Performance of village pharmacies and patient compliance after implementation of essential drug programme in rural Burkina Faso.

After implementation of a nation-wide essential drug programme in Burkina Faso a prospective study was undertaken consisting of non-participant observation in the health centre and in the village pharmacy, and of household interviews with the patients. The study covered all general consultations in nine health centres in three districts over a two-week period as well as all client-vendor contacts in the corresponding village pharmacies; comprising 313 patients in consultations and 498 clients in eight village pharmacies with 12 vendors involved in dispensing 908 drugs. Additionally patients were interviewed in their households.

The economic costs of illness for rural households in Burkina Faso.

Analyses of the health costs in developing countries have mainly dealt with provider costs. This is in spite of the fact that the bulk of illness related costs is borne by households. Where studied, household time and financial costs have not been treated in a comprehensive way.

Reliable treatment of pyogenic granuloma of the hand.

Pyogenic granuloma (PG) is a common skin tumour whose aetiology is unknown. There is a significant recurrence rate whatever method of treatment is used, and there are many studies in the literature on the treatment of recurrence. In our experience, the most effective way of preventing recurrence is the complete removal of the tumour using the microscope, operating in a bloodless field.

[Diagnosis and therapy of tendovaginitis of the extensor carpi ulnaris (stenosis of the 6th extensor compartment)].

Stenosing tenosynovitis over the dorsum of the wrist in the sixth compartment is seldom mentioned in literature. We have collected 28 cases in a four-year period which demonstrate that the incidence is quite high. This condition should be considered in the differential diagnosis of pain over the dorso-ulnar aspect of the wrist.

Intermittent axillary nerve palsy caused by a humeral exostosis.

We report an uncommon case of intermittent axillary nerve palsy caused by a humeral exostosis in an 11-year-old boy. After excision of the cartilagenous exostosis of the proximal end of the left humerus, the pre-operative symptoms of axillary nerve compression were alleviated.

[An unusual case of metastasis to the soft tissues of the palm of the hand with compression of the median and ulnar nerve by kidney cancer. Case report].

The incidence of secondary tumors in the hand is set slightly over 0.1%, the primary tumor localized in the lung, followed by the breast and the kidney. The authors describe a case of a renal carcinoma metastatic to the soft tissue of the palm of the hand in a patient who had undergone nephrectomy for carcinoma of the right kidney eleven years previously.

[Unusual course of scapho-capitate syndrome].

The scapho-capitate-syndrome has been defined as combined fractures of the scaphoid and capitate with rotation of the proximal fragment of the capitate through 90 or 180 degrees. Most injuries are due to falls from heights or car accidents. Only 26 cases of the scapho-capitate fracture syndrome have been reported since 1937.

[Melorheostosis of the hand (report of 2 cases)].

Melorheostosis is a rare monostotic or polyostotic bone disease of unknown etiology. It is characterized by a slowly progressing linear hyperostosis, fibrosis of the skin and subcutaneous tissues, contractures of joints and aching pain. The lower extremities are involved much more often than the upper extremities.

[A realistic practice model for learning microneural surgery without experiments on live animals].

The increasing importance of microneurosurgery in hand and plastic surgery makes it necessary for surgeons to familiarize themselves with these techniques. In most training programs, anesthetized rats have been used to learn basic microneurosurgical techniques. Ethical considerations, the costs involved, and the legislation concerning experiments with live animals permit extensive training in microneurosurgery in only a few medical centers.

[Long-term spontaneous course of carpal instability].

The authors report on the natural history of 26 cases of carpal instabilities observed over a period of 25 to 74 months. Apart from the subjective criterion pain, the parameters range of motion and grip strength have been documented in the course of their development. In addition, radiographic findings have been evaluated.

Training in basic microsurgical techniques without experiments involving animals.

Until recently, anaesthetised rats have been the usual material employed for learning basic microvascular and microneurosurgical techniques. However, ethical considerations, the costs involved and legislation controlling experiments with animals allow training in microsurgery for extended periods of time at a few medical centres only. This paper reports on our experience of an alternative training programme largely conducted without using live animals.

[Isolated compression of the dorsal branch of the ulnar nerve].

The dorsal branch of the ulnar nerve was dissected in 20 upper extremities. The nerve arises from the ulnar aspect of the ulnar nerve at an average distance of 8.5 centimeters from the proximal border of the pisiforme.

[Premature maturation of the carpal bones as an early diagnostic sign of juvenile rheumatoid arthritis].

A rare premature maturation of the carpal bones in combination with swelling and flexion contracture of the wrist is demonstrated in two cases of juvenile rheumatoid arthritis. The radiologically verified premature and asymmetrical maturation of the carpal bones was the earliest diagnostic sign in juvenile rheumatoid arthritis.

[The supinator syndrome. An anatomic and clinical study].

The posterior interosseous syndrome appears in two forms, a) paralytical, and b) painful. In this investigation the authors report on twelve operated patients with painful posterior interosseous or "radial tunnel" syndrome. The intraoperative findings in the arcade of Frohse are compared with the findings on preparation of ten recently deceased.

[The supinator syndrome--an anatomical and clinical study].

The interosseus posterior syndrome appears in two forms: a) the paralytical interosseus posterior syndrome, b) the painful (afferent) interosseus posterior syndrome. We report in this investigation about 12 operated patients with painful interosseus posterior syndrome. The intraoperative findings in the arcade of Frohse are compared with the findings we made at the preparation of 10 recently deceased.

[True trigger wrist (a case report)].

Clicking at the wrist, in association with movements of the fingers, has been commonly but erroneously called "trigger wrist". In true trigger wrist, triggering occurs only in relation to movements of the wrist. The authors report a case of true trigger wrist in a 23-year-old professional tennis player.

[Compression of the median nerve by chondrosarcoma of the hand].

The authors report a case of median nerve compression due to a chondrosarcoma of the wrist. A 30 year-old right handed man complained of typical symptoms of median nerve compression. X-ray examination showed normal findings.

[Education and training in microsurgery without experiments on live animals].

A theoretical concept of a training programme for microsurgery is presented. This programme--as an alternative to the presently existing types of microsurgical education using the living laboratory animal--pursues the training of microsurgical skills exclusively on non-living objects. This paper describes the training laboratory as well as four training procedures, each using separate objects with an increasing degree of difficulty and educational benefit: surgical glove; silastic tube; sciatic nerve of a chicken; perfused coronary arteries of a pig's heart.

[Long term results with a new lunate bone prosthesis].

In the University of Essen Orthopaedic Clinic a lunate prosthesis was developed. Three different sizes are available. The strongest indication for this prosthesis is complete destruction of the lunate.

[Treatment results in fractures and pseudarthrosis of the scaphoid bone].

In 258 patients with fractures and pseudarthroses of the carpal scaphoid the cause and type are given and the results of treatment are presented. It is verified that the majority of fresh fractures are united by plaster immobilisation. In fractures with delayed healing and in cases with non-union the best results are achieved by autologous bone grafting.