Trigger finger: etiology, evaluation, and treatment

Trigger finger is a common finger aliment, thought to be caused by inflammation and subsequent narrowing of the A1 pulley, which causes pain, clicking, catching, and loss of motion of the affected finger. Although it can occur in anyone, it is seen more frequently in the diabetic population and in women, typically in the fifth to sixth decade of life. The diagnosis is usually fairly straightforward, as most patients complain of clicking or locking of the finger, but other pathological processes such as fracture, tumor, or other traumatic soft tissue injuries must be excluded. Treatment modalities, including splinting, corticosteroid injection, or surgical release, are very effective and are tailored to the severity and duration of symptoms.     

直肠指力刺激法在防治胸腰椎骨折术后便秘患者中的应用效果

目的：探讨直肠指力刺激法在防治胸腰椎骨折术后便秘患者中的应用效果。方法将不同节段的胸腰椎骨折术后80例患者随机分为实验组和对照组各40例。实验组早期采用直肠指力刺激直肠,配合常规肠道护理,对照组采用常规肠道护理。结果两组首次排便间隔时间、排便所需时间比较,差异均有统计学意义( P<0.01),即实验组优于对照组。对照组便秘发生率占65%,实验组便秘发生率占30%,两组比较,差异有统计学意义( P<0.01)。结论对不同节段的胸腰椎骨折患者术后定时采用指力刺激法,能刺激腰骶部排便反射,促进排便,降低便秘的发生。     

两种治疗方法治疗老年股骨粗隆间骨折的疗效分析

目的探讨手术疗法及非手术疗法治疗老年股骨粗隆间骨折的临床疗效及临床适应证。方法 84例老年股骨粗隆间骨折患者中,其中非手术治疗21例,手术治疗63例。结果与非手术组相比,手术组术后并发症发生率低,住院期间死亡率低;手术组死亡率为1.6%,并发症发生率为9.58%,非手术组死亡率为9.5%,并发症发生率为23.8%,两组间有显著性差异（P〈0.05）;经6个月至3年的随访,手术组优良率为91.9%,非手术组优良率为89.9%,两组间无显著性差异（P〉0.05）。结论对老年股骨粗隆间骨折应根据骨折类型、年龄、体质因素及骨质疏松程度等作综合分析,手术治疗为首选的治疗方法。     

Anchor钉重建伸肌腱止点治疗锤状指

目的 探讨治疗锤状指的手术方法.方法 对12例锤状指的患者采用Anchor钉重建伸肌腱止点的手术方法治疗.结果 术后随访2～12个月,11例患者于术后6周左右复查X线片均未见骨锚松动、脱落;术后8周远侧指间关节活动自如.结论 使用Anchor钉重建伸肌腱止点治疗锤状指,具有操作简单、肌腱修复可靠、术后并发症少的优点,是一种值得推广的手术方法.     

手指延长器在治疗桡骨远端不稳定骨折中的应用

目的 评价手指延长器在治疗桡骨远端不稳定骨折撑开复位固定的临床效果及应用价值。方法 采用手指延长器的可调控逐步撑开复位固定方法，部分结合克氏针撬拨复位治疗桡骨远端不稳定骨折102例．按AO／ASIF分型：A3型6l例，C2型27例，C3型14例。治疗方法中单纯撑开复位固定76例，加用经皮克氏针撬拨复位26例。结果 102例行此法治疗中，3例改行切开复位植骨加钢板内固定。余99例中。解剖复位57例，功能复位32例，接近功能复位10例；关节功能恢复优73例。良18例，可8例。无严重并发症。结论 手指延长器的可调控撑开复位固定治疗桡骨远端不稳定骨折是一种操作简单、固定确实、疗效满意、并发症少的方法。     

磁性矫正器治疗槌状指畸形的实验研究

目的:探讨槌状指畸形磁性矫正器治疗槌状指畸形的可行性。方法:将新鲜尸体手指标本植入相应大小的永磁铁钉,观察其伸指和屈指效果,分析此方法治疗槌状指畸形的可行性。结果:5例手指标本剔除皮肤、筋膜等软组织,保留手指伸、屈指肌腱,置入永磁铁钉后,根据Dargan功能评定法评定手指关节功能:优3例,良1例,可1例,差0例,优良率为80%。15例手指标本在保留所有组织后,模拟临床进行手术,采用掌侧入路植入相应大小的永磁铁钉,根据Dargan功能评定法评定术后患指关节功能:优10例,良4例,可0例,差1例,评分优良率为93.3%。所有标本术后的屈指活动范围与术前无区别。结论:槌状指畸形磁性矫正器治疗槌状指畸形具有可行性。     

