The evolution of hexamerins and the phylogeny of insects

The impact of group discussion on the decision-making effectiveness of medical teams was examined. Three-person teams of physicians diagnosed 2 hypothetical medical cases. Some of the information about each case was given to all team members prior to discussion (shared information), whereas the rest was divided among them (unshared information). Compared with unshared information, shared information was more likely to be pooled during discussion and was pooled earlier. In addition, team leaders were consistently more likely than other members to ask questions and to repeat shared information and, over time, also became more likely than others to repeat unshared information. Finally, pooling unshared (but not shared) information improved the overall accuracy of the team diagnoses, whereas repeating both shared and unshared information affected bias (but not accuracy) in the diagnoses.     

Load mechanics of the wrist

During the last decade, we have been studying load mechanics under a variety of conditions using pressure-sensitive film and, more recently, three-dimensional reconstructions and motion analysis. In all of these studies using pressure-sensitive film, the simulated pathologic or traumatic conditions that were tested showed that all areas in which an increase in contact area or pressure occurred, localized to one area of one joint, coincided with areas in which degenerative changes occurred in the simulated clinical situation. The areas in which there was a decrease or no change in contact area or pressure coincided with areas that were spared from degenerative changes in simulated clinical situations. More recent work has demonstrated that normal carpal kinematics during wrist flexion and extension do not have an instantaneous screw axis that is fixed in or limited to the capitate. These findings change the understanding previously based on studies suggesting that the center of rotation was fixed in the capitate. It was noted that during global wrist motion the radiolunate joint contributes more motion and flexion than the capitolunate joint, but the capitolunate joint contributes more motion and extension than the radiolunate joint. It also was demonstrated that translational motion is a normal component of carpal kinematics.     

The monitor findings of digitalized conventional wrist x-rays

The study aimed at proving the reliability of monitor systems with the matrix of 1024 x 768 for the detection of scaphoid fractures compared to conventional X-ray. Moreover, we were interested in the significance of procedures of digital imaging post processing, depending in particular on the experience of investigators. 5 investigators with different levels of experience analysed 57 X-rays of the wrist. They compared conventional X-rays with images on a high screen monitor system after the digitalisation of these X-rays by a CCD-scanner and analysed untreated and treated images. A 5-point scale ROC analysis was used for evaluation. The analysis covered a total of 1740 evaluations. The untreated images seen on the monitor system proved slightly better than conventional X-rays. Post-processing has no evident advantage over untreated images. Differing levels of experience had no effect whatsoever on the identification of findings.     

The development of cartilaginous wrist in human fetuses

Wrist bones were studied in fetuses aged 9 to 24 weeks. In fetuses aged 9 weeks the primordia of all wrist bones are present. The joint cavities begins to form early in the 3rd month.     

Magnetic resonance imaging of the wrist

MR imaging of the wrist has the unique capability of simultaneously demonstrating bone and soft tissue structures. Its exquisite sensitivity for detecting bone marrow edema makes it and ideal screening tool for diagnosing radiographically occult osseous injuries and areas of AVN. This, together with its ability to provide a comprehensive, non-invasive assessment of the ligaments, tendons, nerves, and components of the TFC make MRI a very powerful tool for evaluating patients with wrist pain of uncertain etiology. Its exact role in the work-up of these patients has not been entirely established, but with further advances in technology and the radiologist's understanding of wrist anatomy and pathology, MRI is assuming a more central role in this clinical setting.     

Static external fixation of the wrist

Historical evolution in concepts, indications, application, reduction techniques, and the rehabilitation program and complications of external fixation of the wrist are discussed. Indirect reduction techniques using overdistraction and flexion are recommended. Additional stabilization of the epiphysis allows immediate reduction of overdistraction, thus eliminating the potential complications related to overdistraction. Used with the due attention to detail, external fixation of the wrist is a rewarding and efficient treatment method.     

