A case of bleomycin-induced scleroderma

The association of exposure to bleomycin with the development of scleroderma-like cutaneous abnormalities has been reported. We experienced a case of scleroderma involving the hands, feet, and forearms after bleomycin chemotherapy. The present report supports the possible causal relation of bleomycin with scleroderma. Regarding the widespread use of bleomycin, this complication is thought to be under appreciated.     

Analyzing nonverbal behavior in depression.

Describes the use of time-series notation as an objective approach to a refined analysis of nonverbal behavior in depression, using behavioral samples taken from doctor–patient interviews. The movement patterns of 13 26–67 yr old depressed patients were studied twice, first when the patients were diagnosed to be in a severely depressed state, and second, when they were judged to be nearly recovered. The movements of head, trunk, shoulders, upper arms, hands, upper legs, and feet were transcribed as a series of positions over time for the 1st 3 min of each of 26 doctor–patient interviews. Codings were obtained from video recordings, at half-second intervals, for 55 coding dimensions. Three parameters, the mobility, the complexity, and the dynamic activation of body movement, were defined and quantified on the basis of these data matrixes. Findings demonstrate that the time-series notation of nonverbal interaction offers new possibilities in the quantitative study of behavior, especially in the assessment of behavioral features of potential importance in determining diagnostic subgroup and therapeutic response. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A case of basilar impression treated with mandible splitting transoral approach

We report a case of basilar impression treated with mandible splitting transoral approach surgery. A 39-year-old man presented a ten-year history of gait disturbance. He had experienced acceleration of his spastic paraparesis for the past few years. Neurological examination on admission demonstrated tetraparesis (MMT4/5), severe hyperreflexia in his arms and legs, severe sensory loss below C2, urinary retention and inability to open his mouth widely. Radiological findings showed the dens and the body of C2 are deeply invaginated to the atlas and the foramen magnum and medulla and upper cervical cord were markedly compressed by this basilar invagination. After carrying out posterior decompression and occipito-cervical fixation, we attempted to remove the invaginated dens and the C2 vertebral body using a conventional transoral approach. But limitation of mouth opening made operative fields narrow. Consequently because of insufficient anterior decompression his neurological deficits could not be alleviated. Employment of mandible splitting procedure brought about a wide operative view so that complete removal of the residual dens and 70% drilling out of the C2 body was made possible. Postoperative complications were negligible. Finally, great alleviation of his deficits was achieved. Mandible splitting procedure is effective for obtaining a wide operative field on the anterior approach to the craniocervical junction.     

Interferon or corticosteroid: treatment of patients with chronic hepatitis C positive for serum markers of autoimmune diseases

From 1979 to 1994, reparative and reconstructive surgery were used to repair the war injuries of skins, bones, blood vessels and nerves of the limbs in 800 cases. A systematic clinical study was carried out. Many new operative methods were used and the results of treatment were good. Innovations and modifications were made in technique. In 120 cases of war injuries having soft tissues defects including skin and muscles, various tissue transplantations were used with the hope to accomplish one-staged repair of the defect and reconstruction of motor function of muscle. To those infections of bone and joint in war injuries, following early eradication of infected focus, transplantation of musculo-cutaneous flap or omental graft was immediately carried out with the aim to obtain primary healing of the wound. In the treatment of bone defects from war wounds with loss of skin and muscles, the vascularized skeleto-cutaneous graft was used. In the treatment of 150 cases of injury of peripheral nerve from forearms, the result of good to fair rated 68.8 percent for upper extremity and that for lower extremity, it was 62.2 percent. Following the early repair of 500 cases of injury of peripheral blood vessels, the patency rate of the blood vessel was 90 percent. The result following by pass vascular graft in the treatment of forearms injury of blood vessels even with very poor local condition was still very successful.     

