observed with repeat scans for an average of 25.1 months (three to 60 months), revealing no change in size. Twenty-seven patients (31 per cent) were lost to follow-up study. Silent primary (nonmetastatic) masses 3.5 centimeters or less manifested benign behavior without exception. Based upon these data, we conclude that all solid metabolically inactive lesions in the adrenal glands greater than 3.5 centimeters on CT abdominal scan deserve exploration. Lesions less than 3.5 centimeters may be safely followed with serial CT scans.

CT diagnosis of adrenal abnormalities in patients with primary non-adrenal malignancies

Fifty-seven patients with primary non-adrenal malignancy were found to have unsuspected adrenal abnormality on CT. In 33, comparison of histopathologic findings and/or the patients' hospital course or follow-up lead to the diagnosis of adrenal metastases (23), benign non-functioning adenomas (7), metastasis with hyperplasia (1), benign hyperplasia (1), and fatty infiltration (1). The analysis of CT findings indicated that: I) A heterogeneous adrenal mass showing contrast enhancement was always metastatic, II) Nonfunctioning adenomas were always 3 cm or smaller in diameter, III) Bilateral adrenal masses and growth of adrenal mass on follow-up CT or regression on treatment indicated metastases, and IV) metastatic disease could not be excluded purely on the basis of the size of the adrenal mass.

Ultrasonography of pancreatic schistosomiasis: a case report

A 10 year old girl presented with fever, pain, anaemia, hepatosplenomegaly and eosinophilia. No schistosomal ova were found on stool examination. Abdominal ultrasound revealed a mass in front of the portal vein conforming to the shape of an enlarged pancreas. Laparotomy revealed a firm, granular, whitish mass involving the pancreas. Examination of biopsy samples showed granulomata of Schistosoma mansoni in the pancreas, liver and lymph nodes. The patient responded to therapy with oxamniquine.

The effect of tumor size and axillary lymph node metastasis on estrogen and progesterone receptors in primary breast cancer

We evaluated the estrogen receptors (Er) and the progesterone receptors (Pr) in 209 female patients with primary breast cancer. There is statistically a very highly significant negative correlation between the size of the tumor and the Pr (p = 0.007); large tumor contains low Pr. The same correlation was found with Er, but it was not statistically significant (p = 0.40). There is also a negative correlation between the number of axillary metastatic lymph nodes and Er and Pr, but this was not statistically significant.

The effect of age on estrogen and progesterone receptor in primary breast cancer

We evaluated the estrogen receptors (Er) and progesterone receptors (Pr) in 228 female patients with primary breast cancer by Dextran-Charcol method. Their ages vary from 30 to 91 years. Mean age 60.7 years. (SD: 13.6 years). Er mean was 70.31. (SD:103); there exists a statistically significant correlation between age and Er at p less than .001; older patients have higher Er. Pr mean was 60.73, (SD:128). There is statistically significant correlation between age and Pr at .01 less than p less than .025; older patients have higher Pr. There is also very statistical significant correlation between Er and Pr at p less than 0.1; when Er is high Pr is high.

Long-term ureterostomy with suprapubic intravesical drainage used to bypass severe schistosomal obstructive uropathy--preliminary report

Severe obstructive uropathy due to infection with S. hematobium often requires reconstructive surgery. Recent reports, have emphasized that many lesions will disappear after specific chemotherapy given the necessary time. Time for effective chemotherapy may be impossible to allow in severe obstruction. The necessary surgical procedures range from ureteric dilatation to ureteric resection with ileal loop replacement. We suggest that temporary long-term bypass of the diseased ureter using silastic tubes may offer an alternative to resection in many cases while the effect of specific chemotherapy is awaited. One case is described in which ureterostomy with suprapubic intravesical drainage adequately bypassed the diseased and obstructed lower two thirds of the left ureter. In the following six months specific chemotherapy had encouraging effects on the bypassed area.

Synovial swellings over wrist in leprosy

Soft cystic swellings are noticed in leprosy patients during the course of disease and are seen all through the spectrum. The commonest site for these is the dorsum of wrist. At times these are seen over the dorsum and the lateral aspects of ankle as well. These contain straw colored sticky but clear fluid. On exploration these appear to arise from the synovial covering of the extensor tendons of wrist and fingers and have no communication with the wrist joint. Histology of the synovium suggests these swellings to be of inflammatory nature.

