Rehabilitation of musicians with upper limb amputations

Three saxophone players with upper limb amputations have been successfully rehabilitated to play their musical instruments using skin-conductivity touch control. Each attained a standard of musicianship sufficient to perform the standard repertoire of the instrument in a concert setting. The mechanical and electrical modifications to the saxophone are described, as well as the principles of operation of the skin-conductivity touch control module. The touch control module is commercially available for prosthetists who wish to fit musicians or others with upper extremity amputations who require rapid accurate control of a number of channels of powered prosthetic function.     

Injuries of the urogenital system

Ultrasonography is accepted as a valuable screening method for the detection of renal trauma, although it does not make any functional contribution. Computerized tomography has replaced excretory urography for the evaluation of blunt renal trauma, because it makes more precise diagnosis possible. Arteriography is mandatory when injuries of the renal branch are suspected. The management of renal trauma should restore normal circulation and renal function and should preserve as much functioning renal tissue as possible. For renal contusion and minor cortical lacerations, even when there is a small extravasation of urine, conservative management is sufficient, while major cortical lacerations and injuries of the renal vessels require prompt operative methods. The classification of urethral ruptures is based on rectal palpation of the prostate, distribution and size of hematomas and urethrography. A primary catheter for diagnostic purposes is strictly contraindicated. Urinary diversion proximal to the urethral lesion is the primary therapeutic procedure, while the definite management of the ruptured urethra can be postponed. Injuries to the organs of the urogenital system are rarely life threatening, and in the case of multiple trauma their management can be adapted to fit in with the treatment of injuries to other vital organs. Nevertheless, diagnosis and adequate treatment of injured urogenital organs must not be neglected as long-lasting or permanent damage could result.     

Multiple neurinoma of the spinal cord: case report

The patient, a 72-year-old female, was admitted with an 11-year history of progressive dysesthesia in the left leg. Neurological findings on admission revealed weakness in the bilateral legs, hyperreflexia of left leg, hypalgesia and hypesthesia under the Th 8 level, and urinary incontinence. Plain lumber X-ray showed enlargement of the intervertebral foramen of L 1/2. Myelography disclosed block age at the level of Th 9 and filling defect at the level of Th 10/11 and L1/2. CT myelography revealed a cord swelling and partially exophytic tumor from Th 8 to Th 9, another tumor located posterior-laterally at the level of Th 11, and another tumor located extra and intradural at the level of L1/2. Laminectomy was performed from Th 8 to L 3. A tumor of the Th 9 was located intramedullary, another tumor of the Th 11 was located intradural extramedullary, and another tumor of the L1/2 was located in the epidural space (so-called dumb-bell type tumor). These tumors were removed completely except the extra-canal part of L1/2 tumor. Histopathological examination revealed typical Antoni type A schwannoma in all tumors. This case was considered multiple neurinomas of the spine in which tumors were located in three separate anatomical sites, intramedullary, intradural extramedullary, and epidural sites. This patient did not show café-au-lait spot, and neurofibroma in her body. The authors considered the patient might be a case of central neurofibromatosis. The authors stressed that multiple neurinomas of the spine is not rare, so careful study of the whole spine is necessary including its intramedullar space.     

Nonsurgical treatment of a massive macrohematuria following kidney biopsy

In the treatment of massive hematuria after renal biopsy, selective percutaneous vaso-occlusion with detachable balloons is an effective alternative to urological surgery, as demonstrated in the case of a 39-year-old man. A review of the literature, which records success rate of more than 90% in nonmalignant renal hemorrhage, confirms the therapeutic value of the various parenchyma-sparing embolization techniques.