Ewing's sarcoma of the finger: report of two cases and literature review

Ewing's sarcoma of the finger is extremely rare. Pain and swelling of the affected finger are the most frequent presenting features. We report two cases of Ewing's sarcoma located at ring finger and the thumb in two children aged 14 and 10 years. The first patient died of generalised metastases despite surgery, chemotherapy and radiation therapy. The second had no localised recurrence or metastases after surgery and chemotherapy at last follow-up of 4.5 years after tumour resection. The tumour's surgical accessibility, chemotherapy, and radiation therapy improve the prognosis of this tumour.

[An exceptional localization of an intraosseous haemangioma]

The intraosseous capillary haemangioma is classified as a benign vascular bone tumor. It is extremely rare in the hand. We present the case of a carpometacarpal capillary haemangioma involving the capitate and the bases of third and fourth metacarpals. To our knowledge it is the first case reported at this site.

[Macrocystic lymphatic lymphangioma (cystic lymphangioma) of the upper extremity: a case report]

We report on a case of macrocystic lymphatic malformation of the forearm. A male infant, without any medical history, was followed up in our department since the age of 7 months because of a subcutaneous, soft, painless mass of the left forearm. Ultrasonography and the magnetic reasonance imaging (MRI) were evocative of a macrocystic lymphatic malformation. Five sessions of sclerotherapy led to the reduction of the size of the mass but another axillary tumor appeared afterwards. A surgical excision, unfortunately incomplete, was performed rapidly followed by a recurrence of the macrocystic lymphatic malformation. Macrocystic lymphatic malformations are localized in the neck in 75% and axilla in 20% of the cases. Involvement of the upper extremity and particularly the forearm is very rare. MRI is useful for the diagnosis and the definition of tumor limits. The treatment is usually challenging because of their location and rough delimitation.

[Chondromyxoid fibroma. A case report of location in the phalanx of the thumb]

Chondromyxoid Fibroma is a rare benign osseous tumor especially in the hand, because the hand represents less than 3% of all osseous locations. It can causes problems of differential diagnosis with several types of tumors and in particular with chondrosarcoma, for which the management is totally different. We report a case of location of a chondromyxoid fibroma in a phalanx of the thumb, which caused problems of differential diagnosis with chondroma and chondrosarcoma. There were 2 recurrences after local excision. A wide resection with massive cancellous aotograft prevented further recurrence and the patient is disease free with a follow up of 7.5 years.

Les allongements digitaux par distraction progressive

The authors report their experience of digital lengthening and analyze the indications and results of 12 cases performed over 13 years in the plastic and reconstructive surgery service of the Kassab institute. Distraction was performed using a mini-orthofix device. In majority of cases, the procedure was performed on young people, manual workers and victims of industrial accidents. The lengthened osseous segment was the 1st metacarpal in 7 cases, the proximal phalanx of the index in 3 cases, the 3rd metacarpal once and the proximal phalanx of the middle finger in one case. Gradual distraction at the rate of 0.25 to 0.5 mm/day was carried out in 10 cases using the procedure of "callotasis". In 2 cases the distraction was performed at a rate of 1 mm/day followed by bone graft. Callotasis allowed us to obtain an average lengthening of 17 mm (61.5%) in distraction of the phalanx, and 26 mm (63.3%) in distraction of the first metacarpal. This technique avoids the spontaneous shortening observed after the use of bone graft alone. Complications are relatively frequent but had little influence on the final result.

[Halothane-induced hepatitis. 8 case reports]

Halothane (Fluothane) is a halogenic volatile anaesthetic used in therapeutic since 1956. His adverse effects are generally moderate with the exception of hepatitis that is usually severe and sometimes fatal. In our study, we analyze 8 cases of halothane-induced hepatitis, notified in the Centre National de Pharmacovigilance between 1994 and 1999 and validate according to B. Bégaud and collaborators method of imputability. It concerns 5 women and 3 men, aged between 26 and 65 years. The injury was cytolytic in 6 cases and cholestatic in the 2 others. It was fulminant in 3 cases of which 2 leaded to death. These injuries are usually graves, with an unforeseeable appearance and a hypothetical mechanism. In our opinion, a liver function control is necessary at the time of utilization of this drug.

[Trans-scaphoid perilunar carpal dislocations. Two stage treatment]

INTRODUCTION

In this study, the authors have described an original technique for the two-stage treatment of trans-scaphoid perilunar dislocation.

PATIENTS AND METHODS

In this study, the first step consisted of reducing the extent of the perilunar displacement, followed one month later by percutaneous pinning of the scaphoid as described by Galluccio. A series of 20 cases was treated in this manner, with positive results regarding scaphoid stabilization, joint mobility and the state of the median nerve.

CONCLUSION

The advantage of this technique is that it avoids emergency stabilization of the scaphoid, a procedure which may be complicated by accompanying carpal injuries.

[Foreign bodies in the hand]

The strange body at the hand level is frequent consultation pattern. Its extraction seems easy, however it's not. The authors reported one observation of the hand which is penetrated by a ig strange body. It's ablation is performed in a surgical room under anaesthesia, respecting the tension lines at the hand level and avoiding the nerves ramification of the cubital nerve that was hung by the harpoon.

