Carpal Tunnel Syndrome Associated with Bifid Median Nerve and Palmaris Profundus - Case Report and Literature Review

The anatomic variations of the median nerve and of the muscles of the wrist have been widely reported in literature. It is essential for the surgeon to be familiar with these variations in order to avoid accidental injury to the nerve during surgery. We report a rare case of bifid median nerve accompanied by an anomalous tendon of palmaris profundus discovered during the surgical release of carpal tunnel. The transverse carpal ligament was dissected and the anomalous tendon was left in situ because any direct compression over the median nerve was noticed intraoperatively. The patient was evaluated one year postoperatively clinically and radiologically (with MRI). At the follow up the resolution of symptoms was complete and the sleep disturbance was solved. The patient achieved a postoperative QuickDASH score of 9.1 and a Michigan Hand Questionnaire outcome score of 90 points

Surgical treatment of an aseptic fistulized acromioclavicular joint cyst: a case report and review of the literature.

An acromioclavicular joint cyst is an uncommonly reported condition, which seems to result from a massive rotator cuff tear and degenerative osteoarthritis of the acromioclavicular joint. We present the case of an 81-year-old man affected by an acromioclavicular joint cyst, associated to a massive rotator cuff tear, proximal migration of the humeral head and osteoarthritis of the gleno-humeral joint. The mass was 7 x 2.5 cm in size and the overlying skin presented a fistula that drained clear synovial-like fluid. Plain X-ray examination of the left shoulder showed proximal migration of the humeral head migration and osteoarthritis of the gleno-humeral joint, and further MRI evaluation confirmed the clinical diagnosis of a complete rotator cuff tear and observed a large subcutaneous cyst in communication with the degenerative acromioclavicular joint. The patient underwent surgical excision of the cyst and lateral resection of the clavicle to prevent disease recurrence. To the best of our knowledge, this is the first reported case of an acromioclavicular joint cyst complicated by an aseptic fistula resulting from multiple aspirations

Treatment of Severe Post-traumatic Bone Defects With Autologous Stem Cells Loaded on Allogeneic Scaffolds.

Mesenchymal stem cells may differentiate into angiogenic and osteoprogenitor cells. The effectiveness of autologous pluripotent mesenchymal cells for treating bone defects has not been investigated in humans. We present a case series to evaluate the rationale of using nucleated cells from autologous bone marrow aspirates in the treatment of severe bone defects that failed to respond to traditional treatments. Ten adult patients (mean age, 49.6-years-old) with severe bone defects were included in this study. Lower limb bone defects were >or=5 cm3 in size, and upper limb defects .or=2 cm3. Before surgery, patients were tested for antibodies to common pathogens. Treatment consisted of bone allogeneic scaffold enriched with bone marrow nucleated cells harvested from the iliac crest and concentrated using an FDA-approved device. Postsurgery clinical and radiographic follow-up was performed at 1, 3, 6, and 12 months. To assess viability, morphology, and immunophenotype, bone marrow nucleated cells were cultured in vitro, tested for sterility, and assayed for the possible replication of adventitious (contaminating) viruses. In 9 of 10 patients, both clinical and radiographic healing of the bone defect along with bone graft integration were observed (mean time, 5.6 months); one patient failed to respond. No post-operative complications were observed. Bone marrow nucleated cells were enriched 4.49-fold by a single concentration step, and these enriched cells were free of microbial contamination. The immunophenotype of adherent cells was compatible with that of mesenchymal stem cells. We detected the replication of Epstein-Barr virus in 2/10 bone marrow cell cultures tested. Hepatitis B virus, cytomegalovirus, parvovirus B19, and endogenous retrovirus HERV-K replication were not detected. Overall, 470 to 1,150 million nucleated cells were grafted into each patient. This case series, with a mean follow-up of almost 2 years, demonstrates that an allogeneic bone scaffold enriched with concentrated autologous bone marrow cells obtained from the iliac crest provides orthopedic surgeons a novel option for treating important bone defects that are unresponsive to traditional therapies

