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PubMed1994

[Thumb and finger reconstruction by anastomosing the digital arteries of the toe to finger transplant].

In a series of 295 cases of toe-to-finger reconstruction, 30 cases with 40 digits were reconstructed by arterial anastomosis between digital arteries of the toe transplant and the recipient thumb or fingertoe. Among them 5 thumbs were reconstructed by the distal segment of the big toe. 11 thumbs (10 cases), 15 fingers (8 cases) and 1 case with concomitant thumb and 3 fingers were reconstructed by toe transfer. Six cases of thumb pulp defect were also reconstructed by the big toe pulp transfer. The anastomosis of digital arteries instead of dorsalis pedis artery and radial artery and saphenous vein with cephali vein to re-establish circulation is an innovation and has the advantages of simplifying the operative procedure, minimizing operative trauma, reducing operation time, attenuating patients suffering, and obtaining good appearance and function after reconstruction. Besides the operation would not be hindered by anatomical variations of the artery and would reduce blood supply disturbance of the donor foot.

Anastomosis, Surgical↗
PubMed1998

Perception of transplanted toes following toe-to-finger transplantation.

The perception of transplanted toes following toe-to-finger transplantation was investigated. Forty-six (77%) of 60 patients perceived transplanted toes as their fingers immediately or within 6 months after surgery. Such perception occurred following satisfactory surgical outcome, the appearance of adequate sensory or motor function, or both. In the remaining 14 patients, the transplanted toe was perceived as a toe, a toe as well as a finger, or something else. The present data suggest that human perception of transplanted toes appears to be geared toward restoration of the original body image.

Adult↗
PubMed1994

Pathological changes of finger and toe in patients with vibration syndrome.

Pathological findings of the fingers and toes were studied in finger and toe skin specimens from 21 male patients with vibration syndrome and 13 referent male cadavers. Thickening of the medial muscle layer of small arteries or arterioles, and increase of collagen fibers in the connective tissues, especially in perivascular regions, were noted in not only the finger but also the toe in patients with vibration syndrome. The ratio of the media/external diameter in the finger and toe was significantly greater in the patients than in the referents, even in the patients who had operated chain saws, bush cutters or grinders and had not been exposed to vibration of the foot directly. And the ratio in the finger was approximately parallel with that in the toe in the same subject. The present findings pathohistologically confirmed the existence of circulatory disturbances in the feet as well as the hands. The medial thickening of arteries and perivascular fibrosis in the toe can result from not only direct vibration exposure of the foot, but also long-term repeated vasoconstriction and circulatory disturbances in the foot through the activation of the sympathetic nerve system caused by hand-arm vibration.

Aged↗
PubMed2002

Age-related changes in peripheral pulse timing characteristics at the ears, fingers and toes.

It is accepted that older subjects have increasing arterial stiffness, which results in increasingly faster pulse transmission to the periphery. However, this age association is less clear in younger subjects and for different peripheral measurement sites. The aims of this study were to determine the association between age and pulse timing characteristics over a five decade age range at the ears, fingers and toes, and to compare these with any additional effects associated with differences in subject height, systolic blood pressure and heart rate. Photoplethysmography pulse wave-forms were recorded noninvasively from the right and left sides at the ears, fingers and toes of 116 normal healthy human subjects. Their median age was 42 years (range 13-72 years). Systolic blood pressure, height and heart rate were also measured. Pulse transit times (PTTs) were determined and referenced to the electrocardiogram R wave. The results revealed that age was the strongest contributor to PTT differences at all sites (P<0.0001). The decrease with ageing was greatest at the toes: -1.6, -0.6, -0.4 ms/year for the toes, fingers, and ears, respectively. Changes for the right and left body sides at each level were highly similar. Blood pressure was also an important contributor to PTT at all sites (P<0.0001); -1.0, -0.4, -0.3 ms/mm Hg, respectively, with approximately half of the effect explained by age. Height was significantly and independently related to PTT at the fingers and toes (P<0.0001); +1.1, +0.7 ms/cm, respectively. The fraction of PTT variability explained by these relationships was 0.65, 0.48, 0.26 for the toes, fingers and ears, respectively (P<0.0001). Finally, we concluded that the age effect decreased linearly from the second to the seventh decades, demonstrating that the effect of changes in arterial stiffness can be detected noninvasively from an early age at three main peripheral sites. Age is the dominant factor in contributing to PTT, and is greatest at the toes, followed by the fingers and then the ears.

Adolescent↗
PubMed2003

Finger and toe ratios in humans and mice: implications for the aetiology of diseases influenced by HOX genes.

