Renal excretion of phenol from physicians after nail matrix phenolization: an observational prospective study.

BACKGROUND: Animal studies have shown that many signs of acute poisoning result from phenol entry into the systemic circulation by absorption or ingestion. While no evidence of systemic complications in patients who have undergone phenol nail matrixectomies have been reported, the safety of phenol vapour inhalation by physicians performing this treatment has yet to be investigated. OBJECTIVE: The goal of this study was to determine whether the levels of phenol to which physicians are exposed to during a phenol-based matrixectomy procedure are within the limits of safe exposure. METHODS: A continuous prospective study was carried out to measure the urinary phenol concentrations from physicians after performing chemical matrixectomy for ingrown toenails. RESULTS: The highest concentration of urinary phenol was measured at almost 10 mg/L within the first 2 h after exposure, and subsequently decreased approximately 1 mg/L every 2 h for the first 10 h post exposure. The levels dropped to 3 mg/L at 72 h post exposure. CONCLUSIONS: The risk associated with phenol exposure while performing chemical phenol matrixectomy was well below the current safety limits when the physician is exposed to 90% phenol vapour for approximately 20 min. Thus, no further specific safety recommendations are required for physicians performing this procedure.

Articular geometry of the medial tarsometatarsal joint in the foot: comparison of metatarsus primus adductus and metatarsus primus rectus.

The three-dimensional surface geometry of the medial tarsometatarsal joint ("first metatarsocuneiform") of the first ray was analyzed to determine if the shape of the joint is distinct in the medially deviated first metatarsal with metatarsus primus adductus (MPA). Clinical evaluation of 29 cadaver feet identified 13 feet with MPA and 16 with metatarsus primus rectus (MPR). Three-dimensional (3D) coordinates x, y, z of the first metatarsal and medial cuneiform joint facets of the feet were digitized on a Coordinate Measuring Machine (accuracy = 0.01 mm) and the data fitted with B-spline surfaces from which 3D curvature maps were generated. Comparison of means of surface-averaged maximum and minimum principal curvatures and root-mean-square curvatures showed significant (p < .0005) differences between the MPA and MPR subsets, male and female subsets, and metatarsal and cuneiform subsets. These results show that the articular shape of the medial tarsometatarsal joint in feet with MPA is significantly less contoured, or is flatter, than the same joint in normal or MPR feet. Results also showed that the female joints are more curved than male joints, and that metatarsal and cuneiform facets closely conform in shape to each other. These preliminary results may be related to questions concerning the anatomical and functional basis for the first metatarsal deviation, for radiographic presentation of the joint and surgical options in correcting related forefoot deformities.

Gout and hypothyroidism.

A case of gout in a patient with primary hypothyroidism has been presented. Often missed as a companion of gout, hypothyroidism has a frequency of occurrence with gout that is significant and is probably a precipitating factor in these gouty attacks. The physician should be alert for signs and symptoms of this often occult disease in patients with hyperuricemia and gout.

Orthosorb resorption evaluation using MRI and histologic analysis.

Resorbable bone fixation devices may be used in various surgical procedures for internal fixation in place of traditional metallic devices. Currently, there is no radiographic technique for tracing the postsurgical location and resorption of these devices. This study was undertaken to ascertain whether magnetic resonance imaging is a suitable tool for performing such evaluations. Using an animal model, the authors investigated the correlation over time between the magnetic resonance image of a surgically implanted pin and its histologically verified location and state.

A retrospective analysis of distal Chevron and Basilar osteotomies of the first metatarsal for correction of intermetatarsal angles in the range of 13 to 16 degrees.

A retrospective study was performed for Austin (Chevron) and basilar type osteotomies of the first metatarsal in patients with preoperative intermetatarsal angles in the range of 13 to 16 degrees. Results indicated better radiographic correction for both groups than in previous studies. When comparing the results for the Chevron and basilar groups, the radiographic results were almost identical, but the Chevron group appeared to have a slightly better subjective result with less complications of metatarsalgia and callus formation and a better range of motion. Comparing intermetatarsal angle correction as a function of the preoperative hallux adductus, no definitive conclusions were made. However, the trend appears to have reduced correction with higher hallux abductus angles.

Fixation of the Austin osteotomy with bioresorbable pins.

Clinical trials were conducted at the Foot Clinics of New York, testing the use of the Johnson & Johnson Orthosorb absorbable pins as an integral absorbable form of fixation of the Austin osteotomy. Two Orthosorb pins were inserted across the osteotomy from dorsal to plantar. Patients were placed in a plaster splint and allowed to walk with weightbearing as tolerated within 2 weeks of the procedure. A protocol was designed to include a 6-month follow-up with regularly scheduled postoperative examinations. These examinations included a review of pain, walking ability, edema, and measurements of dorsiflexion and plantarflexion. No complications have occurred in this patient population. This study has shown that for a selected group of surgical candidates, Orthosorb bioresorbable pins are an effective form of fixation for the Austin osteotomy.

Contamination and infection rate of percutaneous Kirschner wires in foot surgery.

A study was performed at the Foot Clinics of New York during the months of September 1988 through December 1988, in which 54 Kirschner wires from 40 surgical patients were cultured immediately upon removal to investigate if microorganisms were present. The results and potential implications are presented.

Hallux valgus and metatarsus adductus: the surgical dilemma.

Hallux varus in the presence of metatarsus adductus is a complex clinical entity that requires careful evaluation and preoperative planning. The metatarsus adductus complicates the picture by accentuating the effect of the intermetatarsal angle and also creates compensatory pronation. Transpositional osteotomies of the first metatarsal are difficult to perform in patients with an adducted forefoot and mild increase in intermetatarsal angle. Surgical therapy generally requires aggressive osteotomies of the first ray to decrease its medial prominence. Total metatarsus adductus correction should be considered in patients with severe deformity.

Intraoperative bacteremia during foot surgery.

Numerous studies have shown that bacteremias occur in patients during and immediately after some types of surgeries, placing the patient at risk of serious infection. This study was designed to ascertain whether a bacteremia will exist following routine podiatric surgery. Blood cultures were taken perioperatively from 42 subjects, and were incubated both aerobically and anaerobically, and swabs of the incision were made during the surgery. No bacteremias occurred during this study. This suggests that podiatric surgery, when properly performed, does not present a risk of bacteremia to the patient.

Transchondral fractures of the talar dome.

Transchondral fractures of the talar dome are frequently overlooked on initial and subsequent radiographic examination in the patient with ankle complaints. The etiology, treatment and difficulty in diagnosis of transchondral fractures of the talar dome are discussed.