Treatment of digital pyogenic flexor tenosynovitis: single open debridement, irrigation, and primary wound closure followed by antibiotic therapy.

INTRODUCTION: Digital pyogenic flexor tenosynovitis requires fast, aggressive treatment. Although this infection occurs frequently, treatment consensus is lacking. MATERIALS AND METHODS: Between 2011 and 2015, 22 patients with acute pyogenic flexor tenosynovitis were treated with a single open debridement followed by irrigation; the incision was closed and a 10-day antibiotic course was administered. The average incision-to-suture time was 25 min, and the average hospital stay was 4 days. Recovery was uncomplicated for 20 patients, while two were reoperated, one due to germ resistance and the other due to necrotizing fasciitis. At an average of 30 month postoperatively, 21 of the 22 patients were available for follow-up. The affected finger was inspected, and sensibility, range of motion, and grip force were compared with the opposite side, and the DASH score was determined. Each patient documented pain in the affected finger at rest and during activity, and rated overall satisfaction with the treatment on a visual analogue scale. RESULTS: Almost all patients were free of pain at follow-up and very satisfied. Compared to the contralateral side, each of the affected fingers had the same range of motion and sensibility. Grip force was similar on both sides. The average DASH score was 35 points. CONCLUSION: A single open debridement with irrigation and primary wound closure followed by 10 days of antibiotic treatment resolved uncomplicated pyogenic flexor tenosynovitis. After 2 and a half years, the treatment yielded high patient satisfaction with neither functional nor subjective impairment of the affected finger.

[Safety of patient care on an interprofessional training ward in visceral surgery]. / Sicherheit der Patientenversorgung auf einer viszeralchirurgischen interprofessionellen Ausbildungsstation.

BACKGROUND: Interprofessional training wards (ITW) are increasingly being integrated into teaching and training concepts in visceral surgery clinics. OBJECTIVE: How safe is patient care on an ITW in visceral surgery? MATERIAL AND METHODS: Data collection took place from November 2021 to December 2022. In this nonrandomized prospective evaluation study the frequency and severity of adverse events (AE) in 3 groups of 100 patients each in a tertiary referral center hospital for visceral surgery were investigated. The groups consisted of patients on the ITW and on the conventional ward before and after implementation of the ITW. The Global Trigger Tool (GTT) was used to search for AE. Simultaneously, a survey of the treatment was conducted according to the Picker method to measure patient reported outcome. RESULTS: Baseline characteristics and clinical outcome parameters of the patients in the three groups were comparable. The GTT analysis found 74 nonpreventable and 5 preventable AE in 63 (21%) of the patients and 12 AE occurred before the hospital stay. During the hospital stay 50 AE occurred in the operating theater and 17 on the conventional ward. None of the five preventable AE (in 1.7% of the patients) was caused by the treatment on the ITW. Patients rated the safety on the ITW better than in 90% of the hospitals included in the Picker benchmark cohort and as good as on the normal ward. CONCLUSION: The GTT-based data as well as from the patients' point of view show that patient care on a carefully implemented ITW in visceral surgery is safe.

Scintigraphic imaging with a peptide glucuronide in rabbits: 99mTc- exorphin C glucuronide.

A peptide glucuronide (Exorphin C glucuronide) was labeled with 99mTc using glucoheptonate (GH) as a bifunctional chelating agent. Scintigraphic imaging was performed in male Albino rabbits. Exorphin C glucuronide showed rapid and efficient labeling with 99mTc using glucoheptonate as a bifunctional chelate. Results demonstrated that 99mTc-GEG may be a useful new type of glucuronide derivative of peptides for diagnosis of some cancer diseases.

Synthesis of an estradiol glucuronide derivative and investigation of its radiopharmaceutical potential.

The aim of the current study was to synthesize a derivative of estradiol glucuronide, which is able to be labeled with 99mTc and to investigate its radiopharmaceutical potential using imaging and biodistribution studies. An estrogen derivative, beta-estradiol (1,3,5,[10]-estratriene-3,17beta-diol) attached to diethylenetriamine pentaacetic acid (DTPA) was synthesized in six steps. At the end of these steps a compound of estradiol and DTPA derivative called deoxy demethyl homoestradiolyl diethylenetriamine pentaacetic acid (ESTDTPA) was synthesized. Afterwards, this compound was reacted with UDP-glucuronyl transferase (UDPGT). Following the glucuronidation reaction, the product called deoxy demethyl homoestradiolyl diethylenetriamine pentaaceticacid-glucuronide (ESTDTPAG) was obtained. Synthesized products were purified using high performance liquid chromatography (HPLC). The identification of the purified products and impurities were also established using HPLC. Synthesized compound was labeled with 99mTc. Thin layer radio chromatography (TLRC) technique was used to determine their radiochemical yields and stabilities. Labeling yield was over 96%. The biodistribution studies were performed on female Albino Wistar rats. The activity per gram tissue was calculated and time-activity curves were plotted. The target organs (tumor, as well as uterus, ovaries, adrenals and other ER containing tissues) retain the estradiol derivative longer than nontarget organs, but even these lost most of their activity within a few hours. In addition, the imaging studies were performed on normal and tumor bearing female Albino Wistar rats using Camstar XR/T gamma camera. In gamma-scintigraphic imaging studies with 99mTc-ESTDTPAG the breast tumors could be well visualized up to 24 h.