The microlaparoscope should be used routinely for diagnostic laparoscopy

The objectives of the present study were to evaluate the safety of mixer/loaders and applicators of paraquat to maize crop by knapsack sprayers and to determine the efficacy of safety measures applied to the sprayers. Potential dermal exposure (PDE) was evaluated in 22 worker body parts. The Cu2+ cation of a copper-based fungicide was used as tracer in the spray solution. Sanitary pads and cotton gloves were used to collect the pesticide solution on the sampled body parts. It was observed that paraquat application in front of the applicator's body (0.5 and 1.0 m lance) is unsafe because PDE was 1,979.8 ml/day (for 0.5 m lance) and 1,290.4 ml/day (for 1.0 m lance) and needs 50-80% and 37-69% control of PDE respectively. Control can be achieved by the use of protective garment on the legs and feet only, which received 92-93% of the PDE. Switching the spray nozzle to the back of the operator reduced the PDE by 98% and was sufficient to make working conditions safe, while maintaining the efficiency of application and making the work lighter and more comfortable. Mixer/loaders received 86% of the PDE to the hands and the work condition was safe (MOS > 1), however impermeable gloves could be used as a further safety measure.     

Primary meningioma intimately related to skull: case report and review of the literature

A report is made of a primary meningioma intimately associated with the left sphenoid ridge and temporal bone of a 41-year-old woman. The lesion produced hyperostosis of the involved bones, ipsilateral proptosis, and reduced vision for 4.5 years. The radiotherapy yielded little improvement of the exophthalmos and vision. Review of 125 reported meningiomas intimately related to the skull and presenting primarily with hyperostosis and minimal soft tissue component, including the current case, disclosed that all but one affected the cranium proper, particularly the middle ear, temporal bone, frontal bone, and parietal bone. The exceptional one was in the mandible. They tended to occur between the fifth and seventh decades of life with the peak occurrence between the fifth and sixth decades. The average age was 46 years for overall. The female-to-male ratio was 2:1. Six of 125 primary meningiomas closely associated with the skull were malignant and two of these spread to the lungs. The pulmonary metastasis was spontaneous in one case.     

Coevolution of the mammalian middle ear and neocortex

Phylogenetic analysis with x-ray computed tomography of fossilized and recent crania implicates differential growth of the neocortex in the evolution and development of the mammalian middle ear. In premammalian tetrapods, the middle ear evolved as a chain of bones attached to the mandible and cranium, but in adult mammals the chain is detached from the mandible and lies behind it. The neocortex evolved concurrently with detachment of the chain. In mammalian development the auditory chain arises connected to the mandible but later detaches, recapitulating the phylogenetic transformation. In modern didelphid development, the auditory chain reaches mature size by the third week after birth and is then separated from the jaw and displaced caudally as the neocortex grows for another 9 weeks.     

Soft tissue changes after superior repositioning of the maxilla with Le Fort I osteotomy: 5-year follow-up

Long-term changes in soft tissue landmark positions were examined in 49 patients following superior repositioning of the maxilla by Le Fort I osteotomy. From presurgery to 1 year, on average the upper lip moved up one third the distance that the upper incisor and point A did, but there was considerable variability. In 25% of the patients the upper lip moved up more than 2 mm, and in 6% it moved up more than 4 mm. As the mandible rotated upward and forward in response to the maxillary movement, soft tissue movements paralleled the adjacent hard tissue movements almost exactly in the absence of genioplasty. From 1 to 5 years postsurgery, in 25% of the patients the maxilla moved downward more than 2 mm, and the mandible rotated down and back, often without relapse of occlusal relationships. In both jaws, long-term changes in soft tissue landmarks exceeded hard tissue changes, meaning soft tissue points tended to move downward even if hard tissue points were stable and moved down more than the corresponding hard tissue points when skeletal changes occurred.     

Determination of arterial input impedance spectra from non-invasively recorded pulses

The frequency spectra of modulus and phase of the input impedance (Zin) of large human arteries (abdominal aorta, femoral and subclavian arteries) were computed from transcutaneously recorded, uncalibrated pressure and flow pulses picked up as sphygmograms and Doppler flow velocity pulses, respectively. Since these pulses cannot be calibrated, the modulus (Zin) of the input impedance is calculated in relative units; its spectrum, however, is not influenced by this fact. A modification of the computing procedure makes it possible to determine approximately quasi-continuous frequency spectra of Zin from natural pressure and flow pulses which may be regarded as periodic functions. This is the prerequisite for a detailed analysis of the wave transmission properties of the arterial bed which manifest themselves of the input impedance. For this purpose the peripheral reflection site was moved in a proximal direction by bilateral occlusion of limb arteries. This was done by inflating cuffs placed symmetrically on both sides around the upper or lower parts of the respective limbs. When the occluding cuffs were placed around both lower legs or both thighs, the shortening of the arterial wave transmission line resulted in a marked shift of the first maximum of Zin to higher frequencies in the spectrum of Zin of the abdominal aorta and femoral artery. Bilateral occlusion of the arteries of the forearms or upper arms, however, did not have any measurable influence on Zin of the subclavian artery. Theoretical considerations show that this difference in behaviour of the several parts of the arterial system may be attributed to the varying extent of their inhomogeneity.     

