The aim of this study is to evaluate the amount of training needed by a trainee, with no background in microsurgery, in order to achieve proper skills for microvascular anastomosis. A protocol based on the rat femoral artery was established to provide a quantitative representation. Five inexperienced subjects started performing microvascular anastomosis. Patency was assessed at 30 min. The final assessment was performed at 2 weeks when rats were reoperated and the patency below the anastomosis was checked. The experiment was discontinued for one subject when he/she succeeded to have two series of four anastomosis with 100% patency at 2 weeks. The results were: 47.5% patency rate at 30 min and 7.5% at 2 weeks (series 1-2); 67.5 and 32.5% (3-4); 82.5 and 35% (5-6); 100 and 70% (7-8); 100 and 87.5% (9-10). Two trainees obtained 100% patency at 2 weeks after series 9-10. Other three needed two more series. There is a significant statistic difference (P < 0.01) between the results at 30 min and 2 weeks for the series (1-2, 3-4, 5-6, 7-8). The patency rate at 2 weeks reflects in a better way the microsurgical skills of a trainee. For long term functioning anastomosis, the training period needs an extension beyond that necessary for 100% patency at 30 min.

Rationale:Nail bed solitary neurofibroma is an extremely rare tumor, with only 9 cases recorded in the literature so far.Patient concern:We present the case of a 42-year-old female patient, with a history of a slowly growing tumor in the nail bed of the left index and no clinical features of type I neurofibromatosis.Diagnosis:Nail bed solitary neurofibroma.Intervention:The tumor was surgically removed and the pathology examination established the diagnosis of neurofibroma.Outcomes:The postoperative outcome was good, with no recurrence 12 months after surgery.Lessons:We present the rarity of this type of tumor localized in the nail bed, taking into consideration the only 9 cases recorded in the literature. Nail bed solitary neurofibroma should be also included in the differential diagnosis of a nail bed tumor.

We analyze the effectiveness of ultrasonography in diagnosing carpal tunnel syndrome (CTS) and propose the use of sonographic index of median nerve (MN) in carpal tunnel (SIMNCT) in a diagnostic algorithm and in establishing a scale of severity. We studied a group of 344 patients with CTS symptoms, examining them by ultrasound. We measured in all patients, on the affected hand: the size of the cross-sectional area of the MN at carpal tunnel (CT) inlet and outlet, nerve morphology at passage through CT, the vertical thickness of the MN entering into the CT – G1, the lowest vertical thickness into the CT or leaving the CT – G2, the thickness of the MN in the transversal plane as entering in the CT – L. Normal values were considered the similar measurements taken on the healthy hand and we established as normal SIMNCT = 16%. We proposed the formula SIMNCT = 100% (1-G2/G1) in order to calculate the index. Statistics show a significant sensitivity of SIMNCT ( P < .0001) compared with cross-sectional area (CSA) and flattening ratio in the diagnosis of CTS. Analyzing the SIMNCT developed by us, we demonstrated a sensitivity of 94.81% and a specificity of 99.66% in CTS diagnosis. Thereby, we propose a CTS severity classification: normal = 16%, mild = 16–19%, moderate = 19% to 28%, severe = 28% to 50%, very severe > 50%. Ultrasonography is an effective method of studying the morphology of the tunnel and compressed nerve at various CTS stages and determining the cause of compression. The SIMNCT is a valuable and practical indicator and it can be used in the CTS diagnosis.

No abstract

Hirudotherapy is a complementary medical technique, apparently old, but, at the same time, an up to date technique, having a real efficiency in the treatment of venous congestion. Hirudin, present in the leeches� saliva, was isolated by Markwardt in 1955. It acts by preventing the conversion of fibrinogen into fibrin, thus being a natural inhibitor of thrombin. The saliva of the leeches also contains over 100 proteins with various molecular weights, having an important anticoagulant, anti-inflammatory and analgesic effects, platelet function inhibitor, thrombin function regulator and antimicrobial. The purpose of the study is to confirm the effectiveness of the use of hirudotherapy in the treatment of venous congestion occurring post-replantation, as well as to emphasize some peculiarities of usage, duration and results in the case of using leeches in the treatment of venous congestion.The study included a group of 29 cases, 7 with ear amputations (three cases of complete amputation and four cases of incomplete amputation) and 22 cases of complete finger amputations. For the ears, in complete amputation, microsurgical replantation and arterial reconstruction were performed without being able to identify a vein for microsurgical anastomosis. Postoperatively, in all cases, once the signs of venous congestion had occurred, Medical Leech Therapy (MLT) was initiated. The application of medicinal leaches was initiated several hours postoperatively in those cases of distal digital amputation when no vascular anastomosis was performed, as well as in those where conventional treatment (local heat, elevated hand, general vasodilators and local heparin) was not effective.