Thumb Size Research Articles

A Rule of Thumb for Evaluating Surface Areas of Chronic Wounds.

Rapid estimation of the area of chronic wounds is clinically important. A simple method using the thumb was investigated for universal physical measurement, particularly of small and multiple wounds; the thumb surface area (TSA) was then compared with the total body surface area (TBSA). A cross-sectional observational study and random sampling were used to obtain the characteristics of 343 participants. Data related to handprint surface area of the thumb and palm were collected using a scanner and laptop and assessed using image software. The TSA as a percentage of TBSA was confirmed based on the traditional rule that regards palmar surface area as 1% of TBSA. Information on factors potentially influencing measurement was gathered with questionnaires to analyze correlations. The left and right TSAs were on average 4.27% and 4.28%, respectively, of the palmar surface area for all participants. Multiple linear regression analysis found that male and older participants had higher TSA:TBSA proportions (sex, P = .0020; age, P < .0001). The TSA:TBSA proportion increased by age for both males (by age group, 0.0418%, 0.0426%, 0.0432%, and 0.0460%, respectively) and females (0.0400%, 0.0409%, 0.0427%, and 0.0430%, respectively). Thumb size is relatively stable in relation to TBSA, lending itself to a universal method for estimating the size of chronic wounds as a percentage of TBSA. It therefore represents a convenient physical measurement for assessing the area of burns and other wounds.

Prevalence of Intestinal Parasitic Infections and Transmission Risk Factors in Primary School Children in Mbeere North Sub-County, Embu County, Kenya

Intestinal parasitic infections (IPI) such as soil transmitted helminths (STH) and protozoa can cause diverse negative effects on human health. The prevalence of IPI in primary school children in Mbeere North sub-county in Embu County is not documented, though there are many cases reported in health centers in the area. The aim of this study was to establish the current prevalence of IPIs in primary school children in Mbeere North sub-county and the factors that perpetuate transmission which is necessary for implementation of suitable control programs in the study area. The study was done among primary school children from nine public schools. Three schools per administrative ward were randomly selected to represent each of the three administrative wards. A total of 414 pupils whose parents/guardians gave informed consent participated in the study, 46 pupils per school. Each participant provided a thumb size of early morning stool. The stool samples were processed by Formol-ether concentration technique and direct wet preparation methods for microscopic identification of intestinal parasites. A structured questionnaire was used to collect data on age, sex, sanitation and hygiene practices. The overall point prevalence of intestinal parasitic infections amongst the pupils was 43%. Chi-square (χ²) test was done to determine the relationship between prevalence and the pupils’ age and sex. There was no significant association between prevalence and sex (χ² = 0.184, P = 0.668, df = 1) but a significant association was found between prevalence and age where children 11 years and below were more pre-disposed than those above 11 years old (χ² =4.770, P=0.043, df =1). Similarly, a significant association was found between water source and prevalence of IPI; the parasites infection prevalence decreased when tap water was used and increased when open surface water was used (F = 6.15, P = 0.006). From this study, it is clear that IPIs particularly E. histolytica are a problem in primary school children in Mbeere North Sub-County. There is an urgent need for provision of safe domestic water in the county. Additionally, community education on sanitation and IPI transmission risk factors is urgently required. The information generated in this study is beneficial to the public health service in designing control strategies for areas of high transmission.

