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Munchausen Syndrome is known as a condition where individuals who seek attention for themselves present at healthcare institutions with exaggerated complaints. Diagnosis can be difficult in some cases. In this paper are presented two cases of Munchausen Syndrome diagnosis by removing finger proprioception with local anesthetic based on incompatibility between trauma history and clinical findings. Evaluation of the resting position of the hand is primarily associated with proprioception. Sight and touch are important for proprioception. In patients thought to be potentially faking symptoms in areas where local anesthesia can be applied easily, such as the fingers, removing proprioception in the physical examination is important in diagnosing these individuals. [Hand Microsurg 2016; 5(3.000): 160-163]

A case of intrinsic contracture of a hand of an 18-year-old thin woman following an unrecognized mild trauma is presented. The moderate intrinsic tightness of the second, third, fourth and fifth fingers had been released from the metacarpal bones using the inter-osseous muscle sliding technique. After a 2.5 years follow-up period, no signs of recurrence were recorded and the functional outcome was favorable. Even a very mild trauma in slim patients may lead to hand edema which, in the long-term, could result in intrinsic muscle atrophy of the hand. Key words: [Hand Microsurg 2016; 5(3.000): 156-159]

Lung cancer metastasis to finger bones is very rare compared to that in other bones. When a patient presents with erythematous and painful swelling of a finger, it can be easily misdiagnosed. X-rays usually show a destructive lytic lesion. This metastasis has a very poor prognosis. Here, a case of a sixty-one-year-old male patient with metastasis of non-small-cell lung cancer to the right thumb, initially misdiagnosed as infection, is described. Differential diagnosis and treatment options are also reviewed in this case report. [Hand Microsurg 2016; 5(3.000): 169-171]

BACKGROUND The aim of this study was to assess the usability of an electrocautery device as nerve stimulator and to investigate histopathologically the adverse effects of electrocautery at low power on rat sciatic nerves. METHODS A total of 36 female Sprague-Dawley albino rats were divided into six groups according to the power applied to their sciatic nerves (1, 2, 3, 4, 5 and 6 W, respectively). Pathologic changes were studied by microscopic examination and scored (no change = 0, mild = 1, moderate = 2, severe = 3). Multiple comparisons were provided for all groups by the Bonferroni test (one-way analysis of variance). A p value 0.05 was accepted as statistically significant. RESULTS The average scores were 2.66 ± 0.51, 3.66 ± 0.51, 5.83 ± 1.83, 10.0 ± 1.78, 11.0 ± 1.54, and 13.8 ± 0.89 in groups 1 to 6, respectively. Significant differences were found between all groups (p 0.01), except between groups 1 and 2, groups 2 and 3, and groups 4 and 5 (p 0.05) Variable motor responses and foot deformities were observed at the different power levels. CONCLUSION Although electrocautery devices provoke motor responses if getting in contact with peripheral nerves as do nerve stimulators, their use induces histopathologically adverse effects even at the lowest power. Their use around peripheral nerves should be avoided.

[Hand Microsurg 2016; 5(2.000): 110-111]

Cataloged from PDF version of article. Background: Anti-SOX2 antibody responses are observed in about 10 to 20% of small cell lung cancer (SCLC) patients. The aim of this study was to determine whether such responses reflect a particular pattern of SOX2 protein expression in the tumor and whether this pattern associates with clinical outcome. Methods. Paraffin embedded tumor tissues, obtained from SCLC patients who had no evidence of paraneoplastic autoimmune degeneration, were evaluated for SOX2 expression by immunohistochemistry for both intensity and extent of staining. Sera from the same patients were tested for autologous antibodies against recombinant SOX2 by enzyme-linked immunosorbent assay (ELISA). Correlates between overall survival and various clinical parameters including SOX2 staining and serology were determined. Results: SOX2 protein expression was observed in tumor tissue in 89% of patients. Seventeen patients (29%) were seropositive for SOX2 antibodies and, in contrast to SOX2 staining, the presence of antibody correlated with limited disease stage (p = 0.05). SOX2 seropositivity showed a significant association with the intensity of SOX2 staining in the tumor (p = 0.02) but not with the frequency of SOX2 expressing cells. Conclusion: Anti-SOX2 antibodies associate with better prognosis (limited stage disease) while SOX2 protein expression does not; similar to reports from some earlier studies. Our data provides an explanation for this seemingly contrasting data for the first time as SOX2 antibodies can be observed in patients whose tumors contain relatively few but strongly staining cells, thus supporting the possible presence of active immune-surveillance and immune-editing targeting SOX2 protein in this tumor type. © 2014 Atakan et al.; licensee BioMed Central Ltd.

Purpose: To determine the usefulness of magnetic resonance imaging (MRI) in detecting the tendinous connection in Linburg-Comstock anomaly. Material and Methods: The study comprised 52 patients attending the orthopedic clinic for different hand problems. They were also examined for the presence of Linburg-Comstock anomaly, which was present in nine, and these patients were examined by MRI. Results: The tendinous connection between flexor pollicis longus and flexor digitorum longus in all patients was shown by MRI. The connections were in the wrist, just proximal to the radiocarpal joint or distal forearm. Conclusion: MRI can show localization of the connection in this anomaly and helps the surgeon perform the operation with a limited incision. The operation time is therefore shorter and wound scarring less prominent.

Background In upper and lower extremity fractures and osteotomy fixation, the use of methyl methacrylate (MM) as an external fixator presents an alternative method. The primary aim of this retrospective study was to evaluate the midterm outcome of pediatric patients who underwent corrective humeral supracondylar lateral closing-wedge osteotomy, with the external fixation system composed of MM and multiplane K-wires. Methods Fourteen consecutive cases with cubitus varus, who underwent corrective osteotomy with a limited lateral approach stabilized with MM and the multiplane K-wires external fixator system between January 2006 and May 2010, were retrospectively evaluated. Time of union, preoperative and postoperative elbow range of motion, and humeroulnar angle were measured. Results were rated as excellent, good, or poor, according to Bellemore criteria. Results There were a total of 6 female patients and 8 male patients with a mean age of 5.7 years (range, 3 to 9 y). The mean follow-up period was 28.2 months (range, 24 to 48 mo). The mean humeroulnar angle was (-) 18.6 degrees preoperatively, and (+) 16.3 degrees at the final follow-up. Thirteen patients were evaluated as excellent and 1 patient as good, according to Bellemore criteria. Union was seen in all patients at mean 7 weeks (range, 6 to 8 wk). Pin tract infection was observed in 1 patient and treated with oral antibiotics. Loss of correction was not observed in any patient during follow-up. Conclusions External fixation of corrective supracondylar humeral osteotomy with MM and multiplane K-wires is a practical, effective, reliable, and cheap alternative method that can be applied. Level of evidence Level IV. Retrospective study.