Proximal toe phalanx transplantation for bony stabilization and lengthening of partially aplastic digits

In congenital malformations the lengthening of partially aplastic digits, by on-top plasty of a bone graft or the bony stabilization of finger stumps consisting of soft tissues without skeletal elements, is extremely difficult. The usual bone graft, taken from the iliac crest or the fibula, will undergo resorption and will have disappeared a few months postoperatively. Experience has shown that the proximal toe phalanx will with-stand any resorption if it is taken whole, covered by its periosteum. Another advantage is the possibility of the construction of a new joint between the metatarsophalangeal articular surface of the toe phalanx and the distal end of the recipient bone in the hand, which is usually covered by cartilage. Flexor and extensor tendons exist in most cases. Between 1976 and 1988, 69 transplantations of proximal toe phalanges were performed in 43 children. The indications were: boneless digital stumps or partial absence of digits in symbrachydactyly and ring constriction syndrome. Follow-up examinations of 40 patients with 63 transplanted phalanges at an interval of 36 months (12 to 160 months) has shown a 100% take of the bone graft provided it had not been split and the periosteum was undamaged. The earlier in life the operation was performed, the more postoperative growth was recorded. A joint construction was attempted in 46 digits with variable results; active mobility ranged from 0 degrees to 90 degrees. With the use of a tendon interposition, there is a less degree of shortening of the toes.

Axillary-subclavian venous thrombosis

From 1974 through 1984 six patients with axillary-subclavian venous thrombosis were studied and treated. This disorder represents 1% of the various types of venous thrombosis reported in the literature. Symptoms appeared following effort in four patients, while a cervical rib and a scar bridle after radical mastectomy were identified as the underlying cause in two patients. Ages ranged from 17 to 59 years, with a mean age of 33 and equal sex distribution. None of the six patients had blood clotting defects. The diagnosis was based on clinical evaluation and was confirmed by phlebography. There was edema and functional impairment of the arm in all cases. Pain and venous prominence was found in 83%, rubor of the extremity in 66%, local hyperthermia in 50%, and arterial compression in 33%. Five patients were treated with anticoagulants and bed rest. Surgery was performed in two patients with thoracic outlet syndrome. First rib resection with scalenotomy was performed in one case and cervical rib resection with scalenotomy in the other. After a mean follow-up of 13 months, the results were good in four and average in two patients.

[Biotyping and resistotyping for epidemiological tracing of the fecal origin of Klebsiella pneumoniae in urinary infections]

Twenty-four (82.7%) out of 29 patients suffering from hospital acquired urinary infections by Klebsiella pneumoniae had the same species in their faeces. Biotyping of 24 urinary and 219 fecal strains of K. pneumoniae resulted in 50 different biotypes - an average of four biotypes per fecal sample. Ten patients (34.4%) had the same biotype in urine and faeces without any correlation with previous vesical catheterization (p greater than 0.05). Using resistotyping to four chemical compounds selected among 34 tested substances (brilliant green, malachite green, potassium tellurite and mercuric chloride) 16 different resistotypes were found. Fourteen patients (58.3%) presented the same resistotype in urine and faeces but only in five patients was there correlation with simultaneous biotyping identity. Simultaneous occurrence of identical biotypes or resistotypes in faeces and urine occurred in only 54.2% of cases. However, there was a significant association between resistance ot mercuric and tellurite ions in fecal and urinary strains isolated from the same patient (p less than 0.001).