Left Thumb Research Articles

Increased performance uncertainty in children with ADHD? - Elevated post-imperative negative variation (PINV) over the ventrolateral prefrontal cortex

BackgroundWe aimed to investigate the influences of attention deficit/hyperactivity disorder (ADHD) on response evaluation, as reflected by the postimperative negative variation (PINV), a slow event-related potential.MethodsWe investigated PINV as an indicator of performance uncertainty in an audio-visual contingent negative variation (CNV) paradigm with an interstimulus interval of 3 seconds. A constant, unilateral, quick motor reaction with either the right or the left thumb was required after an auditory forewarned (S1) visual imperative stimulus (S2). We examined 18 ADHD patients (combined or hyperactive-impulsive subtype) aged between 8 and 14 years and an age-, sex and IQ-matched control group of 19 healthy subjects using 64-channel high-density EEG. A first run was recorded drug-free, a second one under methylphenidate (MPH) medication in the ADHD group.ResultsWe found a significantly increased negativity of the PINV-component over the ventrolateral prefrontal cortex in ADHD children compared to the healthy control group. PINV amplitude was influenced by movement side, most likely due to the slightly more difficult task when left hand responses were required. After the intake of MPH, PINV amplitudes of ADHD children normalized.ConclusionsWe conclude that children with ADHD are likely to be more uncertain about the correctness of their performance and interpret the increased PINV as a hint towards compensatory mechanisms for a deficit in the evaluation of contingencies. Further studies are needed to assess the exact extent to which remainders of eye-movement related potentials contribute to PINV amplitude despite the correction for eye-artifacts.

Treatment of a Type 3B Hypoplastic Thumb Using Extra Phalanges From the Contralateral Duplicated Thumb: Case Report

A boy was born with a right duplicated thumb (Wassel type 6) and a left radial club hand (type 3) associated with a hypoplastic thumb (type 3B). He underwent surgical centralization of the left wrist when he was 13 months old. At age 38 months, he underwent reconstruction of the carpometacarpal joint of the hypoplastic left thumb. This procedure involved transplantation of the radial ray of the right duplicated thumb to the base of the left thumb. When he was 6 years old, the patient underwent an abductor digiti minimi muscle transfer to create opposition for the left thumb and deepening of the first web. At the final follow-up, he could grasp items in the first web space and pick up small items between the thumb and other digits of the left hand. The treatment represents a method of using otherwise discarded tissues for effective reconstruction.

