For hand surgeons, the treatment of children with congenital differences of the upper extremity is challenging because of the diverse spectrum of conditions encountered, but the task is also rewarding because it provides surgeons with the opportunity to impact a child's growth and development. An ideal classification of congenital differences of the upper extremity would reflect the full spectrum of morphologic abnormalities and encompass etiology, a guide to treatment, and provide prognoses. In this report, I review current classification systems and discuss their contradictions and limitations. In addition, I present a modified classification system and provide treatment principles. As our understanding of the etiology of congenital differences of the upper extremity increases and as experience of treating difficult cases accumulates, even an ideal classification system and optimal treatment strategies will undoubtedly continue to evolve.
Hand Deformities, Congenital/*classification/pathology/*surgery ; Humans

PURPOSE: To compare the galactographic findings of malignant and benign disease in patients with pathologic nipple discharge and to analyze the features suggesting malignancy. MATERIALS AND METHODS: In 24 patients in whom pathologic nipple discharge had occurred, the findings of preoperative galactography were correlated with those of pathology. RESULTS: Nine of the 24 cases were malignant and the other 15 were benign. Intraductal calcification occurred in five malignant cases (56%) and two (13%) which were benign. Seven malignant cases (78%) involved the segmental ducts, and in eight (89%), the peripheral ducts below the subsegmental duct were involved. Five benign cases (33%) involved the lactiferous sinus, seven (47%) the segmental duct, and two (13%) the subsegmental duct. Distal duct dilatation occurred in four benign cases (27%), while ductal stenosis was noted in six cases (67%) and ductal distortion in seven (78%). A malignant tumor appeared as a multiple (n=5, 56%) or irregular (n=5, 56%) filling defect, and a benign tumor as a single (n=12, 80%), oval (n=6, 40%) or lobular (n=4, 27%) filling defect. CONCLUSION: At galactography, a malignant tumor frequently appeared as an irregular multiple intraductal filling defect in a peripheral duct. A benign tumor, on the other hand, appeared as an oval or lobular single lesion. The presence of ductal stenosis, distortion and intraductal microcalcifications not opacified by contrast material suggest possible malignancy.
Constriction, Pathologic ; Dilatation ; Hand ; Humans ; Nipples* ; Pathology

Tumoral calcinosis of the hand is very rare and usually occurs in the region of large joints. When viewed as an infection, it poses a diagnostic problem. In addition, it is too small to be detected by X-ray, especially at the early stage. These three cases occurred in the hand, and were confirmed by pathology. All cases involved young active women who complained of mild to moderate constant pain.Masses were excised thoroughly and all patients have been followed for more than a year postoperatively without recurrence.
Calcinosis* ; Female ; Hand* ; Humans ; Joints ; Pathology ; Recurrence

Aspiration and injection of the knee joint is a commonly performed medical procedure. Injection of corticosteroid for the treatment of osteoarthritis is the most common reason for knee joint injection, and is performed as an office procedure. Debate exists among practitioners as to the 'best' approach portal for knee injection. This paper examines the various approach portals for injection and/or aspiration of the knee joint, as well as the accuracy of each approach. Searches were made of electronic databases, and appropriate papers were identified and hand-searched. Although there is some evidence that particular approach portals may be more efficacious in the presence of specific knee joint pathologies, generally, in experienced hands, it is of no clinical consequence as to which approach portal is utilised for aspiration or injection of the knee joint. No approach portal is 100% accurate, and the accuracy of injection of the knee joint may be enhanced by the use of techniques such as ultrasound. Practitioners are reminded that they should continuously refine and practice their preferred technique. Knee joint aspiration and injection is a common, simple, and generally safe office procedure.
Hand ; Knee Joint ; Knee ; Osteoarthritis ; Pathology ; Ultrasonography

OBJECTIVETo study the clinical and pathologic features of tumors and tumor-like lesions in the bones of hands and feet.

METHODSClinical, X-ray and pathologic features of 154 cases of tumors and tumor-like lesions in the bones of hands and feet between 1991 and 2002 were investigated.

