The dorsal wrist ganglion is the commonest benign soft-tissue tumour of the hand. Its treatment has been the subject of discussion for centuries, many methods being accompanied by an unacceptably high recurrence rate. Surgical extirpation gives the most reliable results and success has been said to depend on the identification of an unvarying deep attachment of the ganglion to the scapholunate ligament. A previous study has suggested that if this is excised, there will be no recurrences and no residual symptoms. Our experience of 62 dorsal ganglia confirms that although a scapholunate origin is usual, ganglia may also arise from a variety of additional sites over the dorsal wrist capsule, particularly in the region of the capitate. Two ganglia have recurred and clinical review of 52 (84%) of the cases has shown that persistent discomfort following excision is not uncommon. One patient appears to have developed scapholunate instability.

The dorsal wrist ganglion is the commonest benign soft-tissue tumour of the hand. Its treatment has been the subject of discussion for centuries, many methods being accompanied by an unacceptably high recurrence rate. Surgical extirpation gives the most reliable results and success has been said to depend on the identification of an unvarying deep attachment of the ganglion to the scapholunate ligament. A previous study has suggested that if this is excised, there will be no recurrences and no residual symptoms. Our experience of 62 dorsal ganglia confirms that although a scapholunate origin is usual, ganglia may also arise from a variety of additional sites over the dorsal wrist capsule, particularly in the region of the capitate. Two ganglia have recurred and clinical review of 52 (84%) of the cases has shown that persistent discomfort following excision is not uncommon. One patient appears to have developed scapholunate instability.

SummaryAlthough heart donation after cardiac death (DCD) could greatly improve graft availability, concerns regarding warm ischemic damage typically preclude transplantation. Improving tolerance to warm ischemia may thus open a window of opportunity for DCD hearts. We investigated the hypothesis that, compared with normothermia, mild hypothermia (32°C) initiated after ischemic onset improves cardiac functional recovery upon reperfusion. Isolated, working hearts from adult, male Wistar rats underwent global, no-flow ischemia, and reperfusion (n = 28). After ischemic onset, temperature was maintained at either 37°C for 20 or 30 min or reduced to 32°C for 40, 50, or 60 min. Recovery was measured after 60-min reperfusion. Following normothermic ischemia, recovery of ratepressure product (RPP; per cent of preischemic value) was almost complete after 20-min ischemia (97 AE 9%), whereas no recovery was detectable after 30-min ischemia. After mildly hypothermic ischemia (32°C), RPP also recovered well after 40 min (86 AE 4%). Markers of metabolism and necrosis were similar in 37°C/20 min and 32°C/40 min groups. Simple reduction in cardiac temperature by a few degrees after the onset of global ischemia dramatically prolongs the interval during which the heart remains resistant to functional deterioration. Preservation of hemodynamic function is associated with improved metabolic recovery and reduced necrosis. The application of mild hypothermia may be a simple first step towards development of clinical protocols for DCD heart recovery.

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