Tissue preservation in hand injury: the first step to toe-to-hand transplantation

The recommendations outlined in this editorial for the initial management of nonreplantable amputation injuries emphasize tissue preservation. This facilitates future toe-to-hand transplantation in terms of reconstructive options, functional and aesthetic outcomes in the hand, and donor-site morbidity in the foot. It is hoped that surgeons involved in the emergency surgical care of such cases will find these guidelines useful. Although tissue conservation is the main goal at this stage of treatment, this should not be at the expense of tissue viability. If in doubt about management issues, advice should be sought from the reconstructive microsurgery unit.     

Toward a code for the interactions of zinc fingers with DNA: selection of randomized fingers displayed on phage

We have used two selection techniques to study sequence-specific DNA recognition by the zinc finger, a small, modular DNA-binding minidomain. We have chosen zinc fingers because they bind as independent modules and so can be linked together in a peptide designed to bind a predetermined DNA site. In this paper, we describe how a library of zinc fingers displayed on the surface of bacteriophage enables selection of fingers capable of binding to given DNA triplets. The amino acid sequences of selected fingers which bind the same triplet are compared to examine how sequence-specific DNA recognition occurs. Our results can be rationalized in terms of coded interactions between zinc fingers and DNA, involving base contacts from a few alpha-helical positions. In the paper following this one, we describe a complementary technique which confirms the identity of amino acids capable of DNA sequence discrimination from these positions.     

Replantation of multi-level hand severances

Since 1990, the replantation of hands severed at multiple levels has been carried out successfully for 22 patients. In each case the motor and sensory functions of the hand were recovered satisfactorily. We suggest that such wounds should be named 'multi-level severances' and should be classified into five groups according to the wound localities. In order to shorten ischaemic time, debridement should be carried out simultaneously by several groups. The main technical points of the operation are: (1) The order of replantation for multiply severed fingers is that the most distant section should be reattached first, and then the more proximal part. (2) High quality blood vessel anastomosis must be ensured. (3) Avoid taking the blood vessels, nerves and tendons from severed region. (4) During the operation, care should be taken to ensure that the replanted fingers' segments are protected from collision and stretching. In the early stages following the operation correct functional exercise is very important.     

Preferential Flow of a Nonaqueous Phase Liquid in Dry Sand

Geotechnical centrifuge testing is used to examine the preferential (fingered) flow of a nonaqueous phase liquid (NAPL) in a uniform dry sand. The results of nine experiments, containing a total of 87 observations of NAPL finger behavior, are analyzed. The observed finger tip velocities range from 0.01 to 0.3 cm/s, while the observed finger widths range from 0.3 to 3.6 cm. From the experimental data it is concluded that, asymptotically, the NAPL fingers are not fully saturated. For comparison, the behavior of water fingers is examined using the same experimental setup. In contrast to the NAPL fingers, and in agreement with other work reported in the literature, the water fingers are found to be fully saturated. In addition, it is confirmed that the water finger properties can be well predicted from known porous medium and fluid properties. A scaling analysis is presented that allows the NAPL finger properties to be inferred from models developed to describe water finger properties. The analysis predicts NAPL finger velocities to within 15% and NAPL finger widths to within 50% if both finger types are assumed saturated. By adjusting the analysis to account for the fact that the NAPL fingers are not fully saturated, NAPL finger widths can be predicted within to 10%, and NAPL finger velocities to within 30%.     

The prognostic importance of calcitonin screening in familial medullary thyroid carcinoma

A prospective study of 20 patients with traumatic amputations of the fingers and a thumb was carried out during a six week period at Mpilo Central Hospital, Bulawayo. Most of the adult injuries (17 patients) resulted from industrial accidents (76.5 pc) while two out the three children sustained their injury from domestic accidents. Inadequate safety precaution, ignorance and human error contributed significantly to the injuries. Safety education and preventive measures both at home and in industry should be inoculated into the daily life of individuals.     