RESULTSIn the bones of hands and feet the frequency and distribution of many lesions were distinctive when compared to those of other skeletal sites. Cartilaginous lesions were most common (60%), and 72% of them were enchondromas. Enchondromas were most often situated in the second to fifth phalanges and metacarpal bones. Chondroblastomas most frequently involved the irregular bones (such as calcaneus, talus and osnaviculare) of the feet. Whereas the occurance of osteochondromas in the bones of the hands and feet was lower than in the long bones. Most "osteochondromas" of the phalanges were subungual exostoses. A group of reactive or reparative lesions, which are related to trauma, such as subungual exostosis, giant cell reparative granuloma, florid reactive periostitis and bizarre parosteal osteochondromatous proliferations typically occurred in the bones of the hands and feet, but these tumor-like lesions were often misdiagnosted. Another feature of lesions in the bones of the hands and feet was that there were much more benign than malignant lesions (21:1), and that chondrosarcomas were common in malignancies. The diagnostic criteria for benign and malignant cartilaginous tumors in the bones of hands and feet were different from those in long bones and flat bones.

CONCLUSIONSBone tumors of the hands and feet are different from that of long bones, flat bones and axial bones. Because the hands and feet are frequently exposed to trauma, reactive and reparative lesions often occur in these sites. These tumor-like lesions may simulate benign and malignant neoplasia. Knowledge of different types of lesions which commonly affect these sites is of benefit in assessing lesions of the bones of hands and feet.

Bone Neoplasms ; pathology ; Cartilage ; pathology ; Chondroblastoma ; pathology ; Chondroma ; pathology ; Chondrosarcoma ; pathology ; Foot ; Hand ; Humans ; Osteochondroma ; pathology

When one follows a systematic approach to make a diagnosis of pathologic of pathologic lesions, it is relatively easy to render a cancer diagnosis in almost all cases in routine daily practice. The first step is to recognize whether or not the specimen contains a lesion and then to determine whether the lesion is neoplastic or nonneoplastic. Since neoplasm is clonal proliferation, neoplastic conditions are usually composed of a single cell type, whereas nonneoplastic conditions consist of multiple different cell types. After a neoplastic condition has been documented, the next step is to decide whether the neoplasm is of an epithelial origin or mesenchymal origin. The main differences between epithelial tumors and mesenchymal tumors include : 1) the tumor cells in epithelial tumors are oval, round to polygonal, while those in mesenchymal tumors are in general spindleshaped : 2) epithelial tumors generally form tumor cell nests, while mesenchymal tumors arrange diffusely without forming tumor cell nests : 3) in epithelial tumors, desmoplastic stroma is wellformed in between tumor cell nests, while in mesenchymal tumors there is no desmoplastic stroma ; and lastly, 4) feeding vessels open in the stroma in epithelial tumors, while they open between tumor cells in mesenchymal tumors. After this one should decide whether the tumor is benign or malignant. The differences between benign and malignant tumors include : 1) differentiation ; 2) growth rate ; 3) growth pattern ; and 4) metastasis. The benign tumor is ell differentiated, grows slowly, shows an expansile growth lattem with encapsulation, and does not metastasize. On the other hand, the malignant tumor is in general poorly differentiated, grows rapidly with frequent mitoses, shows an invasive growth pat-tern without capsular formation, and frequently metastasizes. In general malignant tumors show a high cellularity, tumor necrosis, and nuclear alterations, which include nuclear enlargement with a high nudear/cytoplasmic ratio, hyperchromatism, pleomorphism, prominent nucleolus, and frequent mitoses. The final step is to classify the type of tumor based on the cellular differentiation and gross and microscopic growth patterns based on the light microscopic exarhination of H & E stained slides. For the correct identification of the tumor, immunostaining, electron microscopic evaluation, and molecular diagnostic tools may be required. After establishment of a diagnosis of malignancy, one should think about the prognostic factors. The two wellknown prognostic (factors (category I) applicable in almost all tumors include stage and grade. Therefore, information about the stage and grade should also be included in the pathology report.
Diagnosis ; Hand ; Mitosis ; Necrosis ; Neoplasm Metastasis ; Pathology ; Pathology, Molecular

