Successful replantation of 2 fingers in an 82-year-old patient: a case report.

We present the case of an 82-year-old patient who had successfully replanted 2 of his 4 amputated fingers in the left, non-dominant hand. Amputation was caused by a circular saw and the patient was delivered to the hospital 3 h after injury with amputated part of the hand appropriately stored. The patient's general health status was good, with no serious systemic diseases. He also did not smoke. Post-operative course was uneventful for the replanted fingers, but after his return home the patient developed left-sided pneumonia, treated successfully with i.v. antibiotics. 8 months after replantation the patient presented with slight movement in the replanted fingers (AROM 45°), a total grip strength 8 Kg and the qDASH score 24; however, he could firmly grasp objects due to having an intact, well-functioning thumb.

Does ultrasonography contribute significantly to the diagnosis of carpal tunnel syndrome?

BACKGROUND: Recent studies have demonstrated ultrasonography as a valuable tool for confirming the diagnosis of carpal tunnel syndrome. The objective of this study was to investigate sonographic parameters of the median nerve in patients diagnosed clinically with carpal tunnel syndrome. PATIENTS AND METHODS: 185 wrists in 185 patients, 149 women (81%) and 36 men (19%), with a mean age of 59 years, with the clinical diagnosis of carpal tunnel syndrome were examined sonographically. We measured cross-sectional area (CSA) of the median nerve at the forearm and at the carpal tunnel inlet, as well as the height (a-p dimension) of the nerve at the tunnel inlet and in the narrowest site in the carpal tunnel. Moreover, in all patients the severity of the disease was assessed by the Levine questionnaire. RESULTS: A significant variability of sonographic data characterizing the median nerve was found: the mean CSA at the tunnel inlet was 17.6 mm2 (range: 7-36) and height of the nerve at the tunnel inlet was a mean of 2.7 mm (range: 1.3-4.5). No correlation was found between sonographic data and severity of the syndrome as expressed by the Levine scores. CONCLUSION: Sonography of the median nerve contributes little to the diagnosis of a clinically relevant carpal tunnel syndrome and its routine use is not justified.

No correlation between sonographic and electrophysiological parameters in carpal tunnel syndrome.

A prospective study was carried out to investigate any correlation between electrophysiological and sonographic findings in patients with a clinical diagnosis of carpal tunnel syndrome. A total of 113 patients (113 wrists) in 90 women and 23 men, with a mean age of 60 years, underwent sonographic and electrophysiological examination. Fifty-five patients (48%) had mild, 43 (38%) moderate and 12 (11%) had severe conduction disturbances and three patients had normal conduction. Sonographic measurements showed a cross-sectional area of the median nerve of 9.9 mm(2) at the forearm and 17.8 mm(2) at the tunnel inlet. The mean anteroposterior diameter (height) of the nerve at the tunnel inlet was 2.7 mm, and the lowest height inside the tunnel was 1.8 mm. No correlation was found between sonographic and electrophysiological parameters.

Adult fibrosarcoma of the wrist: a case report.

Adult fibrosarcoma is a rare malignant soft-tissue neoplasm occurring in middle-aged to elderly adults. We present a case of recurrent tumor involving the wrist, which was treated by wide excision including resection of the scaphoid and radio-lunate fusion, followed by coverage of soft tissue defect with a free flap. Despite macro- and microscopic adequate tumor resection, recurrence of the neoplasm occurred at 6 months and eventually amputation of the forearm was performed.

The effect of the involvement of the dominant or non-dominant hand on grip/pinch strengths and the Levine score in patients with carpal tunnel syndrome.

The Levine questionnaire is a disease-oriented instrument developed for outcome measurement of carpal tunnel syndrome (CTS) management. The objective of this study was to compare Levine scores in patients with unilateral CTS, involving the dominant or non-dominant hand, before and after carpal tunnel release. Records of 144 patients, 126 women (87%) and 18 men (13%) aged a mean of 58 years with unilateral CTS, treated operatively, were analysed. The dominant hand was involved in 100 patients (69%), the non-dominant in 44 (31%). The parameters were analysed pre-operatively, and at 1 and 6 months post-operatively. A comparison of Levine scores in patients with the involvement of the dominant or non-dominant hand showed no statistically significant differences at baseline and any of the follow-up measurements. Statistically significant differences were noted in total grip strength at baseline and at 6 month assessments and in key-pinch strength at 1 and 6 months.

Long term follow-up after finger replantation.

