Biomedical subjects
Publications and source records attributed to M A Posner.
Sarcoidosis confined to a single bone in a patient with chronic systemic sarcoidosis and seen as a soft tissue mass is exceedingly rare. The combination of lytic and sclerotic changes within one bone has not been previously reported.
Although arthrodesis of an arthritic proximal interphalangeal joint provides excellent relief of pain, it does so at the expense of mobility. Silicone rubber implant arthroplasty also provides predictable relief of pain and approximately 60 degrees of motion. Insertion of the implant through a dorsal extensor-splitting approach is preferred when a tendon reconstruction is necessary, as in cases of boutonniére deformity. If tendon reconstruction is not necessary, the lateral approach is an excellent alternative because it does not disturb the extensor mechanism and therefore permits earlier rehabilitation exercises. The following article outlines the dorsal and lateral techniques and postoperative rehabilitation of silicone rubber arthroplasty.
Resection of the ulna is an effective operation in the treatment of rheumatoid disorders of the distal radioulnar joint. Tenosynovectomies of the overlying extensor tendons and synovectomy of the joint are integral parts of the procedure. Following resection, the ulna usually remains in alignment with the radius, although some dorsal displacement is common. Restoring stability to the ulna as well as reconstructing a new sheath for the extensor carpi ulnaris can be accomplished in most cases by using the extensor retinaculum. In those cases where the retinaculum has been destroyed by the disease process or when the distal ulna is severely displaced, stability can be restored using the extensor carpi ulnaris for a tenodesis.
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Compressive neuropathies of the median and radial nerves in the region of the elbow are a frequent cause of pain and weakness as well as sensory complaints. The problems associated with these neuropathies can be as severe and disabling as the more commonly encountered ulnar nerve neuropathies discussed elsewhere in this issue. Regardless of the nerve that is compressed, prompt recognition of the problem and the specific site of compression are important in order to institute effective treatment and limit, if not totally eliminate, permanent sequelae. Diagnosis and treatment are presented.
Patients with systemic lupus erythematosus (SLE) appear to be at increased risk for development of neoplastic disease. We describe the case of a male teenager with SLE and Burkitt's lymphoma. His presentation was similar to that of an exacerbation of his underlying SLE. We believe this to be the first case of Burkitt's lymphoma in a patient with SLE. The association of SLE and malignancy, with emphasis on lymphoproliferative states, is discussed.
An injury to the dorsal aspect of the metacarpophalangeal joint of a finger usually damages the sagittal fibers of the extensor tendon mechanism. Rupture of the underlying joint capsule, a far more serious injury, has received scant attention in the medical literature. The problem is often unrecognized because the extensor tendon may remain in its normal midline position. Eight dorsal capsular ruptures are described in six patients who had closed direct trauma to either the knuckle of their index or long fingers. Most of the injuries occurred in professional boxers.
An external fixator has been developed that is confined to the radius. It is lightweight, has a low profile, and its application is uncomplicated. Because the fixator provides rigid fixation of the fracture fragments, it has the important advantage of allowing immediate active wrist exercises, thus facilitating early restoration of mobility. The radius mini-fixator has been effective in the treatment of unstable Frykman Type I and II Colles' fractures that account for 36.3% in Frykman's series. It has also been used to stabilize osteotomies of the radius for malunited Colles' fractures.
Chronic palmar instability of the metacarpophalangeal joint of the thumb can result in a significant disability. Grasp, particularly pinch, is painful and weak because the thumb goes into hyperextension. Stabilization of the metacarpophalangeal joint can be achieved by distal advancement of the conjoined tendon of the abductor pollicis brevis and lateral fibers of the flexor pollicis brevis.
We investigated whether cortico-cancellous allograft obtained from cadaveric banked bone is effective in the treatment of enchondroma of the hand. Twelve patients had 15 operations on 19 enchondromas using allograft bone. These patients were compared with 16 patients with enchondroma treated with autogenous iliac cancellous bone. The distribution of tumors was similar in both groups. There was no significant difference in the patient's age, their occupations, or whether the operation involved the dominant hand. In both groups, immobilization was maintained until clinical union was obtained. The duration of immobilization for both groups was identical. There were no recurrences, refractures, or complications in patients treated with allograft bone. The grafts incorporated and remodeled in all patients. We concluded that a allograft cortico-cancellous bone can be used effectively in the treatment of enchondromas of the hand. It is especially useful in the treatment of patients with multiple tumors.