Chondrosarcoma of the short tubular bones of the hands and feet

OBJECTIVE: To report 12 cases of chondrosarcoma in a rare location, the short tubular bones of the hands and feet, as well as 12 cases of enchondroma in similar locations, emphasizing the radiologic and histopathologic features. DESIGN AND PATIENTS: All relevant cases that had both histologic slides and radiographs available were taken from the files of one orthopedic referral hospital and the personal files of one of the authors. A similar number of enchondroma cases was selected at random from the files. RESULTS AND CONCLUSIONS: One malignancy arose in a background of enchondromatosis, with all the others being solitary lesions. A pathologic diagnosis of malignancy is often difficult in the absence of radiologic signs of malignancy (cortical destruction with or without soft tissue extension). However, three cases were unusual in that the initial radiograph demonstrated a benign appearance. Another group of three malignancies was surprisingly indolent biologically. The treatment of choice is ray resection (or more limited amputation in a lesion of the middle or distal phalanx).     

Bizarre parosteal osteochondromatous proliferation of bone (Nora's lesion)

Bizarre parosteal osteochondromatous proliferation was first described in 1983, when Nora et al. reported 35 examples of a proliferative lesion involving the small bones of the hands and, less often, the feet. No examples involving the large bones were reported. We present 65 cases of this condition, five from the Mayo Clinic files and 60 from our consultation files, including 34 females and 31 males; patients' ages ranged from 8 to 73 years (average, 33.9 years). Thirty-six lesions involved the hands, 10 the feet, 17 the long bones, one the skull, and one an unknown site. The long bones involved were the radius (three lesions), ulna (six), fibula (two), femur (three), tibia (two), and humerus (one lesion). Roentgenograms typically showed a heavily calcific mass attached to the underlying cortex and having a broad base. Histologically, a large amount of hypercellular cartilage showed maturation to trabecular bone, which frequently contained spindle cells in the intertrabecular spaces, an appearance that could lead to a mistaken diagnosis of parosteal osteosarcoma. A helpful feature was the distinct blue tinctorial characteristic of the bone in the lesion. Follow-up information was available for 40 patients; approximately 55% had a recurrence. No metastasis had been reported in any of the 65 cases. Bizarre parosteal osteochondromatous proliferations are a form of heterotopic ossification and should not be mistaken for chondrosarcoma or osteosarcoma.     

Intraosseous malignant peripheral nerve sheath tumor in a patient with neurofibromatosis

Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon sarcomas that almost always arise in soft tissue. They can develop in pre-existing neurofibromas or schwannomas, de novo from peripheral nerves, or following radiation therapy. Primary intraosseous MPNST is rare and has been reported most frequently in the mandible. Of the reported cases involving the long bones, none has been associated with neurofibromatosis type 1 (NF-1). We report a case of MPNST arising in the femur in a patient with NF-1.     

"Primary" orthostatic tremor. 10 clinical electrophysiologic observations

Distraction osteogenesis has been shown to be an effective method of lengthening and augmenting endochondral bone. It has also been applied effectively in the reconstruction of the membranous bones of the craniofacial skeleton. With the accumulation of clinical experience in mandibular distraction, the differences between endochondral and membranous bone distraction have become apparent, especially in the limitations of uniplanar distraction for the three-dimensional reconstruction of the deficient mandible. Distraction of the mandible in a single plane cannot satisfy fully the functional and structural requirements of the patient with malocclusion as well as deficiency of the skeletal and soft tissue. This study reports the development and clinical use of a multiplanar mandibular distraction device with the ability to achieve linear distraction (Z-plane or sagittal), angular distraction (Y-plane or vertical), and transverse distraction (X-plane or coronal). The device contains two independent gear arrangements attached to two arms that extend from the central unit. Therefore, the trajectory of the regenerated bone may be changed during the distraction process. The device also allows manipulation of the various planes of movement independent of each other. Furthermore, the rotational points for the multiplanar distraction devices are located at a single point; therefore only a single osteotomy and two pin sites are required. The multiplanar distraction device allows the surgeon to customize and contour the dimensions of the distraction process by controlling the trajectory of the translation of the regenerated bone.     

