[Traumatic pseudoaneurysm of the peroneal artery]. / Traumatisk pseudoaneurisme på arteria peronea.

Traumatic arterial pseudo-aneurysm is a rare phenomenon. We describe a case of pseudoaneurysm of the peroneal artery as a late complication to an open crural fracture. Persistent or occurrence of swelling, pain, paraesthesias or sensory deficit at the fracture site should be considered symptoms of a developing arterial pseudo-aneurysm. The presence of a distal pulse and negative results of ultrasound examination in the Doppler modality does not rule out arterial pseudo-aneurysm, therefore arteriography is often indicated. Treatment of traumatic arterial pseudo-aneurysms is surgical, as they often tend to progress.

External fixation of distal radial fractures: 3 or 5 weeks of external fixation.

In a retrospective study we compare the functional and radiographical results of 2 groups of patients with unstable distal radial fractures treated with external fixation. In Group 1, 20 patients with 21 fractures were treated with external fixation for 3 weeks followed by a cast for 2 weeks. In Group 2, 16 patients were treated with external fixation for 5 weeks. The functional outcome was good in both treatment groups with no significant difference between the results in the two groups. Radiologically, Group I had less radial shortening than Group II, but there was no difference in the degree of dorsal angulation.

Comparison of intramedullary fixation and percutaneous pinning of displaced and comminuted Colles' fractures: a prospective and consecutive study.

This consecutive study comprised 86 patients who were available for follow up 5-51 months after sustaining a Colles' fracture--Older type IV. A total of 42 patients were treated with Kirschner (K) wires of whom one had bilateral fracture. Forty-four patients (of whom two had bilateral fractures) were treated with Rush nails. A functional assessment of the patients was made using both a questionnaire and a clinical examination. The end-results of residual deformity, subjective and objective findings, and complications were evaluated according to the Lucas' modification of the Sarmiento demerit point-rating system. At follow-up, the ulnar/radial deviation was significantly better in the patients operated on with K-wires (37 degrees compared with 27 degrees, p < 0.02, range in both groups 0-80 degrees), but no differences were found in the other directions of movement. A total of three patients (7%) developed complications. The final result showed that 40 (93%) of the fractures treated with K-wires were excellent or good compared with 38 (86%) of those operated on with a Rush nail. One fracture in each group (2%) had a poor outcome. Comparison of the final results showed no significant difference between the two groups.

Musculo-skeletal pathology in patients with angina pectoris and normal coronary angiograms.

PURPOSE: To evaluate the role of the musculo-skeletal apparatus in patients with angina pectoris despite normal coronary angiograms. DESIGN: A survey of patients and controls investigated by blinded observers. SETTING: A tertiary cardiologic referral centre. SUBJECTS: Thirty women and 18 men (mean age 52.9 years) with chest pain of an average duration of 3 years and 11 months were investigated. All had normal resting electrocardiograms. No patients showed evidence of left ventricular hypertrophy or valvular heart disease on echocardiography and all had a normal coronary angiogram. All had left ventricular ejection fraction > 50%, and none had signs of coronary vasospasm. Eighteen healthy persons (10 women and eight men, mean age 51.2 years) served as controls. MAIN OUTCOME MEASURES: The group frequency of chest wall complaints, spinal radiograph and physical examination findings; pressure pain thresholds. RESULTS: The patients had significantly more complaints of pain from the neck, chest, and thoracic spine, and sensations and pain radiating to the arms than the controls. The patients had more degenerative findings on radiograph than the controls, mainly at levels C4-C7. Physical examination showed that abnormal findings were significantly more frequent in patients than in the control group in the anterior and posterior chest wall, in the spine at levels Th1-Th6 and in the muscles of the neck and shoulder girdle. There were no statistically significant differences in pain thresholds or in neurological examination. CONCLUSION: The musculo-skeletal abnormalities observed in the patients could include reflex mechanisms. Whether the abnormal findings are mainly responsible for the angina pectoris symptoms or merely epiphenomena warrants further study.

Pelvic fractures. Assessment by conventional radiography and CT.

Sixty-two patients with pelvic fractures were evaluated by conventional radiography and CT. A correct pathoanatomic classification of the fractures was most often obtained by conventional radiography, but CT added information regarding acetabular fractures and involvement of the posterior part of the pelvic ring. Besides, CT was essential in the detection of intraarticular fragments and lesions of the femoral head. Classification of pelvic ring fractures by the pattern of traumatic forces was easily obtainable by conventional radiography, but often difficult to achieve by CT.

Splenic infarction and tissue accumulation of crystals associated with the use of clofazimine (Lamprene; B663) in the treatment of pyoderma gangrenosum.

A male patient 68 years, suffering from pyoderma gangrenosum which was resistant to conventional treatment, received clofazimine 400 mg daily for 5 months, then reducing to 300 mg daily for the next 6 months. Eleven months after starting the drug, he was admitted to hospital with severe abdominal pain, laparotomy revealing infarction of the spleen, with violaceous congestion of the small bowel. The spleen was removed and post-operative recovery was satisfactory. Histopathological examination of the spleen (removed at operation) and of tissue from a duodenal biopsy (taken postoperatively) showed large numbers of striations and outlines suggestive of crystal deposition. Mesenteric lymph node revealed a massive accumulation of crystals in cortical and medullary sinuses. The findings emphasize that clofazamine should not be used in high dosage over prolonged periods of time, except under close clinical and laboratory supervision, and for conditions not amenable to other drugs.

The role of IgA in the prevention of bacterial colonization of the jejunum in the vagotomized subject.

The efficacy of three mechanisms of defence against jejunal bacterial colonization (i.e. gastric acid, vagal and pyloric integrity and intestinal IgA) has been investigated. Only in subjects with disturbance of all three mechanisms did significant jejunal colonization occur, and this was invariably associated with severe diarrhoea. Clearly normal intestinal IgA is of critical importance in the prevention of jejunal bacterial colonization in the vagotomized subject.

The place of transthoracic vagotomy in the management of recurrent peptic ulceration.

For the successful treatment of recurrent peptic ulceration confirmation of the presence of the ulcer by fibreoptic endoscopy is essential. Further investigation by barium meal and gastric acid secretion studies allows a rational surgical approach to be formulated. This process is illustrated by discussion of the investigative findings and the results of treatment in a series of 20 patients with recurrent peptic ulcer over a 5-year period. In one-half of these patients a second abdominal operation was necessary, but in the other half a transthoracic vagotomy alone gave equally good results.

IgA deficiency and severe post-vagotomy diarrhoea.

Between January, 1969, and December, 1973, 2058 truncal vagotomies were performed in the Merseyside Regional Health Authority area. 14 of these patients subsequently developed severe post-vagotomy diarrhoea and were extensively investigated. 6 were found to have IgA deficiency. It is suggested that antecedent IgA deficiency may account for the varied reported incidence of severe post-vagotomy diarrhoea and that preoperative screening could reduce the incidence of this complication.