The effect of glycerol trinitrate on the arterial pressure of the fingers

In 35 patients with healthy vessels, 52 patients with vasospasm and 42 patients with stenoses or obliteration of the finger arteries with the help of the Parks-ultrasound-Doppler device model 806-A and a finger cuff of the size of 3.5 X 5 cm the systolic pressure of the finger arteries was measured before and after the administration of glycerol trinitrate. Since in test persons with healthy vessels no significant differences of the radial and ulnar volar finger artery, of the single fingers of one hand or in the comparison of the sides of the two hands was found, a concentration could be done. The relative and absolute increase of the pressure of the finger artery under glycerol trinitrate was most conspicuous in patients with vasospasm. No essential changes, as we expected, occurred in patients with organic disturbances of the arterial blood supply. Under variation of the lower limits of the norm of the pressure of the finger arteries the high values of the sensitivity, specificity and efficiency which are characteristic for the ultrasound-Doppler pressure measurement, lying over 0.90 particularly after pharmacologic vasodilation.     

A comparative study of EFMT and sublimis transfer operations in the claw hand

Two hundred cases each of EFMT and sublimis transfer operations performed for correction of claw hand deformity following Hansen's disease were studied and the results compared. The cases were selected by systematic sampling. The incidences of reclawing in the index, long, and ring fingers were found to be more in the EFMT series. Also the postoperative intrinsic plus deformity was seen more often in the ring and little fingers in the EFMT series. The occurrence of a sublimis minus deformity following removal of the sublimis tendon is recognized and described. Both operative procedures produced 95% satisfactory results.     

Correction of claw fingers in leprosy--current status.

The operative procedures available for correction of claw fingers have been classified according to the principles involved in correction. The relative merits and demerits of the procedure have been briefly mentioned and an attempt has been made to define proper indications of these procedures.     

Modified Zancolli's operation in claw hand in leprosy.

The operative technique of the Modified Zancolli's operation in claw hand is easy. Re-education is easier in Zancolli's capsulorrhaphy than any other operations. Results of this operation are encouraging. It is particularly required when quick turnover of cases is needed and when adequate facilities for physiotherapy is not available. In cases operated by Zancolli's capsulorrhaphy active flexion of metacarpophalangeal joint is possible. Complications are few e.g. pulling of capsulorrhaphy and development of flexion contracture.     

Assessment of malalignment at the metacarpophalangeal joint of the rheumatoid hand using three-dimensional computed tomogram

Objective. For the assessment of rheumatoid hand, three-dimensional (3D) malalignment including flexed or rotational deformities and dislocation at the finger joint is one of the important findings. The objective of this study is to prove usefulness of 3D computed tomography (3DCT) for the accurate measurement of palmoulnar flexion deformity at the metacarpophalangeal (MP) joint of the rheumatoid hand.

Methods. Swanson implant arthroplasty at the 2nd through the 5th MP joints was performed at 179 joints in 46 hands of 40 patients with rheumatoid arthritis. Pre-and postoperatively, evaluations included Larsen grade and ulnar flexion angle by an x-ray; and ulnar flexion angle, palmar flexion angle, and resected bone length by a 3DCT.

Results. With progression of Larsen grade and the joint dislocation, ulnar flexion angle increased. Average ulnar flexion angle was 18.7 ± 16.0° (mean ± SD) in grade III, 38.4 ± 21.2° in grade IV, and 40.1 ± 21.1° in grade V, 29.6 ± 16.0°in “subluxation,” 24.8 ± 21.2° in “dislocation,” and 41.1 ± 22.2° in “severe dislocation.” There was no significant difference between grade of the MP joint dislocation and palmar flexion angle. With progression of the MP joint dislocation, resected bone length increased.

Conclusion. A 3DCT gives accurate information about deformity of the rheumatoid hand. Also, an appropriate length of bone resection can be determined in the preoperative planning.     

