Juxtacortical chondroma of the hand: treatment by resection of the tumour and the adjacent bone cortex.

A recurrence of a juxtacortical chondroma of the finger after marginal excision prompted us to review the treatment of this condition. Although the recommended treatment is simple curettage or marginal excision, the reported recurrence rate is significantly higher for lesions in the hand than those in other locations and recurrences only occurred in patients who had local treatments which did not include excision of the adjacent bone cortex. We report five patients with juxtacortical chondroma of the fingers. The first patient underwent marginal excision without resection of the underlying bone cortex. The other four patients underwent intralesional, marginal or wide excisions of tumour with resection of the bone cortex underlying the lesion. Recurrence was only seen in the patient who did not undergo resection of the bone cortex. Resection of the underlying bone cortex after excision of this tumour may be advisable for the treatment of this tumour in the hand to reduce the rate of recurrence.

Volar dislocation of the capitate.

In this report we describe a case of volar dislocation of the capitate associated with dislocation of the ulnar side of the carpometacarpal joint. Forced dorsiflexion of the wrist caused the rotation and volar displacement of the proximal portion of the capitate. Dislocation of the capitate is rare and may be seen in more complex injuries. An awareness of this type of injury may contribute to prompt diagnosis and treatment.

Fixation for comminuted phalangeal fractures. A biomechanical study of five methods.

The rigidities of five fixation methods have been studied with a comminuted phalangeal fracture model. Mechanical testing of compression, bending and torsion were performed for each fixation. Lateral plating with six screws seems to provide the most rigid fixation. If such lateral plating is not practicable, the four-Kirschner wire method would be a satisfactory alternative.

Effect of cAMP-dependent protein kinase on catecholamine secretion from bovine adrenal chromaffin cells.

We examined the role of cAMP-dependent protein kinase in Ca(2+)-elicited catecholamine secretion from bovine adrenal chromaffin cells. When the digitonin-treated cells were incubated with the catalytic subunit of cAMP-dependent protein kinase, the secretion of catecholamines from the cells occurred in the absence of Ca2+. The effect of the catalytic subunit was dependent on its activity (50-100 units/ml) and the presence of ATP-Mg2+ in the incubation medium. However, incubation of the cells with the regulatory subunit of cAMP-dependent protein kinase did not affect the secretion. Ca2+ (43 nM-10 microM) also increased the secretion, which was ATP-Mg(2+)-dependent. The catalytic subunit (25-200 units/ml) enhanced the Ca(2+)-evoked secretion at the suboptimal but not optimal Ca2+ concentration, which induced maximal secretion. A potent synthetic peptide inhibitor of cAMP-dependent protein kinase abolished the catalytic subunit-induced secretion, but not the Ca(2+)-evoked secretion. On the other hand, K-252a, a potent inhibitor of protein kinases, inhibited both the catalytic subunit-induced and the Ca(2+)-evoked secretion, but not KT5823, a much less potent inhibitor of protein kinases. These results strongly suggest that the catalytic subunit of cAMP-dependent protein kinase produces the secretion of catecholamines via protein phosphorylation. The results further suggest that the cAMP-dependent protein kinase does not participate in an intrinsic process of Ca(2+)-elicited secretion but it may act as a modulator.

Trichosporin-B-III, an alpha-aminoisobutyric acid-containing peptide, causes Ca(2+)-dependent catecholamine secretion from adrenal medullary chromaffin cells.

We examined the effect of trichosporin-B-III, an alpha-aminoisobutyric acid-containing antibiotic peptide consisting of 19 amino acid residues and a phenylalaninol, on catecholamine secretion from cultured bovine adrenal chromaffin cells. Incubation of the cells with trichosporin-B-III (3-20 microM) caused an increase in the secretion of catecholamines. The secretion induced by trichosporin-B-III at low concentrations (3 and 5 microM) was completely dependent on external Ca2+, whereas that induced by higher concentrations (10 and 20 microM) was partly independent of Ca2+. Trichosporin-B-III at low concentration (5 microM) did not increase the release of lactate dehydrogenase, a marker enzyme of cytoplasm, from the cells. In contrast, the peptide at higher concentration (10 microM) increased the release of the enzyme. Trichosporin-B-III also caused both 45Ca2+ influx into the cells and an increase in the intracellular free Ca2+ concentration. The increases in catecholamine secretion and 45Ca2+ influx behaved similarly in relation to trichosporin-B-III concentration (3-10 microM). The time courses of the increases in secretion, 45Ca2+ influx, and intracellular free Ca2+ concentration induced by trichosporin-B-III were also quite similar. Trichosporin-B-III-induced (at 5 microM) secretion was not affected by the elimination of Na+ from the incubation medium or by the addition of tetrodotoxin, a blocker of highly selective voltage-dependent Na+ channels, or hexamethonium, a blocker of nicotinic acetylcholine receptors. On the other hand, both diltiazem (2-200 microM) and nicardipine (1-200 microM), blockers of voltage-dependent Ca2+ channels, inhibited the secretion induced by trichosporin-B-III (5 microM) in a concentration-dependent manner. Trichosporin-B-III-induced (at 5 microM) secretion also was suppressed by the addition of Mn2+ (5 mM) to the medium. The diltiazem (20 microM) inhibition of trichosporin-B-III-induced (at 5 microM) secretion was reversed by increasing the external Ca2+ concentration. These results indicate that trichosporin-B-III causes the secretion of catecholamines from bovine adrenal chromaffin cells by two mechanisms, Ca2+ dependent and Ca2+ independent (only at high concentrations of trichosporin-B-III). Furthermore, these results strongly suggest that trichosporin-B-III, in Ca(2+)-dependent secretion, activates endogenous voltage-dependent Ca2+ channels, or itself forms the channels in the membranes, and induces Ca2+ influx into the cells.

[Use of iontophoretic anesthesia for venipuncture].

The usefulness of iontophoretic anesthesia with 10% lidocaine was evaluated on insertion of venous catheters on 38 blood donors in a blood bank and on 41 patients in a hospital, after the arm was charged for 3, 6 or 9 minutes with 1.5 mA of electricity by using a hand-made iontophoretic anesthesia apparatus. In the blood donor group, the pain-relief effect was observed in 25% of donors after charging for 3 min; in 68% after 6 min; and in 93% after 9 min. In the patient group, anesthesia was observed in 14% of patients after 6 min and in 65% after 9 min though the effect was observed in 81% after 6 min and in 65% after 9 min. But only 45-48% of subjects in both groups requested the anesthesia after charging for either 6 or 9 min. This suggests that the duration for 9 min was not liked by the subject despite the pain on insertion. Therefore it is concluded that the charging duration of the iontophoresis must be shorter for this method to become useful as local anesthesia.