INJURIES OF THE HAND AND FOREARM—Treatment of Damaged Soft Tissues

Successful primary repair of soft tissue injuries of the hand and forearm holds the ultimate disability to a minimum. The kinds of trauma and the resultant soft tissue damage may be classified. Attention to details and technique in carrying out the primary reparative operation on the injured hand largely obviates a crippling deformity or the need for much reconstruction later.     

SULFHYDRYL AND DISULFIDE GROUPS OF PROTEINS : III. SULFHYDRYL GROUPS OF NATIVE PROTEINS—HEMOGLOBIN AND THE PROTEINS OF THE CRYSTALLINE LENS

Hemoglobin and the proteins of the crystalline lens contain active SH groups while in the native state, the number of active groups increasing as the pH rises. All the SH groups of denatured globin and of the denatured lens proteins are active at a pH so low that practically none of the SH groups of native hemoglobin and of native lens protein are active. The effect of denaturation on the SH groups of a protein is to extend towards the acid side the pH range of their activity. It is possible to oxidize the iron-porphyrin and the SH groups of hemoglobin independently of each other.     

CRUSHING INJURY OF THE HAND—Prevention of Ischemic Contracture

Crushing injury of the hand usually causes “explosive” damage. Subsequent swelling of the palmar structures further impairs venous outflow, and hemorrhage into structural spaces increases the pressure. The arterial system and the large dorsal veins, however, are seldom obstructed and provide adequate circulation unless hampered by improper bandaging. A bandage that compresses the dorsal veins causes back-pressure, which increases the swelling further and brings about ischemia. Swelling and pain cause the patient to restrict exercise of the injured hand, which permits contractures to develop.The author has averted this sequence in more than 100 cases by preserving integrity of veins during debridement, arresting hemorrhage, bandaging the hand with compression dressings in functional flexion, and reducing swelling with hyaluronidase. In these cases, on removal of bandages in 24 hours, swelling was reduced and continued to diminish. All patients exercised the hand at this time without discomfort and only a few required aspirin for pain.     

IMPALEMENT INJURIES OF THE HAND—Repair of Damage from Broken Bean Poles

A not uncommon injury of the hands among agricultural workers is impalement on the sharp ends of tomato-vine or bean-vine stakes that shatter as they are being driven. Careful debridement and tetanus prophylaxis are important in treatment. There are several simple precautions and changes in work methods that could greatly reduce the incidence of such injuries.     

MALIGNANT LYMPHOMA OF THE COLON AND RECTUM—Roentgen Diagnosis

The filling defects of a particular lymphosarcoma of the colon or rectum may present an appearance identical to that of a carcinoma in the same location. In general, lymphosarcomas tend to be longer, more distensible, less sharply demarcated, more frequently polypoid, and to feel larger as palpable masses. The filling defects are infrequently of the annular “napkin ring” appearance, and occasionally the involved segment is dilated.     

VESICULAR AND BULLOUS DISEASES OF THE SKIN—Cytologic Diagnosis

A new technique, first described by Tzanck, for diagnosis of vesicular and bullous diseases of the skin by cytologic examination of material firmly scraped from lesions has a number of advantages over excision of biopsy specimens. It takes relatively little time, is painless, simple and inexpensive. The method also has value in research and teaching.