Stress on the wrist joint in semilunar bone necrosis--a morphologic study in vivo

Sn-mesoporphyrin (SnMP), a potent inhibitor of heme oxygenase (HO), controlled hyperbilirubinemia in rats of the mutant strain EHBR/Eis. This mutant strain displays pronounced conjugated hyperbilirubinuria and dark pigmentation of hepatocytes, characteristics of the Dubin-Johnson syndrome. SnMP administered at a dose of 10 mumol/kg body weight produced an immediate decrease in plasma bilirubin concentrations which could be maintained by weekly injections of this synthetic heme analogue. Marked inhibition of HO activity was demonstrated in liver, kidney and spleen but not in brain. These results demonstrate that SnMP can lower plasma bilirubin concentrations for extended periods in a new mutant rat model of Dubin-Johnson syndrome.     

Late outcome after surgical treatment of perilunar dislocation and dislocation fractures

53 cases of ovarian tumors were diagnosed and operated in the Clinic of Obstetrics and Gynecology of Medical Academy in Bydgoszcz in years 1996-1997. Retrospective analysis of 58 results of ultrasonographic examination with color-Doppler estimated flows and histopathological diagnoses in cases of ovarian tumor was performed. On the ground of sonographically estimated morphology, presence or absence of vascularization and pulsation and resistance indices (PI and RI respectively) an attempt to discriminate benign and malignant tumors was made. Values of RI > 0.6 and PI > 1.0 in absence of morphologically suspicious features in ultrasonographic examination correlated with benign forms of ovarian tumors in histological examination.     

Precision and accuracy of bone landmarks in characterizing hand and wrist position

We have investigated the relationship between plasma endothelin (ET) concentrations and several clinical characteristics in 31 patients with acute myocardial infarction (MI). ET levels were also measured in 10 age-matched healthy subjects, 9 patients with unstable angina, and 20 patients with chronic heart disease. In patients with MI, although no significant relationship was observed between plasma ET concentrations and measured hemodynamic parameters, plasma levels were higher in patients with pulmonary congestion than in those without this complication (1.61 +/- 0.29 vs 1.21 +/- 0.33 fmol/ml; p < 0.01). No significant difference in plasma ET levels was found between cardiac and peripheral sampling sites (pulmonary artery; 1.07 +/- 0.28, right atrium; 1.02 +/- 0.28, peripheral artery; 1.12 +/- 0.23, peripheral vein; 1.14 +/- 0.38 fmol/ml: N.S.), or among patients with uncomplicated MI, unstable angina (1.00 +/- 0.32 fmol/ml), and healthy subjects (1.01 +/- 0.29 fmol/ml). Increased level were observed in patients with decompensated heart failure due to chronic heart disease, but were not found in patients without pulmonary congestion (1.62 +/- 0.60 vs 1.11 +/- fmol/ml; p < 0.01). These observations suggest that plasma ET concentrations are elevated in the presence of congestive heart failure or severe ventricular depression, but are not persistently increased by myocardial ischemia per se.     

Replantation of the hand and fingers

Using microsurgical techniques to replant an amputated hand or digit is one of the most important progress in the field of hand surgery during the last three decades. The result of a replantation depends on: the mechanism and the level of amputation, the length and the type of ischaemia of the amputated segment, the surgical techniques, the postoperative care, the rehabilitation and so on. Although the success of a replantation is first judged on the survival of the replanted segment, it nevertheless should be assessed on the function achieved. Thanks to the 30-year clinical experience, the final functional result of a replantation can now be anticipated at initial examination; thus indications can be better established by patient selection criteria. The replantation of the hand and the digits is henceforth reasonable only if there is a possibility of a useful functional result.     

Replantation of the heel pad

A heel microvascular replantation was done to a 17-year-old patient. The replanted heel survived completely. A year after the operation, the patient is working in agriculture and has no problem walking.     

