Left Ring Finger Research Articles

Whisk finger: an electric hand whisk injury with an ischaemic fingertip

A 38 year old lady sustained an injury to her left ring finger from an electric whisk which became intertwined around the pulp and nail complex, causing multiple lacerations, with ischaemia of the tip of the digit, in a previously undescribed pattern of injury. The apparent complexity of the wire loops led to initial uncertainty as to whether to remove the whisk in the Emergency Department. However, following consultation with the plastic surgery on-call team, wire cutters were used to divide the metal loops and remove the whisk under digital block, and perfusion returned immediately, preserving the digit. Despite initial concerns regarding the possible role for reconstruction or revascularisation, minimal surgical intervention was required as a daycase.

Design and Evaluation of Haptic Constraints for Laparoscopic Instrument Handling.

Learning and mastering laparoscopic skills is an involved and complicated process, especially in the case of pediatric surgery due to extremely fragile tissues and small spaces. Given these constraints, precise, controlled, and gentle laparoscopic tool motions are essential. Proper handling and ergonomics of laparoscopic tool handling are often overlooked when training novice surgeons. Novice surgeons tend to overgrip the tool, which may lead to applying excessive amounts of force and potential surgical complications. We have developed two constraint mechanisms to enable proper tool handling: one mechanism is a passive kinematic constraint which physically prevents the user from over-gripping the tool. The second mechanism operates under dynamic resistive control. An elastic silicone membrane, secured by a hard plastic clip to the finger loop of the laparoscopic tool, actively resists the user's overgrip. These constraint devices were tested in a series of human subject studies with novice learners. The resulting data shows a both a significant reduction in over-grip and overall task completion time when using the passive constraint. The left index, right middle, and right ring fingers are shown to have the least amount of over-grip, as well as the lowest time of non-contact with the tool, indicating the importance of these fingers for laparoscopic tool control.

Tıp Fakültesi Öğreticisinden Kurban Bayramı Sonrası Elde Orf Enfeksiyonu

BACKGROUND Human orf infection – caused by Parapox virus – is an uncommon zoonotic infection transmitted from infected sheep and goats. We report an Orf lesion which occurred on the ring finger of a fifth-grade Medical student who had butchered a goat in Sacrifice Feast (also called Eid al-Adha). CASE REPORT 23 year old male student in fifth-grade of Medical Faculty was diagnosed with hand orf infection after Sacrifice Feast. The patient reported accidental cut on his left ring finger while butchering a goat which was subsequently recognized to be infected. After occurrence of the Orf lesion, he had administered intervention with a sterile syringe needle to remove the scab for drainage due to false impression of abscess formation despite warnings. The patient was treated with daily wound care and regular outpatient visits. Although mild scarring remained owing to intervention administered by the patient, Orf lesion healed well after seven weeks from admission. The patient was complaint free after 18 months from admission. Finger posture, range of motion, sensation were normal. CONCLUSION An Orf lesion developing on the hand skin of a medical student and his approach to a zoonotic infection raised the idea that further and detailed education for zoonotic infection prevention is required, particularly in communities which practice large numbers of slaughtering during Sacrifice Feast. Mode and control of zoonotic disease transmission as well as preventive measures and management should be emphasized not only in veterinarian education, but also in medical, nursing and public schools.

Nonunited medial epicondyle fracture: A threat to ulnar nerve in long run

48yr old male presented with complaints of tingling and numbness over left little and ring finger for one month; with history of injury around elbow 30yrs back which was managed conservatively. He was diagnosed to be suffering from tardy ulnar palsy after Nerve conduction Velocity studies and MRI Study. Injures to elbow are common in childhood, which include fracture of medial epicondyle which may or may not be associated with dislocation. These kind of injures may be managed conservatively or surgically explored. Ulnar nerve is at risk for injury due to its susceptible position behind medial epicondyle which could be due to the direct impact of acute injury, iatrogenic during surgical management or delayed injury due to mal-union with varus or valgus deformity. We report a case of Tardy ulnar nerve palsy without any valgus or varus deformity following non-united medial epicondyle fracture is rare.

