Delayed rupture of the extensor pollicis longus tendon: a retrospective study.

Eight patients with delayed rupture of the extensor pollicis longus tendon are presented. Six had suffered from a fracture of the wrist without dislocation. This is in our opinion a predisposing factor in the etiology of delayed tendon rupture. Our treatment of choice is transfer of the extensor indicis proprius tendon. In all patients satisfactory thumb function was restored.

Hemiarthroplasty in elderly, debilitated patients with an unstable femoral fracture in the trochanteric region.

The purpose of this study was to evaluate the results of patients with an unstable fracture in the trochanteric region who were treated by hemiarthroplasty. During a 10-year period, 154 of the 308 patients with a trochanteric fracture treated in our hospital had an unstable fracture. In patients with severe comminution and osteoporosis an endoprosthesis was inserted: 5 patients with a subtrochanteric and 17 with a pertrochanteric fracture. Ten patients suffered from central nervous system diseases, and in 10 patients cardiovascular or pulmonary disorders were diagnosed. Pre- and postoperative ambulation levels were classified. Seventeen patients (77%) achieved full weight-bearing mobilization. Five patients never walked again (23%): 2 patients died in the first month (9%). It is concluded that for elderly and debilitated patients with an unstable trochanteric fracture, hemiarthroplasty is an acceptable alternative to osteosynthesis.

Reflex sympathetic dystrophy of the head: case report and discussion of diagnostic criteria.

The case of a patient who was involved in a car crash is presented. On the right side her wrist and zygomatic arch were fractured. At both localizations she developed a painful syndrome. The diagnosis of reflex sympathetic dystrophy of her arm was made within 3 weeks after the injury and therapy instituted. The pain in her face and skull were accompanied by vasomotor changes which increased after exercise and by hypesthesia, hyperpathia, paresis, and hyperhidrosis. Disorders of the cranial nerves were excluded by physical examination and electromyography and structural disorders by CT scanning. The diagnosis reflex sympathetic dystrophy of the head was made one year after the injury. The problems in diagnosis are discussed.

First experience and complications with the long Gamma nail.

Treatment of proximal femoral fractures is difficult. A retrospective analysis of 92 patients treated with a custom-made extended gamma nail with a mean follow up of 4 months is presented. The early results of this new method are promising. The indications for the use of the long gamma nail were intertrochanteric fractures with extension to the subtrochanteric region, imminent and pathologic fractures of the intertrochanteric and subtrochanteric region, mostly in elderly patients, proximal femoral fractures, and combination injuries in multiple trauma patients and delayed unions. In 67 cases the patients were primarily treated with a long Gamma nail. In 25 cases the nail was used after the failure of initial treatment. Complications occurred in 32 patients; however, 88 patients were able to walk at the end of the study. The advantage of this new method is that with a closed surgical technique full weight bearing directly after the operation is achieved. The long Gamma nail provides a procedure by which most complex fractures in the proximal femur can be managed.

Dietary influences on cell proliferation in bone marrow.

Oral dietary protein-calorie malnutrition was used in rats to study the influence of malnutrition on the distribution of the dividing cells in the bone marrow (stem cells) over the compartments of the cell cycle. A 5-day period of malnutrition induced an increase in the percentage of cells in the G0/G1 phase of the cell cycle while simultaneously inducing a statistically significant decrease in the percentage of cells in S phase. Similar results were obtained after a 14-day period of malnutrition. Nutritional replenishment after 5 and 14 days of dietary deprivation induced a rapid recovery of the percentage of S phase cells and a decrease in the percentage of cells in the G0/G1 phase of the cell cycle. Malnutrition and nutritional replenishment did not influence hemoglobin concentration and platelet numbers in the peripheral blood, but leucocyte numbers increased significantly after short-term replenishment. These results demonstrate a decrease in the percentage of proliferating bone marrow cells after short periods of deficiency and general malnutrition. The results also demonstrate that bone marrow cells recover quickly after nutritional replenishment. In malnourished cancer patients, suspected of bone marrow insufficiency and receiving therapy that potentially impairs bone marrow proliferation, a short period of nutritional replenishment preceding treatment could possibly be marrow-protective.

