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At least 181 records · Page 10Linked to original sources

PubMed1988

Hair-thread tourniquet syndrome .

We have witnessed six cases of the hair-thread tourniquet syndrome, an entity characterized by strangulation of an appendage (toes, fingers, or external genitalia) by hair or hair-like fibers in the pediatric population. All six of our cases were in infants, 12 days to 5 months of age. The offending fibers were hair in three of the four patients with toe injuries and synthetic fibers from mittens in the finger cases. All six patients were treated by immediate removal of the constricting fibers, and, in spite of the worrisome appearance of the tissue distal to the constriction, all six eventually healed without significant tissue loss. A review of the literature indicated 60 similar cases of this type reported, 24 involving toes, 14 involving fingers, and 22 involving genitals. The majority of the toe and external genitalia cases were caused by hair, whereas the majority of finger strangulations were caused by thread from mittens. At greatest risk for strangulation are the middle finger and third toe, followed by the index finger and second toe. Patients with finger or penile involvement were more likely to suffer significant complications from the injuries than those patients with toe involvement. Based on our own experience and that described in the literature, we recommend prompt removal of the offending fiber, followed by prolonged conservative management of the damaged distal tissue, in the hope of maximal tissue salvage. Increased physician awareness of this syndrome is mandatory for prevention, diagnosis, and early treatment.

Clothing↗

PubMed1987

Occurrence and distribution of neuropeptides in the human skin. An immunocytochemical and immunochemical study on normal skin and blister fluid from inflamed skin.

The content and distribution of substance P (SP), somatostatin, vasoactive intestinal peptide (VIP), calcitonin gene-related peptide (CGRP) and neuropeptide Y (NPY) in human skin were investigated. Radioimmunoassay was performed on pooled tissue samples from several regions (fingers, toes, axillas and thighs) and on tissue fluid from spontaneous blisters on inflamed skin. Immunocytochemical localization showed all peptides examined except somatostatin to be present in nerve fibers. Nerve fibers storing SP and CGRP, which were found to coexist, were mostly present as free nerve endings in the superficial part of dermis and in epidermis. SP/CGRP fibers were most abundant in fingers and toes. VIP fibers and NPY fibers were localized in the deeper parts of dermis around blood vessels and acini of sweat glands. Also fibers containing these neuropeptides were most common in fingertips and toes. VIP occurred in relatively high amounts also in skin from axilla whereas NPY in this region was below detection limit. Immunoreactive somatostatin was found in low concentrations in tissue extracts and was not present in amounts sufficient for reliable immunostaining. Fluid from spontaneous blisters on inflamed skin contained detectable amounts of all neuropeptides.

Adolescent↗

PubMed2003

Free hand-to-toe transfer: a method to minimise donor-site morbidity in free joint transfers.

Reconstruction of a congenital hand anomaly in a child using single free vascularised transfer of the proximal interphalangeal joint of a second toe with the simultaneous microvascular reconstruction of the donor toe using the stiff joint and its dorsal skin paddle from the hand is described. This is not the first reported case of a toe-finger switch, but it is the first in a free joint transfer, for which it is especially indicated.

Child, Preschool↗

PubMed1993

40-Hz oscillations during motor behavior in man.

40-Hz oscillations were measured during finger, toe and tongue movement using an electrode array of 56 electrodes over the pre and post central areas. Each movement was made 150 times in intervals of 12 s. The average power increase in narrow frequency bands between 8 and 40 Hz was then calculated and the topographical distribution studied. 40-Hz oscillations were only found contralateral over the hand area for finger movements, close to the vertex for toe movements and bilateral symmetrical for tongue movements. The maxima of the 40-Hz oscillations occurred before movement onset.

Brain Mapping↗

PubMed1989

Treatment of dermatophyte infection of the finger- and toe-nails with terbinafine (SF 86-327, Lamisil), an orally active fungicidal agent.

We report on the use of a new orally active fungicidal agent, terbinafine (SF 86-327, Lamisil) in the treatment of patients with dermatophyte onychomycosis. Twenty patients with toe-nail, and 10 with finger-nail infection received 250 mg of terbinafine daily: finger-nail infections were treated for 6 months and toe-nail infections for 12 months. All 24 patients who completed the course of therapy achieved mycological cure, as did two subjects who dropped out of the trial. All but two patients had clinically normal nails at the end of the study period. The mean time for mycological cure was 12.5 weeks for finger-nail infection, and 24 weeks for toe-nail infections. The time for a clinical cure with normal nails was 20.5 weeks for finger-nail infection, and 44 weeks for toe-nail infection. An exacerbation of pre-existing dyspepsia occurred in three of the six patients who did not complete the trial but there were no other significant adverse reactions.

