Pre-1900 literature on Dupuytren's disease.
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Dupuytren Contracture↗
Biomedical subjects
D Elliot
Publications and source records attributed to D Elliot.
A prospective study of flexor tendon repair in zone 5.
A prospective study of postoperative mobilization of flexor tendon repairs in zone 5 was conducted over a 2-year period between 1994 and 1996 using a controlled active motion (active extension-active flexion) regimen of mobilization. Fifty-two patients, who had a total of 151 flexor digitorum superficialis (FDS) and 103 flexor digitorum profundus (FDP) divisions, were available for review at a mean follow-up of 10 months. Of the 161 fingers with division of one or both flexor tendons, 66% exhibited independent FDS function and 90% achieved good or excellent results of digital range of motion. No rupture of an FDP tendon repair occurred during the study period. The data allowed us to define a new method of classifying the results of treatment of these injuries in terms of the injured wrists as a whole and not simply as a series of isolated observations for each individual finger with divided flexor tendons. The results of recovery of independent FDS action and range of finger movement achieved for injuries in which the flexors of all four fingers had been divided indicate a statistically significant interdependence of injuries of finger flexors of adjacent fingers at the wrist. Multivariate analysis showed the presence of a "spaghetti wrist" injury to have a significant adverse effect on the recovery of the independent FDS action but not on the recovery of the digital range of motion.
Adolescent↗
"Venting" or partial lateral release of the A2 and A4 pulleys after repair of zone 2 flexor tendon injuries.
The need for lateral release or "venting" of the A2 and A4 pulleys either to facilitate repair of the flexor tendon(s) or to allow free gliding of the repair(s) was examined in 126 consecutive zone 2 flexor tendon injuries within the tendon sheath and distal to the distal edge of the A2 pulley (zones 2A and 2B of Tang's classification) in which at least one flexor tendon had been completely divided. This study showed that 81 (64%) of these repairs required venting of one or the other pulley. It was necessary to vent the A4 pulley between 10 and 100% of its length in 71 (56%) of the fingers and to vent the distal edge of the A2 pulley by 4 to 10 mm in 10 (8%) of the fingers.
Adolescent↗
Treatment of painful neuromas of the hand and wrist by relocation into the pronator quadratus muscle.
Thirteen painful end-neuromas of nerves of the palm and the dorsum of the hand were treated by resection of the neuroma and relocation of the nerve ends into the pronator quadratus muscle proximal to the wrist in ten patients. The effectiveness of this treatment was assessed by measurement of changes in level of spontaneous pain, pain on pressure, pain on movement and hyperaesthesia at the original site and at the site to which the nerve was relocated. Subjective comments on changes of hand function and ability to return to work were also recorded. All ten patients reported total relief or marked improvement in each of the four modalities of pain assessed. In the five patients in whom the neuromas were the only significant cause of hand dysfunction, there was sufficient improvement in hand function to allow the patients to return to work. In this series, the pronator quardratus muscle has proved a suitable site for relocation of sensory nerve ends after resection of painful neuromas in the proximal part of the hand and wrist.
Adult↗
Lack of Fc-epsilon receptors on murine eosinophils: implications for the functional significance of elevated IgE and eosinophils in parasitic infections.
