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Aplasia of the thumbs and great toes, and aplasia of terminal and dysplasia of middle phalanges with absence of nails were noted in the child of related parents, who died at the age of 3 months from cardiorespiratory insufficiency. This is the 7th case of an (AR) genetic syndrome called after Yunis and Varon.
In cases of ischemic extremities and diabetes mellitus, the trauma on finger and toe is very intractable. For such injuries amputation of extremity is indicated very often because of severe necrosis. The number of such cases has been increasing recently because many cases of these patients have arteriosclerotic arterial occlusion and diabetes mellitus, and these are correlated with the changes of aging. The number of cases of Buerger's disease has been also increasing and it is another etiology of intractable trauma in ischemic extremity. The repeated hyperbaric oxygenation, sympathetic block, warfarin therapy and insulin bath with bubbling of hyperbaric oxygen, were applied to has been of such necrosis. By these procedures, the rate of amputation of extremity decreasing. It was concluded that the surgical reconstruction of artery for ischemic extremity has never any meaning as the therapy of such intractable injuries, if blood flow in the peripheral tissue is not kept physiologically, before vascular reconstruction. In order to increase peripheral tissue circulation, the hyperbaric oxygenation, sympathetic block and warfarin therapy wer performed in many cases and these methods were very effective for intractable injuries with severe necrosis.
Blue toe syndrome is easily misdiagnosed because the cyanotic mottling resembles localized bruising from minor foot trauma. Clinicians who think of circulatory problems are sometimes led astray because the patient looks healthy and presents with excellent peripheral pulses. Appropriate laboratory studies can lead to a correct diagnosis. Endarterectomy or graft replacement of the diseased arterial segment is usually the preferred treatment.
Synovial osteochondromatosis is an uncommon lesion in the metatarsophalangeal joint of the great toe. The condition is usually monoarticular, involving a large joint. Common locations include the knee, elbow, shoulder, hip and ankle. The histopathology is one of apparent cartilaginous bodies. Since these cartilage cells often display nuclear atypism, an accurate diagnosis is essential to avoid the erroneous diagnosis of chondrosarcoma. A case of synovial osteochondromatosis as it occurs in the metatarsophalangeal joint is presented, and this condition is discussed with a review of the literature.
This study was designed to determine criteria of normality of peri-ungual capillaroscopy of the toes. The equipment used was a Leitz microscope fitted with a 150 W cold light lighting system. The study involved a population of 84 healthy individuals. Intra-judge and inter-judge concordance tests were carried out, indicating results to be reliable. Capillaroscopy of the hand (reference norms) and capillaroscopy of the feet (with the subject sitting with the legs hanging) were carried out in each case. Examination of the feet was perfectly possible in only 87% of cases. Results showed that the majority of criteria of normality of peri-ungual capillaroscopy of the hand were also found in the foot, whilst others were different (number of capillary loops per millimetre which was on average less, the number of minor dystrophic forms which could be very great, the length of capillary loops which were slightly shorter and background colour which was paler). Finally, certain were not found (peri-capillary haziness more frequent because of physiological oedema and frequent irregularity in the distribution of capillary loops). No major dystrophy was seen and traumatic hemorrhages were no more frequent in the foot than in the hand.
A case of tinea pedis caused by a dual infection with Trichophyton rubrum and Microsporum canis is reported. It is of particular interest because infections of the toe webs caused by M. canis are uncommon and the combination of T. rubrum and M. canis has not been reported. In addition, a marked difference in response to treatment with an imidazole (bifonazole) was observed.
Based upon our experience at the Massachusetts General Hospital, where 32 microneurovascular toe-to-hand transfers have been performed over the past eight years, this method of thumb reconstruction can be quite successful in carefully selected and educated patients.
A comprehensive rehabilitation program for patients who have undergone a great toe to hand transfer for thumb reconstruction can significantly affect eventual functional outcome. When the thumb is amputated near the metacarpophalangeal joint, such a transfer provides a useful and aesthetic thumb substitute. Goals of rehabilitation are to promote optimal functioning of the reconstructed hand by maximizing range of motion, preventing reduction of the first web space, facilitating adequate sensory return, and maximizing strength, coordination, and endurance. Therapeutic modalities include edema control, passive and active exercises, static and dynamic splinting, massage, sensory reeducation, and graded functional activities. Emotional adjustment and vocational adaptation are additional therapeutic concerns. Case histories of two patients are briefly reviewed along with pre- and posttransfer assessments of range of motion, strength, sensation, and dexterity.
A simple, easily readable system for permanent individual identification of rodents was accomplished by clipping off selected toes according to a code. Up to 10,000 animals could be consecutively numbered using this system.
This paper describes a method of using combined 2nd and 3rd toe transfer as one stage procedure for reconstruction of transmetacarpal amputation of the hand to restore chuck pinch and power grip.
The operative experience of twenty cases of second toe to hand transplantations was discussed. Although there was only one total failure, there were frequent complications. The factors leading to the high rate of complications (just over 1/3 of cases) were analysed. A treatment scheme, which took into consideration a large number of precautions and preventive measures against early complications was carefully outlined.
In 1963 Rubinstein and Taybi described, in seven children, a new symptom-complex characterized by broad thumbs and great toes, facial abnormalities, mental retardation and a cluster of congenital malformations. Since then 14 additional cases have been reported. In this paper three more such children are described. Chromosome studies were normal. The etiology of this disorder is unknown but it is probably genetic.
The authors have reviewed 93 cases of arthrodesis of the first metatarso-phalangeal joint performed for various conditions. In 43 cases it was done as a salvage procedure after other surgical procedures. In these cases, the rate of union was only 70 p. 100 compared with 94 p. 100 when the arthrodesis was done as a primary surgical procedure. The technique is described in detail and the use of bone grafts recommended. Functional results were satisfactory in 3 out of 4 cases. The precise position to be applied to the toe is discussed.
A case report is presented of a young patient involved in a motor vehicle accident, who initially demonstrated no physical or radiologic evidence of thoracic injury. Six weeks later the patient was noted to have two blue toes. Arteriography done at that time demonstrated a previously unsuspected false aneurysm of the descending thoracic aorta. An embolic event in a patient with a history of major trauma should be considered a strong indication for arteriographic evaluation of the proximal arterial system.
The second case of chondroid syringoma in a toe is presented. The diagnosis was confirmed microscopically, and histochemical studies suggested the presence of heavily sulfated stromal acid mucopolysaccharides. Glycogen was present only in some tumor cells. Keratin-containing tumor cells and nests were seen with polarization. This tumor should be considered in the differential diagnosis of painless, slow-growing, pedal tumors.
A case of acute Unverricht-Wagner dermatomyositis occurring two years after amputation of a great toe for malignant melanoma graded stage IV in Clark's classification is reported. A review of the literature found only six previous reports of dermatomyositis associated with malignant melanoma.
The authors report a case of bilateral symmetrical macrodactyly affecting the toes in a 17 year old patient. The deformity was treated by bilateral transmetatarsal amputation. After a review of the literature, the authors recall that macrodactyly is more frequently seen in the hand than in the foot. No etiological factor such as neurofibromatosis or a genetic or teratogenic agent was found.
A premature infant developed Staphylococcus osteomyelitis secondary to multiple punctures of the great toe for drawing blood. The infection responded well to antibiotic therapy.