The value of scintigraphy in hips with slipped capital femoral epiphysis and the value of radiography and MRI after 10 years.

Preoperative bone scintigraphy of the femoral head in 33 hips with slipped capital femoral epiphysis, showed no relation to duration of symptoms or degree of slip. The preoperative uptake was always normal or increased. Two hips had postoperative femoral head uptake below normal, both had complications affecting the vascular supply, resulting in necrosis of the femoral head and severe arthrosis. At follow-up after 10 (5-15) years of 28 hips, no relation could be demonstrated between Adolescent Hip Questionnaire which included clinical data, and radiography or magnetic resonance imaging. We only recommend scintigraphy after complications jeopardizing the vascular supply of the femoral head in slipped capital femoral epiphysis.

Immunocytochemical demonstration of pituitary adenylate cyclase activating polypeptide (PACAP) in the porcine epiphyseal cartilage canals.

Pituitary adenylate cyclase activating polypeptide (PACAP), a member of the vasoactive intestinal polypeptide (VIP)/secretin/glucagon family, is known to be a powerful stimulator of adenylate cyclase. Recently, PACAP has been shown to stimulate cAMP in osteoblast-like cells and mouse calvarian bones. In the present study, PACAP immunoreactivity (IR) was demonstrated in cartilage canals from newborn and 3-4-week-old pigs. In tissues from the femoral head and the patella with and without ossification centres, PACAP-IR nerve fibres were found in the cartilage canals innervating blood vessels. The pattern of distribution was not dependent on age or the occurrence of an ossification centre. Co-localization studies showed a high degree of co-localization with calcitonin gene-related peptide (CGRP) and substance P (SP) but little co-localization with VIP. Our findings support earlier findings of CGRP, SP and VIP in bone tissue and add PACAP to the group of neuropeptides with a sensory and/or modulatory function in bone tissue.

Nerves in human epiphyseal uncalcified cartilage.

Increasing evidence demonstrates clinical and neuroendocrine regulation of the skeletal system. We have demonstrated nerve fibers in cartilage canals in human fetal epiphyseal uncalcified cartilage. We investigated specimens from the femur, the proximal tibia, and the humerus from 12 human bodies with an age from the 22nd gestational week to 13 months after birth. We performed Bodian silver staining, Klüver-Barrera staining, and immunostaining for neurofilaments, myelin basic protein. S-100 protein, and vimentin. We observed positive Bodian staining and immunoreaction to neurofilaments in all specimens older than the 30th week of gestational age. Myelin or Schwann cells could not be demonstrated, nor could mechanoreceptors. This indicates a traditional classification as type C nerve fibers with sensory or sympathetic function. In skeletal nerves, an increasing number of neuropeptides influencing bone cells has been detected. The nerves in the cartilage canals may have functions such as regulation of developmental or pathological processes.

["Radio-medical Advice Service"--14 years of overseas medical advice]. / "Radiomedical Advice Service"--laegelig rådgivning til søfarende gennem 14 år.

From 1980 to 1993, the Danish Radio Medical Advice Service (RMAS) had 1136 contacts from overseas Danish merchant ships and 213 contacts from Danish territorial waters. The distribution of the diagnoses in the overseas contacts were: Diseases in the digestive and genitourinary system 30%, traumatic lesions 23%, infectious diseases 14%, diseases in the cardiovascular and respiratory system 9%. The only trend over the years was a significant (p = 0.01) decrease in psychiatric diagnoses. Evacuation was recommended in 53% and medicine was prescribed in 61% of the contacts. The medical speciality for doctors participating in RMAS should be general surgery or orthopaedic surgery but access to advice from all other medical specialities should be available. Experience as a naval medical officers would be beneficial. The education of the officers on the ships should include intravenous infusion. The communication should be by telephone and television would be an advantage.

Radio medical advice--the Danish experience.

