RESUMO
Disseminated histoplasmosis is usually a multifocal process with a wide variety of clinical presentations. Despite frequent bone marrow involvement, overt bone and joint disease is uncommon and isolated synovial involvement is extremely rare. We describe in this report an unusual case of disseminated histoplasmosis presenting as acute tenosynovitis. To our knowledge, this is only the second reported case of synovial involvement by H. capsulatum without a concomitant osseous lesion.
Assuntos
Histoplasmose/diagnóstico , Tenossinovite/diagnóstico , Doença Aguda , Diagnóstico Diferencial , Feminino , Histoplasmose/patologia , Humanos , Pessoa de Meia-IdadeRESUMO
Traumatic carpal instability can be difficult to detect and may present complicated management problems. Post-traumatic palmar carpal subluxation has been previously described only as a theoretical ligament instability. Such a condition implies disruption of the normal ligament attachments either within or around the carpus, or both, which very often results in altered intercarpal relationships and in disturbed kinematics. Post-traumatic palmar carpal subluxation is a form of carpal ligament instability that we could not find in any previous reports. We are reporting the cases of two patients who were followed for three years after such an injury. After closed reduction and non-operative management, both patients had a satisfactory functional result.
Assuntos
Luxações Articulares/terapia , Traumatismos do Punho/terapia , Adulto , Idoso , Humanos , Luxações Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Masculino , Radiografia , Recidiva , Ruptura , Traumatismos do Punho/diagnóstico por imagemRESUMO
The normal and abnormal radiographic appearances of various hand and wrist surgical procedures have been presented. It is hoped that increased familiarity with these procedures and their radiographic features will lead to more meaningful radiographic interpretations by consulting radiologists.
Assuntos
Traumatismos da Mão/diagnóstico por imagem , Ulna/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem , Artrodese/métodos , Traumatismos da Mão/cirurgia , Humanos , Osteotomia/métodos , Radiografia , Ulna/cirurgia , Traumatismos do Punho/cirurgiaRESUMO
The normal and abnormal radiographic appearances of various arthroplasties of the hand and wrist have been presented. It is hoped that increased familiarity with these procedures and their radiographic features will lead to more meaningful radiographic interpretations by consulting radiologists.
Assuntos
Articulações dos Dedos/diagnóstico por imagem , Mãos/diagnóstico por imagem , Prótese Articular , Polegar/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Articulações dos Dedos/cirurgia , Humanos , Radiografia , Polegar/cirurgiaRESUMO
The wrist has been studied morphologically and functionally using advanced technology. The osseous morphology of the wrist was investigated by computed tomography and surface reconstruction software. The functional behavior of the wrist in motion was studied using electromagnetic tracker technology. Three-dimensional imaging from CT scans is emerging as a research tool for the study of gross surface morphology, especially for osseous structures. One of the most demanding applications of this technology lies in the human wrist, because of its small size and inherent complexity. We have demonstrated some of the potential of computer graphics and three-dimensional surface reconstructions in the wrist for patients with osseous abnormalities. Acquisition of six-degree-of-freedom kinematic data to describe carpal motion has been made possible by new electromagnetic tracker technology. Analysis of these data in human wrist experiments revealed that the instantaneous center of rotation was not fixed in the head of the capitate, as was previously thought.
Assuntos
Ossos do Carpo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Articulação do Punho/diagnóstico por imagem , Adulto , Ossos do Carpo/fisiopatologia , Humanos , Aumento da Imagem , Masculino , Restrição Física , Software , Articulação do Punho/fisiopatologiaRESUMO
We describe 4 patients who complained of pain over the course of the flexor carpi radialis tendon at the wrist, and who presented with point tenderness there. These 4 patients presented a spectrum of non-specific tenosynovitis involving the flexor carpi radialis tendon at the wrist, ranging from slight tenderness and swelling to complete disruption of the tendon. Their clinical course and treatment is presented.
Assuntos
Tenossinovite/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sinovectomia , Tenossinovite/terapia , PunhoRESUMO
Ulnar artery thrombosis is well reported but treatment recommendations still vary. We report the 10-year follow-up of a vein graft used to treat a patient with ulnar artery thrombosis. The graft remained patent until the tenth year, when the patient sustained a blunt hyperextension injury to the involved wrist and developed a pseudoaneurysm of the vein graft. The pseudoaneurysm was found to be in the graft itself and not at the anastomosis. The vein graft thrombosed and was successfully treated with resection of the thrombosed vessel, embolectomy of the superficial palmer arch, and replacement with a new vein graft.
Assuntos
Falso Aneurisma/etiologia , Oclusão de Enxerto Vascular/etiologia , Artéria Ulnar/cirurgia , Veias/transplante , Adulto , Falso Aneurisma/cirurgia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Masculino , Trombose/cirurgia , Traumatismos do Punho/complicaçõesRESUMO
To completely open the web space in burn syndactyly and provide tissue that is pliable and elastic, we describe a flap from the lateral and volar surfaces of an adjacent finger which will completely cover the opened defect. The results of this procedure in 24 web spaces are reported.
