Intrahepatic hemorrhage after use of low-molecular-weight heparin for total hip arthroplasty.

Low-molecular-weight heparin (LMWH) has become a popular agent for prophylaxis against deep vein thrombosis and thromboembolic disease after total joint arthroplasty. LMWH allows for consistent dosing in postoperative patients without the need for laboratory monitoring. Hemorrhage is an uncommon but documented adverse reaction when using LMWH; however, intrahepatic hemorrhage has not been previously reported in conjunction with LMWH therapy. We report the case of a woman who suffered intrahepatic hemorrhage presenting with acute abdominal pain and vomiting after the use of enoxaparin for total hip arthroplasty.

Humeral bone density losses after shoulder surgery and immobilization.

This study evaluates disuse osteoporosis of the proximal humerus after shoulder surgery and immobilization. This was accomplished by quantifying bone mineral density changes in 22 patients' proximal humeri after 6 weeks of immobilization for soft-tissue shoulder surgery. The bone mineral density of the humeral head, neck, and proximal diaphyseal subregions was determined 1 to 2 weeks before surgery and at 3, 6, and 12 weeks after surgery with dual-energy x-ray absorptiometry. By the sixth postoperative week statistically significant bone mineral density decreases of 6% to 14% were observed in the humeral neck and head subregions, respectively. The changes in these three regions diminished slightly after 6 weeks of remobilization, but the differences were still statistically significant. No significant bone mineral density changes occurred in any subregion or during any time interval in the nonoperated humerus. Our study represents the first report with dual-energy x-ray absorptiometry to quantify bone loss of the proximal humerus of patients after shoulder immobilization. Further long-term study is warranted to determine the clinical significance of this bone loss and to determine whether these losses are partially or fully recoverable.

Bone mineral density changes in the forearm after immobilization.

This study determined the early natural history of disuse osteoporosis in the ulna and radius. Six women and 2 men (mean age, 48.5 years; range, 35-60 years) having surgery on their wrists or hands had bone mineral density determined by single energy xray absorptiometry at 4 sites of the distal radius and ulna before operation, at cast removal (mean, 4.9 weeks after surgery), and after an average of 4.7 weeks of remobilization and hand therapy. A control group of 4 men and 4 women (mean age, 35.6 years; range, 24-46 years) had bone mineral density measurements of both forearms taken initially and again 5 weeks later. The patients had significant loss in bone mineral density at the ulna and distal sites of the forearm after 4.9 weeks of immobilization. Loss of bone mineral density continued at all 4 sites even after 4.7 weeks of remobilization and hand therapy. Bone mineral density increased significantly at the ultradistal radius of the contralateral forearm (which was not operated on) after 4.9 weeks, but this gain was no longer significant after 4.7 weeks of remobilization of the surgically treated forearm, suggesting that increased activity of the nonimmobilized forearm increased bone mineral density at certain sites. No changes in bone mineral density were seen in the control group. Immobilization of the forearm after hand or wrist surgery significantly decreases bone mass in the distal radius and ulna.

[Contents of the transversal foramen of the seventh cervical vertebra]. / Le contenu du trou transversaire de la septième vertèbre cervicale.

The purpose of our study was to evaluate the individual variations of the foramen sometimes has the same dimensions as the foramen of the other cervical vertebrae, but it can also be smaller, or absent. In cases where the foramen is present in the seventh cervical vertebra, vascular or nerve structures (or both) can be occasionally observed within. When the transverse foramina are found to contain none of the above structures, what then is to be found within this space? According to our results, the transverse foramina of the seventh cervical vertebra almost universally contain vascular and nerve branches as well as fibrous and adipose tissue. This report concerns the results of the macroscopic and microscopic studies concerning the contents of the transverse foramina of the seventh cervical vertebra.

[The inter-metacarpo-phalangeal spaces]. / Etude des espaces inter-métacarpo-phalangiens.

The study of the inter-metacarpophalangeal spaces on 20 human bodies raises the question of the existence of bursae at this level, in line with recent studies (BOSSEY, MIDY) suggesting that such bursae are present at the level of the foot. Careful dissection and histological studies revealed characteristics compatible with both of the following hypotheses: either there are bursae not described until now in anatomy textbooks, or these are virtual spaces limited by a cul-de-sac of the aponeuroses of the hand in the 2nd, 3rd and 4th spaces. Tissue analysis that could determine more specifically the nature of the limiting membrane of these spaces, as well as pathological studies demonstrating the occurrence of common anomalies of bursae in these spaces, are required in order to conclude definitively on the nature of the inter-metecarpophalangeal spaces.

A comparative study of the spaces between the metacarpal and metatarsal heads.

The study of the spaces between the metacarpal heads on 23 cadavers, raises the question of the existence of bursae at this level. This is in line with recent studies suggesting that such bursae are present at this level in the foot. Careful dissection and histological studies revealed characteristics compatible with both of the following hypotheses: either the existence of bursae not described until now in anatomy text-books, or spaces limited by a cul-de-sac of the aponeuroses of the hand in the 2nd, 3rd and 4th digits. Tissue analyses that could determine more specifically the nature of the limiting membrane of these spaces, as well as pathological studies demonstrating the occurrence of common anomalies of bursae in these spaces, are required in order to conclude definitively the nature of the spaces between the metacarpal heads. The gross anatomical and histological characteristics of the spaces between the metacarpal and metatarsal heads and of their limiting membranes were compared and found to be analogous in our series.