Rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the index finger

We report a case of chronic instability due to rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the index finger of the left hand. Because of persistent instability after the initial conservative treatment, surgical treatment was required.     

Safety and tolerability of a multidose formulation of epoetin beta in dialysis patients. Collaborative Study Group

AIM: Previous studies in healthy volunteers and renal patients have demonstrated the favorable tolerability of a new multidose formulation of epoetin beta. The aim of this open, multicenter study was to further assess the safety, tolerability and efficacy of this formulation ofepoetin beta in patients with end-stage renal disease (ESRD). MATERIALS AND METHODS: 375 adult patients receiving maintenance epoetin therapy for renal anemia were switched to the multidose formulation of epoetin beta for 12 weeks, using the same dosage and route of administration. RESULTS: Adverse events were experienced by 123 patients (33%), most commonly hypertension (5.6%) and hypotension (4.5%). Few patients (2%) were prematurely withdrawn because of tolerability concerns. No clinically relevant changes in blood pressure or laboratory variables were observed. Compared with baseline, hemoglobin and hematocrit values remained essentially unchanged during treatment with this new formulation of epoetin beta. No changes in iron metabolism parameters were apparent, and nearly all patients (94%) did not require blood transfusions during the study. CONCLUSION: The results of this study indicate that the multidose formulation of epoetin beta is safe and well tolerated in patients with ESRD. Moreover, switching patients to this new formulation of epoetin beta does not compromise therapeutic efficacy.     

Pelvic lipomatosis: clinical review and report of 4 new cases

First described by the end of the fifties, pelvic lipomatosis is an uncommon disease that develops as a result of an excessive proliferation of benign fat tissue within the perivesical and perirectal spaces. The compressive effect on the urinary, and to a lesser degree, the digestive and vascular structures result in the well-known symptoms. Diagnosis is reached through X-ray studies, primarily computerised tomography. Contribution of four new cases in young males diagnosed through imaging studies as well as biopsies in three of them. Evolution has been varying, with medical control of symptoms in two cases and renal function impairment due to upper obstructive uropathy in the other two.     

Obstetric trauma. A current problem?

Advances in obstetric practice have decreased birth traumas in the last years, although they are still an important chapter in neonatal age. Between 1993-1998 a total of 21,375 stillborns were registered with a total of 309 birth injuries in 303 neonates (1.44%). The diagnoses were: 2 liver subcapsular hematomas, 105 cephalohematomas, 16 parietal fractures, 11 subdural hemorrhages, 107 clavicular fractures, 10 miscellaneous fractures, 8 soft tissue injuries, 25 facial nerve injuries and 25 braquial palsy. About relation between type of labor and birth trauma was found that clavicular fracture and cephalic vaginal delivery were associated in 50% of the cases, cephalohematoma and forceps in 51%, braquial palsy and vaginal delivery in 44% and forceps in 36%. High weight at birth was another risk factor for entities such as clavicular fracture and braquial palsy. We conclude that birth trauma is a pathology with a relevant incidence and their epidemiology factor had to be known.     

Study of the genotoxicity of toluene

Chromosome analysis was conducted for peripheral lymphocytes of 23 printers exposed to toluene concentrations of 590 mg/m3 in a rotary machine workshop and to rotogravure printing inks. The percentages of aberrant cells were 2.30 in the printers and 1.46 in the control group (n = 22) (p < .05). The concentration of hippuric acid in printers was significantly higher than in the control group (p < .01), and the level of blood toluene at the end of the workshift was 0.500 mg/l. The authors also examined rotogravure printing inks-considered a potential source of genotoxic polycyclic aromatic hydrocarbons because they contained carbon black-their use in printing plants, and previous documentation of increased chromosomal aberrations in rotogravure printers. Only milligrams of fluorene and phenanthrene per gram of the printing inks were found; no polycyclic aromatic hydrocarbons with carcinogenic properties were discovered in the inks. The authors used Salmonella typhimurium indicator strains TA 98, TA 100, TA 1537, and YG 1041 in spot tests and indicator strains TA 98 and TA 100 in plate-incorporation assays to determine that there was no bacterial mutagenicity of all four colors of rotogravure inks. Urinary mutagenicity, which was evaluated with a microsuspension assay containing YG 1041 indicator strain both in the presence and absence of metabolic activation, was also studied. No significant difference in bacterial mutagenicity was found between the exposed and control groups. The increased percentage of aberrant cells in printers can be explained by exposure to genotoxicants that are not excreted in urine. Toluene was the most likely cause of the aberration.     

Lethal burn trauma in children

The aims of this retrospective study covering the years 1984-1998 were: 1. to survey burn injuries in children at the present time and 2. to compare the current results with the conclusions of an analogous study performed in the years 1964-1983. A decline in the occurrence of lethal burn wounds was found, as well as in burn shock as a direct cause of death. Children 1-4 years old continue to be the most frequent victims of fatal accidents. The most common cause of burn injury in this group remains scalding in the household.     

Prophylactic percutaneous sealing of lumbar postdural puncture hole with fibrin glue to prevent cerebrospinal fluid leakage in swine

We explored the effect of fibrin glue injection at the site of dural puncture on cerebrospinal fluid (CSF) leakage in a swine model. Pigs were subjected to a lumbar dural CSF puncture in the sitting position with a 17-gauge Tuohy needle. Fibrin glue 1.4 mL was injected through the same needle into the epidural space. Evans blue dye was infused through the cisterna magna 15 min later, and the appearance of dyed CSF through the skin puncture and along the needle trajectory to the dura was inspected and categorized. In seven of eight animals, the CSF leak was sealed with fibrin glue. Control animals were injected with 1.4 mL saline. A sham operation group of animals underwent cisternal dye infusion without a lumbar puncture. CSF pressure at the cisterna magna was recorded throughout the procedure. No significant differences in the leakage indicators were found between the fibrin glue-injected and sham-operated group, whereas both groups showed significant differences with respect to the control group. The fibrin glue seal was effective against CSF pressures of 24.5 [17-31] cm H(2)O. We conclude that percutaneously injected fibrin glue is effective in stopping CSF leaks after dural puncture in this animal model. IMPLICATIONS: In this swine study, we repaired a cerebrospinal fluid leak after a dural puncture by percutaneously injecting tissue adhesive. The technique of percutaneous injection of fibrin glue seems promising for the prophylaxis of headache associated with cerebrospinal fluid leakage, and may be an alternative to an epidural blood patch.     

Capsular contracture in augmentation mammaplasty

In a group of 331 augmentation mammaplasties performed at the Clinic of Plastic Surgery in Prague from 1994-1998, capsular contracture was recorded in 6% cosmetic and 12% of reconstruction operations. The main cause was, in particular, the quality of tissue surrounding the implants along with individual disposition. The incidence of this complication did not differ significantly in relation to the placement of the prosthesis beneath the muscle or gland. Based on histological analysis and the clinical finding, it is obvious that disintegration of the prosthesis does not always lead to severe grades of capsular contracture. It is despite the presence of foreign bodies in the connective tissue.