[Tuberculous osteoarthritis of the foot and ankle joint]

The authors have reviewed 26 cases of tuberculosis of the foot and 32 of the ankle, which they have treated personally. All the patients were adults and most presented with advanced destruction of bone and joints. Bacterial and histological confirmation of the diagnosis was obtained in 56 patients. All were treated by chemotherapy; the drugs and regime varied over the years. All responded well to this treatment, but one relapsed after 24 months. Orthopaedic problems were usually managed by immobilisation in plaster casts, but 6 patients required arthrodesis, 5 of the ankle and one triple fusion. The functional results of the standard treatment were generally good. Arthrodesis is seldom needed and should be performed only for permanent pain or crippling deformity.

[Arrest of maturation in spermatogenesis]

The ultrastructural aspects of the germinal epithelium of 10 infertile men affected by maturative arrest of spermatogenesis were studied. We noted an increased number of malformed germinal cells. Marginal nuclear vescicles were present in spermatogonia of patients affected by spermatogonial arrest. The few spermatid present in the germinal epithelium of the patients affected by a spermatidic arrest presented changes of the nuclear condensation, the acrosome, and the tail. The Sertoli cells presented an immature aspect of the nucleus and changes of the "mantle". A possible correlation between the Sertoli cells changes and the altered spermatogenesis was proposed.

Acute cadmium intoxication: influence of cyproterone acetate on the testis and epididymis of the rat

The changes resulting from treatment with cadmium were studied following the histological changes, the modification of both vascular permeability to vital dyes and of alkaline phosphatase activity in rat testis and epididymis. The testicular extravasation of acriflavine started 90 min following parenteral injection of cadmium and increased thereafter synchronous with an increase in testicular and epididymal weights due to edema. At 14 and 24 hr a striking decrease of interstitial fluorescence and tubular degeneration were noted in testis and caput epididymis due to thrombosis of the microvascular circulation. The barrier noted at 8 hr following cadmium injection. No changes of alkaline phosphatase activity was detected in testicular and epididymal blood vessels after cadmium injection. Previous treatment with cyproterone acetate accelerated the appearance of such alterations. The interstitial nuclear staining with acriflavine appeared in the testis at 1 hr and was diffuse at 90 and 120 min. cyproterone acetate seemed to accelerate the appearance of tubular degeneration at 8 hr after cadmium injection. The changes of the male rat gonad following cadmium treatment were characterized by an increased vascular permeability and generalized thrombosis. An inbalance of androgen stimulation seems to increase the blood vessels susceptibility to cadmium.

Results of conservative treatment in tuberculosis of the elbow

The authors have used conservative treatment in 29 cases of tuberculosis of the elbow with 12 months of specific chemotherapy regim and 1--2 months of plaster immobilisation followed by rehabilitation. Seven elbows were ankylosed at the end of the period of treatment, 20 elbows had a useful range of joint movement, and 14 had more than 70 degrees of free movement. The results were not so satisfactory regarding pronation and supination. The authors believe that conservative management gives better results than classical arthrodesis or excision of the elbow joint.

[The treatment of chronic haematogenous osteomyelitis (author's transl)]

The authors have operated on 106 cases of chronic haematogenous osteomyelitis. On 83 occasions the surgical procedure was on the bone itself and in 23 only on the soft tissues. After a one-stage bone drilling with sequestrectomy and saucerisation the results wee satisfactory in 60 p. 100 of cases. Healing was achieved in 93 p. 100 of cases after a second, third or fourth surgical procedure. An analysis of the results has led to the following conclusion; the prognosis is better in girls, in the humerus, when the onset of the disease was subacute or when it had been present for less than 1 year.

[Foreign bodies in the airways. Role of endoscopy in their diagnosis and treatment]

The inhalation of foreign bodies gives rise to a symptom picture that will depend on the nature and size of the foreign body, its location in the airways, the age of the patient, and the presence of prior lung affections. Non-invasive removal of such bodies is often enough to resolve both acute and chronic symptomatologies. In view of the striking nature of the symptoms and the imminent risk of complications or exacerbation associated with the continued presence of foreign bodies and the therapeutic strategy to be adopted, many workers consider that treatment should be given in a suitable environment, with proper equipment and an experienced staff. Reference is made to a personal series collected at the Chieti and Bologna resuscitation centres in describing the criteria followed in the diagnosis and management of cases of recently inhaled or latent foreign bodies, and their parenchymal complications. Non-invasive management by means of direct bronchoscopy is advised in all cases except those in which the subsequent intervention of serious, evident and irreversible parenchymal alterations make surgery inevitable.

[Causes and methods of re-operation in a patient with a jejuno-ileal bypass for obesity]

One case of re-operation in a patient who previously underwent a jejunoileal by-pass for obesity is described. The serious complications following first surgery are shown. Reasons for re-operation and special pre- and post-operative care are considered.

[Conservative treatment of osteoarticular tuberculosis of the elbow]

The authors have applied conservative treatment in 21 cases of tuberculosis of the elbow with 12 months of specific chemotherapy and antibiotics and plaster immobilization for 3 montths followed by rehabilitation. Four elbows were ankylosed at the end of treatment. Seventeen elbows had useful joint mobility. In thirteen cases, there was more than 70 degrees of movement in flexion but the results were not so satisfactory as regards pronation and supination. The authors believe that conservative management gives better results than surgery by arthrodesis or resection.

The sub-deltoid approach to the metaphyseal region of the humerus

In a new surgical approach to the proximal part of the humerus, used in eighteen patients, the distal part of the tendon of the deltoid muscle was divided and the whole muscle was lifted up to give an excellent view of the proximal one-third of the diaphysis, the metaphysis, the surgical neck, and both tuberosities of the humerus. The exposure allowed visualization and protection of the axillary nerve. Postoperatively the deltoid remained functional and only the preoperative condition of the joint seemed to prevent full recovery of function of the muscles in a few patients.