Open finger tip healing and replacement after distal amputation in rhesus monkey with comparison to limb regeneration in lower vertebrates.

The left thumbs and great toes of three 8 1/2 month old Rhesus monkeys (Macaca mulatta) were amputated in guillotine fashion one millimeter distal to the base of the nail and allowed to heal by the conservative open wound method. Healing occurred in seven to ten days in these small digits. Each of the thumbs and toes grew back with some blunting and shortening of the digit tips, but were functional. The new structures were cosmetically pleasing as in the human instances. The nails grew essentially to normal size and shape supported by the remaining portions of the distal phalanges. Histological studies showed no evidence of blastema formation such as is observed in the regenerating limb of the Urodele (newt) taken as the comparative representative. The possibility of improving the regrowth is discussed against the background of our knowledge of the importance of nerve during limb regeneration in lower vertebrates.

Treatment of hand infections.

Microorganisms most commonly enter the tissues through wounds, large or small. Prevention involves keeping the hands clean by frequent washing and avoiding contamination. Early infections may be aborted by cleansing and antibiotics. If an established infection does not respond to a brief trial of heat, rest, elevation and antibiotics, incision and drainage should be carried out promptly, without waiting for fluctuation. Needle aspiration is not an adequate substitute for early surgical incision.

Functional exteriorized colon for perforations due to diverticulitis.

Three patients had normal bowel function with the sigmoid colon exteriorized through an abdominal wound for 39, 42 and 72 days. Colostomy was thus avoided during the time the patient was recovering from peritonitis and inflammation in the involved segment of colon. Ready access was provided to the distal limb of the colon at second operation.

Some results using triamcinolone on immobilized joints.

The frequency and causes of joint stiffness are reviewed. The most sophisticated repair may be for naught if the joints stiffen. Treatment of the established condition leaves much to be desired. Since mobility cannot be maintained during many postoperative periods and during the treatment of many conditions, any aid to prophylaxis is desirable especially if the side effects are negligible. Steroids have been chosen because of their influence on collagen metabolism and because much is known of their toxicity and side effects. The drug was first given into the knee joints of rats where it was found effective in preventing joint stiffness in joints immobilized three weeks. In view of the animal success, fourteen patients with thenar pedicles have had a single dose of triamcinolone injected into the peri-articular tissues of their proximal interphalangeal joints at the time of construction of the pedicle. Follow up observation shows all patients to have complete proximal interphalangeal joint extension and flexion to 95 degrees. Side effects were minimal.

Occult adrenal insufficiency in surgical patients.

Eight patients admitted to a University hospital with acute surgical problems and related adrenal insufficiency were reviewed and three are presented in detail. Surgical stress and continued sepsis played major roles in the lack of responsiveness to usual modes of therapy until the adrenal insufficiency was corrected. The patients fell into three major clinical categories of adrenal insufficiency. Chronic illness and sepsis are shown to affect steroid production and metabolism, as well as adrenal responsiveness to ACTH. Pharmacologic amounts of steroids are often needed in patients with shock, gram negative sepsis and prolonged illnesses, even if normal or elevated serum cortisols are present. Therapeutic trials of cortisol administration are shown to be confusing when not accompanied by easily performed diagnostic tests of adrenal function. It is emphasized that a pretreatment serum cortisol should be obtained whenever possible. The evaluation of adrenal function is of lifelong importance to the patient.