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Soft tissue injuries of the neck may cause severe long-standing pain. The clinical findings are sparse and the identification of the painful segments with conventional diagnostic tools is often impossible. Temporary segmental external fixation for a soft tissue injury of the cervical spine was performed as a diagnostic procedure in 24 patients. The instrumentation was applied according to the established techniques of the insertion of facet screws in the cervical spine. The segments to be instrumented were evaluated by clinical and radiological findings, such as local pain and increased mobility in the functional X-rays. However, none of these findings were convincing enough to proceed directly to fusion for pain relief. Evaluation of external fixation consisted of alternatively fixing different instrumented segments and having the patients rate their pain on a visual analogue pain scale. External fixation of the suspected segments resulted in marked pain relief, which was recorded subjectively by the visual analogue pain scale in 68% of the patients. The pain relief (8.2 points preoperatively--2.6 points postoperatively on average) could be permanently established by successful fusion of these segments in 17 patients. Four of the patients indicated no relief of pain at the follow-up (12.9 months postoperatively). No fusion was performed in 3 patients in whom the diagnostic procedure with external fixation allowed no conclusion about the painful segment. As it is an invasive procedure, external fixation of the cervical spine should be reserved for cases, in which conventional methods have failed to established a clear diagnosis of segmental instability and conservative therapy could not relieve the symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

For evaluation of the function of the upper cervical spine, especially assessment of the range of motion, functional X-rays films are useful in addition to the clinical examination. For the diagnosis of segmental instability, passive motion should be induced in order to obtain the full range. If anterior instability of the upper cervical spine is suspected, flexion-extension X-rays in the lateral view are appropriate. If a lesion of the alar ligaments is suspected, then lateral flexion X-rays films should be taken. In the normal situation, the atlas glides in the direction of bending, coupled by forced rotation of the axis. In cases with rotatory instability of the upper cervical spine, functional computed tomography should be performed. Atlantoaxial rotation of more than 52 degrees should be considered pathological as a result of a lesion of the alar ligaments. For examination of the relationship between the spinal cord and bony structures or inflammatory tissue in patients with rheumatoid arthritis, functional MRIs are helpful. Not only the exact diameter of the spinal canal can be measured during flexion and extension, but the degree of basilar impression or cranial migration of the axis can also be assessed. Optimal use of functional X-ray diagnostics, including functional the CT and MRI, is not only helpful for clinical diagnoses, but also for the planning of surgical procedures.

Because of relatively low frequency of pathological changes of the upper cervical spine in childhood and adolescence, their management is not well known. Diagnostic problems occur due to the variety of malformations possible, persisting growth plates and ligamentous laxity. Because of this laxity, conservative treatment with immobilization is advocated even in severe dislocations as long as they are reducible. Persistent dislocations, chronic atlantoaxial instability (ADI greater than 5 mm), dens fractures type II and existing or progressing neurological deficits all indicate surgical intervention. Internal fixation allows easier postoperative care. Complications are rare. Patients with orthopedic problems of the upper cervical spine are presented, together with their management.

Fresh human cadaveric specimens of occiput (C0) to C3 were subjected to 1.5 nm of flexion, extension and bilateral bending and axial torque. The resulting physiological motions were studied in an unconstrained three-dimensional manner. The effects of sequential transections of the left and right alar ligaments on the relative motion of C0-1 and C1-2 were studied. After transection of the left alar ligament, the percentage increases in neutral zones (NZ) and ranges of motion (ROM) were documented at both the C0-1 and C1-2 joints. In the sagittal plane, the most increase was at C1-2 due to the flexion moment, e.g., 47.4% in NZ and 27.6% in ROM. In lateral bending, the left alar transsection resulted in mostly right lateral bending increases and at the C0-1 joint, 37.1% in NZ and 19.6% in ROM. In axial rotation, changes in the total motion of the C0-2 joint complex were more reliable indicators. For left alar transsection, most increases were in right axial rotation, e.g., 25.6% for right rotation versus 11.2% for left rotation in the NZ parameter. Functional loss of the alar ligaments indicates a potential for instability which, however, must be determined in conjunction with other clinical findings, such as neurological dysfunction, pain and deformity.

