Long-term oral supplementation with iron is not harmful for young children in a poor community of Bangladesh

The effect of long-term oral iron supplementation on morbidity due to diarrhea, dysentery and respiratory infections in 349 children, aged 2-48 mo, living in a poor community of Bangladesh, was evaluated in this double-blind study. The treatment group received 125 mg of ferrous gluconate (15 mg elemental iron) plus multivitamins and the controls received only multivitamins, daily for 15 mo. House-to-house visits were made on alternate days by trained community health workers for recording symptoms and duration of illnesses and for monitoring medicine intake. Seventy-six percent of the children continued the syrup for over 1 y. No untoward effects were noticed in either treatment group. The attack rates for diarrhea, dysentery and acute respiratory tract infections (ARI) were 3, 3 and 5 episodes per child per year, respectively. Each episode of diarrhea lasted a mean of 3 d, and those of dysentery and ARI, 5 d. The two treatment groups did not differ in the number of episodes, mean duration of each episode, or total days of illnesses due to diarrhea, dysentery and ARI. However, a 49% greater number of episodes of dysentery was observed with iron supplementation in a subset of the study children who were less than 12 mo old (P = 0.03). The results of this study suggest that long-term oral iron supplementation is not harmful for older children in a poor community. Further studies are needed to demonstrate the safety and efficacy of iron administration in young infants.

Three-dimensional organization of a human water channel

Aquaporins (AQP) are members of the major intrinsic protein (MIP) superfamily of integral membrane proteins and facilitate water transport in various eukaryotes and prokaryotes. The archetypal aquaporin AQP1 is a partly glycosylated water-selective channel that is widely expressed in the plasma membranes of several water-permeable epithelial and endothelial cells. Here we report the three-dimensional structure of deglycosylated, human erythrocyte AQP1, determined at 7 A resolution in the membrane plane by electron crystallography of frozen-hydrated two-dimensional crystals. The structure has an inplane, intramolecular 2-fold axis of symmetry located in the hydrophobic core of the bilayer. The AQP1 monomer is composed of six membrane-spanning, tilted alpha-helices. These helices form a barrel that encloses a vestibular region leading to the water-selective channel, which is outlined by densities attributed to the functionally important NPA boxes and their bridges to the surrounding helices. The intramolecular symmetry within the AQP1 molecule represents a new motif for the topology and design of membrane protein channels, and is a simple and elegant solution to the problem of bidirectional transport across the bilayer.

Absorption of nutrients from an energy-dense diet liquefied with amylase from germinated wheat in infants with acute diarrhea

BACKGROUND

Addition of a small amount of amylase rich flour (ARF) to a thick porridge instantly liquefy the porridge and increase the energy intake even by sick children. The present study examined the absorption of macronutrients and calorie from an energy dense diet liquefied with ARF in children aged 6-11 months with acute watery diarrhea.

METHODS

After adequately hydrated with oral rehydration fluid over a period of 24 hours, children were randomly assigned to receive either an ARF treated liquefied porridge (test diet) or a porridge diluted with water (control diet). A 72-hour metabolic balance was performed to determine the absorption of carbohydrate, fat, protein, and calorie.

RESULTS

Thirteen infants received the test diet, and 15 infants received the control diet. The intake of protein (g/kg/d), carbohydrate (g/kg.d), fat (g/kg.d) and calorie (kJ/kg.d) were 1.97, 20.6, 4.3 and 548 respectively in the test group and those in the control group were 1.12, 13.3, 2.8 and 356. The stool loss of protein, carbohydrate and fat were comparable in the two groups. The absorption coefficient (%) of carbohydrate, fat and energy were 69.6, 61.3 and 65.4 in the test group and were 73.2, 58.6 and 66.7 in the control group. The coefficient of absorption of protein was significantly higher in the test group (37.7% vs. 21.7%). The mean (95% CI) nitrogen balance (g/kg.d) in the test and control groups were 0.064 (0.026, 0.102) and -0.029 (-0.055, 0.003) respectively.

