Hemostasis in typhoid fever

Abnormalities of hemostasis in vivo and in vitro were defined in a prospective study of patients with typhoid fever. In a group of 56 patients with a proven diagnosis of typhoid fever, hemostatic abnormalities were frequently found. In patients with normal clotting tests the fibrinogen level was found to be higher than in normal controls. This finding established a new normal level for patients with typhoid fever. Using this redefined normal level it was found that low fibrinogen was associated with other hemostatic abnormalities. Low fibrinogen levels in patients with typhoid fever are possibly the result of disseminated intravascular coagulation. This process affected 20% of our patients and was often of mild to moderate intensity. Clinically significant bleeding occurred in 18 patients and, in contrast to the results of previously published studies, was found to correlate with clotting abnormalities.

Stress fractures associated with adjacent osteoarthritis

Two cases are reported which demonstrate stress fractures occurring about osteoarthritic joints. In both cases altered mechanical factors with increased stress apparently led to bony infraction. As there is a natural tendency to ascribe the patient's clinical manifestations to the joint process itself, it is mandatory that scrutiny of the radiographs be accomplished so that subtle stress fractures are detected.

Pseudomasses in the suprapatellar pouch at arthrography

An arthrographic appearance, confidently diagnosed as synovial chrondromatosis, showed no abnormality at surgery. This experience prompted further investigation which led to the conclusion that a normal variant of the suprapatellar pouch may be confused with synovial masses. Single or multiple pseudomasses in this region may relate to the presence of an embryonic remnant of the synovial folds, the plicae synovialis. If the finding is looked for, with careful arthrographic technique and palpation under fluoroscopic control, along with correlation with the clinical findings, unnecessary arthrotomy may be avoided.

Stress fractures of the inferior pubic ramus following hip surgery

Fractures of the inferior pubic ramus developed in 5 patients following hip surgery. In at least 4 patients the bony abnormality was related to a stress infraction. Stress fractures of the obturator ring are not commonly reported; however, the authors suggest that they are sometimes overlooked as a postoperative complication that may lead to significant symptoms and a battery of unnecessary diagnostic examinations.

Association of diffuse idiopathic skeletal hyperostosis (DISH) and calcification and ossification of the posterior longitudinal ligament

Diffuse idiopathic skeletal hyperostosis (DISH) is a common ossifying diathesis in middle-aged and elderly patients characterized by bone proliferation along the anterior aspect of the spine and at extraspinal sites of ligament and tendon attachment to bone. Four patients with DISH revealed extensive calcification and ossification of the posterior longitudinal ligament in the cervical spine. Review of cervical spine radiographs in 74 additional patients with DISH demonstrated bony hyperostosis of the posterior aspect of the vertebrae in 41%, posterior spinal osteophytosis in 34%, and posterior longitudinal ligament calcification and ossification in 50%. These ligamentous findings, which have previously been described almost exclusively in Japanese people, appear to be an additional skeletal manifestation of DISH.

Proximal tibiofibular joint: anatomic-pathologic-radiographic correlation

An anatomic-pathologic-radiographic study of the proximal tibiofibular joint was undertaken. This synovial articulation between the proximal tibia and fibula may communicate with the knee joint in 10% of adults. Radiography of the normal proximal tibiofibular articulation outlines a consistent relationship between the proximal portions of the tibia and fibula. Disruption of this normal relationship is indicative of anterolateral or posteromedial subluxation or dislocation. Articular disorders of this joint include reheumatoid arthritis and septic arthritis. In the latter, initial alterations of the knee joint may subsequently extend to involve the proximal tibiofibular joint, illustrating the potential communication between these two articulations.