Fingerprints as an Alternative Method to Determine ABO and Rh Blood Groups

Blood grouping is conventionally done with invasive method by taking blood samples. The objective of this study is to determine blood group with uninvasive procedure by taking fingerprints of the participants and know the associations between their fingerprints and blood groups. Seven hundred participants of both genders with no any age limitation from Manipal Teaching Hospital and Manipal College of Medical Sciences were randomly selected. The blood grouping was done by cross reacting blood sample with the antibodies. The fingerprints were taken with the help of stamp pad imprinting the finger ridges over A4 size white papers. The loop, whorl and arch patterns were studied. O+ve blood group 224 (32%) was most prevalent among 700 participants. The loop pattern was highly distributed 3708 (53%) in all blood groups except in A-ve blood group with highest distribution of whorl 20 (40%). The mean comparisons of specific fingerprint in total and also in individual fingers with different ABO and ABO-Rh blood groups showed no any statistical association with P>0.05. However, the loop distribution in individual finger was highest in right middle finger (M) of B-ve blood group 5 (10%). The whorl distribution in individual finger was highest in right index (I), left thumb (T) and left ring (R) fingers of AB+ve blood group 20 (5.5% each). Similarly, the arch distribution was highest in right index fingers of A-ve blood group 3 (6%). The mean comparison of different fingerprints with ABO and Rh blood groups showed no significant statistical association concluding fingerprints cannot be used for blood grouping.

P262 Contraceptive implant induced ulnar neuropathy

Significant complications from subdermal insertion of a contraceptive implant in the medial upper arm are rare; a UK Government drug safety update indicating the risk of intravascular insertion was published in 2016.We report the introduction of an implant into the ulnar nerve sheath. Introduction of a contraceptive implant into the medial aspect of the distal left upper arm was followed 5 min later by the patient reporting pins and needles in the arm and tips of the left ring and little fingers. The implant was not palpable. 2 h later loss of sensation was apparent in these fingers; clinical review was unrevealing. Ultrasound suggested the implant was lying between the ulnar nerve and blood vessel in the medial upper arm. At surgery the implant was found within the left ulnar nerve sheath and removed.3 months post surgery the numbness in the little finger had resolved but reduced sensation was still evident over the dorso-ulnar hand and distal forearm with hypersensitivity over the ulnar styloid, weakness was not apparent. Nerve conduction studies revealed the left dorsal ulnar sensory NAP was small when compared to the right side (13 vs. 31 microvolts).The left digit 5 sensory NAP was normal amplitude. Motor studies showed mild slowing in the left ulnar nerve around the elbow. While publications and warnings have highlighted the rare occurrence of intravascular insertion, the neurovascular bundle is at risk hence drug company advice to avoid the sulcus between biceps and triceps. This case indicates fascicular damage to the ulnar nerve.

Dermatoglyphics in infants with isolated, non-familial cleft lip palate- a case control study from Southern India

Background: The role of genetic factors may be established by study of dermatoglyphics, therefore, any genetic abnormality during the formation of cleft lip and/or palate (CL/P) in the early trimester maybe reflected by altered dermatoglyphics. Aim: This study aims to assess altered dermatoglyphics in children with isolated, non-familial CL/P to understand the role of genetic factors in clefting.Methods: Case control study in a cranio-facial centre comprising of 40 infants (6-9 months) with CL/P and age and gender matched controls. Finger printing was done using black duplicating ink. A p-value of 0.05 was considered significant.Results: Majority (57.5%) had left sided clefting. Ulnar loops were the predominant digital pattern in the study group but there was no statistical difference with the controls, when all the finger patterns were considered together. There was significant difference in digital patterns in between the left thumb (p=0.033), ring (p=0.048) and little fingers (p=0.029) in the two groups. Comparison between the right and left hands within the study group showed significant difference in digital patterns in the thumb (p=0.047) and little finger (p<0.001). The study group also had a wider atd angle with significance (right hand p=0.038, left p=0.003) and a lower a-b ridge count with significance (right hand p= 0.045, left p=0.012).Conclusions: There was a definite dermatoglyphic difference specifically in the left hand, which was also the major side of clefting, within subjects as well as between subjects and controls.

P093 Transcranial cortex stimulation, neuroplasticity and learning: An experimental and computational study