The differentiation of gonads, fingers, and toes is influenced by HOXA and HOXD genes. Therefore variation in the development of the gonads, and their fetal products such as testosterone, may be reflected in the morphology of the fingers and toes. One trait, the relative length of the second and fourth digits (2D:4D), shows sex differences (lower values in males) which are determined early, and 2D:4D has been found to correlate with fetal growth, sperm counts, family size, autism, myocardial infarction, and breast cancer. HOX genes are highly conserved in mammals and they influence the differentiation of all the fingers and toes. We suggest that (a) 2D:4D and other ratios of finger and toe length show sex differences throughout the mammals including humans and mice, (b) finger and toe ratios correlate with sex determination, the fetal production of sex steroids, and fetal programming of disease, and (c) HOX gene influences on sex determination, the morphogenesis of the urinogenital system, fertility, haematopoiesis, and breast cancer suggests that finger and toe ratios in humans and mice may correlate with many sex dependent diseases.

Animals↗
PubMed2001

Superficial acral fibromyxoma: a clinicopathologic and immunohistochemical analysis of 37 cases of a distinctive soft tissue tumor with a predilection for the fingers and toes.

This report describes the clinicopathologic features and immunohistochemical findings identified in 37 cases of a distinctive soft tissue tumor that has a predilection for the hands and feet. The study group included 25 male and 12 female subjects ranging in age from 14 to 72 (mean, 43; median, 46) years. The patients presented with solitary masses 0.6 to 5.0 cm (mean, 1.75 cm) that were present from 3 months to 30 years (median duration, approximately 3 years) before surgical intervention and involved the toes (n = 20), fingers (n = 13), and palm (n = 4). Twenty of the cases were documented to involve the nail region. Histologically, the tumors were typically located in the dermis or subcutis and composed of spindled and stellate-shaped cells with random, loose storiform, and fascicular growth patterns. The lesional cells were embedded in myxoid or collagenous matrix, often with mildly to moderately accentuated vasculature and increased numbers of mast cells. There was generally slight to mild nuclear atypia; only 3 cases had more substantial atypia. Mitotic figures were infrequent. Occasional multinucleated stromal cells were noted in 19 cases. The process showed immunoreactivity for CD34 (21 of 23 cases), epithelial membrane antigen (18 of 25 cases), and CD99 (11 of 13 cases). No immunoreactivity was detected for actins, desmin, keratins, or HMB-45, and only 1 of 23 tumors had weak reactivity for S100 protein. The surgical specimens consisted of biopsy or partial resection specimens (n = 4), local excisions (n = 29), and amputated or partially amputated digits (n = 4). Detailed follow-up, available for 18 patients (mean follow-up interval, 10.1 years), revealed 1 recurrence after local excision and 2 instances of persistent or progressive disease after partial excision. A differential diagnosis of fibrous histiocytoma, dermatofibrosarcoma protuberans, acquired (digital) fibrokeratoma, sclerosing perineurioma, cutaneous myxoma (superficial angiomyxoma), and acral myxoinflammatory fibroblastic sarcoma is discussed.

Adolescent↗
PubMed2004

Immunohistochemical study of skin nerve regeneration after toe-to-finger transplantation: correlations with clinical, quantitative sensory, and electrophysiological evaluations.

Cutaneous nerve regeneration following toe-to-finger transplantation was studied by immunohistochemical technique using antibody to protein gene product 9.5 (PGP 9.5) which is a specific neuronal marker. By this technique, epidermal and dermal nerves were semi-quantified and the Meissner's corpuscles were quantified. There were also quantitative sensory tests (QST) including pinprick, pressure and temperature, as well as electrophysiological studies including digital nerve sensory conduction, digital nerve somatosensory evoked potentials and sympathetic skin response at the pulp of the transplanted toes. The opposite corresponding normal finger and normal toe served as controls. Study subjects were 20 adult patients with toe-to-finger transplantation for at least one year. A score system was used to quantify the results of histochemical, psychophysiological and electrophysiological studies. Clinically 7 patients had good recovery and 13 patients had poor recovery. Cutaneous nerve regeneration in the transplanted toes was incomplete with epidermal nerve, dermal nerve and the Meissner's corpuscle significantly reduced. The nerve regeneration was correlated with clinical recovery, QST and electrophysiological data. These findings indicate that immunohischemical technique is useful to evaluate skin nerve regeneration following toe-to-finger transplantation, and that although nerve regeneration did occur, it was incomplete and correlated with the severity of hand injury.

Adolescent↗
PubMed1994

Raynaud's phenomenon of fingers and toes among vibration-exposed patients.

