ABSTRACT
INTRODUCTION: Giant cell tumors of the tendon sheath (GCTTS) are very common. More recently, a small number of case reports have identified the presence of multifocal GCTTS in the hand. These case reports have identified the presence of a maximum of two simultaneous lesions of a giant cell tumor affecting the same tendon sheath. We present an exceptionally rare case of simultaneous multiple localized GCTTS in which five lesions were identified on a single tendon simultaneously. This number of lesions on a single tendon has never been previously reported. CASE: A 37-year-old tree surgeon initially complained of pain in the region of the base of the ring and little fingers. A month later, he developed multiple soft tissue swellings at these sites and a soft tissue mass in the center of the palm relating to the left ring finger. A magnetic resonance imaging (MRI) scan suggested multiple GCTTS. These masses were excised completely without MRI evidence of a recurrence. Multiple GCTTS should be a differential diagnosis of multiple soft tissue swellings in the hand with an MRI scan and complete excision being the appropriate imaging and treatment modality respectively.
Subject(s)
Fingers , Giant Cell Tumors/diagnosis , Soft Tissue Neoplasms/diagnosis , Tendons/pathology , Adult , Diagnosis, Differential , Follow-Up Studies , Giant Cell Tumors/surgery , Humans , Magnetic Resonance Imaging , Male , Orthopedic Procedures/methods , Soft Tissue Neoplasms/surgery , Tendons/surgeryABSTRACT
A concept of tandem driven dynamic self-inhibition is demonstrated through dynamic inhibitors of acetylcholinesterase (AChE) using reversible transthiolesterification.
Subject(s)
Acetylcholinesterase/chemistry , Cholinesterase Inhibitors/chemistry , Acetylcholinesterase/metabolism , Esterification , Models, Molecular , Sulfhydryl Compounds/chemistryABSTRACT
Management of syndesmotic injuries of the ankle remains controversial. A postal questionnaire was administered to 310 Orthopaedic consultants in the United Kingdom to explore these issues. One hundred and ninety seven (63.55%) replies were received. A large number of surgeons use intra-operative hook test as an aid to assess syndesmotic stability (68.8%). A clear majority favoured the use of a syndesmotic screw as the preferred method of fixation (97.4%). The opinion on technique was divided over issues including number of cortices fixed, position and type of screw used. Most surgeons (88.4%) do not compress the syndesmosis while inserting the screw. Very few surgeons (8.5%) allow full weight bearing immediately after surgery. The survey establishes an overview of current practice of management of syndesmotic ankle injuries.
