Little Finger Research Articles

Hybrid Picking Applied to Classical Guitar

Hybrid picking refers to the practice of using the pick, held between the thumb and index fingers, in a combined action with right-hand medium, ring and pinky fingers. This enables the performance of rhythmic-harmonic accompaniment, as well as polyphonic textures and melodic lines. This work presents the contextualization of this technique applied to classical guitar by discussing historical aspects and indicating musical examples of various genres and composers. For those guitarists who use the pick exclusively, hybrid picking allows the performance of a mostly varied repertoire.

A robot exoskeleton can improve hand function early after stroke

Objective To explore the effectiveness of a myoelectricity-driven hand robot on the recovery of hand motor function early after a stroke. Methods Thirty stroke survivors were randomly assigned to either a control group (n=15) or an experimental group (n=15). Both groups received routine rehabilitation exercises, while the experimental group additionally received hand training using a robotic hand exoskeleton. Before and after 4 weeks of treatment, the motor function of the wrist and fingers in both groups were measured using the Fugl-Meyer assessment. Spasticity in the index, middle, ring and little fingers was quantified using the modified Ashworth scale. The muscle force of the fourth finger, thumb and all of the fingers during maximum voluntary extension and flexion were recorded using the robot′s surface electromyography system. Results Significant increases in the average Fugl-Meyer scores in both groups were observed after 4 weeks of treatment, but the experimental group′s average score was by then significantly higher than that of the control group. The experimental group′s average Ashworth score and the average sEMG amplitudes were also significantly better than those of the control group. Conclusion Supplementing routine rehabilitation exercises with a hand robot can improve hand motor function and muscle force significantly, as well as relieving hand spasticity early after a stroke. Key words: Hands; Robots; Stroke; Hand motor function; Exoskeletons

Variations in distal attachment of muscles of the leg, foot and the hand and their clinical implications in population of central Ethiopia

Anatomical variations in the distal attachment of lower and upper limb muscles are of paramount importance in surgical and clinical practice. Reports show variations in the insertion of the fibularis longus and brevis tendon from the lateral compartment of the leg, extensor hallucis longus and fibularis tertius from the anterior compartment of the leg, flexor digitorium brevis from the sole of the foot and the existence of accessory muscles in the dorsum of the hand. However, reports are scanty from Ethiopia. The present study was aimed at assessing the existence of variation in the distal attachments of muscles of the lower and upper limbs in the central Ethiopia population. Twenty-two formalin fixed cadavers were used. Careful dissection, critical observation and imaging were done accordingly. We have found the presence of two tendons of extensor halluces longus in one cases, absence of the lateral tendon to the 5thdigit of the flexor digitorum brevis of the sole of the foot in another case and the presence of the accessory extensor indicis muscle on the dorsum of the hand in a third case. These variations are important owing to the use of the tendons in tendon transfer surgeries to correct deformities of the hand, foot and ankle joint, and also for radiologists, clinicians, and surgeons in order to prevent adverse surgical events.

Digital metastasis in a patient with squamous cell anal cancer

This is a 69-year-old female with a history of squamous cell carcinoma of the anal canal who presented with a two week history of a mass at the base of the right fifth digit (pinky finger) with foul smelling discharge (Figure 1A). Five months prior, she noticed a small bruise in the area and related it to a recent trauma. She was initially diagnosed with localized anal cancer in 2012 and treated with concurrent chemoradiation. In 2015, she was found to have two lung metastases and had wedge resections for both diagnosis and treatment of metastatic disease. Unfortunately, she progressed in the lung and received several chemotherapy regimens and most recently immunotherapy with Nivolumab (anti-PD-L1). However, Nivolumab caused severe autoimmune hypothyroidism, significant facial and lower extremity swelling. To work up the pinky finger lesion, she had X-rays (Figure 1B and 1C) in February 2018 which showed a heterogeneously dense and lobulated mass with extension into the dorsal soft tissue and associated swelling with near complete destruction of the fifth distal phalanx. Differential diagnosis remained broad and included trauma, infection such as abscess, osteomyelitis, or paronychia, unreported autoimmune reaction to novel biologics such as Nivolumab, a subungal melanoma, or digital metastasis. Amputation of the fifth phalanx showed poorly differentiated carcinoma with basaloid squamous features morphologically consistent with her primary anal cancer. Both the anal biopsy and finger amputation specimens had strong diffuse immunohistochemical p16 expression, indicating human papillomavirus (HPV) positivity. The tumor cells also stained positive with P63 and CK5/6 and negative with CK7, CK20, synaptophysin, chromogranin and CD56, supporting metastatic squamous cell with basaloid features originating from the anus. She had an excellent cosmetic and functional result from the surgery (Figure 1D) and is alive now after seven months follow up.

