Supraacetabular insufficiency fractures

Insufficiency fractures in the supraacetabular region were identified in five women, aged 55-83 years. Factors contributing to the diminished resistance of their bones included postmenopausal osteoporosis, steroid therapy, radiation therapy, and rheumatoid arthritis. The supraacetabular fractures were seen on routine radiographs as hazy bands of sclerosis located immediately above and parallel to the acetabular roof. All five patients had additional fractures in the spine or pelvis. Supraacetabular insufficiency fractures may be an unsuspected cause of hip pain, especially in older women.     

Radioimmunoassay of free thyroxine with prebound anti-T4 microcapsules

Free thyroxine (FT4) may be one of the active throid hormones in contact with target end organs. It is unaffected by alterations in serum protein levels. In most cases, measurement of FT4 reflects an individual's true thyroid function or dysfunction. Previous FT4 assay techniques have been difficult, tedious, indirect, and inaccurate. A rapid, simple, and accurate radioimmunoassay for FT4 has been developed using microencapsulated rabbit anti-T4 antiserum to which I-125 T4 tracer of high specific activity has been complexed. Addition of FT4 standards or unknown samples displaces a proportional amount of I-125 T4 from antibody. Protein-bound T4 is excluded from the reaction by short incubation time and spatial configurations. Specimens representing known thyroid dysfunction were tested using the above procedure. The normal range of FT4 was 0.8-2.4 ng/dl. The mean FT4 for the hyperthyroid group was 6.92 +/- 1.38 (range 4.4-9.6) ng/dl. The mean FT4 for the hypothyroid group was 0.43 +/- 0.37 (range 0.1-1.3) ng/dl, and in pregnancy the mean FT4 was 1.64 +/- 0.44 (range of 1.0-2.2) ng/dl (1).     

Colon perforation following percutaneous nephrostomy and renal calculus removal

Two patients had colonic perforation as a result of percutaneous nephrostomy placement followed by track dilatation and renal calculus removal. We present the technical aspects of nephrostomy placement and stone removal, as well as the clinical diagnosis and management of these cases. Both patients recovered well with conservative therapy and required no surgical intervention. This report reviews the anatomic considerations for percutaneous nephrostomy in patients undergoing renal stone removal.     

Hypertension: pathophysiology and treatment

Arterial hypertension is a major cause of morbidity and mortalitybecause of its association with coronary heart disease, cerebrovasculardisease and renal disease. The extent of target organ involvement(i.e. heart, brain and kidneys) determines outcome. North Americanstudies have shown that hypertension is a major contributorto 500 000 strokes (250 000 deaths) and 1 000 000 myocardialinfarctions (500 000 deaths) per annum.     

The surgical hypertensive patient

We reviewed the pathophysiology and treatment of hypertensionin a recent edition of this journal (see key references). Inthis article, we discuss the management of the hypertensivepatient presenting for surgery and anaesthesia.