Assuntos
Queimaduras/complicações , Transplante de Pele , Sindactilia/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Dedos , Humanos , Masculino , Métodos , Sindactilia/etiologia , Transplante AutólogoRESUMO
Patients with Hurler's syndrome (MPS-1H), I-cell disease (ML-II) and pseudo-Hurler's syndrome (ML-III) had median nerve compression and triggering of the fingers which limited finger extension. To our knowledge, this combination has not been reported previously in patients with mucopolysaccharidoses and related disorders. In all of our 3 cases the median nerve was compressed by thickened flexor tenosynovium. Synovectomy and resection of the volar carpal ligament improved the hand function in all, including the mentally retarded patient with Hurler's syndrome. Release of the fibroosseous tunnel in two patients was followed by an increased range of motion (but not full extension). A fourth patient, without a mucopolysaccharide storage disorder, also had the combination of trigger finger and carpal tunnel syndrome.
Assuntos
Síndrome do Túnel Carpal/etiologia , Dedos , Mucopolissacaridoses/complicações , Síndrome do Túnel Carpal/cirurgia , Criança , Pré-Escolar , Feminino , Dedos/inervação , Mãos/fisiologia , Humanos , Masculino , Mucolipidoses/complicações , Mucopolissacaridose I/complicações , Mucopolissacaridose II/complicações , Mucopolissacaridose III/complicações , SinovectomiaRESUMO
We have attempted to define the optimal time for tenolysis by evaluating the blood supply, the rupture rate, and the tensile strength of tenolysed and control tendons. In 128 chickens tenolysis was performed 1, 3, 6, 12, 16, and 24 weeks after primary tendon repair. Tenolysis at 1 and 3 weeks resulted in devascularization, weak tendons, and high rupture rates. Tenolysis at 6 weeks after the primary repair had mixed effects on the blood supply but weakened the tendon. Tenolysis at 12 weeks after the tendon repair did not weaken the tendon and resulted in an increased blood supply. Tenolysis at 16 and 24 weeks did not weaken the tendon, but had varied effects on the blood supply. We recommend an interval of 12 weeks between primary tendon repair and tenolysis.
Assuntos
Tendões/cirurgia , Animais , Galinhas , Ruptura , Traumatismos dos Tendões/etiologia , Tendões/irrigação sanguínea , Resistência à Tração , Fatores de TempoRESUMO
We selected 500 patients randomly from a total of 1300 patients seen in our Hand Rehabilitation Center between 1971 and 1975; 212 of the 500 presented with a chief complaint of stiff hand joints. Of the 212 patients treated non-operatively, 173 responded sufficiently to this treatment alone. Of the 789 stiff joints, 686 responded sufficiently to this treatment alone. The results of this regime of non-operative treatment of stiff joints provide excellent functional improvement in most patients, with a large saving of money through the reduction in disability payments required.
Assuntos
Terapia por Exercício , Articulações dos Dedos , Articulações dos Dedos/fisiopatologia , Humanos , Artropatias/economia , Artropatias/fisiopatologia , Artropatias/terapia , Articulação Metacarpofalângica , Movimento , Contenções , Estados Unidos , Indenização aos TrabalhadoresRESUMO
Partial lacerations of flexor tendons in chickens come out the strongest and glide best if they are not sutured and not immobilized. We treated 17 patients with 20 partial flexor tendon lacerations by not suturing the tendon and by early mobilization of the digit. These partial tendon lacerations varied from 25 to 95 percent of the cross-sectional area. Sixteen of obtained excellent function of the digit, and one obtained good to excellent function. This technique should be used only in cooperative patients.
Assuntos
Traumatismos dos Tendões/cirurgia , Adolescente , Adulto , Animais , Galinhas , Criança , Feminino , Traumatismos da Mão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Resistência à TraçãoRESUMO
All the applicants to plastic surgery residency programs who participated in the residency matching program for 1992 were reviewed. Data were collected on age, sex, race, nationality, place of birth, undergraduate education, medical education, postgraduate training, research activity, and evaluation scores. Findings indicate that applicants interested in academic careers are significantly more likely to have published research and are generally rated higher in categories of intellectual curiosity, performance, and intelligence by evaluators. Women and some minorities were underrepresented when compared with recent medical school graduating classes. We recommend a longitudinal study of applicants to correlate career achievement with applicant characteristics. We also recommend some changes in the application and evaluation process and in efforts to interest women and minorities in the specialty.
Assuntos
Internato e Residência , Cirurgia Plástica/educação , Adulto , Feminino , Humanos , MasculinoRESUMO
Of 253 consecutive hypospadias repairs by various surgeons, using the Byars technique, 57 (22 percent) had postoperative fistulae; 41 required one operation, 9 required two operations, and 7 required more than two operations for closure of these fistulae. Other complications were infrequent. When performed either by attending or resident physicians, the Byars hypospadias repair produced complete correction of the chordee, a urethra of satisfactory length and caliber, normal penile appearance, and a fistula rate comparable to that reported after other procedures.
