[Treatment of thumb arthrosis using Swanson's trapezial silicone implant]

Complications related to silicone implants have been widely described since 1985. As trapezial replacement with a silicone implant constitutes our preferred treatment for osteoarthritis of the base of the thumb, we decided to evaluate our results by means of a retrospective critical study. Fifty records of patients operated or between 1975 and 1980 constitute an homogeneous study group as all were operated according to the same technique and by the same surgeon. Seven cases of implant instability have led us to modify our fixation technique. The results in terms of mobility, stability and pain relief are good and comparable to other published series. Only two cases presented bony changes around the implant but they both existed before surgery. Our conclusion is that trapezial resection with replacement by a silicone implant can still be recommended as elective treatment for CMC thumb osteoarthritis because of its simplicity effectiveness and reversibility.

Nasal septal melanoma

The controversial issues on management of nasal septal melanoma center around the extent of pretreatment evaluation. Probably the minimum required is a chest radiograph, CBC, and liver function test (Dr. Westbrook). The use of bone scan and CT scans of brain, lungs, and abdomen (Drs. Suen and Medina) is controversial and of little yield. Aside from distant metastasis to the lung, liver, and brain, the regional metastatic spread pattern includes the nodal groups of the buccal, submental, and submandibular areas, with the possibility of bilateral involvement. All consultants agreed that the primary tumor should be treated with a wide local excision; however, there is no agreement as to the extent of nodal groups included in the nodal dissection. No consultant recommended primary septal reconstruction. The use of postoperative radiotherapy in high-dose fractions remains experimental, in the protocol research stage.

Avascular necrosis of bone following combination chemotherapy for acute lymphocytic leukemia

Avascular necrosis of bone (AVNB) is a known complication of systemic adrenocorticosteroid therapy, and one which is thought to be dose-related. However, despite the large amounts of prednisone which have been used in the standard treatment of acute lymphocytic leukemia (ALL), AVNB rarely has been reported in children with that disease. We described our experience with one adolescent with ALL who developed multifocal AVNB presenting as bone pain after aggressive chemotherapy that included a high cumulative dose of corticosteroids as well as other antitumor agents, some of which also have been associated with AVNB. Four similar cases from the literature are reviewed. Because the bone pain of AVNB can mimic that of leukemic relapse, this is an important entity to be aware of, and one which may become more common with increasingly aggressive combination chemotherapy.

The neuroectodermal tumor of bone

Four small round cell malignant tumors of bone occurring in children are described. There was no catecholamine secretion and the clinical, radiologic, and biopsy diagnosis in each was Ewing's sarcoma. Glycogen was sparse both on imprints and in tissue sections. The tumors, when extensively sampled, had areas of a lobular growth pattern and Homer Wright rosettes. The rosettes were always focal and varied in complexity from case to case; they were rudimentary in one instance and markedly fibrillar in the most obvious instance. Neuron-specific enolase was demonstrated in tissue sections and in longterm cell cultures from three of the tumors. The cultured cells put out moderately long beaded processes in serum-free medium but had no catecholamine fluorescence. Electron microscopy of the tumor rosettes and the cultured cells showed processes containing aggregates of microtubules and only one case had rare neurosecretory granules. This study suggests that some small round cell tumors of bone and soft tissue in children, which present as Ewing's sarcoma, are neuroectodermal in nature.

Squamous carcinoma of the external ear

The medical records of 486 patients with pathologically proved squamous carcinoma of the skin of the external ear were analyzed. It is a disease of elderly white men, and the helix is the most common site of origin. Well-differentiated squamous carcinoma is the most frequent histologic variant. Ninety-five percent of our patients were treated surgically with above-clavical control in 87 percent and 28 percent survival. The low survival rate was related to the old age of the patients who frequently died of intercurrent disease and second cancers. A 12 percent incidence of nodal metastases is comparable with the incidence reported in other series. Aggressive surgical ablation and the selected use of adjunctive postoperative irradiation appear justified in those patients with locally invasive tumors, multiple nodal metastases, and extracapsular invasion.

