Long-term outcome of isolated lesser tuberosity fractures of the humerus

Ten cases of an isolated fracture of the lesser tuberosity and their long-term outcome are described. The patient ages at the time of injury ranged from 11 to 68 years, averaging 30 years. In six cases, the injury was acute; in four cases, it had occurred more than 6 months previously. Of the six acute cases: three were treated conservatively, and the result was satisfactory for all of them; surgery was carried out in the other three cases, of which, two outcomes were judged to be excellent, and one outcome was satisfactory. Regarding the four chronic cases, muscle-strengthening exercises were given in two cases, whereas an operation was performed after exercise failed in the remaining two cases. The results of all four cases were graded as excellent. The combination of open reduction and internal fixation is the method most often recommended for acute cases. In chronic cases, conservative treatment is usually the most appropriate. However, when conservative treatment proves to be ineffective, then open reduction and internal fixation should be considered.     

Effect of learning curve on the outcome of external cephalic version

AIM: The aim of this study was to find out the effect of learning curve on the outcome of external cephalic version (ECV) at term, using tocolytics. The effect of various factors affecting the outcome of ECV was also studied in relation to the learning curve. METHODS: This is a prospective longitudinal observational study of 80 consecutive cases of ECV. They were analysed in relation to outcome, parity, type of breech, placental site and birth weight. The cases were divided consecutively into 4 groups of 20 cases each, in order to analyse the effect of learning curve. RESULTS: The learning curve for ECV is very sharp. The success rate of external cephalic version plateau after the first 20 cases from 45% to about 60%. Only parity and type of breech have a significant effect on the outcome. The success rate is lower for primipara and non-flexed breech. This negative effect is strongest in the first 20 cases and again plateaus after the first 20 cases. The high success rate of multipara and primipara flexed breech is obtained even in the first 20 cases and does not improve with further experience. CONCLUSIONS: The learning curve for ECV is sharp and plateaus after the first 20 cases. Outcome of ECV for patients with favourable factors such as multiparity and flexed breech is not affected by learning curve.     

Results of needle aspiration cytology in proliferative fibrocystic disease of the breast (author's transl)

The accuracy of needle aspiration cytology in fibrocystic disease of the breast was evaluated in 101 cases with microscopically proved proliferative fibrocystic disease. The morphology of the obtained cytosmears was described. In about 50% of the cases a cytological diagnosis of proliferating fibrocystic disease is possible with accuracy. The needle aspiration is therefore a new method for intensive follow-up of patients with a high risk of develop carcinoma of the breast. The accuracy is increased in cases with well developed proliferation of the glandular cells. In cases with intraductal and intracystic proliferations, the results were better than in cases with adenosis.     

A case of exceptional survival in sarcoma of the vulva

Toxoplasmin skin test was performed on 574 suspected and 24 control cases. A positive reaction was noted in 92 of 481 ophthalmological cases; two of 17 lymphadenopathy cases; none in 36 cerebral palsy cases and four of 40 miscellaneous cases comprising pyrexia of unknown aetiology, recurrent abortions etc. None from the control group gave a positive reaction. The significance of the results is discussed and the need for further studies employing other investigative methods is stressed.     

Leiomyosarcomas of the oral cavity. Report of four cases and review of the literature

Leiomyosarcomas (LMS) make up 7% of all soft tissue sarcomas. In the oral cavity, the LMS is rare due to the paucity of smooth muscle in that region. Four cases of intraoral LMS are reported, plus 34 cases found in the literature reviewed. There were 24 males and 14 females. The age range at presentation was 10 months to 88 years with no predilection for any particular age group. The commonest presenting symptom was a mass. The intraoral LMS occurred most commonly in the jaws (59% of cases). The mass was painful in 61% of cases. Follow-up of the case reports was assessed. Recurrence occurred in 36% of cases. Distant metastases occurred in 39% of cases, most commonly to the lungs. Cervical nodal metastasis was reported in 15% of cases. The 5-year survival rate determined on cases with adequate follow-up (n = 13) was 23% free of disease, 8% alive with disease and 69% who died of disease. In comparison with stage I and stage II tongue squamous cell carcinomas, the intraoral LMS is very aggressive. It is best treated surgically, early and aggressively.     

