Finger Compression Research Articles

Subumbilical midline vascularity of the abdominal wall in portal hypertension observed at laparoscopy

Background: Large volume paracentesis is a common treatment of ascites. Injury to abdominal wall collateral veins during this procedure can lead to hemoperitoneum. Because of this concern, the midline below the umbilicus is often recommended as a site for paracentesis because of its presumed avascularity. Methods: We examined the subumbilical peritoneal surface in 20 consecutive patients with liver disease undergoing diagnostic laparoscopy. This area was visualized by table tilting and confirmed by external finger compression. Nineteen patients had cirrhosis of various etiologies, and one had advanced fibrosis with evidence of portal hypertension. Results: In these 20 patients, only 7 had avascular midlines below the umbilicus. Seven had small but definite veins running along the path of the urachus (median umbilical fold), and 6 had more prominent veins in this region. The internal landmarks in this region (median and medial folds) were frequently asymmetric with regard to the external appearance of the midline. Conclusion: The subumbilical midline in patients with portal hypertension is commonly vascular. When using this site for paracentesis, care should be exercised to identify venous structures with the narrow-gauge needle used to inject local anesthetic agent before placement of larger paracentesis needles. (Gastrointest Endosc 1998;47:388-90.)

Quantifying Loss of Firmness in Blackberries

Measurement of firmness of blackberries is challenging because of their nonspherical shape, large pyrenes, and mixture of receptacle and epidermal tissues. Firmness at harvest is important to minimize damage from finger compression and after harvest, as fruit that soften during storage often have more decay and leakiness than firmer fruit. We have done subjective ratings over the last 4 years using a scale of 1 (firm) to 5 (mush) and find that discerning between ratings of 2 and 3 is the most difficult subjective decision. We have used a hand-held penetrometer adapted with an insect pin to measure epidermal thickness and receptacle firmness after storage, but correlation with subjective ratings has been unsatisfactory. We have also measured whole fruit compression using a Texture Technologies ® TA2 texture analyzer that collects 500 data points per second. While this works well with fruit subjectively rated 1 to 3, it cannot measure soft fruit rated 4 and 5. However, both puncture and compression tests have successfully quantified firmness loss with ripening.

Cutaneous nerve fibre depletion in vibration white finger.

Vibration white finger or hand-arm vibration syndrome is the episodic blanching of the fingers in response to cold occurring in those who work with hand held vibrating tools. Clinically the condition differs from primary Raynaud's phenomenon as persistent paraesthesiae and pain are common in the hands and arms and these occur independently from the 'white attacks'. Symptoms can become severe enough to warrant a change of occupation. Industrial compensation may be awarded for vibration white finger but, at present, no simple or reliable objective diagnostic test is available. Calcitonin gene-related peptide (CGRP) is a neuropeptide with powerful vasodilator properties. A deficiency of immunoreactive CGRP nerve fibres has been previously demonstrated in the digital cutaneous microvasculature of patients with primary and secondary Raynaud's phenomenon with the distribution and quantity of other types of nerve fibres not being significantly altered. To determine if the innervation of the cutaneous microvasculature in vibration white finger was also abnormal skin biopsy samples from the fingers of 15 patients with vibration white finger, six healthy age matched controls who worked with vibrating machinery and 26 healthy age matched controls who were heavy manual workers without exposure to vibrating machinery were examined by immunohistochemistry. To try to correlate any histological abnormalities with clinical neurological deficit sensory nerve conduction studies have so far been performed in six patients with vibration white finger.(ABSTRACT TRUNCATED AT 250 WORDS)

?Prepubien? section: a new surgical treatment of frequency, nocturia and urge incontinence?

The use of transvaginal ultrasound (7.5 MHz, linear array) during urethral instability enabled us to describe three movements that were seen during the urethral pressure drops: a shortening of the urethra (relaxation of the striated sphincter), an increase in the distance between the probe and the symphysis pubica (relaxation of the levator ani muscles) and a forward displacement of the “prepubien”. During ultrasound examinations (endovaginal and vulvar), the prepubien and its movements are easily visible in the space located between the external urethral meatus and the clitoris. The drop in urethral pressure is sometimes associated with an urgent need to urinate. In 75% of the patients, finger compression of the prepubien on the symphysis inhibited urethral instability and urgency. After all classic treatments for pollakiuria, nocturia and urge incontinence had failed, we tried to cut the prepubien in patients who were under general anesthesia. This operation was carried out in 19 women, of whom 13 were cured (68%), 5 showed improvement and 1 was a failure. Only two short-term side effects were observed: a sexual disability that lasted for 2 months and a labial haematoma.