Eleven patients with Raynaud's phenomenon of the toes as well as the fingers were encountered among about 1,000 vibration-exposed patients. They consisted composed of four chain-saw operators, five rock drillers, a stone quarrier and a welder in a shipyard. All the cases were examined carefully for differential diagnosis, but there were no particular abnormalities in hematological, immunological and homodynamic examinations. The rock drillers, quarrier and welder had direct vibration exposure of the foot, which was considered to be responsible for their Raynaud's phenomenon of the toe. Four chain-saw operators, who had been little exposed to vibration of the foot directly, were examined further on skin temperature of fingers and toes every three hours except at night and in a 30-min cold provocation test at 5 degrees C. The skin temperature of both their fingers and toes was lower than in age-matched healthy controls. The chain-saw operators started to work in the 1960's and early in the 1970's, when the chain saw vibration level was high. It is, hence, considered that they were exposed to strong vibration of the hand from chain saws, and then suffered severe Raynaud's phenomenon of both fingers and toes.

Aged↗
PubMed1999

The uptake of fluconazole in finger and toe nails.

OBJECTIVE: The uptake of the antimycotic agent fluconazole in finger and toe nail following various treatment schedules was investigated in order to characterize the pharmacokinetic basis for the systemic treatment of onychomycosis with fluconazole. SUBJECTS: Between 8 and 12 healthy, male and female Caucasian subjects were included in four separate studies. Mean age of the subjects in the single studies ranged between 34 years (study 4, group 2; n = 4 male and 4 female) and 38 years (study 4, group 1; n = 4 male and 4 female). METHODS: Fluconazole was administered orally over 4 weeks in all studies. The treatment schedules were 150 mg once weekly (study 1), 300 mg once weekly (study 2), 50 mg once daily (study 3) and 150 or 300 mg once weekly in a parallel group study (study 4). At fixed times samples of blood, nail cuttings and nail dust were taken, up to two months after end of treatment. Fluconazole was analyzed in blood plasma and in the nail samples using a highly specific and sensitive gas chromatographic procedure. RESULTS: High concentrations of fluconazole were found in distal nail clippings with all three treatments. Mean maximum concentrations which occurred in the third or fourth week of treatment amounted to 2.1 microg/g (150 mg/w), 5.4 microg/g (300 mg/w) and 6.5 microg/g (50 mg/d) in finger nails and to 9.6 microg/g (150 mg/w), 12.3 microg/g (300 mg/w) and 12.2 microg/g (50 mg/d) in toe nails. The nail concentrations were 1-2 times (finger) and 2-3 times (toe) higher than the corresponding fluconazole plasma levels and were within the MIC range for dermatophytes and yeasts occurring commonly in onychomycosis. The residence times of fluconazole in the nail plate after the end of treatment was long, with approximate half-lives of 33 days in finger nail and 30 days in toe nail. In pharmacokinetic terms there was no evidence of advantages of the daily dosage (50 mg) over the once-weekly (300 mg) dosage. Fluconazole was found to penetrate into both finger and toe nails at a very fast rate. On the first two days of the 150 mg/w and 300 mg/w treatments, i.e. after the first dosage, fluconazole concentrations in the distal nail plates amounted to 50-80% of the later observed peak levels. The initial concentrations in the upper dorsal plate were particularly high, with mean peak concentrations of 11.9 microg/g (150 mg) and 33.7 microg/g (300 mg) in finger nails and 5.7 microg/g (150 mg) and 24.4 microg/g (300 mg) in toe nails. CONCLUSIONS: Fluconazole is rapidly and highly distributed into finger and foot nail, reaching there higher concentrations than in the plasma. The rapid initial uptake of fluconazole in nail, which is unlike the uptake of other antifungal agents, suggests the existence of special routes of access to the nail for fluconazole, possibly based on high diffusion rates.

Adolescent↗
PubMed2003

Aspirin-responsive painful red, blue, black toe, or finger syndrome in polycythemia vera associated with thrombocythemia.

Five patients with red, purple blue, or black toes or fingers due to thrombocythemia associated with polycythemia vera (polycythemia and thrombocythemia vera) in four and essential thrombocythemia (thrombocythemia vera) in one are described. The microvascular erythromelalgic syndrome of thrombocythemia was overlooked and progressed to cold blue swollen and painful fingers or black toes in three patients with polycythemia and thrombocythemia vera due to arteriographically documented occlusions of digital or large peripheral arteries with no evidence of preexistent atherosclerotic vascular disease. Concomitant erythromelalgia of the hand palm could be confirmed by the histopathological findings of arteriolar thrombotic lesions in the reticular dermis in two patients with polycythemia and thrombocythemia vera. The increased hematocrit in the presented patients with polycythemia and thrombocythemia vera contributed to the progression of the microvascular syndrome of thrombocythemia to major occlusive ischemic events of the extremities. Standard therapy with oral anticoagulants and reduction of the hematocrit to normal by bloodletting did not affect the platelet-mediated microvascular erythromelalgic, ischemic symptoms in the patients with polycythemia vera because thrombocythemia vera persisted. Complete relief of pain and restoration of the ischemic acral circulation disturbances in patients with thrombocythemia vera or thrombocythemia associated with polycythemia vera in maintained remission by bloodletting could be obtained by long-term treatment with low-dose aspirin.

