bluuebunny/crossref_metadata_2025 huggingface dataset:
Visceral leishmaniasis cyclical trends in Bihar, India – implications for the elimination programme.
Authors: Deb Rinki M , Stanton Michelle C , Foster Geraldine M , Das Gupta Rudra K , Roy Nupur , Das Pradeep , Dhariwal Akshay C , Coleman Michael
Published: February 2018

Background:Visceral leishmaniasis (VL) is a vector-borne disease of public health importance in India, with the highest burden of disease in the states of Bihar, Jharkhand, West Bengal and Uttar Pradesh. The disease is currently targeted for elimination (annual incidence to less than one per 10,000 population) using indoor residual spraying, active case detection and treatment. Historically the disease trend in India has been regarded as cyclical with case resurgence characteristically occurring every 15 years.  Understanding this pattern is essential if the VL elimination gains are to be sustained. To better understand the cyclical trends, annual climatic indicators including rainfall, temperature and humidity over time were compared with annual VL case incidence data. 

Methods:Annual climate data (rainfall, average and maximum temperature and specific humidity) from 1956-2004 were used to identify potential factors influencing VL incidence.  Months relevant to the VL life-cycle were identified and defined (Monsoon, Sand-fly Peak, Pre-Sand-fly Peak and Annual) for analysis. The Kruskall-Wallis test was used to determine significant difference between categorical rainfall and VL incidence, whilst univariate negative binomial regression models were used to determine predictors of disease incidence.

Results:The negative binomial regression model showed statistically significant associations (p <0.05) for VL incidence and maximum temperature, and average temperature, when considering annual and pre-sand fly peak time periods. No other associations between humidity, rainfall or temperature and VL incidence were detected (all values p >0.05). 

Conclusion:The VL programme in Bihar has made significant progress in adopting best practices for improved treatment and vector control, with the aim to achieve VL elimination.  However, open access granular programme data for indoor residual spray activities and case detection is required to fully understand the role of climate in disease transmission and potential resurgence.
Prospects and Opportunities for New Techno-Economic Paradigms — New Technological Modes
Authors: Басовский Леонид , Basovskiy Leonid , Басовская Елена , Basovskaya Elena
Published: February 2018

The model of long-term technical and economic development of industrial and post-industrial economic systems is constructed. The system consists of several subsystems existing simultaneously. Each new subsystem, embodying a new technical and economic mode, provides a higher level of per capita income. The transition to each new stage of technical and economic development — the transition to the predominance, the dominance of the technical and economic paradigm, and the beginning of the spread of a new technical and economic paradigm occurs at the moment when the upward half-wave of the Kondratiev cycle begins to form. To establish the moments of the onset of the upward halfwaves of Kondratiev cycles and the timing of the start of the spread of new techno-economic modes, econometric models of real per capita GDP in developed countries, including a smooth and cyclic (harmonic) component, were constructed. The average duration of the third cycle in these countries was 51.9 years, the fourth cycle — 49.8 years. Because of the construction of econometric models, it was possible to evaluate the productivity of relic, fourth, fifth and sixth technical and economic paradigms in developed countries. The average value of the maximum productivity of the fourth techno-economic mode was 2594 Geri-Hemis $ 1990, the fifth — 12,245 Geri-Hemis $ 1990, the sixth — 25 374 Geri-Hemis $ 1990. The average contribution to the real per capita GDP of relict modes and the fourth mode in the period of its domination was 5004 Geri-Hemis $ 1990, which corresponds to the value of 161,379 rubles. 2008. The excess of this value in Russia provided isdue to the spread of the fifth technical and economic mode. Its significant contribution to the real per capita GDP of the country began to observe since 2001 and by 2015 reached 47%. Modeling the period of the contribution of the fifth paradigm to Russia’s per capita GDP made it possible to predict the transition to its dominance in 2040. The forecast of the transition to the domination of the fifth mode in the regions of Russia is to include this time from 2010 to 2200. Construction of production functions based on data on per capita GRP over the years made it possible to establish that investment in fixed assets and an increase in the share of employed persons with a higher education can accelerate the spread of the fifth techno-economic mode and have received estimates of their effectiveness in the regions of Russia. A feature of the regions in which new modes did not receive proliferation was the low capitalization of new fixed assets and the increased number of employees of territorial bodies of federal executive bodies.
Dynamic Atomic Congestion Games with Seasonal Flows
Authors: Scarsini Marco , Schröder Marc , Tomala Tristan
Published: February 2018

We propose a model of discrete time dynamic congestion games with atomic players and a single source-destination pair. The latencies of edges are composed of free-flow transit times and possible queuing time due to capacity constraints. We give a precise description of the dynamics induced by the individual strategies of players and of the corresponding costs, either when the traffic is controlled by a planner, or when players act selfishly. In parallel networks, optimal and equilibrium behavior eventually coincide, but the selfish behavior of the initial players has consequences that cannot be undone and are paid by all future generations. In more general topologies, our main contributions are threefold. First, we illustrate a new dynamic version of Braess paradox: the presence of initial queues in the network may decrease the long-run costs in equilibrium. This paradox can arise in networks for which no Braess paradox was previously known. Second, we show that equilibria are not unique and can induce very different long-run costs. In particular, we give a sequence of networks such that the price of stability is equal to 1, and the price of anarchy is equal to n − 1, where n is the number of vertices. Third, we propose an extension to model seasonalities by assuming that departure flows fluctuate periodically over time. We introduce a measure that captures the queues induced by periodicity of inflows. For optimal and equilibrium flows in parallel networks this measure is the increase in cost compared to uniform departures.

