SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A case of vibration-induced white toes and subtle neuropathy in a man aged 46 years is presented. He used to work with his left foot placed on a vibrating pedal for two to three hours a day during 12 years, driving a small wagon at a mink farm.
This work is the summation and analysis of data received from a questionnaire forwarded to all Board Certified podiatric surgeons regarding their experience with the Swanson great toe hemi-prosthesis. The responses pertaining to a variety of concerns, including erosive changes, years in vivo, signs and symptoms indicating retrieval, percentage of surgeons polled performing retrieval and perceived reasons for observed erosive changes, were recorded and analyzed. The resultant data reveal significant erosive changes occur early after implantation with a plateau effect within 3 years. Persistent pain following implantation was the most common reason for removal followed by limited range of motion and nonspecific swelling. These three concerns comprised 70% of the reasons for retrieval followed by 18 other cited problems. The results of this poll originate from subjective and objective impressions of surgeons. It is clear that further work is required to scientifically identify and document the specific reasons for these findings, including the circumstances that result in successful implantation of this prosthesis.
PURPOSE: This study was performed to determine the natural history of patients with symptoms of claudication and systolic toe pressures (TP) of 40 mm Hg or less. METHODS: We followed the clinical course of 56 men with stable claudication and TP of 40 mm Hg or less. All TP measurements were performed on at least two occasions 6 months apart. Primary end points included development of rest pain, tissue loss, or gangrene. The clinical course of 56 case controls with TP greater than 40 mm Hg matched for age, sex, and race was used for comparison. RESULTS: During a mean (+/- SD) follow-up time of 31 +/- 4 months, 37 (66%) patients with TP of 40 mm Hg or less remained stable, and 19 (34%) had ulceration (n = 10), rest pain (n = 6), or gangrene (n = 3). Nine (24%) of the 37 stable patients had gradual improvement of TP values greater than 40 mm Hg. Among the 19 patients whose conditions deteriorated, eight (42%) patients underwent successful bypasses, and five (26%) patients required amputations. Two patients who had rest pain had spontaneous resolution, and three patients who had ulcerations healed without intervention. In contrast, five (9%) of the case controls with TP greater than 40 mm Hg had rest pain (n = 2) or gangrene (n = 3) (p = 0.003). Among patients with TP of 40 mm Hg or less, there were no statistically significant differences between the stable patients and patients with deteriorating conditions in age, ankle-brachial indexes, or risk factors (including diabetes mellitus). However, diabetes conferred a higher probability of clinical deterioration (p = 0.005, Kaplan-Meier). CONCLUSIONS: In patients with symptoms of intermittent claudication, TP of 40 mm Hg or less portends clinical deterioration. Patients with diabetes in this group have a significantly higher risk of development of critical ischemia. Close scrutiny is warranted.
A report is given of two siblings with a congenital claw-like deformity of the fingers and toes, which is extremely rare. The deformity is similar to the claw of lower animals, and perhaps its cause is atavistic. The long-suppressed characteristic might have come to expression by interactions among the genes, perhaps influenced by some unknown environmental factors.
A 27-year-old man had his right dominant thumb amputated, together with skin from the dorsal area of the first metacarpal. Reconstruction was performed using a neurovascular flap taken from his right big toe. It consisted of skin and two-thirds of the distal phalanx, including the nail bed and digital plantar nerves. The vascular pedicle of the flap was formed by branches of the dorsalis pedis artery and the greater saphenous vein. The flap was wrapped around a bony scaffold formed by an iliac bone graft and inserted into the thumb. The revascularization of the flap was performed by connecting the end of the dorsalis pedis artery to the side of the radial artery, and the end of the greater saphenous vein to the end of cephalic vein. Reinnervation was achieved by connecting the plantar digital nerves to the stumps of the digital nerves of the thumb. 1 year later, the patient expressed full satisfaction with the appearance and good function of his reconstructed thumb.
The forefoot reconstruction as a routine treatment, is increasing in significance, not only in treating polyarthritic patients, but also after numerous surgical failures in treating halux valgus or hammer toes. Far from being a simple operation, the reconstruction requires an exact knowledge of the physiopathology of the foot. Special attention should be given to the digital and metatarsal formula. Based on an analysis of 200 forefoot reconstructions, the advantages and the disadvantages of the various methods are discussed. For the first time in the German speaking countries, the frequency of occurrences of the different digitial and metatarsal formulas has been compiled in tables from an examination of 500 forefeet.
A 26-year-old male presented with claw toes and Factor XIII deficiency. Correction for his deformity was undertaken. Pre, intra and post-operative transfusions of plasma and blood prevented any haemorrhagic complications.
