Natural history of advanced osteoarthritis of the hip

We followed long-term osteoarthritis of the hip clinically and radiographically in 38 patients (47 hips) finally reaching an advanced or terminal stage for more than 10 years. The relation between various measured parameters and disease progression and osteophyte formation was analyzed. By multivariate analysis, the clinical outcome of osteoarthritis of the hip could be correctly predicted in 91.5% of cases. In the cases in which initially the slope of the acetabular roof was not steep, the greater trochanter was low, and the cranial joint space was narrow, good roof osteophyte formation was well recognized. The cases with good roof osteophyte formation were characterized by preserved roundness of the femoral head, no shortening of the femoral neck, no lateralization of the femoral head, unchanged cranial joint space, and no worsening of pain at the final follow-up.

Low twinning rate and seasonal effects on twinning in a fertile population, the Hutterites

This paper analyzes from the mid 18th century to 1987 the birth records of the "Dariusleut," one of the three subgroups of the Hutterite population. The aim of this study is to describe several aspects of the twinning rate in a fertile population. The overall rate of twinning was 0.90%: 103 twins among all 11,492 maternities. The rate peaked at the 7th birth order and at the maternal age of 40 years and over. Until the mid 19th century when the Hutterites lived in Russia, the twinning rate was higher (1.5%), and it decreased during the migration period in the second half of the 19th century (0.7%). After the group had settled in the USA and Canada, the population maintained a twinning rate of 1.0% until 1965. After 1965 the rate decreased to 0.7%, partly due to a decline in fertility among women aged 30 years and over. There was a significant seasonal variation: the twinning rate decreased to 0.5% in May-July compared to 1.2% for the other three seasons during the years up to 1965 (P < 0.01), while more recent mothers did not show such a seasonal variation. The incidence of twin births in this population seems to have been influenced by environmental factors, which would change their effect seasonally and secularly.

[Continuous hyperthermic peritoneal perfusion (CHPP) for prevention or treatment of peritoneal dissemination]

We performed CHPP with concomitant use of CDDP and etoposide for prevention or treatment of peritoneal dissemination in gastric (10 cases) and colon (1 case) cancers with serosal invasion or peritoneal dissemination. The patients received intra-abdominal perfusion by saline heated to 41.5-42 degrees C dissolving CDDP and etoposide for 40-50 minutes. The blood concentrations of total CDDP and etoposide rapidly increased and reached maximum at the end of perfusion. Post-operative complications were more frequent in the group without STS than with STS. The prognosis of patients with peritoneal dissemination (P3) was poor, but ascites was observed to disappear in four of five cases. All patients with S (+) or P1 have been alive and free from disease for 1 to 12 months after CHPP. These results suggested that CHPP was effective for prevention and treatment of peritoneal dissemination.

Increased afterload intensifies asynchronous wall motion and impairs ventricular relaxation

To clarify whether impaired left ventricular relaxation elicited by increased afterload is attributable to regional dyssynchrony, we analyzed in dogs simultaneous left ventricular contrast ventriculography and pressure before and during angiotensin II infusion. Regional shortening was measured by a centerline method and a video-intensity method that served to define asynchronous motion. During angiotensin II, peak left ventricular pressure increased 35 +/- 6 mmHg, and the isovolumic pressure time constant (tau) was prolonged from 32.7 +/- 4.1 to 39.2 +/- 7.6 ms (P < 0.01). During increased afterload, early diastolic asynchrony, confined to the apical (5 of 7) and inferior regions (2 of 7), was detected in all dogs. Early systolic asynchrony was detected in the apical (5 of 7) and inferior (1 of 7) regions in six dogs. At control, systolic excursion was lower in the anteroapical than in the anterobasal region (P < 0.05). During angiotensin II, excursion of all regions was reduced, with the apical region lower than other regions (P < 0.01). In the normal dog heart, impaired relaxation with augmented afterload is coincident with asynchronous wall motion, especially in the apical-inferior region. Temporal dispersion of regional contraction may explain delayed left ventricular relaxation associated with increased afterload.