Trispiral tomography is an x-ray technique that is essential in the diagnosis and management of a wide variety of problems involving the carpal bones and their joints. It facilitates the visualization of acute fractures, particularly those of the scaphoid and hook of the hamate, as well as cysts, sclerosis, and erosive lesions. It is useful in differentiating between acute and chronic changes, and it is often indispensable in evaluating healing after acute fractures or bone grafts to treat nonunions.
Juvenile aponeurotic fibroma is a distinctive fibroblastic tumor usually found in young children. The tumor has a predilection for the palms and soles, although it can occur elsewhere, either superficially in subcutaneous tissues or in deeper musculofascial and paraskeletal tissues. In this case the tumor occurred in an adult within the substance of the flexor pollicis longus tendon, a location not previously reported in the literature. Because of the unique location of the tumor, it was excised without sacrificing the tendon. Since recurrence of these lesions is common, continued observation was necessary. Magnetic resonance imaging in this patient 26 months after the operation showed restoration of the normal tendon contour.
Two cases of lipofibroma of the median nerve are described. The literature is reviewed and the clinical and treatment aspects of this unusual condition are discussed.
To assess whether endogenous opioids participate in respiratory depression due to brain hypoxia, we determined the ventilatory response to progressive carboxyhemoglobinemia (1% CO, 40% O2) before and after administration of naloxone (NLX, 0.1 mg/kg iv). Minute ventilation (VI) and ventral medullary surface pH (Vm pH) were measured in six anesthetized, peripherally chemodenervated cats. NLX consistently increased base-line hyperoxic VI from 618 +/- 99 to 729 +/- 126 ml/min (P less than 0.05). Although NLX did not alter the Vm pH response to CO [initial alkalosis, Vm pH +0.011 +/- 0.003 pH units, followed by acidosis, Vm pH -0.082 +/- 0.036 at carboxyhemoglobin (HbCO) 55%], NLX attenuated the amount of ventilatory depression; increasing HbCO to 55% decreased VI to 66 +/- 6% of base line before NLX and to 81 +/- 9% of base line after NLX (P less than 0.05). The difference in response after NLX was primarily the result of a linear increase in tidal volume (VT) with decreasing Vm pH (delta VT = 60.3 ml/-pH unit) which was absent before NLX. To assess whether the site of action of the endogenous opioid effect was the central chemosensors, the ventilatory and Vm pH response to progressive HbCO was determined in three additional cats before and after topical application of NLX (3 X 10(-4) M) to the ventral medullary surface. The effect of topical NLX was similar to systemic NLX; significant attenuation of the reduction in VI with increasing HbCO. We conclude that 1) endogenous opioids mediate a portion of the depression of ventilation due to acute brain hypoxia, and 2) this effect is probably at the central chemosensitive regions.
An unusual rupture of a flexor profundus tendon, previously unreported in the literature, is presented. There was avulsion and proximal displacement of a large bone fragment from the palmar base of the distal phalanx and further retraction of the tendon unattached to the bone fragment.
The locked metacarpophalangeal joint of a finger is an unusual condition frequently confused with a "trigger finger." The causes can be classified into degenerative and spontaneous groups. Ten cases are presented. The cause of locking of one patient in the degenerative group was gouty arthritis, a cause not previously reported in the literature. Although surgery is usually necessary, joint mobility was restored in 30% of the cases by distending the joint capsule with an intraarticular injection of a local anesthetic followed by gentle manipulation. In addition to routine x-ray films, arthrotomography was found to be a useful diagnostic technique in determining the cause of locking.
Seven patients with chronic palmar dislocations of proximal interphalangeal joints are described. The duration of the dislocation ranged from 4 weeks to 19 months. Satisfactory mobility was restored in each patient after operative reduction and reconstruction of the extensor mechanism. Motion of the proximal interphalangeal joint averaged 57.1 degrees and 29.3 degrees at the distal interphalangeal joint. This method of treatment is preferable to an arthrodesis in selected patients.
A case of tuberculous flexor tenosynovitis causing a carpal tunnel syndrome is described. Surgery initially relieved the patient's symptoms, but the disease process continued until the diagnosis was made and appropriate treatment was instituted. This diagnosis, although rare, should be considered as the etiology in a carpal tunnel syndrome, particularly when there is evidence of a proliferative tenosynovitis and radiographs show diffuse osteoporosis.