Persistent brachial plexus birth palsies.

Sixty-six brachial plexus palsies in 64 patients were retrospectively reviewed at the San Francisco Unit of the Shriners Hospital system in a 15-year period from 1973 to 1988. All patients were referred with persistent brachial plexus palsies caused by birth trauma. The distribution of palsies at birth included 34 upper palsies, three lower palsies, and 29 mixed (or global) palsies. At final follow-up, the distribution of palsies had shifted and included 42 upper palsies, 6 lower palsies, and 14 mixed (or global) palsies. One patient had a persistent flail upper extremity. Many previously documented obstetrical risk factors were confirmed. Time to resolution or plateau averaged 4.5 months (range 3 weeks to 18 months). Only two palsies (one patient) resolved completely with time.

Unicameral bone cysts. A comparison of treatment options.

Thirty-two unicameral bone cyst cases from various hospital centers in the San Francisco Bay Area were reviewed in order to compare the results of different treatment methods. Thirteen of the 32 cysts were latent and 19 were active, judged by their proximity to the growth plate. The average age at presentation was 8.9 years, and average follow-up was 5.6 years. Fifteen patients were treated surgically, 12 were given steroid injections, and five were treated nonoperatively. Comparative analysis of these methods supports previous studies which show that steroid injections are as effective as surgical intervention while having lower morbidity.

The efficacy of intraoperative autologous transfusion in major shoulder surgery.

Perioperative blood loss associated with 36 cases of major shoulder surgery in which an intraoperative autologous transfusion device was used was compared with a control group of 36 shoulder surgery patients to determine the effectiveness of intraoperative autologous transfusion (IAT). Total blood loss in this retrospective review was evaluated by assessing the volume of transfused banked blood and the change in hematocrit. All surgical cases were performed by the same surgeon. The procedures considered in the study were humeral head and total shoulder replacement. Use of an intraoperative autotransfusion device was associated with fewer units of transfused banked blood and similar or smaller drops in hematocrit. While shoulder surgery can involve substantial blood loss, the authors recommend intraoperative autologous transfusion for revision of failed shoulder surgery, arthrodesis, joint replacement, or repairs of massive cuff tears when mobilization and tendon transfers are anticipated. The risk of disease transmission through banked blood, especially of acquired immune deficiency syndrome (AIDS) and hepatitis viruses, has increased the need for a heightened awareness and use of alternative blood sources such as IAT.

The efficacy of intraoperative autologous transfusion in major orthopedic surgery: a regression analysis.

Perioperative blood loss associated with 89 cases of major orthopedic surgery was compared with that of a control group of 89 to determine the effectiveness of intraoperative autologous transfusion. Volume of banked blood transfused and hematocrit change were used to determine total blood loss. The orthopedic cases consisted of cemented "virgin" total hip replacement, cemented virgin tricompartmental knee replacement, and spine fusion. Use of an autotransfusion device (Cell Saver) intraoperatively was associated with significantly smaller volumes of transfused banked blood and significantly smaller hematocrit drops in the groups of patients who underwent total hip replacement or spine fusion, but not in the group of patients who underwent total knee replacement. One potential source of bias in the study stems from the fact that four days were allotted for equilibrium from perioperative blood loss in the hip and knee replacement groups, while, for reasons of data availability, equilibrium time in the spine fusion groups was two days.

Administration of monoclonal anti-Sm antibody prolongs the survival and renal function of MRL-lpr/lpr mice.

The repeated administration of a monoclonal anti-Sm antibody (KSml) resulted in a significant prolongation of life in MRL-lpr/lpr lupus mice with a 50% mortality of 36 weeks compared with 18-24 weeks in the control groups. Control animals injected with APC11 (a myeloma protein of the same isotype) lived no longer than an untreated group. In addition the renal function as assessed by blood urea levels was less impaired in the KSml-injected mice than in the controls. All KSml-injected mice showed the presence of circulating anti-Sm antibodies which had a different Sm polypeptide binding specificity from that of the injected monoclonal antibody; the increased prevalence of these antibodies compared to the control mice (10-30%) suggested that the anti-Sm antibody response had been induced. The increased longevity in the KSml-treated animals was not associated with alterations in the anti-dsDNA antibody response. The data suggest that administration of anti-Sm antibodies modifies the course of murine lupus.

An outcome study of group psychotherapy.

In 1975 a long-term follow-up was undertaken on patients collected as in-patients, treated and studied in 1962-64 (Bovill, 1972). Treatment was by didactic group psychotherapy and relaxation. Treatment was for a mean of six months and of 30 sessions, treatment remained available on demand for a mean of two years after discharge from attendance. In 1975 30 treated patients and 24 control patients were traced out of the original 36 in each group. The criterion of success was, as before, the inverse of days spent re-hospitalized. The success ratio fell from 7: 1 in 1962-64 to 2 1/2: 1 in 1965-74 and to 2: 1 in the single year 1974. This fall was expected in view of the known spontaneous recovery rate operating on the controls.