Distal tibiofibular synostosis due to direct trauma.
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Biomedical subjects
Publications and source records attributed to W M Lennox.
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Neurovascular skin island transfers were performed with the prime objective of protecting vulnerable anesthetic areas on the hands of patients with leprosy. After an average follow-up of eight years on sixteen patients, all had long-lasting protective benefits without further loss of tissue consequent to injury. At follow-up, two-point discrimination was less than ten millimeters in only one patient, more than twenty millimeters in ten, and indeterminate in five. Sensory misreference persisted in fourteen patients. Axon sprouting was evident in six but only over short distances (four to eight millimeters beyond the island). Compared with the intact side of the donor finger, nine of the sixteen transfers had lost some sensitivity but sensation was rated normal in one, nearly normal in six, and protective only in nine. The loss of sensation in the donor finger was less than expected and was not a problem. Scar contracture occurred in two donor and five recipient fingers, but this could be attributed to placement of the incision too far anteriorly, and hence was an unavoidable complication. Restoration of protective sensation to the ulnar border of the hand, whatever the cause of anesthesia, is considered extremely worth while.
Four cases of severe pseudomembranous colitis following the use of lincomycin and clindamycin are described; 2 required emergency total colectomy and 2 died. Cases of such gravity after the use of these drugs have not been previously reported. On hundred and fifty-six orthopaedic cases where clindamycin and lincomycin were used postoperatively are reviewed; 34 had diarrhoea (22 per cent), and 3 of the severe cases occurred in this group. The diagnosis of pseudomembranous colitis may be difficult as the latent period from initiation of drug therapy to commencement of diarrhoea may be as much as 18 days, and that from cessation of drug therapy may be as much as 11 days. The value of early sigmoidoscopy in cases of diarrhoea of obscure aetiology is emphasized, and the characteristic sigmoidoscopic and histological appearances of pseudomembranous colitis are described. As these drugs may produce a lethal condition it is suggested that they should be used with appropriate discretion, especially in the elderly female who appears to be most at risk.
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