Operative treatment of ulnar impaction syndrome: a systematic review.

This article critically and systematically reviews the surgical treatments for ulnar impaction syndrome. Three types of treatments currently exist: arthroscopic wafer procedure, open wafer procedure, and ulna shortening osteotomy. A total of 36 articles were included from searching the electronic databases PubMed MEDLINE, Ovid MEDLINE, and Ovid EMBASE. Studies were evaluated for quality using the Modified Detsky Score. Of these, 14 articles had a Modified Detsky Score of 6/10 or higher. Satisfaction rates were 100% for arthroscopic wafer procedure, 89% for open wafer procedure, and 84% for ulna shortening osteotomy. The percentage of participants reporting an excellent or good outcome was 82% for arthroscopic wafer procedure, 87% for open wafer procedure, and 76% for ulna shortening osteotomy. In conclusion, available evidence shows that arthroscopic wafer procedure and open wafer procedure may be viable alternatives to the more popular ulna shortening osteotomy, but clinical superiority is yet to be established. Future research should focus on prospective cohort methods and should report participant outcomes using validated scoring methods.

Seasonality and breast cancer.

We have analysed the data of biopsy, tumour size, size, side and axillary lymph node status in a group of 866 patients presenting with breast cancer in Southampton from September 1975 to August 1981 and a group of 1424 women presenting with benign disease in the same period. The whole group showed a seasonal variation, with a peak presentation in June. The pre-menopausal age group account for almost all of this seasonality. The cause of the variation is not established and requires further investigation. The control group of benign breast disease cases did not show a seasonal variation.

The effect of low frequency, long-wave ultrasound therapy on joint mobility and rehabilitation after wrist fracture.

Thirty-eight patients with dorsally-displaced distal fractures were prospectively studied to assess the clinical effects of low frequency ultrasound treatment, started immediately after plaster removal. Nineteen of the patients represented the control group and a double-blind protocol was followed. Assessment took place on the day of plaster removal and 2 and 8 weeks later. There was no significant difference in wrist motion and duration of follow-up between the treated and control patients.

Intra-articular dislocation of the patella: two cases and literature review.

Intra-articular dislocation of the patella remains uncommon and is generally thought to be a problem of young adolescent males. This report reminds emergency physicians that it can occur in the arthritic knee, and it should be considered in the differential diagnosis of locked knee in the elderly. Closed reduction should be attempted in these cases, because the dislocation is liable to be held in place by osteophytes rather than impaction of the patella deep in the intercondylar notch and a good functional outcome can be expected.

An evaluation of the diagnostic value of synthetic luteinizing hormone releasing hormone.

The potential use of LH-RH as a test of pituitary function in women has been investigated. In this study the synthetic material was administered intravenously, and samples of peripheral blood were removed at defined times. The levels of plasma oestradiol, LH and FSH were determined by radioimmunoassay. The administration of incremental doses of LH-RH (from 1.56 to 450 mug) demonstrated that a maximal response was obtained with 100 mug in the majority of apparently healthy subjects. Accordingly, this amount was selected as the standard dose for use in a test of pituitary function. The application of this test to 96 patients with secondary amenorrhea showed that the release of LH and FSH (as assessed by the maximum value, and the area under the response curve) was within the normal range in 82, high in 4 and low in 10. There was no correlation between the cause of the amenorrhea, the results of the LH-RH test, and the endogenous levels of oestradiol, LH and FSH. In addition 5 patients with primary amenorrhea and 8 patients with pituitary disorders were tested with LH-RH. In primary amenorrhea low basal levels of LH were found, but all subjects had a normal response to LH-RH. In 3 patients with clinical hypopituitarism the basal levels of gonadotrophins were in the normal range, but there was an impaired response to LH-RH. It is concluded that 100 mug of LH-RH administered intravenously may be used to test the ability of the pituitary to release LH and FSH, but the magnitude and duration of the response is not of additional diagnostic value.

The concentrations of urinary oestrone-3-glucuronide, LH and pregnanediol-3alpha-glucuronide as indices of ovarian function.

Methods based upon the principles of radioimmunoassay have been developed and evaluated for the measurement of oestrone-3-glucuronide, LH and pregnanediol-3alpha-glucuronide in samples of unextracted urine. The procedures have been applied to daily urine (early morning fraction and combined 24 hour collections) from 6 women throughout one complete menstrual cycle and to serial samples from an additional 14 women who only collected early morning specimens. The results showed that there were characteristic, well-defined changes in the concentration of all 3 metabolites in both samples of urine and from all subjects. In addition, there was a reasonable correlation between the concentration of all 3 compounds in samples of early morning urine and the corresponding rates of excretion per 24 hours. These findings suggest that the procedures may be of value for monitoring ovarian function over long periods of time, without the problems of stress and inconvenience to the patient. Furthermore, the ratio of values for oestrone-3-glucuronide to pregnanediol-3alpha-glucuronide may be used to indicate the start and finish of the fertile period.

PIP: This study aims to develop alternative methods of monitoring ovarian function over long periods of time. Methods based on the principles of radioimmunoassay were developed and evaluated for measurement of estrone-3-glucuronide, LH and pregnanediol-3alpha-glucuronide in samples of unextracted urine. The methods were applied to daily urine samples (early morning fraction and combined 24-hour collection) from 6 women throughout one complete menstrual cycle and to serial samples from an additional 14 women who only collected early morning specimens. The results show that measurement of estrone glucuronide and pregnanediol glucuronide in samples of early morning urine may be used to monitor follicular development and luteal function in women who are well-motivated to collect urine according to a defined schedule. LH values in the same sample may also be used to predict or detect ovulation. Mean values of the glucuronides are higher in the early morning urine samples. Corresponding values for LH are similar in both urine fractions. The project ultimately aims to develop simple kits which women themselves can use to detect their fertile period.