Non-traumatic dislocation of the hip following screw/plate fixation for a femoral neck fracture.
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Biomedical subjects
Publications and source records attributed to G Schweitzer.
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In order to study the pathomechanisms of the Adult Respiratory Distress Syndrome in an acute animal model, we monitored the alveolar cell pattern and the stimulatory chemiluminescence responses of blood neutrophils and alveolar macrophages in sheep after Escherichia coli endotoxin injection (2 micrograms/kg of body weight). Using appropriate bronchoalveolar lavage techniques, thereby avoiding local inflammation, it was demonstrated that endotoxin injection did not cause any recruitment of neutrophils into the alveoli for a period of up to 24 hours. Following endotoxin injection, blood neutrophils showed a maximal stimulatory response after 5 minutes, and alveolar macrophages after 4 hours. It is concluded that if neutrophils are responsible for initiating the increase in microvascular permeability, then this action must be purely intravascular.
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Avulsion fracture of the olecranon is a relatively common injury in the adult. In the child, however, it is a rare occurrence. The injury is usually due to a fall on the outstretched elbow, with a sudden contraction of the triceps muscle. The contraction of this muscle avulses the olecranon and tears the distal triceps expansion. The fracture is well described in standard textbooks on paediatric orthopaedic surgery.
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The technique of bronchoalveolar lavage was used to obtain serial samples of lavage every two days from non-contused lung areas of seven traumatized patients and four normals; blood was drawn simultaneously. Urea, total protein, albumin, alpha 1-proteinase inhibitor, alpha 2-macroglobulin, lactate dehydrogenase, beta-N-acetyl-glucosaminidase, myeloperoxidase, and elastase enzyme activity, as well as complexed and total elastase concentrations were determined in bronchoalveolar lavage fluids and plasma samples. Lavage fluid cell pattern was counted. Polymorphonuclear leukocytes were isolated from lavage fluids and blood samples. Granulocyte contents of elastase enzyme activity, complexed and total elastase concentrations, and myeloperoxidase and lactate dehydrogenase activity were determined. Polymorphonuclear leukocyte stimulatory functions were measured by luminol-enhanced chemiluminescence. The following results were obtained for the patient group: Patterns of lavage fluid cells were shifted in favour of polymorphonuclear leukocytes and lymphocytes. The protein determinations of bronchoalveolar lavage fluids and plasma samples gave information about the extent of alterations of permeability of the capillary-interstitial-alveolar space (albumin/urea and alpha 1-proteinase inhibitor/urea ratios) as well as about the amounts of cytoplasmic and lysosomal enzymes released by phagocytes (lactate dehydrogenase/urea, beta-N-acetylglucosaminidase/urea, elastase/urea ratios). Polymorphonuclear leukocytes isolated from bronchoalveolar lavage fluids contained a decreased content of myeloperoxidase and elastase enzyme activities and total elastase concentration; the content of complexed elastase was found to be increased more than 100 fold. From chemiluminescence measurements there was evidence for decreased zymosan-induced stimulatory function, while the photon emission rate of polymorphonuclear leukocytes after passage into the alveolar space was increased.
Determinants of glomerular ultrafiltration were studied by micropuncture in clamped kidneys of one-kidney Goldblatt rats (n = 10, mean arterial pressure (MAP) = 183 +/- 18 (SD) mm Hg) and in control kidneys of unilateral nephrectomized rats (n = 14, MAP=120 +/- 14 mm Hg). Following saralasin infusion, no significant MAP change occurred in either group. Renal perfusion pressure of clamped kidneys (115 +/- 13 mm Hg) was not different from MAP in controls. Hydrostatic pressure in glomerular capillaries in clamped kidneys was not different from that in controls (60.9 +/- 2.1 vs. 61.7 +/- 3.5 mm Hg). Early proximal flow rate, as a measure for single-nephron GFR, was decreased to 29.5 +/- 1.5 vs. 36.6 +/- 4.4 nl/min in controls (p less than 0.01). Total renal resistance was increased by 102% in the hypertensive group, mainly due to the stenosis (75%) rather than the renal vasculature (27%). Due to a predominant increase of postglomerular vascular resistance, filtration fraction was increased in clamped kidneys (0.37 +/- 0.05 vs. 0.34 +/- 0.06, p less than 0.001). Single nephron glomerular plasma flow was decreased to 158 +/- 23.5 vs. 209 +/- 45.1 nl/min in controls (p less than 0.001). Efferent net ultrafiltration pressure did not differ significantly from zero in either group, i.e. filtration equilibrium was achieved. These results indicate an increased vascular resistance in clamped kidneys, which is caused by a preferential efferent vasoconstriction. This pattern of the vascular bed helps to prevent a further reduction of GFR despite a decrease of blood flow.
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A patient with an unusual cause of bilateral carpal tunnel syndrome is presented. The condition was due to puff adder (Bitis aristans) bite. The successful outcome of the case after bilateral carpal tunnel decompression and unilateral fasciotomy of the forearm is described.
A retrospective review of 31 sportsmen and 4 sportswomen who underwent arthroscopy of the knee is presented. The indications for and the results of arthroscopy are discussed. The recommendation that an arthroscopy be performed on all patients in whom it is proposed to do a meniscectomy is made.
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An acute brain syndrome in a cannabis-dependent patient, who sustained multiple injuries, is described. Points of difference between this syndrome and delirium tremens are discussed. Recommendations are made regarding the treatment of this complication, which may follow multiple injuries or operative procedures.
Difficulties in the reduction of a traumatic posterior dislocation of the hip, as a result of soft-tissue interposition, are uncommon. A case in which closed reduction was prevented by a partly detached labrum acetabulare is reported.