Aged↗
PubMed1989

Measurements of human pressure-pain thresholds on fingers and toes.

Pressure-pain thresholds (PPT) were measured on fingers and toes with a hand-held electronic pressure algometer in 15 males and 15 females. The pressure algometer offered easy control of pressure application rate. The intra-individual coefficient of variation, based on repeated PPT measurements with a 1 week interval was 14%. The inter-individual coefficient of variation was 28% for females and 33% for males. In the course of 10 consecutive PPT measurements with short intervals (10 and 20 sec), no significant change in PPT was observed. PPT was found to be 50% higher in males than in females (P less than 0.0001). Slightly but significantly higher PPT values were found on the dominant compared to the non-dominant side (P less than 0.005).

Adult↗
PubMed1989

Treatment of mucoid cysts of fingers and toes by injection of sclerosant.

Mucoid cysts of the fingers and toes may be cured by injection of a sclerosant such as sodium tetradecyl sulfate. Easy to perform and inexpensive, this technique appears to be without complications. Most patients are cured after a single injection. Very few need a second or third injection. Relapses are uncommon.

Adult↗
PubMed2000

Mapping the basal ganglia: fMRI evidence for somatotopic representation of face, hand, and foot.

OBJECTIVE: To noninvasively investigate the somatotopy of the basal ganglia in humans. METHODS: Functional MRI, 1.5-T, was performed on six normal right-handed volunteers during simple acoustically paced motor tasks involving the right hand, foot, and face. RESULTS: In a single-subject analysis, statistical parametric maps showed overlapping activation extending along the anteroposterior extent of the left lentiform nucleus (LLN) for the hand, foot, and face representations. Within the LLN, the centers of gravity of each body part, reflecting both the extent and gradient of activation, were all located in the retrocommissural portion of the putamen. Their spatial relationship followed a similar pattern across subjects-face was medial to toes and fingers, toes were dorsal and rostral to fingers. CONCLUSIONS: The somatotopic organization of hand, face, and foot representation in the human lentiform nucleus suggests a triangular pattern, rather than the linear pattern seen in primate studies. The overlap observed between the distinct body parts differs from the cortical sensorimotor representation, indicating a different organizational concept of the basal ganglia.

Adult↗
PubMed2003

Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis.

OBJECTIVE: To evaluate the interobserver agreement of ultrasonographic assessment of finger and toe joints in patients with rheumatoid arthritis (RA) by 2 investigators with different medical backgrounds. METHODS: Ultrasonography and clinical examination were performed on 150 small joints of 30 patients with active RA. A General Electric LOGIQ 500 ultrasound unit with a 7-13-MHz linear array transducer was used. In each patient, 5 preselected small joints (second and third metacarpophalangeal, second proximal interphalangeal, first and second metatarsophalangeal) were examined independently on the same day by 2 ultrasound investigators (an experienced musculoskeletal radiologist and a rheumatologist with limited ultrasound training). Joint effusion, synovial thickening, bone erosions, and power Doppler signal were evaluated in accordance with an introduced 4-grade semiquantitative scoring system, on which the investigators had reached consensus prior to the study. RESULTS: Exact agreement between the 2 observers was seen in 91% of the examinations with regard to bone erosions, in 86% with regard to synovitis, in 79% with regard to joint effusions, and in 87% with regard to power Doppler signal assessments. Corresponding intraclass correlation coefficient values were 0.78, 0.81, 0.61, and 0.72, respectively, while unweighted kappa values were 0.68, 0.63, 0.48, and 0.55, respectively. Ultrasonography showed signs of inflammation in 94 joints, while clinical assessment revealed tenderness and/or swelling in 64 joints. CONCLUSION: An experienced radiologist and a rheumatologist with limited ultrasound training achieved high interobserver agreement rates for the identification of synovitis and bone erosions, using an introduced semiquantitative scoring system for ultrasonography of finger and toe joints in RA. Signs of inflammation were more frequently detected with ultrasound than with clinical examination. Ultrasonography may improve the assessment of RA patients by radiologists and rheumatologists.

Adult↗