Thumb basal joint arthritis: New classification, diagnostic and therapeutic algorithm.

The assessment of thumb basal joint arthritis requires a radiographic evaluation and a classification of the lesions to guide the treatment choice. Arthritis of the thumb basal joint is not limited to trapeziometacarpal arthritis. The radiographic assessment must consider the scaphotrapeziotrapezoid joint, the entire carpus and the rest of the thumb column, in particular the metacarpophalangeal joint. There is currently no classification that captures all these items. This article reviews the existing classifications, proposes a new classification system that takes into account the entire thumb column and sets out the therapeutic options.

Shortening wrist arthrodesis using a Rush pin in adult spastic wrist: A series of 15 cases.

In spastic patients, shortening wrist arthrodesis (SWA) is indicated in cases of severe fixed flexion contracture. At present, the most commonly used technique is dorsal plate osteosynthesis. Ideally, fixation with smaller hardware volume farther from the tendons would limit postoperative tendon irritation and reoperation rates for hardware removal. The objective of our study was to evaluate the efficacy of Rush pin SWA in adults. A retrospective study included all patients with a central neurological impairment, undergoing SWA using a Rush pin inserted through the head of the third metacarpal, and with at least 6 months' follow-up. Attainment of preoperative objectives was evaluated by Global Assessment of Response to Treatment (GART, ranging from -4 to +4) and, for functional objectives, the House score and the Frenchay Arm Test. Consolidation and any degenerative changes in the third metacarpophalangeal joint were assessed on X-ray. Fifteen patients were included, with a mean follow-up of 13 months (range, 6-29). In general, the preoperative objectives were attained: mean GART score was 2.7 (range, 1-4). Functional objectives were attained in 3 of the 11 patients followed up (27%). In all cases, the arthrodesis had healed at a mean 74 days (range, 39-102). Three had hardware removed after consolidation; 1 experienced discomfort at the head of the third metacarpal. Rush pin arthrodesis is an interesting alternative to plate arthrodesis in the management of severe wrist flexion contracture in spastic patients. It gives satisfactory results with regard to preoperative objectives and is not associated with complications. LEVEL OF EVIDENCE: IV, retrospective study without control group.

[Preliminary experience with the Miami type ileocolonic urinary reservoir in the practice of oncologic gynecology]. / Experiencia preliminar con el reservorio urinario ileocolónico tipo Miami en la práctica de Ginecología Oncológica.

OBJECTIVES: For many years we have used both ileal or colon conduits for urinary diversion during pelvic exenteration. Continent urinary reservoirs have replaced ileal and colon conduits as a method of urinary diversion at our institution. The aim of this study was to review the results and complications associated with continent urinary diversion in patients with gynecologic malignancies. METHODS: We reviewed the records of 26 patients who underwent construction of a continent urinary reservoir (Miami pouch) from February 1991 to June 1994 at the Department of Gynecologic Oncology of the National Cancer Institute of Mexico (Instituto Nacional de Cancerología). Twenty-four of these patients had received radiotherapy for gynecologic malignancies. RESULTS: An ileocolonic continent urinary reservoir (Miami pouch) was created in 26 patients, aged 38-81 years, as part of a concurrent anterior or total pelvic exenteration for primary or recurrent gynecologic malignancies (19 pts.), for the relief of a vesicovaginal fistula (3 pts.), hemorrhagic cystitis (2 pts.), or in substitution of an ileal conduit (2 pts.), with follow-up ranging from 2-54 months. Additional procedures performed concurrently with the Miami pouch and pelvic exenteration included low rectal anastomosis (11 pts.), pelvic floor reconstruction (8 pts.), and vaginal reconstruction (4 pts.). The complications associated with the reservoir included incontinence (1 pt.), ureteral strictures (3 pts.), pouch leakage (1 pt.), difficult self-catheterization (4 pts.), and urosepsis and pyelonephritis (6 pts.). One patient developed pouch stones. In this series, 95.6% of the patients were completely continent. No obstruction or reflux was noted in 92.3% of the cases. Nonsurgical management strategies used for reservoir-related complications included percutaneous nephrostomy, intravenous antibiotics, and percutaneous pouch decompression. Reoperation was required in 5 patients: one patient (early) due to a fistula, another patient required reimplantation due to obstruction, one patient with a nonfunctioning kidney underwent nephrectomy, and two patients with stoma stenosis. CONCLUSIONS: The Miami pouch is a low-pressure continent form of urinary diversion. The continence mechanism is easy to construct and the procedure can successfully be accomplished at the time of pelvic exenteration in patients with gynecologic malignancies. The rate of major complications of the Miami pouch is small and the continent urinary diversion can be undertaken with concurrent low rectal anastomosis or vaginal reconstruction.

