The extensor tendon splitting approach to the proximal interphalangeal joint: do we need to reinsert the central slip?

Current approaches to the proximal interphalangeal (PIP) joint have potential complications and limitations. We present a dorsal approach that involves splitting the extensor tendon in the midline, detaching the insertion of the central slip and repairing the extensor tendon without reinserting the tendon into the base of the middle phalanx. A retrospective review of 16 digits that had the approach for a PIP joint arthroplasty with a mean follow up of 23 months found a postoperative PIP active ROM of 61 degrees (range 25-90 degrees). Fourteen digits had no extensor lag, while two digits had an extensor lag of 20 degrees and 25 degrees. This modified approach is fast and simple and does not cause an extensor lag.

Hydrops fetalis associated with congenital myotonic dystrophy.

We report a case of congenital myotonic dystrophy in a newborn infant who presented with hydrops fatalis. Clinical features were hypotonia, generalized edema, pleural effusion, respiratory distress, scalp hematomas, and tented mouth facies. Review of literature shows that congenital myotonic dystrophy is not a rare cause of nonimmune hydrops fetalis as previously thought.

Levels of pesticide residues in Egyptian human milk samples and infant dietary intake.

Contamination of human milk with residues of organochlorine pesticides and polychlorinated biphenyls was studied in a series of investigations concerned with the monitoring of these chemicals in Egyptian food. The DDT complex was the most frequently found pesticide, followed by total hexachlorocyclohexane isomers. Heptachlor and its epoxide, dieldrin, hexachlorobenzene, and oxychlordane were also found but less frequently. Estimated dietary intakes (EDIs) of these contaminants by the breast-fed infants were compared to acceptable daily intakes (ADIs). EDIs of DDT complex, lindane (gamma-HCH), heptachlor + heptachlor epoxide, and oxychlordane were below ADIs. Dieldrin EDI exceeded the acceptable daily intake.

Mechanism of lithium action on the adrenergic function.

The intravenous injection of Lithium chloride (LiCl) in two dose levels (25 & 50 mg/kg) has led to a significant potentiation of the pressor response of rabbits to the i.v administration of both epinephrine and norepinephrine. The i.v injection of LiCl (50 mg/kg) resulted in a marked depression of the carotid occlusion reflex in rabbits. In vitro experiments revealed that LiCl (1.6 mcg/ml) and guanethidine (0.8 mcg/ml) exert the same action on the rabbit mesenteric nerve-intestine preparation and abolish the intestinal relaxation induced by electrical stimulation of the mesenteric nerve. Results confirm the assumption that Li might display a pre-synaptic, guanethidine-like, adrenergic neuronal blocking activity.

Childhood idiopathic thrombocytopenic purpura in Egypt and the neighboring Arab countries: a regional form with three different patterns of clinical expression.

Childhood idiopathic thrombocytopenic purpura in the western world is essentially an acute self-limited disorder. In contrast, the clinical expression of the disease in Arab countries, as revealed by a study of 160 patients from Egypt, Saudi Arabia, Oatar and North Sudan, is heterogenous forming a spectrum that includes three distinct clinical forms: (a) the acute self-limited form, (b) the intermediate form, and (c) the chronic adulthood-like form. The relative proportions of these forms were 40. 15 and 45%, respectively. The chronic form shows limited response to steroids, and runs a platelet count less than 100,000 microliters for more than 1 year, with a tendency for later spontaneous elevation in platelet counts during the first few years of a long follow-up. The intermediate form shows a transient steroid-induced complete remission giving place to widely fluctuating platelet counts above and below 100,000 microliters once the steroid dosage is reduced to maintenance levels. Platelet counts in excess of 100,000 microliters were achieved in this group by extending steroid maintenance therapy fo 6--9 months. In spite of a tendency to chronicity and partial resistance to steroids i the intermediate and chronic forms, the overall response to steroids was enough both to reduce the number of cases requiring splenectomy to 15%, and to prevent the development of major complications in all the children included in the study.

Xanthinol nicotinate in the management of leg ulcers associated with haemoglobinopathies.

The therapeutic role of xanthinol nicotinate, with its potent action on the peripheral circulation, in promoting healing of leg ulcers when added to conservative measures of ulcer treatment in adult beta-thalassaemia major and sickle cell thalassaemia, was evaluated in a double-blind crossover trial in 16 patients suffering from multiple leg ulcers. Conservative measures of ulcer treatment were leg raising in horizontal position for 14 hours, bed-rest, local antiseptic dressings and antibiotics. Xanthinol nicotinate or placebo was administered in a daily dose of 8 tablets (2400 mg) for 10 weeks. Comparison of the treatment results of conservative measures plus xanthinol nicotinate and those of conservative measures plus placebo revealed a statistically significant higher rate of complete ulcer healing during xanthinol nicotinate therapy (p less than 0.01). Apart from a low incidence of generalized itching and flushing at the start of the trial, xanthinol nicotinate was well tolerated in the prescribed dose.

