Simultaneous dislocation of the both interphalangeal joints in the middle finger

Simultaneous dorsal dislocation of both interphalangeal joints in one finger is an uncommon injury. This injury usually occurs on the ulnar side of the hand involving ring and little fingers. We report a case of simultaneous dislocation of both interphalangeal joints in the middle finger with small avulsion fractures. Closed reduction and splinting in ‘intrinsic plus position’ provided a good result with full range of motion by 8 weeks after the initial injury.     

A less invasive surgical approach in the lumbar lateral recess stenosis: direct approach to the medial wall of the pedicle

The lateral recess is one of the main compression sites in lumbar spinal canal stenosis. Lumbar nerve root is mainly entrapped by bony tissue in compression syndrome. The patient has a long history of back pain in conjunction with claudication symptoms. Besides laminotomy and facetectomy techniques, several specific surgical approaches to treat the lateral recess stenosis have been described. The surgical technique of bilateral lateral recess decompression via subarticular fenestrations used in this study is a less invasive technique, which enables to decompress the neural structures while preserving as much of the bony structures and ligamentum flavum as preferred. In 16 patients, we measured lateral recess heights with computerized tomography. The number of involved lumbar segments was one in 11 patients and two in 5 patients. The visual analogue scale (VAS) results were maintained before, 3 and 12 months after the operation. All patients benefited from the operations. Mean VAS scores were 7.0, 5.5, and 4.0, respectively. There were not any surgery-related complications. Mean follow-up period is 22.6 months. The surgical technique described and used in this study provides easy access to every zone of lateral recess and is safe and effective in treating the lumbar lateral recess stenosis syndrome.     

Rhinorrhoea from a frontal encephalocele after reduction of high intracranial pressure

Acquired non-traumatic frontal sinus encephaloceles are very rare lesions that are usually caused by a tumour or hydrocephalus. We present a 31-year-old woman with a frontal sinus encephalocele who developed rhinorrhoea after a ventriculo-peritoneal shunt to treat her hydrocephalus and underwent radiotherapy for a tectum tumour.     

Necrotizing fasciitis: strategies for diagnosis and management

Necrotizing fasciitis (NF) is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically. The literature addressed NF contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy. A delay in diagnosis is associated with a grave prognosis and increased mortality. The main goal of the clinician must be to establish the diagnosis and initially treat the patient within the standard of care. This review is planned as a guide for the clinician in making an early diagnosis of NF and initiating effective medical and surgical therapy.     

Persistent posttraumatic wrist pain: complex regional pain syndrome? Mycobacterium tuberculosis infection should be in the differential diagnosis

It is a common algorithm for hand surgeons to diagnose and treat persistent post-traumatic wrist pain as complex regional pain syndrome (CRPS). Although it works for many patients, some conditions that affect the wrist don’t fall in this category and worsen with this treatment practice. We present a single-handed patient who had had a non-displaced distal radius fracture and was treated as CRPS for the next three months. He was eventually diagnosed with late tuberculous tenosynovitis of the wrist and a total wrist arthrodesis was performed. We believe that Mycobacterium tuberculosis infection should be in the differential diagnosis of persistent post-traumatic joint pain. This is especially important as Mycobacterium infections are becoming more common due to an increase in patients with chronic immunosuppression and definitive diagnosis and treatment of tuberculous tenosynovitis needs a high index of clinical suspicion.     

Objective and early diagnosis of chylous fistula in the postoperative period.

OBJECTIVE: The study goal was to evaluate whether quantitative analysis of neck drainage contents is an important parameter of objective and early diagnosis of chylous fistula (CF) in the postoperative period. STUDY DESIGN AND SETTING: We prospectively evaluated 103 consecutive neck dissections during a 2-year period at a tertiary academic referral center. Six of the patients (5.8%) had CF. The data obtained from the patients with CF were matched with normal data obtained from patients without CF. RESULTS: A statistically significant difference was found between total drainage volumes of the patients with and those without CF (P < 0.05). In almost all patients with CF, drainage levels of triglycerides and cholesterol on postoperative day 1 were higher than serum levels. The difference between the drainage levels of triglycerides and cholesterol of the patients with and without CF was highly significant (P < 0.001). CONCLUSIONS: Serum and drainage levels of triglycerides and cholesterol on postoperative day 1 can be used as objective and early predictive parameters of CF.     

Lack of effect of intrarectal lidocaine for pain control during transrectal prostate biopsy: a randomized prospective study

INTRODUCTION AND OBJECTIVES: Transrectal ultrasound guided biopsy is an essential part in the diagnosis of prostate cancer. Although this procedure is well tolerated by most patients, sometimes it can result in some uneasiness. In this randomised double-blind placebo controlled study, we evaluated the effectiveness of intrarectal lidocaine during TRUS guided biopsy. MATERIALS AND METHODS: 100 consecutive eligible patients who had elevated total prostate specific antigen (tPSA) and/or abnormal digital rectal examination (DRE) were included into this study. Patients were randomised into two groups. Group I received 20 cc of 2% intrarectal lidocaine 20 minutes before transrectal ultrasound guided biopsy and Group II received same amount of serum physiologic. Pain was assessed using a 10 point modified visual analog scale. RESULTS: Mean patient age was 65.5+/-2.5 and 64.5+/-11.5 years, mean tPSA was 12.3+/-3.6 and 11.3+/-1.7 ng/ml, mean biopsy duration was 6.8+/-2.5 and 6.6+/-2.2 minutes, mean pain score during transrectal ultrasound guided biopsy was 4.8+/-2.2 and 4.4+/-2.1 in Groups I and II, respectively. No statistically significant difference was observed with respect to age, tPSA, mean biopsy duration and pain score between these groups. There was only one patient who could not tolerate the procedure at all, and he was paradoxically in the lidocaine group. CONCLUSION: The use of intrarectal lidocaine is not superior to placebo during transrectal prostate biopsy for pain control.     