CONCLUSIONS

The results suggest that energy dense diet liquefied with ARF was well absorbed in children with acute diarrhea and there was a positive nitrogen balance that may have a positive impact in preventing weight loss during acute illness.

Erythromycin and trimethoprim-sulphamethoxazole in the treatment of cholera in children

To evaluate the efficacy of erythromycin and trimethoprim-sulphamethoxazole (TMP-SMX) in the treatment of cholera in children aged 1-8 years, a randomised clinical trial was conducted at a diarrhoea treatment centre in Bangladesh from December 1991 to June 1992. Fifteen children received erythromycin, 50 mg/kg per day, in four equally divided doses, 18 children received 10 mg/kg per day of trimethoprim and 50 mg/kg per day of sulphamethoxazole in two equally divided doses (12 hourly) for five days, and 15 children received no antibiotic; children in all three groups received intravenous cholera saline for severe dehydration and for mild to moderate dehydration, a rice-based oral rehydration solution. The mean stool volumes in mL/kg body weight in the two treatment groups were less than that of the control group, and there were no significant differences in stool volume among the two treatment groups. However, 67% of the children in the erythromycin group and 82% in the TMP-SMX group recovered within 72 hours compared to 33% in the control group (p < 0.01). Similarly, the bacteriological cures were 80% in the erythromycin group and 83% in the TMP-SMX group compared to only 27% in the control group (p < 0.001). These results confirm that both erythromycin and trimethoprim-sulphamethoxazole are effective antimicrobials in the treatment of cholera. These drugs are of value specially in younger children in whom tetracycline is contraindicated or when the infecting Vibrio cholerae are resistant to tetracycline.

Arthroscopic treatment of osteochondral lesion of the talus

A retrospective study of the arthroscopic treatment of osteochondral lesions of the talus in 25 patients was conducted. The follow-up period ranged from 1 to 4 years with an average of 2 years. Of the 25 patients, 20 could recall a history of injury. The diagnosis could be made by standard anteroposterior and lateral X-rays in 22 out of 25 patients. The standard anteromedial and anterolateral portals were usually sufficient. Patients with stage I and II lesions did well uniformly. In the 16 patients with stage III and IV lesions, good results were obtained in 12 and fair in 4. Morbidity was minimal.

Inhibition of sulfamethoxazole hydroxylamine formation by fluconazole in human liver microsomes and healthy volunteers

Sulfamethoxazole toxicity is putatively initiated by the formation of a hydroxylamine metabolite by cytochromes P450. If this reaction could be inhibited, toxicity may decrease. We have studied--in vitro and in vivo--fluconazole, ketoconazole, and cimetidine as potentially suitable clinical inhibitors of sulfamethoxazole hydroxylamine formation. Both fluconazole and ketoconazole in human liver microsomal incubations competitively inhibited sulfamethoxazole N-hydroxylation, with the inhibitory constant (Ki) values of 3.5 and 6 micromol/L, respectively. Cimetidine exhibited a mixed type of inhibition of sulfamethoxazole hydroxylamine formation in human liver microsomes, with IC 50 values (the concentration required to decrease hydroxylamine formation by 50%) of 80 and 800 micromol/L, the lower value being observed when cimetidine was preincubated with microsomes and reduced nicotinamide adenine dinucleotide phosphate. In an in vivo study in six healthy volunteers the inhibition of the cytochrome P450-mediated generation of the toxic metabolite in the presence of fluconazole was shown by a 94% decrease in the area under the plasma concentration-time curve of sulfamethoxazole hydroxylamine. In contrast, the recovery of hydroxylamine in urine decreased by only 60%. Total clearance of sulfamethoxazole was decreased by 26% by fluconazole, most likely because of the inhibition of unidentified P450 elimination pathways. There was close agreement between the predicted (87%) and observed inhibition (94%) of sulfamethoxazole hydroxylamine formation in vivo. Similarly, there was close agreement between in vivo and in vitro Ki values--1.6 and 3.5 micron/L, respectively.

