Congenital lipoid nephrosis with left renal vein thrombosis and Chiari's syndrome.

An infant with primary congenital lipoid nephrosis then developed left renal vein thrombosis and secondary hepatic vein obstruction. This was shown by inferior venacavography. The thrombus detached subsequently, and the child died from massive pulmonary embolism.

The torture or stretch arthritis syndrome (a modern counterpart of the medieval 'manacles' and 'rack').

A characteristic symmetrical bilateral polyarthritis syndrome is described, affecting the compartements of the wrist joints in a characteristic sequence. The pisiform-triquetral joint gives first, exposing the inferior radioulnar joint so that pisiform pain and tenderness are followed by painful supination. The proximal radiocarpal joint slackens next, followed by the mid-carpal joints. The lunates subluxate as their posterior attachments stretch. Synovial oedema may produce additional median and ulnar carpal tunnel syndromes. The best radiologic sign of this distraction is anterior subluxation of the lunates. Nocturnal arthralgia becomes severe; grip and the ability to write are lost and stretching now shows as a traumatic arthritis in the clavicular joints. The patient is incapacitated and therfore progression halts. A history of excessive straining and lifting is obtained eg with a wheel-barrow, iron pots or strenuous rowing. All serologic tests for rheumatoid disease are negative. Serum uric acid levels and blood sedimentation rates remain normal. There are clear analogies with old descriptions of the effects of torture by stretching from manacles or gauntlets or by the rack.

Experiences with priapism.

During a 10-year period 11 cases of priapism were treated with a saphenocavernous bypass. Uniformly good functional results were obtained if the procedure was done within 36 hours of the commencement of priapism. Prior aspiration and irrigation appear to lengthen this interval. The formation of temporary cavernovenous communication with the superficial venous system of the penis by aspiration and irrigation with large needles is demonstrated and is postulated as a mechanism by which this method of treatment alone is occasionally successful. Persisting graft patency has been associated with impotence. If erection does not occur within 3 months of the saphenous bypass the shunt should be ligated.