Innominate osteotomy in adolescents and adults who have acetabular dysplasia.

The results were evaluated for twenty-eight adolescents and adults (thirty-one hips) who had had a Salter innominate osteotomy because of acetabular dysplasia and pain in the hip. The mean age at the time of the index operation was twenty-two years, and the mean duration of radiographic follow-up was seventy-one months. Radiographs were available for twenty-five patients (twenty-eight hips) at the most recent follow-up evaluation. The radiographic evaluation included determination of the acetabular angle, the center-edge angle, the coverage of the femoral head, the height of the joint space, and the Shenton line. Compared with the preoperative measurements, the acetabular angle had decreased by a mean of 10.0 degrees, the center-edge angle had increased by a mean of 13.2 degrees, and the coverage of the femoral head had increased by a mean of 15 per cent (p < 0.001 for all three values). The height of the joint space had decreased but, with the numbers available, this change was not significant. The Harris hip scores, determined for twenty patients (twenty-one hips), improved from a mean of 71.2 points preoperatively to a mean of 88.3 points at the latest follow-up evaluation (p < 0.001). A questionnaire, completed by twenty-seven patients (thirty hips), revealed that twenty-one patients (78 per cent) were satisfied with the result of the operation; twenty-two patients (81 per cent) said that they would recommend this procedure to others who had a similar condition. The pain score (with 1 point indicating mild pain and 5 points indicating severe pain) improved from a mean of 3.7 points preoperatively to a mean of 2.5 points at the latest follow-up evaluation (p < 0.001). There were six postoperative complications. One patient had a non-union; one, an infection; one, heterotopic bone; and three, numbness. Two of these patients subsequently had a total hip arthroplasty at ninety-eight and 150 months, and one patient had a Chiari osteotomy at twenty-two months. Our findings demonstrate that the Salter innominate osteotomy provides notable clinical improvement as well as improvements in the radiographic measurements of the hip in patients who have acetabular dysplasia.

Optimising collection of autologous blood. A pilot study of the use of recombinant human erythropoietin and parenteral iron.

OBJECTIVE: To optimise collection of sufficient autologous blood for elective surgery. METHODS: Prospective study of 40 patients referred for donation of autologous blood, who were booked for elective orthopaedic surgery in the period August 1992 - September 1994. Patients received recombinant erythropoietin (r-EPO) to stimulate erythropoiesis, and sufficient iron by injection so that iron deficiency did not limit the bone marrow response to the r-EPO. RESULTS: Thirty-eight of the 40 patients treated with this protocol stored an average of 3.7 units each on a twice-weekly donation schedule. Only one patient required supplemental homologous blood (two units) in subsequent surgery. One patient developed persistent hypotension, and one a late reaction to parenteral iron (which was controlled with corticosteroids). There were no other adverse events. CONCLUSIONS: r-EPO in combination with parenteral iron is a safe and effective method of ensuring the collection of optimal amounts of autologous blood before surgery.

Autologous blood transfusion and intraoperative cell salvage in a patient with homozygous sickle cell disease.

BACKGROUND: Autologous transfusion can eliminate the need for homologous transfusions. In addition, hypotensive anesthesia and devices that salvage red blood cells for return to the patient can reduce operative blood loss. However, blood from patients with sickle cell disease is difficult to store. SUMMARY: A 16-year-old black girl with homozygous sickle cell disease needed surgery for progressive scoliosis. Her family's religious convictions precluded homologous transfusions. During surgery, 400 mL of autologous blood that had been successfully stored was transfused, as was 800 mL of blood salvaged using a cell-saving device, and 3800 mL of nonblood plasma expanders. Intravenous agents were used to maintain hypotension. However, following a rise in the patient's prothrombin and thromboplastin times, four units of homologous packed red cells were transfused with the permission of the patient's parents. CONCLUSIONS: Patients with sickle cell disease can be given hypotensive anesthesia and autologous transfusions of blood donated before surgery and blood salvaged during surgery using a cell-saving device.

Cardiovascular effects of cromakalim (BRL 34915) in healthy volunteers.

1. The effect of oral doses of cromakalim 0.5, 1.0, 1.5 and 2.0 mg on several cardiovascular parameters was studied in healthy male volunteers. 2. In the first study, no dose of cromakalim reduced systolic or diastolic blood pressure in the supine or standing position. Reductions of diastolic blood pressure after exercise (P less than 0.01) were observed 4 h after administration of 2.0 mg. 3. There was a trend towards increased heart rate after 2.0 mg at all time intervals, and significant changes were observed in supine and standing heart rate at 2 and 4 h (P less than 0.01). No significant change was observed in exercise heart rate. 4. In the second study small increases in forearm blood flow were observed from 3 h to 5 h after oral administration of 1.0 and 2.0 mg of cromakalim. Forearm vascular resistance was significantly reduced after 2.0 mg (P less than 0.025) when compared with placebo. No change was observed in forearm venous capacitance after either dose of cromakalim, or placebo. Supine heart rate was significantly increased 4 h after 2.0 mg of cromakalim (P less than 0.025). 5. These results show that oral administration of cromakalim decreases diastolic blood pressure and forearm vascular resistance. A hypotensive effect is probably attenuated by reflex tachycardia.

