All the actions detailed are correct except the one detailed in option 2. The collection of samples of legal interest will only be carried out in the presence of the coroner, and, without the presence of the coroner, the woman must give her written consent. In addition, the taking of gynecological samples must be adapted to the psychological state of the victim, so in most cases, it is counterproductive to perform it at this time (even more so when they describe the patient's state as "very affected, answering their questions incongruently, slowly and not being able to remember how the aggression occurred".

All the actions detailed are [HIDDEN] The collection of samples of legal interest will only be carried out in the presence of the coroner, and, without the presence of the coroner, the woman must give her written consent. In addition, the taking of gynecological samples must be adapted to the psychological state of the victim, so in most cases, it is counterproductive to perform it at this time (even more so when they describe the patient's state as "very affected, answering their questions incongruently, slowly and not being able to remember how the aggression occurred".

A 25-year-old woman comes to the ED accompanied by a friend reporting that she was the victim of a sexual assault 4 hours ago. The patient is very affected, answering her questions inconsistently, slowly and not being able to remember how the assault occurred. Her vital signs (blood pressure, heart rate and temperature) are normal. Which of the following would be WRONG:

Immediate gynecological examination with cervical cytology.

Administer 500 mg of intramuscular ceftriaxone, 1 g of azithromycin orally and 2 g of tinidazole orally in single doses.

Administer 1500 mg of levonorgestrel orally in a single dose.

Disseminated gonococcemia.

A 26-year-old woman presented with a high-grade fever and chills of 2 days' duration. She complained of associated joint pain, especially in the wrists and knees. One day before admission, tender skin lesions began to develop on the fingers, and subsequently spread to the more proximal extremities. The patient recalled having a sore throat and a nonproductive cough before the onset of the fever and eruption. The past medical history was significant for Gardnerella vaginitis and several urinary tract infections. The patient was taking oral contraceptive pills; her most recent menstruation was 3 weeks before admission. She reported having sexual intercourse with her boyfriend 2 weeks before admission. The patient's temperature was 40 degrees C. Dermatologic examination revealed a 6-mm, hemorrhagic pustule on an ill-defined pink base, overlying the volar aspect of the left second proximal interphalangeal joint (Fig. 1a). Scattered on the upper and lower extremities were occasional round, ill-defined pink macules with central pinpoint vesiculation (Fig. 1b). A skin biopsy of the digit revealed a dense neutrophilic infiltrate with leukocytoclasis and marked fibrin deposition in the superficial and deep dermal vessels (Fig. 2a). Gram stains demonstrated the presence of Gram-negative diplococci (Fig. 2b). Laboratory findings included leukocytosis (leukocyte count of 20 x 109/L, with 81% neutrophils). Analysis of an endocervical specimen by polymerase chain reaction was positive for Neisseria gonorrhoeae and negative for Chlamydia trachomatis. Throat and blood cultures grew N. gonorrhoeae. Specimen cultures obtained by skin biopsy yielded no growth. Results of serologic analysis for human immunodeficiency virus, hepatitis, syphilis, and pregnancy were negative. Beginning on admission, intravenous ceftriaxone, 2 g, was administered every 24 h for 6 days, followed by oral cefixime, 400 mg twice daily for 4 days. Oral azithromycin, 1 g, was administered to treat possible coinfection with C. trachomatis. By treatment day 4, the patient was afebrile, with the resolution of leukocytosis and symptomatic improvement of arthralgias.

Gynecology_Novak

A single dose of 1 g of azithromycin orally or 100 mg of doxycycline orally twice a day for 7 days for treatment of chlamydia (if the patient is pregnant at the time of the assault, erythromycin 500 mg orally four times a day for 7 days may be substituted for doxycycline), PLUS: c. A single dose of 2 g of metronidazole orally for the treatment of trichomoniasis and/or bacterial vaginosis 2. Hepatitis B vaccination should be offered if the sexual assault survivor has experienced vaginal, oral, or anal penetration. Hepatitis B is 20 times more infectious than HIV during intercourse (114). Vaccination is recommended at the time of the initial evaluation. Subsequent doses are provided 1 month and 6 months after the first dose is administered. It is not necessary to treat the patient with hepatitis B immune globulin (167). Vaccination is not necessary if the patient has documented hepatitis B immunity. 3.

Gynecology_Novak

Table 18.4 Clinical Criteria for the Diagnosis of Pelvic Inﬂammatory Disease Additional criteria to increase the specificity of the diagnosis Endometrial biopsy showing endometritis Elevated C-reactive protein or erythrocyte sedimentation rate Temperature higher than 38◦C (100.4◦F) Leukocytosis Positive test for gonorrhea or chlamydia Table 18.5 Guidelines for Treatment of Pelvic Inﬂammatory Disease Cefoxitin, 2 g intramuscularly, plus probenecid, 1 g orally concurrently, or Ceftriaxone, 250 mg intramuscularly, or Plus: Doxycycline, 100 mg orally 2 times daily for 14 days, or Azithromycin, 500 mg initially and then 250 mg daily for a total of 7 days Cefoxitin, 2 g intravenously every 6 hours, or Cefotetan, 2 g intravenously every 12 hours Plus: Doxycycline, 100 mg orally or intravenously every 12 hours Clindamycin, 900 mg intravenously every 8 hours Plus:

Obstentrics_Williams

Symptoms following misoprostol are common within 3 hours and include vomiting, diarrhea, fever, and chills. Bleeding and cramping with medical termination typically is signiicantly worse than with menses. Thus, adequate analgesia, usually including a narcotic, is provided. If bleeding soaks two or more pads per hour for at least 2 hours, the woman is instructed to contact her provider to determine whether she needs to be seen . At the follow-up appointment, routine postabortal sonographic examination is typically unnecessary (Clark, 2010). Instead, assessment of the clinical course along with bimanual pelvic examination is recommended. If sonography is indicated TABLE 18-7. Various Regimens for Medical Termination of Pregnancy aMifepristone, 200-600 mg orally; followed in 24-48 hr by: bMisoprostol, 200-600 �g orally or 400-800 �g vaginally, buccally, or sublingually

Pharmacology_Katzung

Camille E. Beauduy, PharmD, & Lisa G. Winston, MD motion tenderness is present. A first-catch urine specimen is obtained for chlamydia and gonorrhea nucleic acid amplifi-cation testing. A urine pregnancy test is also ordered as the patient reports she “missed her last period.” Pending these results, the decision is made to treat her presumptively for chlamydial cervicitis. What are two potential treatment options for her possible chlamydial infection? How does her potential pregnancy affect the treatment decision? A 22-year-old woman presents to her college medical clinic complaining of a 2-week history of vaginal discharge. She denies any fever or abdominal pain but does report vaginal bleeding after sexual intercourse. When questioned about her sexual activity, she reports having vaginal intercourse, at times unprotected, with two men in the last 6 months. A pelvic examination is performed and is positive for muco-purulent discharge from the endocervical canal. No cervical

Gynecology_Novak

3. One to three extremely painful ulcers, accompanied by tender inguinal lymphadenopathy, are unlikely to be anything except chancroid. This is especially true if the adenopathy is ﬂuctuant. 4. An inguinal bubo accompanied by one or several ulcers is most likely chancroid. If no ulcer is present, the most likely diagnosis is LGV. Recommended regimens for the treatment of chancroid include azithromycin, 1 g orally in a single dose; ceftriaxone, 250 mg intramuscularly in a single dose; ciproﬂoxacin, 500 mg orally twice a day for 3 days; or erythromycin base, 500 mg orally four times daily for 7 days. Patients should be reexamined 3 to 7 days after initiation of therapy to ensure the gradual resolution of the genital ulcer, which can be expected to heal within 2 weeks unless it is unusually large.