The adult hip: an anatomic study. Part I: the bony landmarks

A comprehensive anatomic, pathologic and radiographic study of the adult hip was undertaken to define bony landmarks which, when altered, are reliable indicators of disease. Methodology included radiography of cadaveric specimens and analysis of over 300 anteroposterior (AP) radiographs of "normal" adult hips. This information was applied to clinical situations with the following conclusions: (a) The diagnosis of protrusio acetabuli is warranted if the acetabular line projects medial to the ilioischial line by 3 mm or more in men and by 6 mm or more in women. (b) In acetabular trauma, an AP and two oblique radiographs (30 degrees anterior oblique and 30--45 degrees posterior oblique) are required for complete evaluation. (c) Characteristic alterations in the joint space allow accurate diagnosis of disease.

The adult hip: an anatomic study. Part II: the soft-tissue landmarks

A comprehensive anatomic, pathologic, and radiographic study was undertaken to define reliable soft-tissue landmarks about the hip. Methodology included an analysis of 300 "normal" adult hip radiographs, tissue maceration, cadaveric intra-articular injection studies and review of selected clinical cases. Results, when applied to clinical situations, indicate: (a) The iliopsoas and "capsular" fat planes are poor indicators of small to moderate amounts of intra-articular fluid in the adult. (b) The "capsular" fat plane is not associated with the joint capsule, but in fact is a fat plane between two muscle bundles anterior to the articulation. (c) Distinct soft-tissue planes are available for dissemination of fluid from the hip joint. These include the iliopsoas bursa, which may distend in association with articular disease, and the fat plane of the obturator externus muscle.

Estudio briológico de la Sierra del Torcal de Antequera (Málaga)

Se citan para el Torcal de Antequera setenta y siete especies de briófitos, de las cuales sesenta y ocho pertenecen a la clase Musci y nueve a la clase Hepaticae. Se citan por primera vez en Andalucía oriental: Radula lindbergiana Got. y Cololejeunea rossettiana (Mass.) Schiff, siendo la segunda localidad de Andalucía donde se cita Neckeradelphus menziesii (Hook.) Steere. Se realiza igualmente un estudio sociológico de las principales comunidades briofíticas de la zona, proponiendo como nuevas las asociaciones Neckeradelphetum menziesii y Cololejeuneo- Rhynchostegietum tenellae.

[Pediatric intensive care (author's transl)]

In the Intensive Care Unit of our General Hospital, where an important obstetric-pediatric unit exists, 392 infants have been treated from August 1974 to 1976. Although the results of all age groups are shown, the neonatal one is specially considered. All those patients who recovered and were discharged from the hospital were called for revision and the results of those whom attended are shown. The convinience of the regionalisation and hierarchisation of these intensive care units and the necessity of adequately organise the communication and transport of these patients from the peripheral small units to the regional one, is emphasized.

[Massive pulmonary hemorrhage successfully treated with mechanical respiration and CPAP (author's transl)]

A newborn baby with massive pulmonary hemorrhage at two and a half hours of life is reported. She was successfully treated with mechanical respiration and continuous positive airway pressure. The pathogenetic mechanisms and mode of action of the applied treatment is discussed.

[Intermittent mandatory ventilation (author's transl)]

Intermittent mechanical ventilation is a frequent form of therapy for respiratory failure in children. Due to its difficult application in patients with high respiratory rate and difficult synchronization with the respirator, intermittent mandatory ventilation (I.M.V.) was tried on these patients, introducing a unidirectional valve, connected to a continuous flow of gases, on the inspiratory side of the respirator. With I.M.V. the patient is able to breath spontaneously the gases coming from the unidirectional valve and at the same time the respirator provides periodical insuflations at a frequency previously determined by us. The pressure generated by the respirator in the respiratory circuit, closes the unidirectional valve sending gases to patient. This technique not only reduced time of application of mechanical ventilation but made weaning shorter, easier and safer.

[Decanulation of tracheostomised children (author's transl)]

It is described eight tracheostomised patients, advising an early and gradual tracheal decanulation using silver tracheostomy tube with a window in the posterior curvature (fenestrated tube, Alder Hey pattern) and proper sedation at the moment of definitive decanulation. Decanulation techniques and the mechanical and functional difficulties that can occur and how to avoid them are described: Finally the tracheostomy tubes that have been used are mentioned.