Amoxycillin in treatment of typhoid fever in patients with haematological contraindications to chloramphenicol.

Thirty adults with proved typhoid fever were treated with amoxycillin 1 g six-hourly by mouth for an average of 14 days because of haematological contraindications to chloramphenicol. Eighteen patients were Egyptian men with the Mediterranean variety of glucose-6-phosphate dehydrogenase deficiency and an enzyme activity in the red cells fanging from 0 to 3%, and 12 patients had a history of severe but reversible myelosuppression after eight to 12 days' treatment with chloramphenicol 1-5-2 g daily. The clinical and bacteriological responses in this group of patients were compared with those of 30 haematologically normal patients of comparable age and sex treated with chloramphenicol. The results showed that amoxycillin is an effective alternative to chloramphenicol for treating typhoid fever in patients with haematological contraindications to chloramphenicol.

Potentiation by lithium and protection by rubidium of digitalis intoxication.

Investigating the effects of Li and Rb on the toxicity of digoxin and ouabain revealed Li to be a potentiator while Rb to be a protector. The effects of Rb in this respect are, more or less, qualitatively comparable to those of K; the intensity of Rb effects is more than that of K. In case of digoxin the effect produced from the combined use of both Rb and K is more than each individual effect. With ouabain, however, whereas Rb offered protection K failed to do so. Electrolyte changes in cardiac tissue showed that Li increased the tissue content of Ca while Rb produced the opposite effect. In comparing Rb with K, both increased the K level in the cardiac muscle. However, in the case of ouabain the infusion of K failed to decrease the Ca level and this might explain its failure to protect against ouabain toxicity. This points to the importance of Ca, rather than K, in controlling the excitability of the cardiac muscle and in effecting the toxicity of cardiac glycosides. Evidences presented indicate the superiority of Rb over K and propose its trial in clinical practice.

Immunoblastic lymphosarcoma, a cytological and clinical entity?

We have studied 20 cases of haematosarcomas belonging to lymphosarcomas (T or B-cell markers, absence of the reticulosarcoma characters in sections, on smears, with conventional and scanning electron microscopy). Their cells which appear as large pyroninophilic cells on sections, as large very basophilic cells with blastic nuclei and often cytoplasmic vacuoles on smears, as having many polyribosomes and usually no ergastoplasm with conventional electron microscopy, and as large cells of the lymphocytic series with scanning electron microscopy resemble the cells which we described in adenitis in 1955 (9) and in the graft-versus-host-reaction in 1961 (6), which Gowans (15) showed resulted from lymphocyte transformation, and which Dameshek (10) called immunoblasts. Many of these cases of immunoblastic lymphosarcoma (ILS) identified on their cytohistological characteristics [also recognized by Lukes et al. (24, 25) and Lennert et al. (21, 22)], present aetiological, clinical and pronostic characters which let us suppose that it may be not only a cytological entity but also a cytoclinical entity : a) it affects males in 85% or the subjects; eight patients came from mediterranean countries outside France; two patients had a history of chronic rheumatoid manifestations; b) the disease was at stage IV at the first presentation in 10 patients out of 20; it was revealed by profound (mediastinal or abdominal) localizations in 60% of cases (12 out of 20); it presented a hypoglobulinaemia in eight out of 13 patients; in six out of the 15 patients treated before leukaemic conversion, the chemotherapy usually efficient in lymphosarcoma (LS) failed to induce remission. This type of LS has a poorer prognosis than other types of LS (median for all stages : eight months). It led to the death either after its conversion to leukaemia (nine out of 20 cases), or by vital organ (as brain or kidney) infiltrations.

High dose ascorbic acid in the management of thalassaemia leg ulcers--a pilot study.

Eight patients with beta thalassaemia major suffering from leg ulcers, were treated over an 8-week period with 3 g ascorbic acid daily in a controlled double-blind crossover study. The ulcers of all the patients showed a high rate of either complete or partial healing.

Myeloma cells in the cerebrospinal fluid in plasma cell neoplasia.

Myeloma cells were detected in the cerebrospinal fluid of two patients with plasma cell neoplasia during the myelographic studies of 38 patients whose myeloma was associated with extensive neurological complications. The myeloma cells were looked for in Wright stained centrifuged deposit of 2-5 ml samples of the cerebrospinal fluid obtained during myelography. The possibility that occult traumatic lumbar puncture had allowed entry of circulating myeloma cells from the peripheral blood into the subarachnoid space was excluded by the absence of myeloma cells in smears of peripheral blood and its buffy coat. Up to the end stages of the disease the meningeal myeloma lesions remained microscopical and no signs of raised intracranial tension were manifested by either patient.