Carpal tunnel syndrome caused by hand injuries.

Although carpal tunnel syndrome associated with injury to the wrist is common, it is possible to overlook symptoms of median nerve compression caused by an ascending tenosynovitis secondary to trauma distal to the wrist. One should look for these symptoms in such patients who complain of pain and weakness of the hand, and release the carpal tunnel if nerve compression is suspected.     

Common injuries of the athlete's hand.

Hand injuries are among the most frequent accidents seen in sports medicine. All too commonly they are considered trivial since the athlete may continue to participate actively and neglect his injury. The consequent delay in diagnosis and proper treatment may result in long-standing or even permanent disability. This paper describes the more commonly encountered hand injuries, their diagnosis and their optimal treatment. Included are soft-tissue injuries, ligamentous injuries, fractures and tendon avulsions. The basic principles applicable to skeletal and soft-tissue trauma of the hand, which physicians at all levels of sports medicine may encounter, are stressed.     

200 injuries caused by playground equipment.

Two-hundred children with injuries caused by playground equipment were studied. Whereas only about 9% of the total casualty attendances are for fractures, 26-5% (53) of these children had fractures. The climbing frame and the slide seemed to be associated with more severe injuries than the swing or other equipment, but more cases need to be studied to confirm this. The youngest children were at particular risk on equipment such as the wooden rocking horse or roundabout, when the speed of operation could be controlled by older children. Many of the injuries to the very youngest children occurred when they were walking behind a moving swing. Faulty equipment did not seem to be a major factor in causing accidents, but the use by older children of apparatus designed for young ones led to accidents. There was supervision, either at home, in a school playground, or in a park, in 62% of the cases. Many of the accidents were the result of the normal desire of children for experimentation and adventure.     

Comparison of injuries to New Zealand rock lobsters (Jasus edwardsii) caused by hand versus snare collection

Abstract

Following the prohibition in New Zealand of lobster snares in late 2005, we undertook research to compare the frequency and extent of injuries to rock lobsters (Jasus edwardsii) (Hutton) caused by recreational SCUBA divers using lobster snares compared with hand collection. Rock lobsters were sampled between January 2006 and October 2006 from multiple dive sites around the North Island of New Zealand. Of the 124 rock lobsters caught, 20.9% were in a soft shell state. Female rock lobsters constituted 43.5% of the catch, but only one was carrying eggs. Female mean tail width was 72.2 mm; male mean tail width was 71.9 mm. We found that hand collection caused significantly more injuries than snare collection, to both soft shell and hard shell animals. Hand collection also resulted in more major injuries, with 18% of hard shell animals and 31% of soft shell animals losing two or more limbs. We recommend that the prohibition on the use of rock lobster snares be lifted, as their use appears to significantly reduce injury and stress to rock lobsters in recreational dive areas, and increase the survival of undersized individuals released after capture.     

Serious childhood injuries caused by air guns.

OBJECTIVE: To determine the severity of nonfatal injuries to children caused by air guns and pellet guns. DESIGN: Case series (hospital chart review). SETTING: Inpatient wards of the Children''s Hospital of Eastern Ontario. PATIENTS: All children under 18 years of age admitted to the hospital from Jan. 1, 1979, to Dec. 31, 1989, under ICD code E917, E922, E955, E965, E970 or E985 who had suffered air gun injuries. MAIN OUTCOME MEASURES: Personal data, circumstances of event and clinical data. RESULTS: The 43 children (37 boys) had a median age of 12 years. The circumstances of the accident were known in 20 cases: 17 children were playing and 3 were cleaning the gun when it went off. Four children thought the gun was unloaded. In five cases the bullet ricocheted into the eye. Nine injuries were self-inflicted. Injury was to the extremities in 21 (49%), the eyes in 15 (35%) and the head and neck in 7 (16%). The median length of hospital stay was 4 days. Six children had long-term disabilities, all the result of eye injuries; two had cataract surgery, and four required enucleation of the eye. CONCLUSIONS: Air guns can cause serious injury to children. Their sale needs to be banned or at least carefully regulated.     

