Lumbosacral agenesis; management and embryological implications

566

ABSTRACTS

penile shortening after sloughing due to misuse of diathermy. The illustration showing an erect ph.allus after successful surgery is. unfortunately. printed upside down. which rather lessens its impact.---J.H. Johnston Reproductive gical

ond

Treatment

Endocrine of

Function

Biloterol

After

Sur-

Cryptorchidism.

f. J. Bramble, A. 1. Houghton, Sheila EC&S, A. O’Shea, and H. S. Jacobs. Lancet 2:311-314 (August),

1974.

The reported fertility rate of adults who had previously undergone surgical treatment of bilateral undescended testes ranges from 30.5”,) to 77”“. These figures are obviously dependent upon the original diagnostic criteria and also the criteria selected to define fertility. This paper reports a comprehensive evaluation of the long-term results of surgical treatment of a group of bilaterally cryptorchid patients giving the relation between spermatogenesis, as judged by the sperm count, and endocrine function, as reflected by the concentrations of testosterone and pituitary gonadotropins in blood. Their results suggest that the main adverse effect of cryptorchism is on spermatogenesis, and when the effect is severe it results in raised levels of serum F.S.H. There is also some evidence that Leydig cells may be damaged.--M.H. Cough

MUSCULOSKELETAL Displaced

Supmcondylor

SYSTEM

Fractures

of

the

El-

J. V. Fowler, and M. T. Korsob. J. Bone Joint Surg. (Br) 56:49&499 (August), 1974.

bow

in

Children.

One hundred ten fractures in I IO patients are dealt with, all of them being of type 3 (Lagrange and Riganer1962) or type 4. One hundred four were treated primarily by closed reduction and six by skeletal traction. All fractures were stabilized finally by the insertion of two lateral percutaneous pins. The operative technique is described. After satisfactory radiographic appearance the pins were cut short and the elbow immobilized with plaster. Cast and pins were removed 3-4 wk later. Complications included IS nerve lesions in 13 patientsmedian. radial. and ulnar, all of which recovered. There were no ischemic complications and the average stay in hospital was only 4 days. Results 6 mo to 5 yr after injury in extension fractures (80) were, 70 good, 7 fair, and 2 poor. In flexion fractures (l7), results were much poorer and failure occurred in one third of the patients. Functional and cosmetic results were unsatisfactory in one half.- J. .4 itken

Fotigue

Fracture:

Spondylolisthesis.

The L.

D. W. Jockson. (January), 1975.

Basic 1.

lesion

Wilfse,

in

lsthmic

H.

Wide//e, ond J. Bone Joint Surg. (Am.) 57:17-22

Seventeen patients were reviewed to document the authors’ thesis that the defect in the pars interarticularis in spondylolysis is the result of repetitive trauma, leading to a fatigue or an acute fracture. Cases were presented where on initial x-rays this diagnosis should have been made. Adolescent children with these fractures, with adequate immobilization of initial spinal injuries, were shown to go on to healing. The lesions were shown to develop at an earlier age than other fatigue fractures. A hereditary predisposition was noted. Minor trauma can be the inciting event.--Anfhony H. Alter Lumbosocral bryologicol

Agenesis;

Monogement

and

Em-

Implications.

R. J. lguelzi ond R. A. W. J. Neural. Neurosurg. Psychiatry 37:1273-

Lehman.

1276, 1974. A case of this interesting developmental abnormality is reported and reviewed in conjunction with I3 cases from the literature. Pathologically the cord usually ends at the last intact vertebra and muscle tissue is absent in the lower limbs though bony and vascular tissue appear normal; it is suggested that the lack of muscle indicates lack of trophic influence from motor nerves and that the spinal agenesis is secondary to nondevelopment of the lower spinal cord and notochord. The presence of sensation in the lower limbs and normal ganglion cells shown on rectal biopsy suggest that neural crest tissue was present although the cord was absent. A single etiological factor is suggested by common associated renal abnormalities. especially horseshoe kidney. The reported case of lumbosacral agenesis and l6”,, of reported cases of sacral agenesis had a history of maternal diabetes. The possible role of insulin is discussed.J. Lister Avascular lowing

Necrosis

of

the

Osteomyelitis

Metophysis. Roberts. (November),

H. J.

Bone

B.

of S. Joint

Copitol the

Kemp Surg.

Epiphysis

Proximal and (Br)

C.

Fol-

Femoral C.

Lloyd-

56:688-697

1974.

This paper has been written to emphasise the danger of avascular necrosis of the capital femoral epiphysis as a late complication of osteomyelitis of the intertrochanteric region. The authors consider this to be due to interference with vascular channels to the capital femoral epiphysis rather than to spread of infection into