[Dorsal intra-articular end-phalangeal fractures]

In a retrospective clinical study, thirty-six patients with a dorsal intraarticular fracture of the DIP-joint were examined. The fracture can be classified according to the size of the dorsal fragment as a mallet finger or as an intraarticular fracture with the tendency for dislocation. Subcutaneous tendon ruptures with a small dorsal fragment respond well to conservative treatment. Intraarticular fractures should be treated surgically. Anatomical reduction and joint stability are the treatment aims. In 21 patients, tension band wiring was performed, in eight cases percutaneous treatment with the "Hakendraht" was carried out.

Immunophenotypic characteristics of monocytes in elderly subjects

Since ageing is accompanied by various alterations of the immune system, the aim of the present study was to investigate the effect of age on the expression of surface markers in peripheral blood monocytes. We studied 28 healthy young subjects and 28 elderly subjects fulfilling the criteria of the SENIEUR protocol. Peripheral blood mononuclear cells were isolated and the expression of various surface markers was analysed by double colour flow cytometry. The mean fluorescence intensity of the intercellular adhesion molecule- (CD54), CD29, CD45RO and CD32 was increased significantly in CD14+ cells of elderly people when compared with the young subjects. No significant differences were found in the expression of CD11a, CD11b, CD15, CD26, CD27, CD33, CD45RA, CD45RB, CD49d, HLA-DR and CD65. In summary, we demonstrated significant increase in four monocyte surface markers in subjects of old age; this finding may be related to certain immune phenomena observed in ageing subjects such as auto-immunity.

Marginal leakage in class II-restorations after use of ceramic-inserts luted with different materials

The efficiency of using prefabricated ceramic inlays to prevent microleakage has been discussed in different investigations. The purpose of this study was to evaluate the marginal microleakage of a new glass ceramic inlay system in combination with two different composite luting materials and one polyacid-modified composite, respectively. Standardized class II cavities (n = 60) were filled with (1) Empress inlays fixed with a highly viscous luting composite as a control group, and with glass ceramic inlays (Cerana) in combination with (2) a highly viscous luting composite, (3) a low-viscous luting composite and (4) a polyacid-modified composite, respectively. After thermocycling the marginal quality was analysed with scanning electron microscopy, and the dye penetration along the cavity walls was measured. The use of the Cerana inlays with a polyacid-modified composite resin did not reveal a good marginal adaptation. However, the combination of the Cerana and the Empress inlays with the highly viscous composite exhibited a comparable marginal fit. Within the limitations of an in vitro study it is concluded that the combination of the new glass ceramic inlays with a polyacid-modified composite cannot be recommended for clinical use.

[Palmar and dorsal nail anlage of the small finger. A case report]

A congenital malformation of a 18-month-old boy is presented. Palmar and dorsal surface of the small finger presented a complete nail. Active flexion of the PIP and DIP joints was not possible. The small finger displayed typical dorsal skin both dorsally and palmarly. Flexion creases were absent. The palmar nail was removed, and the defect was covered by a cross-finger flap.

[Replantation. Indications and organization]

Although experience in replantation surgery increased during the past 30 years, there are still problems remaining. Refinement of microsurgical operations and improvement in rehabilitation technique have lead to superior functional results. Beside clear indications as thumb loss or replantation in children there are only few absolute contraindications. A retrospective analysis of more than 300 replantation showed that there are still problems concerning exhaustive supply of replantation centres. Because time is one of the many critical components of successful preplantation improvements are necessary in extra- and intrahospital organization of replantation surgery.

[Surgical therapy of camptodactyly]

Camptodactyly is caused by an imbalance between the flexor and extensor forces at the proximal interphalangeal joint of the fingers. Although the etiology is not completely clear, the lumbrical muscle anomalies seem to play an important part in the pathogenesis of camptodactyly. The insertion of this intrinsic muscle often differs greatly from that described in anatomical textbooks. In our series, we transposed the lumbrical muscle and the superficial flexor tendon to the extensor tendon creating a better balance between extensor and flexor forces. Additionally, we performed skin-lengthening procedures and, if necessary, an arthrolysis of the proximal interphalangeal joint. In this study, we present a new classification of preoperative guidelines to ameliorate the operative treatment of camptodactyly.

[Post-traumatic carpal collapse (SLAC- and SNAC-wrist)--stage classification and therapeutic possibilities]

Longstanding scaphoid nonunion or scapholunate ligament injuries can lead to carpal collapse. SLAC-wrist (scapholunate advanced collapse) following scapholunate dissociation and SNAC-wrist (scaphoid nonunion advanced collapse) after missed fusion of scaphoid fracture should be differentiated. Severity of degenerative changes is classified by three stages. In stage I where arthrosis is limited to the radial styloid reconstructive procedures of the scaphoid or scapholunate ligament are the treatment of choice. In stage II including arthrosis of the radioscaphoid joint and stage III with additional arthrosis in the midcarpal joint these procedures are excluded. Salvage procedures preserving wrist mobility like midcarpal fusion or proximal row carpectomy are preferable to total wrist fusion which represents the last line of defence.

