Is synovectomy a sure treatment procedure for synovial osteochondromatosis?

In recent literature synovectomy is recommended for treating osteochondromatosis. In the case of a 25-year-old woman with an affected knee joint, who was treated with synovectomy, the authors observed recurrence 5 years later. Ten years after the operation a severe osteoarthritis had developed. Our experience suggests that this method should not be overestimated. F. Kroh came in 1932 to the same conclusion.     

Pharyngo-oesophageal reconstruction with free jejunal transplants. New design of the upper anastomosis to improve monitoring of viability of transfer.

Since 1987, 13 free microsurgical jejunal transplants for large pharyngo-oesophageal tumors have been done in 12 patients at Tampere University Hospital. The conventional technique was used for the end to end upper anastomosis in seven patients, and our new end to side anastomotic technique in six. Five patients were alive at the time of writing, the mean survival being 22 months (range 1-48). Five patients developed orocutaneous fistulas, three of which healed spontaneously. In the remaining two the fistulas were caused by rapid recurrence of the tumour. There was no significant difference in ability to feed orally or swallow among the patients operated upon by the end to end or the end to side anastomotic technique. Our results show that the free microvascular jejunal transfer is a safe procedure for repair of the hypopharynx. Our new end to side hypopharyngojejunal anastomosis makes it possible to monitor the transplanted bowel reliably by direct vision.     

Tissue PCO2 in brain ischemia related to lactate content in normo- and hypercapnic rats.

The amount of lactate formed during ischemia determines the rise in tissue PCO2 (PtCO2). Conflicting results exist on the relationship between lactate and PtCO2. The objective of this study was to settle this issue. We varied the preischemic plasma glucose concentration of normo- and hypercapnic rats, assessed tissue lactate and total CO2 contents, and determined the PCO2/lactate relationship over the lactate range 2-40 mmol kg-1. The results showed that whatever the equilibration time, the PCO2/lactate relationship was linear. The results obtained could be reproduced by a theoretical buffer system that mimics the buffering behavior of intracellular fluid. Our results bear on the question of whether compartmentation of H+ occurs during ischemia, with glial cells becoming more acid than neurons. A discontinuous PCO2/lactate relationship, with a constant PCO2 above a certain lactate content, would support this contention. Since our results demonstrate a linear relationship between lactate and PCO2 over the lactate range 2-40 mmol kg-1, they considerably weaken any argument for gross compartmentation of H+.     

Poor prognosis in atypical Perthes' disease. Radiographic analysis of 19 hips after 35 years.

We analyzed clinical and radiographic long-term results in 96 patients (106 hips) with Perthes' disease 35 years after nonoperative treatment. 19 hips in 17 patients had early radiographic signs indicating atypically severe course of the disease and poor prognosis. None of them was radiographically good at skeletal maturity; 2 cases were fair and 17 poor. At the final follow-up 12 hips had radiographic arthrosis.     

Etiologic structure of exacerbations in chronic bronchitis

The etiological appearance of exacerbations of chronic bronchitis was investigated in 117 patients. A combined study was aimed at the detection of viral, mycoplasmal, fungal and bacterial endobronchial infections. The etiological role of the latter was verified by a pathogen isolated from the sputum. Exacerbation of chronic bronchitis was determined by bacterial (79%) and/or viral (55%) infections, mostly by pneumococcal infection (45%), H. influenzae (30%), and influenza (31%). The role of pyogenic cocci was minimal (2%). Exacerbation of chronic purulent endobronchitis was more frequently caused by H. influenzae than in catarrhal bronchitis. In 9% of the patients the infectious etiology of an inflammatory bronchial process could not be established.     

Pretransplant herpesvirus serology and acute graft-versus-host disease

Logistic regression was used to analyze the influence of pretransplant herpesvirus antibodies, in both patients and donors, on the development of acute graft-versus-host disease in 111 consecutive HLA-identical bone marrow recipients. In bivariate analysis, recipient seropositivity for cytomegalovirus (P = 0.01), donor seropositivity for herpes simplex virus (P = 0.02), and low bone marrow cell dosage (P less than 0.05) were associated with a high incidence of grade II-IV acute GVHD. In multivariate analysis the P values were P less than 0.05 for a positive recipient CMV serology and P = 0.07 for a positive donor HSV serology. Positive serology for 1-2 herpes-viruses among recipients or donors both resulted in a 12% incidence of grade II-IV acute GVHD. Positive serology for 3-4 herpesviruses among patients or donors resulted in an incidence of 32% and 38% of acute GVHD, respectively (P less than 0.05). It is concluded that recipient and donor pretransplant herpesvirus immunity can be used to calculate the risk of moderate-to-severe acute GVHD.