Urethritis

A variety of drugs may be prescribed based on the cause of urethritis: Gonococcal urethritis (caused by N. gonorrhoeae): The CDC recommends administering an injection dose of ceftriaxone 250 mg intramuscularly and oral dose of azithromycin 1g simultaneously. Cefixime 400 mg oral single dose can be used as an alternative if ceftriaxone is not available. Non-gonococcal urethritis (caused by Chlamydia trachomatis): The CDC recommends administering an oral single dose of azithromycin 1g or a 7-day course of doxycycline 100 mg orally twice daily.' Alternative treatments can also be used when the above options are not available: Erythromycin base 500 mg orally four times daily for 7 days Erythromycin ethylsuccinate 800 mg orally four times daily for 7 days Levofloxacin 500 mg orally once daily for 7 days Ofloxacin 300 mg orally twice daily for 7 days

Not your average birth: considering the possibility of denied or concealed pregnancy.

A 23-year-old woman presented to the emergency department (ED) with a 3-day history of lower back pain. She had seen her general practitioner 2 days previously who prescribed trimethoprim for a confirmed urinary tract infection. Routine admission observations showed she was tachycardic, tachypnoeic and slightly hypotensive but non-feverish with normal oxygen saturations. Her urine sample revealed that she was pregnant but was otherwise negative. The patient maintained that she was unaware she was pregnant. She was reviewed by an ED staff grade who was suspicious of a ruptured ectopic pregnancy. She was subsequently referred to the obstetrics and gynaecology registrar who on examination found she had a gravid uterus and vaginal examination revealed that her cervix was 8 cm dilated. The patient was very promptly admitted onto the labour ward for further assessment. She gave birth to a live male infant in the early hours of the next morning.

Cervicitis -- Treatment / Management

1g single oral dose azithromycin PLUS either 800 mg cefixime in a single oral dose or 250 mg intramuscular ceftriaxone in a single dose 100 mg oral doxycycline twice daily for 7 days PLUS either 800 mg cefixime in a single oral dose or 250 mg intramuscular ceftriaxone in a single dose For severe allergy to penicillins/cephalosporins: 2g oral azithromycin in a single dose [2] [3] [15] For infectious agents identified by laboratory investigations, the treatment is as follows: Chlamydia: A single oral dose of 1g azithromycin OR 100mg doxycycline twice daily for 7 days Gonorrhea: 250mg intramuscular ceftriaxone PLUS a single oral dose of 1g azithromycin Mycoplasma: 400mg moxifloxacin after treatment failure with 1g oral azithromycin Trichomonas: A single oral 2g dose of metronidazole OR tinidazole Bacterial vaginosis: Twice daily 500mg metronidazole for 7 days OR intravaginal 0.75% metronidazole gel once daily for 5 days HSV: Oral 400mg acyclovir three times daily for 7 to 10 days

Haemophilus ducreyi

Pathogenesis H. ducreyi is an opportunistic microorganism that infects its host by way of breaks in the skin or epidermis. Inflammation then takes place as the area of infection is inundated with lymphocytes, macrophages, and granulocytes. This pyogenic inflammation causes regional lymphadenitis in the sexually transmitted disease chancroid. Diagnosis Although antigen detection, serology, and genetic amplification methods are sometimes used to diagnose infections with H. ducreyi and the genetic tests have greater sensitivity, they are not widely available, so cultures are currently considered the "gold standard" test. Treatment The first line treatments are one of four options : azithromycin 1 g orally in a single dose, ceftriaxone 250 mg intramuscularly in a single dose, ciprofloxacin 500 mg orally 2 times a day for 3 days, or erythromycin base 500 mg orally 3 times a day for 7 days. See also Sexually transmitted disease References

One Woman's Insanity

"Show Me" also entered the non-genre-specific Billboard Bubbling Under Hot 100 chart, an extension of the Hot 100, peaking at number 22 on the chart dated December 25, 1993. On the Dance Singles Sales chart, the double-A-side release of "Show Me"/"Joy" peaked at number 21 on the September 4, 1993, chart. The single also proved a minor hit outside of the United States, entering the UK Singles Chart and peaking at number 62 on the chart dated January 29, 1994. Critical

[Three Japanese cases of hypnic headache].

We described three cases of hypnic headache with successful treatment by lithium carbonate or caffeine. This is the first detail report of Japanese cases. An endocrinological test and rhythm analyses of ambulatory blood pressure (ABP) and heart rate variability in a case suggested possible association between hypnic headache and hypothalamic-pituitary dysfunction. Case 1: A 48-year-old female migraineur complained of new-onset nocturnal headaches. Her headache awakened her from sleep between 1 AM and 2 AM. The headache occurred 3-4 times per week and lasted from 1 hour to 2 hours. The headache were moderate intensity and bilateral dull throbbing pain that located in the forehead to temples. There was no accompanying symptoms such as nausea, phonophobia, photophobia, nor the other autonomic features including conjunctival injection or tearing during the headache attacks. Physical and neurological examinations showed normal results except slight weakness and mild dysesthesia of the left arm due to a vertebral disk herniation at C5/6 level. In the pituitary endocrinological test, the prolactin level remarkably increased in response to the TRH loading. The single cosinor analysis demonstrated significant circadian rhythm of ABP parameters. However, the analysis did not demonstrate any significant circadian rhythm of Holter ECG parameters of time domain analysis and frequency analysis. Receiving 200 mg lithium bicarbonate before sleep, her nocturnal headache completely disappeared. Case 2: A 68-year-old woman had been followed up by her chronic tension-type headache since her forties. At her 66-years, she suffered from a new nocturnal headache. She awoke from sleep by the headache about 3 AM and the headache lasted 30 min. Moderate, dull headache located on her left temple to parietal head, 3-4 times/week. She was able to go back asleep without any medication after spontaneous headache cessation. She first complained the nocturnal headache at the 10 months later of the new headache appearance. She received 200 mg caffeine just before sleep and her headache has been disappeared. Case 3: 70-year-old women had been regularly visited our clinics for her migraine and chronic tension-type headache. She received amitriptyline and her headaches was well controlled. At her 69 years, she complained nocturnal headache. It occured every other day. The headache was moderate pulsative dull pain on the occipital region and lasted 90 minutes without any autonomic symptoms. Headache began between midnight and 1 AM. She told us her new nocturnal headache one year later of the onset. Oral caffeine (200 mg) just before sleep did not improve her headache and caused insomnia. Receiving 100 mg lithium before sleep, her hypnic headache disappeared completely. These three cases are compatible with the diagnostic criteria proposed in ICHD-II. There were some patients with hypnic headache in Japan and neurologists should pay attentions to this form of benign headache, because some beneficial treatments are currently available.

