Spinal fusion for chronic low back pain.

Results of spinal fusion for chronic low back pain in 46 patients are analyzed, and the authors set forth the clinical circumstances in which the procedure may relieve this common complaint.

Undiagnosed bleeding states and medical treatment.

Relatively little attention has been placed in mild hemophilia in the orthopedic literature even though there are probably an equal number of patients with mild as compared to classic manifestations. Mild hemophilia and similar related conditions frequently are undiagnosed and may represent major problems and if associated with surgery, catastrophic results. Patients with milder bleeding diatheses may not have a diagnosis made until late in life. Mild hemophilia and hemophiloid conditions are defined and typical findings are given. Other causes of intra or postoperative hemorrhagic states are mentioned. Three case reports of mild Factor VIII and Factor XI deficiency, undiagnosed prior to the author's medical treatment, are presented. Knowledge of the typical historical findings, diagnostic methods, and proper treatment of patients seeking medical treatment with mild hemophilia, hemophiloid and similar conditions explaining hemorrhage following trauma and intra and postoperatively will help to prevent undesirable results as well as severe complications.

Vascular and adjacent soft tissue injuries associated with fractures of the pelvis.

One hundred fifty-one patients with fractures of the pelvis and associated injuries have been reviewed. Patients who have these injuries are likely to have uncontrollable, fatal hemorrhage. Of this group, nine died, 11 had exploratory laparotomies, ten had bladder injuries, and two had rectal damage. Blood gas determinations, arterial catheterization, and pulmonary wedge pressure determinations are valuable in making and early diagnosis of pathologic changes resulting from internal hemorrhage.