Biomechanics of the human flexor tendon sheath investigated by tenography.

Tenography has been performed on eight detached fingers and two intact hands of cadavers. Bulging and overlapping of synovial pockets between the ligamentous structures during flexion, their flattening during extension and the continuous change in expansion of the proximal cul de sac suggests a possible mixing mechanism for the synovial fluid. During flexion and extension a physiological joint-type bowstringing of the flexor tendons was observed at the PIP and DIP joints. This finding supports the theory that the flexor tendon moment arm is increased at these joints.

Anatomy of the chicken foot for the experimental investigation in flexor tendon surgery.

A chicken model for research in flexor tendon surgery is used despite the considerable differences between avian foot and human hand anatomy. In order to properly correlate and interpret the data collected from such experiments, a reexamination of chicken anatomy and terminology was undertaken. Thirty chicken feet were studied anatomically for tendon-tendon sheath structures including vascularization, flexor systems, and histologic specimens. The data collected show, besides striking similarities between human and avian anatomy, differences critical enough to warrant a reevaluation of previous descriptions of the avian structure.

[Writing difficulty syndrome--a rare symptom complex involving the median nerve and the carpal tunnel]. / Mogigraphia-syndroma--a nervus medianus ritka alagút tünetegyüttese.

Authors describe the cases of two patients, suffering from the rare, however frequently not diagnosed real writing spasm. In these patients surgery brought healing or significant improvement. After a review of the literature the symptoms, the possibilities of diagnosis and therapy are described. With their paper they want to call attention to this not well known disease.

[Experimental study of postoperative scarring around the tendon sheath]. / Az ínhüvely körüli posztoperatív hegesedés kísérletes vizsgálata.

Authors have compared two kind of exposures of the flexor tendons. The results were assessed by measuring the flexion oft the given finger on pulling, by light and electron microscopic examination. It was found that in fingers where the tendon sheat was detached from the subcutis the scarring was greater and its effect, limiting the motion has its maximum on the fourth postoperative week. It is raised that the role of the tendon sheat in respect of the success of the flexor tendon reconstruction is mainly mechanic and most effective if its highly integrated connection with its surrounding is not disturbed.

[Questions about the two-stage reconstruction of flexor tendon injuries. IV. Clinical experience]. / A hajlítóín-sérülések kétszakaszos helyreállításának kérdései. IV. Klinikai tapasztalatok.

Authors report on clinical experiences gained with the two stage flexor tendon transplantation described by Hunter. Their modifications are described and the results given in details. They touch also upon the indications of the procedure considering the preoperative evaluation. Other procedures are also offered for injuries with bad prognosis and the future trends of investigation, held to be important, are mentioned.

[Questions concerning two-stage reconstruction of injured flexor tendons. III. Ultrastructure of the tenosynovium in the pseudo-tendon sheath created by using a silicone rod]. / A hajlítóínsérülések kétszakaszos helyreállításának kérdései. III. A tenosynovium ultrastruktúrája a szilikonrúddal kialakított pseudoínhüvelyben.

Authors have investigated the ultrastructure of the pseudo tendon sheath, formed with silicon rod and man. They have observed a superficial structure, resembling the normal tendon sheath in scanning electron microscopic examination. With transmission electron microscopy phagocyte "A" type and secretion "B" type synovial cells were found. Authors state that the newly formed tenosynovium has an important role in the nutrition of the tendon graft and the prevention of adhesions.

[Functional treatment of humeral diaphyseal fractures using a Hungarian-manufactured brace]. / Humerus szár törések funkcionális kezelése hazai gyártású brace-szel.

Authors suggest, in their paper, a new method in this country, the so called brace treatment for the functional treatment of the diaphyseal fractures of the humerus. A 2-4 fifth of the diaphyseal fractures of the humerus can be treated in the majority with this method. An other novelty of this treatment is the humerus brace developed and manufactured in Hungary. This fracture treatment has unequivocal advantages both for the health service and the patient for its shorter duration of healing and treatment.

