[Accidental explosions in Denmark when working on containers for combustible fluids]

Gases may be formed in containers for inflammable fluids and these may burn explosively if lit. Even apparently empty containers may contain sufficient quantities of gas to result in violent explosions precipitated by procedures which produce heat or sparks in the neighbourhood of the container. Seventeen persons were found to be injured in accidents of this type in a Danish investigation. Two of the accidental injuries proved fatal. The serious risk involved in handling and treating containers which contain or have contained inflammable fluids is, therefore, emphasized.

Oil and petrol drum explosions. Injuries and casualties by exploding oil and petrol drums containing various inflammable liquids

If ignited, an evaporated inflammable liquid remaining mixed with air in an oil or petrol drum may cause an explosion in which the top and bottom of the drum are blown off by the blast and act as projectiles causing extensive injuries to persons nearby. To analyse the occurrence of this type of accident and to study the injuries involved information was sought from all police districts in Denmark and all the departments of plastic surgery with a burns unit. The investigation revealed a total of 21 accidents caused by oil drum explosions over a period of 36 years with 16 injured within the last 5 years in a population of five million people. Fifteen accidents occurred during attempts to divide a drum with a disc grinder or a cutting blow-torch; five of the victims were welding drums or using drums as a support when welding or cleaning iron materials and one man was shifting a drum which exploded because of the heat of the sun. Five men were killed: three died from burns and two from fatal brain injuries. Two men with several facial fractures survived. Five victims received injuries to the lower limb and presented with a total of six open, comminuted fractures of the tibia. Nine men had burns covering from 2 to 50 per cent of the body surface, up to 30 per cent of the burns being full-thickness. This paper draws attention to the extreme danger of working on apparently empty oil or petrol drums with tools generating heat or sparks, unless specific precautions are taken.

Short-term prophylaxis with cefotaxime in colorectal surgery. A prospective, randomized trial

In a controlled, randomized study the effect of penicillin and streptomycin on postoperative septic complications in colorectal surgery (penicillin, 2 ml, IU, intramuscularly, three times daily for a period of six days and concomitantly streptomycin, 0.5 gm, intramuscularly, two times daily for a period of four days) was compared with the effect of cefotaxime, 2 gm, intravenously, three times on the day of surgery. One hundred patients completed the study: 48 were treated with penicillin and streptomycin (Group 1) and 52 with cefotaxime (Group 2). Wound infection occurred in one patient (2.1 percent) in Group 1, but not in Group 2 (0%, N.S.). Rupture of the wound occurred in one patient in each group (2.1 percent vs. 1.9 percent, N.S.). Insufficiency of the anastomosis occurred in four patients in Group 1 (8.3 percent) and in one patient in Group 2 (1.9 percent). It is concluded that short-term prophylaxis with cefotaxime is as effective as long-term prophylaxis with penicillin and streptomycin.

Long-term follow-up of meniscectomy in athletes. A prospective longitudinal study

We report the results of a prospective longitudinal study of 147 athletes who had had a meniscectomy for an isolated meniscus injury. The patients were reviewed in detail after median periods of 4.5 years and 14.5 years and the results analysed. The frequency of complaints related to the operation increased from 53% at 4.5 years to 67% at 14.5 years, while demonstrable knee instability increased from 10% to 36%. The incidence of radiographic changes of degeneration rose from 40% to 89% and at late review 8% of patients had definite osteoarthritis by the criteria of Ahlbäck (1968). In consequence 46% had given up or reduced their sporting activity, and 6.5% had changed their occupation. Radiographic deterioration started after the 4.5-year review in 49% of the patients and was more frequent after lateral than medial meniscectomy.

Dislocation of the tibialis posterior tendon in two athletes

Dislocation of the tibialis posterior tendon occurred in an 18-year-old man and in a 36-year-old woman during running activities. Several years earlier both patients had suffered minor injuries to the affected ankle. The mechanism of the current injury was dorsal flexion and inversion of the foot. Suturing the flexor retinaculum to the posterior margin of the medial malleolus obtained good results in both cases. Dislocation of the tibialis posterior tendon is rare, but should be considered in athletes with even minor traumas to the foot accompanied by pain on the inside of the ankle.

Conservative treatment of patellar dislocations. Influence of evident factors on the tendency to redislocation and the therapeutic result

The factors predisposing to recurrent dislocation and the results of conservative treatment were investigated in 79 cases of patellar dislocation. Patella alta and subluxation were significantly more common in patients without than in those with a history of injury. No single predisposing factor caused more redislocation than any other. The tendency to redislocation was significantly greater in patients younger than 20 years of age than in those older than 20 years of age at the time of primary dislocation. Corroborating reports in a large literature on the disorder, the present experience validates conservative management for primary dislocations and surgical treatment for redislocations of the patella.

Lung split function test and pneumonectomy. A lower limit for operability

Regional 133Xe ventilation/perfusion studies were used to predict residual lung function after pulmonary resections. The accuracy of the method was good as checked by postoperative spirometry in 11 patients. In 25 patients with impaired lung function and pulmonary cancer, who were consecutively selected for surgery, the predicted postoperative maximal breathing capacities (MBC) ranged from 17 to 41 l/min-1 m-2. No patients became permanent pulmonary invalids. One patient died from myocardial infarction, 7 had transient pulmonary insufficiency and 17 patients survived operation without complications. Perfusion studies alone proved as reliable as perfusion/ventilation studies.