Reconstruction for dysplastic polydactyly of thumb with an island compound flap

To investigate the necessity and feasibility of digit fusion with an advanced island flap in thumb dysplasia of radial polydactyly. From February 2007 to January 2015,we collected the patients with radial polydactyly, whose nail width or thumb girth was less than 80％ of contralateral side. Among them, some patients were also associated with radial deviation deformities in two thumbs or a shorter radial thumb compared with ulnar thumb. In these cases, an island compound flap, which was based on proper palmar digital artery (PPDA) in radial thumb and contained nail, part distal phalanx and skin, combining with ulnar side of ulnar thumb was used to reconstruct a new thumb. Only the patients with a smaller thumb girth were treated by an island flap to augment the thumb size. There were 26 patients, including 29 sides.Preoperative Doppler ultrasonic examination was assigned to observe the amount and distribution of princepspollicisartery(PPA) and PPDA. Appearances were evaluated by Wang -Gao scoring system and functions were evaluated by Tata scoring system. There were two basic artery forms through preoperative ultrasonography and surgical exploration in 29 hands: both thumbs only had one PPDA; the main thumb had two while the extra thumb still had one. The former was responsible in 82.76％ (24 hands).All cases were operated according to preoperative design using an island compound flap.26 hands in 23 patients were followed up more than 6 months. Flap results included survival in 22 patients, tension vesicle in 2 patients and tip necrosis in 2 patients. The incision was infected in one patient with the treatment of changing dressing regularly. The function results were excellent in 21 patients, good in 4,fair in 1.Aesthetic results were excellent in 13 patients, good in 4 and fair in 1. There is always one developed PDAA in extra thumb, which can be used to design a flap. The longitudinal advanced flap can also eliminate the tension caused by unequal length in two thumbs. Using an axial or island flap to reconstruct a new thumb can not only change the appearance, but also make the reconstructed thumb acquire two sets of blood supply and nerve system.

Reconstruction for Dysplastic Radial Polydactyly With an Island Compound Flap

Purpose: To investigate the necessity and possibility of digit fusion with an advanced island flap in thumb dysplasia of radial polydactyly. Methods: We collected the patients with radial polydactyly, whose nail width or thumb girth was less than 80% of contralateral side, from February of 2007. Among them, some patients were also associated with radial deviation deformities in two thumbs or a shorter radial thumb compared with ulnar thumb. In these cases,the proper palmar digital artery island flap was harvested and advanced to eliminate the tension between the radial and ulnar duplicate. Besides the island compound flap containing a part of the distal phalanx and nail bed was harvested from the accessory radial duplicate to augment the retained ulnar duplicate. The patients only with a smaller thumb girth were treated by an island flap to augment the thumb size. There were 26 patients, including 29 sides. Preoperative Doppler ultrasonic examination was assigned to observe the amount and distribution of princepspollicisartery (PPA)and proper palmar digital artery (PPDA). Appearances were evaluated by Wang-Gao scoring system and functions were evaluated by Tada scoring system. Results: There were two basic artery forms through preoperative ultrasonography and surgical exploration in 29 hands: both thumbs only had one PPDA which was observed in 82.76% (24 hands); the main thumb had two while the extra thumb still had one which was observed in 17.24% (5 hands). All cases were operated according to preoperative design using an island compound flap. 26 hands in 23 patients were followed up more than 6 months. Flap results included survival in 22 patients, tension vesicle in 2 patients and tip necrosis in 2 patients. The incision was infected in one patient with the treatment of changing dressing regularly. The function results were excellent in 21 patients, good in 4, fair in 1. In terms of aesthetic, there were 13 excellent results, 4 good and 1 fair. Conclusion: There is one developed PDAA, which can be used to design a flap, in the accessory radial duplicate. The longitudinal advanced flap can also eliminate the tension caused by unequal length in two thumbs. Using an axial or island flap to reconstruct a new thumb can not only change the appearance, but also make the reconstructed thumb acquire two sets of blood supply and nerve system.

A Matched Comparative Study of the Bilhaut Procedure Versus Resection and Reconstruction for Treatment of Radial Polydactyly Types II and IV

To compare outcomes of the Bilhaut procedure with outcomes of conventional resection and reconstruction in radial polydactyly types II and IV. Patients treated with the Bilhaut procedure were radiologically matched with patients treated with reconstruction. Evaluated outcomes included the Rotterdam assessment system, pinch strength, and thumb size measurements. To determine objectively which aesthetic outcome scores truly depended on surgical technique rather than observer opinion, we analyzed evaluations by a panel of 22 individuals with varying clinical experience who were blinded to the study protocol, using a linear mixed regression model. The Bilhaut procedure reduced the risk of suboptimal outcome for metacarpophalangeal joint instability in type IV radial polydactyly. Conversely, the Bilhaut procedure increased the risk of suboptimal scar appearance, residual prominence at amputation site, thumb size, and nail appearance. Tip pinch strength was more significantly reduced after the Bilhaut compared with reconstruction, whereas pulp circumference and nail width exceeded 100% of the unaffected contralateral hand after the Bilhaut reconstruction. There was no significant difference in active range of motion between procedures. Nail appearance proved the only aesthetic drawback of the Bilhaut procedure after adjustment for clinical experience. There was superior metacarpophalangeal joint stability after the Bilhaut procedure for radial polydactyly type IV, but this did not result in the presumed benefit to thumb strength. For experienced surgeons, both procedures resulted in comparable thumb active range of motion. However, aesthetic results were more likely perceived as pleasing after conventional reconstruction, even after adjusting for observer experience with regard to nail appearance. Despite possible benefits of modified Bilhaut procedures that preserve the nail, conventional reconstruction is the preferred procedure until otherwise proven. Therapeutic III.

