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Despite their potential use as cerebral vasodilatory agents there are few studies of the effect of nitric oxide (NO) donors on the cerebral circulation in non-anaesthetised man. We determined the effect of the NO donor glyceryl trinitrate (GTN) at clinically relevant doses on global and regional cerebral blood flow (CBF) in healthy non-anaesthetised volunteers, using H(2)(15)O PET, ultrasonic colour velocity flow imaging of carotid artery flow, and transcranial Doppler (TCD) of middle cerebral artery velocities (MCAv). Three rates of GTN infusion (0.1, 0.4, 1.0 microg/kg/min) were used. There was no significant change in common or internal carotid artery flow following GTN administration although a dose dependent fall in MCAv post GTN was observed. There was no significant change in either global or regional CBF following GTN. Thus intravenous GTN at therapeutic doses in awake humans does not alter global or regional CBF. However it does produce basal cerebral artery vasodilatation as evidenced by a fall in MCAv in the absence of a change in internal carotid artery flow.

The post-operative complications in 57 children under the age of 16 years requiring removal of metalwork during a 12-month period are presented. The grade of surgeon performing the operation is also discussed. The overall complication-rate was 14 per cent. Minor complications such as transiently painful scars and superficial infection occurred in 7 per cent of cases. There was one intermediate complication following removal of Knowles pins of an unacceptable scar requiring revision by a plastic surgeon. The major complication (7 per cent of all cases) involved fracture with retention of the distal part of the screws during attempted removal of Knowles, Crawford-Adams or Moores pins used for the management of slipped upper femoral epiphysis. When considering this sub-group of patients, the actual complication rate for removal of metalwork from the hip was 27 per cent. So significant was this finding that the authors changed their practice to the use of a partially threaded single cannulated screw for the fixation of slipped upper capital epiphyses.

This prospective study of 1000 femoral neck fractures (476 intertrochanteric and 524 subcapital) found the pre-injury mobility to be the most significant determinant for post-operative survival. The intrahospital mortality of the 975 surgically treated fractures was 11.3 per cent. Non-operatively treated fractures had a mortality of 60 per cent. The best predictors of morbidity and discharge mobility were age and pre-injury mobility. Delay was significant in the development of morbidity but only after 30 h from admission. Internal fixation produced a lower mortality than uncemented hemiarthroplasty. The use of acrylic cement was associated with an increased morbidity and mortality rate in hemiarthroplasties. Neither the grade nor the experience of the operating surgeon had an effect on mortality or morbidity.

This paper reports the results in a prospective series of recent fractures of both the femur and tibia treated by the Grosse and Kempf locking system of intramedullary nailing. Although the technique requires some attention to detail, it has been possible to treat a wide range of relatively severe injuries with a short hospital stay and rapid rehabilitation, with benefit to both the patient and hospital services.

This paper reports the results of a series of recent fractures of the tibia treated by closed medullary nailing. The technique is simple and it has been possible to extend the indications for closed nailing. This method of fixation is biomechanically sound and the semi-rigid fixation obtained prevents significant deformity and seems to provide an ideal environment for fracture healing.

Secondary tumors in the hand are very uncommon. Of the reported cases the majority arise from primary bronchial carcinoma, with multiple secondary deposits into bone. A case is reported of bony metastasis to the middle phalanx of the small finger in a patient who had a resection of a colonic adenocarcinoma 2 years previously.