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A case of severe shoulder deformity after radical excision of soft tissue, proximal humerus, scapula, and clavicle is presented. Satisfactory restoration of the shoulder contour was accomplished by the use of a silicone implant.

The appearance of a radiolucent band at the cement-bone interface is a frequent finding in lower limb prostheses. This is still a controversial subject, but almost certainly has a multifactorial basis. Stress related to loading may be one of the causal factors. The authors therefore studied the evolution and behaviour of this radiolucent line at the bone-cement interface in 31 upper limb prostheses not subjected to significant loading or stress. These were special prostheses designed to replace the upper humerus after the radical excision of bone tumours. The development of a radiolucent band was not significantly different from the usual conditions in which loading is present but in our cases it was nonprogressive and there was never any evidence of loosening of the prosthesis.

Cataract, the leading cause of blindness in the United States, chiefly affects the elderly. Surgical therapy in the 1920's is contrasted with that in the 1970's. Visual corrections with spectacles, contact lenses, and intraocular lenses are discussed. Intraocular lens implantation, when performed by specially trained surgeons, offers cataract patients prompt and complete visual rehabilitation.

A silicone rubber tube with bonded Dacron felt cuffs have been implanted in dogs as a ureteral replacement prosthesis. A one-way valve has also been developed to prevent reflux so the prosthesis may be put into the bladder. The prosthesis has been implanted for periods up to nine months. Although there are some problems associated with the prosthesis, most animals have maintained a normal serum creatinine, sterile urine, and a normal excretory urogram.

Three main designs of posterior chamber lenses in 140 cases have been reviewed. The visual results are satisfactory; patient satisfaction is good; and postoperative complications are limited to anterior dislocation of the feet of the lens and the necessity to wash out cortical remnants from behind the prosthesis in a small percentage of cases. The posterior chamber prosthesis is free from some of the complications of other intraocular lenses and probably provides the most 'normal' looking eye of any pseudophakoi.

Definitive surgical treatment of ureteral obstruction may not be appropriate in patients with advanced malignancy, complex benign ureteral disease or even simple obstructive disease accompanied by unacceptable operative risk. Endoscopic placement of self-retained internal ureteral catheters (stents) offers satisfactory relief for many of these patients. A new 6F pigtail ureteral stent and placement technique are described. These stents are placed easily, effective and well tolerated for short-term drainage in selected patients with ureteral obstruction.

A new endoprosthesis for the treatment of subcapital fractures is described. It is hemispherical with a high density polyethylene (HDP) core which is snap-fitted onto a Charnley-type femoral prosthesis. The aim is to prevent acetabular erosion by its virtual lack of movement of the cartilage-metal interface. If this should occur then conversion to a total hip is readily performed without removing the femoral stem. So far 14 have been inserted without any complications. In fact, they are easily mobilized with very little pain.

The authors describe a modification of Hunter's technique of flexor tendon grafting. The operation is performed in two stages. At the first stage, a silastic prosthesis is inserted and the proximal end of the flexor digitorum profundus is sutured to the tendon of palmaris longus. This suture will represent the proximal suture of the future graft. At the second stage, six weeks later, the palmaris longus is divided proximally and the graft is passed distally to be sutured to the terminal phalanx. This modified technique allows a gain in time, a better blood supply to the graft and a safer proximal suture.

This paper describes a new type of corneal prosthesis made of aluminum oxide ceramic. The implant consists of a retaining plate with a 3-mm central performation to which an optical cylinder is threaded. The cylinder also made of ceramic material, has a high refractive index and 60 diopters of power. Experimental study has shown that soft tissue adheres to the surface of the material, thus preventing its extrusion and surface epithelial ingrowth. The techniques of implantation and the early results in seven patients are described.

The authors report a new route of approach to the hip, specific to cervico-diaphyseal region. Its main application seems to be for the insertion of diaphyseal prostheses in cervico-trochanteric fractures in the eldery. The lack of damage to the capsule, the reconstruction of a solid weight-bearing point on the trochanter, the precise repair of the joint cavity and of muscle continuity make this a simple route of approach with minimal shock, permitting rapid rehabilitation of the patient with immediate weight-bearing.

