Radiographic assessment of the relative lengths of the bones of the fingers of the human hand

The study assessed whether a relationship existed between the lengths of the phalanges of the fingers of the hand. The centres of rotation of the joints in each finger were determined by dissection of cadaveric hands. Using these data, the distances between the joint centres was determined on anteroposterior hand X-rays taken for clinical purposes. The study has shown that, for all the fingers, there is a ratio of 1 for the distance between the metacarpophalangeal and proximal interphalangeal joint and the distance between the proximal interphalangeal joint and the finger tip. The ratio for the distances between the interphalangeal joints and the distal joint and the tip approximates to 1.3 for the index, middle and ring fingers and to 1.0 for the little finger. No evidence was found to support Littler's hypothesis that the interarticular distances of the finger follow the Fibonacci sequence.     

Distribution of the vascular network of the adenohypophysis of the rat

From various experiments it has been suggested that the blood flow to the different parts of the adenohypophysis is not the same. By developing the peroxidase activity of the red and white blood cells we have obtained a satisfactory image of the distribution of the intrahypophysial vessels, which indicate that the organization and distribution of these vessels varies from one portion to another in the pars distalis. On the lateral portion of the gland vascular routes are irregular, whilst in the media zone they run in a sagittal plane. Between the above-mentioned portions, on either side of the edge of the pars intermedia, a rich vascular network extending along the dorsal limit, which is fed by the long portal vessels and by numerous smaller vessels from the ventral vascular chain of the pars intermedia and neural lobe, is observed.     

Prevention of the development of the typical dislocation of the hip

Applying a diaper and baby clothing without changing the naturally flexed leg requires education of mothers and nurses. Retaining the flexed position which is present from the very beginning of postnatal life, markedly reduces the incidence of click sign. A program on neonatal diapering, clothing, and general care, reduced the incidence of congenital dislocation of the hip in 3 to 7 months old infants in a sample population of 200,000.     

Analysis of the impact of the course of hydration on the mechanical properties of the annulus fibrosus of the intervertebral disc

Purpose

The aim of this study was to determine the impact of free hydration on the mechanical parameters of the annulus fibrosus (AF) of the intervertebral disc (IVD), determined in a standard manner. Attention was also given to the hydration occurring in real time and geometric changes resulting from swelling of the AF.

Methods

Uniaxial tensile tests of multilayer samples of the AF with bone attachment were performed for two groups: samples subjected to 30 min of hydration prior to the mechanical test, and control samples, which were not subjected to additional hydration.

Results

As a result of hydration, the values of both the failure stress (σ _UTS) and the tensile modulus (E) were lower than in the control group. A decrease in these values was observed for the AF from both the anterior and posterior parts of the IVD.

Conclusions

The tests showed a significant dependence of the determined mechanical parameters on the cross-sectional area. The larger the cross-sectional area, the lower the obtained value of stress. By contrast, the value of the stiffness coefficient is independent of the cross-sectional area. The differences in mechanical parameters are related mainly to water absorption into structures of the AF during hydration. This is confirmed by microscopic analysis of geometric dimensions of the AF during hydration conducted in real time. The greatest changes occurred in the radial direction, where the thickness increased by 2.05 mm, while in the axial direction the main change concerned an increase in height by 0.69 mm. There were negligible changes in the circumferential direction.

     

Fractures of the shafts of the phalanges of the hand.

Fractures of the shafts of the phalanges are common and often disabling. Little detailed information is available as to the results of treatment, against which new methods of treatment may be compared. Thirty-nine comminuted fractures and 109 which were not comminuted were followed-up and their results are presented in detail. In both groups only about 57% obtained satisfactory results. Possible methods of improving these are discussed and the importance of accurate reduction of non comminuted fractures is emphasised.     

Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus

We reviewed 39 patients with displaced three- and four-part fractures of the humerus. In 21 patients (group A) we had used an anatomical prosthesis for the humeral head and in 18 (group B) an implant designed for fractures. When followed up at a mean of 29.3 months after surgery the overall Constant score was 51.9 points; in group A it was 51.5 and in group B 52.4 points. The subjective satisfaction of the patients was assessed using a numerical rating scale and was similar in both groups. In group A complete healing of the tuberosities was found in 29% and 50% in group B. Partial integration was seen in 29% of group A and in only one patient in group B, while resorption was noted in 43% of group A and 44% of group B. The functional outcome was significantly better in patients with complete or partial healing of the tuberosities (p=0.022). The specific trauma prosthesis did not lead to better healing of the tuberosities. The difference in clinical outcome obtained by the two designs did not reach statistical significance.     

