Fractures of the fifth metacarpal neck: is reduction or immobilisation necessary?

Sixty two patients with fractures of the neck of the little finger metacarpal have been studied. Treatment consisted of unrestricted exercises without any splintage or attempts at reduction, irrespective of the degree of angulation of the fractures. Patients were reviewed at one or two-weekly intervals until movement had recovered and return to work was possible. One year after injury, patients were recalled for examination. Recovery was rapid with no long-term functional restriction, although 14% of patients noted minor cosmetic deformity.

Peripheral neurotoxicity of 2-chloroprocaine and bisulfite in the cat

The responses of peripheral nerves less than 6 hr after and 2 weeks after exposure to 2-chloroprocaine (2-CP) and bisulfite (BS) were studied in cats using electrophysiologic techniques and by light and electron microscopy. Three percent 2-CP with 0.07% or 0.2% BS was not toxic to peripheral nerves. Three percent 2-CP with 1.2% BS and 1.2% BS (pH 2.8) alone had an acute effect on the peripheral nerves but no chronic effect. Ten percent BS (pH 2.8) caused Wallerian degeneration. However, at pH 4.8, no chronic toxicity was observed. Using conductivity measurements, it was shown that 2-CP and BS, when mixed, form an ion pair in solution that lowers the effective concentration of BS.

Fractures of the metacarpals: treatment by A. O. screw and plate fixation

Twenty-two patients with 26 fractured metacarpals were treated by internal fixation using A. O. mini-fragment screws and plates. This form of internal fixation was reserved for metacarpal fractures which were multiple, unstable, displaced or rotated. Nine patients had open fractures, two had divided extensor tendons and four had multiple fractures. Fractures consistently united without infection or deformity. The mean duration of postoperative immobilization was seven days and mean time off work was six weeks. All but one patient did manual work. No patients had persistent symptoms which caused difficulty with work or sport. Fourteen patients regained full movement. Four had total active movement of 220 degrees or more in the involved ray and 6 patients had total active movement of between 180 and 220 degrees. Restricted movement was present in patients with open fractures and divided extensor tendons or intra-articular fractures of the metacarpal head. Uniformly satisfactory results were found after mini-screw and plate fixation of metacarpal fractures.

Fractures of the phalanges: results of internal fixation using 1.5mm and 2mm A. O. screws

Thirty-six patients were treated for 38 phalangeal fractures using 1.5 mm and 2 mm A. O. screws. Plates were not used in the fingers. Oblique fractures of the condyles, shafts or bases of the proximal or middle phalanges were treated by internal fixation because of instability, displacement or rotation. 40% of fractures had associated skin wounds, were comminuted or had damage to the extensor mechanism. The mean duration of post-operative immobilization was 9 days and the mean time off work was 6 weeks. Total active movement in the involved ray was 220 degrees or greater in 24 cases, 180 degrees to 215 degrees in eight cases, and less than 180 degrees in two patients at follow up. The patients were reviewed between three and 54 months after treatment and the mean duration of follow up was 24 months. The most frequent complication was 10 degrees to 30 degrees of flexion deformity of the proximal interphalangeal joint after internal fixation of condylar fractures. Results were satisfactory in 90% of cases.

Fractures of the Metacarpals: Treatment by A. O. Screw and Plate Fixation

Twenty-two patients with 26 fractured metacarpals were treated by internal fixation using A. O. mini-fragment screws and plates. This form of internal fixation was reserved for metacarpal fractures which were multiple, unstable, displaced or rotated. Nine patients bad open fractures, two had divided extensor tendons and four had multiple fractures.

Fractures consistently united without infection or deformity. The mean duration of postoperative immobilization was seven days and mean time off work was six weeks. All but one patient did manual work. No patients had persistent symptoms which caused difficulty with work or sport. Fourteen patients regained full movement. Four had total active movement of 220 degrees or more in the involved ray and 6 patients had total active movement of between 180 and 220 degrees. Restricted movement was present in patients with open fractures and divided extensor tendons or intra-articular fractures of the metacarpal head.

