[Value of early diagnosis of urinary tract infections in pregnancy]

Clinical report of severe nephrological and urological complications in pregnancy leading to the importance of early diagnosis of urinary tract infections in pregnant women. In this respect the central point is looking for asymptomatic significant bacteriuria. Microscopical methods and chemical practices are to be abandoned. The method of choice is quantitative urine culture. Early diagnosis and treatment of clinically symptomless infections in pregnancy is one of the fundamental criteria of quality in prenatal care.

Surgical treatment of dislocations of the sternoclavicular joint

Six patients with dislocation of the sternoclavicular joint are presented. Their main complaints were chronic recurrent spontaneous dislocation and local tenderness and discomfort during normal use of the shoulder. Two patients were treated according to Brown's modified procedure while four patients were operated with Burrow's technique. Ten weeks immobilization postoperatively is recommended to obtain a satisfactory result.

Release of endogenous histamine in the hypothalamus of anaesthetized cats and conscious, freely moving rabbits

The hypothalamus of anaesthetized cats and conscious, freely moving rabbits was superfused with CSF through double-walled, push-pull cannulae and the release of endogenous histamine was determined in the superfusates by a radioenzymatic assay. In the posterior hypothalamic area of the anaesthetized cat, the rate of release of endogenous histamine varied rhythmically; phases of high rate of release appeared at 60 min cycles. The release of histamine was increased by electrical stimulation of the superfused area, as well as by hypothalamic superfusion with potassium-rich CSF. In the conscious rabbit, the anterior hypothalamic area and the posterior hypothalamic nucleus were superfused simultaneously. In both regions, the resting release of histamine varied rhythmically at approximately 70 min cycles. Phases of high or low-rate of release in the anterior hypothalamic area coincided with the corresponding phases in the posterior hypothalamic nucleus. The rhythmic release of endogenous histamine in the hypothalamus, as well as the ability of depolarizing stimuli to enhance the release of the amine support the idea that histamine acts as a neurotransmitter in the central nervous system.

Juxta-articular bone cyst

Juxta-articular bone cyst was first described as a distinct clinical entity by Hicks in 1956 and called "intraosseous ganglion". Hitherto, some 150 similar cases have been described. The cyst, which is usually solitary, occurs in the epiphysis near a weight-bearing joint in middle-aged persons. It may cause persistent pain but is easily overlooked on ordinary X-rays. The histogenesis is uncertain. Six patients treated by thorough curettage and autologous bone transplantation are presented. All achieved immediate relief from pain. Some theoretical aspects concerning the histogenesis are discussed.

Femoral and sciatic neuropathies after total hip arthroplasty

Six patients with peripheral nerve lesions after total hip replacements were reviewed. The incidence of peripheral nerve lesions was six out of 825, i.e. 0.7 per cent. The neuropathies, four sciatic, one femoral and one combined femoral and sciatic, were due to damage by the reamer in one case, haemorrhage in two, whereas the cause was unknown in three patients. After conservative treatment and 1-5 years follow-up the recovery was classified as good in three, fair in one and poor in two patients.

The throw: biomechanics and acute injury

The throw and its modifications are integral components of many sports. This study correlates case histories of acute injuries in throwing with a biomechanical analysis of the throwing mechanism. Comparisons are made with a similar analysis of the kick analyzed by the same film technique and computer program. Just prior to ball release, the pitching arm extends through an arc of about 73 degress in 40 msec, beginning with the elbow flexed at 80 degrees. This produces an axial load on the humerus and coincides with a pulse of external torque at the shoulder. This acts as stress protection to the humerus which is developing an internal torque of 14,000 inch-lb prior to ball release. The change in angular velocity, or the angular acceleration, during the throw is acquired in a much shorter time than in the kick. Torque is directly proportional to angular acceleration. This necessitates the development of substantially higher torques in the humerus during the throw than about the knee during a kick. The kinetic energy in the arm is 27,000 inch-lb during the throw. This is much higher than the kinetic energy in the kicking leg because the kinetic energy varies proportionally with the square of the angular velocity of the extremity. The angular velocity of the arm is about twice that of the leg. Thus, the pitching arm contains about four times as much kinetic energy as the kicking leg. These severe overloading conditions predispose the upper extremity to injury in the throwing mechanism.

Chronic compartmental syndrome of the abductor pollicis longus and extensor pollicis brevis muscles: report of a case treated with fasciotomy

A 32-year-old man with a chronic compartmental syndrome of the muscle bellies of the abductor pollicis longus and the extensor pollicis brevis muscles was successfully treated by fasciotomy of the muscle sheath. It is pointed out that this condition was primarily due to hypertrophy of the muscles combined with overuse edema. This condition should be differentiated from De Quervain's disease.

Osteomyelitis after operative fracture treatment. A report of 62 cases treated with radical surgery and lincomycin (Lincocin)

During the years 1967--1975 a total of 62 patients were treated for postoperative osteomyelitis. The lower extremities had been fractured in 89 per cent of the cases and 54 per cent were closed injuries. The fractures, mostly caused by traffic accidents and falls, had been immobilized by plates in 30 and by intramedullary nails or pins in 25 patients. Staphylococcus aureus was cultured in 80 per cent, 68 per cent of them were resistant to penicillin, but in 84 per cent the organisms were highly lincomycin sensitive and only three patients with four osteomyelitic lesions presented lincomycin resistance. The treatment consisted chiefly of sequestrectomies and saucerizations supported by 3--12 months of lincomycin treatment. In 30 operations a closed irrigation-suction technique was used, perfusing the wound with lincomycin solution. Stable implants should be left in place until the fracture is clinically solid whereas unstable osteosyntheses should be replaced by rigid internal or extraskeletal fixation. At follow-up, the results were judged as good in 74 per cent, fair 8 per cent and poor 18 per cent. The amputation rate was 13 per cent. Plates should not be used in the treatment of comminuted tibial fractures with considerable soft tissue damage.

Unilateral and bilateral partial laminectomy in lumbar disc prolapse. A follow-up study of 156 patients

The results of two comparable groups of in all 156 operated patients with lumbar disc prolapse were evaluated 4-9 years postoperatively. Sixty-seven patients had received bilateral and 89 unilateral partial laminectomy. At follow-up, the results of the bilaterally operated were all excellent or good, whereas 15% with unilateral exposure were unchanged or worse. The unilaterally operated presented a significantly higher incidence of low back pain and recurrences of sciatica than the bilaterally operated. There were no reoperations for recurrent prolapses following the bilateral approach compared with four after unilateral approach. It is concluded that bilateral partial laminectomy affords a good view of the disc pathology and a greater possibility for obtaining relief of the symptoms without reducing the stability of the column.

[Portal blood flow in minipig and its change by nicotinic acid (author's transl)]

The chronic double catheterisation of portal vein permits estimation of portal flow by dye dilution for example, the withdrawal of blood from the mesenteric vein and proximal portal vein, the injection of drugs into the portal circulation and measurement of portal pressure simultaneously. Beside the well known diminution of portal flow by vasopressin, which is extreme in anaesthetised minipig, there could be shown a remarkable diminution by high intravenous doses of nicotinic acid too without significant changes of systemic blood pressure and heart rat. Nicotinic acid causes also a diminution of pH in portal and venous blood.