Case Report: Bilateral Ainhum in a 6-year-old Black African Male child

Background: Ainhum is an uncommon surgical condition and rarer still in children, and is gradually disappearing due to improved socioeconomic condition of the populace. This has consequently led to paucity of literature on the lesion, making it relatively unknown and may be unrecognized by many. This case report describes the clinical features of this relatively uncommon condition occurring in a black African child, in order to facilitate recognition and appropriate management. Case Summary: The patient was a 6year old child born to a polygamous family, that presented with complains of bilateral progressive pain and swelling in the 5th little toes for about 5months. Attendance to other health facilities including traditional medications has not yielded any improvement. A bilateral constriction at the base of both fifth toes was found on examination. A diagnosis of bilateral Ainhum of the 5th digits was made followed by bilateral amputation at the metatarsophalangeal joint after counseling and due investigations. He had uneventful recovery. Conclusion: Ainhum may occur in children ultimately leading to mutilation, and amputation being the only viable option of treatment. Socio-demographic factors play an important role in the changing pattern of surgical diseases, more ostensibly in Africa, these needs to be considered in the planning of health services.

Clinical effect observation of vascularized anterior transposition of ulnar nerve for treatment of severe cubital tunnel syndrome

Objective To evaluate the clinical outcomes of a modified procedure of ulnar nerve anterior transposition in the treatment of severe cubital tunnel syndrome. Methods From September 2015 to May 2016, 25 patients with cubital tunnel syndrome underwent vascularized ulnar nerve anterior transposition were followed up after operation. All the patients had severe muscular atrophy and deformity of elbow joint before operation. According to Gu Yudong's classification of cubital tunnel syndrome, they were graded as severe. In this modified procedure, the sufficient neurolysis of ulnar nerve as well as the anterior transposition of ulnar nerve accompanied with superior ulnar collateral artery were conducted. Results All the 25 patients were follow-up from 12 to 21 months with an average of 15.3 months. All the patients achieved sensory recovery in different degrees without temporary worsening of clinical symptoms. Completely sensory recovery was observed in 20 patients (80%). 4 patients (16%) remained occasional sensory symptoms while only 1 patient (4%) remained persistently moderate sensory symptoms. The mean two-point discrimination of little finger pulp was improved from preoperative 6.08 mm to postoperative 2.93 mm. Obvious improvement of intrinsic muscular atrophy was observed in 17 patients (68%). According to the Gu Yudong's function evaluation standard of cubital tunnel syndrome, the results were excellent in 16 patients, good in 6 patients and fair in 3 patients with the excellent and good rate being 88%. Conclusion The modified technique of vascularized anterior transposition of unlar nerve appears to be an effective and safe procedure for the treatment of severe cubital tunnel syndrome. It might reduce the incidence of postoperative nerve symptoms caused by devascularization of ulnar nerve. Key words: Cubital tunnel syndrome; Ulnar nerve; Vascularized; Anterior transposition

Repair of distal finger degloving injury with homodigital flap based on the dorsal branch of the digital artery and adjacent finger island flap