Reconstruction of thumb II-III degree defect by big toe wrap-around flap combined with second toe proximal interphalangeal joint

To investigate the reconstruction of thumb II-III degree defect by big toe wrap-around flap combined with second toe proximal interphalangeal joint. Between May 2004 to July 2012, 25 cases with thumbs II-III degree defects were treated. The ipsilateral big toe wrap-around flap combined with second toe proximal interphalangeal joint was designed to reconstruct the thumb defects based on the thumb size on the healthy side. The distal end of hallux was covered by flap at tibial side. The wound at the fibula side was covered by skin graft and flap. The bone defect at the second toe was filled with remnant hallux or iliac bone. All the 25 reconstructed thumbs survived completely. The patients were followed up for 6-26 months without any joint degeneration. According to the finger reconstruction functional criterion publicized by China Medical Association, the finger function was assessed as excellent in 10 case, good in 11 cases, poor in 4 cases. Joint necrosis happened in 2 cases and bone malunion in 2 cases. The 4 cases received dead bone debridement and iliac bone graft. No malfunction occurred in the donor site. Our surgical method is a currently effective way to reconstruct II-III degree thumb defects. Satisfactory functional and cosmetic results can be achieved both in donor site and recipient site.

HYPOPLASTIC THUMB TYPE IIIB: AN ALTERNATIVE METHOD FOR SURGICAL REPAIR

Hypoplastic thumb is the second most common congenital deformity of the thumb. Thumb hypoplasia is characterized by diminished thumb size, metacarpal adduction, metacarpophalangeal joint instability, and thenar muscle hypoplasia. In the literature, different classification types of hypoplastic thumb have been used and different treatment methods described. In this case we presented an alternative palliative treatment method for a ten-year-old patient with modified Blauth’s classification type IIIB hypoplastic thumb and one-year follow-up results.

Factors affecting surgical results of Wassel type IV thumb duplications

The aim of this study is to review the outcomes of Wassel type IV thumb duplications with a minimum of one year follow-up, and to identify any factors that may compromise the quality of results. Forty one patients (42 thumbs) returned for assessment of thumb alignment, metacarpophalangeal joint and interphalangeal joint stability and motion; carpometacarpal joint motion; pinch and grip strengths; and thumb size. The subjective assessment considered thumb shape and contour, scarring, nail deformity and examiner and patient/parent satisfaction. The mean age at surgery was 16 months and the mean follow-up time was 79 months. Metacarpophalangeal joint and interphalangeal joint mal-alignment was present in 56% and 38% of cases, respectively. Interphalangeal ulnar collateral ligament laxity was significant. Metacarpophalangeal joint and interphalangeal joint motion was significantly decreased. Pinch and grip strength measurements were normal. A novel and comprehensive assessment scale is introduced, which revealed results of one (2.5%) excellent, 23 (59%) good, 14 (36%) fair and one (2.5%) poor. We consider that greater attention should be directed to the avoidance of mal-alignment and instability to improve these results.

Thumb Hypoplasia

Thumb hypoplasia, congenital underdevelopment of the thumb, can range from a slight decrease in thumb size to complete absence of the thumb. As part of the radial longitudinal deficiency spectrum, other organ systems may be affected as well. Hence, the global health of the child should be addressed before focusing on the thumb. The decision of whether to reconstruct the existing thumb or to ablate the thumb and perform a pollicization of the index finger hinges primarily on the examination of trapeziometacarpal joint stability. Ultrasound imaging may play a role in decision making in borderline cases. The ultimate goal of surgical treatment is to provide a stable and functional thumb.

