Preoperative identification of patients at high risk of deep venous thrombosis despite prophylaxis in total hip replacement.

Clinical and laboratory variables were measured on the day before operation in 111 patients who underwent total hip replacement prophylactically treated with acetylsalicylic acid or heparin-dihydroergotamine. Postoperative deep vein thrombosis (DVT) was detected in 16 patients by ascending venography. Stepwise logistic discriminant analysis was used to identify DVT predicting factors. Three such factors, fibrinogen degradation products (FDP), plasminogen activator inhibitor (PA-inhibitor) and tissue type plasminogen activator (t-PA), were found to be significantly associated with DVT and were used to construct a predictive index. The predictive index, I = -2.09 + 0.46 (FDP) + 1.39 (PA-inhibitor) -0.24 (t-PA), was 100% sensitive and 95% specific in the prediction of DVT. This index would allow for identification of those patients in whom routine prophylaxis would be sufficient and for selecting those in whom more effective prophylactic regimens would be necessary.

Treatment of infected tibial pseudarthrosis by external fixation with the Wagner device.

We analyzed our experience with infected tibial pseudoarthrosis which resulted in a therapeutic plan for a radical operation or a step-by-step method, depending on the type of pseudarthrosis (PS), the severity of the infection, and the skin damage. We think that external fixation with the Wagner device is the procedure of choice. Owing to its simplicity and good stability, it is possible to treat the PS and the infection and to obtain good final results.

Chronic lateral instability of the ankle.

The authors present 14 cases of chronic lateral instability of the ankle in 13 patients, in whom we performed ligamentoplasty using peroneus lateral brevis. The importance of careful preoperative evaluation of clinical findings as well as stress-roentgenograms and arthrographies is emphasized and a simple surgical technique is presented. We also realize an assessment of the results obtained which are very encouraging at the present.

[Chordoid sarcoma of the femur. Electronic and optical microscopy study of a case]. / Sarcoma cordoide de fémur. Estudio a microscopio óptico y electrónico de un caso

Areas of chordoma and chondrosarcoma have been reported extensively in the same tumoral mass located in espheno-palatine region. The same association in long bones of the extremities have been reported recently, with the name of "chordoide sarcoma", "parachordoma" or "chondroid chordoma". We present a case of "chordoid sarcoma". The cells of this tumor have morphologic features of chordoma and chondrosarcoma in both the optical and ultrastructural study. However some morphological, radiological and clinical aspects, suggest that this tumor possesses characteristics that define it as a separate entity.