Comparison of the Fascia Iliaca Compartment Block with the 3-in-1 Block in Children

A new single injection procedure, the fascia iliaca compartment block, is described for blocking the femoral, lateral cutaneous, and obturator nerves. The technique consists of injecting a local anesthetic immediately behind the fascia iliaca at the union of the lateral with the two medial thirds of the inguinal ligament, and forcing it upward by finger compression. This block was prospectively evaluated in 60 pediatric patients aged 0.7 to 17 years undergoing surgery of the lower limb, and then compared with a similar group of 60 children given a 3-in-1 block. Adequate analgesia was only obtained in 20% of the patients given 3-in-1 blocks (group 1), whereas the fascia iliaca compartment block proved to be easy, free of complications, and effective in more than 90% of patients (group 2). Such a high failure rate in group 1 was not due to misplacement of the needle since a femoral nerve block developed in all patients. Therefore it is unlikely that the local anesthetic can spread rostrally towards the lumbar plexus then return peripherally along the issuing nerves, and this was, indeed, not confirmed by radiological findings. In the authors' opinion, a multieffective block can only develop when the local anesthetic is introduced behind the fascia iliaca, which circumscribes a potential space where the femoral, lateral cutaneous, and obturator nerves run for a considerable part of their course. This report shows that deliberately injecting this space almost always results in an easy and effective block of these three nerves. The fascia iliaca compartment block can be recommended for use in children.

Hepatic transcatheter arterial embolization with gastroduodenal artery blocking by finger compression.

Hepatic transcatheter arterial embolization was performed in two patients by blocking the gastroduodenal artery with finger compression on the abdominal surface. The embolizing material, which was injected into the common hepatic artery, did not enter the gastroduodenal artery. No postoperative complications were experienced. This method may be useful for patients in whom superselective catheterization of the proper hepatic artery is not feasible.

Elevation of pain threshold by vaginal stimulation in women

In 2 studies with 10 women each, vaginal self-stimulation significantly increased the threshold to detect and tolerate painful finger compression, but did not significantly affect the threshold to detect innocuous tactile stimulation. The vaginal self-stimulation was applied with a specially designed pressure transducer assembly to produce a report of pressure or pleasure. In the first study, 6 of the women perceived the vaginal stimulation as producing pleasure. During that condition, the pain tolerance threshold increased significantly by 36.8% and the pain detection threshold increased significantly by 53%. A second study utilized other types of stimuli. Vaginal self-stimulation perceived as pressure significantly increased the pain tolerance threshold by 40.3% and the pain detection threshold by 47.4%. In the second study, when the vaginal stimulation was self-applied in a manner that produced orgasm, the pain tolerance threshold and pain detection threshold increased significantly by 74.6% and 106.7% respectively, while the tactile threshold remained unaffected. A variety of control conditions, including various types of distraction, did not significantly elevate pain or tactile thresholds. We conclude that in women, vaginal self-stimulation decreases pain sensitivity, but does not affect tactile sensitivity. This effect is apparently not due to painful or non-painful distraction.

Late cataclysmic hemorrhage from the innominate artery after tracheostomy.

We report on 12 patients sustaining late cataclysmic hemorrhage as a complication of tracheostomy or endotracheal intubation, resulting from erosion of the innominate artery. Four long-term survivors are reported. A number of surgical techniques was used and up-to-date management is briefly described. Our technique mainly consists of transecting and suturing the innominate artery without prior debridement. Innominate artery blood flow was not reestablished in all patients, thereby avoiding local wound infection and recurrence of hemorrhage. Initial temporary control of bleeding was achieved either by hyperinflation of the cuff of the tracheostomy tube, or finger compression of the innominate artery against the sternal notch. Definite surgical repair of this lesion and reestablishment of innominate artery flow is carried out through complete sternotomy in combination with right cervical extension which is considered the incision of choice by the authors. To prevent this unusual and lethal complication, tracheostomy should not be used without proper indication and technical errors of its performance, such as placing it lower than the level of third tracheal ring, must be avoided.

One Hour Hepatic Ischemia Without Serious Damage

To the Editor:— Since an aggressive surgical approach to resection of major portions of the liver for massive trauma or tumor is currently being suggested 1 and liver transplant is being evaluated, the length of time that hepatic ischemia can be effected without permanent damage has increasing significance. Our case is reported because it offers one observation on this point. Report of a Case:— A 33-year-old woman with previously demonstrated cholelithiasis was found to have acute cholecystitis, a normal-sized common duct, and a normal liver. As the cystic artery was being dissected, there was sudden severe arterial hemorrhage. Immediate control with finger compression through the foramen of Winslow was accomplished. At 10:09 AM a vascular clamp was placed across the portal triad, with complete control of bleeding. The common hepatic artery was identified and individually clamped in approximately one-half hour, at which time the clamp was removed from the porta

部分的腎剔除術後の腎内血行の研究

Changes of the renal circulation after the partial nephrectomy were examined by the injection of Indian ink into the abdominal aorta on 36 dogs. The changes of the renal circulatiyn were apprenciated by a distribution of Indian ink. The obtained results are as follws:1) Marked ischemia of the cortex and hyperemia of the medulla were observed for 24 hours after operation. These changes being transient, the normal distribution was regained within 10 days. When the renal pedicle was clamped, the changes were more marked than when the pedicle was treated with finger compression.2) Similar changes of the renal circulation occurred even when the renal pedicle was clamped without resecting renal parenchyma. This fact indicates that the renal circulation after the partial nephrectomy are chiefly due to clamping the renal pedicle during the resection.3) The postoperative changes of the renal circulation were observed not only in the kidney, a portion of which was resected, but also in another kidney. Restoration from these changes of the contralateral kidney were more rapid.4) The described changes bear a resemblance to “renal vascular shunt” of Trueta.