Amaurosis secondary to massive blood loss after lumbar spine surgery.

Reported herein is the unusual complication of blindness resulting from massive blood loss during a lumbar spine surgery. Amaurosis resulting from distant hemorrhage is rare and, to the authors' knowledge, has not been reported in the orthopedic literature. Although there have been several case reports in the ophthalmologic journals, none were secondary to an orthopedic surgical procedure.

Use of a Herbert screw for interphalangeal joint arthrodesis.

Fifty-one Herbert-screw fixation procedures were performed for interphalangeal fusion in the hand. The preoperative diagnoses included rheumatoid arthritis, degenerative arthritis, posttraumatic arthritis, and chronic mallet finger. All patients were observed until there was clinical and radiographic evidence of union. Solid osseous union occurred in all patients. Herbert screw fixation for interphalangeal arthrodesis was a simple, effective technique permitting early mobilization; complications were minimal.

Determining the prognosis for limb salvage in major vascular injuries with associated open tibial fractures.

Nineteen patients with open tibial fractures and associated arterial injuries were reviewed. Vascular injuries were documented by either arteriography (74%) or clinical examination and direct visualization of injuries intraoperatively. Arterial injuries were divided into those proximal to and those distal to the trifurcation. Proximal injuries involved the popliteal artery in all cases, whereas distal injuries involved the anterior tibial artery, posterior tibial artery, peroneal artery, or combinations of these arteries. All patients' limbs were initially considered salvageable. The eventual amputation rate was 58%. The Mangle Extremity Severity Scores ranged from 4 to 9, and Gustilo's open fracture classification system included 21% Type IIIB and 79% Type IIIC injuries. An isolated anterior tibial artery or peroneal artery injury had a good prognosis. A poor outcome was correlated with posterior tibial artery and popliteal artery injuries and injuries involving all three major distal trifurcation arteries simultaneously. These findings were statistically significant (P less than .05). Traditional criteria for primary amputation are reviewed, and the relevance of a varied prognosis with specific vascular injuries is discussed.

Epidemiology of primary osteogenic sarcoma in the San Francisco Bay Area of California.

This epidemiologic study represents an analysis of all registered new cases of osteogenic sarcoma (OGS) during the 14-year period from January 1973 to December 1986 in five San Francisco Bay counties. Inclusion into the study was limited to patients who were diagnosed in the first three decades of life and who were residents within the Bay Area at the time of diagnosis. To determine epidemiologic characteristics of OGS, records on 96 patients from the Bay Area Resources for Cancer Control with histologically proven OGS were reviewed. The incidence of OGS was influenced by age, gender, and race, but none of the effects were statistically significant. A geographic variation in the incidence of OGS was discovered, although it was not statistically significant. The results are presented in support of a continued search for environmental variables that may someday reveal the etiologic factors of OGS.

Retroviral vector-mediated gene transfer into human hematopoietic progenitor cells.

The transfer of the human gene for hypoxanthine phosphoribosyltransferase (HPRT) into human bone marrow cells was accomplished by use of a retroviral vector. The cells were infected in vitro with a replication-incompetent murine retroviral vector that carried and expressed a mutant HPRT complementary DNA. The infected cells were superinfected with a helper virus and maintained in long-term culture. The production of progeny HPRT virus by the bone marrow cells was demonstrated with a colony formation assay on cultured HPRT-deficient, ouabain-resistant murine fibroblasts. Hematopoietic progenitor cells able to form colonies of granulocytes or macrophages (or both) in semisolid medium in the presence of colony stimulating factor were present in the nonadherent cell population. Colony forming units cloned in agar and subsequently cultured in liquid medium produced progeny HPRT virus, indicating infection of this class of hematopoietic progenitor cell.