Malignant melanoma of the anorectum

Melanoma is a virulent tumor that can be widely disseminated and is genrally incurable even when the primary growth is small. Review of the cases of 34 patients with primary melanoma of the anorectum, with follow-up ranging from two to five years, suggests that improvement in survival depends on acute surgical awareness and aggressive surgical intervention. Read at the meeting of the American Society of Colon and Rectal Surgeons, Atlanta, Georgia, June 10 to 14, 1979.     

Management of Children With Ambulatory Cerebral Palsy: An Evidence-based Review

This article reviews the current best evidence for musculoskeletal interventions in children with ambulatory cerebral palsy (CP). The effectiveness of interventions in CP must first consider what CP and its associated pathophysiology are and take into account the heterogeneity and natural history of CP to put definitions of "effectiveness" into perspective. This article reviews the current standards of the definition and classification of CP, discusses the natural history and specific goals for the management of ambulatory CP, as well as the outcome measures available to measure these goals. The current best evidence of effectiveness is reviewed for specific interventions in children with ambulatory CP including spasticity management with botulinum toxin A injections and selective dorsal rhizotomy; multilevel orthopaedic surgery to address contractures and bony deformity; and the role of gait analysis for surgical decision-making before orthopaedic surgery.     

Infective endocarditis caused by Granulicatella adiacens

Granulicatella adiacens, a recently nomenclatured bacterium, was considered as one of the nutritionally variant streptococci (NVS) and is a mouth commensal. It is redesignated as a streptococcus like bacterium since it differs from streptococci. We report a case of infective endocarditis (IE) caused by this fastidious and unusual bacteria in a 63-year-old man with rheumatic valvular heart disease. G. adiacens was isolated from four of his blood culture samples, which was sensitive to beta lactams, moderately sensitive to gentamicin and resistant to erythromycin and co-trimoxazole. Patient recovered completely on treatment with high dose of ampicillin and gentamicin for 28 days.     

Obstruction of the infrarenal portion of the abdominal aorta: results of treatment with balloon angioplasty.

Our experience in the treatment of stenoses of the infrarenal portion of the abdominal aorta with balloon angioplasty in 27 patients is reported. Clinical findings were lower limb claudication (all patients), impotence (eight patients), and blue-toe syndrome (two patients). The underlying disease was atherosclerosis in 24 patients and nonspecific aortoarteritis in three patients. Dilatation was successful in all patients. Embolic occlusions of the left common iliac artery (one patient) and left superficial femoral artery (one patient) were the only major complications. Claudication in the affected limb continued in the first patient; the second died when diagnostic angiography, performed 3 months after angioplasty, caused a severe atheroembolus. Of the other 25 patients, nine of the 10 followed up for 13-48 months and all seven followed up for 3-8 months were free of symptoms. Six of eight patients with sexual dysfunction had normal function after angioplasty. Seven patients still awaited follow-up and one was lost to follow-up. Our experience suggests that balloon angioplasty is an effective treatment of stenoses of the infrarenal portion of the abdominal aorta.     

Immobilization of operated ankle fractures

Forty-three patients with stable internal fixation of fresh ankle fractures were treated at random with a plaster cast for 6 weeks without weight bearing or were only immobilized for 3 days, after which active movements were encouraged. The two groups were followed for a year. Only at 6 weeks were there significant differences between the groups.     

Periosteal osteosarcoma

Periosteal osteosarcoma is a surface lesion without evidence of medullary involvement. This report extends the Mayo Clinic series of periosteal osteosarcoma cases from 11 to 22 cases. In a review of demographic information from our 22 cases and from 30 additional cases, referred only for pathologic diagnosis, the average age at the time of diagnosis in our series was 20.5 years. The proximal tibia was the most frequent site of tumor. Men and women were affected in approximately equal numbers. Limb pain and swelling were common complaints, as were findings of limb mass and tenderness. Excision of a tumor demands at least wide margins. When surgical margins were less than wide, there were higher rates of local tumor recurrence and tumor metastasis. A relatively high rate of tumor recurrence and metastasis occurred with femoral lesions despite wide excisional margins, suggesting that femoral lesions may need more aggressive surgical treatment.     

Comparative study of NZB mice under germfree and conventional conditions.

Groups of New Zealand Black (NZB) mice born and reared in germfree conditions were studied at three, six, nine, and 12 months of age. Compared with NZB mice of the same ages raised under conventional conditions, the germfree mice showed: (1) significantly lower gamma-globulin levels, (2) significantly higher frequency of serum antinuclear factor (ANF), and (3) significant decreases in the incidence and severity of renal disease. The lower gamma-globulin levels probably reflect lack of antigenic stimulation by common bacteria. The higher frequency of ANF may be a chance finding or may reflect lack of deposition of complexes in the kidneys. The latter also may explain the decreased severity of renal disease. It is possible that complexes of antibody with common antigens (such as bacteria) may deposit in diseased kidneys and aggravate the condition.