Give and take.
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Attitude of Health Personnel↗
Biomedical subjects
S P Kay
Publications and source records attributed to S P Kay.
Happy hens lay bigger eggs.
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Attitude of Health Personnel↗
Early parental experiences of obstetric brachial plexus palsy.
Early parental experiences of having a child with obstetric brachial plexus palsy were examined to determine whether there were any areas of dissatisfaction and, if so, whether these resulted from their distress and a need to blame someone, or from problems in the communication of bad news. A high level of dissatisfaction was reported with similar levels of dissatisfaction found in a mildly injured group that did not require surgery, and a severely injured group that did. This suggests either that degree of dissatisfaction is not related to degree of disability, or that dissatisfaction was due to factors other than a reaction to their child having a problem. Support was found for the latter as the parents reported details of problems in communication, particularly the giving of inaccurate and misleading information.
Adaptation, Psychological↗
Paroxysmal finger haematomas (Achenbach's syndrome) with angiographic abnormalities.
We present two cases of women with Achenbach's syndrome (paroxysmal finger haematomas) with abnormal angiograms.
Adult↗
Developmental and behavioural outcome in obstetric brachial plexus palsy.
Forty-four children with obstetric brachial plexus palsy were assessed for both developmental attainment and behavioural problems. Analysis of the resulting data revealed developmental and behavioural problems previously not identified, particularly in those with more severe injuries. These effects were independent of the general condition of the child at birth, as indicated by their Apgar scores. Further studies are required to provide clarification of these children's difficulties, the mechanisms by which they occur and effective strategies to address them.
Brachial Plexus↗
Microneurovascular transfer of contralateral latissimus dorsi in Poland's syndrome.
A 2-year-old girl with Poland's syndrome presented with syndactyly of the first, second and third webs of the left hand and ipsilateral absence of the sternocostal portion of pectoralis major. Latissimus dorsi on the same side was also absent. A microvascular free contralateral latissimus dorsi muscle transfer was undertaken to reconstruct the chest wall and anterior axillary fold. The transfer was innervated by intercostal nerve transfer and produced a neuromuscular unit of good aesthetic appearance and function.
Child, Preschool↗
The role of low-profile titanium miniplates in emergency and elective hand surgery.
We report our experience of a low-profile mini-plating system in the treatment of fractures of the hand in 57 consecutive patients (five children and 52 adults). Thirteen procedures were performed electively, and 44 procedures were performed on an emergency basis. Indications for plating included fixation of metacarpal (36) and phalangeal (eight) fractures, bony fixation following rotation osteotomy (six) digital replantation (two) or free toe transfer (two). Seventeen patients had postoperative problems, including restricted range of motion (12), rotation deformity (two), significant cold intolerance (two) or fracture (two). Plate removal was required in seven patients, twice as a result of a second injury, and plate removal was unsuccessfully attempted in one other patient. Two patients required extensor tenolysis. We have found this system to be useful for bony fixation in the hand. However, as with other methods of internal fixation in the hand, there may be complications.
Adult↗
Psychological aspects of toe to hand transfer in children. Comparison of views of children and their parents.
Thirty-seven children with congenital (n = 32) or post-traumatic (n = 5) hand anomalies underwent unilateral or bilateral toe transfers. All had undergone preoperative counselling. After rehabilitation and more than 1 year after surgery, the children and their parents were reviewed by a clinical psychologist to assess the psychosocial outcome of the surgery. A high level of satisfaction was reported with regard to the surgery, in terms of function, cosmesis, donor site, psychosocial wellbeing and the reactions of others. This was true regardless of the gender of the child. However, there was a tendency for the children to be more positive in their responses than their parents.
Adolescent↗
Clinical and genetic studies on 12 preaxial polydactyly families and refinement of the localisation of the gene responsible to a 1.9 cM region on chromosome 7q36.
Polydactyly is the most frequently observed congenital hand malformation with a prevalence between 5 and 19 per 10000 live births. It can occur as an isolated disorder, in association with other hand/foot malformations, or as a part of a syndrome, and is usually inherited as an autosomal dominant trait. According to its anatomical location, polydactyly can be generally subdivided into pre- and postaxial forms. Recently, a gene responsible for preaxial polydactyly types II and III, as well as complex polysyndactyly, has been localised to chromosome 7q36. In order to facilitate the search for the underlying genetic defect, we ascertained 12 additional families of different ethnic origin affected with preaxial polydactyly. Eleven of the kindreds investigated could be linked to chromosome 7q36, enabling us to refine the critical region for the preaxial polydactyly gene to a region of 1.9 cM. Our findings also indicate that radial and tibial dysplasia/aplasia can be associated with preaxial polydactyly on chromosome 7q36. Combining our results with other studies suggests that all non-syndromic preaxial polydactylies associated with triphalangism of the thumb are caused by a single genetic locus, but that there is genetic heterogeneity for preaxial polydactyly associated with duplications of biphalangeal thumbs. Comparison of the phenotypic and genetic findings of different forms of preaxial polydactyly is an important step in analysing and understanding the aetiology and pathogenesis of these limb malformations.
Animals↗
Sternomastoid muscle flap for closure of a dural fistula after a brachial plexus injury.
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Brachial Plexus↗
What is cold intolerance?
There are four types of symptoms on exposure to cold in the condition known as cold intolerance: pain/discomfort, stiffness, altered sensibility and colour change. They may occur in isolation or in any combination. Symptoms were present in at least 64% of 200 patients 24 months after hand injury. Pain was found to be the most troublesome symptom. Colour change in the digits was regarded by patients as the least troublesome symptom. Symptoms may begin immediately after injury, but are more likely to develop with the first onset of cold weather if there is a lag period between injury and onset. Pre-existing cold related symptoms are uniformly made worse by hand injury. A definition of the condition has been proposed and it has been suggested that this collection of symptoms be known as "Trauma Induced Cold Associated Symptoms".