[Injuries to the knee extensors. Rupture of the patellar tendon and the quadriceps]. / A térdízületi extensor apparátusának sérülései. Patella-in és quadriceps ruptura.

Authors discuss, based on the experiences of their 18 cases, the injuries of the knee extensors. 5 ruptures of the quadriceps and 9 of the lig. patellae propr. were observed in the 14 cases controlled. Based on their own experiences and the standpoints of the literature they suggest the operative therapy within 6 hours in the open injury and within 1-5 days following the accident in closed cases. The experiences, the operative technique, the viewponts of the aftercare and the end results are described.

[Surgical treatment of inveterate Monteggia injury in childhood]. / A gyermekkori, nem friss Monteggia-sérülés mütéti kezelése.

Authors, based on the experience gained from the operative therapy of a 9 year old child with inveterated Monteggia injury, discuss the types, the diagnosis and the principles of treatment of this injury. They take the part of urgent treatment following early diagnosis as the results of the treatment of the non-fresh cases are generally less favourable.

[Surgical management of acetabulum fractures]. / Az acetabulum törések mütéti kezelése.

Author reports on the experiences with the operative treatment of 48 acetabular fractures in his Department during 19 years. He thinks that the operative treatment of the acetabular fractures may be successful only after the exact preoperative diagnosis and classification of the type of the fracture. After this the exposure may be chosen. During the operation one has to strive to the exact reconstruction of the articular surfaces and the performance of such stable osteosynthesis that will enable the early movements of the joint without weight bearing. If, because of the severity of the injury, the exact reconstruction of the acetabulum is not possible an effort must be made to create an anatomical situation that will give favourable conditions to late reconstruction operations (arthrodesis or endoprosthesis). Author describes after discussing the classification, diagnosis and treatment of the acetabular fractures his own results: in more than 3/4 of his cases excellent or good late results could be achieved. For this, with correct indication, the performance of the reconstruction operation is suggested.

[Posterior dislocation of the median end of the clavicle]. / A kulcscsont mediális végének hátsó ficamodása.

Authors discuss, based on the experiences gained in the operative treatment of posterior sternoclavicular dislocation in two patients, the frequency, the symptoms, the classification, the diagnosis and treatment of this rare injury. One of the two injuries was fresh the other inveterated. No description of the operative treatment of similar injuries was found in the literature of this country. Finally the importance of the early recognition and the definitive treatment of this rare dislocation are stressed.

[Tenodermodesis: a method for the management of inveterate extensor tendon injuries on the distal finger joint]. / Tenodermodesis: eljárás a végízület feletti inveterált extensorín sérülések kezelésére.

Authors describe the operative method of Iselin for the treatment of inveterated extensor tendon injuries over the DIP joint and their results. On the basis of favourable experiences they suggest the use of this method. No description of this procedure was found in the literature of this country.

[Traumatic fat embolism syndrome]. / Traumás "zsírembólia syndroma".

After a short literary review authors analyse the clinical and pathological process of the traumatic fat embolism. They call attention to the difficult diagnosis of the syndrome and to its frequency. The demonstration of the fat globuli from the peripheric blood is suggested by the authors who perform this as a screening for an easier diagnosis--if characteristic clinical symptoms are also joined to the microscopic finding.

[Diagnosis and treatment of thromboembolic diseases of the right heart]. / A jobbszívfél thromboemboliás betegségeinek diagnózisa és kezelése.

