[Pediatric femoral shaft fracture in the 6-14 year age group. A retrospective therapy comparison between conservative treatment, plate osteosynthesis and external stabilization]. / Die kindliche Femurschaftfraktur in der Altersgruppe 6-14 Jahre. Ein retrospektiver Therapievergleich zwischen konservativer Behandlung, Plattenosteosynthese und externer Stabilisierung.

The optimal choice between operative and conservative therapy in the treatment of femur shaft fractures in school age children remains controversial. Between 1985 and 1991, 34 children aged 6-14 years were treated in our institution for fractures of the femoral shaft: 8 were treated conservatively with traction, while 10 underwent plate fixation and 15 external fixation. The 34 cases were analyzed retrospectively. In the conservatively treated group a plate osteosynthesis become necessary in 2 patients because of delayed union and fracture malalignment. Hospitalization was the longest in these children, although their concomitant injuries were the least extensive. In the group with plating there were no serious complications but open surgery is needed for two major operations for insertion and removal. The average time on crutches after plate fixation was 56 days. In the group treated by external fixation four secondary plate osteosyntheses were performed, two at an early stage because of unacceptable fracture malalignment and two others because of fracture instability after removal of the fixateur. The stay in hospital was the shortest in this group. The 11 children who had been completely managed by external fixation achieved walking without crutches in the shortest time, viz. 15 days after the operation on average. The average time to removal of the fixateur was 67 days. Review was possible in 27 of the 28 children who had been completely managed by the initial treatment method. All had unlimited hip and knee motion. Two children in the conservative treatment group were seen on radiographical examination to have a varus angulation of more than 10 degrees. In the plate and fixator group no malalignment was present.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of sauna on tetraplegic and paraplegic subjects.

Six tetraplegic (T) and 4 paraplegic (P) subjects underwent a 20-minute pre sauna phase (30 degrees C DB; 65% RH), and an up to 15-minute sauna (85 degrees C DB; less than 10% RH), followed by a 15 minute post sauna phase (30 degrees C DB; 65% RH). During all phases subjects wore a bathing suit and remained supine on a hospital trolley. Heart rate (HR) and blood pressure (BP) were recorded during all phases. Rectal temperature (Trec) was measured by a probe (AD590) inserted approximately 14 cm into the rectum. Oral temperature (Toral) also utilising (AD590) circuitry was recorded simultaneously with Trec. Skin temperature (Tsk) (AD590) was measured on the head, chest, right thigh and right calf. Forehead sweat rate (SR) was determined from dew point temperature (Tdp). A catheter was inserted into a dorsal hand or foot vein and venous blood was withdrawn at selected times and analysed for haemoglobin (Hb) and haematocrit (Hct), and the separated plasma was analysed for glucose (Glu), sodium (Na+), potassium (K+) and chloride (C1-). Venous blood sampled just prior to entering and just prior to leaving the sauna, was analysed for adrenalin (A) and noradrenalin (NA) using high performance liquid chromatography. For both groups HR rose significantly during the sauna with a significant decline in HR for the P group during the post sauna phase. There were no significant changes in systolic BP for either group. A significant decline in diastolic BP was found for the T group during the post sauna phase. There were no episodes of syncope.(ABSTRACT TRUNCATED AT 250 WORDS)

Prognostic value of pretreatment carcinoembryonic antigen, neuron-specific enolase, and creatine kinase-BB levels in sera of patients with small cell lung cancer.

Carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and the BB isoenzyme of creatine kinase (CK-BB) were evaluated before therapy in the sera of 195 patients with histologically confirmed small cell lung cancer (SCLC) in a prospective multicenter trial. Forty-four percent (84 of 193) of all patients had CEA levels higher than 5 ng/ml, 66% (111 of 168) had NSE levels higher than 12.5 ng/ml, and 32% (40 of 123) had CK-BB levels higher than 10 ng/ml. Clear pathologic levels were less frequently observed. Significantly higher pretreatment titers for CEA, NSE, and CK-BB were found in patients with bone marrow and/or liver metastases. The most elevated marker levels were observed in the group of nonresponding patients with bone marrow and/or liver metastases. Only a slight correlation between the pretreatment CEA level and survival time could be observed. Patients with pathologic NSE (greater than or equal to 30 ng/ml) levels and, in particular, those with pathologic CK-BB (greater than or equal to 25 ng/ml) levels had a significantly shorter median survival than those with normal or elevated levels. In addition, a positive linear correlation between pretreatment NSE and CK-BB (n = 116, r = 0.54) levels was found, but CEA levels did not correlate with other marker levels. From these data it is concluded that pretreatment CEA, NSE, and CK-BB levels are helpful in the clinical management of a subset of patients with SCLC, i.e., those with bone marrow and/or liver metastases.