Adult↗
An unusual variant of the levator claviculae muscle encountered in exploration of the brachial plexus.
The levator claviculae muscle is a vestigal muscle which occurs in less than 2% of humans. The embryological origin of this muscle is controversial. We report a case in which an unusual variant of this muscle was encountered during exploratory surgery following a brachial plexus injury. The anatomical findings in this case suggest that this muscle may arise from either the sternocleidomastoid or trapezius muscles or from the primordial ventrolateral musculature.
Adult↗
Obstetrical brachial palsy.
Obstetrical brachial palsy (OBP) (also known in its various forms as Erb's palsy, Klumpke's paralysis, Erb-Duchenne palsy) complicates a very small proportion of births. Furthermore it seems likely that many cases recover with little in the way of remaining deficit but it is equally certain that some cases will not recover. There is increasing evidence that microsurgical help at an early stage can improve the prognosis in some cases. Scepticism exists about the role of surgery and many cases are referred too late for primary nerve surgery. Specialist surgical advice, specialist physiotherapy and where appropriate, either early nerve surgery or secondary reconstructive procedures at a later date can improve the condition of many of these children. This review condenses many of the current opinions and highlights areas of developing knowledge and debate.
Brachial Plexus↗
The Hand Injury Severity Scoring System.
A descriptive severity scoring system for injuries to the hand, distal to the carpus, has been designed. Each ray of the hand is assessed separately. Each ray's score is then multiplied by a weighting factor for that ray and added to the scores of the other rays to obtain a total score for the injury. This system has been tested on a series of specimen injuries and compared with the opinion of experienced hand surgeons. A retrospective study of hand injuries has also been conducted, and the Hand Injury Severity Score (HISS) has been found to closely correlate with return to work. Four grades of increasing severity of hand injury have been described. Although this system has been designed as a research tool, it is envisaged that it would be a useful immediate measure of severity and a guide to likely outcome.
Adult↗
Toe to hand transfer in children. Part 1: technical aspects.
Between 1988 and 1994 40 children (age range 9 months-14 years) with either congenital (85%) or acquired hand deformities underwent reconstruction by microvascular autotransplantation of one or more toes. Fourteen underwent a single toe transfer whilst 26 had two second toes transferred to one hand. In 14 of these cases both second toes were transferred at one operation. Whether one or two toes were transferred, the children spent on average 9 days in hospital. None of the transfers failed but 75% of the children underwent staged additional surgery to improve appearance and function. Thirty-seven of the 40 children attended with their parents for follow-up examination by an independent surgeon, a physiotherapist and a clinical psychologist in order to evaluate the results and consequences of surgery. This paper presents the technical considerations for this surgery and examines the influence of the transfer on growth.
Adolescent↗
Toe to hand transfer in children. Part 2: Functional and psychological aspects.
Forty children with congenital (85%) or acquired hand disorders underwent transfer of one or two toes to one hand. The children were reviewed with their parents and assessed for functional and psychosocial performance. There was some evidence that the older the child at the time of transfer, the better the range of motion. The passive range of motion was on average 60 degrees more than the active range of motion despite subsequent procedures such as tenolysis. All transfers recovered protective sensibility and the majority recovered good levels of two point discrimination and light touch perception. Almost all transfers were naturally incorporated into the use pattern of the limb for some or most of the time. Most parents and patients reported a very positive effect of this surgery on the child's psychosocial functioning.
Adolescent↗
Microvascular free-tissue transfers in elderly patients: the leeds experience.
Free-tissue transfer in the elderly has received increasing attention in the literature. Existing reports are limited by small samples or inadequate definition of the term elderly. This study reviewed 5 years' experience with free-tissue transfer in a geriatric population (mean age 75 years, range 70 to 83 years). Forty-nine free flaps were performed in 42 patients between 1986 and 1991. This review focuses on the 39 flaps undertaken in 33 head and neck cancer patients, the main indication being reconstruction after tumor resection (80 percent). In the head and neck cancer group, donor sites included the radial forearm (20), rectus abdominis (6), jejunum (5), and others (8). Thirty-four flaps (87 percent) were primarily successful. Reexploration was required in 10 patients (26 percent) for compromised flaps (5) and bleeding (5). Three of the compromised flaps were salvaged, giving an overall flap success rate of 95 percent. One patient (3 percent) died within 30 days of surgery. These results compare favorably with other published series in elderly patients, as well as with larger cohorts of younger subjects. Free flaps are safe in the elderly. Chronologic age alone should not be an exclusion criterion when selecting patients for free-tissue transfer.
Age Factors↗
Iatrogenic accessory nerve injury.
Accessory nerve injury produces considerable disability. The nerve is most frequently damaged as a complication of radical neck dissection, cervical lymph node biopsy and other surgical procedures. The problem is frequently compounded by a failure to recognise the error immediately after surgery when surgical repair has the greatest chance of success. We present cases which outline the risk of accessory nerve injury, the spectrum of clinical presentations and the problems produced by a failure to recognise the deficit. Regional anatomy, consequences of nerve damage and management options are discussed. Diagnostic biopsy of neck nodes should not be undertaken as a primary investigation and, when indicated, surgery in this region should be performed by suitably trained staff under well-defined conditions. Awareness of iatrogenic injury and its consequences would avoid delays in diagnosis and treatment.
Accessory Nerve↗