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A 76-year-old woman developed a slowly growing lesion over the right index and the adjacent part of the metacarpus. A cell proliferation filling up the skin veins was classified as intravascular endothelioma. This rather rare oncological entity with a good prognosis should be differentiated from peculiar pattern occasionally seen in organisation of thrombi as well as malignant endothelial tumours.
The authors review the past five year's case history covering the humeral arteriographies carried out for the purpose of studying the vascularization of the hand in patients presenting Raynaud-like symptomatology. It is pointed out that in the majority of cases digital arteries show significant lesions and that a certain percentage of these are accompanied by haemodynamically significant alterations of the peripheral part of arteries of the forearm and of the metacarpus. Deep general narcosis is fundamental for a correct interpretation of the angiographies. Within the cases recorded the clinical data are a concomitant of arterious lesions typical of Raynaud's disease.
The treatment of very serious crush injuries of the metacarpus is reported in three examples. It is recommended that in such injuries reconstruction of all damaged structures should not be performed in the first operation. The most important step beside the stabilisation of the skeleton is microsurgical revascularisation.. The reconstruction of nerves and tendons should be limited during the primary operation. Secondary reconstruction then has a lower risk and gives a good functional result. In such trauma the use of distant flaps for the reconstruction of large soft tissue defects seems more advantageous than the transplantation of free flaps by microvascular anastomoses.
Serial sections of bone and soft tissue from the metacarpophalangeal joints of 2 mature and 2 immature horses were evaluated for substance P immunoreactive sensory nerve fibers. Formalin-fixed specimens were sectioned, either nondemineralized or demineralized with formic acid or EDTA. Rabbit antiserum to substance P (SP) was used in the streptavidin-biotin-peroxidase complex method for immunolocalization of SP antigen, and staining with 3,3'-diaminobenzidine was used for permanent identification of SP fibers. Abundant sensory nerve fibers were identified in the joint capsule, synovial membrane subintimal layers, collateral ligaments, suspensory ligament and distal sesamoidean ligament attachments to the sesamoid bones, and the periarticular periosteal layers. Sparse SP-immunoreactive nerve fibers were found in subchondral bone plates of the metacarpus, proximal first phalanx, and dorsal articular surface of the sesamoid bones. Most SP fibers were associated with blood vessels in the small cancellous spaces and haversian canals of the subchondral bone. The deeper marrow spaces contained increased numbers of SP sensory fibers; a few appeared in small groups and as several SP-immunoreactive fibers in a larger nerve. Cortical bone contained only a few SP fibers in the haversian canals. Substance P fibers were not identified in the osteocytic lacunae, canaliculi, or the bony lamellae of the haversian systems of the subchondral bone plate, and its extension to the metaphyseal and diaphyseal cortical bone. Equine metacarpophalangeal joint soft tissues have an abundant sensory nerve supply, similar to that of other species.(ABSTRACT TRUNCATED AT 250 WORDS)
The early diagnosis and treatment of osteoporosis is considered to be important for the prevention of fractures which often cause elderly to become bed-ridden. Computed X-ray densitometry (CXD), a method to measure bone mineral content in the metacarpus II utilizing a simple X-ray image, has been used for mass-screening of osteoporosis, because of its utility and reliability. However, due to its requiring adequate X-ray equipment, this method is often unsuitable for use in small facilities in a remote mountain areas. The use of CXD for osteoporosis screening, was attempted in a mobile unit for tuberculosis screening, by our public health center. The results showed that it is possible to use CXD in combination with a mobile unit, correcting the obtained values according to the radiographic conditions. With this set-up, CXD was used for mass-screening of osteoporosis in a total of 1150 subjects living in mountainous areas of Yoshino-gun, Nara prefecture, and CXD was found to be convenient and effective for mass-screening. The use of CXD in a mobile chest X-ray unit can be expected to be useful for mass-screening of osteoporosis especially in remote mountainous areas having inadequate X-ray equipment.
