Usefulness of ultrasound for the diagnosis of pyogenic flexor tenosynovitis: A prospective single-center study of 57 cases.

Pyogenic flexor tenosynovitis (PFT) is a functional emergency in hand surgery; however, its diagnosis can be difficult to make. It should always be considered when a patient presents with an inflamed finger. The goal of this study was to investigate the usefulness of ultrasound in the diagnosis of early PFT. Seventy-three patients with suspected pyogenic flexor tenosynovitis were candidates for the study. Since the diagnosis of PFT was obvious in 16 patients, they were excluded from the study and immediately underwent surgery. The remaining 57 patients underwent a clinical examination by a senior surgeon, a blood test for C-reactive protein levels and an ultrasound (US). The US results were compared to the intraoperative findings if the patients were operated or to the clinical outcome in non-operated patients. Seventeen patients had the US diagnosis of PFT confirmed intraoperatively. In 10 patients, the US diagnosis of PFT was not confirmed intraoperatively. In 29 other patients, the diagnosis of PFT was ruled out by US; they all had good outcomes after being treated with antibiotics. In one patient for whom the diagnosis of PFT had been ruled out by US, PFT was actually present. Ultrasound had 94% sensitivity, 65% specificity, 63% positive predictive value, and 95% negative predictive value. Ultrasound is useful as a diagnostic tool for managing early PFT thanks to its excellent negative predictive value and specificity. This objective examination complements the surgeon's subjective clinical examination.

Open volar radiocarpal dislocation with extensive dorsal ligament and extensor tendon damage: A case report and review of literature.

The authors present the case of a patient with a rare combination of open volar radiocarpal dislocation and complete destruction of the dorsal capsule-ligament complex and tendons. The treatment consisted of open reduction and arthrorisis (temporary arthrodesis during 45 days) with four K-wires (radiocarpal and radioulnar). The capsule-ligament complex was fixed with anchors and the extensor tendons were repaired by suturing. A long-arm cast was applied for six weeks. After an 18-month follow-up, the Cooney-modified Green and O'Brien score was 70 and the wrist range of motion was 85°. Dynamic intraoperative X-rays are needed to look for bone or ligament (intracarpal or radioulnocarpal) injuries. Arthrography, arthroscopy or MRI may provide additional information. In cases of stable lesions without intracarpal ligament injuries, conservative treatment may be sufficient. Otherwise, surgical treatment is required, using temporary external fixation or arthrorisis (temporary arthrodesis) associated with anatomic repair of capsular ligaments. The average duration of postoperative immobilization is 6.6 weeks. An external fixator seems to be useful for reduction and for placing optimal tension on repaired ligament repair. Twenty-three cases of volar radiocarpal dislocation are described in published studies. None of them was associated with bone, tendon, skin or capsule-ligament complex injuries. Few studies describe the long-term functional and radiological outcomes of these injuries.

High-energy injuries of the wrist.

High-energy injuries to the wrist gather complex fractures of the distal radius, radiocarpal dislocations, perilunate dislocations, and other intracarpal dislocations. Depending on the energy of the injury and the position of the wrist at the time of impact, the patient, often a young male with a high functional demand, presents one of these injuries associating fracture(s) and ligament injury. The trauma is often bilateral, with proximal lesions (elbow) very often associated with contusion or compression of the median nerve. Diagnosis is confirmed by wrist X-rays, which are sufficient to determine treatment for radiocarpal and perilunate dislocations. In cases of distal radius fractures or other intracarpal dislocations, a preoperative CT is necessary. Reduction of the dislocation and relief of neurovascular compression are performed immediately. The final treatment of each lesion (bone fixation, ligament repair) can be undertaken simultaneously or delayed, depending on the patient and the lesions. Cartilage lesions, resulting from the high-energy injury, can be estimated using arthroscopy but cannot be repaired and determine the prognosis. The surgeon's objective is to restore joint congruence, which does not prevent stiffness, the main complication of these rare injuries, which the surgeon must know how to recognize and treat.

Snowblower injuries to the hand.

The aim of this study was to describe the nature and incidence of hand injuries caused by snowblowers, as well as the accident conditions and accident prevention. We conducted a retrospective evaluation over ten consecutive winters. Nine patients were included. All were men with an average age of 49.7 years (17-71). The accidents occurred at home in seven out of nine patients. The machine was running in 50% of the injury events. In most cases, the injuries occurred when the patient tried to unclog snow from the lateral discharge chute. Only four out of the nine patients had read the instructions or received instructions from the salesperson. The dominant hand was injured in 7 out of 9 patients. An average of 2.7 fingers were injured. The longest fingers were most commonly injured: 8 middle fingers, 7 ring fingers, 4 little fingers, 2 indexes and 1 thumb. All the fractures were open. Three patients were operated on several times. In 7 out of 9 cases, the patients had sequelae such as amputation. The mean time off work was 11.4 weeks (3-24). All the patients were experienced snowblower users (9 years and 57th use on average). Snowblower accidents are very mutilating. Prevention must include protected access to blades and better verbal and written safety warnings.