Question Noninvasive cortical stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) are capable of increasing and decreasing cortical excitability and thereby might be clinically relevant for rehabilitation of neurological and neuropsychiatric disorders. However, the induced after-effects are usually too short-lasting to be clinically relevant. In this study we investigated if combining rTMS with operant learning can induce long-lasting after-effects not achievable neither with rTMS alone nor with operant learning alone. Methods Experimental approach: Forty-six subjects were randomly assigned to three experimental groups. Experimental groups 1 & 2 received a psychophysical pretest of tactile discrimination abilities with the left ring finger, a training procedure to improve performance with this finger, and a posttest. In experimental group 1 the training procedure was combined with 15 Hz rTMS over the primary sensory cortex (SI) while in experimental group 2 the training was combined with sham rTMS. In the third experimental group, psychophysical pre- and posttests of tactile discrimination abilities were assessed. However, they received 15 Hz rTMS over SI without training. Computational approach: As a preliminary simulation trial we developed a neural model, which enabled us to discriminate between the encoding and decoding of particular input frequency represented in several scenarios. Results Combining rTMS with operant learning induced long-lasting after-effects not achievable neither with rTMS alone nor with operant learning alone. A conceptual framework for the efficiency of combining cortical stimulation with operant learning can be derived from the Bienenstock–Cooper–Munro theory of bidirectional synaptic plasticity. According to this theory the change of synaptic efficiency during learning processes is dependent on the preactivation level of the involved neural network, suggesting that high-frequency rTMS can transiently decrease the threshold for the induction of LTP-like effects and thereby gate practice-dependent plasticity. Conclusions Our findings provide important implications for the use of rTMS in combination with operant learning as a therapeutic tool for neurorehabilitation.

Pseudodystonia in sarcoid myopathy

AbstractWe describe a 61‐year‐old woman with difficulty extending her left ring finger and little finger caused by sarcoid myopathy. As her symptom temporarily improved with carpal flexion or forearm pronation, we once misdiagnosed her as having dystonia of the upper limb. Her symptom gradually worsened, and muscle biopsy specimen revealed sarcoid myopathy. Muscle magnetic resonance imaging of the left forearm showed abnormal signals in the quadriceps femoris and biceps brachii muscles, and the area surrounding the flexor digitorum profundus and supinator muscles. Treatment with prednisolone was effective, and stopped progression of the symptom. Adhesion of the supinator muscle and flexor digitorum profundus as a result of inflammation might have caused limited extension of the flexor digitorum profundus.

The Onset and Duration of Action of 0.2% Lidocaine in a One-per-Mil Tumescent Solution for Hand Surgery.

BackgroundOne-per-mil tumescent solution, which contains 0.2% lidocaine with 1:1,000,000 epinephrine, has been reported to be clinically effective for hand surgery under local anesthesia. However, it was lacking in its basic pharmacokinetics profile in regard to the onset of action (OOA) and duration of action (DOA).MethodsA randomized, double-blind study was conducted on 12 volunteers who met the inclusion criteria from October to November 2014. All volunteers had their right and left ring finger pulps injected with either one-per-mil solution or 2% lidocaine. Semmes-Weinstein and two-point discrimination tests were used to test sensation. Visual analogue scale was recorded at the time when the finger lost its sensation and when it regained normal sensation to measure the OOA and DOA. The data were then analyzed with a paired t-test and a Wilcoxon signed-rank test.ResultsThe OOA and DOA of 2% plain lidocaine were 1 minute and 99.67 minutes, respectively. Meanwhile, 0.2% lidocaine in a one-per-mil tumescent solution showed an OOA of 5 minutes and a DOA of 186.83 minutes. The OOA of 0.2% lidocaine in a one-per-mil tumescent solution is statistically shorter than 2% plain lidocaine (P=0.04); while its DOA is statistically longer than 2% plain lidocaine (P<0.001).ConclusionsThe 0.2% lidocaine in a one-per-mil tumescent solution is statistically and clinically superior to 2% plain lidocaine in achieving longer duration of local anesthesia.

Congruency of body-related information induces somatosensory reorganization

Chronic pain and impaired tactile sensitivity are frequently associated with “blurred” representations in the somatosensory cortex. The factors that produce such somatosensory blurring, however, remain poorly understood. We manipulated visuo-tactile congruence to investigate its role in promoting somatosensory reorganization. To this aim we used the mirror box illusion that produced in participants the subjective feeling of looking directly at their left hand, though they were seeing the reflection of their right hand. Simultaneous touches were applied to the middle or ring finger of each hand. In one session, the same fingers were touched (for example both middle fingers), producing a congruent percept; in the other session different fingers were touched, producing an incongruent percept. In the somatosensory system, suppressive interactions between adjacent stimuli are an index of intracortical inhibitory function. After each congruent and incongruent session, we recorded somatosensory evoked potential (SEPs) elicited by electrocutaneous stimulation of the left ring and middle fingers, either individually or simultaneously. A somatosensory suppression index (SSI) was calculated as the difference in amplitude between the sum of potentials evoked by the two individually stimulated fingers and the potentials evoked by simultaneous stimulation of both fingers. This SSI can be taken as an index of the strength of inhibitory interactions and consequently can provide a measure of how distinct the representations of the two fingers are. Results showed stronger SSI in the P100 component after congruent than incongruent stimulation, suggesting the key role of congruent sensory information about the body in inducing somatosensory reorganization.