Technique and diagnostic value of musculoskeletal ultrasonography in rheumatology. Part 6: ultrasonography of the wrist/hand

Sonography of the hands is especially helpful in the diagnosis of early arthritis. Sonography allows for a very sensitive detection of small joint-effusion, tenosynovitis and small erosive bone lesions earlier than conventional radiography. Musculoskeletal sonography is also helpful in morphological analysis of changes of the median nerve in patients with carpal tunnel syndrome. The following standard scans are suggested for the sonographic evaluation of the wrist: 1. dorsal longitudinal scan along the radio-carpal joint, 2) along the ulno-carpal joint, and 3) dorsal transverse scan along the wrist to detect joint fluid collection, synovitis, tenosynovitis, ganglia, irregularities of the bone surface in osteoarthritis, and erosions due to inflammatory disease, 4) volar longitudinal scan along the radio-carpal joint, and 5) along the ulno-carpal joint, and 6) volar transverse scan along the wrist to diagnose the same objective as the above mentioned scans and to evaluate the median nerve in cases of carpal tunnel syndrome. Optional scans are the following: 7) ulnar longitudinal 8) transverse scan along the ulnar joint space and the extensor carpi ulnaris muscle to detect tenosynovitis and caput ulnae syndrome, 9) radial longitudinal, and 10). transverse scan along the joint space to diagnose synovitis and tenosynovitis. The following standard scans are suggested for the sonographic evaluation of the fingers: 1) volar longitudinal, 2) volar transverse scan in extension along the finger joints to detect effusion and synovial proliferation, tenosynovitis, irregularities of the bone surface (osteophytes, erosions), 3) dorsal longitudinal scans in extension and flexion >70 degrees along the CMC I, MCP, PIP and DIP joints to evaluate effusion and synovial proliferation, tenosynovitis or tendinitis, irregularities of the bone surface (osteophytes, erosions), and 4) dorsal transverse scans along the finger joints to evaluate these structures in an additional dimension. Optional 5) scans include the following: medial longitudinal scan along the MCP I, II, PIP and DIP joints, and 6) lateral longitudinal scan along the MCP V, PIP and DIP joints to evaluate the erosive bone process and joint instability. A linear transducer with a frequency of between 7.5 and 12 MHz is recommendable. The anterior distance between the bone and the joint-capsule of the wrist is > or = 3 mm in probable and > or = 4 mm in definite synovitis or effusions. Synovitis or effusions are probable if the difference between right and left wrist is > or = 1 mm, and they are definite if the difference is > or = 2 mm. A carpal tunnel syndrome is probable with a cross-sectional area of the median nerve of > or = 12 mm(2).     

When pliers become fingers in the monkey motor system

The capacity to use tools is a fundamental evolutionary achievement. Its essence stands in the capacity to transfer a proximal goal (grasp a tool) to a distal goal (e.g., grasp food). Where and how does this goal transfer occur? Here, we show that, in monkeys trained to use tools, cortical motor neurons, active during hand grasping, also become active during grasping with pliers, as if the pliers were now the hand fingers. This motor embodiment occurs both for normal pliers and for “reverse pliers,” an implement that requires finger opening, instead of their closing, to grasp an object. We conclude that the capacity to use tools is based on an inherently goal-centered functional organization of primate cortical motor areas.     

Occlusion of the arteries of the fingers after hyperextension trauma

Acute occlusion of digital arteries due to a sport injury A 33 year old female patient with acute ischaemia of the fingers I-II of the right hand was admitted to our emergency unit. She reported that this complete ischaemia had shortly occurred after a sport injury due to an extreme hyperflexion of the right hand in a volleyball match. Four days after this trauma she felt pain and paraesthesia in the right hand. Circular areas of ischaemia were developed with skin colour change to grey and dark blue. The primary measure of the blood pressure by doppler analysis showed no signals in the first and second finger. Initially she received 500 mg Aspirin by intravenous injection. The full therapeutic dose of LMWH related to the weight of the patient was given. On the basis of the short time interval between the occurrence of the symptoms and admission of the patient we decided to perform a so called retrograde intravenous injection. The aim of this therapy was the intraarterial lysis and reperfusion. The blood pressure in all fingers were nearly normal after three days. Daily intravenous transfusion of prostaglandin were given additionally. Necrosis could be prevented as a result of our treatment over seven days. At the end of our therapy only the skin epithelium of the second finger was slightly raised and showed a tendency to desquamation. All other fingers occurred in a normal colour.     