Total hip replacements have been recorded in the Norwegian Arthroplasty Register since 1987, and recording of the other joint arthroplasties was started in January 1994. After 12 months 1,589 primary arthroplasties had been registered; these referred to 962 knees, 11 ankles, 76 toes, 113 shoulders, 69 elbows, 12 wrists, 335 fingers and 11 carpometacarpal 1 joints. Median age of the patients was 70 years. 80% were women. Rheumatoid arthritis was the predominant reason for joint replacement, except in the case of the knees where the dominant cause was osteoarthrosis (71%) and of shoulders, 28% of which were replaced because of fractures. Cement was used in 83% of the primary arthroplasties in knee, ankle, shoulder, and elbow joints. 74% of the cement types used contained antibiotics. 9% were uncemented and 8% hybrids. 97% were given systemic antibiotic prophylaxis, most commonly first generation cephalosporins. 114 reoperations were reported. The reason was aseptic loosening in 56%, and infection in 15%. The cooperation with Norwegian orthopaedic surgeons is good. The Register thus provides a reliable picture of implants of Norway, and a good basis for future follow-up studies.
We present eight cases of the hair-thread tourniquet syndrome which affected the toes in 6 cases and presented strangulation of the penis in two. All patients were infants and the mechanism of injury was the strangulation by hair or thread wrapped around an appendage. Neither lesions were promptly recognized by their physicians and the patients were seen in the emergency room with swelling, erythema and a circumferential scar with the typical distal edema. The lesions had ischemic signs, but without tissue necrosis. All patients were treated by immediate removal of the constricting fibers and sometimes a simple vertical, short and deep incision over the area of strangulation, avoiding injury to tendons and digital nerves and vessels, was performed. The potential risk of amputation and the need for a premature diagnosis and treatment are stressed.
A rare case of well differentiated fibrosarcoma occurring in the left second toe is described in a 12-year-old boy who presented with a destructive lesion that had almost totally destroyed the distal phalanx, except for the epiphysis. Amputated specimens showed microscopic evidence of proliferation of uniform spindle cells arranged in both fascicles and a characteristic herringbone pattern with a small number of mitotic figures. This tumor did not show any specific immunoreactivity except for vimentin and had basic ultrastructural characteristics of fibroblasts and myofibroblasts. The tumor was treated by amputation at the middle phalanx level and had not recurred 3 years later. From the presenting radiographic features, some benign neoplasms and reactive lesions were considered in the differential diagnosis. Only results from the pathologic examination were useful in reaching a correct diagnosis.
Evaluation, therapeutical possibilities, and surgical planning for the restoration of bilateral grip function are described, based upon a 34-year-old engineer presenting after severe bilateral frostbite of the hands and feet with loss of all fingers and toes. Finally, the given level of amputation and remaining components of the hand together with distraction-lengthening of both thumbs permitted restoring a basic grip on both sides in combination with bone and soft tissue procedures.
A 68-year-old woman first noticed Raynaud's phenomenon at the age of 35, and she was diagnosed as having systemic sclerosis (SSc) because of cutaneous calcinosis, sclerodactyly, telangiectasia, sausage-like finger, digital pitting scar in 1971. In October, 1994, she was suffered from cold sensation in her right foot, and on November 2 she noticed the painful ulcers on the right toe, which progressed to be gangrenous. Every antiplatelet or thrombolytic agents including PGE1, argatroban, sarpogrelate hydrochloride and urokinase were unsuccessful. Angiograms revealed marked narrowing of bilateral anterior and posterior tibial and peroneal arteries. Prednisolone 30 mg/day was started, which resulted in successful response within 10 days. Large vessel involvement in SSc patients has been reported to be rare, and its treatment remains to be established. We believe our case help understanding the pathophysiology of such rare manifestation in SSc.
We report on two cases of congenital unilateral anterolateral bowing and focal defect of the tibia associated with ipsilateral polydactyly of the great toe. Computed tomographic examination showed an unusual partial cleft of the tibia at the site of bowing. A long follow-up of one patient showed spontaneous resolution of the bowing without progression to pseudoarthrosis. These anomalies should be considered as a new entity related to the tibial developmental field.
BACKGROUND: Cutaneous manifestations of pheochromocytoma other than sweating, and facial pallor during paroxysmal episodes of hypertension are exceptional. CASE REPORT: We observed partial necrosis of the fourth toes which revealed pheochromocytoma. DISCUSSIONS: Signs of peripheral vascular disease are uncommon during the course of pheochromocytoma. Only four cases have been reported in the literature. Occurrence of distal necrosis in combination with hypertension and palpable pulses is suggestive of pheochromocytoma requiring assay of urinary catecholamines. The pathogenic mechanisms of necrosis would be vasospasm of cutaneous vessels due to excessive plasmatic catecholamine levels and thrombocytosis as an aggravating factor.