Chronic infection with Schistosoma mansoni induces in humans and mice a Th2-dominant immune response in which eosinophils and IgE are conspicuously elevated. Human eosinophils express IgE receptors that participate in an IgE-dependent eosinophil-mediated ADCC reaction against Schistosomula larvae in vitro. To investigate the expression of IgE receptors on murine eosinophils, they were purified (>95% pure by Giemsa-stained cytospin preparations) from liver granulomas of Schistosoma-infected mice. Flow cytometric analysis showed the absence of the low-affinity IgE receptor Fc-epsilon RII (CD23) and Mac-2 and the absence of binding of murine IgE. Reverse transcription-polymerase chain reaction (RT-PCR) analysis of granuloma eosinophil mRNA did not detect transcripts for Fc-epsilon RII or the alpha-chain of the high-affinity IgE receptor Fc-epsilon RI, but did detect transcripts that encode Mac-2 and the low-affinity IgG receptors Fc-gamma RIIb2, Fc-gamma RIII, and the FcR-associated gamma-chain. In vitro stimulation of granuloma eosinophils with interleukin-4 (IL-4) did not induce IgE binding, surface expression of Mac-2, or the transcription of Fc-epsilon receptors (Fc-epsilon RI, Fc-epsilon RII/CD23). To investigate normal murine eosinophils, we cultured normal mouse bone marrow cells with recombinant IL-3, recombinant IL-5, and recombinant granulocyte-macrophage colony-stimulating factor, conditions that promote eosinophil differentiation. Flow cytometric analysis of bone marrow-derived eosinophils failed to detect IgE binding or cell surface expression of Fc-epsilon RII and Mac-2, and RT-PCR analysis of fluorescence-activated cell sorted bone marrow-derived eosinophils failed to detect transcripts that encode Fc-epsilon RI or Fc-epsilon RII. These findings show that, in contrast to human eosinophils, murine eosinophils do not express cell surface receptors that bind IgE. However, because IgG receptors (Fc-gamma RIIb2, Fc-gamma RII) were present on eosinophils purified from granulomas, we investigated whether they might be involved in eosinophil activation. We found that an oxidative burst in eosinophils could be triggered through their IgG receptors.
Animals↗
A historical record of traumatic rupture of Dupuytren's contracture.
Traumatic rupture of Dupuytren's contracture is rare. It has been reported only twice in recent times and only on four previous occasions over the last millenium. These cases are reported and the forces involved in rupturing Dupuytren's contracture are discussed.
Dupuytren Contracture↗
Composite graft replacement of digital tips. 1. Before 1850 and after 1950.
The successes of composite grafting of fingertips in the early years of plastic surgery have been repeated in the few studies of this treatment which have been reported during the last 50 years. The early and recent history of this subject are reviewed in the light of the increasingly pessimistic view of composite graft replacement of fingertips taken by recent reviewers.
Amputation, Traumatic↗
Composite graft replacement of digital tips. 2. A study in children.
This study investigated the outcome of composite graft replacement of 50 amputated digital tips in 50 children over a period of 3 years and 6 months. Eleven of 18 tips (61%) which were replaced within 5 hours survived completely while none of 32 digital tips replaced after 5 hours survived completely. This difference was highly significant. The mean delay time between amputation and replacement in the successful group was 3.9 hours and in the others was 7.2 hours. This difference was also statistically significant. The implications of the findings of this series to the use of this treatment are discussed.
Adolescent↗
Spontaneous rupture of the flexor pollicis longus tendon on a sesamoid bone.
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Carpal Bones↗
Effects of a multidimensional anabolic steroid prevention intervention. The Adolescents Training and Learning to Avoid Steroids (ATLAS) Program.
OBJECTIVE: To test a team-based, educational intervention designed to reduce adolescent athletes' intent to use anabolic androgenic steroids (AAS). DESIGN: Randomized prospective trial. SETTING: Thirty-one high school football teams in the Portland, Ore, area. PARTICIPANTS: Seven hundred two adolescent football players at experimental schools; 804 players at control schools. INTERVENTION: Seven weekly, 50-minute class sessions were delivered by coaches and student team leaders, addressing AAS effects, sports nutrition and strength-training alternatives to AAS use, drug refusal role play, and anti-AAS media messages. Seven weight-room sessions were taught by research staff. Parents received written information and were invited to a discussion session. MAIN OUTCOME MEASURES: Questionnaires before and after intervention and at 9- or 12-month follow-up, assessing AAS use risk factors, knowledge and attitudes concerning AAS, sports nutrition and exercise knowledge and behaviors, and intentions to use AAS. RESULTS: Compared with controls, experimental subjects at the long-term follow-up had increased understanding of AAS effects, greater belief in personal vulnerability to the adverse consequences of AAS, improved drug refusal skills, less belief in AAS-promoting media messages, increased belief in the team as an information source, improved perception of athletic abilities and strength-training self-efficacy, improved nutrition and exercise behaviors, and reduced intentions to use AAS. Many other beneficial program effects remained significant at the long-term follow-up. CONCLUSIONS: This AAS prevention program enhanced healthy behaviors, reduced factors that encourage AAS use, and lowered intent to use AAS. These changes were sustained over the period of 1 year. Team-based interventions appear to be an effective approach to improve adolescent behaviors and reduce drug use risk factors.
