Osteoid osteoma: the difficult diagnosis.

The diagnosis of osteoid osteoma can be difficult. We present eight children where the diagnosis of osteoid osteoma was difficult, due to a clinical history suggesting an alternative diagnosis, misleading radiological findings, or where the osteoid osteoma was in an unusual site. In some cases, diagnosis was only reached after biopsy, despite radiological investigation and radioisotope studies. The diagnosis should be considered in a child with bony pain or bony swelling, especially where the history is a chronic one. We present a radiological algorithm for the investigation of patients suspected of having an osteoid osteoma.

46-year survival of a Smith-Petersen mold arthroplasty.

The case, of a patient who is believed to be the longest surviving person with a hip arthroplasty is reported. The patient is still pleased with the function of the Smith-Petersen arthroplasty 46 years following its insertion, and has declined revision to a total hip arthroplasty.

The Mennen plate in periprosthetic hip fractures.

We would like to report five patients with periprosthetic hip fractures, treated with a Mennen plate, as we felt there were contraindications to revision surgery in these patients. Their average age was 79.1 years. All patients were uncomfortable in Thomas splint traction and more comfortable after surgery; they required an average of 2 units of blood to be transfused; they were partially weight-bearing with a caliper in an average of 9 weeks, home in an average of 10 weeks, and the average time to clinical or radiological union was 4.8 months. We considered a reasonable level of mobility was regained after surgery and would recommend Mennen plate fixation for periprosthetic fractures in those patients perhaps too frail for revision.

Iodine therapy for thyroidectomy patients exhibiting high thyroid-stimulating hormone values: a randomised study.

After thyroidectomy there is an appreciable incidence of hypothyroidism as judged by FT4I estimates. Pharmacological doses of iodine (10-300 mg/day) usually suppress, whereas physiological doses of iodine (< 5 mg/day) have been reported to both decrease and increase thyroid function. The value of iodine supplementation in preventing post-thyroidectomy hypothyroidism was assessed in a prospective randomised trial. A series of 55 patients with a TSH > 6 mU/l 1 month after bilateral subtotal thyroidectomy or unilateral lobectomy for benign disease were randomised to receive either chloroform water 5 ml/day (placebo) or chloroform water 5 ml/day with 1 mg of iodine to be taken for 20 weeks. With placebo, 62% of bilateral subtotal thyroidectomies were euthyroid at 6 months on no thyroid replacement, while with iodine all were hypothyroid as judged by FT4I. After bilateral subtotal thyroidectomy, the recovery of remnant function is delayed by an iodine supplement of 1 mg/day.