Intraneural Ganglions of the Hand and Wrist.

PURPOSE: To review 15 patients who were treated for intraneural ganglions of the hand and wrist. METHODS: Between 1990 and 2012, 15 patients were treated for intraneural ganglions of the hand and wrist. There were 9 women and 6 men, averaged age 42 years. Ten patients presented with a mass and 5 with symptoms of entrapment neuropathy. The ganglions involved the ulnar nerve at the wrist in 5 patients, the dorsal branch of the ulnar nerve in 2, the superficial radial nerve in 2, a digital nerve in 4, and the dorsal branch of a digital nerve in 2. Eight patients had magnetic resonance imaging evaluations that showed cystic masses that did not confirm intraneural ganglions. In all patients diagnosis was made intraoperatively. Ganglions were treated by intraneural dissection and excision of the cyst in 10 patients, excision of the articular branch and decompression of the cyst in 4, and excision of the ganglion and the nerve in 1. RESULTS: Postoperative follow-up averaged 57 months. There were no complications or recurrences. Five patients had transient paresthesias that improved after an average of 2 months. Preoperative symptoms improved in all patients. Patients returned to normal daily and work activities at an average of 10 days. CONCLUSIONS: Intraneural ganglions should be considered in the differential diagnosis of a mass in the vicinity of a nerve. Surgical excision is usually curative but simple excision of the articular branch and decompression of the cyst seems simpler and equally effective. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Functional outcome of open reduction of chronic perilunate injuries.

PURPOSE: Perilunate injuries are complex and occasionally go unrecognized acutely. Open reduction and internal fixation is a valid treatment option for these injuries. The purpose of this study was to evaluate the functional outcome of treating chronic perilunate injuries with open reduction and internal fixation. METHODS: Between 1998 and 2007, we treated 24 patients for chronic perilunate injuries. We excluded 5 patients from this study because they underwent proximal row carpectomy or limited wrist arthrodesis. We treated the remaining 19 patients with open reduction and internal fixation. Mean time from injury to surgery was 29 weeks. All patients were men, with a mean age of 27 years. A total of 13 patients had fracture dislocations (group 1); of these, 11 were transscaphoid and 2 were transscaphoid transcapitate fracture dislocations. Six patients had perilunate dislocations (group 2). RESULTS: Postoperative follow-up averaged 58 months. All carpal fractures healed at an average of 18 weeks. At final evaluation, the average pain scores during rest, daily activities, and manual work on a 20-point visual analog scale were 0, 2, and 3, respectively, with no significant difference between groups. The active extension and flexion of the wrist averaged 39% and 52% of the uninjured side, respectively. Grip strength averaged 87% of the uninvolved extremity. According to the Mayo wrist scoring system, 58% of all patients (69% of group 1 and 33% of group 2) achieved good to excellent results. A total of 18 patients returned to their original work activities; 14 patients (74%) were very satisfied. No patients required secondary procedures. CONCLUSIONS: Despite late presentation, patients with chronic perilunate injuries can be treated with open reduction internal fixation, with satisfactory results. Patients with lesser arc injuries have less successful outcome. Patients with irreducible dislocations or major articular damage may require wrist salvage procedures.

Enhancing physico-mechanical and antibacterial properties of natural rubber using synthesized Ag-SiO2 nanoparticles.

The incorporation of the prepared Ag-SiO2 core-shell particles in natural rubber matrix was investigated on antibacterial and mechanical properties of resulting composites. Significant antibacterial effect against S. aureus (Gram positive) and P. aeruginosa (Gram negative) was observed and achieved inhibition growth up to 85 and 90%, respectively, after 24 h depending on the amount of Ag-SiO2 core-shell. It was found that SiO2 acted as crosslinking agent and controlling the amount of silver release. UV-vis spectra and TEM, XRD showed Ag-SiO2 core-shell particles formation. SEM, FTIR, XRD and mechanical analysis showed uniform distribution of Ag-SiO2 core-shell into rubber matrix with enhanced tensile strength.

Visual internal urethrotomy in management or urethral strictures.

Visual internal urethrotomy was used in the treatment of urethral strictures in 103 patients. The procedure was performed mostly under local anesthesia. Urethral catheter for forty-eight hours or urethral splinting for two weeks was used as complementary treatment in some cases. We obtained an overall success rate of 95.1 per cent.

The contractile effect of bombesin on the rat isolated urinary bladder.

We have investigated and compared the myotropic effects of bombesin (BB) and carbachol (C) in the rat isolated urinary bladder. BB (0.5 x 10(-9) to 0.5 x 10(-5) M) and C (2.7 x 10(-8) to 5.4 x 10(-5) M) were found to produce dose-dependent increases of the basal tone of the rat detrusor muscle. The maximal contraction produced by C was about 4 times greater than that elicited by BB or substance P (SP). However, the threshold concentrations of BB and SP required to stimulate the detrusor muscle were much lower than those of C. The pD2 (-log ED50) values of BB, SP and C were respectively 7.63, 7.05 and 5.8. The tissues exposed to BB relaxed more slowly after washout than those challenged with C or SP. The contractile effects of medium range concentrations of BB were not affected by pretreating the tissues with tetrodotoxin, atropine, antihistaminics, indomethacin, alpha- and beta-adrenergic blockers, methysergide or 8-leucine-angiotensin II. Tissues desensitized with high concentrations of bradykinin maintained their sensitivity to BB. The result suggest that the contractile effect of BB on the rat isolated urinary bladder is likely to be the result of a direct effect on the smooth muscle cells.