Adolescent↗
Palmar bands in rheumatoid arthritis and other chronic conditions of the upper limb.
Palmar prolapse of the flexor tendons as a result of attenuation of the A1 and A2 pulleys occurs in rheumatoid arthritis and other conditions in which the joints of the fingers are chronically flexed. The flexor tendons may be palpable and sometimes visible as longitudinal bands crossing the palm. This can lead to confusion with the palmar bands of Dupuytren's disease. These bands are illustrated in a small series of patients and a serious complication of a misdiagnosis of Dupuytren's disease is presented. The pathogenesis of these palmar bands in rheumatoid arthritis is discussed.
Adult↗
Upper arm fasciotomy. A new approach.
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Arm Injuries↗
Dupuytren's disease in children.
Although Dupuytren's disease of the hand has been reported in teenagers, it is generally considered to be a disease of adults. A series of nine children who developed Dupuytren's disease of the hand before the age of 13 years is presented. Eight had surgical removal of the diseased tissue and histological confirmation of the diagnosis before the age of 13 years and one at 14 years of age. The presence of the condition in young children and teenagers is discussed and the literature summarized.
Adolescent↗
A new technique of attachment of flexor tendons to the distal phalanx without a button tie-over.
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Fingers↗
Total middle ray amputation.
Eight patients underwent middle ray amputation with excision of the whole of the middle metacarpal and careful soft tissue repair. Excision of the base of the middle metacarpal allowed easier approximation of the index and ring rays without the tendency of these fingers to either scissor on finger flexion or to remain slightly apart. Complete removal of the middle metacarpal appears to allow the bases of the index and ring metacarpals to migrate together. The removal of the metacarpal base caused no functional problems and the technique created a good three-finger hand from both a functional and cosmetic point of view.
Adult↗
Radiofrequency ablation: a review of its application and nursing considerations.
Radiofrequency ablation (RFA), a therapeutic electrophysiological procedure, has become the treatment of choice for a number of cardiac arrhythmias. These arrhythmias include those of anomalous pathways, as seen in AV nodal re-entry tachycardia and Wolff-Parkinson-White syndrome, and re-entry tachycardias of atrial and ventricular origins. This paper discusses the mechanism of RFA and the physiology of re-entry circuits, and outlines the cardiac arrhythmias treated by RFA. The nursing responsibilities associated with the RFA procedure--including patient education, observation for potential complications, and other peri- and post-procedure considerations--are then addressed.
Arrhythmias, Cardiac↗
Intervention and prevention of steroid use in adolescents.
Athletes with a higher intent to use anabolic steroids were similar to students who indicated no predisposition to use steroids on economic, academic, and physical measures. They had similar understandings of anabolic steroid effects, and their self-rated understandings of how to weight train and of sports nutrition were similar. In addition, the influence of the coaches and the media and the perceived prevalence of anabolic steroid use were not different between the higher- and lower-intent students. These results demonstrated several significant differences. Higher-intent students had higher levels of alcohol and marijuana use, which suggest that those items might be tackled concurrently. These athletes had higher hostility, impulsivity, and a win-at-all-costs attitude. Despite similar physical measures, they had a high body image, but were less satisfied with their current weight. These findings underscored the importance of using nutrition and appropriate training as effective alternatives to anabolic steroids. Higher-intent students had greater peer tolerance of drug use and less parental influence not to use drugs, which implies that a peer-led small group format might be important to dispel the perceived peer tolerance. Including a parent-based component, one that emphasizes a disapproval of drug use also could be effective. Higher-intent athletes had less ability to refuse an offer of steroids. The dynamics of turning down steroids may differ from that of other illicit substances so that training in refusal skills specific to steroids is needed. These differences provide a needs assessment to identify curricular components for an intervention to permit anabolic steroid use. The sports team may be a unique educational setting because it can capitalize on peer ties, the coach's influence, and an athletes' motivation to improve, to prevent drug use, and to promote healthy behaviors.
Adolescent↗
The neurovascular Tranquilli-Leali flap.
A modification of the flap first described in 1935 by Tranquilli-Leali and described again by Atasoy et al (1970) is presented. The relative indications for use of the original and the modified flap are examined in the light of our experience of 116 flaps over a period of 4 years.
Adolescent↗