Rib impingement in first class cricketers: case reports of two patients who underwent rib resection.

Two first class cricket bowlers presented with costoiliac pain secondary to rib impingement. In both patients, conservative management of the injury had failed to improve symptoms. Surgical resection of the affected rib was undertaken. At follow up, both patients had made a good recovery and had returned to competitive cricket.

External fixation for tibial fractures: clinical results and cost effectiveness.

We report our experience with the Orthofix external fixator in the management of closed and Gustilo grades 1 and 2 compound unstable tibial shaft fractures. Forty-four fractures were treated between January 1988 and December 1989. All the fractures united. Median time in hospital was 13 days. Median time to union was 21 weeks for closed and 22 weeks for compound fractures. A method of estimating the overall cost per patient is described. Using this method we compared the cost of using the Orthofix with that of intramedullary nailing and plating according to AO principles. The Orthofix fixator was cheaper than alternative methods in particular because no readmissions were required for implant removal.

Heel pain: diagnosis and management.

Chronic non-traumatic heel pain is not an uncommon symptom in patients presenting to GP, orthopaedic or rheumatological clinics. A full history and examination will provide a diagnosis in most cases. Rarer causes need to be excluded in certain patients. This article outlines the differential diagnosis and discusses the more common causes.

Septic arthritis and unpasteurised milk.

Green-top, or unpasteurised, milk is an increasing source of illness. A case of a previously unreported cause of septic arthritis of the hip joint, secondary to the ingestion of raw milk is reported.

Spontaneous rupture of the Achilles tendon: pathology and management.

Rupture of the Achilles tendon, one of the strongest tendons in the body, can cause significant long-term morbidity if diagnosis or treatment is delayed. This article discusses the current debate concerning the ideal management of these injuries, as well as their pathology and diagnosis.

The experimental basis of idiopathic scoliosis.

Idiopathic scoliosis is a complex three-dimensional deformity of the spine of which the scoliotic deformity and rotation are entirely secondary to an abnormality of shape in the median sagittal plane. In the thoracic region, there is a lordosis where a kyphosis should exist. In a controlled series of animal experiments using the growing New Zealand white rabbit as the model, idiopathic scoliosis can readily be produced if an asymmetric lordosis is created in the lower thoracic spine. Neither pure lordosis nor pure scoliosis produces the progressive idiopathic deformity. In the experimental animal when the normal thoracic kyphosis is reconstituted before maturity, the idiopathic deformity spontaneously improves. This lays the foundation for a more physiologic approach to treatment.

The pathogenesis of idiopathic scoliosis. Biplanar spinal asymmetry.

A clinical, cadaveric, biomechanical and radiological investigation of the pathogenesis of idiopathic scoliosis indicates that biplanar asymmetry is the essential lesion. Many normal children have coronal plane asymmetry (an inconsequential lateral curvature of the spine), and certainly all have vertebral body asymmetry in the transverse plane, but when median plane asymmetry (flattening or more usually reversal of the normal thoracic kyphosis at the apex of the scoliosis) is superimposed during growth, a progressive idiopathic scoliosis occurs. Idiopathic kyphoscoliosis cannot and does not exist, from the mildest cases in the community to the most severe cases in pathology museums. Median plane asymmetry is crucial for progression and the lateral profile of the spine must be carefully scrutinised. Increased anterior vertebral height at the apex of the curve with posterior end-plate irregularity characterises the median plane asymmetry and suggests that idiopathic scoliosis is the reverse of Scheuermann's disease.

Femoral neck fractures--two populations.

A survey of 128 patients with femoral neck fractures has emphasised the difference in physical condition and clinical behaviour between those with cervical fractures and those with trochanteric fractures. The latter group of patients manifest advanced biological ageing and present a greater health care problem. Maintenance of mobility in the elderly may alleviate this situation.

Chemotherapy following palliative resection of gastric cancer.

Twenty-five patients with residual tumour after resection of a primary gastric cancer were randomized to receive either 5-Fluorouracil or BCNU postoperatively or kept under close observation. Some patients receiving chemotherapy may have benefited by a delay in progression of their disease but this was short lived and subsequently all but one patient has died within a 4-year period of follow-up. There does not seem to be any advantage in treating patients who have residual gastric cancer with 5-FU and BCNU therapy.

Phase II study of chlorozotocin in the treatment of advanced colorectal cancer.

In 39 patients with advanced colorectal cancer and no previous chemotherapy, treatment with chlorozotocin was associated with a 5% objective response rate and a median survival of 19 weeks. All of the responses occurred in patients with rectal tumors. Mild gastrointestinal symptoms affected 64% of the patients after treatment, but bone marrow suppression was not evident. Chlorozotocin is not effective against colorectal cancer when used as a single agent given as an iv bolus at doses of 120 mg/m2 (30 patients) and 150 mg/m2 (nine patients). However, further studies using a higher dose might be worthwhile.

Evaluation of CEA in patients with known residual disease after resection of colonic cancer.

Serial carcinoembryonic antigen (CEA) levels were measured in 43 patients following incomplete excision of colorectal cancer. Twenty-seven patients received chemotherapy. In the majority the subsequent elevation of CEA could be related to clinical progression, but some patients receiving chemotherapy may have a suppressed rate of CEA rise and may have a more prolonged survival.The clinical application of serial CEA estimations remains of dubious value. However, one area which may be worthy of study is to determine whether suppression of the CEA slope by chemotherapy is attended by clinical control and an improved survival.