Donor site morbidity in cross-finger flaps

As relevant literature is scarce, this study was undertaken to assess the donor site morbidity of cross-finger flaps. It included 23 patients who had undergone reconstruction of a finger defect with a cross-finger flap. Any additional trauma to the donor finger was an exclusion criterion. Split thickness skin grafts were employed for donor site closure in 13 cases, full thickness skin grafts were used in 10 cases. Follow-up time averaged 83 months. Active and passive total range of motion of the donor finger and maximal pinch grip strength in kilopascals were measured. Both parameters were compared to the corresponding finger of the other hand. The donor site scar was evaluated for instability and pain in the donor finger was determined subjectively with a visual analogue scale. Cold intolerance and the cosmetic appearance of the donor site were also assessed.Active total range of motion of the donor fingers averaged 156°. Average active total range of motion of the contralateral control fingers was 173.6°. There was a significant difference between the donor fingers and the control fingers (p=0.03) but not between split thickness and full thickness grafted donor sites (p=0.91). Grip strength was significantly impaired in the donor fingers (p=0.03), but there was no significant difference between split thickness and full thickness grafted donor sites. Subjective cosmetic evaluation by the patients revealed significantly better results for full thickness grafted donor sites. Donor finger pain averaged 2.4 with a range of 0–8. Five of the 13 patients with split thickness grafted donor sites and two of the 10 patients with full thickness grafted donor sites mentioned cold intolerance.In conclusion, the cross-finger flap is a secure and valuable option. There is, however, significant donor site morbidity. Our results suggest that alternative solutions should also be considered and if a cross-finger flap is employed, donor sites should be closed with full thickness grafts.     

Assessing insulin sensitivity in the cat: evaluation of the hyperinsulinemic euglycemic clamp and the minimal model analysis

A case of self-inflicted bite injuries of the fingers with an episode of small intracerebral haemorrhages is presented. There were many injuries on the right fingers. The tip of the right forefinger was bitten off, and some small pieces of the finger had been aspirated and swallowed. This unusual case seemed to be an emotional response to pain from cerebral episode.     

New contributions to clinical hypertension from molecular biology

The authors constructed a new dynamic guiding splint assisting the active mobilisation after flexor tendon repair distal to the wrist. In these cases, the "inverse" wrist position seems to be the best position for mobilisation. This means that finger flexion should be carried out during wrist extension, and finger extension during wrist flexion. The splint guides and co-ordinates the movements of the wrist and the fingers, and it limits the free usage of the hand.     

Study of workload and cervicobrachial disorder among sign language interpreters

We conducted a nationwide questionnaire study on the workload and health conditions of professional sign language interpreters to investigate the relationship between occupational cervicobrachial disorders (OCD) and the sign language workload. The number of valid respondents was 542 (92.3%), 85.8% of them females. They were employed by the national or local governments or organizations for the disabled. The complaint rates of subjective symptoms involving the neck, shoulders, arms, fingers, eyes and ears, being equal or higher than the rates reported for cashiers, telephone operators and nursery school teachers when OCD occurred frequently. As the workload of sign language increased, the number of complaints of symptoms in the cervicobrachial region, which also includes fingers, increased as well. Occupational safety and health management for preventing OCD should be carried out immediately for sign language interpreters.     

Mesoaxial complete syndactyly and synostosis with hypoplastic thumbs: an unusual combination or homozygous expression of syndactyly type I?

Syndactyly type I is an autosomal dominant condition with complete or partial webbing between the third and fourth fingers or the second and third toes or both. We report here a previously undescribed phenotype of severe mesoaxial syndactyly and synostosis in patients born to affected parents. The characteristic features of these severe cases are (1) complete syndactyly and synostosis of the third and fourth fingers; (2) severe bone reduction in the proximal phalanges of the same fingers; (3) hypoplasia of the thumbs and halluces; (4) aplasia/hypoplasia of the middle phalanges of the second and fifth fingers; and (5) complete or partial soft tissue syndactyly of the toes. We report on three offspring with this phenotype from two different branches of a syndactyly type I family, suggesting that they may be homozygous for this condition. SSCP and linkage analysis indicated that neither HOXD13 nor other relevant genes in the chromosome 2q31 region was responsible for this phenotype.     

Localization of tactile stimuli and body parts in space: Two dissociated perceptual experiences revealed by a lack of constancy in the presence of position sense and motor activity.

Two motor acts were analyzed at the level of tongue and fingers. These motor acts generated illusions. When subjects voluntarily rotated the tongue by 90°, the perceived orientation of a tactile stimulus applied to the tongue did not covary with the perceived orientation of the tongue itself. Analogously, when subjects voluntarily crossed two adjacent fingers, the perceived position of two tactile stimuli applied to the fingers did not covary with the perceived position of the fingers themselves. Although tongue and fingers were positioned accurately in space, a lack of perceptual constancy occurred for tactile stimuli applied to these body parts. Therefore, whereas position sense was preserved, correct localization of objects was lost. The occurrence of this perceptual dissociation suggests that spatial localization of tactile stimuli may be independent both of knowledge of body part location and motor activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Centrifuge Modeling of Unstable Infiltration and Solute Transport

Unstable flow can result in the formation of fingers during infiltration into dry soil. Centrifuge modeling is a potentially useful tool to study the relationship between finger size, spacing, and velocity. It can also be used to investigate solute transport in such fingers. Physical properties of the fingers are obtained for three tests conducted at elevated acceleration levels. A fourth test was conducted at 1g. The physical parameters compare well with theoretical predictions. To assess solute transport in fingers, a known concentration of solute was introduced after the fingers had formed. The resulting breakthrough curves were analyzed using the two-region model as well as the advection dispersion equation with appropriate initial and boundary conditions. Although the two-region model is physically more plausible, it was found to match the extensive tailing observed in the breakthrough curves only marginally better than the advection-dispersion equation.     

