Changes in Heart Rate Variability in Patients with Spleen-Qi Deficiency Syndrome

Many functional diseases are related to dysautonomia, and heart rate variability has been used to assess dysautonomia. However, heart rate variability has not been studied in Spleen-Qi deficiency syndrome (SQDS). Healthy volunteers (n = 37) and patients with SQDS (n = 67), recruited from the Clinic of the State University of Ecatepec Valley were included in the study. Outcome measures were average heart rate, standard deviation of the normal-to-normal heartbeat intervals, low frequency (LF), high frequency (HF) power, and the LF/HF ratio. Also, intestinal peristalsis, gastrointestinal symptoms (GSs), fatigue, and level of attention were measured. Standard deviation of the normal-to-normal heartbeat intervals (17 ± 2.3%) and HF (14 ± 3.1%) were lower in SQDS patients (17 ± 1.3%) than in healthy volunteers. SQDS patients had higher heart rate, LF power, LF/HF ratio, and fatigue scores (9.6 ± 1.12%, 16 ± 2.1%, 22 ± 3.8%, and 21 ± 4.1%). The fatigue correlated positively with the LF/HF ratio and negatively with HF power. The SQDS group had lower concentration performance (16.2 ± 1.9%) in the d2 test. The intestinal peristalsis showed a reduction (15 ± 1.3%) as compared with control. GS score and peristalsis correlated negatively with HF. Our results suggest that the pathology of SDQS could be associated with a low vagal tone which causes a decrease in peristalsis, increased fatigue, reduced attention, and appearance of GSs.     

Severe irreducible slipping of upper femoral epiphysis: a review of 14 cases treated by subtrochanteric osteotomy

Children with signs of slipping of the upper femoral epiphysis often present in an Accident Service, particularly after a severe, acute slip. In some cases the displacement is irreducible and correction of the persistent deformity by either cervical or trochanteric osteotomy is required. This paper is a review of 14 cases of irreducible slipped upper femoral epiphysis treated by subtrochanteric osteotomy. Clinical and radiological assessment of these cases some years later shows a high proportion of successful results and suggests that this is a safe and satisfactory method of treating this condition.     

Shark attack in Natal.

The injuries in 5 cases of shark attack in Natal during 1973-74 are reviewed. Experience in shark attacks in South Africa during this period is discussed (1965-73), and the value of protecting heavily utilized beaches in Natal with nets is assessed. The surgical applications of elasmobranch research at the Oceanographic Research Institute (Durban) and at the Headquarters of the Natal Anti-Shark Measures Board (Umhlanga Rocks) are described. Modern trends in the training of surf life-guards, the provision of basic equipment for primary resuscitation of casualties on the beaches, and the policy of general and local care of these patients in Natal are discussed.     

The syndrome of the fracture of the lesser trochanter in adults: a neglected aspect of the trochanteric fracture

The effects of associated fractures of the lesser trochanter were observed in 18 (47.4 per cent) out of 38 patients with trochanteric and subtrochanteric fractures when the lesser trochanter was grossly displaced. This syndrome, comprising mechanical, reflex, post-traumatic, and late features, is a reliable guide to the prognosis of these elderly patients.     

A simple instrument designed to simplify measurement of required nail length during fixation of a fractured neck of femur

Possible causes of inaccuracy in estimating the required length of nail for a fractured neck of femur are discussed. A simple instrument designed to make correct measurement easier is described.     

Auger injuries

Attention is drawn to accidents caused by the auger used on the farm and in industry. The worst machine is the portable grain auger which produces severe, mutilating injuries of the forearm, hand or lower limb. There are large numbers of these portable conveyors in the Prairies, and probably 5000 or more in Manitoba alone. It is likely that some 120 amputations occur each year on the farm, and many of these are due to augers.     

Haemodynamic defect in patients with severe head injury

Haemodynamic studies were made in 34 patients with severe head injury. The changes of cardiac output were noteworthy and correlated well with the clinical course and the prognosis of the patients. Marked systemic hypotension at the moment of brain death was mainly caused by the decrease of cardiac output. At this moment, peripheral resistance fell only to normal limits from the raised level. In the patients who survived, the cardiac output increased in proportion to the respiratory insufficiency, that is, the increased A-aDO₂ and Q?s/Q?t. The increase of oxygen consumption was also accompanied by an increased cardiac output, but in the patients with the severest head injury who died, the cardiac output remained low. It failed to respond to increased A-aDO₂ and Q?s/Q?t, and oxygen consumption remained low.     

Injuries of the axillary artery caused by fractures of the neck of the humerus.

Three patients are presented in whom the axillary artery was injured in combination with a simple fracture of the neck of the humerus. The pathological anatomy, symptomatology, diagnosis and treatment of these lesions are discussed with reference to our own experience.     

Rehabilitation of the brain-damaged survivor.

This paper described the detailed examination of 121 patients who had suffered from traumatic brain damage. An important feature of the study was that all patients were examined by methods devised by the therapists in the department concerned, and the results subsequently integrated. The patients are described and their ability to return to independent existence is assessed in relation to the duration of unconsciousness and of post-traumatic amnesia (PTA). One method in particular, devised in the physiotherapy department, seems to suggest scope for developing recovery curves that might prove valuable indicators of the effectiveness of long-term therapy.     

Osteochondral fracture of the trochlea associated with fracture-dislocation of the elbow

A case of osteochondral fracture of the trochlea occurring as part of a fracture-dislocation of the elbow is reported. The damage to the medial articular surfaces was not apparent until the joint was explored. The osteochondral fragment was replaced and fixed with Smillie's pins and the result of treatment was good.