Surgical management for isolated macrodactyly in an adult PIK3CA mutant.

Isolated macrodactyly in adults caused by mosaic pattern PIK3CA mutation can result in significant functional impairment and psychological burden. Due to the rarity of this condition there are no clear treatment guidelines, and those few available are focused on paediatric cases. Reports on surgical management of isolated macrodactyly in adults are lacking. We present here the surgical management through partial amputation of enlarged rays of the right hand in an individual affected by low-grade mosaic PIK3CA mutation.

Early outcomes of Pyrocardan® implants for trapeziometacarpal osteoarthritis.

The aim of this retrospective study was to assess the early outcomes of trapeziometacarpal osteoarthritis treatment using Pyrocardan® implants in patients with early Eaton (stage I and II) osteoarthritis. We analyzed the results of 27 patients, with a median age of 59 years (range, 34-78 years) and a mean follow-up of 24 months (range, 12-41). The level of satisfaction was assessed using a postoperative questionnaire. Twenty patients mentioned having improvements in their activities of daily living, 20 patients were satisfied with the outcomes of surgery, and 19 patients would consider undergoing the procedure a second time. Five patients needed reoperation for complications, including persistent pain, grinding, or implant dislocation. Pyrocardan® implants may be a valuable temporary therapy as more conventional arthroplasty techniques are still feasible in case of failure. However, multicenter randomized controlled trials with a longer follow-up are needed to assess the long-term outcomes.

Microvascular ear reconstruction using a free radial forearm flap after dog bite.

A 68-year old woman suffered from a subtotal amputation of the left ear due to a dog bite. The recovered ear was implanted and reconstructed using a radial forearm flap. In our opinion, the forearm is an excellent choice for implantation of recovered ear cartilage as preparation for one-stage reconstruction.

Epiphysiolysis of the capitellum humeri.

A four-year-old girl presents at the emergency department with left elbow pain after a fall. X-ray demonstrated an epiphysiolysis of the capitellum humeri, without a bony fragment, the so-called Salter Harris Type 1 fracture. The fracture was treated by open reduction and internal fixation. This case is unusual because avulsions of the capitellum are usually associated with a bony fracture.

Effect of propofol on cerebral circulation and autoregulation in the baboon.

The purpose of this study was to investigate the effect of propofol on cerebral blood flow, cerebral metabolism, and cerebrovascular autoregulatory capability. Seven anesthetized baboons were given propofol at three different infusion rates. An infusion of 3 mg.kg-1.h-1 caused minimal changes, but infusion rates of 6 and 12 mg.kg-1.h-1 decreased cerebral blood flow by 28% and 39%, respectively. The changes in cerebral metabolic rate of oxygen were not statistically significant. However, with the two higher infusion rates, there was a trend toward decrease, by 5% and 22%, respectively, for the cerebral metabolic rate of oxygen, and by 18% and 36% for the cerebral metabolic rate of glucose. A 25-30 mm Hg increase in arterial blood pressure had no influence on cerebral blood flow. Replacement of nitrous oxide by nitrogen had no significant influence on cerebral blood flow or metabolism. It is concluded that propofol causes a dose-dependent decrease in cerebral blood flow. However, the study does not prove that this decrease in cerebral blood flow is accompanied by the same degree of decrease in cerebral metabolism. Further studies are clearly needed to clarify propofol's influence on the coupling between cerebral metabolism and blood flow. The physiologic responsiveness of the cerebral circulation to alterations in arterial pressure is well preserved. Propofol appears to prevent the metabolic stimulation and increased cerebral blood flow that has been associated with the administration of nitrous oxide.

[Effect of nifedipine and urapidil on autoregulation of cerebral circulation in the presence of an intracranial space occupying lesion]. / Der Einfluss von Nifedipin und Urapidil auf die Autoregulation der zerebralen Durchblutung in Gegenwart einer intrakraniellen Raumforderung.

We investigated in dogs with an intracranial space occupying lesion the effects of the antihypertentive agents nifedipine and urapidile on intracranial pressure (ICP) and intracerebral autoregulation. During the application of nifedipine the ICP rose significantly whereas urapidile had no influence on the ICP. By continuous angiotensin infusion the mean arterial pressure was raised by 50% by which a simultaneous increase of the ICP could be seen in the nifedipine group, whereas the urapidile group remained unaffected.

The effect of sufentanil on intracranial pressure (ICP) in anesthetized dogs.

The use of sufentanil in neuroanesthesia has been questioned because of a potential increase in intracranial pressure (ICP) in dogs and humans. The effect of sufentanil administration on ICP was studied in 6 dogs with normal and elevated baseline ICP, anesthetized with nitrous oxide and an intravenous piritramide infusion. No significant change in ICP could be demonstrated over a 30 minute observation period after administration of 2 micrograms/kg of sufentanil. The results indicate that this dose of sufentanil does not increase ICP in moderately hyperventilated dogs under stable anesthetic conditions.