Juvenile aponeurotic fibroma: A case report

Juvenile aponeurotic fibroma is a rare lesion of the palmar surface of the hands and, occasionally, of the feet of children. It is a benign tumor which is self limited in growth, but which has a strong propensity to recur. Grossly and histologically it exhibits a tendency to invade all surrounding structures, but does not metastasize. Rapidity of growth seems to slow down with increasing age. It should be recognized and treated conservatively by repeated surgical removal.     

Intraosseous nerve transposition for treatment of painful neuromas

Symptomatic painful neuromas of the sensory nerves are a frequent cause of major impairment of the hand. Numerous techniques and measures have been used for managing this challenging problem. Boldrey first advocated a technique in 1943 in which the nerve end was transposed and implanted into bone and reported the successful use of this method in one patient. In 1981, Hemmy used a similar technique in five patients with no recurrence of pain. To date, no other studies that used this method have been reported. We performed intraosseous transposition of 23 painful neuromas in the hand of 11 patients and were successful in 10 cases.     

JOHN WILKINS MRCS,FRCS (EDIN.), 1826–1905: HIS HOUSE AT 121 COLLINS STREET EAST,MELBOURNE

The three-storeyed house at 70 Collins Street (formerly 121 Collins Street East), Melbourne, was built in 1857 as a home and surgery for Dr John Wilkins. It was associated for 100 years with surgical practice, especially general surgery and eye and ENT diseases, then with obstetrics and gynaecology, but in time had to yield to commercial pressures. However, the exterior remains intact, its special architecture reminiscent of its early elegance.     

Effect of Mesterolone* on Plasma L.H., F.S.H. and Testosterone

Der Einfluß von Mesterolon auf LH, FSH und Testosteron im Blutplasma Es ist gefordert worden, daß peroral zugeführtes Mesterolon — im Gegensatz zu 17α-methyl-Testosteron — weder die endogenen Gonadotropine noch testosteron unterdrückt. Um dieses genauer zu untersuchen, wurden beide Medikamente nacheinander 4 gesunden Personen verabreicht und dabei die Plasmakonzentration von Testosteron, LH und FSH regelmäßig bestimmt. Die Zufuhr von Mesterolon hatte bei alien Probanden einen signifikanten und ähnlichen Abfall von Plasmatestosteron, eine signifikante Unterdrückung von LH und FSH fand nur in zwei Fällen statt. Alle beobachteten Veränderungen wurden am Ende der ersten Woche festgestellt. Die Verabreichung der halben Dosis von 17α-methyl-Testosteron führte bei alien Probanden zu einer signifikanten Unterdrückung von Testosteron, von den Gonadotropinen wurde jeweils eines oder aber beide signifikant unterdrückt. Während einer längeren Studie, die sich über 5–30 Monate hinzog, ergab sich bei regelmäßigen Untersuchungen in 1–2 monatlichen Intervallen eine signifikante Unterdrückung von LH und FSH durch 17α-methyl-Testosteron, nicht jedoch durch Mesterolon, das klinisch ein weniger wirksames Androgen war.     

Primary flexor tendon repair followed by immediate controlled mobilization.

A study was made of the results of immediate repair and controlled mobilization in 156 severed flexor tendons in 68 patients occuring over an 18-month period. Eight patients with 16 tendon injuries could not be followed. Results were obtained from examinations done 6 weeks to 18 months (mean, 5.3 months) after repair. Thirty-one of the 60 patients were less than 20 years old, and 44 of the 60 were less than 30 years old. Seventy-nine (56%) of the injuries occurred in the area known as "no man's land"; 28 patients with repair of tendons in this area were rated by our standards as "excellent" or "good"--75% of patients as compared to 84.4% for the results of repair in other areas. In one fourth of the cases of severance of both tendons, because of local conditions in the wound, the superficialis was excised, but in all others it was repaired.     