Outcomes of Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Introduction: Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far. Methods: Retrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke. Results: Of 1443 ACS patients aged >75 years (median age 80 years, interquartile range 77-84), 41% were classified as ST-elevation myocardial infarction (STEMI), and 59% had non-ST-elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45% vs 50%, P <.001). At a median follow-up of 12 months, 51 (8.6%) STEMI patients had died, vs 39 (4.6%) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95% confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95% CI, 1.01-4.38), and stroke (cHR 4.8; 95% CI, 1.7-13.7). Conclusions: Despite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention

Kinetic analysis of catalytic hydrodechlorination process of polychlorinated biphenyls (PCBs)

Catalytic hydrodechlorination (HDCl) of 2,4,4′,6-tetrachlorobiphenyl and 2,3,4,5-tetrachlorobiphenyl has been studied in the presence of a sulphided Ni–Mo/γ-Al2O3 catalyst. The reaction runs were carried out at constant temperature and pressure in a stirred batch reactor using hexadecane as the reaction medium. Temperature levels of T=250°C and T=300°C at a hydrogen pressure of PH2=20 bar were tested. The results demonstrate that the HDCl process proceeds via an irreversible stepwise pattern. The kinetic constants of all observed intermediate HDCl steps were evaluated. The selectivity of HDCl reactions has been interpreted on the basis of electrophilic aromatic substitution mechanism. It shows that the HDCl rate is slower when carbon atoms adjacent to a substituted chlorine atom are bonded to other chlorine atoms. This depends on the inductive effect of chlorine atoms. It also shows that ortho-substitution is slower than meta- and para-substitution. In this case, both steric and electronic effects are probably relevan

Surgical Neck Fracture

This book covers every aspect of humeral fractures from the proximal to the distal tip, including surgical and nonsurgical treatment, rehabilitation and more. Common fixation techniques are described with the help of high-quality illustrations.16The treatment of humeral fractures is a complex issue and the source of considerable controversy. In the case of fractures of the proximal humerus, early range of motion is the main aim of treatment. If a fracture modifies the anatomy or function of the glenohumeral and scapulothoracic joints, the surgeon must adhere meticulously to treatment principles in order to ensure a satisfactory outcome. Humeral shaft fractures are frequent, accounting for 1% to 3% of all fractures in adults; while excellent functional results have been reported with nonoperative management, open reduction and internal fixation is preferred in specific clinical settings. In contrast, intra-articular fractures of the distal humerus are frequently complex and full functional recovery is difficult to achieve.This volume clearly explains the concepts that are central to an understanding of humeral fractures from the proximal to the distal tip. Indications for different forms of treatment, including nonsurgica16l, are presented in detail, and all of the commonly used fixation techniques are described with the help of high-quality illustrations. Further important aspects such as complications, rehabilitation, and treatment of sequelae are also fully considered. This book will be an invaluable and comprehensive aid for all surgeons who treat humeral fractures.04PART 1 Proximal humerus: 1 Main anatomy.- 2 Understanding the Fracture.- 3 Operating theatre setup.- 4 Closed reduction principles.- 5 Surgical Approaches.- 6 Percutaneous fixation: when and how.- 7 ORIF in three-/four-part fractures.- 8 Intramedullary nail rationale and surgical technique.- 9 Anatomical shoulder arthroplasty.- 10 Reverse total shoulder arthroplasty.- 11 Surgical neck fracture.- 12 The tuberosities.- 13 Malunions of the tuberosity.- 14 Nerve injuries.- 15 Fracture dislocations.- 16 Treatment of the sequelae.- 17 Conservative treatment.- PART 2 The diaphysis: 18 Surgical anatomy.- 19 Radial palsy and humerus fractures.- 20 Internal Fixation: plate or IM Nail.- 21 External fixation.- 22 Periprosthetic fracture.- PART 3 Distal Humerus: 23 Surgical anatomy.- 24 Surgical approaches and fracture pattern.- 25 Internal fixation principles.- 26 Prosthesis.- 27 External fixation when and how.- 28 Malunion and non union.- 29 Terrible triad.13From the book reviews:"This book represents an attractive concept in the age of information technology that allows easy Internet access to almost all data. ... This book is written for practitioners and residents who want detailed information on humeral fractures in general, or on a specific fracture. ... it is a potentially useful addition to an academic medical library that wants to be complete, and where the medical librarian identifies that medical personnel are using books as reference sources." (Samuel J. Chmell, Doody's Book Reviews, February, 201