Urogenital tuberculosis. Apropos of 40 cases

The authors report a series of 40 cases of genitourinary tuberculosis diagnosed and treated in the department of urology "B" of Avicenne hospital over a 7-year period. The objective of this study is to define the various diagnostic and therapeutic aspects of this disease. The patients were predominantly males (62.5%) with a mean age of 40 years. 25% of cases reported a history of extra-urinary tuberculosis. The very polymorphous clinical presentation is dominated by signs of cystitis (45%). Intravenous urography is frequently suggestive of the diagnosis based on the appearance and multiplicity of the lesions. The radiological lesions most frequently encountered were silent kidney (19 cases) and small tuberculous bladder (11 cases). The definitive diagnosis was established by pathological examination in 38 cases (biopsies, operative specimens, prostatic resection chips) and/or by demonstration of AFB in 2 cases (urine, pus). Tuberculostatic treatment was administered to all patients, either alone (5 cases) or, more usually, in combination with surgical and/or endo-urological treatment (35 cases), reflecting the magnitude and severity of the destructive and scar lesions.     

Integrity, maintenance and caries susceptibility of sealed surfaces in adolescents receiving regular care from general dental practitioners in Scotland

The non-tumorous skin diseases are common in hospital consultation in tropical countries. These infections constitute a great health problem in black Africa. Their diagnosis is often clinically easy, but sometimes histologically examination is necessary to have the positive diagnosis. In Togo, a retrospective study conducted during ten years, allowed to note 516 cases of non-tumoural dermatosis which were histologically diagnosed. The principal infections were: inflammatory dermatosis 339 cases (213 cases were not specific against 108 specific cases predominated by leprosy: 82 cases), epidermal dermatosis (97 cases, predominated by eczema and psoriasis), dermal lesions (44 cases), lesions of dermic and epidermic junction (23 cases), hypodermic (13 cases). The results of this study shows the diversity of non-tumorous dermatosis diagnosed by the histology. The eradication of these diseases in Africa needs to have efficient laboratory diagnosis and research means in every country.     

Pilomatrixoma of the head and neck in children: a study of 38 cases and a review of the literature

OBJECTIVES: To describe the clinical presentations and discuss the guidelines for surgical management of pilomatrixoma involving the head and neck in children. DESIGN: Retrospective study. SETTING: A tertiary care center. PATIENTS: Thirty-three patients, with a mean age of 4.5 years, underwent surgical treatment for pilomatrixoma (n = 38) between 1989 and 1997. INTERVENTION: All patients were treated surgically. In 34 cases, a direct approach was used to achieve complete removal of the lesion with (n = 11) or without (n = 23) skin resection. In the remaining 4 cases, an indirect approach via a parotidectomylike incision was used. RESULTS: In 88% of cases, the presenting symptom was a hard, slow-growing, subcutaneous tumor. The lesion was associated with pain and inflammation in 7 cases (18%) and abscess or ulceration in 4 cases (11%). Twenty-nine patients presented with single nodules and 4 presented with multiple occurrences. The lesions were located on the face (cheek, eyelid, or forehead) in 20 cases (53%), on the neck in 8 cases (21%), in the parotid region in 8 cases (21%), and on the scalp in 2 cases (5%). CONCLUSIONS: Pilomatrixoma is a rare, benign skin tumor, but practitioners should be aware of its clinical features. Diagnosis is usually easy based on clinical findings, but computed tomographic scan is helpful, especially in cases involving tumors located in the parotid region. Spontaneous regression is never observed. Complete surgical excision, including the overlying skin, is the treatment of choice.     

Simple arthrolysis for flexor rigidity of the proximal interphalangeal joint

The authors report 19 cases of simple arthrolysis of the proximal interphalangeal joint for flexion rigidity. Their cases were limited to isolated lesions of the joint without any flexor or extensor tendon involvement. The technique is described, and the importance of postoperative physical therapy is stressed. The results in these cases, in contrast with those in complicated cases of rigidity, are very satisfactory. The etiology is primarily sprains and dislocations of the proximal interphalangeal articulation, immobilized for too long a time in flexion (in the so-called "functional position").     

