Surgical treatment for clubfoot has been largely directed at finding the best one-stage operation for the resistant clubfoot. Eighteen patients with 27 clubfeet (average follow-up 11 years since first surgery; range, 3.5-24 years) were reviewed. More than one clubfoot operation was required in 56% of cases. Forty-six percent were corrected after one surgery; 33% required a second surgery and 14% required a third operation. One patient with particularly severe feet required a fourth operation on each foot. The mean age at the time of surgery was 1.26 years, 5.12 years, and 8 years for the first, second, and third operations, respectively. The first operation consisted of a soft-tissue release. The second and third operations consisted of more extensive soft-tissue release and various rearfoot and forefoot procedures. Radiographic values revealed an AP talocalcaneal angle of 18 degrees, AP talo-first metatarsal angle of 6 degrees, lateral talocalcaneal angle of 29.6 degrees, lateral talo-first metatarsal angle of 15 degrees, and calcaneo-first metatarsal angle of 143 degrees. At follow-up all patients had adequate function as determined by personal interview and clinical examination. We conclude that correction of resistant congenital clubfoot often requires more than one surgery, not because of a "failed first operation," but due to dynamic muscle imbalances that may not be fully recognized in infancy and early childhood. Thus, the need for a second operation should not be perceived as a failure of the first, but as part of the natural history of congenital clubfoot.

Adolescent↗

PubMedDate not supplied

[Tissue burden with exogenous trace elements caused by roentgen contrast media in bone cements].

In 44 patients undergoing a change of total hip prosthesis, made of Co-Cr alloy and at one point with a Refobacin-Palacos chain we analyzed samples of the hip joint capsule and fascia lata. Using Instrumental Neutron Activation Analysis (INAA) up to 18 elements were analyzed. The findings demonstrate that the tissues in the surroundings as well as in direct contact with the total hip prosthesis are burdened by corrosion products of the alloy and by decomposition of the bone cement. The decomposition of bone cement can be shown in the extraordinary high concentration of Barium, Zirconium and Hafnium which are added to Bone Cements as X-ray contrast. Microscopic findings at the same time complete and confirm the trace element analyses.

Adult↗

PubMedDate not supplied

Acute amphetamine abuse. Problems during general anaesthesia for neurosurgery.

A case of unsuspected acute amphetamine abuse by a 22-year-old girl which led to serious intracranial hypertension during anaesthesia for a neurosurgical procedure is described. It was difficult to maintained anaesthesia with an intermittent positive-pressure ventilation technique using muscle relaxants, N2O and O2 and supplements of fentanyl despite large doses of pancuronium and fentanyl. The differing effects of chronic and acute amphetamine dosage on anaesthetic requirements are reviewed.

Acute Disease↗

PubMedDate not supplied