Sonographic diagnosis of the entrapment of the flexor digitorum profundus tendon complicating a fracture of the index finger

Flexor digitorum tendon entrapment is a known complication of proximal phalangeal fractures and is commonly diagnosed clinically. However, it can sometimes be subtle and may not be suspected initially. A case of proximal phalangeal fracture of the index finger complicated by entrapment of the flexor digitorum profundus tendon is presented in which the diagnosis was made based on sonographic findings subsequently confirmed by CT and later surgical findings. This case demonstrates that tendon entrapment complicating phalangeal fractures can be diagnosed using sonography.     

超声引导诊治狭窄性腱鞘炎的临床应用价值

正狭窄性腱鞘炎又称扳机指或弹响指,是手部常见的疾病之一~([1]),以往诊断多依赖于患者的主观表现和体格检查,缺少客观的检查指标。该病治疗多为开放手术或盲视下切割,易造成创伤大或松解不彻底,且并发症较多。随着超声技术的发展,超声已成为肌肉、肌腱等软组织疾病诊断和引导治疗的首选。高频超声对手指肌腱有较高的分辨率,显示清晰。本组回顾性分析狭窄性腱鞘炎患指的超声表现及超声引导下治疗效果,旨在探讨超声在其诊治中的临床应用价值。     

Animal Models of Neurodegenerative Disease: Insights from <Emphasis Type="Italic">In vivo</Emphasis> Imaging Studies

Animal models have been used extensively to understand the etiology and pathophysiology of human neurodegenerative diseases, and are an essential component in the development of therapeutic interventions for these disorders. In recent years, technical advances in imaging modalities such as positron emission tomography (PET) and magnetic resonance imaging (MRI) have allowed the use of these techniques for the evaluation of functional, neurochemical, and anatomical changes in the brains of animals. Combining animal models of neurodegenerative disorders with neuroimaging provides a powerful tool to follow the disease process, to examine compensatory mechanisms, and to investigate the effects of potential treatments preclinically to derive knowledge that will ultimately inform our clinical decisions. This article reviews the literature on the use of PET and MRI in animal models of Parkinson’s disease, Huntington’s disease, and Alzheimer’s disease, and evaluates the strengths and limitations of brain imaging in animal models of neurodegenerative diseases.     

Hodgkin’s-like disease of the thymus. Clinical,surgical and morphological correlations

Summary The histogenesis and relationship of so-called ‘granulomatous thymoma’ to Hodgkin’s disease is still a matter of controversy. Three of these lesions were selected from 43 thymomas and their clinico-pathological patterns are described. Two cases were diagnosed as Hodgkin’s disease of the mediastinum because of the absence of epithelial structures of thymic origin. In one case, together with the morphological aspects of Hodgkin’s disease, we noticed epithelial structures indicating a primary neoplastic lesion in the thymus. Accordingly we conclude that the term ‘Hodgkin’s disease of the thymus’ must be limited only to those lesions of the mediastinum in which structures of thymic origin are present. Other mediastinal Hodgkin’s lesions, even in the presence of clinical, radiological and surgical evidence of thymic origin but in which it is not possible to observe such thymic structures, must be classified as Hodgkin’s disease localized to the anterior mediastinum.     

Coexistent primary open-angle glaucoma and cataract: Preliminary analysis of treatment by cataract surgery and the iStent trabecular micro-bypass stent

INTRODUCTION: Reducing intraocular pressure (IOP) is the only proven treatment modality for reducing the risk of glaucomatous progression. In this study, we evaluated the safety and efficacy of a new tool in IOP reduction, implanted with cataract surgery: the Glaukos iStent trabecular micro-bypass stent. METHODS: This was a prospective, 24-month, uncontrolled, non-randomised, multicentre study. Subjects with uncontrolled primary open-angle glaucoma (including pseudoexfoliation and pigmentary) and a cataract underwent clear cornea phacoemulsification cataract extraction with ab-interno gonioscopically guided implantation of the study stent. Subjects who had completed at least 6 months of follow-up were included in this interim analysis (n=47). RESULTS: At baseline, mean (+/-standard deviation) IOP was 21.5+/-3.7 mmHg, and subjects were taking a mean of 1.5+/-0.7 ocular hypotensive medications. Six months after implantation of the study stent the mean IOP was 15.8+/- 3.0 mmHg, a mean IOP reduction of 5.7+/-3.8 mmHg (25.4%, P<0.001). The mean number of patient medications after 6 months was 0.5+/-0.8 medications, a mean decrease of 1.0+/-0.8 medications (66.7%, P<0.001). Most subjects (70%) were able to discontinue all glaucoma medications. There were no complications traditionally associated with filtering surgery, and no serious adverse events were reported. CONCLUSION: In this interim analysis of subjects with glaucoma and cataracts, this novel stent implantation in subjects undergoing cataract surgery represents a new surgical approach to provide clinically significant decreases in IOP and drug burden.     