Adriamycin-induced lipid peroxidation of erythrocyte membranes in the presence of ferritin and the inhibitory effect of ceruloplasmin

When erythrocyte membranes were incubated with adriamycin (ADM) in the presence of ferritin, lipid peroxidation occurred with release of iron from the ferritin. In the presence of apoferritin, ADM did not cause lipid peroxidation. Deferoxamine inhibited the ADM-induced lipid peroxidation in the presence of ferritin. These results indicate that lipid peroxidation depends upon the release of iron from ferritin. Even when the iron content in ferritin was very low, ADM could induce lipid peroxidation. Superoxide dismutase, catalase and hydroxyl radical scavengers did not substantially affect lipid peroxidation, indicating that the peroxidation reaction was independent of superoxide, H2O2 and hydroxyl radicals. Ceruloplasmin, a ferroxidase, markedly inhibited lipid peroxidation but did not affect the release of iron from ferritin. ADM-Fe(3+)-binding erythrocyte membranes were readily formed during the incubation of erythrocyte membranes with ADM in the presence of ferritin, and deferoxamine removed iron from the ADM-Fe(3+)-binding membranes, indicating that the iron moiety of the ADM-Fe(3+) complex is exposed at the membrane surface. These results may suggest that the peroxidation reaction occurs in a site-specific manner.

Thy-1 antigen dendritic cells and rejection of composite tissue limb allografts in rats

Dendritic-shaped cells (Thy-1+DC) characterized by the surface phenotype of Thy-1+, asialo GM1+, Ia- are reported to exist exclusively in mice. However, Thy-1+ dendritic cells were observed in the skin of normal athymic nude F344, euthymic F344, and WKAH rats. Their phenotypic markers were Thy-1+, asialo GM1+, Ia-, W3/25 (helper/inducer)-, OX8 (cytotoxic/suppressor)-, W3/13 (pan T lymphocytes)-, OX39 (IL-2)-, and OX41 (macrophages)-. These phenotypic markers were analogous to those of mice. The density of Thy-1+DC in the skin of normal nude F344 rats was approximately twice as much as that of F344 and WKAH rats. When WKAH rats were used as donors with nude F344 rats as recipients (this combination being a major mismatch with regard to a MHC, rejection-like changes such as edema and erythema were observed 1 week after the grafting. An immunohistochemical examination demonstrated that the density of Thy-1+DC had increased 3-fold within the donor skin at 1 week after transplantation, although almost no W3/25 positive cells, OX8 positive cells, or other inflammatory cells were observed. Within 2 weeks of transplantation the donor skin ceased rejection-like changes and the density of Thy-1+DC was reduced to preoperation levels. When WKAH rats were used as donors with F344 rats as recipients, severe rejection was observed, and many T cells with W3/25 or OX8 antigens and granulocytes had infiltrated into the skin at the donor sites. Thy-1+DC could not be found in the donor skin. These findings suggest that a correlation exists between Thy-1+DC and rejection-like changes in the donor skin when nude rats are used as recipients.

Collagen and alkaline phosphatase gene expression during bone morphogenetic protein (BMP)-induced cartilage and bone differentiation

Endochondral bone formation induced by bone morphogenetic protein (BMP) involves expression of collagen Types I and II and alkaline phosphatase (ALP) genes. Expression of these genes was studied in mice after implantation of BMP. The amount of Type I collagen mRNA increased from Day 3 to Day 7, when mesenchymal cell aggregation was observed. On Day 17, Type I collagen mRNA expression was correlated with an increased number of osteoblasts. Type II collagen mRNA increased from Day 7 and coincided with chondroblast appearance. This increase was suppressed by Day 17, although hypertrophic and degenerative chondrocytes were present. Alkaline phosphatase mRNA increased markedly from Day 7 with the appearance of chondroblasts. The high level of ALP mRNA continued until Day 11, during chondrogenesis. Mineral deposition was first observed roentgenographically on Day 11. Thus, BMP-induced bone formation occurs with the expression of collagen Types I and II and ALP genes.