Intraocular lens power calculations in the triple procedure.

When a triple procedure is planned, calculation of the intraocular lens becomes a problem. Postoperative corneal power bears no relation to preoperative power, and the axial length of the globe also changes. A prospective study of 24 keratoplasties revealed a close relationship between postoperative corneal power and donor corneal power. Changes in axial length were found to be too small to produce errors in calculation. The equation derived in this series to describe the relation between postoperative and donor corneal power is applicable only when certain trephine sizes are used and when the recepient cornea is not excessively scarred.

Adenohypophyseal activity in relation to suprarenal function in tuberculosis.

This work was carried out on 150 subjects. They were classified into four groups: group I: Bronchogenic pulmonary T. B. (n = 96); group II: Haematogenous T. B. (n = 15); group III: Healed T. B. (n = 16), group IV: Healthy control (n = 23). Insulin tolerance test was done for each subject to assess the hypothalamo-hypophyseal axis. Glucose, ACTH, cortisol, GH, and PRL levels were estimated during fasting and over three hours after insulin administration. In group I and II the patients exhibited higher fasting levels of anti-insulin hormones and they respond greater than normals to insulin-induced hypoglycaemia. This might indicate early affection of the pituitary gland by TB infection, yet insulin-induced hypoglycaemia assured efficient function of the gland. In healed TB patients, no significant changes were obtained in the different hormonal behaviour, whether in the fasting state or after stimulation. This might be explained by improvement of the health condition of the patients, and relief of the stress induced by TB infection.

Stomatognathic dysfunction in the western desert of Egypt: an epidemiological survey.

Results of a study of 215 male subjects from Siwa oasis are presented. The Siwian community is representative of the Bedouin communities in the Egyptian western desert. The population belongs to a characteristic ethnic group, living in a primitive way. The most prevalent symptoms were headache (29%), pain in the ear (24%) and clicking joint sounds (19%); 84% of the subjects suffered from tenderness of one or more of the masticatory muscles; 8% of the subjects had painful movements of the mandible. The results extend knowledge of the distribution of jaw dysfunction complaints into hitherto uninvestigated communities.

The swallowing position as a centric relation record.

A brief review of the swallowing position and its relation to centric relation records was presented. Intraoral tracings of the swallowing position for six patients were made at the natural occlusal vertical dimension. Deviations of the position from the IP were measured. The swallowing position deviated anteroposteriorly and laterally from the IP, and this raises questions as to the validity of this method for recording centric relation.

Corneal astigmatism induced by oversized rigid anterior chamber implants.

Postoperative corneal astigmatism induced by implantation of an oversized rigid anterior chamber intraocular lens has been studied. Sources of error leading to the choice of an oversized lens as well as the mechanism by which an oversized lens induces corneal astigmatism are discussed.

Accuracy of freely adapted resin record bases.

Forty autopolymerizing resin record bases were made; 10 bases were adapted by finger pressure on tray resin material dough, 10 bases by sprinkling orthodontic resin, and 10 of repair material by either of the two previous techniques. Stone casts and acrylic resin bases were sectioned at canine, premolar, and molar coronal planes. Width of the gap between base and cast and the thickness of the base were measured at the buccal sulcus, ridge crest, lateral palatal slope, and palatal midpoint. Measurements were made through the eyepiece of a microhardness tester. Statistical analysis of 760 pairs of measurements revealed that (1) sprinkled bases fit better than finger-adapted dough bases; (2) specifically formulated materials fit better than repair material with either technique; (3) gap widths differed at different areas of the same base; and (4) gap width was not related to base thickness at any point.

Stomatognathic dysfunctional symptoms in Saudi Arabian adolescents.

Secondary school Saudi students participated in a questionnaire about stomatognathic dysfunction symptoms. The adolescents were interviewed about general health, peripheral joint disease, chewing function, oral parafunctions, and symptoms of dysfunction. Thirty-two per cent of participants had at least one dysfunction symptom. Pain on opening was the most common (35.7%), followed by headache (33.6%), and joint sounds (32.2%). Symptoms increased with decline in general health, particularly the health of peripheral joints. Chewing functions were not impaired. Tooth loss did not affect dysfunction symptoms in adolescents, whilst a weak relation was evident between oral parafunctions and symptoms of mandibular dysfunction.

Role of urethral ischemia in the development of urethral strictures after cardiovascular surgery: a preliminary report.

