Malformations of the liver: some prenatal and postnatal developmental aspects.

The discovery of a large articulated lobe weighing 165.4 g dependent from the anterior margin of the left liver lobe in a 93-year-old female culminated two decades of observation of anomalous liver conditions in anatomic cadavers. When this data was compared with the information previously recorded from a series of 52 perinatal livers, remarkable discrepancies between the adult and perinatal incidences of various anomalous manifestations were noted. Ectopic accessory lobes were very rare in our adult series as well as in the groups reported in literature reviews. However, they were a relatively common occurrence in the perinatal cases, as were also gallbladder bridges of hepatic tissue, hypertrophic papillary lobes, and marked accessory fissures. In contradistinction, marginal accessory lobes were not noticed in any of the perinatal livers. Because the liver undergoes considerable postnatal reformation, it was concluded that most ectopic lobes, gallbladder bridges, hypertrophic caudate lobe extensions, and accessory fissures disappear during postnatal remodeling, whereas marginal accessory lobes may result from retention of the original perinatal boundaries of the anterior liver margins.

The surgical treatment of fingertip injuries.

Soft tissue and pulp loss severely damages the functional effectiveness of any digit. Prompt treatment must be individualized with reference to age, occupation, pre-injury problems and associated injuries to nerve, tendon and bone. Amputation of severely damaged digits may be a preferable alternative to reconstruction.

The infra-aortic arteries of the spine: their variability and clinical significance.

The infra-aortic spinal arteries caudal to the aortic bifurcation were studied in 20 perinatal and adult cadavers to determine their import relative to extraforaminal approaches to the lower lumbar discs as well as their probable involvement in certain cases of radiculomedullary ischemia. Analysis of these specimens indicated that, despite considerable variation, the arteries to the L4-L5 and L5-S1 intervertebral foramens generally were not related to the disc dorsolateral zones where lateral surgical approaches are best accomplished. Also, the frequency in which the fourth as well as the fifth lumbar and all sacral segmental vessels were dependent on the posterior division of the hypogastric artery may help explain how spinal cord ischemia could occur in individuals with vulnerable cord vascular patterns and/or spinal arteriopathy after interruption of hypogastric artery blood flow during pelvic operations.

Nailgun injuries of the hand.

Nailgun injuries of the digits and palm are an occupational hazard for carpenters. Sixty-five percent of all nailgun injuries have been reported to involve the hand. Clinically they can be further classified into three types, varying with the injury and the prognosis. Prompt nail removal after i.v. antibiotics, minimal wound debridement, operative curettement of the nail tract with removal of any foreign material, irrigation, open wound drainage, and nonoperative treatment of skeletal injuries resulted in healing without infection and with good function in seven cases.

Avascular necrosis of the hamate: a case report with reference to the hamate blood supply.

Avascular necrosis of the hamate bone has not previously been reported. In this case the proximal fragment of the fractured hamate underwent avascular necrosis and prolonged healing. In an attempt to explain this sequela, angiography of the cadaver carpus followed by dissection of intact wrists and a study of enzyme-cleaned hamates showed that their wedge-shaped proximal segments were mostly enveloped by a distal extension of the midcarpal joint cavity and thus totally dependent on intraosseous nutrition. Consequently, the segment is at risk when a fracture line transects the body proximal to the base of the wedge. Clinically, this condition resulted in persistent discomfort and limitations of motion. A postinjury bone scan of the wrist indicated avascular changes in the proximal third of the hamate, and a delayed union was followed by later revascularization and a more normal scan image.

Hand lacerations of the combined interdigital-intermetacarpal region (split hand).

Longitudinal lacerations involving the finger commissures and adjacent intermetacarpal clefts (including the adjacent tendons, the intrinsic muscles, the deep transverse metacarpal ligament, adjacent arteries, nerves, bones and joints), present multiple problems not seen in the unusual hand lacerations. Thorough cleansing, delayed closure, accurate repair of all injured structures with prompt appropriate rehabilitation results in excellent appearance and early function.

Swine bites of the hand.

Severe infections of the hand may follow bites by swine who carry a wide range of gram-negative and gram-positive flora. Early treatment must be primarily surgical, with prompt and thorough wound cleansing, superficial and deep debridement of the wound, drainage, and delayed closure of wounds only after cultures show no bacterial growth. Appropriate antibiotics are especially important with local or systemic symptoms of infection, as well as prophylactically. An illustrative case is presented.

Hand tumors: extraskeletal chondroma and osteoma--case reports.

Superficially simulating ganglion, extra skeletal tumors of cartilage and bone may occur in the soft tissues of the hand with no relation to the skeleton. Typical examples are presented with the pathological findings and clinical findings.

Kohler's osteochondrosis of the tarsal navicular: case report with twenty-eight year follow up.

A white male, age 5, was seen on December 29, 1960, with Kohler's osteochondrosis. His limping and pain were promptly relieved by built-up shoes, with subsequent restoration of normal bony architecture. This clinical and roentgenographic result has been maintained over twenty-eight years despite a life of arduous activity.