Pollicisation of the index finger. A 27-year follow-up study

We have reviewed 11 patients with congenital absence of the thumb, treated by pollicisation of the index finger, after follow-up for 20 to 38 years. Seven of the hands also had an associated radial club-hand deformity. Function as assessed by the Percival score was excellent in six, good in three, fair in two and poor in four; three of the poor results were in patients with radial club hand. Ten of the 15 transfers were used as normal thumbs, but in five hands function required trick movements. Of the seven unilateral cases, two transplants were used as the dominant hand, and in another two thumb strength was more than 50% of that on the opposite side. For patients with isolated congenital absence of the thumb, pollicisation of the index finger gives good functional and cosmetic results which are maintained. The results are less reliable for those with radial club hand.     

Spontaneous reduction of intussusception: verification with US

PURPOSE: To report cases of spontaneous reduction of intussusception. MATERIALS AND METHODS: The authors reviewed the clinical and imaging findings in four patients with intussusception. Patients ranged in age from 3 to 7 months and were seen over a 12-year period. RESULTS: Intussusception was diagnosed with ultrasound (US) in all four patients; however, when enema studies were performed, intussusception was not identified. Repeat US also failed to demonstrate the presence of an intussusception, and all four patients showed concomitant rapid resolution of symptoms. CONCLUSION: Spontaneous reduction of intussusception is probably more common than is generally thought, and its documentation was facilitated with US. It is likely that spontaneously reduced intussusception will be documented more frequently in the future.     

Comparison of behavior modification approaches to smoking reduction.

Compared 2 experimental treatments for the modification of cigarette smoking with 2 control conditions, using a refined methodology for collecting daily smoking records and providing for an examination of therapist effects. 65 undergraduates served as Ss. The 1st experimental treatment employed a stimulus satiation technique in which Ss smoked 3 cigarettes on each smoking occasion. The 2nd, a hierarchy approach, involved gradual reduction beginning with the period of the day judged easiest for relinquishing cigarettes. In 1 control treatment, Ss used a pill designed to coat the mouth to make cigarettes aversive; the other control groups were instructed to quit entirely. Each of the 4 conditions showed its own characteristic reduction curve and all reduced to a mean level below 25% of base. There was a significant effect of therapist during treatment, but none at 6-mo follow-up by which time all groups had shown a considerable relapse. (15 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A literacy index for the mailbag.

Aliteracy index for predicting the educational level of the writers of public mail was developed on 162 letters sent to the editor of the Boston Herald. Accuracy of predicted educational level with actual educational level is 66.7% for grammar school educated, 69.2% for high school educated, and 79.8% for college educated. Coding instructions and directions for scoring are included in the text. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The reduction of anxiety vulnerability through the modification of attentional bias: A real-world study using a home-based cognitive bias modification procedure.

Recent laboratory work suggests that biased attentional responding to negative information causally impacts anxiety reactivity to a contrived laboratory stressor. However, it remains unknown whether such attentional bias contributes to real-world anxiety vulnerability. In the present study, the authors addressed this issue by experimentally inducing biased attentional response to emotionally negative stimuli, using a home-based attentional training program and then examining the influence of this attentional manipulation on trait anxiety scores and on state anxiety responses to a subsequent stressful life event. The attentional bias modification procedure was effective in inducing attentional avoidance of negative information. Furthermore, this attentional manipulation served to reduce trait anxiety scores and to attenuate state anxiety responses to the subsequent naturalistic stressor. These findings support the hypotheses that biased attentional responding to emotionally negative information contributes causally to real-world anxiety vulnerability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gas enema for the reduction of intussusception: relationship between clinical signs and symptoms and outcome

OBJECTIVE: The aim of this study was to establish the extent to which the clinical features of intussusception can be used to predict successful outcome of gas enema and to determine whether the nonsurgical management of intussusception in children can be improved by refining the criteria used to select patients for gas enema. SUBJECTS AND METHODS: Clinical data on 282 consecutive episodes of intussusception (255 patients) were collected prospectively from January 1987 to July 1991. Gas enema was performed in 273 episodes, in which the clinical signs and symptoms were studied by using logistic regression. Nine patients had primary surgery. RESULTS: Gas enema was successful in 216 (79%) of 273 enemas attempted. Fifty-seven patients had surgery after unsuccessful enema. Univariate analysis showed significant associations between successful enema and duration of signs and symptoms less than 12 hr, no rectal bleeding, absence of small-bowel obstruction, presence of a palpable mass, and normal hydration. Multivariate analysis showed that dehydration, small-bowel obstruction, and duration of signs and symptoms longer than 12 hr were significant predictors of unsuccessful enema; yet, in these groups the rate of success still justified attempted enema. Even in severe dehydration, the successful enema reduction rate was 31%. CONCLUSION: Our data suggest that although the factors identified had some predictive value in determining the outcome of attempted enema reduction, they could not be used to indicate patients in whom enema reduction should not be attempted. All patients with intussusception should have a gas enema if the absolute contraindications to enema (i.e., peritonitis or perforation) are absent.     

