Cases reported "Hand Injuries"

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1/7. Hand infections caused by delayed inoculation of vibrio vulnificus: does human skin serve as a potential reservoir of vibrios?

    vibrio vulnificus may cause severe soft tissue infections of the upper extremity. This pathogen usually gains access to soft tissues either by direct inoculation through a penetrating injury by an infected marine animal or by exposing abraded skin to contaminated water. We report five patients with vibrio vulnificus hand infections following superficial hand injuries incurred within 24 hours after uneventful handling of fish. This clinical observation, together with the fact that the physiologic characteristics of human sweat simulate the natural environment of the vibrio vulnificus, support the assumption that human skin may serve as a reservoir for Vibrios. The anamnesis in patients presenting with hand infection should essentially include an inquiry regarding recent, albeit uneventful, fish handling.
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2/7. Hand wound caused by an active sting with a toxin spine of a catfish (Heteropneustes fossilis)--a case report.

    A case of a 33-years-old aquarist admitted to the Clinic with a painful wound caused by a Stinging Catfish (Heteropneustes fossilis) was presented. While cleaning the aquarium the fish actively stung him in the hand. After irrigating and debriding of the wound the patient was given tetanus anatoxin and antibiotic course. The opioid analgesia and local anesthesia had to be provided to relieve the pain. The follow up after 2 weeks showed healed wound of the hand and the patient had no subjective complaints. There is an urgent need for a bill about venomous and poisonous animals which will be allowed to be kept at home. The registration of venomous and poisonous animals in the Regional poison control centers should be compulsory. There is a need for initiating educational activity among people who keep dangerous animals at home as their pets.
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3/7. Septic arthritis and osteomyelitis from a cat bite.

    A 39-year-old man with no prior history of underlying arthritis developed osteomyelitis and septic arthritis in his hand following a cat bite. This case illustrates the virulence of pasteurella multocida infections associated with animal bites, particularly those of cats, whose teeth can inoculate bone directly. The onset of cellulitis caused by P. multocida infections is often rapid, and the drug of choice for such infections remains penicillin. Appropriate antibiotic therapy, however, does not always prevent complications such as those seen in this patient.
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4/7. pasteurella multocida--the major cause of hand infections following domestic animal bites.

    pasteurella multocida is a common cause of infection following bites or scratches caused by dogs and (especially) cats. It is rarely reported, however, and apparently often overlooked as a pathogen. The typical clinical manifestation is a rapidly developing cellulitis at the site of injury. The infection is potentially dangerous and can cause a chronic local infection of deep tissues and osteomyelitis. It responds well to several antimicrobials, with penicillin being drug of choice. Fifty-five patients are reported--72% with cat bites and/or scratches and 28% with dog bites. Ninety-two percent of the wounds went deeply through the skin. All patients presented for treatment 12 to 72 hours after receiving the animal wounds to their hands. drainage from all wounds was serosanguineous or purulent, and cultures taken were positive for P. multocida. All of the wounds responded to surgical drainage and penicillin. One patient developed osteomyelitis. The acute onset of cellulitis, lymphangitis, and serosanguineous or purulent drainage from hand wounds 12 to 24 hours after cat or dog bites should suggest P. multocida as the predominant etiologic agent. Immediate surgical drainage and penicillin therapy is the treatment of choice.
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5/7. High-frequency electromagnetic radiation injury to the upper extremity: local and systemic effects.

    Industrial use of radiofrequency and microwave energy sources (nonionizing, high-frequency electromagnetic radiation) is a growing and widespread phenomenon, with projected risks of exposure to more than 20 million workers in the united states. A description of the nature of this form of electromagnetic energy is given, with emphasis on the variability of energy absorption by humans. The current state of biological research is reviewed, and a summary of the known effects of radiofrequency and microwave radiation exposure on animals and humans provided. These known effects appear to be principally thermal, similar to conventional electrical burn injuries, but with some unique systemic expression. Derangements of cardiovascular, gastrointestinal, endocrine, hematological, ophthalmological, and behavioral functions are well described in animal experimentation. Two patients are presented--one a young woman exposed to a high-density radiofrequency field in an industrial setting, leading to necrosis of the entire hand and wrist as well as to a constellation of systemic effects, and one an older woman exposed to excessive microwave radiation from a malfunctioning microwave oven, leading to chronic hand pain and paresthesias resembling median nerve entrapment at the carpus. The prevalence of potential exposure in certain industries is noted and recommendations for follow-up care of workers exposed to this form of trauma are delineated.
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6/7. Accidental injuries from captive-bolt guns (slaughterer's gun).

    Captive bolt guns or 'slaughterer's guns' are weapons used in slaughtering animals. Lesions caused by these weapons are likely to have a more serious character than is to be expected from the size of the entrance wound. The wounds are primarily contaminated and it is imperative to explore the wound thoroughly as foreign bodies are often deeply embedded. Three cases are reported of accidental injuries to personnel working with such weapons.
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7/7. Progressive changes in cutaneous trigger zones for sensation referred to a phantom hand: a case report and review with implications for cortical reorganization.

    The dominant model of cortical plasticity induced by peripheral denervation suggests that a physiologically-reorganized cortical area can acquire new perceptual meaning, including a change in the peripheral referral of sensation. An alternative view is that such an area may retain its former perceptual significance, even though it becomes responsive to new peripheral inputs. To examine evidence related to this issue, a clinical case is presented documenting the time course of changes in phantom limb sensation in a patient with accidental amputation of a hand. About 24 h after injury, a vivid phantom hand was present; tactile stimulation revealed cutaneous trigger zones on the arm, stimulation of which elicited sensation referred to specific fingers of the phantom. While the phantom hand percept remained fairly stable over time, the trigger zones expanded progressively in size during the next 1-8 weeks but had contracted and changed location considerably about one year later. At all times studied, the trigger zones were topographically related to specific fingers and other parts of the phantom hand. The implications of these and other recent clinical findings for cortical reorganization are discussed, and the following tentative conclusions are drawn. (1) A phantom percept is mediated by central neural networks which remain functionally intact after amputation. (2) Cutaneous trigger-zones mapped in humans correspond to novel receptive fields of cortical neurons mapped in animals following peripheral denervation. (3) Cortical reorganization induced by denervation does not produce a major change in perceptual meaning or peripheral reference. In the present case, stimulation of new trigger zones (receptive fields) on the patient's arm presumably activated a reorganized cortical hand area but evoked sensation still referred to the (now missing) hand. Hence, physiological cortical remapping is not necessarily accompanied by functional respecification.
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