A clinical, ultrastructural and immunochemical study of Dupuytren's disease.

Aponeurotic tissue from seven normal subjects and from apparently unaffected branches, nodules and cords of 16 Dupuytren's patients were compared. Control tissue was characterized by polymorphous cells, showing cytoplasmic microfilament bundles, numerous pinocytic vesicles, basement membrane-like structures, and a thick coat of interwoven filaments, and by type I- and III-positive heterogeneous collagen fibrils, fibronectin, vitronectin, decorin and proteoglycans. The clinically normal branches consisted of fibroblast-like cells, small type III-highly positive collagen fibrils, fibronectin and proteoglycans. Nodules and fibrotic cords contained fibroblast-like cells, type I and III collagen, fibronectin and proteoglycans. Myofibroblast-like cells in only five out of 16 patients were present. There was no relation between clinical stage and structural alterations; the whole aponeurosis always seemed to be involved; cord retraction would seem to depend on the interactions among fibroblast-like cells and matrix components and among matrix macromolecules themselves.

[Correlation between Dupuytren's disease and arcus senilis: is dyslipidemia a common etiopathological factor?]. / Corrélation entre la maladie de Dupuytren et l'arc cornéen: la dyslipidémie peut-elle être un facteur étiopathogénique commun?

Because of the frequent presence of corneal arcus senilis in patients affected by Dupuytren's disease in order to evaluate this association, the authors conducted a biomicroscopic examination of the cornea in 336 patients treated surgically for Dupuytren's disease, at the Hand Surgery Unit of the University of Modena from November 1985 to December 1989. They observed corneal arcus senilis in 259 patients, i.e. in 77.1% of patients with Dupuytren's disease. Due to the statistically significant correlation between arcus senilis and hyperlipidemia as reported by Tschetter (1980) and Felder (1981), the Authors collected a blood sample from all 336 patients to evaluate serum cholesterol and tryglicerides. This study revealed a dyslipidemia in 54.8% of patients with Dupuytren's disease and in 60.2% of patients suffering from both Dupuytren's disease and arcus senilis. Because of the high frequency of dislipidemia in patients with Dupuytren's disease and arcus senilis, which are apparently two well-distinguished disease, the authors suggest that a lipid disorder may be a common aetiopathogenic factor. In particular, in favour of the possible role of hyperlipidemia in Dupuytren's disease, Electron Microscope Studies revealed lipid inclusions within fibroblasts and in the extracellular connective tissue of all pathologic palmar aponeurosis from 11 patients with Dupuytren's disease: these lipid inclusions were never seen in the normal aponeurosis taken from 5 control patients treated for traumatic palmar injuries.

[Clinical experiences with thymopentin administered by intra- and periarticular routes in degenerative pathology of the shoulder, knee and hip]. / Esperienze cliniche con timopentina per via intra- e periarticolare nella patologia degenerativa della spalla, del ginocchio, dell'anca.

The aim of this study was to assess the efficacy and tolerability of thymopentin, a synthetic pentapeptide with an immunomodulating action, in treating patients suffering from gonarthrosis, coxarthrosis and scapolo-omeral periarthritis by evaluating pain when resting, during activity and in response to digital pressure. Painful symptoms, quantified according to Scott-Huskisson's scale, disappeared in the majority of patients two months after the end of treatment. No collateral effects were recorded. Thymopentin may therefore be put forward as a useful alternative to cortisone compounds in the treatment of not severe degenerative joint pathologies.

Hemangioma of the hand.

The authors describe the anatomopathological and clinical findings of 24 cases of benign hemangioma of the hand. The instrumental methods used to diagnose hemangioma are discussed, and MRI imaging is given particular importance in the preoperative evaluation of the site, size, extent, and relationship with the surrounding tissues and any multiple locations of the vascular tumor. This evaluation is essential to perform a wide resection of the tumor, which is the only means of avoiding recurrence. After an average follow-up of 33 months (14-54) recurrence was observed in 7% of the cases treated.

Epidemiological and structural findings supporting the fibromatous origin of dorsal knuckle pads.

Epidemiological, optical and electron microscopical findings suggest that dorsal knuckle pads and Dupuytren's disease are fibrosing disorders with common features. In all cases examined, knuckle pads were always associated with Dupuytren's contracture and, in a significant number of cases, with bilateral Dupuytren's contracture. In a statistically significant number of patients with knuckle pads, Ledderhose's and Peyronie's diseases were also present (P less than 0.001). Optical and electron microscopical studies showed that cell types and extracellular matrix were identical in knuckle pads and Dupuytren's nodules in different patients.

Operative treatment of the post-traumatic boutonnière deformity. A modification of the direct anatomical repair technique.

We report 20 cases of post-traumatic boutonnière deformity treated by a modification of the direct anatomical repair technique, particularly indicated in late cases which have complete passive motion. A swallow-tailed flap is excised from the fibrous tissue between the two ends of the central slip. The proximal one is then advanced up to the coaptation with the distal edge of the scarred capsular tissue at the insertion on the middle phalanx to which it is sutured in correct tension. Excellent results have been obtained in 72% of cases and good in 5.5%. The 16% of fair results are probably due to the fact that patients didn't use the splint post-operatively and didn't cooperative with physiotherapy.

Evaluation of ischaemic necrosis of carpal bones by magnetic resonance imaging.

Nine patients with chronic pain in the wrist were examined by M.R.I. to evaluate its accuracy in the detection of ischaemic necrosis of carpal bones. In seven patients, M.R.I. confirmed scintigraphic and radiographic signs of ischaemic necrosis. In two patients with radionuclide accumulations, M.R.I. did not confirm the diagnosis: in one, M.R.I. was totally normal and in the other it showed signs of a healing scaphoid fracture. From this limited experience, M.R.I. seems to be a sensitive imaging modality which is more specific than scintigraphy.