The classification of benign and malignant human prostate tissue by multivariate analysis of 1H magnetic resonance spectra

1H magnetic resonance spectroscopy studies (360 MHz) were performed on specimens of benign (n = 66) and malignant (n = 21) human prostate tissue from 50 patients, and the spectral data were subjected to multivariate analysis, specifically linear-discriminant analysis. On the basis of histopathological assessments, an overall classification accuracy of 96.6% was achieved, with a sensitivity of 100% and a specificity of 95.5% in classifying benign prostatic hyperplasia from prostatic cancer. Resonances due to citrate, glutamate, and taurine were among the six spectral subregions identified by our algorithm as having diagnostic potential. Significantly higher levels of citrate were observed in glandular than in stromal benign prostatic hyperplasia (P < 0.05). This method shows excellent promise for the possibility of in vivo assessment of prostate tissue by magnetic resonance.

Tendon transfers in radial nerve palsy

Radial nerve palsy results in a lack of extrinsic extensors of the wrist, fingers and thumb. The degree of dysfunction depends on the level of trauma to the radial nerve. If the wrist is not stable there is a loss of prehensile grip. Patients have great difficulty picking up large or heavy objects. In high radial nerve palsy the loss of triceps function can cause additional problems. Based on our knowledge of anatomy and biomechanics, radial nerve function can be restored sufficiently. The indications, preoperative planning, technique of transposition and postoperative managment are explained.

[Replacement operations in radial paralysis]

Radial nerve palsy results in a lack of extrinsic extensors of the wrist, fingers and thumb. The degree of dysfunction depends on the level of trauma to the radial nerve. If the wrist is not stable there is a loss of prehensile grip. Patients have great difficulty picking up large or heavy objects. In high radial nerve palsy the loss of triceps function can cause additional problems. Based on our knowledge of anatomy and biomechanics, radial nerve function can be restored sufficiently. The indications, preoperative planning, technique of transposition and postoperative management are explained.

Entamoeba histolytica and Entamoeba dispar infection in children in Bangladesh

The prevalence of infection by the invasive parasite Entamoeba histolytica and the noninvasive parasite Entamoeba dispar was determined in 2000 children in Bangladesh. Antigen detection identified more cases of E. histolytica-E. dispar infection than did culture or microscopy. Microscopic identification of E. histolytica-E. dispar complex infection in stool did not equate with the diagnosis of amebic dysentery because most amebic infections in this population were due to E. dispar: Urban children with diarrhea had a 4.2% prevalence of E. histolytica infection and a 6.5% prevalence of E. dispar infection; rural asymptomatic children had a 1.0% prevalence of E. histolytica infection and a 7.0% prevalence of E. dispar infection. Shigella dysenteriae and Shigella flexneri infections were more frequent in children who also had Entamoeba infection, a potentially important consideration for the empiric treatment of dysentery in this population.

[Coincidence of primary sclerosing cholangitis and sarcoidosis--case report and review of the literature]

Primary sclerosing cholangitis (PSC) and sarcoidosis are diseases of unknown etiology which are rarely associated. Here we report the case of a 31-year-old man with PSC and pulmonary sarcoidosis. In addition, we include a brief review on PSC and sarcoidosis, in particular with respect to etiopathogenesis and diagnosis.

Explosion injuries of the hand. Spatial relationship and injury pattern

Twenty-six hands in 25 male patients were treated for peace-time explosion injuries of the palmar aspect. All patients were examined after a mean interval of 7 (1-17) years. In order to establish a regional pattern for each injury the palmar surface of the hand was divided in 21 fields. For each field a score depending on the extent of injury was calculated. Comparing this regional score with the spatial relation between hand and exploding object resulted in six typical patterns depending on the grip during explosion. With knowledge of the three-dimensional relation between the hand and exploding object, the hand surgeon is prepared for potential problems during operation.

[Flexor pulleys of the fingers. Anatomy, biomechanics, reconstruction]

Primary or secondary flexor tendon surgery occasionally leads to damaged flexor pulleys. Insufficient pulley reconstruction causes loss of finger function by bow stringing of the flexor tendon. This paper reviews the anatomy and biomechanics of the flexor pulley system. Different techniques of reconstruction are discussed.