Creatine

Maintenance phase After the 5–7 day loading phase, muscle creatine stores are fully saturated and supplementation only needs to cover the amount of creatine broken down per day. This maintenance dose was originally reported to be around 2–3 g/day (or 0.03 g/kg/day), however, recent studies have suggested 3–5 g/day maintenance dose to maintain saturated muscle creatine. Absorption Endogenous serum or plasma creatine concentrations in healthy adults are normally in a range of 2–12 mg/L. A single 5 gram (5000 mg) oral dose in healthy adults results in a peak plasma creatine level of approximately 120 mg/L at 1–2 hours post-ingestion. Creatine has a fairly short elimination half life, averaging just less than 3 hours, so to maintain an elevated plasma level it would be necessary to take small oral doses every 3–6 hours throughout the day. Clearance It has been shown that once supplementation of creatine stops, muscle creatine stores return to baseline in 4–6 weeks.

InternalMed_Harrison

C. trachomatis infections in adults. Azithromycin causes fewer adverse gastrointestinal reactions than do older macrolides such as erythromycin. The single-dose regimen of azithromycin has great appeal for the treatment of patients with uncomplicated chlamydial infection (especially those without symptoms and those with a likelihood of poor compliance) and of the sexual partners of infected patients. These advantages must be weighed against the considerably greater cost of azithromycin. Whenever possible, the single 1-g dose should be given as directly observed therapy. Although not approved by the FDA for use in pregnancy, this regimen appears to be safe and effective for this purpose. However, amoxicillin (500 mg three times daily for 7 days) also can be given to pregnant women. The fluoroquinolones are contraindicated in pregnancy. A 2-week course of treatment is recommended for complicated chlamydial infections (e.g., PID, epididymitis) and at least a 3-week course of doxycycline

Ciprofloxacin

Ciprofloxacin is weakly bound to serum proteins (20–40%). It is an inhibitor of the drug-metabolizing enzyme cytochrome P450 1A2, which leads to the potential for clinically important drug interactions with drugs metabolized by that enzyme. Ciprofloxacin is about 70% orally available when administered orally, so a slightly higher dose is needed to achieve the same exposure when switching from IV to oral administration The extended release oral tablets allow once-daily administration by releasing the drug more slowly in the gastrointestinal tract. These tablets contain 35% of the administered dose in an immediate-release form and 65% in a slow-release matrix. Maximum serum concentrations are achieved between 1 and 4 hours after administration. Compared to the 250- and 500-mg immediate-release tablets, the 500-mg and 1000-mg XR tablets provide higher Cmax, but the 24‑hour AUCs are equivalent.

I Am Woman

Despite the chord it was striking with television viewers, the song's trek to the top of the charts was still a long, hard climb. It first entered the Billboard Hot 100 at number 99 in the issue of the magazine dated June 24, 1972, peaked at number 97 two weeks later, fell off the Hot 100, re-entered at number 87 two months later in the September 16 issue, and reached number one three months later, in the December 9 issue.

Synephrine

200 mg caused side-effects such as heart palpitations, headache, sweating, and feelings of apprehension. When given intravenously, doses of 25–50 mg sufficed to produce a mean maximum increase in the blood pressure of 29 mmHg in 2 minutes, and a return to baseline within 30 minutes. Respiration was generally not affected during these experiments. Subcutaneous administration of synephrine in doses ≤ 200 mg had no effects on blood pressure or pulse rate. Oral doses of 500–1500 mg of the drug did not affect blood pressure or respiration, but pulse rate was increased by ~12%, and the highest doses caused nausea and vomiting.

She's Every Woman

Chart history "She's Every Woman" debuted at number 38 on the Billboard Hot Country Singles & Tracks charts on the chart week of September 9, 1995, climbing to number 10 the next week. It reached its peak of number 1 on the chart week of October 21, its seventh week on the charts.

Gabapentinoid

(as active gabapentin) is about 2.1 to 2.6 hours across all doses (350–2,800 mg) with single administration and 1.6 to 1.9 hours across all doses (350–2,100 mg) with repeated administration. Conversely, the Tmax of the extended-release (XR) formulation of gabapentin enacarbil is about 5.1 hours at a single dose of 1,200 mg in a fasted state and 8.4 hours at a single dose of 1,200 mg in a fed state. The Tmax of phenibut has not been reported, but the onset of action and peak effects have been described as occurring at 2 to 4 hours and 5 to 6 hours, respectively, after oral ingestion in recreational users taking high doses (1–3 g).

[Three cases of psittacosis].

Case 1 was a 55 year old female whose primary complaint was pyrexia. Anamnesis consisted of a fever at a 39 degrees C level beginning on September 15, 1987 with headache and muscle pain. The patient was examined by a nearby physician. Despite taking medication, there was no break in the fever. The patient was examined and admitted to this institution on September 18. Case 2 was a 32 year old female whose primary complaint was pyrexia and an abnormal sensation in the pharynx. Anamnesis consisted of a fever at a 39 degrees C level beginning on February 13, 1989 and the manifestation of a cough beginning on February 17. Although the fever broke on February 20, as the abnormal sensation in the pharynx persisted, the patient was examined and admitted to this institution on February 21. Case 3 was a 42 year old male whose primary complaint was pyrexia. Anamnesis consisted of a fever of 38 degrees C, cough and a sensation of pressure in the right precordia beginning on November 18, 1989. The patient was examined and admitted to this institution on November 21. Chest X-rays revealed the presence of atypical pneumonia in all three cases. As a significant rise in antibodies to the Chlamydia of parrot fever was observed in the cases at the time of admittance as well as after admittance, treatment was begun by administration of Minocycline.(ABSTRACT TRUNCATED AT 250 WORDS)

TIK-301

Pharmacokinetics TIK-301 is administered orally. Compared to melatonin, it has nine times greater bioavailability and six times greater area under the curve (AUC), which means the body retains more of an administered dose. TIK-301 was detected in blood plasma within 10 to 15 minutes of administration of a single oral dose and remains in a patient's system until 12 hours after the single dose. Plasma concentrations increased rapidly and peaked at 1 hour after the dose, independent of dose size. TIK-301's half-life is about 1 hour. This extended half-life may be partially due to the chlorine in its structure. Elimination constants depended on dose, 20 mg dose had a different elimination constant from all other doses above 35 mg.

Just a sore throat?

A man, 43 years of age, presents to his general practitioner with a 6 day history of sore throat. There are no other symptoms of an upper respiratory tract infection. In passing, the patient mentions that 6 days ago he experienced an episode of exertional chest pain. On further questioning it is found the chest pain was central with no radiation, it lasted 30 minutes, resolved spontaneously and was associated with nausea. He did not seek medical assessment at the time and has no cardiac history. He takes no regular medication and has no allergies. He is an exsmoker with a 15 pack-year history (he quit 7 years ago) but has no other known cardiac risk factors. He does not drink alcohol or take illicit drugs. On examination, he appears well built with a body mass index of 27. He is not in distress apart from a moderate sore throat. He is afebrile. His heart rate is 66 bpm, regular and his blood pressure is 122/80 mmHg. His tonsils and uvula are neither inflamed nor swollen. He has no cervical lymphadenopathy. His lungs are clear on auscultation and his heart sounds are dual with no murmur. His electrocardiogram is shown in Figure 1.