Hand Deformities ; pathology ; Humans ; Klippel-Feil Syndrome ; pathology ; Thumb

Scapholunate advanced collapse (SLAC) deformity most often occurs with chronic rotary scaphoid instability from scaphoiunate ligament tear and scaphoid fracture. Prior to 1984 when Watson HK reported his concept on SLAC wrist deformity, the most popular procedure for this pathology was scaphoid implant arthroplasty with or without midcarpal fusion. We have reviewed 15 cases of SLAC deformity treated with scaphoid excision and midcarpal fusion from 1984 to 1993. Among them, scaphoid implants made of silicone were inserted in 4 cases. Scaphoid implant arthroplsty without carpal fusion has been excluded. The mean period of follow-up was 8.8 years and the mean age of patients was 47.5 years. Males and right wrists were predominant. Wrist motion was 56% and grip power was 71% of the normal opposite side. On the average overall, 8 patients had no pain and 7 patients had mild pain. The grade of pain was minimal, 0.5 in grade (Rating system: no pain-0, mild- 1, moderate-2, severe-3). However, all of the 4 cases of limited carpal fusion with a scaphoid implant developed silicone particulate induced synovitis and pain. The procedure appears to be effective in maintaining function of the hand with minimal pain up to 5.8 years. However, silicone scaphoid implant appears not to be necessary and is not recommended with a limited carpal fusion for this pathology.
Arthroplasty ; Congenital Abnormalities ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Ligaments ; Male ; Pathology ; Silicones ; Synovitis ; Wrist

To analyze the preoperative and postoperative characteristics of the patients over 80 years of age who had undergone cataract extraction, we reviewed the clinical records of 120 patients(167 eyes) over 80 years of age. The preoperative visual acuity was worse than 2/20 in 139 eyes(84%) and the preoperative visual acuity of 76 eyes(45%) were hand motion or worse. One hundred and twelve eyes(67%) had cataract more dense than nucleosclerosis of grade III and 54 eyes had total cataract. Seven patients were not cooperative enough to check the postoperative visual acuity. Among the 113 patients(156 eyes) with the measured postoperative visual acuity, 73 eyes(47%) resulted in the visual acuity of 20/40 or better. Among 83 patients with the postoperative visual acuity less than 20/40, the ocular 28 eyes. In conclusion, 25%(39 eyes among 156 eyes) of the patients older than 80 years could not see better than 20/40 after cataract surgery without any ocular organic pathologies. Age factor can have the predictive value of visual outcome after cataract extraction.
Age Factors ; Cataract Extraction ; Cataract* ; Hand ; Humans ; Pathology ; Visual Acuity

The encapsulated hepatocellular (HCC) is a pathologic subtype of HCC. It is a well defined tumor that tends to grow slowly, and has a better prognosis than any other gross forms of HCC. Twenty surgically resected HCC were evaluated retropectively to correlate the thickness of pseudocapsules in pathology with those in computed tomography and ultrasound. At a histologic examination, pseudocapsules of seven cases were composed of two layers, an inner compact fibrous zone and outer loose fibrous zone interlaced with compressed liver parenchyma containing small vessels and newly formed bile ducts. Sonographic thickness and pathologic measurements of pseudocapsule relatively well correlated, but the former slightly overestimated the thickness of pathologic pseudocapsule (r=0.825, y=2.56x-1.23, P<0.05). On the other hand, thickness in CT and pathologic measurement did not correlate well. Thirteen cases showed one layer of pseudocapsule in which two cases were composed of thin layer of compact fibrosis and eleven cases composed of loose fibrosis. There were poor correlations in this group between thickness of pseudocapsules in pathology and those in images. Image overtly overestimated the thickness of the pseudocapsules in pathology. In conclusion, radiologic pseudocapsule of HCC may represent the compressed liver parenchyma as well as the fibrous pseudocapsule.
Bile Ducts ; Carcinoma, Hepatocellular* ; Fibrosis ; Hand ; Liver ; Pathology ; Prognosis ; Ultrasonography