Vaginal myxoma presenting as acute urinary retention.

Vaginal myxoma is an extremely rare tumor. We report a case in which the initial complaint was acute urinary retention. The tumor had grown quite rapidly over a 4-month period. It was resected easily and did not recur over the next 5 years.

Computer-assisted measurement of peripheral blood flow.

An automated system for the measurement of peripheral blood flow using venous occlusion plethysmography based on the low-cost Apple II microcomputer, together with purpose-built compressor unit and data acquisition interface, has been developed. The computer performs the dual role of controlling the timing of inflation and deflation of the occluding cuffs and recording the resulting increase in limb circumference. Ten 8 s epochs of data are acquired and analysed per session. Flow rate is computed using a least squares fit between 0.5 and 4.0 s after cuff inflation, giving on-line indication of blood flow. Venous capacitance and digital systolic pressure may be measured using additional algorithms. The system has been used for the investigation of circulatory disorders and in the assessment of drugs acting on the peripheral circulation.

Pseudoobstruction of the colon.

A previously unreported complication of extraperitoneal node dissection, pseudoobstruction of the colon, is described as a case report, and its etiology and treatment are discussed.

Assessment of delayed-type hypersensitivity in man: a comparison of the "Multitest" and conventional intradermal injection of six antigens.

Recall of delayed type hypersensitivity (DTH) as a test for cell-mediated immune competence was assessed in 254 subjects using the Multitest device which delivers seven skin-test antigens intradermally; 77 subjects were tested concurrently by Multitest and a conventional panel of six antigens. Similar results were obtained with Multitest and the conventional panel (R = 0.65). Reproducibility of Multitest between three observers, who independently assessed the aggregate size of reactions (the reaction score) in 45 subjects, was high (R = 0.89). Twenty-four subjects were tested twice 3 months apart; the correlation for the reaction score was high (R = 0.88), demonstrating the suitability of Multitest for serial studies of immune function. Anergy was infrequent (1%) among 110 healthy male controls but was more frequent (8%) among a group of 101 healthy male homosexuals (P less than 0.05). The response rate to particular test antigens differed for the three Australian groups tested and a previously studied French group. Hence there is a need to establish normal profiles of DTH responsiveness for different geographic areas, as well as among subjects of known age and sex, when assessing cell-mediated immunity by the level of DTH responsiveness to multiple skin test antigens.

Electrophoretic study of enzymes from cereal aphid populations : 4. Detection of hidden genetic variation within populations of the grain aphid Sitobion avenae (F.) (Hemiptera: Aphididae).

A study of variation in three peptidases (PEP-3 to -5) in a parthenogenetic S. avenae field population at Rothamsted using serial one-dimensional polyacrylamide gel electrophoresis (involving changes of gel concentration and electrophoretic run-time) increased the overall number of "allozymes" (mobility variants) detected from 10 under standard conditions (6% gels, 2 h run-time) to 22, as well as revealing putative heterozygous banding patterns under some test conditions. However, an examination of another enzyme, 6-phosphogluconate dehydrogenase (6-PGD) in a sample collected at Rothamsted the following year failed, using a combination of serial methods (changes of gel concentration) and isoelectric focusing, to increase the total number of 6-PGD bands separated (seven, none of which appeared to be allelic in origin). Nevertheless, some major bands were split into several bands, whilst other infrequent bands were either gained or lost. The findings are briefly discussed.

The multiple choice tutorial: its use in the reinforcement of fundamentals in medical education.

Multiple choice questions (MCQs) were developed on major themes in physiology and delivered in a weekly tutorial to first and second year medical students. The sequence of the MCQs was arranged to follow the usual explanation of tissue function. These multiple choice tutorials (MCTs) were either composed entirely of MCQs or were 50:50 lecture and MCQs. The importance of the MCT was the diversification of questions around the components of the MCQ, hence the MCQs served as the springboard from which different avenues of understanding were able to be investigated. The effectiveness of the MCT was assessed by performance at faculty mid- and end-of-year examinations against a control group of students who received 'conventional' tutorials. This comparison suggests that the MCT may have contributed to improved performance. The multiple choice tutorial is popular and achieves considerable student participation. For the tutor, it represents a consistently reproducible tutorial with an appropriate thrust of emphasis.

Delivery of antiviral chemotherapeutic agents to neurons by retrograde axonal transport.

It may be possible to eliminate herpes simplex or zoster viruses from the neurons of carriers by treatment with an antiviral chemotherapeutic agent such as adenine arabinoside, ribavirin or acyclovir, coupled to a compound such as horseradish peroxidase that undergoes retrograde axonal transport.

Computed tomography in the diagnosis of pseudotumor cerebri.

The authors reviewed 17 patients with the clinical diagnosis of benign intracranial hypertension (pseudomotor cerebri). All of these patients underwent CT scans of the head which were interpreted as normal. Comparison of mean ventricular size with that of a group of control subjects showed no significant difference. On the basis of this study and others cited, there would appear to be almost no instances in which invasive neuroradiological procedures would be required to confirm the diagnosis of pseudotumor cerebri.