Objective To explore the surgical procedure and the clinical results of repairing distal finger degloving injury with homodigital flap based on the dorsal branch of the digital artery and adjacent finger island flap. Methods From April 2012 to August 2016, 20 patients with degloving injury of the distal finger caused by machine were treated. There were 16 males and 4 females with age ranging from 18 to 59 years (mean, 31 years). The time from injury to operation was 1 to 5 hours (mean, 2.5 hours). Affected fingers included index finger in 8 cases, middle finger in 6 cases, ring finger in 4 cases, little finger in 2 cases. The totally degloving range was 1/2 distal finger in 3 cases, 2/3 in 12 cases, 3/4 in 5 cases. The defect area ranged from 3.0 cm×2.0 cm to 5.5 cm×3.8 cm, with mild to severe pollution, tendons and phalanx bone exposure. No tendon insertion rupture was seen. The homodigital flap based on the dorsal branch of the digital artery and adjacent finger island flap were applied to repair the wound. The area of homodigital flap based on the dorsal branch of the digital artery ranged from 2.0 cm×1.5 cm to 2.6 cm×2.2 cm, and of adjacent finger island flap ranged from 2.5 cm×2.0 cm to 3.5 cm×2.5 cm. The donor sites were repaired with skin grafts. Results Postoperatively flap blister occurred in 5 cases and vascular crisis occurred in 1 case, which survived completely after symptomatic treatment. The rest of the flaps survived uneventfully. Primary healing was achieved in 18 cases, secondary healing in 2 cases. The postoperative follow-up time ranged from 3 to 20 months with an average of 10.6 months. The flaps had well-stacked shape with soft texture and no tenderness in fingertip. According to the Total Active Movement (TAM) system evaluation standard, the finger function was assessed excellent in 17 cases, good in 2 cases and fair in 1 case. Conclusion The combination of homodigital flap based on the dorsal branch of the digital artery and adjacent finger island flap is an easy, useful and reliable technique for reconstruction of distal finger degloving injury with satisfactory results. Key words: Finger injuries; Surgical flaps; Finger distal degloving injury; Wound reconstruction

Effect of intraoperative electromyogram stimulation on surgical effectiveness of cubital tunnel syndrome

Objective To observe the effect of intraoperative electromyogram (EMG) stimulation on surgical effectiveness of cubital tunnel syndrome. Methods A total of 288 patients with cubital tunnel syndrome and confirmed as invalid conservative treatment cases were divided into intraoperative EMG stimulation treatment group (experimental group) and control group, 144 cases in each. All cases were monitored by intraoperative electrophysiological examination 1 time before operation, and by recording the latency and amplitude of compound muscle action potential (CMAP) in the abductor muscle of the little finger. After release again the same intraoperative electrophysiological monitoring was done. In the experimental group after the release of nerve compression at the most serious site, electrical stimulation was done, and the stimulation parameters were as follows: 100 mA, 2 Hz, 10 min. The latency and amplitude of CMAP before and after the intraoperative release were compared. The patients were followed up every 2 months, and all cases were followed up for at least 8 months. The number of cases with different evaluation criteria was evaluated at each follow-up visit. The chi square test was used for the comparative analysis. Results The amplitude difference was (3.4±0.4) mV, and the latency difference was (10.1±0.2) ms in the control group, and those were (2.5±0.4) mV and (14.4±0.6) ms in the experimental group, with the difference being statistically significant (P=0.007 and P=0.001). At 2nd month after operation, the number of cases obtaining recovery and improvement in the experimental group was significantly greater than in the control group (P=0.000), more significant at 4th month after operation. At 6th month after operation, the recovery rate and improvement in experimental group and control group showed no significant difference (P=0.054). At 8th month after operation, the number of ineffective cases in experimental group was significantly less than in the control group (P=0.000). Conclusion Intraoperative EMG stimulation after surgical release of cubital tunnel syndrome can quickly improve the CMAP amplitude and latency of abductor muscle of the little finger. Key words: Intraoperative electromyogram stimulation; Cubital tunnel syndrome

