Ultrasound for the diagnosis of retained splinters in the soft tissue of the hand.

Foreign material may present both a diagnostic and a surgical problem. Most irretrievable foreign bodies are wood and are radiolucent. Ultrasound offers an alternative way of preoperative imaging in these situations. We describe four cases of retained splinters in the hand that were localized with sonography and subsequently removed surgically. This report supports the reliability and efficiency of ultrasound as the primary imaging tool for the detection of foreign bodies if conventional radiographs are negative. Preoperative sonographic localization of the foreign body may be extremely useful to the surgeon and may minimize surgical dissection and operating room time.

Acrocallosal syndrome: a case report.

This report describes the case of an 18-month-old Caucasian male infant with clinical and radiological findings indicative of the Schinzel acrocallosal syndrome. He was born to non-consangiuneous parents. His father had been diagnosed with Greig syndrome. The patient underwent surgery for preaxial polysyndactyly of both hands and feet. The similarity to the Greig syndrome is discussed. It is possible that both the acrocallosal syndrome and the Greig syndrome are variant expressions of the same autosomal dominant condition. Surgery may improve thumb opposition and shoe wear.

Rupture of the extensor pollicis longus tendon.

Rupture of the extensor pollicis longus (EPL) tendon after nondisplaced fracture of the distal radius is a known complication, but can also occur in nonrheumatoid patients without a history of fracture. This study is a retrospective analysis of seven patients treated between 1985 and 1992. Five EPL ruptures occurred with nondisplaced Colles' fractures. Two involved a chronic tenosynovitis of the second dorsal extensor compartment of the wrist. The age of the patients ranged from 29 years to 68 years (mean, 42 years). Length of follow-up ranged from 6 weeks to 62 months (mean, 30 months). Rupture occurred at a median of 7 weeks (range, 2 weeks to 11 months) from the time of the distal radius fracture. Three extensor indicis proprius tendons and four free palmaris longus tendon grafts were performed. At final follow-up, six patients had an extensor lag < 10 degrees or normal thumb interphalangeal joint motion. One patient had a 25 degrees extensor lag. The causes of EPL rupture include mechanical irritation, attrition, and vascular impairment leading to delayed rupture. Synovitis of the extensor carpi radialis due to repetitive use may invade the EPL tendon and lead to rupture. Extensor indicis proprius transfer or free palmaris longus grafts yield good results after EPL rupture.

Acute carpal tunnel syndrome in a patient taking Coumadin: case report.

The case of a 26-year-old patient who developed acute carpal tunnel syndrome while taking warfarin (Coumadin) is reported. She underwent carpal tunnel release with complete resolution of symptoms. We found reports of two other patients taking Coumadin with acute carpal tunnel syndrome. In all three cases, discontinuation of Coumadin therapy and open surgical release of the carpal tunnel led to a good result.

Degenerative arthritis of the carpus associated with congenital hypoplastic thumb.

The case history of a young man with bilteral congenital hypoplastic thumbs and early degenerative arthritis involving the base of the thumb and scaphotrapeziotrapezoid joints is reported. To our knowledge this association has not been previously made. Limited intercarpal arthrodesis and/or trapezium arthroplasty may be required at a relatively early age in patients with thumb dysplasia. We believe the hypoplastic thenar musculature may lead to instability and excessive shear stresses on the radial side of the carpus, causing the early arthritic changes.

[Electroencephalographic evaluation potentials in severely burned patients in intensive care]. / Elektroenzephalographische Beurteilungsmöglichkeiten bei schwerverbrannten intensivpatienten.

In severely burned patients water and electrolyte imbalance is the most obvious disturbance during the shock period but problems also occur because of large protein losses and absorption of toxic products from the damaged skin. These factors may impair brain function and this may be further affected by the action of drugs used for therapy. Brain function was assessed in 12 burned patients by EEG recordings. The EEG records showed no changes specific to burned patients. Changes were seen similar to those seen in patients under intensive care for other surgical conditions and seemed to be related to the level of consciousness and to the drug therapy.

Morphological changes of the corneal epithelium after application of topical anaesthetic ointments.

The effect of topical anaesthetic ointments (4% cocaine, 4% xylocaine, 0.5% proparacaine, 0.2% oxybuprocaine) on the corneal epithelium of rabbits was examined using a scanning electron microscope. Even after a single application, the more toxic effect of cocaine compared to the other topical anaesthetics was evident. Cocaine caused disruption of both the plasma membrane and the cytoplasm. After a single application, the other preparations caused a marked decrease in the microvilli and microplicae, disruption of the intercellular spaces and the prominence of the cell nucleus which under normal condition is not visible. Repeated applications caused regular cell desquamation and damage to the plasma membrane and cytoplasm. The damage also affected several cell layers. The cell reactions described are clearly a consequence of the topical anaesthetics, as the ointment base itself produced no essential cell damage. The scanning electron microscope findings were supported by results from the transmission electron microscope.