Evaluation of recurrent macrodactyly with three-dimensional imaging.

Macrodactyly is a deformity that may progress beyond initial surgical resection. Three-dimensional computed tomography imaging may aid in the surgical planning, given the osseous irregularities that may exist. The objective in revisional surgery of this type is to provide the most functional and cosmetic result. In this case, the hallux was saved when the patient previously had requested an amputation. The case also illustrates that when earlier surgery has been performed, the classic approaches to macrodactyly advocated in the literature may not be feasible. The surgeon must then approach the deformity with some flexibility, and three-dimensional imaging may be a useful tool.

Polydactyly.

Polydactyly is a fairly common, genetically induced deformity of the hands and feet found more often in blacks than in whites. Careful clinical and radiographic evaluation should be made prior to treatment because the complexity of the deformity ranges from a simple soft tissue appendage to a completely developed accessory ray. Treatment usually consists of surgical excision of the least functional, least developed digit. Hallux varus, angular deformities, and a splayed forefoot are common postoperative complications.

Appendiceal obstruction by a toothpick removed at colonoscopy.

A case of obstruction of the appendix simulating colon carcinoma is presented. The cause of the patient's symptoms and radiographic findings was found at colonoscopy to be a toothpick embedded in the appendix. The toothpick was extracted colonoscopically. Cases of intestinal obstruction by toothpicks reported in the literature are reviewed.

Tuberculous arthritis: a case study and review of the literature.

Tuberculosis of the bones and joints is a rare but treatable disease. This curable condition is frequently overlooked in the differential diagnosis, and often serious cases are not diagnosed until after severe joint destruction has already taken place. The literature on tuberculosis of the bones and joints is reviewed and the incidence, etiology, pathogenesis, diagnosis, and treatment of this condition are discussed. A case history of ankle joint involvement is presented in which antibiotic treatment before clinically significant joint destruction had occurred might have prevented surgery. Tuberculous involvement should thus be considered in any patient with chronic and subacute monoarticular arthritis.

Necrotizing fasciitis and progressive bacterial synergistic gangrene of the vulva.

Necrotizing fasciitis and progressive bacterial synergistic gangrene are two infrequently reported diseases in the gynecologic literature. The author reports 2 cases highlighting the many similarities and some important differences between these clinical entities. Diabetes mellitus and arteriosclerosis predispose women to both diseases. Aggressive antibacterial and surgical treatment is imperative.

Postoperative gas gangrene.

Gas gangrene is a rare complication of elective surgery. Caused by several species of Clostridia, it is an acute, highly invasive necrotizing infection of muscle and fascia often leading to coma and death. Gas gangrene should be suspected if the patient has unremitting pain, high temperature, tachycardia, and prostration. Edema, brown watery exudate emanating from he wound, evidence of gas in tissues, and gram-positive rods on smear support the clinical diagnosis. Rapid surgical decompression and debridement is the basis of treatment. Adjuvant antibiotic, hyperbaric oxygen, antitoxin, local, and supportive therapies aid in treatment. The authors review the literature and discuss etiologies, pathogenesis, clinical features, and treatment.

Role of cryosurgery in the treatment of intraepithelial neoplasia of the uterine cervix.

Six hundred five women with varying degrees of intraepithelial neoplasia of the uterine cervix were treated with 4 different modalities: 315 patients were treated with cryosurgery, 43 with electrocautery, 127 with conization, and 120 with hysterectomy. Of the patients undergoing cryosurgical treatment, 83 had cervical intraepithelial neoplasia (CIN) I (mild dysplasia), 172 had CIN II (moderate dysplasia), and 60 had CIN III (severe dysplasia and carcinoma in situ). Patients undergoing electrocautery all had either CIN I or II. Of 247 patients undergoing conization and hysterectomy, all had CIN III except for 2 with CIN II. A follow-up study revealed a failure rate of 5.5% in CIN I or II and of 15.5% in CIN III among patients with cryosurgical treatment. Following conization for CIN III, 12.5% of patients had treatment failure; no treatment failure was reported among patients who underwent hysterectomy for CIN III. Cryosurgery and conization were equally successful in treating CIN III. Cryosurgical therapy of CIN is therefore an effective means of treatment, but a precise diagnosis must be established by colposcopy and colposcopically directed biopsy before therapy. Also, restricted criteria should be used with regard to the geographic extent of the disease, and endocervical curettage should be performed as part of the evaluation of patients with CIN undergoing cryotherapy.