Pediatric residencies: differences between 1959/1960 and 1984/1985.

Patient, contact data, collected by two first year pediatric residents, separated in time by 25 years, were compared, and it is concluded that pediatric residency has undergone major changes throughout the past quarter century. Pediatric training has increased in length and includes more female residents. The overall intensity of patient care pediatric residents provide has increased. Children with chronic disorders that were often lethal conditions 25 years ago now make up a large portion of pediatric admissions to teaching hospitals.

The role of carpal instability in scaphoid nonunion: casual or causal?

We studied twenty consecutive scaphoid nonunions in twenty patients between the ages of eighteen and thirty-eight years. There were nineteen males and one female. The mean age was 25.2 years. Factors evaluated were fracture displacement, delay in treatment, and carpal instability. Fracture displacement and carpal instability were documented in patients by abnormal x-rays showing fragment displacement, abnormal scapholunate and radiolunate angles, etc., or by fluoroscopically controlled arthrography. We concluded that intercarpal ligamentous instability is consistently present and, therefore, the critical factor in wrists with ununited scaphoid fractures. Thirteen patients have been treated surgically; ligamentous disruption was confirmed at surgical exploration. In twelve patients, treatment of the nonunion included intercarpal ligamentous reconstruction. A satisfactory outcome was achieved in all twelve of these patients. One patient's treatment did not include ligament reconstruction. Although the scaphoid fracture united after a Russe bone graft, he remains symptomatic with persistent intercarpal instability. The remaining seven patients are being evaluated or awaiting surgery. Since ligamentous injury is so common in nonunion, we believe it is causal and that surgical care of nonunion involves ligamentous repair or other stabilization procedure. Prevention of nonunion involves early attention to the therapy of carpal instability when associated with scaphoid fracture.

Chronic osteomyelitis of the hand caused by Salmonella typhimurium. A case report.

Salmonella osteomyelitis of the hand unassociated with hemoglobinopathy developed in a 39-year-old woman. After 11 debridement and curettage operations on the affected finger, she was successfully treated with excision of the diseased bone and reconstruction with a silicone prosthesis and extensor indicis transfer. This patient, examined 19 years after the onset of symptoms, illustrates that Salmonella osteomyelitis may persist for an exceedingly long period when limited curettage is the only method of treatment.

Nonossifying fibroma. Electron microscopic examination of two cases supporting a histiocytic rather than a fibroblastic origin.

Nonossifying fibromas appear to be histiocytic lesions. On the basis of light and electron microscopic studies, as well as behavior, they are identical to benign fibrohistiocytomas found in soft tissues. The fibroblastic appearance of some of these lesions by light and electron microscopy, especially in older lesions, reflects the ability of histiocytes to behave as facultative fibroblasts. Final data of the cell of origin for these lesions must await more definitive studies by other methods, perhaps using immunologic, immunoperoxidase and/or surface markers techniques.