Narrow Results

Lifetime-standing psychosocial effects of congenital hand anomalies are inevitable in patients who have not received a comprehensive treatment with appropriate timing and approach. Herein, two adult cases of untreated thumb polydactyly are presented. Both of them had hands with striking appearance and late consequent psychosocial problems.

We report a case of Linburg-Comstock syndrome, which is characterized with anomalous tendon slips connecting flexor pollicis longus (FPL) to the flexor digitorum profundus (FDP), usually at the index finger. The present patient started to be a carpenter and was suffering from his disability of flexing the thumb and the index finger independently when he handled the screws in his work. We surgically removed the tendinous connection of the FPL tendon and the index FDP tendon. After surgery, he could work as a carpenter without any difficulty. Surgical disconnection was effective treatment. Dynamic high-resolution ultrasound and three dimensions of computed tomography of the left distal forearm were helpful to confirm the diagnosis.

A 16-year-old girl complains that she has yet to experience menstruation.

• Is this abnormal?
• What produces menstruation?
• What conditions may explain her complaint?
• What investigations should be performed on her?

The onset of puberty in girls is marked by the beginning of ovarian function in estrogen secretion followed by physical development of breast buds detectable as firm nodules directly beneath the nipples. This occurs between the ages of 10 and 11.5 years old and is known as thelarche. The first menstruation, or menarche, should occur within three years of thelarche. The mean age of menarche is 12.5 years old. Fewer than 10% of girls menstruate before 11 years old and 90% of girls are menstruating by 13.7 years old. Absence of menarche three years after thelarche or after 16 years old is an abnormal delay known as primary amenorrhea. The incidence of primary amenorrhea is less than 1%.