SURGEON, PARK PREWETT HOSPITAL, BASINGSTOKECONGENITAL arteriovenous fistula of the extremities would appear from the literature to be a rare condition. Pemberton and Saint (1928) surface. The hand was used by the patient for all ordinary purposes, and its function was fair. Elevating the arm caused the dilated veins to disappear. With the stethoscope a continuous-cycle bruit with systolic accentuation could be heard over most of the hand, but was maximum on the palmar surface at the base of the first finger. The bruit was high-pitched and musical, and could be heard conducted as high as the right supraclavicular fossa. No murmur could be detected above and 1931. Some of these were only diagnosed by the venous oxygen content, and had no murmur or thrill, so it is possible that the condition is not so rare, but sometimes escapes recognition. Bone changes and local gigantism are reported in many of the cases, but malacia of the semilunar has not been mentioned.
CASE REPORTThe mother stated that a purplish discoloration of the right hand had been present from birth. Disproportionate increase in the size of the hand, associated with some deformity, had been noticed in the last two or three years. The patient's only complaint was of mild pain in the deformed fingers and in the wrist.ON EXAMINATIoN.-The patient was an intelligent healthy girl. The right hand showed a large irregular port-wine stain on both palmar and dorsal surfaces. The whole hand, with the exception of the thumb, which was quite normal, was swollen and covered with dilated tortuous veins. Dilated veins were also present in the forearm. The four fingers showed gigantism and deformities (Fig. 277). A thrill was palpable, maximum in the palm. In addition to the radial and ulnar arteries, four deep pulsating vessels could be palpated, one on the palmar surface and three on the dorsal A girl aged IZ was first seen on Feb. 7, 1943. the wrist when a tourniquet had first been applied at this level, thus proving the arteriovenous communications responsible for murmurs to be at or below the wrist. This was not absolute proof, however, that other communications did not exist higher up, as cases have been described without murmurs (Horton, 1932).The right hand was definitely warmer, and usually moister, than the left. The heart showed no clinical signs of enlargement or abnormality. The right humerus, radius, and ulna were approximately half an inch longer than the left.The blood-pressure findings were interesting and were taken with the experimental model of the M.E.M. sphygmoscope, (Mendelssohn et al., 1945) as it was found to be very difficult to determine the pressure in the