Atrial myxoma in a primigravida presenting as Raynaud’s phenomenon

A 32-year-old primigravida at 8 weeks of gestation presented with gangrene of both great toe for 10 days. Two years back, she had an episode of Raynaud’s phenomenon involving left ring finger diagnosed as primary Raynaud’s phenomenon and was treated with nifedipine following which she improved. In the following months, she had 2-3 similar episodes of Raynaud’s phenomenon in the upper extremity which were less severe. On diagnostic evaluation she was found to have an intra cardiac mass arising from mitral leaflet. We present a case of atrial myxoma initially presenting as an isolated Raynaud’s phenomenon with a long asymptomatic period before the next clinical manifestation which to our knowledge is the first such report.

Extra-articular tenosynovial chondromatosis of the left ring finger in a 23-year-old man: A case report and literature review.

Tenosynovial chondromatosis is an extra-articular version of articular synovial chondromatosis and a relatively rare condition that can affect the tendon sheath, bursa, or joint synovial tissue. Tenosynovial chondromatosis is rarely reported in the literature and is often misdiagnosed. In the present study, a case of extra-articular tenosynovial chondromatosis of the left ring finger in a 23-year-old man is reported. Three different-sized nodules were identified upon surgery and all were removed via synovectomy. The patient was symptom free 6 months postoperatively, and there were no signs of recurrence after 1.5 years of follow-up. The literature describing tenosynovial chondromatosis in the fingers is also reviewed.

Effectiveness of Two Training Methods for Avoiding Excessive Inflation of Laryngeal Mask Airway Supreme.

To evaluate the effectiveness of two training methods for avoiding excessive inflation of laryngeal mask airway(LMA)Supreme. Totally 41 anesthesiologists were randomly divided into hand touch group(H group,n=20)and short-term pressure gauge training group(G group,n=21). Before training,subjects were asked to inflate the cuff of LMA Supreme to two target pressures,30 cmH(2)O and 60 cmH(2)O, according to their own experiences. The actual cuff pressures were recorded as baseline pressures. Subjects in H group then received the training of hand touch:touch the vermilion of the lip and apex nasi with the left ring finger and feel the hardness. A cuff pressure with hardness similar to the vermilion of the lip was defined as 30 cmH(2)O, and similar to the apex nasi as 60 cmH(2)O. Subjects in G group were asked to inflate the cuff with a pressure gauge and feel the hardness of the cuff when the pressure reached 30 cmH(2)O and 60 cmH(2)O. After one-week training,two groups of subjects repeated the cuff inflation test. Actual cuff pressures after training were also recorded and compared with the baseline pressures. Results Actual cuff pressures after training[Group H:(39.7±15.7) cmH(2)O(P=0.00);Group G:(26.2±13.2) cmH(2)O(P=0.03)]were significantly lower than baseline pressures in both groups when the target cuff pressure was 30 cmH(2)O, and the differences were not statistically significant between these two groups(P=0.06). When the target pressure was 60 cmH(2)O,the actual cuff pressure of H group [(91.1±24.3)cmH(2)O] was significantly higher than that of G group [(58.1±15.4) cmH(2)O (P=0.01)]. However,the actual cuff pressure of G group was similar to the target pressure. The two training methods are equally effective when the target pressure is 30 cmH(2)O, while short-term pressure gauge training method is superior when the target pressure is 60 cmH(2)O.

Onychomycosis: A Rare Presentation of Fungal Urinary Tract Infection (UTI) in Extremely Preterm Neonate

Onychomycosis refers to nail infections caused by any fungus, including yeasts and nondermatophyte molds. Fungal infection has emerged as an important cause of neonatal infections with significant morbidity and mortality, especially in extremely low and very low birth weight infants. We report a 24-days-old boy who presented with onychomycosis on left ring finger nail associated with fungal urine tract infection. Nail finding helped us in detecting fungal urinary tract infection (UTI). Further studies are needed to evaluate the etiologies and treatment of neonatal onychomycosis, and dermatologists should pay attention to this rare event. Hence we are reporting this rare case.