Reconstruction of the Hypoplastic Thumb

Thumb hypoplasia is characterized by diminished thumb size, metacarpal adduction, metacarpophalangeal joint instability, thenar muscle hypoplasia or aplasia, extrinsic tendon dysplasia, and in the most severe cases, carpometacarpal joint instability or thumb aplasia. Severe thumb hypoplasia and aplasia are best treated by thumb ablation and pollicization of the index finger. Less severe thumb hypoplasia can be reconstructed by a combination of soft tissue release, first web space local flap coverage, metacarpophalangeal joint collateral ligament and capsule reconstruction, extrinsic tendon tenolysis, and muscle or tendon transfers.

Thumb Size and Appearance Following Reconstruction of Radial Polydactyly

Thumb Size and Appearance Following Reconstruction of Radial Polydactyly

Thumb Size and Appearance Following Reconstruction of Radial Polydactyly

To evaluate thumb size, shape, and appearance after surgical correction of radial polydactyly. Thirty-one reconstructed thumbs in 26 children with radial polydactyly were evaluated at an average of 45 months after surgery. The length, girth, nail width, and joint angulation were measured and compared with the contralateral side of patients with unilateral polydactyly and with standard thumb measurements for patients with bilateral involvement. A surgeon, therapist, and caregiver each subjectively assessed the aesthetic outcome, using a visual analog scale (VAS); raters also provided the principal reasons for their assessment of the altered appearance. The average length of the reconstructed thumb relative to the index finger proximal phalanx was 81%; that of the unaffected, contralateral thumb was 80%. The girth of the reconstructed thumb relative to the index finger was 102%; that of the contralateral thumb was 103%. Thumbnail width in proportion to index fingernail width was significantly decreased in the reconstructed thumbs, at 111% (compared with the contralateral value of 136%). The VAS scores averaged 7.7; the most common reason cited for decreased VAS score was an angulated thumb. Lower VAS scores were associated with Wassel type VI and VII thumbs and with increased interphalangeal, but not metacarpophalangeal, joint angulation. Thumb polydactyly reconstruction typically provides a satisfactory thumb appearance. The primary issues affecting appearance after reconstruction are reduced nail width, interphalangeal joint angulation, and presence of type VI and VII radial polydactyly.

Digit Ratios (2D:4D and other) and Relative Thumb Length: A Test of Developmental Stability

Sex and side differences in relative thumb length of children and adolescents have been reported by prior researchers. These findings mirror those reported for the second-to-fourth digit ratio (2D:4D), a likely biomarker for the organizational (permanent) effects of prenatal androgens on the human brain and body. The present study investigated relative thumb length, in particular, its associations with all possible digit ratios (2D:3D, 2D:4D, 2D:5D, 3D:4D, 3D:5D, and 4D:5D), in a sample of young adults (60 men and 64 women). Relative thumb length was less precisely measurable than direct or image-based finger-length measurements, as used in digit ratio research. There were no significant sex or side differences in relative thumb length. Contrary to expectation, thumb size was not positively correlated with any digit ratios. Relative thumb length appears to be developmentally unstable (decreases during childhood and adolescence). Additional findings, such as the magnitude ranking of sex differences in digit ratios and the comparability of direct versus image-based finger-length measurements, are also discussed.