Sweat studies in hyperhidrosis palmaris and plantaris. A survey of 60 patients before and after cervical sympathectomy

60 patients suffering from excessive sweating in the hands underwent cervical sympathectomy. At follow-up 1-7 years after operation the hands were dry in 55. No differences in electrolyte concentrations were found in the sweat from palms, arms, or body prior to and after the surgical intervention. Similarly no differences were found in electrolyte concentrations between healthy subjects and hyperhidrotics. Palmar sweat was hypertonic in comparison to arm or body sweat. The Na and K sweat concentrations were: palmar 50 +/- 20 and 16 +/- 7 mEq/1; arm 30 +/- 11 and 8 +/- 2 mEq/1; and body 21 +/- 20 and 4 +/- 3 mEq/1, respectively. Na/K ratio was: palmar 3.2; arms 3.6 and body 5.8. Total sweat loss prior to the operation was 5.7 +/- 4.2 g/kg BW/h; afterwards it was 5.9 +/- 4 g/kg BW/h. These equal sweat rates were associated with compensatory sweating in areas of the body not affected prior to the operation.     

Renal artery stenosis and accessory renal arteries: accuracy of detection and visualization with gadolinium-enhanced breath-hold MR angiography

Extracellular volume (ECV) of arms, trunk, and legs determined from segmental bioimpedance data in 11 healthy men (31.6 +/- 7 yr) obtained at the end of a 30-min equilibration phase in the supine body position was compared with ECV determined from whole body measurements (ECVWB). ECV was calculated from extracellular resistance (RECV) identified from the bioimpedance spectrum for a range of 10 frequencies. Whole body RECV (527.6 +/- 55.6 Omega) was equal to the sum of RECV in the arms, trunk, and legs (241.6 +/- 36. 3, 49.2 +/- 5.1, and 236.3 +/- 25.5 Omega, respectively). The sum of equilibrated ECV in arms (1.31 +/- 0.25 liters), trunk (10.08 +/- 1.65 liters), and legs (2.80 +/- 0.82 liters) was smaller than ECVWB (20.90 +/- 2.59 liters). In six subjects who changed from a standing to a supine body position, ECV decreased in arms (-2.59 +/- 2.51%, P = NS) and legs (-10.96 +/- 3.02%, P < 0.05) but increased in the trunk (+4.2 +/- 3.2%, P < 0.05). ECVWB also decreased (-4.98 +/- 1. 41%, P < 0.05). However, the sum of segmental extracellular volumes remained unchanged (-0.06 +/- 0.07%, P = NS). The sum of segmental ECVs is not sensitive to changes in body position, which otherwise interferes with the estimation of ECV in bioimpedance analysis when ECVWB is used.     

Effect of acute dietary fibre supplementation on colonic pH in healthy volunteers

Two patients presented with a tumor involving mainly the supplementary motor area or the premotor cortex. Shortly after tumor resection, each developed transient impairment of voluntary movements. An electromyogram, with the skin electrodes placed over the muscles of the upper arms and forearms, demonstrated aberrant ipsilateral, contralateral or bilateral muscle activation during unilateral motor tasks in both patients. The bilateral activation was more prominent in the patient who had an intact dominant hemisphere. The present study suggests for the first time the importance of non-primary motor areas of the human brain in activating the proper set of muscles on the proper side of the body.     