The usefulness of the quantitative measurement of vibration perception threshold (VPT) was assessed by a biothesiometer in the diagnosis of peripheral neuropathy in 36 patients with type I diabetes mellitus. The study included: a) clinical assessment (history and neurological examination); b) measurement of VPT at right metatarsus, right pretibial area and right metacarpus; c) electromiographical study (right peroneal, posterior tibial, right sural, right medial plantar); d) assessment of the autonomous nervous system (sympathetic and parasympathetic indexes); e) metabolic assessment (HbA1c at study and mean HbA1c in the previous year). The prevalence of peripheral neuropathy was 38%. VPT at metatarsal region in diabetic patients was higher than in controls (p < 0.05) and a positive correlation with evolution time of disease at metatarsal region (p < 0.05) and tibia (p < 0.05) was observed. Clinical symptoms and changes at examination correlated with VPT at metatarsus (p < 0.05) and tibia (p < 0.05). No relationship was observed between VPT and metabolic control. In conclusion, vibration threshold increases with evolution time in diabetes, but it was not influenced by metabolic control. Its measurement by a simple method, such as biothesiometer, could be useful in diagnosing peripheral neuropathy in clinically asymptomatic patients.
The principles of microdensitometry (MD) and digital image processing method (DIP), as well as the application of these methods to measure bone mineral density in clinical practice, were mentioned in the report. MD and DIP assess bone mineral content and bone mineral density by analyzing relative contrast of the metacarpus II on X-ray image. However, the parameters obtained by these methods have been reported to be closely related to lumber vertebral bone mineral density and whole-body bone mineral content as measured by dual energy X-ray absorptiometry (DXA). Being easy to use, MD and DIP are adequate for the screening of osteoporosis. Once any reduction in bone mineral content or bone mineral density is shown by MD or DIP, it is recommendable to measure bone mineral density of vertebrae and femoral neck by DXA.
A case of heterotopic replantation of the metacarpus is demonstrated. This procedure shows the successful primary reconstruction of a severely injured hand. The result seventeen months after the injury is shown. The patient is rehabilitated and is able to manage basic activities of daily living.
The role of US was investigated in the study of rheumatoid arthritis, since the method depicts the changes in the periskeletal soft tissues--i.e., where the disorder preferably locates in both its early and late phases. A hundred and fifty-eight patients affected with rheumatoid arthritis according to American Rheumatism Association criteria were examined: the hand (wrist, carpus, metacarpus and fingers), the knee and the foot (metatarsus and toes) were studied in all patients. The study population was divided into two groups according to the time of onset of the disease: in 82 of them (52%) the onset of symptoms dated back to less than a year, while 76 of them (48%) had been suffering for over a year. US appears as the most accurate method to study the early phases of rheumatoid arthritis, for it makes early diagnosis possible, thus allowing the correct treatment to be chosen and preventing the disease from causing the irreversible lesions which progressively disable the patient. In the early phases of rheumatoid arthritis, US detects the exudative effects of synovial inflammation in periskeletal soft tissues. Joint effusions and synovial pannus are also depicted by US, as well as the thickening of tendon sheaths and tendon ruptures and rheumatoid nodules. In the late phases of rheumatoid arthritis, US supports conventional radiology, the latter remaining the irreplaceable method of choice to demonstrate skeletal lesions. Nonetheless, in such phases US yields further information on periarticular soft tissue involvement which no other method would make available--e.g., the presence of effusions, bulgings, synovial pannus, joint cartilage erosions, damaged tendons and sheaths, hypoplasia of the muscles ending on the involved joint and finally periarticular changes. Finally, US proves of great value in the early demonstration of reactivating phases, with unquestionable prognostic advantages.