31P NMR study of the impact of dietary manipulation on tumor metabolism and response to methotrexate.

The effects of nutritional manipulation and subsequent chemotherapeutic treatment upon growth and metabolism of a transplanted rat rhabdomyosarcoma were investigated by in vivo 31P NMR spectroscopy. Nutritional manipulation was accomplished by administration of a protein deprived diet containing no protein and 75.5% glucose. After 5 days the protein deprived rats (PD rats) were nutritionally replenished with a normal protein diet containing 27% protein and 47.3% glucose. Twenty-four hours after nutritional replenishment the PD rats and continuously well-fed controls (NP rats) received methotrexate (MTX, 30 mg/kg, i.p.). 31P NMR spectroscopy of the tumors 24 h after MTX administration showed a decreased ratio of nucleoside triphosphates to inorganic phosphate (referred to as 'ATP/Pi ratio') in PD rats in contrast to an unchanged ATP/Pi ratio in the NP controls. At the time of MTX administration the PD rats had a significantly lower tumor pH than the NP group (6.75 +/- 0.03 [SEM] vs 6.95 +/- 0.04; p less than 0.02). Tumor response in the PD group was significantly (p less than 0.01) enhanced compared to the NP group. These findings indicate that a period of dietary protein deprivation combined with a high glucose load and followed by nutritional replenishment impairs tumor metabolism. The altered metabolic status is expressed by acidification of the tumor and distinct changes in ATP/Pi ratio and appears to relate to an enhanced susceptibility to MTX chemotherapy.

Alterations in serum levels, anti-tumor activity and toxicity of methotrexate in rats after a short period of nutritional depletion.

The alterations in serum levels, anti-tumor activity and host toxicity of methotrexate (MTX) were tested in tumor bearing rats following a period of dietary manipulation. A protein deprived (PD) diet or a diet containing a normal protein content (NP) was administered for 5 days and MTX injected intra-peritoneally (i.p.) at the end of the 5 day period. The MTX serum levels were significantly elevated in rats which received the PD diet, as compared to NP dietary rats. This elevation correlated with an enhanced tumor response to MTX administration. In addition, bone marrow toxicity and intestinal tract toxicity, measured with flow cytometry (FCM) of the bone marrow and morphometry of the jejunal mucosa respectively was increased in rats receiving the PD diet. These results indicate that the serum clearance of MTX is delayed in animals suffering from malnutrition, leading to both enhanced tumor response and increased host toxicity.

Operative treatment of unstable distal radial fractures.

The results of operative treatment of unstable distal radial fractures were evaluated in 46 patients according to the criteria of Steinmann and Spier. The overall results were excellent or good in 35 patients (76.1%) and fair in 11 patients (23.9%). There were no poor results. Intra-articular fractures with volar dislocation (Smith type II) and fractures with severe comminution (Sarmiento type IV) are unstable and require surgery. Special attention must be paid to the Sarmiento type-II fracture with severe comminution of the dorsal cortex, severe radial shortening (greater than 10 mm) and dorsal tilt (greater than 25 degrees). Although not intra-articular, this fracture type may also prove to be unstable. The treatment of a Smith type-II fracture is a volar buttress plate unless extended comminution is present. Then, and in all other unstable fracture types, external fixation should be employed. In cases with severe loss of the dorsal cortex, bone grafting may be indicated.

Ischemic damage to the spinal cord following surgery of the abdominal aorta.

Ischemic damage to the spinal cord after reconstructive procedures of the abdominal aorta is a rare complication. The literature up to and including 1980 records 46 of these cases. In this paper we present four additional cases and discuss the etiological factors and the practical measures available to minimize the risk of this unpredictable complication.