2. Compound nerve action potential (CNAP) study is a useful examination for evaluating muscle afferent Ia fibers

s of the 40th Annual Meeting of Japanese Society of Clinical Neurophysiology, Kobe, Japan, November 1–2, 2010 Ryuji Kaji , Koichi Hirata b,⇑ a Secretariat: Koishikawa Building 4F, 5-3-13 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan, Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan 1. Traumatic injury of the digital nerve by snow shoveling—Rie Haga, Chieko Murakami, Masayuki Baba (Aomori Prefectual Central Hospital, Aomori, Japan) We presented a case with traumatic injury of the median palmar digital nerve by snow shoveling. A woman aged 74 visited us for three month-history of numbness and dysesthetic pain in the left index finger and thumb after snow shoveling. On examination, there was hypoesthesia on the palm side of the left index finger and thumb. Tinel sign was positive by percussion to the upper edge of the thenar eminence. The left median motor conduction to the abductor pollicis brevis muscle was normal. Compound sensory action potentials recorded from the left thumb and the index finger were around 5 lV, both distinctively reduced compared with those from the left middle and ring fingers, 27 and 18 lV, respectively. Inching records of the sensory potential from the index finger by electric stimulation with successive decrement by one cm from the wrist demonstrated prolonged conduction time more than 0.7 ms at the particular segment including the Tinel sign point: all other segments had normal conduction time of around 0.3 ms. These findings indicated the focal demyelination and Wallerian degeneration at the site of the injury. doi:10.1016/j.clinph.2011.01.013 2. Compound nerve action potential (CNAP) study is a useful examination for evaluating muscle afferent Ia fibers—Keisuke Abe, Tadashi Kanouchi, Teruhiko Sekiguchi, Hidehiro Mizusawa, Takanori Yokota (Tokyo Medical and Dental University, Tokyo, Japan) The aim of this study was to investigate whether CNAP is useful tool for evaluation of Ia fiber conduction. The conventional sensory nerve conduction study recording the sensory nerve action potential (SNAP) gives us the information of only the cutaneous afferents but not about the muscle afferents. We tried to use CNAP of the median nerve for evaluating muscle afferent. The median nerves of seven patients with sensory neuropathy and 4 normal subjects were studied. CNAPs was clearly recorded in all patients with inexcitable SNAP as well as normal subjects. The velocity of CNAP was faster than those of SNAP and CMAP (compound muscle action potential) in the same segment in all normal subjects. The CNAPs in three of 5 patients with no SNAP evoked were obviously faster than the CMAPs. In three patients whose SNAP was evoked, the CNAPs were the fastest among the three responses. Because the conduction velocity of CNAP is determined by that of Ia fiber in normal subjects, CNAP study has the potential to evaluate Ia fiber conduction. Furthermore, in patients with severe sensory neuropathy showing inexcitable SNAP, CNAP study is expected to be an only and new examination for sensory nerve function. doi:10.1016/j.clinph.2011.01.014 3. Comparison in placement location of disposable surface electrode in antidromic sensory nerve conduction study—Kenji Sekiguchi, Toko Miyawaki, Mariko Takata, Akihiro Nomura, Ichiro Yokota, Yoshihisa Otsuka, Naoko Yasui, Horotoshi Hamaguchi, Hisatomo Kowa, Fumio Kanda, Tatsushi Toda (Department of Neurology, Kobe University, Kobe, Japan) Although the ring electrodes generally used in antidromic sensory nerve conduction study of hand, disposable surface electrode is frequently used in recent years and there are many advantages in terms of infection control and usability. However, there are no reports of investigation in optimal location of electrode placement. Antidromic median nerve sensory conduction study was performed in 20 hands of 10 healthy subjects. We made comparison with each measurement of disposable surface electrodes placed at various locations and ring electrodes. The latency and the amplitude delivered by disposable surface electrode placed on midline volar aspect of index finger showed no significant difference compared to using a ring electrodes. In case of surface electrode placement on the radial aspect of index finger, lower amplitude and shorter latency were doi:10.1016/j.clinph.2011.01.012 ⇑ Corresponding author. Tel.: +81 282 87 2152; fax: +81 282 86 5884. E-mail address: hirata@dokkyomed.ac.jp (K. Hirata). Clinical Neurophysiology 122 (2011) e9–e14

P164. Squamous cell carcinoma of the thumb fingers of dental X-ray radiographer: A case report

Introduction: Careless dealing with diagnostic X-ray may end up with serious health problems. This was prevalent immediately after a decade of invention of X-ray where it had not been known that the accumulative exposure to X-ray carries huge health hazards. With occurrence of many cases with finger carcinoma, the health authorities started to develop safety standards to be followed by all x ray clinics and technicians. Since then no X-ray related health problem has been recorded. Details: A 48-year old male who has been working as an incharge clerk in Radiology Division, Oral Medicine Department, Faculty of Dentistry, Damascus University, Syria since 1995, had his thumbs amputated in September 2010. Past medical history revealed that he used to stabilize the periapical films in the patients‘ mouths by one of his thumbs to accelerate the flow of the patients. Seven years before amputation he noticed an asymptomatic ulcer on his right thumb. He had neglected it for a period enough for common ulcers to heal. He used local and systemic antibiotics; however, no healing occurred. In August 2010, he noticed pus discharging from his right thumb which pushed him to consult. By this time, he took notice a similar ulcer in his left thumb. Oral Medicine Department referred him to a general surgeon. The radiographs of both hands revealed erosion of distal phalanx in both thumbs, though more prominent in the right one. Accordingly, the distal phalanges of both thumbs were amputated. Histopathological evaluation revealed Squamous cell carcinoma grade II. Conclusion: Insufficiency in understanding the harm health effects associated with diagnostic X-ray or carelessness in applying the recommended safety standards might end up with a tragic health problem. Relevance: Whatever the working load of diagnostic X-ray clinic, the technician must apply the recommended safety standards strictly.