Cutaneo-muscular reflexes of the human hand. II. Neurophysiologic aspects of reflex organization and coordination

The organization and coordination of cutaneo-muscular reflexes of human finger and arm muscles to electrical stimulation of the digital nerves were investigated in 14 healthy volunteers. Thumb and finger muscles, although antagonists, showed homonymous reflex effects whereas the wrist and elbow muscles exhibited an reciprocally alternating reflex pattern in pairs of antagonists (Fig. 1). The mechanographical correlate of the homonymous reflex activity in distal muscles was a short release (Fig. 6). The receptive field for evoking such reflex effects covered both the palmar and dorsal surfaces of the fingers (Fig. 2). However, with stimulation of the thumb, the muscles of the fingers and of the wrist showed reflex reversal (Figs 3, 5). If the stimulus was moved from the second to the fifth fingers, a successive attenuation of the transcortical reflex component was seen (Fig. 4). It is concluded that the reflexes investigated are complex flexor reflexes comprising both a distal release and a proximal flexion synergy. According to opposition of the thumb in grasping, the receptive field terminates between thumb and index finger. These reflexes are supposed to have no assisting function during corticalized manipulatory movements--in contrast to the long-loop reflexes evoked by epicritic sensibility. The transcortical servo is blocked if the eliciting stimulus is contaminated by nociceptive signals; its receptive field is confined to those fingers used in the precision grip.     

Value of echography in the diagnosis of post traumatic pathology of the ulnar artery, in manual workers

Three cases of hypothenar hammer syndrome are reported in manual workers who experienced repeated traumatism of the palm of the hand either because of personal habit or the use of professional tools. Hemodynamic examination of the upper limb was performed by plethysmography (Perivein Etna) and Doppler ultrasound (8 MHz) complemented by angiography by direct puncture of the humeral artery. Ultrasonography was performed using a 7.5 MHz probe (Sononranger) for exploration of the ulnar artery at the wrist and in its course through the palm. The 3 patients presented aneurysmal dilatation of the ulnar artery in the palm, complicated by postembolic thrombosis of the collateral arteries of the fingers. The ulnar artery lesion was permeable 1 time, already thrombosed 1 time and thrombosed secondarily 1 time. Ultrasonography of the palm showed suspected aneurysm of the ulnar artery in 2 patients: one case was confirmed by angiography, whereas the other remained only suspect since the thrombosed ulnar artery was not opacified. The third patient presented an ulnar artery thrombosis without true aneurysmal dilatation. It may be concluded that ultrasonography can show suspected aneurysmal dilatation of the ulnar artery and be complementary to arteriography when the ulnar artery is thrombosed.     

White fingers after excessive motorcycle driving: a case report

An 18-year-old male presented with Raynaud's phenomenon which was found to be caused by occlusion of the proper palmar digital arteries on the right hand and obstruction of the superficial palmar arterial arch on the left hand. These lesions in the arteries of both hands resemble those found in patients with vibration-induced white fingers such as in mine or foundry workers. The only likely cause for the pathological vascular findings in our patient was an exposure to vibration due to excessive off-street motorcycle driving. Therapy with intraarterial prostaglandins resolved the ischemic syndrome but it promptly recurred when the patient resumed motor cycle driving. Therefore, we suggest that excessive cross country motor cycle driving may cause vibration-induced white fingers.     

Patterns of disease progression in the rheumatoid wrist: a long-term followup.

