In order to assess the effect of the no-touch isolation technique, in the treatment of large bowel cancers, on the site of first recurrence and disease-free and overall survival, 236 patients were prospectively and randomly assigned to either the no-touch isolation technique (117 patients) or to a conventional resection technique (119 patients). No patient with distant metastases or unresectable disease entered the study. The two treatment groups were comparable with regard to patient characteristics. Pre- and postoperative complications (including mortality within 30 days) were similar in both groups. After a complete follow-up of 5 years, a tendency for reduction in the number of, and time to, occurrences of liver metastases was seen in the no-touch isolation group (P = 0.14). This effect was most obvious in the sigmoid colon with angio-invasive growth. Overall (P = 0.42) and corrected (P = 0.25) survival did not differ significantly among the treatment groups although in every analysis the survival data of the no-touch isolation group were superior. The data do suggest a limited benefit of the no-touch isolation technique. This observation is important since the morbidity and mortality of surgery were equal in both groups.

Immobilization of the knee as part of the treatment in bone or joint lesions leads to atrophy and consequently loss of functionally. In patients this atrophy and loss of functionality is difficult to quantify because of interfering symptoms and missing baseline data. In the present study structural and functional changes in thigh muscles were examined in eight healthy volunteers of whom one leg was immobilized in a cast for four weeks. Quadriceps cross-sectional area determined with computed tomography was 21% +/- 7% diminished after four weeks immobilization (p < 0.05). Muscle biopsies from the musculus vastus lateralis revealed an 16% decreased fiber diameter (p < 0.05) and no significant shift in fiber types. Isokinetic strength measurements of knee extensors and flexors demonstrated a fall in peak torque of 53% +/- 9% and 26% +/- 13% at an angular velocity of 60 deg.s-1 (p < 0.01). Aerobic power in one-leg-cycling exercise was not significantly affected, but isokinetic quadriceps endurance work decreased from 9.1 kJ to 5.6 kJ (p < 0.05). Despite the fall in quadriceps performance the subjects had only minor functional complaints for a few days. It is concluded that immobilization of the knee is an important factor in the development of thigh muscle atrophy in patients and should therefore be diminished as much as possible.

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In a series of 921 patients with acute inversion trauma of the ankle joint, the diagnostic features of lateral ligamentous ruptures were evaluated. Patients with proven lateral ligamentous rupture (150 patients in this series) were submitted to a prospective trial to compare three methods of treatment. In the 50 patients operated upon, the results of clinical diagnosis, stress radiography, and ankle arthrography were compared with surgical findings. Clinical diagnosis proved to be of very little value. The positive signs of ankle arthrography showed a reliability of 96% in predicting ligamentous rupture. Inversion stress radiography under full anesthesia showed a reliability of 92%, but the same investigation under local anesthesia, however, was only 68%.

Adhesive capsulitis or "frozen ankle" is a syndrome resulting from repeated ankle sprains, or perhaps following immobilization after trauma. Ankle arthrography is a useful and safe diagnostic procedure in this syndrome. Typical arthrographic features are described together with case histories of two patients with frozen ankle. We suggest that early mobilization of the patient following trauma is particularly important in preventing the development of a forzen ankle syndrome.