The electronic companion is available at https://doi.org/10.1287/opre.2017.1683 .
RECURRENT OSTEOCHONDRAL FRACTURE OF THE PATELLA
Authors: Coleman H. M.
Published: February 2018

Osteochondral fractures of the patella should be recognised early, loose bodies removed, and defects in the articular surfaces smoothed off, or the patella removed if it is extensively involved. Plication of the capsule on the medial side is recommended in order to prevent recurrence of the injury and to prevent dislocation of the quadriceps tendon. in cases where the patella is removed.
THE BONE BLOCK METHOD FOR RECURRENT DISLOCATION OF THE SHOULDER JOINT
Authors: Palmer Ivar , WideÌn Anders , Sweden Stockholm
Published: February 2018

The purpose of this paper is to call attention to the anterior bone block method of Hybbinette-Eden for recurrent dislocation of the shoulder joint.

1. The operative technique is not difficult, and the after-treatment is short and relatively agreeable for the patient.

2. Sixty of our own cases are described, with four recurrences. The recurrences all occurred as the result of real trauma. In a total of 128 Scandinavian cases there were eight recurrencesâthat is 6Â·3 per cent.

3. In our opinion, based on the observations of radiography, arthrography, and operation, it is the compression fracture of the head of the humerus which deserves the name "essential lesion." Destruction of the anterior rim of the glenoid may be very slight, or entirely lacking. No false joint cavity or rupture big enough to receive the head of the humerus was ever observed by arthrography or by inspection during operative exploration.

Recurrent dislocation is an intracapsular subluxation, which occurs when the anterior rim of the glenoid slides into the hollow in the humeral head.
FATIGUE FRACTURES OF THE FIBULA
Authors: Burrows H. Jackson
Published: February 2018

1. A hope expressed in 1940, that further cases of spontaneous fracture of the lowest third of the apparently normal fibula would be described, has been fulfilled. The literature is here reviewed. Five further personal cases are added.

2. The clinical and radiographic features, diagnosis, treatment and results are considered in the light of the information so far available. Special note is made of misleading freedom of ankle and tarsal movements and the occasional absence of tenderness.

3. It is established that fractures of the lowest third occur particularly in two groups of subjects: 1) young male runners and skaters; 2) active and hard-pressed women of middle age and over.

4. In male runners and skaters the fracture usually occurs through slender, mainly cortical bone, two inches or more above the tip of the lateral malleolus; in middle-aged women the fracture is usually distal to the interosseous ligament through thicker, mainly cancellous bone, one and a half inches from the tip of the lateral malleolus.

5. The most convenient name for both groups of fractures in the lowest third is low fatigue fracture of the fibula.

6. A review of the literature of fatigue fracture of the uppermost third of the fibula shows that it is very often precipitated by jumping. The most convenient name for it is high fatigue fracture of the fibula.

7. Like all clinical classifications this distinction between low and high fractures has exceptions (a low fracture of one fibula in a runner was followed later by a high fracture of the other; most military fractures were high, but a few may have occurred at other levels).

8. Fatigue fracture of the fibula, high or low, may be bilateral.

9. A fracture similarly situated to the high fatigue fracture of the fibula has been frequent in parachute schools. It is a speculative possibility that military and parachutist fractures of the upper third of the fibula indicate the link between true fatigue fractures (as exemplified by march fractures with minimal trauma often repeated) and purely traumatic fractures (with adequate trauma applied once only).
POSITIVE PRESSURE IN ARTHRODESIS OF THE KNEE JOINT
Authors: Charnley John C.
Published: February 2018

1. The technique of compression-arthrodesis of the knee joint is described.

2. Fifteen consecutive cases are reported in which clinical union was detected at the first inspection from twelve days to six weeks after operation. By this method the total period of disability is reduced to three months.

3. Three mechanical factors which might be responsible for this very early clinical union are examined: compression is believed to be the main factor, although fixation is also important.

4. A fallacy is exposed in the use of bone grafts for arthrodesis of the knee; the graft is less osteogenic than the substance of the bones which form the joint, and it provides inefficient internal fixation.

5. A theory is suggested that compression, even in the presence of slight movement, acts by producing a fixed "hinge" without shearing movement; at this point a bridgehead of flexible osteoid tissue is established in which ossification inevitably takes place despite slight bending movement.

6. A second theory is suggested that high compression forces stimulate early union by liberating bone salts at points of maximum pressure through the action of osteoclasts, and that the local excess of bone salts is redeposited under cellular activity within a range of a few millimetres where there is no pressure.
NAILING THE FEMORAL NECK BY A SIMPLE METHOD
Authors: Kinsella V. J.
Published: February 2018

A method of nailing the femoral neck is described which combines efficiency with simplicity, both in method and in apparatus.
DEVELOPMENTAL COXA VARA
Authors: Le Mesurier A. B.
Published: February 2018

Most of what I have said has been said before by various writers. Abduction osteotomy is the recognised form of treatment for developmental coxa vara. The results from this operation are usually good. But the results of treatment would probably be better if the condition could be diagnosed before deformity had become disabling, and if the gap in the bone could be closed by other means than osteotomy. Good results of bone grafting in early cases of developmental coxa vara are reported.
KNEE JOINT CHANGES AFTER MENISCECTOMY
Authors: Fairbank T. J.
Published: February 2018