Associations between apolipoprotein E gene polymorphism and plasminogen activator inhibitor-1 and atherogenic lipid profile in dialysis patients

BACKGROUND: Apolipoprotein-E (ApoE) gene polymorphism has an important role in lipoprotein metabolism and could participate in the development of cardiovascular diseases (CVD). Plasminogen activator inhibitor-1 (PAI-1) is also regarded as a risk factor for CVD. The aim of the present study is to further investigate the possible link(s) between ApoE gene polymorphism and plasma PAI-1 antigen and serum lipid profile in peritoneal dialysis (PD) and hemodialysis (HD) patients. MATERIAL AND METHODS: We studied 72 PD patients (38 female, mean age 49.9 +/- 16.1 years), 72 HD patients (22 female, mean age 57.4 +/- 14.6 years), and 42 healthy subjects (21 female, mean age 50.1 +/- 18.6 years). Serum lipid parameters, plasma PAI-1 levels, and ApoE genotypes were determined in all subjects. RESULTS: The distribution of ApoE genotypes and alleles frequencies was similar in dialysis patients and healthy controls. In PD patients, total cholesterol (TC), low-density lipoprotein (LDL)-C, and ApoB levels were significantly higher than that of HD patients. HD patients with E3/4 genotype had elevated TC, LDL-C and ApoB levels compared with E3/3 genotype. TC and triglyceride levels were also higher in E3/4 genotype than that of E2/3 genotype. PD and HD patients showed a significantly increased PAI-1 levels compared with controls, whereas PAI-1 levels were highest in HD patients. There was no significant relation between ApoE genotypes and PAI-1 levels. CONCLUSIONS: The present study suggests that ApoE polymorphism significantly affects serum lipid profile in HD patients and epsilon4 allele carriers are more susceptible to have atherogenic lipid profile.     

Interpleural versus epidural analgesia with ropivacaine for postthoracotomy pain and respiratory function

STUDY OBJECTIVE: To evaluate the impact of interpleural analgesia (IP) on postthoracotomy pain and respiratory function as an alternative to thoracic epidural analgesia (TEA). DESIGN: Prospective, randomized study. SETTING: Tertiary-care military hospital. PATIENTS: Sixty young patients scheduled for elective thoracic surgery (correction of aorta coarctation and patent ductus arteriosus). INTERVENTIONS: Patients were randomized into two groups to receive either IP or TEA for postthoracotomy pain management. MEASUREMENTS: Patients in the IP group (n = 30) had a catheter inserted between the parietal and visceral pleura by a surgeon, and 0.2% ropivacaine was given through this catheter. In the TEA group, ropivacaine was administered through a thoracic epidural catheter. The impact of both methods on pain control, respiratory function, and pulmonary complications was analyzed and compared. MAIN RESULTS: The frequency of atelectasis and pleural effusion was also significantly high in the IP group (P < 0.01). Respiratory function and postoperative pain scores were better in the TEA group (P < 0.01). Arterial blood gas analysis on the fifth postoperative day was significantly better in the TEA group. CONCLUSION: Thoracic epidural analgesia has more beneficial effects on respiratory function and postoperative pain after thoracotomy than does IP.     

Body mass index, percent body fat, and bone mass in a cohort of Chinese twins aged 6 to 18 years

Introduction This report examines the relationship of body mass index (BMI), percent body fat (%BF), and bone mass in a cohort of male and female twins recruited from Anhui province, China, ages 6–18 years—577 male pairs (mean age = 11.4) and 478 female pairs (mean age = 11.6). Methods Whole body bone mineral content (WBMC) in (g), whole body bone area (WBA) in (cm²), and %BF were measured using DEXA (Lunar Prodigy, USA). Regression analysis of within-pair differences was used to assess the strength of the association, and the analysis was stratified by gender and age group, where age cut-offs were based on ages at spermarche or menarche estimated from large population based studies in China. Males were stratified at ages before 14 and age 14–18, and females at ages prior to 12 and age 12–18. Results Univariately, BMI and %BF were associated with WBMC and WBA in the younger males and females, and in older males; %BF was significant only in older females. Multivariate models included both BMI and %BF. Among the younger males, age < 14, BMI and %BF were significantly associated with WBMC and WBA. In the younger females, age < 12, %BF was only significant to WBA. In the older age group, only BMI was significant to WBMC and WBA in females, but in males, BMI was positively associated, and %BF was negatively associated with both bone measures. Discussion These findings show that association between BMI and %BF and bone mass differ across gender and developmental stages, and %BF appears to be beneficial at younger ages, but detrimental or non-beneficial at older ages of development.