Assuntos
Hipospadia/cirurgia , Pré-Escolar , Humanos , Masculino , Métodos , Complicações Pós-Operatórias , Estudos Retrospectivos , Doenças Uretrais/etiologia , Fístula Urinária/etiologiaRESUMO
An atypical elderly patient with spontaneous regression of a primary lesion of malignant melanoma is presented. The 12 previously reported cases are also reviewed. The histological diagnosis of spontaneous regression of a melanoma can still be made after the regression appears to be grossly complete. All localized areas of depigmentation, or of scarring, should be biopsied when searching for an "occult" primary.
Assuntos
Melanoma , Regressão Neoplásica Espontânea , Idoso , Feminino , Humanos , Melanoma/patologia , Metástase NeoplásicaRESUMO
We evaluated 123 patients in which we treated 150 fractured fingers primarily. Sixty-seven percent of these fractured fingers required open reduction with internal fixation; the remainder had closed reduction with internal or external fixation, or immediate arthrodeses. Active and passive range-of-motion (ROM) exercises were usually begun within 3 days after injury. The active and passive ROM of all joints of each finger in the involved hand were measured at regular intervals until no further change in ROM occurred. An associated crush injury, a flexor or extensor tendon injury, or a skin loss (each) caused a significantly more frequent decrease in the final ROM of the unfractured fingers of the same hand. An associated joint injury, more than one fracture per finger, a crush injury, a flexor or extensor tendon injury, or a skin loss (each) caused a significant decrease in the ROM of the fractured fingers. After treatment of a simple fracture, the ROM in both the fractured and the unfractured fingers was essentially normal.
Assuntos
Traumatismos dos Dedos/reabilitação , Fraturas Ósseas/reabilitação , Movimento , Adolescente , Adulto , Idoso , Criança , Terapia por Exercício , Traumatismos dos Dedos/cirurgia , Traumatismos dos Dedos/terapia , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Fraturas Fechadas/cirurgia , Fraturas Expostas/cirurgia , Humanos , Pessoa de Meia-Idade , Dispositivos de Fixação OrtopédicaRESUMO
We performed flexible-implant arthroplasty in three metacarpophalangeal joints in two patients at the time of finger replantation. We believe flexible-implant arthroplasty is preferable to permanent arthrodesis for most patients.
Assuntos
Amputação Traumática/cirurgia , Traumatismos dos Dedos , Dedos/cirurgia , Prótese Articular , Articulação Metacarpofalângica/lesões , Reimplante/métodos , Adolescente , Adulto , Artrodese , Humanos , Ligamentos Articulares/cirurgia , Masculino , Articulação Metacarpofalângica/cirurgia , ReoperaçãoRESUMO
Synovial sarcoma is a high-grade malignancy with a marked propensity for local recurrence and a moderate rate of regional lymph node involvement. It usually causes death from massive pulmonary metastases. Despite its aggressive biologic behavior, en bloc wide local resection of small extremity tumors rather than amputation may be indicated if removal of all gross disease is possible. Extremity morbidity from resection of vessels, nerves, and soft-tissue bulk can be minimized by the use of composite reconstruction techniques currently available. A case report is presented to illustrate aggressive limb-sparing surgical therapy of a small, favorably located synovial sarcoma with immediate neurovascular and soft-tissue reconstruction. The literature is reviewed to aid subsequent surgeons faced with management of this uncommon tumor.
Assuntos
Cotovelo/inervação , Nervo Mediano/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Sarcoma Sinovial/cirurgia , Músculos Abdominais/transplante , Adulto , Anastomose Cirúrgica , Feminino , Humanos , Veia Safena/transplante , Transplante de Pele , Nervo Sural/transplante , Retalhos CirúrgicosRESUMO
Symptomatic upper extremity digital ischemia is an uncommon disorder reflecting diverse etiologies. Herein we present an algorithm to aid in evaluation and treatment of digital ischemia. This approach seeks to establish the diagnosis and lead to appropriate treatment while minimizing testing and therapy. Practical application of the algorithm is demonstrated through illustrative cases.
Assuntos
Dedos/irrigação sanguínea , Isquemia/diagnóstico , Adulto , Arterite/diagnóstico , Temperatura Corporal , Embolia/diagnóstico , Antebraço/irrigação sanguínea , Humanos , Isquemia/etiologia , Isquemia/terapia , Masculino , Pessoa de Meia-Idade , Pletismografia , Doença de Raynaud/diagnóstico , Doença de Raynaud/tratamento farmacológico , Trombose/diagnósticoRESUMO
Significant and lasting improvement in stiff MP and PIP joints can be achieved by operative management. Operative intervention should be considered only after persistence of stiffness after a vigorous program of nonoperative therapy. In our series of 135 such stiff finger joints, capsulotomy increased the range of motion in MP joints by more than 30 degrees in 68 percent of the patients, more than 50 degrees in 57 percent, and more than 70 degrees in 32 percent. The increased range of motion for the PIP joints was more than 30 degrees in 63 percent of the patients, more than 50 degrees in 41 percent, and more than 70 degrees in 25 percent.