Biomécanique des nerfs collatéraux digitaux – étude cadavérique

Injuries to digital collateral nerves after hand trauma are frequent and results from surgical treatment are poor. Characterization of mechanical behavior of healthy collateral nerves is necessary to produce numeric models and enhance the comprehension of nerve repair and regeneration process. There is no standard in the literature to characterize healthy nerve mechanics. The mechanical properties of the repaired nerve should be as similar as the healthy nerves, following the principles of mechanobiology. The aim of this study was to characterize the mechanical properties of human digital collateral nerves to look for a correlation with density as an intrinsic property of materials. 4 hands, 18 digital collateral nerves of 5 cm average length, were harvested and preserved by immersion in a NaCl 0.9 % solution to be tested. Each nerve was labelled to identify the corresponding finger during the tensile test. The nerves were positioned in a frame of emery paper, sutured and glued with ethyl-2-cyanoacrylate. Once positioned and aligned in the tensile test machine, Instron ® 3345 the tensile test was performed at speed of 6 mm min. During the test the nerve was continuously rehydrated with a NaCl 0.9 % solution. Density was measured using a Pycnometer and registered for each nerve. The test was recorded by a high-speed camera to identify the failure pattern according to wether the failure occurs in distal, middle and proximal area of the nerve. Finally, the diameter was measured using ImageJ software in a posterior image analysis. The results concern 3 thumbs, 2 index fingers, 6 middle fingers, 3 ring fingers and 4 pinky fingers There is no statistical significant difference between the studied variables among fingers. The failure pattern was distal in 72.22 %, middle 11.11 % and proximal in 16.67 % of the cases in contrast to the results presented by Goldberg et al. [Goldberg SH et al., 2007]. Our study presented a specific modulus characterization of human digital collateral nerves, we do not found other studies to compare our results. A pattern for each finger can be expected, but due to the scanty number of probes patterns do not emerge. We presented the human digital collateral nerve specific modulus constituted of 18 nerves. The failure pattern was distal in 70 % cases. Further studies in nerve composition must be conducted to enhance the knowledge of nerve biomechanical behaviour.

Kinetic analysis of canine gait on the effect of failure tendon repair and tendon graft

Kinetic analysis of canine gait has been extensively studied, including normal and abnormal gait. However, no research has looked into how flexor tendon injury and further treatment would affect the walking pattern comparing to the uninjured state. Therefore, this study was aimed to utilize a portable pressure walkway system, which has been commonly used for pedobarographic and kinetic analysis in the veterinary field, to examine the effect of a failed tendon repair and tendon graft reconstruction on canine digit kinetics during gait. 12 mixed breed (mongrel) hound-type female dogs were included in this study and 2nd and 5th digits were chosen to undergo flexor tendon repair and graft surgeries. Kinetic parameters from the surgery leg in stance phase were calculated. From the results, after tendon failure repair, decrease of weight bearing was seen in the affected digits and weight bearing was shifted to the metacarpal pad. After tendon graft reconstruction, weight bearing returned to the affected digits and metacarpal pads. Slight alteration in peak pressure and instant of peak force were identified, but it was estimated to have little influence on post-reconstruction gait. This study could serve as a reference in evaluating canine digit function in flexor tendon injury for future studies.

Recontraction by the microdissected thin fibular skin flap of the great toe for soft tissue defects of the finger

Objective To investigate the therapeutic effect of the microdissected thin fibular skin flap of the great toe to repair the finger pulp defect, and to discuss the operation and outcome of the flap for finger pulp defect. Methods From September, 2012 to January, 2016, 12 cases of finger pulp defect were treated with the thin fibular skin flap of great toe removed partially subcutaneous fat under the microscope. One case for index finger, 3 cases for middle finger, 4 cases for ring finger, and 4 cases for little finger. Among them, 5 cases were crush injury, 6 cases were stamping injury, 1 case was avulsion injury. The flap area was 3.0 cm×1.5 cm-3.2 cm×2.2 cm. The donor site was closed directly or covered with flap. Results All the 12 flaps survived completely without blood supply crisis, and the primary healing was achieved in donor site. Ten cases were followed-up from 6 months to 36 months. The blood-supply, texture and elasticity of transferred flaps and the shape of fingers pulp were excellent. Function recovery of the fingers was good. Pain and temperature sense were regained without hypersensitivity, two-point discrimination of finger pulp was 5-8 mm. Conclusion It is a reliable approrach for the repare of the finger pulp defects using the microdissected thin fibular skin flap of the great toe, especillay in repare finger pulp defect of ring and little finger. Key words: Finger injuries; Surgical flaps; Microsurgical operation

Structural and functional anatomy of the palmaris brevis: grasping for answers.