Dupuytren's disease affecting the wrist

A unusual example of Dupuytren's disease occurred in a black patient with a strong diathesis. The disease affected the insertion of flexor carpi ulnaris at the wrist as well as the palm.     

Fractures of the wrist and hand

The hands are extremely vulnerable to injury because of their constant use. This chapter features analyses of the evaluation, treatment, rehabilitation, and complications of fractures of the distal radius, carpus, metacarpals, and phalanges.     

The traumatology of the articular disc of the wrist (author's transl)

At 89 Patients with painfull wrist and clinical symptoms like a lesion of the triangular disc, arthrography of the radiocarpal joint was performed. In 18 cases with corresponding arthrographical findings removal of the disc results in clear recovery respectively painlessness. That simple operation seems to be an alternative to the resection of the ulna and a replaceable method if symptomatology and arthrography are accordingly. The described proceeding becomes important because no recovery was seen by conservative treatment.     

The role of arthroscopy in the treatment of wrist injuries in the athlete

Wrist arthroscopy provides an ideal means of evaluating intraarticular soft-tissue injuries of the wrist. Many lesions such as tears of the triangular fibrocartilage complex can be treated by arthroscopic means as well. Reduction of articular fractures of the distal radius and pin fixation, reduction of scaphoid fractures and intramedullary fixation, and arthroscopic reduction and transcutaneous pin stabilization of acute carpal dissociation patterns can all be accomplished with minimally invasive techniques under arthroscopic control. These measures often provide the athlete with shorter periods of immobilization and earlier return to athletic competition. Wrist arthroscopy provides a very useful adjunct to the treatment armamentarium of all sports medicine physicians.     

The relative contribution of selected carpal bones to global wrist motion during simulated planar and out-of-plane wrist motion

The present study assesses the endocrinological, endometrial histology and vaginal ultrasound profiles of nomegestrol acetate subdermal implant users at varying times after insertion. Follicle stimulatory hormone, luteinizing hormone, oestradiol, progesterone, vaginal ultrasound assessment of the ovaries and the histological dating of the endometrium were serially assessed for a period of 50 days immediately after the insertion, and after at 6 months and 12 months of use. The endocrinological results of this prospective observational clinical trial indicated that 75% of the cycles across the study period in Uniplant users were anovulatory, 63% showing development of a persistent non-luteinized follicle. Anovulatory cycles devoid of follicular development were seen primarily in the first months after Uniplant insertion. Ovulatory cycles represented 25% of the Uniplant cycles. Inadequate luteal phase or disregulation of follicular growth was a common feature of ovulatory cycles. In conclusion, these findings suggest that the contraceptive mechanisms of a single nomegestrol acetate subdermal implant involve prevention of follicular growth, development of a persistent non-luteinized follicle, inadequate luteal phase and disruption of the endometrial architecture.     

The phylogeny of unicellular, extremely halotolerant cyanobacteria

We examined the morphology, physiology, and 16S rRNA gene sequences of three culture collection strains and of ten novel isolates of unicellular cyanobacteria from hypersaline environments. The strains were morphologically diverse, with average cell widths ranging from 2.8 to 10.3 micron. There were single-celled, colonial, and baeocyte-forming strains. However, morphological traits were markedly variable with culture conditions. In contrast, all strains displayed extreme halotolerance (growing close to optimally at above 12% salinity); all were obligately marine, euryhaline, and moderately thermophilic; and all shared a suite of chemotaxonomic markers including phycobilins, carotenoids, and mycosporine-like amino acids. 16S rRNA gene sequence analysis indicated that the strains were related to each other. Sequence similarity analysis placed the strains in a monophyletic cluster (which we named the Halothece cluster) apart from all cultured or uncultured, not extremely halotolerant cyanobacteria whose 16S rRNA gene sequences are available in public nucleotide sequence databases. This represents the first case in which a phylogenetically coherent group of cyanobacteria can be defined on the basis of physiology. The Halothece cluster contained two subclusters that may be divergent at the generic level, one encompassing 12 strains (spanning 5% 16S rRNA gene sequence divergence and named the Euhalothece subcluster), and a single deep-branching isolate. Phenotypic characterization of the isolates, including morphological, physiological, and chemotaxonomic traits, did not distinguish these subclusters and only weakly suggested the existence of two separate clades, one encompassing strains of small cell size (cell width < 5 m) and another one encompassing strains of larger cell size.     