Atypical squamous cell carcinoma of the nail bed with phalangeal involvement

We report an atypical presentation of squamous cell carcinoma (SCC) of the distal phalanx of the left thumb. On physical examination, there was no clinical evidence of a local lesion, but magnetic resonance imaging (MRI) showed multiple intraosseous cavities filled with fluid. A biopsy specimen showed a well-differentiated SCC, which was treated by amputation of the distal phalanx.

Thumb salvage with skin grafted medial femoral corticoperiosteal free flap

A 23-year-old man suffered a severe crush injury with fracture of his left thumb base phalanx and destruction of his extensor pollicis longus tendon. Immediate plate stabilisation and soft tissue coverage was performed; however, a recalcitrant pseudarthrosis developed in this compliant non-smoker despite three revisions with avascular iliac crest grafts for interphalangeal joint arthrodesis, corticocancellous bone application and hardware exchange. An attempt to improve thumb vascularity and soft tissue cover with a pedicled Foucher flap as well as through extracorporeal shock wave therapy failed. Bone healing and subsequent thumb salvage were finally achieved with a free vascularised medial femoral condyle (MFC) bone flap, which was covered directly with a full-thickness skin graft. Both bony and soft tissue healing went well and after 3 months the patient returned to work. This case demonstrates that skin grafting the periosteal surface of the MFC flap is safe and results in a thin skin-bone compositae transplant which also might be very useful for indications other than hand surgery.

Bilateral trigger finger in a 5-year-old child: Case report

Trigger finger is rare in children. Herein, we report on a 5-year-old boy with trigger digits in several of his fingers since 1 month before which got worse. Triggering occurred in decreasing order of severity in proximal interphalangeal joints of the left middle, index, ring fingers and thumb. There was also triggering of the right index finger. The patient had no history of trauma, metabolic disorders and viral infections. The examination revealed triggering of the above-mentioned digits and was otherwise unremarkable. The patient was treated with physiotherapy (eight sessions) and non-steroidal anti-inflammatory drugs (NSAIDs) (for 20 days). The symptoms were completely resolved 4 months after its onset. Although surgical release is recommended by many authors for the treatment of trigger finger in children, if an inflammatory process is not unlikely, particularly when the symptoms present at older ages, the patient may be treated with a short course of empirical treatment with physiotherapy and/or NSAIDs to see his/her response.

Nonfunctioning Periurethral Paraganglioma Incidentally Detected by FDG PET/CT.

Paragangliomas are extra-adrenal neuroendocrine tumors that are derived from neural crest cells. Among all the paragangliomas, those in a pelvic location are extremely rare. In addition, the prevalence of nonfunctioning paragangliomas is underestimated because of their clinical latency, and they are often underdiagnosed unless they cause symptoms. We report a case of a nonfunctioning periurethral paraganglioma that was incidentally detected by FDG PET/CT during regular follow-up after excision of a melanoma on the left thumb.

Le traitement percutané du pouce à ressaut chez l’enfant : à propos de 63 cas

Introduction Congenital trigger thumb is secondary to a conflict between the flexor pollicis longus tendon and its inextensible tendon sheath. Though, the exact aetiology is still unknown, its treatment is usually surgical. Patients The authors present their experience of treating 52 consecutive patients with 63 trigger thumbs, with mean age 32 months, range (12 months to five years). Twenty-nine boys and 23 girls. Right thumb 37 and left thumb 26, 11 patients had have bilateral trigger thumb. Each was exclusively treated by percutaneous release of the A1 pulley using a needle. Results Fifty-two with 50 treated trigger thumbs were available for follow-up. The mean follow-up after this procedure was 28 months (range 12–30 months). Fouty-eight thumbs had a good result without any recurrence of triggering. Two thumbs had recurrent triggering and were subsequently successfully treated by open release. No thumbs demonstrated any neurovascular deficit clinically. Conclusion Percutaneous release of congenital trigger thumb can be performed safely and effectively in children by a surgeon specializing in hand surgery.