Changes in the knee joint after meniscectomy include ridge formation, narrowing of the joint space, and flattening of the femoral condyle. Investigations suggest that these changes are due to loss of the weight-bearing function of the meniscus. Meniscectomy is not wholly innocuous; it interferes, at least temporarily, with the mechanics of the joint. It seems likely that narrowing of the joint space will predispose to early degenerative changes, but a connection between these appearances and later osteoarthritis is not yet established and is too indefinite to justify clinical deductions.
TRACTION INJURIES OF THE BRACHIAL PLEXUS IN ADULTS
Authors: Barnes Roland
Published: February 2018

1. Sixty-three traction injuries of the brachial plexus in adults are reviewed. Most of the patients were seen at regular intervals for more than three years after injury.

2. The mechanism of injury is described. Forcible separation of the head and shoulder is the essential factor, but the type of lesion is determined by the position of the upper limb at the time of the accident.

3. In traction injuries the main damage is intraneural, and the lesions are of considerable extent. Extraneural scarring is a conspicuous feature of old injuries, but it does not cause any damage to uninjured parts of the plexus.

4. The prognosis of each type of lesion of the plexus is discussed. Satisfactory recovery occurs in most lesions of the upper three roots. Degenerative lesions of the whole plexus never recover completely. Cases with Horner's syndrome always have severe residual paralysis.

5. Conservative treatment is advocated for traction injuries of the plexus and evidence is cited against early or late operations on the plexus. Reconstructive surgical procedures are sometimes indicated.
SCOLIOSIS WITH PARAPLEGIA
Authors: McKenzie K. G. , Dewar F. P.
Published: February 2018

1. Five cases of scoliosis with paraplegia are reported, and thirty-six comparable cases from the literature are reviewed. These forty-one cases have been studied with the object of determining the etiology of scoliosis, the reason why cord compression sometimes develops, and the results of conservative and operative treatment of such compression of the cord.

2. The cause of paraplegia is nearly always compression of the spinal cord by the dura, which, in severe scoliosis, is under longitudinal tension because of its firm attachment to the foramen magnum above and the sacrum below. Such tension, resisting displacement of the spinal cord from the straight line, may be shown to cause incomplete spinal block even when there is no paralysis.

3. When paralysis occurs it usually develops during the years of most rapid growth, the tight dura being unable to accommodate itself to the rate of growth of the spinal column; cord compression is probably increased by narrowing of the dural sac by rotational displacement.

4. The most striking results have been secured by laminectomy with section of the dura and sometimes division of dentate ligaments and tight nerve roots. After such division there is evidence of release of compression: the cord herniates through the dural slit; and spinal pulsation returns.

5. It is important to control bleeding in order to avoid post-operative compression by blood clot; and to prevent leakage of cerebro-spinal fluid through the arachnoid.

6. It is unwise to perform spinal fusion at the same time as decompression because it increases the danger of haematoma formation. Moreover the improvement gained by decompression is maintained even if no fusion of the spine is performed.

7. Conservative treatment of scoliosis with paraplegia should not be continued for long periods unless there is evidence of early and progressive improvement because prolonged compression causes irreversible changes in the cord.

8. In three cases, paraplegia was not due to dural compression: one turned out later to be a case of syringomyelia; one, reported by Heyman, was due to the pressure of a bone spur; and one, reported in this series, was due to a congenital tight band of developmental origin which might have caused the scoliosis as well as the paralysis, and in which, after resection of the band, recovery from the paralysis was complete.
POLYOSTOTIC FIBROUS DYSPLASIAâALBRIGHT'S SYNDROME
Authors: Warrick C. K.
Published: February 2018

1. Four cases of polyostotic fibrous dysplasia are presented.

2. All are males, all show cutaneous pigmentation, and in two there has been precocious puberty.

3. The literature has been reviewed, and present conceptions of the pathology and etiology of the disease have been discussed.

4. The dysplasia if often confused with parathyroid osteodystrophy and sometimes the parathyroid glands are needlessly explored. This confusion should not arise if it is remembered that no general skeletal decalcification, and no constant changes in the blood calcium or phosphorus, occur in polyostotic fibrous dysplasia. The radiographic appearances of healing parathyroid osteodystrophy are, however, indistinguishable.

5. No effective therapy has been discovered for this disease. Pathological fractures and deformities may require treatment.
TROCHANTERIC FRACTURES OF THE FEMUR
Authors: Murray R. C. , Frew J. F. M.
Published: February 2018

1. A series of one hundred consecutive cases of trochanteric fractures treated conservatively by the authors has been reviewed.

2. Analysis of the results obtained and a study of the relevant literature has led us to the firm conclusion that the routine treatment of this group of fractures should be conservative.

3. Internal fixation should be reserved for those exceptional cases where traction is found to be inadequate: this is specially likely in cases associated with an upper motor neuron lesion, where difficulty is experienced in maintaining reduction owing to muscle spasm.

