A new method of extension-block splinting for the proximal interphalangeal joint--Preliminary report.

Many methods of treating proximal interphalangeal joint volar plate avulsions have been described, and although some of these methods are appealing, they do have certain drawbacks which limit their usefullness. This paper describes a splint which is easily made, covers only the finger involved, and blocks extensions nicely.

Bowen's disease in multiple nail beds--case report.

Bowen's disease is in situ squamous cell carcinoma of the skin. A histologically confirmed case of Bowen's disease in multiple nail beds in the hands of a 40-year-old is reported. Treatment consisted of multiple operations involving excision, skin grafting, and the use of 5-fluorouracil.

Physeal remodeling after internal fixation of slipped capital femoral epiphyses.

Rounding off the femoral neck metaphysis helps improve hip function in slipped capital femoral epiphysis (SCFE). Remodeling by physeal growth, not previously reported, may also contribute. By studing the changes in physeal-shaft angle after internal fixation (IF), we found evidence of physeal remodeling in one of 21 mild, five of 23 moderate, and in all of 11 severe slips. Although the amount of remodeling averaged 11.7 degrees, it occurred in 100% of severe slips (p less than 0.001). This support the use of initial pin fixation and a wait of at least 2 years before realignment femoral neck osteotomies are considered.

Prophylactic bypass grafting of the prepseudarthrotic tibia in neurofibromatosis.

Nine cases of prophylactic bypass grafting of the prepseudarthrotic tibia in neurofibromatosis were reviewed. The age at operation ranged from 0.9 to 9.2 years. The graft used was variously the opposite tibia, autograft rib, allograft fibula, and allograft bone chips in combination with autograft or allograft. All patients were braced postoperatively. Follow-up ranged from 2.9 to 18.8 years. Allograft bone chips resorbed in every case. All autografts and the one fibular allograft united with the tibia. Three tibias required further procedures to obtain union after development of pseudarthrosis, whereas six remained intact.

The third dimension in renal diagnosis. Scanning electron microscopy of normal and abnormal kidney.

Scanning electron microscopy, a relatively young discipline, has been used mainly for research purposes and very seldom as a diagnostic procedure. A study was made of normal and abnormal kidneys by light, transmission and scanning electron microscopes. Normal human and rat kidneys were examined under the scanning electron microscope but cellular detail was not clearly defined. Tissue was then cryofractured, critical-point dried, sputter-coated and examined again. Scanning electron microscopy then revealed greater cellular detail. Rats were injected with a solution of 0,6% uranyl nitrate in normal saline, and cryofractured sections were examined. Pathological changes were seen in the glomerulus as well as in the tubules. Scanning electron microscopy, while not replacing conventional modes of examination, can provide a rapid third dimension in the diagnosis of renal lesions.

Effects of low and high density lipoproteins on renal cyclosporine A and cyclosporine G disposition in the isolated perfused rat kidney.

PURPOSE: This study investigated the effects of low (LDL) and high density lipoproteins (HDL) on renal cyclosporine A (CsA) and cyclosporine G (CsG) disposition in the isolated perfused rat kidney model. METHODS: Kidneys were perfused with CsA or CsG in perfusion medium containing 6% protein, bovine serum albumin only (BSA) (Control), LDL (200 mg/dl) and BSA, or HDL (200 mg/dl) and BSA. In vitro protein binding studies were conducted with CsA and CsG in the same media. RESULTS: The unbound fractions (fu) of CsA and CsG were significantly reduced with LDL and HDL in the perfusion media. In the presence of LDL, fu for CsA and CsG was 3.9% and 5.9%, respectively. With HDL, fu was 2.1% for CsA and 1.8% for CsG. fu for the controls was 14.7% for CsA and 11.9% for CsG. Renal clearance (CLR) of CsA and CsG was significantly reduced when perfused with perfusion medium containing LDL and HDL. LDL and HDL had similar effects on reducing CsA and CsG CLR, and were approximately four-fold lower when compared to controls (approximately 0.006 Vs. 0.023 ml/min). Renal CsA and CsG tissue (whole organ, cortex and medulla) concentrations were lower than corresponding controls when perfused with LDL or HDL. CONCLUSIONS: The interaction of CsA and CsG with LDL and HDL significantly reduced the CLR and extent of renal tissue distribution of both compounds.

Fatal adenovirus pneumonia: Clinical and pathological features.

A review of autopsies of 107 young children with pneumonia showed that 15 children (14%) had adenovirus infections, the diagnosis being based on characteristic histopathological and ultrastructural features in the lungs. Eleven (73%) of the cases of adenovirus infection followed on measles infection, and it is suggested that some became infected with adenovirus after admission to hospital. A review of clinical aspects revealed no unique features. Histopathological examination of tissues showed a common picture of necrotising bronchopneumonia, with minor degrees of rental tubular damage, infiltrates of large mononuclear cells in spleen and nodes, and an absence of lymphoid germinal centres. On light microscopy, "rosette" and "smudge" cells were seen in these cases, and two patterns of virus particle distribution in infected cells were seen ultrastructurally. It is postulated that "smudge" cells contain numerous crystalline viral arrays.

External fixation maintained until fracture consolidation in the skeletally immature.