The palmaris brevis (PB) is a small cutaneous hand muscle that has been described as the most mysterious muscle from a functional and developmental perspective [Kaplan () Kaplan's Functional and Surgical Anatomy of the Hand]. Functionally, the PB is considered to deepen the hollow of the palm and to protect the neurovasculature of the ulnar canal. Although the function of the PB has been inferred from cadaveric observations, the electromyographic (EMG) activity of this muscle has not been explored systematically during specific movements of the hand. The purpose of this study was to record PB intramuscular EMG activity during dynamic grasping tasks, and to quantify the change in PB muscle length (ML ) and thickness (MT ) incurred during maximal contraction using ultrasound imaging. Intramuscular EMG was recorded from the PB in the dominant hands of 12 healthy participants (11 males, one female; age: 27 ± 4 years) during maximal abduction, flexion and opposition of the 5th digit, and two grasping tasks. Abduction of the 5th digit yielded the greatest EMG activity in most individuals (seven out of 11), and produced significantly less PB EMG activity when compared with grasping a cylindrical-shaped object (P = 0.003) but not a spherical-shaped object (P=0.130). During maximal abduction of the 5th digit, PB ML decreased in both the left (28±11%; P=0.002) and right (32±5%; P=0.002) hands. Similarly, a concomitant increase in PB MT was observed in the left (68±30%; P=0.002) and right (85±44%; P=0.002) hands during the same contraction. These EMG results indicate that the PB is voluntarily activated during prehensile and non-prehensile movements of the hand with significant changes in muscle architecture. The study supports the preservation of the PB in surgical procedures based on its proposed protective role as a muscular barrier to the neurovasculature within the ulnar canal.

Transfer of double hump flap from the same finger for repair of distal finger degloving injury

Objective To investigate the surgical procedures and the clinical results of repairing degloving injury of the distal finger. Methods Between January 2010 and May 2014, 34 patients (34 fingers) with degloving injury of the distal finger were treated. There were 24 males and 10 females with ages ranging from 21 to 60 years (mean, 35 years). The time from injury to operation was 1 to 8 hours (mean, 4.5 hours). Affected fingers included index finger in 7 cases, middle finger in 15 cases, ring finger in 9 cases, and little finger in 3 cases. Twelve cases were complicated with fracture of the distal phalanx. The defect area ranged from 2.0 cm×1.8 cm to 3.0 cm×2.5 cm. Modified reverse island flap based on the dorsal branch of the digital artery was used to cover the defects of the distal finger caused by the degloving injury. The flap shaped like the humps of a camel (double hump flap). Full thickness skin graft from the forearm was used to cover the donor site. Results Blister and scabs occurred in 8 cases, and two of them were revised by second intention. The other flaps and skin grafts survived uneventfully. The patients were follow-up for 6 to 20 months (mean, 9.3 months). All the flaps presented satisfactory appearance and texture, and the flexion and extension function of affected fingers nearly returned to normal. Two-point discrimination ranged from 6.2 to 9.1 mm at the last follow-up. According to the functional assessment criteria of the upper limb formulated by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 24 cases, good in 8 cases, and fair in 2 cases, the excellent and good rate being 94.1%. Conclusion Modified reverse island flap based on the dorsal branch of the digital artery, namely the double-hump flap, is a simple and safe, easy-to-operate and effective method for treating degloving injury of the distal finger. Key words: Finger injuries; Surgical flaps; Degloving injury; Proper digital artery

Left Elbow Pain- Push Ups

HISTORY: 17-year-old female presents complaining of left elbow pain ongoing for 4 years. She has a history of a diagnosed subluxing ulnar nerve on the left. She complains of difficulty playing sports such as softball and doing push-ups. She would like to enlist in the Armed Services and is concerned about the symptoms limiting her from doing so. She mainly complains of symptoms when the nerve is subluxing during flexion of the elbow, including discomfort over the cubital tunnel with numbness and tingling in her 4th and 5th digits. She denies symptoms when the nerve is not subluxing. She is right hand dominant and has never had treatment for this, including physical therapy. She believes the symptoms of subluxation started when she suffered a direct fall to the ground landing on the elbow years ago. No fractures were diagnosed at that time. PHYSICAL EXAM: Examination of the left upper extremity reveals intact skin without discoloration, atrophy or swelling. Mild tenderness to palpation in the cubital tunnel. Sensation to light touch is intact. AROM with flexion is to 140 degrees. Strength is 5/5 with arm flexion. Tinel’s sign is positive at the elbow. There is palpable subluxation of the ulnar nerve over the medial epicondyle when brought into flexion from extension. A second snap is also appreciated when the elbow is brought into further flexion. DIFFERNETIAL DIAGNOSIS: 1. Subluxing Ulnar Nerve 2. Snapping Triceps 3. Cubital Tunnel Compression TESTS AND RESULTS: -EMG shows no cubital tunnel compression at baseline. -Dynamic ultrasound evaluation reveals an ulnar nerve in cross section located in the normal position within the cubital tunnel during extension. With the elbow slowly flexed past 90 degrees, a palpable snapping of the ulnar nerve was noted on exam and seen dynamically with ultrasound crossing over the medial epicondyle. As the elbow was brought into further flexion, a second snap was appreciated by palpation and on dynamic ultrasound evaluation as the muscle belly of the triceps was noted snapping over the medial epicondyle. FINAL WORKING DIAGNOSIS: -Subluxing Ulnar Nerve -Snapping triceps muscle TREATMENT AND OUTCOMES: 1. Conservative measures including physical therapy and bracing with no relief. 2. Surgical Treatment: Anterior transposition of the ulnar nerve with triceps assessment. Expected rehab is 3-4 months.