Successful treatment of a guitarist with a finger joint injury using instrument-assisted soft tissue mobilization: a case report

Finger injuries are common and can greatly affect a musician’s quality of life. A 55-year-old man, who had injured the proximal interphalangeal joint of the left index finger 6 months prior to any intervention, was treated with a manual therapy approach incorporating instrument-assisted soft tissue mobilization (IASTM). Initial examination findings included self-reported pain and functional limitations and physical impairments that significantly impeded his ability to play the acoustic guitar. He was treated once a week for 6 weeks with IASTM, joint mobilization, therapeutic exercise, and ice massage. Additionally, a home exercise program and self-care instructions were provided. The patient gained positive outcomes with improvements in pain (Numerical Pain Rating Scale while playing the guitar: initial 5/10, discharge 1/10) and function (Disability Arm Shoulder Hand Sports-Performing Arts Optional Module: initial 75; discharge 6·25), each reaching a minimum clinically important difference. Importantly, he was able to play the guitar with minimal to no pain as desired. Physical measures also improved, including an immediate gain in finger range of motion with IASTM alone. Manual therapy approaches integrating IASTM may provide an effective conservative treatment strategy for patients with finger/hand conditions in the performing arts and other patient populations.     

Diagnosis and management of common maxillofacial injuries in the emergency department. Part 2: mandibular fractures

The majority of mandibular fractures occur in young males aged 16-30 years. As with all traumas, the history and examination cannot be over emphasised as diagnoses can be made with these tools. It is important when taking an accurate history to ascertain the mode and mechanism of injury (fall, punch, road traffic accident), and the magnitude and direction of the force involved (high or low velocity impact).     

Successful treatment of a guitarist with a finger joint injury using instrument-assisted soft tissue mobilization: a case report

Finger injuries are common and can greatly affect a musician’s quality of life. A 55-year-old man, who had injured the proximal interphalangeal joint of the left index finger 6 months prior to any intervention, was treated with a manual therapy approach incorporating instrument-assisted soft tissue mobilization (IASTM). Initial examination findings included self-reported pain and functional limitations and physical impairments that significantly impeded his ability to play the acoustic guitar. He was treated once a week for 6 weeks with IASTM, joint mobilization, therapeutic exercise, and ice massage. Additionally, a home exercise program and self-care instructions were provided. The patient gained positive outcomes with improvements in pain (Numerical Pain Rating Scale while playing the guitar: initial 5/10, discharge 1/10) and function (Disability Arm Shoulder Hand Sports-Performing Arts Optional Module: initial 75; discharge 6·25), each reaching a minimum clinically important difference. Importantly, he was able to play the guitar with minimal to no pain as desired. Physical measures also improved, including an immediate gain in finger range of motion with IASTM alone. Manual therapy approaches integrating IASTM may provide an effective conservative treatment strategy for patients with finger/hand conditions in the performing arts and other patient populations.     

Hypericum perforatum versus fluoxetine in the treatment of mild to moderate depression

In a randomized, controlled, double-blind trial, 70 patients (mean age, 49.7 years) suffering from mild to moderate depression received one tablet of either St. John's Wort (Hypericum perforatum) extract (Calmigen) or fluoxetine hydrochloride (Prozac) twice a day for 6 weeks. Efficacy was determined according to the 17-item Hamilton Rating Scale for Depression (HAMD), the von Zerssen depression scale (DS), Clinical Global Impression (CGI), and patients' overall evaluation. Significant decreases (P<.001) of 50% in the Hypericum group and 58% in the fluoxetine group in the HAMD score and of 42% and 52% on the DS spoke to the efficacy of both medications. The Hypericum extract achieved 83% of the efficacy of fluoxetine on the HAMD and 78% on the DS. Assessments by physicians (CGI) and patients indicated considerable improvement with no between-treatment differences. Of the 9 dropouts (13%), 2 in the Hypericum group and 2 in the fluoxetine group were due to adverse reactions. Safety evaluations demonstrated only minor changes. The Hypericum preparation tested in this study is therapeutically equivalent to fluoxetine and is therefore a rational alternative to synthetic antidepressants.     

