[Unrepaired fracture of the styloid process of the ulna: not a bad treatment result at distal radius fracture]. / Unbehandelter Abriss des Processus styloideus ulnae: Kein schlechteres Behandlungsergebnis bei distaler Radiusfraktur.

BACKGROUND: There are well-defined criteria for the treatment of distal radius fractures but the impact of an unrepaired fracture of the styloid process of the ulnar on recovery after operative treatment is uncertain. This study evaluated radiological and functional results after different operative treatment procedures of distal radius fractures in patients with an untreated fracture of the styloid process of the ulna and those without such a fracture. METHODS: Out of 480 patients with operatively treated distal radius fractures 238 were examined at least 1 year after injury. The fracture of the styloid process of the ulna was not repaired. Three groups (patients without a fracture of the styloid process of the ulna, patients with a tip fracture and those with a basal fracture) were evaluated by multivariate analysis (MANOVA) in order to detect influences of the fracture of the styloid process of the ulna on the radiological and functional results. RESULTS: Neither the existence nor the location of the fracture of the styloid process of the ulna had a significant effect on the radiological and functional results (p(function)=0,849, p(radiology)=0,330, p(scores)=0,426, MANOVA). CONCLUSIONS: The repair of a fracture of the styloid process of the ulna is not necessary if reduction and fixation of the distal radius fracture is anatomical and stable.

Observation of a new superfluid phase for 3He embedded in nematically ordered aerogel.

In bulk superfluid 3He at zero magnetic field, two phases emerge with the B-phase stable everywhere except at high pressures and temperatures, where the A-phase is favoured. Aerogels with nanostructure smaller than the superfluid coherence length are the only means to introduce disorder into the superfluid. Here we use a torsion pendulum to study 3He confined in an extremely anisotropic, nematically ordered aerogel consisting of ∼10 nm-thick alumina strands, spaced by ∼100 nm, and aligned parallel to the pendulum axis. Kinks in the development of the superfluid fraction (at various pressures) as the temperature is varied correspond to phase transitions. Two such transitions are seen in the superfluid state, and we identify the superfluid phase closest to Tc at low pressure as the polar state, a phase that is not seen in bulk 3He.

Comparison of 1% lignocaine with 0.5% bupivacaine in digital ring blocks.

In a randomised double-blind trial comparing 1% lignocaine with 0.5% bupivacaine in digital ring block, the mean time of onset of complete anaesthesia was 5.8 minutes (range 5 to 10 minutes) for lignocaine and 11.2 minutes (range 8 to 20 minutes) for bupivacaine. The duration of action was 59.6 minutes (S.D. +/- 28.7 minutes) for lignocaine and 476 minutes (S.D. +/- 277 minutes) for bupivacaine. We describe how these differences can be exploited in clinical practice.

[Post-traumatic anterior shoulder instability--arthroscopic stabilization method using bone anchors]. / Prední poúrazová nestabilita ramena--artroskopická stabilizacní technika metodou kostních stehových kotev.