4. The basal type of fracture offers a special problem because it merges imperceptibly into that of the true transcervical fracture. No difficulty has been experienced in this series in the conservative treatment of such fractures, but we recognise that they might well be regarded as a variety of transcervical fracture and treated by nailing in order to avoid the risk of non-union.
TREATMENT OF OSTEOCLASTOMA BY RADIATION
Authors: Ellis Frank
Published: February 2018

The problems of diagnosis and treatment of osteoclastoma are considered. The importance of full investigation, and the advantages of drill biopsy in confirming the diagnosis, are discussed. Treatment by radiation is believed to be better than treatment by surgical measures. Curettage and excision are unnecessary. Amputation for benign osteoclastoma is unjustifiable.
THE FATE OF VOLUNTARY MUSCLE AFTER VASCULAR INJURY IN MAN
Authors: Bowden Ruth E. M. , Gutmann E.
Published: February 2018

1. Biopsies of muscle were taken during the course of operation from sixteen patients with vascular injuries to the limbs. Three types of histological change were found.

2. In the first, there was massive necrosis of muscle fibresâa group of cases in which there had always been serious damage to the main artery of the limb or to the vessel supplying the affected muscles.

3. In the second type there was dense interstitial fibrosis, the muscle fibres sometimes being normal and sometimes showing necrosis or denervationâa group of cases in which the vascular injury varied from severance of the vessels by gunshot wounds to trivial damage, causing slow haemorrhage within fascial-bound spaces.

4. The third type showed scattered foci of necrosis together with patchy interstitial fibrosisâdue to the pressure of tight plasters, crushing of the limb, fractures with arterial contusion, or slow haemorrhage or extravascular transfusion within fascial planes. The rise of tension within the muscles was probably sufficient to occlude the smaller arterioles with resultant patchy necrosis.

5. The vulnerability of certain muscles to vascular damage is partly related to the intramuscular vascular pattern, of which five types have been described.

6. In ischaemic muscles the intramuscular nerve trunks may be normal or they may show evidence of degeneration or necrosis; but in favourable circumstances there may be regeneration of axons.

7. In some cases there was evidence of regeneration of muscle fibres in man, the regeneration being dependent to some extent upon the efficiency of intramuscular anastomoses.

8. The prognosis, in cases of ischaemia of human voluntary muscle, depends upon the extent and the reversibility of damage to both muscle and nerve fibres and upon the extent of regeneration of muscle fibres.
THE PAINFUL SHOULDER Significance of Radiographic Changes in the Upper End of the Humerus
Authors: Harrison Stewart H.
Published: February 2018

1. Degenerative lesions of the shoulder joint can often be demonstrated radiographically before there is actual rupture of the musculo-tendinous cuff.

2. The characteristic pathological, clinical and radiographic features of degenerative lesionsare described.

3. All injuries of the shoulder joint, however trivial, occurring in patients over middle age, should be studied carefully by radiographic examination.

4. In injuries of the shoulder joint the presence of a degenerative lesion prolongs the duration of symptoms, and the prognosis is less satisfactory than when there is no radiographic evidence of abnormality.
LEÌRI'S PLEONOSTEOSIS, CARPAL TUNNEL COMPRESSION OF THE MEDIAN NERVES AND MORTON'S METATARSALGIA
Authors: Watson-Jones Reginald
Published: February 2018

1. LeÌri's pleonosteosis is characterised by broadening and deformity of the thumbs and great toes, flexion contracture of the interphalangeal joints, limited movement of other joints, and often a Mongoloid facies. Four such cases are described.

2. A review of the twenty reports in the literature, and the cases now described, shows that the deformities are due to capsular contracture rather than deformity of bone.

3. In one patient there was striking evidence of fibro-cartilaginous thickening of the anterior carpal ligaments. It is suggested that the primary pathological change in pleonosteosis may be in the joint capsules rather than in the epiphyses.

4. The patient with thickening of the anterior carpal ligaments had bilateral median palsy from carpal tunnel compression.

5. The causes of carpal tunnel compression of the median nerve are reviewed. Acute compression may be due not only to dislocation of the semilunar bone but to haemorrhage in the palm. Late compression by bone may occur twenty to fifty years after injury. Late compression without bone abnormality has been attributed to occupational stress, but it is suggested that pathological thickening of the anterior carpal ligament may be the cause.

6. The patient with pleonosteosis and bilateral median palsy had also bilateral Morton's metatarsalgia with large digital neuromata.

7. Plantar digital neuritis has already been shown to be an ischaemic nerve lesion preceded by degenerative changes in the digital artery. The significance of the fibrous tunnel through which the artery passes to reach the digital cleft is considered.
DYSCHONDROPLASIA WITH HAEMANGIOMATA (MAFFUCCI'S SYNDROME)
Authors: Strang Christopher , Rannie Ian
Published: February 2018

1. Maffucci's syndrome consists of dyschondroplasia (Ollier's disease) in association with cavernous haemangiomata and phlebectasia. Twenty-two cases have hitherto been described.

2. A further case is recorded with autopsy findings showing the characteristic features of the syndrome. Death was caused by a chondrosarcoma of the sphenoid, which led to subarachnoid haemorrhage, cranial nerve palsies, crossed hemiplegia and cavernous sinus thrombosis with almost total pituitary necrosis.
A CASE OF RENAL RICKETS SIMULATING "METAPHYSIAL DYSOSTOSIS"
Authors: MuÌller G. M. , Sissons H. A.
Published: February 2018

A case is described in which a clinical diagnosis of "metaphysial dysostosis" was made, but in which histological examination of involved bones showed the changes of rickets, presumably renal, with secondary hyperparathyroidism.
TUBERCULOSIS OF THE SPINE
Authors: Dobson J.
Published: February 2018

1. Nine hundred and fourteen cases of tuberculosis of the spine are analysed and the late results ascertained three or more years after discharge from hospital.