Administration, Oral↗

PubMed1988

Forehead pulse oximetry compared with finger pulse oximetry and arterial blood gas measurement.

Usual monitoring sites for pulse oximetry involve the fingers, toes, ear lobe, and nasal septum. This study examined the performance of a forehead sensor compared with a finger sensor for the pulse oximeter and arterial blood gas (ABG) analysis. Ten healthy adult volunteers and 22 ventilator-dependent patients were studied. The arterial oxygen saturation detected by forehead pulse oximetry (SpO2) correlated well with finger SpO2 and arterial oxygen saturation (SaO2) determined by arterial blood gas analysis in the healthy volunteers. Forehead SpO2 in mechanically ventilated patients correlated well with finger SpO2 and SaO2 when heart rate detected by pulse oximeter differed less than 10% from apical heart rate. Factors that caused a difference in oximeter-detected heart rate and apical heart rate were extensive tissue edema, head movement, and difficulty securing good tape placement. This suggests that when signal strength is weak, causing poor pulse rate detection, there will also be problems associated with accurate SpO2. The forehead pulse oximeter sensor works well on healthy, well-oxygenated volunteers. Difficulty was experienced when applying and using the sensor on critically ill patients. The reliability of the forehead pulse oximeter sensor has not been established at low saturations.

Adolescent↗

PubMed1983

Finger movement versus toe movement-related potentials: further evidence for supplementary motor area (SMA) participation prior to voluntary action.

The cerebral potentials associated with voluntary, self-paced rapid flexions of (1) right fingers, (2) left fingers, (3) right toes, and (4) left toes were compared in the same experiment using 32 right- and left-handed subjects. The Bereitschaftspotential (BP) or readiness potential was, in the first half of the foreperiod, bilaterally symmetrical for both finger and toe movements of either side. In the later foreperiod there were differences: Finger movements showed two maxima, an early one at Cz and a late one, which was lateralized toward the contralateral precentral region. With toe movements, the maximum BP amplitude was always at Cz and not lateralized and was twice as large as with finger movements. The data are compatible with the view that two principal sources of different spatial and temporal characteristics are active in the foreperiod of a voluntary movement. The early generator is probably the supplementary motor area (SMA) on the mesial surface of the hemispheres; the later is the primary motor cortex (MI) which is lateralized for finger but not for toe movements. In lateral leads, rather remote from the mesial source, the BP for toe movements showed a small but significant ipsilateral preponderance, which is obviously due to the fact that dipole sources located on the mesial surface of the hemispheres point to the opposite direction as compared to those on the convexity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1976

Peripheral circulation, particularly heat regulation reactions, in patients with amyloidosis and polyneuropathy.

As patients with amyloidosis and polyneuropathy often have signs and symptoms of circulatory disturbances in the extremities, especially the legs, we have examined such patients and controls with oscillometry and digital pulse plethysmography in order to estimate the occurrence of any arterial circulatory insufficiency. No signs of significant obliterative arterial changes were found. Skin temperature was also determined in fingers and toes during body-cooling and at subsequent indirect heating. At low environmental temperature the skin temperature was higher in patients than in controls. In a few patients there was almost no decrease in skin temperature, despite a long period of cooling and a low rectal temperature. Indirect heating elicited a marked increase in the skin temperature of the toes and fingers of the controls. In most patients this reaction was completely absent in the toes and absent or reduced in the fingers. These deviations can be explained by nerve damage caused by amyloid deposition in the nerves. Amyloid deposits in the wall of small blood vessels may be an additional factor. Maximum blood flow in the anterior tibial muscle after combined ischemia and exercise, investigated with radioactive xenon, was reduced in half of the patients.

Adult↗

PubMed1987

[Juvenile digital fibroma: apropos of 2 cases].

The authors report 2 cases of infantile digital fibromatosis. These benign tumours occur in newborns and infants, involving mainly the extremities (fingers, toes). Its prevalence is probably higher than the reported cases. The pathogenesis and treatment are discussed. The diagnosis of such fibrous tumours is useful since surgical treatment can be avoided in a majority of cases.

Female↗

PubMed1983

Somatosensory evoked potentials via lumbosacral pathways: a comment on naturalistic stimulation.

Somatosensory evoked potentials (SEPs) were averaged from several scalp derivations in 3 subjects (1 M, 2 F) for transcutaneous electrical stimulation of toes and perineum. These lumbosacral SEPs were amplitude-focal at vertex for 40-300 msec components. Peak latencies in the 40-120 msec time segment were significantly later for perineal stimulation of equivalent subjective magnitude, contrary to expectation from relative afferent pathway lengths. One subject (M) showed a monotonic latency retardation of an intermediate component (SP50-SN75) for equivalent stimuli at lips, fingers, toes, genitalia, and perianum. Vertex potentials (SN140-SP200) did not show this temporal sequence. Though interpretation of such data is currently ambiguous, systematic application of comparative evoked potential/magnetic field techniques could yield data useful to clinical neurologists.