PURPOSE OF THE STUDY: To evaluate the short-term results of re-insertion of the ventral labrum associated with plication of the capsular structures in anterior post-traumatic instability of the shoulder. MATERIAL: The patients treated in our institution between April 2000 and December 2002 and followed up for periods ranging from 3 to 20 months were included. A total of 65 patients were treated for post-traumatic ventral instability. Open capsular shift, after a final evaluation of preoperative examination under total anesthesia and arthroscopic inspection of the labroligamentous complex affected, was used in four patients. Arthroscopic stabilization was carried out in 49 men and 12 women, aged 18 to 49 years (average, 28.5). These patients were allocated to groups according to the number of previous dislocations as follows: group 1 (24 patients), one to five dislocations; group 2 (27 patients) six to ten dislocations; and group 3 (10 patients) 11 and more dislocations. The glenohumeral joint was inspected arthroscopically to find out potential lesions and evaluate them in relation to the number of previous dislocations. METHODS: Stabilization was carried out by means of non-absorbable anchors. It involved re-insertion of the ventral labrum and plication of the ventral capsular structures. The patients were evaluated on the basis of a modified system of Rowe and Zarins. RESULTS: In group 1, the anterior labrum or capsule showed only isolated lesions; most injury-related lesions were found in group 3. With the increasing number of dislocations, there was an increase in associated findings and severity of injury to the labroligamentous complex. The average score before the operation was 37.87 points (range, 20 to 60). After rehabilitation was completed, 57 (93.44%) patients scored good or excellent (70 or more points), with 29 (47.54%) having over 90 points; only four (6.56%) patients scored less than 70 points. Fifty-seven patients resumed their previous sports and four patients carried on with recreational sports activities. DISCUSSION: Open stabilization has been reported as being slightly more effective in maintaining stability, as compared with arthroscopic procedures. The major advantages of arthroscopy include a good view of the intra-articular structures, minimal invasiveness and less restricted range of postoperative motion. However, the arthroscopic stabilization technique becomes more difficult with an increasing number of dislocations sustained before this procedure. The ventral structures of the shoulder joint, known as labroligamentous complex, should be regarded in their complexity and anterior stability should be achieved both by re-insertion or adaptation of the glenoid labrum and by stretching the capsular structures, particularly the inferior glenohumeral ligament. Studies reporting a high degree of recurrence after the initial dislocation in subjects aged 20 to 30 years are discussed. In top, active sportsmen and sportswomen, stabilization after the first dislocation followed by instability appears to be a very effective therapy. CONCLUSIONS: Arthroscopic stabilization with the use of non-absorbable anchors for the treatment of anterior post-traumatic instability of the humeral joint is a method that, in indicated cases assessed mainly by mobility of the labrum and laxity of the anterior capsule, shows a high success rate. Indications are based on medical histories, clinical and radiographic findings and, most importantly, clinical tests under total anesthesia and arthroscopic confirmation of lesions of the ventral structures of the joint.

Pulmonary embolism in patients attending the accident and emergency department with pleuritic chest pain.

A series of 92 patients presenting to an accident and emergency department with pleuritic chest pain is described. Only one of the patients had a diagnosis of pulmonary embolus. All the patients were followed up over a period of 3 months. During this time none of them suffered from mortality or morbidity which could be related to pulmonary embolism. No evidence was obtained during this study that a more aggressive approach to such patients is required in order to achieve the diagnosis.

Electrical injuries due to railway high tension cables.

We have noted a large number of young boys being admitted to our Unit with burns due to railway high tension cables. On review of these cases we have noted: most of the burns were due to arcing, there is a high level of ignorance among the population at risk. We propose some ways of preventing these injuries.

Use of analgesia in severe pain in the accident and emergency department.

The adequate management of severe pain in accident and emergency departments depends on knowledge of the pharmacology of analgesic drugs. To evaluate such a knowledge a study by questionnaire was conducted. Fourteen accident and emergency departments participated and one hundred senior house officers answered the questionnaire. A large percentage of the respondents would use an inappropriate route of administration (intramuscular 50% rather than intravenous 50%), some would use an inappropriate drug and often wait too long (90 min) before giving a further dose of analgesic should the patient continue to be in severe pain after the initial dose. These results suggest that there is need for further teaching on pain relief at medical schools, casualty officers need to be taught about analgesia when they start working in accident and emergency departments, and it may be beneficial for accident and emergency departments to have an analgesic policy.

Oesophageal perforation: a rare complication of minor blunt trauma.

Oesophageal perforation following blunt trauma is rare and accounts for less than 10% of all oesophageal ruptures. Review of published reports revealed only two cases of isolated oesophageal perforation after minor blunt trauma, and these were as a direct result of the Heimlich manoeuvre. This paper describes a case of perforation of the oesophagus as an isolated injury following blunt minor trauma.