Lack of prognostic value of immunoreactivity for p62 oncoprotein in colorectal carcinoma

Immunohistochemical staining for c-myc p62 oncoprotein (p62) was performed in 59 colorectal carcinomas using mouse monoclonal antibody against human c-myc protein (MYC1-6E10). The immunoreactivity for p62 was intense in 22 (37.3%), and weak in 37 (62.7%) of the tumors. Advanced disease and nodal metastasis were more frequently seen in tumors showing intense staining but the difference did not reach statistical significance. Sixteen patients have died of the disease but overall survival rates did not differ between patients with tumors showing intense staining and those with tumors showing weakly staining. In 50 patients undergoing grossly curative resection, local or distant metastasis developed in 15 patients. Immunoreactivity for p62 had no effect on the rate of recurrence or disease free survival rates in these 50 patients undergoing grossly curative resection. The present study revealed that the immunoreactivity for p62 had no prognostic value in colorectal carcinoma.

Biomechanical analysis of radial wedge osteotomy for the treatment of Kienböck's disease

Biomechanical analysis of force transmission through the lunate was performed with the use of a two-dimensional mathematical model to evaluate the usefulness of radial wedge osteotomy, a procedure that decreases radial inclination, in the treatment of Kienböck's disease. The forces acting on the carpal bones were compared before and after radial wedge osteotomy in 29 patients with Kienböck's disease. The average osteotomy angle was 9.6 degrees. The total force through the lunocapitate joint at the midcarpal level was decreased by 23%, while the total force through the radiolunate and ulnolunate joints at the radioulnocarpal level was decreased by 10% and 36%, respectively. These changes correlated directly with the osteotomy angle and demonstrate decompression of the lunate by radial wedge osteotomy.

Transforming growth factor-beta 1 enhances the generation of allospecific cytotoxic T lymphocytes

We investigated the effects of transforming growth factor-beta 1 (TGF-beta 1) on the proliferation and generation of murine T lymphocytes in vitro. TGF-beta 1 suppressed T- and B-lymphocyte proliferation, mixed lymphocyte reaction (MLR), and the generation of natural killer (NK) cells and lymphokine-activated killer (LAK) cells. On the other hand, TGF-beta 1 significantly enhanced the generation of allospecific cytotoxic T lymphocytes (CTL) at low concentrations (0.01-1 ng/ml) in a dose-dependent manner and restored it to the control level at higher concentrations (10-40 ng/ml). Allospecific CTL generation by TGF-beta 1 was maximally enhanced when added at the beginning of culture. Less enhancement occurred when the addition was delayed. Anti-TGF-beta 1 antibody completely abolished the enhancing effects of TGF-beta 1. Furthermore, platelet-derived TGF-beta (pTGF-beta) as well as recombinant TGF-beta 1 similarly enhanced the generation of allospecific CTL. These data demonstrate that TGF-beta has not only immunosuppressive effects but also immuno-enhancing effects in vitro.

[Terminal phalangeal osteosclerosis in rheumatoid arthritis]

OBJECTIVE

Osteosclerosis of the terminal phalanges of the hand has been reported in the collagen diseases including rheumatoid arthritis (RA). The current study was made to clarify the significance of terminal phalangeal osteosclerosis in RA.

METHODS

Hand x-ray films of 108 patients (male 13, female 95) with RA for more than 10 years were assessed by Halim's grading. Grade 2, (Distance between both cortices is < 1 mm but there is still an intermediate space discernible), and grade 3, (Complete fusion of both cortices, but the base of the terminal phalanx is open), were classified as the positive group. Grades 0 and 1 were classified as the negative group. Both groups were compared and sigma GS/D values was measured at terminal phalanges, middle phalanges and metacarpuses of right middle fingers using digital image processing method. sigma GS/D index was calculated as being equal to the ratio of sigma GS/D value of the terminal or middle phalanx to sigma GS/D value of the metacarpus.

