Thermographic observations in unilateral carpal tunnel syndrome: report of 61 cases

This study was undertaken to assess the sensitivity and specificity of thermographic diagnosis of unilateral carpal tunnel syndrome in a patient population large enough to permit meaningful statistical analysis. Sixty-one persons with clinical diagnoses of unilateral carpal tunnel syndrome confirmed by electrodiagnostic examination and 40 symptom-free volunteers underwent standard thermographic examinations. The thermographic images were then randomly sorted and interpreted by an experienced physician thermographer. Fifty-seven of the 61 patients with carpal tunnel syndrome were found to have thermographic abnormalities, while only one of the control group was found to have such an abnormality. Individual area sensitivity was highest in the dorsal area, but addition of other regions increased this measure; specificity ranged between 98% and 100%. These findings would appear to confirm the value of thermography in the diagnosis of unilateral carpal tunnel syndrome.

Clinical trial in adults of an antimicrobial varnish for reducing mutans streptococci

An abbreviated treatment with a chlorhexidine-containing varnish was compared with a similar treatment with a placebo varnish and with a prophylaxis alone for its effects on the numbers of detectable salivary mutants streptococci in 51 adults. The varnishes, applied once weekly for four weeks, were held in place with a covering layer of either of two polyurethane sealants (FluorProtector or Adhesit). On the first appointment, the varnish-sealant combination was applied to all tooth surfaces, but on succeeding appointments only the occlusal and approximal surfaces were covered. The chlorhexidine varnish, covered with either sealant, reduced the salivary mutans streptococci by an average of 3 logs (99.9%) in all of the 20 subjects treated, and below detectable levels for at least four weeks in nine of them. In the groups receiving placebo varnish-sealant combinations, the mean log number of mutans streptococci of the subjects was reduced only by approximately 0.5 log (32%), and none of the subjects experienced loss of their detectable mutans streptococci for four weeks, although one subject did so for three weeks. No significant difference between the effects of the two polyurethane sealants was observed. Treatment with a single prophylaxis had no effect on mutans streptococcus levels. Subjects treated with chlorhexidine varnish also experienced an increase in S. sanguis and a small decrease in yeasts. Loss of detectable mutans streptococci did not cause changes in the numbers of other micro-organisms examined, beyond those observed with chlorhexidine varnish treatment alone.

Trichorhinophalangeal syndrome

Trichorhinophalangeal syndrome type 1 is an autosomal dominant variety of peripheral dysostosis. I have reviewed nine cases of this syndrome and have described two of these cases. I have also presented an extensive review of the literature.

Immediate closure of traumatic upper arm and forearm injuries with the latissimus dorsi island myocutaneous pedicle flap

This paper reports the authors' experience with latissimus dorsi island pedicle flaps in the acute treatment of massive arm injuries. Seven patients with upper arm injuries and four patients with forearm injuries were treated with latissimus dorsi pedicle flaps. All cases involved massive soft-tissue loss and open fractures. Primary healing of wounds occurred without complications in 10 of 11 patients; the eleventh developed a wound infection. There were no instances of flap loss or vascular complications. This report compares and discusses surgical management options and details the importance of robust, immediate soft-tissue coverage for optimal functional recovery. Contrary to traditional thought, delay in definitive wound closure may be unnecessary when aggressive debridement is followed by acute flap closure.

Brachydactyly in acrosyndactyly

Metacarpal and phalangeal length were determined in thirty-five patients with constriction band syndrome and acrosyndactyly. Shortening of the remaining phalanges is a consistent component of acrosyndactyly and gives additional functional disability.