2. The relative frequency with which the various segments of the spine are involved has been found. Cervical disease was present in 3Â·5 per cent of cases, thoracic in 43Â·l per cent, lumbar in 32Â·9 per cent, thoraco-lumbar in 16Â· 7 per cent and lumbo-sacral in 3Â·8 per cent.

3. The mortality rate was 16Â·7 per cent. In patients with multiple lesions 25Â·5 per cent died, compared with 12Â·3 per cent in the group without complications. When chronic secondarily infected abscesses and sinuses were present the mortality rate was 19Â·1 per cent, and of patients with paraplegia 24Â·8 per cent died.

4. In the late results the working capacity of 390 patients was ascertained. It was full in 86 per cent, partial in 5Â·8 per cent and nil in 8Â·2 per cent.

5. An attempt has been made to determine the site of the primary bone focus from the radiograph. Early "epiphysial" changes were present in 33 per cent ; the central focus beginning in the spongy tissue of a vertebral body was present in 11Â·6 per cent; subperiosteal lesions were present in 2Â·1 per cent; and infection of the neural arch was present in only 0Â·5 per cent. In 52Â·8 per cent, however, widespread destruction had taken place when the patient first came under observation.

6. The ill effect of complications upon the prognosis is stressedâespecially in the cases of multiple foci of active tuberculosis, secondarily infected abscesses and sinuses, and paraplegia. Paraplegia occurred in 31Â·2 per cent of the cases of thoracic disease.

7. An attempt has been made to determine the frequency with which tuberculosis of the spine heals by spontaneous bony fusion of the affected vertebral bodies. It was found in 27Â·3 per cent of the cases in the present series.

8. Reasons for further treatment after the initial discharge of the patient are examined.
THE TREATMENT OF CLAW TOES BY MULTIPLE TRANSFERS OF FLEXOR INTO EXTENSOR TENDONS
Authors: Taylor R. G.
Published: February 2018

1 . The principles and technique of flexor-extensor tendon transfers for claw toes are described. The operation is tedious, but it is effective in selected cases.

2. Sixty-eight patients have been operated upon and followed up; good results were obtained in fifty, fair results in eleven, and poor in seven. More careful selection and better operative technique might have avoided some of the failures.

3. The operation restores useful function to the toes at the cost of their prehensile action, diminishes any cavus deformity of the foot, and, by lessening the prominence of the metatarsal heads in the sole, avoids callosities and discomfort.
MYOSITIS OSSIFICANS COMPLICATING ANTERIOR POLIOMYELITIS
Authors: Costello Francis V. , Brown Austin
Published: February 2018

1. Three cases of poliomyelitis complicated by myositis ossificans are reported.

2. A search of the literature has failed to reveal any similar reported cases.

3. The cause is still obscure.
TRANSFER OF THE TIBIALIS ANTERIOR TENDON FOR RELAPSED CLUB-FOOT
Authors: Critchley J. E. , Taylor R. G.
Published: February 2018

1 . Twenty-two cases of transplantation of the tibialis anterior for relapsed club-foot have been reviewed. Results were good in sixteen cases, fair in two and bad in four.

2. The operation and routine treatment are described.

3. The reasons for the four failures are discussed.

4. It is concluded that the operation is well worth while, and will often avoid the need for bony stabilisation at a later date.
FLAKE FRACTURE OF THE TALUS PROGRESSING TO OSTEOCHONDRITIS DISSECANS
Authors: Marks Kenneth L.
Published: February 2018

1. A case of flake fracture of the talus progressing to osteochondritis dissecans is reported.

2. The relationship between direct injury and the onset of the lesion is noted.

3. The sequence of events was observed radiographically and clinically for two years from the date of the original injury.
MALIGNANT OSTEOCLASTOMA
Authors: Cameron J. A. P. , Marsden A. T. H.
Published: February 2018

A case is described of malignant osteoclastoma of the lower end of the femur in which death occurred from pulmonary metastases. The history was short and there was no interference with the primary growth, treatment being confined to disarticulation at the hip. Reasons are given for considering this neoplasm a malignant osteoclastoma rather than an osteogenic sarcoma, and the question of nomenclature is discussed.
NUCLEOGRAPHY
Authors: Erlacher Peter R.
Published: February 2018

1. The technique of nucleography, in which a radio-opaque watery solution of iodine is injected into the nucleus pulposus for contrast-radiography, is described.

2. The merits of the procedure in demonstrating the shape and condition of nucleus are discussed.
TECHNIQUE, DANGERS AND SAFEGUARDS IN OSTEOTOMY OF THE SPINE
Authors: Adams J. Crawford
Published: February 2018

1. The steps of the operation of spinal osteotomy, as carried out with the patient in the lateral posture, are described.