RESULTS

Thirty cases (28%) were positive (male 1, female 29). Osteosclerosis of terminal phalanges usually appeared in more than two digits bilaterally. It was located as follows; thumb-1 case, index-13 cases, middle-24 cases, ring-51 cases, little-58 cases. Obliteration of the medullary space of middle phalanges was seen in 5 cases. No difference was observed between the positive and negative groups about sex, age, the mean value of C-reactive protein, the incidence of Steinblocker's class classification and the rate of seropositive patients. Osteosclerosis of terminal phalanges was observed at first consultation in 93% of positive cases. Osteosclerosis is expected to appear in the early phase of RA and to last for more than 10 years. sigma GS/D index of the positive group (1.03 +/- 0.24, mean +/- SD) was greater than that of the negative group (0.63 +/- 0.25) (p < 0.05).

Changes in carpal alignment following radial osteotomy for Kienböck's disease

Changes in carpal alignment following radial osteotomy were studied in 30 patients with Kienböck's disease. The carpal height ratio and carpal-ulnar distance ratio were significantly less in wrists with Kienböck's disease than unaffected wrists. This observation implies proximal-ulnar translation of the capitate. In addition, the lunate-covering ratio increased significantly, reflecting radial translation of the lunate. Radial osteotomy corrected ulnar translation of the capitate and increased the radial translation of the lunate, thus increasing the lunate-covering ratio. The increased lunate-covering ratio is believed to increase the area of distribution of the axial load through the lunate by increasing the contact area with the radius. The satisfactory clinical outcome of radial osteotomy is believed to be due to this effect on carpal alignment.

Serum collagenase-like peptidase activity correlated with bone mineral density. A study of 102 elderly women

To clarify the relationship between collagenase-like peptidase (CL-peptidase) and bone metabolism, serum CL-peptidase activity and bone mineral density (BMD) in the lumbar spine, measured by dual energy X-ray absorptiometry (DEXA), were determined in 102 women with a mean age of 70 (41-94) years. The serum activity of CL-peptidase increased slightly with age up to the 8th decade, and then decreased. Next, we classified the subjects into the following 2 groups by age: a postmenopausal group 50-69 years, and an elderly group over 70 years. In the younger group serum CL-peptidase activity did not correlate with BMD, while in the elderly it did. Our result suggests that serum CL-peptidase activity may reflect bone resorption in elderly women.

Specific mechanism of the knee joint preventing tumor invasion

Tumor extension from the anterior aspect of the distal femur into the knee joint was examined histologically and with MRI in 10 patients with primary malignancy of bone. Histologically, 1 tumor had invaded the joint with destruction of the transitional area between the articular cartilage and bone. In another case, the transitional area had been destroyed by mechanical traction of the periosteum by the tumor without invasion. The fatty connective tissue and superficial synovial layer were detached from the femoral cortex and elevated upwards by tumor growth without destruction in 7 tumors but were unchanged in 3 tumors. TI-weighted MRI clearly revealed high signal intensity of the connective tissue and synovium in the 7 tumors with elevation. The average elevation of this detachment of the fatty connective tissue and synovium from the femoral cortex calculated from MR images was 12 mm. Destruction of the transitional area between the articular cartilage and bone was detected in 2 tumors on TI-weighted MR images. Our results indicate that fatty connective tissue and the superficial synovial layer are easily detached and elevated by tumors. This mechanism probably prevents tumor extension into the joint space.

