[Complete avulsion of the scalp. Apropos of a case]. / Les avulsions totales du scalp. A propos d'un cas.

The authors present a case about a traumatic totally avulsed scalp, realizing a loss of substance of 1,000 cm2. After the unsuccessful treatment with classical methods by skin grafting, a mixed myocutaneous Latissimus Dorsi and cutaneous parascapular flap allow the coverage of 25 centimetres of the scalp in his larger axis. The remaining surface is covered with full-thickness skin grafts. Though unperfect according to the esthetic aspect, the result is stable 6 months after the operation.

A double nidus osteoid osteoma in a finger.

The diagnosis of an osteoid osteoma in the proximal phalanx of the right index finger was suggested by the patient's history and the initial radiographs. The diagnosis was histologically confirmed postoperatively. One year later, however, persistent symptoms and typical radiographic findings, again suggested the presence of an osteoid osteoma. Subsequent en bloc resection of the second nidus, which was again histologically confirmed as an osteoid osteoma, was followed by complete resolution of the symptoms. The definitive diagnosis of a double-nidus osteoid osteoma was suggested after careful analysis of the initial radiographs demonstrated the existence of two distinct intracortical nidi.

Peripheral nerve mucoid degeneration of the upper extremity.

Peripheral nerve mucoid degeneration of the upper extremity is an extremely rare entity. Four new cases encountered in a 14-year period are added to the 10 cases reported in the world literature. Usually affecting males in their forties, it is heralded by an entrapement type syndrome. Pain, paresthesias, paralysis, and possible palpability, succinctly summarizes the order and frequency of the appearance of the differential diagnostic symptoms and signs. Soft part imaging may aid in the preoperative diagnosis. Therapeutically, conservative neurolysis, pertinent arcade sectioning, prudent neural dissection, partial pseudocyst wall excision, and content drainage all under optical enlargement is the treatment of choice. There are no recurrences with this treatment; however, the functional results depend on early diagnosis and surgical intervention before neural fiber destruction is complete.

Neurotization via the spinal accessory nerve in complete paralysis due to multiple avulsion injuries of the brachial plexus.

The authors report their experience with 21 cases of neurotization via the spinal accessory nerve for multiple nerve root avulsion injuries of the brachial plexus associated with total paralysis of the upper limb. They performed microneuroanastomoses with interposed cable nerve grafts between the spinal accessory nerve taken in the supraclavicular fossa and the musculocutaneous nerve at its entrance into the biceps muscle. Surgical indications depend on the accurate diagnosis of spinal nerve root avulsion, especially C5. The anatomicosurgical basis of this technique is as precise as are the indications. As many as two-thirds of the patients with a neurotized musculocutaneous nerve can be expected to achieve strength of at least Grade 3 on late muscle testing. Nevertheless, these results are always inferior to those obtainable when grafting is performed with carefully selected unavulsed C5 or C6 spinal nerve root fibers in the intervertebral foramina. Therefore, neurotization via donor nerves extrinsic to the plexus should only be considered as a second-choice intervention.

Is surgical intervention justifiable for total paralysis secondary to multiple avulsion injuries of the brachial plexus?

The authors have studied 28 patients with total paralysis of the upper extremity due to multiple avulsions of the brachial plexus nerve roots or rupture of the primary trunks of the branchial plexus. All 28 patients refused amputation, and the authors describe the value of the overall functional results realized by the patients, obtained by surgery versus amputation.

Sex ratio in the progeny of mothers with toxemia of pregnancy.

Maternal-fetal incompatibility may be an essential component in the etiology of toxemia of pregnancy. A prior study found an abnormally high sex (male:female) ratio, suggestuve of Y-dependent histoincompatibility. We studied the records of 373 patients alleged to have some indication of toxemia among 3,246 births and applied standard criteria for classification. There were no significant differences for any group compared with the sexondary sex ratio expected of the population(94.6% Black).