LTHOUGH physicians have a choice of treating acute injuries of the spinal cord by realignment of the spinal column, surgical decompression, or measures that alter neuronal metabolism and prevent or reduce edema of the cord, or by combinations of these methods, the relative merits of these procedures appear to be unknown because they have not been evaluated comparatively. There is no known experimental model to assess bony alignment, but Freeman and Wright s have described an experimental spinal cord concussion-contusion in which sufficient threshold trauma produces at least a moderately prolonged paraplegia and possibly a lasting neurological deficit and by which the relative efficacy of most current treatments could be compared. Using a similar experimental model, we evaluated standard dural decompression, direct local cord hypothermia, intramuscular dexamethasone, and intrathecal methylprednisolone. Materials and Methods We used beagle dogs:~ raised specifically for research; all were young and weighed 8.4 to 15 kg. Most of the animals weighed approximately 12 kg and were female. They were anesthetized with intravenous sodium pentobarbital (30 mg/kg). Endotracheal tubes were placed in all the dogs, but assisted respiration was not required. Following the usual aseptic technique, a midline longitudinal incision was utilized to remove the posterior laminae of the tenth, eleventh, and twelfth dorsal vertebrae completely. The epidural fat was removed, but the dura was not opened.
The charts of 68 patients from 65 to 99 years of age who underwent appendectomy for appendicitis were reviewed between 1964 and 1976. Thirty-three were men and 35 women. All patients underwent appendectomy. Four patients had normal appendices. The remainder had appendicitis; 74% were ruptured. The duration of symptoms varied greatly, and was related to outcome. The mean duration was 58 hours, but both those who died and those who suffered complications had significantly longer mean duration while those who had an uncomplicated course had a shorter mean duration of symptoms. The incidence of rupture rose from 60% in those seen with symptoms less than 48 hours to 90% in those with symptoms longer than 49 hours. Delay was invariably related to delay in seeking medical treatment. In no case was the patient under the care of another physician for an extended period of time. Pain was the chief complaint in 63 patients, and was present in all. Seventy-four per cent had fever and 78% had leukocytosis. Those with normal appendices had normal white blood cell counts. Right lower quadrant tenderness was present in 80%. Thirty-nine per cent had significant additional medical problems. Most (73%) had operation within six hours of their original evaluation, and yet the overall complication rate was 34% including six deaths. Delay during evaluation did not correlate with unsatisfactory outcome as did delay in seeking medical attention. The most common complications were due to infection. In at least three of the deaths wound infection was associated with sepsis and death. Delay in seeking medical care, advanced age, and underlying problems were the most significant factors in those who died.
CONDYLOMATA ACUNIINTA, or venereal warts, are lesions which ordinarily can be diagnosed by their gross warty appearance and effectively treated either with podophyllin or by cautery. Occasionally, however, a condylomatous lesion may suggest the possibility of a malignant growth by its clinical appearance or may be found to harbor a maligniancy on histologic examination. We recentlv have encountered three cases of unusual condylomata wvhich prompted us to review the literature on this suibject a.nd to report our cases. Case Reports Case 1. A 36-year-old man was admitted January 1, 1972, for removal of multiple large condylomata involving the skin of the penis, the scrotum and the perineum, including coccygeal, gluteal, and both inguinal regions. The largest lesion measured 11.5 cm., X 8.5 cm. (Fig. 1). The patient stated that similar lesions had been treated successfully with podophvllin ten years previously. Three years prior to admission the lesions recurred, and attempted treatment with podophyllin w%as unsuccessful. During the month prior to admission the lesions began to enlarge and spread. Two days following admission the lesions were excised with cautery. Because of the depth of the lesions, it was not possible to preserve any skin beneath the lesions (Fig. 2). On January 19, 1972, the larger woun(ds wvere covered with split thickness grafts, and the smaller wounds were closed secondarily. When the patient was seen in the surgery clinic (Fig. 3) on March 2, 1972, two recurrences were noted, one on the penis and one in the peerianal region. These were thoroughly cauterized The patient was last seen on April 7, 1972, at w hich time no recurrences were notedl.
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