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To correct angulation and to avoid plaster immobilization in diaphyseal fractures in childhood, intramedullary nailing with flexible titanium pins is an easy and safe method. Under radiographic control, fractures of femur, tibia, and humerus are stabilized with two crossing pins. Forearm fractures are splinted with a single pin each in the radius and the ulna. Even displaced fractures of the radial neck can be corrected with a distally introduced titanium pin. This method is safe in elective trauma surgery and will especially be useful in polytraumatized children in whom multiple fractures should be stabilized with minimal x-ray exposure in a short time.

Background: Melphalan administered by isolated hyperthermic perfusion of the affected limb is an accepted treatment for malignant melanoma of the extremities. In contrast, pharmacologic and phase I studies suggest that, because of its high uptake, mitoxantrone may give even better local control, but data on survival, onset of metastases, and local and systemic toxicities have not yet been reported. Methods: A matched-pairs comparison was performed to examine differences in the tolerability and effectiveness of isolated hyperthermic extremity perfusion with mitoxantrone (n = 44) and melphalan (n = 44) in high risk and locoregionally metastatic malignant melanoma. Criteria evaluated were local and systemic complications, and recurrence-free and overall survival. Results: Local complications, such as delayed wound healing, were more frequent in the mitoxantrone (27.9%) than in the melphalan group (9.8%) (P < 0.05). Systemic toxicity, in particular bone marrow toxicity, was also more severe with mitoxantrone (78.6% versus 15.4%, P < 0.001). Hepatotoxic effects were more frequent among patients in the melphalan group who were older and had lower tissue perfusion temperatures (P < 0.05). There was no difference between the two groups in overall or recurrence-free survival (P < 0.41). Conclusions: Local and systemic toxicity seem to be higher with mitoxantrone. Survival rates were similar with both drugs. The data obtained suggest a randomized phase II study with an appropriate number of patients.

Experience with acute peritoneal dialysis gathered over the last 10 years shows that, in 63 premature newborns and infants (up to 1 year of age), a standardized surgical procedure using a silicone catheter with a Dacron cuff (individually glued to fit) has a lower complication rate and is more effective than placement of a trocar catheter.