Complications of lumboperitoneal shunts. A retrospective study of a series of 195 patients (214 procedures)

BACKGROUND AND PURPOSE: We report our experience with the lumboperitoneal shunt (LPS) in 195 patients. The aim of this retrospective study was to assess and compare the rate of complications and to discuss 4 indications. MATERIAL AND METHOD: Between January 1983 and July 1994, 195 patients including 14 pediatric cases were treated with a LPS. Sex ratio was 1.24. The mean age at insertion was 59.5 years (from 6 months to 88 years) and the follow-up in this series was from 6 months to 12.5 years. The indications for a LPS were: chronic idiopathic hydrocephalus (115 cases), post-hemorrhagic hydrocephalus (37 cases), cerebrospinal fluid fistula (11 cases), post-traumatic hydrocephalus (9 cases), post-surgical hydrocephalus (8 cases), hydrocephalus of the child (6 cases), post-meningitis hydrocephalus (4 cases), benign intracranial hypertension (4 cases), post-radiotherapy hydrocephalus (1). Forty patients (20.5%) presented with at least one complication. A total of 47 complications were observed: chronic subdural effusion (8 cases), meningitis (10 cases), mechanical failures (28 cases), acquired Chiari abnormality (1 case). Mechanical complications varied with the type of shunt. CONCLUSION: Complications of LPS in adults are less frequent than is usually reported after ventricular atrial or peritoneal shunting. In adults, LPS can be used as the first valuable treatment in case of chronic communicating hydrocephalus. LPS is also valuable in the treatment of benign intracranial hypertension or recurrent CSF fistulae. Conversely, in the pediatric cases general and specific complications are frequent, so an indication for LPS must be strictly discussed.     

Determination of visual function after implantation of intraocular lens

OBJECTIVE: To understand whether the binocular visual function could be restored after posterior chamber intraocular lens (IOL) implantation. METHODS: The visual function including corrected vision, simultaneous perception, fusion, stereoacuity, aniseikonia and retinal correspondence point were determined for 50 cases (64 eyes) after the surgery. RESULTS: The corrected visual acuities were 0.6 or better. Visual acuities of 1.0 or better were achieved in 65% and 0.6-0.9 in 35% of the eyes. All patients obtained simultaneous perception and fusion function. The near stereoacuity of 50 cases showed foveal stereoacuity < or = 60 seconds in 23 cases (46%), macular stereoacuity 80-200 seconds 10 cases (20%) and peripheral stereoacuity 400 seconds 17 cases (34%). The far stereoacuity of 50 cases comprised 34 cases of foveal stereoacuity (68%), 9 cases of macular stereoacuity (18%) and 7 cases of peripheral stereoacuity (14%). The postoperative retinal correspondence points were normal. There was no aniseikonia in 35 cases, except 15 cases of aniseikonia which was within normal tolerable limits. CONCLUSION: When binocular corrected vision is > or = 0.4 with ocular alignment, the binocular visual function could be restored for varying degrees.     

Endodermal cysts of the posterior fossa. Report of three cases and review of the literature

The pathogenesis of endodermal cysts of the posterior fossa is still incompletely understood. The authors reviewed three new cases and those reported in the literature to clarify the clinical, pathological, radiological, and surgical characteristics of these lesions. A total of 49 cases were reviewed. Details on demographic profiles, clinical characteristics, histopathological and radiological features, and surgical methods were collected. These cysts have a predominance in male patients (61%) and can occur at any age (birth-77 years). In patients with posterior fossa endodermal cysts there is a bimodal age distribution and headache is the most frequent complaint. On immunohistopathological examination, endodermal cysts were reactive for epithelial membrane antigen and for keratin immunostains whenever the latter were tested. The cysts were reactive for carcinoembryonic antigen in nine of 11 cases. Endodermal cysts were located anterior to the brainstem in 51% of cases and in the fourth ventricle in 21% of cases. They frequently appeared hypodense on computerized tomography scans, and in five cases, the lesion was missed. The cyst's appearance on magnetic resonance imaging is variable. Resection was complete in 19 cases and partial in 11; marsupialization was achieved in two cases. Three recurrences have been reported. Total excision with preservation of neurological function should be the goal. Cranial base approaches are helpful for surgical access in selected examples of these lesions.     