From 1980 to 1993, the Danish Radio Medical Advice Service (RMAS) had 1136 contacts from overseas Danish merchant ships and 213 contacts from Danish territorial waters. The diagnoses were almost always of acute conditions. The distribution of the diagnoses in the overseas contacts were; diseases in the digestive and genitourinary system 30%, traumatic lesions 23%, infectious diseases 14% and diseases in the cardiovascular and respiratory system 9%. The only trend over the years was a significant (P = 0.01) decrease in psychiatric diagnosis. Evacuation from the ship was recommended in 53% and medicine was prescribed in 61% of the contacts. The medicine was antibiotics in 40% and analgesics in 29% of the contacts. Intravenous infusion was evaluated as relevant in 5% of the cases and this procedure will be included in the new education of officers on the ships. In the contacts from Danish territorial waters, where many ships are recreational yachts, evacuation was recommended in 79% and medicine was prescribed in 28% of the contacts. This was probably due to the short distance to the nearest harbour and the variation in medical equipment and knowledge. The medical speciality for doctors participating in RMAS should be general surgery or orthopaedic surgery but access to advice from all other medical specialities should be available. Experience as a naval medical officer would be beneficial. The education of the officers on the ships should be more comprehensive including e.g. intravenous infusion. Communication should be by telephone and television would be an advantage.

The Cotrel-Dubousset instrumentation for unstable sacral fractures. Report of 3 patients.

We present a new operative procedure using the Cotrel-Dubousset (C-D) instrumentation in unstable sacral fractures, where the vertebral column is dissociated from the pelvis. This technique is based on screw fixation in the ileum and in the first sacral and the fifth lumbar vertebrae or the fifth and fourth lumbar vertebrae, with help of interconnecting rods. 3 patients were successfully treated.

Pressure-position relations in the glenohumeral joint.

The intra-articular pressures in the glenohumeral joint in different positions were measured in 12 cadaveric shoulders. The lowest pressure was found in abduction combined with traction. A significant rise in pressure was seen in positions combining flexion or abduction with rotation. The injected volume to produce a certain pressure as well as the maximum pressure attained in each shoulder showed great variation. These factors are important considerations for immobilization of the shoulder and manipulation during arthroscopy.

CT scan compared to tomography in suspected hip fracture.

In a prospective study the diagnostic value of CT scanning and tomography were compared in the cases of eight consecutive patients in whom initial radiographs showed a suspected hip fracture. CT scan did not contribute more to diagnosis than tomography.

Intraarticular fractures of the distal end of the radius in young adults. A 16 (2-26) year follow-up of 42 patients.

Forty-two patients, aged 29 (17-42) years when they sustained an intraarticular fracture of the distal end of the radius, were reexamined after 16 (2-26) years. More than two thirds of the fractures were caused by high-energy trauma. Subjectively, 34 patients had excellent or good results, while only 8 had fair or poor results; 6 patients had changed their occupation owing to disability from the wrist. Almost half of the patients had residual deformity at the follow-up clinical examination. Slightly more than half of the patients had radiographic arthrosis. Subjective evaluation correlated with residual deformity and arthrosis, but not with radiographic displacement or intraarticular step off. Arthrosis correlated with residual deformity and intraarticular step off, but not with radiographic displacement. Clinical residual deformity included soft-tissue changes in contrast to radiographic displacement. More interest should be directed to soft-tissue changes following this type of fracture.

An unusual type of fracture in the upper sacrum.

An unusual type of indirect isolated fracture of the upper sacrum is presented. The upper sacrum was markedly comminuted and nondisplaced relative to the lower fragment. There was a neurologic deficit present. On the basis of a review of the literature, a previous classification system and the actual fracture mechanism, this fracture is classified as a special type; type 4, or the neutral position fracture.

The influence of skeletal traction on intraarticular pressure of the hip.

Patients with a femoral neck fracture often undergo skeletal traction until surgery. These patients may develop hip joint tamponade that can lead to necrosis of the femoral head. We have measured the pressure variations in 20 cadaveric hips using a semiflexion frame and various loads of skeletal traction. We found a significant decrease in pressure with loads of 5 kg or more of skeletal traction. Skeletal traction does not increase the risk of femoral head necrosis.

Hematomas and subcutaneous suture techniques in total hip replacement. An ultrasound study.

Thirty-five patients undergoing total hip replacement due to primary arthrosis were randomized into two groups. In one group each subcutaneous suture included a stitch in the fascia; in the other group the fascia was not included in the suture. Ultrasonography examination showed no significant difference in the number of subcutaneous hematomas in each group. Nine subcutaneous and nine deep hematomas were diagnosed by ultrasound in 15 patients. Three patients had a clinical diagnosis of hematoma and in only one of these did ultrasonography support the diagnosis. It appears that the clinical diagnosis of hematomas, even subcutaneous hematomas, is unreliable. Careful hemostasis is recommended.