Adult↗

PubMed2005

Measurement of joint space width and erosion size.

Measurement of radiographic abnormalities in metric units has been reported by several investigators during the last 15 years. Measurement of joint space in large joints has been employed in a few trials to evaluate therapy in osteoarthritis. Measurement of joint space width in small joints has been reported by several investigators but has not yet found a place in clinical trials in rheumatoid arthritis or osteoarthritis. We review methods for measuring joint space width in finger, toe, and wrist joints; special attention is given to how the joint edges are found, the method used to measure distance between joint margins, size of an area of the sampled joint, and reproducibility of measurements. Methods for measurement of erosion size, which have had less attention, are briefly discussed.

Arthrography↗

PubMed1984

Spacetime body maps and somatosensory evoked potentials.

Scalp-recorded somatosensory evoked potentials (SEPs) in humans and dogs suggest that it takes longer for peripheral information to reach the brain from the anogenital perineum than from the distal hind limbs, in spite of a shorter afferent pathway. The delay seems to be centrally determined, rostral to the lumbar segments, rather than by slower conduction velocities in the peripheral pudendal-sacral afferents. Thus the mammalian brain may temporally conserve the spatial sequence of segmental inputs in spite of variable afferent pathway lengths and/or conduction velocities. Human SEPs indicate the arrival timetable in cortex to be ordered: Lips, fingers, toes, genitals, anus; with a delay between lips and anogenital perineum of 30-40 msec. This delay is comparable to the interpair-interval threshold for human detection of two successive tactile events on the fingers, while ambiguous temporal defusion of two successive identical stimuli can be perceived down to objective separations of about 15 msec. It is suggested that, whereas the metric tensor model proposes central correction of asynchronous sensorimotor signals within an approximately 30 msec predictive function by cerebellar circuitry (in order to avoid spatial distortion in a spacetime tensor of sensorimotor processing), the brain may use longer time differences between proximal and distal receptive fields to develop a Cartesian, four-dimensional body map within its adaptive, behavioral world.

Anal Canal↗

PubMed1983

Peripheral hemodynamics in patients with Fabry's disease.

Altered vasomotor activity has been reported as a clinically prominent feature of Fabry's disease (angiokeratoma corporis diffusum universale). While symptomatic cardiovascular involvement occurs eventually in most patients with this disorder, little is known concerning the effect of Fabry's disease on peripheral hemodynamics. Peripheral hemodynamics in the extremities and digits were studied in eight patients with Fabry's disease by means of segmental and venous occlusion pneumoplethysmography and thermal probes, and the results obtained were compared with those of 10 normal subjects. Forearm vascular resistance in Fabry's disease patients was significantly higher (p less than 0.01) than that in normal subjects. Forearm venous capacitance in Fabry's disease was significantly lower (p less than 0.01). Segmental pulse volume amplitudes showed no significant difference in any segments (upper arm, wrist, thigh, above and below knee, and the calf) between the two groups. Finger and toe blood flow, finger and toe pulse volume, and temperature in the resting state were all significantly less (p less than 0.01, p less than 0.05: p less than 0.01, p less than 0.01: p less than 0.05, p less than 0.05, respectively) than those in normal subjects. Finger and toe blood flow and pulse volume after vasodilation procedures were significantly less (p less than 0.05, p less than 0.01: p less than 0.05, p less than 0.01, respectively) than those in normal subjects despite equal elevation of digital temperature obtained after vasodilation in both groups. These findings indicate the presence of vasoconstrictive process in both resistance vessels and capacitances vessels in cutaneous and skeletal muscular beds. A limited response in the cutaneous circulation to vasodilation procedures also was seen. These data suggest the possibility that latent enhanced sympathoadrenal discharge as well as the accumulation of glycolipid in the autonomic nervous system and vessel walls plays an important role in the disturbed pathophysiology of this disorder.

Adolescent↗

PubMed1982

Widespread cutaneous candidiasis and tinea infection masking mycosis fungoides.