An Embedded Finger Ring

We present a case of a 71-year-old woman with a partially embedded finger ring in her left ring finger after a mechanical fall and laceration to the finger approximately 9 weeks earlier. It was removed on the ward under local anesthetic without event.

Porocarcinome eccrine bowénoïde : un carcinome annexiel de diagnostic difficile

Eccrine porocarcinoma is a rare malignant sweat gland tumor, representing less than 0.01% of all cutaneous neoplasms, with eccrin differentiation. Its acrosynringeal origin and physiopathology still remain discussed. The prognosis of this carcinoma is held to be poor with a significant risk of lymph node metastasis and local recurrence. Also, this not specific tumor can be a challenging histological diagnosis, in particular, in Bowenoid variant. We report a case of Bowenoid and keratinizing variant of eccrine porocarcinoma of the left ring finger with pejorative evolution and initial diagnosis of infiltrating squamous cell carcinoma arising in Bowen's disease. The knowledge of these patterns and identification of eccrine differentiation of the tumor are essential for the diagnosis and for adapted therapeutic care.

Distal Phalanx Osteomyelitis Complicating Zone I Flexor Tendon Repair with a Non-Pullout Suture Tied Over a Dorsal Button: A Report of Two Cases.

Traditional methods for flexor tendon-to-bone repair, such as zone I flexor tendon injuries or distal graft fixation in flexor tendon reconstruction, include a pullout suture tied over a dorsal button as described by Bunnell1-8. However, locking suture techniques have a higher load to failure than nonlocking configurations9-13; a non-pullout locking suture configuration previously has been described14,15. With use of this technique, the non-pullout suture is cut flush with the nail at the time of button removal, leaving suture material within the distal phalanx and tendon. Complications of a tie-over button method include nail deformity5,6,16-18, perionychial irritation or necrosis6,16,19, and infection5,6,16-22. We present two cases of delayed presentation of distal phalanx osteomyelitis after zone I flexor tendon repair with a non-pullout suture configuration that was tied over a dorsal button. Both patients were informed that data concerning their cases would be submitted for publication, and they provided consent. Case 1. A healthy twenty-eight-year-old man with a closed distal flexor digitorum profundus (FDP) avulsion injury of the left ring finger underwent surgical repair ten days after injury. We performed an eight-strand modified Becker technique with use of 3-0 looped Supramid suture (S. Jackson, Alexandria, Virginia) tied over a well-padded polypropylene suture button. Sutures were placed 3 mm apart through the distal phalanx with straight Keith needles; the needles were drilled from the midpoint of the FDP insertion, exiting the midportion of the sterile nail matrix. Preoperative antibiotics were administered intravenously within one hour of surgery. There were no perioperative complications. Rehabilitation emphasizing early motion and tenodesis as a low force/high excursion protocol was initiated under the supervision …

Prevalence and risk factors of louse-borne relapsing fever in high risk populations in Bahir Dar city Northwest, Ethiopia.

BackgroundLouse- borne relapsing fever (LBRF) is a vector borne acute febrile illness caused by Borrelia recurrentis and the disease is more prevalent in the high risk groups like prisoners, yekoloremaries and street children. However, prevalence and risk factors of LBRF in these populations about the disease are not known. Therefore, the aim of this study was to determine the prevalence and risk factors of LBRF in high risk populations.MethodsA cross- sectional survey on prevalence and risk factors of LBRF in high risk populations in Bahir Dar city was conducted in December, 2012. For the study, blood was taken from the tip of the left ring finger of the participants by laboratory technicians and thick blood film was prepared from each participant and stained with 3% Giemsa for 30 min. The slides were examined and the result was reported as positive or negative using light microscopy and finally, data was also collected using a pre- tested questionnaire by face to face interviews.ResultsOf the 407 study participants, 383 (94.1%) were males with the mean age of 31 years and 243 (59.7%) had no formal education. The prevalence of LBRF was 2.5% and the positivity rate of LBRF was highest in yekolotemaries (6.1%) followed by street children (4.9%). However, prisoners had nil and statistically significance association was observed between high risk populations and LBRF prevalence (p < 0.001). Those study participants who lived in mud houses had the highest positivity rate (2.2%), followed by those in wood houses (0.3%). However, those who lived in brick houses had nil. Study participants who had low levels of knowledge had the highest prevalence rate of LBRF.ConclusionThe overall prevalence of LBRF was 2.5% and the rate of positivity was highest in yekolotemaries, followed by street children. Therefore, health education should be given for these high risk populations.

Pigmented villonodular synovitis

Pigmented villonodular synovitis