Surgical experience with 5 n3(+) early gastric carcinoma cases

Of 370 patients who underwent a resection for early gastric carcinoma, 317 (85.6%) were N(-), 28 n1(+), 20 n2(+) and five (1.4%) n3 respectively. In this study, n3(+) early gastric cancers were clinicopathologically evaluated and sites of the metastatic nodes were also defined. In addition, a comparative study in DNA ploidy patterns between primary and metastatic node cell was performed according to Hedley's method using a FACS-IV scan of paraffin-embedded tissues. All n3(+) early gastric cancers showed an aneuploidy pattern. R2 or R3 operations are recommended for early gastric carcinomas with aneuploidy pattern and most of the metastatic nodes arise from the identical stem cell line of cancer cells.

Do angiotensin converting enzyme inhibitors limit myocardial infarct size?

1. Effects of captopril, ramiprilat and Hoe 140, a specific bradykinin receptor antagonist, on infarct size were assessed in a rabbit model of myocardial infarction. 2. Rabbits were untreated or pretreated with 0.5 mg/kg of captopril, 0.05 mg/kg of ramiprilat or 20 nmol/kg of Hoe 140 before 30 min coronary artery occlusion and 72 h reperfusion. 3. Captopril and ramiprilat treatment reduced systemic blood pressure by about 10 mmHg without alteration of heart rate, and the dose of Hoe 140 almost completely blocked hypotensive response to intravenous injection of bradykinin (100 ng/kg). 4. Infarct size expressed as percentage of area at risk was 44.5 +/- 3.3% in the control group, 41.9 +/- 1.6% in the captopril group, 51.8 +/- 2.7% in the ramiprilat group and 46.7 +/- 2.2% in the Hoe 140 group. All percentages were not significantly different. 5. These data suggest that angiotensin converting enzymes (ACE), with or without sulfhydryl groups do not limit myocardial infarct size and that endogenous bradykinin in ischaemic myocardium does not play a major protective role against ischaemic myocardial necrosis.

Alpha 1-adrenergic blockade reduces exercise-induced regional myocardial ischemia in dogs

The effect of selective alpha 1-adrenoceptor blockade on regional myocardial blood flow and contractile function during exercise-induced myocardial ischemia was determined in nine dogs having chronic single vessel coronary stenosis (ameroid constrictor). Treadmill exercise performed after beta-adrenoceptor blockade (1.0 mg/kg i.v. propranolol), to block potential prejunctional effects recently recognized with alpha-blockade, elicited severe regional myocardial ischemia with a steady-state reduction of regional systolic wall thickening of the post-stenotic myocardium from a resting value of 21.8% to 7.0%. Blood flow to the ischemic subendocardium was reduced from 0.76 to 0.36 ml/min/g (microspheres). Prazosin (80 micrograms/kg i.v.) was administered during continued running, and angiotensin II was simultaneously infused to prevent the decrease in systemic arterial pressure caused by prazosin. During the subsequent steady state, with arterial pressure matched to the pre-prazosin level, regional subendocardial blood flow improved to 0.60 ml/min/g and systolic wall thickening in the post-stenotic region increased modestly to 10.2%. No changes in blood flow to the outer portion of the post-stenotic region or to the remote control region were seen, and prazosin caused no effect on regional function in the control area, indicating effective blockade of prejunctional effects of prazosin (demonstrated in pilot studies). The finding that blockade of alpha 1-adrenoceptors resulted in improved ischemic zone subendocardial blood flow and contractile function are consistent with alpha 1-adrenoceptor-mediated reduction of blood flow to the ischemic subendocardium during exercise-induced ischemia in dogs with beta-blockade.