Limitation of finger systolic pressure measurement as a diagnostic test for primary Raynaud's phenomenon in a female population

Summary. The diagnostic value of measurement of the finger systolic pressure (FSP) was assessed during combined local and whole body cooling in a population-based sample of women with a medical history of primary Raynaud's phenomenon. Forty women had mild Raynaud's phenomenon and 40 had pronounced Raynaud's phenomenon. The results were compared with subjective assessments of complaints from Raynaud's phenomenon as indicated on a visual analogue scale (VAS) in the same group of women. The mean FSP at 10°C was significantly lower in the patients than in 24 age- and sex-matched controls, but there was a large overlap in individual responses. The sensitivity of the FSP method was only 51% for the whole group with primary Raynaud's phenomenon. There was no significant difference in FSP at 10°C between subjects with mild and those with pronounced Raynaud's phenomenon. The subjective severity of the symptoms as indicated on VAS was significantly higher in these two combined groups than in the controls. The mean VAS value was significantly higher in the group with pronounced Raynaud's phenomenon (P<0·01) than in that with the mild type. The low sensitivity of FSP measurement implies that this method is of limited value as a diagnostic test in subjects with primary Raynaud's phenomenon. Furthermore, there was no significant correlation between FSP and the VAS values (r= 0·23).     

Alzheimer’s disease treatment: Assessing caregiver preferences for mode of treatment delivery

Introduction  Management of patients with Alzheimer’s Disease (AD) can exert a substantial burden upon caregivers. As new modes of treatment administration are developed, it is important to assess caregiver satisfaction and preference in a standardized manner. This study describes the development of the Alzheimer’s Disease Caregiver Preference Questionnaire (ADCPQ) to assess AD caregivers’ satisfaction with and preference for patch or capsule treatments in AD patients. Methods  Twenty-five published articles (1987-2002) were reviewed to identify potential ADCPQ domains. Three caregiver focus groups (n=24) were conducted to develop a first draft of the questionnaire. After evaluating the acceptance of ADCPQ to caregivers through in-depth interviews (n=10), its psychometric properties were assessed using data from 986 patients enrolled in a multicenter, randomized, double-blind, four-arm, placebo- and active-controlled, 24-week trial. Results  Focus groups indicated that caregivers expressed dissatisfaction with current AD treatment routines including limitations related to: efficacy, administration schedule, number of pills, adherence to treatment, side effects, and taking pills. In-depth interviews with caregivers found the ADCPQ to be comprehensible with an acceptable layout. The resultant ADCPQ comprises three modules: A) baseline, 11 items assessing treatment expectations; B) week 8, 33 items on satisfaction and preferences with treatment options; C) week 24, 10 items assessing overall opinions of treatment options. Missing data per item was low (≤0.3%) and domain internal consistency reliability was good (0.71–0.91). Preference items were also valid when evaluating concordance and discordance between convenience and satisfaction patch and capsule domain scores. Conclusion  AD treatment puts a significant strain on caregivers. New modes of treatment delivery may be less burdensome to caregivers, thereby increasing satisfaction and potential treatment adherence. The ADCPQ was well accepted by AD caregivers and its domains demonstrated satisfactory psychometric properties. The ADCPQ is a useful tool to understand caregiver preferences for patch versus oral therapies in AD.     

Entrapment of pacemaker lead by a large netlike Eustachian valve within the right atrium

Summary During pacemaker implantation in a patient with permanent atrial fibrillation, it remained impossible to advance a passive fixation lead with fins through the right atrium. However, a lead with a retractable screw easily passed the right atrium and was positioned in the right ventricle. Transesophageal echocardiography revealed an extensive net–like perforated Eustachian valve within the right atrium that had caused entrapment of the anchor fins during lead implantation. Remnants of embryonal structures within the right atrium should be considered a rare possible barrier during pacemaker implantation.     

锁骨骨折诊疗策略

目的：探讨锁骨骨折诊疗方案，提高治疗水平。方法：150例锁骨骨折，新鲜骨折125例，陈旧性骨折25例，按照骨折的不同类型给予手法复位或内固定术。结果：均得到6个月～3年随访，无畸型愈合、不愈合及功能障碍。结论：按照不同的分型，分类治疗，可以提高疗效，减少并发症。