The role of arthroscopy in the treatment of wrist injuries in the athlete

Wrist arthroscopy provides an ideal means of evaluating intraarticular soft-tissue injuries of the wrist. Many lesions such as tears of the triangular fibrocartilage complex can be treated by arthroscopic means as well. Reduction of articular fractures of the distal radius and pin fixation, reduction of scaphoid fractures and intramedullary fixation, and arthroscopic reduction and transcutaneous pin stabilization of acute carpal dissociation patterns can all be accomplished with minimally invasive techniques under arthroscopic control. These measures often provide the athlete with shorter periods of immobilization and earlier return to athletic competition. Wrist arthroscopy provides a very useful adjunct to the treatment armamentarium of all sports medicine physicians.     

Surgical treatment of wrist deformity in hereditary multiple exostosis

This two-part series describes the collaborative summer home care nursing program for Korean nurses conducted by the Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, in cooperation with the College of Nursing of Yonsei University, Seoul, Korea. Part I focuses on the development of the collaboration, and part II focuses on the content of the three-week summer home care program and describes related issues and problems as well as suggests solutions. The series concludes with the findings on the program from the postprogram evaluations of students, preceptors, and patients. The collaborative educational program was developed to give Korean home care nurses an opportunity to gain clinical experience in home care nursing in the United States so that they could learn how to deliver better-quality home care for patients and their informal caregivers. Therefore, the program focused on practice-oriented lectures and clinical experiences.     

Improved wrist fracture localization with digital overlay of bone scintigrams and radiographs

The diagnosis of scaphoid fracture is often difficult and of interest in traumatology. Because of the low sensitivity of repeated scaphoid radiographs, a bone scintigram is advocated and considered the gold standard. In this study, we tried to simplify the interpretation of the bone scintigram of hand and wrist in localizing the hot spot by the digital overlay of the radiograph and the bone scintigram, using a simple device, in patients after wrist trauma. METHODS: Twenty-one consecutive patients (22 wrists) with clinically-suspected scaphoid fracture and negative initial radiographs were included. The PA view of the wrist was obtained with the hand of the patient placed in an acrylic device with three lead markers. For the bone scan, a similar device was used with 57Co markers at the same positions. We called this device the "hand-fix." The PA radiograph was digitized with a videocamera and overlaid on the bone scan. Each bone scan was interpreted twice by each of three observers, one nuclear physician and two residents in nuclear medicine. The first interpretation was made without the digital overlay, and the second was made with the digital overlay. RESULTS: The bone scintigrams were positive in the scaphoid, distal radius and in other carpal bones. Out of the 22 bone scans, Observer 1 judged 19 correctly, Observer 2 judged 16 correctly and Observer 3 judged 10 correctly without the digital overlay images. All three observers gave a correct localization in the 22 wrists using the digital overlay images. CONCLUSION: The digital overlay of a radiograph and a bone scintigram, using the hand-fix, simplifies and improves interpreting and localizing the hot spot on bone scintigrams in patients with wrist injuries.     

Intravenous regional anesthesia for closed treatment of fractures and dislocations of the upper extremities

Intravenous regional anesthesia for the treatment of fractures and dislocations of the upper extremity is a very effective, consistent and safe form of analgesia which requires low doses of lidocaine and can be performed in an emergency room using a regular blood pressure cuff. Dosage should be related to body weight and the blood pressure cuff should be maintained at higher than systolic pressure for a minimum of 15 minutes after the lidocaine is injected. Release of the tourniquet should be staged as described. Ninety-one per cent of 77 patients had excellent analgesia following the IVRA. Eight per cent had fair results, but this was still adequate to perform the reduction with only minimal but definite discomfort to the patient. Only one patient failed to respond to the IVRA technique. Other advantages such as muscle relaxation during the anesthetic and rapid full return of sensation after cuff release, permit ease of reducion and early anticipation of cast discomfort or pressure pain from sharp edges of plaster. Unpleasant long term side effects of axillary block anesthesia, such as persistent paresthesia have not been seen.     