In cases of total loss of the lacrimal canalicular system, e.g. due to untreated traumatic laceration, resection of an infiltratively growing malignant tumour of the medial canthus or severe canaliculitis a substitutional surgical procedure using the newly developed hydrophilic lacrimal tube is indicated, as experience with homoplastic material has shown that successful long-term results with homoplastic material (arteries, veins and prepared conjunctival tube) cannot be expected. The advantages of the new material compared to the acrylic tubes of L. T. Jones are the hydrophilic nature and its softness as a result of which no problems with fixation of the tube and pressure necrosis of the medial canthus exist. The implantation is done after performing a conjunctivo-dacryocystotomy or conjunctivo-ductostomy. In cases of conjunctivo-dacryocystotomy the tube may be removed after 1 to 1 1/2 years.

Surgical correction was carried out successfully in a severely cyanotic 3-year-old Japanese girl who had a very rare type of double-outlet right ventricle. The malformation was associated with bilateral conus, 1-transposition of the great arteries, and subpulmonary ventricular septal defect without significant pulmonary stenosis in situs solitus. A large amount of subaortic conal musculature which separated the aortic valve from the subpulmonary ventricular septal defect was removed, as was the anterior rim of the ventricular septal defect. A tunnel, constructed with a woven Teflon prosthesis, was inserted in such a manner as to direct blood from the left ventricle through the defect and out to the aorta. The pulmonary outflow tract was reconstructed with a Teflon patch lined with pericardium. The patient's postoperative recovery was uneventful, and she was doing well 3 months postoperatively. To our knowledge, no identical case with a similar type of surgical correction has previously been reported.

Prostheses of the trigonum vesicae made of silicone rubber and covered with a textile layer were implanted in 18 mini pigs. Investigations were done in two series: in the first the prostheses were covered on the outside with a narrow woven textile layer, in the second with Dacron-velour. While the narrow woven textile-lined prostheses were rejected into the urinary bladder after a short period, the Dacron-velour-lined prostheses remained well attached to the bladder wall.

Air within a pacemaker pocket may cause transient malfunction of a replacement unipolar cardiac pacemaker. This was noted in a patient in whom entrapped air prevented tissue contact of the anode, resulting in complete cessation of myocardial stimulation and absence of an electrocardiographic pacemaker artifact. Methods for avoiding this complication are proposed.

This report outlines orthoterminal correction in an 8-year-old boy with coexisting d-transposition of the great arteries (d-TGA), subpulmonary stenosis, and a complete form of atrioventricular canal (CAVC). The repair consisted of covering the tricuspid valve and atrial part of the atrioventricular canal with a Dacron patch and inserting a valve-containing conduit between the then isolated right atrium and the pulmonary artery to create a venous outlet. The patient's exercise tolerance has improved remarkably. The arterial oxygen saturation has risen from 86 to 90 per cent. A plea is made to expand the indications for orthoterminal correction to patients in whom the severity of the heart malformation precludes application of well-established methods of surgical repair.

Aortic valvotomy, aortic valve replacement, resection of the subaortic membrane and aortic patch angioplasty do not always provide satisfactory relief of left ventricular outflow tract obstruction. From August 1975 through January 1977, 15 patients underwent creation of a left ventricular vent by means of a Dacron fabric conduit containing a heterograft valve going from the left ventricle to the supraceliac portion of the abdominal aorta (Cooley's point). All patients had valvular, subvalvular, supravalvular aortic stenosis, or combined defects. One patient had severe hemolytic anemia following aortic valve replacement. Eleven of our 15 patients had undergone one or more previous surgical procedures for relief of aortic stenosis. The operative mortality has been one patient. At postoperative catheterization, there was a normalization of pressure gradients, and the blood flow through the conduit was 40% of the cardiac output. An interesting case of supravalvular aortic stenosis associated with stenosis of the vessels of the arch is presented.