Hexosamine concentration (an index of proteoglycan content), DNA content (an index of cellularity), and [35S]sulfate incorporation (an index of proteoglycan synthesis) of articular cartilage were measured in biopsy specimens from medial proximal sesamoid bone, medial condyle of the third metacarpal bone, and proximal dorsal rim of the proximal phalanx in both metacarpophalangeal joints of 6 adult horses. One limb was then placed in a fiberglass cast that extended down from the proximal portion of the metacarpus and enclosed the hoof; the other limb was not casted. After 30 days of stall confinement, additional specimens were taken from the medial proximal sesamoid bone, medial condyle of the third metacarpal bone, midproximal portion of the proximal phalanx, distal portion of the proximal phalanx, and proximal portion of the middle phalanx of both limbs for comparison. Immobilization resulted in an apparent decrease in the hexosamine content of the cartilage when the 30-day immobilized vs 30-day mobilized specimens were analyzed. This decrease was accentuated by opposing trends in the 2 limbs. The immobilized cartilage tended to lose hexosamine, whereas the mobilized limb tended to gain hexosamine during the 30-day period; a similar trend also was seen with [35S] incorporation, but this trend was not statistically significant. The largest change was a significant increase in glycosaminoglycan synthesis in the mobilized limb, compared with little change in the immobilized joint cartilage. We concluded that contralateral limbs are unsuitable for controls in immobilization studies because of their biological response to increased weight bearing.(ABSTRACT TRUNCATED AT 250 WORDS)
OBJECTIVE: To compare the axial stability provided by 4 methods of attaching transfixation pins into a fiberglass cast. DESIGN: Axial stability of 4 methods of transfixation pin attachment to a fiberglass cast cylinder was determined in vitro. Methods of attachment included simple incorporation of the pins into the cast, placement of a washer and nut on the pin and incorporation into the cast, extension of pins beyond the cast and attachment to a steel halo, and washers within the cast and attachment to a steel halo. POPULATION: A model was designed to simulate a transfixation cast applied to the equine metacarpus. 8 identical constructs were present in each of the 4 groups. 6 fiberglass cylinders were also tested to identify the contribution of the cast cylinder to the overall stability of the transfixation cast. PROCEDURE: Load-sufficient curves were recorded, and a stiffness modulus was calculated for each treatment group and for a simple fiberglass cylinder without transfixation pins. RESULT AND CONCLUSION: There was no significant difference among the 4 methods of attachment. The fiberglass cast material appears to be the major determinant of axial stability.
OBJECTIVE: To determine whether monokines produced by activated rabbit peritoneal macrophages can inhibit development of exuberant granulation tissue formation in distal limb wounds in ponies. DESIGN: Randomized block. ANIMALS: 5 castrated male ponies, 2 to 6 years old and weighing 140 to 190 kg. PROCEDURE: In vitro activity of cell-free rabbit peritoneal macrophage supernatant was determined after incubation of fibroblasts from the flank and the distal portion of limbs of horses and ponies. Tritiated thymidine was then added, and after reincubation, radioactivity was measured. After creation of a 4-cm2, full-thickness wound on the mid dorsal aspect of each metacarpus and metatarsus of each pony, in vivo activity of the macrophage supernatant was evaluated. Biopsy specimens were collected at random sites near a border of each wound at 4, 6, and 10 weeks after creation of the wounds. Treatment effects were evaluated on the basis of presence of exuberant granulation tissue requiring excision, number of times that excision was required, total area of the wound, epithelialized area, area of granulation bed, and histologic evaluation of the biopsy specimens. RESULTS: The macrophage supernatant effectively inhibited proliferation of equine fibroblasts in vitro. No significant in vivo treatment effects were found among the 4 treatment groups. CONCLUSION AND CLINICAL RELEVANCE: Monokines from stimulated rabbit peritoneal macrophages may have potential for improving wound healing in horses and ponies because of their effective inhibition in vitro of equine fibroblast proliferation.
We describe an infant who died shortly after birth, with Potter sequence and prune belly anomaly, omphalocele, single umbilical artery, imperforate anus and micropenis with empty scrotum. Fetopathological examination revealed multiple vertebral anomalies with rudimentary sacrum, hypoplasia o2 the first metacarpus on right hand, complex cardiovascular anomalies, malrotation of intestines, a dilated and blind-ending cloaca to which both ureters and a bicornuate uterus were connected, normal ovaries, hypoplastic kidneys with cystic renal dysplasia. The descending colon ended blindly and showed a fistulous communication with the cloaca. Chromosome studies on peripheral blood lymphocytes and fibroblasts of a skin biopsy demonstrated a normal 46,XX karyotype. The possible mechanisms underlying the concurrence of a caudal developmental field defect with female pseudo-hermaphroditism and additional features of the VACTERL association are discussed.
