Isolated first rib fracture in athletes.

Isolated fractures of the first rib are uncommon. They are caused by major blunt trauma, a violent muscular pull, or fatigue. Diagnosis is usually made by chest radiography and computed tomography. Angiography is justified when certain criteria are met. Treatment is rest and mild analgesia. Early and late complications have been reported and are treated accordingly. The purpose of this article is to report a case of first rib stress fracture in a kick boxer and review the pertinent literature.

Experimental investigation of the tension band in fractures of the patella.

We investigated the strain pattern developed in the anterior and posterior part of the fixed patella during knee motion. Eight fresh cadaver knees were used but two were excluded because of non reliable measurements due to misplacement of gauges. Two strain gauges were bonded in the midline of the anterior and two in the posterior surface of the patella. Threaded steel rods were cemented into the intramedullary femoral and tibial canals. The knee was placed on a special device. The quadriceps tendon was gripped and a 4.5 kg weight was attached to the tibial rod 16.5 cm distal to the joint line. Ten flexion/extension cycles were performed before testing. Initially the intact patella was tested. A transverse osteotomy was performed before being stabilized by the AO recommended tension band technique. The knee was retested again as above. Finally an additional circular wire was passed around the patella and the knee was tested again under the same loading configuration. The intact patella showed weak tensile strain on the anterior and compressive strain on the posterior surface through the range of knee motion. Tension band fixation produced weak tensile strains in the first few degrees of flexion and then weak compressive strains in the posterior surface. The presence of the additional circular wire significantly increased the compressive strain. The classical tension band is highly effective for the fixation of the fractured patella but is improved by an additional circular wire.

Tumors of the ribs: experience with 47 cases.

OBJECTIVES: To emphasise the existing difficulties in differentiating benign from malignant rib tumours, and especially the problems that a clinical doctor encounters when dealing with a hyperplastic rib. METHODS: Forty-seven patients with rib tumour underwent surgery in a period of 12 years (1984-1996). In 40 cases (85%), the lesion was benign and in seven (15%) was malignant. Twenty-one benign tumours originated from cartilage and bone, seven were inflammatory, six originated from the bone marrow, and minor percentages (2.5-5%) had vascular, neurogenous, degenerative or miscellaneous origin. Three of the malignant tumours were primary chondrosarcomas and two were metastatic from kidney. The rest were metastatic from stomach (adeno-Ca), and skin (melanoma). The mean age in the benign group was 25.2 years and in the primary malignant group was 20.7 years. Related symptoms were pain (47%) and swelling (42.5%). One-third (32%) of the patients were asymptomatic and the lesion was accidentally found during routine chest radiography. All patients were treated surgically with wide excision of the tumour and the diagnosis was established histologically. RESULTS: Resection was complete and curative in all cases without recurrence. CONCLUSIONS: Since the likelihood of malignancy cannot be excluded, all rib tumours should be considered malignant until proven otherwise. Therefore, prompt intervention is necessary and wide and radical initial excision of the involved rib is advocated.

Pulmonary xanthoma. A case report with immunohistologic study and DNA-image analysis.

A case is reported of a xanthoma of the lung in a 32-year-old asymptomatic male. Detailed roentgenographic and immunohistopathologic studies, as well as DNA-image analysis, are presented. The benign nature of this tumor is well recognised and it is generally agreed that conservative local excision with a margin of uninvolved lung is the treatment of choice. The existing literature is reviewed.

Preoperative computed tomography of the brain in non-small cell bronchogenic carcinoma.

BACKGROUND: Computed tomography of the brain is the most accurate diagnostic investigation for detecting intracranial tumours. A prospective study was undertaken to try to maximise the cost effectiveness of computed tomography of the brain in the preoperative evaluation of non-small cell lung cancer. METHODS: All patients with non-small cell lung cancer who were free of neurological symptoms and were thought to be free of metastases from the results of routine investigations were subjected to computed tomography of the brain in the 12-24 hours immediately before surgery. RESULTS: Of 158 such patients, five showed positive evidence of metastases, confirmed on craniotomy and excision biopsy; one of these patients was found to have a non-metastatic tumour (false positive). Five patients with a negative scan who underwent lung resection returned within 12 months with neurological defects and positive findings on further computed tomography (false negative). The predominant cell type in patients with positive and false negative scans was adenocarcinoma or adenosquamous carcinoma (7/10); the majority had nodal state N2. CONCLUSIONS: Computed tomography of the brain should be carried out if mediastinal disease is suspected or confirmed in non-small cell lung cancer before proceeding to surgery.