[Outcome of flexor tenolysis after injury in zone 2]

Tenolysis of flexor tendons was performed in 48 fingers of 36 patients. After a mean follow-up to ten months, the total active movement (TAM) was improved from 79 degrees preoperative to 189 degrees postoperative in 84% of the fingers with a minimal improvement of 40 degrees. Following the classification of Buck-Gramcko, 80% (38) of the fingers showed an excellent, good, or fair result. In addition, the influence of nine factors (associated injuries or procedures) on the outcome was investigated. These results showed that there is a decrease in improvement when severity of trauma increases. Arthrolysis of PIP-joint showed no negative influence on the results. We are not able to establish a predictive score for flexor tenolysis from our results.

[Communication in hand surgery]

Computer-aided communication provides us with an easy way of exchanging different messages. Personal data (E-Mail) can be transferred as easy as pictures. News-groups would be intended to act as a forum where many people could interact and share information on issues related to the practice and the advancement of hand surgery. This paper explains the technique and the advantage of electronic communication. Using already existing computer-networks will enable us to start communication at once.

Does an ulnar nerve lesion influence the motion of the index finger?

Clawing of the ring and little fingers and "rolling" during prehension grip are well-known clinical phenomena of ulnar nerve lesions. In contrast to this the index and middle fingers seem to move normally. We compared the movement of right index fingers in healthy people with the right index fingers of people with an ulnar nerve lesion. The movement was measured using a three-dimensional real time motion analysis system based on ultrasound. The angles of the joints were plotted in a rectangular coordinate system. Statistical analysis of the numerical data showed no difference between the two groups. We trained a neural-network (Learning Vector Quantization) with the data of both groups. The network was able to distinguish between people with and without lesions of the ulnar nerve. We conclude that prehension grip of the index finger is also influenced by paralysis of the ulnar nerve.

Long-term outcome of radical radiation therapy for prostatic carcinoma: 1967-1987

PURPOSE

This study was done to review long-term results of radical radiotherapy for prostate cancer.

METHODS AND MATERIALS

The records of 674 patients with Stage T1a, T1b, T2a, T2b, T3, and any T,N1,M0 disease, treated with external beam radiotherapy between January 1, 1967 and December 1987, were reviewed. These patients were treated to an average total dose of 66 Gy, with an average fractional dose of 2.05 Gy, using megavoltage. The duration of follow-up for surviving patients ranged from a minimum of 7 years to more than 20 years.

RESULTS

The survival for 151 Stage T1a,T1b patients was 98.5% at 5 years, 93.6% at 10 years, and 75.2% at 15 years. Survival for 346 Stage T2a,b patients was 94.4% at 5 years, 67.9% at 10 years, and 41.5% at 15 years. Survival for 92 Stage T3 patients was 87.3% at 5 years, 54% at 10 years, and 26.6% at 15 years. The survival for 85 any T,N1,M0 patients was 73.9% at 5 years, 34.4% at 10 years, and 8.5% at 15 years. At 15 years, 75.2% of Stage T1a,b patients, 41.5% of Stage T2a,b patients, 21.7% of Stage T3 patients, and 8.5% of Stage T,N1,M0 patients remained free of local recurrence and distant metastases. The elevation of prostatic acid phosphatase prior to radiotherapy was an unfavorable prognostic factor, with impact on both loco-regional recurrences and survival.

CONCLUSIONS

The external beam radiotherapy for localized carcinoma of the prostate produced a good loco-regional control, NED, and overall survival. Patients with smaller tumors and low grade fared better than the ones with more aggressive and/or bulky tumors. The weakness of this study is the absence of serial prostate-specific measurements, which were not available during the period under study. The complication rate requiring surgical intervention was low, i.e. 0.4%.

Quantitative analysis of the linkage between the interphalangeal joints of the index finger. An in vivo study

We have established a simple method of measuring joint motion under physiological conditions. For this purpose we use an ultrasound measuring system employing marker points consisting of miniaturized ultrasound transmitters. This device was tested on a simple biomechanical model, the linkage of the proximal and distal interphalangeal joints. The angles of these joints were recorded during opening and closing of the fist in 34 index fingers of 17 healthy persons. The results of the measurements were plotted on a rectangular coordinate system. Analysis showed an approximately linear linkage between the IP joints of the index finger. The curve for extension was the same as that for flexion. The linkage varies greatly. On average 1 degree of PIP joint flexion is equivalent to 0.76 degree of DIP joint flexion. Our study showed no significant difference between the dominant and non-dominant hand. The results showed that there is a linear linkage between the proximal and distal interphalangeal joints, which is equal for flexion and extension.