Effect of the bedside arm droop venepuncture

Objective To explore the effect of the bedside arm droop venepuncture for promoting success rate of venepuncture and relieving patients' pain. Methods 1 000 patients were randomly divided into observation group and control group. There were 500 cases in each group. The patients' forearm were drooped for 30 seconds in the observation group, so that venous filling exposed. Tied a tourniquet 6 ～8 centimeters upon the puncture point, The forearm was placed on the side of the body and would not make a fist. To fix the skin of puncture site by left thumb and make needle tip and skin angulation of 35 ～40°by right hand. The needle would be pricked into the blood vessels quickly along the vein, after seeing the return of blood into the needle lowered angle of the needle and then transferred into 0.2cm and routinely fixed. The control group used traditional method. The venous filling degrees and puncture success rate of the two groups were compared. Results Venous filling full of the observation group and control group were 81.6% and 20. 0% respectively. There was significant difference between the two groups ( P ＜0. 01 ); the success rate of vein puncture only by once was 98.4% in the observation group while 90.0% in the control group and there was significant difference between the two groups (P ＜0. 05 ).Conclusions The bedside arm droop veinpuncture can gets veins filling exposed and have a high success rate. It can relieve the patients' pain and make drug located rapidly, accurately and safely. Key words: Arm drooping; Vein puncture; Nursing

Anterior interosseous nerve palsy following the use of elbow crutches

Context:Lesions of the anterior interosseous nerve are rare and comprise less than 1% of all upper extremity nerve palsies. Traumatic causes include blunt trauma, forearm fractures, penetrating injury and local pressure from a plaster cast, but has never before been described in association with crutch use. This is the first reported case of the use of elbow crutches causing symptomatic anterior interosseous nerve compression.Case Report:This case describes a 30-year-old male who developed an inability to pinch with his left hand following the use of elbow crutches for a foot injury. On examination he was unable to flex the interphalangeal joint of his left thumb. A diagnosis of anterior interosseous palsy was made and the patient was treated conservatively and crutch use was ceased. At six weeks follow-up the patient made a complete recovery with full function of his left hand.Conclusion:This report highlights the importance of adequate education in the safe use of elbow crutches for all patients. The side effects of inappropriate use should be carefully examined for during follow-up care.

The Appearance of a Candidate Site for a Primary Melanoma: A 5 Year-gap with a Melanoma of an Unknown Site

Although more than 90% of melanomas have cutaneous origins, melanomas sometimes present metastatically with no apparent primary lesion. A 62-year-old female presented with black pigmentation on her left thumbnail that had begun 2 years earlier and after the biopsy, she was diagnosed with malignant melanoma. Interestingly, 7 years earlier, a 4 cm palpable mass on her left axilla had been diagnosed as melanoma from an unknown primary site (MUP) with the involvement of an axillary lymph node. We speculate that the melanoma of the left thumb was the primary site and the melanoma in the axilla was a metastasis from the left thumb, and suggest several hypotheses explaining the appearance of the primary lesion as acral lentiginous melanoma after detecting a metastatic site. We consider this case interesting because it helps us to understand the pathogenesis of MUP and reminds physicians to conduct careful periodical work-ups of melanoma patients, and highlights the importance of continued long-term follow-up, especially for patients with MUP.

Prevalence and impact of musculoskeletal pain in Japanese gastrointestinal endoscopists: A controlled study

To examine the frequency and prevention of musculoskeletal pain in Japanese gastrointestinal endoscopists and non-endoscopist physicians. Questionnaires were sent to 275 endoscopists and 173 non-endoscopists working in Hiroshima University Hospital and its affiliated hospitals. The completed questionnaires were returned by 190 (69%) endoscopists and 120 (69%) non-endoscopists. The frequency of pain in the hand and wrist, and especially the left thumb, was significantly higher in endoscopists than in non-endoscopists (17% vs 6%, P = 0.004). Using multivariate analysis, the only significant factor associated with this pain was the age of the endoscopist (odds ratio 2.77, 95% confidence interval, 1.23-6.71, P = 0.018). Interestingly, endoscopists had made significantly fewer modifications to their endoscopic practices than non-endoscopists (12% vs 33%, P < 0.0001) to prevent pain. Pain in the hand and wrist may be endoscopy-related. However, endoscopists made little modifications in practice to prevent such pain. More attention to prevention appears necessary.

