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A prospective study of 50 patients with low back and radicular pain caused by an L4-L5 protruded disc were treated by percutaneous laser nucleolysis with a carbon dioxide laser. The followup ranged from 2 to 5 years, and all the patients were evaluated clinically and by imaging with computed tomography scans and magnetic resonance images before and after the procedure. According to the Macnab criteria, 74% of the patients had excellent or good results and 26% had fair or poor results. The laser disc decompression opens up new options in the treatment of discogenic pain, but it is still an experimental procedure.

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Percutaneous laser discectomy has developed as a new modality in the treatment of herniated intervertebral discs. An experimental study of percutaneous nucleolysis using a carbon dioxide laser beam was performed in 10 dogs, each dog having 2 intervertebral disc spaces treated, for a total of 20 discs. The intradiscal pressure decreased in all instances with the drop ranging from 10% to 55% at the L2-L3 disc and 40% to 69% at the L4-L5 disc. The macroscopic and microscopic studies showed vaporization of the nucleus pulposus, and in 8 spaces, thermal damage to the end plate was observed. This study suggests that carbon dioxide laser nucleolysis is easy and effective, but 300 J of laser energy can damage the end plates in some intervertebral discs in dogs.

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Limb salvage operations using large custom-made prostheses have become the treatment of choice for juxta-articular tumours at the knee. Resection-arthrodesis has been used since the 1920s and offers a satisfactory long term solution for young active patients. The good functional results after this procedure in 9 patients is presented here. This method should still be considered in selected cases.

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A case of tumoral calcinosis simulating osteomyelitis and associated with bunion formation in a 20-year-old female is presented. The most striking findings in this patient were the soft tissue calcifications. There was no evidence of any of the known causes of heterotopic calcifications. This kind of simulation between tumoral calcinosis bunion formation and osteomyelitis has not been previously described.

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Sever's disease is an apophysitis or osteochondrosis of the calcaneal apophysis. Clinically, it includes painful heels and limitation of movement; and radiologically, fissuring and fragmentation of the calcaneal apophysis. Treatment is usually conservative, but when migration of the apophysis occurs, either posterior or plantar, surgical treatment is sometimes indicated. J Orthop Sports Phys Ther 1989;10(9):370-373.

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Synovial chondromatosis of the hip joint is uncommon entity. Two cases are presented, and the spectrum of the disease is discussed. Partial synovectomy with loose body removal is recommended as the treatment of choice. Joint replacement is performed only in patients with severe secondary osteoarthritis, and used only in selected cases.

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Percutaneous lateral discectomy (PLD) in a 32-year-old man was followed by postoperative disc space infection and adjacent vertebral osteomyelitis caused by Staphylococcus aureus. The simplicity and decreased morbidity associated with PLD may be offset by severe infections. The small incision made in the annulus during PLD may not allow adequate drainage in the case of infection and may subsequently direct the infective process to the adjacent vertebral endplates. Meticulous aseptic technique, and possibly the use of prophylactic antibiotic therapy, is important in PLD.

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During the last 10 years, we have treated 54 cases of fracture or dislocation of the lateral clavicle by transposing the coracoid process onto the clavicle. Recently, a postoperative musculocutaneous nerve injury was observed in 3 cases, all of which recovered spontaneously within 5 months. Our technique seems to entail a certain risk of causing stretch injury to the musculocutaneous nerve. Apart from resting the affected arm for a month or two, the condition does not require specific treatment.

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Ten patients with clinical and radiological evidence of herniated discs at lower lumbar levels were treated with partial discectomy by a lateral percutaneous approach. Eight patients had complete relief from radicular pain and were discharged within four days. They returned to normal daily activity within one month.

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A new operative approach is presented for treatment of fractured distal end of clavicle associated with recurrent anterior shoulder subluxations. One case is presented in which open reduction of the fractured clavicle and stabilizing the anterior shoulder joint were accomplished by transfer of the coracoid process with its attached muscles under the subcapularis muscle onto the clavicle. The operation was followed by complete reduction of the fracture and a stable shoulder joint.

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Two patients suffering from Paget's disease, involving the hip joint, with pain and limitation of movement, were treated by total hip replacement. The operative course was normal and without excessive bleeding. At follow-up five years later, the patients are free of pain, and have almost complete range of motion; there is no sign of prosthetic loosening.

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Three patients underwent hip arthroplasty--one total hip replacement and two, Thompson's hemiarthroplasty. The diagnosis was degenerative joint disease and subcapital fracture of the femur, respectively. Histologic and bacteriologic examination revealed mycobacterial infection. None of the patients had a past history of mycobacterial infection. In one instance, there was a reactivation of the infection eight months following surgery, which was treated successfully by antituberculosis drugs.

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A patient with Salmonella group D (Salmonella enteritidis) acute osteomyelitis of an operated femur is described. The patient failed to respond to chloramphenicol therapy and aztreonam therapy. The local infection that complicated the presence of a foreign body was eradicated only with the removal of the foreign body, an internal fixation plate.

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More than half the patients with permanent cardiac pacemakers (PCPMs) are over the age of 70 years. Patients in this age group are also more susceptible to fractures of the femoral neck requiring surgical intervention. The authors studied five patients with PCPMs who underwent surgery for femoral neck fracture. They discuss the special precautions necessary during surgery to prevent electromagnetic interference with the cardiac pacemaker as well as the special management of these patients.

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The device described indicates accurately the amount of weight borne on an affected leg. This device consists of two major elements: a weight measuring system incorporated in the walking cane's body, and a feedback mechanism situated in the cane's handle. By means of vibration or lights the patient and the therapist can determine whether or not the affected leg is bearing the prescribed weight. Thirty patients (10 with fractures, 10 with vascular disorders, and 10 below-knee amputees) and 10 healthy people participated in the study. The study concluded that young patients used the feedback information more readily than older patients. The intention in designing such a device is to help orthopedically disabled patients during their convalescence, to minimize strain on ischemic legs, and to assist amputees in monitoring weight-bearing postoperative walking.

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During the years 1958-1978, seventeen patients were treated for extra-appendicular carcinoid tumors of the gastrointestinal tract in Tel-Hashomer and Belinson hospitals. Most of the tumors were located in the colon (eight cases) and in the rectum (four cases). A direct correlation between the tumor size and invasiveness has been noted, with distant metastases in eight of 12 patients with tumors more than 2 cm in size. Gastrointestinal bleeding was the most frequent clinical symptom, whereas the "carcinoid syndrome" appeared only in three patients. Curative surgery was performed in six patients, palliative procedure in two cases, explorative laparotomy was performed in four cases, and in two patients diagnosis was made in postmortem examination. Eight of the 17 patients (47%) had distant metastases at the time of the diagnosis, and six of the 15 operated patients (40%) died during the first year after the operation. The malignant nature of these tumors, together with the high incidence (23%) of associated malignant neoplasms is stressed. Radical resection is advocated in the cases where the tumor's size is more than 2 cm or in the presence of muscular invasion.

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