POEMS syndrome - a unique presentation of a rare paraneoplastic syndrome.

POEMS (peripheral neuropathy, organomegaly, endocrinopathy, M protein, skin changes) syndrome is a rare multisystem paraneoplastic disorder. A 40-year-old male with a history of peripheral neuropathy and erectile dysfunction presented with a pathological fracture of the neck of the femur, found to be a solitary plasmacytoma. Additional unusual features included splenomegaly, hyperprolactinaemia and skin changes. The patient had a total hip replacement at a specialist orthopaedic hospital and is due to undergo radiotherapy to the femoral lesion and autologous stem cell transplantation.

Traumatic anterior shoulder instability: current concepts in management.

This review will give an overview of the current management practice and ethos of recurrent anterior shoulder instability, a condition which continues to puzzle and intrigue the shoulder surgeon.

Posterior subluxation and dislocation of the shoulder in obstetric brachial plexus palsy.

We describe the results of surgical treatment in a prospective study of 183 consecutive cases of subluxation (101) and dislocation (82) of the shoulder secondary to obstetric brachial plexus palsy between 1995 and 2000. Neurological recovery was rated 'good' or 'useful' in all children, whose lesions fell into groups 1, 2 or 3 of the Narakas classification. The mean age at operation was 47 months (3 to 204). The mean follow-up was 40 months (24 to 124). The mean gain in function was 3.6 levels (9.4 to 13) using the Mallet score and 2 (2.1 to 4.1) on the Gilbert score. The mean active global range of shoulder movement was increased by 73 degrees ; the mean range of active lateral rotation by 58 degrees and that of supination of the forearm by 51 degrees . Active medial rotation was decreased by a mean of 10 degrees . There were 20 failures. The functional outcome is related to the severity of the neurological lesion, the duration of the dislocation and onset of deformity.

Inferior epigastric artery avulsion: a fracture table complication.

The use of traction as an aid to fracture reduction and treatment is well recognized. We present a patient with a complex subtrochanteric femoral fracture that was reduced and fixed using traction on a fracture table. This led to avulsion of the contralateral inferior epigastric artery and life-threatening hemorrhage that necessitated operative intervention.

Social adjustment of children successfully treated for cancer.

Compared 56 children between the ages of 5 and 12 years to a sample of healthy controls. All cancer patients had been treated between the ages of 2 and 5 years. Children completed the Self-Perception Profile for children and questionnaires assessing social adjustment. Parent and teacher ratings were also obtained. The cancer patients reported greater feelings of isolation than the controls but otherwise few differences were noted. There were few differences between cancer patients and controls in the teacher and parent report. Results are discussed in terms of the need to investigate behavioral sequelae of childhood illness and directions for future research.

A comparison of two stress-reduction treatments for mothers of neonates hospitalized in a neonatal intensive care unit.

Thirty mothers of preterm infants requiring neonatal intensive care unit (NICU) hospitalization were assigned randomly to one of three groups to assess differences in treatment effectiveness of facilitating parental adaptation to the NICU stresses. Groups consisted of: (a) a treatment group receiving videotape training in active problem-focused coping strategies; (b) a treatment group receiving videotape training in emotion-focused strategies to help manage anxiety; and (c) a control group receiving promotional information about the hospital and the NICU. On pretreatment measures most of the mothers exhibited little distress, a finding unlike those for the majority of NICU studies. On posttreatment follow-up both the problem-focused and emotion-focused treatment groups were significantly less anxious than the controls and lower levels of depression were observed for the emotion-focused group. Findings suggest that the coping interventions examined were cost efficient and appear promising in facilitating mothers' coping with NICU stresses.