Post-streptococcal glomerulonephritis: not an extinct disease!

We present the case of a 29-year-old type 1 diabetic patient with the diagnosis of acute post-streptococcal glomerulonephritis. The incidence of this textbook example of acute glomerulonephritis has dropped dramatically in the developed world during the past decades due to the more widespread use of antibiotics. However, the present case illustrates that it is not an extinct disease and that clinicians should be aware of this entity. Particular attention is needed for the fact that the clinical context in which the disease occurs may be different from the classical "post-angina" presentation.

Sensory nerve repair in perforator flaps for autologous breast reconstruction: sensational or senseless?

The spontaneous return of sensation in autologously reconstructed breasts, especially in the Transverse Rectus Abdominis Myocutaneous (TRAM) flap, generated the belief that sensory reinnervation by nerve repair of the flap would be superfluous. This study compares the sensation of the following non-reconstructed and reconstructed breasts: (1) non-operated breasts; (2) flaps of patients reconstructed with the Deep Inferior Epigastric Perforator (DIEP) flap with sensory nerve repair; (3) flaps of patients reconstructed with the Deep Inferior Epigastric Perforator (DIEP) flap without nerve repair; and (4) flaps of patients reconstructed with the free TRAM flap without nerve repair. Statistically significant lower pressure thresholds were found for DIEP flaps with nerve repair through Semmes-Weinstein testing. More segments of the DIEP flaps with nerve repair reacted to cold, warm and vibratory stimuli compared to flaps without nerve repair. Delayed but satisfactory sensory evoked potential responses were obtained for all reconstructed breasts, but in 46% of TRAM flaps no response could be registered compared with 23% and 0% for DIEP flaps without and with nerve repair, respectively. Questionnaires confirmed the objective data and showed return of erogenous sensation in 30% of the patients with DIEP flaps with nerve repair. Our data reconfirm the possibility of spontaneous return of sensation in pedicled and/or free lower abdominal flaps without nerve repair. Nerve repair in free DIEP flaps nevertheless does restore sensation earlier postoperatively, increases the quality and quantity of sensation in the flap and has a higher chance of providing erogenous sensation. The benefits obtained outweigh the disadvantages of the increased operating time.

Biceps tendon rupture after successful reinnervation: a case report.

Although rupture of the long head of biceps is a fairly common event, its etiology in young healthy individuals has been assumed to be related to an extraordinarily strong muscle contraction. In this report we describe such a rupture following minor trauma in a reinnervated muscle. The case brings up several points of interest concerning tendon tensile strength and potential for rupture.

Noncemented acetabular revision and bone grafts.

In a retrospective study 14 acetabular components, implanted as part of a revision total hip arthroplasty, are radiographically analyzed. Major loss of bone was present in all cases. A bone augmentation technique is described in which a hemispherical porous coated cup was used without additional fixation together with morcelized bone grafts. No failure was noted and radiographic evidence of cup stability was noted in all cases.

Total hip arthroplasty with the porous-coated anatomic (PCA) prosthesis: the femoral component.

This paper reviews the clinical and roentgenographic results of 228 primary non-cemented porous-coated (PCA) total hip replacements after a follow-up time of at least 2 years. The overall clinical results in the current series were satisfactory with at least 84% excellent and good clinical results at 2 years as well as 5 years postoperatively. Although functional results showed no deterioration with time we remain concerned about the high rate of persisting midthigh pain, the progressive loss of bone in the proximal part of the femur and the further loosening of beads from the femoral component's porous coating.

Total hip arthroplasty with the porous-coated anatomic (PCA) prosthesis: the acetabular component.

Two hundred and twenty-eight uncemented total hip arthroplasties using the porous coated anatomic (PCA) one-piece acetabular component were implanted between June 1984 and July 1987 at two hospitals. The PCA total hip was one of the first hip implants to offer uncemented fixation by bone ingrowth. It was used in the younger patients with adequate bone stock. While most arthroplasties were performed for osteoarthritis, it was also used in rheumatoid arthritis, osteonecrosis and dysplastic hips. Revisions were excluded in this series. Bone grafts (autograft) were used to reconstruct the acetabulum in segmental and contained defects. All components were inserted without cement. In all cases a 32 mm femoral head was used. In cases of protrusion often the deep socket design was inserted for reestablishment of the anatomic hip rotation center. Initial cup stability was aimed for by line to line reaming while rotatory stability was augmented by the presence of two peripheral pegs. A maximum contact with the acetabular rim was always aimed for. A variation of the straight lateral approach was used in all cases. In a prospective study the clinical scores were evaluated. X rays were evaluated on AP and lateral views taken immediately after the operation, at two years and at latest follow-up. Cup migration was recorded when there was a change in cup angle, vertical migration of more than two millimeters. Polyethylene (PE) wear was recorded in case of eccentric localisation of the femoral head in the cup. The relationship between PE wear and cup size was also recorded.(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous ruptures of the flexor carpi radialis tendon secondary to STT osteoarthritis.

Two cases of closed ruptures of the flexor carpi radialis which resulted from attrition of the tendon caused by bony spurs secondary to Scapho Trapezo Trapezoidal (STT) osteoarthritis are described. Treatment is conservative.

Conservative treatment of displaced supracondylar humerus fractures of the extension type in children.

Numerous methods for the treatment of displaced supracondylar humerus fractures of the extension type are described in the literature. From 1974 until 1988, we treated conservatively 33 children with such fractures with Dunlop traction. Twenty-nine patients (88%) were re-examined. Four patients (12%) were interviewed by telephone. Good or excellent results were obtained in 31 patients. The Dunlop method is a simple, well-tolerated and safe method that permits surveillance for possible complications. In comparison with other methods, it yields good and reproducible results.

The peroneal nerve: is repair worthwhile?

In this study, the long-term results of secondary common peroneal nerve repair are evaluated. The general consensus has been that the long-term outcome of peroneal nerve repair is poor, because of its mixed sensory-motor nature and the long-distance necessary for axon regeneration. Since the introduction of microneurosurgery and autogenous nerve grafting, an amelioration of poor results might be expected; however, recent reports on common peroneal nerve repair are not available. Four patients underwent either direct peroneal nerve repair (2) or nerve grafting (2) over a five-year period. Dorsiflexion was achieved with peroneal muscle power Grade 3 or above in three patients. The fourth patient is still regaining peroneal power and has not plateaued. These results show that secondary common peroneal nerve repair, even with autogenous nerve grafting, is a worthwhile procedure. The age of the patient, the timing of the repair, meticulous microsurgical technique, and avoidance of tension are critical factors in achieving a successful outcome.