2. Details of post-operative management are given.

3. The major risks of the operation are discussed and precautions suggested.
THE OSTEOPOROSIS OF IMMOBILISATION IN RECUMBENCY
Authors: Stevenson F. Harwood
Published: February 2018

While it is not denied that immobilisation of a diseased joint may be essential, there is a growing mass of evidence that immobilisation in recumbency of the whole patient has severe effects both in the neighbourhood of the actual lesion and upon the skeleton as a whole. Further search for measures to counteract the undesirable skeletal effects of recumbency is much needed.
DEFORMITY OF THE ELBOW JOINT AS A SEQUEL TO ERB'S OBSTETRICAL PARALYSIS
Authors: Aitken John
Published: February 2018

1. In a survey of 107 cases of Erb's paralysis, twenty-seven instances of incipient or actual posterior dislocation of the upper end of the radius were discovered.

2. The type of case in which the dislocation occurs is defined and the early clinical and radiographic signs of the displacement are described and illustrated.

3. The probable causesâmuscle imbalance and rigid splinting over a long periodâare adumbrated and the prevention and remedies are suggested.

4. The occurrence of anterior dislocationâsix casesâand its significance are discussed.
HAEMOPHILIAC ARTHROPATHY OF THE HIP
Authors: Winston M. E.
Published: February 2018

1. Seven cases of haemophiliac arthropathy of the hip joint are reported.

2. Attention is drawn to the different appearances in the hip when it is affected before and after puberty. Before puberty there are features similar to pseudocoxalgia. After puberty there may be cyst formation, coxa valga, or features similar to osteoarthritis.

3. It is suggested that intra-osseous haemorrhage is important in the production of these changes and that intra-epiphysial haemorrhage is responsible for the appearances seen before puberty.
SOME OBSERVATIONS ON VENOUS PRESSURE ESTIMATIONS IN THE LOWER LIMB
Authors: Boyd A. M. , Catchpole B. N. , Jepson R. P. , Rose S. S.
Published: February 2018

1 . A technique for measuring venous pressure during exercise is described.

2. The findings in normal and abnormal conditions of the lower limb are recorded.

3. The mechanisms involved in the return of blood from the lower limb in various conditions are discussed, with particular reference to the post-phlebitic state.

4. The need for an objective method of assessing the results of surgical treatment of venous abnormalities in the lower limb is stressed.
ELMSLIE'S OPERATION FOR THE CALCANEUS FOOT
Authors: Cholmeley J. A.
Published: February 2018

1 . Paralytic talipes calcaneus and calcaneo-cavus are difficult deformities to correct and keep corrected. Many operations have been devised for this purpose.

2. Emslie's operation is a simple procedure by which satisfactory correction can be obtained and maintained. It can be modified to suit individual cases without altering the basic principles of the procedure and is physiologically sound.

3. Illustrative cases are described.
FRAME REDUCTION IN CONGENITAL DISLOCATION OF THE HIP
Authors: Scott J. C.
Published: February 2018

The frame described has a place in the treatment of congenital dislocation of the hip especially if the diagnosis is not made until after the age of one year. Analysis of comparable series of hips reduced on the frame and by manipulation shows that dysplasia of the femoral head is decidedly commoner after the manipulative method.
THE NORMAL VASCULAR ANATOMY OF THE FEMORAL HEAD IN ADULT MAN
Authors: Trueta J. , Harrison M. H. M.
Published: February 2018

1. The form and distribution of the blood vessels within the adult human femoral head are described.

2. It has been found possible to delimit the proximal femoral epiphysis in mature years by reference to arterial form alone.

3. Two morphologically different sets of vessels are described interposed between the arterioles and venules of the bone marrow. One, a true capillary bed, lies mainly within the fat marrow; the other, constituted by sinusoids, lies within the red marrow. The departure of these findings from current views is noted.

4. A capillary system is described in relationship to the calcified zone of the articular cartilage.

5. No evidence has been found in support of the common belief that the circulation within the femoral head decreases quantitatively with advancing age.
POST-TETANIC KYPHOSIS
Authors: Quinlan A. G.
Published: February 2018

1. A case of post-tetanic kyphosis is reported.

2. The clinical and radiographic features are described.

3. The theories of the mechanism of production of the deformity are discussed.
NUCLEAR HERNIATIONS OF THE INTERVERTEBRAL DISC
Authors: Begg A. C.
Published: February 2018

1. As a result of degenerative changes in the intervertebral disc, nuclear tissue often herniates through its confining structures. These lesions are common, even in children, and often lead to difficulty in diagnosis.

2. The radiological manifestations of nuclear herniations into the spongiosa of the vertebral body, through the anterior part of the annulus fibrosus, beneath the epiphysial ring, and through the posterior part of the annulus are described and illustrated. The clinical significance of these radiological appearances and their pathological basis is indicated.

3. An understanding of the significance of the radiological findings in herniation of the nucleus pulposus and a careful correlation with the clinical features of the case are necessary for accurate diagnosis.
THE NATURAL HISTORY OF OSTEOID OSTEOMA
Authors: Golding J. S. R.
Published: February 2018

1. The clinical features in twenty cases of osteoid osteoma have been analysed and compared with other cases reported in the literature.

2. The lesion is regarded as a benign neoplasm and its unusual clinical behaviour is attributed to its vascular nature.

3. The frequency with which an erroneous diagnosis of "neurosis" is made is stressed.
PARALYTIC DISLOCATION OF THE HIP
Authors: Jones G. Blundell
Published: February 2018

1. Twenty-two dislocations of the hip occurring in patients paralysed from an early age have been studied. All showed abnormal coxa valga. The coxa valga, which may gradually reach 180 degrees, precedes dislocation and makes it inevitable. The presence of unbalanced adductor power may hasten dislocation, but the latter can occur in complete flaccid paralysis.