Incidence of C5 isozyme of serum cholinesterase (E2 locus) in populations of Andhra Pradesh, South India

The distribution of the C5 isozyme of the serum cholinesterase (E2 locus) was studied in several endogamous Hindu caste groups and Muslim sub-sects of Andhra Pradesh in South India. Both intra and inter population variation was marked with a comparatively low incidence of C5 in the populations studied.

Differentiation of malignant from benign adrenal masses: predictive indices on computed tomography

CT findings in 43 adrenal masses were analyzed to see which features correlated most significantly with malignancy. Size, contrast enhancement, and consistency emerged as important discriminators of malignant from benign adrenal masses. These three factors were further analyzed by logistic regression technique to examine the joint influence of computed tomographic (CT) features in prediction of malignancy. As a result of logistic regression analysis, a table of estimated probability of malignancy as a function of tumor size alone and another table of estimated probability as a joint function of size and contrast enhancement were developed. Given a similar patient sample and by using the data given, it would be possible to predict chances of malignancy in an adrenal mass if its CT features are known; for example, a 5-cm adrenal mass without enhancement has a 0.31 probability of malignancy; with enhancement, a 0.68 probability.

Ultrasonographic diagnosis of schistosomal periportal fibrosis

Hepatosplenic schistosomiasis results from infestation by Schistosoma mansoni, a blood fluke. Presinusoidal periportal fibrosis is invariably the result of this infestation. The ultrasonic pattern of schistosomal periportal fibrosis in 22 patients in whom schistosomal hepatic involvement was proven histologically is described. Echogenic areas of pipestem fibrosis seen as tubular shadows, some containing central lucencies, were present in every case. These tubular shadows conformed to the structure of the portal veins, producing a characteristic appearance. In endemic areas this appearance may be the only clue to the diagnosis of hepatosplenic schistosomiasis, because patients may remain asymptomatic for years after the onset of the disease.

Urography and cystoscopy in bladder mucosal abnormality

A prospective study was carried out on 60 patients. The diagnostic usefulness of intravenous urography (IVU) compared with that of cystoscopy in assessing the state of the bladder mucosa was evaluated. Collectively, radiology was as good as cystoscopy in suggesting the final diagnosis of the location and severity of a mucosal lesion. The after-micturition film (AMF) from IVU was the single most informative film which produced correct results in 59 of 60 patients. The full bladder film was the least useful examination and in 45 cases suggested an incorrect or misleading diagnosis.

Chemical reactivity and mutagenicity of some dihalomethanes

Four dihalomethanes; dichloromethane, bromochloromethane, dibromomethane and diiodomethane, have been studied with respect to their reactivities towards nucleophilic compounds of different strengths in water solution and with respect to their toxicities and mutagenic effectiveness in bacterial test systems. The correlation between biological activity (toxicity and mutagenic effectiveness in Salmonella TA100) and reactivity towards strong nucleophiles indicates that reactions with nucleophilic groups of high reactivity in the biological material, possibly SH or amino groups in proteins, are involved in their mechanism of action.

The production of high affinity monoclonal antibodies to human growth hormone

The primary aim of this work was to produce specific monoclonal antibodies to human growth hormone (hGH) for use in a diagnostic RIA of hGH levels in serum. Three different schedules were used for immunization of BALB/c mice and the splenocytes from each mouse were fused with myeloma cells Sp 2/0 Ag 14. Each fusion resulted in the production of hundreds of hybridomas secreting hGH-directed antibodies. Six antibodies have been fully characterized and have been grouped into pairs which recognize 3 different epitopes on the hGH molecule. One pair exhibits no cross reaction with the structurally related placental hormone, human placental lactogen (hPL), a second pair has low cross reaction with hPL (1.6-3%) and a third pair reacts equally well with hGH and hPL indicating binding to a common epitope in the 2 molecules. The highest affinity antibody, 74/6, which has an affinity constant of 4.4 X 10(10) l/mol and 3% cross-reactivity with hPL, has been used to establish a RIA for serum hGH measurements. Evidence is provided that hGH levels measured in this assay correlate well with those obtained in a conventional rabbit antiserum assay.