Increasing age is a risk factor for the development of osteoarthrosis of the joints of the hand in adults between 21 and 60 years of age. Only in the very old (> or = 80 years) is osteoarthrosis of the hand part of the age related degeneration. The literature contains different parameters and indices correlating the amounts of minerals and ashes of metacarpal bones. Our results speak in favour of the presumptions published by Exton-Smith et al. (1969 b) that bone mass belongs among the biological characteristics of old age. Our investigations of hand roentgenograms reveal that remodeling of the joint socket as described by pathologists is not a general but an elective phenomenon. With age the wrist shows only an increasing angle of the radial joint surface (males, right hand) and there is a variation of form in the medial sesamoid bone at the first metacarpus (males, left hand).
UNLABELLED: Technetium-99m-labeled polydiethylenetriamine pentaacetic acid polymannosyl polylysine (DTPA-man-PL) was synthesized and tested for lymph node scintigraphy by subcutaneous administration. The agent was designed for receptor-mediated uptake by mannosebinding protein, which resides on the plasma membrane of reticuloendothelial cells. METHODS: Subcutaneous injections of a 99mTc-labeled agent having 18 DTPA and 82 mannosyl groups attached to a polylysine of 100 units ([99mTc]DTPA18-man82-PL100) were made at the level of the metacarpus and metatarsus of three healthy rabbits. Images were acquired at 1, 6, 12 and 24 hr. Popliteal and axillary nodes were then assayed for percent of injected dose (%ID). A negative control study was performed in three normal rabbits with [99mTc]DTPA18-PL100. RESULTS: Significant differences in mean 24-hr %ID between the receptor specific and nonspecific agents were observed for both the popliteal (p < 0.006) and axillary (p < 0.012) nodes. Popliteal percent injected dose at 24 hr was 3.00 +/- 0.72% for [99mTc]DTPA-man-PL and 0.13 +/- 0.08% for [99mTc] DTPA-polylysine. Axillary accumulation at 24 hr was 2.84 +/- 0.83% for [99mTc]DTPA-mannosyl-polylysine and 0.22 +/- 0.12% for [99mTc] DTPA-polylysine. Percent injected dose of the receptor-specific agent was highest (4%) during the 6-hr scan. Accumulation of the nonspecific agent by the popliteal and axillary nodes at 6-hr postinjection was approximately 0.5%. CONCLUSION: This study provides proof of principle for lymphoscintigraphy by receptor-mediated delivery of a nonparticulate imaging agent.
The authors present 15 unstable fractures of the wrist treated by external fixation. The fractures were classified based on the AO system, while results were evaluated clinically (Gartland and Werley method modified by Sarmientio) and radiographically. In two cases stabilization with metal wiring was used in addition to external fixation. Results were excellent in 4 cases, good in 9, unsatisfactory in 2 (1 fair, 1 poor). Intraoperative complications included a compound fracture of the second metacarpus, and late complications included a case of algodystrophy.
OBJECTIVE: The purpose of this study was to analyze the different hand anomalies observed in Poland's syndrome. PATIENTS AND METHODS: Thirty-eight clinical histories were revised. There were 28 boys and 10 girls. In 18 cases the right side was affected and in 20 cases the left side. Special attention was placed on the analysis of the anatomical hand findings, in both the clinical and radiographic studies. The patients were classified into 5 types: Type 1, without syndactyly; type 2 syndactyly and hypoplastic or aplastic middle phalanx; type 3 or "shovel hand" with complete syndactyly also affecting the thumb; type 4 longitudinal deficiency of some digits or radius and type 5 transversal absence. RESULTS: Four cases presented associated chest wall anomalies. We have observed four cases of type 1, 25 cases of type 2 (65.7%), 5 cases of type 3, 3 cases of type 4 and one case of type 5. The middle phalanx was hypoplastic in 15 cases, aplastic in another 15 cases and combined hypo and aplastic in 4 cases. In 18 hands we observed two fissure plates in metacarpals. CONCLUSIONS: 1) We did not observe any side predominance.) Two fissure plates in the first metacarpus is frequently observed (78.2%). 3) We propose a classification according to the anatomical hand anomalies.
A calf was treated for chronic infectious arthritis and osteomyelitis of the carpus and metacarpus by carpal bone excision, debridement, and cancellous bone graft placement in the metacarpal medullary cavity. Following 6 weeks of limb immobilization, carpal-metacarpal arthrodesis was achieved. The heifer is pain free, and has produced 3 calves.