Scaphotrapeziotrapezoid (STT) joint fusion was carried out for pain relief in eight patients with isolated arthritis. Seven patients had satisfactory relief of symptoms. The subjective results were excellent in five, good in two and bad in one patient, who had non-union of the arthrodesis and was also the only patient to develop trapeziometacarpal arthritis. Average grip strength was 0.8 and lateral pinch strength was 0.7 of that in the other hand. There was a very small relative difference in dexterity. There was an average difference of 9 degrees of flexion-extension and 13 degrees of radio-ulnar deviation. It is concluded that for isolated idiopathic STT arthritis, fusion gives very satisfactory results with minimal complications.
The aim of this study was to quantify the risk of blood splashes to the conjunctiva during ear, nose and throat surgery. Two hundred and sixty consecutive operations by three surgeons were assessed for contamination of safety glasses and other factors. We found that 15 per cent of operations resulted in blood droplet contamination of safety glasses. In 92 per cent of these, contaminations were on the exterior of the glasses and eight per cent were on both sides. We concluded that about one and a half per cent of operations would result in droplet contamination of the conjunctiva and that safety spectacles reduced the risk by a factor of about 10. This study generally concurs with that of previous research in the areas of general and orthopaedic surgery and necropsies. We substantiate the need for eye protection for all ear, nose and throat procedures. Spectacles do provide a reasonable degree of protection but where absolute protection is needed i.e. in high risk groups, goggles should be used in preference to safety spectacles
Gastrojejuno appendicular fistula is a rare condition. To our knowledge it has not been reported previously in the literature. We report the first case of a gastrojejuno appendicular fistula occurring in a patient who had previous gastroenterostomy for ulcer disease. He presented to us with recurrent episodes of abdominal pain and bilious vomiting. An endoscopy revealed intense gastritis with bile reflux. He was diagnosed as alkaline gastritis and put on medication. As there was no relief of his symptoms; it was decided to do a biliary diversion. At laparotomy there were extensive adhesions which was gently separated. Patient had an anticolic anastomosis and a long tubular structure was seen fistulating to the stoma site. It was traced and found to be the appendix. The gastrojejunal stoma was opened and the fistulous mouth was identified and cannulated following, which a retrograde appendicectomy was performed and a cuff of intestine around the fistula was excised. The Stoma was closed in a single layer. A Braun's enteroenterostomy was done to correct the alkaline reflux. The patient is symptomatically better and is gaining weight. The pathogenesis of alkaline gastritis. appendicular fistula and gastrojejunocolic fistula is discussed.
A case of zygomycosis presenting with non-healing multiple discharging sinuses in a diabetic patient is reported here. The debrided tissue on histopathological examination revealed dense inÞ ltration with aseptate fungal hyphae. Potassium hydroxide mount showed hyaline aseptate hyphae suggestive of zygomycosis. On culture, Absidia corymbifera was isolated. The patient responded to surgical debridement and therapy with amphotericin B followed by itraconazole.
One rare and peculiar result of repeated minor trauma to the leg is Madura foot. Caused by fungi or fungus-like bacteria, Madura foot is found mainly in the tropics. A report of a classic case with chronic indurated swelling involving the leg and a discharge of yellowish granules is presented. The case is reported to highlight the fact that though Maduramycosis needs prolonged intensive antibacterial chemotherapy, even extensive disease can be successfully managed with conservative therapy.
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