Effects of phospholipid chain length, concentration, charge, and vesicle size on pulmonary insulin absorption

PURPOSE

Non drug loaded lipid vesicles have been investigated as promoters of pulmonary insulin absorption.

METHODS

Physical mixtures of liposomes with insulin were delivered intratracheally to rats by direct instillation method at an insulin dose level of 1 U/kg.

RESULTS

The overall hypoglycemic response, represented by area above the curve (AAC), correlated linearly with the lipid concentration for both the neutral and charged liposome-insulin preparations. The strongest response was observed with the positively charged liposomes followed by negatively charged and neutral liposome-insulin mixtures. Further toxicological studies indicated that charge-inducing agents, i.e., stearylamine and dicetylphosphate, can cause apparent disruption of pulmonary epithelial cells. From the difference of overall hypoglycemic response (AAC) among various formulations, it appears that the stronger hypoglycemic effect following positively charged liposome-insulin mixture is due to the membrane destabilizing effect on stearylamine. Optimum hypoglycemic effect was observed with a medium acyl-chain lipid (C10). The cumulative hypoglycemic response appeared to correlate inversely with the acyl carbon number of the phospholipid component from C10 to C18. The overall hypoglycemic effect does not appear to change within the liposomal size range of 0.1 micron - 1.98 microns, indicating that insulin absorption following intratracheal instillation is independent of the vesicle size within the range studied.

CONCLUSIONS

Phospholipid promoted insulin pulmonary absorption is significantly dependent on the concentration, charge and acyl chain length of the phospholipids.

Vitreous disposition of two acycloguanosine antivirals in the albino and pigmented rabbit models: a novel ocular microdialysis technique

A novel ocular microdialysis-perfusion technique was developed that allowed for the continuous sampling of the vitreous humor for drug. The technique produced accurate and rapid vitreous drug concentration time profiles with a resolution of 20 minutes on the time axis. The vitreous elimination of ganciclovir (GCV) and acyclovir (ACV) was extremely rapid, having vitreous half lives of 2.62 and 2.98 hours, respectively, and a transretinal mechanism of clearance was established for these compounds. Further, it was shown that the compounds do not exhibit saturation kinetics over the dosage ranges used in the clinical setting. Ocular pigmentation had a dramatic effect on the vitreous pharmacokinetics of GCV and ACV. The rate of elimination of GCV and ACV from the vitreous of the pigmented rabbit was much slower than the elimination from the albino rabbit (t 1/2 = 5.59 vs. 2.62 for GCV and 8.63 vs. 2.98 for ACV). The mean residence time of GCV was 2 times greater in the pigmented rabbit than in the albino rabbit and 3 times greater for ACV. Further, the volumes of distribution increased by 3.5 fold for GCV and 6.2 fold for ACV, respectively.

Tarsometatarsal (Lisfranc's) injuries--results of open reduction and internal fixation

Injuries of the tarsometatarsal (Lisfranc's) joint are uncommon and are potentially associated with chronic disability. The aim of our study was to review retrospectively the results of open reduction with Kirschner wire internal fixation of tarsometatarsal injuries. In this study, 12 patients with Lisfranc's injuries treated between January 1986 and March 1993 were reviewed at an average of 36 months after the injuries. Majority of the patients suffered from type B injuries (Hardcastle's classification, 1982). There were 9 closed and 3 open injuries. All were high energy injuries sustained in motor vehicle accidents, fall from a height or crush force. All were treated with open reduction and internal fixation with Kirschner wires. Anatomical reduction was achieved and maintained. There was no postoperative redisplacement. During follow-up, most patients developed radiological evidence of post-traumatic osteoarthritic changes. However, majority of the patients were pain-free or had very little foot pain, and were able to return to their previous occupation. Our study showed that open reduction with Kirschner wire internal fixation offered satisfactory anatomical and functional results.