Our method of arthrodesis of the wrist

An interdisciplinary review of 16 ventilator-assisted, cervical-cord injured youth, aged 3-19 years, was completed to explore long-term outcomes and develop recommendations for care. Ten youths were younger than 12 years; 6 were adolescents. The mean initial hospital length of stay was 192 days. Discharged youths were followed for 1-73 months after hospitalization. Nursing implications were developed using a systems approach with North American Nursing Diagnosis Association (NANDA) approved diagnoses. Nursing case management was used to coordinate discharge planning and continuity of care. At the time of data collection 13 youths had been successfully reintegrated to home, school and community, the least restrictive environments for all.     

Gymnastic wrist injuries

The evolution of enteral feeding via tubes, syringes, and other mechanical devices probably began in Egypt before the birth of Christ. Today's feeding tubes are a safe and effective means for providing long-term feeding to patients unable to maintain sufficient nutrition by oral intake. The needs of enterally-fed patients are presently being met with feeding tubes that are biocompatible, easy to use, and relatively inexpensive to manufacture.     

An unusual transcapitate fracture of the wrist

The lymphocyte proliferative response to PHA, Con A and PWM was studied in patients with lung tumors (stage I-IV) and other histological types. Disorders in the mitogen-induced lymphocyte activation were identified in more advanced tumors. Certain peculiarities of lymphocyte proliferative activity were found to be determined by histological pattern and localization. A method of evaluation of blasttransformation consequences with due account of lymphocyte functional activity in cancer patients is suggested.     

Luno-triquetral angle and dislocation of the wrist

BACKGROUND: In the United States, pulmonary adenocarcinomas have recently replaced squamous cell carcinomas as the most frequent type of lung cancer encountered. The incidence of pulmonary adenocarcinoma continued to increase worldwide. METHOD: To determine the roles of the transforming growth factor-beta 1 (TGF-beta 1), and TGF-beta type I receptor (T beta R-I), and the TGF-beta type II receptor (T beta R-II) in the progression of a pulmonary adenocarcinoma, their respective expressions have been immunohistologically studied in specimens from 120 pulmonary adenocarcinoma patients. RESULT: The overall prognosis was significantly poorer for patients showing positive TGF-beta 1, T beta R-I, T beta R-II expressions than for patients who were negative to all three immunostainings (P < 0.01). Our multivariate analysis also revealed that a positive TGF-beta 1 response significantly affect prognosis (P < 0.05). CONCLUSIONS: TGF-beta 1, T beta R-I, and T beta R-II play important roles in tumor progression, and a positive TGF-beta 1 expression can serve as a pulmonary adenocarcinoma marker. T beta R-I and T beta R-II expressions are necessary for TGF-beta signal transduction.     

Common wrist injuries

Patients with wrist injuries often present to primary care physicians. Many times, mild clinical injury involves significant damage to carpal bones and soft tissue elements. The long-term outcome of these injuries depends on prompt diagnosis and appropriate therapy. Familiarity with the functional anatomy and physical examination of the wrist, accompanied by radiologic evaluation, may aid the physician in differentiating simple sprains from potentially debilitating wrist injuries.     

Total wrist arthroplasty

Although arthroplasty is a well-established procedure for many joints, its use in the wrist is less common, and the indications are less well defined. The standard procedure for the painful arthritic wrist remains radiocarpal arthrodesis. However, as technology and surgical procedures improve, wrist arthroplasty is being used more frequently. The authors provide a brief history of total wrist arthroplasty and review the arthroplasties most commonly used in the United States. Results with total wrist implants, the complications related to arthroplasty, technical aspects of the procedure, and salvage options are also discussed.