Non-magnetic compliant finger sensor for continuous fine motor movement detection.

A non-magnetic MEG compatible device has been developed that provides continuous force and velocity information. Combined with MEG, this device may find utility in characterizing brain regions associated with force and velocity relative to individual digits or movement pattern. 15 healthy right-handed participants were given visual cues to perform random finger movements on the prototype finger sensor for 21s and then rest for 21s (7 times). Respective finger flexion data were obtained, during 151-channel MEG brain scanning, by feeding the signal from finger sensor into four input Analog to Digital Converter (ADC) channels in the MEG hardware. The source activity was reconstructed in beta band using a Linearly Constrained Minimum Variance (LCMV) beamformer in the beta band. The ADC channels were used as regressors for a continuous time General Linear Model (GLM) and a Region of Interest (ROI) was identified to examine activity. MEG analysis showed bilateral activation in the primary motor cortex region. Because individual digits could be isolated in the ADC data, somatotopy of the fingers were observed consistent with the homunculus except pinky finger. The total span was calculated to be 5.5662mm. The study confirms that the finger sensor is magnetically compatible with MEG measurements and may potentially provide a means to study complex sensorimotor functions. Improved isolation of individual digit information along with the use of machine learning algorithms can help retrieve more accurate results.

Mutagen resistance and mutation restriction of St. Louis encephalitis virus.

The error rate of the RNA-dependent RNA polymerase (RdRp) of RNA viruses is important in maintaining genetic diversity for viral adaptation and fitness. Numerous studies have shown that mutagen-resistant RNA virus variants display amino acid mutations in the RdRp and other replicase subunits, which in turn exhibit an altered fidelity phenotype affecting viral fitness, adaptability and pathogenicity. St. Louis encephalitis virus (SLEV), like its close relative West Nile virus, is a mosquito-borne flavivirus that has the ability to cause neuroinvasive disease in humans. Here, we describe the successful generation of multiple ribavirin-resistant populations containing a shared amino acid mutation in the SLEV RdRp (E416K). These E416K mutants also displayed resistance to the antiviral T-1106, an RNA mutagen similar to ribavirin. Structural modelling of the E416K polymerase mutation indicated its location in the pinky finger domain of the RdRp, distant from the active site. Deep sequencing of the E416K mutant revealed lower genetic diversity than wild-type SLEV after growth in both vertebrate and invertebrate cells. Phenotypic characterization showed that E416K mutants displayed similar or increased replication in mammalian cells, as well as modest attenuation in mosquito cells, consistent with previous work with West Nile virus high-fidelity variants. In addition, attenuation was limited to mosquito cells with a functional RNA interference response, suggesting an impaired capacity to escape RNA interference could contribute to attenuation of high-fidelity variants. Our results provide increased evidence that RNA mutagen resistance arises through modulation of the RdRp and give further insight into the consequences of altered fidelity of flaviviruses.