South Turkwel: a new pliocene hominid site in Kenya

New fossils discovered south of the Turkwel River in northern Kenya include an associated metacarpal, capitate, hamate, lunate, pedal phalanx, mandibular fragment, and teeth. These fossils probably date to around 3.5 m.y.a. Faunal information suggests that the environment at South Turkwel was predominantly bushland. The mandibular and dental remains are fragmentary, but the postcranial fossils are informative. Comparisons with Australopithecus, modern human, chimpanzee and gorilla hand bones suggest that the Turkwel hominid was most like Australopithecus afarensis and A. africanus. Carpometacarpal articulations are intermediate between those of modern humans and African apes, suggesting enhanced gripping capabilities compared with extant apes. The hamulus was strikingly large, similar in proportion only to Neandertals and some gorillas, suggesting the presence of powerful forearms and hands. There are no indicators of adaptations to knuckle-walking or suspensory locomotion in the hand, and the pedal phalanx suggests that this hominid was habitually bipedal.     

Effects of lead exposure on licking and yawning behaviour in rats

Most studies on facial trauma in the pediatric age group focus on special subgroups. This investigation encompasses all traumatic facial injuries, minor and major, of children and adolescents. Epidemiological data of the type and pattern of injury of trauma patients less than 19 years of age, treated during a 3-year-period in a large metropolitan trauma centre were reevaluated. Of the 1385 patients, 68% had soft tissue injuries, 24% had dental trauma, and 8% fractures of facial bones. More than 90% suffered from minimal or minor trauma. The leading cause of injury was a fall, predominantly at the toddler stage. In adolescents an adult mechanism of trauma prevailed: over 60% of injuries were sequelae of an assault or altercation. The male sex predominated through all age groups and for all types of injuries. The bulk of soft tissue injuries are located within a small falling zone, extending from the nose to the mental area. There was a rising incidence of fractures of facial bones towards older age groups, mandibular fractures being the most common. Condylar fractures, with their potential impact on further growth of the mandible, are seen frequently in children and adolescents, making up 80% of the fractures of the lower jaw.     

Influence of phenoxyherbicides and their metabolites on the form of oxy- and deoxyhemoglobin of vertebrates

We describe the clinical features, natural history, and neuropathology of 32 patients presenting with "burning feet," for whom no specific cause was identified. All had neuropathic pain in the feet and morphological abnormalities of cutaneous innervation in skin obtained using punch biopsy. Most (29) had an abnormal sensory examination. All had normal strength, proprioception, tendon reflexes, and nerve conductions. Two clinical patterns were apparent, based on natural history and spatial distribution of cutaneous denervation. Most (28) patients presented with neuropathic pain initially restricted to the feet and toes but extending more proximally to involve the legs and hands with time. Intraepidermal nerve fiber (IENF) density was most severely reduced distally, with more normal IENF densities in skin from proximal sites. In contrast, a minority (4) presented with the abrupt onset of generalized cutaneous burning pain and hyperesthesia. In these patients, IENF densities were reduced in skin from both proximal and distal sites. Absolute IENF densities in calf skin were reduced below the lower limit of normal (5th percentile) in 26 (81%). Of the 6 who underwent sural nerve biopsy, 4 had selective loss of small myelinated and/or unmyelinated axons and 2 had normal histology and fiber densities despite reduced IENF densities in skin biopsy specimens. Punch skin biopsy from proximal and distal sites is a useful means of assessing these distinctive patients and may provide further insight into pathophysiology.     

Comparison of arterialized venous sampling from the hand and foot in the assessment of in vivo glucose metabolism

To determine whether arterialized venous blood obtained from a foot vein could be substituted for arterialized venous blood obtained from a hand vein during studies using the glucose clamp technique, we simultaneously measured glucose concentrations and PO2 in blood samples obtained from the heated hands and feet of five normal volunteers during the euglycemic and hyperglycemic steps of a hyperinsulinemic clamp. Plasma glucose concentrations were found to be virtually identical in arterialized venous blood drawn from the hand and the foot under both euglycemic and hyperglycemic conditions. The correlation between these values was significant (R2 = .99, P < .001). PO2 measurements in blood drawn from the heated hand or foot were not statistically different. We conclude that the glucose concentration measured in arterialized venous blood drawn from the foot is equivalent to the concentration in arterialized venous blood drawn from the hand. These observations will allow investigators to study in vivo glucose metabolism in individuals with poor venous access in the upper extremities and to use protocols that make the arms of the subject inaccessible for blood sampling during the study.