Metabolism of dapsone to its hydroxylamine by CYP2E1 in vitro and in vivo

Dapsone toxicity is putatively initiated by formation of a hydroxylamine metabolite by cytochromes P450. In human liver microsomes, the kinetics of P450-catalyzed N-oxidation of dapsone were biphasic, with the Michaelis-Menten constants of 0.14 +/- 0.05 and 0.004 +/- 0.003 mmol/L and the respective maximum velocities of 1.3 +/- 0.1 and 0.13 +/- 0.04 nmol/mg protein/min (mean +/- SEM). Troleandomycin (40 mumol/L) inhibited hydroxylamine formation at 100 mumol/L dapsone by 50%; diethyldithiocarbamate (150 mumol/L) and tolbutamide (400 mumol/L) inhibited at 5 mumol/L dapsone by 50% and 20%, respectively, suggesting that the low-affinity isozyme is CYP3A4 and the high-affinity isozymes are 2E1 and 2C. Disulfiram, 500 mg, 18 hours before a 100 mg oral dose of dapsone in healthy volunteers, diminished area under the hydroxylamine plasma concentration-time curve by 65%, apparent formation clearance of the hydroxylamine by 71%, and clearance of dapsone by 26%. Disulfiram produced a 78% lower concentration of methemoglobin 8 hours after dapsone.

The CHIP28 water channel visualized in ice by electron crystallography

Electron crystallography of frozen-hydrated two-dimensional crystals of deglycosylated human erythrocyte CHIP28 reveals an aqueous vestibule in each monomer leading to the water-selective channel that is enclosed by multiple transmembrane alpha-helices.

Hyperimmune cow colostrum reduces diarrhoea due to rotavirus: a double-blind, controlled clinical trial

The therapeutic efficacy of hyperimmune bovine colostrum (HBC) from cows immunized with four serotypes of human rotavirus was evaluated in a double-blind, randomized trial in 75 boys, aged 6-24 months, infected with rotavirus diarrhoea. The treatment group received 100 ml of HBC three times a day for 3 consecutive days, while the controls received the same amount of bovine colostrum from significantly shorter duration of diarrhoea than the controls (median 56 versus 72 h (p<0.001); confidence interval of median difference (CI) 8-32 h). Total stool output (g/kg) between admission and cessation of diarrhoea was reduced by 29% in the HBC-treated group compared with controls (median 205 versus 290 g (p=0.04); CI = 1-154 g). In 50% of the children in the study group, diarrhoea stopped by 48 h, whereas 100% of the controls were still suffering from diarrhoea. No untoward effects were noted in either group. Colostrum from cows immunized with rotavirus antigen is clinically effective in reducing the duration and severity of childhood diarrhoea due to rotavirus.

Surgical treatment of symptomatic accessory navicular

The accessory navicular is a known cause of foot pain. When symptomatic and conservative measures have failed, surgical intervention may be required. Simple excision of the ossicle or the Kidner procedure with transplantation of tibialis posterior tendon to the undersurface of the navicular bone may be done. Eighteen patients with symptomatic accessory navicular were reviewed at the Singapore General Hospital, Department of Orthopaedic Surgery 'O' Unit. All 18 patients had foot pain and restriction of activities. Thirteen noticed a prominence on the medial side of the affected foot and 7 had difficulty with shoe fitting. Nine underwent simple excision of the ossicle while the other 9 had the Kidner procedure done. The average follow-up period was 3.1 years. Both the simple excision and the Kidner procedure were equally successful in relieving symptoms in 15 out of the 18 cases. The Kidner procedure did not confer any particular advantage over simple excision.

