Abnormal temperature control suggesting sympathetic dysfunction in the shoulder skin of patients with frozen shoulder.

In view of the possibility that sympathetically mediated pain could be responsible for frozen shoulder symptoms we compared shoulder skin vasomotor control in 11 patients with frozen shoulder and 17 similarly aged normal subjects without shoulder pain. Using computer-assisted thermography the shoulder skin temperature was assessed before and following a 'cold challenge' which consisted of a 15 degrees C cold pack being held against the skin for 60 sec. Both prior to and immediately following the cold challenge shoulder skin temperatures tended to be lower in the patients. During a 10-min rewarming phase, however, the between-group temperature difference increased and became significant at the 0.05 level. These abnormalities of temperature control in patients clearly suggest sympathetic dysfunction in the dermatome subserving pain sensation from the affected shoulder. Whether these abnormalities are primary or secondary remains unresolved.

Management of hip fractures in nursing home patients: to treat or not to treat?

Nursing home patients who sustain hip fractures have a much higher than average complication rate after surgical repair, and few ever walk again. Operation is not necessary to ensure the patient's survival in the postfracture period. The majority of these patients are better off managed without surgery. For patients with little or no chance to walk again, a nonsurgical treatment regimen in the nursing home is safer, more humane, and far less expensive than hospitalization.

Retching and termination of ventricular tachycardia. Report of two cases.

Two patients had ventricular tachycardia that reverted to sinus rhythm during retching. These cases are consistent with recent experimental and clinical observations that suggest the presence of significant vagal innervation of the ventricles and an important vagal effect on some ventricular arrhythmias.

Nontreatment of hip fractures in senile patients.

Five elderly patients with hip fractures were deemed unsuited for surgical repair because of severe organic mental syndromes. All survived the postfracture period without the morbidity of decubitus ulcers and pulmonary complications, or the pain, mental anguish, and expense of hospitalization and surgery. Surgical repair of a hip fracture is not necessarily a mandatory or life-saving procedure. For patients unlikely to walk again, nonoperative management is a reasonable alternative--provided good nursing care is available.