THE USE OF FIBRINOLYTIC AGENTS—Present Status in the Treatment of Cardiovascular Disease

Fibrinolysins are involved in the dissolution of clots. They are still in the experimental stage and are not yet ready for use by practicing physicians. The materials available for clinical use have undesirable serious side effects. However, the future for fibrinolysins in clinical practice has promise.     

CONGENITAL DISLOCATION OF THE HIP—A Study of Open Reduction After Failure of Conservative Treatment

In a study of 42 cases in which open reduction of congenital dislocation of the hip was carried out after conservative treatment had failed, the following observations were made (in a relatively short period of follow-up observation):No one pathological change, as observed at operation, was inordinately associated with failure of closed reduction.By far the highest incidence of successful results of open reduction was obtained in cases in which the operation was done in the second and third year of life.The highest incidence of successful operation, as appraised immediately after the procedure, was in patients more than one year and less than six years of age.Results as determined roentgenographically were in close agreement with results observed clinically.     

DIVERTICULITIS OF THE COLON—Surgical Treatment

Appropriate surgical treatment of diverticulitis of the colon can result in a highly satisfactory proportion of permanent cures, with an operative mortality of 2 to 5 per cent.Colostomy is a valuable emergency procedure for the control of severe infection or the relief of obstruction but is not a satisfactory definitive treatment for the cure of diverticulitis. Definitive surgical treatment requires resection of the involved segment of colon.Three indications for surgical intervention in “uncomplicated” diverticulitis are: (1) continued or repeated attacks, (2) persistent deformity as seen by x-ray examination, and (3) persistent blood in the stools.Although a three-stage operation is usually considered a safer procedure, one-stage resections may be safely and satisfactorily employed in many instances.     

FRACTURE OF THE METACARPAL SHAFT—A Method of Treatment

Anatomically, metacarpal fractures, when reduced, are not spontaneously stable. They require maintenance of this reduction because of the forces acting on the fragments. Closed methods of maintaining this reduction are ideal, but in selected cases, intramedullary fixation of the fracture, using the Kirschner wire, gives excellent results. The method under consideration does not disturb the fracture site itself, the Kirschner wire being introduced “blind.” Correct placement of the site of insertion of the wire, coupled with the rigid immobilization thus attained, gives excellent results in a high proportion of selected cases.     

MENTAL DISORDERS OF THE AGED—The Role of the State Hospital in the Treatment; Report of a Pilot Study

The number of patients age 65 and over at the Agnews State Hospital now constitutes over one-third of the resident population. The geriatric population is increasing in all California state hospitals.Because this is a relatively new area of concern for the psychiatric institution, the role of the state hospital in the care of the aged is not yet clearly defined.A pilot study of admissions in this age group committed from one county during a 12-month period was undertaken, with an attempt made to evaluate the suitability of the patient for commitment, as well as special problems in admission, treatment during hospitalization, and release from the hospital. The study indicated 42 per cent of persons admitted were considered unsuitable for commitment. Physical illness was found to be a major factor in precipitating admission and a predominating factor in the treatment program after admission. Almost 40 per cent of the patients died within a year after admission.     

THE LARGE INGUINAL RING—Its Significance in the Diagnosis of Inguinal Hernia

A large external inguinal ring is often reported by a medical examiner as a “potential hernia.” This finding may cause the subject to be denied job opportunities and may make him apprehensive about many normal activities.The author believes that unless a sac is present and is causing symptoms that necessitate surgical relief, the term hernia should not be used, regardless of how it is qualified. The ordinary intraabdominal stresses due to coughing, sneezing, etc. increase intraabdominal tension more than heavy lifting, except with loads of nearly the body''s own weight. The lifetime effect of such stresses can contribute to the development of a direct hernia, but most of these cannot be eliminated.