Implication of superoxide radicals on ischemia-reperfusion-induced skeletal muscle injury in rats

This study was designed to clarify the mechanism of ischemia-reperfusion injury to skeletal muscle using long-acting polyoxyethylene-modified superoxide dismutase (SOD-POE) in rats. The gastrocnemius muscles of male Lews rats were investigated. Tissue levels of ATP decreased to 20% of nonischemic values after 3 h ischemia and returned to 94% after 1 h reperfusion. In contrast, they decreased to 3.5% after 4 h ischemia and remained at 20% after 1 h reperfusion. Although SOD-POE did not affect the decrease of ATP during ischemia, it improved significantly the recovery of ATP: 28%. Tissue levels of lipid peroxides (LPO) after 3 h ischemia and 1 h reperfusion did not change significantly compared with the nonischemic levels (0.71 +/- 0.32 nmol/mg protein, mean +/- SD). They showed no increase after 4 h ischemia, but increased explosively after 1 h reperfusion (2.15 +/- 0.73 nmol/mg protein). SOD-POE did not affect LPO levels during ischemia but prevented the increase of LPO significantly after reperfusion (0.98 +/- 0.25 nmol/mg protein). Xanthine oxidase activity did not increase after 3 h ischemia (22.3 +/- 7.0 mU/g) compared with the nonischemic values (17.6 +/- 10.0 mU/g). In contrast, it increased 2.5-fold after 4 h ischemia (50.1 +/- 13.7 mU/g) and remained at a significantly high level after 1 h reperfusion. SOD-POE did not affect xanthine oxidase activity during ischemia and reperfusion. These results suggest that lipid peroxidation by superoxide radicals produced by xanthine oxidase is a contributory factor to ischemia-reperfusion injury to skeletal muscle, and the clinical application of SOD-POE might be expected.

[Coronary vasodilation during intracoronary injection of papaverine and acetylcholine in syndrome X: evaluation by coronary arteriograms and coronary venous oxygen saturation dynamics]

To evaluate coronary vasodilatory reserve in syndrome X, left coronary arteriography and continuous measurement of coronary venous oxygen saturation (CSO2-Sat) were performed during intracoronary injection of papaverine (PAP) and acetylcholine (ACh) in 11 patients of syndrome X and 13 control subjects. Coronary diameter after PAP increased 10.2% in the control group and 9.8% in the syndrome X group, but after ACh decreased 1.7% in the control group and decreased 2.3% in the syndrome X group. These changes in coronary diameter by PAP and ACh in the two groups were not significantly different. However, coronary vasodilatory responses estimated by CSO2-Sat dynamics to ACh and to ACh/PAP were significantly lower in the syndrome X group than those in the control group (p < 0.05), although coronary response to PAP in the 2 groups was not significantly different. These findings suggest that endothelial-dependent vasodilation of coronary microcirculation is decreased in syndrome X.

[Chemotherapy with cisplatin and daily administration of UFT for unresectable non-small cell lung cancer]

A combination chemotherapy of cisplatin and UFT was administered to fourteen patients with unresectable non-small cell lung cancer. To determine the maximum safety dose of UFT combined with CDDP (80 mg/m2), patients were assigned to three groups as follows: step 1: UFT (400 mg/m2) from day 1 to day 14; step 2: from day 1 to day 21; step 3: from day 1 to day 28. Cisplatin was administered on day 8 in each group. Myelosuppression with grade 3-4 and gastrointestinal toxicity of grade 3 were observed in one and two patients, respectively. The other toxicity was mild. There was no difference in the degree of toxicity among the three groups. The response rate of twelve evaluable patients was 50%; CR 0, PR 6, NC 4 and PD 2. Thus, chemotherapy using cisplatin 80 mg/m2 with daily administration of UFT 400 mg/m2 was considered to be well tolerated and effective in the treatment of non-small cell lung cancer.

Primary embryonal carcinoma of the retroperitoneum

A 32-year-old man with primary embryonal carcinoma of the retroperitoneum, a very rare condition, is reported. The disease took an acute course with rapid enlargement of cervical and inguinal lymph nodes, and high serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) values were observed. His testes were, however, intact. Remarkable tumor regression was achieved by systemic combination chemotherapy with cisplatin, vinblastine, and bleomycin (PVB therapy). This chemotherapy is beneficial even in advanced cases. In the two years since therapy, no recurrence has been observed.