[Acute Carpal Tunnel Syndrome due to Spontaneous Bleeding after Taking Rivaroxaban (Xarelto®)]. / Akutes Karpaltunnelsyndrom durch spontane Blutung nach Einnahme von Rivaroxaban (Xarelto®).

A 64-year-old man suffered from acute carpal tunnel syndrome of his right hand without explainable reason. An emergency operation drained a pronounced haematoma. There is a strong suspicion this was a bleeding complication related to taking rivaroxaban (Xarelto(®)).

[Supplementary arthrolysis of the proximal interphalangeal joint of fingers in surgical treatment of Dupuytren's contracture]. / Die ergänzende Mittelgelenkarthrolyse bei der operativen Behandlung einer Dupuytren'schen Beugekontraktur am Finger.

OBJECTIVE: Correction of residual flexion deformity of the proximal interphalangeal (PIP) joint after excision of diseased connective tissue in Dupuytren's contracture by stepwise arthrolysis. INDICATIONS: Flexion deformity of the PIP joint of 20° or more after excision of the diseased connective tissue in Dupuytren's contracture. CONTRAINDICATIONS: Joint deformities, osteoarthrosis, intrinsic muscle contracture, instability of the PIP joint. SURGICAL TECHNIQUE: Arthrolysis of the PIP joint is performed by six consecutive steps: dissection of the remaining skin ligaments, opening the flexor tendon sheath by transverse incision at the distal end of the A2 pulley, dissection of the checkrein ligaments, dissection of the accessory collateral ligaments, releasing the palmar plate proximally, releasing the palmar plate up to its insertion at the middle phalanx base. POSTOPERATIVE MANAGEMENT: Dorsal plaster of Paris with extended fingers and compressive dressing in the palm for 2 days, occupational/physical therapy, static and possible dynamic extension splint several weeks/months. RESULTS: A total of 31 fingers in 28 patients with Dupuytren's contracture were evaluated an average of 22 months after arthrolysis of the PIP joint. In all, 26 joints with an average recurrent flexion contracture of 29° were improved compared to the preoperative flexion contracture of 81°; 4 PIP joints with a recurrent flexion contracture averaging 60° were worse. In one patient, PIP flexion contracture of 90° was unchanged at follow-up although the joint could be extended intraoperatively to 10° of flexion.

[Surgical anatomy of the abdominal wall]. / Chirurgische Anatomie der Bauchdecke.

Knowledge of the anterolateral abdominal wall anatomy is crucial for a surgical approach to the abdominal cavity and for reconstructive surgery of abdominal wall defects. Furthermore it can help the surgeon ensure optimal surgical results by avoiding anatomical complications. This overview presents the surgical relevant anatomy and emphasizes surgical principles and pitfalls in abdominal wall surgery.

[Amputation of the hand due to necrotising fasciitis: a case report]. / Amputation der Hand bei nekrotisierender Fasziitis: Ein Fallbericht.

We report the case of an 81-year-old woman who fell at home on her left hand and suffered a laceration of her forehead. Within days a fulminant necrotizing fasciitis of the hand from group A ß-haemolytic streptococcus developed. Lacking an apparent local germ entry point at the hand, the infection was initially misinterpreted as compartment syndrome. The patient's life was saved by amputation of the hand.

New radiolabeled CCK-8 analogues [Tc-99m-GH-CCK-8 and Tc-99m-DTPA-CCK-8]: preparation and biodistribution studies in rats and rabbits.

The aim of this study is to label CCK-8 with Tc-99m and to investigate its radiopharmaceutical potential. CCK-8 was labeled with Tc-99m using GH and DTPA as bifunctional chelating agents. Labeling efficiency was higher than 99%. Complex was stable more than 5 hours at room temperature. 37 MBq Tc-99m-GH-CCK-8 or Tc-99m-DTPA-CCK-8 was administered intravenously to rabbits for biodistribution experiments. Dynamic and static images were obtained from anterior projection using a Camstar XC/T gamma camera. For quantitative evaluation, regions of interest were drawn on organs and time-activity curves were generated. The highest accumulation occurred in brain within 10 and 30 minutes after injection. Renal and hepatobiliary excretion were observed. Brain distribution studies in rats showed the highest activity was in hypothalamus. Results demonstrated that Tc-99m-GH-CCK-8 and Tc-99m-DTPA-CCK-8 analogs may be a useful new class of receptor-binding peptides for diagnosis and therapy of brain diseases related with CCK-B receptor-expressing tumors.