OBJECTIVE: To identify different patterns of disease manifestation and changes in the rate of progression of rheumatoid arthritis (RA) in the wrist. METHODS: Forty wrists, with normal baseline radiographs, of 20 patients with RA were evaluated by means of a retrospective radiographic review for a period of at least 15 years. RESULTS: Radiographical scores for damage (Larsen method) and malalignment (carpal collapse and ulnar translocation index; radial deviation of the wrist and ulnar shift of the fingers) showed progression with increasing disease duration for all patients. Women had higher Larsen scores than men (p < 0.05) and rheumatoid factor positive patients had higher Larsen scores than rheumatoid factor negative patients. For all 3 left-handed patients the dominant scores were somewhat higher than the right-handed scores, but the difference was not significant. For the 17 right-handed patients no differences were found between the dominant and the left hand. Early in the course of the disease 4 types of wrist involvement can be identified on the basis of the first localization of damage in the wrist (central, radial, ulnar, and diffuse type). Radial deviation of the wrist was increased in wrists with "central" involvement compared to wrists with "diffuse" involvement (p < 0.05). Furthermore, radial deviation of the wrist was positively correlated with ulnar drift of the fingers (p < 0.01). CONCLUSION: Wrist involvement was found to play an important role in the typical rheumatoid deformity of the hand. Early treatment of the wrist is proposed to prevent this deformity.     

Frequency of a positive modified Allen's test in 1,000 consecutive patients undergoing cardiac catheterization

The modified Allen's test (A.T.) is used to prove the adequacy of the blood supply through the ulnar artery to the hand. The test is considered normal if, after compression of both the ulnar and radial arteries followed by repeated clenching of the fingers to squeeze out the blood, the normal or a slightly more pronounced red color of the palm of the hands returns within < 10 sec after release of only the ulnar artery. It is important to perform the test whenever intravascular access to the radial artery is planned. The objective of this study was to determine the percentage of patients presenting a clearly positive (< 5 sec), a moderately positive (between 5–9 sec), or a negative A.T. (10 sec and more). We performed an A.T. on 1,000 consecutive and different patients undergoing cardiac catheterization, on the right wrist, two times, each time by a different examinator trained in this test. An A.T. was performed on 1,000 patients: 640 men, 360 women, mean age 62,3 yr (range 28–90 yr). In our population of patients, the relative percentages of a clearly positive (< 5 sec), moderately positive (between 5–9 sec), or negative modified Allen's test (10 sec and more) is 49%, 24%, and 27%, respectively. © 1996 Wiley-Liss, Inc.     

Ischemic retraction of the intrinsic muscles of the hand in leprosy (a trial of physiopathologic and therapeutic re-evaluation)

An attempt of reevaluation of the ischemic contracture of intrinsic muscles is presented, study of a mechanism identical to the Volkman Syndrome (forearm muscles), etiopathogenic treatment (excision of infarcts) in the first stage and efficient palliative methods for the Swan neck fingers and deformity of the thumb.     

Selection of DNA binding sites for zinc fingers using rationally randomized DNA reveals coded interactions.

In the preceding paper [Choo, Y. & Klug, A. (1994) Proc. Natl. Acad. Sci. USA 91, 11163-11167], we showed how selections from a library of zinc fingers displayed on phage yielded fingers able to bind to a number of DNA triplets. Here, we describe a technique to deal efficiently with the converse problem--namely, the selection of a DNA binding site for a given zinc finger. This is done by screening against libraries of DNA triplet binding sites randomized in two positions but having one base fixed in the third position. The technique is applied here to determine the specificity of fingers previously selected by phage display. We find that some of these fingers are able to specify a unique base in each position of the cognate triplet. This is further illustrated by examples of fingers which can discriminate between closely related triplets as measured by their respective equilibrium dissociation constants. Comparing the amino acid sequences of fingers which specify a particular base in a triplet, we infer that in most instances, sequence-specific binding of zinc fingers to DNA can be achieved by using a small set of amino acid-nucleotide base contacts amenable to a code.     