Correction of Pincer Nail Deformity Using Dermal Grafting

Pincer nail deformity is characterized by excessive curvature and distortion of the nail in the transverse dimension, and particularly at the distal part of the nail plate. This deformity leads to pinching off and loss of soft tissue in the affected digit, causing severe pain. Many treatment methods have been proposed; however, an effective long-term method preserving the nail matrix has not yet been established. We present here a case of pincer nail in the left thumb in a 49-year-old woman who was treated successfully with dermal grafting under the nail bed. We describe the surgical method and the treatment results. To the best of our knowledge, this is the first report in the Korean medical literature on the use of dermal grafting for the treatment of pincer nail deformity.

Patterns - "A crime solver"

Objective:This study is intended to analyze the predominant pattern of lip and finger prints in males and females and to correlate lip print and finger print for gender identity.Materials and Methods:The study sample comprised of 200 students of Vishnu Dental College, Bhimavaram, Andhra Pradesh, 100 males and 100 females aged between 18 to 27 years. Brown/pink colored lip stick was applied on the lips and the subject was asked to spread it uniformly over the lips. Lip prints were traced in the normal rest position of the lips with the help of cellophane tape. The imprint of the left thumb was taken on a white chart sheet and visualized using magnifying lens. While three main types of finger prints are identified, the classification of lip prints is simplified into branched, reticular, and vertical types. Association between lip prints and finger prints was statistically tested using Chi-square test.Results:This study showed that lip and finger patterns did not reveal statistically significant results within the gender. The correlation between lip and finger patterns for gender identification, was statistically significant. In males, branched type of lip pattern associated with arch, loop, and whorl type of finger pattern was most significant. In females, vertical lip pattern associated with arch finger pattern and reticular lip pattern associated with whorl finger patterns were most significant.Conclusion:We conclude that a correlative study between the lip print and finger print will be very useful in forensic science for gender identification.

Elegy with a Stopped Knife in It, for Larry Levis

Elegy with a Stopped Knife in It, for Larry Levis Theodore Deppe (bio) The angel of the Lord grasps Abraham’s huge hand, and the halted knife glistens inches from Isaac’s throat. The naked boy’s contorted mouth would scream if it could as his father’s left hand pins him to the rock: sunlight and shadow, this world and the next, everything balanced a split second from the edge. The model Caravaggio used for Isaac doubled as the angel, also naked, so Abraham, stopped in his deed, glares at his offspring’s mirror image. Half vision, half nightmare, I’m reminded of the dream journal I kept in college, of entries in which my father—an absurdly gentle man—strangles me, or else I’m trying to kill him, then sleep with my friend’s mother. Fathers and sons—maybe I’d read too much Dostoyevsky, but I stopped recording dreams, having learned, I thought, enough. In his poem “Winter Stars,” Larry Levis’s father breaks a farm worker’s hand on a tractor to stop the man from killing his own father. The knife dazzles and briefly stops time, and it doesn’t matter that in real life the poet’s father broke up a fight between two young men— Levis needed this attempted parricide as he made up, as honestly as he could, a sort of afterlife for his dying father. Today, in the Uffizi, [End Page 99] between glinting blade and throat, this poet I never met is present. Abraham’s thick left thumb immobilizes the boy. The son is naked, and the angel. The bearded father wears a golden robe, red sash flowing from his waist. So what if the farm workers were both young men? The battle is always between father and son. Say that an angel caused Abraham and all his descendents to struggle with those who gave us life and those we helped bring into this world— the knife gleams in dreamtime light. The angel of the Lord also commands us to stop. [End Page 100] Theodore Deppe Theodore Deppe is the author of four collections of poetry: Orpheus on the Red Line (Tupelo, 2009), Cape Clear: New and Selected Poems (Salmon, 2002), The Wanderer King (Alice James Books, 1996), and Children of the Air (Alice James Books, 1990). His work has received two fellowships from the NEA and a Pushcart Prize. Since 2000, he has lived mostly on the west coast of Ireland, and he coordinates Stonecoast in Ireland, part of the Stonecoast M.F.A. Program in Maine. Copyright © 2011 Middlebury College Publications

Acute hepatic failure secondary to extensive hepatic replacement by metastatic amelanotic melanoma: an autopsy case report.

