Long-term outcome following upper extremity replantation after major traumatic amputation.

BACKGROUND: Amputations in general and amputations of upper extremities, in particular, have a major impact on patients' lives. There are only a few long-term follow-up reports of patients after macro-replantation. We present our findings in contrast with the existing literature. METHODS: Sixteen patients with traumatic macro-amputation of an upper extremity were eligible for inclusion in this study. Altogether, the patients underwent replantation in 3 institutions between 1983 and 2011. RESULTS: Twelve male and four female patients with an average age at injury of 40.6 years (range, 14-61 years) were included in this study. The mean follow-up period was 13.5 years (range, 4.4-32.6 years; SD, 5.7 years). The mean disabilities of the arm, shoulder and hand (DASH) outcome measure was 41 (range, 5.2-94.8; SD, 18.2), functional independence measurement (FIM) was 125 (range, 120-126; SD, 1.8). Chen I representing very good function was accounted in six, Chen II representing good function in eight, Chen III (fair) in one and Chen IV (bad function) in one patient. CONCLUSIONS: We found that while the majority of the included patients exhibited good or very good function of the extremity, none of the replanted appendages regained normal levels of functionality. In addition, all participants were very satisfied with their outcomes. Positive long-term results with high rates of subjective satisfaction are possible after replantation of upper extremities.

The neonatal treatment of rats with monosodium glutamate induces morphological changes in the subfornical organ.

The parenteral administration of monosodium glutamate (MSG) to neonatal rats induces specific lesions in the central nervous system that lead to a well characterized neuroendocrinological dysfunction. Additionally, it has been shown that MSG-treated rats present a blunted blood pressure response to the injection of nitric oxide synthase inhibitors. Recently, a similar cardiovascular alteration has been reported after the electrolytic lesion of the anteroventral region of the third ventricle affecting the connections of the subfornical organ (SFO). We hypothesized that the treatment of neonatal rats with MSG could affect the nitrergic cells of the SFO. In the present work, we have looked for alterations in the NADPH-diaphorase activity (a commonly used marker for nitrergic neurons) in the SFO of MSG-treated rats of either sex and at two different ages. Our results shown that the treatment of neonatal rats with MSG induced a substantial reduction in the volume of the SFO and in the number of its nitrergic cells with regard to control animals. These findings suggest that the SFO could be implicated in some of the cardiovascular alterations observed in MSG-treated rats.

[Dislocation of the Ulnar Head following Malunion of Distal Radius Fracture in Childhood]. / Ellenkopfluxation nach fehlverheilter Speichenfraktur im Kindesalter1.

Four children between the age of 10 and 13 years with distal radius fractures healed with dorsal angulation presented to us in our out-patient department. All had been treated conservatively with an upper-arm cast, all fractures had healed with an average dorsal angulation of 10 degrees. Despite this dorsal angulation, the patients were pain free. Subsequent minor injury resulting in pain to the wrist was now the reason for their presentation. On examination we found a spontaneous palmar dislocation of the ulnar head during supination. This proved to be resistant to conservative therapy. In all cases corrective osteotomy of the radius at the level of angulation was performed. Redislocation of the ulnar head was prevented by this method in all cases.

Intraluminal leiomyosarcoma of the superior vena cava: a cause of superior vena cava syndrome.

Intraluminal tumours of the superior vena cavae (SVC) are extremely rare. We report a 75 year old male who suffered an acute syndrome of the SVC. The CT scan and phlebogram showed thrombosis of the right internal jugular, subclavian and innominate veins and the SVC. Fibrinolysis was started with 250.000 U, of urokinase and maintained for 72 hrs (75.000 U/h). A control phlebogram showed a great filling defect of the SVC which was enhanced in a postcontrast CT scan. An intraluminal leiomyosarcoma was diagnosed. A long and narrow pedunculated tumour was resected through a medial sternotomy and the SVC closed by direct suture without either a patch or a graft. The histopatholoy study confirmed the diagnosis. We cosider this protocol to be the procedure of choice for the diagnosis and treatment of the SVC syndrome since it can demonstrate any intraluminal or extramural aetiology.

[Inflammatory-type malignant fibrohistiocytoma of the mesocolon associated with colonic parasitosis due to Trichocephalus]. / Fibrohistiocitoma maligno de tipo inflamatorio de mesocolon asociado a parasitosis colónica por tricocéfalos.

A case of inflammatory malignant fibrous histiocytoma of the mesocolon is reported. The lesion presented as a right lower quadrant abdominal mass, located at the mesocolon, with obstructive symptoms and accompanied by a severe infestation by Trichuris trichiura. It had a benign histologic appearance and was considered initially as an inflammatory and necrotic process with severe tissue eosinophilia secondary to the severe parasitosis. The tumor relapsed 13 months later at the anastomotic site and the patient died. Diagnostic, prognostic and therapeutic aspects of this rare tumor are discussed.