Coccygodynia treated by resection of the coccyx.

Sixty-five patients suffering from coccygodynia resistant to conservative treatment had total or partial coccygectomy, all without serious complications. Eight reoperations were performed. After an average of 15 years, 46 of the 55 patients seen at follow-up were satisfied. A normal radiograph of the coccyx does not exclude a good result from coccygectomy. We recommend total coccygectomy using a longitudinal incision in carefully selected and well-informed patients.

[Hypertension following blunt kidney injury]. / Hypertension efter stumpe nyretraumer.

The incidence of hypertension after blunt renal injury is reviewed on the basis of the available literature in English and Danish from 1934 to the present day. The selected literature fulfills defined requirements as regards quality. Hypertension develops one to two days after the trauma and this remits spontaneously after an average of 29 (7-50) days. The reason for this is a perirenal haematoma which produces ischaemic renal tissue by compression after which the haematoma is resorbed. This is demonstrated by urography and investigation of the renin-angiotensin system. The frequency is stated to be 6.7% in an isolated investigation but this must be regarded with reservation. A considerably longer period after the trauma, permanent hypertension develops. This is due to permanent pathological changes which produce ischaemic renal tissue by compression or stenosing of the lumina of the renal arteries. The frequency of this type of hypertension is so low that it cannot be estimated on the basis of the follow-up examinations carried out. These show a frequency of hypertension of between 2.3 and 3.8% which may be explained by the development of spontaneous hypertension. A definite relationship between permanent hypertension and blunt renal injury has only been found in 28 case reports.

Resection of the first rib, following deep arm vein thrombolysis in patients with thoracic outlet syndrome.

In order to evaluate, the prophylactic effect of first rib resection in patients with fibrinolytic recanalised deep arm vein thrombosis, we present our experience with 21 patients. After recanalisation 12 had phlebographic signs of venous compression in the costoclavicular space, with the arm in the normal position. This fulfills the requirements for thoracic outlet syndrome (TOS). In 60 normal persons without symptoms of TOS none had phlebographic signs of venous compression with the arm in normal position. This difference is significant. In the 12 patients TOS was suspected was to be the underlying cause of rethrombosis and first rib resection was performed. Two patients with TOS had rethrombosis before first rib resection could be performed. At follow up 1 to 6 years after the thrombosis no rethrombosis was found. TOS and deep arm vein thrombosis is rare. Controlled studies are not available. We advocate first rib resection in patients with successful fibrinolysis and TOS in order to avoid rethrombosis.

The effect of skeletal traction on femoral neck fractures.

Patients with fracture of the femoral neck often undergo skeletal traction until surgery. We found that the fracture position worsened in 5 of 15 patients during the period with skeletal traction. Accordingly, skeletal traction does not prevent further vascular damage to the femoral head. We advocate operating as soon as the patient's condition is stable.

Bacteriologic contamination of suction tips during hip arthroplasty.

We obtained positive cultures from 12 out of 22 suction tips used in total hip arthroplasty performed in operating theaters with conventional ventilation. We recommend that the suction tubes be turned off when not in use and that the tubes be changed during operations.

Anomalous inferior vena cava impeding implantation of aortobifemoral vascular prosthesis.

A case of double inferior vena cava (IVC) impeding surgery of the abdominal aorta is presented. The patient also had duplication of the kidney and ureter on both sides. The anatomical anomalies of the IVC, kidney and ureter interfering with abdominal aortic surgery are reviewed.

The reliability of transabdominal ultrasound scanning in the determination of prostatic volume. An autopsy study.

The prostatic volume as determined by transabdominal ultrasound scanning using the ellipsoid method was compared to the prostatic volume determined by autopsy in 26 post-mortem men. The regression line was nearly optimal (Y = 1.06 chi + 0.57) although it seems that ultrasound underestimates prostatic volume slightly. The parametrical correlation coefficient was 0.86 and the non-parametrical Spearmans rho was 0.76. It is concluded that transabdominal ultrasound scanning has a definite value in the assessment of prostatic size.