A procedure for rabbit blood serial collection

Blood serial collection is required for many applied reproduction and nutrition trials with rabbits. The experimental design of these researches very often includes repeated samplings of large volumes of blood for metabolites and hormones analysis. Our proposed procedure has been tested in many surveys with success. It is based on a blood collection by aspiration, featuring a sterile butterfly cannula with a vacuum tube. By this procedure, the use of syringes is avoided. As a matter of fact when a syringe is used, excessive suction frequently causes the rabbit blood vessel collapse. Furthermore a rough handling of blood, such as excessive suction or the forcing of clotted blood from a syringe, will cause hemolysis: this can interfere with the serum or plasma fractions needed. Blood collection from ear vessels is a technique commonly used with rabbits. The central ear artery is recommended for collecting larger volumes of blood (over 5ml). 10ml of blood/kg body weight can be collected in this manner but the rabbit must be carefully restrained and hematomas must be prevented by direct pressure. Removal of more than 10% of blood volume may result in hypovolemic shock, a potentially fatal reaction.Materials. For local anesthesia EMLA Cream (Lidocaine 2.5% + Prilocaine 2.5%) is a topically applied local anesthetic that is very useful in removing sensation from the venipuncture site.Blood collection set: 1) Butterfly cannula (23 gauge needle for small blood samples and 21 gauge for large samples). 2) Vacutainer blood collection tube and vacutainer holder. 3) Luer adapter (which is designed to allow the attachment of the butterfly to holders using a single venipuncture). Procedure. a) Remove the rabbit from its cage. Proper technique in grabbing and carrying a rabbit is important to prevent vertebral fractures. Grab the rabbit's skin in the shoulder region and place its head underneath your arm. Support the rabbit's legs with the hand of the arm that the head is tucked under. Alternatively, grab the rabbit's skin with both hands (over both the shoulder and the rump region). b) Apply about one thumb size of anesthetic cream on the site selected for blood collection, and leave the cream in contact with skin for 5 minutes c) Check the ear artery if visible and if doesn't dilate, tapping it gently (or flicking it) may help. For vessels dilation the use of topical irritants such as xylene is not recommended. Xylene tends to cause leukocytosis and if it comes in contact with blood, will cause hemolysis. Adequate dilation of vessels can generally be achieved by use of a heat lamp, alcohol or gentle massaging of the ear. d) Only when the blood vessel is clearly visible, with the needle bevel up, parallel to, and alongside the artery, insert the needle quickly under the skin and then into the artery. The needle has to be pointed towards the base of the ear and the insertion into the skin and artery can be performed in one complete motion. e) If the blood vessel has been correctly entered, blood will flow into the tubing of the butterfly cannula. f) Push the vacutainer tube all the way into the holder; vacuum is broken, and blood flows freely being drawn from the artery into the tube. g) Once the blood sample has been taken, the needle must be carefully and quickly removed. When the desired amount is collected, gently hold gauze over needle entry point and remove the needle. h) Hemostasis should be achieved applying pressure to the injected area using thumb and a piece of cotton. Keep pressure on the area for 60-90 seconds, or until blood stops flowing. i) Observe the rabbit for at least another 30 seconds to insure that bleeding has stopped. l) Return rabbit to cage, and check again in 10-15 minutes.

Ultra-low power transmit/receive ASIC for battery operated ultrasound measurement systems

Absract This paper describes the design of the complete transmit and receive electronics circuitry for a piezoelectric transducer in one single ASIC. The chip will be one building block in a thumb size battery operated ultrasound measurement system. The main design target has been to achieve extremely low power consumption while keeping the number of external components minimal. To overcome the dynamic range limitations imposed by a battery supply an on-chip boost converter uses one external inductor to generate up to 40 V for excitation of the transducer. The transducer itself is used as a storage capacitor, whereafter it is rapidly discharged to generate an ultraso und pulse. An on-chip amplifier with intermittent operation is controlled by a state machine and used to amplify incoming echoes. The chip has been

Normative Values for Thumb Length, Girth, and Width in the Pediatric Population

To determine the normal relative length, girth, and nail width of the pediatric thumb with respect to the index finger in children ages 1 through 18 years. Measurements of relative thumb length, girth, and nail width were performed on 546 hands in 273 volunteers ages 1 through 18 years. At least 22 hands were included for each age group. The data were analyzed by age, gender, and hand, with the thumb compared with the index finger for all measurements. The adducted thumb tip reached an average of 70% of the length of the index finger proximal phalanx and 32% of the length of the index finger from the metacarpophalangeal joint to its tip. The thumb girth and nail width as a percentage of corresponding levels of the index finger girth and nail width were 133% and 105%, respectively. Relative thumb size remained constant with no significant difference in length, width, or girth between age groups. The relative size of the thumb remains constant during growth. These normative data will allow a more objective assessment of thumb size and appearance.

