Hand infections in the diabetic and the diabetic renal transplant recipient

We present a series of 41 diabetic patients with severe tissue destruction and deformity secondary to hand infections. Thirty (73%) of the patients showed propagation of the infection to bone, tendons, or deep palmar spaces, and 26 of 41 (63%) required amputations. Sixty-three percent of the cultures were mixed; pure Staphylococcus aureus accounted for only 12%. Diabetics who were renal transplant recipients were at increased risk, with a 100% amputation rate and an average hospitalization of 41 days. Recommendations for management of diabetic hand infections are given to reduce the mortality and morbidity in these patients.     

Techniques of splenic preservation using fibrin glue

Fibrin glue (FG) was used to achieve hemostasis of 16 splenic injuries in 14 patients. The etiologies of injury included five gunshot wounds, two stab wounds, four iatrogenic injuries, and five patients with blunt splenic trauma. The intraoperative blood loss averaged 1.8 +/- 2.4 (SD) liters and patients were transfused 3 +/- 2 units of blood perioperatively. The amount of FG required to achieve splenic hemostasis averaged 11 +/- 8 ml and varied directly with the grade of injury. One patient with a splenic hilar vascular injury (Grade V) underwent splenectomy following failure to achieve complete hemostasis despite the use of 25 ml of FG. All other splenic injuries were successfully managed using less than 25 ml of FG. Postoperative computerized tomographic (CT) scanning, performed in ten patients, was negative for rebleeding or abscess formation. The overall splenic salvage rate was 86%. FG was effective in achieving hemostasis of both superficial and deep splenic injuries. Its use as an adjunct in trauma surgery should result in increased splenic salvage rates compared with that obtained using conventional surgical techniques.     

Perforation of hepatic hydatid cysts into the abdominal cavity in children

Perforation of echinococcal cysts of the liver into the free abdominal cavity was observed in 10 patients. The operative intervention was performed after overcoming the shock in patients, correction of homeostasis. The performance of wide laparotomy, through revision of the abdominal cavity and its sanitation by means of the abundant washing by the furacin solution are important. No lethal outcomes, disease recurrences were noted.     

The mechanism of an osteoporosis center

The cost of osteoporosis to the quality of human life and well-being are immeasurable; its costs to society are significant. Osteoporosis affects approximately 20 million Americans and has been estimated by the National Osteoporosis Foundation to equal $7 to $10 billion in health care costs and productivity annually. Osteoporosis represents a major health problem. Clearly, a screening and bone maintenance program can be managed by nurses in a cost-effective manner and serves as an efficient facilitator in the education and care of patients. Furthermore, an osteoporosis center can provide invaluable support for professionals in various disciplines of medicine. In our experience at The Hospital for Special Surgery most of our patients come to our center as a result of a physician referral. An average of 600 to 800 patients are seen annually and about 15 per cent of these patients are referred from the screening program to a metabolic bone treatment source. Approximately 5 per cent of patients referred for treatment are hospitalized for an extensive evaluation which includes an iliac crest-bone biopsy. As the patient population in the Osteoporosis Center has grown there has been a recognition of special patient groups who have specific needs. This has resulted in the establishment of clinics which address the problems associated with patients who are renal stone formers, anorexic, and amenorheic (many of this latter group are athletes or dancers).(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinico-roentgenological and physiological evaluation of the spine in patients with juvenile kyphosis

203 patients with juvenile kyphosis, aged 11-16 years, have been subjected to the complex examination, including ++clinico-roentgenologic and physiologic methods. Along with the cardinal signs, common for juvenile kyphosis diagnosis and characteristic of the dystrophic process (wedge distortion, osteoporosis of vertebra bodies and fragmentation of their apophyses, dedifferentiation of the bone structure, height reduction and pathologic restructuring of intervertebral disks following the pattern of fibrosis, presence of discal hernia), the signs of bone ++ dysplasia of spine and skeleton in general should be singled out of the roentgenologic characteristic of disease which determine the variants of pathologic process course and treatment tactics. The presence of dysontogenesis signs in patients with juvenile kyphosis is suggested.     

The Goodwin sound: an aid in treating obliterated membranous urethral strictures endoscopically

The treatment options for a man with obliteration of the membranous urethra are many today because of the great progress that has been made in the past 40 years. No one procedure is likely to be ideal for all situations. Pullthrough, two-stage scrotal inlay, and transpubic or perineal approaches can be applied with success. Endoscopic treatment can also be used with satisfactory results and less morbidity in selected patients. A failed endoscopic attempt should not interfere with a subsequent open procedure. Conversely, a failed open procedure may be remedied by endoscopic surgery. We feel our technique is simpler than other reported endoscopic techniques, as it requires only one urologist, and it does not require fluoroscopy or endoscopy from above. Significantly, it provides a guide to cut on that relieves the fear of inadvertent incision into the rectum.