Diagnosis of acute bone pain using isotope bone imaging.

Twenty-one patients with acute bone pain in areas other than the scaphoid were referred for isotope bone imaging directly from the A&E department. Of these scans 61% were positive. The various pathologies seen included stress fractures, osteomyelitis and bony metastases. Implications of the findings are discussed.

Use of isotope scanning as an aid to the diagnosis of pulmonary embolism in the accident and emergency department.

Twenty-five patients with a clinically suggestive diagnosis of pulmonary embolism were referred directly from the accident and emergency department for a ventilation and perfusion isotope scan. On the basis of a negative scan, the authors were able to discharge 19 patients. The advantages of having direct access to isotope imaging are described.

[Dependence of blood flow in human aorto-coronary bypass grafts on the extravascular resistance (author's transl)]. / Abhängigkeit der Strömung im aorto-koronaren Bypass des Menschen vom extravasalen Widerstand.

As has been shown in a large number of animal experiments, there is a marked difference between the systolic-to-diastolic flow ratios of the right coronary artery and the left. We examined these ratios in 107 patients who were undergoing aorto-coronary bypass surgery as treatment for coronary artery disease. After cessation of cardio-pulmonary bypass, the blood flow was recorded electromagnetically in a total of 126 venous grafts to the right or to the branches of the left coronary arteries. From these tracings, the following magnitudes were calculated: coronary stroke flow per heart beat, systolic and diastolic stroke flows, mean flow, systolic and diastolic flows. The ratio of the systolic to the diastolic stroke flow was 0.30 +/- 0.17 for the branches of the left coronary artery (n = 79) and 0.61 +/- 0.30 for the right coronary artery (n = 47). The ratio of systolic to diastolic flow was found to be 0.46 +/- 0.25 (branches of the left coronary artery) and 1.01 +/- 0.62 (right coronary artery), respectively. All these values differ statistically on a probability level of p less than 0.001. In principle, our results agree with those of canine experiments. The considerable variation of the individual values of the systolic-to-diastolic flow ratios can be explained by the following: 1. the variability of the pattern of coronary blood supply in man; 2. the actual right and left ventricular pressures; 3. the extent of stenoses present; 4. the degree of myocardial impairment due to ischemia. These factors combined determine the actual value of the extravascular (myocardial) component of the peripheral coronary resistance, which is most effective during systole.

Foreign body in the throat.

The management of 104 patients complaining of foreign body (FB) in the throat in an accident and emergency (A&E) department was analysed over a period of 7 months. The majority of these patients (88.4%), underwent a soft tissue radiograph of the neck. Less than 10% of the radiographs were thought to be abnormal by the A&E staff. Two thirds of the patients (69.2%) were referred to the ear, nose and throat (ENT) surgeons. Of these 84.7% had indirect laryngoscopy. Eighteen (17.3%) FBs were found in addition to five (4.8%) other causes of the symptom. It is concluded that routine use of radiographs in the assessment of FB in the throat is inappropriate. By contrast thorough clinical examination and indirect laryngoscopy (IDL) have a high diagnostic yield. A protocol is suggested for managing the condition.

[Treatment of hand surgery patients in chronic pain]. / Therapie chronischer Schmerzpatienten in der Handchirurgie.

The treatment of hand surgery patients suffering from chronic pain requires an interdisciplinary procedure. An imbalance between nociception and antinociception can be seen as a reason for the chronification of pain. The complexity of the problem of chronic pain patients is marked by a wide variety of symptoms. Full diagnostic assessment to detect or to exclude other organic diseases is required. Rehabilitation to improve function and reduce pain intensity has priority. Our therapeutic strategy consists of intensive physiotherapy and analgesic drugs as well as a series of blockades with buprenorphine (Temgesic) of the ganglion stellatum (GLOA). This specific therapy achieved an improvement of the function of the upper extremity and a reduction of pain intensity. The majority of patients were satisfied with the outcome.