Incidence of brachydactyly and hand exostosis in hereditary multiple exostosis

Forty-two radiographs and charts of twenty-two patients with a diagnosis of hereditary multiple exostosis and hand involvement were examined to determine the incidence of hand exostoses and association with brachydactyly. An average of 11.6 exostoses were found per hand. The proximal phalanges and metacarpals are affected in the majority of patients and the thumb and distal phalanges are rarely involved. Most exostoses were located in the juxtaepiphyseal region (61.8%) and typically involved less than 50% of the bone diameter. Brachydactyly can be seen in patients with hereditary multiple exostosis when no exostoses is present; however, the presence of an exostosis results in even more shortening. The location and size of the exostosis had no relationship to increased bone shortening. Operative treatment was required in four of twenty-two patients for debulking and impingement.

Tennis elbow

The term "tennis elbow" has been used in the medical literature for over 100 years to describe a variety of conditions on the lateral aspect of the elbow. Recent writers seem to agree that the two most common causes for this condition, which may be either distinct or coexisting, are lateral epicondylitis and radial tunnel syndrome. Lateral epicondylitis is not limited to tennis players; 95% of the reported cases occur in non-players. The presenting symptoms are pain over the origin of the extensor carpi radialis brevis and weakness in the wrist and digital extensors. The location of maximal tenderness differentiates lateral epicondylitis from other conditions. A variety of treatments has been suggested, but the most successful is conservative treatment with rest, restriction of lifting with the palms down, anti-inflammatories and local applications of ice. Once the acute inflammatory phase has passed, a flexibility and strengthening program is recommended. Steroid injection may be utilized at this stage if the discomfort has not been reduced. In a small percentage of cases, surgery may be required.

Epidural Peg Electrodes for the Presurgical Evaluation of Intractable Epilepsy

A new electrode design for the extradural recording of electrical brain activity is described. Epidural peg electrodes are implantable mushroom-shaped composites of Silastic clastomer and a stainless steel or platinum disc. These electrodes are useful for the preoperative mapping of seizure foci in some patients who have cranial defects or severe muscle artifacts on scalp recordings. They are also used for canvassing wide areas of cortex to determine whether a seizure is focal in origin, arises diffusely from a hemisphere, or has a bilateral origin. Advantages of epidural peg electrodes over screw and other types of epidural electrodes include low risk of infection or hemorrhage and improved patient comfort.

Epidural peg electrodes for the presurgical evaluation of intractable epilepsy

A new electrode design for the extradural recording of electrical brain activity is described. Epidural peg electrodes are implantable mushroom-shaped composites of Silastic elastomer and a stainless steel or platinum disc. These electrodes are useful for the preoperative mapping of seizure foci in some patients who have cranial defects or severe muscle artifacts on scalp recordings. They are also used for canvassing wide areas of cortex to determine whether a seizure is focal in origin, arises diffusely from a hemisphere, or has a bilateral origin. Advantages of epidural peg electrodes over screw and other types of epidural electrodes include low risk of infection or hemorrhage and improved patient comfort.

Immediate reconstruction of bone and skin defects of the humerus with free fibular graft and muscle flap

The following Case Report describes the immediate reconstruction of bone and skin defects of the humerus with a free fibular graft and muscle flap. A 33-year-old white female sustained a gunshot wound to the left upper extremity with a 3.08 caliber high-powered rifle. The entry wound was on the lateral aspect of her mid-arm. The exit wound on the anteromedial aspect of the upper extremity measured approximately 10 x 15 cm. A segmental loss of the middle of the humerus and a defect of the radial nerve were noted. Within 48 hours after injury, reconstructive surgery was begun. A free vascularized fibula graft, peroneal artery, and concomitant vein were harvested from the left lower extremity, prepared, and inserted "peg in hole" fashion between the humerus fragments. The proximal segment was inserted between two fracture fragments, and the two fragments, including the proximal fibula, were transfixed with a single screw. The graft was revascularized with end-to-side anastomosis of the peroneal vessels to the brachial artery and its concomitant vein. The entire reconstruction was then covered with rotation of the latissimus dorsi muscle flap and a split-thickness skin graft. All wounds and the donor site healed primarily. Post-operative orthopaedic management consisted of maintenance of the external fixator for three months. Postoperative x-rays at 5 months showed healing at both ends of the fibular graft. A history of free fibula transfers and a discussion of the importance of aggressive, early, bony reconstruction using the free vascularized fibula graft are presented.

