Arthroscopic subacromial decompression for advanced (stage II) impingement syndrome: a study of 52 patients with five years follow-up.

The authors report a prospective five-year follow-up study of 52 patients who had arthroscopic subacromial decompression for advanced (stage II: type 1 and 2) rotator cuff disease. All patients were assessed preoperatively, at six months and at five years postoperatively using the Constant-Murley score and the revised American Shoulder and Elbow Surgeons (ASES) score. From six months until five years postoperatively, 45 (out of 52) patients showed a further progressing improvement and relief of symptoms. This is established by a significant (p < 0.001) increase of the mean Constant-Murley score from 76.4 at six months postoperatively to 84.9 at five years postoperatively.

Synovial actinomycosis of the hip: case report and review.

A case of hematogenous spread of an actinomycotic granule to the left hip joint is presented. This occurred in a 62-year-old woman under immunosuppressive treatment for Wegener's disease. It was a chance finding on routine synovium biopsy during a total hip replacement. Treatment consisted of 1 g ampicillin I.M. a day for six weeks. The postoperative course was uneventful.

Ochronotic arthropathy: the black hip. Case report and review of the literature.

Ochronosis is the dark pigmentation of connective tissues in patients with alkaptonuria. The latter is an autosomal recessive deficit of phenylalanine and tyrosine metabolism with various clinical manifestations. We report on a 63-year-old man with familial ochronosis, who presented with a terminal degenerative right hip joint; his older brother had already been successfully treated at our department by total hip replacement. The postoperative course was uneventful and satisfactory for both.

Improvement of clinical staging in cervical cancer with serum squamous cell carcinoma antigen and CA 125 determinations.

Staging of cervical cancer is routinely performed by means of examination under anesthesia in combination with radiographic and/or endoscopic techniques. This "clinical" staging leads to 10-25% misclassification, mostly due to positive lymph nodes or lymph or blood vessel invasion. Determination of pretreatment squamous cell carcinoma antigen (SCC) and CA 125 serum levels may solve part of this staging problem and may improve the selection of the most appropriate individual therapy. Using 2.5 ng/ml (SCC) and 35 U/ml (CA 125) as cutoff levels, we studied 99 patients retrospectively. Elevated levels were found in 27% (SCC) and 23% (CA 125). In clinical stage IB or IIA disease 45/81 patients had positive nodes or lymph or blood vessel invasion at operation. Of these patients 49% had elevated serum levels of SCC or CA 125. Strongest correlation was found with blood vessel invasion (57%). Only 19% of low-stage patients without evidence of vascular spread of disease had positive levels. The positive predictive value of SCC and CA 125 for detection of vascular spread of disease in low-stage cervical cancer was 76%. In most centers surgery is the primary treatment of choice in low-stage cervical cancer. Nevertheless, with respect to patient survival, results of primary surgery and primary radiotherapy are comparable. Radiotherapy given in an adjuvant setting leads to a high incidence of severe complications. In order to overcome part of these complications one should consider radiotherapy as the primary therapy of choice in patients with clinical stage IB or IIA cervical cancer with elevated pretreatment SCC or CA 125 levels.

Fryns syndrome without diaphragmatic hernia?

We report on a child with Fryns syndrome including lung hypoplasia, characteristic facial appearance, cleft palate, cardiac anomaly, distal limb abnormalities, absent nipples, bicornuate uterus and early death. In contrast to most patients with Fryns syndrome, diaphragmatic hernia was absent in our patient. However, the diaphragm was reduced to a fibrous web with reduced muscular component.