Caustic burn caused by intradermal self administration of muriatic acid for suicidal attempt: optimal wound healing and functional recovery with a non surgical treatment.

BACKGROUND: Caustic burns are burns of third and fourth degree caused by strong acids or strong bases. Muriatic acid is often used for suicidal attempt by ingestion. We describe a case of a caustic skin lesion caused by intravenous failed attempt of suicide by injection of Muriatic acid in a woman affected with bipolar-syndrome. Generally, caustic burns are treated by cleansing, escarectomy and coverage with skin grafts. CASE REPORT: We treated the patient with a non invasive technique with collagenase and hyaluronic acid sodium salt cream (Bionect start®), hyaluronic acid-based matrix (Hyalomatrix®) and Vacuum-Assisted Closure (VAC) Therapy®. RESULTS: We obtained complete healing in 6 weeks. CONCLUSIONS: Combined use of non invasive techniques seems to ensure only advantages for both the patients and the Health System. It reduces health care costs and risks for the patients such as nosocomial infections. Patient's compliance is high, as its quality of life. Complete healing of the wound is fast and recovery of function is full.

Bilateral hand squamous-cells carcinoma in patient affected with non-Hodgkin lymphoma. Case report and literature review.

BACKGROUND: Squamous-cell skin cancer is the most frequent tumor in the hand. It occurs on sun-damaged skin, especially in lightskinned individuals with a long history of chronic sun exposure. CASE REPORT: We describe a case of bilateral hand squamous-cell carcinoma in a elderly patient affected with non-Hodgkin's lymphoma, who underwent several non-successful surgical treatment, radiotherapy and at the least, amputation of right hand for rapid clinical evolution after radiotreatment. Available literature on the subject has been reviewed. RESULTS: In our case, after several non-successful treatment, elective amputation at the distal third of forearm was performed. We reviewed 56 items including books, original articles, reviews, cases report. CONCLUSIONS: Current evidence on treatment of hand squamouscells carcinoma is to perform a first radical surgical treatment in order to avoid recurrence/metastasis and to achieve a safer level of amputation thus increasing the surface area of healthy tissue available for eventually subsequent reconstruction/prosthesization.

Masson's tumor: a soft tissue tumor simulating a tendon cyst: case report.

INTRODUCTION: Intravascular papillary endothelial hyperplasia (Masson's hemangioma or Masson's tumor) is a benign vascular disease with an exuberant endothelial proliferation in normal blood vessels. Although relatively uncommon, its correct diagnosis is important because it can clinically be like both benign lesions and malignant neoplasms. We present a case of intravascular proliferative endothelial hyperplasia simulating a tendon cyst both clinically and on ultrasound. CASE REPORT: A 74-year old Caucasian female presented with a 4-month history of soreness and swelling in the fourth finger of the right hand. Ultrasound showed an oval mass with fluid content, referred to a tendon cyst. A wide surgical excision was subsequently performed. The final histological diagnosis was Masson's tumor. DISCUSSION: The pathogenesis of intravascular papillary endothelial hyperplasia is still unclear but the exuberant endothelial cell proliferation might be stimulated by an autocrine loop of endothelial basic fibroblast growth factor (bFGF) secretion. There are three types of papillary endothelial hyperplasia: primary, or intravascular; secondary, or mixed; and extravascular. The main differential diagnosis is against pyogenic granuloma, Kaposi sarcoma, hemangioma, and angiosarcoma. CONCLUSIONS: Masson's tumor can be like both benign lesions and malignant neoplasms clinically and on ultrasound. For this reason, the right diagnosis can be made only by histology, which reveals a papillary growth composed of hyperplastic endothelial cells supported by delicate fibrous stalks entirely confined within the vascular lumen.

Customized mini-plate for scaphoid fractures and nonunions.

Scaphoid fractures detected in the subacute stage require a more meticulous and prompt approach to prevent chronicity and regain wrist function. Oblique-type scaphoid fractures are potentially unstable and may result in detrimental sequelae. Aim of this study is to suggest an easy surgical approach to restoration of the oblique-type scaphoid fractures or nonunions by using of a customized mini-plate, italic-S shaped. This surgical intervention is associated with promising outcomes and at long-term follow-up showed to avoid the development of a carpal collapse with concomitant arthritis of the radiocarpal joint.

