We reviewed 30 patients with subungual glomus tumours of the hand operated on between 1964 and 1997. Seven patients were male and 23 were female. Their age ranged from 16 to 78 years. A transungual approach was selected in 27 patients, and a periungual approach in three. Pre-operative pain subsided in all of the patients, but recurrence of the pain was observed in nine. Nail deformities were observed in nine patients before surgery. After surgery, it disappeared in three patients, persisted in six, and new deformities developed in five. To avoid recurrence of pain, it is important that the accurate pre-operative localisation of the tumour and a complete extirpation should be performed. To avoid nail deformity, it is better to apply a periungual approach for tumours developing in the peripheral region, and a transungual approach followed by meticulous repair of the nail bed for tumours developing in the central region.

Findings in 34 patients with traumatic brachial plexus injury documented by surgical exploration and intra-operative somatosensory-evoked potentials were correlated with findings on myelography and magnetic resonance imaging (MRI) to determine whether MRI can identify nerve root avulsion. The coronal and sagittal planes were not able to demonstrate avulsion of the individual nerve roots. The axial and axial oblique planes did provide useful information to determine which nerve root was avulsed in the upper plexus, although it was difficult to clearly delineate the lower cervical rootlets. The accuracy of MRI was 73% for C5 and 64% for C6 and that of myelograpby 63% for C5 and 64% for C6. Thus, the diagnostic accuracy of MRI for upper nerve roots was slightly superior to myelography. Although its primary diagnostic value is limited to the upper nerve roots whose avulsion is relatively difficult to diagnose by myelography, MRI can provide useful guidance in the waiting period prior to surgical exploration after brachial plexus injury.

Twelve patients underwent reconstruction of injured finger joints using our technique of a vascularized transfer of the second toe proximal interphalangeal joint. The age of the patients at operation ranged from 7 to 47 years and the postoperative follow-up was 9 to 48 months. All the joint transfers survived and united with resolution of the preoperative joint pain, deformity and instability. The average range of motion of the reconstructed joints was 59 degrees in the proximal interphalangeal and 54 degrees in the metacarpophalangeal joints. No patient complained of pain or functional deficits in the donor foot.

No abstract

We examined the effects of dorsal root ganglion isografts on the denervation process of skeletal muscle. A segment of sciatic nerve was removed from each of 25 inbred Wistar-Kyoto rats. Fifteen were set aside as controls. In the remaining 10 rats, isogeneic cervical dorsal root ganglia were grafted to the severed distal stump of the common peroneal nerve. Between day 72 and day 286 postoperatively, both controls and recipients were killed after twitch and tetanic tension recording of the extensor digitorum longus was performed. The wet muscle weight and the twitch and tetanic tensions of the denervated extensor digitorum longus in the graft group were significantly greater than those in the control group. The mean area of the denervated tibialis anterior muscle fibers in the graft group also was significantly larger than that in the control group. In electron and light microscopic images, nerve cells along the periphery of each dorsal root ganglion were found surviving with regenerating axons throughout the experimental period. Numerous myelinated axons were observed in the common peroneal nerve of the graft group, and there were significantly more axonal branches in the extensor digitorum longus of the graft group than in the extensor digitorum longus of the control group. Thus sensory nerve fibers from the grafted dorsal root ganglia had certain beneficial effects to slow the denervation process, presumably secreting trophic factors into the denervated muscle. Clinically, we have transferred avulsed dorsal root ganglia in cases of total brachial plexus avulsion directly into denervated skeletal muscle. This procedure, accompanied by nerve crossing procedures, will probably keep denervated skeletal muscle in a better condition until regenerating motor axons from the repair site reach their target muscle.