2. The combination of structural instability of the hip joint and muscular weakness may make independent walking impossible, but restoration of stability gives considerable improvement in any remaining muscular power and may alter the patient's whole future.

3. A method of correcting the basic deformity of coxa valga by osteotomy is described and the results of nine operations are reviewed.
BONE ABSCESS CAUSED BY BACTERIUM COLI
Authors: Meyer R.
Published: February 2018

A bone abscess in the distal femoral metaphysis of an eighteen years old girl is described which was found to have been caused by bacterium coli sensitive to chloromycetin only. Surgical treatment combined with local administration of chloromycetin promptly cured the lesion.
HISTOCHEMICAL STUDIES OF BONE IN NORMAL AND PATHOLOGICAL CONDITIONS
Authors: Schajowicz Fritz , Cabrini Romulo L.
Published: February 2018

1. Histochemical studies have been made of the distribution of alkaline phosphatase, glycogen and acid mucopolysaccharides in normal growing bones (mice, rats and men) and also in forty cases of pathological bone processes (neoplastic and dystrophic).

2. The study of normal material confirmed that alkaline phosphatase is plentiful in calcification of cartilage and even more plentiful in bone formation (whether enchondral or direct).

3. It was observed that glycogen increased in the cartilage areas about to be calcified, and that it disappeared in those calcified. It seemed that osteoblasts did not always contain glycogen.

4. In the pathological material (tumours and dystrophic processes) there was great phosphatase activity in the osteogenic areas and also in the cartilage about to be calcified. Whereas glycogen was plentiful in some cases of neoplastic or reactive osteogenesis, it was absent from others.

5. In every area of normal or pathological ossification, the presence of phosphatase seems to be a rule; glycogen is often but not always present.

6. It appears that alkaline phosphatase plays an important role in the formation of the protein matrix of bone, but is not associated with the elaboration of the mucoprotein cartilage matrix.

We believe it is premature to draw any definite conclusion on the behaviour and role of the metachromatic substances in the processes of calcification and ossification.

The histochemical study of alkaline phosphatase has shown that this is a valuable method in the detection of reactionary or pathological osteogenic processes which in some cases are difficult to demonstrate with the usual histological methods.
OSTEOMYELITIS IN THE NEW-BORN
Authors: Potter C. M. C.
Published: February 2018

1. Recent published reports of neonatal osteomyelitis in long bones are reviewed.

2. Six further cases are described.

3. The source of infection is usually the skin or the umbilicus, and the common organisms are the haemolytic streptococcus and staphylococcus aureus.

4. Cases fall into two groups: in one the patient is acutely ill with septicaemia and the bone lesion is of secondary importance; in the other the general condition is well maintained even though there may be multiple bone lesions.

5. Sequestration is uncommon; but when it occurs it prevents the rapid healing that is usually observed after drainage.

6. The most important complication is suppurative arthritis, which may lead to total destruction of a joint.

7. It is probable that the lowered mortality from infantile septicaemia will be matched by a corresponding increase in the cases of acute osteomyelitis encountered in clinical practice.
FANCONI'S SYNDROME
Authors: Singer Martin
Published: February 2018

1. A case of Fanconi's syndrome, with evidence of renal tubular dysfunction, is reported.

2. Healing of the rachitic lesions followed massive doses of calciferol. There was simultaneous improvement in the biochemical state. This case is probably unique in that the amino-aciduria disappeared.

3. Two-stage osteotomies were undertaken for the correction of severe bowing of the tibiae.

4. No toxic symptoms have developed so far from the calciferol therapy.
THE NATURAL HISTORY OF PLEURAL EFFUSION AND ORTHOPAEDIC TUBERCULOSIS
Authors: Stevenson F. Harwood
Published: February 2018

1. Details are given of sixty-three consecutive cases with a history of pleural effusion seen at an orthopaedic hospital.

2. Twenty-four of these were post-primary effusions occurring before the onset of symptoms of the orthopaedic lesion. The bone and joint lesions ultimately developing in this group of patients were widely scattered throughout the skeleton.

3. Three others were secondary to adult-type pulmonary lesions.

4. Thirty-six patients had a pleural effusion after the beginning of their orthopaedic tuberculous history. Seven were certainly secondary to operative intervention, six in the thorax near the parietal pleura (costotransversectomy or antero-lateral decompression of the cord) and one from a haematogenous dissemination after fusion of a hip joint.

5. The remainder of this group with pleural effusion during the history of their orthopaedic tuberculous disease numbered twenty-nine. Of these, twenty-five suffered from disease of the thoracic spine; in two more details are defective. Only two definitely had neither pulmonary nor thoracic spinal disease; their lesions were in the lumbar spine.

The conclusion is drawn that the overwhelmingly common cause of pleural effusion in patients with orthopaedic tuberculosis who have normal lungs and have not recently suffered spinal decompression is transpleural infection from thoracic spinal disease and that the sequence is by no means rare. It had occurred in approximately one in six of 145 patients with thoracic Pott's disease seen during this investigation.

