Glomus tumours of the hand and foot

Summary. Between 1982 and 1991 we treated 48 patients with a glomus tumour in the hand or foot. There were 42 women and 6 men, aged between 14 and 61 years. Forty-five tumours were in the subungual region and 41 were on the anterolateral aspect of a distal phalanx. The lesions presented with a classic triad of pain, tenderness and sensitivity to temperature, particularly cold. Excision of the tumour was curative.

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Resumé. Entre 1982 et 1991, 48 patients présentant une tumeur glomique de la main et du pied ont été traités dans notre département. Il y avait 42 femmes et 6 hommes, agés de 14 à 61 ans (moyenne 38 ans). 45 tumeurs étaient en situation sous-inguéale et 41 en situation latéro-palmaire de la phalange distale. 44 se situaient au niveau de la main et 4 au niveau du gros orteil. Ces lésions sont souvent non palpables fréquemment invisibles et habituellement indétectables à la radiographie. Cependant, le diagnostic est assez facile, lorsqu’existe la triade symptomatique: douleur, tumefaction molle et sensibilité au froid. L’excision complète après dissection soigneuse est le traitement adéquate. Le suivi des 48 malades a toujours montré une guérison complète.

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Accepted: 21 May 1996     

Passive exercise system: effect on muscle activity, strength, and lean body mass.

There is little information concerning the effects of passive exercise training in healthy humans. This prompted an investigation to evaluate muscle activity and the associated changes in strength and lean body mass resulting from a passive exercise program. Twenty-eight healthy volunteers, aged 26 to 44 years, participated in this six-week study. Lean body mass changes were evaluated by tetrapolar bioelectric impedance measurements, strength changes by isokinetic strength evaluation, and muscle activity by surface EMG techniques. Reproducible muscle activity was recorded in all three muscles studied during two of three preselected exercises. This involuntary muscle activity was attributed to fusimotor and postural reflexes. No significant change (p greater than .05), however, occurred in muscle strength or lean body mass at the end of the six weeks. Lack of these physiologic changes in light of the documented muscle activity is attributed to insufficient training effect.     

Fetal dexamethasone exposure affects basal ornithine decarboxylase activity in developing rat brain regions and alters acute responses to hypoxia and maternal separation

Although glucocorticoids are widely used to stimulate fetal/neonatal lung function, they also interfere with cellular development in the central nervous system. Dexamethasone was administered to pregnant rats in late gestation at a dose (0.8 mg/kg) that lies just above the threshold for stimulation of lung surfactant synthesis, and the impact on ornithine decarboxylase (ODC) was evaluated in three brain regions. Dexamethasone treatment produced an initial inhibition of basal ODC activity followed by postnatal elevations, a pattern known to be associated with delays in cell replication and differentiation. Dexamethasone also interfered with the ability of the 1-day-old neonate to turn off ODC acutely in response to a 2-h period of maternal separation; as this response conserves energy in the absence of the dam, the effect of dexamethasone is maladaptive. Additionally, dexamethasone sensitized the neonatal brain to hypoxia: the acute increase of ODC associated with a 2-h exposure to 7% O2 was exacerbated in 8-day-old rats exposed to dexamethasone prenatally. These results suggest that administration of dexamethasone, in doses that promote respiratory competence, delays cell development in the central nervous system and renders the brain more vulnerable to adverse neonatal conditions, such as maternal separation or hypoxia.     

Soda pop vending machine injuries: an update.

Soda pop vending machine tipping continues to be a dangerous behavior that can result in lethal or crippling injuries. This study analyzes 64 cases of injuries secondary to crushing by a soda machine. All were male victims except one. The average age was 19.8 years with a range of 5-39 years. Thirteen victims sustained multiple trauma. Fifteen victims were killed. Increased public awareness coupled with support by the government and private industry has contributed to a sharp reduction in incidence of accidents and improved public safety.     

Benefits and limitations of burn wound excision

This review is intended to provide a balanced view of the role of surgical burn wound excision and closure within the larger context of the total care and rehabilitation of patients with burn injury. The historical background leading to present practice is outlined. The salient technical and logistical problems associated with the performance of wound excision are discussed, with emphasis on the necessity for expeditiously completing these procedures which are associated with major blood loss. A realistic analysis of the results of excisional therapy in patients with burns of varying severity is presented. Benefits attributable to the surgical phase of therapy become progressively more difficult to identify as the size of deep burns increases beyond 20% of total body surface area.

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Resumen La presente revisión propone proveer una visión equilibrada del papel de la resección tangencial quirúrgica de la quemadura y su cierre en el contexto más amplio del cuidado total y la rehabilitación de pacientes con lesiones térmicas. Se hace un recuento de los antecedentes históricos y se discuten los más prominentes problemas técnicos y logísticos relacionados con la resección tangencial de la quemadura con énfasis en la necesidad de implementar en forma expedita estos procedimientos, los cuales se asocian con pérdidas mayores de sangre. Se presenta el análisis realista de los resultados de la resección tangencial en pacientes con quemaduras de gravedad variable. Los beneficios atribuibles a la fase quirúrgica de la terapia se hacen progresivamente más difíciles de identificar en cuanto la extensión y profundidad sobrepasan el 20% de la superficie corporal.

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Résumé Cette article fait le point sur les avantages et inconvénients respectifs de l'excision et la suture dans le cadre du traitement et la rééducation des grands brûlés. L'historique de cette technique est résumée. Les principaux problèmes de technique et de logistique de l'excision des brûlures sont discutés, en soulignant la nécessité d'assurer un geste rapide enfin de réduire les pertes sanguines. Une analyse réaliste des résultats de la technique excisionnelle des brûlures de sévérité variable est présentée. Les bénéfices directement en rapport avec la chirurgie deviennent plus difficiles à apprécier lorsque la surface brûlée dépasse 20 % de la surface corporéelle.

     

Hemodynamic study of external counterpulsation with left and right cardiac catheters in 15 cases]

The hemodynamic changes of 15 cases during external counterpulsation with left and right cardiac catheters were reported. The results showed that the diastolic pressure at the root of the aorta was remarkably increased, the peak value (countercurrent pressure) was 8.02 +/- 2.05 kPa higher than the diastolic pressure before counterpulsation; the aortic systolic pressure during counterpulsation was slightly decreased with a mean value of 0.81 kPa; there was no apparent change in the central venous pressure and pulmonary arterial pressure; pulmonary arterial wedge pressure was slightly reduced during counterpulsation. All the above data are useful in showing the improvement of cardiac and brain perfusion volume and clarifying its mechanism.     

Fracture of the patella treated by open reduction and external compressive skeletal fixation

Open reduction combined with external compressive skeletal fixation was used to treat twenty-seven patients who had a separated fracture of the patella. Fixation was obtained by the use of two compressive clamps applied to stainless-steel pins that were inserted just proximal and distal to the proximal and distal poles of the patella. Range-of-motion exercises for the knee were begun at two weeks and the pins were removed at three to four weeks. All of the fractures healed. Twenty-four patients regained a range of motion that was equal to that of the opposite knee. There was no evidence of chronic osteomyelitis. Osteoarthritis was noted in one patient who refused excision of a portion of the patella.