Clubbed fingers and arthralgia as a reversible paraneoplastic syndrome (Pierre-Marie-Bamberger syndrome) in non-small-cell bronchial carcinoma

HISTORY AND CLINICAL FINDINGS: During chemotherapy for a non-small-cell bronchial carcinoma with metastasis to the right femur (previously locally excised), a 34-year-old man suddenly developed severe, lasting joint pain in the ankle, knee, elbow and wrist without signs of increased warmth or swelling of these joints. At the time of diagnosis clubbed fingers had been noted. INVESTIGATIONS: Radiography of the hands showed bilateral periosteal hyperostoses. Computed tomography of the thorax revealed tumor progression. DIAGNOSIS, TREATMENT AND COURSE: The triad of clubbed fingers, periosteal hyperostoses and arthralgia/arthritis with the pulmonary findings established the diagnosis of hypertrophic pulmonary osteoarthritis (HPO; Marie-Bamberger syndrome). Initially there had merely been the signs of the much more frequent incomplete form with only the clubbed fingers, the complete form developing with progression of the disease during chemotherapy, joint pains dominating the symptoms. After right upper lobectomy (primary adenocarcinoma) the joint pains ceased and the finger clubbing regressed. CONCLUSIONS: Only 10% of non-small-cell bronchial carcinomas are associated with HPO. Conversely, such a tumor is found in 90% of HPO of recent onset and should therefore be sought of when searching for the primary tumor. The signs of HPO are reversible if the underlying disease is adequately treated.     

The effect of acebutolol on the cerebral circulation of man

The term dyshidrosis describes a nonspecific tissue pattern reaction characterized by a noninflammatory, pruritic (and sometimes burning) intraepidermal vesicular dermatosis involving selected areas of the fingers, palms, and soles. It should be distinguished from various pustular and vesicular dermatoses of the palms and soles with or without associated lesions elsewhere. When dyshidrotic lesions appear in areas where friction or pressure from the handling or wearing of sport gear occurs, the discomforting symptoms are noticeably accentuated and can thus interfere with the participant's effectiveness in the performance of the sport. A composite approach of dermatologic therapeutic acumen and physician-sponsored emotional support is essential in effectively handling this problem so that dyshidrosis does not "handicap" the patient.     

A mutation outside the two zinc fingers of ADR1 can suppress defects in either finger

A second-site mutation that restored DNA binding to ADR1 mutants altered at different positions in the two zinc fingers was identified. This mutation (called IS1) was a conservative change of arginine 91 to lysine in a region amino terminal to the two zinc fingers and known from previous experiments to be necessary for DNA binding. IS1 increased binding to the UAS1 sequence two- to sevenfold for various ADR1 mutants and twofold for wild-type ADR1. The change of arginine 91 to glycine decreased binding twofold, suggesting that this arginine is involved in DNA binding in the wild-type protein. The increase in binding by IS1 did not involve protein-protein interactions between the two ADR1 monomers, nor did it require the presence of the sequences flanking UAS1. However, the effect of IS1 was influenced by the sequence of the first finger, suggesting that interactions between the region amino terminal to the fingers and the fingers themselves could exist. A model for the role of the amino-terminal region based on these results and sequence homologies with other DNA-binding motifs is proposed.     

Recognition of diverse sequences by class I zinc fingers: asymmetries and indirect effects on specificity in the interaction between CF2II and A+T-rich elements

The Drosophila CF2II protein, which contains zinc fingers of the Cys2His2 type and recognizes an A+T-rich sequence, behaves in cell culture as an activator of a reporter chloramphenicol acetyltransferase gene. This activity depends on C-terminal but not N-terminal zinc fingers, as does in vitro DNA binding. By site-specific mutagenesis and binding site selection, we define the critical amino acid-base interactions. Mutations of single amino acid residues at the leading edge of the recognition helix are rarely neutral: many result in a slight change in affinity for the ideal DNA target site; some cause major loss of affinity; and others change specificity for as many as two bases in the target site. Compared to zinc fingers that recognize G+C-rich DNA, CF2II fingers appear to bind to A+T-rich DNA in a generally similar manner, but with additional flexibility and amino acid-base interactions. The results illustrate how zinc fingers may be evolving to recognize an unusually diverse set of DNA sequences.