The aim of this retrospective study was to assess objective and subjective aspects of the long-term results of finger replantations and revascularisations. Forty patients with 59 successfully replanted or revascularised fingers, who had a mean age of 38 years, were followed-up over an average of 3.5 years. The assessment included: the profile of the blood flow in the digital arteries of replanted fingers with Doppler ultrasound, active range of motion, total grip strength, pinch grip, static two-point discrimination test and Semmes-Weinstein monofilament testing. The dexterity of the hand was evaluated subjectively with the Carlsson's questionnaire and cold intolerance with a modified McCabe's questionnaire. Statistical analysis was performed and a statistically significant correlation was found between the Carlsson's functional score, active range of motion and total grip strength. In 28 fingers (74%), blood flow in the digital arteries showed an undisturbed profile, while ten fingers showed mild stenosis or impaired microcirculation.

[Sympathetically maintained pain syndrome--a case report]. / Zespól bólu o podlozu wspólczulnym--opis przypadku.

Sympathetically maintained pain syndrome (SMPS) is considered to be a clinical form of reflex sympathic dystrophy. It develops usually after trauma, and consists of continuous, burning pain with sympathetic component. We present a case of this syndrome affecting both hands, that developed in a patient 3 months after severe burn injury. Intravenous fentolamine test was used to recognise sympathetic transmission of the pain. The management included regional intravenous fentolamine blocks and orally administrated phenoxybenzamine. The former gave only temporary relief; after latter improvement lasted 2 months, but patient eventually failed to recover. Diagnostic and therapeutic considerations concerning this syndrome were underlined.

[Results of treatment for high-pressure injection hand injuries]. / Wyniki leczenia urazów rak spowodowanych wysokocisnieniowym nastrzyknieciem tkanek.

High-pressure injection injuries of the hand have a reputation for being dangerous for individual fingers and even for whole hand. Usually appearing innocuous at presentation because of small puncture entry wound, these injuries result in severe damage of most internal structures in finger and hand due to extensive penetration of injected substance. This paper reviews the outcome of the treatment of such injuries in 10 patients: 9 sustained injection of toxic paint, and one lead shot. All the patients were operated on: eight a few hours after injury and two with 3 days delay. The surgical technique included wide exposure from site of injection up to the farthest place in which foreign substance was seen. Thorough debridment of injected material and contaminated tissue was performed with careful preservation of neurovascular structures and tendons. Wounds were not closed, but managed by open technique. In all patients wounds healed well: in 3 by secondary intention, in 6 by delayed closure and 2 were covered by skin grafts. No amputation was performed. Final results were assessed form 1.5 to 3.5 years after initial injury (mean at 2.5 years). Two patients complained of moderate pain related to the weather, five of cold intolerance and two of impaired sensation on fingertips. Active range of motion of affected fingers was in whole group from 90% to 104% (mean 97%) of the range of motion of unaffected fingers from the other side. Range of motion of the wrist (2 patients) was 76% and 117% of range of motion of the other side. Pinch grip strength was from 81% to 116% (mean 99%), and global grip strength from 77% to 119% (mean 97%) of the other side. All patients went back to their previous jobs and periods of sick leave were from 2 weeks to 6 months (mean 3 mo). Excellent results achieved in this study--full functional recovery in 9 of 10 patients confirm the effectiveness of aggressive treatment by open wound technique of such injuries.

[Biocompatibility assessment of aqueous extracts from new multiblock poly(ester-ester) copolymer]. / Badania biologiczne wyciagów wodnych z nowego multiblokowego poli(estro-estro) kopolimeru.

In the Technical University of Szczecin, Department of Chemical Fibres and Physical Chemistry of Polymer there has been synthesised a new polymer based on butylene terephthalate--PBT and dimerized fatty acid--DFA. Five different polymers varying in mechanical properties depending on hard segments--PBT and soft segments--DFA composition were obtained. Assessment of biocompatibility of the new materials was conducted according to FDP. Prepared water extracts from polymers were applicated intravenously to mouse and intra-abdominaly to mice and guinea pigs. All animals survived spell of the experiment and no signs of physical degradation were noticed. Kidney, liver, spleen, heart and peritoneum specimens was taken and evaluated microscopically. There was no signs of toxic action of the extracts. Based on principles in FDP and the data from animal studies it is applicable that evaluated materials have no increased toxicity.

[The advanced stomach cancer]. / Zaawansowany rak zoladka.

In the years 1993 to 1997, 106 patients with gastric carcinoma were treated. The age of patients ranged from 24 to 90 years. There were 73 males and 33 females. Variant advancement of gastric carcinoma was diagnosed in the patients: 29 had III grade and 77 IV grade according to TNM. The following resections of the stomach were performed: total in 38 (46%), subtotal or partial 45 (54%). While the remaining 23 patients had other operative procedures. The resection rate increased from 13% to 54%. Chemotherapy was also used. 53 patients died. The authors conclude that the increase in surgical radicalness and application of aggressive chemotherapy are the methods improving the results in gastric carcinoma.