異時性六重複癌を有し，ＤＩＣを起こして死亡した悪性黒色腫の剖検例

An autopsy case who died of multiple metastatic malignant melanoma with Disseminated intravascular coagulation (DIC) was reported. The patient was a 75-year-old femal, who noticed a black papule on her left cheek ten years before. It was resected with minimal margin and diagnosed as malignant melanoma. Two years after the resection, a mild blue subcutaneous nodule without pain appeared on the operated lesion and gradually elevated and enlarged to the thumb size. Therefore, in May, 1994, an extended resection was performed and she received chemotherapy in our clinic because of the diagnosis of local recurrence. After the operation, there was no sign of local recurrence or metastasis. In November, 1994, DIC suddenly occured. Although treated for the DIC, she died of multipe metastatic malignant melanoma with DIC. The patient had six primary tumors including malignant melanoma, double rectal adenocarcinomas, colon carcinoma and occult right thyroid papillaly adenocarcinoma.

Metal vapor vacuum arc ion sources (invited)

High current beams of metal ions can be produced efficiently using a metal vapor vacuum arc to establish the metal plasma from which the beam is formed. Pulsed beam currents of several amperes of metallic ions have been produced from nearly all of the solid metals of the periodic table, and in some recent tests dc beams have been produced also. Beam extraction voltage up to 100 kV has been used and since the ions produced in the vacuum arc plasma are in general multiply ionized the ion energy is up to several hundred keV. These kinds of sources are finding application for heavy-ion synchrotron injection, metallurgical ion implantation, and other uses. A number of different embodiments of the source have been developed at Berkeley and elsewhere around the world. Interesting features include multiple cathodes and the ability to switch between up to 18 separate cathode materials simply and quickly, and broad beam source versions (up to 50 cm diameter) as well as miniature versions (about ‘‘thumb size’’). Here we review the design features, operational behavior, and beam performance characteristics of these sources from the perspective of the Berkeley program.

極めて悪性の経過をたどった喉頭カルチノイドの１例

Although carcinoid tumor occurs most commonly in the gastrointestinal tract and lungs, they are very rare in the laryngeal region. After the first case reported by Goldman et al., in 1959, only 26 cases have been reported in the past literature. Among them 4 cases were reported in Japan. In this paper, we reported a case of carcinoid tumor in the supraglottis of a 55 year old man. Indirect laryngoscopy showed a bulge on the right false cord. Three lymph nodes of thumb size were palpable in the right upper part of the neck. Pathological exams of the biopsied specimens from both false cords showed a poorly differentiated squamous cell carcinoma. A right radical neck dissection and total laryngectomy were performed. Histological examinations of the removed specimen showed a malignant transformation of carcinoid tumor and lymph node metastasis. The patient died of liver metastasis 46 days after the operation. Carcinoids have been understood to have malignant characteristics, although they do not exhibit a typically agressive course. It has been reported that carcinoid tumor is not sensitive to irradiation, and therefore, wide surgical removal with neck dissection should be the primary treatment. Besides, pre- and post operative chemotherapy, radiotherapy, and other treatment should also be considered.

球状上がくのう胞の２例

This report presents two cases of globulomaxillary cyst at our hospital.Case 1. This case was a 22 year old Japanese female who visited our hospital on February 18, 1982. She complained of unusual sensitivity in upper left side lateral incisor area. The upper left side lateral incisor with resin filling showed non-vital pulp, the upper left side canine was vital. Labial and palatal mucosa of their apical part showed no abnormal swelling nor redness, though the area was severely painful. The root distance between the upper left side lateral incisor and canine was expanded, as seen in radiograph. Using a local anesthesia, the cyst was surgically removed; part of the cyst wall contacted with the sinus mucosa. The cyst contained a light, yellow colored serous fluid.Microscopic examination revealed cystic lining with stratified columner and cuboidal epithelium with scattered squamous epithelium. The wall of the cyst was infiltrated with chronic inflamatory cells. Case 2. A 50 year old Japanese male visited our hospital on October, 16, 1975. He complained of labial gingival swelling of upper left side, central and lateral incisor apical part. The upper left side central, lateral incisor and canine were vital. The cyst was the tip of thumb size, recognized clearly under the upper left side central and lateral incisor apical part in radiograph. Using a local anesthesia, the cyst was surgically removeed. The cyst contained yellow colored serous fluid. Microscopic examination revealed cystic lining with cuboidal epithelium. The loose connective tissue with few infiltrated cells was seen in subepithelial region. In addition to these two cases, we analyzed 62 cases in the existing Japanese literatures (1939-1983).