Lambrinudi triple arthrodesis for correction of severe rigid drop-foot

The results of 10 patients with severe rigid drop-foot corrected by the Lambrinudi triple arthrodesis were studied. The average amount of correction was 47 degrees, as evaluated from standing radiographs taken before and after operation. Radiological features of osteoarthritis and of flattening of the talus were common, but the feet were painless when reviewed at an average of 70 months later. A satisfactory range of movement was obtained at the ankle joint.

Treatment of comminuted trochanteric femoral fractures with Dimon Hughston displacement fixation and acrylic cement--a preliminary report of sixteen cases

A new method for the treatment of unstable intertrochanteric fracture of the femur is proposed. This consists of stabilizing the fracture with a Dimon and Hughston medial displacement osteotomy and then restoring the cortical defect at the fracture site with methylmethacrylate cement (Dimon and Hughston, 1967). A preliminary trial on sixteen patients showed the excellent stability of the fracture achievable by this method. No mechanical failure was encountered, even though patients were all starting to walk and bearing full weight within the first week. No infection or non-union occurred. Early walking by the elderly patient suffering from a comminuted trochanteric fracture is important to counter the ill effects of decubitus associated with this fracture.

A method of evaluation of results after coracoclavicular ligament rupture

A method of evaluation of results after coracoclavicular ligament rupture is proposed with consideration of treatment duration, pain, mobility and use of extremity. It has been applied in 13 cases among whom 8 had been operated on. The small number does not allow definite conclusions but is in favour of conservative treatment.

Dwyer instrumentation in the treatment of adolescent idiopathic scoliosis

Twenty-eight patients with adolescent idiopathic scoliosis treated by anterior spinal fusion with Dwyer instrumentation were reviewed. The average length of follow-up was 6.9 years. This technique produced better correction of lateral curvature and rotation than Harrington instrumentation, particularly in the thoracolumbar and lumbar region. The length of spine requiring fusion was also shorter. There is, however, a tendency for Dwyer instrumentation to lead to kyphosis. Morbidity was significant and included one case of paraplegia, four cases of deep infection and one case of instrument failure. All of these complications, except one case of deep infection, occurred in patients with curves with an apex above the seventh thoracic vertebra.

Pulmonary coin lesions: a ten-year review of 239 cases

The results of a study of 239 resected solitary pulmonary nodules are presented; 66.5% of the resected nodules were malignant, and there were three patients with malignant coin lesions who were under 30 years of age. These findings confirm the generally accepted fact that most solitary pulmonary nodules must be resected if the presence of cancer is to be excluded. Transbronchial biopsy under biplane fluoroscopic guidance through a flexible bronchoscope may provide an effective alternative to early thoracotomy in the future, so that malignant nodules can be diagnosed before operation and patients with benign lesions are spared a thoracotomy.

Essential hypernatraemia, antidiuretic hormone and neurophysin secretion: response to chlorpropamide

An adolescent boy with essential hypernatremia, absent corpus callosum, mental retardation, hypodipsia, and partial diabetes insipidus with "inappropriate" ADH regulation and secretion was studied regarding factors controlling ADH and neurophysin release. Persistent hyperosmolality was noted while on 100 mEq sodium intake daily. Endogenous vasopressin activity was demonstrated after prolonged water deprivation. Hypertonic saline infusion produced increased volumes but dilute urine. Aqueous pitressin increased urinary osmolality, decreased serum osmolality, urine flow rate, and free water clearance. Stable water diuresis was induced by water loading and on normal saline infusion. Nicotine-stimulated neurophysin remained unexpectedly low and below the level of detectability when sampled during the physiologic studies, whereas oestrogen-stimulated neurophysin was elevated during oestrogen stimulation, water loading, and orthostasis procedures. Plasma vasopressin was suppressed with water loading but remained suppressed 90 min after tilt table testing. These data indicate impairment of the osmoreceptor mechanism: however, since the patient had a normal response of oestrogen-stimulated neurophysin, that part of the neurohypophysis appears intact. Chlorpropamide was effective in alleviating the hyperosmolar state acutely and maintained normal osmolar concentrations during two years of therapy.

Cushing's syndrome in infancy: difficulties in diagnosis and adrenal autotransplantation after therapeutic adrenalectomy

A two-month-old female with clinical manifestations of Cushing's syndrome including mild virilization exhibited an unusual steroid pattern illustrating difficulties in diagnosis of this disorder in infancy. Unequivocal abnormalities were limited to serial elevations of serum cortisol concentration, hyperresponsiveness to ACTH, resistance of serum cortisol to dexamethasone suppression, and elevation of testosterone and dehydroepiandrosterone sulfate concentration. On the other hand, twenty-four hour urinary 17-hydroxysteroid, 17-ketosteroid, free cortisol, and 6B-hydroxycortisol excretion were normal for the age. At laparotomy the adrenals were only minimally enlarged, and their architecture was normal by light microscopy. Following total adrenalectomy, adrenal slices were transplanted into the rectus abdominis muscles. Progressive hypertension developed three weeks later, suggesting adrenal regeneration. The infant then developed acute Salmonella enteritis and expired. At autopsy, the adrenal transplant showed outer cortical preservation, inner zone degeneration, and some growth into the surrounding tissue. The unfavorable outcome notwithstanding, this study adds to existing data in the adult that adrenal autotransplantation may have significant therapeutic value in Cushing's syndrome treated by bilateral adrenalectomy.

Prostaglandins stimulate thyroid function in pregnant women

Intravaginal or intravenous administration of prostaglandin F(2alpha) to pregnant women produced significant elevations of plasma triiodothyronine and thyroxine concentrations, but no rise of thyrotropin. These observations are consistent with those of previous in vitro studies indicating that prostaglandins can act directly on the thyroid gland to stimulate thyroid hormone synthesis or release, or both.