Treatment of persistent radial nerve palsy through "tendon minimal transfer" technique.

Palliative tendon transfer procedures for radial nerve palsy are continuing to evolve. This paper reports outcomes of 10 patients with isolated and traumatic radial nerve palsy underwent "minimal transfer". All patients improved functionally and could attend their routine activities. The flexor carpi ulnaris and palmaris longus tendon transfer has some advantages in terms of simplicity, shorter operative time, less morbidity, better wrist and finger extension and thumb extension and abduction.

Extensive facial trauma caused by dog bites in woman suffering from systemic fluconazole-resistant Candida infection.

INTRODUCTION: Dog bites present a complex problem. Extensive facial trauma is a challenging problem to treat with priority for functional outcome. This paper describes the conservative treatment in a very difficult case of facial trauma with unusual infections due to the bites. CASE REPORT: A 45 year-old woman was admitted in hypovolaemic shock with amputation of nose, upper and lower lips, left cheek and chin caused by dog bites. After vital parameters and volaemy were stabilized, wound toilet was performed, followed by skin and mucosal rotation flaps and anterior nasal tamponade; the lesion has then been covered with a collagen/oxidized regenerated cellulose dressing and sterile gauzes. Culture test highlighted coagulase-negative Staphylococcus and Candida albicans. However after few days, the patient developed septic-undulant hyperpyrexia, retinitis, renal candidiasis, folliculitis. Systemic Candida infection resistant to fluconazole was diagnosed. Amphotericin B was given to the patient and the facial wound was managed conservatively with an active medication because of inoperability conditions. The outcome of the use of active medications was an immediate response with excessive granulation tissue followed by a rapid re-epithelization. CONCLUSION: As our case has shown, conservative treatment can be a valid alternative therapy in the treatment of large wounds with invasive candidosis and candidaemia or other major contraindications to surgery. In fact, in cases where surgical reconstruction is not a feasible option, conservative treatment can allow a rapid repair of the skin barrier.

The pillar pain in the carpal tunnel's surgery. Neurogenic inflammation? A new therapeutic approach with local anaesthetic.

AIM: After the surgical decompression of the transverse carpal ligament as treatment of the tunnel carpal syndrome, pillar pain manifestation is possible. This is a painful and temporary invaliding syndrome with unknown aetiology. Aim of the study is to demonstrate that pillar pain is based on autonomic irritation that disappears with simple infiltration of local anaesthetic (LA), or rather by neuromodulation. METHODS: Eighty-four patients were enrolled for this study and underwent an open release technique surgery. They were then asked for regular postoperative follow-ups. RESULTS: Thirty-two out of 84 patients (38%) developed pillar pain. Accordingly, injection of LA as pain treatment has since been studied and results compared with the conventional protocol for this painful syndrome. CONCLUSION: Even if the number of the patients considered is not great, there is evidence of a decrement of pillar pain by means of LA injections. Excellent functional outcomes and satisfaction were achieved using LA infiltrations for pillar pain after carpal tunnel decompression. The minimally invasive technique offers a quick, easy, effective, and inexpensive method useful to minimize and cure in a few days the pillar pain.

[Dupuytren's disease simulated by epithelioid sarcoma with atypical perineural invasion of the median nerve. Case report]. / Malattia di Dupuytren simulata da un sarcoma epitelioide con atipica invasione perineurale del nervo mediano. Caso clinico.

Epithelioid sarcoma is an infrequent tumour, especially in upper limb, which nerve spread is not common. We describe the case of a 27 years old caucasian male with initial diagnosis of Dupuytren's disease. He underwent palmar fascia surgery, but the surgical treatment was followed by recurrence of the deformity in retraction of 4th and 5th finger of the left hand. When he presented himself at our attention, the patient underwent surgical biopsy and new histological examination was made with diagnosis of epithelioid sarcoma. We highlight essentially two aspects of this case: the diagnostic delay of tumour caused by simulation of the Dupuytren's disease and the atypical perineural spread along the median nerve.

[Tenosynovial giant cell tumour of the hand and wrist: early diagnosis and surgical treatment]. / Tumore a cellule giganti tenosinoviale della mano e del polso: diagnosi precoce e trattamento chirurgico.