Fractures and dislocations of the foot

The incidence and severity of fractures and dislocations vary depending on their location and on the direction of the forces responsible for the injury. The radiologist's role in evaluation of the injured foot is to recognize the types of injuries produced by particular forces. Because there is considerable overlap of fractures and dislocations of the foot and ankle, evaluation of one area to the neglect of the other can lead to significant oversights and failure to recognize additional injury patterns. For example, fractures of the talus, calcaneus, base of the fifth metatarsal, and to a lesser extent, the cuboid and navicular bones may masquerade as ankle sprains or malleolar injuries. The most important aspects to correct interpretation of traumatized foot radiographs are (1) pertinent clinical history, (2) a complete radiographic series, and (3) detection of soft-tissue swelling or injury.     

Replantation of degloved skin of the hand

The treatment of a degloving injury is one of the most difficult problems in hand surgery. Various reconstructive procedures have been adopted in the past years, all with poor results. Between 1988 and 1995, nine patients with degloving injuries of the hand and fingers were treated by microsurgical replantation. The injury involved the thumb in three patients, the ring finger in three patients, the little finger in one patient, and multiple fingers in two patients. Successful complete revascularization was obtained in seven patients. In one case a superficial necrosis of the replanted thumb skin occurred with good preservation of the subcutaneous layer. In one patient with a degloving injury involving multiple fingers, revascularization was achieved only in the middle finger, and the first ray was secondarily resurfaced by a free flap from the foot. In our experience revascularization of the degloved skin does represent the best solution and must be managed as an emergency procedure. Coverage obtained in this way offers the best cosmetic result and allows early mobilization with good recovery of joint movement. Reestablishing sensibility is more difficult. It is not always possible to suture the nerves damaged by the trauma, and even when a careful primary nerve anastomosis is performed, the results often are unsatisfactory, probably because of the avulsive mechanism of nerve injury.     

Bisphosphonates in the treatment and prevention of bone metastases

Bone metastases occur frequently in cancer and are commonly associated with bone degradation due to the tumoral production of factors which stimulate the development and activation of osteoclasts. During osteolysis growth factors are released which stimulate tumour growth. Bisphosphonates inhibit osteoclastic bone resorption. Recently, in several large randomised studies of patients with multiple myeloma or bone metastases of breast cancer, long-term treatment with clodronate or pamidronate gave significant bone protection.     

Fractures of the wrist and hand

The hands are extremely vulnerable to injury because of their constant use. This chapter features analyses of the evaluation, treatment, rehabilitation, and complications of fractures of the distal radius, carpus, metacarpals, and phalanges.     

Fractures and dislocations of the cervical spine in children

Correct diagnosis of fractures and dislocations of the cervical spine in children requires an awareness of the pseudosubluxation and other normal variants noted in x-ray films of patients in this age group. Fractures of the odontoid process occur frequently and almost always can be treated by closed reduction and external fixation until union occurs. Fractures of the lower cervical spine are difficult to detect roentgenographically, and x-ray changes can belie the severity of soft tissue injury and cord trauma. Instability tends to persist in adolescent patients after cervical spine injury because of the combination of epiphyseal and posterior ligamentous disruption. Neoplastic, inflammatory, and congenital lesions render the cervical spine vulnerable to injury and can permit major damage to result from minor stress.     

腕月骨脱位及月骨周围脱位的诊断与治疗

目的:探讨腕月骨脱位及月骨周围脱位的诊断手段与治疗方法,为临床月骨脱位及月骨周围脱位的诊断与治疗提供依据,防止误诊和漏诊的发生.方法:收集本院2001年1月到2010年6月收治并就诊的在外院漏诊或误诊的月骨脱位或月骨周围脱位患者21例,采用拍摄腕部正位和侧位X片进行诊断,并依据病情进行早期复位和适当的固定,并于术后1年后进行Mayo Modified Wrist Score功能评价.结果:①共诊断出月骨脱位5例,经舟骨月骨脱位2例,月骨周围脱位9例,经舟骨月骨周围脱位4例,不典型月骨周围脱位1例.②术后患者的平均得分为81.2±3.8分,除1例患者得分为差外,其余20例患者得分均在尚可以上,占95.2%.结论:腕月骨脱位及月骨周围脱位情况比较复杂,应避免漏诊和误诊,尤其是不典型月骨周围脱位,及时和分型的术后治疗有助于腕关节功能的恢复.