Infusion of propofol, sufentanil, or midazolam for sedation after aortic surgery: comparison of oxygen consumption and hemodynamic stability

We conducted a prospective, randomized study to compare quality of sedation, hemodynamic stability, and oxygen consumption of three different drugs for continuous i.v. sedation in the immediate postoperative period in patients scheduled for aortic surgery (propofol [n = 12], sufentanil [n = 12], or midazolam [n = 12]). After arrival in the recovery room, patients were randomized into one of the following groups: Group P (continuous infusion of propofol 2 mg x kg(-1) x h(-1)), Group S (continuous infusion of sufentanil 0.25 microg x kg(-1) x h(-1), with bolus doses of midazolam 2 mg to maintain sedation at 3-4 on the Ramsay scale), and Group M (continuous infusion of midazolam 0.07-0.15 microg x kg(-1) x h(-1) to maintain sedation at 3-4 on the Ramsay scale). The three drugs were associated with similar hemodynamic stability, incidence of myocardial ischemia, and comparable kinetics and mean values for VO2, but a significant higher number of peaks for VO2 in Group S during the period of rewarming. To obtain an appropriate Ramsay score, we needed to increase the rate of administration of the drug in Group P, and to decrease this rate in Group M. After the drugs were discontinued, Group P required mechanical ventilation for less time. In conclusion, propofol is as effective as sufentanil or midazolam in controlling increased VO2 postoperatively. The initial dose of 2 mg x kg(-1) x h(-1) had to be increased for most patients. In addition, propofol sedation is associated with a quicker recovery compared with midazolam and sufentanil.

IMPLICATIONS

A prospective, randomized comparison of propofol, sufentanil and midazolam infusions revealed similar effects on hemodynamics, oxygen consumption, and rate of myocardial ischemia after aortic surgery, although propofol was associated with a quicker recovery compared with midazolam and sufentanil.

[Inspiratory aid with facial masks during acute respiratory failure without hypercapnia]

This prospective study assessed, in 10 conscious patients without a history of chronic respiratory disease, the feasibility of mechanical pressure support ventilation with PEEP by face mask for the treatment of acute respiratory failure without hypercapnia. Pressure support level was determined to obtain a VT of 5 to 10 mL.kg-1 and a decrease of respiratory rate of more than 20%. FIO2 and PEEP levels were determined to obtain a SpO2 > 92% and a PaO2 > 70 mmHg. The efficiency of the technique was assessed through the time course of respiratory rate, PaO2, PaCO2 and SaO2. The technique was efficient in all patients and tracheal intubation was not required. During face mask ventilation, a significant decrease in respiratory rate and an increase in PaO2 and SaO2 were observed. Pressure support ventilation with PEEP by face mask is an efficient technique for the treatment of acute non hypercapnic respiratory failure in conscious and cooperative patients.

[Comparison of the effects of ketorolac and aspirin on hemostasis in the rabbit]

OBJECTIVE

Comparison of ketorolac with aspirin and placebo for the antithrombotic activity using the Folts' model of experimental arterial thrombosis and the perioperative blood loss.

STUDY DESIGN

Experimental randomized blinded study anaesthetized, tracheotomized and mechanically ventilated. Carotid blood flow variations were detected by a probe directly inserted around the artery and monitored by an electromagnetic flowmeter. A segment of the exposed carotid artery was de-endothelialized by gently squeezing the artery with a needle holder forceps, and an external constrictor was placed around it (stenosis 60%), to induce cyclic flow reductions (CFR). During 20 min, CFR rate was assessed. Animals were then randomized in 3 groups of 9: ketorolac (K) 1 mg.kg-1, aspirin (A) 10 mg.kg-1 or saline (S), injected intravenously (peripheral ear vein). After drug administration, CFR rate was assessed over 20 min, to determine the potential antithrombotic activity of the drug (curative phase). Thereafter, the opposite carotid artery was injured and stenosed and the occurrence of CFR was assessed over 20 min (preventive phase). The amount of blood loss of a xipho-pubic laparotomy with a spleen section was also measured 30 min after drug administration.

RESULTS

In all untreated animals, CFRs developed with a mean rate of 4 cycles/20 min. Aspirin completely abolished CFR during the curative phase in all rabbits, except in one. No effect was observed during this phase with ketorolac or saline. During the preventive phase, a partial inhibition of CFRs was induced by ketorolac and aspirin. Peri-operative bleeding was not increased significantly by ketorolac or aspirin. Postinjection bleeding-time did not differ between the three groups.

CONCLUSIONS

Ketorolac (1mg.kg-1) has not a strong antithrombotic activity. Ketorolac and aspirin do not increase peri-operative blood loss, and therefore do not seem to strongly interfere with haemostasis in the rabbit.

[Anatomo-clinical study of mycetomas]

The mycetomes of foot are rare in Tunisia, only 36 cases was reported. The authors report 10 cases of mycetomes, followed during 16 years, since 1976 to 1992 in dermatology department of Charles Nicolle hospital. This study describe the anatomo-clinical aspects of this rare affection of foot.