Management of human bite injuries of the hand.

On the basis of experience at the Ottawa Civic Hospital over the past 10 years, a classification of and protocol for the management of human bite injuries of the hand are presented. Early exploration of such wounds under local anesthesia improves the outcome by facilitating adequate cleansing of the wound and enabling deep structures to be visualized. In this way the risk of major sepsis and of the disability so frequently associated with these innocent-looking injuries can be reduced.     

Inhibition of sphingomyelinase activity helps to prevent neuron death caused by ischemic stress

Magnesium-dependent neutral sphingomyelinase (N-SMase) present in plasma membranes is an enzyme that can be activated by stress in the form of inflammatory cytokines, serum deprivation, and hypoxia. The design of small molecule N-SMase inhibitors may offer new therapies for the treatment of inflammation, ischemic injury, and cerebral infarction. Recently, we synthesized a series of difluoromethylene analogues (SMAs) of sphingomyelin. We report here the effects of SMAs on the serum/glucose deprivation-induced death of neuronally differentiated pheochromocytoma (PC-12) cells and on cerebral infarction in mice. SMAs inhibited the enhanced N-SMase activity in the serum/glucose-deprived PC-12 cells, and thereby suppressed the apoptotic sequence: ceramide formation, c-Jun N-terminal kinase phosphorylation, caspase-3 activation, and DNA fragmentation in the nuclei. Administration of SMA-7 (10 mg/kg i.v.) with IC50= 3.3 microM to mice whose middle cerebral arteries were occluded reduced significantly the size of the cerebral infarcts, compared to the control mice. These results suggest that N-SMase is a key component of the signaling pathways in cytokine- and other stress-induced cellular responses, and that inhibiting or stopping N-SMase activity is an important strategy to prevent neuron death from ischemia.     

HTK solution helps to preserve endothelial integrity of saphenous vein: an immunohistochemical and ultrastructural analysis

The aim of the study is to demonstrate the ability of HTK (Histidine-tryptophan-ketoglutarate) solution to preserve endothelium. Ten saphenous veins (SVs) were prospectively collected from 10 patients who underwent coronary artery bypass grafting (CABG). The SVs were divided into two sets of segments, one of which preserved in HTK solution at 4°C (group A), and the other preserved at 4°C in saline solution NaCl 0.9% (group B); ten pieces from the SVs were processed as control. The control sample was fixed in 10% neutral buffered formalin immediately after harvesting. The observation lasted up to the 5th postoperative day. A morphological, ultrastructural, and immunohistochemical analysis (CD31) was performed on each piece. Immunohistochemical analysis demonstrated significant protection on endothelium in group A compared to group B starting from the 1st observational day. Ultrastructural data confirmed immunohistochemistry. These preliminary results represent a basis for further analysis. They suggest the protective role of HTK solution in preserving endothelial integrity and may imply some clinical benefits in organ protection.     

High-pressure hand injection injuries caused by dry cleaning solvents: case reports,review of the literature,and treatment guidelines

A previously unreported subset of high-pressure injection injuries, namely those involving solvents used in the garment dry cleaning industry, is presented. Dry cleaning solutions contain isoparaffinic hydrocarbons, methoxypropanol, and dichlorofluoroethane. Although these solvents have limited potential for systemic toxicity, severe local toxicity causing tissue necrosis often results in loss of the injured digit. Proper treatment includes prompt surgical exploration, careful débridement and irrigation, intravenous antibiotics, and in selected cases, high-dose systemic corticosteroids.     

Vacuum-assisted closure for the treatment of degloving injuries

Degloving injuries of the hand and foot pose difficult reconstructive and rehabilitation challenges. After an excellent experience with split-thickness skin grafting with the vacuum-assisted closure device, we began studies with full-thickness skin grafts and traumatized skin. The device has been used with successful reapplication of full-thickness degloved skin in two patients. The first patient suffered degloving of the foot; the second patient, degloving of the hand.