Right heart thrombosis (RHT) was found by 2D-echocardiography in 8 cases. Clinical suspicion of RHT could be documented in only 3 patients, while in the other 5 cases syncope, low output syndrome, essential pulmonary hypertension, cerebral embolism or congestive heart failure was the clinical diagnosis on first presentation. Out of the 4 cases of mobile RHT of extracardiac origin 1 patient had an emergency operation, 2 patients died shortly after the 2D-echo diagnosis before treatment could have been started and 1 patient improved on anticoagulant treatment. RHT of intracardiac origin was due to a central line or a ventriculoatrial shunt in 3 cases and no source could be found in 1 patient. Complete recovery was achieved in 2 cases by medical, in one case by surgical management and in 1 patient medical and surgical treatment resulted in clinical improvement. In conclusion authors 1. consider 2D echocardiography necessary in the clinical setting of acute or chronic pulmonary embolism or "primary" pulmonary hypertension and 2. they recommend emergency operation in case of mobile large RHT detected by 2D-echocardiography.

[Results of surgical management of Bennett fractures]. / Eredményeink a Bennett-törések mütéti kezelése után.

Authors examined in a 15-year material of the Department of Traumatology, Clinic of Surgery of the Pécs University of Medicine the late results of Bennett's fracture, treated surgically. In the treatment of 51 patients they came to the conclusion that the reduction of the fracture with anatomical exactness and the early functional treatment improved the results considerably.

[The role of an external mini-fixator in the management of infected injuries of the hand]. / A mini külsö rögzítö szerepe a kéz fertözött sérüléseinek kezelésében.

Authors use since 1982 the mini fixateur externe in the treatment of the severe infected injuries of the hand. The stable, external fixation resulted in all the 31 patients, treated unsuccessfully with other methods, in healing.

Preserved tendon grafts in reconstructive hand surgery: a review.

The authors discuss the use of tendon grafts, primarily in flexor tendon repair, a problem not yet satisfactorily resolved. Criteria for successful non-autogenous tendon grafts are presented, with interest focussing on the immunologic antigenicity of the grafts and the physiologic properties and processes of tendon regeneration. Methods for preserving tendon grafts, including freeze-drying and the use of various chemical agents, are compared and recommended, as well as methods for managing tendon grafting procedures. Questions remaining to be answered in the area of preserved tendon grafts are raised, with suggestions for some answers and avenues for future research. Possibilities for wider clinical applications of the procedure are supported and discussed as well.

Analysis of simple GSR measures: differential diagnostic GSR signs in hypertonics, neurological patients and healthy controls.

A statistical analysis of GSR measures in three groups of Ss (Hypertonics-HP, Neurological patients-NP, and Controls-CG), subjected to standard electrodermal stimulation supports the existence of a differentiated inner connection among various GSR measures in the three groups. Latency in the CG was found negatively to correlate with amplitude of the derivational curve, while in the other two groups it proved to be an independent measure. It is assumed that the temporal GSR measures reflect its dynamic properties, while amplitude is an indicator of the overall level of the sympathetic nervous system and of the magnitude of changes in the membrane potentials of sweat glands. A point is also made of certain diagnostic applications for differentiating disorders due to organic causes from functional ones, within the framework of man's psychophysiological unit.

[Biological and functional factors in 2-stage flexor tendon reconstruction]. / Biologische und funktionelle Faktoren bei der zweizeitigen Beugesehnenrekonstruktion.

After a review of the morphological and biological relationship of the intact human flexor tendon-sheath unit, the authors discuss injuries of the flexor tendon. They summarize research to date, including their own results. In their opinion, the success of two-stage tendon grafting used in the treatment of such injuries, apart from the known clinical factors, also depends on biological and functional factors.

[Current observations on the morphology and biomechanics of the human flexor tendon sheath]. / Ujabb megfigyelések az emberi hajlítóínhüvely morfológiájáról és biomechanikájáról.

Authors give a short description, based on own experimental work and literary data, of the tendon sheat biomechanics of the long fingers. The importance of the integrity of the tendon sheat--subcutis--skin unit is presented. Starting from this, a new possibility of exposing the flexor tendons, a laterobasal exposure is shown. The experimental character of their work is stressed, it is however underlined that clinical importance is attached to their aspect.