Synergy between adjacent zinc fingers in sequence-specific DNA recognition

Zif268-like zinc fingers are generally regarded as independent DNA-binding modules that each specify three base pairs in adjacent, but discrete, subsites. However, crystallographic evidence suggests that a contact also can occur from the second helical position of one finger to the subsite of the preceding finger. Here we show for the three-finger DNA-binding domain of the protein Zif268, and a panel of variants, that deleting the putative contact from finger 3 can affect the binding specificity for the 5′ base in the adjoining triplet, which forms part of the binding site of finger 2. This finding demonstrates that Zif268-like zinc fingers can specify overlapping 4-bp subsites, and that sequence specificity at the boundary between subsites arises from synergy between adjacent fingers. This has important implications for the design and selection of zinc fingers with novel DNA binding specificities.     

Ultrasonography in detection of effusion in the radiocarpal and midcarpal joints.

Sixty radiocarpal and midcarpal joints in 30 healthy adults and 20 swollen wrists in 20 patients with chronic arthritis were examined by dorsal longitudinal ultrasonography (US). In five other patients intraarticular application of fluid into the radiocarpal joint could be seen as a change in the US scan. In 49 out of the 60 healthy wrists the unechogenic zone dorsally above the scaphoid bone was less than two millimetres, and the measurement did not change in dorsal or volar flexion. The side difference was less than one millimetre. In the healthy wrists the midcarpal area above bones was echogenic in US. In 15 radiocarpal and in 10 midcarpal joints out of the 20 swollen wrists, effusion could be depicted with US as an unechogenic zone. It was two millimetres or more in radiocarpal joint and it got bigger in dorsal and smaller in volar flexion.     

Handedness and deformities, radiographic changes, and function of the hand in rheumatoid arthritis.

The correlation of handedness with deformities, radiographic changes, and function of the hand was studied in a large group of patients with rheumatoid arthritis and a dominant right hand. There was no significant difference in the proportion of patients who had swan neck deformity, boutonnière deformity, uncorrectable ulnar deviation, and flexor tenosynovitis in the dominant and non-dominant hands. There were significantly greater radiological changes in the dominant hand, however, and the middle and index fingers were most severely affected. The severe involvement of these fingers may be related to their greater use in daily activities. There was also more severe functional impairment in the dominant hand.     

Ecchymotic patches of the fingers and Gardner-Diamond vascular purpura

Ecchymotic patches on the fingers and vascular purpura in Gardner-Diamond syndrome are two benign but recurrent clinical disorders occurring chiefly in young women. They involve superficial cutaneous hemorrhagic signs. Both disorders testify to microvascular fragility without perturbation of general hemostasis. Diagnosis is easy for those familiar with the disorders. Ecchymotic episodes accompanied by sharp pain begin at the roots of the fingers. Microtraumatism is soon seen to be involved. Ecchymosis develops at the flexor muscles of the fingers but "capillary" resistance is only reduced in one third of cases. The pathogenic explanation involves rupture of a small post-capillary vein due to disorders in the control system of kinins and local metabolites. The autoerythrocyte sensitization syndrome described in 1955 by Gardner and Diamond is characterized by painful and febrile episodes followed by purpuric and ecchymotic lesions of the skin on various parts of the body, but not necessarily on the legs. Dysneurotonic effects are frequent but diagnosis is based upon promotion of the disorder by intradermal or subcutaneous injection of a minimal quantity of autologous blood. Immunological effects are considered but the ailment involves microvascular control disorders, notably of the capillary-vein segment, in particular at Copley's endo-endothelial fibrin film. Imbalance in fibrin formation and lysis is associated with perturbation of the kinin and serotonin systems. In addition to the use of certain bioflavonoids and calcium inhibitors, prevention and treatment should involve consideration of drugs which affect plasticity in the vascular wall and pericapillary interstitial conjunctiva and the rheological properties of blood flow and interstitial tissue.     

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.