Metastatic malignant melanoma (MM) of the liver evolving into acute hepatic failure is a rare occurrence. We describe the case of an 82-year-old man with a history of MM on the left thumb treated with amputation and chemotherapy 40months previously. On admission, he had abdominal pain, weight loss, lethargy and jaundice. Radiologic investigations such as enhanced computed tomography and abdominal ultrasound failed to establish an etiologic diagnosis. A liver biopsy revealed amelanotic melanoma cells diffusely infiltrating the hepatic parenchyma. His liver injury progressed and the patient died of hepatic failure on the 13th hospital day. Autopsy revealed >70% infiltration by metastatic amelanotic melanoma in the liver.

Age-related differences in human corticospinal excitability during simple reaction time

Age-related declines in central processing may delay the facilitation of corticospinal (CS) tracts that underlie emergence of voluntary responses to external stimuli. To explore this effect, single pulse transcranial magnetic stimulation (TMS) was applied to the left motor cortex at different latencies from the go-signal (auditory tone) during a simple reaction time (SRT) task with the right or left thumb [i.e. right (RHM) or left hand move (LHM)]. Motor evoked potentials (MEPs) in the right abductor pollicis brevis (APB) were recorded from eleven healthy right-handed participants (aged 22–65; six young adults and five old adults). Both age groups showed significant facilitation of CS excitability approximately 100–120 ms from the onset of the go-signal in the RHM SRT that occurred before the onset of EMG voluntary burst, with no evidence for motor slowing in old adults. Old adults demonstrated a significant facilitation of MEPs in the time that preceded the go-signal for RHM SRT and a marked depression of CS excitability in preparation for the LHM SRT that was sustained up to 80 ms after the onset of the go-signal. Both effects were not seen in young adults. While the small number of participants may hinder the generality of the present observations, this pilot study suggests for the first time that old adults implemented selective tuning of CS excitability prior to the onset of the go command to speed up their response generation.

Digital Dermatoglyphic Heritability Differences as Evidenced by a Female Twin Study

The genetic and environmental contributions to determine digital dermatoglyphic traits were investigated by using female dizygotic and monozygotic twin pairs to estimate heritability indexes (h(2)). The evaluated sample was composed by 20 monozygotic twin pairs and 13 dizygotic twin pairs. A significant heritability (h(2) = 0.65 to 0.96) was observed for 12 dermatoglyphic characteristics (delta indexes and ridge counts for right hand, left hand and both hands, and ridge counts for most individual fingers). A negative correlation between the ridge counts and heritability indexes from individual fingers was found for the left hand, which appears to be associated to a higher arch pattern frequency in most left-hand fingers, since this frequency was negatively correlated with ridge counts and positively correlated with heritability indexes. Heritability indexes of right-hand fingers were positively correlated with loop pattern frequency and negatively correlated with whorl pattern frequency. The low heritability of ridge counts from left thumb, ring and little fingers (h(2) = 0.11 to 0.32) indicates a higher chance that the chorion type had an influence in the intra-pair variance of monozygotic twins. Results confirmed the predominant genetic influence on the total ridge count. The heritability indexes varied in up to 8 times between different fingers and its association to ridge counts and pattern frequency was very variable between hands, evidencing that the use of dermatoglyphic traits from individual fingers as indicators of genetic influences to other human traits should consider this variability.

High Frequency Sensory Stimulation Improves Tactile but Not Motor Performance in Older Adults

We examined the effect of high frequency tactile stimulation (tHFS) on tactile and motor performance as well as tactile-motor interactions. Seventeen right-handed participants (66-78 years) underwent a pretest (tactile frequency and spatial discrimination task, manual dexterity test, and precision grip task) with their left hand, received 30 min of tHFS on the tips of their left index finger and thumb, and performed a posttest (control group: no stimulation). Results indicated an improvement in frequency and spatial discrimination in the experimental but not the control group. In the precision grip task, however, training effects as found for the control group seem to be blocked in the experimental group. For the manual dexterity task no effect was found. Our data indicate that tHFS positively influences tactile performance. Assuming tHFS-induced plastic reorganization in somatosensory cortex our results give further evidence to the notion of an interrelation between sensory and motor performance.