Black widow spider (Latrodectus tredecimguttatus) bite. Presentation of 12 cases

The most severe cases of arachnidism are those due to Latrodectus tredecimguttatus spider-bite. The Mediterranean area is the habitat of the L. tredecimguttatus species. In the last few years no series of patients with latrodectism has been reported in Spain. A retrospective study of the patients admitted for L. tredecimguttatus spider bite in the Torrecárdenas Hospital in Almeria, Spain from 1984 to 1994 was performed. Twelve patients were diagnosed with latrodectism. Eleven were bitten while carrying out agricultural tasks, 8 of which were performed in greenhouses. The mean time between the bite and the appearance of the general symptoms was 40 minutes (20-120 minutes), with the most common signs and symptoms being: pain and abdominal stiffness (10 cases), erythema (10 cases) or pain (8 cases) at the site of the bite, thoracic pain, pain in extremities and contractures and psychomotor alterations (6 cases). Laboratory findings were limited to leukocytosis (4 cases), increase in creatinphosphokinase count (4 cases) and proteinuria (3 cases). All the patients received analgesics, 6 were administered myorelaxants and calcium gluconate was given in 6 cases. The evolution was good without complications in all of the patients. Latrodectism is a rare phenomenon Spain. The diagnosis is difficult when there is absence of a clear history of spider bite and due to the lack of knowledge as to its semiology. Antivenom serum is not usually required.     

Angiography in giant-cell tumours of bone

The angiographic appearance of 9 cases of genuine giant-cell tumour of bone, 6 cases of aneurysmal bone cyst and one case of non-ossifying fibroma is described. Differential diagnosis would appear to be possible to a certain extent. The non-ossifying fibroma was poorly vascularized. The genuine giant-cell tumours were hypervascularized as well as some of the aneurysmal bone cysts making a differential diagnosis in these cases impossible. On the other hand, a poorly vascularized tumour devoid of soft tissue component and arteriovenous fistulas is probably an aneurysmal bone cyst. A hypervascular soft tissue component is of great prognostic value in cases of geniune giant-cell tumour.     

Non-pigmented extrabulbar sarcomas of the eye-region (author's transl)

The authors report on 30 cases with non-pigmented extrabulbar sarcomas of the eye-region which occurred in our clinic within the period of 1955 till 1975. The primary sarcomas of the orbit predominate with 11 cases over the secondary involvement with 9 cases. More seldom (5 cases) is the involvement of the lids and the epibulbar space. The various groups of lymphosarcoma predominate with 16 cases over the spindle-cell sarcoma with 6 cases. The age distribution shows that these tumors prefer the first three decades and the fifth and the following decennia. The prognosis is bad for the conservation of the eye as well as for the preservation of life. With reference to the localisation the distribution at the time of the beginning of the therapy as well as the histological findings an intensive therapy (operation, radiation, chemo-therapy) has to be accomplished.     

Treatment of thoracic malignancy accompanied with cardiovascular disease

We treated 10 cases of thoracic malignancy accompanied with cardiovascular disease. Among thoracic malignancy, 7 cases were lung cancer and 3 were esophageal cancer. Accompanied cardiovascular diseases were ischemic heart disease (2 cases), valvular disease (3 cases), WPW syndrome (1 case), aortic aneurysm (4 cases). The mean age was 66, ranged from 51 to 79. The simultaneous occurrence of the two lesions were observed in 6 cases and thoracic malignancy was diagnosed after a varying interval of time following surgery of cardiovascular disease in 4 cases. In cases of thoracic malignancy accompanied with heart disease, the treatment of heart disease should precede the operation of malignant disease to reduce the risk of surgery. For the patient with esophageal cancer, posterior mediastinal esophagostomy should be applied who may have heart surgery in future. In cases of coexisting malignancy and aortic aneurysm, the priority of treatment should be determined considering the size of aneurysm. If the transverse diameter of aneurysm is larger than 7 cm, there is a high risk of rupture, so surgery for the aneurysm precedes operation of malignant diseases. It is desirable to avoid concomitant operation of malignancy and cardiovascular disease.     