The immune restorative effect of Isoprinosine administration on the local graft-versus-host reaction of cancer patients

The immunorestorative effect of Isoprinosine (ISO) in vivo on T-cell-induced local graft-versus-host reaction (GVHR) was analyzed in 60 cancer patients randomized into three groups: 20 patients received 1 g/day ISO orally for 7 days, 20 patients received 4 g/day ISO for 7 days, and 20 patients received no treatment for 7 days. The local GVHR was assessed before and after the 7 days of treatment (or no treatment). A significant augmentation of the local GVHR was observed among the ISO-treated patients (44.1 +/- 19.1 vs 61 +/- 37.1 for 1 g ISO, P less than 0.05; 42.1 +/- 20.1 vs 58.9 +/- 23.8 for 4 g of ISO, P less than 0.01). This was not so for patients who received no treatment (38.5 +/- 20.4 vs 38.3 +/- 21.2; P greater than 0.1). Nine patients treated with 1 g of ISO and 5 treated with 4 g of ISO/day, who were initially characterized by a negative local GVHR (less than 50 mm3), converted to a positive reaction (greater than or equal to 50 mm3) compared to none of the patients who received no treatment. Two patients treated with 1 g of ISO and 2 patients treated with 4 g, who initially had a positive GVHR, demonstrated further augmentation (greater than or equal to 50% increase) in the GVHR after 7 days of treatment. In 2 patients (one in each treated group) the ISO induced a suppression of the GVHR from positive to negative. Incubation of the patients' lymphocytes in vitro with ISO (100 micrograms/ml X 1 hr) failed to induce augmentation of the GVHR and did not correlate with the in vivo effect in the same patients. These results demonstrate an immunomodulatory effect of ISO in cancer patients and lend further support to the use of this drug as an immunomodulating therapy among cancer patients.

Clinical effects of closed suction drainage on wound healing in patients with head and neck cancer

This study was undertaken to determine what optimal levels of suction pressure were necessary to provide good drainage volume and obliteration of any dead space and also to determine the prevalence of clotting and complications secondary to various levels of suction pressure. The patients were grouped by their degree of nutritional depletion, prior radiation exposure, the types of surgical procedures undergone, and the results of tests using four levels of suction pressure. Three of the suction pressure values were obtained with a wall suction and one was obtained using a portable closed system. All wall suction pressure levels were certainly comparable with the portable unit. However, the portable unit provided continuous suction pressure when the patients were ambulatory and was not associated with any statistically significant increase in wound complications or equipment failure.

[Newberyte in old calculi of the urinary system]

In 542 old calculi belonging to the collection complied by Dr. P. Cifuentes Díaz, we have found newberyte in 81 calculi (14.9%). Newberyte appears in the struvite and apatite calculi in the form of small crystals looking like a mosaic. This results from the transformation of the struvite when it loses NH3 and H2O which we have only found in old urinary calculi.

Kinky hair disease. Report of a case

A confirmed case of kinky hair disease is described. Findings include a defect in copper metabolism, peculiar facies, retrognathia, skeletal open-bite, generalized gingival enlargement, and skeletal radiographic abnormalities.

Electrophysiological study of hemiplegia. Motor nerve conduction velocity, brachial plexus latency, and electromyography

Motor nerve conduction velocities of the ulnar and common peroneal but not the median nerves were substantially reduced in the affected limbs in a series of hemiplegic patients. Slowing of conduction velocity of the common peroneal nerve was related to the reduction of skin temperature in the hemiplegic limbs. Brachial plexus latencies to biceps and deltoid muscles were longer in the affected than in the unaffected sides in five of 12 hemiplegic patients. Electromyograms (EMGs) of limb muscles showed absence of spontaneous activity in 83% of patients. Spontaneous EMG activities in 12 of the 13 patients were related to an associated subclinical neuropathy or plexopathy in the involved limbs. Entrapment andtraction causing subclinical or clinical neuropathy or radiculopathy may be present in some hemiplegic patients.

Drug injection injuries of the hands: evaluation and treatment

Twenty-six patients with hand infections caused by drug injection were seen at Detroit General Hospital between 1974 and 1976 and were followed up. The duration of drug abuse was 2 to 25 years. The time before the patient sought medical help ranged from three days to 20 weeks. Among the 26 patients were three webspace infections, three finger abscesses, four gangrene of distal phalanx, nine cellulitis and abscess, one ulceration of the thenar eminence, and two ulcerations of the volar aspect. Follow-up was difficult due to unreliability of drug addicts.