A 71-year-old female with a widespread double mycotic infection caused by C. Albicans and T. rubrum was discovered to be suffering from mycosis fungoides. Clinically she was found to have large, polycyclic erythematous plaques with scaly, slightly infiltrated borders, covering almost all areas of the glabrous skin, and also involving the scalp (with no hair penetration), the soles and palms, toe-webs, finger and toe nails; there was also perleche and oral thrush. Cultures yielded C. albicans from most of the skin lesions, from the scalp, mouth, finger nails and urine and stool specimens, and T. rubrum from intermingled skin specimens, from the palms and soles and toe-nails. Blood culture was negative as were intracutaneous tests with fungal antigens and tuberculin. Histological examination confirmed the fungal invasion of the horny layer and at the same time revealed an underlying pathologic picture of mycosis fungoides, the lesions having been masked by the mycotic eruption. Intensive cytostatic and antifungal therapy led to a transient improvement but shortly thereafter there was a relapse of the fungal and lymphoproliferative manifestations and the patient died in septic shock.

Aged↗

PubMedDate not supplied

[Meningococcal meningitis in the adult complicated by cutaneous necrosis: description of a clinical case].

Meningitis and meningococcal sepsis are emergency conditions associated with high mortality. The outcome is worsened by the onset of disseminated intravascular coagulation. This may present, particularly in children, with the clinical picture of purpura fulminans, characterized by extensive necrotic-hemorrhagic skin lesions, ischemia of the extremities and multiorgan failure. It has been observed that depletion of coagulation inhibitors, particularly protein C, plays a key role in the development of this severe complication. We describe the case of a woman who presented in the Emergency Room with signs of meningitis, drowsiness, hypotension and petechie. Bacterioscopic examination of the cerebrospinal fluid evidenced characteristic gram-negative diplococci. Laboratory data disclosed initial disseminated intravascular coagulation with low levels of proteins C and S. Following intravenous infusion of antibiotics, fluids and fresh frozen plasma, the patient's condition rapidly improved. However, multiple skin lesions appeared on her fingers, toes and heels. It is likely that the infusion of coagulation inhibitors contained in fresh frozen plasma, prevented evolution to full-blown purpura fulminans. The first choice treatment for purpura fulminans in meningococcal sepsis is infusion of protein C concentrate, which is not, however, currently available on the market.

Aged↗

PubMed1984

Short-latency cortical potentials evoked by tactile air-jet stimulation of body and face in man.

Natural cutaneous stimulation was performed in 10 healthy volunteers by means of a brief, localized air jet directed to the glabrous skin of the face, finger or toe. Neurograms (from finger stimulation) and somatosensory evoked potentials (SEPs) were recorded and, in the case of finger and toe stimulation, compared with the SEPs obtained by low intensity electrical stimulation. Comparing the latencies at wrist and elbow of the respective neurograms, it appears that a 2 msec period accounts for skin indentation and build-up of the generator potential in the receptors activated by the air jet. A slightly lower conduction velocity was obtained on natural than on electrical stimulation, and the cortical SEPs accordingly had a longer latency. In spite of the much smaller amplitude of the air-jet evoked neurograms, the amplitudes of the SEPs from finger and toe were similar to the amplitudes of the SEPs on electrical stimulation of the same regions. Natural stimulation in the regions innervated by the 3 branches of the trigeminal nerve (tongue included) yielded consistent SEPs, comparable with those reported in the literature to electrical stimulation. These potentials were distinguishable from the electrical activity due to the blink reflex, which invariably takes place on air-jet stimulation of the first trigeminal branch.

Adult↗

PubMed2003

Symmetrical peripheral gangrene and dopamine.

We describe a case of a 55-year-old man with hypovolemic shock who developed a symmetrical peripheral gangrene (SPG) on hands and feet. The SPG syndrome consists of sudden onset of symmetrical gangrene of the fingers, toes and rarely, the nose, upper lip, ear lobes or genitals without large vessel obstruction or vasculitis. Vasopressors have been implicated directly or as a contributory cause in many cases. In this case, dopamine was used with high dose (> 20 microg/kg/min) which is inappropriate in hypovolemic shock states. SPG might be a severe and rare complication of dopamine. Care should be taken with the use of dopamine in patients with shock.

Blood Transfusion↗

PubMed1995

Functional segregation of movement-related rhythmic activity in the human brain.

Multiple synaptic interconnections in the human brain support concerted rhythmic activity of a large number of cortical neurons, typically close to 10 and 20 Hz. Our present neuromagnetic data provide evidence for distinct functional roles of these spectral components in the somatomotor cortex. The sites of suppression during movement and the subsequent rebound of the 20-Hz rhythm followed, along the motor cortex, the representation of fingers, toes, and mouth, as opposed to the stable origin of the 10-Hz rhythms close to the hand somatosensory cortex. The 20-Hz activity appears to be a signature of active immobilization following movement, whereas the reactive 10-Hz signals likely reflect lack of relevant sensory input from the important upper limbs.

Adult↗