Stability of iodine content in iodized salt.

lodization of consumed salts is mandatory in many countries fighting against to iodine deficiency. In salts iodine stability is affected by storage conditions. In this study, stabilization of iodine in salt has been determined by using Isotope Dilution Analysis. Heating, heating with oxidizing agent, incubation by time were the parameters which have been determined. Iodine loss was 41.16% by heating at 200 degrees C up to 24 hours. When the iodized salt heated with oxidized agent iodine loss rose up to 58.46% in 24 hours. Iodine loss mechanism seems similar in both cases. However iodine loss is greater in the presence of H202. After the salt was stored at room temperature with a relative humidity of 30%-45% and in sealed paper bags for three years, 58.5% of iodine content lost in approximately 3.5 years.

A correlative study between 99mTc-ESTCPTA and 99mTc-MIBI in rats.

Tissue distribution of the 99mTc labeled derivative of the estrogen compound 3,17-alpha-estradiolyl propyl 1,4,8,11-tetraazacyclotetradecanyl-l-(4-methylbenzoic acid) ester (ESTCPTA), which has an 3,17-alpha-estradiolyl propinol coupled to l-(4-methylbenzoic acid)1,4,8,11-tetraazacyclotetradecane (CPTA), was compared to 99mTc-MIBI (methoxyisobutyl isonitrile) in female Albino Wistar rats. Tissues of interest included lung, liver, heart, kidneys, spleen, stomach, intestines, pancreas, muscle, blood, breast, ovary, fat, and uterus. 99mTc-ESTCPTA uptake by the uterus and ovary, as ER-rich tissues, was highly selective. Maximum uptakes for 99mTc-MIBI and 99mTc-ESTCPTA are 90 min in breast, ovary and uterus. The pancreas also showed significant receptor saturated and unsaturated ratios for 99mTc-ESTCPTA. Results are sufficiently encouraging to generate further evaluation of these and related compounds as possible estrogen receptor based tumor imaging and therapeutic agents in estrogen-rich tissues.

[Fused little finger in the palm after operation for recurrent Dupuytren's contracture]. / Festgewachsener Kleinfinger in der Hohlhand nach operativer Behandlung einer Rezidivbeugekontraktur bei Dupuytren'scher Erkrankung.

A 72-year-old woman suffered from Dupuytren's contracture of her right little finger, which was treated operatively 3 times in 4 years. However, the finger bent back into the palm. Over time she hid her little finger in the fist. In 2010, she presented with the hand in our office. Surprisingly a fused finger in the palm was observed. The woman reported that she had ignored her little finger and that it was no longer present in her conscious mind.

Determination of iodine concentration in urine by isotope dilution analysis and thyroid volume of school children in the west coast of Turkey after mandatory salt iodization.

OBJECTIVE: This study was designed to evaluate iodine deficiency status in children 6-12 years in the west coast (Aegean Region) of Turkey after 5 years of mandatory iodine prophylaxis. A total of 2300 children from 72 populations (rural and urban area) were evaluated with urinary iodine excretion and thyroid volume. DESIGN: Cross-sectional, observational study designed and performed according to surveillance methods for iodine deficiency disease (IDD) prevalence recommended by WHO/UNICEF/ICCIDD. SUBJECTS: The study population consisted of 2300 school children age ranging from 6 to 12 years. The children were selected by multiple stage randomization from 91 primary schools of 76 zones (91 clusters). Information about the use of iodized salt was obtained from the families. MEASUREMENTS: Data on the following were collected: birth date, sex, weight, height, thyroid size by palpation and ultrasonography; and urinary iodine by isotope dilution analysis method. Thyroid volumes above 97th percentile according to the WHO/ICCIDD by age and body surface area (BSA) were accepted as goitre. RESULTS: Iodized salt consumption was 51.7%. The prevalence of goitre determined by palpation was 12.1% and by ultrasound based on BSA and age were 9.8% and 5.5%, respectively. Median urinary iodine was 53 (2-142) microg/l. CONCLUSION: Mild to severe degree of iodine deficiency was detected in the west coast of Turkey.

[Value or lack of value of the Landwehr so-called balance scale]. / Wert oder Unwert der sogenannten Balancewaage nach Landwehr.

A screening investigation was carried out at our department to study the equilibrium balance according to Landwehr, which is used for X-ray photographs as well as for Moiré or grid photometric analyses of the spine while standing in the upright position. If has been demonstrated that the balance could be "deceived" without difficulty by persons who are aware of its mechanism of action and who intend to do so, which means that its application does not necessarily yield "faultless reproducible radiographs", as Bernau has insisted. If the experiment is carried out with persons standing on the balance without prejudice, there is a high probability of better reproduction of the posture than without using the balance, though particular cases may assume an unnatural posture. A screening investigation using the equilibrium balance with 3000 pupils yielded 12% less false positive results. As a consequence of this investigation, we believe that after weighing the advantages and disadvantages, we can recommend the balance for both X-ray photographs and Moiré as well as grid analyses of the dorsum. In addition, appropriate use of the equilibrium balance provides better comparison of different results of treatment.