Giant lipoma of the thenar--case study and contemporary approach to its aetiopathogenicity.

Giant lipomas of the thenar are rare tumours of the adipose tissue of the hand, with a benign prognosis. Apart from the cosmetic problems they may cause, their most frequent complications include a compromise in functionality and pressure upon the nerves, mainly on the radial nerve. The first step in their management is their differential diagnosis from well-differentiated liposarcomas (WDLPS), as they require a different therapeutic approach. This step is completed with the aid of MRIs, biopsies and modern immunohistochemical methods, which offer high specificity and sensitivity. Our paper presents a case of giant lipoma of the thenar, with a review of the relevant literature, focusing on the disease's molecular genetics, which is a very important field of research today.

Bone mineral density, body mass index, and hip axis length in postmenopausal cretan women with cervical and trochanteric fractures.

We assessed the bone mineral density (BMD), the body mass index (BMI), and the hip axis length (HAL) in 78 postmenopausal women with 38 cervical and 40 trochanteric hip fractures. The results were compared with those of age-matched, control postmenopausal women. No statistically significant difference was found in the values of BMD, BMI, and HAL between the groups of patients with cervical and those with trochanteric fractures, but lower BMD and BMI were found in fracture patients compared with the corresponding values of the control subjects. Contrary to the existing data, HAL was found to be shorter in the fracture patients compared with the controls. Thus, the type of hip fracture was found to be independent of the value of BMD, BMI, and the length of the patient's hip axis. The fact that a shorter hip axis was found in the group of fracture patients compared with that found in the control subjects raises questions about the significance of this parameter as an independent risk factor for hip fracture.

Possible predisposing factors for the second hip fracture.

Among 1685 patients who sustained a hip fracture at the island of Crete (Greece) in a 4-year period we found 106 patients with bilateral noncontemporary hip fractures. Pathologic hip fractures and fractures that emerged from high energy trauma were excluded. To investigate the possible factors predisposing to the later fracture in the sound hip, we studied these 106 patients and compared them with the 1579 patients who sustained a single hip fracture (control group). There was no significant difference between the mean age of the bilateral group at the time of the first hip fracture (78.3 +/- 7.4 years, range 52-94 years) and the mean age of the control group (77.3 +/- 11.9 years, range 50-101 years). We found no significant difference in the bone status between the two groups, using both lumbar spine dual photon absorptiometry (DXA) and calcaneus broadband ultrasound attenuation (BUA). Falls, which were the main cause of all the hip fractures, were much more common in the bilateral group. The second hip fracture was of the same location (trochanteric or cervical) in 92% of the trochanteric and 68% of cervical fractures and a tendency to greater displacement or instability was observed. Of the second hip fractures 75% happened in the first 48 months after the first one. The mean interval time was much longer (160 months) when a neck fracture was followed by a trochanteric one.

Architecture of the femoral medullary canal and working length for intramedullary nailing. Biomechanic indications for dynamic nailing.

We classified human femoral intramedullary architecture into 3 types. The cortex in the first type is thick and the medullary canal narrow with an even and smooth translation towards the metaphysis. In the second type, the cortex is thin and the canal wider, also evenly distributed along the entire length, while in the third type the canal narrows just distal to the subtrochanteric region and similarly a few centimeters distally. Some medullary canals of the second type do not allow dynamic nailing, while canals of the third type presents some difficulties for unreamed nails. Most medullary canals belong to the first and second type and only few belong to type three. We performed comparative experimental loading in 11 pairs of cadaveric fractured femora fixed with static and dynamic nailing. Dynamic nailing was found to behave as safely as static ones in the presence of a sound femoral shaft central and peripheral to the fracture with a length twice the diameter of the femur at the fracture level. This could be checked intraoperatively with gentle rotation under image intensifier. In a clinical series, dynamic nailing was performed in about one quarter of the patients with femoral shaft fractures (18 of 72 patients) with excellent results.

Analgesia induced by N-acetylserotonin in the central nervous system.

The relationship between N-acetylserotonin (NAS) in the central nervous system (CNS) and responses to pain was investigated. Using the rat tail-flick model, we initially replicated the work of others showing that intraventricular (IVC) injection of a dipeptide structurally similar to both NAS and serotonin was capable of inducing analgesia in the rat. We then showed that IVC-NAS, but not serotonin elicited analgesia in much the same manner as the dipeptide. This effect proved to be very specific as it required the presence of both an acetyl group on the terminal side chain amine as well as a hydroxyl group on the C-5 position of the indole ring. Substitution of the C-5 hydroxyl by a methoxyl group (melatonin) abolished the analgesic effect. Similarly, removing the N-acetyl substitution (serotonin) also eliminated the analgesia. IVC injection of highly specific antiserum to NAS induced hyperalgesia. Furthermore, an interaction was found between NAS and opiate systems. We demonstrated that while naloxone, the opiate antagonist, has no hyperalgesic properties of itself, it did counteract the analgesia induced by NAS. Similarly, NAS antiserum reversed the analgesia induced by the opiate morphine. This work provides evidence that NAS is an endogenously active substance within the CNS pain network.

Identification and quantification of n-acetylserotonin (NAS) in the developing hippocampus of the rat.

1. A specific anti-NAS antibody and fluorescein-labelled second antibody were employed to investigate the presence of NAS in the dentate gyrus of the hippocampus as a function of age. 2. Immunoreactive NAS (INAS) was present in the granular cell layer of the dentate gyrus as early as 20 days postconception. 3. INAS appears to be present primarily in cell bodies. 4. Cross-reactivity and inhibition experiments confirm the positive identification of INAS. 5. INAS is age-dependent and increases with age reaching adult levels by day 30 post-conception/17 days after birth. 6. The appearance and subsequent increase in INAS correlates with the development of dentate granular cells and their subsequent synapse development suggesting a role for NAS in the normal functioning of these cells.