Clinical and biomechanical testing of the stability of atlantoaxial fusions was studied. For biomechanical testing, four different techniques for posterior atlantoaxial fusion were tested: (1) wire fixation with one median graft; (2) wire fixation with two bilateral grafts; (3) transarticular screw fixation and two bilateral posterior clamps. Ten fresh human cadaveric specimens were tested. The loads applied were 6 pure moments. The motion of C1 relative to C2 in the intact, injured and mechanically fixed spine were measured and compared. In flexion/extension the difference between Brooks, Magerl and Halifax were not significant, but each was significantly less than the Gallie-system. For the anterioposterior translation the stabilization of all fixation techniques was about equal. In axial rotation measuring the translations between C1 and C2, the screw-fixation technique proved to be the most stable. For lateral bending, there was no significant difference between the different techniques, except for Galliefixation, but the screw-fixation technique allowed the least motion. In additional in vivo tests ten patients with posterior atlantoaxial fusion by the transarticular screw-fixation technique underwent bending X-rays of the upper cervical spine as well as computertomograms. Solid fusion was achieved in all patients. Both investigations proved the reliability of the multidirectional stability of the atlantoaxial screw fixation technique.

Among the methods for intramuscular injection, Hochstetters technique into the gluteus medius muscle is anatomically sound, but there are a few practical defects which make it difficult to perform. The method we describe has been tested and is simpler. Anatomical orientation is easier, vessels and nerves are not endangered, asepsis is better guaranteed, and the injection can be given with the patient in any position, even lying down. Instead of Hochstetters method of injecting into the vastus lateralis muscle, in which three connecting lines must be drawn mentally, we use our simple method: the injection is given in the middle third of the thigh, dorsal to a line joining the anterior superior iliac spine and the lateral border of the patella.

Mechanics of the respiratory system was simulated on analogue computer by a two-compartmental model. Each compartment expresses a functionally (not anatomicall) different part of the lungs, corresponding to some unhomogeneity within the system. The influence of this unhomogeneity on characteristics parameters of the lung (resistance, compliance) was analysed in simulated experiments. This seems to show the way how to express the degree of the lung function disturbance by some quantitative relations.

The occurrence of three causative organisms of the so called intertriginous dermatophytoses--Epidermophyton floccosum, Trichophyton mentagrophytes var. interdigitale and T. rubrum--was compared according to the localization of the lesions. The differentiation of invasion into solitary and combined sites showed a prevalence of E. floccosum in solitary lesions and T. rubrum in combined lesions. In T. mentagrophytes var. interdigitale, the frequency of occurrence of both types of the lesions was approximately the same. The differences found suggest various adaptation-ability of dermatophytes to different parts of the body. The study of localization of solitary lesions is important from the epidemiological point of view because it assists in revealing the sources of dermatophytic infection and the ways of transmission.

The fibrinolytic capacity was assessed in 18 healthy subjects and in 8 patients each with non-idiopathic venous thrombosis, idiopathic venous thrombosis and myocardial infarction after intravenous administration of 1-deamino-8-D-arginine vasopressin (DDAVP) (0.4 microgram/kg) in comparison to venous occlusion. In healthy subjects the results obtained by either stimulus were approximately in agreement. Compared to the control group, in patients with non-idiopathic venous thrombosis the fibrinolytic capacity was not changed either after venous occlusion or after administration of DDAVP. In 5 out of 8 patients with idiopathic venous thrombosis the capacity was significantly reduced both after venous occlusion and after administration of DDAVP. In 4 out of 8 patients with myocardial infarction the capacity was significantly below the limit after administration of DDAVP while it was not after venous occlusion. In determining the fibrinolytic capacity DDAVP proved to be superior to venous occlusion.

We have amended and added to Fabian's tables giving a functional assessment of individual masticatory muscles. The data in our tables refer only to the temporalis, masseter, pterygoideus medialis, pterygoideus lateralis and digastricus muscles. The weights of these muscles were determined in three fixed human cadavers and the mean values compared with those of apes, carnivores, herbivores and rodents. In humans, the most powerful masticatory muscle is the M. temporalis, followed by the M. massater, as in apes and carnivores. The M. pterygoideus is also one of the most important. This is remarkable, since in the other groups this muscle occupies the last place. This relative strengthening of the M. pterygoideus lateralis is an important characteristic of the human masticatory apparatus. In humans, the difference between the relative weights of the individual masticatory muscles is not nearly so great as in other mammalian groups. The M. pterygoideus lateralis does lie close behind the other two big adductors (Mm temporalis and masseter) but, as regards power and weight, it hardly differs from the M. pterygoideus medialis and the M. digastricus. In humans the strengthening affects not only the M. pterygoideus lateralis but also the M. digastricus. It would seem that these two masticatory muscles could become the key to the understanding of the specific changes in human mastication.