Drospirenone

Pharmacokinetics Absorption The oral bioavailability of drospirenone is between 66 and 85%. Peak levels occur 1 to 6 hours after an oral dose. Levels are about 27 ng/mL after a single 4 mg dose. There is 1.5- to 2-fold accumulation in drospirenone levels with continuous administration, with steady-state levels of drospirenone achieved after 7 to 10 days of administration. Peak levels of drospirenone at steady state with 4 mg/day drospirenone are about 41 ng/mL. With the combination of 30 μg/day ethinylestradiol and 3 mg/day drospirenone, peak levels of drospirenone after a single dose are 35 ng/mL, and levels at steady state are 60 to 87 ng/mL at peak and 20 to 25 ng/mL at trough. The pharmacokinetics of oral drospirenone are linear with a single dose across a dose range of 1 to 10 mg. Intake of drospirenone with food does not influence the absorption of drospirenone.

Gynecology_Novak

Physical Examination A thorough gynecologic physical examination is typically performed at the time of the initial visit, on a yearly basis, and as needed throughout the course of treatment (Table 1.6). The extent of the physical examination during the gynecologic visit is often dictated by the patient’s primary concerns and symptoms. For example, for healthy teens without symptoms who are requesting oral contraceptives before the initiation of intercourse, a gynecologic examination is not necessarily required. Some aspects of the examination—such as assessment of vital signs and measurement of height, weight, blood pressure, and calculation of a body mass index— should be performed routinely during most office visits. Typically, examination of the breasts and abdomen and a complete examination of the pelvis are considered to be essential parts of the gynecologic examination. It is often helpful to ask the patient if the gynecologic examination was difficult for her in the past; this

Chancroid

Antibiotics Macrolides are often used to treat chancroid. The CDC recommendation is either a single oral dose (1 gram) of azithromycin, a single IM dose (250 mg) of ceftriaxone, oral (500 mg) of erythromycin three times a day for seven days, or oral (500 mg) of ciprofloxacin twice a day for three days. Due to a paucity of reliable empirical evidence it is not clear whether macrolides are actually more effective and/or better tolerated than other antibiotics when treating chancroid. Data is limited, but there have been reports of ciprofloxacin and erythromycin resistance. Aminoglycosides such as gentamicin, streptomycin, and kanamycin has been used to successfully treat chancroid; however aminoglycoside-resistant strain of H. ducreyi have been observed in both laboratory and clinical settings.[7] Treatment with aminoglycosides should be considered as only a supplement to a primary treatment.

Obstentrics_Williams

Distinct from allergy, a Jarisch-Herxheimer reaction develops following penicillin treatment in most women with primary syphilis and approximately half with secondary infection. Uterine contractions, mild maternal temperature elevation, decreased fetal movement, and fetal heart rate decelerations are findings. Reaction treatment is supportive with antipyretics as needed, hydration, and oxygen supplementation (Klein, 1990). In a study of 50 gravidas who received benzathine penicillin for syphilis, Myles and associates (1998) reported a 40-percent incidence of Jarisch-Herxheimer reactions. Of the 31 women monitored electronically, 42 percent developed regular uterine contractions, and 39 percent developed variable decelerations. All contractions resolved within 24 hours of therapy. Accordingly, for fetuses of viable age, some recommend administering the irst dose of antibiotic in labor and delivery and with continuous fetal monitoring for at least 24 hours (Rae, 2017). Others recommend

Darolutamide

The absolute bioavailability of darolutamide with oral administration of a single 300-mg dose without food is approximately 30%. The bioavailability of darolutamide is increased by about 2- to 2.5-fold when administered with food, with a similar increase in exposure occurring for ketodarolutamide. Exposure to darolutamide and ketodarolutamide increases in a nearly linear or dose-proportional manner across a dose range of 100 to 700 mg (or about 0.17- to 1.17-fold the recommended 600-mg dosage). No further increase in exposure to darolutamide was observed at a dosage of darolutamide of 900 mg twice per day (or 1.5 times the recommended 600-mg dosage), indicating a saturation of absorption at doses above 700 mg. Following a single 600-mg dose of darolutamide, peak levels of darolutamide occur after approximately 4 hours. Steady-state levels of darolutamide occur after 2 to 5 days of continuous administration with food, during which time an approximate 2-fold accumulation in darolutamide

"One-minute treatment" with thiamphenicol in 50,000 cases of gonorrhea: a 22-year study.

The results obtained with single-dose (2.5 g of thiamphenicol) therapy of gonorrhea in 50,000 patients are reported. Male patients included recent cases of acute or subacute urethritis and uncomplicated cases; all female patients had uncomplicated gonorrhea. Asymptomatic gonorrhea in both men and women was included in the therapy trial in all cases when "epidemiological" treatment was necessary. Tolerance of thiamphenicol was excellent; we observed only 62 cases of gastralgia or nausea and 12 cases of generalized pruritus reaction. No hematologic side effect was reported. The prescribed dose does not conceal incubating syphilis since 211 cases of recent syphilis were observed. Failures are reported year by year from 1961 to 1982 and, on the average, failure rates for men and women were 3.42% and 3.24%, respectively.

Glucosamine

A number of studies have measured the bioavailability of glucosamine after oral administration to horses. When given as a single oral dose (9 g) with or without chondroitin sulfate (3 g) to ten horses, glucosamine (hydrochloride) was detected in the blood with a maximum level of at two hours after dosing. Another study examined both the serum and the joint synovial fluid after nasogastric (oral) or intravenous administration of 20 mg/kg glucosamine hydrochloride to eight adult horses. Although joint fluid concentrations of glucosamine reached 9–15 μmol/L following intravenous dosing, it was only 0.3–0.7 μmol/L with nasogastric dosing. The authors calculated that these glucosamine synovial fluid levels achieved by the oral route were 500 times lower than that required to have a positive effect on the metabolism of cartilage cells. A follow up study by the same research group compared glucosamine sulfate with glucosamine hydrochloride at the same dose (20 mg/kg) in eight horses and

Infectious disease capsules: a pox on your house.

A 31-year-old, previously healthy white man presented to the emergency department with complaints of malaise, fevers, shortness of breath, a non-productive cough, and a "rash." His physical exam revealed a temperature of 100.2F, a pulse of 129 bpm, respiratory rate of 14 BPM, and blood pressure of 140/74 mm Hg. He was alert, oriented, and in no distress. His oropharynx was dry, his neck was supple, and cervical lymphadenopathy was absent. He had tachycardia, bilateral wheezes, and rhonchi with prolonged expirations. There was a diffuse vesicular eruption enveloping his entire body with involvement sparing his palms and soles (Figures 1 and 2). Laboratory values showed a hemoglobin of 16.0 g/dL and a white blood cell count of 7100 cells/pL, with 39%neutrophils, 23% bands, and 35% lymphocytes. His platelet count was mildly decreased to 86,000 x 103/pL. Chest radiograph revealed bilateral diffuse interstitial infiltrates. A diagnosis of acute varicella-zoster virus pneumonia (varicella pneumonia) was made, and the patient was started on IV acyclovir (10 mg/kg every 8 hours). Upon further questioning, the patient stated that his daughter had been diagnosed with "chickenpox" 7 days ago. The patient had numerous exposures to chickenpox in the past but had never developed clinical expressions of varicella. He was not at risk for HIV infection, not having multiple sexual partners, IV drug abuse, or blood transfusions. During the 1 day of in-hospitalization, his fever abated and the pulmonary signs diminished. Following discharge, IV acyclovir was replaced by valacyclovir to complete a 7-day course of therapy.

