Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament. A review of 41 cases.

We studied retrospectively a consecutive series of 547 shoulders in 529 patients undergoing operation for instability. In 41, the cause of instability was considered to be lateral avulsion of the capsule, including the inferior glenohumeral ligament, from the neck of the humerus, the HAGL lesion. In 35, the lesion was found at first exploration, whereas in six it was noted at revision of a previous failed procedure. In both groups, the patients were older on average than those with instability from other causes. Of the primary cases, in 33 (94.3%) the cause of the first dislocation was a violent injury; six (17.4%) had evidence of damage to the rotator cuff and/or the subscapularis. Only four (11.4%) had a Bankart lesion. In patients undergoing a primary operation in whom the cause of the first dislocation was a violent injury, who did not have a Bankart lesion and had no suggestion of multidirectional laxity, the incidence of HAGL was 39%.

Out-patient follow-up after routine surgery: a questionnaire study.

A questionnaire was sent to all consultant general surgeons and urologists in Wales to assess current practice in out-patient follow-up after surgery for nine commonly performed procedures. A further questionnaire was sent to a random sample of general practitioners in South Glamorgan to assess the possibility of GPs taking on responsibility for post-operative follow-up. This should, therefore, reduce the number of post-operative patients passing through the out-patient department. Of the 58 (77%) consultants who responded, the percentage who routinely followed up patients with at least one post-operative visit was calculated. Of the 33 (66%) GPs who responded the percentage who were prepared to take responsibility for post-operative follow-up was calculated for patients having the same operations. There was agreement and disagreement between consultants and GPs, but not distinct pattern emerged. A larger study must be performed before the out-patient department is rationalized using protocols based on this study.

An evaluation of the Constant-Murley shoulder assessment.

We have analysed the Constant-Murley (1987) assessment for 25 patients with shoulder pathology. We found the score easy to use, with low inter- and intraobserver errors, but sufficiently imprecise in repeated measurements to give concern in its use for clinical follow-up of patients. We have calculated 95% confidence limits for a single assessment to be within 16 to 20 points in most cases. In addition, we found that all our subjects with instability as their main problem scored within five points of the maximum; this suggests that the scoring method may need to be revised for use on these patients.

The Seidel humeral locking nail: an anatomical study of the complications from locking screws.

The Seidel locking nail was inserted into the humeri of 20 cadavers. Subsequent dissection showed that the proximal locking screws had damaged the circumflex nerve or biceps tendon in eight of the cases.

Prenatal undernutrition permanently decreases enteric neuron number and sympathetic innervation of Auerbach's plexus in the rat.

The density of the sympathetic innervation and enteric neuron number in Auerbach's plexus has been investigated by glyoxylic acid histofluorescence and by enzyme histochemistry respectively, in the jejunum of adult rats whose mothers had undergone dietary restriction during the last two weeks of pregnancy. Enteric neuron numbers were reduced by 27% and the sympathetic innervation was more sparse, less regularly arranged and showed less fluorescence in the undernourished rats compared to control groups. These results indicate that the effects of maternal undernutrition on the sympathetic and enteric nervous systems are long lasting in the offspring and also that the terminal parts of the sympathetic neuron, as well as the cell body, are susceptible to a nutritional insult.

Effects of prenatal undernutrition on prevertebral sympathetic neurons in the rat: a morphological and fluorescence histochemical study.

The effects of maternal undernutrition during the last seven and last fourteen days of pregnancy on neurons of the rat coeliac-superior mesenteric ganglion has been investigated in neonates and in adult animals. The parameters studied were neuron diameter and the level of neuronal noradrenaline fluorescence. The morphology was more permanently affected by fourteen than by seven days undernutrition as shown by the smaller neuron diameters persisting at six months. Both periods of undernutrition affected noradrenaline levels permanently: seven days undernutrition producing a rise and fourteen days producing a depression. These changes demonstrate the permanent effects of maternal undernutrition on the development and maturation of prevertebral sympathetic neurons.