Anatomic variations of the midcarpal joint

Two distinct anatomic variations in the human midcarpal joint have been identified. In type I the triquetrohamate joint is on a smooth oblique plane with the capitolunate joint. In type 2 the triquetrohamate joint is separated from the capitolunate joint by a concave transition facet on the hamate and lunate. Degenerative change occurring at the proximal pole of the hamate and the opposing transition facet on the lunate have been identified as characteristic of both a type 2 joint and lunotriquetral interosseous ligament tears.

EEG mapping for surgery of epilepsy

This report describes the objectives, problems, and current techniques associated with using EEG maps in the management of surgery of epilepsy. The purpose of EEG mapping in epilepsy is to precisely identify and characterize epileptogenic zones of the brain. Such zones may be single or multiple, pointlike or diffuse, and may be near or distant from the recording electrodes. The resulting measured electric fields are used to obtain information which, when analyzed in light of all the complementary clinical information, can frequently help to localize and describe the epileptic foci with more precision.

A new method of determining patellar position

A new ratio has been devised which allows direct measurement of the position of the patella in relationship to the femur. The range of normal values is from 0.56 to 0.76.

Dental caries

Dental caries is one of the most prevalent diseases afflicting mankind. It reached a peak in the 1950s but has been declining drastically in recent years in children and young adults. This article describes the three contributing factors in dental caries: microbial plaque, tooth susceptibility, and diet, and discusses practical preventive measures which help to reduce caries incidence. Some of these, such as vaccines and antimicrobial varnishes, are still in the research stages, while others, such as sucrose substitutes, low-calorie sweeteners, and limitation of frequency of sugar snacks are well established and can be promoted by family physicians.

Hypertrophic ulnar styloid nonunions

Eleven patients with chronic pain on the ulnar side of the wrist and roentgenographic evidence of a hypertrophic ulnar styloid nonunion were treated with subperiosteal excision of the nonunion fragment. This procedure relieved the localized pain without changing either radiocarpal or distal radioulnar joint stability.

Effects of cheese extract and its fractions on enamel demineralization in vitro and in vivo in humans

In order to isolate and identify the most active anti-cariogenic components(s) of aqueous cheese extract (CE), we separated it into low (LMW) (MW less than 500), medium (MMW) (500 less than MW less than 10,000), and high (HMW) (MW greater than 10,000) molecular weight fractions by means of the Amicon ultrafiltration system. These fractions were then tested in vitro with a bacterial system containing S. mutans, adapted from that of Turtola (1977). The LMW fraction reduced the demineralization caused by the fermentation of sucrose by 96% (p less than 0.001) as compared with the water control; this was not significantly different from a 50% concentration of the CE. The MMW and HMW fractions reduced demineralization by 36 and 42%, respectively. The concentrations of acid-soluble calcium and phosphorus in CE, LMW, MMW, and HMW were 1509 and 462, 991 and 310, 231 and 7, and 162 and 3 micrograms/mL, respectively. A solution containing the same levels of calcium and phosphorus as CE was somewhat more effective in reducing demineralization in vitro than was CE itself (p less than 0.01). In vivo, the addition of these same calcium and phosphorus levels to a 10% sucrose solution reduced its cariogenicity by 67% (p less than 0.001), as judged by the intra-oral cariogenicity test (ICT). Plaque calcium and phosphorus concentrations were significantly higher in the ICT plaque samples subjected to the sucrose-Ca,P solution (p less than 0.01) than in the sucrose control. The resting pH, minimum pH, and shape of the pH curves produced by the sucrose control and sucrose-Ca,P were similar.(ABSTRACT TRUNCATED AT 250 WORDS)