The behavioral and cognitive effects of two benzodiazepines associated with drug-facilitated sexual assault.

Recently, sexual assaults have included the use of benzodiazepines to impair the victim. Our aim was to examine the physiological, cognitive, and behavioral effects of flunitrazepam (FN) and clonazepam (CLO). In the first study, ten healthy volunteers received a single oral dose of 2 mg of FN. Mini Mental State Examination (MMSE), behavioral reports and staff observations were then collected. In the second study, ten healthy volunteers received a single oral dose of 3 mg of CLO. Vital signs, performance on the MMSE and Digit Symbol Substitution Test, and behavioral changes were examined. FN significantly decreased systolic and diastolic blood pressure 4 h post drug ingestion with diastolic remaining low at 6 h. CLO was associated with changes in temperature and decreased systolic pressure. FN affected memory and attention 4 h following ingestion. CLO affected memory and attention throughout the study (6 h), and psychomotor performance was decreased 2 h post ingestion. In both studies, subjects were disinhibited and did not perceive their own impairment.

Robert Spencer (doctor)

According to Rothstein, Spencer inserted something to dilate X's cervix and instructed the women to return in the morning. The next morning, Rothstein was left in a room while X went with Spencer to another room for her abortion. "Eventually," Rothstein wrote, "Dr. Spencer returned with X over his shoulder in a fireman's carry, out cold. He gently unloaded her onto the cot; her eyes were rolled back so only the whites showed. After she came to and had rested, he checked her, gave her post-op instructions and antibiotics, and wished her well. The entire charge, including anesthesia, was $50." Spencer's records Spencer's records were burned by his second wife, preventing researchers from accurately documenting his practice. Thus, neither his technique nor the number and type of patients treated can be verified. The Mary Davies case


Both the flexor carpi radialis and the abductor pollicis longus are anatomically far from the ulnar. The palmaris longus is medial, as is the flexor digitorum profundus. The tendon that runs alongside the ulnar nerve, inserting into the pisiform, is the flexor carpi ulnaris, thus answer 1.

Both the flexor carpi radialis and the abductor pollicis longus are anatomically far from the ulnar. The palmaris longus is medial, as is the flexor digitorum profundus. The tendon that runs alongside the ulnar nerve, inserting into the pisiform, is the flexor carpi ulnaris, thus [HIDDEN].

A 31-year-old bricklayer comes to the emergency department with tenosynovitis caused by a penetrating wound. On examination, the ulnar bursa is found to be infected with consequent tendon necrosis. Which tendon will be affected?

Tendon of the deep flexor of the fingers.

Common flexor sheath of hand

The common synovial sheath for the flexor tendons or the ulnar bursa is a synovial sheath in the carpal tunnel of the human hand. It contains tendons of the flexor digitorum superficialis and the flexor digitorum profundus, but not the flexor pollicis longus. The sheath which surrounds the flexor digitorum extends downward about halfway along the metacarpal bones, where it ends in blind diverticula around the tendons to the index, middle, and ring fingers. It is prolonged on the tendons to the little finger and usually communicates with the mucous sheath of these tendons. References External links https://web.archive.org/web/20070814124446/http://moon.ouhsc.edu/dthompso/namics/labs/wrist2.htm Upper limb anatomy

Common flexor tendon

The common flexor tendon is a tendon that attaches to the medial epicondyle of the humerus (lower part of the bone of the upper arm that is near the elbow joint). It serves as the upper attachment point for the superficial muscles of the front of the forearm: Flexor carpi ulnaris Palmaris longus Flexor carpi radialis Pronator teres Flexor digitorum superficialis See also Common extensor tendon References Tendons

[Closed tendon injuries of the hand].

Cases of subcutaneous tendon ruptures of the hand were compiled over a period of 10 years; the lesions were all traumatic rather than due to degenerative illness. The 914 injuries fall into two categories: 867 extensor and 47 flexor tendon ruptures. The localisation of the lesions is most often distal. The extensor tendon lesion is accompanied more often by a ruptured bony fragment; the distal flexor tendon is mostly torn-off bony fragment. The extensor tendon ruptures can be subdivided as follows: distal injuries of the extensor aponeurosis in the DIP joint (751 cases), IP joint (31), tractus intermedius (27), ext. carpi radialis longus (5) and brevis (1), ext. carpi ulnaris (6); proximal ruptures of the ext. pollicis longus (42), ext. digitorum communis II and indicis (1 each) and ext. carpi radialis longus and brevis (1 each). The flexor tendon lesions are as follows: distal injuries to flex. digitorum profundus (32 cases), flex. pollicis longus (9), and the opponens pollicis, which is classified under this heading (2). Proximal lesions to flex. pollicis longus (2) and flex. digitorum profundus and superficialis (1 each).

Hand Infection -- Treatment / Management

Deeper infections more frequently require intravenous antibiotic treatment and prompt surgical management. In certain cases of flexor tenosynovitis, a trial of intravenous antibiotics under close inpatient observation may be attempted, provided the patient presents within 24 hours of symptom onset. [22] Typically, however, the treatment of choice for flexor tenosynovitis is incision and drainage of the flexor tendon sheath. [22] Incision and drainage of the flexor tendon sheath may be accomplished by passing an angiocatheter through a small proximal or distal incision on the digit. Depending on the presentation, however, a full open exposure may be required. [22] If untreated, thumb or index finger flexor tenosynovitis may spread to the deep thenar space or radial bursa, and the more ulnar digits may spread to the deep midpalmar space or ulnar bursa. [22] [25] The development of a “horseshoe abscess” is based upon similar connections, where infection communicates between the thumb and small finger flexor tendon sheaths in a potential space located between the pronator quadratus and flexor digitorum profundus tendons (i.e., Parona space). [22] [25]

Median nerve

Hand The median nerve enters the hand through the carpal tunnel, deep to the flexor retinaculum along with the tendons of flexor digitorum superficialis, flexor digitorum profundus, and flexor pollicis longus. From there, it is divided into recurrent muscular branch and digital cutaneous branch: The muscular branch (also known as recurrent branch) supplies the thenar muscles (opponens pollicis, abductor pollicis brevis, and superficial part of flexor pollicis brevis)

Flexor pollicis longus muscle

It arises also from the adjacent part of the interosseous membrane of the forearm, and generally by a fleshy slip from the medial border of the coronoid process of the ulna. In 40 percent of cases, it is also inserted from the medial epicondyle of the humerus, and in those cases a tendinous connection with the humeral head of the flexor digitorum superficialis is present. The fibers end in a flattened tendon, which passes beneath the flexor retinaculum of the hand through the carpal tunnel. It is then lodged between the lateral head of the flexor pollicis brevis and the oblique part of the adductor pollicis, and, entering an osseoaponeurotic canal similar to those for the flexor tendons of the fingers, is inserted into the base of the distal phalanx of the thumb.

[Extensor indicis muscle as a replacement for the abductor pollicis longus muscle. A case report].