Extending traceability of malignant testicular tumours using hospital discharge records: an experience in Veneto Region (Northern Italy)

validation of codes of hospital discharge records (SDO) for identification of new cases of malignant testicular tumour in the Veneto Region (Northern Italy). record linkage between the regional archive of SDO and the archive of the Veneto Tumour Registry (VTR). extraction of cases from SDO source with ICD-9-CM 186 code for diagnosis and 62.3-62.4 codes for surgical procedure, and from VTR database using ICD-O-3 C62 code for site and 9060-9062, 9064-9066, 9070, 9071, 9080-9083, 9085, 9100, 9101 codes for morphology, with 5th digit behaviour code equal to "/3". Comparison of the two sources in a classification table using VTR data as gold standard. positive predictive value and sensitivity of SDO, with 95% confidence interval (95%CI) based on binomial distribution. from 2006 to 2008, in areas covered by the registry, SDO and VTR identified, respectively, 221 and 216 cases of testicular cancer. SDO procedure showed a sensitivity of 92% (95%CI 87%- 95%) and a positive predictive value of 90% (95%CI 85%-93%). the SDO procedure can be considered an acceptable proxy for testis cancer incidence, thus allowing a wider spatiotemporal observation of the epidemiological trends.

Neural lipoma in little finger with macrodactyly

Neural lipoma in little finger with macrodactyly

The clinical research of flexor digitorum superiicialis muscle branch of the median nerve to repair the hand intrinsic muscle branch of the ulnar nerve

Objective To investigate the clinical application of flexor digitorum superiicialis muscle branch of the median nerve to repair the hand intrinsic muscle branch of the ulnar nerve. Methods From June, 2006 to June, .2010, 7 volunteers of level ulanr never pure injuries near to the elbow were treated by transferring flexor digitorum superiicialis muscle branch of the median nerve to the hand intrinsic muscle branch of the ulnar nerve.The follow-up period ranged from 3 months to 5.5 years, with an average of 1.5 years..The shape and the musle power of hand intrinsic musle, the sensory fuction of ulnar nerve, and the results of EMG after operation were observed. Results The pinkie finger sensory recovery time was about 1.5 years, .and two-point discrimination test showed that the sensory of the wounded hand recovered effectively, .but was significantly worse than the healthy side. And the other sesory recover well. 7 months later, the motion relevant to ulnar nerve began to recover. The adduction and abduction functions of little finger recovered firstly. The ring, middle and index finger followed. Finally, the function of adductor muscle recovered. 1.5 years later, the intrinsic muscle strength grade was about 2-4, paper clip test experiment (-) , Froment sign (-) . There were no obvious claw hand deformity in 6 cases, and the atrophy with varying degrees of adductor muscle occurred in 3 cases. Conclusion Flexor digitorum superiicialis muscle branch of the median nerve transfer to the hand intrinsic muscle branch of the ulnar nerve combined with functional exercise can effectively treated and slow down the intrinsic muscles atrophy. Key words: Ulnar nerve, hand intrinsic muscle branch; Median nerve, flexor digitorum superiicialis muscle branch; Hand intrinsic muscle; Muscular atrophy

Osteomyelitis of the Fifth Toe after Human Bite

Human bite wounds are the third leading cause of bite wounds seen in the emergency departments. Osteomyelitis due to animal bite is well known. However there are very few reports of osteomyelitis secondary to human bite. We present a case of osteomyelitis of the fifth toe due to a human bite. A 13 year old previously healthy Male developed severe pain, redness and swelling with oozing from the wound, 2 days after sustaining a human bite to the right foot. The Magnetic Resonance Imaging (MRI) showed a mild T2 prolongation and enhancement within the proximal phalanx of the fifth digit consistent with osteomyelitis. He was treated for 4 weeks: Ampicillin/Sulbactam for 5 days followed by 11 days of Amoxicillin/Clavulanic and Clindamycin for 25 days. Human bite wounds are a source of serious morbidity with hand and foot wounds due to higher risk of infection. The oral cavity harbors more than 300 different bacterial species. The most common bacteria isolated from bite wounds are Streptococcus sp., Staphylococcal epidermis and Staphylococcus aureus. Anaerobes such as Eikenella, Fusobacterium, Peptostreptococcus, Prevotella and Porphyromonas species are also common. The teeth can cause a deep laceration implanting oral and skin organisms into the joint capsules causing septic arthritis or osteomyelitis with signs and symptoms appearing within 24 to 72 hours. The absence of fever or laboratory evidence of serious bacterial infection in our patient is due to non-hematogenous, contiguous nature of spread of infection. Without imaging by MRI, osteomyelitis would have been missed in this case. Though rare, human bites to the distal extremities should be suspected and assessed for underlying osteomyelitis using MRI to guide appropriate length of antibiotic treatment.