Fatal road accidents in Birmingham: Times to death and their causes

The intervals between injury and death in the 254 fatalities after road traffic accidents in Birmingham during 1969 and 1970 were analysed and correlated with other data. Sixty-three per cent were pedestrians and 23 per cent were passengers and drivers of vehicles. In round figures, about a third of the series died within half an hour, a half by 2 hours, two-thirds by 24 hours, and three-quarters by 2–4 days. The patterns of survival-time could be divided into three phases. There was an early steep decline, with 36 per cent dying during the first half-hour and 44 per cent within 1 hour of the accidents. This was followed by a longer stage during which the rate of dying decreased progressively in logarithmic fashion. The cumulative tolls were 51 per cent by 2 hours, 58 per cent by 4 hours, 68 per cent by 24 hours, and 83 per cent by 7 days. The curve then flattened into a prolonged tail. Between 7 and 28 days another 10 per cent died, making 93 per cent by 28 days. The remaining 7 per cent succumbed during the subsequent weeks and months, 3 patients surviving longer than a year.

Fifty-six per cent of vehicle occupants and 40 per cent of pedestrians died within an hour of injury, and the excess of rapid deaths among vehicle occupants was mainly due to a higher proportion of rupture of the aorta. All the ruptured aortae in vehicle occupants occurred after accidents at night or the early hours of the morning. Many of the affected drivers and passengers had consumed alcohol and their injuries were more rapidly lethal than after accidents at other times. Serious cerebral trauma dominated all groups of road users and multiple injuries were common. Included among the fatality tail was a group of subjects, mainly pedestrians, with relatively modest injuries who might have survived had they not developed pulmonary embolism, respiratory infection, or other complications.     

Fingertip reconstruction with a palmar advancement flap and free dermal graft: a report of six cases

The palmar thumb advancement flap was first described by Moberg in 1964. It was further utilized for the thumb and defined by Posner and Smith in 1971. In 1980, Macht and Watson favorably reported their technique of palmar advancement that was applicable not only for the thumb, but also for all five digits with soft tissue tip losses. A further refinement of their technique is to augment the digital tip with an autogenous dermal graft. This dermal "padding" is placed directly over the bony tuft to act as a "shock absorber," add bulk and contour to the distal tip of the finger, increase soft tissue stability, eliminate direct percussive tenderness of the bone, and decrease disability for specific occupations such as those requiring typewriting. Six cases are reported.     

Radial nerve palsy at the elbow following venipuncture-case report

A 29-year-old man sustained a radial nerve lesion when a blood bank technician attempted to cannulate the cephalic vein. Severe pain in the hand and fingers led to removal of the 16-gauge needle. A complete motor and sensory deficit occurred below the elbow. Electrical testing confirmed the neurologic lesion. Complete recovery took 3 months.     

Localized constrictive radial neuropathy in the absence of extrinsic compression: three cases

Three patients, one with bilateral disease, experienced spontaneous onset of radial nerve dysfunction. Each demonstrated significant motor paralysis and had surgical exploration 3 weeks to 3 months after symptoms were first noted. All three patients showed well-localized hourglass constrictions of the radial nerve that could not be attributed to extrinsic compression. Each subsequently required tendon transfers for a persistent radial nerve palsy. Each showed electrical evidence of late recovery, although this was incomplete in two out of three.     

Significance of absent vas deferens at hernia repair in infants and children.

An absent vas deferens may be associated with unilateral renal agenesis or undiagnosed cystic fibrosis. Such patients should be further evaluated with a sweat chloride and intravenous pyelogram. The finding of absent vas deferens during exploration for an undescended testis does not provide absolute evidence for absence of the testis, since these structures have independent embryologic origins.     

Fasciectomy and Dupuytren's disease: a comparison between the open-palm technique and wound closure

An analysis of 153 patients treated surgically for Dupuytren's disease is presented. One hundred fifteen patients were treated with the closed-palm technique, while 38 patients were treated with the open-palm technique. The groups were comparable in terms of preoperative metacarpophalangeal and proximal interphalangeal joint involvement, as well as the total number of rays involved. The patients were analyzed in terms of average pre- and post-operative total active motion (TAM) in the digital joints. The patients in the closed-palm group had a 10% improvement in TAM surgery, while those in the open-palm group had a 17% improvement (p less than 0.05). The complication rate in the closed-palm group was 19% and in the open-palm group, 8%. There were no hematomas in the open-palm group and no infections in either group. In a later follow-up of 103 patients who could be contacted, 33 of the 78 closed-palm group showed residual contracture (42%), while five of the 25 open-palm group were similarly affected (20%).