Serenomyces associated with palms in southeastern USA: isolation, culture storage and genetic variation.

Serenomyces is a genus belonging to the family Phaeochoraceae, which is known to occur only in association with the plant family Arecaceae (palms). It is presumed to be one of the causes of a leaf disease referred to as either rachis blight or petiole blight, depending on the palm species affected. The fungus is not readily observed, with few reports in the literature; it cannot be readily isolated from tissue, with only one known instance of it being cultured on artificial media and has no DNA sequences deposited in GenBank. Over an 8 y period, leaves symptomatic for rachis or petiole blight were obtained from Florida and South Carolina, USA. The fungus was induced to produce ascospores, and single-spore isolates were obtained in culture and, in some instances, induced to produce ascospores in culture. Based on ascospores size and ITS sequencing, Serenomyces from Phoenix canariensis and P. dactylifera form one group, Serenomyces from Thrinax radiata form a second group and Serenomyces from Sabal palmetto form a third. All three groups are most similar morphologically to Serenomyces phoenicis. Due to the observed instability of Serenomyces in culture, we have suggestions regarding the storage of this fungus.

[Is there any correlation between the strength of pronation and supination of the dominant hand and that of the non-dominant one in right-handed healthy adults: preliminary results]. / Existe-t-il une corrélation entre la force de pronation-supination du côté dominant et celle du côté non dominant chez l'adulte sain droitier : résultats préliminaires.

We searched the existence of a link between the strength of pronation and supination of the dominant forearm and those of the non-dominant one. Ninety-seven volunteers were tested in pronation and supination with an analog dynamometer. Gender, age, dominance, height and weight were recorded. The measurement position was: 90° of elbow flexion, 0° of shoulder abduction, wrist slightly extended and neutral pronation-supination. We took four measurements per patient: strength in pronation and supination, in both the dominant and non-dominant sides. Fifteen subjects were evaluated twice. The left-handed (4) were removed from the statistical analysis. There were 38 men (37 years, 18-66) and 55 women (45 years, 21-71). Torques were higher (P<0.05) in men than in women, higher in supination than in pronation and in the dominant side compared to the non-dominant one (average ratio "non-dominant/dominant": 0.85; σ=0.16). There was a strong correlation between non-dominant hand strength and dominant hand strength (Pearson>0.6). Relating to the 15 subjects evaluated twice, the value of the forces varied during the day, but the ratio "non-dominant/dominant" was constant. The left-handed people were excluded, their values may be different from those of right-handers, as has been shown for grip strength. There was a strength variation during the day, but the ratio "non-dominant/dominant" was constant, making it more relevant intra-individual comparison (non-dominant side versus dominant side) rather inter-individual (based on charts of gender, age, weight and height). In the right-handed, the ratio "strength non-dominant side/dominant" is constant, defining easily in consultation the expected value of recovery of an injured forearm.

[Large diameter nerve conduits use in the upper limb: report of four cases and literature review]. / Utilisation des neurotubes de gros diamètre au membre supérieur : à propos de quatre cas et revue de la littérature.

UNLABELLED: Defects of the median, ulnar or radial nerves in the forearm, can be treated by conventional nerve grafts, or by interposing a synthetic guide such as nerve conduits. Wounds without nerve loss treated with simple suture may be supplemented by sleeving to prevent the nerve irritation symptoms using a nerve conduit or a vein sleeve. We studied the results of nerve conduits in both cases in a single-center retrospective study. PATIENTS AND METHODS: Four patients underwent surgery with placement of a nerve conduit in the forearm, between May 2007 and January 2011. All patients were reviewed by the same examiner. Pain, tenderness, motor (Medical Research Council classification, MRC), time to return to work and self-evaluation by the patient were measured. The averages of these data were calculated and compared with results of other studies in the literature, the nerve grafts for defects and the Socket joints for venous ulcers. RESULTS: The decrease is on average 30 months (2 years). The defect never exceeds 40mm and is 22mm on average. According to the classification MRC, sensitivity found after inserting nerve conduits in the forearm after a defect is excellent (S4) for two of three patients and good (S3) for the third. Motor results were very good (M4 and M3 for one patient) andM2 for the other. As for the insertion of a nerve conduit as a sleeve, the result is good in terms of sensitivity (S3) and excellent in terms of motor (M5) for our case in the study. For our small group of patients with neuroma we obtained, results similar to those published in the literature with conventional techniques. CONCLUSION: The nerve conduits seem to give results similar to conventional techniques, in situations of defects or neuromasin the forearm, with a diameter greater than 2mm, but defects of less than 30mm.

Fusarium oxysporum f. sp. palmarum, a Novel Forma Specialis Causing a Lethal Disease of Syagrus romanzoffiana and Washingtonia robusta in Florida.