The abductor pollicis longus muscle is very important for the function of the thumb. Its deficit hinders grasping bigger objects. Therefore, the reconstruction of the APL tendon is important in chronic injuries. The interposition of a tendon graft is considered the best method. However, the muscle loses its contractility very quickly because of its small gliding amplitude. Consequently, this procedure is only usable in the first six to eight weeks after injury. Later the function of the abductor pollicis longus muscle can only be recovered by a tendon transposition. The described tendon transposition methods the palmaris longus tendon, the flexor carpi radialis tendon and the radial half of the extensor carpi radialis longus tendon--do not fulfill the requirements of a good tendon transposition. Functional considerations may make the extensor indicis muscle the best substitution for the abductor pollicis longus. There is no disturbance of the function of the index finger by loss of the extensor indicis muscle. Both the extensor indicis and the abductor pollicis longus are functional synergists and are under voluntary control of the brain. By mobilization of the extensor indicis, abductor pollicis longus strength can be approached. A difference exists in the gliding amplitude of both muscles. The gliding amplitude of the extensor indicis is 55 mm while that of the abductor pollicis longus is 28 mm. If the extensor indicis muscle is placed under moderate tension the gliding amplitudes are identical. The strength of the abductor pollicis longus is 0.092 kp/m. The strength of the extensor indicis is unknown.(ABSTRACT TRUNCATED AT 250 WORDS)

Flexor carpi ulnaris muscle

Action The flexor carpi ulnaris flexes and adducts at the wrist joint. Innervation The flexor carpi ulnaris is innervated by the ulnar nerve. The corresponding spinal nerves are C8 and T1. Tendon The tendon of flexor carpi ulnaris can be seen on the anterior surface of the distal forearm. On a person's distal forearm, just before the wrist, there are either two or three tendons. The tendon of the flexor carpi ulnaris is the most medial (closest to the little finger) of these. The most lateral one is the tendon of flexor carpi radialis muscle, and the middle one, not always present, is the tendon of palmaris longus. Function The muscle, like all flexors of the forearm, can be strengthened by exercises that resist its flexion. A wrist roller can be used and wrist curls with dumbbells can also be performed. These exercises are used to prevent injury to the ulnar collateral ligament of elbow joint.

Palmaris profundus muscle

Palmaris profundus (also known as musculus comitans nervi mediani or palmaris bitendinous) is a rare anatomical variant in the anterior compartment of forearm. It was first described in 1908. It is usually found incidentally in cadaveric dissection or surgery. Structure Pirola et al. classified the muscle into subtypes depending on its origin: (1) from the radius, (2) from the flexor digitorum superficialis fascia, and (3) from the ulna. Though, other origins of the muscle were reported including the medial epicondyle of humerus, the palmaris longus and the flexor pollicis longus. It runs deep to the pronator teres and lateral to the flexor digitorum superficialis. Its tendon passes beneath the flexor retinaculum through the carpal tunnel before broadening out to insert to the deep part of palmar aponeurosis.

Pyogenic Flexor Tenosynovitis -- Introduction -- Anatomy of Flexor Tendon Sheaths

The flexor tendon sheaths for the index, middle, ring, and little fingers terminate at the level of the flexor digitorum profundus tendon insertion into the distal phalanx. The flexor tendon sheath ends at the flexor pollicis longus tendon insertion level in the thumb. Proximally, the flexor sheaths of the index, middle, and ring fingers extend to the A1 pulley at the level of the neck of the metacarpal bone. The sheath of the flexor pollicis longus tendon communicates with the radial bursa proximally. The little finger flexor sheath communicates with the ulnar bursa in about 80% of the population. [9] The radial and ulnar bursa are connected in 80% of people in the space of Parona, a potential space between the digital flexor tendons and the pronator quadratus in the volar distal forearm. This anatomic space allows a little finger or thumb infection to cause a horseshoe abscess. [10] [11]

Palmaris longus muscle

Clinical significance Use in tendon grafts The palmaris longus muscle is the most popular for use in tendon grafts for the wrist due to the length and diameter of the palmaris longus tendon, and the fact that it can be used without producing any functional deformities. When a tendon becomes ruptured in the wrist, the palmaris longus tendon may be removed from the flexor retinaculum and grafted to take the place of the ruptured tendon. The tendons most commonly replaced or supplemented by the palmaris longus tendon when ruptured are the long flexors of the fingers and the flexor pollicis longus tendon.

Flexor digitorum profundus muscle

The flexor digitorum profundus is a muscle in the forearm of humans that flexes the fingers (also known as digits). It is considered an extrinsic hand muscle because it acts on the hand while its muscle belly is located in the forearm. Together the flexor pollicis longus, pronator quadratus, and flexor digitorum profundus form the deep layer of ventral forearm muscles. The muscle is named . Structure Flexor digitorum profundus originates in the upper 3/4 of the anterior and medial surfaces of the ulna, interosseous membrane and deep fascia of the forearm. The muscle fans out into four tendons (one to each of the second to fifth fingers) to the palmar base of the distal phalanx. Along with the flexor digitorum superficialis, it has long tendons that run down the arm and through the carpal tunnel and attach to the palmar side of the phalanges of the fingers.

Anatomy, Shoulder and Upper Limb, Hand Extensor Pollicis Longus Muscle -- Surgical Considerations -- Tendon transfers

Patients requiring surgical reconstruction of a ruptured extensor pollicis longus tendon may get a tendon transfer or a free tendon graft. The extensor indicis is commonly used for tendon transfer, while other tendons that are usable include the palmaris longus, extensor carpi radialis longus, extensor carpi radialis brevis, and abductor pollicis longus. While the palmaris longus tendon is avascular, a palmaris longus tendon transfer may be performed to preserve index finger extension power, which commonly decreases after a tendon transfer involving the extensor indicis. It is essential to make sure there is an appropriate amount of tension in the reconstructed tendon; if there is too much tension, the thumb will be hyperextended and will not be able to flex correctly. Without enough tension, there will be extension deficits. A surgical technique to approximate the appropriate tension is to lay the patient’s hand on the table, with the forearm pronated and the wrist in a neutral position, and measure the distance of the center of the patient’s thumbnail edge to the table. The distance should be 2 cm. If it is more or less the suturing holding together, the reconstruction should be removed and re-done to achieve appropriate tension in the reconstructed EPL so that the thumbnail edge remains 2 cm off the table. [25]

Proper palmar digital nerves of median nerve

In the palm of the hand the median nerve is covered by the skin and the palmar aponeurosis, and rests on the tendons of the flexor muscles. Immediately after emerging from under the transverse carpal ligament the median nerve becomes enlarged and flattened and splits into a smaller, lateral, and a larger, medial portion. The lateral portion supplies a short, stout branch to certain of the muscles of the ball of the thumb, viz., the abductor pollicis brevis, the opponens pollicis, and the superficial head of the flexor brevis, and then divides into three proper palmar digital nerves of median nerve (proper volar digital nerves): two of these supply the sides of the thumb, while the third gives a twig to the first lumbricalis and is distributed to the radial side of the index finger.