Toe transplantation for isolated index finger amputations distal to the proximal interphalangeal joint

Functional deficit following single distal index finger amputations has been considered insignificant, and reconstruction is usually not recommended. Herein, 19 cases of second toe transplantation for reconstruction of isolated index finger amputation distal to the proximal interphalangeal joint are presented with long-term functional results. There are 14 men and 5 women. The average age was 26 years. The toe transplantations were performed either as a primary procedure (5 patients) while the wounds were still open or as a secondary procedure (14 patients) after the wounds healed. In 11 patients, the dominant hand was involved. All toes survived completely, although re-exploration was required in three cases (16 percent). The functional evaluation included (1) sensory recovery, where the average static and moving two-point discrimination were 8 mm (range 4 to 15 mm) and 6 mm (range 2 to 15 mm); (2) motor function, where the average of index-thumb pulp-to-pulp pinch compared with the normal hand was 67.5 percent (range 36 to 96 percent); (3) average range of motion in index finger joints (extension/flexion), where metacarpophalangeal joint was 14/90, proximal interphalangeal joint was 0/94, and distal interphalangeal joint was 19/38; and (4) functional and cosmetic results, where percentage of involvement in daily activities and functional capacity of the reconstructed index were 69 percent and 70.5 in average, respectively, over a total score of 100. Average scores of aesthetic appearance and acceptability of donor-site deformity were 74 and 87.5 over a total score of 100, respectively. Toe transplantation for distal index finger amputations improved hand function when performed in selected patients with specific job requirements or high motivation.     

A new method of treatment for mallet finger. A preliminary report

An infant with a typical Edwards syndrome and a modal chromosome number of 46 is reported. In all cells analyzed one chromosome G was missing and an additional chromosome similar to a pair No. 16 was present. The phenotype of the child indicates that the extra element is a translocation between G and 18 chromosomes as in one case described previously.     

A test for specific and general behavioral effects of infantile stimulation with shock in the mouse.

The hypothesis tested was that exposure of the infant mouse to shock which could not be terminated by some specific response would lead to greater fearfulness later on than exposure to shock whose termination was contingent on a specific response. 3 groups of mice 8 to 11 days of age were each subjected to different shock conditions. One group could terminate the shock by an avoidance response (response-contingent group), one group had no control over the duration of shock (arbitrary shock group), and the third group received no shock in the apparatus. Later an open-field test of emotionality showed no significant differences, but an adult avoidance learning test showed that the run times of the response-contingent group were significantly shorter than those of the no-shock group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pierre Robin syndrome with hyperphalangism-clinodactylysm of the index finger: a possible new palato-digital syndrome

A nine day old boy who had the Pierre Robin syndrome also had an unusual associated hand malformation consisting of bilateral clinodactyly of the index finger. A supernumerary phalanx was inserted between the second metacarpal and the proximal phalanx of both index fingers with a radial deviation of the same phalanx. The same hand malformation has been previously described in three patients who had either the Pierre Robin syndrome or isolated cleft palate. On the basis of ours and the three previous cases, the existence of a new palato-digital syndrome is suggested.     

Self-statement modification with adults: A meta-analysis.

Self-statement modification (SSM) has rapidly grown in popularity, and is commonly a principal technique of cognitive-behavioral therapies. Reviews to date, however, are inconclusive about its efficacy and less than exhaustive in their coverage. The present authors attempted to locate all controlled studies in which therapy incorporated direct modification of covert self-statements. Meta-analysis was used as a statistical method of integrating the outcome data across studies. Aggregating across all types of clinical outcome measures, SSM evidenced considerable gains beyond no-treatment controls. This advantage was sufficient to place the average SSM-treated S at a level of therapeutic outcome comparable to the 77th percentile of controls. As suspected, there were many salient qualifiers of outcome, and effects were generally smaller when therapy was contrasted to placebo treatment rather than no treatment at all. Implications are discussed in terms of the need for greater specificity in the terminology for cognitive-behavior techniques. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

MR imaging of adult colo-rectal intussusception. A case report

MR imaging of an intussuscepted sigmoid cancer misinterpreted as a rectal carcinoma is described. High-resolution technique with pelvic-phased array coils and fast spin-echo was used. The diagnosis is discussed in relation to the MR findings.     

A method of two-dimensional measurement for evaluating finger motion impairment. A description of the method and comparison with angular measurement

A new method has been designed for direct measurement of the two-dimensional range of motion (ROM) of the finger. The two-dimensional method encompasses the postures imposed by various combinations of contraction and relaxation of the finger motors, so that an individual muscle injury or adhesion might be more easily detected. The figures and values obtained from the two-dimensional method are easier to interpret than those from conventional measurements, making the progress of the rehabilitated finger more apparent. Since the passive ROM cannot be evaluated by this method, it is a supplement rather than a substitution for the conventional range of motion evaluation for each joint. The drawback of the two-dimensional method is that it is more difficult to use than the conventional method.     

A noninvasive evaluation of baroreceptor sensitivity with the Valsalva maneuver and phenylephrine methods

In a double-blind crossover study, we compared baroreceptor sensitivity (BS) and latency, derived from the phenylephrine method with BS and latency derived from phase IV of the Valsalva maneuver (VM), using the Finapres, a noninvasive blood pressure monitor. Ten healthy volunteers were enrolled in the study and BS was determined with placebo, atropine (0.03 mg/kg) and atenolol (10 mg) and was expressed as the linear relation between the change in RR interval following the blood pressure rise induced by either phenylephrine or phase IV of the VM (i.e., after cessation of straining). Baseline baroreceptor sensitivity (p<0.001) and baroreceptor sensitivity in the presence of atropine (p<0.02) was smaller with the VM but no differences in baroreceptor sensitivity between the two methods were evident after atenolol. Although no linearity existed between the two methods under any of the experimental conditions, baroreceptor sensitivity in the presence of atropine was significantly smaller (p<0.01)(and latency delayed (p<0.08)) compared to atenolol-induced changes with both methods. We found excellent correlation between baroreceptor sensitivity derived from the ECG tracing and Finapres recorded beat-to-beat pulse intervals (p<0.001; r>0.8, under all conditions) although the correlation after atropine was not as close (p<0.01; r=0.7). The smaller baroreceptor sensitivity induced by the Valsalva maneuver with placebo and atropine, but not with atenolol, suggests a parasympathetically influenced vasodilation, and sympathetically medicated tachycardia during phase IV of the VM.