Preconditioning enhances myocardial resistance to postischaemic myocardial stunning via adenosine receptor activation

OBJECTIVE

The aim was to test a hypothesis that ischaemic preconditioning attenuates myocardial stunning via adenosine receptor activation.

METHODS

Myocardial stunning was induced in male rabbits by a transient 5 or 10 min coronary artery occlusion, and alteration of regional systolic thickening fraction (TF) was measured by using an epicardial Doppler sensor before and after the regional ischaemia. Rabbits were either untreated, preconditioned with 1 min ischaemia, given 8-phenyltheophylline (8-PT, 10 mg.kg-1 intravenously), or given 8-PT plus 1 min ischaemic preconditioning. Preconditioning and 8-PT were given 5 min and 20 min before stunning the heart, respectively.

RESULTS

Postischaemic recovery of the thickening fraction was significantly improved by preconditioning with 1 min ischaemia. TF (% baseline) after 10 min ischaemia/30 min reperfusion was 84.3(SEM 5.0)% in the preconditioned group, which was significantly higher than the value of 51.3(8.1)% in the control rabbits. Treatment with 8-PT alone did not significantly alter the recovery of TF from 10 min ischaemia [TF = 45.0(7.4)%,], but 8-PT treatment completely abolished the effect of 1 min preconditioning [TF = 51.3(6.4)%]. Attenuation of myocardial stunning by 1 min preconditioning was also observed when the stunning was induced by 5 min ischaemia [92.2(1.3)% in preconditioned group v 75.9(3.2)% in controls].

CONCLUSIONS

These findings suggest that preconditioning protects the myocardium against stunning through activation of the adenosine receptors.

Intraventricular repair for Taussig-Bing anomaly

Among 41 patients with Taussig-Bing anomaly who underwent intracardiac repair, 10 patients were treated by intraventricular rerouting repair. The ages at operation ranged form 1 month to 8 years (average 2 years 3 months). Primary repair was done in four (average age 2 years 7 months), and repair was done after pulmonary artery banding in six patients (average age 2 years 2 months). The relationship of the great arteries was side by side in nine patients and oblique in one. After extensive resection of the infundibular septum, a distance of 8 to 18 mm from the tricuspid ring or chordae to the pulmonary valve was obtained (24% to 71% of total circumference for the subaortic route). The subaortic route was created to obtain an internal diameter at least equal to that of the aortic route. Tricuspid chordal or papillary muscle reattachment was performed in two patients. There were no early or late deaths. Follow-up ranged from 1 year 4 months to 22 years 3 months (average 5 years 8 months), and reoperation was required in one patient for residual pulmonary stenosis. The intraoperative pressure gradient between the left ventricle and aorta was 0 to 24 mm Hg (average 10.3 mm Hg), and postoperative study showed the gradients to be less than 19 mm Hg (n = 8). The age at operation, left ventricular-aortic pressure gradient, and postoperative tricuspid regurgitation were not significantly affected by the presence of severe hypertrophy of the infundibular septum (n = 4). These results indicate that intraventricular rerouting may be feasible in most patients who have the Taussig-Bing anomaly with side-by-side or similar relationships of the great arteries, and the age and conal anatomic variations do not appear to be significant limiting factors.

Scaphoid non-union: factors affecting the functional outcome of open reduction and wedge grafting with Herbert screw fixation

50 patients with scaphoid non-union were treated by open reduction, anterior wedge bone grafting and internal fixation using the Herbert screw. Intra-operative image intensifier control enabled us to insert the screw into the scaphoid accurately. An excellent or good functional outcome was less likely when more than 5 years had elapsed since injury, the non-union was in the proximal third, when sclerosis of the proximal fragment was present, and when reduction of carpal and scaphoid deformity was unsatisfactory. These four factors are believed to be the primary determinants affecting the functional results of the surgical treatment of scaphoid non-union, even when bony union is achieved.