6. Details are given of a group of cases with thoracic paravertebral abscess tracking laterally. When the abscess is well clear of the spine and spinal ligaments it may project forwards and radiologically it may appear in the antero-posterior chest film as a shadow in the middle of one or other lung field rather than as a shadow obviously connected with the central paravertebral abscess. Aspiration will yield pus from this posterior extra-pleural abscess extension.

7. The belief that Pott's disease most commonly follows direct spread from caseous paraaortic glands secondary to tuberculous pleurisy is discussed. It is concluded that the evidence is insufficient for so sweeping a statement.
THE SURGICAL TREATMENT OF TARSO-METATARSAL FRACTURE-DISLOCATIONS
Authors: del Sel Jose Manuel
Published: February 2018

1. In the treatment of tarso-metatarsal fracture-dislocations open reduction is advocated whenever closed reduction is found impossible.

2. A technique of operation is described whereby, after reduction, temporary transfixion wires are used to prevent redisplacement.
LUMBO-SACRAL ARTHRODESIS AFTER LAMINECTOMY
Authors: Adkins E. W. O.
Published: February 2018

1. The usual methods of posterior arthrodesis of the lumbo-sacral joint are not satisfactory in cases in which laminectomy has been performed.

2. Estimation of fusion by mobility radiographs is unreliable and cannot distinguish between fibrous ankylosis and bony fusion.

3. Bone grafts inserted from behind between the vertebral bodies almost invariably fail to become incorporated.

4. Intertransverse arthrodesis has given promising results and is probably the best method available at present.
SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN
Authors: Madsen Erin
Published: February 2018

1. Reduction of supracondylar fractures in children by lateral rotation of the arm combined with mechanical traction and manipulations is described. Fixation in a plaster shoulder spica is recommended.

2. The results are presented and seem to be satisfactory.
DEPOSITION OF CALCIUM SALTS IN THE POPLITEUS TENDON
Authors: Holden N. T.
Published: February 2018

1. Two cases of deposition of calcium on the outer side of the knee are described.

2. The condition is believed to be uncommon and does not appear to have been described before.

3. One case resolved with conservative treatment, the other after an operation at which the deposit was found in the tendon of popliteus.
THE FANCONI SYNDROME
Authors: Saville Paul D. , Nassim R. , Stevenson F. Harwood , Mulligan Lily , Carey Margaret
Published: February 2018

1. Metabolic balance studies in two cases of the Fanconi syndrome are presented.

2. The actions of sodium bicarbonate and calciferol on the calcium and phosphorus balance were observed separately in the two cases.

3. The results show that sodium bicarbonate alone corrects acidosis and decreases the loss of calcium in the urine.

4. Calciferol in high dosage will increase intestinal absorption of calcium and phosphorus, but the urine calcium excretion then increases and vitamin D alone does not, therefore, give a positive balance adequate for complete healing and normal growth.

5. Alkalies and calciferol together put these cases into strongly positive calcium and phosphorus balance and promote healing of rickets, osteomalacia and pseudo-fractures.

6. Large doses of sodium bicarbonate in tablet form correct acidosis, do not adversely affect intestinal absorption of calcium, and facilitate accurate dosage and convenient administration.

7. Alkali therapy may lower serum potassium and precipitate symptoms of hypokalaemia in potassium-losing patients. This is thought to have been the cause of symptoms in several cases reported in the literature.
DISPLACEMENT OSTEOTOMY OF THE UPPER END OF THE FEMUR
Authors: Wardle E. N.
Published: February 2018

1. Forty patients out of sixty-nine operated upon between 1932 and 1952 by displacement osteotomy for congenital dislocation of the hip, ununited fracture of the neck of the femur, and osteoarthritis of the hip have been reviewed and the results analysed.

2. The factors responsible for the success of the operation are discussed and the technique of operation is described.
THE USE OF LIVELY SPLINTS IN UPPER LIMB PARALYSIS
Authors: Smythe N. , Parry C. B. Wynn
Published: February 2018

1. The indications for the use of lively splints in upper limb paralysis instead of reconstructive surgery are discussed.

2. Examples of lively splints used for the elbow, wrist and hand are described and illustrated.
SACRAL EXTRADURAL CYST: AN UNCOMMON CAUSE OF LOW BACK PAIN
Authors: Schurr Peter H.
Published: February 2018

1. A case of low back pain due to a sacral extradural cyst is reported. Radiographs of the sacrum showed an ovoid expansion of the sacral canal. Myelography and exploratory laminectomy revealed an extradural cyst associated with a defect in the dural root sleeve surrounding the second left sacral roots. Relief of symptoms followed evacuation of the cyst and repair of the defect.

2. The differential diagnosis of the condition, the varieties of extradural cyst, and the features which distinguish them from perineurial cysts are described.
FATIGUE FRACTURES OF THE ULNA
Authors: Evans David L.
Published: February 2018

1. Two cases of fatigue fracture of the ulna are reported.

2. Three cases previously reported are reviewed and a striking similarity with one of the present cases is noted.

3. In all cases the mechanism of injury appears to have been the same.
ORTHOPAEDIC PROBLEMS OF HEREDITARY SENSORY NEUROPATHY
Authors: Heller Leon , Heller Irving H. , Petrie J. G.
Published: February 2018

1. Three cases of hereditary sensory neuropathy are reported.

2. Neuropathic destruction of joints and chronic infected ulcers are the primary problems of management.

3. This entity must be considered in the differential diagnosis of trophic ulcerations of the extremities.