Fourty two patients with tenosynovial giant cell tumour, treated with radical excision, underwent detailed follow-up to evaluate the outcomes and to find early the possible recurrence of disease. Radical excision is the only way to have a complete recovery from disease and total recovery of function. Early diagnosis of recurrence is possible by careful clinical examination, ultrasonography and, in selected cases, magnetic resonance imaging.

[Surgical treatment of painful amputation neuromas with hyaluronic acid gel. Preliminary study of six patients]. / Trattamento chirurgico dei neuromi d'amputazione dolorosi con gel di acido ialuronico. Lavoro preliminare su 6 casi.

Amputation neuroma is the consequence of a traumatic event that interrupt the anatomic structure of a nerve. After the lesion, the nerve begin an plerosis attempt. This condition determines hyposensitivity on its innervation area and a painful syndrome. The pattern's resolution is possible with the neuroma's tissue exeresis and the sinking of proximal stump into closer tissue. This operation reduces or eliminates axonal nerve's flux. The hyaluronic acid (Hyaloglide 0.8-1 ml) use is based on the necessity of proximal stump preservation from mechanical and thermic stimuli that are responsible of typical neuroma's symptoms. In this study we used hyaluronic acid on six painful amputation neuroma patterns on sensitive nerves of upper and lower extremities.

[Complex Regional Pain (CRPS) Syndrome type II. Timing for surgery and therapeutic options: neuromodulation]. / La Sindrome Complessa Dolorosa Regionale (CRPS) tipo II. Timing chirurgico e strategie terapeutiche: la neuromodulazione.

OBJECTIVE: The object of this study is to evaluate the importance of a correct timing for surgery, the different strategies of therapy and the use of the neuromodulation in the Complex Regional Pain Syndrome (CRPS) type II. PATIENTS AND METHODS: The last 2 years we observed 8 patients with the clinical picture of a CPRS type II, due to previous peripheral nerve lesions of the upper extremity. All the patients followed a therapeutic protocol of neuromodulation and reconstructive surgical repair. RESULTS: Six patients out of eight had almost a complete recovery of the symptoms 6 months after the surgery. CONCLUSIONS: Our study demonstrates that the patients who underwent surgical repair followed by neuromodulation didn't present any recurrence of the symptoms.

[Double compression of the ulnar nerve at the elbow and at the wrist (double-crush syndrome). Case report and review of the literature]. / Doppia compressione del nervo ulnare alla doccia epitrocleo-olecranica ed al polso (double-crush syndrome). Descrizione di un caso e revisione della letteratura.

Double compression of a peripheral nerve is not rare in medical practice. This article describes an ulnar neuropathy along the elbow and the wrist segments with electro-diagnostic examination (EDX). The proximal compression was an ulnar entrapment at the olecranon-epitrochlear semi-canal; the distal one was after the canal of Guyon, due to an arthro-synovial cyst arising from the pisohamatum joint. There aren't analogous clinical reports in the literature.

Solitary enchondroma in the distal phalanx of the right thumb. An unusual localization.

An unusual localization of solitary enchondroma in the distal phalanx of the right thumb is reported. The lesion was studied by radiograph and magnetic resonance imaging (MRI) investigation. It was surgically treated by curettage with bone grafting.

Use of vein grafts in emergency in peripheral nerve defect.

Peripheral nerve defects represent a frequent lesion in emergency. The vein graft is the alternative to nerve graft in cases where the nerve defect does not allow a direct approximation. Our experience on the use of venous graft has brought about excellent functional results that, together with a simple execution of the methodology, are at the bottom of our study. During the last 6 months we have treated 3 cases of peripheral nerve defect with nerve gap >2 cm; 1 lesion of ulnar nerve, 1 lesion of median nerve treated with vein graft and in 1 case an association of the median and ulnar nerve treated with reversed vein graft. An immediate resolution of the pain was observed in all patients already during the first 36/48 hrs. The clinical and electrophysiological evaluations at 3 and 6 months have demonstrated encouraging data regarding functional reparation and re-innervation. Even in consideration of the limited number of cases, comparison with data related to the autologous nerve graft shows a slightly slower recovery, but certainly overlapping to the classical methodology; moreover, excellent clinical results appear from the use of reversed vein graft. The advantage of vein grafts are multiple. There is an overlapping of the functional recovery, that represents the condition sine qua non of each new surgical experimental procedure. The simplicity of the technical execution and the possibility to cover missing nerves without sensory damage is advantageous both for the patient and for the structure, reducing operating time and related costs.