Exostosis presenting as solitary loose body in the ankle of two children

Two children, aged 5 and 11 years, presented clinically with ankle pain and a mobile bony hard lump in the ankle. Radiological examination revealed a large radio-opaque shadow in relation to the talus. Intraoperatively, a loose body was found. It resembled a detached exostosis with cartilaginous cap and was confirmed histologically as an osteochondroma. In the older child, there was a remnant stalk attached to the lateral surface of the talus. In the younger child, the exostosis probably came from the talus as the osteochondroma could not originate from the epiphyses that form the ankle mortise.

A case report on bilateral avascular necrosis of the medical cuneiforms

Avascular necrosis rarely affects the cuneiform bones. The treatment has been mainly conservative and histological confirmation of osteonecrosis is therefore not available. The authors report a case of bilateral avascular necrosis of both medial cuneiforms with histological confirmation. The patient was treated operatively with decompression of intra-osseous pressure through multiple drill holes. Six weeks postoperatively, the symptoms subsided and radiographs showed reconstitution of both medial cuneiforms.

The importance of breastfeeding in minimizing mortality and morbidity from diarrhoeal diseases: the Bangladesh perspective

Despite world-wide promotion of breastfeeding, there is a declining trend in breastfeeding practice in many developed as well as developing countries. In these countries, health planners are faced with the difficult task of re-educating women on the value of breastfeeding. In this context, it is useful to review the role of breastfeeding in combating infectious diseases, especially childhood diarrhoea, and in preventing deaths. Studies have shown that the duration of benefits of breastfeeding in diarrhoea can range from a few months to several years. However, breastfeeding is not consistently protective in all types of diarrhoea. For example, there is evidence of increased risk of rotavirus diarrhoea in breastfed children compared to non-breastfed children after certain age. Impairment of child growth is another controversial issue associated with prolonged breastfeeding. Is this growth-faltering, or do breastfed children follow a normal growth pattern which is below the reference growth curve? How long should mothers be advised to continue breastfeeding? This review focuses on answers to these questions and discusses benefits of breastfeeding and its controversial issues. The reasons for choosing the case study in Bangladesh are: (i) the prevalence of breastfeeding in Bangladesh is often cited as one of the highest in the world, (ii) diarrhoeal diseases are hyper endemic in this country; and (iii) issues of breastfeeding in several diarrhoeal diseases have been well documented here.

Social aspects in patients following proximal femoral fractures

Between January 1989 and December 1990, a study was conducted on the social aspects of 123 patients admitted to the Singapore General Hospital, Department of Orthopaedic O, with proximal femoral fractures. Twenty-three patients passed away, leaving 100 patients for review at 2 years post-fracture. Of the 20 social functions evaluated, less than 60% improvement was observed in 6 lower limb dependent activities. Before fracture, 82 patients were independent and 83 were ambulating without aids. After fracture, improvement occurred progressively and reached a plateau at 1 year with 62 (75.6%) patients independent and 41 (49.4%) patients ambulating normally. All the patients stayed in their own home before fracture and 90 (90%) patients returned to their home after their discharge. Of the 59 patients who were unable to ambulate without aids, 21 had visual problems, 9 had cerebrovascular accident and 8 had both problems.

Projection structure of the CHIP28 water channel in lipid bilayer membranes at 12-A resolution

Osmotic water transport across plasma membranes in erythrocytes and several epithelial cell types is facilitated by CHIP28, a water-selective membrane channel protein. In order to examine the structure of CHIP28 in membranes, large (1.5-2.5-microns diameter), highly ordered, two-dimensional (2-D) crystals of purified and deglycosylated erythrocyte CHIP28 were generated by reconstitution of detergent-solubilized protein into synthetic lipid bilayers via detergent dialysis. Fourier transforms computed from low-dose electron micrographs of such crystals preserved in negative stain display order to 12-A resolution. The crystal lattice is tetragonal (a = b = 99.2 +/- 1.4 A) with plane group symmetry p4g. A projection density map at 12-A resolution defines the molecular boundary and organization of the CHIP28 monomers in the membrane plane. The unit cell contains four CHIP28 dimers, each composed of two oblong-shaped (37 x 25 A ) monomers with opposite orientations. The CHIP28 monomers associate to form tetrameric structures around the 4-fold axes normal to the membrane plane where stain is excluded. The 2-D crystals of CHIP28 display order extending beyond the limit typically achieved by negative staining and therefore may be amenable to high-resolution structure analysis by cryo-electron microscopy.