In a prospective study, we investigated the effects of external fixation on fracture union in skeletally immature patients. Twenty-five fractures of the femur and tibia in 21 patients were fixed externally with the intention of leaving the fixator in place until the fractures consolidated or nonunion was established. The main indications were head injury and multiple trauma. One hundred percent of the fractures consolidated with the fixator in place; 45 of 50 joints had 100% motion, three had 95% motion, and two had 60% motion owing to scarring from traumatic wounds. Eight-four percent of the fractures lost no position in the fixator, and 16% lost < or = 5 degrees.

Shelf-lives and factors affecting the stability of morphine sulphate and meperidine (pethidine) hydrochloride in plastic syringes for use in patient-controlled analgesic devices.

Published reports regarding the stability of morphine are at variance, especially in syringes used in patient-controlled analgesia (PCA) devices. In addition to the effects of container type and vehicle, reasons for this variation include the effect of excipients temperature and light during storage. Furthermore, the literature varies regarding the mechanisms of decomposition for morphine. To our knowledge, the stability of meperidine (pethidine) stored in plastic syringes has not been reported. The purposes of this study were to investigate the stability of morphine sulphate (1 and 5 mg/ml) and meperidine hydrochloride (5 and 10 mg/ml) in plastic syringes for use in PCA devices for a duration of 12 weeks, and evaluate the influence of light (240 foot-candles), temperature (-20, 4 and 23 degrees C), diluent (5% dextrose or normal saline), and drug concentration on the stability of these narcotic analgesics. Samples were taken bi-weekly for solutions protected from light and weekly for solutions exposed to light. Morphine sulphate and meperidine hydrochloride concentrations were quantified using independent, stability-indicating, high performance liquid chromatographic assays. The within-day and between-day coefficients of variation for these assays were < or = 4% over each of the concentration ranges studied. Under the conditions of this study, it is proposed that although decomposition of morphine to its main product, pseudomorphine, can be interpreted using first-order kinetics, consecutive (to form the N-oxide) and parallel mechanisms (to form apomorphine) exist. Morphine solutions were more stable in normal saline than in 5% dextrose. Shelf-life data indicate that morphine is stable for at least 6 weeks when protected from light.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of atenolol on treadmill performance in patients with angina pectoris.

The efficacy and safety of atenolol was evaluated in 16 patients with exertional angina pectoris in a single-blind, once daily, increasing dose study. All patients had coronary artery disease documented by previous myocardial infarction, coronary angiography, or an abnormal exercise ECG. After a four-week placebo period, patients received 25, 50, and 100 mg of atenolol once daily during three two-week periods. This was followed by a three-week treatment period with 200 mg of atenolol once daily. The study was concluded with a two to four week posttreatment period. Antianginal efficacy was assessed by monitoring changes in treadmill exercise performance in each patient 3 and 24 hours after the administration of atenolol. The endpoint of the treadmill exercise was mild but definite chest pain. At 3 and 24 hours after all dosages, atenolol significantly prolonged the duration of exercise and increased the work performed. The pulse rate and double product at the endpoint of exercise were lower with all atenolol doses. Overall, at 24 hours after the administration of atenolol, exercise tolerance was progressively increased as the dose increased. The mean duration of exercise and work performed increased 28.5 and 35.4%, respectively, on the 25-mg dose; 36.9 and 45.5%, respectively, on the 50-mg dose; 45.1 and 59.5%, respectively, on the 100-mg dose; and 65.4 and 84.8%, respectively, on the 200-mg dose. Patient acceptance and compliance were good. Single daily doses of atenolol constitute effective therapy for exercise-induced angina.

Three cases of staphylococcal pyomyositis in adolescence, including one patient with neurologic compromise.

Pyomyositis is rarely reported in the United States and is not easily recognized. In a 4-year period, we treated three adolescents from our vicinity with muscle infection resulting from Staphylococcus aureus. One was an insulin-dependent diabetic patient. Two patients had deep infections about their pelvis, one of which resulted in acute loss of bowel and bladder function. In all three cases, the patient did not recover until the abscess was operatively drained. Diagnosis was delayed because of lack of awareness of the condition, the deep muscles involved, and clinical presentation before formation of a localized abscess. Indium scan may be a very useful initial diagnostic test.

Rotational remodeling of malrotated femoral fractures: a model in the rabbit.

It is estimated that 20-40% of femoral fractures in children heal in malrotation, yet few patients later complain. To determine if malrotation corrects spontaneously, midshaft osteotomies were made in femurs of 16 rabbits aged 8 weeks and the distal fragments were internally rotated 45 degrees, where they were held with external fixators. The animals were killed between week 0 and week 17. Version of the femoral necks was determined by computed tomography scan (CT). The version altered rapidly toward normal from weeks 0 to 4 and then remained stable, with an average rotational remodeling of 55%.

A randomized trial of exercise training in patients with coronary heart disease.

In order to determine whether or not regular exercise could alter myocardial perfusion or function, we randomized 146 male volunteers with stable coronary heart disease to either a supervised exercise program (n = 72) or to a usual care program (n = 74). Subjects underwent exercise tests initially and one year later. Significant differences between the two groups included improved aerobic capacity, thallium ischemia scores, and ventricular function in the exercise intervention group. It was not possible to classify the conditions of patients as to the likelihood of improvement or deterioration. This study demonstrated changes in myocardial perfusion and function in a select group of middle-aged men with coronary heart disease who underwent a medically appropriate exercise program lasting one year, but these changes were relatively modest.