A high incidence of urethral stricture was noted following cardiovascular surgery. In an attempt to elucidate factors predisposing to the occurrence of urethral stricture, we studied the penile blood flow in 7 patients presenting with strictures after cardiovascular surgery. Of these patients 5 had penile-brachial pressure indexes less than 0.5 and 6 had weak or absent erections. Of 14 patients studied prospectively by penile blood flow 2 had a low penile-brachial pressure index and suffered urethral strictures 6 weeks after cardiovascular surgery. This finding suggests that urethral ischemia could be a predisposing factor for the development of urethral strictures after cardiovascular surgery.

Sectional impressions for mandibular distal extension removable partial dentures.

STATEMENT OF PROBLEM: Corrected impression procedures provide the best possible support to be gained from an edentulous ridge for a removable partial denture, but they are time-consuming and technique-sensitive. PURPOSE: An experimental mandibular distal extension removable partial denture was used to measure the vertical movement of denture bases during biting. MATERIAL AND METHODS: Five patients participated for whom vertical movement of denture bases was measured by comparing the thickness of plaster interocclusal records made with the denture at rest and under biting pressure. Denture bases were processed on master casts formed from final impressions made in full arch custom trays. Secondly, bases were readapted using sectional relining impressions with the same regular body polysulfide impression material. RESULTS: Statistical analysis of the vertical movement of denture bases during biting at 4 points on the right and left denture bases showed a significant decrease in vertical movement with sectional impression. The reduction was less than a 0.1 mm, a result that questions the routine use of sectional impression for every distal-extension mandibular removable partial denture. CONCLUSION: Supportive form of distal-extension edentulous ridges can be recorded successfully by full arch impressions in custom trays.

Urethral stricture following cardiovascular surgery: role of urethral ischemia.

The incidence of urethral stricture has been surprisingly high following cardiovascular surgery in the last few years. We conducted a prospective study on 68 male patients undergoing cardiovascular surgery to determine the main factor(s) responsible for the development of urethral stricture. The penile-brachial pressure index was checked by strain gauge plethysmography. We found that urethral strictures developed in 15 patients (22 per cent) within an average of 3 months after cardiovascular surgery. Of these patients 13 had a penile-brachial index of 0.6 or less and complained of erectile impotence. A latex type of catheter was used in 11 and a silicone catheter in 4 of these 15 patients for urinary drainage. We conclude that urethral ischemia has an important role in the development of stricture, particularly when a latex urethral catheter is used for drainage. We recommend that a vascular penile study should be done in patients with erectile impotence undergoing an open heart operation, and that serious consideration should be given to the use of a cystocatheter diversion the night before the operation in those with a penile-brachial index less than 0.6. We strongly recommend the use of a silicone catheter in all other patients undergoing open heart surgery with hypothermia.

Urethral stricture after cardiovascular surgery, a retrospective and a prospective study.

In a review of our cases presenting with urethral stricture we noted a high incidence following cardiovascular surgery. A retrospective study was done, including 87 patients treated for urethral stricture and 304 undergoing open heart surgery during the same period, to search for a possible etiologic factor. A prospective study also was done on 98 patients subjected to cardiovascular surgery. Strictures developed in 17.5 per cent of 63 patients who had a urethral catheter placed for urinary diversion at operation compared to none of 35 who had a suprapubic cystocatheter. We believe that the urethral catheter is at least partly responsible for stricture formation. Associated factors, for example urethral ischemia, may be contributory.

Response of the urethral smooth muscles to pharmacological agents. I. Cholinergic and adrenergic agonists and antagonists.

We studied the effects of cholinergic and adrenergic agents on the 2 muscle layers of the proximal urethra of the cat. Strips were challenged with bethanechol chloride, phenylephrine and isoproterenol. Bethanechol chloride caused contraction of the longitudinally oriented strips; the circularly oriented strips revealed either minimal or no response to the same doses. The difference between the response of the 2 layers was highly significant (p less than 0.001). Phenylephrine stimulated both layers with a nonsignificant difference. Isoproterenol caused relaxation of both layers with a significant action on the circularly oriented fibers (p less than 0.05). It could be concluded that the cholinergic effect which is predominant on the longitudinal fibers is important for voiding by shortening the proximal urethra. alpha-adrenergic innervation of the bladder neck has a function during ejaculation: closure of the bladder outlet by the circular fibers. beta-adrenergic agonists decrease the urethral pressure probably by relaxing both layers with a dominant effect on the circular layer.

Vesicourethral electromyography: facts or artefacts.

A vesicourethral electromyographic study was carried out on 21 cats of both sexes with extracellular electrodes along with monitoring of contraction and relaxation of various parts of the bladder and urethra. No consistent electromyographic pattern of slow and fast waves was observed in the bladder and urethra either in any empty bladder or during filling and voiding phases. Most of the recorded waves were traced to a defined source of artefact. Twenty-two experiments were done with glass microelectrodes recording intracellularly in bladder strips of various animals bathed in normal and modified Krebs solutions. No spike activity was recorded during periods of contractions, whether spontaneous or electrically stimulated. Both in vivo and in vitro experiments suggest that the mechanism of excitation-contraction coupling of the bladder remains unidentified. The clinical application of bladder electromyography (EMG) has to be interpreted cautiously.