Maternal posttraumatic stress response after the birth of a very low-birth-weight infant.

OBJECTIVE: For parents, the premature birth of a child represents a traumatic event for which they are poorly prepared. To date, the focus of scientific interest has been on maternal psychological stress responses, such as anxiety and depression, or on appropriate coping mechanisms, whereas only scant attention has been paid to the traumatic aspect of the maternal experience after very low-birth-weight (VLBW) birth. The present study is the first to investigate the posttraumatic stress response of mothers after the birth of a VLBW infant in a prospective longitudinal study. METHODS: Fifty mothers of VLBW infants were examined at four measuring time points (1-3 days pp, 14 days pp and 6 and 14 months pp) with respect to posttraumatic symptoms [Impact of Event Scale (IES-R)], psychiatric diagnosis (SKID I for DSM-IV) and the extent of depression [Beck Depression Inventory (BDI) and Montgomery Asberg Depression Scale (MADRS)] and anxiety [State-Trait Anxiety Inventory (STAI) and Hamilton Anxiety Scale (HAMA)]. The control group comprised a group of 30 mothers after the uncomplicated spontaneous birth of a healthy child. RESULTS: At all four measuring timepoints (except 6 months pp), the mothers of the premature infants recorded significantly higher values for traumatic experience and depressive symptoms and anxiety compared with the controls. In contrast to the mothers in the control group, the mothers of the premature infants displayed no significant reduction in posttraumatic symptoms (IES-total), even 14 months after birth. CONCLUSION: The results indicate that the situation of a mother who has given birth to a VLBW infant is a complex, with long-term traumatic event necessitating ongoing emotional support extending beyond the period immediately after the birth.

[Chronic paronychia and synovialitis of extensor tendons due to Mycobacterium marinum. Is diagnosis or treatment the problem?]. / Chronische Nagelwallinfektion und Synovialitis der Strecksehnen durch Mycobacterium marinum. Ist die Diagnose oder die Therapie das Problem?

Most infections of the upper extremity are caused by staphylococcus or streptococcus and respond well to beta-lactam antibiotics. Hand surgeons should be aware of the possible diagnosis of Mycobacterium marinum infection: 90% of the lesions are found in the upper extremity. We present a case of a chronic, cutaneous lesion of the right middle finger with synovialitis of the extensor tendons observed in a 35-year-old woman. Routine cultures from tissue of the infected finger led to the diagnosis of paronychia due to staphylococcus aureus. Despite surgical and antibacterial treatment, the lesion persisted and the patient developed multiple raised, non-tender satellite lesions to the right hand and elbow. Based on the clinical aspect and a detailed history (she kept fish and had suffered a chicken bone stab to her middle finger 12 weeks earlier), we suspected a Mycobacterium marinum infection. Tissue was obtained mainly by synovialectomy. Culture of the biopsy tissue for Mycobacterium marinum confirmed the diagnosis. The patient responded to a triple therapy (rifabutin, ethambutol and clarithromycin) and had an uncomplicated recovery. The importance of a high index of suspicion, adequate examination and a complete patient's history for a correct diagnosis is stressed. Culture for Mycobacterium marinum is not routinely performed and ought to be initiated once an infection is suspected. We also discuss the best timing for the onset of medical treatment.

[The interosseous palmaris muscle of the thumb. Results of an anatomic study of a muscle of the first ray]. / Der M. interosseus palmaris des Daumens. Ergebnisse einer anatomischen Studie zu einem Muskel des ersten Strahls.

In sixteen of twenty adult human cadaveric hands a muscle fascicle was isolated from the adductor pollicis muscle. It had osseous origins from the base of the first metacarpal bone and from the trapezium bone in eleven hands. These origins were connected by a fibrous arch, which was a soft tissue origin itself. In two of the sixteen hands, muscle fibers emerged from the palmar aspect of the first dorsal interosseous muscle near the radial artery. The findings can be explained by the ontogenesis of the human hand. The described muscle is neither a part of the oblique head of the adductor pollicis nor an equivalent to the three palmar interosseous muscles. In our dissections it was a constant muscle. Other studies have to show the exact function of the muscle. We postulate a stabilization of the carpometacarpal joint of the thumb.

