Central fracture-dislocation of the hip in a child

A case report of a 10-year-old child with a central fracture-dislocation of the hip, managed by open reduction is presented, with a long-term result. The rarity of this injury in children is discussed, with the possible complications of inadequate joint congruity and potential growth injury.     

Assessing blood pressure control in patients treated for hypertension: comparing different measurements and targets.

We examined how different methods and definitions of blood pressure affect the achievement of targets in general practice. There was a wide range in the proportion of treated patients achieving the different target levels recommended by the National Institute for Health and Clinical Excellence, British Hypertension Society and the general medical services contract. Among non-diabetic patients this ranged from; 10-37% (average office), 15-39% (standardised nurse measurement), 11-49% (last recorded) and 31-56% (ambulatory blood pressure). Defining targets without a clear definition of how blood pressure should be measured is largely meaningless and ignoring ambulatory blood pressure results in many patients being classified incorrectly as failing to achieve targets.     

Carcinoma of the thyroid in black patients.

In the period from January 1, 1976 to December 31, 1988, we reviewed the charts of 33 patients treated for carcinoma of the thyroid at Howard University Hospital. The three non-black patients (two Whites and one Pakistani) were excluded from the study. There were 19 females and 11 males. Of the 30 cases elevated, 10 were papillary, 7 were follicular variant of papillary, 8 were follicular, 3 were undifferentiated (anaplastic), and 2 were medullary. Ten patients had either distant metastasis (Hoffman, South Med J 80:741, 1987) or locally advanced disease in the neck (Woolner et al., Am J Surg 102:354, 1961.) at the time of diagnosis. The treatment of these lesions depended on, among other variables, the cell type, the extent of the lesion, and the personal preference of the attending surgeon. Carcinoma of the thyroid remains an uncommon lesion in Black patients. Because of its rarity, the diagnosis may often be delayed and, as a result, patients may first come to attention with a more advanced stage of this disease. To prevent this occurrence, a high index of suspicion must be maintained for all thyroid nodules, and appropriate diagnostic steps taken. Diagnostic and treatment options are discussed.     

Corticotrophin-releasing factor immunostaining is present in placenta and fetal membranes from the first trimester onwards and is not affected by labour or administration of mifepristone

BACKGROUND AND OBJECTIVES Corticotrophin releasing factor (CRF) is present in the human placenta and fetal membranes. Placental CRF content and plasma CRF concentrations rise throughout gestation and fail rapidly after delivery. The regulation of CRF production from the placenta is poorly understood. The objective of this study was to use the antiprogestin, mifepristone, to determine whether progesterone has a regulatory effect on CRF production in the first trimester of pregnancy. PATIENTS Women undergoing first trimester (gestation 5-12 weeks) therapeutic abortion (by suction curettage with and without the synthetic PGE, analogue, gemeprost (16,16-dimethyl-trans- Δ²-PGE₁ methyl ester) vaginally 2-4 hours prior to the procedure; or with 600 mg mifepristone 48 hours prior to receiving 1 mg gemeprost vaginally), second trimester therapeutic abortion (600 mg mifepristone, 1 mg gemeprost), In association with pre-term delivery (gestation 25-34 weeks) and at term (gestation 35-42 weeks) by spontaneous delivery, induced labour or elective Caesarean section. MEASUREMENTS immunohistochemical localization Of CRF and quantification of CRF content by radioimmunoassay of tissue extracts, in human placenta and fetal membranes. RESULTS CRF was Immunolocalized to the syncytlo-trophoblast cells of the placenta at ail stages of gestation from 5 to 42 weeks. In the fetal membranes CRF immunoreactlvity was localized in the epithelial and subepithelial cells of the amnion, some cells of the reticular and cellular layers of the chorion, and in decidual stroma. This pattern was seen in all tissues studied. Pretreatment with prostaglandins, mifepristone or both during the first trimester did not alter the distribution or the intensity of the CRF Immunostaining. Placental CRF content rose throughout gestation but, consistent with the Lmmunostaining results, was unaffected by the administration of mifepristone or by labour. CONCLUSIONS CRF is localized in the syncitlotropho-blast cells of the placenta and is clearly present early in the first trimester of pregnancy. The lack of an effect of mifepristone or mode of delivery suggests that syncytlo-trophoblast produces CRF constitutively throughout pregnancy.     

Temporomandibular joint: surgically created disk displacement causes arthrosis in the rabbit.

To document a causal relationship between temporomandibular joint disk displacement and arthrosis, the disk was surgically displaced in one temporomandibular joint in each of three rabbits. The rabbits were sacrificed after 4 weeks and the mandibular condyles were studied radiographically and histologically. All three joints that underwent disk displacement had radiographic and histologic evidence of arthrosis, which included erosion of the bone, irregularity and fissure formation of the articular soft tissue cover, disruption of the subchondral layer of cartilage cells, and chondrocyte proliferation. No radiographic or histologic changes occurred in the joints that were untouched. The results suggest that surgically created disk displacement can cause arthrosis in the temporomandibular joint of the rabbit.     

Persistent Hypotension Associated with Hypermedullipinemia: A New Syndrome

A new syndrome is described in a patient with advanced renal insufficiency. This consists of severe and persistent hypotension causing weakness but associated with a clear mental status. Also present is evidence for decreased vascular reactivity. The hypotension was not orthostatic. The hypotension was associated with a circulating vasodepressor substance having the characteristics of medullipin I. The medullipin appears to have been derived from the remaining right kidney. Hypotension existed despite the presence of major prohypertensive mechanisms, including an endstage kidney, hyperreninemia and hyperaldosteronemia. It is likely that hypotension due to hypermedullipinemia is an entity occurring in the human being.