Familial osteochondritis dissecans and dwarfism

We review four generations of a short statured family in whom 12 members have osteochondritis dissecans (O.D.) affecting the knees, elbow, or both, and other minor anomalies of bony development are recorded. Four of the family, unaffected by O.D., exhibit idiopathic scoliosis.

A prospective study of lumbar spinal movements before and after discectomy using biplanar radiography. Correlation of clinical and radiographic findings

The significance of alteration of lumbar spinal motion in cases of herniated disc was examined using a three-dimensional x-ray technique (biplanar radiography) before and 3 months after discectomy. Fifteen consecutive cases of disc herniation were studied prospectively. Predictions of clinical examination, myelography, and motion study for the level and site of the lesion were correlated with the operative findings for their accuracy in localization of the lesion. Changes in lumbar spinal motion after surgery were also correlated with the clinical results. The clinical and myelographic predictions were similar to previously published studies. The present study showed that patients with a sequestrated or prolapsed disc lesion (as opposed to bulging disc) had an abnormally large lateral bend or axial rotation during flexion and extension at the level above, which reduced after surgery. Primary lumbar spinal motions (flexion and extension) were generally reduced to half of the normal value and were not significantly altered by surgery. The restriction of lumbar spinal motion was not significantly reflected in the clinical results, which were satisfactory in most cases. Discectomy by fenestration and minimal resection of the lamina did not produce instability.

The effect of environmental temperature and nutritional intake on the metabolic response to abdominal surgery

Ambient temperatures of 29°C. had no effect on the nitrogen balance after elective abdominal surgery in 15 well-nourished men compared with 29 similar patients nursed at 24°C. The catabolic response as measured by nitrogen balance is small following operation of moderate severity and can be abolished by an increased intake of nitrogen and calories.

Independent and combined effects of Bisphenol A and Diethylhexyl Phthalate on gestational outcomes and offspring development in Sprague-Dawley rats

Bisphenol A (BPA) and Diethylhexyl Phthalate (DEHP) are well-studied endocrine disrupting chemicals (EDCs), however, the effects of mixtures of these EDCs are not. To assess the consequences of prenatal exposure to a mixture of these EDCs, dams were orally administered either saline (control), BPA (5 μg/kg BW/day), high dose DEHP (HD-D; 7.5 mg/kg BW/day), or a combination of BPA with HD-D in experiment 1; saline, BPA (5 μg/kg BW/day), low-dose DEHP (LD-D; 5 μg/kg BW/day) or a combination of BPA with LD-D in experiment 2. Gestational weights, number of abortions, litter size and weights, number of live births and stillbirths were recorded. Morphometric measures were obtained at birth and body weight, food and water intake were monitored weekly from postnatal weeks 3-12. Offspring were sacrificed at 16-24 weeks of age and organ weights were measured. The abortion rate of dams exposed to HD-D and the mixtures, BPA + LD-D and BPA + HD-D were higher at 9, 14 and 27% respectively. Prenatal exposure to BPA or HD-D significantly decreased relative thymus weights in male but not female offspring. Apoptotic cells were detected in thymus sections of both male and female offspring prenatally exposed to DEHP. Relative heart weights increased in BPA + HD-D exposed male offspring compared to the other groups. The results indicate that a mixture of BPA and DEHP, produced a pronounced effect on pregnancy outcomes. Male offspring appear to be more susceptible to the programming effects of these EDCs or their mixture suggesting a need to reconsider the possible additive, antagonistic or synergistic effects of EDC mixtures.

Avoidable causes of cancellation in elective orthopaedic surgery

As part of an audit of clinical practice in an orthopaedic unit for elective surgery, a study was made of the causes of cancellation of operations. Despite careful liaison with general practitioners, and a booked admission policy, over 6% of patients were cancelled as unsuitable. The results of this study suggest that the number of cancellations on medical grounds would be reduced by closer liaison with general practitioners, and the establishment of preadmission clinics. Ensuring that only consultants book patients for surgery would also reduce the number of cancellations due to incorrect indications for surgery.