1/12. candida lambica polyarthritis in a patient with chronic alcoholism.We describe a patient with an indolent polyarthritis over a period of several years caused by candida lambica probably acquired from a contaminated wound. C. lambica has not been previously reported to cause infectious arthritis. Hematogenous spread was manifest by 4 separate sites of involvement. Chronic alcoholism was the only apparent risk factor for dissemination. The infection seems to be environmentally acquired.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/12. The sandwich temporoparietal free fascial flap for tendon gliding.Microsurgical transfer of the superficial and deep temporal fascia based on the superficial temporal vessels has been documented. This article analyzes the functional recovery when each layer of this facial flap is placed on either side of reconstructed or repaired tendons, to recreate a gliding environment. This fascial flap also provided a thin, pliable vascular cover in selected defects of the extremities.Six patients (four male and two female) with tendon loss and skin scarring of the hand (three dorsum, one palmar, and one distal forearm) and posttraumatic scarring of the ankle with tendoachilles shortening (one patient) underwent this procedure. No flap loss was witnessed. Good overall functional recovery and tendon excursion were observed. Complication of partial graft loss was observed in two patients.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/12. Hypovolaemic shock by rat bites. A paradigmatic case of social deprivation.This report describes an unusual complication of a comparatively common problem of rat bites, causing a near fatal case of hypovolaemic shock. An 8 month old girl was bitten on her head and hands by norway rats (Rattus norvegicus) while sleeping after falling from her parent's bed. She could not be attended to because of her parents' alcoholic condition. She was found in hypovolaemic shock. She required ventilatory and haemodynamic support for five days. At late follow up, the child had no medical problem. In this case, evident social risk factors include extreme poverty, poor hygiene, and rat infested environment, which are frequently associated in potential rat bite victims.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/12. Hand infections caused by delayed inoculation of vibrio vulnificus: does human skin serve as a potential reservoir of vibrios?vibrio vulnificus may cause severe soft tissue infections of the upper extremity. This pathogen usually gains access to soft tissues either by direct inoculation through a penetrating injury by an infected marine animal or by exposing abraded skin to contaminated water. We report five patients with vibrio vulnificus hand infections following superficial hand injuries incurred within 24 hours after uneventful handling of fish. This clinical observation, together with the fact that the physiologic characteristics of human sweat simulate the natural environment of the vibrio vulnificus, support the assumption that human skin may serve as a reservoir for Vibrios. The anamnesis in patients presenting with hand infection should essentially include an inquiry regarding recent, albeit uneventful, fish handling.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/12. Infected fractures of the hand and wrist.Infected fractures of the hand and wrist are uncommon, occurring most often after open crushing injury in a contaminated environment. Fundamental principles of treatment include thorough debridement of necrotic material, appropriate antibiotic selection, and adequate stabilization of bone. Delayed reconstruction of bone and soft tissue is at times aided by the use of free tissue transfer.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/12. Adhesive bacterial colonization of exposed traumatized tendon.Recent studies of compromised or damaged tissues, as well as biomaterials, have shown that they provide a particularly fertile substratum for bacterial colonization. Colonization in these environments is mediated by a process of microbial adhesion to surfaces of the substrata. In this report, we present electron microscopic studies of a portion of damaged and infected tendon. These studies demonstrate colonies of bacteria surrounded by a ruthenium red-staining exopolysaccharide biofilm and adhesion to the surface of the tendon by means of an exopolysaccharide polymer. We suggest that this adhesive form of bacterial colonization may partially explain the resistance of exposed tendon to effective debridement by simple mechanical measures and to coverage with granulation tissue, partial-thickness skin grafts, and vascularized tissue grafts.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/12. replantation of a transmetacarpal amputation. A case report.A case is presented of a 23-year-old male who sustained a traumatic transmetacarpal amputation of his nondominant hand. The injury consisted of complete severance of structures distal to the midpalm. Microsurgical reconstruction involved the primary repair of arteries, veins, nerves, extensor and flexor tendons, and metacarpal fractures. Skeletal reconstruction also employed a primary Swanson prosthesis for the fifth metacarpophalangeal (MP) joint. Early postoperative range-of-motion exercises were encouraged, with the achievement of a functionally capable replanted extremity. The general management of an amputation injury is also discussed, as it applies to a community hospital environment.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/12. Microvascular free-flap coverage of mechanical injuries to the upper extremity.Extensive soft-tissue avulsion injuries of the upper extremities with or without bony involvement are difficult reconstructive problems. They usually cannot be adequately managed by traditional methods using skin grafts or local flaps. Microvascular free-tissue transplantation may offer the best chance for success with these severe injuries. Free-tissue transfer is indicated in this type of injury (1) when no simpler method of obtaining a closed wound is available, or (2) when the quality of soft-tissue coverage by simpler methods would not be adequate from a functional standpoint. For example, if a skin graft is placed over bone and tendons, there may be impairment of function, and certainly this is a poor environment for tendon transfers, nerve repairs, and so forth. The much more adequate tissue of a free-flap coverage provides a better environment for reconstruction. Three cases demonstrating these principles have been presented.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
9/12. Hand and forearm infections caused by aeromonas hydrophila.This is a report of two cases of hand and forearm infections caused by Aeromonas hydrophila. This organism is resistant to penicillin and most cephalosporins and is found in most freshwater environments. It is recommended that broad-spectrum coverage such as a combination of cephalosporin and aminoglycoside antibiotic be used.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/12. A clinical experience with a hierarchically controlled myoelectric hand prosthesis with vibro-tactile feedback.Improved performance of externally powered myoelectric hands is possible when the direct control of the digit flexion and grip force are given over to an electronic controller which frees the operator to concentrate on other demands. DESIGN: A commercial myoelectric hand was modified to take the new touch and slip sensors and novel control method. SUBJECT: An adult male with a traumatic mid-forearm amputation. OUTCOME MEASURE: The range and ease of use of the prosthetics system. RESULT: The hand was easily and usefully operated in the home and work environment. CONCLUSION: Hierarchical control of a hand is possible using sensory feedback to a sophisticated electronic controller. Such a control method reduces the demands on the user's concentration and enhances the hand's range.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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