A prospective study of nerve root infiltration in the diagnosis of sciatica. A comparison with radiculography, computed tomography, and operative findings.

Fifty nerve root infiltration studies were evaluated prospectively in a consecutive series of 50 patients referred to the Sheffield Problem Back Clinic with complicated back problems. All were over 35 years of age (mean, 51 years). Ten (20%) demonstrated abnormal segmentation of the lumbar spine. Sixteen (32%) had undergone previous surgery. Before nerve root infiltration all patients were investigated by radiculography and computed tomography. Nerve root infiltration identified two types of response. In 20 patients, infiltration reproduced the symptomatic pain, which then was abolished by local anesthetic--the positive result. These patients were considered suitable for surgery. One patient in this group had spontaneous resolution of pain and thus did not undergo operative treatment. In 30 patients, infiltration did not reproduce the symptomatic pain regardless of the level studied, or only partially reproduced the pain at two or more levels--the negative result. Radiculography and computed tomography in these patients also was inconsistent. This group were considered unsuitable for surgery. In those patients undergoing surgical decompression, nerve root infiltration correctly identified the symptomatic level in 18 of the 19. Computed tomography and radiculography identified the level in 14 and 12 patients, respectively.

Bone mass in women with hip fractures.

Bone mass was measured by single photon absoptiometry in 52 women with hip fractures and compared to controls of similar age. No difference in the forearm bone mineral content (BMC) was detectable between the groups. Extracapsular fractures had lower forearm BMC than intracapsular fractures, but these differences were eliminated by allowance for age. Clinical management therefore was not influenced by such measurements.

Salmonella paratyphi--an unusual cause of primary septic arthritis of the hip.

Salmonella paratyphi is an extremely rare cause of primary septic arthritis of the hip, especially in the U.K. The presentation is no different from other causative organisms. A case is described illustrating that uncommon organisms can cause septic arthritis and that for successful treatment correct organism identification is paramount.

Type III tibial spine avulsions treated with arthroscopic Acutrak screw reattachment.

Type III fractures of the tibial spine require open reduction and internal fixation when conservative treatment fails. The Acutrak cannulated screw system has been used successfully for arthroscopic reduction and fixation of these injuries. It was used in four children and two adults; all patients have returned to their preinjury exercise status. The use of a tent peg technique in children allows preservation of the proximal tibial physis, which prevents premature epiphysiodesis.

Trigger thumb in children: results of surgical correction.

Stenosing tenosynovitis of the thumb, or trigger thumb, is relatively uncommon in children. The surgical correction of trigger thumb in 15 children is described to illustrate the clinical features of this condition. The literature is reviewed in order to alert the orthopaedic surgeon to the natural history of triggering digits in childhood.

Dynamic liver scanning in cirrhosis.

Dynamic liver scanning using 99mTc sulphur colloid has been used in assessing 41 patients with cirrhosis and the data compared with 33 control subjects. The mesenteric fraction (MF) was significantly reduced in cirrhotics (0.30 +/- 0.17) compared with controls (0.58 +/- 0.09), P less than 0.001. The liver: spleen ratio (L:S) was also significantly different (1.6 +/- 0.95 compared with 4.9 +/- 1.4), P less than 0.001. Those patients who had undergone a recent variceal bleed had values less than patients who had not bled. Dynamic scintigraphy may be of value in monitoring the progress of disease and response to treatment.

Liver tumour blood flow and responses to arterial embolization measured by dynamic hepatic scintigraphy.

Liver and tumour blood flow has been studied in 30 patients with multiple liver metastases and in 14 patients with solitary liver tumours by means of dynamic hepatic scintigraphy. Observations were compared with those of a group of 33 control subjects. Haemodynamic changes were also measured in 10 patients who underwent hepatic arterial embolization (HAE). The mesenteric fraction (MF) to tumour regions in 32 subjects showed a wide range compared with control subjects. In 9 patients the MF to the tumour region was within the normal range suggesting that some tumours may possess a portal venous supply. The MF to the uninvolved liver regions was below the normal range in 25% of patients, indicating that HAE could be hazardous in this group. Following HAE the MF rose in all 4 tumour regions and fell in 4 non-embolized uninvolved liver regions. No increase in colloid clearance rate (k) was seen though a significant decrease occurred in 4 patients. These changes may well represent increased portal venous flow into tumours.