[Post-traumatic subperiosteal chondroma of the hand. Clinical case]. / Condroma sottoperiosteo post-traumatico della mano. Caso clinico.

The authors report a case of rapidly developing periosteal chondroma of the fifth metacarpal. No erosion of the bone cortex could be observed radiographically. The development of the tumor appears to follow a violent trauma without skeletal lesions occurred seven months before.

[A case of nodular pseudosarcomatous fasciitis treated with "presuture" technique]. / Su di un caso di fascite nodulare pseudosarcomatosa trattato con tecnica di "presutura".

This paper reviews a case of nodular (pseudosarcomatous) fasciitis. It consists of a rare benign lesion of the soft tissues. The rapidity of its growth and the cellular features represent a diagnostic challenge when compared with that of a sarcoma. The patient, a 36 year old female, 20 days before surgical treatment, noticed the growth of a nodular lesion on the left forearm skin. After echotomography and ultrasound guided needle biopsy diagnosis of nodular pseudosarcomatous fasciitis was established and the patient underwent surgical treatment. The nodular lesion, noncapsulated, (diameter 2.5 x 1.2 cm) greyish-white colored, with slimy consistency, and myxoid character, was microscopically composed by atypical fibroblasts, with myxoid ground substance. The nodular lesion was removed using the "pressure" technique by Serge Baux of Rothschild Hospital in Paris using two Kirschner threads pulling the skin surrounding the biopsy wound. By this technique was possible to achieve a rapid skin expansion. The nodular pseudosarcomatous fasciitis remains a very difficult lesion to recognise unless the aid of a biopsy.

The clinical value of percutaneous transluminal angioscopy. Angioscopical findings in primary vascular diagnosis and in interventional radiology.

Since the introduction of ultrathin angioendoscopes into clinical application conventional or digital angiography have been controlled by using the same approach like in angiography. In dogs and angiography patients this new angioscopic method for arteries without surgical intervention has been developed. The approach is transfemoral. Endoscopy is combined with angiography, percutaneous transluminal angioplasty (PTA), thrombolysis, thrombus extraction and a new kind of stents and their application. An ultrathin endoscope with an outer diameter of 1.6 mm and working channel of 0.35 mm is used. Guide wires, contrast media and drugs for local thrombolysis can be applied through this channel. The endoscope is placed into the region of interest under fluoroscopic control and view is obtained by using 0.9% NaCl for decreasing blood flow. Endoscopy is documented by video or by a high-speed camera. It was possible to demonstrate the proceedings of dilatation, recanalization, local lysis, stent-application and thrombus-extraction.

The long-term effects of percutaneous transluminal angioplasty, local catheter-lysis and stent-implantation.

During a period of 8 years 4750 percutaneous transluminal angioplasties and local lyses have been performed in the Department of Radiology of the University of Freiburg and the Hochrheinklinik Bad Säckingen. From 1984 to 1988 all patients have been controlled clinically and in 320 cases angiographically. The main localization of the lesions was the pelvic and the femoro-popliteal region. The short-term results have been compared with long-term results i.e. 2-8 years after PTA therapy. Long term success of PTA (2-8 years after the intervention) reached 85% in stage IIa, 73% in stage IIb, 68% in stage III and 36% in stage IV including all regions of treated arteries. 8 patients with stent implantation could be controlled and showed remarkably good results: 5 patients had patent stents after 16 months.

[Neuritis of the sensory branch of the radial nerve: Wartemberg's syndrome. A case report]. / La neurite dei rami terminali del nervo radiale: la sindrome di Wartemberg. Descrizione di un caso e revisione della letteratura.

Wartembergs syndrome is an entrapment of the sensory branch of the radial nerve in the forearm. It is not mentioned with the other peripheral nerve entrapments and it is very rare. Wartemberg's syndrome is too often misdiagnosed as the De Quervain's disease or is not diagnosed at all. The Authors report their experience with a case surgically treated.