Uniformly satisfactory results were found after mini-screw and plate fixation of metacarpal fractures.

The Herbert screw for fractures of the scaphoid. A review of results and technical difficulties

We have reviewed 22 patients with scaphoid fractures treated by internal fixation with the Herbert screw. Three patients had trans-scaphoid perilunar dislocations, one had an oblique displaced fracture of the waist of the scaphoid and 18 had fractures with delayed or non-union. Corticocancellous bone grafts were added in nine of the cases of non-union. Results were excellent or good in 80% of cases after a mean duration of postoperative immobilisation of four weeks. The technical difficulties are analysed and the problems of applying the jig and of operative exposure are discussed.

Acute carpal tunnel syndrome. Complications of delayed decompression

Five patients suffered injuries around the wrist complicated by acute tunnel syndrome. Pain associated with median nerve paraesthesia or hypo-aesthesia are indications for urgent treatment; in four patients where operation was delayed, the outcome was poor.

Post mastectomy pain after brachial plexus palsy: metastases or radiation neuritis?

Three patients have been reported who developed metastatic tumour within the neural tissue of the brachial plexus three years, four years and fourteen years respectively after treatment of breast carcinoma by simple mastectomy and postoperative radiotherapy. A fourth patient who developed bilateral upper limb paralysis after radiotherapy for a lymphoma is also reported. At exploration of the brachial plexus extensive fibrosis was present in all cases with metastases only diagnosed through biopsy of neural tissue. The clinical features and the role of surgery are discussed in the light of our experience and a review of available literature.

Duration and toxicity of bupivacaine for topical anesthesia of the airway in the cat

To assess bupivacaine as a topical anesthetic of the airway, 0.5 ml of 1, 2, and 4% bupivacaine was sprayed down the trachea of lightly anesthetized cats and the duration of anesthesia, systemic toxicity, and local toxicity was compared to that produced by 4% lidocaine. Two percent bupivacaine suppressed the cough reflex longer than 4% lidocaine with no increase in either local or systemic toxicity. Four percent bupivacaine produced arrhythmias in 5 of 10 cats in two groups and apnea in 4 of 6 cats. This study indicates that 2% would be an appropriate concentration to assess bupivacaine as a topical anesthetic of the airway in humans.

Comparison of insulated and uninsulated needles for locating peripheral nerves with a peripheral nerve stimulator

This study was designed to compare the use of insulated and uninsulated needles with a peripheral nerve stimulator for locating a peripheral nerve in an anesthetized cat. The needles were mounted on a one-dimensional manipulator and both the saphenous and sciatic nerves were located. The tip of the insulated needle was consistently placed on the sciatic nerve. The tip of the uninsulated needle was placed 0.1-0.9 cm past the sciatic nerve. Injecting saline to assess the position of the tip of the needle relative to the sciatic nerve did not detect the needle being past the nerve. With the saphenous nerve preparation, both the needle and nerve were visible through the tissue. Using an insulated needle, the minimum current required to stimulate the nerve occurred when the tip of the needle touched the saphenous nerve. Using an uninsulated needle, the minimum current occurred when the tip was 0.1-0.8 cm past the nerve. The conclusion is that insulated needles more precisely locate the peripheral nerve than uninsulated needles.

Effects of hypersensitivity to a halothane metabolite on halothane-induced liver damage

The effect of immunologic hypersensitivity to a metabolite of halothane (trifluoroacetate) on the halothane-hypoxia-induction model was tested in mice and rats. Male Fisher 344 rats (200 g) were immunized with ovalbumin-trifluoroacetate (OVA-TFA) and the time course of the delayed hypersensitivity response determined. The animals had a peak response between 4 and 6 weeks after immunization. Rats were immunized with OVA-TFA, OVA, or saline 5 weeks before being anesthetized. Ten days before anesthesia, the animals were started on 0.1% phenobarbital in the drinking water. The animals were anesthetized with 1% halothane and 14% oxygen for 2 h. Hypersensitivity to TFA had no effect on the liver damage in either the mouse or the rat. These results do not rule out an immunologic vector in halothane hepatitis but make the involvement of TFA unlikely.

