Citations

Ten normal ring fingers from ten donors were used to determine the effect of flexor tendon repair on the gliding resistance between the tendon and the A2 pulley. Gliding resistance was measured for the intact FDP tendon and for the same tendon after it was cut transversely and repaired with a 4/0 Ticron core suture and a 6/0 running epitendinous nylon suture. After repair, the gliding pattern of the tendon through the A2 pulley changed significantly. The resistance and the friction coefficient were approximately doubled ( P<0.005).

Correspondence is presented recording an operation for release of the carpal tunnel performed in 1924, together with a biographical note on the surgeon, Herbert Galloway.

Flexor tendon repair remains one of the more difficult technical tasks facing the hand surgeon. A good repair must be both strong and able to glide smoothly through the tendon sheath. The purpose of this study is to present a model that allows surgeons to improve their technique of flexor tendon repair by receiving feedback on these important biomechanical parameters. The set-up requires testing equipment found in most biomechanical laboratories and should be available in many academic medical centres. Preliminary data suggest that receiving feedback about the strength and smoothness of a flexor tendon repair may be a very useful tool in helping surgeons improve the overall quality of their tendon repair technique.

ABSTRACT Fosmidomycin is effective against malaria, but it needs to be given for ≥4 days when used alone. We conducted a study of 50 children with Plasmodium falciparum malaria to evaluate the safety and efficacy of consecutively shortened regimens of artesunate-fosmidomycin (1 to 2 mg/kg of body weight and 30 mg/kg of body weight, respectively; doses given every 12 hours). All dosing regimens were well tolerated. Artesunate-fosmidomycin acted rapidly, resulting in consolidated geometric mean parasite and fever clearance times of 24 h and 15 h, respectively. Treatment regimens of ≥2 days led to cure ratios of 100% by day 14 (39/39; 95% confidence interval [95% CI], 91% to 100%). Most importantly, the 3-day regimen achieved 100% cure on day 28 (10/10; 95% CI, 69% to 100%). Treatment with artesunate-fosmidomycin was associated with transient grade I or II neutropenia (absolute neutrophil counts of 750 to 1,200/μl and 400 to 749/μl, respectively) in six or two patients, respectively. Artesunate-fosmidomycin demonstrates the feasibility and potential value of short-course artemisinin-based combination chemotherapy with rapidly eliminated combination partners.

PurposeAlthough rare overall, marginal zone B-cell lymphoma (MZBCL) is the most common primary low-grade CNS lymphoma reported in the literature. The aim of this study is to elucidate the biology and genetic features of this unusual tumor.Patients and MethodsFifteen CNS MZBCLs were studied clinically, pathologically, and genetically, including fluorescent in situ hybridization analyses with commercially available MALT1 and IgH break-apart and centromere 3, 7, 12, and 18 probes.ResultsCNS MZBCLs preferentially affect middle-aged women (female-to-male ratio, 4:1), with 93% presenting as dural-based masses mimicking meningioma. Ten patients with 1 to 7.6 years of follow-up after diagnosis showed no evidence of disease after radiation and/or chemotherapy. Like MZBCLs outside of the CNS, they consisted of CD20+, CD3−small B lymphocytes with varying degrees of plasmacytic differentiation and predominantly κ light-chain restriction (78%). Lymphoid follicles with follicular colonization were seen in three patients and deposition of amyloid was noted in samples from two patients, one of which was tumefactive. Neither Bcl-6 protein nor Epstein-Barr virus–encoded RNA was expressed. Trisomy 3 was detected in six of 12 patients, with no rearrangements of MALT1 or IgH and no trisomies of 7, 12, or 18 detected.ConclusionOur data suggest that intracranial MZBCL is an indolent primary CNS lymphoma that typically presents as a meningioma-like dural-based mass. Trisomy 3, but not MALT1 or IgH translocation, is a common genetic abnormality that may contribute to the pathogenesis of this CNS lymphoma.

We reviewed retrospectively a series of 128 consecutive patients who had wrist arthroscopy at our institution between January 1988 and July 1991. The aim of the procedure was to establish a diagnosis in 27 patients, to challenge a pre-operative diagnosis in 95 patients and to evaluate joint surfaces in six patients. For the 27 patients with a previously unknown diagnosis, the diagnostic sensitivity was 67% and the specificity 100%. Arthrotomy or other intervention was avoided in 18. For the 95 patients with an established pre-operative diagnosis, arthrotomy was avoided in 45: in 26 the desired procedure could be done arthroscopically, and in 19 the diagnosis, as improved by arthroscopy, was felt not to require further treatment. Procedures performed arthroscopically included débridement of triangular fibrocartilage and inter-carpal ligament tears; lysis of adhesions, and synovectomy. In six patients, arthroscopy was performed to evaluate joint surfaces after fracture reduction or before ulnar shortening osteotomy. In none of the six was arthrotomy felt necessary after arthroscopy. Wrist arthroscopy avoided the need for further surgery in 66 (52%) of our patients; arthrotomy was avoided in 69 (54%). In cases with significant carpal instability evident pre-operatively, arthroscopy was unlikely to avoid the need for open treatment.

12 adult cadaver wrists were dissected to identify the regions of origin of the four palmar radio-carpal ligaments. A non-dimensionalized value, called the radio-carpal ligament ratio (RLR), was defined as the width of ligament origin from the radius divided by the length of the capitate. Both values were measured directly from radiographs of the cadaver specimens. The RLRs for the four palmar radio-carpal ligaments were found to be statistically consistent. We applied the RLR concept retrospectively to 20 wrists with intraarticular distal radius fractures requiring open reduction. It was found that those fracture patterns in which the fracture fragment ratios (FFR: widths of the fracture fragments divided by the length of the capitate) were outside the limits of corresponding RLRs had clear intra-operative evidence of palmar radio-carpal ligament disruption, while those with FFRs within the limits of corresponding RLRs were noted to have no ligament disruption.