Inflammatory pseudotumour of the liver

Inflammatory pseudotumour is not a common lesion. The first series of 12 cases was described in 1986, to which 37 more cases have now been added. The histology, differential diagnosis, and prognosis of this lesion have been described in detail, but the aetiology is unknown and the mode of treatment remains controversial. A new case is presented and compared with the previously reported cases. Fine needle aspirate yielded a growth of klebsiella organisms. The possibility of this infection as an aetiological agent is considered.     

Airborne asbestos in the vicinity of a freeway

Many of the disturbances resulting from dysregulations in the autonomous nervous system of children with cerebral palsy are rarely discussed in the doctor's praxis. Nevertheless, they are causes of trouble and worry for the parents. For this reason we started an inquiry into this matter. Questionnaires were sent to the parents of 452 C.P. patients. 374 were answered with sufficient care. The following factors were evaluated: sleep, bladder and bowel activity, temperature regulation, vomiting, sweating, blood circulation, growth. The C.P. children were compared to their own siblings especially to the next younger ones. The diagnoses were as follows: Spastic tetraplegia 197 patients. Spastic hemiplegia 44 patients, Athetosis 33 patients, Mixed cases of spasticity and athetosis 82 patients, Other 15 patients. The degrees of handicap in terms of motor development were: severe (unability to sit unsupported) 166 cases, moderate (unability to kneel or walk unsupported) 118 cases, mild (ability to kneel and/or walk unsupported) 87 cases. Summarized, the statements of the parents gave the following results: sleep disturbances: 169 cases (46%), constipation: 145 cases (39%), tendency towards temperature dysregulation: 112 cases (30%) , tendency towards increased vomiting: 91 cases (25%), sweating increased or decreased: 110 cases (30%), irregular and frequent voiding of bladder: 92 cases (25%), unstable regulation of blood circulation: 101 cases (27%), cold skin: 264 cases (71%), body-length deficit: 119 cases (32%), low-weight: 177 cases (48%), feet too small for age: 252 cases (68%). Results are related to diagnosis and severeness of handicap. In addition, it is discussed, whether there are relations between several of the investigated factors. The influence of the patients sex is discussed.     

Role of surgery in the treatment of hemangiomas. A retrospective study apropos of 29 surgically treated children

Conservative management is usually proposed for common childhood hemangiomas because most lesions resolve spontaneously. The authors report 29 cases of children with hemangiomas treated surgically. Surgical indications were defined at various stages. The study concerned 29 children operated in our pediatric surgery and plastic surgery departments between 1989 and 1995. The average postoperative follow-up was 3 years and 8 months. The average age of the patients was 5 years; two-thirds of children were girls. The hemangioma was a very large lesion, subcutaneous and cutaneous (mixed) in 23 cases, only subcutaneous in 2 cases, only cutaneous in 4 cases, and was located on the face in 19 cases. Six complications (5 ulcerations, 1 Kassabach-Merritt syndrome) were observed.     

Multidrug-resistant tuberculosis. 3. Epidemiology of drug-resistant tuberculosis in Japan

In Japan, the frequency of drug-resistant tuberculosis has been investigated every 5 years since 1950s and increase of initial and acquired drug resistance has not been observed. However, the mathematical model analyse of time trend of prevalence of drug-resistant tuberculosis and frequency of initial drug resistance in Korea shows that there is little difference of infectivity and/or proportion of clinical breakdown between susceptible bacilli and resistant ones. The prognosis of isoniazid (INH) and rifampicin (RFP) resistant tuberculosis cases in Fukujuji Hospital was investigated. 367 cases including 50 initial drug resistant cases were analyzed with life table analysis. 50% of all cases and 70% of initial drug resistant cases became negative, 13% of all cases and 4% of initial drug resistant cases remained as positive, 37% of all cases and 27% of new cases died. Among cases who did not convert negative within one year, 41% of all cases and 34% of initial drug resistant cases died. The prognosis of INH and RFP resistant tuberculosis cases were still not satisfactory.