Differential peripheral nerve block by local anesthetics in the cat

Controversy still surrounds the differential susceptibility of nerve fibers to local anesthetic conduction block. In order to help resolve this controversy, we developed an in vivo model of peripheral nerve blockade in the cat that closely reproduced the clinical state. Using this model, differential rate of nerve blockade of A-alpha, A-delta, and C fibers by 2-chloroprocaine, lidocaine, bupivacaine, and etidocaine was observed and quantitated. C fibers were blocked first by 2-chloroprocaine, lidocaine and bupivacaine. Etidocaine blocked A-delta fibers first. A-alpha fibers always were blocked last. Of the four local anesthetics tested, 2-chloroprocaine produced the greatest differential rate of block of the nerve fibers, and etidocaine produced the least.

The effect on mice of practical diets containing different protein and energy levels

Mice of 2 strains were fed diets of natural ingredients in 3 different laboratories. The diets, which were fed before and after pelleting, contained levels of protein and energy within the ranges comparable to those found in existing laboratory diets and were the same formulation as those fed to rats in a previous paper. The diet with the lowest energy level supported the lowest rate of bodyweight gain, as it had with rats. Little effect was noticed on food consumption, conversion efficiency or water intake. Animals fed the pelleted diets gained bodyweight faster and there were indications of greater food and water consumption and also food conversion efficiency. It was concluded that food intake was improved with the pelleted diets resulting in the other increases.

The effect on rats of practical diets containing different protein and energy levels

Rats of 3 strains were fed diets of natural ingredients in 4 different laboratories. The diets contained different levels of protein and energy within ranges comparable to those found in existing laboratory diets. Energy level over the range examined appeared to exert greatest influence on bodyweight gain, but had no effect on food intake. The diet with the highest amino acid content was consumed in smaller amounts than the other diets. Food utilization was less efficient in the lower energy diets. Fat deposition was reduced in animals fed the lowest energy diet. It is concluded that energy level of the diet exerts an effect on the rate of bodyweight gain in rats, but that for longer-term studies a reduced energy level may be beneficial by leading to smaller fat deposits with consequent increase in longevity.

Pilot study on disposition and pain relief after i.m. administration of meperidine during the day or night

Two groups (four patients each) of sickle cell anemia patients with severe pain were studied. One group comprised patients admitted to emergency unit in the morning (5:40 to 9:15) and the other patients admitted in the evening (18:53 to 22:50). All patients received intramuscular meperidine (1.5 mg/kg). Pain intensity and pain relief were followed for 4 h; blood samples were taken up to 6 h after drug administration. Significant differences in drug disposition were found between the day and night groups, as the elimination half-life was 46% shorter during the night and the total serum clearance was 70% greater during the night. Whereas a positive correlation was found between drug concentration and pain relief for the day group, no such correlation was found for th night group. Even though peak concentrations were higher during the night, analgesia was lower. This pilot study suggests that much higher meperidine doses might be required during the night to achieve equieffective analgesia.

Genotype X diet interaction for litter size in mice

Substantial interaction was observed in 3 inbred strains of mice maintained on 5 normal commercial pelleted diets. Strain B10.BR was most sensitive to the unknown dietary factor, and the ranking of B10.BR and A2G was reversed across the array of diets. There was no apparent relationship between the ‘biological’ value of the diet and 21 dietary ingredients determined chemically. The study shows that the diet which gives the best performance for one strain of mice may not be the best for another.

Immunological properties of peptic fragments of bovine serum albumin

The effect of peptic degradation on the immunological and antigenic properties of bovine serum albumin (BSA) was investigated. Molecular fragments obtained after various times of digestion (3-360 min) were studied. Enzymatic digestion resulted in a rapid loss of serologically defined antigenic determinants. The immunogenicity of the fragments as measured by the level of reaginic and total anti-BSA antibody response in BDF1 mice was also diminished. Pre-treatment of mice with fragments exhibiting a low density of B-cell interacting determinants before immunization with BSA, resulted in significant suppression of both the primary and secondary antibody response. The most effective immunosuppressive fragments were obtained following removal of peptides which bound to anti-BSA antibodies. The suppression was shown to be antigen specific. It was concluded that separate determinants on the BSA molecule were responsible for the immunogenic and suppressive properties of the antigen.