Mucous sheaths on back of wrist

The mucous sheaths of the tendons on the back of the wrist are protective coverings for tendons in the wrist. Between the dorsal carpal ligament and the bones six compartments are formed for the passage of tendons, each compartment having a separate mucous sheath. One is found in each of the following positions: on the lateral side of the radial styloid process, for the tendons of the Abductor pollicis longus and Extensor pollicis brevis; behind the styloid process, for the tendons of the Extensores carpi radialis longus and brevis; about the middle of the dorsal surface of the radius, for the tendon of the Extensor pollicis longus; to the medial side of the latter, for the tendons of the Extensor digitorum communis and Extensor indicis proprius; opposite the interval between the radius and ulna, for the Extensor digiti quinti proprius; between the head and styloid process of the ulna, for the tendon of the Extensor carpi ulnaris.

Flexor carpi radialis muscle

In anatomy, flexor carpi radialis is a muscle of the human forearm that acts to flex and (radially) abduct the hand. The Latin carpus means wrist; hence flexor carpi is a flexor of the wrist. Origin and insertion The flexor carpi radialis is one of four muscles in the superficial layer of the anterior compartment of the forearm. This muscle originates from the medial epicondyle of the humerus as part of the common flexor tendon. It runs just laterally of flexor digitorum superficialis and inserts on the anterior aspect of the base of the second metacarpal, and has small slips to both the third metacarpal and trapezium tuberosity. The tendon of the flexor carpi radialis is visible on the anterior surface of the forearm, just proximal to the wrist, when the wrist is flexed. It is the tendon seen most lateral, closest to the thumb.

Anatomy, Shoulder and Upper Limb, Hand Ulnar Bursa -- Physiologic Variants

The ulnar bursa typically originates at the pronator quadratus level and continues distally, terminating 1 to 3 cm proximal to the flexor tendon sheaths of digits 2-4. However, studies reveal that the ulnar bursa may communicate with the flexor tendon sheaths of digits 2, 3, and 4, with prevalence rates of 5.1%, 4%, and 3.5%, respectively. [7] Communication with the 5th digit's flexor tendon sheath is much more common, occurring in 50% to 80% of cases. [3]

Anatomy, Shoulder and Upper Limb, Hand Ulnar Bursa -- Introduction

The synovial tendon sheath is a bursa that surrounds tendons as they pass through anatomic spaces. The ulnar bursa is the synovial tendon sheath enclosing the tendons of the medial 4 fingers' flexors as they pass through the carpal tunnel (see Image . Hand Bursae). It possesses 3 distinct invaginations that surround the structures of the carpal tunnel [2] : Deep layer: between the carpal bones and the flexor digitorum profundus tendons Intermediate layer: between the flexor digitorum profundus tendons and flexor digitorum superficialis tendons Superficial layer: superficial to the flexor digitorum superficialis tendons

Abductor digiti minimi muscle of hand

Variation In rare cases accessory fascicles of the abductor digiti minimi have been found arising from the antebrachial fascia, the radius, and the ulna. The abductor digiti minimi is the most variable hypothenar muscle, and might be joined by accessory slips from the tendon of the flexor carpi ulnaris, the flexor retinaculum, the fascia of the distal forearm, or the tendon of the palmaris longus. Occasionally, the muscle is partially inserted onto the fifth metacarpal bone. In case of polydactyly it may insert to the sixth finger instead, if there is one. Function It is an abductor of the little finger at the metacarpophalangeal joint. It is also possible that the muscle contributes to extension of the middle phalanx of the little finger through its connection to finger's extensor mechanism. It plays an important role when the hand is grasping large objects with outspread fingers.

Flexor carpi ulnaris muscle

Variability The muscle can be doubled as accessory flexor carpi ulnaris muscle and is often accompanied by concomitant variants. Clinical significance Ulnar entrapment by the aponeurosis of the two heads of the flexor carpi ulnaris muscle may cause cubital tunnel syndrome. Tendon of flexor carpi ulnaris can be used for tendon transfer. Additional images References External links Muscles of the upper limb Forearm

Flexor retinaculum of the hand

The flexor retinaculum is continuous with the palmar carpal ligament, and deeper with the palmar aponeurosis. The ulnar artery and ulnar nerve, and the cutaneous branches of the median and ulnar nerves, pass on top of the flexor retinaculum. On the radial side of the retinaculum is the tendon of the flexor carpi radialis, which lies in the groove on the greater multangular between the attachments of the ligament to the bone. The tendons of the palmaris longus and flexor carpi ulnaris are partly attached to the surface of the retinaculum; below, the short muscles of the thumb and little finger originate from the flexor retinaculum. Function The flexor retinaculum is the roof of the carpal tunnel, through which the median nerve and tendons of muscles which flex the hand pass. Clinical significance

Anatomy, Shoulder and Upper Limb, Hand Ulnar Bursa -- Other Issues -- Deep Hand Infections

During ulnar bursa endoscopic tenosynovectomy, a 3-4 mm skin incision is made at the ulnar palmar portal through the palmar aponeurosis. The ulnar palmar portal is the viewing portal. The trocar cannula is placed across the metacarpal necks, passing to the first webspace. The thumb is then abducted. An incision is made to create the first web portal at the tip of the trocar. Synovectomy is performed along the long flexor tendons between the thumb and index fingers. [17]

Carpal tunnel

Superficial to the carpal tunnel and the flexor retinaculum, the ulnar artery and ulnar nerve pass through the ulnar tunnel/Guyon's canal. Function Ten structures pass through the carpal tunnel, most of them flexor tendons (not the muscles themselves): flexor digitorum profundus (four tendons) flexor digitorum superficialis (four tendons) flexor pollicis longus (one tendon) Median nerve between tendons of flexor digitorum profundus and flexor digitorum superficialis The flexor carpi radialis (one tendon), is often incorrectly stated to travel within the carpal tunnel. More precisely, it travels within the fibers of the flexor retinaculum which forms the roof of the carpal tunnel, rather than running inside the tunnel itself.

Ultrasonic assistance in the diagnosis of hand flexor tendon injuries.

In contrast to routine flexor tendon injuries, flexor tendon ruptures following blunt injury or re-ruptures following repair can be difficult to diagnose. The authors investigated the efficacy of using ultrasound to assist in the diagnosis. From 1996 to 1997, 8 patients underwent evaluation of the flexor tendons using an ATL HDI-3000 ultrasound machine with a high-resolution, 5 to 9-MHz hockey stick linear probe. Dynamic evaluation was performed in real time, simulating clinical symptoms. Six patients underwent surgical exploration. Sonographic diagnosis and intraoperative findings were correlated. Ultrasound was used to diagnose 3 patients with ruptured flexor digitorum profundus tendons. Mechanisms of injury included forceful extension, penetrating injury, and delayed rupture 3 weeks after tendon repair. Subsequent surgical exploration confirmed the ruptures and location of the stumps. Five patients had intact flexor tendons by ultrasound after forceful extension, penetrating injury, phalangeal fracture, crush injury, and unknown etiology. In 3 patients who underwent surgery for tenolysis, scar release, or arthrodesis, the flexor tendons were found to be intact, as predicted by ultrasound. The authors found ultrasound to be accurate in diagnosing the integrity of flexor tendons and in localizing the ruptured ends. They conclude that ultrasound is helpful in evaluating equivocal flexor tendon injuries.