A new disease of Syagrus romanzoffiana (queen palm) and Washingtonia robusta (Mexican fan palm) has spread across the southern half of Florida during the past 5 years. The initial foliar symptom is a one-sided chlorosis or necrosis of older leaf blades, with a distinct reddish-brown stripe along the petiole and rachis and an associated discoloration of internal tissue. Within 2 to 3 months after onset of symptoms, the entire canopy becomes desiccated and necrotic but the leaves do not droop or hang down around the trunk. Based on pathogenicity and morphological and molecular characterization, the etiological agent has been identified as a new forma specialis of Fusarium oxysporum, designated f. sp. palmarum. Sequence analysis of a portion of the translation elongation factor 1-α gene (EF-1α) separated 27 representative isolates into two EF-1α groups, which differed by two transition mutations. Members of both EF-1α groups are pathogenic on both species of palm. A phylogenetic analysis inferred from partial EF-1α sequences from a genetically diverse set of F. oxysporum isolates, including three other formae speciales pathogenic on palm (i.e., f. sp. albedinis, f. sp. canariensis, and f. sp. elaeidis), suggested that f. sp. palmarum and f. sp. albedinis may be more closely related to one another than either is to the two other palm pathogens.

Bone mineral density and body composition in Noonan's syndrome: effects of growth hormone treatment.

We assessed bone mineral density (BMD) and body composition in children with Noonan's syndrome (NS) before and during growth hormone (GH) treatment. Sixteen children (12 boys, 4 girls) with NS aged 5.8-14.2 (mean 10.0) years were studied for 2 years. Anthropometry, BMD measurements by radiographic absorptiometry and bioimpedance measurements (Akern-BIA 101/S) were performed at baseline and after 3, 6, 12 and 24 months. Daily GH dosage was 0.05 mg/kg. Trabecular volumetric BMD was normal; cortical BMD was in the lower normal range at baseline and slightly increased over the 2 years. Fat free mass and total body water were below normal at the start and increased significantly over the first 3 months, with a slight increment thereafter. Percentage fat mass decreased over the first 6 months and increased thereafter. These findings are comparable to the data on body composition in short normal children and girls with Turner's syndrome treated with GH.

Viability and stability of biological control agents on cotton and snap bean seeds.

Cotton and snap bean were selected for a multi-year, multi-state regional (south-eastern USA) research project to evaluate the efficacy of both commercial and experimental bacterial and fungal biological control agents for the management of damping-off diseases. The goal for this portion of the project was to determine the viability and stability of biological agents after application to seed. The biological seed treatments used included: (1) Bacillaceae bacteria, (2) non-Bacillaceae bacteria, (3) the fungus Trichoderma and (4) the fungus Beauveria bassiana. Seed assays were conducted to evaluate the following application factors: short-term (< or = 3 months) stability after seed treatment; quality (i.e. isolate purity); compatibility with chemical pesticides and other biocontrol agents; application uniformity between years and plant species. For the bacterial treatments, the Bacillaceae genera (Bacillus and Paenibacillus) maintained the greatest population of bacteria per seed, the best viability over time and the best application uniformity across years and seed type. The non-Bacillaceae genera Burkholderia and Pseudomonas had the least viability and uniformity. Although Beauveria bassiana was only evaluated one year, the seed fungal populations were high and uniform. The seed fungal populations and uniformity for the Trichoderma isolates were more variable, except for the commercial product T-22. However, this product was contaminated with a Streptomyces isolate in both the years that it was evaluated. The study demonstrated that Bacillaceae can be mixed with Trichoderma isolates or with numerous pesticides to provide an integrated pest control/growth enhancement package.

Detection of an arbuscular mycorrhizal fungus in roots of different plant species with the PCR.

PCR was used with the primer pair VANS1-NS21 to detect the arbuscular mycorrhizal fungus Glomus intraradices (commercial inoculum source) on roots of lettuce, zinnia, leek, pepper, and endive plants. The appropriate amplification product was obtained directly from roots without DNA extraction and purification.

Selective medium for isolation of Xanthomonas maltophilia from soil and rhizosphere environments.

A selective medium (XMSM) was developed for isolation of Xanthomonas maltophilia from bulk soil and plant rhizosphere environments. The XMSM basal medium contained maltose, tryptone, bromthymol blue, and agar. Antibiotics added to select for X. maltophilia were cycloheximide, nystatin, cephalexin, bacitracin, penicillin G, novobiocin, neomycin sulfate, and tobramycin. A comparison was made between XMSM and 1/10-strength tryptic soy broth agar for recovery of X. maltophilia from sterile and nonsterile soil infested with known X. maltophilia isolates. A recovery rate of 97% or greater for XMSM was demonstrated. XMSM was used to isolate X. maltophilia from a variety of soil and rhizosphere environments.