Composition of the milk of the common marmoset (Callithrix jacchus) and milk substitutes used in hand-rearing programmes, with special reference to fatty acids

Analyses of marmoset (Callithrix jacchus) milk were carried out to determine values for crude protein, lactose, total lipids, major minerals, and osmotic pressure. Mean values were (g/100 ml): protein, 3.6; lactose, 7.5; total lipids, 7.7; minerals (mg/100 ml): sodium, 21.4; potassium, 54.3; calcium, 92.2; phosphorus, 22.8; magnesium, 5.0; chloride, 52.2; osmotic pressure, 354 mosm/kg water. Similar analyses were conducted on 2 milk substitutes used in hand-rearing programmes. Fatty acid analyses were carried out on natural milk, the milk substitutes, and the marmoset diet. For hand-rearing C. jacchus it is recommended that a human milk substitute is modified by increasing the levels of protein, carbohydrate, and total lipids, and that a small amount of fish oil is added.

Influence of diet pellet hardness and particle size on food utilization by mice, rats and hamsters

Increasing hardness of diet pellets reduced food wastage by each species. Also, less wastage occurred when pellets made from finely ground materials were given, an effect that was not related to hardness. The hardest diet reduced growth of the mice by reducing true food consumption and a poorer food conversion efficiency (true food consumption/growth) was obtained. Apparent food consumption increased with the softness of the diet and food utilization (apparent food consumption/growth) of the softest diets was less efficient than those of the others. Grinding of the raw materials prior to pelleting had no effect on food conversion, but food utilization was less efficient because of the greater wastage of pellets from coarsely ground materials and consequent apparent food comsumption.

Effect of autoclaving and physical structure of diets on their utilization by mice

A pelleted and 2 expanded rodent diets were autoclaved at 121 degrees C for 20 minutes, and fed to DBA/1 and LACA strains of mice. Reproduction was not significantly different on any diet and autoclaving had no effect other than increasing the intervals between litters. However, apparent food consumption was greater and efficiency of food utilization (expressed as young weaned/diet consumed) was poorer in mice fed pelleted diets. Diet had no significant effect on growth, but food wastage and consequently apparent food consumption were less and food utilization more efficient when expanded diets were fed. In addition, true food consumption was lower and food conversion more efficient. Autoclaving had little effect on expanded diets but caused a significant reduction in wastage and in apparent and true consumption of the pelleted diet, perhaps because of increased hardness.

The effect of methods of sterilization on the nutritive value of protein in a commercial rat diet

1. The effect on protein quality of treating a commercial rat diet by autoclaving at various temperatures for different periods of time, or by irradiation with 2-5 or 10 Mrd, was studied. True digestibility (TD) and biological value (BV) were measured and the available and total amino acids in the diets were estimated using microbiological and chemical methods. 2. Autoclaving at 121 degrees for 60 min reduced BV, TD and net protein utilization (NPU) more than autoclaving at 134 degrees for 3 min. Availability of amino acids was reduced by both treatments but to a greater extent by autoclaving at 121 degrees for 60 min. Total amino acids were essentially unaffected. Irradiation had no effect on BV, TD, NPU or total amino acids, and the availability of amino acids was also unaffected, with the exception of lysine which was slightly reduced. 3. When the diet was autoclaved at 115 or 121 degrees for 15, 30 or 60 min, or at 134 degrees for 3 min the availability of the amino acids was reduced with increasing time and temperature of treatment. Treatment at 134 degrees for 3 min had an effect on available amino acids similar to treatment at 121 degrees for 15 or 30 min. 4. Ethylene oxide fumigation of the diet caused reduced availability of histidine, methionine and tryptophan but had negligble effect on arginine, leucine and lysine. 5. It is concluded that from a practical point of view irradiation causes least damage to proteins in rodent diets. If such diets are to be autoclaved they should be supplemented with complete protein to counteract amino acid destruction.