Anatomy of the adductor pollicis muscle. A basis for release procedures for adduction contractures of the thumb.

Release of the origins of the adductor pollicis muscle is used to treat adduction contractures of the thumb. A knowledge of the anatomy of the adductor pollicis muscle is therefore the basis for this technique. A study of 20 specimens showed that the origins of the adductor pollicis are more extensive than generally described. This must be taken into account in release procedures in the first web space.

[Hand surgery: information services on the internet]. / Handchirurgie: Informationsangebot im Internet.

The Internet provides hand surgeons with a powerful tool to exchange and gather information on an international level. Commercial and non-profit services are offered to disseminate knowledge of hand surgery. The success will depend on the number of active participants who use these new media. This paper gives an idea of the possibilities offered by already existing services for and by hand surgeons.

[Misinterpretation of a solitary breast carcinoma metastasis of the hand as an enchondroma. Case report and literature review]. / Fehlinterpretation einer solitären Mammakarzinommetastase in der Hand als Enchondrom. Fallbericht und Literaturübersicht.

Carcinoma of the breast is the third most common primary tumor leading to metastases in the hand. It is preceded by carcinoma of the lung and kidney. A review of literature is presented, following the case report of an isolated skeletal metastasis in the middle phalanx of the left ring finger in a 67-year-old patient seven years after mastectomy of the right breast. At first, the findings were misinterpreted as enchondroma.

[Paralysis of the interosseous nerve by a tendinous margin of the extensor carpi radialis brevis]. / Nervus interosseus posterior-Parese durch einen sehnigen Rand des M. extensor carpi radialis brevis.

A 41-year-old woman was seen with a posterior interosseus nerve palsy. Exploration showed this to be caused by entrapment and neurotmesis of the posterior interosseus nerve under the tendinous margin of the extensor carpi radialis brevis muscle. One year after nerve reconstruction, the functional outcome was nearly normal.

Reliable treatment of pyogenic granuloma of the hand.

Pyogenic granuloma (PG) is a common skin tumour whose aetiology is unknown. There is a significant recurrence rate whatever method of treatment is used, and there are many studies in the literature on the treatment of recurrence. In our experience, the most effective way of preventing recurrence is the complete removal of the tumour using the microscope, operating in a bloodless field. Only then can the whole tumour with its supply vessels be reliably removed. 20 cases of PG on the hand, three cases in the shoulder-neck area and one case on the foot have been treated in our department over a period of 4 years. Five of these were recurrences and all involved the hand. Three of these were infected. 17 patients were followed for 3 months to 3.5 years. There were no recurrences in these patients, all of whom were operated on using the method described above.

Intermittent axillary nerve palsy caused by a humeral exostosis.

We report an uncommon case of intermittent axillary nerve palsy caused by a humeral exostosis in an 11-year-old boy. After excision of the cartilagenous exostosis of the proximal end of the left humerus, the pre-operative symptoms of axillary nerve compression were alleviated.

[An unusual case of metastasis to the soft tissues of the palm of the hand with compression of the median and ulnar nerve by kidney cancer. Case report]. / Ungewöhnlicher Fall einer Metastase in die Weichteile der Hohlhand mit Kompression des N. medianus und N. ulnaris in Folge eines Nierenkarzinoms. Fallbericht.

The incidence of secondary tumors in the hand is set slightly over 0.1%, the primary tumor localized in the lung, followed by the breast and the kidney. The authors describe a case of a renal carcinoma metastatic to the soft tissue of the palm of the hand in a patient who had undergone nephrectomy for carcinoma of the right kidney eleven years previously. The sixty-one year old female patient developed a swelling of the palm of the left hand and showed symptoms of median and ulnar nerve compression. The patient had neurosurgery because of a solitary metastatic brain tumor of the right hemisphere three months earlier and did not approve to an additional surgical intervention in the hand at that time. The decision was made to treat the tumor with a local radiation therapy. Five months later, the treatment showed no effect and the patient decided to have the operation done. Histologic examination established the diagnosis of a metastatic renal cell carcinoma. The healing was prolonged. An ulceration developed in the distal part of the wound area and healing took seven weeks. Seven months after the operation the patient was alive and well without evidence of disease. The hand showed a good function with little impairment and the symptoms of nerve compression had completely disappeared.