On the Phenomenology of the Perforating Vein of the Elbow

The perforating veins, as the name suggests, are the veins that perforate the muscular aponeuroses ensuring communication between the superficial and the deep veins. Located at the bend of the elbow, almost constantly, there is a vein, named perforating vein of the elbow, which is of great interest to the nephrologist who is responsible for the management of vascular access for hemodialysis (HD). It represents, in fact, because of its intrinsic characteristics and topographical reasons, a valuable resource for the creation of a vascular access for HD, especially in obese patients, elderly patients, diabetics, and patients affected by peripheral vasculopathy. Arterio-venous fistulae (AVF) constructed with the perforating vein of the elbow are relatively easy to perform, have an excellent patency rate, a low incidence of early thrombosis, adequate flows, and a low incidence of the steal syndrome. In other types of AVFs, the perforating vein of the elbow subtracts flow to the superficial veins slowing or preventing their full maturation, and can become a problem in measuring the blood flow of the AVF. But still, its presence can maintain patent a fistula in case of poor compliance of the superficial veins, while awaiting for interventional procedures able to accelerate a subsequent maturation. This review intends to explore the role that the perforating vein of the elbow plays in the physiology and pathology of the AVF, in relation to the issues that most frequently occur in clinical practice.     

三角韧带损伤的手术治疗

[目的]探讨踝关节三角韧带损伤的手术治疗及效果。[方法]2002年4月-2005年4月治疗伴有三角韧带损伤的踝关节骨折40例，均采用切开复位和坚强内固定，并修复重建三角韧带，恢复踝关节内外侧结构的稳定性。下胫腓联合分离仍不稳定者，给予皮质骨螺钉横向内固定。[结果]全部病例得到16个月-3a随访，平均1．5a。按齐氏疗效评定标准：优良30例，可8例，差2例，优良率75％。[结论]强调踝关节骨折切开解剖复位，坚强内固定的同时，应充分重视修复重建三角韧带。     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

The influence of the geometry of the dialyzer and the composition of the dialysate in activating the complement system

During hemodialysis there is a complex interaction between the patient and the extracorporeal circuit that activates the complement system, among others. To better understand the influence of the dialyzer geometry and the dialysate composition, we compared hollow fiber versus parallel plate dialyzers and acetate versus bicarbonate dialysates and their role in the production of C3a, C4a and C5a. There was no significant difference in the plasmatic levels of these anaphylotoxins and their des-Arg derivates, as measured by RIA, in either dialyzer. The same was true when the dialysate in question had a different composition. We thus concluded that neither the geometric configuration of the dialyzer nor the composition of the dialysate influence their biocompatibility as regards the activation of the complement system, and that the differences that have been described shall have to be explained in another manner or assessed by methods other than those used in this study.     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

Remote results of the treatment of fractures of the distal portion of the bones of the forearm]

Under observation were 309 patients with fractures of the distal portion of the antebrachial bones, in whom 311 fractures were observed (in 2 cases fractures occurred twice for a 9-year period). All these patients were subdivided into two groups: the Ist group comprised 139 patients treated at the in-and outpatient center of general surgery, and in the second group (172) patients were treated at the traumatological in-outpatient center. The results of treatment in both groups are analysed, and some appropriate conclusions are made.     

Quantification of the diameter of muscular fibres in the course of the development of the quadriceps]

Muscle biopsies were taken from the medium portion of the vastus lateralis of a hundred fetuses (aged between 10 and 40 weeks), children, adolescents and adults without any neuro-muscular disease. Diameters of the muscle fibers were measured with a Leitz ASM 68K on frozen sections which had been stained for myofibrillar ATPase. The results have been expressed as average diameters and histograms. The results demonstrated a gradual increase in diameter of the fibers during fetal development. At the birth, the average diameter of the type I and II fibers is 10-15 microns. Growth continues during postnatal development up until puberty, when the fibers reach their final diameter of 60-65 microns. Analysis of the histograms shows that before 18 weeks of gestation, there is a large dispersion in the diameter of the fibers. The first type I fibers are larger than the others and correspond to Wohlfart type b fibers. This is followed by the appearance of a second population of smaller type I fibers. These fibers gradually increase in diameter and one observes a homogenous population of type I fibers at the birth.     

Fracture of the process of the scapula

Authors call attention, describing 3 cases of their own, to the diagnostical difficulties of these rare injuries. They think the axillary Roentgenogram, except the dislocated fractures of the humerus, in all injuries of the shoulder region necessary. In 2 cases operations were performed, 1 patient was treated conservatively. In case of fracture of the process with impirtant dislocation operation is suggested. The patients healed with good functional results.     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

Fractures of the hook of the hamate

Fractures of the hook of the hamate are rare injuries. Six new cases are presented; the most usual mechanism is probably a direct blow to the area of the hook. The diagnosis, which can only be made by special roentgenographic techniques is usually missed at the acute phase. Most of the cases are diagnosed when painful non-union, fraying tendinitis of the flexor tendons to the ulnar fingers, ulnar or median nerve deficits appear. The adequate treatment is usually excision of the hook fragment.