Estimation of genetic risks of alkylating agents. VI. Exposure of mice and bacteria to methyl bromide

Methyl bromide was studied in a forward mutation system of E. coli to evaluate the relationship between dose and mutagenic response. The compound had a high toxicity and a low mutagenic efficiency, as expected from the high s value. The mutagenic effectiveness was estimated to be 1 mutation per 10(8) surviving bacteria per mM . h, in reasonable agreement with expectation from reaction kinetic data. To study the possibilities of using hemoglobin alkylation for an estimation of DNA alkylation in vivo, mice were treated with 14C-labeled methyl bromide. The degree of alkylation of DNA, determined in liver and spleen, was considerably lower than expected (200 and 20 times, respectively) from the degree of alkylation of hemoglobin and from the relative reactivities of DNA and hemoglobin towards methyl bromide in vitro. when hemoglobin alkylation is used for quantitative risk estimations, a correction factor has to be applied by taking into account the difference between the dose in red blood cells and the dose in the compartments of DNA.

Preoperative arteriographic spasm and outcome from aneurysm operation

The timing of intracranial operation for the treatment of ruptured cerebral aneurysm remains controversial. To find objective parameters to guide us, we performed angiography 24 to 72 hours before contemplated operation in 35 Grade I patients in whom subarachnoid hemorrhage had occurred at least 1 week earlier. Operation in the presence of angiographic vasospasm in Grade I patients over 1 week after SAH was associated with increased morbidity and mortality rates. Only 1 of 28 patients in whom spasm was absent or mild at the time of operation had an unsatisfactory outcome from operation (P less than 0.003). There was no correlation between clinical grade and significant spasm; 17 patients who were clinically Grade I over 1 week after SAH had moderate or severe angiographic spasm. These data suggest that all patients should undergo angiography just before contemplated operation and that operation should be postponed if vasospasm is present.

Rationalising abdominal radiography in the accident and emergency department

A retrospective analysis is presented of 100 consecutive patients attending an accident department and referred for abdominal radiography. In general the reasons for requesting supine films appeared sound. Five per cent of referrals were for haematemesis which is not a valid reason for plain radiography. An erect abdominal film as a routine request is indicated only in suspected intestinal obstruction (4% in this series), but 83% of patients were referred for both erect and supine films. If haematemesis were excluded as a reason for X-ray referral, and if erect films were limited to suspected intestinal obstruction, 95% of the patients would still have been referred for radiography, but almost half the abdominal films would not have been required. This would have reduced film wastage, workload and more important, gonadal irradiation.

Arterial thrombosis in essential thrombocythemia

The course of essential thrombocythemia has been observed in ten patients, ages 46 to 83, of whom nine were followed for a period of 4 months to 9 years. In contrast to the experience with essential thrombocythemia recorded in the literature, manifestations of arterial thrombosis were far more common than hemorrhage. In six of the ten patients, the presenting complaints were ascribable to incipient gangrene of the toes and several of these patients additionally developed occlusion of tibial and larger arteries while under our observation. All patients with incipient gangrene showed marked clinical improvement accompanying busulfan-induced reduction and normalization of the platelet count. Relapses in five patients after 2 to 87 months responded well to retreatment with busulfan. No patient has shown evolution to another myeloproliferative disorder. Essential thrombocythemia should be considered in the differential diagnosis of occlusive arterial disease.

Histalog gastric analysis

A histalog gastric analysis was done in 20 patients with gastroduodenal disorders and 12 subjects with non-ulcer dyspepsia who were used as controls. Due to overlap of secretory responses its use as a diagnostic tool is limited. About 46% patients with duodenal ulcer exceeded the upper limit of acid secretion of control subjects. Values for stimulated secretion in controls and the patients with gastric ulcer were the same. Endoscopy if possible is the investigation of choice for the diagnosis of gastroduodenal disorders and the secretory studies should be limited to patients under-going surgery for peptic ulceration.

The radiology of nasal injuries: problems of interpretation and clinical relevance

Films of 50 normal patients and 50 dry skulls were examined to detect lines which might stimulate a nasal fracture. These were visible on the occipito-mental view but on the lateral view any line which reaches the anterior cortex must be regarded as a fracture. The results of an analysis of 100 patients with trauma to the nasal bone are also presented. It is concluded that radiography of the nasal bone is an unnecessary examination unless requested by the E.N.T. surgeon, and this will in any case occur infrequently.