[Arthroscopic refixation of traumatic 1B-lesions of the TFCC--a retrospective study]. / Arthroskopische Refixation von traumatischen 1B-Läsionen des Discus ulnocarpalis--eine retrospektive Studie.

AIM: The aim of the study was to investigate the postoperative outcome of the arthroscopic sutures of traumatic 1B-lesions of triangular fibrocartilage complex (TFCC) tears. METHODS: Thirty-six patients who underwent an arthroscopic repair of traumatic 1B-lesions of the TFCC without a dislocation of the ulnar styloid process were included in this study. The average age of the 18 male and 18 female patients was 43.8 (range: 22-70) years. In 16 cases, we operated the left and in 20 cases the right TFCC. On average, the follow-up examination was performed after 7.9 years (range: 3.2-14.3) years. Patients with revision operations or neurovascular pathology were excluded. The Mayo modified wrist score and the disability of arm, shoulder and hand (DASH) score were used to identify the outcome. RESULTS: The Mayo modified wrist score was preoperatively 49.74+/-20.99 and postoperatively 82.43+/-15.89 (p<0.001). The DASH score was preoperatively 48.68+/-21.47 and postoperatively 24.1+/-19.81 (p<0.001). Only five patients demonstrated an isolated 1B-lesion of the TFCC and showed, likewise, significant improvements both regarding the DASH score and the Mayo modified wrist score (p<0.05). However, there was no significant difference to the patients with further wrist injuries (p>0.05). CONCLUSION: The results of the current study suggest that 1B-lesions of the TFCC can be successfully repaired by arthroscopically assisted suture techniques. An isolated 1B-lesion of the TFCC is rather unusual.

Water-insoluble paraproteins with anticoagulant properties.

A 78-year-old woman, who had received steroid therapy for four years, had strikingly prolonged prothrombin time (PT) and partial thromboplastin time (PTT). The presumptive diagnosis was chronic hemolytic anemia. Platelet count and functions, fibrinogen, and factor XIII assays were all normal, but other factors assayed abnormally low; Sia water-dilution test was positive. When water-insoluble protein was removed by centrifugation, coagulation factors became normal. Dissolution of this precipitate in normal plasma caused marked prolongation of PT and PTT and lower factor assays. Serum electrophoresis showed a homogeneous M spike and an anomalous IgM, lambda-antigenic type in the gamma-globulin zone at point of origin. Ultracentrifugation of serum and of the precipitate showed 10% S17 and almost 100% S17 components, respectively. Five other patients with water-insoluble paraproteins were tested; two were clot-inhibitory.

Cardiac neoplasm, tachyarrhythmia, and anasarca in an infant.

An infant had supraventricular tachycardia and massive anasarca at birth. The supraventricular tachycardia and congestive heart failure were minimally responsive to medical therapy. At 1 month of age, a diagnosis of atrial and ventricular septal defect was made by cardiac catheterization. At 5 months of age, at an operation for pulmonary banding, a peculiar neoplasm of the right atrium was noted. On clamping and resection of the neoplasm, the supraventricular tachyarrhythmia reverted to normal sinus mechanism. The neoplasm, by light and electron microscopy, was thought to be a conduction system hamartoma and was thought to have caused the arrhythmia. A review of the literature showed that no such lesions had been reported previously.