A 33-year-old black woman with an unusual case of a solitary granular cell tumor (GCT) involving the toe is presented, as is a review of the literature. The clinical presentation, histopathologic appearance, differential diagnosis, and treatment of solitary granular cell tumors are discussed. GCTs are uncommon tumors and are thought to be of Schwann cell origin. These tumors usually present as reddish-brown to flesh-colored papules that are occasionally tender or pruritic. The surface is usually smooth, but may be ulcerated or verrucous. Although they are usually solitary, they may be multiple. These tumors are almost always benign, but malignant variants have been reported. Predilection is greatest in females, and blacks are affected several times more often than whites. The skin overlying the face, trunk, fingers, and mucous membranes account for the vast majority of reported cases.
Different movement synergies used to restore balance in response to sudden support surface displacements have been described, which include the ankle movement synergy and a number of multisegmental movement synergies. The purpose of this study was to extend the analysis of the effects of stimulus magnitude on the pattern and scaling of balance reactions to larger magnitudes of balance disturbances, and to other types of balance disturbances, in particular, forward translations (FT), backward translations (BT), and toes-up rotations (RT). In addition, we examined whether the timing and magnitude of center of body mass (CM) displacement is an invariant feature of corrective responses to varying magnitudes of balance disturbances. Thirteen healthy adults were subjected to FT, BT, and RT of varying acceleration/velocity. The balance disturbance induced by FT and BT was fundamentally different from that induced by RT. The balance requirement during FT and BT was to rapidly translate the CM forward/backward to the new position within the displaced base of support. For RT, the requirement was to minimize the backward displacement of the CM. As evidenced from the initial phase of ankle, knee, and hip angular displacements and anterior-posterior (A-P) center of foot pressure displacement, the magnitude of the balance disturbance increased with increasing platform acceleration/velocity. For FT and BT, the present findings are consistent with the view that trajectory of CM is a control variable, as the timing, peak magnitude, and time to peak CM displacement did not vary as a function of platform acceleration/velocity. However, for RT, the peak magnitude and time to peak CM displacement did increase with increasing platform acceleration/velocity. The results demonstrate that in response to FT, BT, and RT, stability was restored by distinct multisegmental movement synergies. The corrective response to FT consisted of early knee flexion then ankle dorsiflexion and hip extension. The corrective response to BT consisted of hip flexion and ankle plantar flexion. For RT early hip flexion and knee flexion was observed. All muscles recorded (tibialis anterior, soleus, gastrocnemius, hamstrings, and quadriceps) were activated within a range of 60 to 170 ms from onset of platform displacement. For FT, BT, and RT, the pattern and timing of angular displacements and muscle responses did not vary as a function of platform acceleration/velocity, while there was a significant effect of platform acceleration/velocity on the magnitude of the corrective response, that is, peak magnitude of corrective hip, knee, and ankle angular displacements and magnitude of muscle responses. The present findings indicate that multiple sources of spatial information are necessary for the selection and initiation of the appropriate corrective response to meet the requirements of the different balance tasks. The present results strongly endorse the concept of a postural control network for recovery of standing balance, as opposed to positive feedback through local segmental or long loop reflex circuits.
Greig cephalopolysyndactyly syndrome is an autosomal dominant form of complex polydactyly in man. Attention is called to the evidence that, on both morphological and comparative gene mapping grounds, this defect is homologous to Xt-extra toes in the mouse. The pattern of polydactyly in both species is very similar. In addition, both conditions probably map close to the T-cell receptor gamma polypeptide at 13 A2-3 in mouse and 7p15 in humans.
The developmental sequence of Grandry corpuscles was traced in the toe skin of embryonic, young and adult chickens by light and electron microscopy. The developing Grandry cells as well as Schwann cells can first be identified at stage 38 (approximately 12 days of incubation) due to the cytoplasmic content of scattered secretory granules of approximately 100 nm in diameter. Such developing Grandry cells are always associated with nerve fibers. During late stages (stages 40-42, 14-16 days of incubation) several immature Grandry cells formed cell clusters in the dermis. Such cell clusters were always in contact with growing nerve tips of Schwann cells. Immature Grandry cells were separated from one another and dispersed in the connective tissue compartment at stages 44-45 (near hatching). By the time of hatching the developing Grandry cells began to have the morphological characteristics of adult cells. They were relatively large in cell diameter (approximately 10 micron) containing numerous secretory granules and bundles of filamentous material. These cells had finger-like cytoplasmic processes. The Grandry cells at this time had an intimate relationship with nerve fibers and satellite cells. The fact that Grandry cells were always associated with nerve fibers throughout development would support the hypothesis that Grandry cells are derived from neural elements, perhaps neural crest. Satellite cells of Grandry corpuscles are apparently derived from Schwann cells. Grandry cells and corpuscles are adult in form by two to three months of age.