Cocaine use and cerebrovascular disease: two cases of ischemic stroke in young adults.

We report two cases of ischemic stroke in young adult cocaine abusers occurring shortly after drug use. We review the literature and discuss the possible pathogenetic mechanisms.

Silent cerebral ischemia in patients with chronic atrial fibrillation--a case-control study.

The cerebral CT-scan results of 72 patients with chronic atrial fibrillation (AF) were compared to those of an age- and sex-matched control group, affected by muscle-tensive headache. None of the patients in the study had any neurologic symptoms. All were normal on neurologic examination. Mean age was 68 years in both groups. Patients with atrial fibrillation had a higher prevalence of hypertension, diabetes and hyperlipidemia, although the differences were not significant. Thirty-two patients (44.4%) with AF showed hypodense lesions on cerebral CT-scan, suggestive of small infarcts, whereas this finding was present only in eight control subjects (11.1%) (p less than 0.05). These results confirm in part the observations reported in literature and suggest a more thorough examination of the problem regarding the prophylaxis of thrombo-embolic risk in patients affected by chronic AF.

Osteoid osteoma of the metacarpus. A case report.

The authors present a case of osteoid osteoma which is of interest not only because of the extreme rarity of its localisation in the 1st metacarpal, but also because of its unusual clinical features. These consisted of atypical pain, which was constant and did not respond to salicylates. There was marked local reaction, particularly in the soft tissues surrounding the 1st metacarpal, with a fine superficial venous reticulum. It was possible to follow the complete radiographic development of the tumour from its earliest stage to its final rather atypical appearance, and this allowed us to make the presumptive diagnosis without dependence on other more sophisticated methods.

Neurovascular island flap by the disconnecting-reconnecting technique.

The authors report nine cases of hetero-digital neurovascular island flaps raised by the "disconnecting-reconnecting" technique for defects of the tactile pad of the thumb. At an average follow-up of 25 months, all cases had good restoration of sensibility without any "double sensibility" phenomenon and patients regained good dexterity. No tender neuromata developed and donor site complications were not troublesome.

Glomus tumours of the hand.

Based on 8 cases of glomus tumour of the hand, observed over the last 3 years, the authors review the clinical features and pathological anatomy of this rare condition. They propose nuclear magnetic resonance as a preoperative instrumental study as an alternative to angiography because it is non-invasive, free from risk and is clinically very effective.

First web-space reconstruction by Caroli's technique in congenital hand deformities with severe thumb ray adduction.

A personal technique is described for reconstruction of the first web-space in congenital hand deformities with severe adduction of the thumb. The technique is based on the use of two local rotation flaps, one designed on the thenar area and the other on the radial half of the back of the hand. Seven patients were treated with such a technique and followed up for an average of 32 months. Excellent results were obtained in five cases.

Pirprofen in the treatment of migraine and episodic headache attacks: a placebo-controlled crossover clinical trial.

A double-blind, within patient, randomized study to compare the efficacy and tolerability of acute rectal administration of 600 mg pirprofen capsules with matched placebo was carried out in 40 out-patients. They were divided into two groups of 20 patients each according to diagnosis of episodic headache or common or classic migraine. Treatment was given once during each of two consecutive attacks according to a crossover design. None of the patients was withdrawn after randomization. There was a statistically significant difference in favour of pirprofen as regards the preferences expressed by patients at the end of the trial: 34 patients preferred pirprofen, two preferred placebo and four patients had no preference. Pirprofen significantly reduced the duration of headache attack and associated symptoms, but not the peak of pain intensity. Tolerability of the drug was good.

[Hemicrania and cerebral ischemia in young adults]. / Emicrania e ischemia cerebrale nei giovani adulti.

A retrospective study was conducted on a young adults population affected by permanent symptoms of cerebral focal ischemia. Within 6 years, 24 patients between the ages of twenty and fifty were admitted to the Neurological and Medical department of our Hospital because of cerebral ischemic stroke. In 7 (29.2%) there was a previous history of common or classic migraine. No patients suffered headache at the time of neurologic deficit onset. In the other 17 patients in the study, 6 (25%) had valvular heart disease, 2 (8.3%) had signs suggestive of vasculitis, 2 (8.3%) had a story of head and neck injury, and in the remaining 7 (29.2%) patients no discernible etiology was demonstrated. Our data confirm the hypothesis that migraine may be considered an etiologic factor for persistent cerebral ischemia in young adults.

[Transient global amnesia]. / Amnesia globale transitoria.

Transient global amnesia is a well known syndrome, characterised by sudden loss of short term memory with retrospective amnesia, that appears in otherwise good healthy subjects. Transient global amnesia is often unknown and misunderstood. Authors explain pathogenetic hypothesis and diagnostic criteria, showing some clinical cases.

Effect of fenfluramine on prolactin secretion in obese patients: evidence for serotoninergic regulation of prolactin in man.

The present investigation was carried out to study the effect of serotoninergic stimulation on prolactin (PRL) secretion in man. Fenfluramine (60 mg, orally), an anorexiant drug which under acute circumstances stimulates the serotoninergic system, was administered to eight obese patients. Compared with placebo, drug administration increased PRL significantly (P less than 0.05 at 180 and 300 min, P less than 0.01 at 240 min). No significant changes were observed after fenfluramine in blood pressure, plasma aldosterone (PA), plasma cortisol, plasma renin activity, serum electrolytes or growth hormone. Since it has been reported that dopaminergic blockade raises PA concentration, the lack of change in PA in obese patients treated with fenfluramine suggests that the observed increase in PRL induced by fenfluramine is likely to be mediated by serotoninergic stimulation.