Rapid diagnosis of Entamoeba infection by using Entamoeba and Entamoeba histolytica stool antigen detection kits

Humans are infected by two morphologically identical species of Entamoeba: Entamoeba histolytica causes amebic colitis and liver abscess, and Entamoeba dispar is noninvasive. Several weeks of culture and isoenzyme (zymodeme) analysis are required to differentiate E. histolytica from E. dispar. Here we report a field trial of commercial antigen detection kits designed to rapidly detect and differentiate E. histolytica from E. dispar in stool specimens. Stool specimens from 202 patients with diarrhea were examined for E. histolytica and E. dispar by microscopy, culture, and antigen detection. Compared with culture, microscopic identification of the E. histolytica-E. dispar complex was 60% sensitive and 79% specific, while the screening antigen detection test for the E. histolytica-E. dispar complex was 80% sensitive and 99% specific. Differentiation of E. dispar from E. histolytica by the E. histolytica-specific test was 95% sensitive and 93% specific compared with zymodeme analysis. We conclude that the antigen detection test for the E. histolytica-E. dispar complex is more sensitive and specific than microscopy and that the E. histolytica-specific antigen detection test is as reliable and much more rapid than zymodeme analysis for the differentiation of E. histolytica from E. dispar.

Free gracilis muscle transplantation for hand reconstruction

Free muscle transplantation with motor innervation is the only way to add contractile elements to upper extremities with extensive loss of musculature due to direct trauma or untreated compartment syndrome (Volkmann's contracture). The functional cross-sectional area and the mean resting fiber length determine the maximum power and the contracting amplitude of the donor muscle, respectively. Although considerably weaker than the finger flexors to be replaced, the gracilis muscle was the preferred donor muscle because of the consistent anatomy of its neurovascular pedicle and the minimal donor site morbidity. In a series of 15 gracilis transplantations, all 13 muscles that survived regained function. Finger motion was dependent on the preoperative condition of tendons and joints. Even after complete loss of the flexor and extensor compartment after direct trauma or infection, a useful upper extremity could be restored, which was preferable to the only alternative--amputation.

Congenital unilateral muscle hyperplasia of the hand with ulnar deviation of the fingers

Three cases of congenital unilateral muscular hyperplasia of the hand combined with ulnar deviation of the fingers are presented. In all three patients the deformity was confined to the right upper extremity, and there were no other associated congenital malformations. All patients displayed anomalous or hyperplastic musculature acting on the proximal phalanges of the fingers, contributing to the associated ulnar drift of the hand. This condition is previously unreported, and is a different entity from the previously described "windblown hand".

Leukemia in patients with breast cancer following adjuvant chemotherapy and/or postoperative radiation therapy

We investigated the possible etiological role of adjuvant chemotherapy and postoperative radiation therapy in the development of leukemia. A case-control design with four controls matched to each case of leukemia from a cohort of women who had been treated for breast cancer during the years from 1970 to 1985 was used. Thirteen (0.23%) of the women in this cohort developed leukemia over varying lengths of follow-up time, ranging from 3 to 14 years. A higher percentage of the leukemia cases previously had adjuvant chemotherapy compared to their matched controls (54% versus 13%). The relative odds estimate of developing leukemia after chemotherapy compared to no chemotherapy was 14.8 (95% C.I. (1.8; 125.3) p < 0.01). This estimate and the test of statistical significance was based on the likelihood function for matched sets with one case and more than one control. Approximately the same percentage of leukemia cases as their controls had received postoperative regional radiation therapy (28% versus 23%). No significant association was found between postoperative radiation therapy and development of leukemia. A combination of adjuvant chemotherapy and postoperative radiation therapy was found more frequently in the leukemia cases than in their matched controls (33% versus 9%). The leukemia developing in patients having received adjuvant chemotherapy was frequently therapy resistant, resulting in a short survival.

Ontogeny of acyl-CoA: cholesterol acyltransferase in rat liver, intestine, and adipose tissue

The development of acyl-coenzyme A: cholesterol acyltransferase (ACAT), was determined in the rat liver, intestine, and white (WAT) and brown adipose tissue (BAT). Animal studies have shown that dietary manipulation of cholesterol metabolism during an animal's early development can have persistent and permanent effects. Therefore it is important that the ontogeny of ACAT, one of the key enzymes in cholesterol metabolism, be clearly established. White Wistar rats were killed on day 21 of gestation, at birth, and on postnatal days 10, 14, 18, 21, 22, 25, 30, and 60. The tissues were rapidly excised, microsomes were prepared, and the activity of ACAT was measured as the rate of incorporation of [1-14C]oleoyl coenzyme A into cholesterol esters. Age-specific changes were observed in three of the four tissues investigated. Rat liver and intestine possess significant amounts of ACAT activity throughout development with marked variations in activity during this time. ACAT activity in BAT is low and variable throughout development with the exception of high activity noted in the adult animal. WAT contained little or no ACAT activity during development.