Enhancement of intestinal insulin absorption by bile salt-fatty acid mixed micelles in dogs

The pharmacokinetics and pharmacodynamics of porcine zinc insulin following intravenous (iv), intrajejunal, and ileocolonic delivery were evaluated in dogs. The concentration-time profile of plasma immunoreactive insulin following iv injection could be best described by a two-compartment model with a mean distribution half-life of 1.1 min and a mean elimination half-life of 5.6 min. Maximum hypoglycemia occurred at 15 min after injection. Intrajejunal administration of 10 units/kg insulin in phosphate-buffered saline resulted in minimal insulin absorption or hypoglycemia. Incorporation of mixed micelles containing 30 mM sodium glycocholate and 40 mM linoleic acid significantly improved enteral insulin absorption. When delivered with mixed micelles, the mean absolute bioavailability of insulin was 1.8%. To study the effect of intestinal site on insulin uptake, the same formulation was delivered to the ileocolonic region. The mean absolute bioavailability of insulin absorbed from this site was 0.6%. Delivery of insulin to both sites caused significant hypoglycemia in all dogs. Insulin combined with mixed micelles is enterally absorbed in dogs; however, the bioavailability is much lower than that observed in similar studies with rats.

Cyclodextrins as mucosal absorption promoters of insulin. II. Effects of beta-cyclodextrin derivatives on alpha-chymotryptic degradation and enteral absorption of insulin in rats

The relative effectiveness of two beta-cyclodextrin derivatives, i.e., dimethyl-beta-cyclodextrin (DM beta CD) and hydroxypropyl-beta-cyclodextrin (HP beta CD), in enhancing enteral absorption of insulin was evaluated in the lower jejunal/upper ileal segments of the rat by means of an in situ closed loop method. The incorporation of 10% (w/v) DM beta CD to a 0.5 mg/ml porcine-zinc insulin solution dramatically increased insulin bioavailability from a negligible value (approximately 0.06%) to 5.63%, when administered enterally at a dose of 20 U/kg. However, addition of 10% (w/v) HP beta CD did not improve enteral insulin uptake significantly with a bioavailability of only 0.07%. Similarly, the pharmacodynamic relative efficacy values obtained after the enteral administration of 20 U/kg insulin, 20 U/kg insulin with 10% HP beta CD, and 20 U/kg insulin with 10% DM beta CD were 0.24%, 0.26%, and 1.75%, respectively. Biodegradation studies of 0.5 mg/ml insulin hexamers by 0.5 microM alpha-chymotrypsin revealed no inhibitory effect on the enzymatic activity by the two cyclodextrins. On the contrary, the apparent first-order rate constant increased significantly in the presence of 10% DM beta CD, suggesting insulin oligomer dissociation by DM beta CD. Histopathological examination of the rat intestine was performed to detect tissue damage following enteral administration of the beta-cyclodextrin derivatives. Light microscopic inspection indicated no observable tissue damage, thereby arguing direct membrane fluidization as the primary mechanism for enhanced insulin uptake. This study indicates the feasibility of using cyclodextrins as mucosal absorption promoters of proteins and peptide drugs.