Síndrome de cáncer hereditario de mama-ovario y genes de susceptibilidad. El consejo genético con un enfoque médico-psicológico / Hereditary breast-ovarian cancer syndrome and susceptibility genes. A medical- psychological approiach to genetic counseling and testing

El cáncer de mama es la primera causa de muerte por cáncer en mujeres. El factor epidemiológico más importante de riesgo para desarrollar ésta neoplasia es tener una historia familiar de cáncer de mama. El 5 por ciento al 10 por ciento de casos son heredados en forma autosómica dominante. Los individuos predispuestos heredarían una copia funcional y una inactiva del gen de susceptibilidad, y una mutación somática eliminando el alelo funcional eliminaría su función supresora de tumores. Desafortunadamente, el desarrollo de clínicas de consejo genético no es paralelo al de la investigación molecular. Dada la constante evolución de la genética del cáncer existe una imperiosa necesidad de actualización de los médicos debido al interés creciente de la población en riesgo para examinarse para el cáncer hereditario de mama (AU)

Prevalence of enlarged ovarian follicles among users of levonorgestrel subdermal contraceptive implants (Norplant).

OBJECTIVE: The aim of this study was to determine the prevalence of enlarged follicles, as detected by a single clinical or ultrasonographic examination, among users of levonorgestrel subdermal contraceptive implants (Norplant implants). STUDY DESIGN: This was a cross-sectional study of 103 users of Norplant implants and 50 users of the TCu380A intrauterine contraceptive device, all of whom received reproductive health services from PROFAMILIA, Santo Domingo, Dominican Republic. Bimanual pelvic examination and vaginal ultrasonography were performed. Enlarged follicles (>25 mm) were followed up weekly. The chi(2) test was applied to these data. RESULTS: Enlarged follicles were detected by ultrasonography in 17. 5% of Norplant implants users and 4% of TCu380A intrauterine contraceptive device users, respectively (P <.04). There was no difference according to duration of use. The longest time to involution of the follicles was 4 weeks. Forty percent of the enlarged follicles detected by ultrasonography were also detected by bimanual pelvic examination. CONCLUSION: Enlarged follicles are a frequent finding among women who use Norplant implants, but they are less frequent than described in previous studies, which were based on serial ultrasonographic scans in selected groups of users. Physicians and users should be aware of the transient nature of these enlarged follicles, which do not require intervention.

Sperm migration at different stages of the menstrual cycle.

Sperm migration to the upper genital tract was studied in 15 volunteers who were to be surgically sterilized to see if sperm migration to the upper genital tract is consistent during different stages of the menstrual cycle. Five subjects underwent surgery during the midproliferative phase, five during the periovulatory period and five during the secretory phase. The stage of the cycle was determined by endometrial and ovarian biopsy at the time of surgery. Volunteers had a single coitus 5-12 h before surgery, confirmed by Sims-Huhner test. Sperm were found in the uterus and at least one oviduct in all five subjects studied during the periovulatory phase, and only in two of the five cases undergoing surgery during either of the other phases. A good correlation was also observed between presence and number of sperm in the upper genital tract and quality of Sims-Huhner test. However, neither the cycle stage nor the postcoital test had an absolute prognostic value over sperm migration.