1 . A personal series of twenty-nine discoid menisci is reviewed. 2. Three anatomical types are recognised and described. 3. The characteristic lesions incurred by each type is recorded. 4. The anatomical and pathological features of the specimens are compared with those of cases previously recorded. 5. A discoid medial meniscus is described, and compared with the only other specimen known to be recorded in the literature.

1. The record is presented of an attempt to treat osteochondritis dissecans on idealistic lines. 2. The operative technique to be adopted in the various circumstances likely to be encountered in the knee joint is described. Two cases affecting the talus are recorded. 3. The radiological appearance has become virtually normal in twenty-seven cases (the remaining four are recent); healing has been observed directly in seven cases in which a second operation to remove the means of internal fixation was necessary; and the patients' complaints have been eliminated, but the long term results of treatment are unknown. 4. Suggestions are made for possible developments in the technique of operation.

Whole body vibration (WBV) has been proposed as an alternative exercise stimulus to produce adaptive responses similar to resistance exercise. Few studies have analysed acute hormonal responses to WBV. Purpose To evaluate neuromuscular and hormonal responses to an acute bout of isometric half-squat exercise with and without superimposition of WBV. Methods Seven healthy males (22.3+/-2.7 years) performed 10 sets of half squat isometric exercise for 1 min with 1-min rest between sets. Two separate trials were conducted either with WBV [30 Hz; 3.5 g (1 g=9.81 m.s2)] or without vibration (Control). Salivary concentration of testosterone and cortisol was collected and maximal isometric unilateral knee extensions (MVC) were completed before, immediately after, 1, 2 and 24 h after treatment. Results Significant decreases in MVC were observed immediately after (229.4+/-53.2 Nm), 1 h (231.6+/-59.9 Nm), and 2 h (233.0+/-59.1 Nm) after WBV compared with baseline (252.7+/-56.4 Nm; P<0.05). No significant change in MVC was recorded in Control. Rate of torque development in the first 200 ms (RTD200 ms), and salivary testosterone and cortisol concentrations were unaffected in both conditions. However, there was a trend for change over time in cortisol (P=0.052), with an increase after WBV and decrease after Control. Conclusion A 10 min session of intermittent WBV was shown to produce an acute reduction in MVC in healthy individuals, which recovered after 24 h. No significant changes were identified in salivary concentration of testosterone and cortisol suggesting that WBV with low acceleration does not represent a stressful stimulus for the neuroendocrine system.

Objective: We report a rare case of a 51-year-old woman with ocular and nasal infestation by Oestrus ovis.Method: Clinical case report and review of current literature regarding nasal and ophthalmomyiasis. Results: Myiasis is infestation of the tissues and organs of vertebrates by certain dipteran fly larvae. Oestrus ovis myiasis is endemic in the region from North Africa to South Asia, but few cases are reported within the UK. A 51-year-old patient presented and was treated successfully in Sunderland Royal Hospital for combined ocular and nasal infestation with Oestrus ovis.Conclusions: Oestrus ovis has a largely subtropical distribution; however, it is important to remember the diversity of disease which can present within the UK from an external source. This point is illustrated by this rare case, which highlights the fact that prompt treatment can avoid poor outcomes for our patients.

More deprived areas have a higher outpatient DNA rate for cleft patients resulting in suboptimal follow-up. Ultimately, causation of poorer outcomes in this group is likely to be multi-factorial but the financial implication of travelling to multiple clinics should be considered and it may be that resource reallocation is the answer to address the current inequality of health care provision.

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A dedicated paediatric voice clinic is the optimal method for assessment, diagnosis and management of these patients. Diagnosis is possible on the majority of the patients in clinic, with the predominant pathology being vocal cord nodules that receive speech and language therapy. Socioeconomic group appears to have an influence on paediatric voice particularly vocal cord nodules and muscle tension dysphonia.

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