Carpal tunnel

Structure The carpal bones that make up the wrist form an arch which is convex on the dorsal side of the hand and concave on the palmar side. The groove on the palmar side, the sulcus carpi, is covered by the flexor retinaculum, a sheath of tough connective tissue, thus forming the carpal tunnel. On the side of the radius, the flexor retinaculum is attached to the scaphoid bone, more precisely its tubercle, as well as the ridge of trapezium. On the ulnar side, it is attached to the pisiform and hook of hamate. The narrowest section of the tunnel is located a centimetre beyond the mid-line of the distal row of carpal bones where the sectional area is limited to 1.6 cm2. The tendons of the flexor digitorum superficialis and profundus pass through a common ulnar sheath, while the tendon of the flexor pollicis longus passes through a separate radial sheath. The mesotendon shared by these tendons is attached to the radial and palmar walls of the carpal tunnel.

Flexor digitorum profundus muscle

Along with the flexor digitorum superficialis, it has long tendons that run down the arm and through the carpal tunnel and attach to the palmar side of the phalanges of the fingers. Flexor digitorum profundus lies deep to the superficialis, but it attaches more distally. Therefore, profundus's tendons go through the tendons of superficialis, and end up attaching to the distal phalanx. For this reason profundus is also called the perforating muscle. The lumbricals of the hand arise from the radial side of its tendons.

Extensor digitorum muscle tendon to the index finger from the extensor carpi radialis brevis: a cadaveric case report.

The forearm extensor compartment is known for its wide variability in terms of muscle origin, number of tendons and their distal insertion. The index finger on its dorsal aspect is the typical place of insertion of the two tendons of the extensor digitorum (ED-index) and of the extensor indicis. Being acquainted with their anatomy is of immense importance to orthopedic surgeons in the treatment of e.g., de Quervain's syndrome. The current report presents a rare finding of the ED-index tendon arising from the extensor carpi radialis brevis (ECRB). A routine dissection revealed their fused course from the lateral epicondyle of humerus, though separate from the extensor carpi radialis longus. The ED-index muscle belly separated from the ECRB, 119 mm distal to the lateral epicondyle. The distal insertion point of the ED-index was located radially to that of the extensor indicis. The deep branch of the radial nerve and the recurrent interosseous artery supplied the ED-index. No other musculotendinous variations were encountered neither on the ipsilateral nor the contralateral upper limb of the cadaver. This study presents in detail a tendon of the ED-index arising from the ECRB, aknowledge that can be applied namely in the lateral epicondylitis treatment or approach to the ulnar nerve at the level of the elbow. Extensive depiction of both the proximal and distal attachment points of the muscles, their course and dimensions is indispensable to attain the best patient outcomes and avoid iatrogenic injuries.

Acupotomy in the treatment of tenosynovitis of hand flexor tendons: A systematic review and meta-analysis.

Acupotomy was used to treat tenosynovitis of hand flexor tendons (THFT) in China. But it's uncertain about the efficacy of acupotomy for THFT. We plan to evaluate the efficacy and safety about acupotomy therapy in the treatment of THFT through this review. The protocol about this review was registered in PROSPERO (registration number: CRD42022330568). We searched 6 databases from their respective inception dates to January 11, 2022. Studies searched was screened by our reviewers, and then the raw data was filtered out. We used RevMan 5.3 software to perform statistical analysis. 11 studies involving 828 patients were shortlisted. The experimental group showed obvious advantages compared with the control group, such as effective rate (odds ratio [OR] = 6.77, 95% CI [confidence intervals] = [3.89, 11.77], P < .00001), cure rate (OR = 3.32, 95% CI = [1.81, 6.11], P = .0001) and Vas score (MD = -1.21, 95% CI = [-2.00, -0.42], Z = 3.01, P < .003). According to the above results, Acupotomy is an effective and safe treatment for THFT. So it should be recommended for the treatment of THFT patients.

Adductor pollicis muscle

From this origin the greater number of fibers pass obliquely downward and converge to a tendon, which, uniting with the tendons of the medial portion of the flexor pollicis brevis and the transverse head of the adductor pollicis, is inserted into the ulnar side of the base of the proximal phalanx of the thumb, a sesamoid bone being present in the tendon. A considerable fasciculus, however, passes more obliquely beneath the tendon of the flexor pollicis longus to join the lateral portion of the flexor pollicis brevis and the abductor pollicis brevis. Transverse head The transverse head (Latin: adductor transversus pollicis) is deeply seated. It is triangular, arising by a broad base from the lower two-thirds of the palmar surface of the third metacarpal bone; the fibers converge, to be inserted with the medial part of the flexor pollicis brevis and the oblique head into the ulnar side of the base of the proximal phalanx of the thumb.

Hand Extensor Tendon Lacerations -- History and Physical -- Superficial Extrinsic Extensors

Extensor carpi radialis longus (ECRL) Extensor carpi radialis brevis (ECRB) Extensor digitorum communis, (EDC) Extensor digiti minimi (EDM) Extensor carpi ulnaris (ECU)

[De Quervain's tenosynovitis: Clinical aspects and diagnostic techniques].

De Quervain's tenosynovitis is a tendon sheath inflammation of the musculus abductor pollicis longus (APL) and the musculus extensor pollicis brevis (EPB) in the first extensor compartment of the wrist. Typically, patients present with pain symptoms on the radial side of the wrist as a result of repetitive moments and consequent overload of the tendons. During physical examination, De Quervain's tenosynovitis is easily distinguishable from other wrist injuries. Early recognition is of utmost importance for treatment decisions due to the fact that it is very well treatable, especially in the acute phase. A multimodal approach with conservative management is the most effective. Surgical intervention is usually not necessary.

Management and functional outcomes of combined injuries of flexor tendons, nerves, and vessels at the wrist.

A retrospective review of 42 patients with spaghetti wrist lacerations operated on by the author between June 1997 and May 2005 was completed. A total of 31 males and 11 females, average age of 17.1 years (range, 2-40 years), sustained spaghetti wrist injuries. The most frequent mechanisms of injury were accidental glass lacerations (55%), knife wounds (24%), and electrical saw injuries (11%). An average of 9.16 structures was injured, including 6.95 tendons, 1.4 nerves, and 0.8 arteries. The most frequently injured structures were median nerve (83%), flexor digitorum superficialis 2-4 tendons (81%), flexor digitorum profundus 2-4 tendons (66%), ulnar nerve and ulnar artery (57%), and flexor pollicis longus (40%). Combined flexor carpi ulnaris, ulnar nerve, and ulnar artery (ulnar triad) injuries occurred in 31%, while combined median nerve, palmaris longus, and flexor carpi radialis injuries (radial triad) occurred in 43%. Simultaneous injuries of both median and ulnar nerves occurred in 40.5%. Simultaneous injuries of both ulnar and radial arteries occurred in 14%. Neither artery was injured in 30.9%. Follow-up has ranged from 1 to 8 years, with an average of 46 months. Only four patients have been completely lost to follow-up. Range of motion of all involved digits (tendon function) was excellent in 34 patients, good in 3 patients, and poor in only 1 patient. Opposition was excellent in 31 patients, good in 5 patients, and poor in 2 patients. Intrinsic muscle recovery was subjectively reported to be excellent in 29 patients, good in 7, and fair to poor in 2 patients. Minor deformity (partial clawing) was reported in 4 patients and 1 patient has major deformity (total clawing). Sensory recovery was reported, excellent in 32 patients, good in 5 patients, and fair in only 1 patient.