A surgical approach to the posterior interosseous branch of the radial nerve through the brachioradialis--a cadaveric study

Twelve cadaveric upper limbs were selected to evaluate the surgical approach to the posterior interosseous nerve through the midline of brachioradialis. There were 6 right and 6 left upper limbs. The limbs were placed with forearm in mid-prone position and elbow at 90 degrees of flexion. The incisions were made 2 cm distal to the lateral condyle and along the midline of the brachioradialis towards the radial styloid process for an average of 4.7 cm. The lateral cutaneous nerve of forearm was found lying on the anterior third of the brachioradialis. The brachioradialis was split along the midline. The following structures were identified. The radial nerve branched into superficial radial nerve and posterior interosseous nerve at an average of 1.8 cm below the lateral condyle. The superficial branch descended along the anterior third of the brachioradialis. The posterior interosseous nerve passed beneath the arcade of Frohse at an average of 3.8 cm below the lateral condyle. The radial recurrent artery was found crossing the posterior interosseous nerve at an average of 2.7 cm below the lateral condyle. The nerve to the extensor carpi radialis brevis originated from the radial nerve bifurcation or its branches at an average of 2.3 cm below the lateral condyle and entered the muscle at an average of 3.9 cm below the lateral condyle. The arcade of Frohse and the superficial head of supinator were divided to expose the entire posterior interosseous nerve.(ABSTRACT TRUNCATED AT 250 WORDS)

Glutathione S-transferase mediated detoxification and bioactivation of xenobiotics during early human pregnancy

Glutathione S-transferase (GST) with activity towards CDNB as a substrate from human intrauterine conceptual tissues (HICT) at 6-10 weeks of gestation was purified approximately 200-fold by GSH coupled Sepharose 4B affinity chromatography. The preparations of affinity purified HICT-GST were used in all the experiments. There was no significant difference in specific activity of GST towards CDNB among 6-, 8- and 10-week-old HICT. GST specific activity decreased with an increase in the gestational age using p-nitrobenzyl chloride and 3,4-dichloro-1-nitrobenzene as the second substrate. Similarly, the lower the gestational age, the higher was the degree of GST mediated ethylene dibromide (EDB) conjugation with GSH. Covalent binding of [14C]EDB to DNA and protein was greater in the presence of HICT-GST at 6 weeks gestation than that at 10 weeks gestation. These results suggest that HICT possess a significant amount of GST capable of detoxification or activation of xenobiotics during the critical organogenesis period.

Role of arthroscopy in ankle disorder--early experience

Eighty-four consecutive cases of ankle arthroscopy performed between 1985 and 1990 were reviewed. These patients had all undergone conservative treatment for at least six months for chronic ankle pain. This consisted of non-steroidal anti-inflammatory agents, physiotherapy and/or immobilisation. Arthroscopy was performed when there was no response to conservative treatment. Eighty-one percent (68) of the patients were between the ages 20 and 29 years. Eighty-nine percent (75) were male. The most common lesions identified were transchondral fractures, localised synovitis, osteoarthritis and loose bodies. These were treated by arthroscopic surgery which included debridement, removal of loose bodies and abrasive chondroplasty. All the patients were followed up for at least one year or until they were asymptomatic. Excellent results were observed in transchondral fracture, localised synovitis associated with chronic lateral ligament instability, loose bodies, anterior impingement syndrome, osteochondritis dissecans and meniscoid syndrome. Good to fair results were obtained in osteoarthritis and fibroarthrosis. There were no intra-operative or postoperative complications.

Function following limb salvage for primary tumors of the shoulder girdle. 10 patients followed 4 (1-11) years

10 patients with primary neoplasms of the shoulder girdle underwent limb salvage procedures involving resection of the proximal humerus and parts of the scapula and clavicle. The function of the ipsilateral limb was assessed in all patients, in 9 at least one and a half years after surgery. Function was good in 3 of the 6 patients in whom an interposition bone graft was used and a successful shoulder arthrodesis was achieved. In the remaining 3, proximal arthrodesis was unsuccessful and the result was fair in 2 and a failure in 1. All 3 patients in whom the extended Tikhoff Linberg type of reconstruction was undertaken had good function although unsatisfactory cosmetic results. The 10th patient, who had a temporary cement and wire interposition, died of distant metastases 8 months after surgery and was considered a failure.